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116th Congress } { Report
HOUSE OF REPRESENTATIVES
1st Session } { 116-62
_______________________________________________________________________
DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND
RELATED AGENCIES APPROPRIATIONS BILL, 2020
----------
R E P O R T
of the
COMMITTEE ON APPROPRIATIONS
HOUSE OF REPRESENTATIVES
ON
H.R. 2740
together with
MINORITY VIEWS
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
May 15, 2019.--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, 2020
116th Congress } { Report
HOUSE OF REPRESENTATIVES
1st Session } { 116-62
_______________________________________________________________________
DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND
RELATED AGENCIES APPROPRIATIONS BILL, 2020
__________
R E P O R T
of the
COMMITTEE ON APPROPRIATIONS
HOUSE OF REPRESENTATIVES
ON
H.R. 2740
together with
MINORITY VIEWS
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
May 15, 2019.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
_________
U.S. GOVERNMENT PUBLISHING OFFICE
36-295 WASHINGTON : 2019
116th Congress } { Report
HOUSE OF REPRESENTATIVES
1st Session } { 116-62
======================================================================
DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND
RELATED AGENCIES APPROPRIATIONS BILL, 2020
_______
May 15, 2019.--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. 2740]
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, 2020,
and for other purposes.
INDEX TO BILL AND REPORT
_______________________________________________________________________
Page number
Bill Report
Summary of Estimates and Appropriation.....................
3
General Summary of the Bill................................
3
Title I--Department of Labor:
Employment and Training Administration............. 2
13
Employee Benefits Security Administration.......... 18
21
Pension Benefit Guaranty Corporation............... 18
22
Wage and Hour Division............................. 19
22
Office of Labor-Management Standards............... 20
23
Office of Federal Contract Compliance Programs..... 20
24
Office of Workers' Compensation Programs........... 20
24
Occupational Safety and Health Administration...... 24
26
Mine Safety and Health Administration.............. 26
29
Bureau of Labor Statistics......................... 27
30
Office of Disability Employment Policy............. 28
31
Departmental Management............................ 28
31
General Provisions................................. 33
35
Title II--Department of Health and Human Services:
Health Resources and Services Administration....... 42
36
Centers for Disease Control and Prevention......... 50
56
National Institutes of Health...................... 57
80
Substance Abuse and Mental Health Services
Administration................................. 64
116
Agency for Healthcare Research and Quality......... 69
127
Centers for Medicare & Medicaid Services........... 70
128
Administration for Children and Families........... 75
142
Administration for Community Living................ 86
155
Office of the Secretary............................
161
Public Health and Social Services Emergency
Fund................................... 93
169
General Provisions................................. 95
173
Title III--Department of Education:
Education for the Disadvantaged.................... 117
177
Impact Aid......................................... 118
179
School Improvement Programs........................ 119
180
Indian Education................................... 120
184
Innovation and Improvement......................... 121
185
Safe Schools and Citizenship Education............. 121
190
English Language Acquisition....................... 122
192
Special Education.................................. 122
193
Rehabilitation Services............................ 126
196
Special Institutions for Persons with Disabilities. 127
197
Career, Technical and Adult Education.............. 128
198
Student Financial Assistance....................... 128
200
Federal Direct Student Loan Program Account........
204
Student Aid Administration......................... 128
205
Higher Education................................... 130
207
Howard University.................................. 131
213
College Housing and Academic Facilities Loans...... 131
213
Historically Black College and University Capital
Financing Program Account...................... 131
213
Institute of Education Sciences.................... 133
214
Departmental Management............................ 134
216
General Provisions................................. 135
222
Title IV--Related Agencies:
Committee for Purchase from People Who Are Blind or
Severely Disabled.............................. 141
223
Corporation for National and Community Service..... 142
223
Corporation for Public Broadcasting................ 146
226
Federal Mediation and Conciliation Service......... 147
227
Federal Mine Safety and Health Review Commission... 148
227
Institute of Museum and Library Services........... 149
227
Medicaid and CHIP Payment and Access Commission.... 149
229
Medicare Payment Advisory Commission............... 149
229
National Council on Disability..................... 149
229
National Labor Relations Board..................... 150
230
National Mediation Board........................... 150
231
Occupational Safety and Health Review Commission... 150
232
Railroad Retirement Board.......................... 150
232
Social Security Administration..................... 153
233
Title V--General Provisions:
House of Representatives Report Requirements.......
240
Summary of Estimates and Appropriations
The following table compares on a summary basis the
appropriations, including trust funds for fiscal year 2020, the
budget request for fiscal year 2020, and the Committee
recommendation for fiscal year 2020 in the accompanying bill.
2020 LABOR, HHS, EDUCATION BILL
[Discretionary funding in thousands of dollars]
----------------------------------------------------------------------------------------------------------------
Fiscal Year-- 2020 Committee compared to--
Budget Activity -------------------------------------------------------------------------------
2019 Enacted 2020 Budget 2020 Committee 2019 Enacted 2020 Budget
----------------------------------------------------------------------------------------------------------------
Department of Labor............. $12,123,251 $10,905,405 $13,321,641 +1,198,390 +2,416,236
Department of Health and Human 90,490,781 78,085,971 99,375,512 +8,884,731 +21,289,541
Services.......................
Department of Education......... 71,448,416 64,005,915 75,923,812 +4,475,396 +11,917,897
Related Agencies................ 15,316,511 13,543,842 15,678,035 +361,524 +2,134,193
----------------------------------------------------------------------------------------------------------------
General Summary of the Bill
For fiscal year 2020, the Committee recommends a total of
$191,718,000,000 in current year discretionary funding,
including offsets and adjustments. The fiscal year 2020
recommendation is an increase of $11,745,000,000 above the
fiscal year 2019 enacted level.
The Labor-HHS-Education bill supports some of the nation's
most critical programs that touch individuals and families
throughout their lifespan, from Early Head Start to Social
Security. Many of the bill's programs have been shortchanged
over the past eight years, and the President's fiscal year 2020
budget request, if enacted, would do irreparable damage to
critical programs that provide opportunities for millions of
families. Instead, through this bill, the Committee is moving
ambitiously to make up for lost ground by recommending
increased investments to help provide every individual with a
better chance at a better life--with a good education, a good
job, and access to affordable health care.
The Committee recommends historic investments in education
programs, including early childhood development, K-12 public
education, Special Education, and postsecondary education.
The Committee continues to build on investments made over
the past four years in biomedical research by increasing the
National Institutes of Health (NIH), while also beginning a new
multi-year initiative to rebuild Federal, State, and local
public health capacity through a significant increase in the
Centers for Disease Control and Prevention (CDC).
And the Committee invests in workforce training, and
reverses years of eroding budgets at the Wage and Hour Division
(WHD) and the Occupational Safety and Health Administration
(OSHA), while continuing to protect retired workers by
including a significant increase for the Social Security
Administration's operating expenses.
Some of the most notable initiatives in fiscal year 2020
include:
EARLY CHILDHOOD EDUCATION
The Committee includes nearly $20,000,000,000 for early
childhood education programs through the Child Care and
Development Block Grant, Head Start, and Preschool Development
Grants--an increase of $4,000,000,000 over the fiscal year 2019
enacted level. This is the largest single-year increase ever
provided for these programs.
Child care is one of the most critical needs of families
with young children--but CCDBG currently reaches only 15
percent of the nearly 14 million children who are eligible to
receive child care services. The increase included in this bill
will provide CCDBG-funded child care for approximately 300,000
additional children, which will also enable more parents in
low-income families to remain in the workforce.
The bill also provides an increase of $1,500,000,000 for
Head Start, including increases of $750,000,000 for Quality
Improvement Funding for Trauma-Informed Care and $525,000,000
for Early Head Start-Child Care Partnerships. Early Head Start
reaches approximately seven percent of eligible children, but
the increase in this bill will expand access to an additional
80,000 infants and toddlers from low-income families.
The Committee further recommends an increase of
$100,000,000 for Preschool Development Grants to build State
and local capacity to provide early childhood care and
education for children birth through five from low- and
moderate-income families. This would be the first increase for
Preschool Development Grants since the program was initiated in
fiscal year 2015 and it would enable continued support for
additional States to implement or expand preschool programs.
INVESTING IN PUBLIC EDUCATION
The Committee is committed to increasing investments in
core formula grant programs that support high-quality public
education opportunities for all students. Our nation's public
schools serve more than 50 million children, more than 50
percent of whom come from low-income families. Research shows
that low-income students are more likely to struggle
academically and often attend high-need schools with fewer
resources, less experienced teachers, and more limited access
to advanced coursework. At the same time, there is growing
evidence that increases in education spending are correlated
with improved educational outcomes. Unfortunately, support for
federal K-12 formula programs has been relatively stagnant over
the past decade, allowing inflation to erode the value of this
vital assistance.
Overall, the Committee recommendation provides
$42,232,117,000 for federal K-12 education programs, including
Individuals with Disabilities Education Act (IDEA), an increase
of $3,382,571,000 over the fiscal year 2019 enacted level and
$8,136,130,000 over the fiscal year 2020 budget request. The
recommendation is a nine percent increase over last year.
In particular, the Committee recommends an additional
$1,000,000,000 over the fiscal year 2019 enacted level and the
fiscal year 2020 budget request for Title I-Grants to Local
Educational Agencies for a total of $16,859,802,000. Title I
serves an estimated 25 million students in nearly 90 percent of
school districts and nearly 60 percent of all public schools.
The Committee also increases investment in formula programs
that have not seen any increase in several years. The Committee
recommendation includes $2,555,830,000 for Supporting Effective
Instruction State Grants (Title II-A), an increase of
$500,000,000 over the fiscal year 2019 enacted level. The
fiscal year 2020 budget request proposes to eliminate this
program. Funds 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. Title II-A represents the
only dedicated funding stream for teacher professional
development for many States and school districts. The
Committee's recommended 24 percent increase would be the
program's first increase since 2010.
The Committee recommends $980,000,000 for the English
Language Acquisition program, which provides formula grants to
States to serve English Leaners (EL), an increase of
$242,600,000 over the fiscal year 2019 enacted level and the
fiscal year 2020 budget request. Federal data show that
significant achievement gaps exist between ELs and their peers.
However, funding to support these students has been flat since
fiscal year 2015. At the same time, many States and school
districts have experienced rapid growth in their EL
populations.
The Committee recommends $13,364,392,000 for Individuals
with Disabilities Education Act (IDEA) Part B Grants to States,
which is $1,000,000,000 above the fiscal year 2019 enacted
level and the fiscal year 2020 budget request, reflecting the
largest increase to the program in more than a decade. The
Committee is concerned that the federal share of the excess
cost of educating students with disabilities has declined and
notes the critical role this increase will play in helping to
reverse this trend.
SOCIAL-EMOTIONAL LEARNING INITIATIVE
The Committee includes a new initiative to support a
landmark federal investment in social-emotional learning (SEL),
``whole child'' approaches to education, and community schools.
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.
In total, the Committee recommends $260,000,000 for the
initiative, which includes dedicated funding for SEL and
``whole child'' projects and activities across a variety of
programs within the Department of Education. In particular,
$170,000,000 is made available through the Education Innovation
and Research program for grants for evidence-based, field-
initiated innovations that address student social, emotional,
and cognitive needs.
The Committee also recommends $25,000,000 through the
Supporting Effective Educator Development (SEED) grant program
for a new competition to support professional development that
helps educators incorporate SEL into teaching, and for pathways
into teaching that provide a strong foundation in child
development and learning, including skills for implementing
SEL. The Committee also recommends $40,000,000, an increase of
$22,500,000 over the fiscal year 2019 enacted level for the
Full-Service Community Schools Program, which supports
evidence-based models to meet the holistic needs of children
and families. The fiscal year 2020 budget request proposes to
eliminate this program.
In addition, $25,000,000 is provided within School Safety
National Activities to increase the number of well-trained
school counselors, social workers, psychologists, or other
mental health professionals qualified to provide school-based
mental health services. Research shows that building the
capacity of students to develop social and emotional skills,
and take responsibility for their community, can reduce
bullying, violence, and aggressive behaviors, making schools
safer.
SUPPORTING ACCESS TO AND COMPLETION OF POSTSECONDARY EDUCATION
The Committee recommendation includes robust increases to
bolster the supports students need to access and complete
postsecondary education, including sufficient funding to
support an increase in the maximum Pell Grant by $150 over the
fiscal year 2019 enacted level and the fiscal year 2020 budget
request, from $6,195 to $6,345 to help the award keep up with
inflation.
In addition, the Committee recommendation provides
$1,434,000,000 for Federal Work Study, an increase of
$304,000,000 over the fiscal year 2019 enacted level and
$934,000,000 over the fiscal year 2020 budget request. The
Committee recommendation also includes $1,028,000,000 for the
Supplemental Educational Opportunity Grants, an increase of
$188,000,000 over the fiscal year 2019 enacted level. The
fiscal year 2020 budget request proposes to eliminate this
program.
To support a variety of outreach and support services to
encourage low-income, often first-generation individuals, to
enter and complete college, the Committee recommendation
includes $1,160,000,000 for the TRIO programs, an increase of
$100,000,000 over the fiscal year 2019 enacted level and
$210,000,000 over the fiscal year 2020 budget request. The
Committee also recommends $395,000,000 for the Gaining Early
Awareness and Readiness for Undergraduate Programs, which is
$35,000,000 more than the fiscal year 2019 enacted level. The
fiscal year 2020 budget request proposes to eliminate this
funding stream and support similar activities through a
modified TRIO program.
To help close gaps among racial and socioeconomic groups in
college enrollment and degree attainment, the Committee
recommendation includes a total of $917,464,000 for programs
that serve high proportions of students of color, an increase
of $250,910,000 over the fiscal year 2019 enacted level and
$377,845,000 over the fiscal year 2020 budget request. This
funding will help support institutions, such as Historically
Black Colleges and Universities, Hispanic-Serving Institutions
and Tribally Controlled Colleges and Universities.
NIH RESEARCH
The Committee includes $41,084,000,000 for the National
Institutes of Health, an increase of $2,219,000,000 within this
bill, which is a larger increase than the Committee has
provided in three of the previous four fiscal years. This bill
ensures a net increase of at least $2,000,000,000 over the
previous year for NIH research, despite the loss of
$219,000,000 due to reductions in funding made available
through the CURES Act.
The Committee continues its ongoing support for NIH
initiatives, including the Cancer Moonshot; the BRAIN
Initiative; the ``All of Us'' Precision Medicine Initiative;
Alzheimer's research; and research to develop a universal flu
vaccine.
In addition, the bill includes sufficient funding to
provide an across-the-board increase of approximately five
percent for all Institutes and Centers (IC). The Committee is
concerned that Congress has moved too far in the direction of
targeted funding for specific initiatives, which has resulted
in less funding being available for foundational research that
may lead to unforeseeable scientific breakthroughs. This bill
maximizes the across-the-board increase for all ICs, thereby
ensuring a significant boost for the best peer-reviewed
research across all scientific disciplines.
PUBLIC HEALTH SYSTEMS
The Committee makes a significant investment to improve the
long-term capacity of Federal, State, and local public health
systems. The bill includes $8,275,363,000 for the Centers for
Disease Control and Prevention (CDC), an increase of
$937,622,000 over the fiscal year 2019 enacted level.
The bill begins a multi-year initiative to modernize public
health capacity at CDC and its public health partners at the
state and local levels. A new investment of $100,000,000 will
start to move our public health system away from antiquated
data reporting to a common data platform that will enable the
public health workforce to use real-time data to predict and
prevent public health threats in the future.
The Committee also invests in existing programs to address
some of the country's most costly chronic diseases. These
conditions are costly in reduced quality of life as well as
high medical costs. The bill includes a total increase of
$44,700,000 to prevent Diabetes and Heart Disease; an increase
of $37,500,000 to promote early detection and prevention of
cancer; and an increase of $16,000,000 to expand targeted
activities to reach underserved minority populations. The bill
also includes an increase of $40,000,000 to expand efforts to
reduce tobacco use, with an emphasis on the troubling increase
in e-cigarette use among youth.
WOMEN'S HEALTH
The Committee makes a strong commitment to advance women's
health after years of underfunding and deliberate attempts by
the Administration to undermine programs that ensure access to
health care for women in low-income communities.
The bill includes $400,000,000 for Title X Family Planning,
an increase of $113,521,000 above the fiscal year 2019 enacted
level and the 2020 budget request. Title X-funded health care
providers serve more than four million low-income women and men
every year--offering contraceptive counseling and services,
screening for STDs and HIV/AIDS, screening for cervical and
breast cancer, and primary health care services. Two-thirds of
Title X patients have incomes below the federal poverty level,
and 60 percent of women who receive health care services from a
Title X-funded clinic consider it their primary provider.
The bill also includes $110,000,000 for the Teen Pregnancy
Prevention Program, an increase of $9,000,000 above the fiscal
year 2019 enacted level and $110,000,000 above the 2020 budget
request.
The Committee maintains last year's investment of
$50,000,000 for an initiative to reduce maternal mortality
rates while further bolstering that effort with an increase of
$5,000,000 through the Maternal and Child Health Bureau; an
increase of $2,500,000 to educate midwives to address the
national shortage of maternity care providers; and increased
funding through the Office on Women's Health.
And the Committee strongly supports the mission of the
WISEWOMAN program, helping uninsured and under-insured low-
income women ages 40 to 64 understand and reduce their risk for
heart disease and stroke; by providing risk factor screenings;
and connecting them with lifestyle programs, health counseling
and other community resources that promote healthy behavior
change. The Committee includes an increase of $25,650,000 to
expand the program to all 50 States and the District of
Columbia.
HIV INITIATIVE
The Committee invests in a new HIV initiative to reduce
transmission of HIV by 90 percent in the next 10 years. The
bill includes an increase of nearly $500,000,000 for HIV
research, prevention, and treatment--almost twice the size of
the increase requested by the Administration.
The bill includes an increase of $170,000,000 for HRSA
programs--including Ryan White and Community Health Centers--to
increase the use of pre-exposure prophylaxis (PrEP) among
people at high risk for HIV transmission and to increase the
use of antiretroviral therapy (ART) for individuals living with
HIV.
The bill also includes $140,000,000 for CDC activities 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. There is also an increase of $16,919,000 for School
Health-HIV and an increase of $17,000,000 for the Minority AIDS
Initiative, a cross-cutting initiative to improve prevention,
care, and treatment for minority populations disproportionately
affected by HIV.
Furthermore, the Committee rejects the Administration's
proposal to cut NIH's HIV research budget by more than
$400,000,000. Instead, the Committee continues to invest in
research that led to breakthroughs in current treatments such
as PrEP and ART. The bill includes an increase of $149,000,000
for NIH to continue funding research that could lead to an HIV
vaccine or a cure.
FIREARM INJURY AND MORTALITY PREVENTION RESEARCH
The Committee addresses the public health emergency of
firearm violence for the first time in more than two decades.
According to CDC data, there were nearly 40,000 firearm-related
deaths in 2017. In addition, more than 130,000 non-fatal
firearm injuries from assault or self-harm are treated annually
in hospital emergency departments.
To address this public health emergency, the bill includes
a total of $50,000,000 for research through CDC and NIH to
better understand and prevent injury and death as a result of
firearm violence. Research is intended to focus on activities
that will have the greatest potential public health impact,
including strengthening data collection to better understand
firearm deaths and non-fatal injuries to help inform firearm
injury prevention; and applied research projects and evaluation
that align with the Institute of Medicine/National Research
Council recommendations to better understand public health
prevention strategies for reducing firearm injury and death.
In addition, the Committee includes increases of
$13,000,000 for Project AWARE and $5,000,000 for Healthy
Transitions. These programs began as a part of the 2013 ``Now
Is the Time'' initiative and are designed to increase access to
mental health treatment for youth and young adults reporting
symptoms of major depression, serious psychological stress, and
suicidal thoughts and actions.
PREPARING WORKERS FOR GOOD JOBS WITH FAIR WAGES
The biggest economic challenge of our time is that too many
people are in jobs that do not pay them enough money to live
on. More than two-thirds of adults do not have a four-year
degree, and economic projections show that soon two out of
three jobs will require some education and training beyond the
high school level.
To that end, the Committee provides new investments in
several areas of workforce training. Overall, the Committee
recommendation includes $5,846,270,000 for programs authorized
by the Workforce Innovation and Opportunity Act, an increase of
$624,915,000, above fiscal year 2019 and $1,583,280,000 above
the fiscal year 2020 budget request. In addition, the Committee
recommendation provides $250,000,000, an increase of
$90,000,000 over the fiscal year 2019 enacted level and fiscal
year 2020 budget request, to expand the registered
apprenticeship model and $1,868,655,000, an increase of
$150,000,000 over the fiscal year 2019 enacted level and
$853,072,000 over the fiscal year 2020 budget request for Job
Corps. These programs, and others, will help in the effort to
ensure everyone can benefit from the economic recovery, and
that everyone has the training they need to get good jobs with
fair wages.
To help meet local and regional labor market demand for a
skilled workforce, the Committee includes a new $150,000,000
initiative to support community colleges--the Strengthening
Community Colleges Training Grant (SCCTG) program--in providing
training to workers in in-demand industries, such as
manufacturing, information technology, health care, and energy
among others. Community colleges are strategically placed to
meet not only the educational needs of our country, but our
workforce development needs, as well. SCCTGs will help
community colleges and other four-year colleges and
universities through consortia build capacity and leverage
their expertise and resources, so that more individuals are
acquiring industry-recognized skills.
PROTECTING AMERICA'S WORKERS
The Committee recommends $1,840,453,000 for Department of
Labor agencies responsible for worker protection and worker
rights. This is an increase of $236,586,000 over the fiscal
year 2019 enacted level and $462,961,000 over the fiscal year
2020 budget request.
WHD employs fewer investigators today than it did in 1948,
despite the workforce having grown significantly in that time.
To help make up for this lost ground, hold bad-acting employers
accountable and defend working people so they receive the pay
they earned and are legally entitled to, the Committee
recommendation includes $298,131,000, an increase of
$69,131,000 over fiscal year 2019 enacted level and an increase
of $65,563,000 over the fiscal year 2020 budget request.
OSHA currently has the lowest number of health and safety
inspectors in the agency's 48-year history. OSHA enforcement is
critical to preventing workplace tragedies from occurring,
which is why it is concerning that the number of OSHA
investigations following a work-related fatality or catastrophe
reached 929 investigations in fiscal year 2018, up almost 100
from the previous year, reflecting a ten-year high. To make up
for years of flat funding and the erosion of capacity at OSHA,
the Committee includes $660,908,000, an increase of
$103,121,000 over the fiscal year 2019 enacted level and
$103,375,000 over the fiscal year 2020 budget request for this
critical worker protection agency.
The Committee also recommends $341,500,000 for the National
Labor Relations Board, an increase of $67,276,000 over the
fiscal year 2019 enacted level and $99,950,000 over the fiscal
year 2020 budget request. This increase will address the 17
percent decline in field staff the Board has seen in over just
two years by supporting 300 additional regional field staff and
two unfilled regional director positions.
Oversight of the Executive Branch
The Subcommittee has also fulfilled its responsibility to
maintain oversight of the Executive Branch by holding six
oversight hearings--in addition to annual hearings on the
fiscal year 2020 budget request. The Committee has focused on
abuses in health care, education, and labor in addition to
holding Administration officials accountable for their actions.
These oversight hearings have informed many of the decisions in
the fiscal year 2020 Labor-HHS-Education bill--including the
first investment in firearm injury and mortality prevention
research in more than two decades. Furthermore, the
Subcommittee intends to hold additional oversight hearings
throughout the rest of this Congress.
OVERSIGHT HEARINGS
Impact of the Administration's Policies Affecting the
Affordable Care Act. The Committee held a hearing to examine
the Administration's intentional policies to undermine the
Affordable Care Act, which have raised prices for Americans
already struggling with skyrocketing health care costs.
Moreover, the fiscal year 2020 budget request makes clear that
the Administration has not abandoned its attacks on the ACA or
protections for people with preexisting conditions. The
Committee examined those policies, specifically with regards to
affordability, the increasing number of uninsured, and the
quality of health insurance benefits. As a result of the
Committee's hearing, this bill directs the Centers for Medicare
& Medicaid Services (CMS) to allocate no less than $100,000,000
of carryover funds in fiscal year 2020 to support the ACA
Navigators program, as well as outreach, enrollment assistance,
and advertising during the next ACA open enrollment period.
Reviewing the Administration's Unaccompanied Children
Program. The Committee held a hearing to examine the
Administration's cruel and immoral policy of family separation,
which led to thousands of immigrant children being forcibly
separated from their parents, with no plan to reunify them.
Many of these children were less than 12 years old, and some
were less than 12 months old. Furthermore, the Administration's
policies led to tens of thousands of children spending
additional months in federal custody instead of being placed in
a home with relatives willing to care for them. These
intentional policies also caused hundreds of millions of
dollars in cost overruns, forcing the Secretary to transfer or
reprogram $385,000,000 from other HHS programs. As a result of
the Committee's hearing, this bill places legal conditions on
funding for the Unaccompanied Children program to return the
program to its core mission of taking care of vulnerable
children and placing them with sponsors, rather than acting as
an extension of the Administration's failed immigration
policies.
Protecting Student Borrowers: Loan Servicing Oversight.
Today, 44.7 million people owe $1,500,000,000,000 in student
loans, more than credit card debt or car loans. During the
Subcommittee's oversight hearing on loan servicing, Members of
Congress heard from a panel of experts on the critical role
loan servicing plays in assisting these individuals with paying
off their debt. Unfortunately, there are serious concerns that
these servicing companies are failing and that the Department
of Education is asleep at the wheel. In particular, the
Subcommittee heard from the Assistant Inspector General for
Audit in the Office of the Inspector General (OIG) at the
Department, who testified that between 2015 and 2017, loan
servicers were out of compliance in 61 percent of the Federal
Student Aid (FSA) monitoring reports analyzed. According to the
OIG report, ``by not holding servicers accountable for
instances of noncompliance with Federal loan servicing
requirements, FSA did not provide servicers with an incentive
to take actions to mitigate the risk of continued servicer
noncompliance that could harm students.'' Such noncompliance
includes loan servicers failing to provide borrowers with
accurate information about their repayment options,
miscalculating how much students should be paying through
income-based repayment, and putting borrowers into forbearance
without first informing them of other, less costly options.
As a result, the Committee recommendation includes new bill
language requiring the Department to award student loan
servicer contracts on the basis of their past performance and
compliance with Federal and state law. It also requires the
Department to prioritize services to help borrowers avoid
delinquency or default in contract solicitations and for the
Department to include accountability measures that account for
the performance of the portfolio and contractor compliance with
FSA guidelines.
Addressing the Public Health Emergency of Gun Violence. The
Committee held the first appropriations hearing in more than
two decades on the public health emergency of gun violence. In
2017 alone, guns killed nearly 40,000 Americans, including
24,000 suicide deaths. It is imperative that our foremost
public health and medical research agencies are engaged to
better understand this crisis. As a result of the Committee's
hearing, this bill includes $50,000,000 for the CDC and NIH to
support firearm injury and mortality prevention research, with
the potential to identify interventions that will save hundreds
of thousands of lives in the future.
Oversight of For-Profit Colleges: Protecting Students and
Taxpayer Dollars from Predatory Practices. The Subcommittee
held a hearing on predatory for-profit colleges. The
Subcommittee has a vested interest in conducting rigorous
oversight of these schools as they receive nearly 14 percent of
all Pell Grant funding, and while accounting for only 9 percent
of all students enrolled in postsecondary education, they
account for more than a third of all defaults. In addition,
during the hearing, the Subcommittee heard testimony from a
disabled veteran who was assured by a for-profit college that
he would not take out any student loans to enroll and would
only use grant aid and GI Bill benefits to attend; however, he
came to find out that he now owes approximately $100,000 in
student loan debt, and was unable to find employment in his
field of study after graduating from the for-profit
institution. His story is not an outlier.
For-profit colleges prey on servicemembers and veterans
with aggressive marketing and recruiting because of a loophole,
known as 90/10, that allows for-profit colleges to exclude from
the cap on federally derived institutional revenue any Federal
aid and educational benefits from sources other than the
Department of Education. To shine a light on this problem and
assist in identifying solutions, the Committee directs the
Secretary of Education to submit a report to the Committees on
Appropriations providing an analysis of all for-profit
institutions receiving 85 percent or more of their revenue from
Department of Education sources as well as revenue from the
Department of Veterans Affairs (VA) and Department of Defense
(DoD), as later described in the Committee report.
In addition, the Committee is deeply concerned by the
Secretary of Education's agenda to roll back regulations that
protect the well-being of students and taxpayers. While a court
has ordered the Secretary to implement the 2016 Borrower
Defense regulation, which provides relief to students who were
defrauded and misled by institutions of higher education, the
Secretary recently testified that not one claim has been
approved since June 2018. To conduct further oversight, the
Committee directs the Secretary to provide updates to the
Borrower Defense to Repayment Report on FSA's Data Center on a
monthly basis and directs the Secretary to submit a report to
the Committees on Appropriations on the number of claims and
the total amount of the loans covered by those claims by school
and institutional type, as later described in the Committee
report.
Combatting Wage Theft: The Critical Role of Wage and Hour
Enforcement. The Subcommittee held an oversight hearing on wage
theft and heard testimony from a panel of experts on how pay-
related violations by employers cost workers billions of
dollars annually. In addition, the Subcommittee discussed how
the WHD employs fewer investigators today than it did in 1948,
despite the workforce having grown significantly in that time.
To help make up for this lost ground, hold bad-acting employers
accountable and defend working people so they receive the pay
they earned and are legally entitled to, the Committee
recommendation for the WHD includes $298,131,000, an increase
of $69,131,000 over the fiscal year 2019 enacted level and an
increase of $65,563,000 over the fiscal year 2020 budget
request.
TITLE I--DEPARTMENT OF LABOR
Employment and Training Administration
Appropriation, fiscal year 2019....................... $9,905,660,000
Budget request, fiscal year 2020...................... 8,573,241,000
Committee Recommendation.............................. 10,614,487,000
Change from enacted level........................... +708,827,000
Change from budget request.......................... +2,041,246,000
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 2019....................... $3,502,700,000
Budget request, fiscal year 2020...................... 3,247,407,000
Committee Recommendation.............................. 3,977,615,000
Change from enacted level........................... +474,915,000
Change from budget request.......................... +730,208,000
Training and Employment Services provides funding for
Federal job training programs authorized primarily by the
Workforce Innovation and Opportunity Act of 2014 (WIOA).
Adult Employment and Training Activities.--For Adult
Employment and Training Activities, the Committee recommends
$900,000,000, which is $54,444,000 more than the fiscal year
2019 enacted level and the fiscal year 2020 budget request.
Youth Employment and Training Activities.--For Youth
Employment and Training Activities, the Committee recommends
$964,000,000, which is $60,584,000 more than the fiscal year
2019 enacted level and the fiscal year 2020 budget request.
The Committee remains concerned with the challenges facing
disconnected youth and encourages the Department to prioritize
funding for such youth and develop new strategies, including
how to market the Department's youth-based resources to
disconnected and opportunity youth through social media, local
advertisements and partnerships with local communities and
workforce boards.
Dislocated Worker Employment and Training Activities.--For
Dislocated Worker Employment and Training Activities, the
Committee recommends $1,103,360,000, which is $62,500,000 more
than the fiscal year 2019 enacted level and the fiscal year
2020 budget request.
Dislocated Worker Assistance National Reserve.--The
Committee recommends $370,859,000 for the Dislocated Workers
National Reserve, an increase of $150,000,000 over the fiscal
year 2019 enacted level and $236,142,000 over the fiscal year
2020 budget request.
Community colleges are strategically positioned to meet not
only the educational needs of our country, but our workforce
development needs as well. The Committee recommendation
includes $150,000,000 for a new initiative--the Strengthening
Community College Training Grants--to better align workforce
development efforts in in-demand industries with postsecondary
education. The Trade Adjustment Assistance Community College
Career Training Grant (TAACCCT) Program made a major investment
in community colleges between 2010 and 2014 and achieved
success in helping more adults attain industry-recognized
skills and credentials. Nearly 500,000 individuals enrolled in
programs supported through TAACCCT and earned more than 320,000
credentials in areas of manufacturing, healthcare, information
technology, energy, transportation and other industries. To
build on lessons learned from this initiative, the Committee
recommendation includes new funding to support a competitive
capacity building grant program to again leverage community
colleges in supporting local workforce development and industry
needs and to collaborate with employers in the design and
implementation of courses and programs.
Within 120 days of enactment of this Act, the Committee
directs the Secretary to issue a Solicitation for Grant
Applications (SGA) for this program. The Committee also directs
the Secretary to make individual grants to community colleges
of at least $1,500,000, unless grants are awarded in consortia
to community colleges and other eligible institutions of higher
education as defined in section 101(a) of the Higher Education
Act. In making grant awards, the Committee directs the
Secretary to ensure geographic diversity among grant
recipients, to require a plan for third party evaluations in
each individual grant proposal and to conduct a national
assessment of all grantee proposals once complete. In addition,
the Committee directs the Secretary to ensure grantees
incorporate a plan for sustainability of funding under the
grant proposal. While grants may be awarded to a consortium of
institutions of higher education, including public and private,
non-profit four-year institutions, the Committee directs the
Secretary to ensure that the lead grantee in the consortium is
a community college. The Committee directs the Secretary to
report to the Committees on Appropriations not less than 45
days in advance of issuing the SGA with specific details of the
SGA and 15 days in advance of announcing awards through this
program. The Secretary is directed to update the Committees
quarterly thereafter until all funds are expended.
Native Americans.--For the Indian and Native American
programs, the Committee recommends $55,000,000, which is
$500,000 more than the fiscal year 2019 enacted level. The
fiscal year 2020 budget request proposes to eliminate this
program.
Migrant and Seasonal Farmworkers.--For the National
Farmworker Jobs program, the Committee recommends $98,896,000,
which is $10,000,000 more than the fiscal year 2019 enacted
level. The fiscal year 2020 budget request proposes to
eliminate this program. The Committee recommendation includes
sufficient funding for the first time to carry out Section
127(a)(1) of WIOA to support farmworker youth activities. The
Committee recommendation also includes new bill language that
changes the availability of funds from July 1 to April 1 to
improve administrative efficiencies and ensure grants are
awarded in a timely manner.
YouthBuild.--For the YouthBuild program, the Committee
recommends $127,500,000, which is $37,966,000 more than the
fiscal year 2019 enacted level and $42,966,000 more than the
fiscal year 2020 budget request.
Reintegration of Ex-Offenders.--The Committee recommends
$100,000,000 for ex-offender retraining and reintegration
activities, which is $6,921,000 more than the fiscal year 2019
enacted level and $21,676,000 more than the fiscal year 2020
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.
Workforce Data Quality Initiative.--The Committee
recommends $8,000,000 for the Workforce Data Quality
Initiative, which is $2,000,000 more than the fiscal year 2019
enacted level. The fiscal year 2020 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
$250,000,000 for the apprenticeship grants program, which is
$90,000,000 more than the fiscal year 2019 enacted level and
fiscal year 2020 budget request. The Committee established this
program 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.
However, the Committee is deeply concerned that funds are
being used to support unregistered apprenticeship programs, an
untested, unproven, and duplicative version of registered
apprenticeships. The Committee is also concerned that the
funding under this program is not being used effectively to
support State, regional, and local apprenticeship efforts, as
well as efforts by intermediaries to expand registered
apprenticeships into new industries and to expand opportunities
for underserved or underrepresented populations.
Therefore, the bill includes new language clarifying that
funds may only be used for registered apprenticeships and
requires that funds be used by the Secretary to support State
grants and for contracts and cooperative agreements for
national and local apprenticeship intermediaries.
As part of these opportunities, the Committee directs the
Secretary to continue funding for business and labor industry
partner intermediaries as part of the set asides for national
and local intermediaries and ensure that labor 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.
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.
While the Committee recognizes the important role of
registered apprenticeship programs in developing our nation's
workforce, more could be done to leverage registered
apprenticeships in aligning our nation's workforce development
and traditional educational systems. The Committee therefore
requests a report, not later than 120 days from enactment of
this Act, outlining how registered apprenticeships may be used
to connect secondary and postsecondary systems with workforce
development, providing examples, best practices for replication
in the field, and an examination of postsecondary degree-
apprenticeship and dual enrollment strategies, including dual
enrollment for high school students through construction and
manufacturing-oriented accredited apprenticeship colleges. The
report should include information on the Department's efforts
to expand apprenticeship programs to high school aged youth in
order to connect such youth to professions in-demand fields
facing shortages.
The Committee supports the use of apprenticeship grants
that provide worker education 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.
Furthermore, the Committee is concerned with the persistent
gender inequity in apprenticeship programs. While
apprenticeships are an important path to the middle-class,
women are often underrepresented in apprenticeship programs,
and women who do participate often make far less than their
male counterparts. The Committee encourages the Department to
commit to addressing these inequalities within the
apprenticeship programs and directs the Department to include
an update on such efforts in its fiscal year 2021 Congressional
Budget Justification.
Open Data Reporting.--The Committee encourages the
Secretary, to the extent practicable, to disclose information
related to registered apprenticeships, including through the
Apprenticeship.gov website, or its successor website, and to be
published using an open source description language to allow
for public search and comparison of such data, including data
on credentials earned through or as a result of registered
apprenticeships.
National Defense Workforce Pipeline.--Over the next ten
years, an estimated 15,000 new workers will be needed to
support new submarine construction, with a particular focus on
trades such as welding, pipefitting, electrical, machining,
shipfitting, and carpentry, among others. The Committee
encourages the Department to work with the Departments of
Defense, Education, and Commerce to develop and implement a
strategy for strengthening the workforce pipeline, including
new submarine construction.
Engineering Programs.--The Committee encourages the
Department to support programs based on engineering concepts
for career transitioning professionals, returning veterans, and
youth in underserved areas.
JOB CORPS
Appropriation, fiscal year 2019....................... $1,718,655,000
Budget request, fiscal year 2020...................... 1,015,583,000
Committee Recommendation.............................. 1,868,655,000
Change from enacted level........................... +150,000,000
Change from budget request.......................... +853,072,000
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
2019 enacted level and $694,868,000 more than the fiscal year
2020 budget request.
Construction, Rehabilitation, and Acquisition.--The
Committee recommends $233,000,000 for construction,
rehabilitation, and acquisition activities of Job Corps
centers, which is $150,000,000 more than the fiscal year 2019
enacted level and $157,984,000 more than the fiscal year 2020
budget request. The increase in funding is intended to support
the elimination of Job Corps' maintenance backlog.
Administration.--The Committee recommends $32,330,000 for
the administrative expenses of the Job Corps program, which is
the same as the fiscal year 2019 enacted level and $220,000
more than the fiscal year 2020 budget request.
The Committee is concerned with the administration of the
Job Corps program, including its financial management, the
underutilization of centers relative to on-board strength, 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 most recent fiscal year
to the Committees on Appropriations and to the authorizing
committees of jurisdiction.
To better utilize Job Corps centers, the Committee directs
the Department to include an update in the fiscal year 2021
Congressional Budget Justification on specific outreach and
admissions efforts that includes the most recent geographic
assignment plan required by Sec. 145(c) of the WIOA, including
an analysis of Job Corps application and enrollment data to
evaluate the relative efficacy of different outreach strategies
for prospective Job Corps applicants and their families,
including social media, national television or radio buys, and
local outreach efforts. 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 requests an update in its fiscal year 2021
Congressional Budget Justification on how the Department will
rebalance Job Corps incentive payments in order to ensure
student outcomes are the highest priority, including a timeline
for implementation.
The Department has announced plans to reduce Job Corps
training opportunities in Florida by nearly half relative to
the State's capacity five years ago, despite Florida having the
fourth largest population of disconnected youth and annually
sending hundreds of youth out-of-state to receive Job Corps
training. The Committee directs the Department to submit to the
Committees on Appropriations, within 90 days of enactment of
this Act, the most recent geographic assignment plan required
by Sec. 145(c) of the WIOA, including the analyses required by
Sec. 145(c)(2)(A) and (B), as well as a detailed plan for
increasing Job Corps' Florida slot capacity to align with
demand in the State.
COMMUNITY SERVICE EMPLOYMENT FOR OLDER AMERICANS
Appropriation, fiscal year 2019....................... $400,000,000
Budget request, fiscal year 2020...................... - - -
Committee Recommendation.............................. 463,800,000
Change from enacted level........................... +63,800,000
Change from budget request.......................... +463,800,000
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 $463,800,000 for the Community
Service Employment for Older Americans program, which is
$63,800,000 more than the fiscal year 2019 enacted level. The
fiscal year 2020 budget request proposes to eliminate this
program.
FEDERAL UNEMPLOYMENT BENEFITS AND ALLOWANCES
Appropriation, fiscal year 2019....................... $790,000,000
Budget request, fiscal year 2020...................... 680,000,000
Committee Recommendation.............................. 680,000,000
Change from enacted level........................... -110,000,000
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 2020 is lower
than the fiscal year 2019 enacted level for this reason.
STATE UNEMPLOYMENT INSURANCE AND EMPLOYMENT SERVICE OPERATIONS
Appropriation, fiscal year 2019....................... $3,335,649,000
Budget request, fiscal year 2020...................... 3,475,986,000
Committee Recommendation.............................. 3,465,761,000
Change from enacted level........................... +130,112,000
Change from budget request.......................... -10,225,000
The total includes $3,381,695,000 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
$2,618,230,000, which is $102,414,000 more than the fiscal year
2019 enacted level and $3,000,000 more than the fiscal year
2020 budget request.
The recommendation provides contingency funding for
increased workloads that States may face in the administration
of UI. The Committee recommendation includes new bill language
so that, during fiscal year 2020, for every 100,000 increase in
the total average weekly insured unemployment above 1,758,000,
an additional $28,600,000 shall be made available from the
Unemployment Trust Fund.
While the national unemployment rate has declined,
investments in state unemployment systems are still critical
for ensuring claimants receive timely processing of benefits.
The Committee recommendation includes new bill language
requiring the Secretary to provide unearned above-base State UI
funds through supplemental funding opportunities to States, in
order to improve operations and modernize State UI systems to
help ensure that workers and their families receive fast and
high-quality assistance in their time of need.
The Committee is aware that when a large worker dislocation
occurs, an American Job Center (AJC) in a local area will
experience a surge in the demand for services. The Committee
expects the Department to continue assisting State agencies and
AJCs, as appropriate, with Rapid Response activities to provide
a surge response in these situations, so that impacted workers
are provided necessary assistance without delay. The Committee
directs the Department to work closely with States and local
AJCs to understand if any difficulties in providing TAA
services are related to service capacity issues and to include
this information in its fiscal year 2021 Congressional Budget
Justification.
The Committee includes $9,000,000, the same as the fiscal
year 2019 enacted level and $3,000,000 more than the fiscal
year 2020 budget request for the continued support of the UI
Integrity Center of Excellence (UIICE), including $6,000,000
for the benefit of States to the entity operating the UIICE.
The Committee includes $117,000,000 for the Reemployment
Services and Eligibility Assessments program, and an additional
$58,000,000 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 2019 enacted level and equal to the fiscal year
2020 budget request.
Unemployment Compensation National Activities.--The
Committee recommends $12,000,000 for National Activities, which
is the same as the fiscal year 2019 enacted level and
$36,000,000 below the fiscal year 2020 budget request.
Employment Service.--The Committee recommends $680,000,000
for the Employment Service allotment to States, which is
$16,948,000 more than the fiscal year 2019 enacted level and
the fiscal year 2020 budget request.
The Committee also recommends $22,318,000 for Employment
Service National Activities, which is $2,500,000 more than the
fiscal year 2019 enacted level and the fiscal year 2020 budget
request. The increase in funds is intended to help modernize,
streamline and reduce the processing backlog for the Work
Opportunity Tax Credit certification process.
Foreign Labor Certification.--The Committee recommends
$70,560,000 for the Foreign Labor Certification (FLC) program,
which is $8,250,000 more than the fiscal year 2019 enacted
level and equal to the fiscal year 2020 budget request. The
recommendation includes $56,278,000 for Federal administration
and $14,282,000 for grants to States in proportion to their use
of the H-2A and H-2B programs.
H-2A Program.--The H-2A program has tripled in size from
approximately 80,000 approved H-2A jobs in fiscal year 2008 to
more than 240,000 in fiscal year 2018. Given the program's
growth, the program's requirements against adverse effects on
U.S. workers, and the potential for U.S. worker displacement
and exploitation of both U.S. and vulnerable foreign workers,
the Committee directs the Secretary to submit a report to the
Committees on Appropriations on the Department's implementation
and enforcement of the H-2A program's requirements within 180
days of enactment of this Act. The report shall include a
comprehensive analysis of inspections, audits, investigations,
administrative complaints and judicial litigation and data
regarding findings of violations of H-2A program; the actions
taken following such findings; and the remedies sought and
obtained.
One-Stop Career Centers/Labor Market Information.--The
Committee recommends $62,653,000 for One-Stop Career Centers
and Labor Market Information, which is equal to the fiscal year
2019 enacted level and $3,327,000 more than the fiscal year
2020 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 2019....................... $158,656,000
Budget request, fiscal year 2020...................... 154,265,000
Committee Recommendation.............................. 158,656,000
Change from enacted level........................... - - -
Change from budget request.......................... +4,391,000
The recommendation includes $108,674,000 from the General
Fund of the Treasury and $49,982,000 from the Employment
Security Administration Account in the Unemployment Trust Fund.
Office of Apprenticeship.--The Committee urges the
Department to ensure that each of the State Offices of
Apprenticeship are fully and adequately staffed. Further, the
Committee directs the Department to include, in its fiscal year
2021 Congressional Budget Justification, information on what
percentage of Program Administration funds are used to support
registered apprenticeships and non-registered apprenticeships,
respectively, in fiscal years 2019 and 2020, as well as the
full-time equivalent staffing levels for each of these efforts.
Employee Benefits Security Administration
SALARIES AND EXPENSES
Appropriation, fiscal year 2019....................... $181,000,000
Budget request, fiscal year 2020...................... 193,500,000
Committee Recommendation.............................. 183,155,000
Change from enacted level........................... +2,155,000
Change from budget request.......................... -10,345,000
The Employee Benefits Security Administration (EBSA)
assures the security of retirement, health and other workplace-
related benefits of working people.
The Committee recommends $183,155,000 for EBSA, which is
$2,155,000 more than the fiscal year 2019 enacted level and
$10,345,000 less than the fiscal year 2020 budget request.
On October 11, 2018, DOL-OIG issued a report entitled
``EBSA Can Provide Greater Oversight of the Thrift Savings Plan
by Strengthening its Audit Program.'' The Committee is
concerned with the DOL-OIG finding that despite identifying
significant IT security weaknesses, of all recommendations made
in the Thrift Savings Plan (TSP) audit reports EBSA issued from
2010 through 2017, 73 percent remain open. In response, the
Committee provides $2,155,000 for EBSA to perform a
comprehensive, detailed review of the TSP's IT operating
environment--specifically to review the adequacy of controls at
contractor sites and over contractor IT personnel and monitor
the agency's progress in remediating previously identified
issues. The Committee directs EBSA to provide a summary of the
review's findings to the Committees on Appropriations, and to
publicly post the review on its website, once it is complete.
The Committee is encouraged that EBSA agrees with DOL-OIG's
recommendations and directs the agency to update the Committees
on Appropriations on the status of their implementation within
90 days of the enactment of this Act.
The Committee is deeply concerned by the Department of
Labor's efforts to sabotage the Affordable Care Act (ACA) and
strip access to affordable, comprehensive health coverage from
millions of Americans through its association health plan (AHP)
rule. The AHP rule seeks to expand skimpy plans that do not
provide consumers with access to the care they need or
financial protection against the high cost of many medical
conditions. The rule will increase costs for consumers and
destabilize the health insurance marketplace by cherry-picking
healthier, lower cost individuals, while leaving older, sicker,
and more expensive consumers in the traditional market with
skyrocketing costs. This will be devastating for patients with
pre-existing conditions, who the Administration already tried
to abandon by refusing to defend the ACA and its key patient
protections in court. The Committee agrees with a Federal
judge's recent conclusion that the AHP rule ``is clearly an
end-run around the ACA'' and that that it ``does violence'' to
the Employee Retirement Income Security Act. Therefore, the
bill does not include the Administration's requested increase
for the administration of AHPs under the new rule.
Pension Benefit Guaranty Corporation
Appropriation, fiscal year 2019....................... $445,363,000
Budget request, fiscal year 2020...................... 452,858,000
Committee Recommendation.............................. 452,858,000
Change from enacted level........................... +7,495,000
Change from budget request.......................... - - -
Congress established the Pension Benefit Guaranty
Corporation to insure the defined-benefit pension plans of
working people.
The recommendation includes new bill language that extends
the period of availability for administrative expenses to
ensure the agency has sufficient time to manage a large,
unanticipated influx of participants.
Wage and Hour Division
SALARIES AND EXPENSES
Appropriation, fiscal year 2019....................... $229,000,000
Budget request, fiscal year 2020...................... 232,568,000
Committee Recommendation.............................. 298,131,000
Change from enacted level........................... +69,131,000
Change from budget request.......................... +65,563,000
WHD enforces Federal minimum wage, overtime pay,
recordkeeping, and child labor requirements of the Fair Labor
Standards Act. WHD also has enforcement and other
administrative responsibilities related to the Migrant and
Seasonal Agricultural Worker Protection Act, the Employee
Polygraph Protection Act, the Family and Medical Leave Act, the
Davis Bacon Act, and the Service Contract Act.
On April 9, 2019, the Subcommittee on Labor-HHS-Education-
Related Agencies held a hearing entitled ``Combatting Wage
Theft: The Critical Role of Wage and Hour Enforcement,'' during
which the Subcommittee heard from a panel of national experts
how pay-related violations by employers cost workers billions
of dollars annually. The Subcommittee discussed how WHD employs
fewer investigators today than it did in 1948, despite the
workforce having grown significantly in that time, and how the
agency's lack of resources hinders efforts to make sure workers
receive their promised wages. By the end of the hearing, there
was bipartisan consensus that increased funding was needed to
make sure WHD has the resources to carry out its statutory
mission and protect workers. Panelists also discussed how
agencies such as WHD can implement a strategic enforcement
approach to use limited resources to sustainably change
employer behavior.
To address these urgent needs, the Committee provides an
increase of $69,131,000 over the fiscal year 2019 enacted level
and $65,563,000 over the fiscal year 2020 budget request. The
Committee directs WHD to hire at least 500 additional
investigators with the increased funding. This increase would
bring WHD to roughly 1,300 investigators, to reverse the
impacts of years of flat funding that have eroded and reduced
investigative capacity. The Committee also urges WHD to explore
and expand strategic enforcement approaches to the agency's
work to make the most of this increase.
When the Payroll Audit Independent Determination (PAID)
program was first announced in March 2018, the Department
pledged to do an evaluation of it after six months before
expanding it, which is why the Committee is concerned that the
PAID program was expanded in October 2018 without any prior
evaluation or knowledge of its effectiveness. The Department
frequently cites the $304,000,000 in wages WHD recovered in
fiscal year 2018 as a justification for its actions; however,
the agency has not disclosed how much of that amount was
recovered through the PAID program. In addition, the Department
has not disclosed how much the PAID program costs to administer
or how many businesses participate. To provide needed
transparency, the Committee directs WHD to provide a report to
the Committees on Appropriations within 30 days of enactment of
this Act, and quarterly thereafter, detailing administrative
expenditures on PAID, amounts recovered through PAID, and the
number of businesses participating in PAID since March 2018.
The Committee is also deeply concerned with recently
proposed regulatory rollbacks at WHD. The Department's proposed
overtime rule would take away basic benefits from roughly three
million workers that were protected under the 2016 overtime
rule, which would have raised the overtime salary threshold to
$47,476 with automatic annual increases. The proposed joint
employer rule would limit corporate liability when contractors
and franchisees commit wage theft. Further, efforts to revise
and repeal protections for 16- and 17-year-olds in health care
professions would put teenagers at risk of injury. Taken
together, these proposals reflect a systematic effort to tip
the scales to benefit powerful corporate interests at the
expense of working people. The Committee strongly urges WHD to
adjust course and abandon misguided proposals that stand in
conflict with the agency's mission to protect workers.
Office of Labor-Management Standards
SALARIES AND EXPENSES
Appropriation, fiscal year 2019....................... $41,187,000
Budget request, fiscal year 2020...................... 49,134,000
Committee Recommendation.............................. 40,187,000
Change from enacted level........................... -1,000,000
Change from budget request.......................... -8,947,000
The Office of Labor Management Standards (OLMS) administers
the Labor-Management Reporting and Disclosure Act, which
establishes safeguards for union democracy and union financial
integrity, and requires public disclosure reporting by unions,
union officers, employees of unions, labor relations
consultants, employers, and surety companies.
The Committee is aware that the Department chose to use
transfer authority provided by the Committee to transfer
$1,235,000 from the State Unemployment Insurance and Employment
Service Operations appropriation to this account to support
activities under the International Union Compliance Audit
Program (I-CAP). The Committee acknowledges the Department's
inconsistency in supporting enforcement efforts across the
agency and believes this transfer reflects misplaced
priorities. Therefore, the Committee recommendation includes a
$1,000,000 decrease for OLMS below the 2019 enacted level and
$8,947,000 below the fiscal year 2020 budget request. The
Committee rejects the budget request to provide funds that
would support and expand I-CAP.
Office Of Federal Contract Compliance Programs
SALARIES AND EXPENSES
Appropriation, fiscal year 2019....................... $103,476,000
Budget request, fiscal year 2020...................... 103,576,000
Committee Recommendation.............................. 120,000,000
Change from enacted level........................... +16,524,000
Change from budget request.......................... +16,424,000
The 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.
To support OFCCP's efforts to make sure contractors and
subcontractors are adhering fully with EO 11246, the Committee
provides an increase of $16,524,000 over the fiscal year 2019
enacted level, and $16,424,000 above the fiscal year 2020
budget request, to add personnel, expand enforcement, and
ensure contactor and subcontractor compliance with reporting
requirements.
In the fiscal year 2021 Congressional Budget Justification,
the Committee directs OFCCP 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.
Office Of Workers' Compensation Programs
SALARIES AND EXPENSES
Appropriation, fiscal year 2019....................... $117,601,000
Budget request, fiscal year 2020...................... 117,782,000
Committee Recommendation.............................. 120,782,000
Change from enacted level........................... +3,181,000
Change from budget request.......................... +3,000,000
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 recommendation includes $118,609,000 in General Funds
from the Treasury, $3,185,000 above the fiscal year 2019
enacted level and $3,000,000 above the fiscal year 2020
request, and $2,173,000 from the Special Fund established by
the Longshore and Harbor Workers' Compensation Act.
The Committee continues to support the efforts of OWCP to
reduce fraud and abuse related to the prescription of compound
pharmaceuticals and opioids and encourages continued
collaboration with the DOL-OIG on this critical issue.
SPECIAL BENEFITS
Appropriation, fiscal year 2019....................... $230,000,000
Budget request, fiscal year 2020...................... 234,600,000
Committee Recommendation.............................. 234,600,000
Change from enacted level........................... +4,600,000
Change from budget request.......................... - - -
These funds provide mandatory benefits under the Federal
Employees' Compensation Act.
SPECIAL BENEFITS FOR DISABLED COAL MINERS
Appropriation, fiscal year 2019....................... $25,319,000
Budget request, fiscal year 2020...................... 34,970,000
Committee Recommendation.............................. 34,970,000
Change from enacted level........................... +9,651,000
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 $34,970,000 for Special Benefits
for Disabled Coal Miners. This amount is in addition to the
$14,000,000 appropriated in fiscal year 2019 as an advance for
the first quarter of fiscal year 2020. The total program level
recommendation is $9,651,000 more than the fiscal year 2019
enacted level and the same as the fiscal year 2020 budget
request.
The Committee recommendation also provides $14,000,000 as
an advance appropriation for the first quarter of fiscal year
2021. These funds ensure uninterrupted payments to
beneficiaries.
ADMINISTRATIVE EXPENSES, ENERGY EMPLOYEES OCCUPATIONAL ILLNESS
COMPENSATION FUND
Appropriation, fiscal year 2019....................... $59,098,000
Budget request, fiscal year 2020...................... 59,846,000
Committee Recommendation.............................. 59,846,000
Change from enacted level........................... +748,000
Change from budget request.......................... - - -
These funds provide mandatory benefits to eligible
employees or survivors of employees of the Department of Energy
(DOE); its contractors and subcontractors; companies that
provided beryllium to DOE; atomic weapons employees who suffer
from a radiation-related cancer, beryllium-related disease, or
chronic silicosis as a result of their work in producing or
testing nuclear weapons; and uranium workers covered under the
Radiation Exposure Compensation Act.
BLACK LUNG DISABILITY TRUST FUND
Appropriation, fiscal year 2019....................... $328,182,000
Budget request, fiscal year 2020...................... 365,240,000
Committee Recommendation.............................. 365,240,000
Change from enacted level........................... +37,058,000
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 2019....................... $557,787,000
Budget request, fiscal year 2020...................... 557,533,000
Committee Recommendation.............................. 660,908,000
Change from enacted level........................... +103,121,000
Change from budget request.......................... +103,375,000
The Occupational Safety and Health Act of 1970 established
the 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:
------------------------------------------------------------------------
FY 2020
Budget Activity Committee
------------------------------------------------------------------------
Safety and Health Standards.......................... $23,100,000
Federal Enforcement.................................. 246,383,000
Whistleblower Programs............................... 18,809,000
State Programs....................................... 123,233,000
Technical Support.................................... 30,597,000
Federal Compliance Assistance........................ 86,623,000
State Consultation Grants............................ 64,687,000
Training Grants...................................... 12,690,000
Safety and Health Statistics......................... 41,168,000
Executive Direction and Administration............... 13,618,000
------------------------------------------------------------------------
The Committee is concerned that the number of OSHA
investigations following a work-related fatality or catastrophe
reached 929 investigations in fiscal year 2018, up almost 100
from the previous year, reflecting a ten-year high. OSHA
enforcement is critical to preventing workplace tragedies from
occurring, which is why the Committee is concerned that OSHA
currently has the lowest number of health and safety inspectors
in the agency's 48-year history.
Further, the Committee notes that under OSHA's current
staffing levels, it would take the agency an average of 165
years to inspect each employer within its jurisdiction just one
time. To restore OSHA capacity to staffing levels in fiscal
year 2010, when the average frequency for inspections was once
every 129 years, the Committee provides an increase of
$103,121,000 over the fiscal year 2019 enacted level and
$103,375,000 more than the fiscal year 2020 budget request. To
ensure OSHA makes adequate progress in hiring additional
inspectors, the Committee directs the agency to submit
quarterly reports on new hiring and overall personnel numbers
to the Committees on Appropriations. The report shall include
the number of inspector vacancies and the number of on-board
inspectors.
The Committee is deeply concerned with the Department's
failure to comply with a provision of the Department of Labor
Appropriations Act, 2018 requiring the Secretary to reserve not
less than $4,500,000 for Capacity Building Developmental grants
in the Susan Harwood Training Program. After the Committee
inquired on the funding status, the Department informed the
Committee that OSHA was unable to satisfy the funding
requirement because it received an insufficient number of
eligible, qualified applications to award $4,500,000 for
Capacity Building Developmental grants. Instead, OSHA used
funds for five noncompetitive awards. To provide increased
transparency and oversight, the Committee modifies the bill's
noncompetitive reporting requirement to capture those
instances, like Harwood, where there are several smaller awards
that individually do not meet the reporting threshold but do in
total. Further, the Committee directs OSHA to publish Funding
Opportunity Notices for fiscal year 2020 funds for the Susan
Harwood Training Grant program no later than June 30, 2020.
Whistleblowers are this nation's eyes and ears, identifying
and helping to control not only hazards facing workers at
jobsites, but also practices that endanger the public's health,
safety, or well-being. According to OSHA's own data, since
fiscal year 2014, the number of whistleblower investigators has
declined 24 percent while the number of complaints has grown by
29 percent, and in fiscal year 2018, the backlog of cases has
grown to 2,540 pending cases. To assure that claims are
processed in a timely manner, the Committee directs OSHA to
maintain all current regional supervisory positions in the
whistleblower program.
The Committee notes it is OSHA's responsibility under the
law to approve and monitor State-run OSHA plans. If the agency
removes on the ground oversight, it will make it increasingly
difficult for OSHA to effectively oversee State programs. OSHA
regional and area offices work directly with States to set
inspection goals, taking into account staffing and funding
levels in each State. Regional and area officials review State-
run program performance reports and meet with State officials
to monitor their progress toward meeting their inspection
goals. OSHA's regions also conduct reviews of each State-run
program called Federal Annual Monitoring Evaluation reviews.
Removing this on the ground oversight would have significant
negative consequences for worker safety. Therefore, the
Committee directs OSHA to maintain all regional full-time
equivalent staff that monitor State plans. Within 90 days of
enactment of this Act, and every six months thereafter, OSHA
shall report staffing levels for those monitoring State plans
to the Committees on Appropriations.
In February of 2019, the GAO published a report on safety
and health records of Department of Defense (DoD) contractors
that found that among the sample of contractors they studied,
80 percent of DoD contractors inspected by OSHA had received a
citation for an OSHA violation, and that some involved serious
worker injuries or fatalities. The report also found that some
contractors continued to receive contracts after receiving OSHA
citations for serious workplace safety and health violations.
Of great concern, GAO also found that the DoD contracting
offices did not know how to access and use the data on OSHA's
website to learn about safety and health violations or severe
injuries of prospective or current contractors. Further, GAO
found that the incidence of OSHA violations among all inspected
companies with DoD contracts cannot be determined because
``OSHA does not require its staff to obtain and enter a
corporate identification number in its inspection data, which
is needed to match contracting data to inspection data.'' To
educate DoD procurement officers on how to use the OSHA website
to find citation and other records, the Committee directs OSHA,
in consultation with DoD, to develop a webinar for DoD
procurement officers on how to use OSHA's website to find OSHA
violations and Severe Injury Reports. This webinar shall be
developed and provided to DoD within 180 days of enactment of
this Act and shall be sent to the Committees on Appropriations.
In addition, within 360 days of enactment of this Act, the
Committee directs OSHA compliance officers to gather the
Employee Identification Number from all inspections of
worksites with more than 20 employees.
The Committee is concerned that it does not receive
information about how much OSHA spends on its Voluntary
Protection Programs (VPP); therefore, within 180 days of
enactment of this Act, the Committee directs OSHA to submit to
the Committees on Appropriations how much was spent on VPP
annually since fiscal year 2015. In addition, OSHA shall
include VPP spending information in its fiscal year 2021
Congressional Budget Justification. To make sure there is
adequate funds control within VPP, the Committee recommendation
includes new bill language allowing not more than $3,500,000
for VPP.
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 2021
Congressional 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. Women workers 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.
Although occupational noise is a leading cause of hearing
loss, which, in turn, is one of the most commonly recorded
occupational illnesses, the current OSHA Noise Standard for
occupational noise has not been updated since its inception in
1983. Accordingly, to better protect U.S. employees and reduce
noise-induced hearing loss, OSHA should explore updating the
more than 35-year old standard to the level currently required
by the DoD and many U.S. employers.
The Committee strongly urges OSHA not to revoke ancillary
provisions from the 2017 final rule limiting exposure to
beryllium that protect workers in shipyard and construction
industries. Such an effort would reflect the first time OSHA
has proposed to weaken a standard protecting workers against a
known human carcinogen, and it would leave construction and
shipyard workers vulnerable to life-threatening beryllium-
related diseases.
Mine Safety and Health Administration
SALARIES AND EXPENSES
Appropriation, fiscal year 2019....................... $373,816,000
Budget request, fiscal year 2020...................... 376,043,000
Committee Recommendation.............................. 417,290,000
Change from enacted level........................... +43,474,000
Change from budget request.......................... +41,247,000
The Mine Safety and Health Administration (MSHA) enforces
the Federal Mine Safety and Health Act in underground and
surface coalmines and metal/non-metal mines.
The Committee notes MSHA's budget has been frozen over the
past six years, which has eroded the agency's capacity to
protect mine workers. To restore MSHA's capacity, the Committee
provides an increase of $43,474,000 over the fiscal year 2019
enacted level and $41,247,000 more than the fiscal year 2020
budget request. This increase will support MSHA's enforcement
of the 2014 respirable dust rule and expanded monitoring of
operator compliance with its existing silica rule. In addition,
the Committee strongly encourages MSHA to develop a more
protective silica monitoring standard.
The Committee continues bill language designating up to
$2,000,000 for mine rescue recovery activities, and provides
for the retention of fees up to $2,499,000 for the testing and
certification of equipment. The Committee includes $10,537,000
for State assistance training grants.
The Committee is concerned by MSHA's proposal to merge the
Coal Mine Safety and Health budget activity with the Metal and
Nonmetal Mine Safety and Health budget activity. Given the
differences in complex safety and health issues between both
categories of inspections, the Committee is concerned that a
merger could compromise MSHA's mission and make workers less
safe. Therefore, the Committee recommendation does not
consolidate these two activities as proposed in the fiscal year
2020 budget request.
Bureau of Labor Statistics
SALARIES AND EXPENSES
Appropriation, fiscal year 2019....................... $615,000,000
Budget request, fiscal year 2020...................... 655,000,000
Committee Recommendation.............................. 675,800,000
Change from enacted level........................... +60,800,000
Change from budget request.......................... +20,800,000
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 $610,800,000 from the
General Fund of the Treasury and $65,000,000 from the
Employment Security Administration Account in the Unemployment
Trust Fund.
Within the total for BLS, the Committee provides the
following amounts:
------------------------------------------------------------------------
FY 2020
Budget Activity Committee
------------------------------------------------------------------------
Employment and Unemployment Statistics............... $237,900,000
Labor Market Information............................. 65,000,000
Prices and Cost of Living............................ 222,900,000
Compensation and Working Conditions.................. 88,400,000
Productivity and Technology.......................... 14,200,000
Executive Direction and Staff Services............... 47,400,000
------------------------------------------------------------------------
The Committee is concerned that a decade of flat funding
has left BLS in critical condition. Therefore, the Committee
provides an increase of $60,800,000 over the fiscal year 2019
enacted level, and $20,800,000 over the fiscal year 2020 budget
request, to make up for the loss of purchasing power and to
take full advantage of advances in statistical methods to
produce the high-quality statistics required for a thriving,
21st century economy. Specifically, the Committee directs BLS
to spend $40,000,000 of the total increase to support the
following essential investments:
Modernize the Consumer Expenditure Survey
and provide robust data to support the Supplemental
Poverty measure;
Provide 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 the alternate years, including an occasional
veterans supplement;
Expand Job Openings and Labor Turnover
Survey to provide greater industry detail and State-
level data;
Modernize Industrial Price and Import/Export
Program systems;
Modernize Quarterly Census of Employment and
Wages systems for data collection and communication
with States;
Modernize infrastructure for BLS public
internet and public database;
Continue research and work toward a pilot
test of a new Survey of Employer Provided Training;
Continue research and work toward a pilot
test of a quick-response employer survey (either Annual
Refiling Survey or Employment Cost Index platform);
Add a second Electronic Data Collection
Facility to expand electronic collection and improve
resilience; and,
Invest in staff development, cybersecurity,
and other computationally intensive or IT capacity
related upgrades.
In addition, the Committee provides $10,000,000 for a new
youth cohort for the National Longitudinal Survey of Youth
(NLSY). The Committee notes that the current NLSY 1979 and NLSY
1997 cohorts cannot provide information about teens and young
adults under the age of 25, as they are entering the labor
market--leaving critical gaps in data about the new generation
of young workers. By establishing a new cohort, BLS will be
able to better produce timely and relevant data on the U.S.
labor workforce.
Furthermore, the Committee is aware of the development of
artificial intelligence and encourages BLS to examine this
trend's impact on the economy.
Finally, the Committee provides $10,000,000 to support BLS'
eventual headquarters move.
Office of Disability Employment Policy
SALARIES AND EXPENSES
Appropriation, fiscal year 2019....................... $38,203,000
Budget request, fiscal year 2020...................... 27,000,000
Committee Recommendation.............................. 38,500,000
Change from enacted level........................... +297,000
Change from budget request.......................... +11,500,000
Office of Disability Employment Policy provides policy
guidance and leadership to eliminate employment barriers to
people with disabilities.
The Committee recommendation is $297,000 above the fiscal
year 2019 enacted level and $11,500,000 above the fiscal year
2020 budget request.
Departmental Management
SALARIES AND EXPENSES
Appropriation, fiscal year 2019....................... $338,064,000
Budget request, fiscal year 2020...................... 266,866,000
Committee Recommendation.............................. 382,939,000
Change from enacted level........................... +44,875,000
Change from budget request.......................... +116,073,000
The Departmental Management appropriation provides funds
for the staff responsible for Departmental operations,
management, and policy development.
The recommendation includes $382,631,000 from the General
Fund of the Treasury, $44,875,000 above the fiscal year 2019
enacted level and $116,073,000 above the fiscal year 2020
budget request, and $308,000 from the Employment Security
Administration Account in the Unemployment Trust Fund.
Within the total for Departmental Management, the Committee
provides the following amounts:
------------------------------------------------------------------------
FY 2020
Budget Activity Committee
------------------------------------------------------------------------
Program Direction and Support........................ $30,250,000
Departmental Evaluation.............................. 8,040,000
Legal Services....................................... 128,374,000
International Labor Affairs.......................... 122,125,000
Administration and Management........................ 29,004,000
Adjudication......................................... 35,000,000
Women's Bureau....................................... 17,750,000
Civil Rights Activities.............................. 6,880,000
Chief Financial Officer.............................. 5,516,000
------------------------------------------------------------------------
Of the $122,125,000 recommended for the International Labor
Affairs Bureau (ILAB), the Committee directs the Secretary to
allocate not less than $36,000,000 in grants to build the
capacity of countries to enforce labor rights to promote a more
level playing field for workers in the United States, including
as a priority Mexico, while maintaining existing grant funding
for combatting child labor.
The Committee is concerned by a GAO report, which found
that limited resources have prevented more proactive monitoring
of trade partner compliance under 14 trade agreements with 20
countries, as well as monitoring of trade preference programs
with 120 countries. In response, the Committee directs ILAB to
provide an increase of $3,500,000 over fiscal year 2019 to the
Office of Trade and Labor Affairs (OTLA) to fund an additional
20 U.S.-based full-time equivalent employees to increase
monitoring and enforcement activities, and directs ILAB to
spend an increase of $2,500,000 to fund no fewer than five
additional labor attaches in critical U.S. Embassies to
increase field-based and international monitoring and labor
compliance facilitation, including two in Mexico and one each
in Bangladesh, Vietnam, and Geneva, Switzerland, for engagement
with the International Labor Organization. In addition, 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.
The Committee is also concerned with violence and threats
shown towards activists around the world, including gender-
based violence targeted towards women activists, particularly
in nations with which we have trade agreements with enforceable
labor and environmental protections. The Committee urges ILAB
to more actively engage with trade partner nations to end these
human rights violations so as to better comport with the labor
provisions of trade agreements.
Of the $17,750,000 appropriated to the Women's Bureau, the
Committee provides $4,994,000 for the Women in Apprenticeship
and Nontraditional Occupations (WANTO) program, an increase of
$4,000,000 over fiscal year 2019. The Committee rejects the
fiscal year 2020 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.
There are concerns about the breakdown of the normal flow
of information from some areas of the Department to the
Committee. The Committee expects the Department to correct
these shortcomings. If no improvement is made, the Committee
will evaluate the resources spent on the offices and staff
involved in the unacceptable delays regarding the transmission
of information to the Committee and whether the resources are
better allocated to other areas of the bill.
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 2021 budget justification:
Expenditures for fiscal year 2019 and expected expenditures for
fiscal years 2020 and 2021, 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 2018 and 2019. In addition, the Department shall
submit a report to the Committees reflecting projected costs
for fiscal years 2020 and 2021 in the fiscal year 2021
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 2017, 2018 and 2019 and
estimates for fiscal year 2020 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, and high-poverty areas, as defined as any census
tract with a poverty rate of at least 20 percent as measured by
the 2013-2017 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.
The Committee is supportive of efforts by the Department to
consider evidence of effectiveness in grant competitions.
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 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.
VETERANS EMPLOYMENT AND TRAINING
Appropriation, fiscal year 2019....................... $300,041,000
Budget request, fiscal year 2020...................... 306,041,000
Committee Recommendation.............................. 316,341,000
Change from enacted level........................... +16,300,000
Change from budget request.......................... +10,300,000
The recommendation includes $60,000,000 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:
------------------------------------------------------------------------
Budget Activity FY 2020 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.............. 60,000,000
------------------------------------------------------------------------
The Committee recommendation includes $29,379,000 for the
Transition Assistance Program, which is $6,000,000 more than
the fiscal year 2019 enacted level and the same as the fiscal
year 2020 budget request. The additional 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 $60,000,000 for the Homeless
Veterans Reintegration Program to further support the needs of
veterans experiencing homelessness.
The Committee includes $500,000 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 to establish a Disabled Veteran Program
(DVP) to address the high unemployment and low labor force
participation rate of veterans with service-connected and non-
service-connected disabilities. The DVP will help 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.
INFORMATION TECHNOLOGY MODERNIZATION
Appropriation, fiscal year 2019....................... $23,269,000
Budget request, fiscal year 2020...................... 37,000,000
Committee Recommendation.............................. 37,000,000
Change from enacted level........................... +13,731,000
Change from budget request.......................... - - -
Information Technology (IT) Modernization provides a
dedicated source of funding for Department-wide IT
modernization projects together with funding through the
Department's Working Capital Fund.
The Committee provides an increase of $13,731,000 over the
fiscal year 2019 enacted level, and the same level as the
fiscal year 2020 budget request, to support Department-wide IT
initiatives. While the Committee is supportive of the
Department's efforts to seek efficiencies and meet IT needs
within a longer-term plan, the Committee rejects the
Department's requests for additional transfer authority.
OFFICE OF INSPECTOR GENERAL
Appropriation, fiscal year 2019....................... $89,147,000
Budget request, fiscal year 2020...................... 90,121,000
Committee Recommendation.............................. 96,121,000
Change from enacted level........................... +6,974,000
Change from budget request.......................... +6,000,000
The DOL-OIG conducts audits of Department programs and
operations in order to determine that they comply with the
applicable laws and regulations, that they use resources
effectively, and that they are achieving their intended
results.
The recommendation includes $90,461,000 from the General
Fund of the Treasury, $6,974,000 above the fiscal year 2019
enacted level and $6,000,000 above the fiscal year 2020 budget
request, and $5,660,000 from the Employment Security
Administration Account in the Unemployment Trust Fund.
The Committee supports the DOL-OIG efforts to reduce fraud
and abuse in the Workers' Compensation programs related to the
prescription of compound pharmaceuticals and opioids, among
other areas.
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 providing the
Secretary with the authority to transfer up to one percent of
discretionary funds between appropriations, provided that no
appropriation is increased by more than three percent by any
such transfer.
Sec. 103. The Committee continues a prohibition on use of
funds to purchase goods that are in any part produced by
indentured children.
Sec. 104. The Committee continues a provision related to
grants made from funds available to the Department under the
American Competitiveness and Workforce Improvement Act.
Sec. 105. The Committee continues a provision to prohibit
recipients of funds provided to the Employment and Training
Administration from using such funds for the compensation of
any individual at a rate in excess of Executive Level II.
(TRANSFER OF FUNDS)
Sec. 106. The Committee continues a provision providing the
Secretary 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 modifies a provision relating to
surplus property and apprenticeship programs.
Sec. 109. The Committee includes a new provision providing
an additional year for the expenditure of funds for
unemployment insurance projects carried out in fiscal years
2015 through 2019 by State consortia.
Sec. 110. The Committee continues a provision relating to
the Secretary's security detail.
Sec. 111. The Committee modifies a provision relating to
the Treasure Island Job Corps Center.
Sec. 112. The Committee includes a new provision ensuring
that the proceeds of any sale of a Job Corps center are
returned to the program under 158(g) of the WIOA.
TITLE II--DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Resources and Services Administration
Appropriation, fiscal year 2019....................... $6,843,503,000
Budget request, fiscal year 2020...................... 5,841,352,000
Committee Recommendation.............................. 7,326,109,000
Change from enacted level........................... +482,606,000
Change from budget request.......................... +1,484,757,000
The Health Resources and Services Administration (HRSA)
supports programs that provide health services to
disadvantaged, medically underserved, and special populations;
decrease infant mortality rates; assist in the education of
health professionals; and provide technical assistance
regarding the utilization of health resources and facilities.
PRIMARY HEALTH CARE
Appropriation, fiscal year 2019....................... $1,626,522,000
Budget request, fiscal year 2020...................... 1,626,522,000
Committee Recommendation.............................. 1,676,522,000
Change from enacted level........................... +50,000,000
Change from budget request.......................... +50,000,000
Health Centers
The Committee recommends $1,676,522,000 for the Health
Centers program, which is $50,000,000 above the fiscal year
2019 enacted level and the fiscal year 2020 budget request.
The Committee includes bill language providing up to
$120,000,000 for the Federal Tort Claims Act program, which is
the same as the fiscal year 2019 enacted level and the fiscal
year 2020 budget request.
Domestic HIV Initiative.--The Committee includes
$50,000,000 within the Health Centers program for the first
year of the initiative to reduce the transmission of HIV by 90
percent over the next ten years. Funds will be distributed to
Health Centers in high-need jurisdictions to increase the use
of pre-exposure prophylaxis (PrEP) among people at high risk
for HIV transmission.
Behavioral Interventions for Pain Management.--In
addressing the opioid epidemic, the Committee recognizes the
growing need for highly trained professionals to deliver
evidence-based behavioral interventions for pain management.
The Committee encourages HRSA to invest in programs that expand
access to treatment for substance use disorders in Federally-
Qualified Health Centers (FQHCs) and requests a report within
180 days of enactment of this Act about continued gaps in the
behavioral health workforce and whether graduate-level health
service psychologists in FQHCs could improve health outcomes.
Health Professional Shortage Area.--The Committee directs
HRSA to submit a report within 180 days of enactment of this
Act examining the impact of rotating residents on the
calculation of health care providers' Health Professional
Shortage Area (HPSA) scores.
Improving Integration of Health Centers and Home
Visiting.--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. The Committee appreciates
the Bureau's efforts to identify how these partnerships may fit
within Health Centers' scope of practice, recognizing the ways
in which home visiting programs can provide cost-effective
benefits such as care coordination and service referral that
help Health Centers achieve community health goals.
Native Hawaiian Health Care Program.--The Committee
provides $19,000,000 for the Native Hawaiian Health Care
Program, an increase of $1,500,000 above the fiscal year 2019
enacted level. The Native Hawaiian Healthcare Systems helps
improve the health status of Native Hawaiians by making health
education, health promotion, disease prevention, and Native
Hawaiian traditional healing services available.
Free Clinics Medical Malpractice
The Committee recommends $1,000,000 for carrying out
responsibilities under the Federal Tort Claims Act, the same as
fiscal year 2019 enacted level and the fiscal year 2020 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 2019....................... $1,096,695,000
Budget request, fiscal year 2020...................... 304,714,000
Committee Recommendation.............................. 1,244,942,000
Change from enacted level........................... +148,247,000
Change from budget request.......................... +940,228,000
Health Professional Staffing Shortages.--The Committee
recognizes the current and growing shortage of primary care
physicians, psychiatrists, behavioral health specialists, and
geriatric medical professionals. The Committee requests a
report within 120 days of enactment of this Act on ways HRSA
can support efforts to recruit, train, and support health
professionals in these fields, including existing workforce
training opportunities and recommendations to address health
professional staffing shortages.
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.
Shortage Designation Modernization Project.--The Committee
is concerned that HRSA is implementing the Shortage Designation
Management System without a thorough understanding of the
potential impact of the revised Health Professional Shortage
Area scores on States. The Committee requests a briefing from
HRSA within 60 days of enactment of this Act on the revised
methodology and implications for addressing health care
workforce shortages in States.
Trafficking Awareness for Health Professionals.--The
Committee encourages HRSA to identify best practices for
accredited schools of medicine or nursing to train students in
identifying and responding to human trafficking victims and to
respond appropriately to such individuals. Best practices
should be developed in consultation with law enforcement
personnel, social service providers, and other experts in the
field of human trafficking.
Health Professions
The Committee recommends $854,942,000 for the Health
Professions programs, which is $108,247,000 above the fiscal
year 2019 enacted level and $550,228,000 above the fiscal year
2020 budget request. The Health Professions programs support
grants for the development of the health workforce in fields
challenged by a high need and insufficient supply of health
professionals. Given that colleges and universities serve the
dual role of training students and carrying out a majority of
Federally-funded biomedical research, the Committee believes
that they serve as an ideal setting to expose future clinicians
to the evidence base that underlies their intended profession.
National Health Service Corps
The Committee includes $120,000,000 for the National Health
Service Corps (NHSC), $15,000,000 above the fiscal year 2019
enacted level and the fiscal year 2020 budget request. NHSC
supports qualified health care providers dedicated to working
in underserved communities in urban, rural, and tribal areas
through scholarships and loan repayment assistance.
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 requests a report within 120 days of
enactment of this Act 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.
National Health Service Corps Loan Repayment Program.--The
Committee encourages HRSA to conduct a review of the NHSC Loan
Repayment Program with a specific focus on the qualifications
for the program and whether those qualifications, including
designation as an HPSA, alone capture candidates that
effectively address the health care needs of the community.
Centers of Excellence
The Committee includes $25,000,000 for Centers of
Excellence (COE), $1,289,000 above the fiscal year 2019 enacted
level and $25,000,000 above the 2020 budget request. The
Committee commends the Bureau of Health Workforce (BHW) on the
continued implementation of COE and notes that partnerships
with HRSA have allowed minority health professions institutions
to address the need for diverse and culturally competent health
professionals that contribute to the healthcare needs of
underrepresented populations. The Committee asks that HRSA
report within 120 days of enactment of this Act on the
achievements and challenges of COE and the contribution COE
makes to workforce development.
Health Careers Opportunity Program
The Committee includes $20,000,000 for the Health Careers
Opportunity Program (HCOP), $5,811,000 above the fiscal year
2019 enacted level and $20,000,000 above the fiscal year 2020
budget request. The Committee notes that HCOPs have assisted
students from minority and economically disadvantaged
backgrounds to enter the health professions for decades by
focusing on student development, retention, matriculation, and
graduation. The Committee encourages BHW to continue its
improvement of the diversity and distribution of needed health
care professionals through National Health Career Opportunity
Program Academies (NHCOPA) and report back to Congress within
120 days of enactment of this Act on the progress of the NHCOPA
pipeline.
Faculty Loan Repayment
The Committee includes $1,190,000 for Faculty Loan
Repayment, the same as the fiscal year 2019 enacted level and
$1,190,000 above the fiscal year 2020 budget request.
Scholarships for Disadvantaged Students
The Committee includes $53,470,000 for Scholarships for
Disadvantaged Students, $4,500,000 above the fiscal year 2019
enacted level and $53,470,000 above the fiscal year 2020 budget
request. These scholarships provide financial stability to
disadvantaged and non-traditional students and are an important
resource to the influx of eligible students going into the
health professions. Within this program, the Committee directs
$2,500,000 to be set aside to educate midwives to address the
national shortage of maternity care providers, and specifically
the lack of adequate diversity in the maternity care workforce.
Primary Care Training and Enhancement
The Committee includes $48,924,000 for Primary Care
Training and Enhancement, the same as the fiscal year 2019
enacted level and $48,924,000 above the fiscal year 2020 budget
request.
Oral Health Training
The Committee recommends $40,673,000 for Oral Health
Training programs, the same as the fiscal year 2019 enacted
level and $40,673,000 above the fiscal year 2020 budget
request. These programs serve to increase the number of medical
graduates from minority and disadvantaged backgrounds and to
encourage students and residents to choose primary care fields
and practice in underserved urban and rural areas.
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 predoctoral and postdoctoral
training grants initially awarded in fiscal year 2015, and for
section 748 Dental Faculty Loan Program (DFLRP) grants
initially awarded in fiscal years 2016, 2017, 2018 and 2019.
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 affiliated sites.
Area Health Education Centers
The Committee provides $41,250,000 for the Area Health
Education Centers (AHEC) program, $2,000,000 above the fiscal
year 2019 enacted level and $41,250,000 above the fiscal year
2020 budget request. AHEC facilitates the diversity of the
healthcare workforce; increases access to healthcare; delivers
vital patient care; reduces health disparities; improves health
outcomes; and increases revenue by creating new jobs and
services. The AHEC programs and centers play a critical
national role in addressing health care workforce shortages,
particularly those in primary care through an established
infrastructure. The AHEC Program grantees support the
recruitment and retention of physicians, students, faculty and
other primary care providers in rural and medically underserved
areas by providing local, community-based, interdisciplinary
primary care training.
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.
Geriatrics Program
The Committee provides $43,384,000 for the Geriatrics
Workforce Enhancement Program (GWEP), $2,647,000 above the
fiscal year 2019 enacted level and $43,384,000 above the fiscal
year 2020 budget request. This program provides grants for
training across the provider continuum to integrate geriatrics
and primary care delivery systems.
Mental and Behavioral Health Education Training Programs
The Committee includes $36,916,000 for Mental and
Behavioral Health Education Training Programs (MBHET), the same
as the fiscal year 2019 enacted level and the fiscal year 2020
budget request. This program provides grants to institutions of
higher education and accredited training programs to recruit
and train professionals and faculty in areas of mental and
behavioral health.
Graduate Psychology Education.--Within the total for MBHET,
the Committee includes $18,000,000 for the inter-professional
Graduate Psychology Education (GPE) Program to increase the
number of health service psychologists trained to provide
integrated services to high-need, underserved populations in
rural and urban communities.
Behavioral Health Workforce Education and Training
The Committee includes $85,000,000 for the Behavioral
Health Workforce Education and Training Grant Program (BHWET),
$10,000,000 above the fiscal year 2019 enacted level and the
fiscal year 2020 budget request. This program establishes and
expands internships or field placement programs in behavioral
health serving populations in rural and medically underserved
areas.
Peer Support Specialists in the Opioid Use Disorder
Workforce.--Within the total for BHWET, the Committee includes
$39,800,000, an increase of $10,000,000 above the fiscal year
2019 enacted level, for community-based experiential training
for students preparing to become peer support specialists and
other types of behavioral health-related paraprofessionals.
This program provides training in the provision of opioid use
disorder (OUD) and other substance use disorder (SUD)
prevention, treatment, and recovery services in high-need and
high-demand areas. The program will expand and improve access
to quality treatment and foster an integrated approach to
address OUD and other SUD treatment emphasizing the role of the
family and lived experience of the consumer through academic,
community, and non-traditional community organization
partnerships.
Loan Repayment Program for Substance Use Disorder Treatment Workforce
The Committee includes $25,000,000 to establish the Loan
Repayment Program for Substance Use Disorder Treatment
Workforce, which was authorized under section 7071 of the
SUPPORT for Patients and Communities Act (P.L. 115-271). This
program will address shortages in the substance use disorder
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.
Mental and Substance Use Disorder Workforce Training Demonstration
The Committee includes $10,000,000 to establish the Mental
and Substance Use Disorder Workforce Training Demonstration,
which was authorized under section 9022 of the 21st Century
Cures Act (P.L. 114-255). The Committee recognizes that
treating the over 20 million Americans with a substance use
disorder (SUD) will require training that is too often lacking
in our nation's current addiction workforce. HRSA has projected
a workforce shortage of 250,000 providers in the SUD/mental
health field by 2025. This program will make 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 assistance, and others, to provide SUD
treatment in underserved communities.
Workforce Information and Analysis
The Committee includes $5,663,000 for Workforce Innovation
and Analysis, the same as the fiscal year 2019 enacted level
and $1,000,000 above the fiscal year 2020 budget request.
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 2019 enacted level and $19,000,000 above the
fiscal year 2020 budget request. Within this total, the
Committee provides an increase of $1,500,000 for the Preventive
Medicine Residency Training Program and an increase of $500,000
for Public Health Training Centers.
Advanced Education Nursing
The Committee includes $77,585,000 for the Advanced
Education Nursing Workforce Program, $3,004,000 above the
fiscal year 2019 enacted level and $77,585,000 above the fiscal
year 2020 budget request. This program provides traineeships
and curriculum and faculty development to improve advanced
nursing education and increase the number of qualified nurses
in the primary care workforce.
The Committee continues to provide $8,000,000 to award
grants for the clinical training of sexual assault nurse
examiners to administer medical forensic examinations and
treatments to victims of sexual assault in hospitals, health
centers, and other emergency healthcare service provider
settings.
Nurse Practitioner Optional Fellowship Program.--The
Committee includes an increase of $20,000,000 to make grants to
establish or expand optional community-based nurse practitioner
fellowship programs that are accredited or in the accreditation
process for practicing postgraduate nurse practitioners (NPs)
in primary care or behavioral health. The Committee directs
HRSA to give preference to Federally Qualified Health Centers
(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
The Committee includes $43,590,000 for the Nurse Education,
Practice, Quality and Retention (NEPQR) Program, $1,677,000
above the fiscal year 2019 enacted level and $43,590,000 above
the fiscal year 2020 budget request. The NEPQR program supports
academic, service, and continuing education projects to enhance
nursing education, improve the quality of patient care,
increase nurse retention, and strengthen the nursing workforce.
The program focuses on exposing students to enhanced curriculum
and meaningful clinical experience and training in medically
underserved areas, so that they will be more likely to choose
to work in these settings after graduation.
Nursing Workforce Diversity
The Committee includes $18,037,000 for the Nursing
Workforce Diversity (NWD) program, $694,000 above the fiscal
year 2019 enacted level and $18,037,000 above the fiscal year
2020 budget request. The NWD program supports stipends,
scholarships, and a variety of pre-entry preparation, advanced
entry preparation, and retention activities for students from
disadvantaged backgrounds.
NURSE Corps Scholarship and Loan Repayment
The Committee includes $90,620,000 for NURSE Corps,
$3,485,000 above the fiscal year 2019 enacted level and
$7,485,000 above the fiscal year 2020 budget request.
Nursing Faculty Loan Program
The Committee includes $29,640,000 for the Nursing Faculty
Loan Program, $1,140,000 above the fiscal year 2019 enacted
level and $29,640,000 above the fiscal year 2020 budget
request. This program makes grants to schools of nursing who in
turn provide student loans to graduate-level nursing students
to increase the number of qualified nurse faculty.
Children's Hospitals Graduate Medical Education
The Committee recommends $350,000,000 for the Children's
Hospitals Graduate Medical Education (CHGME) Payment program,
$25,000,000 above the fiscal year 2019 enacted level and
$350,000,000 above the fiscal year 2020 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 includes $40,000,000 to expand support to
colleges of medicine at public universities located in the top
quintile of States projected to have a primary care provider
shortage. This is $15,000,000 above the fiscal year 2019
enacted level and $40,000,000 above the fiscal year 2020 budget
request. The Committee directs HRSA to maintain existing
eligibility criteria for the second year of grants for this
program.
National Practitioner Data Bank
The Committee assumes $18,814,000 for the National
Practitioner Data Bank, which is the same as the fiscal year
2010 enacted level and the fiscal year 2020 budget request.
MATERNAL AND CHILD HEALTH
Appropriation, fiscal year 2019....................... $926,789,000
Budget request, fiscal year 2020...................... 783,200,000
Committee Recommendation.............................. 972,751,000
Change from enacted level........................... +45,962,000
Change from budget request.......................... +189,551,000
Maternal and Child Health Block Grant
The Committee recommends $705,000,000 for the Maternal and
Child Health Block Grant, $27,300,000 above the fiscal year
2019 enacted level and $44,300,000 above the fiscal year 2020
budget request. States use the block grant to improve access to
care for mothers, children, and their families; reduce infant
mortality; provide pre-and post-natal care; support screening
and health assessments for children; and provide systems of
care for children with special health care needs.
Special Projects of Regional and National Significance
The Committee continues bill language identifying a
specific funding level for Special Projects of Regional and
National Significance (SPRANS). The Committee provides the
following within SPRANS:
------------------------------------------------------------------------
FY 2020
Budget Activity Committee
------------------------------------------------------------------------
Set-aside for Oral Health............................ $5,250,000
Set-aside for Epilepsy............................... 3,642,000
Set-aside for Sickle Cell Disease.................... 3,000,000
Set-aside for Fetal Alcohol Syndrome................. 477,000
------------------------------------------------------------------------
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 encourages the Maternal
and Child Health Bureau (MCHB) to develop protocols to train
professionals to screen, diagnose, and provide evidence-based
interventions to individuals suffering from adverse childhood
experiences 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.
Alliance for Maternal Health Safety Bundles.--The Committee
includes $5,000,000, an increase of $2,000,000 above the fiscal
year 2019 enacted level, 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,
and U.S. territories, as well as 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.
Breastfeeding Services and Supplies.--The Committee
recognizes that exclusivity and duration of breastfeeding
confers meaningful clinical benefits for babies and mothers and
saves health care costs. The Committee remains committed to
improving breastfeeding rates across the country and
understands that there may be risk factors during pregnancy and
delivery that can impact a mother's ability to meet her own
breastfeeding duration goals. The Committee urges HRSA, during
the next review of the Women's Preventive Services Guidelines
for breastfeeding services and supplies, to incorporate into
the clinical and implementation considerations section of the
guideline: evidence of the critical timeframe for breastfeeding
initiation following delivery; and recommendations for
assessing risk factors, initiating milk production and ensuring
that women are able to build supply and sustain breastfeeding
in the early post-partum period (as well as during the
antenatal, perinatal, and the postpartum period) in both pre-
term and term infants.
Children's Health and Development.--The Committee continues
to provide $3,500,000 to continue efforts to promote systemic
change that would positively impact the policy of child-health-
related institutions and systems in States with high levels of
childhood poverty.
Hemophilia Treatment Centers.--The Committee provides level
funding for Hemophilia Treatment Centers. The Regional
Hemophilia Network Program uses a regional infrastructure of
hemophilia treatment centers to promote and improve the
comprehensive care of individuals with hemophilia and related
bleeding disorders or clotting disorders.
Infant-Toddler Court Teams.--The Committee includes
$10,000,000 for the third 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 expects this
increase of $7,000,000 above the fiscal year 2019 enacted level
to: (1) build upon the work of sites established through the
Quality Improvement Center for Research-based Infant Toddler
Court Teams, including by providing training and technical
assistance in support of such court teams' efforts across the
country, and (2) support additional outreach sites to start a
court team.
Maternal Mortality Disparities.--The Committee is concerned
about the finding from the Centers for Disease Control and
Prevention (CDC) that black women experience maternal mortality
at nearly four times the rate of white women. Black maternal
mortality rates in the U.S. are similar to rates in developing
countries at 40 deaths per 100,000. 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. The Committee
encourages HRSA to work with States to collect comprehensive
data associated with all pregnancy-associated and pregnancy-
related deaths, regardless of the outcome of the pregnancy.
Pediatric Hospice Care.--The Committee understands the
unique conditions surrounding pediatric hospice care and grief
support for families including the need to support family
members, the recognition that child death can have more intense
and longer grieving periods, and the need for development of
best practices for counseling, support, medication, and other
factors impacting the end of life experience for children. The
Committee provides $1,000,000 within SPRANS to work with
experienced hospice providers which are not conflicted by
decisions of whether to provide hospice or curative treatments
in the hospital to children nearing the end of life to
establish a pilot program aimed at developing best practices.
Set-aside for Oral Health.--The Committee includes $250,000
to continue demonstration projects to increase the
implementation of integrating oral health and primary care
practice. The projects should model the core clinical oral
health competencies for non-dental providers that HRSA
published and initially tested in its 2014 report, Integration
of Oral Health and Primary Care Practice. The Committee expects
the Chief Dental Officer to continue to direct the design,
monitoring, oversight, and implementation of these projects.
Maternal and Child Health Programs
In addition to the Maternal and Child Health Block Grant,
the MCHB supports several programs to improve the health of all
mothers, children, and their families. These programs support
activities that develop systemic mechanisms for the prevention
and treatment of sickle cell disease; provide information and
research on and promote screening of autism and other
developmental disorders; provide newborn and child screening of
heritable disorders; provide grants to reduce infant mortality
and improve perinatal outcomes; fund States to conduct newborn
hearing screening; and provide grants to improve existing
emergency medical services.
Within the total for Maternal and Child Health Programs,
the Committee recommends the following amounts:
------------------------------------------------------------------------
FY 2020
Budget Activity Committee
------------------------------------------------------------------------
Sickle Cell Anemia Program........................... $7,000,000
Autism and Other Developmental Disorders............. 53,099,000
Heritable Disorders.................................. 22,000,000
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
------------------------------------------------------------------------
Sickle Cell Anemia Demonstration Program
The Committee provides $7,000,000 for the Sickle Cell
Anemia Demonstration Program, $2,545,000 more than the fiscal
year 2019 enacted level and $7,000,000 more than the fiscal
year 2020 budget request.
Autism and Other Developmental Disorders
The Committee recommends $53,099,000 for Autism and Other
Developmental Disorders, $2,500,000 above the fiscal year 2019
enacted level and $53,099,000 above the fiscal year 2020 budget
request. These programs seek to improve the health and well-
being of children and adolescents with autism spectrum disorder
and other developmental disabilities and to advance best
practices for the early identification and treatment of autism
and related developmental disabilities.
Leadership Education in Neurodevelopmental and Related
Disabilities.--The Committee provides not less than $35,245,000
for the Leadership Education in Neurodevelopmental and Related
Disabilities (LEND) program, an increase of $1,745,000 above
the fiscal year 2019 enacted level. This funding will support
the program's capacity to train professionals to screen,
diagnose, and provide evidence-based interventions to
individuals with autism spectrum disorder and other
developmental disabilities as authorized by the Autism CARES
Act (P.L. 113-157). This program provides advanced training to
students and fellows from at least 12 disciplines in the
identification, assessment, and treatment of children and youth
with a wide range of developmental disabilities, including
autism.
Heritable Disorders
The Committee provides $22,000,000 for the Heritable
Disorders program, which is $5,617,000 above the fiscal year
2019 enacted level and $22,000,000 above the fiscal year 2020
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.--Within the total amount
for Heritable Disorders, the Committee provides $3,000,000, an
increase of $1,000,000 above the fiscal year 2019 enacted
level, for the third year of a grant to continue supporting
wider implementation, education, and awareness of newborn
screening for Severe Combined Immune Deficiency.
Healthy Start
The Committee recommends $130,500,000 for the Healthy Start
program, $8,000,000 above the fiscal year 2019 enacted level
and the fiscal year 2020 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 includes $15,000,000, an increase of
$3,000,000 above the fiscal year 2019 enacted level, 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 2019....................... $2,318,781,000
Budget request, fiscal year 2020...................... 2,388,781,000
Committee Recommendation.............................. 2,435,157,000
Change from enacted level........................... +116,376,000
Change from budget request.......................... +46,376,000
The Ryan White Human Immunodeficiency Virus/Acquired
Immunodeficiency Syndrome (HIV/AIDS) program funds activities
to address the care and treatment of persons living with HIV/
AIDS who are either uninsured or underinsured and need
assistance to obtain treatment. The program provides grants to
States and eligible metropolitan areas to improve the quality,
availability, and coordination of health care and support
services to include access to HIV-related medications; grants
to service providers for early intervention outpatient
services; grants to organizations to provide care to HIV
infected women, infants, children, and youth; and grants to
organizations to support the education and training of health
care providers.
Within the total for the Ryan White HIV/AIDS program, the
Committee provides the following amounts:
------------------------------------------------------------------------
Budget Activity FY 2020 Committee
------------------------------------------------------------------------
Emergency Assistance................................. $677,535,000
Comprehensive Care Programs.......................... 1,331,665,000
AIDS Drug Assistance Program..................... 912,017,000
Early Intervention Program........................... 207,567,000
Children, Youth, Women, and Families................. 76,047,000
AIDS Dental Services................................. 13,296,000
Education and Training Centers....................... 34,047,000
Special Projects of National Significance............ 25,000,000
Domestic HIV Initiative.............................. 70,000,000
------------------------------------------------------------------------
Domestic HIV Initiative.--The Committee includes
$70,000,000 within the Ryan White HIV/AIDS Program for the
first year of an initiative to reduce the transmission of HIV
by 90 percent over the next ten years. Funds will be
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.
Minority AIDS Initiative.--The Committee includes
$175,000,000 within the Ryan White program for the Minority
AIDS Initiative, an increase of $5,923,000 above the fiscal
year 2019 enacted level and the fiscal year 2020 budget
request.
HEALTH CARE SYSTEMS
Appropriation, fiscal year 2019....................... $115,193,000
Budget request, fiscal year 2020...................... 111,018,000
Committee Recommendation.............................. 123,693,000
Change from enacted level........................... +8,500,000
Change from budget request.......................... +12,675,000
These programs support national activities that enhance
health care delivery in the U.S. Activities include maintaining
a national system to allocate and distribute donor organs to
individuals awaiting transplant; building an inventory of cord
blood units; maintaining a national system for the recruitment
of bone marrow donors; operating the 340B drug discount
program; and operating a national toll-free poison control
hotline.
Within the total for Health Care Systems, the Committee
provides the following amounts:
------------------------------------------------------------------------
Budget Activity FY 2020 Committee
------------------------------------------------------------------------
Organ Transplantation................................ $32,049,000
National Cord Blood Inventory........................ 16,266,000
C.W. Bill Young Cell Transplantation Program......... 24,609,000
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 $32,049,000 for the Organ
Transplantation program, which is $6,500,000 above the fiscal
year 2019 enacted level and $4,500,000 above the fiscal year
2020 budget request.
Liver Transplantation Policy.--The Committee supports the
new liver allocation policy that was recently passed by the
Organ Procurement and Transplantation Network (OPTN) Board of
Directors. The policy, called the ``Acuity Model'', reduces
inequities by ensuring that transplants are prioritized by the
medical need of patients wherever they may live (rural or
urban), whatever their socioeconomic status, and regardless of
the organ procurement infrastructure in their area.
National Living Donor Assistance Center Program.--The
Committee includes $10,000,000 for the National Living Donor
Assistance Center (NLDAC), an increase of $6,500,000 above the
fiscal year 2019 enacted level. The NLDAC currently supports
donation and expands access to transplantation through
reimbursement of organ donor travel expenses. The Committee
strongly supports HRSA's three-year demonstration project to
assess the impact of reimbursement of lost wages on
individuals' willingness to become living organ donors. The
Committee urges HRSA to consider the expansion of NLDAC to
reimburse a comprehensive range of living donor expenses for
the greatest possible number of donors, including lost wages,
childcare, eldercare, and similar expenses for donor caretakers
and expansion of income eligibility for the program to allow as
many donors as possible to qualify.
National Cord Blood Inventory
The Committee recommends $16,266,000 for the National Cord
Blood Inventory (NCBI), the same as the fiscal year 2019
enacted level and $4,000,000 above the fiscal year 2020 budget
request. The NCBI program builds a genetically and ethnically
diverse inventory of high-quality umbilical cord blood for
transplantation.
C.W. Bill Young Cell Transplantation Program
The Committee recommends $24,609,000 for the C.W. Bill
Young Cell Transplantation program, the same as the fiscal year
2019 enacted level and the fiscal year 2020 budget request.
This program provides support to patients who need a bone
marrow or umbilical cord blood transplant, which may be
necessary for some patients who have leukemia, lymphoma, sickle
cell anemia, or other inherited metabolic or immune system
disorders. The Committee appreciates HRSA's efforts to increase
the diversity of the volunteer registry and encourages HRSA to
expand efforts to improve the availability, efficiency, and
safety of transplants and improve outcomes for all transplant
recipients regardless of socioeconomic status, age, ethnic
ancestry, or any other individually defining characteristic.
Regenerative Cell Therapy Pilot Registry.--The Committee
looks forward to reviewing the state of the science report
required by P.L. 114-104 on using adult stem cells and birthing
tissues to develop new types of therapies for patients, for the
purpose of considering the potential inclusion of such new
types of therapies in the C.W. Bill Young Cell Transplantation
Program.
Office of Pharmacy Affairs
The Committee provides $10,238,000 for the Office of
Pharmacy Affairs, which is the same as the fiscal year 2019
enacted level and the fiscal year 2020 budget request. The
Office of Pharmacy Affairs oversees the 340B Drug Pricing
Program, which requires drug manufacturers to provide discounts
on outpatient prescription drugs to certain safety net health
care providers.
Poison Control Centers
The Committee recommends $24,846,000 for Poison Control
Centers, which is $2,000,000 above the fiscal year 2019 enacted
level and the fiscal year 2020 budget request. This program
funds poison centers, supports a national toll-free number
(800-222-1222), and implements a nationwide media campaign to
educate the public and health care providers about poison
prevention and poison center services.
Hansen's Disease Program
The Committee recommends $15,685,000 for the Hansen's
Disease Program, Hansen's Disease buildings and facilities, and
payment to Hawaii for treatment, which is the same as the
fiscal year 2019 enacted level and $2,175,000 above the fiscal
year 2020 budget request. The Hansen's Disease Program provides
medical care, education, and research for Hansen's disease
(leprosy) and related conditions.
RURAL HEALTH
Appropriation, fiscal year 2019....................... $317,794,000
Budget request, fiscal year 2020...................... 188,645,000
Committee Recommendation.............................. 317,794,000
Change from enacted level........................... - - -
Change from budget request.......................... +129,149,000
Rural Health programs provide funding to improve access,
quality, and coordination of care in rural communities; for
research on rural health issues; for technical assistance and
recruitment of health care providers; for screening activities
for individuals affected by the mining, transport, and
processing of uranium; for the outreach and treatment of coal
miners and others with occupation-related respiratory and
pulmonary impairments; and for the expansion of telehealth
services.
Attracting Health Care Providers to Rural Communities.--
Rural healthcare providers ensure that essential health care
services are made available to people living in rural and
underserved communities, many of whom are seniors. However, the
rural hospital closure crisis is leaving millions of patients
without access to healthcare providers. Since 2010, nearly 104
rural hospitals have closed and one-in-three rural hospitals is
financially vulnerable. The Committee requests an update in the
fiscal year 2021 Congressional Justification on the best
practices and strategies to attract healthcare practitioners to
rural clinics and hospitals in areas with healthcare
professional shortages.
Coordinating with USDA.--The Committee notes the passage of
the Agriculture Improvement Act and increased use of United
States Department of Agriculture (USDA) programs to help better
deliver health care services and improve health outcomes in
rural America. The Committee further notes the Agriculture
Improvement Act creates a new Rural Health Liaison position
which is directed to consult with HHS in coordinating
activities at the USDA that could impact health in rural
America. The Committee encourages HRSA, namely the Federal
Office of Rural Health Policy, to coordinate with USDA and,
when established, the Rural Health Liaison to ensure
communities have access to the full suite of federal resources
and those resources are used effectively to improve health
outcomes.
Rural Health Outreach Programs
The Committee includes $84,609,000 for Rural Health Care
Services Outreach, Network, and Quality Improvement Grants,
which is $7,109,000 above the fiscal year 2019 enacted level
and $43,798,000 above the 2020 budget request. These programs
fund activities that improve access to and coordination of care
in rural communities, with a focus on building sustainable
health programs that continue beyond Federal funding. Outreach
programs focus on supporting rural community needs related to
issues such as behavioral health, oral health, care
coordination, quality improvement, workforce training, chronic
disease management and enhancing the rural health care delivery
system of rural hospitals, clinics and other safety net
providers.
Telementoring Training Center.--The Committee includes
$3,000,000 within the total for Rural Health Outreach Programs
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. To
ensure access to quality healthcare for underserved
populations, there is a need for cost-effective, long-term
professional education and support of primary care providers in
rural and underserved areas, especially for treatment of
complex conditions such as diabetes, addiction (particularly
concerning the opioid epidemic), hypertension, obesity, and
HIV/AIDS, among others. The Committee directs HRSA to give
preference to models of professional education and support that
are adaptable to culturally and regionally diverse populations.
Rural Health Research and Policy Development
The Committee includes $9,351,000 for Rural Health
Research, the same as the fiscal year 2019 enacted level and
$4,351,000 above the fiscal year 2020 budget request.
Rural Hospital Flexibility Grants
The Committee includes $59,000,000 for the Rural Hospital
Flexibility Grants program and the Small Rural Hospital
Improvement program, which is $5,391,000 above the fiscal year
2019 enacted level and $59,000,000 above the fiscal year 2020
budget request.
State Offices of Rural Health
The Committee includes $12,500,000 for State Offices of
Rural Health, $2,500,000 above the fiscal year 2019 enacted
level and $12,500,000 above the fiscal year 2020 budget
request.
Black Lung Clinics
The Committee includes $12,000,000 for Black Lung Clinics,
$1,000,000 above the fiscal year 2019 enacted level and the
fiscal year 2020 budget request.
Telehealth
The Committee includes $28,500,000 for Telehealth, an
increase of $4,000,000 above the fiscal year 2019 enacted level
and $18,500,000 above the fiscal year 2020 budget request.
Within the funds provided for Telehealth, the Committee
provides $6,000,000 for Telehealth Centers for Excellence, an
increase of $2,000,000 above the fiscal year 2019 enacted
level. These Centers identify best practices, serve as national
training resources, and test the efficacy of different
telehealth clinical applications. 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. 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 help to
address the access to care issue faced by rural America.
In addition, the Committee provides $2,000,000 to support a
comprehensive evaluation of telehealth investments to date on
rural areas and populations, to include an assessment of
access, cost, experience, and effectiveness for patients and
providers. The Committee directs HRSA to conduct additional
evaluations in conjunction with an academic medical center not
previously funded through the Telehealth Centers of Excellence
program that has experience providing telemedicine services
across the care continuum in medically underserved areas in
both rural and urban settings.
Telehealth Solutions and Virtual Models of Care.--The
Committee believes that innovative, scalable, and patient-
centric solutions are necessary to address the opioid crisis.
The Committee urges HRSA to consider telehealth solutions and
virtual models of care, specifically those models that allow
for increased access to care professionals while decreasing
geographic barriers and cost of care such as remote patient
monitoring models. The Committee encourages the Secretary to
consider pilot programs on a variety of telehealth solutions
with the goal of finding an effective, scalable solution to
treating substance use disorder in rural communities where
access to care is limited.
Rural Communities Opioid Response
The agreement provides $100,000,000 for the Rural
Communities Opioid Response program. This amount fully funds
continuing activities--the reduction in comparison to fiscal
year 2019 reflects one-time investments in fiscal year 2019
that do not need to be repeated in fiscal year 2020.
Rural Health Residency Program
The Committee includes $10,000,000 for Rural Health
Residency Program, the same as the fiscal year 2019 enacted
level and $10,000,000 above the fiscal year 2020 budget
request.
FAMILY PLANNING
Appropriation, fiscal year 2019....................... $286,479,000
Budget request, fiscal year 2020...................... 286,479,000
Committee Recommendation.............................. 400,000,000
Change from enacted level........................... +113,521,000
Change from budget request.......................... +113,521,000
The Committee includes $400,000,000 for the Family Planning
program, which is $113,521,000 above the fiscal year 2019
enacted level and the 2020 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. 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 2019....................... $155,250,000
Budget request, fiscal year 2020...................... 151,993,000
Committee Recommendation.............................. 155,250,000
Change from enacted level........................... - - -
Change from budget request.......................... +3,257,000
Program management supports the cost of Federal staff and
related activities to coordinate, direct, and manage the
programs of HRSA.
Chief Dental Officer.--The Committee is pleased that HRSA
has restored the position of Chief Dental Officer (CDO) and
looks forward to learning how the agency has ensured that the
CDO is functioning at an executive level authority with
resources to oversee and lead HRSA oral health programs and
initiatives. The Committee requests an update in the fiscal
year 2021 Congressional Budget Justification request on how the
CDO is serving as the agency representative on oral health
issues to international, national, State or local government
agencies, universities, and oral health stakeholder
organizations.
Chronic Obstructive Pulmonary Disease.--The Committee
commends HRSA for its partnership with the National Heart,
Lung, and Blood Institute on educating providers and patients,
including in rural and low-income communities, on COPD
awareness, detection and management best practices. The
agency's efforts in this area are a model for effective
collaboration across Federal agencies.
Oral Health Literacy.--The Committee includes $500,000 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 expects the
Chief Dental Officer to play a key role in the design,
monitoring, oversight, and implementation of this project.
HRSA Strategy to Address Intimate Partner Violence 2017-
2020 and Project Catalyst.--The Committee recommends continued
support for the HRSA Strategy to Address Intimate Partner
Violence 2017-2020, and specifically supports training,
technical assistance and resource development to assist public
health and health care professionals in better serving
individuals and communities impacted by intimate partner
violence.
Targeted Investments in Persisten 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 2017, 2018 and 2019 and
estimates for fiscal year 2020 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, and high-poverty areas, as defined as any census
tract with a poverty rate of at least 20 percent as measured by
the 2013-2017 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 after enactment of this Act
on how the Department is carrying out this directive.
VACCINE INJURY COMPENSATION PROGRAM TRUST FUND
Appropriation, fiscal year 2019....................... $317,200,000
Budget request, fiscal year 2020...................... 319,200,000
Committee Recommendation.............................. 319,200,000
Change from enacted level........................... +2,000,000
Change from budget request.......................... - - -
The National Vaccine Injury Compensation Program provides a
system of compensation for individuals with vaccine-associated
injuries or deaths. Funds for claims from vaccines administered
on or after October 1, 1988 are generated by a per-dose excise
tax on the sale of selected prescribed vaccines. The Vaccine
Injury Compensation Trust Fund receives revenues raised by this
tax. Trust funds made available will support the liability
costs of vaccines administered after September 30, 1988.
The Committee recommends $11,200,000 for administration of
the program, which is $2,000,000 above the fiscal year 2019
enacted level and the same as the fiscal year 2020 budget
request. This increase will enable HRSA to hire additional
contractors to conduct initial medical reviews and full-time
medical officers to review the contractors' work. The
additional funding will also allow HRSA to process additional
claims and reduce the backlog of claims.
Centers for Disease Control and Prevention
Appropriation, fiscal year 2019....................... $7,337,741,000
Budget request, fiscal year 2020...................... 6,587,190,000
Committee Recommendation.............................. 8,275,363,000
Change from enacted level........................... +937,622,000
Change from budget request.......................... +1,688,173,000
The Committee recommendation for the Centers for Disease
Control and Prevention (CDC) program level includes
$7,140,755,000 in discretionary budget authority, $55,358,000
in mandatory funds under the terms of the Energy Employees
Occupational Illness Compensation Program Act, $854,250,000 in
transfers from the Prevention and Public Health (PPH) Fund, and
$225,000,000 in transfers from the Nonrecurring Expenses Fund.
CDC's mission is to protect Americans from health, safety,
and security threats, which it accomplishes by supporting core
public health functions at State, local, and Tribal health
departments, detecting and responding to new and emerging
health threats, promoting health and safety, and providing
leadership in the public health workforce.
IMMUNIZATION AND RESPIRATORY DISEASES
Appropriation, fiscal year 2019....................... $798,405,000
Budget request, fiscal year 2020...................... 730,231,000
Committee Recommendation.............................. 847,558,000
Change from enacted level........................... +49,153,000
Change from budget request.......................... +117,327,000
The Committee recommendation includes $499,758,000 in
discretionary budget authority and $347,800,000 in transfers
from the PPH Fund.
Immunization grants are awarded to State and local public
health departments for planning, developing, and conducting
childhood, adolescent, and adult immunization programs,
including enhancement of the vaccine delivery infrastructure.
CDC directly maintains a stockpile of vaccines, supports
consolidated purchase of vaccines for State and local health
agencies, and conducts surveillance, investigations, and
research into the safety and efficacy of new and presently-used
vaccines.
Within the total for Immunization and Respiratory Diseases,
the Committee recommends the following amounts:
------------------------------------------------------------------------
FY 2020
Budget Activity Committee
------------------------------------------------------------------------
Section 317 Immunization Program..................... $650,000,000
National Immunization Survey..................... 12,864,000
Acute Flaccid Myelitis........................... 10,000,000
Influenza Planning and Response...................... 197,558,000
------------------------------------------------------------------------
Acute Flaccid Myelitis.--The Committee includes $10,000,000
to support CDC's efforts to identify the cause, prevention, and
treatment of acute flaccid myelitis. Since 2014, this rare but
serious condition that affects the nervous system was confirmed
in 579 cases in at least 41 States, with a median age of four
years old.
Cost Estimates.--The Committee looks forward to reviewing
the fiscal year 2021 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, 2020. 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 2021
report should include specific information on the estimated
cost to fully address evidence-based public health strategies
that could be funded through the CDC to improve coverage for
human papillomavirus and influenza. The Committee also notes
that this long-standing report failed to meet the expected
deadline by many months and sometimes has been late by over a
year. In order to assess the needs of this critical program
concurrent with the appropriations cycle, the Committee expects
the report to be submitted on time.
Immunization Rates.--The measles outbreaks in multiple
States highlight the importance of immunizations, which are the
most effective way to protect the public from highly infectious
and potentially deadly 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 Vaccine.--The Committee includes an increase of
$10,000,000 to improve the effectiveness of and reduce barriers
to seasonal influenza vaccination. Furthermore, the Committee
encourages CDC to consider including vaccines produced through
recombinant DNA technology in addition to traditionally-
produced vaccines in future solicitations to facilitate the
competitive process for all vaccine manufacturers.
Section 317 Immunization Program.--The Committee views the
317 Immunization Program, including the Vaccines for Children
Program, as a pivotal part of the U.S. public health
infrastructure. The Committee includes an increase of
$39,153,000 for the enhancement of this infrastructure, as it
is critical to ensure high vaccination coverage levels,
prevention of vaccine-preventable diseases, and rapid response
to outbreaks.
HIV/AIDS, VIRAL HEPATITIS, SEXUALLY TRANSMITTED DISEASES, AND
TUBERCULOSIS PREVENTION
Appropriation, fiscal year 2019....................... $1,132,278,000
Budget request, fiscal year 2020...................... 1,318,056,000
Committee Recommendation.............................. 1,335,197,000
Change from enacted level........................... +202,919,000
Change from budget request.......................... +17,141,000
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 2020
Budget Activity Committee
------------------------------------------------------------------------
Domestic HIV/AIDS Prevention and Research............ $945,631,000
School Health-HIV................................ 50,000,000
Viral Hepatitis...................................... 50,000,000
Sexually Transmitted Diseases........................ 167,310,000
Tuberculosis......................................... 152,256,000
Infectious Diseases & the Opioid Epidemic............ 20,000,000
------------------------------------------------------------------------
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 planning councils
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 2021 Congressional Budget
Justification.
Congenital Syphilis.--The Committee is concerned regarding
the recent data showing that congenital syphilis (CS) cases are
at the highest level since 1997. The Committee urges CDC to
design an initiative that will, among other approaches,
strengthen prenatal outreach programs in high burden States,
for patients, including those with a drug addiction, who are at
a high risk for contracting syphilis. The Committee further
urges CDC to increase awareness of CS through community
organizations and to inform 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 emphgasis 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 Initiative.--The Committee includes an increase of
$140,000,000 to support the goal of reducing new HIV infections
by 90 percent in the next ten years. 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. Innovative data management solutions will
be developed and deployed, and access to pre-exposure
prophylaxis increased, along with better detection and response
to HIV clusters.
Infectious Diseases and the Opioid Epidemic.--The Committee
includes an increase of $15,000,000 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.
Latent Tuberculosis.--CDC estimates that there are up to 13
million individuals in the U.S. with latent TB infection. The
preventive treatment of individuals with latent TB infection
will prevent future active TB cases and reduce future
healthcare costs. The Committee requests a report on progress
towards TB elimination in the U.S., including identification
and preventive treatment of TB infection cases, in the fiscal
year 2021 Congressional Budget Justification.
Pre-Exposure Prophylaxis.--The Committee recognizes that
the advancement of Pre-Exposure Prophylaxis (PrEP) is one of
the most effective methods for preventing the spread of HIV,
yet there continues to be barriers to access to PrEP. The
Committee also requests that CDC and HRSA work to engage with,
and support infrastructure for the implementation of PrEP in a
diversity of service sites, including community health centers,
Title X and STD clinics.
School Health.--The Committee includes an increase of
$16,919,000 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 $10,000,000 for sexually transmitted infections
(STI) prevention and control. The Committee is concerned that
STI rates across the U.S. are at a 20-year high. Furthermore,
the Committee recognizes that sexually transmitted diseases are
associated with increased risk of HIV acquisition. The
Committee urges CDC to include, as part of the focused HIV
initiative, an expansion of STI programs and initiatives
designed to increase HIV testing; Pre-Exposure Prophylaxis and
condom availability at STD clinics; increase in the number of
Disease Intervention Specialists to prevent the spread of STIs
and HIV; and implementation of HIV and STI education and
prevention programs in schools.
Tuberculosis.--The Committee includes an increase of
$10,000,000 to combat tuberculosis through research for new
tools, and support of prevention and treatment.
Viral Hepatitis.--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 urges CDC to incorporate
viral hepatitis prevention, testing, and linkage to care and
treatment into its response to the HIV epidemic.
Viral Hepatitis Vaccine.--The Committee is concerned that
despite the availability of 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. Therefore, the Committee urges
the CDC to partner with State, local and tribal health
departments, along with leading national hepatitis B
organizations to develop a plan that takes into account best
practices and model strategies to increase HBV immunization
coverage among adults. The Committee requests a report within
90 days of enactment of this Act of CDC's plan to increase the
rate of HBV adult vaccination to the levels necessary to
eliminate new infections of hepatitis B in the U.S. and to
improve collaboration and coordination across CDC to achieve
this plan.
EMERGING AND ZOONOTIC INFECTIOUS DISEASES
Appropriation, fiscal year 2019....................... $620,372,000
Budget request, fiscal year 2020...................... 509,472,000
Committee Recommendation.............................. 644,622,000
Change from enacted level........................... +24,250,000
Change from budget request.......................... +135,150,000
The Committee recommendation includes $592,622,000 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 2020
Budget Activity Committee
------------------------------------------------------------------------
Core Infectious Diseases............................. $438,800,000
Emerging Infectious Diseases..................... 188,797,000
Lab Safety and Quality........................... 8,000,000
Antibiotic Resistance Initiative................. 173,000,000
Vector-borne Diseases............................ 43,603,000
Lyme Disease..................................... 13,000,000
Prion Disease.................................... 7,000,000
Chronic Fatigue Syndrome......................... 5,400,000
Food Safety.......................................... 66,000,000
National Health Care Safety Network.................. 22,750,000
Quarantine........................................... 31,572,000
Advanced Molecular Detection......................... 32,500,000
Epidemiology and Laboratory Capacity................. 40,000,000
Healthcare-Associated Infections..................... 12,000,000
Harmful Algal Blooms................................. 1,000,000
------------------------------------------------------------------------
Advanced Molecular Detection.--The Committee includes an
increase of $2,500,000 to support the dissemination of
technologies to State and local health departments to advance
the nation's public health system.
Antibiotic Resistance.--The Committee includes an increase
of $5,000,000 and recognizes the importance of 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.
Furthermore, the Committee is pleased with CDC's Antimicrobial
Resistance (AMR) Challenge and its implementation of a ``One
Health'' approach to encourage governments, private industries,
and non-governmental organizations across the world to combat
AMR. The Committee encourages CDC to build on findings and
experiences from the AMR Challenge as it winds down the effort
later this year.
Harmful Algal Blooms.--The Committee includes $1,000,000 to
support the work that CDC is doing to conduct surveillance for
and report health concerns related to harmful algal blooms and
urges CDC to continue this work with a focus on fresh water and
other affected waters: (1) to provide more outreach to numerous
State and local public health officials to use these
surveillance and reporting systems; (2) to work with other
agencies, in addition to the U.S. Army Corp of Engineers,
including the Environmental Protection Agency, National
Institute of Environmental Health Sciences, National Oceanic
and Atmospheric Administration, and United States Geological
Survey, to integrate disparate sets of data to allow for a
broader understanding of the spatial and temporal dynamics of
the environmental and health impacts of harmful algal blooms
(HABs); and (3) to continue to work together on efforts that
support HAB surveillance, emergency response, and mitigation of
public health impacts. The Committee encourages CDC to expand
the scope of this work to include focus on impacted populations
where citizens rely on potentially impacted waters for their
drinking water, fishing and recreation, including the Great
Lakes. There is an important nexus between freshwater and
drinking water, 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
$6,000,000 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
$1,000,000 to intensify CDC's efforts to develop improved
diagnostics, and bolster critical prevention and surveillance
networks.
Mycotic Diseases.--The Committee includes an increase of
$2,000,000 in Emerging Infectious Diseases to enhance efforts
to prevent illness and death from fungal diseases.
National Healthcare Safety Network.--The Committee includes
an increase of $1,750,000 for the National Healthcare Safety
Network. The Committee encourages CDC to work with the Centers
for Medicare & Medicaid Services (CMS) and the Office of the
National Coordinator for Health Information Technology (ONC) to
identify and deploy existing policy authorities and resources
that may be used to increase the number of hospitals and other
health care facilities (including long-term care facilities)
that report antibiotic use and resistance data to the National
Healthcare Safety Network with the aim of meeting the goal set
forth in the National Action Plan for Combating Antibiotic
Resistance Bacteria for 95 percent of hospitals to report these
data by 2020. Within one year, CDC, CMS and ONC should report
to Congress on the new strategies implemented to increase
reporting, current number of hospitals and other health care
facilities reporting, and any additional authorities or
resources needed to meet the National Action Plan goal.
Prion Disease.--The Committee provides an increase of
$1,000,000 for prion disease. The Committee supports the work
of the National Prion Disease Pathology Surveillance Center to
develop a real-time field test for the presence of chronic
wasting disease (CWD). The CWD-related workload 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 and families.
Vector-Borne Diseases.--The Committee includes an increase
of $5,000,000 and recognizes the critical role of CDC to
continue to address new and existing vector-borne disease
threats, such as the Zika virus; advance innovation and
discovery; and provide support to States and Territories,
particularly those at the greatest risk of outbreaks.
Vector-Borne Disease Centers of Excellence.--The Committee
is concerned about the Pacific Northwest being an underserved
region for funding and representation in the Regional Centers
of Excellence in Vector-Borne Diseases network recently
established by CDC. The ecology, disease transmission dynamics,
and resources for vector-borne disease training, surveillance,
and control in the Northwest differ significantly from those in
the five regional centers currently funded. The Committee
encourages CDC to examine options to provide greater coverage
of the Northwest region for vector-borne disease resources.
CHRONIC DISEASE PREVENTION AND HEALTH PROMOTION
Appropriation, fiscal year 2019....................... $1,187,771,000
Budget request, fiscal year 2020...................... 951,250,000
Committee Recommendation.............................. 1,357,571,000
Change from enacted level........................... +169,800,000
Change from budget request.......................... +406,321,000
The Committee recommendation includes $1,080,121,000 in
discretionary appropriations and $277,450,000 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 2019 and does not
provide funding for the America's Health Block Grant proposed
again in the fiscal year 2020 Congressional Budget
Justification. 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 2020
Budget Activity Committee
------------------------------------------------------------------------
Tobacco.............................................. $250,000,000
Nutrition, Physical Activity, and Obesity............ 58,920,000
High Obesity Rate Counties....................... 15,000,000
School Health........................................ 17,400,000
Food Allergies................................... 2,000,000
Health Promotion..................................... 29,100,000
Glaucoma......................................... 4,000,000
Vision and Eye Health............................ 2,000,000
Alzheimer's Disease.............................. 10,500,000
Inflammatory Bowel Diseases...................... 1,000,000
Interstitial Cystitis............................ 1,100,000
Excessive Alcohol Use............................ 5,000,000
Chronic Kidney Disease........................... 2,500,000
Chronic Disease Education & Awareness............ 3,000,000
Prevention Research Centers.......................... 32,461,000
Heart Disease and Stroke............................. 160,062,000
Diabetes............................................. 168,129,000
National Diabetes Prevention Program................. 30,000,000
Cancer Prevention and Control........................ 410,049,000
Breast and Cervical Cancer....................... 245,000,000
WISEWOMAN.................................... 46,770,000
Breast Cancer Awareness for Young Women.......... 4,960,000
Cancer Registries................................ 51,440,000
Colorectal Cancer................................ 45,294,000
Comprehensive Cancer............................. 19,675,000
Johanna's Law.................................... 12,000,000
Ovarian Cancer................................... 12,000,000
Prostate Cancer.................................. 14,205,000
Skin Cancer...................................... 5,000,000
Cancer Survivorship Resource Center.............. 475,000
Oral Health.......................................... 20,000,000
Safe Motherhood/Infant Health........................ 60,000,000
Maternal Mortality Review Committees............. 12,000,000
Preterm Birth.................................... 2,000,000
Sudden Unexpected Infant Death & Sudden 2,000,000
Unexplained Death in Childhood..................
Other Chronic Diseases............................... 31,000,000
Arthritis........................................ 12,000,000
Epilepsy......................................... 11,500,000
National Lupus Patient Registry.................. 7,500,000
Racial and Ethnic Approaches to Community Health..... 71,950,000
Good Health and Wellness in Indian Country....... 21,000,000
Million Hearts....................................... 4,000,000
National Early Child Care Collaboratives............. 4,500,000
Hospitals Promoting Breastfeeding.................... 10,000,000
------------------------------------------------------------------------
Alzheimer's Disease.--The Committee provides an increase of
$5,000,000 to build a robust Alzheimer's and other dementias
public health infrastructure across the country, as authorized
by the Building Our Largest Dementia (BOLD) Infrastructure for
Alzheimer's Act.
Arthritis.--The Committee includes an increase of
$1,000,000 for arthritis, the country's leading cause of
disability, to further support the national dissemination of
evidence-based programs.
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 for a new effort to
award grants to address chronic diseases and their risk factors
that do not already have a specified amount 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 chronic obstructive pulmonary disease and psoriasis.
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 Insitute in coordination with CDC. CDC should fully
integrate COPD surveillance, research, prevention, and
management strategies into its existing chronic disease
efforts.
Colorectal Cancer.--The Committee includes an increase of
$2,000,000 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. The Committee requests a report on the risk factors for
colorectal cancer no later than 180 days after enactment of
this Act.
Diabetes.--The Committee includes an increase of
$20,000,000 for additional efforts to prevent diabetes, its
complications, and to reduce inequities through prevention
strategies, translational research, and education. The
Committee also includes an increase of $4,700,000 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.
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 an increase of $500,000 for the National Early Child
Care Collaboratives Program to support direct provider-level
training in implementation of healthy eating and physical
activity best practices, including strategies for engaging
families. Funds will also support technical assistance to
States for integrating such best practices into existing State
and local systems for early care and education, such as
professional development for providers. The additional $500,000
above the fiscal year 2019 funding level shall be used to
expand geographic reach to at least two new geographic areas,
with a focus on provider-level interventions, and to support
the testing of pilots regarding innovative ways to engage
families in health promotion in 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 $3,000,000
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.
Excessive Alcohol Use.--The Committee includes an increase
of $1,000,000 to strengthen the scientific foundation for
preventing excessive alcohol use.
Fatty Liver Disease.--The Committee recognizes that the
prevalence of non-alcoholic fatty liver disease and non-
alcoholic steatohepatitis is growing dramatically in the U.S.
The Committee encourages CDC to develop prevention, education,
diagnosis, and treatment programs to combat existing incidence
and provide appropriate prevention activities to mitigate
further increases.
Food Allergies.--The Committee includes $2,000,000 for a
school-based effort to reduce potentially fatal anaphylactic
reactions due to food allergies.
Glaucoma.--The Committee is pleased by CDC's work in
improving glaucoma screening, referral, and treatment
particularly for populations that face disparity in access to
glaucoma care. Early detection and treatment are vital in
glaucoma care because, by the time vision loss or other
symptoms appear, permanent and irreversible damage to the eye
has already occurred and lost vision cannot be restored.
Heart Disease and Stroke.--The Committee includes an
increase of $20,000,000 to support, strengthen, and expand
evidence-based initiatives, given that almost half of the U.S.
population has some form of cardiovascular disease.
High Obesity Rate Counties.--The Committee continues to
include $15,000,000 to support the rural extension and outreach
services grants for rural counties with an obesity prevalence
of over 40 percent. CDC is encouraged to give preference to
projects in States where at least 10 percent of counties meet
the requirements of the program.
Hospitals Promoting Breastfeeding.--The Committee includes
an increase of $2,000,000 for evidence-based practice
improvements in hospitals, with an emphasis on physician and
care provider education, with the aim of supporting
breastfeeding and increasing breastfeeding rates.
Inflammatory Bowel Diseases.--The Committee commends CDC
for investing in research on the epidemiology of Irritable
Bowel Diseases (IBD) in the U.S. as well as on disparities in
treatment patterns and overall health outcomes within minority
populations and underserved communities. The Committee
recognizes the need to increase the rate of early diagnoses and
to improve health outcomes in these populations. The Committee
encourages CDC to continue supporting this research and to
develop a plan to reduce the time for persons from underserved
communities to receive a diagnosis, including by increasing
understanding and awareness of IBD among these populations and
the healthcare providers who serve them.
Interstitial Cystitis.--The Committee includes an increase
of $100,000 for interstitial cystitis activities. This increase
is to support additional funding for education, outreach, and
public awareness activities.
Johanna's Law.--The Committee includes an increase of
$4,500,000 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.
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
encourages CDC to work to increase public awareness of lung
cancer screening for individuals at high risk for lung cancer
and increase the percentage of high-risk individuals who are
screened.
Lymphedema.--The Committee commends the Division of Cancer
Prevention and Control for working to expand access to
resources on lymphedema. The Committee notes that lymphedema is
the most common side effect of many cancer treatments and urges
the Division to work with stakeholders to advance information
and resources for healthcare professionals and the public on
this often debilitating condition.
Nutrition, Physical Activity and Obesity.--The Committee
includes an increase of $2,000,000 to expand efforts to protect
the health of individuals at every stage of life by encouraging
regular physical activity, good nutrition, and preventing adult
and childhood obesity.
Oral Health.--The Committee includes an increase of
$1,000,000 for 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
$2,000,000 for ovarian cancer prevention activities. The
Committee notes that ovarian cancer causes more deaths each
year than any other gynecological cancer in the U.S.
Polycystic Ovary Syndrome.--The Committee recognizes the
significant health burden of Polycystic Ovary Syndrome (PCOS),
which has metabolic, reproductive, dermatologic, and mental
health manifestations. PCOS is a pervasive metabolic health
issue that increases the risk of type 2 diabetes, infertility,
nonalcoholic fatty liver disease, pregnancy complications,
endometrial cancer, depression, cardiovascular disease, and
other comorbidities. Studies report inadequate information
about PCOS, a delay in diagnosis, and 50 to 70 percent of PCOS
patients go undiagnosed or misdiagnosed. There is also a
paucity of data in the U.S. on PCOS prevalence, ethnic and
genetic differences, and its impacts on long-term health.
Therefore, the Committee encourages CDC to raise awareness and
increase knowledge about PCOS among the general public, PCOS
patients and health care providers.
Prostate Cancer.--The Committee includes an increase of
$1,000,000 to expand 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.
Prevention Research Centers.--The Committee includes an
increase of $7,000,000 for additional institutions to join the
national network committed to conducting prevention research
and translating research results into policy and public health
practice that address local public health needs.
Psoriatic Disease.--The Committee recognizes the growing
body of evidence linking psoriatic disease, which impacts more
than eight million Americans, to other comorbidities such as
cardiovascular disease, mental health and substance abuse
challenges, kidney disease, and other conditions. The Committee
commends CDC for identifying opportunities for expanded
research on psoriatic disease in its Public Health Agenda for
Psoriasis and Psoriatic Arthritis.
Racial and Ethnic Approaches to Community Health.--The
Committee includes an increase of $16,000,000 for Racial and
Ethnic Approaches to Community Health for additional approved
but unfunded organizations for the first year of a three-year
cooperative agreement, with at least two additional grantees
from each of the racial and ethnic target populations described
in the funding announcement CDC-RFA-DP18-1813. The Committee
continues funding for Good Health and Wellness in Indian
Country at the fiscal year 2019 enacted level.
Reducing Residual Cardiovascular Risk.--Cholesterol
therapies, such as statins, have been successful in reducing
risk of cardiovascular disease in many individuals, but
substantial residual and untreated risk remains beyond
cholesterol management. The Committee commends CDC for playing
an important role in bridging the knowledge gap and encouraging
healthcare professionals and their patients to take action
toward well-informed decisions for care. The Committee urges
CDC to promote awareness among physicians and patients of
residual cardiovascular risk beyond statin therapy, and the
importance of taking preventative action to reduce this risk.
Safe Motherhood and Infant Health.--The Committee
recognizes CDC's ongoing efforts to address the pressing public
health issue of rising maternal mortality rate in the U.S. Each
year, almost 700 women die during or within a year of the end
of their pregnancy in the U.S. as a result of pregnancy or
delivery complications. These statistics are all the more
concerning given that accurate and complete data regarding the
cause of pregnancy-related deaths is lacking. The Committee
includes $12,000,000 in the Safe Motherhood and Infant Health
Program for CDC to continue its technical assistance to
existing State Maternal Mortality Review Committees (MMRCs) to
build stronger data systems, improve data collection at the
State level and create consistency in data collection across
State MMRCs. The Committee believes this investment will lead
to better information necessary to provide accurate national
statistics for U.S. maternal mortality rates and will inform
data-driven actions for preventing these deaths. 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. PQCs are working to address a
number of important health threats to women and infants,
including the impacts of opioid use disorder and NAS. This
platform can also be integrated into existing State-based bio-
surveillance efforts to pilot the integration of a maternal
health component, ensuring any additional efforts work within
the PQC infrastructure and strengthen those existing efforts to
improve the data available and its ability to impact and
improve clinical care and community linkages.
Furthermore, the Committee requests CDC to provide routine
updates on the status of implementing programs authorized under
the Preventing Maternal Deaths Act of 2018.
Skin Cancer.--The Committee includes an increase of
$2,000,000 for skin cancer prevention activities, the most
common cancer in the U.S.
Sudden Unexpected Infant Death and Sudden Unexplained Death
in Childhood.--The Committee is aware that Sudden Infant Death
Syndrome (SIDS) is the leading cause of death of infants under
one year of age in the U.S. Currently, there is no known way to
prevent SIDS, but there are ways to reduce the risk. Several
factors present during pregnancy, at birth, and throughout the
first year after birth that can impact SIDS risk. The Committee
encourages CDC to increase public awareness and provider
education to reduce the risks.
Furthermore, the bill includes $2,000,000 for training
grants to States, local governmental entities and nonprofits to
improve the quality of death scene investigations and resulting
prevention efforts, utilizing CDC training curriculum, with
standardized forms and doll re-enactment.
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 $40,000,000 so that CDC and
States can use evidence-based strategies to more robustly
respond to the public health risk caused by the dramatic
increase of youth use of e-cigarettes, 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.
Vision and Eye Health.--The Committee includes an increase
of $1,000,000 to enhance programs that prevent blindness and
preserve sight. The Committee changes the title of this line to
better reflect the extensive surveillance, epidemiological, and
public health research and intervention capacity of CDC's
Vision Health Initiative and its wide-ranging vision and eye
health promotion, and disease prevention partnerships with
Federal, State, and community partners.
WISEWOMAN.--The Committee strongly supports the mission of
the WISEWOMAN program, helping uninsured and under-insured low-
income women ages 40 to 64 understand and reduce their risk for
heart disease and stroke; by providing risk factor screenings;
and connecting them with lifestyle programs, health counseling
and other community resources that promote healthy behavior
change. The Committee includes an increase of $25,650,000 to
expand the program to all 50 States and the District of
Columbia.
BIRTH DEFECTS, DEVELOPMENTAL DISABILITIES, DISABILITIES AND HEALTH
Appropriation, fiscal year 2019....................... $155,560,000
Budget request, fiscal year 2020...................... 112,000,000
Committee Recommendation.............................. 161,560,000
Change from enacted level........................... +6,000,000
Change from budget request.......................... +49,560,000
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 2020
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.. 68,660,000
Disability & Health incl. Child Development...... 30,000,000
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..................................... 8,000,000
Congenital Heart................................. 8,000,000
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......................... 2,000,000
Surveillance for Emerging Threats to Mothers and 10,000,000
Babies..............................................
------------------------------------------------------------------------
Congenital Heart Defects.--The Committee includes an
increase of $4,000,000 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 newborns, evaluation, diagnosis, results
reporting, data collection, surveillance, intervention
programs, systems, and follow-up of children identified through
Critical Congenital Heart Defects screening to better
understand the long-term outcomes and needs of this population.
Duchenne Muscular Dystrophy Surveillance.--The Committee is
encouraged by CDC's support of efforts to implement the updated
ICD 10 code for Duchenne and Becker Muscular Dystrophy (DBMD)
and requests an update on the use of MD STARnet to measure how
accurately and effectively the code is being applied to known
cases of DBMD. The Committee is also aware of CDC's ongoing
efforts to assess healthcare utilization and disease burden in
DBMD and requests an update in the fiscal year 2021
Congressional Budget Justification.
Health Promotion for People with Disabilities.--The
Committee supports the National Center on Birth Defects and
Developmental Disabilities in funding the National Center on
Health, Physical Activity, and Disability (NCHPAD) and its
primary goal of promoting better health, wellness, and quality
of life for people with disabilities. The Committee encourages
NCHPAD to implement a demonstration project to develop and
implement strategies to reduce diabetes and obesity among
people who are mobility-impaired.
Maternal Mortality.--The Committee remains concerned about
the maternal mortality rate in the U.S., which doubled in the
last two decades. In light of studies exploring the effect of
Cesarean sections on maternal mortality, the Committee urges
CDC to provide technical assistance for State databases and
data collection of pregnancy-associated and pregnancy-related
deaths, to include data on whether a delivery was vaginal, via
Cesarean section, or otherwise. Furthermore, the Committee is
concerned that implicit bias may be a factor in the
disproportionately high mortality rate of black mothers
compared to their white counterparts. Accordingly, the
Committee encourages the CDC to provide technical assistance to
State Maternal Mortality Review Committees that includes
evidence-informed interventions to address implicit bias in
health care providers and to States establishing Maternal
Mortality Review Committees.
Myotonic Dystrophy.--The Committee recognizes that myotonic
dystrophy is a serious degenerate genetic condition that is
often difficult to diagnose. However, early detection can
improve health outcomes for individuals living with the
condition. The Committee encourages CDC to review how it can
advance education, knowledge, and related outreach activities
to foster myotonic screening for newborns. The Committee
requests an update on these activities in the fiscal year 2021
Congressional Budget Justification.
Spina Bifida.--The Committee includes an increase of
$2,000,000 for Spina Bifida, the most common permanently
disabling congenital disability compatible with life in the
U.S. While Spina Bifida and related neural tube defects are
sometimes preventable through education and adequate daily
folic acid consumption, there are an estimated 166,000
individuals, more than half of whom are 18 and older, living
with all forms of this complex birth defect. The Committee
encourages CDC to use funding provided for the National Spina
Bifida Program 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.
Surveillance for Emerging Threats to Mothers and Babies.--
The Committee recognizes the innovative work of the National
Center on Birth Defects and Developmental Disabilities, and
also recognizes the threat that the Zika virus continues to
pose to mothers and babies across the United States and the
U.S. Territories. The Committee urges the Center to continue to
track mothers and infants to better understand how exposure to
Zika and other emerging threats can affect children as they
age.
Thalassemia.--The Committee is aware of the critical work
done by the thalassemia program at CDC in identifying patients
with this rare genetic blood disorder and connecting them to
services and to life-saving treatment centers. Thalassemia
patients experience serious comorbidities that can impact
almost every aspect of their lives. The Committee urges CDC to
continue and strengthen this collaboration among thalassemia
treatment centers, non-profits organizations, and patients and
their families.
PUBLIC HEALTH SCIENTIFIC SERVICES
Appropriation, fiscal year 2019....................... $496,397,000
Budget request, fiscal year 2020...................... 468,000,000
Committee Recommendation.............................. 603,897,000
Change from enacted level........................... +107,500,000
Change from budget request.......................... +135,897,000
This account supports programs that provide leadership and
training for the public health workforce, support
infrastructure to modernize public health surveillance, promote
and facilitate science standards and policies, and improve
access to information on disease outbreaks and other threats.
Within the total, the Committee recommends the following
amounts:
------------------------------------------------------------------------
Budget Activity FY 2020 Committee
------------------------------------------------------------------------
Health Statistics.................................... $160,397,000
Surveillance, Epidemiology, and Informatics.......... 387,500,000
Public Health Workforce.............................. 56,000,000
------------------------------------------------------------------------
Familial Hypercholesterolemia.--The Committee includes
$500,000 for provider education and public awareness for
Familial Hypercholesterolemia (FH), an inherited genetic
disorder that causes early, aggressive, heart disease. The
Committee is concerned that more than 90 percent of those in
the U.S. who are affected with FH are completely unaware of the
condition, and supports CDC working with a national
organization to increase provider education and public
awareness so that early diagnosis and treatment can normalize
the risk of heart disease for people with FH.
Neurological Diseases Surveillance System.--The Committee
is pleased that CDC initiated developmental and implementation
work for the National Neurological Conditions Surveillance
System (NNCSS). The NNCSS will provide a foundation for the
evaluation and understanding of neurological conditions by
collecting information on incidence and prevalence, geographic
clusters of conditions, demographic variability, outcome
measures and health care practices and utilization. The
Committee provides $5,000,000 within the total for
Surveillance, Epidemiology, and Informatics to add at least one
severe neuropsychiatric disorder, such as schizophrenia, to
NNCSS implementation.
Primary Immunodeficiencies.--The Committee includes
$3,000,000, an increase of $2,000,000, to continue and expand
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 Surveillance/IT Systems Modernization.--
The Committee acknowledges that CDC has taken important steps
to modernize its surveillance infrastructure through the
implementation of its Surveillance Strategy and development of
its essential Surveillance Data Platform, but recognizes 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. The
nation's public health data systems are antiquated, rely on
obsolete surveillance methods, and are in dire need of security
upgrades. Lack of interoperability, reporting consistency, and
data standards leads to errors in quality, timeliness, and
communication. In addition, CDC must take steps to ensure that
the public health workforce possesses and maintains state of
the art data science skills needed to put the data to use
through public health action. The Committee includes
$100,000,000 for the first year of a multi-year initiative for
CDC to lead the effort to improve public health data by
providing support to Federal data modernization efforts
including the National Center for Health Statistics, State,
local, tribal and territorial partners, and to work with
academic and private sector partners to innovate new tools and
approaches for maximizing the public health impact of the data
that keeps our communities safe and healthy. Within 120 days of
enactment of this Act, the Committee requests a multi-year plan
for this initiative, including at least five years of budget
projections, as well as the innovation strategy for surveys
conducted by the National Center for Health Statistics.
Public Health Workforce.--The bill includes an increase of
$5,000,000 to support expansion of 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.
ENVIRONMENTAL HEALTH
Appropriation, fiscal year 2019....................... $209,350,000
Budget request, fiscal year 2020...................... 157,000,000
Committee Recommendation.............................. 243,350,000
Change from enacted level........................... +34,000,000
Change from budget request.......................... +86,350,000
The Committee recommendation includes $226,350,000 in
discretionary appropriations and $17,000,000 in transfers from
the PPH Fund.
Programs supported within Environmental Health conduct
surveillance and data collection to detect and address emerging
pathogens and environmental toxins that pose significant
challenges to public health, as well as determine whether and
at what level of exposure these substances are harmful to
humans.
Within the total, the Committee recommends the following
amounts:
------------------------------------------------------------------------
Budget Activity FY 2020 Committee
------------------------------------------------------------------------
Environmental Health Laboratory...................... $73,750,000
Newborn Screening Quality Assurance Program...... 20,000,000
Newborn Screening /Severe Combined 1,250,000
Immunodeficiency Diseases.......................
Environmental Health Activities...................... 54,600,000
Environmental Health Activities.................. 21,000,000
Safe Water....................................... 8,600,000
Amyotrophic Lateral Sclerosis (ALS) Registry..... 10,000,000
Climate Change................................... 15,000,000
Environmental and Health Outcome Tracking Network.... 40,000,000
Asthma............................................... 34,000,000
Trevor's Law......................................... 1,000,000
Childhood Lead Poisoning............................. 40,000,000
------------------------------------------------------------------------
Childhood Lead Poisoning.--The Committee includes an
increase of $5,000,000 to strengthen blood lead surveillance by
supporting additional State and local programs to improve blood
lead screening test rates, identify high-risk populations, and
ensure effective follow-up for children with elevated blood
lead levels.
Climate and Health.--The Committee recognizes that
communities are already having to adapt to the health effects
caused by climate change, 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 for the Climate and Health Program 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.
Environmental Health Tracking Network.--The Committee
includes an increase of $6,000,000 to add at least three States
that participate in this public health surveillance system that
develops a comprehensive data source of environmental hazard,
exposure, and health data.
Laboratory Harmonization.--The Committee includes an
increase of $4,000,000 to enhance efforts of the Environmental
Health Laboratory to harmonize the reporting of clinical
laboratory test results, so that more patients can have access
to dependable and accurate results, which play an important
role in medical decision-making.
National Asthma Control Program.--The Committee includes an
increase of $5,000,000 for the National Asthma Control Program
(NACP). The Committee directs the NACP to increase the number
of States carrying out programmatic activities and to use a
population-adjusted burden of disease criteria as a significant
factor for new competitive awards.
Newborn Screening.--The Committee includes an increase of
$4,000,000 to further support newborn screening efforts and so
that affected newborns can receive early and often life-saving
treatment.
Per and Polyfluoroalkyl Substances Screening.--The
Committee includes $5,000,000 for CDC to conduct a health study
at multiple domestic, non-Department of Defense sites to
examine the health effects of exposure to per- and
polyfluoroalkyl substances (PFAS) for the purpose of expanding
the science about the relationship between PFAS exposure and
certain health outcomes.
INJURY PREVENTION AND CONTROL
Appropriation, fiscal year 2019....................... $648,559,000
Budget request, fiscal year 2020...................... 628,839,000
Committee Recommendation.............................. 697,559,000
Change from enacted level........................... +49,000,000
Change from budget request.......................... +68,720,000
Programs supported within Injury Prevention and Control
provide national leadership on violence and injury prevention,
conduct research and surveillance, and promote evidence-based
strategies to inform real-world solutions to prevent premature
death and disability and to reduce human suffering and medical
costs caused by injury and violence.
Within the total, the Committee recommends the following
amounts:
------------------------------------------------------------------------
FY 2020
Budget Activity Committee
------------------------------------------------------------------------
Intentional Injury................................... $144,730,000
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............. 5,500,000
Firearm Injury and Mortality Prevention Research. 25,000,000
Rape Prevention.................................. 54,430,000
Suicide.......................................... 10,000,000
National Violent Death Reporting System.............. 25,500,000
Unintentional Injury................................. 11,800,000
Traumatic Brain Injury........................... 6,750,000
Drowning......................................... 2,000,000
Elderly Falls.................................... 3,050,000
Injury Prevention Activities......................... 28,950,000
Opioid Overdose Prevention and Surveillance.......... 475,579,000
Injury Control Research Centers...................... 11,000,000
------------------------------------------------------------------------
Adverse Childhood Experiences.--The Committee commends CDC
for providing funding to States to conduct surveillance on
youth and adult behavioral risk factors. The Committee
encourages CDC to prioritize collection and reporting of data
on adverse childhood experiences, including exposure to
violence. The Committee also encourages CDC to report on the
prevalence of adverse childhood experiences across geographic,
race and ethnicity, disability and socioeconomic status and to
work with State and local health departments to implement
evidence-based interventions aimed at reducing adverse
childhood experience.
Child Sexual Abuse Prevention.--While the incidence of
child sexual abuse is believed to be far greater than reported,
it is estimated to affect nearly 10 percent of all U.S.
children, according to CDC. In light of the harmful physical,
cognitive and emotional effects on a child's development, a far
more proactive approach is needed to prevent child sexual
abuse. Therefore, the Committee includes $2,000,000 for a new
research effort supporting the development, evaluation, and
dissemination of effective child sexual abuse prevention
practice and policy.
Drowning.--The Committee includes $2,000,000 to prevent
fatal drownings. This funding allows CDC to scale proven
drowning prevention programs with national organizations
working with underserved youth, and to support State drowning
surveillance efforts and a national plan on water safety.
Elderly Falls.--The Committee includes an increase of
$1,000,000 to enhance programs and research to prevent older
adult falls.
Firearm Injury and Mortality Prevention Research.--The
Committee includes $25,000,000 for firearm injury and mortality
prevention research through a public health approach that
focuses on data to understand its causes and to inform
prevention strategies. According to CDC data, there were nearly
40,000 firearm-related deaths in 2017. In addition, more than
130,000 non-fatal firearm injuries from assault or self-harm
are treated annually in hospital emergency departments. The
Committee directs CDC to focus on activities that will have the
greatest potential public health impact including strengthen
data collection to better understand firearm deaths and non-
fatal injuries to help inform firearm injury prevention; and
conduct evaluation and other applied research projects that
align with the Institute of Medicine/National Research Council
recommendations to better understand public health prevention
strategies for reducing firearm injury and death. Projects
should focus on addressing the gaps in knowledge, such as the
characteristics of firearm violence, risk and protective
factors for self-directed and interpersonal firearm violence,
and effectiveness of interventions to prevent firearm injury
such as safe storage practices.
Injury Prevention Research Centers.--The Committee includes
an increase of $2,000,000 to award additional Center grants.
Furthermore, the Committee is aware of alarming rates of injury
and their significant potential to affect the long-term
psychological and physical well-being of college athletes.
Thus, the Committee encourages CDC to work with the Centers to
identify best practice standards to prevent these injuries.
National Violent Death Reporting System.--The Committee
includes an increase of $2,000,000 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.
Rape Prevention.--The Committee includes an increase of
$5,000,000 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 47,000 deaths in 2017. While depression and other mental
health conditions are a significant risk factor for suicide,
less than half of the people who die from suicide have a known
mental health condition. The Committee includes $10,000,000 for
a new effort at CDC to explore the leading mechanisms of
suicide deaths and identify prevention strategies to reduce the
deaths by suicide through pilot projects to enhance the
completeness of data to capture mechanisms of death; expand
syndromic surveillance; and support research and evaluation
projects to understand the pathways and mechanisms that
contribute to suicide attempts, and identify prevention
strategies.
NATIONAL INSTITUTE FOR OCCUPATIONAL SAFETY AND HEALTH
Appropriation, fiscal year 2019....................... $336,300,000
Budget request, fiscal year 2020...................... 190,000,000
Committee Recommendation.............................. 346,300,000
Change from enacted level........................... +10,000,000
Change from budget request.......................... +156,300,000
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:
------------------------------------------------------------------------
FY 2020
Budget Activity Committee
------------------------------------------------------------------------
National Occupational Research Agenda................ $118,000,000
Agricultural, Forestry, and Fishing.............. 27,500,000
Education and Research Centers....................... 31,000,000
Personal Protective Technology....................... 20,000,000
Mining Research...................................... 59,500,000
Firefighter Cancer Registry.......................... 1,600,000
Other Occupational Safety and Health Research........ 116,200,000
National Mesothelioma Registry and Tissue Bank... 1,600,000
Total Worker Health.............................. 8,300,000
------------------------------------------------------------------------
Agricultural, Forestry, and Fishing.--The Committee
includes an increase of $2,000,000 to expand 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 an
increase of $2,000,000 to further support efforts to reduce
work-related injuries and illnesses by prevention research, and
implementing programs to improve occupational health and
safety.
Firefighter Cancer Registry.--The Committee includes an
increase of $600,000 to further support the implementation of
the Firefighter Cancer Registry Act of 2018.
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
$2,000,000 in the Other Occupational Safety and Health Research
line for the Total Worker Health program that funds Centers of
Excellence that advance the overall safety, health, and well-
being of the diverse population of workers in our nation.
ENERGY EMPLOYEES OCCUPATIONAL ILLNESS COMPENSATION PROGRAM
Appropriation, fiscal year 2019....................... $55,358,000
Budget request, fiscal year 2020...................... 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 2019....................... $488,621,000
Budget request, fiscal year 2020...................... 456,984,000
Committee Recommendation.............................. 523,621,000
Change from enacted level........................... +35,000,000
Change from budget request.......................... +66,637,000
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.
Within the total, the Committee recommends the following
amounts:
------------------------------------------------------------------------
FY 2020
Budget Activity Committee
------------------------------------------------------------------------
Global AIDS Program.................................. $128,421,000
Global Tuberculosis.................................. $10,000,000
Global Immunization Program.......................... $226,000,000
Polio Eradication................................ $176,000,000
Other Global/Measles............................. $50,000,000
Parasitic Diseases and Malaria....................... $26,000,000
Global Disease Detection and Emergency Response...... $123,400,000
Global Public Health Capacity Development............ $9,800,000
------------------------------------------------------------------------
Global Disease Detection.--With the intent of maintaining
the global health capacity developed over the past five years
with Ebola supplemental funds, the Committee includes an
increase of $25,000,000 to advance global efforts to detect
epidemic threats earlier, respond more effectively, and prevent
avoidable crises. The Committee supports CDC's efforts to
provide additional support for 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 Health Research.--The Committee supports 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 disease and other health threats. As
emerging infectious diseases like Ebola and Zika represent
profound challenges for our health system, the Committee
supports continued 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 officials
to ensure that the importance of research and development to
global health security is appropriately reflected in their
international engagements.
Global Health Security Strategy.--The Committee is
disappointed that the Global Health Security Strategy failed to
meet the required deadline and remains past due. The Committee
expects the Administration to prioritize this document and
promptly provide it to the appropriate Congressional
committees.
Global Tuberculosis.--The Committee provides and increase
of $10,000,000 above the fiscal year 2019 program level for
Global Tuberculosis activities. These funds are intended to
supplement, not supplant, existing funding provided through a
transfer from Tuberculosis in the HIV/AIDS, Viral Hepatitis,
STD and TB Prevention account to Global Tuberculosis in the
Global Health account.
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, and to enhance efforts to
improve the impact of WASH interventions in humanitarian
emergencies by assisting partners to improve monitoring of WASH
interventions, conduct research on innovative WASH
interventions, and improve disease surveillance for WASH-
related illness among refugees, displaced persons, and
emergency affected populations. The Committee further
encourages CDC to provide laboratory support for global WASH
activities.
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 currently
funded CDC projects aimed at surveillance, source remediation
and clinical care to reduce soil transmitted helminth
infection.
PUBLIC HEALTH PREPAREDNESS AND RESPONSE
Appropriation, fiscal year 2019....................... $855,200,000
Budget request, fiscal year 2020...................... 825,000,000
Committee Recommendation.............................. 880,200,000
Change from enacted level........................... +25,000,000
Change from budget request.......................... +55,200,000
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.
Within the total, the Committee recommends the following
amounts:
------------------------------------------------------------------------
Budget Activity FY 2020 Committee
------------------------------------------------------------------------
State and Local Preparedness and Response Capability. $708,200,000
Public Health Emergency Preparedness Cooperative 700,000,000
Agreement.......................................
Academic Centers for Public Health Preparedness.. 8,200,000
CDC Preparedness and Response........................ 172,000,000
BioSense......................................... 23,000,000
All Other CDC Preparedness and Response.......... 149,000,000
------------------------------------------------------------------------
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 ready to rapidly respond in an emergency.
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 2019....................... $30,000,000
Budget request, fiscal year 2020...................... 30,000,000
Committee Recommendation.............................. 255,000,000
Change from enacted level........................... +225,000,000
Change from budget request.......................... +225,000,000
The Committee recommendation includes $30,000,000 in
discretionary budget authority and $225,000,000 in transfers
from the HHS Nonrecurring Expenses Fund.
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.
Chamblee Research Support Building 108 and Campus
Infrastructure Improvements.--The Committee directs
$225,000,000 from the HHS Nonrecurring Expenses Fund for the
Chamblee Research Support Building 108 and campus
infrastructure improvements. These one-time projects will
result in enhanced research collaboration and long-term lease
cost avoidance.
CDC-WIDE ACTIVITIES AND PROGRAM SUPPORT
Appropriation, fiscal year 2019....................... $323,570,000
Budget request, fiscal year 2020...................... 155,000,000
Committee Recommendation.............................. 323,570,000
Change from enacted level........................... - - -
Change from budget request.......................... +168,570,000
The Committee recommendation includes $163,570,000 in
discretionary funds and $160,000,000 in transfers from the PPH
Fund.
This account supports public health leadership and support
activities at CDC.
Within the total, the Committee recommends the following
amounts:
------------------------------------------------------------------------
FY 2020
Budget Activity Committee
------------------------------------------------------------------------
Preventive Health and Health Services Block Grant.... $160,000,000
Public Health Leadership and Support................. 113,570,000
Infectious Disease Rapid Response Reserve Fund....... 50,000,000
------------------------------------------------------------------------
Infectious Disease Rapid Response Reserve Fund.--The
Committee includes $50,000,000 for the Infectious Diseases
Rapid Response Reserve Fund. The Reserve Fund will provide an
immediate source of funding to quickly respond to a future,
imminent infectious disease crisis that endangers lives. Funds
are available until expended.
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.
National Institutes of Health
Appropriation, fiscal year 2019....................... $39,084,000,000
Budget request, fiscal year 2020...................... 34,151,068,000
Committee Recommendation.............................. 41,084,000,000
Change from enacted level........................... +2,000,000,000
Change from budget request.......................... +6,932,932,000
The Committee recommendation for the National Institutes of
Health (NIH) program level includes $39,937,179,000 in
discretionary appropriations and $1,146,821,000 in Public
Health Service Act section 241 evaluation set-aside transfers.
Within the total appropriation, the Committee recommendation
includes $492,000,000 in budget authority authorized in the
21st Century Cures Act (P.L. 114-255). The bill includes an
increase in discretionary budget authority of $2,219,000,000
above the fiscal year 2019 enacted level, which is necessary to
maintain an overall increase of $2,000,000,000 while
compensating for a reduction of $219,000,000 in funding made
available by the Cures Act.
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
$149,000,000 from the Cures Act); $411,000,000 for the Brain
Research through Application of Innovative Neurotechnologies
(BRAIN) Initiative (including $140,000,000 from the Cures Act);
and $8,000,000 for regenerative medicine.
The Committee includes specific funding allocations for a
number of initiatives and activities detailed in the Institute-
and Center-specific sections below. The funding level also
allows for an increase of 5 percent outside of these designated
activities to support other efforts, including an increase in
the number of new and competing Research Project Grants, with a
focus on early-stage investigators and investigators seeking
first-time renewals. The Committee expects NIH to provide a
stipend level increase to training grantees that is consistent
with any fiscal year 2020 Federal employee pay raise.
National Cancer Institute (NCI)
Appropriation, fiscal year 2019....................... $6,143,892,000
Budget request, fiscal year 2020...................... 5,246,737,000
Committee Recommendation.............................. 6,444,165,000
Change from enacted level........................... +300,273,000
Change from budget request.......................... +1,197,428,000
Mission.--NCI leads, conducts, and supports cancer research
across the nation to advance scientific knowledge and help all
people live longer, healthier lives.
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.--The Committee includes
$50,000,000 for the first year of the Childhood Cancer Data
Initiative, as proposed in the fiscal year 2020 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.
Brain Cancer in Children.--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 support additional 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.
Cancer Immunotherapy.--The Committee continues to be
encouraged by new breakthroughs in cancer immunotherapy, which
are revolutionizing treatments for a growing number of cancers.
The Committee urges NCI to prioritize research and trials for
innovative immunotherapeutic approaches. In some cases,
however, the side effects of such treatments are far different
than those associated with chemotherapy. Early recognition and
management of cancer immunotherapy-related side effects can
result in resolution of these side effects before permanent
damage is done, and allows for continued cancer treatment. The
Committee urges NCI to prioritize research and education on the
underlying mechanisms of cancer immunotherapy.
Children's Oncology Group.--The Committee continues to
support the important work of the Children's Oncology Group and
encourages NCI to continue their important role in drug
development. The majority of childhood cancer patients are
enrolled in trials conducted by the Children's Oncology Group
and advances in treatment are dependent on their ability to
conduct trials quickly and enroll as many pediatric patients as
possible.
Clinical Trials for Primary Prevention of Breast and
Ovarian Cancers.--The Committee urges NCI to support phase I,
phase II, phase II/III, and phase III clinical trials focused
on primary immunoprevention of breast cancer and primary
immunoprevention of ovarian cancer. The Committee encourages
NCI to include costs related to GMP and GLP expenses, direct
subject/patient expense reimbursement associated with
enrollment, participation, retention, long-term patient
outcomes, and long-term research outcomes. These trials should
involve relevant underrepresented and minority communities. The
Committee encourages NCI to work consultation with NCI-
designated Cancer Centers, the National Clinical Trials
Network, the NCI Community Research Program, and nonprofit
foundations currently working in this area.
Collaboration Between Agencies Regarding Pediatric
Investigation of Appropriate New Drugs.--The Committee
recognizes that Title V of Food and Drug Administration
Reauthorization Act (FDARA) amended the Pediatric Research
Equity Act (PREA) to support the early evaluation of
potentially effective drugs by requiring evaluation of new
molecularly targeted drugs and biologics intended for adults
with cancer if the drug is directed at a molecular target
substantially relevant to the growth or progress of a pediatric
cancer. The law directs the FDA, in collaboration with the NCI,
to establish, publish, and regularly update a list of molecular
targets considered based on data the Agency determines to be
adequate, to be substantially relevant to the growth or
progression of pediatric cancers, and that may trigger the
requirement for pediatric investigations. The Committee
encourages NCI and FDA to continue to collaborate with the
patient community, providers, and manufactures, and continue to
conduct a transparent and inclusive process to implement FDARA.
Deadliest Cancers.--The Committee notes that while more
effective screening methods and treatments have lowered overall
cancer incidence and death rates, several cancer types with
particularly low survival rates have limited screening methods,
and effective treatments for these cancers are also limited.
The Recalcitrant Cancers Research Act of 2012 defined
``recalcitrant cancers'' as those with a five-year survival
rate below 50 percent. These cancers account for nearly half of
all cancer deaths in the U.S. and include cancers of the brain,
esophagus, liver, lung, ovary, pancreas, and stomach. The
Committee notes that in fiscal year 2020, NCI will report on
the effectiveness of the scientific framework process NCI
undertook to carry out implementation of the Recalcitrant
Cancers Research Act.
Early Onset Colorectal Cancer.--The Committee notes that
while overall colorectal cancer incidence rates decreased over
the last 20 years, there has been an increase among adults ages
20-54. The Committee urges NCI to support research on the
causes for the increased rate of colorectal cancer in this
population. The Committee encourages NCI to expand its
knowledge of the natural history of the disease to help advance
the development of improved screening modalities and treatment.
Electronic Cigarettes.--The Committee recognizes that the
increased use of electronic cigarettes and similar devices pose
possible threats to public health, particularly for teenagers
and young adults. While these devices are often promoted as
safe alternatives to tobacco, studies suggest they may still
contain chemicals that pose health risks to the user. The
Committee urges NIH to expand research on the oral health
consequences of e-cigarettes, and to consider interdisciplinary
collaboration between schools of dentistry and traditional
cancer researchers.
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 commends NCI for supporting
research on liver cancer and for its inter-institute work to
encourage more research focused on liver cancer, but urges
greater priority to address the threat of liver cancer, the
second deadliest cancer with a five-year survival rate of 20
percent. The Committee also notes that the link between
hepatitis B infection and primary liver cancer is well
established with up to 60 percent of global liver cancer cases
caused by the hepatitis B virus (HBV) and, therefore,
encourages continued close collaboration with 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
newly-established Trans-NIH Hepatitis B working group. The
Committee requests an update on NCI's activities in these areas
in the fiscal year 2021 Congressional Justification.
Melanoma.--The Committee encourages NCI to support research
from development of experimental models to identify mechanisms
and associated biomarkers of risk for development of melanoma,
new technologies for early detection as well as trials that
develop population-based evidence for screening, including
ophthalmologic, and sun protection practices. The Committee
also encourages collaboration with the FDA to develop
scientific review pathways that more efficiently evaluate new
sunscreen ingredients.
Discovery of biomarkers of response and resistance is
critical at this point in melanoma research. The Committee
urges NCI to support mechanistic research into response and
resistance to therapy, and to develop a strategic plan across
the public and private sector to systematically focus on
biomarker research with the most advanced technologies
(genetic, gene expression, or protein-based), so that
physicians have the diagnostic tools to deliver personalized
medicine to each patient. The Committee also urges NCI to
continue the advances in adjuvant therapy by extending research
to earlier stage disease and testing shorter, less toxic and
more economical regimens. The Committee further encourages
research to understand mechanisms that underlie clinical
dormancy to provide an effective means of preventing tumor
recurrence and improving quality of life and longevity of
survivors.
The Committee is aware symptomatic brain (CNS) and
leptomeningeal (LMD) metastases remain difficult to treat and
may become the last frontier in systemic therapy in melanoma
and other cancers. The Committee urges expanding research to
identify treatments for CNS and LMD melanoma, which may pave
the way for advances in other cancers.
Melanoma is a heterogeneous cancer and includes rare
subtypes such as uveal melanoma, the most common cancer of the
eye, as well as mucosal and pediatric melanoma. States have
difficulty capturing and defining cases due to the complex
nature of arriving at the true diagnosis. The Committee
encourages NCI to support research through national registries
to better understand natural history, epidemiology, as well as
patient reported and clinical outcomes in these rare melanoma
subtypes.
The Committee requests an update on these requests in the
fiscal year 2021 Congressional Justification.
Metastatic Cancer in the Surveillance, Epidemiology, and
End Results Registry.--The Committee notes recent discussions
about modernizing the Surveillance, Epidemiology, and End
Results (SEER) Registry and filling in key data gaps, such as
metastatic recurrence. The Committee encourages NCI to advance
this effort in a systematic and meaningful way that ultimately
improves SEER Registry infrastructure and capabilities.
Office of Cancer Survivorship.--The Committee recognizes
that the Office of Cancer Survivorship (OCS) provides
leadership in research on a wide range of cancer survivorship
topics. However, the Committee recognizes that the needs of
childhood cancer survivors are unique. By 2020, there will be
at least 500,000 childhood cancer survivors in the U.S. Two-
thirds of childhood cancer survivors suffer from at least one
health problem late effect caused from their treatment. The
Committee urges the OCS to provide a special focus on childhood
cancer survivorship, including analyzing secondary prevention
strategies that go beyond the standard and routine therapies of
diet, exercise and tobacco avoidance and focus on specific
needs for childhood cancer survivors, such as psycho-social
treatments.
Pancreatic Cancer.--Pancreatic cancer is the third leading
cause of cancer-related death in the U.S. More than 56,700
Americans will be diagnosed with the disease in 2019,
representing a two percent increase over last year, and
pancreatic cancer remains the only major cancer with a five-
year survival rate in the single digits at just nine percent.
The Committee appreciates NCI's recent submissions of the five-
year updates to the reports required by the Recalcitrant Cancer
Research Act of 2012. The Committee encourages NCI to continue
to support research efforts to advance progress for patients
diagnosed with pancreatic cancer and other cancers with low
five-year survival rates.
Pediatric Immunotherapy Trials.--The Committee encourages
NCI to collaborate with pediatric immunotherapy trials that are
combining novel immunotherapy with the standard-of-care
chemotherapy and radiation treatments. The Committee recognizes
the need for the expansion of scope in ongoing trials to
include more types of pediatric cancers and encourages NCI to
use data produced from the trials when creating larger
comprehensive data sets.
Prostate Cancer.--The Committee is aware of NCI's efforts
in prostate cancer research and encourages additional
investment into understanding why certain populations,
including African-American men and men with a strong family
history of prostate cancer, have the highest incidence rate of
this disease. The Committee urges NCI to consider how
diagnostic and genetic testing and screening may reduce the
rate of mortality among high-risk populations.
Rare Cancer Therapeutic Research and Development Program.--
More than 500,000 Americans are diagnosed with a rare form of
cancer every year. Rare cancers account for 374 of 396 distinct
forms of cancer, and include all pediatric cancers. Each of
these forms of cancer would benefit from targeted therapies
that frequently work more effectively and with fewer side
effects than traditional chemotherapy and radiation. The NCATS
novel scientific model has proven successful in addressing
other rare diseases and would benefit rare cancer therapeutic
development. Therefore, the Committee urges NCI to collaborate
with NCATS as appropriate on a 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.
Recalcitrant Cancers.--The Committee encourages NCI to
incorporate the deadliest forms of childhood cancers into the
recalcitrant cancers category, and to prioritize research on
such cancers, which include anaplastic astrocytoma, diffuse
intrinsic pontine glioma, glioblastoma, Juvenile myelomonocytic
leukemia, high risk neuroblastoma, recurrent osteosarcoma,
rhabdomyosarcoma, and diffuse anaplastic Wilms tumors. The
Committee urges NCI to utilize available resources to aid in
the discovery of better treatments and cures to improve overall
childhood cancer survival rates. The Committee requests that
NCI include an update on the progress being made to increase
childhood cancer research in the Fiscal Year 2021 Congressional
Justification.
Specialized Programs of Research Excellence in Cancer.--The
Committee notes that the SPORE program is NCI's cornerstone
effort to promote collaborative, interdisciplinary
translational cancer research. The Committee continues support
for the SPORE grant program as it works to bring basic research
into practical treatments, including multi-center SPORE grants
to encourage better understanding of closely related cancers in
function and impact on different organ systems to advance
science toward more effective treatments, cures, and
prevention. The Committee requests an update in the fiscal year
2021 Congressional Budget Justification on a timeline to expand
multi-center SPORE grants.
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 the
fiscal year 2021 Congressional Justification.
NATIONAL HEART, LUNG, AND BLOOD INSTITUTE (NHLBI)
Appropriation, fiscal year 2019....................... $3,488,335,000
Budget request, fiscal year 2020...................... 3,002,696,000
Committee Recommendation.............................. 3,658,822,000
Change from enacted level........................... +170,487,000
Change from budget request.......................... +656,126,000
Mission.--NHLBI provides global leadership for a research,
training, and education program to promote the prevention and
treatment of heart, lung, and blood disorders and enhance the
health of all individuals so that they can live longer and more
fulfilling lives.
Chronic Obstructive Pulmonary Disease.--The Committee
commends NHLBI and HRSA on educating providers and patients,
including in rural and low-income communities, on Chronic
Obstructive Pulmonary Disease (COPD) awareness, detection and
management best practices. The agencies' efforts in this area
are a model for effective collaboration across Federal
agencies. The Committee encourages NHLBI to accelerate
implementation of the action plan across relevant Federal
agencies by supporting research and partnerships with various
agencies.
Alzheimer's Disease and Vascular Dementia.--The Committee
recognizes the value that well-characterized, longitudinal,
population-based cohort studies provide in bringing to light
more information about the risk factors related to dementia. By
studying participants over time, much can be learned about
cognitive decline and early biomarkers that will help us
understand the role of environmental and genetic factors in
disease development and progression. In time, however, mature
cohorts naturally dwindle as participants pass away, requiring
that the research mission be adjusted to continue to leverage
the previous science and build upon it. Therefore, the
Committee urges NHLBI to fund a pilot project on next
generation cohorts, with the goal of determining the
feasibility of recruiting descendant cohort participants to
continue study into the development and progression of risk
factors and to detect early signs of cognitive decline.
Asthma.--The Committee applauds NHLBI for its efforts to
develop new National Asthma Education and Prevention
guidelines. According to CDC, 24.6 million U.S. adults and
children have asthma. Appropriate asthma management can
significantly reduce costly services, including
hospitalizations.
Blood Donor Questionnaire Educational Materials.--The
Committee is concerned that certain FDA guidance in the
educational materials provided in the blood donor questionnaire
are inappropriate and misguided. The recommendations for
deferral should not mention someone's sexual orientation, and
rather focus on risk factors that might expose a potential
donor to blood-borne illness. The Committee strongly recommends
that NHLBI continue to provide the FDA with the latest science
on the risks of transmission of STIs through blood donation and
transfusion.
Heart Disease.--Heart disease is the leading cause of death
for both men and women in the U.S. Despite significant progress
over the last half century, the Committee is concerned that
this largely preventable disease continues to place a high
burden on our nation's health and economy. The Committee is
discouraged that new evidence shows that previous declines in
cardiovascular disease (CVD) have stalled or even reversed for
certain demographics. The Committee supports a NIH-wide
prioritization of heart research to significantly strengthen
the fight against heart disease. We commend NHLBI for its work
focused on congenital heart disease, high-risk populations,
including rural communities, and on the relationship between
high blood pressure and age-related cognitive impairment and
dementia. We further support NHLBI for its research on South
Asians, who are four times more likely to have heart disease
than the general public; experience heart attacks ten years
earlier; and have higher mortality rates from heart disease
than any other ethnic group.
Lymphedema and Lymphatic Diseases.--The Committee commends
NHLBI's efforts to expand research on lymphedema and lymphatic
diseases and encourages continued implementation of the
research recommendations of the 2015 Trans-NIH Lymphatics
Symposium and coordination across relevant Institutes and
Centers.
Reducing Residual Cardiovascular Risk.--Cardiovascular
events account for one of every three deaths in the United
States; about 2,300 Americans die of cardiovascular disease
each day. Cholesterol therapies, such as statins, have been
successful in reducing risk of cardiovascular disease, but
substantial residual and untreated risk remains for these
individuals beyond cholesterol management. A clinical trial
called REDUCE-IT has demonstrated a 25 percent relative risk
reduction in major adverse cardiovascular events beyond
cholesterol management, from the use of highly purified and
stable eicosapentaenoic acid (EPA) in addition to statin
therapy. The Committee is concerned that, despite these
statistics, many individuals do not regularly access treatments
for residual risk beyond statin therapy. The Committee urges
NHLBI to support research in this area as well as efforts,
particularly through the ``Know Your Numbers'' campaign, to
promote awareness among physicians and patients of the residual
cardiovascular risks beyond statin therapy and the importance
of taking preventative action to reduce this risk.
Sickle Cell Disease.--Sickle cell disease (SCD) is the most
common inherited blood disorder in the U.S. Academic medical
centers located in states with significant populations of
sickle cell patients have made progress in treating the disease
through NIH-sponsored clinical trials and through blood and
marrow transplantation, which is currently the only therapy
that can cure the disease. The Committee urges NHLBI to
prioritize and implement robust investment to drastically spur,
strengthen, accelerate and coordinate sickle cell disease
research. The Committee also encourages NIH to support clinical
trials for treatment of SCD, which includes multiple promising
approaches to eradicate this disease, save lives, and reduce
dramatically the substantial health care costs associated with
SCD for children and adults. Finally, 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.
Sleep and Circadian-Dependent Mechanisms Contributing to
Opiate Use Disorder.--The Committee applauds NIDA and NINDS for
their work to address the opioid crisis through innovative
research directions supported by the Helping to End Addiction
Long-Term (HEAL) Initiative. The Committee notes the promise
that research on sleep and circadian mechanisms can play in the
prevention and treatment of opiate use disorder and encourages
NIDA to work collaboratively with NHLBI and other relevant
Institutes and Centers to continue the exploration of
innovative research pathways.
Sleep Disorders.--The Committee commends the recent
expansion and advancement of the sleep and circadian research
portfolio under the coordination of the National Center on
Sleep Disorders Research (NCSDR). The Committee encourages
dedicated research activities on specific sleep disorders, such
as narcolepsy and restless legs syndrome, to ensure scientific
progress benefits patients impacted by debilitating conditions
disordering their sleep and biological rhythms.
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 have been 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. Accordingly, the Committee
encourages the NHLBI to continue support for The Heart Truth
program, and to continue working closely with its longstanding
partners, as well as new, non-traditional partners, to broaden
the program's reach.
NATIONAL INSTITUTE OF DENTAL AND CRANIOFACIAL RESEARCH (NIDCR)
Appropriation, fiscal year 2019....................... $461,781,000
Budget request, fiscal year 2020...................... 397,493,000
Committee Recommendation.............................. 484,350,000
Change from enacted level........................... +22,569,000
Change from budget request.......................... +86,857,000
Mission.--The mission of NIDCR is to improve dental, oral,
and craniofacial health through research, research training,
and the dissemination of health information.
Oral Health.--The Committee recognizes that oral health is
integral to overall health and that the oral cavity holds
tremendous promise for indicating disease and health issues,
targeting therapies, and diagnostic and therapeutic discovery.
The Committee encourages NIDCR to continue research on the
underlying biologic mechanisms of dental, oral and craniofacial
diseases and their potential linkages to other diseases,
including cardiovascular disease, Alzheimer's disease, diabetes
mellitus, and others.
Surgeon General's Report on Oral Health.--The Committee
appreciates NIDCR's contributions to the Surgeon General's 2020
Report on Oral Health and looks forward to the much-needed
update of the seminal Oral Health in America report from 2000.
NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASES
(NIDDK)
Appropriation, fiscal year 2019....................... $2,029,823,000
Budget request, fiscal year 2020...................... 1,746,493,000
Committee Recommendation.............................. 2,129,027,000
Change from enacted level........................... +99,204,000
Change from budget request.......................... +382,534,000
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.
Conditions of the Pancreas.--The Committee encourages NIDDK
to further support research activities focused on conditions of
the pancreas, particularly pancreatitis and pancreatic cancer,
and to consider leveraging collaborative opportunities to
advance auxiliary projects for ongoing successful efforts.
End-Stage Renal Disease.--The Committee recognizes the work
in supporting critical kidney research that NIDDK has
accomplished including end-stage renal disease (ESRD). The
Committee continues to encourage NIDDK to work with
stakeholders to facilitate new opportunities for research.
Glomerular Diseases.--The Committee recognizes the work
that the Cure Glomeruloneuropathy (CureGN) initiative and the
Nephrotic Syndrome Study Network (NEPTUNE) are supporting to
obtain insights into these diseases that could lead to
breakthroughs for critical clinical trials. The Committee
encourages NIDDK to continue supporting research that has
proven to lead to new therapies.
Hepatitis B.--The Committee notes that hepatitis B virus
(HBV) infections are a serious public health threat. The
hepatitis B research community convened a virtual consensus
conference to prepare a ``Roadmap for a Cure'' that resulted in
identifying the most urgent research questions related to
hepatitis B. The Committee urges NIDDK to pursue these research
opportunities and to work in coordination with other Institutes
and Centers on hepatitis B research planning.
Inflammatory Bowel Diseases.--The Committee continues to
encourage NIDDK to incorporate patient centricity in
Inflammatory Bowel Diseases (IBD) research, including support
for a translational bedside-to-bench research that leverages
patient priorities and perspectives with respect to biomedical
research, such as personalized medicine approaches, to address
a patient-identified clinical need. The Committee recognizes
interactions among food, the gut, and the brain/nervous system
as an area of high interest to patients and relevant to
multiple chronic gastrointestinal diseases that is supported by
a growing body of evidence, and identifies it as a potential
topic for ongoing research.
Interstitial Cystitis.--The Committee is pleased with the
progress of interstitial cystitis research through the MAPP
Program. The Committee encourages NIDDK and stakeholders to
continue collaboration on a comprehensive state of the science
conference to examine mechanisms for scientific opportunity.
Pediatric Kidney Disease.--The Committee is encouraged by
the research funded by NIDDK on pediatric kidney disease and
continues to urge the Institute to support research toward
multicenter clinical and translational research focused on
clinical approaches to children with kidney disease. However,
the Committee believes that NIDDK could do more to support
research toward the development of novel therapeutic strategies
that utilize genomics and personalized medicine in this patient
population. To this end, the Committee urges NIDDK to fund
additional research and support clinical trials in this area.
The Committee requests that NIDDK report back in the fiscal
year 2021 Congressional Justification on the progress made
towards additional pediatric focused clinical trials and novel
therapeutic development.
NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKE (NINDS)
Appropriation, fiscal year 2019....................... $2,274,413,000
Budget request, fiscal year 2020...................... 2,026,031,000
Committee Recommendation.............................. 2,385,571,000
Change from enacted level........................... +111,158,000
Change from budget request.......................... +359,540,000
Mission.--The NINDS mission is to seek fundamental
knowledge about the brain and nervous system and use that
knowledge to reduce the burden of neurological disease.
BRAIN Initiative.--The Committee directs NIH to transfer
$70,000,000 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.
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, implement 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 2019 enacted
level of $250,000,000 within NINDS for this research.
Acute Flaccid Myelitis.--The Committee is aware that there
remains no dedicated funding for Acute Flaccid Myelitis (AFM),
an inflammatory disease of the spinal cord characterized by
acute onset flaccid paralysis that predominantly affects
healthy children and young adults. Epidemiological evidence has
suggested an association between AFM and circulating viruses
which produce respiratory, gastrointestinal and febrile
illnesses. AFM falls into the same category of disease as
Poliomyelitis. In response to a recent upsurge in cases of AFM
in young children, the Committee urges that NIH, including
NINDS and NIAID, determine a clinical characterization and
disease pathogenesis for AFM.
Advancement of Non-Opioid Chronic Pain Therapies.--Fifty
million Americans suffer from chronic pain; living with chronic
pain can be life-altering, deeply impacting people on many
levels. The current state of chronic pain management is often
inadequate for many patients and places an economic burden on
the health care system, costing the U.S. $560 billion annually.
Management of chronic pain often requires both non-
pharmacological treatment as well as medicines. Unfortunately,
the current pharmacological options do not meet the needs of
all patients, and additional treatments are needed. The
Committee requests in the fiscal year 2021 Congressional
Justification an update on the progress of the development and
advancement of non-opioid chronic pain therapies.
Dystonia.--The Committee commends NINDS for holding a
conference on dystonia to revitalize the dystonia research
portfolio. The Committee encourages NINDS to follow the
recommendations, including identifying new research and
therapeutic needs that will lead to a better understanding of
dystonia etiology and evaluation of the status of translational
research that may lead to more treatment options for those
affected by dystonia.
Headache Disorders.--The Committee strongly urges NINDS to
fund fundamental, translational, and clinical research on
headache disorders, including migraine, post-traumatic
headache, the trigeminal autonomic cephalalgias, and
intracranial hypo/hypertension through the HEAL study.
Parkinson's Disease.--The Committee commends NINDS for
taking critical steps in identifying priority research
recommendations to advance research on Parkinson's disease,
which impacts between 500,000 and 1,500,000 Americans and is
the second most prevalent neurodegenerative disease in the U.S.
The Committee recognizes that NINDS is prioritizing public
health concerns with severe gaps in unmet medical needs and
supports the research recommendations set forth by the NINDS
planning strategy to bring us closer to better treatments and a
cure for Parkinson's disease. The Committee also encourages
NINDS to submit an update of its progress on implementing these
recommendations in the fiscal year 2021 Congressional
Justification.
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.
Stroke.--Due in large part to NIH-funded research, the
stroke mortality rate has decreased by 71 percent since 1969.
Despite this remarkable progress, strokes cost Americans $37
billion annually in health care bills and lost productivity at
work. Furthermore, after more than four decades of steep
decline, stroke death rates in the U.S. have recently slowed,
stalled, or reversed among some groups. The Committee
encourages the NINDS to prioritize studies that help develop
interventions to reduce health disparities in stroke and to
advance promising stroke prevention, treatment, and
rehabilitation research, including endovascular therapy and
tele-rehabilitation. The Committee also urges continued
collaboration with the other Institutes and Centers on research
related to vascular contributions to cognitive impairment and
dementia.
Traumatic Brain Injury.--The Committee understands that
regenerative medicine, including the use of adult stem cells
and neuroplasticity may play an important role in developing
treatment of Traumatic Brain Injury (TBI). The Committee
strongly encourages NINDS to work with all relevant parts of
NIH, 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,
including research on regenerative medicine and
neuroplasticity. The Committee requests an update in the fiscal
year 2020 Congressional Justification on efforts in these
specific areas of TBI research.
Valosin-Containing Protein Disease.--The Committee
encourages NINDS to support research on the Valosin-Containing
Protein (VCP) gene and the related disorders to develop a
focused patient natural history study.
NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES (NIAID)
Appropriation, fiscal year 2019....................... $5,523,324,000
Budget request, fiscal year 2020...................... 4,754,379,000
Committee Recommendation.............................. 5,808,268,000
Change from enacted level........................... +284,944,000
Change from budget request.......................... +1,053,889,000
Mission.--The NIAID mission is to conduct and support basic
and applied research to better understand, treat, and
ultimately prevent infectious, immunologic, and allergic
diseases.
Universal Influenza Vaccine.--The Committee directs NIAID
to allocate at least $200,000,000 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
requests an update on these efforts within 60 days of enactment
of this Act.
Combating Antibiotic-Resistant Bacteria.--The Committee
includes sufficient funding to maintain NIAID research related
to combating antibiotic-resistant bacteria at no less than the
fiscal year 2019 enacted level. 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.
2020 AIDS Conference.--The Committee recognizes the United
States is hosting the International AIDS Conference for the
first time since 2012. The Committee includes $5,100,000 for
the U.S. contribution to the AIDS2020 Conference.
Centers for AIDS Research.--As part of the domestic HIV
initiative, the Committee includes $51,000,000 for the Centers
for AIDS Research, an increase of $6,000,000 above the
estimated fiscal year 2019 enacted level and the same as the
fiscal year 2020 budget request. These Centers will offer
evidence-based practices on prevention and treatment to
initiative partners and evaluate the initiative.
Autoimmune Disease Coordinating Committee.--The Committee
recognizes the devastating impact of autoimmune diseases on the
lives of some 50 million Americans and the promise of ground-
breaking research underway at NIH to determine underlying
causes of autoimmune disease and emerging evidence of
connectivity to other conditions, such as cancer. The Committee
urges NIH to expand collaborations with internal and external
research experts, professional associations, patient groups,
and other stakeholders to advance current research priorities,
promising areas of inquiry, and opportunities for NIH and the
Coordinating Committee to make progress in autoimmune disease
research.
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 (GBS) and chronic inflammatory
demyelinating polyneuropathy (CIDP). The Committee continues to
encourage both Institutes to continue their work with patient
stakeholders on this important conference.
Celiac Disease.--The Committee encourages NIH to devote
sufficient, focused research to the study of Celiac disease,
including the autoimmune causation underpinning the affliction.
Today, the only known treatment for this disease is a gluten-
free diet; but, recent public and private sector research has
revealed that such a ``treatment'' is insufficient for many who
suffer from Celiac disease. Therefore, the Committee urges
NIAID to support new research to better coordinate existing
research and focus new research efforts toward causation and
ultimately, a cure of this disease. NIAID is encouraged to
coordinate with other Institutes and Centers as appropriate and
to submit its plan for coordination and execution of this
research to the Committee on Appropriations no later than 90
days after enactment of this Act.
Food Allergy Research.--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
clinical sites for this critical research, including seven
sites as part of the Consortium of Food Allergy Research
(CoFAR). The Committee urges NIH to support robust investment
to expand its clinical research network to add new centers of
excellence in food allergy clinical care and to select such
centers from those with a proven expertise in food allergy
research.
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 nine years, and the
drug resistance to multiple classes of antibiotics. The
Committee commends NIAID for its efforts in developing new
antibiotics to kill the bacterium that causes this disease and
encourages NIAID to continue its work in this area for
diagnosis, treatments, and cures for this STI.
Hereditary Angioedema.--The Committee recognizes NIAID for
its ongoing stewardship of the Hereditary Angioedema (HAE)
research portfolio, including advancements that have taken HAE
from a debilitating and fatal condition to a manageable chronic
disease. The Committee notes the potential of gene therapy and
other cutting-edge research to further improve health outcomes
for HAE patients and encourages NIAID to maintain the
commitment to HAE research at this critical time.
HIV Prevention in Women.--The Committee notes that recent
clinical studies have found limited success in the use of PrEP
to prevent HIV infection in women. Effective prevention
strategies for women are essential to curtailing new HIV
infections. The Committee urges NIAID to support research on
the most effective strategies for preventing HIV infections.
Lyme Disease and Other Tick-Borne Diseases.--The Committee
encourages NIAID to intensify research and development on Lyme
and other tick-borne diseases, including research that will
increase understanding of the full range of processes that
cause Lyme disease infection. This should include research on
the physiology of Borrelia burgdorferi and Borrelia mayonii,
including the mechanisms of possible persistent infection,
potential treatment protocols for extended or long-term
symptoms attributed to Lyme and other tick-borne diseases, and
development of more sensitive and accurate diagnostic tests for
Lyme and tick-borne diseases, including next generation
polymerase chain reaction (PCR) and new testing methodologies
such as proteomics and metabolomics. The Committee directs
NIAID to support research on the heightened incidence of Lyme
Disease and vector-borne diseases due to global warming.
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 to
help end the epidemic.
Post-Infectious Neuroimmune Disorders.--The Committee is
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 prioritize research efforts in this area and
report to the Committee on the current understanding of
incidence, causes, diagnostic criteria, and treatment of these
conditions and to describe the status of research related to
this area in the fiscal year 2021 Congressional Justification.
Syphilis.--The Committee continues to be concerned about
the increased rates in syphilis, the rise in congenital
syphilis, and the link between syphilis and transmitting HIV.
The Committee commends NIAID for the work in this area and
encourages them to continue and accelerate the development of
screening tests, vaccines for prevention and new treatment
options, for both adults and newborns, to provide a quicker
more efficient way to diagnose and define the stages of this
infection.
Threat of Emerging Infectious Diseases.--The usage of
machine learning, data-driven dynamical modeling, and other big
data techniques, to identify early warning signals for
outbreaks of rare diseases, is an integral part of scientific
research on the ecology and evolution of infectious diseases.
The Committee recognizes the threat of Emerging Infectious
Diseases (EID) from animals and urges NIH to support further
research in disease mapping and forecasting in order to
identify early warning signals for outbreaks of emerging
diseases. The Committee directs NIH to include a progress
report on the use of machine learning and validated mechanistic
models to advance critical biomedical research, improve
decision support for epidemiological interventions, and enhance
human health in the fiscal year 2021 Congressional
Justification.
Tuberculosis.--Tuberculosis (TB) remains one of the
deadliest infectious diseases worldwide. Research has been key
to developing the tools currently available to combat TB, such
as rapid diagnostic testing, medications, and vaccine for some
forms of the disease. However, there is a need for safer and
more effective medications, faster diagnostics, and more
effective vaccines. The Committee commends NIAID for developing
the NIAID Strategic Plan for Tuberculosis Research and urges
NIAID to expand research to address the research questions
outlined in the Plan and stimulate the development of promising
diagnostics, treatments, and vaccines.
NATIONAL INSTITUTE OF GENERAL MEDICAL SCIENCES (NIGMS)
Appropriation, fiscal year 2019....................... $2,872,780,000
Budget request, fiscal year 2020...................... 2,472,838,000
Committee Recommendation.............................. 3,033,183,000
Change from enacted level........................... +160,403,000
Change from budget request.......................... +560,345,000
Mission.--NIGMS supports basic research that increases our
understanding of biological processes and lays the foundation
for advances in disease diagnosis, treatment, and prevention.
Institutional Development Awards.--The Committee provides
$381,573,000 for the Institutional Development Awards (IDeA)
program, an increase of $20,000,000 above the fiscal year 2019
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.
EUNICE KENNEDY SHRIVER NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN
DEVELOPMENT (NICHD)
Appropriation, fiscal year 2019....................... $1,506,458,000
Budget request, fiscal year 2020...................... 1,296,732,000
Committee Recommendation.............................. 1,580,084,000
Change from enacted level........................... +73,626,000
Change from budget request.......................... +283,352,000
Mission.--NICHD investigates human development throughout
the entire life process, with a focus on understanding
disabilities and important events that occur during pregnancy.
Congenital Syphilis.--The Committee is concerned about the
rise of congenital syphilis and the lifelong health effects the
disease can have on a child, as well as the link between
syphilis, and other STIs, and the rise in injection drug use.
The Committee encourages NICHD to prioritize research in this
area and to work with NIAID on new testing, diagnosis, and
treatment efforts.
Endometriosis.--The Committee is aware that endometriosis
is a serious chronic condition that impacts an estimated one in
10 women in the U.S. between the ages of 18 and 49. Women with
this condition can suffer up to 10 years before being properly
diagnosed, often due to lack of awareness, invasive methods of
diagnosis, and limited treatment options. The Committee directs
NICHD to submit a report to the Committee within 180 days of
enactment of this Act on the current state of endometriosis,
including topics such as disease prevalence, an evaluation of
diagnostic standards, treatment options, and outcomes. The
report should also identify remaining knowledge gaps in
understanding this disease and recommendations for filling
these gaps. Further, the Committee encourages NICHD, in
collaboration with the CDC, to continue to support education,
outreach, and awareness to promote early and accurate diagnosis
of endometriosis.
Fertility Issues for Rare Disease Patients.--Patients with
rare diseases like thalassemia face a number of issues related
to reproductive health due to complications both from their
conditions and from their treatments. Because of medical
advances, many rare disease patients are now living long enough
to contemplate fertility, when it may previously not have been
feasible. The Committee requests that NICHD provide an report
on current research and future initiatives to address these
issues in the fiscal year 2021 Congressional Justification and
continue to provide updates to the Committee on advances being
made.
Male Reproductive Health.--The Committee encourages NICHD
to support research on male mechanisms of infertility. There is
a gap in the knowledge of how to diagnose and treat male
infertility and abnormal embryo development. The Committee
supports research to identify new proteins and sperm structures
that are necessary for normal sperm formation and,
consequently, for fertility and embryo development
Maternal Mortality.--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
tests evidence-based interventions to address this disparity.
NICHD should collaborate with NIMHD as appropriate.
Maternal-Fetal Medicine Units Network.--NICHD's investment
in maternal and child health outcomes is essential to
understanding rising maternal mortality rates and to optimize
maternal and child health. The Committee fully supports the
work of the Maternal Fetal Medicine Units network (MFMU) and
encourages NICHD to continue to build on its success by
ensuring its highly efficient structure of multicenter
collaborative research continues. The Committee is particularly
concerned that any change in the funding mechanism or structure
for the MFMU could compromise the ability of the network to
remain nimble and directly address the changing landscape of
women's health, including to reduce health disparities. The
Committee directs NICHD to submit a report to the Committee
outlining any potential changes being considered to the funding
mechanism or structure of the MFMU network within 90 days of
enactment of this Act.
Population Research.--Since the Institute's inception in
1962, NICHD has had a clear mandate to support a robust
research portfolio focusing on maternal and child health, the
social determinants of health, and human development across the
lifespan. NICHD has supported innovative and influential
population science initiatives, including numerous scientific
research initiatives that have advanced our understanding of
specific diseases and conditions, including obesity, autism,
and maternal mortality, and, further, how socioeconomic and
biological factors jointly determine human health. The
Committee urges NICHD to reaffirm its commitment to supporting
population research as part of its revised 2020-2024 strategic
plan.
Spina Bifida.--The Committee recognizes that Spina Bifida
is the most common permanently disabling birth defect in the
U.S. While Spina Bifida and related neural tube defects are
sometimes preventable through education and adequate daily
folic acid consumption, there are an estimated 166,000
individuals, more than half of whom are 18 and older, living
with all forms of this complex birth defect. The Committee
supports the efforts of the National Spina Bifida Program
(NSBP) to continue 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. The
Committee encourages NIH to expand the National Spina Bifida
Patient Registry to allow for the inclusion of more clinics.
Task Force on Research in Pregnant and Lactating Women.--
The Committee is aware that PRGLAC's report to the Secretary
dated September 2018 outlined 15 recommendations to facilitate
the inclusion of pregnant women and lactating women in clinical
research, and commends the Secretary for extending the task
force for two additional years. The Committee believes with
this extension, the Task Force should oversee the
implementation of the already released recommendations working
with other relevant NIH Institutes and Centers as well as the
FDA; and should ensure health care professionals and consumers
have accurate information on the safety and efficacy of drugs
taken by these populations. The Committee looks forward to
reviewing future recommendations from the task force and to
working with NICHD on this issue. The Committee requests a
progress report within 120 days of enactment of this Act.
NATIONAL EYE INSTITUTE (NEI)
Appropriation, fiscal year 2019....................... $796,536,000
Budget request, fiscal year 2020...................... 685,644,000
Committee Recommendation.............................. 835,465,000
Change from enacted level........................... +38,929,000
Change from budget request.......................... +149,821,000
Mission.--NEI conducts and supports basic and clinical
research, research training, and other programs with respect to
blinding eye diseases, visual disorders, and mechanisms of
visual function, preservation of sight, and the special health
problems and needs of individuals who are visually-impaired or
blind.
Blepharospasm.--The Committee continues to encourage NEI to
pursue collaboration with stakeholders on cross-cutting
research opportunities that affect all forms of dystonia,
including blepharospasm.
Human Ocular Tissue Availability.--The Committee encourages
NEI to work with nonprofit eye banks to find solutions to
provide high quality, low cost human ocular tissue to
universities and other nonprofit research institutions.
NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES (NIEHS)
Appropriation, fiscal year 2019....................... $774,707,000
Budget request, fiscal year 2020...................... 666,854,000
Committee Recommendation.............................. 812,570,000
Change from enacted level........................... +37,863,000
Change from budget request.......................... +145,716,000
Mission.--NIEHS's mission is to discover how the
environment affects people in order to promote healthier lives.
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.
NATIONAL INSTITUTE ON AGING (NIA)
Appropriation, fiscal year 2019....................... $3,083,410,000
Budget request, fiscal year 2020...................... 2,654,144,000
Committee Recommendation.............................. 3,286,107,000
Change from enacted level........................... +202,697,000
Change from budget request.......................... +631,963,000
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 $2,392,000,000 for Alzheimer's disease research, as
recommended in the NIH Bypass Budget Proposal for Fiscal Year
2020. NIA should continue to address the research goals set
forth in the National Plan to Address Alzheimer's disease, as
well as the recommendations from recent research summits on
Alzheimer's disease and related dementias and care and services
for individuals living with these conditions.
The Committee commends NIA for its leadership in supporting
longitudinal, population-based cohort studies into the causes
of dementia. Because rural, poor, and minority populations may
be at enhanced risk for dementia, the value and application of
these studies is enhanced when they include individuals from
various geographic, ethnic, socio-economic and generational
backgrounds. The Committee directs NIA to support diversity in
its cohort studies, with the specific goal of better
understanding disease burden and biomarkers by race and
geographic region. The Committee believes this could be
accomplished through enhanced partnerships between existing
NIA-funded Alzheimer's Disease Research Centers (ADRC) and non-
ADRC dementia centers in high-risk geographic regions or
through the creation of new long-term cohorts in under-
represented groups/regions.
The Committee also recognizes that as participants in these
studies have aged, much has been learned about cognitive
decline and the role of mid-life risk factors, but key
challenges remain, particularly in the identification of
biomarkers and in understanding the role of environmental
versus genetic factors. The Committee encourages NIA to support
a pilot program to test community-based clinical trials for the
prevention of cognitive decline. Such a longitudinal study
should include an ethnically representative sample, incorporate
genomic and environmental Alzheimer's disease risk factors, and
monitor cognitive and motor function, disability, and morbidity
over time.
Population Research.--The Committee applauds NIA for
supporting an innovative and productive population aging
research portfolio. The Committee urges NIA to pursue its plans
to renew and expand the Demography and Economics of Aging
Centers Program and to reaffirm the Institute's commitment to
supporting population aging research overall as part of its
revised strategic directions document, Aging Well in the 21st
Century: Strategic Directions for Research on Aging.
NATIONAL INSTITUTE OF ARTHRITIS AND MUSCULOSKELETAL AND SKIN DISEASES
(NIAMS)
Appropriation, fiscal year 2019....................... $605,065,000
Budget request, fiscal year 2020...................... 520,829,000
Committee Recommendation.............................. 634,637,000
Change from enacted level........................... +29,572,000
Change from budget request.......................... +113,808,000
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 Areata.--The Committee notes NIAMS leadership is
continuing autoimmune research to advance treatment development
for alopecia areata and related conditions. The Committee
requests an update from NIAMS on developments from cross-
cutting autoimmune research projects in the fiscal year 2021
Congressional Justification.
Epidermolysis Bullosa.--The Committee continues to
recognize promising scientific gains and applauds private
partners advancing research in pursuit of treatments for
Epidermolysis Bullosa. The Committee encourages NIH to continue
supporting research for Epidermolysis Bullosa.
Scleroderma.--The Committee notes the work of NIAMS and
other stakeholders in the recent discovery of the biomarker
CCL2 that can lead to early detection of scleroderma. The
Committee continues to encourage NIAMS to support the
scleroderma research portfolio and continue collaborative
opportunities with other Institutes and community stakeholders
to advance critical research.
NATIONAL INSTITUTE ON DEAFNESS AND OTHER COMMUNICATION DISORDERS
(NIDCD)
Appropriation, fiscal year 2019....................... $474,404,000
Budget request, fiscal year 2020...................... 408,358,000
Committee Recommendation.............................. 497,590,000
Change from enacted level........................... +23,186,000
Change from budget request.......................... +89,232,000
Mission.--NIDCD conducts and supports biomedical and
behavioral research and research training in the normal and
disordered processes of hearing, balance, taste, smell, voice,
speech, and language. NIDCD also conducts and supports research
and research training related to disease prevention and health
promotion; addresses special biomedical and behavioral problems
associated with people who have communication impairments or
disorders; and supports efforts to create devices which
substitute for lost and impaired sensory and communication
function.
Spasmodic Dysphonia.--The Committee continues to encourage
NIDCD to work with stakeholders to advance critical research
into spasmodic dysphonia.
NATIONAL INSTITUTE OF NURSING RESEARCH (NINR)
Appropriation, fiscal year 2019....................... $162,992,000
Budget request, fiscal year 2020...................... 140,301,000
Committee Recommendation.............................. 170,958,000
Change from enacted level........................... +7,966,000
Change from budget request.......................... +30,657,000
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 2019....................... $525,591,000
Budget request, fiscal year 2020...................... 452,419,000
Committee Recommendation.............................. 551,278,000
Change from enacted level........................... +25,687,000
Change from budget request.......................... +98,859,000
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 2019....................... $1,419,844,000
Budget request, fiscal year 2020...................... 1,296,379,000
Committee Recommendation.............................. 1,489,237,000
Change from enacted level........................... +69,393,000
Change from budget request.......................... +192,858,000
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.
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 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
2019 enacted level of $250,000,000 within NIDA for this
research.
The Committee continues to be extremely concerned about the
crisis of prescription opioids, heroin, and illicit synthetic
opioid use, addiction and overdose in the U.S. Approximately
192 people die each day in this country from drug overdose
(over 130 of those are directly from opioids). 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. The Committee encourages NIDA
to emphasize: the development of safe and effective
medications, including new formulations and combinations to
treat opioid use disorders and to prevent and reverse overdose;
the role of comprehensive care models to prevent opioid misuse,
expand treatment capacity, enhance access to overdose reversal
medications, and enhance prescriber practice; testing the
effectiveness of medications and other treatment interventions
within the justice system; and developing evidence-based
strategies to integrate screening and treatment for opioid use
disorders in emergency department and primary care settings.
Addressing the Opioid Crisis in Rural Regions.--The
Committee encourages NIDA to continue its partnership with the
CDC, SAMHSA, and the Appalachian Regional Commission in support
of research to help communities develop comprehensive
approaches to prevent and treat consequences of opioid
injection, including substance use disorders, overdose, HIV,
hepatitis B and C virus infections, and sexually transmitted
infections. These projects will serve as models for addressing
the consequences associated with opioid injection epidemics
that can be implemented by health systems in similar rural
communities in the U.S.
Barriers to Research.--The Committee is concerned that
restrictions associated with Schedule I of the Controlled
Substance Act effectively limit the amount and type of research
that can be conducted on certain Schedule I drugs, especially
marijuana or its component chemicals and new synthetic drugs
and analogs. At a time when we need as much information as
possible about these drugs to find antidotes for their harmful
effects, we should be lowering regulatory and other barriers to
conducting this research. The Committee directs NIDA to provide
a short report on the barriers to research that result from the
classification of drugs and compounds as Schedule I substances.
Electronic Cigarettes.--The Committee understands that
electronic cigarettes (e-cigarettes) and other vaporizing
equipment are increasingly popular among adolescents, and
requests that NIDA fund 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.
The HEALthy Brain and Child Development Study.--The
Committee recognizes and supports the NIH HEALthy Brain and
Child Development (HEALthy BCD) Study, which will establish a
large cohort of pregnant women, including those 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
HEALthy BCD Study is supported in part by the 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.
Housing Supports and Substance Use Disorder Treatment
Outcomes and Costs.--The Committee acknowledges that there is
growing anecdotal evidence to suggest a strong correlation
between successful substance use disorder treatment outcomes
and stable housing arrangements, especially for those facing
mental health challenges or of limited economic means. The
Committee strongly encourages NIDA to support a
multidisciplinary academic research partnership using clinical
expertise and cost function analysis (CFA) to assess how
affordable housing impacts substance use disorder treatment
outcomes and costs in acutely affected regions like New England
where, according to the Federal Reserve Bank of Boston, each
state in the six-state region spends more per capita on opioid
related costs including criminal justice, medical treatment,
and medical complications, and where treating opioid use
disorder on an emergency and long-term basis comprises the
majority of costs.
Kratom.--The Committee requests that NIH expand research on
all health impacts of kratom, including its constituent
compounds, mitragynine, and 7-hydroxymitragynine. The Committee
is aware of the potential promising results of kratom for acute
and chronic pain patients who seek safer alternatives to
sometimes dangerously addictive and potentially deadly
prescription opioids.
Marijuana Research.--The Committee is concerned that
marijuana public policies in States (medical marijuana,
recreational use, etc.) are being changed without the benefit
of scientific research to help guide those decisions. The
Committee encourages NIH 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.
Raising Awareness and Engaging the Medical Community in
Drug Abuse and Addiction Prevention and Treatment.--The
Committee notes that education is a critical component of any
effort to curb drug use and addiction, and it must target every
segment of society, including healthcare providers (doctors,
nurses, dentists, and pharmacists), patients, and families.
Medical professionals must be in the forefront of efforts to
curb the opioid crisis. The Committee continues to be pleased
with the NIDAMED initiative, targeting physicians-in-training,
including medical students and resident physicians in primary
care specialties (e.g., internal medicine, family practice, and
pediatrics). The Committee encourages NIDA to continue its
efforts in this space, providing physicians and other medical
professionals with the tools and skills needed to incorporate
substance misuse and addiction screening and treatment into
their clinical practices. The Committee encourages NIDA and CDC
to develop strategies for increasing participation in its
online continuing medical education course on safe prescribing
for pain and managing patients who misuse prescription opioids.
The Committee also encourages NIDA and CDC to develop
strategies for increasing participation in its online
continuing medical education courses on safe prescribing for
pain and managing patients who abuse prescription opioids.
NATIONAL INSTITUTE OF MENTAL HEALTH (NIMH)
Appropriation, fiscal year 2019....................... $1,870,296,000
Budget request, fiscal year 2020...................... 1,630,442,000
Committee Recommendation.............................. 1,961,704,000
Change from enacted level........................... +91,408,000
Change from budget request.......................... +331,262,000
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.
Computational Medicine and RNA Molecules.--The Committee is
encouraged by recent advances in computational medicine that
are helping scientists understand what causes disease and how
disease progresses. One such example is new evidence about how
a person's sex, race, ethnicity, and geographic origin affect
the individual's regulatory RNA molecules and the proteins that
these molecules control. More research on these links could
uncover new and important biological discoveries, improve our
understanding of disease processes and herald highly
personalized approaches to diagnosis, prognosis and therapy.
The Committee urges NHGRI to support additional research on RNA
molecules and the mechanisms through which they affect
biological processes that cause disease.
BRAIN Initiative.--The Committee directs NIH to transfer
$70,000,000 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.
Disproportionate Suicides by Youth of Color.--The Committee
is pleased with NIMH efforts to prioritize suicide prevention
research. The Committee notes that the rate of suicide has
increased by 2 percent each year since 2006, and that suicide
is the second leading cause of death among children ages 10 to
17. The Committee is especially concerned with recent findings
that African-American children ages 5 to 12 are dying by
suicide at nearly twice the rate of their white counterparts.
Accordingly, the Committee encourages NIMH to continue its
support of research to address youth suicide, with a focus on
addressing the disparity in youth of color. NIMH should
collaborate with other NIH institutes, including NIMHD, as
appropriate.
NATIONAL HUMAN GENOME RESEARCH INSTITUTE (NHGRI)
Appropriation, fiscal year 2019....................... $575,579,000
Budget request, fiscal year 2020...................... 495,448,000
Committee Recommendation.............................. 603,710,000
Change from enacted level........................... +28,131,000
Change from budget request.......................... +108,262,000
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 includes $10,000,000 for a new competitively awarded
center-based award program for ``Emerging Centers of
Excellence''. The purpose of the awards is to build capacity at
institutions that are not prior or present awardees of the
Centers for Excellence in Genomic Sciences program. The
Committee 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 2019....................... $389,464,000
Budget request, fiscal year 2020...................... 335,986,000
Committee Recommendation.............................. 408,498,000
Change from enacted level........................... +19,034,000
Change from budget request.......................... +72,512,000
Mission.--The NIBIB mission is to improve health by leading
the development and accelerating the application of biomedical
technologies.
NATIONAL INSTITUTE ON MINORITY HEALTH AND HEALTH DISPARITIES (NIMHD)
Appropriation, fiscal year 2019....................... $314,679,000
Budget request, fiscal year 2020...................... 270,870,000
Committee Recommendation.............................. 341,244,000
Change from enacted level........................... +26,565,000
Change from budget request.......................... +70,374,000
Mission.--NIMHD's mission is to lead scientific research to
improve minority health and reduce health disparities.
Research Centers at Minority Institutions.--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. Therefore, the Committee includes $75,000,000, an
increase of $11,186,000, for RCMIs to ensure that critical
capacity development in historically minority graduate and
health professional schools continues to be enhanced to meet
these critical needs. In addition, the Committee recognizes the
importance of the RCMI Translational Research Network in
ensuring that collectively, institutions can engage in multi-
site collaborative research.
Research Endowment Program.--The Committee is concerned by
NIMHD's lack of engagement with stakeholders and the broader
community regarding Research Endowment Program (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 NIMHD issuing its next FOA for REP.
Focal Segmental Glomerulosclerosis.--The Committee
encourages NIMHD to collaborate with other Institutes and
Centers and stakeholders to expand research opportunities on
the APOL1 gene that causes African-Americans to be
disproportionately affected by focal segmental
glomerulosclerosis.
Interdisciplinary Rural African-American Aging Research.--
Although racial and rural disparities in health have been well-
documented, there remain major gaps in our understanding of how
psycho-social stressors, particularly those salient and unique
to the experiences of rural African-Americans, contribute to
multi-system aging across biological systems. The committee
urges NIMHD to work with extramural partners to develop the
infrastructure needed for conducting interdisciplinary aging
epidemiologic studies in rural contexts despite the above
challenges. The committee encourages NIMHD to prioritize
efforts focused on establishing partnerships with rural
stakeholders and service providers; implementing a multistage
probability sampling design for rural populations, and creating
a sophisticated recruitment and project management and database
system; and conducting research involving collection of
biological and physiological aging measures, specifically in
rural areas through the application of novel methods to collect
biospecimens in participants' homes.
Maximizing Access to Research Careers.--The Committee
recognizes the importance of the Maximizing Access to Research
Centers (MARC) program and encourages the continuation and
enhancement of efforts underway with our nation's historically
black colleges and universities (HBCUs). The Committee also
recognizes the important work of those HBCUs located in rural
parts of the U.S., particularly the Black Belt region in
educating significant numbers of underserved students in STEM
fields, and it encourages the NIH to continue and strengthen
its engagement of institutions located in this region.
NATIONAL CENTER FOR COMPLEMENTARY AND INTEGRATIVE HEALTH (NCCIH)
Appropriation, fiscal year 2019....................... $146,473,000
Budget request, fiscal year 2020...................... 126,081,000
Committee Recommendation.............................. 153,632,000
Change from enacted level........................... +7,159,000
Change from budget request.......................... +27,551,000
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 2019....................... $806,373,000
Budget request, fiscal year 2020...................... 694,112,000
Committee Recommendation.............................. 845,783,000
Change from enacted level........................... +39,410,000
Change from budget request.......................... +151,671,000
Mission.--NCATS was established to transform the
translational process so that new treatments and cures for
disease can be delivered to patients faster.
Clinical and Translational Science Awards.--The Committee
expects NIH to fund Clinical and Translational Science Awards
at not less than the level provided in fiscal year 2018.
JOHN E. FOGARTY INTERNATIONAL CENTER (FIC)
Appropriation, fiscal year 2019....................... $78,109,000
Budget request, fiscal year 2020...................... 67,235,000
Committee Recommendation.............................. 84,926,000
Change from enacted level........................... +6,817,000
Change from budget request.......................... +17,691,000
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.
NATIONAL LIBRARY OF MEDICINE (NLM)
Appropriation, fiscal year 2019....................... $441,997,000
Budget request, fiscal year 2020...................... 380,463,000
Committee Recommendation.............................. 463,599,000
Change from enacted level........................... +21,602,000
Change from budget request.......................... +83,136,000
Mission.--The NLM collects and organizes information
important to biomedicine; serves as a national information
resource for medical education, research, and health service
activities; enhances access to biomedical literature through
electronic services; serves the public by providing electronic
access to reliable health information for consumers; supports
and directs the national network of libraries of medicine;
provides grants for research in biomedical communications,
medical library development, and training health information
specialists; conducts and supports research in biomedical
informatics and computational biology; and creates information
resources for genomics, molecular biology, toxicology, medical
images, environmental health, emergency preparedness and
response, and health services research.
OFFICE OF THE DIRECTOR (OD)
Appropriation, fiscal year 2019....................... $1,909,075,000
Budget request, fiscal year 2020...................... 1,756,544,000
Committee Recommendation.............................. 2,049,992,000
Change from enacted level........................... +140,917,000
Change from budget request.......................... +293,448,000
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.
All of Us Program.--The Committee provides a total of
$500,000,000 for the All of Us precision medicine initiative,
an increase of $124,000,000 above the fiscal year 2019 enacted
level.
The Committee recognizes the importance of including
populations historically underrepresented in biomedical
research in the All of Us research program, a key component of
the precision medicine initiative. By ensuring meaningful and
broad inclusion, the program ensures more equitable benefit
from future medical discoveries using All of Us data, including
those in the field of cancer research. The Committee directs
NIH to continue its efforts to recruit and retain participants
from these historically underrepresented populations so that
the All of Us scientific resources reflect the rich diversity
of our country.
Biomedical Research Facilities.--The Committee includes
$25,000,000 for grants or contracts to public and not-for-
profit entities to expand, remodel, renovate, or alter existing
research facilities or construct new research facilities as
authorized under 42 U.S.C. section 283k.
We also support the Director's efforts to ensure geographic
and institutional diversity of the grant program through the
Institutions of Emerging Excellence, and direct NIH to allocate
no less than 25 percent of funding for this program to these
institutions.
Common Fund.--The Committee recommends $617,761,000 for the
Common Fund (CF), and an additional $12,600,000 provided to
support the Gabriella Miller Kids First Research Act for the
sixth year of the ten-year Pediatric Research Initiative. NIH
is expected to continue the longstanding CF policy for projects
to be short-term, high-impact awards, with no projects
receiving funding for more than ten years.
Environmental Influences on Child Health Outcomes.--The
Committee includes no less than the fiscal year 2019 enacted
level for the Environmental Influences on Child Health Outcomes
(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 to the program's
progress toward goals, milestones, and projected funding
estimates with both external stakeholders and Congress.
Regenerative Medicine.--The Committee provides $8,000,000
for regenerative medicine activities authorized in the 21st
Century Cures Act.
Regenerative medicine and tissue engineering are emerging
disciplines that aim to revolutionize the treatment of disease
by providing cures rather than treating symptoms. Approaches
include the use of Induced Pluripotent Stem Cell technology,
derived from adult skin cells, to provide limitless supplies of
cells for transplant therapy and disease modeling as well as
bioengineering and tissue engineering to generate replacement
tissues and organs. The Committee encourages NIH to support
research into the fields of regenerative medicine and tissue
engineering.
Advisory Committees.--The Committee is concerned that
despite the legal requirement that all NIH advisory councils
have at least two representatives from the fields of public
health and the behavioral or social sciences, recent reviews of
the membership of advisory councils reveal that not all
Institutes and Centers are in compliance with this requirement.
The Committee urges compliance with this statute and requests a
report on the fields of public health and behavioral and social
sciences that are represented on each advisory committee.
Biorepository Catalog.--The Committee is encouraged by
efforts within the medical 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 directs NIH to partner with one or more research
institutions to implement innovative approaches for improving
the discoverability of biorepositories for tissues and
associated data for cardiovascular diseases, neurodegenerative
diseases, and cancer. The Committee expects NIH, along with the
sponsoring research institution or institutions, to establish
protocols for the release of tissues and associated data from
such biorepositories.
Harassment Policies.--The Committee recognizes that recent
events make clear that harassment occurs in all workplaces,
including science and medicine, and that changing the culture
that fosters sexual harassment will require sustained
commitment and resources. The National Academies of Sciences,
Engineering, and Medicine report released last year found that
sexual harassment is rampant in the labs and institutions
supported by NIH and American taxpayers. The Committee commends
NIH for taking steps to remind institutions of the agency's
expectation that they implement and enforce policies for
reporting sexual harassment and notify NIH when key personnel
named on an NIH grant award have been removed because of sexual
harassment concerns. However, as the funder of the vast
majority of biomedical research conducted in the U.S., the
Committee believes NIH must play a more active role in changing
the culture that has long perpetuated the problem. The
Committee directs NIH to require institutions not just to
notify the agency when key personnel named on an NIH grant
award are removed because of sexual harassment concerns, but
also when they are placed on administrative leave for such
concerns, and to submit to the Committee plans to implement
measures that attend to harassment in extramural settings with
the same level of attention and resources as those devoted to
other research misconduct. The Committee also directs NIH to
support research in the areas identified in the Report,
including the psychology underlying harassment and the
experiences and outcomes of diverse groups when subjected to
harassment. Additionally, the Committee directs NIH to
collaborate with the National Academies to develop best
practices for developing more diverse and inclusive cultures in
the grantee research environments, including training
individuals in institutions that receive NIH funds to recognize
and address sexual harassment, and evaluating the efficacy of
various sexual harassment training programs.
Mitochondrial Disease.--The Committee is aware that medical
research continues to identify new mitochondrial disorders and
to confirm the central role that mitochondrial dysfunction
plays in a host of major diseases. The Committee urges the
Director to support one or more mitochondrial disease centers
of excellence. The Committee also encourages the Director to
continue supporting and empowering efforts to coordinate this
work, including through the trans-NIH Mitochondrial Disorders
Working Group. The Committee strongly supports continuing the
work of the North American Mitochondrial Disease Consortium
(NAMDC) and the Mitochondrial Disease Sequence Data Resource
(MSeqDR) Consortium, and applauds the work of NINDS to develop
the first set of Common Data Elements (CDEs) for mitochondrial
disease to support further research, including through the
BRAIN Initiative as well as the All of Us and ECHO research
programs.
Needs of Children in NIH-Wide Initiatives.--The Committee
requests an update from the NIH 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, the BRAIN Initiative, and the Cancer
Moonshot. The Committee asks that 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 on the
activities of the Consortium and its plans to better coordinate
pediatric research across the institutes, including identifying
gaps and opportunities for collaboration.
Office of AIDS Research.--The Committee directs NIH to
increase funding for HIV/AIDS research by at least the same
percentage as the increase in NIH overall funding. The
Committee recognizes that OAR's AIDS allocation to each IC is
based on scientific need and opportunity. Therefore, individual
IC AIDS budgets may not each grow at the same rate, but total
AIDS and non-AIDS funding will continue to grow at a comparable
rate.
Office of Behavioral and Social Sciences Research.--The
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 the ICs
cannot fund alone. While the NIH budget has grown in recent
years, OBSSR funding has remained stagnant. Therefore, the
Committee encourages NIH to provide OBSSR funding commensurate
with increases given to the ICs.
Women and Opioid Use Disorder.--Research suggests that
gender differences in opioid use have significant implications
for preventing opioid misuse and treating pain and opioid use
disorder (OUD), For example, women are more likely to be
prescribed opioids for pain, even for chronic conditions such
as headache for which there is little evidence that opioids are
an effective treatment. Some medications for treatment of
addiction are not as effective in women as they are in men, and
vice versa. Additionally, OUD treatment approaches that address
an individual's needs as a caregiver, such as child care and
domestic counseling, have shown improved engagement of women in
treatment. However, much of what is known about substance use
interventions is based on the experiences and concerns of men.
The Committee urges NIH to support research related to women
and OUD, including research that identifies treatment
approaches that may be more effective in women.
Women in Research.--Women represent half of the U.S.
population. As such, conditions and diseases that are specific
to women's health, or those that present differently in women
than men, must be a priority for Federally-funded research. The
Committee encourages the NIH, under the leadership of the
Office of Research on Women's Health and the NICHD, to do the
following: report on the total dollar amount of research
invested in health conditions specific to women over the last
ten years, including but not limited to pregnancy, gynecologic
oncology, and infertility; provide a list of which Institutes
provide the highest amount of funding toward health research on
conditions specific to women; and report on how and whether
funding for research in this area is coordinated across the
NIH. The Committee looks forward to a report from the NIH in
the fiscal year 2020 Congressional Justification.
Multi-Institute Research Issues
Firearm Injury and Mortality Prevention Research.--The
Committee includes at least $25,000,000 to support research on
the prevention of gun violence. Research should focus on
biological, behavioral, and environmental mechanisms that
underlie aggression, as well as prevention of self-directed
violence.
Trisomy 21.--The Committee commends NIH for its support of
the Investigation of Co-Occurring Conditions Across the
Lifespan to Understand Down Syndrome (INCLUDE) Initiative. The
Committee includes no less than $60,000,000 within the Office
of the Director for the INCLUDE Initiative, an increase of
$22,000,000 above the expected fiscal year 2019 funding level.
The Committee expects that this multi-year, trans-NIH research
initiative may yield scientific discoveries that could
significantly improve the health and quality of life of
individuals with Down syndrome as well as millions of typical
individuals.
Amyloidosis.--The Committee encourages NIH to continue its
expansion of research efforts into amyloidosis, a group of rare
diseases characterized by abnormally folded protein deposits in
tissues. Amyloidosis is often fatal, and there is no known
cure. Left untreated, there is an average survival of 15
months. Current methods of treatment are risky and unsuitable
for many patients. The Committee directs NIH to inform the
Committee on the steps taken to increase the understanding of
the causes of amyloidosis and the measures taken to improve the
diagnosis and treatment of this devastating group of diseases
in the fiscal year 2021 Congressional Justification.
Amyotrophic Lateral Sclerosis (compromise language proposed
by NIH).--The Committee directs the NIH Director to facilitate
further efforts involving at a minimum, NINDS and NIA to study
ALS disease mechanisms and identified genes to facilitate the
expeditious development of targeted therapies. These efforts
shall bring together research results that will be available to
academic researchers, nonprofit organizations, and industry
researchers, and will supplement, not supplant, existing NIH-
supported activities for ALS research. The near-term research
opportunity to find a cure is real for ALS. Any such
breakthroughs will have significant benefits for related
neurological conditions including traumatic brain injury (TBI),
Parkinson's, and Alzheimer's. The Committee directs the NIH to
report to the Committee within 180 days of enactment of this
act on progress in furthering these research areas.
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.
Childhood Post-Infectious Neuroimmune Disorders.--The
Committee is 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 the NIH to
prioritize research efforts in this area and report to the
Committee on incidence, causes, diagnostic criteria, and
treatment of these conditions, including ways to further
understanding and improve clinical care.
Chronic Fatigue Syndrome.--The Committee commends the NIH
on its new ME/CFS efforts, including its plans for a 2019
conference on accelerating research into ME/CFS and its
formation of the National Advisory Neurological Disorders and
Stroke (NANDS) Council Working Group. The Committee encourages
NIH to expand ME/CFS efforts such as (1) new ME/CFS disease
specific funding announcements, including those with set-aside
funds, to deliver needed diagnostics and treatments as quickly
as possible, (2) an initiative to reach consensus on the ME/CFS
case definition, and (3) mechanisms to incentivize researchers
to enter the field.
Coordination with the National Endowment for the
Humanities.--The Committee supports interagency collaboration
between NIH and the National Endowment for the Humanities
(NEH). The Committee strongly encourages NIH to engage with NEH
in collaborative funding initiatives that combine research in
health and medical fields with scholarship originating in
humanities disciplines. The Committee recognizes that
integrated research and education should include scientists,
health professionals, and humanists to create opportunities for
new approaches to both research and practice in health care.
Dual Diagnosis Addiction and Mental Health Research.--A
Surgeon General report recently showed that over 40 percent of
Americans with a substance use disorder suffer a dual diagnosis
with comorbid mental illness. Understanding the relationship
between mental illness and addiction is imperative to providing
effective treatment. The Committee encourages NIMH, NIDA, and
other relevant Institutes and Centers as appropriate to support
research on this topic.
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.
Ehlers-Danlos Syndrome.--The Committee encourages NIH to
support research with respect to Ehlers-Danlos Syndrome and
related connective tissue disorders.
Fibrotic Diseases.--The Committee notes recent discoveries
by Institutes concerning fibrotic diseases. The Committee
continues to encourage NIH to work to advance critical fibrotic
disease research.
Food is Medicine.--The Committee recognizes the important
role of nutrition in health outcomes and commends work being
done across integrated care organizations, as coordinated by
NIDDK, to conduct research on Food is Medicine. The Committee
further encourages additional collaboration among the
Institutes on these topics, included but not limited to:
medically-tailored meals, medical nutrition therapy, produce
prescription programs, maternal nutrition, and gut microbial
changes.
Fragile X.--The Committee commends NIH for supporting
research to understand the nature of Fragile X (FX) and its
association with other conditions such as autism. The Committee
encourages NIH to continue to fund at least three FX research
centers, supporting interdisciplinary research in important new
areas. The Committee urges NIH to assure that the FX research
centers program includes clinical and translational research
that directly addresses the needs of affected children and
their families, and that applicants for new centers may propose
clinical trials as part of their research portfolio. Given the
inextricable connection between the FX protein and autism, the
Committee urges the Director and her counterparts at each
institute with Fragile X and autism portfolios to explore ways
to create greater efficiency and synergy among these two
research tracks to accelerate translational research toward a
better understanding of both conditions and to shorten the time
to bring effective treatments for both conditions to market
including the funding for clinical trials for both disorders.
Full Spectrum of Medical Research.--The Committee applauds
NIH efforts to support and advance the full spectrum of medical
research, which ensures breakthroughs in basic science are
translated into therapies and diagnostic tools that benefit
patient care while disseminating cutting-edge information to
the professional community. The Committee notes the importance
of flagship initiatives, including the Clinical and
Translational Science Awards program, to these important
efforts.
Gene-Environment Interactions in Neurodegenerative
Disorders in the Diverse Populations of African-Americans and
Latinos.--In the context of NIH's robust neurological disease
research portfolio, the committee commends the leadership of
the 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 elderly and diverse populations of African
Americans and Latinos. The Committee encourages NIH to
accelerate collaborative research across relevant institutes
and the research community to address the goal of determining
the role of the interaction between environmental exposures to
toxic chemicals 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.
Headache Disorders.--The Committee recognizes that migraine
is the second leading cause of global disability, and that
migraine and other headache disorders are poorly responsive to
opioids, but that these drugs are often inappropriately
prescribed for these diseases. Under the HEAL Initiative, the
NIH has recently issued Funding Opportunity Announcements for
research relevant to all types of pain, including migraine and
headache disorders, and a few specific announcements that focus
specifically on increasing research on back pain and
hemodialysis-related pain. The Committee strongly urges the
Director of NIH to consider a similar focused group of HEAL
Initiative Requests for Applications to fund fundamental,
translational, and clinical research on headache disorders,
including migraine, post-traumatic headache, the trigeminal
autonomic cephalalgias, and intracranial hypo/hypertension.
Hepatitis B.--The Committee commends the Director for
establishing a trans-NIH Hepatitis B Working group to include
representation from NCI, NIAID, NIDDK and NIMHD to coordinate
their research agendas to fund the research necessary to find a
cure for hepatitis B and improve liver cancer outcomes. The
Committee urges the Director to use the Common Fund to support
the integrated trans-NIH research needed to fully address these
conditions. The Committee requests that the Office of the
Director keep the Committee informed on progress of the Trans-
Institute Hepatitis B Working Group and requests a status
report be sent to the Committee within 90 days of enactment of
this bill into law.
Inflammatory Bowel Diseases.--The Committee recognizes that
as many as 3.1 million persons in the U.S. are impacted by
Crohn's disease and ulcerative colitis and is concerned about
the growing prevalence of IBD and other autoimmune diseases and
disorders in the country. The Committee also recognizes that
IBD is a complex, immune-mediated, chronic disease model
relevant to other such disorders, and that multiple research
topics must be explored to understand IBD including
psychosocial issues; health disparities; triggering
environmental factors; the complex interplay between food,
mind-gut, and immune response; and the maternal health of IBD
patients as well as their children. The Committee encourages
NIH to explore these and other research questions with multiple
Institutes and Centers, including NIDDK, NICHD, and NIMHD.
Intramural Non-Human Primate Research.--The Committee has
expressed concern since 2015 about the NIH's intramural use of
nonhuman primates in biomedical research. The Committee is
especially concerned by a nearly 50 percent increase in NIH's
use of nonhuman primates in research involving pain and
distress since fiscal year 2014. The Committee is encouraged,
however, by the NIH's January 2019 letter to Congress
expressing support for the retirement of primates no longer
needed for research. The Committee urges the NIH to accelerate
efforts to reduce and replace the use of nonhuman primates with
alternative research models and directs the NIH to provide a
report to the Committee no later than 180 days after enactment
that includes: (1) an overview of current NIH nonhuman primate
use, including a table with summaries of all active projects,
USDA pain categories, and their cost; (2) a detailed
explanation of current NIH efforts to reduce and replace the
use of primates in research with alternative methods; (3) an
assessment of existing research technology not already in use
by NIH to reduce and replace primate research and the
feasibility of employing it to meet current and future research
needs; (4) an assessment of areas where alternatives to primate
research may not yet be available; (5) a detailed strategy and
timeline for the reduction and replacement of NIH primate
research with alternative research methods; and (6) standard
operating procedures for the retirement of nonhuman primates no
longer needed in research to suitable sanctuaries.
Lyme and Other Tick-Borne Diseases.--The Committee
encourages NIH to improve early diagnosis and treatment of Lyme
and other tick-borne diseases (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. In addition to
development of highly sensitive and specific diagnostics for
all stages of disease, a goal should be to develop diagnostics
with appropriate sensitivity and specificity for the detection
of infection. Treatments also should be developed for all
stages of Lyme and other TBD, determining optimal combinations
of new candidate or older drugs and exploring novel
combinations.
The Committee strongly encourages NIH to hold 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.
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.
National Commission on Lymphatic Diseases.--The Committee
applauds the Office of the Director, NHLBI, NIDDK, and NIAID
for facilitating the 2015 Trans-NIH Lymphatics Symposium. The
Committee notes the scientific potential that lymphatics
research has to treat a wide variety of severe diseases,
including heart disease, AIDS, diabetes, rheumatoid arthritis,
Alzheimer's, and cancer. The Committee recommends continuing
and extending the efforts of the trans-NIH Coordinating
Committee for Lymphatic Research, with participation from other
relevant institutes, to explore scientific directions that
might expand and advance research in this field.
National Laboratories.--Collaborative research efforts
between the NIH and the Department of Energy (DOE) are pushing
the boundaries in health research, including drug discovery,
brain research and other biomedical research areas. The
Committee encourages NIH to expand its relationships with DOE
and the National Laboratories to work together more closely and
in more strategic ways to leverage DOE's research capabilities,
including instrumentation, materials, modeling and simulation,
and data science, which will support application in many areas
of biomedical research. Not later than 180 days after enactment
of this Act, NIH shall provide to the Committee a report on
successful NIH-DOE collaborations to date.
Neurofibromatosis.--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
significant 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 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. NFl 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.
Pediatric Physician-Scientist Workforce.--The Committee is
concerned about the challenges in attracting and retaining
researchers, particularly physician-scientists, to careers in
pediatrics and the impact these challenges will have on the
pace of innovation and discovery. The Committee directs NIH to
build upon the formation of the Trans-NIH Pediatric Research
Consortium (N-PeRC) to develop a framework for expanded
pediatric research training that would supplement and not
supplant existing programs, cut across multiple Institutes and
Centers, and focus on supporting individual physician-
scientists who have not yet achieved a level of research
independence so they can be qualified to meet current and
future needs in pediatric research.
Undiagnosed Disease Network.--The Committee continues to
support the work of the Undiagnosed Disease Network (UDN) and
urges the UDN to continue efforts to enhance access to
patients, caregivers, and other stakeholders as well as make
information obtained through the UDL available to other Federal
agencies.
Wound Care Research.--In its fiscal year 2019 Congressional
Justification, NIGMS estimates the direct cost of chronic
wounds to the healthcare system to exceed $50 billion. Patients
with nonhealing wounds are likely to be older adults,
nonambulatory or paralyzed, unable to provide self-care, and/or
suffering from dementia. The committee urges NIH to explore
ways to optimize resources for specific chronic and acute wound
care research at multiple Institutes. The research may include
understanding the development of chronic wounds, including
transition from acute wounds, and on development of treatments
that simultaneously reduce pain, promote healing, and prevent
infection and on methods to diagnose and monitor chronic
wounds. The Committee directs NIH to provide a report to the
Committee summarizing NIH's investments in wound care funding
over the past five years within 90 days of enactment of this
Act.
BUILDINGS AND FACILITIES
Appropriation, fiscal year 2019....................... $200,000,000
Budget request, fiscal year 2020...................... 200,000,000
Committee Recommendation.............................. 200,000,000
Change from enacted level........................... - - -
Change from budget request.......................... - - -
Mission.--This account provides for the design,
construction, improvement, and major repair of clinical,
laboratory, and office buildings and supporting facilities
essential to the mission of the NIH. The funds in this
appropriation support the buildings on the main NIH campus in
Bethesda, Maryland; the Animal Center in Poolesville, Maryland;
the 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 2019....................... $5,742,496,000
Budget request, fiscal year 2020...................... 5,677,600,000
Committee Recommendation.............................. 5,870,996,000
Change from enacted level........................... +128,500,000
Change from budget request.......................... +193,396,000
The Committee recommendation for the Substance Abuse and
Mental Health Services Administration (SAMHSA) program level
includes $5,725,329,000 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.
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 2020.
MENTAL HEALTH
Appropriation, fiscal year 2019....................... $1,558,013,000
Budget request, fiscal year 2020...................... 1,506,086,000
Committee Recommendation.............................. 1,656,013,000
Change from enacted level........................... +98,000,000
Change from budget request.......................... +149,927,000
Within the total provided for Mental Health Programs of
Regional and National Significance, the Committee includes the
following amounts:
------------------------------------------------------------------------
FY 2020
Budget Activity Committee
------------------------------------------------------------------------
Capacity:
Seclusion and Restraint.......................... $1,147,000
Project AWARE.................................... 84,001,000
Mental Health Awareness Training................. 20,963,000
Healthy Transitions.............................. 30,951,000
Improving Mental Health on College Campuses...... 1,000,000
Infant and Early Childhood Mental Health......... 10,000,000
Children and Family Programs..................... 7,229,000
Consumer and Family Network Grants............... 4,954,000
Project LAUNCH................................... 23,605,000
Mental Health System Transformation.............. 3,779,000
Primary and Behavioral Health Care Integration... 49,877,000
National Strategy for Suicide Prevention......... 16,200,000
Zero Suicide................................. 14,000,000
American Indian and Alaska Native Set-Aside.. 2,200,000
Suicide Lifeline................................. 20,000,000
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.................. 20,000,000
Homeless Prevention Programs..................... 30,696,000
Minority AIDS.................................... 9,224,000
Criminal and Juvenile Justice Programs........... 9,269,000
Assisted Outpatient Treatment.................... 15,000,000
Assertive Community Treatment for Individuals 10,000,000
with Serious Mental Illness.....................
Science and Service:
Garrett Lee Smith-Suicide Prevention Resource 5,988,000
Center..........................................
Practice Improvement and Training................ 7,828,000
Consumer and Consumer Support Technical 1,918,000
Assistance Centers..............................
Primary and Behavioral Health Care Integration 1,991,000
Technical Assistance............................
Minority Fellowship Program...................... 10,059,000
Disaster Response................................ 1,953,000
Homelessness..................................... 2,296,000
------------------------------------------------------------------------
Criminal and Juvenile Justice Programs.--The Committee
includes an increase of $5,000,000 to continue to address 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 or substance
use disorder.
Improving Mental Health on College Campuses.--The Committee
includes $1,000,000 to plan, establish, and begin coordinating
and evaluating a targeted public education campaign designed to
increase access to mental health services for students at
institutions of higher education, as well as to reduce the
stigma associated with such services, as authorized by section
9033 of the 21st Century Cures Act (P.L. 114-255).
Infant and Early Childhood Mental Health.--The Committee
includes an increase of $5,000,000 to fund grants in additional
States, which will expand 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.
Minority Fellowship Program.--As Congress seeks to better
address substance abuse and mental health disorders across all
populations, the Committee includes an increase of $2,000,000
in the Minority Fellowship Program in order to improve
prevention, wellness, and treatment across the lifespan. 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 $13,000,000 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. Recent data from the National Survey on
Drug Use and Health indicates that there has been a significant
increase in the number of youth and young adults aged 12 to 25
reporting symptoms of major depression, serious psychological
distress, and suicidal thoughts and actions. 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 youth and young adults. In addition, the
Committee provides an increase of $5,000,000 for 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 are at risk of developing a serious mental health
condition.
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. Given that LGBTQ youth are more
than four times more likely to attempt suicide than their
peers, and that one in five LGBTQ youth and more than one in
three transgender youth report attempting suicide this past
year, SAMHSA must be equipped to provide specialized resources
to this at-risk community. The Committee urges SAMHSA to
provide specific training programs for National Suicide
Prevention Lifeline counselors to increase competency in
serving LGBTQ youth through the utilization of existing
specialized resources. The Committee also urges SAMHSA to
consider the diversion of calls to specialty partners who are
best situated to serve the LGBTQ community. The Committee
includes an increase of $5,000,000 to expand the implementation
of the Zero Suicide model, a comprehensive, multi-setting
approach to suicide prevention in health care systems. The
Committee also includes an increase of $8,000,000 for the
Suicide Life-line to expand support for rapid access at any
time of the day or night to crisis intervention, and when
needed, emergency response. In fiscal year 2018, the Lifeline
answered 18 percent more calls than in the prior fiscal year.
On August 14, 2018, the National Suicide Hotline Improvement
Act (P.L. 115-233) was signed into law, which asked the Federal
Communications Commission and SAMHSA to conduct a study
examining the feasibility of designating a three-digit dialing
code and provide overall recommendations for improving the
National Suicide Prevention Lifeline. SAMHSA has completed
their portion of the study that reveals that the greatest
challenges to the effectiveness of the Lifeline are its
capacity to respond rapidly to the steadily increasing call
volume and uneven coverage among States. A three-digit dialing
code is anticipated to increase call volume, further
exasperating these challenges. To address this issue, the
Committee includes additional resources for the Suicide
Lifeline to be used for grants to build capacity in States with
the highest need. Additionally, the Committee requests that
SAMSHA report in the fiscal year 2021 Congressional Budget
Justification the following: answer rates from each State,
average wait time per State, how the Lifeline Centers are
funded State-by-State, State-based resources per capita, total
amount of funds spent on the suicide prevention lifeline by
State, and how Congress can support the Lifeline's State-based
capacity challenges as demand continues to grow.
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 10 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. The Committee directs SAMHSA to include in the fiscal
year 2021 budget request a detailed table showing at a minimum:
State allotments, the name of the program being implemented,
and a short description of the program.
National Child Traumatic Stress Initiative
The Committee includes $70,887,000, an increase of
$7,000,000, for the National Child Traumatic Stress Initiative.
The National Child Traumatic Stress Initiative continues to be
an extremely valuable resource to improve behavioral health
services and interventions for children and adolescents exposed
to traumatic events. The increase in funding is provided for
new grants to expand support for community-based mental health
clinics through the National Child Traumatic Stress Network,
who develop and promote effective community practices for
children and adolescents exposed to a wide array of traumatic
events.
Children's Mental Health
The Committee includes $130,000,000, an increase of
$5,000,000, 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 $66,635,000, an increase of
$2,000,000 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 $150,000,000 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.
SUBSTANCE ABUSE TREATMENT
Appropriation, fiscal year 2019....................... $3,818,756,000
Budget request, fiscal year 2020...................... 3,787,967,000
Committee Recommendation.............................. 3,842,256,000
Change from enacted level........................... +23,500,000
Change from budget request.......................... +54,289,000
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.
State Opioid Response Grants
The Committee includes $1,500,000,000 for grants to States
to address the opioid crisis, of which $50,000,000 is for
grants to Indian Tribes or tribal organizations. In addition,
the Committee continues the 15 percent set-aside for States
with the highest age-adjusted mortality rate related to opioid
use disorders. Consistent with the objective of Comprehensive
Opioid Recovery Centers, as authorized in section 7121 of the
SUPPORT Act, 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 provided through the State
Opioid Response grants program dramatically improve outcomes
for individuals and generate meaningful outcomes data to
contribute to best practices for substance use disorders.
Within the total provided for Programs of Regional and
National Significance, the Committee recommends the following
amounts:
------------------------------------------------------------------------
Budget Activity FY 2020 Committee
------------------------------------------------------------------------
Capacity:
Opioid Treatment Programs and Regulatory $8,724,000
Activities......................................
Screening, Brief Intervention, Referral to 33,000,000
Treatment.......................................
Budget Authority............................. 31,000,000
PHS Evaluation Funds......................... 2,000,000
Targeted Capacity Expansion-General.............. 100,192,000
Medication-Assisted Treatment................ 89,000,000
Tribal Set-aside......................... 10,000,000
Grants to Prevent Prescription Drug/Opioid 12,000,000
Overdose........................................
First Responder Training......................... 36,000,000
Rural Focus.................................. 18,000,000
Grants to Develop Curricula for DATA Act Waivers. 4,000,000
Pregnant and Postpartum Women.................... 29,931,000
Recovery Community Services Program.............. 2,434,000
Children and Families............................ 29,605,000
Treatment Systems for Homeless................... 38,386,000
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................. 6,000,000
Peer Support Technical Assistance Center......... 2,000,000
Strengthening Community Crisis Response Systems.. 2,500,000
Comprehensive Opioid Recovery Centers............ 10,000,000
Science and Service:
Addiction Technology Transfer Centers............ 9,046,000
Minority Fellowship Program...................... 4,789,000
------------------------------------------------------------------------
Comprehensive Opioid Recovery Centers.--The Committee
includes $10,000,000 to help ensure that people with substance
use disorders can access proper treatment, as authorized by
section 7121 of the SUPPORT Act. 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.
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.
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.
Digital Health.--The Committee appreciates SAMHSA's
dedication to provide science-based, best-practice guidance to
the behavioral health field. In H. Rept. 115-862, the Committee
requested that SAMHSA include an update on its efforts to
update the January 2015 Federal Guidelines for Opioid Treatment
Programs in its fiscal year 2020 Congressional Budget
Justification. This information was not included in the fiscal
year 2020 Congressional Budget Justification, but prescription
digital health technologies are now used to deliver evidence-
based therapeutic interventions to patients to prevent, manage
or treat a medical disorder or disease. Within one year of
enactment of this Act, the Committee directs SAMHSA to provide
a report to Congress that includes a discussion on how
prescription technologies could be used by the behavioral
health field as a tool to combat substance abuse and amplify
mental health services.
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 Develop Curricula for DATA Act Waivers.--The
Committee includes $4,000,000 for this new program, which is
authorized by section 3203 of the SUPPORT for Patients and
Communities Act, to enhance access to substance use disorder
treatment by providing grants to accredited schools of
allopathic or osteopathic medicine and teaching hospitals
located in the U.S. to support the development of curricula.
Grants to Prevent Prescription Drug/Opioid Overdose and
First Responder Training.--The Committee includes $12,000,000
for Grants to Prevent Prescription Drug/Opioid Overdose Related
Deaths. The Committee also includes $36,000,000 for First
Responder Training for Opioid Overdose Reversal Drugs, of which
$18,000,000 is to address the critical needs of the rural
populations.
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.
Peer Support Technical Assistance Center.--The Committee
provides $2,000,000 for the creation of a Peer Support
Technical Assistance Center, as authorized in section 7152 of
the SUPPORT Act. The Center will provide technical assistance
and support to recovery community organizations and peer
support networks, including such assistance and support related
to best practices and data collection.
Pregnant and Postpartum Women.--The Committee provides
$29,931,000 for 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)
authorizes 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 includes an increase of $3,000,000 for a new
effort focused on reducing underage drinking. The Committee
provides this additional funding for grants to pediatric health
care providers in accordance with the specifications outlined
in section 9016 of the 21st Century Cures Act. Training grants
should focus on screening for underage drinking, and opioid and
other drug use.
Strengthening Community Crisis Response Systems.--The
Committee provides $2,500,000 for the creation of a competitive
grant opportunity to support communities for crisis
intervention and prevention, as authorized by section 9007 of
the 21st Century Cures Act.
Targeted Capacity Expansion.--The Committee includes
$100,192,000 for Targeted Capacity Expansion activities. Of
this amount, the Committee includes $89,000,000 for the
Medication-Assisted Treatment for Prescription Drug and Opioid
Addiction program, of which $10,000,000 is 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.
Treatment Systems for Homeless.--The Committee includes
$38,386,000 for the Treatment Systems for Homeless program,
which is an increase of $2,000,000 to expand the Grants for the
Benefit of Homeless Individuals program.
Center for Substance Abuse Treatment
Addiction Treatment Centers.--The Committee encourages all
addiction treatment centers to either offer comprehensive care
for substance use and mental health disorders on site or have a
network in place should they need to refer patients to services
not available in their location. This includes having available
a multidisciplinary staff to provide a range of diagnostic
tools, psychopharmacology, all forms of evidence-based
medication assisted treatment for substance use disorders
(methadone, buprenorphine, vivitrol, and naltrexone),
psychotherapy, contingency management, and recovery supports.
Continuum of Care.--Evidence demonstrates that efforts to
coordinate opioid abuse treatment that promote a continuum of
care model can produce effective results. Successful examples
include the development of ``no wrong door'' treatment models
like scale-up training, availability of peer coaches, and the
use of mobile application technology to enhance access to
services and successful treatment outcomes and support long-
term relapse prevention. SAMHSA is encouraged to work with
State and local grantees to prioritize the implementation of
coordinated continuum of care approaches.
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.
Opioid Treatment.--The Committee is aware that pregnancy
and child birth can present a unique window of opportunity to
assist parents in overcoming addiction to opioids and other
substances. The Committee encourages SAMHSA to support
approaches that consider the needs of infants and mothers
impacted by substance use as a dyad, to enhance treatment
effectiveness, improve treatment outcomes, and reduce relapse
and the number of subsequent substance-impacted pregnancies.
Sober Homes.--The Committee urges SAMHSA to provide
information, training and support for communities dealing with
the opioid addiction crisis. Specifically, to provide
information to local government officials regarding sober home
best practices, providing information and support to State and
local governments on model legislation dealing with effective
oversight of drug treatment facilities, sober homes and
marketing entities, in an effort to protect vulnerable persons
with substance use disorder, and their families, from
fraudulent and abusive practices.
SUBSTANCE ABUSE PREVENTION
Appropriation, fiscal year 2019....................... $205,469,000
Budget request, fiscal year 2020...................... 244,090,000
Committee Recommendation.............................. 212,469,000
Change from enacted level........................... +7,000,000
Change from budget request.......................... -31,621,000
The Committee does not accept the proposal to include
$100,000,000 for the Drug-Free Communities program in SAMHSA's
Substance Abuse Prevention appropriation. The Committee directs
the program to remain in the Office of National Drug Control
Policy.
Within the total provided for Programs of Regional and
National Significance, the Committee provides the following
amounts:
------------------------------------------------------------------------
Budget Activity FY 2020 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......................... 46,205,000
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.................. 20,000,000
Science and Service:
Center for the Application of Prevention 7,493,000
Technologies....................................
Science and Service Program Coordination......... 4,072,000
Minority Fellowship Program...................... 321,000
------------------------------------------------------------------------
Minority AIDS Initiative.--The Committee includes an
increase of $5,000,000 for the Minority AIDS Initiative to
expand efforts for HIV/AIDS prevention, screening, treatment,
education, and outreach to minority communities heavily
impacted by HIV/AIDS though culturally and linguistically
appropriate care and services.
Sober Truth on Preventing Underage Drinking Act (STOP
Act).--The Committee includes an increase of $1,000,000 for the
public service campaign and an increase of $1,000,000 for
community-based coalition enhancement grants. These increases
will strengthen efforts to reduce and prevent underage
drinking.
HEALTH SURVEILLANCE AND PROGRAM SUPPORT
Appropriation, fiscal year 2019....................... $160,258,000
Budget request, fiscal year 2020...................... 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:
------------------------------------------------------------------------
Budget Activity FY 2020 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
------------------------------------------------------------------------
Inpatient Treatment for Mental Health and Substance Abuse
Disorders.--The Committee recognizes that communities across
the nation are experiencing a shortage of psychiatric and
substance abuse treatment capacity to provide acute inpatient
care. According to the Treatment Advocacy Center, communities
should have a capacity of 40 to 60 inpatient beds per 100,000
residents. However, the national average is 11.7 beds per
100,000 residents. Therefore, the Committee directs SAMHSA to
study the impact of the inpatient hospital bed shortage on
mental health and substance abuse treatment and recovery and
provide those findings to the Committee within 90 days of
enactment of this Act.
Agency for Healthcare Research and Quality
HEALTHCARE RESEARCH AND QUALITY
Appropriation, fiscal year 2019....................... $338,000,000
Budget request, fiscal year 2020...................... - - -
Committee Recommendation.............................. 358,217,000
Change from enacted level........................... +20,217,000
Change from budget request.......................... +358,217,000
The Committee includes $358,217,000 in program level
funding for the Agency for Healthcare Research and Quality
(AHRQ), including $339,809,000 in budget authority and
$18,208,000 in transfers available under section 241 of the PHS
Act.
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:
------------------------------------------------------------------------
Budget Activity FY 2020 Committee
------------------------------------------------------------------------
Prevention/Care Management........................... $12,649,000
Health Information Technology (IT)................... 16,500,000
Patient Safety Research.............................. 80,776,000
Health Services Research, Data, and Dissemination.... 105,192,000
Medical Expenditure Panel Survey..................... 71,800,000
Program Management................................... 71,300,000
------------------------------------------------------------------------
Antimicrobial Resistance.--The Committee continues to
provide no less than $10,000,000 for combating antibiotic-
resistant bacteria.
Diagnostic Errors.--Within the Patient Safety portfolio,
the Committee includes no less than $4,000,000 to support
improving diagnosis in medicine, including 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. This is an
increase of $2,000,000 above the fiscal year 2019 enacted
level.
EvidenceNOW Health Extension Regional Offices.--The
Committee supports the work of AHRQ to better serve the health
needs of rural and under-served minorities through such
programs as the Evidence Now network. The Committee encourages
AHRQ to expand its efforts to include additional health
extension program sites connected to public academic health
centers in States with high populations of ethnically under-
served minorities, rural communities, and tribal populations.
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 an additional $3,000,000 for this research and
directs 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.
Understanding the Impact of Prior Authorization.--The
Committee is concerned about the potential adverse impacts the
prior authorization process has on patient health outcomes. The
Committee includes no less than $500,000 for research that
examines whether and to what extent delays in treatment due to
prior authorization negatively impact patient outcomes.
Centers for Medicare and Medicaid Services
GRANTS TO STATES FOR MEDICAID
Appropriation, fiscal year 2019................ $276,236,212,000
Budget request, fiscal year 2020............... 273,188,478,000
Committee Recommendation....................... 273,188,478,000
Change from enacted level.................... -3,047,734,000
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 $137,931,797,000, which was
provided as advance funding for the first quarter of fiscal
year 2020. In addition, the Committee recommends an advance
appropriation of $139,903,075,000 for program costs in the
first quarter of fiscal year 2021.
The Committee continues bill language providing indefinite
budget authority for unanticipated costs in fiscal year 2020.
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 2019................ $378,343,800,000
Budget request, fiscal year 2020............... 410,796,100,000
Committee Recommendation....................... 410,796,100,000
Change from enacted level.................... +32,452,300,000
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 2019....................... $3,669,744,000
Budget request, fiscal year 2020...................... 3,579,427,000
Committee Recommendation.............................. 3,984,744,000
Change from enacted level........................... +315,000,000
Change from budget request.......................... +405,317,000
Research, Demonstration, and Evaluation
The Committee includes $20,054,000 for Research,
Demonstration, and Evaluation, which is the same as the fiscal
year 2019 enacted level and $20,054,000 more than the fiscal
year 2020 budget request.
Program Operations
The Committee includes $2,824,823,000 for Program
Operations, which is $305,000,000 more than the fiscal year
2019 enacted level and $435,121,000 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.
Medicaid Health Home.--The Committee urges the Secretary to
establish standards for qualification as a Medicaid health home
that ensure the requirement to ``coordinate prompt care for
children with medically complex conditions, including access to
pediatric emergency services at all times,'' is not limited to
facilities with an onsite or affiliated emergency department.
The requirement to include access to pediatric emergency
services at all times should include facilities that coordinate
with another entity that provides emergency services.
Adult Vaccinations.--Adults seeking access to and coverage
for vaccines encounter multiple financial hurdles. Addressing
cost-sharing and payment issues with Part D vaccines is
critical to ensuring that Medicare beneficiaries have access to
vaccines that have the potential to prevent serious disease. To
help in addressing current low vaccination rates, the Committee
encourages CMS to find ways for patients to have no-cost access
to Part D vaccines, similar to the coverage of Part B vaccines.
Alternatives to Cardiac Stress Test.--The Committee is
aware of the significant health and cost savings advantages of
new technology for non-invasive diagnosis of coronary arterial
disease (e.g., coronary computed tomography angiography and
associated technologies). These less invasive diagnostic
options have been recognized by private insurers, health
associations, and other health systems as a preferred option
for diagnosing coronary arterial disease. The Committee
strongly encourages CMS to assess the benefits to patient care
and savings to Federal health programs these less invasive
options represent, when determining reimbursement policies. The
Committee requests an update in the fiscal year 2021
Congressional Justification on the diagnostic options available
under CMS-administered health programs for coronary arterial
disease.
Ambulatory Surgical Centers.--The Committee requests an
update on any increased costs to the Medicare program and its
beneficiaries due to the potential migration of procedures from
ambulatory surgical centers (ASCs) to higher cost settings. The
update should examine volume changes over the past ten years
and identify whether there are procedures that are migrating
from ASCs to higher cost settings. The update also should
include any recent changes in the ASC payment system to address
migration of procedures.
Biosimilars.--The Committee is concerned about the
underutilization of lower cost biosimilars, particularly those
in Medicare Part B, and encourages the Administration to
support development and implementation of new policies such as
reducing patient co-pays or creating shared cost savings
programs with healthcare providers that would help to increase
the uptake of biosimilars in the United States. The Committee
encourages CMS to identify the uptake rate for biosimilars in
the Medicare and Medicaid populations.
Birth Centers.--The Committee is concerned that the U.S.
spends significantly more per capita on childbirth than any
other industrialized nation, with costs estimated to be well
over $50 billion annually, and yet despite this investment
continues to rank far 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 was pleased
that the CMMI Strong Start Initiative was created to look at
how three different models of care (Maternity Care Homes,
Centering Group Model Prenatal Care, and Birth Centers) would
impact these outcomes and the costs associated with childbirth.
The Committee notes that findings of this five-year study
showed no differences in cost or outcomes for the Maternity
Care Home model, and some slight cost savings and improved
rates of low birthweight for the Centering model. But the birth
centers, which provided a midwife-led model of holistic care,
showed significant cost savings and improved childbirth
outcomes across all measures. The Committee urges CMS to widely
disseminate these findings to payors and consumers. Since
Medicaid is the primary payor for almost half of all
childbearing women and newborns in this country, the Committee
strongly urges CMS to develop a proposal for how it will
increase access to birth centers and midwives in all state
Medicaid programs, and incentivize this model of care for low-
risk women. The Committee requests a report within 120 days of
enactment of this Act.
BRCA Genetic Testing.--The Committee understands that the
use of pre-treatment interventions, such as screening for
biomarkers or testing through the use of companion diagnostics,
can help healthcare providers select treatment options with a
greater probability of success leading to better outcomes for
patients. The Committee also recognizes that the use of these
interventions can reduce unnecessary costs in the current
health care system by avoiding ineffective treatments and that
awareness of genetic risk factors can encourage preventive care
and early diagnosis. An example is in breast cancer, the most
common cancer among women. Genetic predisposition is
responsible for up to 10 percent of cases of breast cancer. Two
genetic mutations, BRCA1 and BRCA2, have been found to
significantly contribute to the genetic risk of developing
breast cancer. Between 55 percent and 90 percent of women with
a BRCA mutation will develop breast cancer during their
lifetime compared to only 12.5 percent among women in the
general population, and breast cancers related to BRCA
mutations have a higher chance of recurrence and of developing
into triple-negative breast cancer, which is difficult to
treat. The Committee urges CMS to identify ways to expand
access to BRCA genetic testing, especially among the most
vulnerable patient populations; expand eligibility criteria for
testing and screenings; and increase public and health care
provider awareness of the importance of early testing and
companion diagnostics.
Center for Program Integrity.--The Committee applauds CMS's
Center for Program Integrity's efforts to shift from a pay-and-
chase model to one that prioritizes claim review prior to
payment. The time to identify and resolve billing errors and
therefore avoid improper payments is during the claim
adjudication and prior to payments being made. Once a claim is
paid, it is harder to address billing errors and improper
payments. The Committee encourages the Center to explore how it
can leverage effective commercial pre-payment solutions to
rapidly review and adjudicate outlier payments within
Medicare's Inpatient Prospective Payment System.
Central Receiving Facilities.--The Committee is aware there
are Central Receiving Facilities (CRFs), or similarly
designated facilities, receiving mental health patients in
Crisis Stabilization Unit in-patient care, which are not
presently deemed eligible for Medicare Part A reimbursement for
patient psychiatric admissions. The Committee encourages CMMI
to explore the feasibility and cost savings to CMS resulting
from a demonstration project authorizing reimbursements to
full-continuum CRFs with an integrated medical and community-
based service provider, admitting mental health patients where
it is psychiatrically determined that a patient requires more
than one night of hospitalization.
Charitable Assistance.--The Committee remains concerned
with the promulgation of rules restricting the utilization of
charitable assistance to Medigap plans, marketplace plans, and
other forms of coverage, as well as the implementation of
associated barriers to care, most notably out-of-pocket
accumulators. These restrictions are particularly harmful for
patients with rare, chronic, and life-threatening conditions
that have historically relied on charitable assistance as a
necessary safety net to maintain access to life-sustaining
therapies or care. CMS is encouraged to examine efforts to
protect patient access to charitable assistance and rein-in
coverage practices where they harmfully or arbitrarily obstruct
the availability of charitable assistance for patients with
critical circumstances and limited alternatives.
Chief Dental Officer.--The Committee is concerned that the
Chief Dental Officer position at CMS has been vacant since
October 2017. Without a dentist to oversee oral health issues
in Medicare and Medicaid, this vacancy leaves a significant gap
of clinical oral health expertise within CMS. Medicaid provides
oral health services to millions of children, pregnant women,
and adults across the country. The Early Periodic Screening,
Diagnosis and Treatment program requires dental services to be
provided to beneficiaries eligible for the program. The
Children's Health Insurance Program also requires dental
services as part of the benefit package available to children.
A licensed dentist clinician is an invaluable resource to these
programs and the agency's strategy to expand access to oral
health care. The Committee urges CMS to move forward with
filling this vacancy.
Diabetic Retinal Exams.--The Committee recognizes that
diabetic retinopathy remains a major national health challenge.
According to the National Eye Institute within the National
Institutes of Health, early detection and treatment of diabetic
retinopathy can reduce the risk of blindness by 95 percent. The
Committee encourages CMS to update its policy to promote
earlier diagnosis by making diabetic retinal exams more
accessible to diabetic patients in primary care settings,
through the use of digital retinal imaging with remote
specialist interpretation.
Clinical Laboratory Fee Schedule.--The Committee is pleased
that CMS developed and issued a panel pricing policy that
ensures the agency is not paying more for a single clinical
diagnostic laboratory test, or a group of individual clinical
diagnostic tests, than it would for a clinical diagnostic
laboratory testing panel that tests for the same analytic(s).
This new policy was effective January 1, 2019, and the
Committee requests that the agency submit a report no later
than 90 days after enactment of this Act to the Committees on
Appropriations, as well as the authorizing Committees of
jurisdiction, on the status of the implementation of this new
policy and the cost savings to the Medicare program.
Community Participatory Health Dashboard.--The Committee
encourages CMS and CDC to devise a strategy on how to construct
a decision-support tool that includes Geographic Information
System epidemiologic data paired with Medicaid and other health
program claims data that can contribute to community-
participatory health prevention efforts. The strategy could
guide HHS agencies to collaborate to construct a dashboard for
community use to evaluate rates of disease and the associated
costs.
Depression and Precision Medicine.--The Committee
recognizes that millions of Medicare beneficiaries are living
with depression and primary care physicians often treat these
patients, prescribing a significant share of prescription drugs
for depression. The Committee is concerned that current
Medicare policies may interfere with the ability of primary
care physicians to have access to precision medicine tests to
guide the selection of drugs for depression. The Committee
encourages CMS to review and update existing local coverage
policies for genetic testing for depression to ensure Medicare
beneficiaries have coverage for these tests when seen by their
primary care physician.
Dialysis-Related Amyloidosis.--The Committee is concerned
that patients suffering from Dialysis-Related Amyloidosis may
not have access to FDA-approved treatments, including apheresis
treatments administered in the dialysis facility. The Committee
is particularly concerned that CMS has not acted in a timely
manner in assigning an appropriate Medicare benefit category
for such apheresis treatments, following FDA approval in 2015.
The Committee urges CMS to complete its benefit category
analysis and issue a determination as soon as possible. The
Committee directs CMS, in conjunction with FDA, to report to
the Committee within 90 days of enactment of this act, on the
status of CMS's benefit category analysis and expected timeline
for determination.
Disproportionate Share Hospitals.--The Committee is
concerned about the effect Disproportionate Share Hospitals
(DSH) funding cuts will have on providers, patients, and
communities nationwide. The Committee directs CMS to study the
effects of the DSH cuts, under current law, on hospitals
ability to furnish care for those uninsured and underserved,
and to train and retain quality staff.
Drug Pricing Report.--The Committee directs the Secretary
of Health and Human Services to submit a report to the
Committees on Appropriations not later than 120 days after the
date of enactment of this Act regarding price changes of
prescription drugs since 2008. The report should include
comparative prescription drug prices (net of rebates) paid by
the following programs for the 10 most frequently prescribed
drugs and the 10 highest-cost drugs for each of the following:
(1) The Medicare program under part B of title XVIII of the
Social Security Act; (2) The Medicare prescription drug program
under part D of title XVIII of the Social Security Act; (3) The
Medicaid program under title XIX of the Social Security Act;
and (4) The Department of Veterans Affairs. The report should
also provide a breakdown of the comparative prices (net of
rebates) for each of the 10 most frequently prescribed drugs
and the 10 highest-cost drugs between ambulatory settings and
retail settings. In addition, the report should include total
annual costs due to prescription drugs to the Medicare program
under part B of title XVIII of the Social Security Act, the
Medicare prescription drug program under part D of title XVIII
of such Act, and the Medicaid program under title XIX of such
Act. Finally, the report should list the drugs that have been
registered for sale by the Food and Drug Administration (FDA)
in the past five years that have benefited significantly from
government grants or research subsidies in either the pre-
clinical or clinical stages of development, as well as the
price (net of rebates) and total spending in Medicare and
Medicaid for each of those drugs.
Duchenne/Becker ICD10 Code.--The Committee is aware of the
addition of the new ICD10 code for Duchenne/Becker to the CMS
FY 2019 Coding Addenda. The Committee requests an update in the
FY 2021 Congressional Justification regarding the rates of
utilization for the newly established ICD10 code.
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. Extravasations 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 encourages CMS to consider adding required monitoring
of injection quality and submission of reportable
extravasations to the Nuclear Regulatory Commission to its
conditions of participation for nuclear medicine services. The
Committee requests an update on this issue in the fiscal year
2021 Congressional Budget Justification.
GAO Report on Anesthesia Services.--The Committee
recognizes the importance of access to timely and accurate data
on payment rates for medical services. Recently there have been
efforts to examine the difference in Medicare rates and private
payment rates, including by the Medicare Payment Advisory
Commission. The Committee understands, however, access to
necessary data is limited and, therefore, leads to inconclusive
and incomplete findings. As such, the Committee, to the extent
feasible, encourages the Government Accountability Office to
update its July 2007 report entitled, `Medicare Physician
Payments: Medicare and Private Payment Differences for
Anesthesia Services'. In this report, GAO noted the `2004
average Medicare payments for a set of seven anesthesia
services provided by anesthesiologists alone were 67 percent
lower than average private insurance payments in 41 Medicare
payment localities.' In updating this report, GAO should
examine, to the extent feasible, if this payment discrepancy
remains and how payment rates in Medicare and the private
market for anesthesia services have changed since 2004.
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.
Home Visiting Programs.--The Committee recognizes the wide
range of improved outcomes and cost-savings that evidence-based
home visiting programs provide to first-time at-risk mothers
and their children. However, the Committee is concerned that
the lack of clarity on how to use Medicaid dollars alongside
other funding sources has slowed or stopped state action to
effectively leverage Medicaid to support home visiting
services. The Committee directs the Centers for Medicaid and
CHIP Services (CMCS) to build on its 2016 Joint Informational
Bulletin on this topic to clarify how Medicaid dollars can be
blended and braided appropriately to reach eligible families,
and also provide streamlined coverage options for home
visiting. In addition, once CMCS has finalized its November
2018 Medicaid Managed Care rule, the Committee directs CMCS to
update its November 2017 Informational Bulletin on Delivery
System and Provider Payment Initiatives under Medicaid Managed
Care Contracts to explain how states can use the revised
managed care authority to fund evidence-based home visiting
programs.
Hospital Acquired Conditions.--The Committee recognizes
that HHS research has shown that preventable Hospital-Acquired
Conditions (HACs), including pressure ulcers and their
associated complications, kill more than 60,000 hospital
patients per year. October 2017 data from CMS's Office of
Enterprise Data and Analytics identified an alarming 58 percent
increase in pressure ulcer discharges between the first quarter
of 2016 and the first quarter of 2017. The Committee believes
additional efforts to reduce the prevalence of HAIs and their
associated complications through HHS and CMS are necessary to
reduce these events. The Committee supports efforts by CMS to
conduct an evaluation of agency efforts to: (1) monitor the
rising prevalence of HACs; (2) reduce the incidence of HACs and
subsequent Hospital Acquired Infections, including pressure
ulcers; and (3) develop and enact more effective reduction
practices.
Hospital Outpatient Prospective Payment.--The Committee is
concerned about the rule entitled ``Medicare Program: Changes
to Hospital Outpatient Prospective Payment and Ambulatory
Surgical Center Payment Systems and Quality Reporting
Programs'' (83 Fed. Reg. 58818, November 21, 2018) and urges
CMS to reconsider this rule after taking into account harmful
effects to hospitals that are designated as a Sole Community
Hospital, or that are located in a HRSA-designated Health
Professional Shortage Area (HPSA). The Committee requests a
report within 180 days of enactment of this Act detailing the
financial impacts of this rule on these two categories of
hospitals and the impact of the rule on the health provider
workforce within HRSA-designated HPSAs.
Limited Wraparound Coverage.--The Committee strongly urges
CMS to extend the pilot program established by a final
regulation published on March 18, 2015, to allow limited
wraparound benefits, or supplements, to individual health
insurance coverage (or Basic Health Plan coverage). Wraparound
coverage is a specialized offering targeted to help part-time
workers and retirees whose employers or former employers meet
standards of responsibility and have agreed to provide this
supplemental coverage as an option. The Committee recommends
this pilot program be made permanent. The Committee requests a
report within 90 days of enactment of this Act on the status of
the program.
Liquid Oxygen.--The Committee urges the Secretary to
monitor the supplemental liquid oxygen market to evaluate the
impact that policy has on oxygen patients and suppliers and to
ensure appropriate patient access to all modalities of
supplemental oxygen, particularly in the gap years of
competitive bidding, and address any market access problems as
identified.
Malnutrition.--Malnutrition in older adults remains a
serious health problem in the United States. One in two older
adults is either malnourished, or at risk of becoming
malnourished. In addition to the impact on quality of life for
seniors, malnutrition imposes significant burdens on the U.S.
health care system. The annual cost of disease-associated
malnutrition in older Americans is more than $50 billion. And
yet, CMS has declined to include malnutrition quality
measurements in the Hospital Inpatient Quality Reporting
Program. The Committee is 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 strongly urges CMS to include
malnutrition quality measurements in the Hospital Inpatient
Quality Reporting Program.
Medicaid Dental Audits.--The Committee is concerned 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. These
practices deter providers from participation in the program and
negatively affect care to patients. The Committee therefore
directs CMS to instruct contracted auditors to utilize dental
profession clinical guidelines, best practices, and policies of
the American Academy of Pediatric Dentistry and American Dental
Association when conducting dental audits, and require
independent peer-to-peer review. The Committee directs CMS to
report back to the Committee within 90 days of enactment of
this Act on steps taken to address these auditing concerns.
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 (MA). The
Committee further directs CMS to design and maintain its online
coverage options tool in a manner that provides complete and
unbiased information, particularly as CMS works to replace the
Medicare Plan Finder with the new Medicare Coverage Tools
platform. 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 Simulation.--The Committee supports efforts by CMS
to perform data simulations on the potential impact of more
comprehensive payment incentives for efficiency and quality in
the Medicare program. This Medicare simulation could test
consolidation of Medicare's readmissions, complications, and
value-based purchasing programs into one value-based payment
program that is focused on a larger set of avoidable outcomes
and uses clinically credible categorical risk-adjustment for
comparing performance. Such a simulation would increase
transparency and give CMS and Congress guidance about how to
improve care and reduce health care costs within the programs.
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, liability or no-fault
insurers including those who self-insure.
Medicare Reimbursement in Noncontiguous States and
Territories.--The Committee requests the Government
Accountability Office conduct an audit to examine Medicare
funding for noncontiguous U.S. States and the territories. This
report would review the Medicare reimbursement rate formula for
noncontagious states and block grant funding level for the
territories compared to the expenses in these locations and the
funding provided to states in the Continental United States.
Mental Health Parity.--The Mental Health Parity and
Addiction Equity Act (MHPAEA) was enacted more than 10 years
ago to prevent group health plans and health insurance
providers that provide mental health or substance use disorder
benefits from imposing less favorable benefit limitations on
qualifying mental health benefits than on medical or surgical
benefits. The Committee is aware of instances where insurers,
covered health care plans and managed care organizations (MCO),
including MCOs that manage state Medicaid programs, may be
imposing conditions for access to treatment for mental health
services, including services for Down syndrome and autism
spectrum disorder, that are not imposed on medical or surgical
benefits. These limitations may include parent or caregiver
participation requirements, preauthorization processes,
location of services exclusions, and fail-first policies. The
Committee directs CMS to ensure compliance with MHPAEA by
regularly issuing guidance to insurers, covered healthcare
plans, and MCOs, that outlines how compliance with MHPAEA is to
be achieved. This guidance should include recommendations for
appropriate training of personnel responsible for benefit
authorizations, adverse benefit determinations, and payments.
These agencies should ensure that such informational bulletins
also provide appropriate consumer and complaint information
that helps patients take action when they encounter MHPAEA
violations.
National Health Expenditure (NHE) Database.--The Committee
is concerned about discrepancies between official CMS estimates
and industry surveys suggesting that CMS understates the growth
of private health insurance and total health spending at the
household level. If private health spending is under reported
in NHE, estimates of total health U.S. spending may be too low
as well. The Committee requests that CMS include information in
its FY 2021 budget justification explaining its methodology for
including data in the National Health Expenditure database, as
well as an analysis of how CMS-published data compares to other
comparable information on health expenditures.
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. Moreover, the
Committee recommends that the agency meet with physician,
hospital, and other industry stakeholders from underserved
areas to better understand changes in population health. The
agency shall provide an update to the Committees on
Appropriations on these efforts within 90 days of enactment of
this Act.
Nonemergency Medical Transportation.--The Committee is
concerned about the impact of the administration's policy to
permit state Medicaid programs to drop Nonemergency Medical
Transportation (NEMT) coverage. The committee directs CMS to
commission a study by the National Academy of Medicine to
examine the impact on Medicaid beneficiaries of the potential
elimination of NEMT from state Medicaid programs, including
impacts to beneficiaries with chronic diseases including End
Stage Renal Disease, substance abuse disorders, pregnant
mothers, and patients living in remote areas. The Committee
strongly urges CMS to delay implementation of any changes to
NEMT benefits until the study has been submitted to the
Congress.
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. Opioids may be inadvertently
incentivized over alternative pain management treatments
through CMS packages which provide hospitals with the same
payment regardless of whether the additional cost of a non-
opioid postsurgical pain management treatment is incurred.
Nurse Practitioner/Physician Assistants.--The Committee is
aware of the clinical training site shortage for Nurse
Practitioner/Physician Assistant (NP/PA) students, and
recognizes that re-performing student documentation is a
significant administrative burden for teaching clinicians.
Therefore, as CMS continues to eliminate paperwork burdens for
clinicians, the Committee encourages the Secretary to authorize
all teaching clinicians to verify, rather than re-document,
notes provided by NP/PA students during the provision of
evaluation and management services, in order to ensure that
this paperwork burden is eliminated.
Nurse Staffing Requirements.--The Committee recognizes the
link between appropriate nurse staffing levels and improved
patient safety and outcomes. As part of its oversight function,
CMS is charged with ensuring that Medicare-participating
hospitals meet important patient safety standards, including
meeting appropriate nurse staffing requirements. The Committee
requests that CMS provide, in its fiscal year 2021
Congressional Justification, information relating to its
criteria for evaluating appropriate nurse staffing.
Nursing Home Safety.--The Committee is concerned about the
findings of the HHS Office of Inspector General (OIG) report
entitled, ``CMS Guidance to State Survey Agencies on Verifying
Correction of Deficiencies Needs to be Improved to Help Ensure
the Health and Safety of Nursing Home Residents.'' The
Committee requests a report within 60 days of enactment of this
Act on the actions that CMS has taken to implement the OIG's
recommendations. In addition, the report should include an
assessment of whether the CMS Special Focus Facility Initiative
has substantially improved the quality of care at
underperforming nursing facilities and what, if any,
improvements to the initiative need to be made.
Orphan Drugs.--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, however, treatments
exist for only 5 percent of rare diseases. Scientific
advancement is discovering the next generation of biologic and
gene therapy medicines that have the potential to both modify
disease progression and revolutionize the treatment of fatal
and debilitating rare diseases. To realize these potentials,
the Committee urges CMS to support access to biologic and gene
therapies, including potential testing of health insurance
benefit designs that eliminate specialty tiers.
Out-of-State Cases.--The Committee recognizes that
children, particularly those with highly complex conditions and
healthcare needs, often require healthcare services outside of
their home states and that the process of screening and
enrolling out-of-state providers in Medicaid programs can delay
a child's access to care. The Committee applauds CMS for
recognizing these challenges, particularly by including plans
for a pilot to screen Medicaid providers on behalf of states in
its most recent Medicaid Program Integrity Strategy. The
Committee urges the agency to advance this pilot.
Pneumococcal Vaccine.--The Committee is concerned about the
underutilization of pneumococcal vaccinations for adults,
including high-risk adults where vaccination rates do not
exceed 20 percent, and strongly urges CMS to work toward
achievement of the Healthy People 2020 goals to reduce invasive
pneumococcal infections and increase the percentage of adults
(age 65 or older) who are vaccinated against pneumococcal
disease. The Committee encourages CMS to support development
and implementation of electronic health records and other
technologies, such as reminder recall programs, to identify
Medicare beneficiaries who have not received the full course of
pneumococcal vaccinations and remind those beneficiaries and
their providers to adhere to the recommendations.
Preliminary Determinations.--As the Committee has reported,
CMS previously granted ``preliminary determinations'' to
hospitals to be designated as a Critical Access Hospitals
(CAH). Following CMS guidance, these facilities made
preparations to receive a final CAH designation, including
paying for expensive upgrades and an on-site survey.
Subsequently, CMS revised its guidance for attaining CAH
designation. Due to the length of time required to comply with
the requirements included in the preliminary determination,
facilities that were deemed in compliance by CMS proceeded to
comply with CMS guidance, but were then subsequently denied
final CAH status due to the change in CMS policy regarding CAH
designation. The Committee remains concerned about the
financial and operational sustainability of these hospitals,
which acted in good faith but may have been put in a difficult
situation by revisions to Federal policy. The Committee
supports efforts by HHS to help identify funding opportunities
for these affected facilities, provided that the facilities
meet all other requirements for any such funding opportunities.
Prior Authorization.--The Committee is aware that Medicare
Advantage (MA) plans have increased the use of prior
authorization (PA), which requires physicians and other health
care providers to obtain advance approval from the plan before
services can be delivered to patients. While PA is a valid
utilization review tool to ensure appropriate care, health care
provider experience and research studies demonstrate that
inappropriate use of PA causes significant patient care delays,
administrative costs and workflow disruptions. The Committee
directs CMS to improve Medicare beneficiary timely access to
care, increase transparency, and reduce the burdens on patients
and providers by providing guidance to MA plans on their use of
PA. Specifically, CMS should require MA plans to selectively
apply PA requirements, excluding from PA those services that
align with evidence-based guidelines and have historically high
PA approval rates. In addition, CMS should increase
transparency by requiring MA plans to report annually to the
Secretary a list of items and services that are subject to PA,
the percentage of PA requests approved, and the average time
for approval. Finally, the Committee encourages CMS to work
with stakeholders to increase the use of electronic prior
authorization.
Protected Classes.--The Committee is concerned by the
recent proposed rule, ``Modernizing Part D and Medicare
Advantage to Lower Drug Prices and Reduce Out-of-Pocket
Expenses.'' Shortly after Congress enacted the Medicare Part D
program, CMS required all Part D plans to have adequate
coverage for six therapeutic categories of drugs, known as
protected classes, to ensure patients have timely access to
critical therapies combating HIV, cancer, mental health
conditions, and other serious illnesses. The provisions of this
proposed rule would allow increased use of prior authorizations
and step therapy requirements and potentially delay access to
these therapies.
Rural Health Care Access.--In order to address regional
disparities in health care access and quality, when developing
regulations, the Committee supports efforts by CMS to take into
account factors that could negatively impact the ability of
hospitals to provide care for rural communities. The Committee
is particularly concerned about areas with low population
density, low household income, or high rates of rural hospital
closure.
Sepsis.--The Committee is concerned that sepsis and
antibiotic resistant bacteria continue to be leading public
health threats that are responsible for a significant number of
deaths, as well as rising costs within the healthcare system.
According to the most recent data, the national average
compliance rate for CMS's sepsis treatment measure, known as
SEP-1, is only 49 percent. The Committee urges CMS to issue a
Request for Information to gather views on proposals to
modernize and optimize CMS's current SEP-1 measure. The
Committee requests an update on these activities in the fiscal
year 2021 Congressional 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.
Standardized Assessment-Based Data.--The Committee is aware
that CMS has recently developed standardized assessment-based
data that is designed specifically for adult Medicare
beneficiaries and does not address the needs of an individual
under the age of twenty-one, especially a child with complex
medical needs that may also include an intellectual or
developmental disability. The Committee recommends that CMS
work with relevant partners to develop, test, and implement
appropriate assessment tools and quality indicators for
children currently served in pediatric post-acute and long-term
healthcare facilities.
Sexually Transmitted Infection (STI) Screening.--The
Committee continues to be concerned about high rates of STIs,
especially in 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 directs CMS to collaborate
with the CDC's Division of STD Prevention to develop a
screening and treatment initiative under its Medicaid Program.
The Committee also notes that some states are limiting
reimbursement for STI testing to only once a year. This is
counter to CDC guidelines which recommend testing at three-to-
six month intervals for certain individuals. The Committee
urges CMS to encourage states to comply with CDC screening
guidelines.
Virtual Health Care.--The Committee recognizes the
potential for virtual health care to help meet the needs of
patients and families across the country, especially in rural
areas. The Committee is aware that the lack of consistency
related to billing and coding for such services across Medicaid
programs can result in challenges and inefficiencies related to
payment for and data analysis of virtual care services. To
address this issue, the Committee encourages CMS to issue
guidance outlining a recommended but voluntary set of billing
codes, modifiers, or place of service designations for use in
state Medicaid programs.
State Survey and Certification
The Committee provides $407,334,000 for State Survey and
Certification activities, which is $10,000,000 more than the
fiscal year 2019 enacted level and $34,858,000 less than the
fiscal year 2020 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.
Survey Frequency Rates.--The Committee is concerned that
flat funding for several consecutive years has reduced the
frequency of statutorily-mandated surveys of health care
facilities. The Committee provides an increase of $10,000,000
to improve survey frequency rates for nursing homes, home
health agencies, and hospice facilities, as well as increase
quality oversight for facility types without statutorily-
mandated survey frequency standards.
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 2019 enacted
level and $15,000,000 below the fiscal year 2020 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
include funding requested by the Administration 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 2019....................... $765,000,000
Budget request, fiscal year 2020...................... 792,000,000
Committee Recommendation.............................. 786,000,000
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 $475,000,000 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 2019 enacted level and
$6,000,000 below the fiscal year 2020 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 revises 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.
The Committee expects all recipients of funds from the
Health Care Fraud and Abuse Control Account, the Centers for
Medicare & Medicaid Services, the Department of Health and
Human Services Office of Inspector General, and the Department
of Justice, to use funds for efforts to address fraud and abuse
as described in section 1128C of the Social Security Act.
Medicaid Program Integrity.--The Committee supports efforts
by CMS to develop a Medicaid Program Integrity Strategy. The
Committee encourage States to utilize all available tools to
increase transparency and oversight, ensure compliance with
Federal rules, and reduce improper payments.
Administration for Children and Families
PAYMENTS TO STATES FOR CHILD SUPPORT ENFORCEMENT AND FAMILY SUPPORT
PROGRAMS
Appropriation, fiscal year 2019....................... $2,922,247,000
Budget request, fiscal year 2020...................... 2,890,000,000
Committee Recommendation.............................. 2,890,000,000
Change from enacted level........................... -32,247,000
Change from budget request.......................... - - -
The Payments to States for Child Support Enforcement and
Family Support Programs support State-administered programs of
financial assistance and services for low-income families to
promote their economic security and self-sufficiency.
The Committee also recommends $1,400,000,000 in advance
funding, as requested, for the first quarter of fiscal year
2021 to ensure timely payments for Child Support Enforcement
programs.
LOW INCOME HOME ENERGY ASSISTANCE
Appropriation, fiscal year 2019....................... $3,690,304,000
Budget request, fiscal year 2020...................... - - -
Committee Recommendation.............................. 3,840,304,000
Change from enacted level........................... +150,000,000
Change from budget request.......................... +3,840,304,000
The Low Income Home Energy Assistance Program (LIHEAP)
supports eligible families and households through programs
providing assistance with energy costs.
The Committee recommends $3,840,304,000 for the Low Income
Home Energy Assistance program, $150,000,000 above the fiscal
year 2019 enacted level and $3,840,304,000 above the fiscal
year 2020 budget request. The Committee strongly opposes the
Administration's proposal to eliminate this important program
that serves almost six million low-income households each year.
Hold Harmless.--The Committee is concerned that as a result
of yearly formula variances, some States received a reduction
in funding in fiscal year 2019 despite a $50,000,000 increase
in the overall account. To correct this and hold States,
territories, and Tribes (funded through the States) harmless
from reductions when overall funding in the account is
increased in a given fiscal year, the bill includes language to
restore funding to States and territories at fiscal year 2018
levels, and then distribute the additional $200,000,000
recommended in this bill (over the fiscal year 2018 enacted
level) to States and territories in proportions similar to
previous fiscal years.
Information Memorandum.--The Committee believes there is a
need for additional transparency in the statutory formula
distribution of LIHEAP funds. Therefore, the Secretary is
encouraged to publish on its website an Information Memorandum
for LIHEAP Appropriations and Regular Block Grant Allocations
for fiscal year 2020. This will help provide grantees with
relevant information concerning fiscal year 2020 LIHEAP
funding.
Technical Assistance.--The Committee strongly encourages
ACF to expand its use of contracts with nonprofit organizations
with the fiscal expertise required for technical assistance,
training, and monitoring of LIHEAP program activities, and to
report back to the Committee within 90 days of enactment of
this Act on efforts towards using nonprofit organizations in
the future, in accordance with the authorizing legislation.
Weatherization.--The Committee recognizes that some States
use waivers to provide weatherization funding above LIHEAP's
current cap. The Committee is interested in how many of these
waivers have allowed States to implement health, safety and
other innovative practices, through LIHEAP's weatherization
program and the related weatherization program at the
Department of Energy. The Committee directs the agency to
provide a report within 120 days of enactment of this Act
describing the types of allowable weatherization activities and
to what extent LIHEAP grantees are using DOE rules for their
LIHEAP-funded weatherization work, as reported by State LIHEAP
grantees on their most current LIHEAP Plan submitted to the
Administration for Children and Families (ACF).
REFUGEE AND ENTRANT ASSISTANCE
Appropriation, fiscal year 2019....................... $1,905,201,000
Budget request, fiscal year 2020...................... 1,804,066,000
Committee Recommendation.............................. 2,411,701,000
Change from enacted level........................... +506,500,000
Change from budget request.......................... +607,635,000
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.
Within the total, the Committee includes the following:
------------------------------------------------------------------------
FY 2020
Budget Activity Committee
------------------------------------------------------------------------
Transitional and Medical Services.................... $354,000,000
Victims of Trafficking............................... 28,255,000
Refugee Support Services............................. 207,201,000
Unaccompanied Children............................... 1,803,245,000
Victims of Torture................................... 19,000,000
------------------------------------------------------------------------
Transitional and Medical Services
The Committee includes $354,000,000, which is equal to the
fiscal year 2019 enacted level and $35,000,000 above the fiscal
year 2020 budget request. The Transitional and Medical Services
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. The Committee
includes sufficient funding to provide the full eight months of
assistance for all qualified arrivals estimated in fiscal year
2020.
Victims of Trafficking
National Human Trafficking Hotline.--The recommendation
includes an additional $1,500,000 to fund the National Human
Trafficking Hotline at its authorized funding level of
$3,500,000. The Committee expects ACF to include in its fiscal
year 2021 Congressional Budget Justification a line item noting
enacted and requested funding levels for the Hotline.
Refugee Support Services
The recommendation includes $207,201,000, which is equal to
the fiscal year 2019 enacted level and $56,380,000 above the
fiscal year 2020 budget request. The Refugee Support Services
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 $1,803,245,000 for the
Unaccompanied Alien Children (UAC) Program, which is
$500,000,000 above the fiscal year 2019 enacted level and the
fiscal year 2020 budget request. The Committee provides this
additional funding with legal restrictions on the use of funds,
to ensure the UAC program fulfills its statutory mission to
care for children in ORR's custody and to place them with
sponsors as expeditiously as possible. To address the
Committee's significant concerns with how the program is
currently operating, while acknowledging the tremendous needs
of the children referred to ORR's care, the Committee includes
increased funding contingent on the conditions included in bill
language and in the directives included in this report.
The Committee directs ORR to prioritize funding for
expanded use of community-based residential care placements
(including long-term and transitional foster care and small
group homes) and shelter care other than large-scale
institutional shelter facilities. The bill includes language
requiring the Secretary of HHS to submit a spend plan for all
funds provided in the Refugee and Entrant Assistance account
and to submit an updated plan every 60 days. The Committee
expects the spend plan to reflect spending levels included in
this report (including legal services, child advocates, and
post-release services as directed below) and to demonstrate the
steps ORR is taking to increase permanent bed capacity so that
continued reliance on influx facilities will not be necessary.
The Committee includes an increase of not less than
$30,000,000 above the funding available in fiscal year 2019 to
provide qualified and independent legal services for
unaccompanied children, including but not limited to know-your-
rights orientations, legal screenings, court preparation and
assistance, representation, and pro bono referrals. The
Committee notes that legal counsel for unaccompanied children
increases the efficiency and effectiveness of immigration
proceedings and significantly reduces the failure-to-appear
rate of children who are released from HHS custody. The
recommended increase would allow for the resumption of services
to children released from ORR custody and the extension of
released-child representation to high-release communities that
are not currently being served.
The recommendation includes not less than $10,000,000 for
the Child Advocate program, which provides support for
particularly vulnerable children, including victims of abuse or
trafficking, children 12 or younger, and those who are expected
to remain in ORR custody for prolonged periods of time. The
Committee notes that Independent Child Advocates provide a
vital resource to the most vulnerable unaccompanied and
separated children in Federal custody by identifying and
advocating for their best interests with Federal agencies
including HHS, Department of Homeland Security (DHS) and the
Department of Justice (DOJ). 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.
The recommendation includes not less than $60,000,000 for
home studies and increased social services following release
(i.e., post-release services). ORR should arrange for such
services to be provided by non-governmental organizations
(NGOs) with experience and expertise in working with these
children.
The Committee directs ORR to comply with the March 8, 2019
ruling of the Ms. L.; et al., v. U.S. ICE; et al. case, and to
account for any children who were separated from their parents
by DHS and referred to ORR on or after July 1, 2017. The
Committee provides $4,000,000 for ORR to prioritize this work.
Starting no later than 30 days after enactment of this Act, HHS
is directed to provide monthly reports to the Committee on the
progress of this effort.
Memorandum of Agreement.--The bill includes a proviso to
prohibit any funding from being used to implement or enforce
the Memorandum of Agreement (MOA) between ORR and DHS that
provides for information sharing and permits ICE to detain and
remove sponsors and other members of a household applying to
sponsor a child. The MOA deters potential sponsors from
approaching ORR, extending stays in custody--further
traumatizing children, and exponentially increasing costs of
the program. The Committee strongly believes that sponsors will
come forward faster if the MOA is formally and publicly
terminated, and directs the Secretary to rescind it
immediately.
Influx Shelters.--The Committee believes the need for
influx shelters in fiscal years 2018 and 2019 has been due
largely to the Administration's misguided and willfully harmful
policies toward unaccompanied children. 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. The
Committee includes funding in the bill and directives in this
report to support ORR efforts to phase out the use of influx
shelters by increasing permanent bed capacity. However, until
this capacity is established, the Committee supports strong
oversight of influx facilities and includes bill language
prohibiting the use of soft-sided dormitories and limiting the
use of influx shelters under a series of conditions designed to
maximize child welfare and minimize additional trauma to
children.
In addition, within 30 days of enactment of this Act, and
monthly thereafter, the Committee directs ORR to submit a
report for each influx shelter in operation. This report must
include the total number of children in care at the facility
and the demographic data of those children; the average length
of time children at the influx shelter have been in care, both
at the influx shelter and in ORR custody; the capacity and
occupancy rates of the influx shelter; the expected length of
time the influx facility will remain in operation; and the
steps ORR is taking to increase permanent bed capacity so that
continued reliance on the influx facility will not be
necessary.
Ongoing Separations.--The Committee is alarmed by the
Office of Inspector General's January 17, 2019 Report
``Separated Children Placed in Office of Refugee Resettlement
Care'' (Report OEI-BL-18-00511), that finds that ORR is still
receiving children separated from their parents by immigration
officials. The bill includes a requirement that the Secretary
update the Committee, and make publicly available online on a
weekly basis, 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 this information to be
critical to oversight efforts to make sure that family
separation does not occur again.
Prohibiting HHS from Facilitating ICE.--The bill includes a
provision prohibiting funds from being used to facilitate DHS
removing sponsors or potential sponsors of unaccompanied
children based on information provided by ORR as part of the
sponsor's application to accept custody of an unaccompanied
child, except when that information meets specified criteria.
Congressional Oversight.--The Committee reiterates its
position on the importance of Congressional oversight of
facilities that house unaccompanied children. HHS was clearly
mistaken when it denied entry to three Members of Congress
attempting to enter the Homestead facility on April 8, 2019,
despite the fiscal year 2019 enacted law that explicitly
prohibits HHS from using funds to do so. The bill includes a
modification of that general provision to ensure proper
Congressional oversight of conditions at these facilities
during normal business hours without any requirement to provide
advance notice of arrival.
In-Kind Donations.--The bill continues to include a general
provision to allow for in-kind donations from the private
sector, non-governmental organizations and other groups to
support children in ORR's care.
Siblings in ORR Care.--The bill includes a general
provision mandating, to the extent practicable, siblings be
cared for in the same facility, or be placed with the same
sponsor.
Communicating with Congress.--The Committee directs the
Department to notify the Committees on Appropriations 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.
Data Reporting.--The previous year's experience between DHS
and HHS revealed interoperability gaps and data reporting
limitations in HHS' online case management system. The
Committee encourages ORR to explore whether there are
commercially available software solutions capable of enhancing
data reporting.
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 fully destroyed after
testing and the probability of a genetic relationship is
calculated. The entities conducting the DNA testing shall
obtain the consent of any individual over age 18 prior to
testing, and shall make every effort to obtain the consent of a
guardian prior to testing on anyone under age 18. The Committee
requests ORR continue to include in its fiscal year 2021
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.
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. The
Committee reiterates its direction, pursuant to House Report
115-862, that ORR, within 60 days of the enactment of this Act,
submit a report to the Committee detailing the number and
nature of facility violations, and the steps it is taking to
work with grantees to address and prevent such infractions.
Age-Outs.--The Committee is concerned about reports that
approximately two-thirds of 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), often because of a lack of planning for alternative
placements during the child's time in ORR care. 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.
Victims of Torture
The Committee includes $19,000,000 for the Victims of
Torture program, which is $5,000,000 above the fiscal year 2019
enacted level and the fiscal year 2020 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 2019....................... $5,276,000,000
Budget request, fiscal year 2020...................... 5,276,000,000
Committee Recommendation.............................. 7,676,000,000
Change from enacted level........................... +2,400,000,000
Change from budget request.......................... +2,400,000,000
The Committee recommends $7,676,000,000 for the Child Care
and Development Block Grant (CCDBG) program, which is
$2,400,000,000 above the fiscal year 2019 enacted level and the
fiscal year 2020 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.
The bill includes the largest funding increase ever
provided for the Child Care and Development Block Grant. CCDBG
reaches only 15 percent of the nearly 14 million children who
are eligible to receive child care services. The Committee
believes that significant additional investment is necessary to
address large gaps in the number of eligible children served by
the program. The increase included in this bill will provide
CCDBG-funded child care to almost 300,000 additional eligible
children, enable more low-income parents to work, allow States
to expand eligibility for children and families, and raise
payments to providers.
Diaper Need and Child Care.--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 1 in 3 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 many child
care centers, including ones under the Child Care and
Development Block Grant, require parents to provide diapers for
their children who attend. Therefore, the Committee requests
HHS to submit a report, within 180 days of enactment of this
Act, estimating the amount of diapers and diapering supplies
that enrolled child care providers require for the population
of children under the age of three who are served under the
Child Care and Development Block Grant and the estimated cost
of those diapers and diaper supplies.
SOCIAL SERVICES BLOCK GRANT
Appropriation, fiscal year 2019....................... $1,700,000,000
Budget request, fiscal year 2020...................... - - -
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 2019....................... $12,239,225,000
Budget request, fiscal year 2020...................... 11,187,485,000
Committee Recommendation.............................. 13,967,468,000
Change from enacted level........................... +1,728,243,000
Change from budget request.......................... +2,779,983,000
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 2020
Budget Activity Committee
------------------------------------------------------------------------
Programs for Children, Youth, and Families:
Head Start....................................... $11,563,095,000
Early Head Start-Child Care Partnerships..... 1,330,000,000
Preschool Development Grants..................... 350,000,000
Runaway/Homeless Youth........................... 125,280,000
Abuse of Runaway Youth Prevention................ 22,141,000
State Child Abuse Prevention..................... 90,000,000
Discretionary Child Abuse Prevention............. 34,000,000
Community-Based Child Abuse Prevention........... 75,000,000
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...... 7,012,000
Native American Programs......................... 60,000,000
Community Services:
Community Services Block Grant................... 760,000,000
Community Economic Development................... 25,000,000
Rural Community Facilities....................... 11,000,000
Domestic Violence Hotline............................ 12,000,000
Family Violence/Battered Women's Shelters............ 175,000,000
Independent Living Training Vouchers................. 43,257,000
Disaster Human Services Case Management.............. 1,864,000
Program Direction.................................... 209,000,000
------------------------------------------------------------------------
Head Start
The Committee recommends $11,563,095,000 for the Head Start
program, which is $1,500,000,000 above the fiscal year 2019
enacted level and the fiscal year 2020 budget request. Head
Start promotes school readiness of children under 5 from low-
income families through education, health, social and other
services.
Early Head Start-Child Care Partnerships.--The Committee
recommends $1,330,000,000 for Early Head Start-Child Care
Partnership (EHS-CCPs) and EHS Expansion, which is $525,000,000
above the fiscal year 2019 enacted level and the fiscal year
2020 budget request. The EHS-CCP program brings together EHS
and child care through layering of funding to provide
comprehensive and continuous services to low-income infants,
toddlers, and their families. The program enhances
developmental services and supports for low-income infants and
toddlers, and their families, by providing strong relationship-
based experiences and preparing them for the transition into
Head Start and preschool. The Committee understands the Office
of Head Start (OHS) was only able to fund approximately 18
percent of applicants for this funding in fiscal year 2019,
despite many highly-qualified grant applications. The Committee
provides additional funding to support expansion of the EHS and
EHS-CCPs to add over 80,000 more slots for eligible children.
Quality Improvement Funding for Trauma-Informed Care.--The
Committee is aware of the rise of adverse childhood experiences
(ACE) attributable to increased prevalence of substance misuse,
economic hardship, home and community violence, and other
traumatic experiences that can negatively impact child
development and lead to disruptions in classroom environments.
The Committee recommends $750,000,000 be allocated within
section 640(a)(5) of the Head Start Act for grantees to engage
in activities that support children and families who have
experienced trauma, such as increasing services from mental
health professionals to provide expert care and counseling to
families and the Head Start workforce; providing staff training
on trauma-informed approaches to service delivery; and adding
staff to Head Start classrooms. Funding should be made
available for all grantees, with awards not less than $100,000
for smaller grantees, to ensure that quality improvement
funding is awarded in amounts substantial enough to have a
meaningful impact for children enrolled in these programs.
Tribal Colleges and Universities-Head Start Partnership
Program.--The Committee directs $8,000,000 to the Head Start
program to reestablish the Tribal Colleges and Universities
(TCU)-Head Start Partnership Program. Only 39 percent of Indian
Head Start teachers and assistants meet the national standard
for qualified teachers, compared to almost 75 percent
nationwide. Reinvesting in early childhood education at TCUs
will help to address these disparities in the preparation of
Head Start teachers in Indian Country.
Cost of Living Adjustment.--The Committee includes
$217,000,000 for a cost of living adjustment.
Service Duration.--The Committee understands that the Head
Start program standard finalized in Fall 2016 that required
programs to provide 1,020 annual hours of planned class
operations over the course of at least eight months per year
was based on research showing that at-risk children benefit
from longer exposure to enriching early learning programs. The
Committee directed funding in previous fiscal years to help
Head Start programs meet the extended duration requirement. The
Committee continues to encourage extended duration, especially
in communities with demonstrated family need, and requests a
briefing from OHS not later than 30 days after the comment
period on the NPRM has closed. In addition, the Committee
requests OHS to include in future budget justifications the
number of Head Start slots that offer 1,020 hours of service
per year duration programs. It is the Committee's expectation
that additional flexibility for providers that are not in a
position to offer extended duration services at this time will
not result in reductions to services to vulnerable children who
would benefit from extended duration.
Migrant and Seasonal Head Start.--The Committee is
concerned with recent Migrant and Seasonal Head Start (MSHS)
enrollment declines and understands that the program may
fluctuate due to reasons outside of OHS's control, however, the
Committee directs OHS to be responsive to the needs of
communities as demands change.
Further, the Committee supports OHS's restoration of MSHS
program funding to terminated localities and the maintenance of
student enrollment levels through increased consideration of
all impoverished student populations subject to transient
living conditions or unstable educational environments. In
order to avoid recent issues with grantee fiscal
irresponsibility, the Committee directs OHS to assess program
service capacity based on the aggregate of individual
applicants' regional partnerships, as opposed to a single
organization's supposed ability to conduct an equivalent
nationwide program coordination. The Committee encourages OHS
to partner with local academic institutions that have
established regional networks of accredited resources. OHS
shall submit a report to the Committee on these efforts within
60 days of enactment of this Act.
Preschool Development Grants
The Committee recommends $350,000,000 for Preschool
Development Grants, which is $100,000,000 above the fiscal year
2019 enacted level and $350,000,000 above the fiscal year 2020
budget request. This program provides grants to States to build
State and local capacity to provide early childhood care and
education for children birth through five from low- and
moderate-income families. The Committee understands 47 States
and territories received planning grants in fiscal year 2018 to
conduct needs assessments and gather data about the current
early learning landscape in their States. The Committee notes
that fiscal year 2019 funding may only allow about half of the
States that received planning grants to receive implementation
grants. The Committee includes additional funding in this bill
to fund applications from the fiscal year 2019 competition that
may not have received funding due to budget constraints.
Runaway and Homeless Youth
The Committee recommends $147,421,000 for the Runaway and
Homeless Youth (RHY) program, which is $20,000,000 above the
fiscal year 2019 enacted level and $28,300,000 above the fiscal
year 2020 budget request. The Committee supports the ability of
grantees to provide prevention services, such as counseling and
case management, regardless of enrollment in residential
services.
Homeless Management Information System.--RHY program
grantees are required to report data in the RHY-Homeless
Management Information System (HMIS), which is maintained by
the Department of Housing and Urban Development and provides an
array of data on programs for the homeless. The Committee
strongly encourages ACF to continue providing technical
assistance to support RHY programs through this transition to
ensure accurate and timely reporting of data on outcomes for
homeless children and youth.
State Child Abuse Prevention
The Committee recommends $90,000,000 for Child Abuse
Prevention and Treatment Act (CAPTA) State Grants, which is
$4,690,000 above the fiscal year 2019 enacted level and the
fiscal year 2020 budget request.
Plans of Safe Care.--The Committee continues to emphasize
the importance of Safe Care Plans and addressing the health and
safety of the child, and any substance use disorder treatment
for their caregivers. The Committee urges the Secretary to
prioritize funding for States that have high rates of neonatal
abstinence syndrome or are seeing an increase in neonatal
abstinence syndrome rates, and that partner with community-
based organizations to deliver services that are consistent
with the Safe Care Plan for these newborns and their
caregivers. The Committee also directs ACF to enhance their
coordination with the States and continue working with those
States with high rates of neonatal abstinence syndrome and with
States that are seeing an increase in new cases of neonatal
abstinence syndrome. The Committee requests an update on the
work of the Secretary and ACF to implement these new policies.
Child Abuse Discretionary Activities
Child Abuse Hotline.--The Committee includes an increase of
$1,000,000 to support an additional year of the innovation
grant to develop and research text- and online chat-based
intervention and education services through a national child
abuse hotline. The Committee is pleased that the recent
initiation of the text line has increased the incidence of
youth seeking assistance from Hotline counselors and looks
forward to data regarding best practices for delivering
services through text and chat platforms.
Community-Based Child Abuse Prevention
The Committee recommends $75,000,000 for Community-Based
Child Abuse Prevention, which is $35,236,000 above the fiscal
year 2019 enacted level and the fiscal year 2020 budget
request. These formula grants support community-based
approaches to child abuse and neglect prevention.
Adoption Opportunities
The Committee recommends $42,100,000 for Adoption
Opportunities, which is $3,000,000 above the fiscal year 2019
enacted level and the fiscal year 2020 budget request.
Social Services Research and Demonstration
The Committee recommends $7,012,000 for Social Services and
Income Maintenance Research, which is $500,000 above the fiscal
year 2019 enacted level and the fiscal year 2020 budget
request.
Community Resource Centers.--The Committee directs the
program to research how centralized community resource centers,
which allow citizens to apply for several Federal social
services in a single location, can reduce the burden on
constituents and ensure the cost-effective allocation of
Federal resources.
Veterans' Mediation.--The Committee encourages the program
to research topics related to mediation strategies that reduce
homelessness, unemployment, declining physical and mental
health, and substance abuse among veterans and military
families.
Native American Programs
The Committee recommends $60,000,000 for Native American
Programs, which is $5,450,000 above the fiscal year 2019
enacted level and $7,950,000 above the fiscal year 2020 budget
request. These programs assist Tribal and village governments
and Native American institutions and organizations in their
efforts to support and develop stable, diversified local
economies. Tribes and non-profit organizations use funds to
develop and implement sustainable community-based social and
economic programs and services to improve the well-being of
Native people.
Within the total, the recommendation includes $14,000,000
for Native American language preservation activities. The
Committee provides not less than $5,000,000 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
$760,000,000 for the Community Services Block Grant, which is
$35,000,000 more than the fiscal year 2019 enacted level and
$760,000,000 more than the fiscal year 2020 budget request. The
Community Services Block Grant provides funds to alleviate the
causes and conditions of poverty in communities.
Community Economic Development.--The Committee recommends
$25,000,000 for Community Economic Development Grants, which is
$5,117,000 above the fiscal year 2019 enacted level and
$25,000,000 more than the fiscal year 2020 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.
Rural Community Facilities Development.--The Committee
recommends $11,000,000 for the Rural Community Facilities
Development program, which is $2,000,000 above the fiscal year
2019 enacted level, and $11,000,000 above the fiscal year 2020
budget request. Rural Community Development is a grant program
that works with regional and Tribal organizations to manage
safe water systems in rural communities.
Domestic Violence Hotline
The Committee recommends $12,000,000 for the Domestic
Violence Hotline, which is $1,750,000 above the fiscal year
2019 enacted level and the fiscal year 2020 budget request. The
Hotline provides 24-hour, toll-free and confidential services
immediately connecting callers to local service providers.
Additional funding is recommended to add capacity and reduce
the number of calls, chats, and texts that go unanswered due to
a lack of resources.
Family Violence Prevention and Battered Women's Shelters
The Committee recommends $175,000,000 for the Family
Violence Prevention and Battered Women's Shelters programs,
which is $10,500,000 above the fiscal year 2019 enacted level
and the fiscal year 2020 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).
Independent Living Training Vouchers
The Committee understands that foster and homeless youth
experience increased burdens in accessing and completing higher
education. The Committee is deeply concerned that access to the
Free Application for Federal Student Aid (FAFSA), federal
financial aid, and other existing resources and programs,
including TRIO and the Chafee Education and Training Voucher
program, are not consistently available and that many children
are not aware of these resources. Therefore, the Committee
urges the Department of Education and ACF to work together with
State and tribal welfare systems and runaway and homeless youth
programs to conduct further outreach and disseminate
information on financial aid, TRIO, and the Chafee program to
these audiences. The Committee also requests that these
resources be made available online so that foster youth can
also access them.
Program Direction
The Committee recommends $209,000,000 for Program
Direction, which is $4,000,000 above the fiscal year 2019
enacted level and the fiscal year 2020 request.
Status of Funds.--The Committee directs ACF to 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 2019....................... $444,765,000
Budget request, fiscal year 2020...................... 404,765,000
Committee Recommendation.............................. 424,765,000
Change from enacted level........................... -20,000,000
Change from budget request.......................... +20,000,000
The Committee recommends $345,000,000 in mandatory funds
and $79,765,000 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. The recommendation
includes $20,000,000 to support Kinship Navigator programs. The
Committee understands that the Clearinghouse of evidence-based
programs is not yet fully established, so discretionary
appropriations are provided for transition funding while
Kinship Navigator programs eligible for IV-E reimbursement are
being identified.
Family First Implementation.--The Committee is aware that
P.L. 115-123 authorized States to receive the same Title IV-E
Federal matching funds for maintenance costs for children who
are living with a parent in a licensed family-based residential
Substance Use Disorder (SUD) treatment facility as if the child
were placed in out-of-home foster care, away from the parent.
The Committee understands the goal of this funding is to enable
the parent to continue or resume parenting and reduce the
burden on the foster care system; therefore, the Committee
urges ACF to work with States to ensure that this authority and
funding is used to broaden access to family-based SUD
treatment.
PAYMENTS FOR FOSTER CARE AND PERMANENCY
Appropriation, fiscal year 2019....................... $6,035,000,000
Budget request, fiscal year 2020...................... 5,744,000,000
Committee Recommendation.............................. 5,744,000,000
Change from enacted level........................... -291,000,000
Change from budget request.......................... - - -
The Committee also recommends an advance appropriation of
$3,000,000,000 for the first quarter of fiscal year 2021 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 chose to delay final enactment of regulations that
collect critical child welfare data elements in order to remove
LGBTQ identity data. 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.
Administration for Community Living
AGING AND DISABILITY SERVICES PROGRAMS
Appropriation, fiscal year 2019....................... $2,120,200,000
Budget request, fiscal year 2020...................... 1,996,556,000
Committee Recommendation.............................. 2,294,343,000
Change from enacted level........................... +174,143,000
Change from budget request.......................... +297,787,000
Created in 2012, the Administration for Community Living
(ACL) brings together the efforts and achievements of the
Administration on Aging, the Administration on Intellectual and
Developmental Disabilities, and the HHS Office on Disability to
serve as the Federal agency responsible for increasing access
to community supports, while focusing attention and resources
on the unique needs of older Americans and people with
disabilities across the lifespan.
The Committee continues to fund the Senior Medicare Patrol
Program through the Health Care Fraud and Abuse Control
Account.
Reorganization.--The Committee is disappointed that the
Secretary notified the Committee of an intent to reorganize ACL
less than 30 days after the President's budget was submitted to
Congress. For the purposes of transparency with the public and
in accordance with the spirit of an annual budget justification
and review process, the Committee directs ACL to submit future
reorganization proposals through Congressional Budget
Justifications so that Congress may fully consider any
reorganization in the context of the annual budget process and
with input from stakeholders. The Committee strongly urges ACL
to engage with stakeholders before it implements its current
reorganization plan, and expects ACL to engage with union
representatives as early as practicable to address any employee
concerns.
Home and Community-Based Supportive Services
The Committee recommends $422,000,000 for Home and
Community-Based Supportive Services, which is $36,926,000 over
the fiscal year 2019 enacted level and the fiscal year 2020
budget request. This program provides formula grants to States
and territories to fund a wide range of social services that
enable seniors to remain independent in their homes for as long
as possible.
Preventive Health Services
The Committee recommends $24,848,000 for Preventive Health
Services, which is the same as the fiscal year 2019 enacted
level and the fiscal year 2020 budget request. This program
funds activities that help seniors remain healthy and avoid
chronic diseases. While States have the flexibility to use
funding provided through this program to fund Chronic Disease
Self-Management Education (CDSME) and Falls Prevention
programs, the Committee does not accept the proposal to
consolidate these programs within Preventive Health Services.
Protection of Vulnerable Older Americans
The Committee recommends $23,658,000 for activities to
protect vulnerable older Americans, which is $2,000,000 above
the fiscal year 2019 enacted level and $3,030,000 above the
fiscal year 2020 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 Committee recommends additional funding
to expand the reach of the ombudsman program to assisted living
facilities.
Family Caregiver Support Services
The Committee recommends $200,000,000 for the National
Caregiver Support program, which is $18,814,000 above the
fiscal year 2019 enacted level and $49,414,000 above the fiscal
year 2020 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.
Native American Caregiver Support Services
The Committee recommends $12,056,000 for the Native
American Caregiver Support program, which is $2,000,000 above
the fiscal year 2019 enacted level and $4,500,000 above the
fiscal year 2020 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 $1,000,000,000 for
senior nutrition. The recommendation includes: $525,000,000 for
Congregate Nutrition Services, which is $29,658,000 above the
fiscal year 2019 enacted level and the fiscal year 2020 budget
request; $305,000,000 for Home-Delivered Meal Services, which
is $53,658,000 above the fiscal year 2019 enacted level and the
fiscal year 2020 budget request; and $170,000,000 for the
Nutrition Services Incentives program, which is $9,931,000
above the fiscal year 2019 enacted level and the fiscal year
2020 budget request. These programs help older Americans remain
healthy and independent in their communities by providing meals
and related services in a variety of settings (including
congregate facilities such as senior centers) and via home-
delivery to older adults who are homebound due to illness,
disability, or geographic isolation.
Native American Nutrition and Supportive Services
The Committee recommends $37,208,000 for Native American
Nutrition and Supportive Services, which is $3,000,000 above
the fiscal year 2019 enacted level and the fiscal year 2020
budget request. This program provides grants to Tribes to
promote the delivery of nutrition and home and community-based
supportive services to Native American, Alaskan Native, and
Native Hawaiian elders.
Aging Network Support Activities
The Committee recommends $12,461,000 for Aging Network
Support Activities, which is $5,000,000 below the fiscal year
2019 enacted level and $958,000 above the fiscal year 2020
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.
Alzheimer's Disease Program
The Committee recommends $27,500,000 for the Alzheimer's
disease program, which is $4,000,000 above the 2019 enacted
program level and $8,010,000 above the fiscal year 2020 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.
Additionally, the Committee recognizes the complexity of
care required by persons with advanced dementia and the
tremendous value of caregivers and of unpaid respite care. The
Committee provides an increase of $4,000,000 for the
Alzheimer's disease program to issue grants to demonstrate the
benefits of providing direct respite care services to
caregivers supporting individuals living with Alzheimer's
Disease and Related Dementias (ADRD).
Respite Care
The Committee recommends $5,500,000 for Respite Care, which
is $1,390,000 above the fiscal year 2019 enacted level and
$2,140,000 above the fiscal year 2020 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.
The Committee notes that funding increases included in the
Family Caregivers Support Services and Alzheimer's Disease
programs will provide States with additional funding available
for respite care direct services.
Falls Prevention
The Committee recommends $5,000,000 to be transferred from
the PPH Fund to ACL for the Falls Prevention program, which is
the same as the fiscal year 2019 enacted level and $5,000,000
above the fiscal year 2020 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 the same as the fiscal year 2019 enacted
level and $8,000,000 above the fiscal year 2020 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 $20,874,000 for Elder Rights
Support Activities, which is $5,000,000 above the fiscal year
2019 enacted level and $7,000,000 above the fiscal year 2020
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 supports ACL's efforts to develop a National
Adult Maltreatment Reporting System and provides an increase of
$3,000,000 to enhance the data system and assist States making
system modifications to access it. An additional $2,000,000 is
provided for additional screening for elder abuse, neglect, and
exploitation. The Committee recognizes that the opioid crisis
is affecting Adult Protective Services, especially with respect
to clients who have been victimized by those using opioids and
believes this work can be part of the increased screening
effort. This should not come at the expense of existing Elder
Rights Support activities.
Aging and Disability Resource Centers
The Committee recommends $8,119,000 for Aging and
Disability Resource Centers, which is the same as the fiscal
year 2019 enacted level and $2,000,000 above the fiscal year
2020 budget request. These centers provide information,
counseling and access for individuals to learn about the
services and support options available to seniors and the
disabled so they may retain their independence.
State Health Insurance Assistance Program
The Committee recommends $55,000,000 for the State Health
Insurance Assistance Program, which is $5,885,000 above the
fiscal year 2019 enacted level and $18,885,000 above the fiscal
year 2020 budget request. The State Health Insurance Assistance
Program provides Medicare beneficiaries with information,
counseling, and enrollment assistance.
Paralysis Resource Center
The Committee recommends $8,700,000 for the Paralysis
Resource Center, which is the same as the fiscal year 2019
enacted level and $8,700,000 above the fiscal year 2020 budget
request. The Paralysis Resource Center offers activities and
services aimed at increasing independent living for people with
paralysis and related mobility impairments, and supporting
integration into the physical and cultural communities in which
they live.
Limb Loss Resource Center
The Committee recommends $4,000,000 for the Limb Loss
Resource Center, which is $500,000 above the fiscal year 2019
enacted level and $4,000,000 above the fiscal year 2020 budget
request. The Limb Loss Resource Center supports a variety of
programs and services for those living with limb loss,
including a national peer support program, educational events,
training for consumers and healthcare professionals, and
information and referral services.
Traumatic Brain Injury
The Committee recommends $12,321,000 for the Traumatic
Brain Injury program, which is $1,000,000 above the fiscal year
2019 enacted level and $3,000,000 above the fiscal year 2020
budget request. The program provides grants to States for the
development of a comprehensive, coordinated family and person-
centered service system at the State and community level for
individuals who sustain a traumatic brain injury.
Developmental Disabilities State Councils
The Committee recommends $80,000,000 for State Councils on
Developmental Disabilities, which is $4,000,000 above the
fiscal year 2019 enacted level and $24,000,000 above the fiscal
year 2020 budget request. The Developmental Disabilities State
Councils work to develop, improve and expand the system of
services and supports for people with developmental
disabilities.
Developmental Disabilities Protection and Advocacy
The Committee recommends $43,000,000 for Developmental
Disabilities Protection and Advocacy, which is $2,266,000 above
the 2019 enacted level and $4,266,000 above the fiscal year
2020 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.
Voting Access for Individuals with Disabilities
The Committee recommends $8,963,000 for Voting Access for
Individuals with Disabilities program, which is $2,000,000
above the fiscal year 2019 enacted level and $4,000,000 above
the fiscal year 2020 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 $13,000,000 for Developmental
Disabilities Projects of National Significance, which is
$1,000,000 above the fiscal year 2019 enacted level and
$11,950,000 above the fiscal year 2020 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
$1,000,000 above the fiscal year 2019 enacted level and
$9,073,000 above the fiscal year 2020 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 2019 enacted level and $7,537,000 above the
fiscal year 2020 budget request. Independent Living programs
maximize the leadership, empowerment, independence, and
productivity of individuals with disabilities.
National Institute on Disability, Independent Living, and
Rehabilitation Research
The Committee recommends $108,970,000 for the National
Institute on Disability, Independent Living, and Rehabilitation
Research (NIDILRR), which is the same as the fiscal year 2019
enacted level and $18,599,000 above the fiscal year 2020 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 $1,000,000 above the fiscal year 2019
enacted level and $5,061,000 above the fiscal year 2020 budget
request. The Committee provides a $1,000,000 increase for
Section 4 of the Assistive Technology Act. 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 2019
enacted level and $2,076,000 above the fiscal year 2020 budget
request. This funding supports Federal administrative costs
associated with administering ACL's programs.
Office of the Secretary
OFFICE OF MEDICARE HEARINGS AND APPEALS
Appropriation, fiscal year 2019....................... $182,381,000
Budget request, fiscal year 2020...................... 182,381,000
Committee Recommendation.............................. 182,381,000
Change from enacted level........................... - - -
Change from budget request.......................... - - -
This Office supports hearings at the administrative law
judge level, the third level of Medicare claims appeals.
Medicare Appeals Backlog.--The Committee remains concerned
about the size of the Medicare Appeals Backlog. The Committee
continues to provide a significantly elevated funding level for
the Office of Medicare Hearings and Appeals--an amount that was
initially provided in fiscal year 2018.
GENERAL DEPARTMENTAL MANAGEMENT
Appropriation, fiscal year 2019....................... $545,457,000
Budget request, fiscal year 2020...................... 408,749,000
Committee Recommendation.............................. 549,997,000
Change from enacted level........................... +4,540,000
Change from budget request.......................... +141,248,000
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
2018 enacted level and $4,012,000 below the fiscal year 2020
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 the
Department to include the following information in its fiscal
year 2021 budget justification: Expenditures for fiscal year
2019 and expected expenditures for fiscal years 2020 and 2021,
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.
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.
Departmental Appeals Board.--The Committee includes
$20,000,000 for the Departmental Appeals Board, including rent
and overhead costs, an increase of $6,000,000 above the fiscal
year 2019 enacted level. The additional funds are provided to
address the growing backlog of cases at the Medicare Operations
Division, as well as the influx in workload due to increased
dispositions from the Office of Medicare Hearings and Appeals.
Domestic Violence Survivors with Companion Animals.--The
Committee urges the Secretary of Health and Human Services to
enter into consultations with the Secretary of Agriculture as
soon as possible, and enter into any memoranda of understanding
as directed, in order to establish during fiscal year 2020 the
requirements for grant application and execution under Section
12502 of P.L. 115-334, the Agriculture Improvement Act of 2018,
to provide emergency and transitional shelter and housing
options for domestic violence survivors with companion animals.
Gene and Cellular Therapies.--The Committee is encouraged
by the promise of the new cancer treatment, CAR T-cell therapy
that is already producing remarkable results for patients. The
Committee urges the Secretary to ensure coordination between
NIH, FDA, and CMS to develop policies that support the
innovation of new gene and cell therapies and protect patient
access by providing equitable reimbursement for these therapies
and the associated services needed by patients being treated.
The Committee requests an update in the fiscal year 2021
Congressional Budget Justification on activities to ensure
appropriate patient access to these treatments.
HIV Initiative.--The Committee supports the
Administration's HIV Initiative to decrease new HIV diagnosis
by 75 percent by 2025 and 90 percent by 2030. The initiative
builds on existing HIV programs and new innovations to ramp up
HIV testing, care and treatment, and prevention services,
including Pre-Exposure Prophylaxis.
The Committee includes the full amount of funding requested
for the HIV Initiative under HRSA, CDC, and NIH. Moreover, the
Committee provides additional increases--beyond the fiscal year
2020 budget request--of $46,376,000 for the Ryan White HIV/AIDS
program; $5,000,000 for the Minority AIDS program in SAMHSA;
and $6,100,000 for Minority HIV/AIDS prevention and treatment
activities under the Office of the Secretary. The Committee
also rejects the Administration's proposal to cut funding for
NIH's HIV research portfolio; instead, the bill includes an
increase of approximately $149,000,000 for NIH's HIV research
to continue its efforts to develop an HIV vaccine or a cure.
The Committee directs the Secretary to submit to the
Committees on Appropriations a comprehensive multi-year plan
outlining the HIV Initiative, including metrics the Department
will use to measure progress on reducing HIV transmission, as
well as cost estimates for the initiative for fiscal years 2021
through 2025. The Secretary shall submit an initial plan within
90 days of enactment of this Act and then annually thereafter.
KidneyX.--The Committee recognizes that more than 40
million Americans are living with kidney diseases, and for more
than 700,000 of those individuals, the diseases progress to
kidney failure, requiring access to dialysis or kidney
transplantation to live. The Committee also notes that kidney
failure accounts for approximately $35,000,000,000 in annual
Medicare spending, while kidney disease accounts for a total of
approximately $115,000,000,000 in annual Medicare spending.
Given the high cost of kidney disease in both health
consequences and federal spending, the Committee includes
$10,000,000 for the Office of the Secretary for prize
competitions (as described in section 24 of The Stevenson-
Wydler Technology Innovation Act of 1980 (15 U.S.C. 3719))
through a public-private partnership to accelerate the
development and adoption of novel therapies and technologies
that improve the diagnosis and treatment of patients with
kidney diseases, including prize competitions to accelerate
innovation in dialysis. The Committee urges the Secretary to
coordinate across operating divisions--including NIH, FDA, and
CMS--to demonstrate a Department-wide commitment to supporting
innovative therapies and technologies with the potential to
improve quality of life for individuals with kidney diseases
while reducing federal costs. The Committee requests that the
Secretary include a multi-year plan in the fiscal year 2021
Congressional Budget Justification outlining possible prize
competitions in future fiscal years.
Maternal Mental Health.--The Committee is concerned that up
to 20 percent of new or expectant mothers will experience a
maternal mental health disorder during pregnancy or within the
first year after childbirth--such as depression, anxiety, or
postpartum psychosis. Untreated maternal mental health
disorders negatively impact the short and long-term health of
affected mothers and their children, with symptoms leading to
adverse birth outcomes, impaired maternal-infant bonding, poor
infant growth, childhood emotional and behavioral problems, and
significant medical and economic cost. The Committee directs
the Secretary to submit a report, in consultation with HRSA,
SAMSHA, CDC, CMS, Office of the Surgeon General, Office on
Women's Health, and Office of Minority Health, to the
Committees on Appropriations within 180 days of enactment of
this Act on the role that each agency can take to address gaps
in maternal mental health public awareness, screening,
diagnosis and delivery for pregnant and postpartum women.
Nondiscrimination Report.--The Committee directs the
Secretary to submit a report within 90 days of enactment of
this Act on the Department's efforts to enforce
nondiscrimination regulations 45 CFR 75.300 (c) and (d) in
health and human service programs, specifically including
efforts to ensure that foster children are not discriminated
against based on their sexual orientation and gender identity,
given that HHS-funded research has shown that lesbian, gay,
bisexual, and transgender (LGBT) foster children suffer poorer
outcomes related to safety, well-being, and permanency than
their non-LGBTQ counterparts, including greater rates of poor
treatment, multiple placements, longer stays in residential
care rather than in family settings, and greater rates of
hospitalization for emotional reasons, criminal justice
involvement, and homelessness.
Nonrecurring Expenses Fund.--The Committee includes bill
language in the CDC account to direct funding to the Chamblee
Research Support Building 108 project and campus infrastructure
improvements.
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.
Proposed Reductions in the Fiscal Year 2020 Budget
Request.--The Committee includes no funds for Secretarial
Initiatives and Innovations or Acquisition Reform. These
activities were proposed for reduction or elimination in the
fiscal year 2020 budget request. The Committee agrees with the
Secretary's proposal to support acquisition reform through the
HHS Service and Supply Fund.
Research on Poverty.--The Committee includes sufficient
funding for the Office of the Assistant Secretary for Planning
and Evaluation to continue the existing Poverty Research Center
cooperative agreement in fiscal year 2020. The Committee
includes an increase of $1,000,000 above the fiscal year 2019
enacted level for the fourth year of this five-year cooperative
agreement to initiate new research projects, data analysis, and
evaluation plans.
Section 520 Report.--The Committee commends HHS and the CDC
for working with state and local partners to take necessary
steps to reduce the number of new infections of HIV and
hepatitis due to intravenous drug use. The Committee notes that
studies have shown that People Who Inject Drugs (PWIDs) are
twice as likely to be unaware of their HIV status as the
general public. The Committee also recognizes that syringe
services programs (SSPs) have been associated with reduced risk
for infection of HIV, viral hepatitis and other blood-borne
infections. Section 520 of division H of the fiscal year 2016
Consolidated Appropriations Act allowed for elements of SSPs to
be purchased if it was determined that a state or local
jurisdiction was experiencing, or was at risk for, a
significant increase in hepatitis infections or an HIV outbreak
due to injection drug use. Such authority was continued in
fiscal years 2017, 2018, and 2019. Therefore, the Committee
directs the Secretary to submit a report within 180 days of
enactment of this Act on the implementation of Sec. 520 of P.L.
114-113, P.L. 115-31, and P.L. 115-141. The report should
include the number of states, programs, or grantees requesting
the use of funds for SSPs; the number of PWIDs served;
information on services provided to the PWIDs and the programs
to which such PWIDs were linked; and, where possible, the
impact of such programs on HIV and hepatitis infection rates.
Staffing Reports.--The Committee continues a general
provision requiring the Department to submit a staffing report
to the Committees on Appropriations by the 15th day of each
month. The Excel table shall 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.
Teen Pregnancy Prevention Evidence Review.--The Committee
includes $600,000 for the Assistant Secretary for Planning and
Evaluation to maintain and continue to update the existing Teen
Pregnancy Prevention Evidence Review.
Office of the Assistant Secretary for Health
African American Children and Suicide.--The Committee is
concerned that the suicide rate among children ages 10 to 17
increased by 70 percent between 2006 and 2016. The Committee is
also concerned that African American children ages 5 to 12 are
dying by suicide at nearly twice the rate of their white
counterparts. Accordingly, the Committee directs the Office of
the Surgeon General to submit a report on this pressing public
health issue, within 90 days of enactment of this Act,
including an examination of factors that may be causing this
disparity as well as evidence-based interventions. The Surgeon
General should collaborate with the CDC, SAMHSA, ACF, the
National Institute of Minority Health and Health Disparities,
the National Institutes of Mental Health, and the National
Institute of Child Health and Human Development, as
appropriate.
Chronic Fatigue Syndrome Advisory Committee.--The Committee
is concerned about the Secretary's decision to disband the
Chronic Fatigue Syndrome Advisory Committee (CFSAC) without
alternative plans to carry out its functions and current
projects. There remains an urgent need for U.S. inter-agency
coordination and collaboration with stakeholders to adequately
address the needs of the ME/CFS health crisis. In the absence
of CFSAC, the Committee requests that HHS submit a plan within
90 days of enactment of this Act outlining how the Department
intends to address the crisis in ME/CFS clinical care;
accelerate drug development for ME/CFS; and collaborate across
HHS agencies and stakeholders.
Embryo Adoption Awareness Campaign.--The Committee includes
$1,000,000 for the Embryo Adoption Awareness Campaign, the same
as the fiscal year 2019 enacted level. These funds will be used
to educate Americans about the existence of frozen human
embryos (resulting from in-vitro fertilization), which may be
available for donation or adoption to help other couples build
their families. The Committee includes bill language permitting
these funds also to be used to provide medical and
administrative services to individuals adopting embryos, deemed
necessary for such adoptions, consistent with the Code of
Federal Regulations.
Immunization Objectives.--The Healthy People immunization
and infectious disease objectives are a cornerstone to national
efforts to protect against vaccine preventable conditions
across the lifespan. As the Office of Disease Prevention and
Health Promotion (ODPHP) works to finalize objectives for
Healthy People 2030, the Committee notes that the proposed list
of objectives includes only eight immunization objectives. This
reduction is a missed opportunity to emphasize immunizations at
a time when it is critically important to elevate this as a
public health priority across the lifespan. The HHS Strategic
Plan recognizes that infectious diseases are a major health and
economic burden for the United States and makes a commitment to
support access to preventive services including immunizations
and screenings, especially for high-risk, high-need
populations. To help fulfill this priority, the Committee
strongly urges ODPHP to work with the National Vaccine Program
Office to adopt an Adult Immunization Composite Status Measure
Objective, which targets multiple vaccine preventable
conditions (influenza, Td/Tdap, zoster and pneumococcal) in one
quality measure. Adoption of the Composite would align HP2030
objectives with external health care quality measurement tools,
streamlining the patchwork of existing adult immunization
measures, reducing the reporting burden to providers, and
providing a meaningful national picture of access to this
important preventive service.
Reorganization.--The Committee strongly opposes the
Secretary's reorganization of the Office of the Assistant
Secretary for Health--in particular, the Secretary's misguided
decision to merge the Office of Adolescent Health into the
Office of Population Affairs and the decision to dismantle HHS
Regional Offices that currently administer the Title X Family
Planning program. The Committee believes the reorganization
will harm the Teen Pregnancy Prevention Program and its ability
to provide evidence-based and medically accurate programs that
reduce teen pregnancy. The Committee disagrees with the
Secretary's decision to move forward with the reorganization
after satisfying only the bare minimum of requirements for
congressional notification. As a result, the Committee modifies
reprogramming authority to remove the ability of the Secretary
to reorganize offices unless the reorganization proposal is
included in the President's budget request.
Sexual Risk Avoidance.--The Committee includes no funding
for grants to implement education in sexual risk avoidance,
also known as abstinence-only until marriage programs.
Sexually Transmitted Infections (STIs).--The Committee is
aware of the recent statistics regarding the rise in STIs
across the nation and is pleased that the Assistant Secretary
for Health is creating a National STD Action Plan to address
increasing rates in these diseases. The Committee requests a
report within 90 days of enactment of this Act on the
Administration's progress on such an Action 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.
Unfortunately, in July 2017, HHS sought to abruptly shorten
existing grants after the third year of their five-year awards.
This action was subsequently found to be unlawful and
overturned by multiple federal courts. Although HHS was ordered
to restore funding for the final two years of the grants, the
attempt to de-fund awards in the middle of multi-year programs
caused considerable disruption. The committee is therefore
providing a sixth year of funding for grants awarded for fiscal
years 2015 through 2019 to mitigate this disruption and
increase the opportunity for grantees to meet the original
goals for their projects.
Office of Minority Health
The Committee provides $65,000,000 for the Office of
Minority Health (OMH), which is $8,330,000 above the fiscal
year 2019 enacted level and $13,202,000 more than the fiscal
year 2020 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.
Health Disparities.--The Committee includes an increase of
$13,202,000 above the amount requested in the fiscal year 2020
budget request and directs OMH to allocate the additional funds
for research or public health interventions related to Sickle
Cell, Sickle Cell Trait, Lupus, Alzheimer's, Diabetes, and
peripheral artery disease, as well as stomach, liver, and
cervical cancer to help reduce the racial and ethnic
disparities that exist in these diseases. The Committee
encourages OMH to support research at Historically Black
Colleges and University medical colleges and Hispanic Serving
Institution medical schools to explore the disproportionate
impact these diseases have on minority populations.
The Committee directs OMH to submit an update to the
Committees on Appropriations no later than September 30, 2020,
including the name of each organization receiving funding in
fiscal year 2020; the amount of each award; a summary of each
project; and a projected timeline for each project.
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 their work with Historically Black Colleges and Universities
medical schools. The Committee requests a report on these
efforts within 180 days of enactment of this Act.
Office on Women's Health
The Committee includes $36,000,000 for the Office on
Women's Health, which is $3,860,000 above the fiscal year 2019
enacted level and $8,684,000 more than the fiscal year 2019
budget request.
The Committee includes $4,100,000, an increase of
$1,000,000 over the fiscal year 2019 enacted level, to combat
violence against women through the State partnership
initiative. This program provides funding to State-level public
and private health programs to partner with domestic and sexual
violence organizations to improve healthcare providers' ability
to help victims of violence and improve prevention programs.
Maternal Mortality.--The Committee continues to be
concerned about the high rate of maternal mortality in the
United States. The Committee includes additional funding for
OWH's activities to reduce maternal mortality, including
expansion of evidence-based interventions and dissemination of
information about evidence-based interventions.
Menstrual Hygiene Products.--The Committee is concerned
with the lack of data on the usage of--and preferences for--
different types of menstrual hygiene products, which are basic
health care necessities. The Committee directs the Office on
Women's Health to commission a study on the usage of, type,
preferences, and frequency in changing of different menstrual
hygiene products by race and socioeconomic status. The
Committee directs the Office on Women's Health to commission
the study in time to be submitted to Congress no later than 180
days after enactment of this Act.
OFFICE OF THE NATIONAL COORDINATOR FOR HEALTH
INFORMATION TECHNOLOGY
Appropriation, fiscal year 2019....................... $60,367,000
Budget request, fiscal year 2020...................... 43,000,000
Committee Recommendation.............................. 60,367,000
Change from enacted level........................... - - -
Change from budget request.......................... +17,367,000
The Office of the National Coordinator (ONC) is the
principal Federal entity charged with coordinating efforts to
implement and use health information technology and exchange
electronically health information.
Patient Data Matching.--The Committee is aware that one of
the most significant challenges inhibiting the safe and secure
electronic exchange of health information is the lack of a
consistent patient data matching strategy. With the passage of
the Health Information Technology for Economic and Clinical
Health (HITECH) Act, a clear mandate was placed on the Nation's
healthcare community to adopt electronic health records and
health exchange capability. Although the Committee continues to
carry a prohibition against HHS using funds to promulgate or
adopt any final standard providing for the assignment of a
unique health identifier for an individual until such activity
is authorized, the Committee notes that this limitation does
not prohibit HHS from examining the issues around patient
matching. Accordingly, the Committee continues to encourage the
Secretary, acting through the ONC and CMS, to provide technical
assistance to private-sector-led initiatives to develop a
coordinated national strategy that will promote patient safety
by accurately identifying patients to their health information.
OFFICE OF INSPECTOR GENERAL
Appropriation, fiscal year 2019....................... $80,000,000
Budget request, fiscal year 2020...................... 80,000,000
Committee Recommendation.............................. 85,000,000
Change from enacted level........................... +$5,000,000
Change from budget request.......................... +$5,000,000
The Committee provides $85,000,000 for the Office of
Inspector General (OIG), which is $5,000,000 more than the
fiscal year 2019 enacted level and $5,000,000 more than the
fiscal year 2020 budget request.
In addition, within the Health Care Fraud and Abuse Control
(HCFAC) program discretionary appropriations for fiscal year
2020, the Committee provides the OIG with $93,000,000.
Mandatory appropriations for this office also are contained in
the HCFAC program and the Health Insurance Portability and
Accountability Act of 1996.
Unaccompanied Children.--The Committee appreciates the
OIG's ability to respond quickly to warning signs in the Office
of Refugee Resettlement's (ORR) Unaccompanied Children program
and looks forward to the OIG's forthcoming series of reports on
critical issues related to unaccompanied children in ORR's
custody.
OFFICE FOR CIVIL RIGHTS
Appropriation, fiscal year 2019....................... $38,798,000
Budget request, fiscal year 2020...................... 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.
Expulsions and Suspensions in the Head Start program.--The
Committee is deeply concerned about expulsions and suspensions
that occur in preschool settings and K-3 classrooms,
particularly given the racial and gender disparities that
exist. These outcomes are problematic given the research that
indicates these practices can adversely affect development,
health, and education outcomes. The Committee strongly urges
the Office of Civil Rights to collect data annually from all
Head Start grantees on the number and type of suspension and
expulsions of children enrolled in Head Start or Early Head
Start, disaggregated by race/ethnicity, sex, disability status,
and English Language Learner (ELL) status. The Office of Civil
Rights should also submit to the Committee on Appropriations of
the House of Representatives no later than 180 days after the
enactment of this act, and annually thereafter, a report
detailing school discipline in all Head Start programs,
including disaggregated data and any disparities by subgroup in
disciplinary rates. The report should include specific
recommendations given to schools on expulsions and
suspensions--including evidence-based interventions, consumer
education specific to each school, and opportunities to improve
school climate. The Committee urges OCR to provide technical
assistance to help prevent or severely limit expulsion and
suspension practices in Head Start programs; eliminate
disparities in the provision of discipline; and ensure the
safety and well-being of all young children.
RETIREMENT PAY AND MEDICAL BENEFITS FOR COMMISSIONED OFFICERS
Appropriation, fiscal year 2019....................... $629,209,000
Budget request, fiscal year 2020...................... 623,591,000
Committee Recommendation.............................. 623,591,000
Change from enacted level........................... -5,618,000
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 2019....................... $2,631,458,000
Budget request, fiscal year 2020...................... 2,666,591,000
Committee Recommendation.............................. 3,008,458,000
Change from enacted level........................... +377,000,000
Change from budget request.......................... +341,867,000
This account supports the activities of the Assistant
Secretary for Preparedness and Response (ASPR) and other
components within the Office of the Secretary to prevent,
prepare for, and respond to the health consequences of
bioterrorism and other public health emergencies, including
pandemic influenza. It also includes funding for the
Department's cybersecurity efforts.
Office of the Assistant Secretary for Preparedness and Response
The Committee provides $2,372,128,000 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.
Research and Development.--The Committee supports the
critical role of research and development (R&D) for new tools
to protect Americans from the threat of biological incidents,
including infectious diseases and diseases of epidemic
potential, and supports the prioritization of R&D within the
National Biodefense Strategy. The Committee requests that HHS
include in the fiscal year 2021 Congressional Budget
Justification an update on progress made in supporting U.S.
leadership and investment in emerging technologies and medical
countermeasures, including new drugs, diagnostics, vaccines,
and devices, as well as an update on progress made towards
integrating research and development into Federal Planning,
including work to facilitate policies and incentives across
interagency response R&D efforts.
Public Health Emergency Medical Countermeasures Enterprise
Multi-Year Budget.--The Committee appreciates the release of
the Public Health Emergency Medical Countermeasures Enterprise
multi-year budget in February 2019. The Committee expects more
timely future submissions, as the updates are due annually.
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 $57,404,000 for the National
Disaster Medical System (NDMS). NDMS deploys trained medical
teams to communities impacted by public health and medical
emergencies due to natural and man-made incidents.
Hospital Preparedness Program
The Committee includes $316,555,000, an increase
$52,000,000, 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 such as Ebola, Lassa Fever, Severe Acute
Respiratory Syndrome (SARS), Middle Eastern Respiratory
Syndrome (MERS), and other special pathogens. The Committee
includes $11,000,000 to be provided directly to the National
Ebola Training and Education Center (NETEC) and the ten
existing regional Ebola and other special pathogen treatment
centers.
Hospital Preparedness Grants.--The Committee includes an
increase of $35,000,000 for critical support to State, local
and regional partners to advance health care system
preparedness and response.
Regional Disaster Health Response System Demonstration
Pilots.--The Committee includes $6,000,000 for the expansion of
the current Regional Disaster Health Response System
demonstration pilots. The Committee directs HHS to include a
plan in the fiscal year 2021 Congressional Budget Justification
that is based on the results of these pilots that does not
duplicate current services.
Treatment Reimbursement.--During the Ebola outbreak,
Americans who became infected were successfully treated at
Academic Health Centers, using a reimbursement model to ensure
adequate compensation for treatment provided to Ebola victims.
Unfortunately, this model has not been extended to other
serious communicable diseases such as Lassa fever, which
represent an equal risk. Given the significant cost of
preparedness and care associated with any serious communicable
disease, when any Federal agency refers any highly contagious
individuals to a designated treatment center, the Committee
encourages the use of the previously developed reimbursement
model for Ebola to be applied.
Biomedical Advanced Research and Development Authority
The Committee includes $566,700,000, an increase of
$5,000,000, for the Biomedical Advanced Research and
Development Authority (BARDA). BARDA supports the advanced
development of vaccines, drugs, and therapeutics for potential
serious public health threats, including chemical, biological,
radiological, and nuclear threats, pandemic influenza, and
emerging and re-emerging infectious diseases.
Blood Products.--The Committee remains concerned over the
predicted platelet shortfall and vulnerability of the current
blood supply, in the event of an emergency. Advanced blood
products, e.g., freeze-dried platelets and plasma are key to
insuring a national response capability in order to save lives.
Next-generation blood products are needed. The Committee
encourages the acceleration of the development of freeze-dried
hemostatic products.
Tuberculosis.--The Committee previously encouraged BARDA to
support the development of new tuberculosis (TB) diagnostic
tests, drugs and vaccines for drug resistant TB. The Committee
requests a report on this issue within 180 days of enactment of
this Act.
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.
Zika Vaccine Development.--The number of new Zika virus
infections has dropped dramatically because much of the
population in Zika-endemic areas has developed an immunity to
the virus. However, like other similar mosquito-borne
flaviviruses, the virus is likely to reemerge in these areas in
several years, and could emerge unpredictably in isolated areas
in the meantime, including within the U.S. Given the links
between Zika virus infections and serious birth defects, and
the length of time necessary to develop vaccines, the Committee
believes it is prudent to continue efforts to develop a vaccine
for the Zika virus. Within the total funding provided for
BARDA, the Committee directs BARDA to continue to support
research and development on a vaccine for the Zika virus.
Policy and Planning
The Committee includes $14,877,000 for Policy and Planning.
The Office of Policy and Planning leads HHS' emergency
preparedness and response strategic direction and policy
coordination.
Project BioShield Special Reserve Fund
The Committee 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 $920,000,000, an increase of
$310,000,000, for the Strategic National Stockpile. The
Committee commends the Department for its efforts to achieve
efficiencies in its public health preparedness activities. 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.
Forward Deployment.--The Committee strongly urges HHS to
use discretion in allowing the forward deployment of Strategic
National Stockpile (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.
Saline.--The Committee encourages ASPR to explore ways with
industry to surge normal IV saline production capabilities for
response efforts.
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 $58,860,000 for information
technology cybersecurity in the Office of the Assistant
Secretary for Administration. These funds provide for
continuous monitoring and security incident response
coordination for the Department's computer systems and
networks.
Office of Security and Strategic Information
The Committee provides $7,470,000 for the Office of
Security and Strategic Information to maintain the security of
the Department's personnel, systems, and critical
infrastructure.
Office of Public Health and Science--Medical Reserve Corps
The Committee includes $6,000,000 for the Medical Reserve
Corps program, which is a network of local volunteers who work
to strengthen the public health infrastructure and preparedness
capabilities of their communities.
Pandemic Influenza Preparedness
The Committee includes $270,000,000, an increase of
$10,000,000, 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 Influenza Efficiencies.--The Committee is
committed to improving and modernizing our nation's pandemic
influenza preparedness and ensuring first responders are
protected. To that end, HHS is urged to consider novel pandemic
stockpiling concepts, such as Vendor Managed Inventory, already
used successfully in the Strategic National Stockpile, which
will reduce the overhead required to maintain the pandemic
stockpile, and will ensure a safe, reliable supply of pandemic
countermeasures are available from vaccine manufacturers as is
required.
Pandemic Influenza Vaccine.--The Committee remains
concerned about our nation's limited ability to rapidly respond
to a pandemic influenza outbreak and meet the Federal
government's goal of delivering vaccines within 12 weeks of a
declared pandemic. Historically HHS has entered into agreements
with multiple suppliers to ensure optimal level of preparedness
against pandemic influenza outbreaks. The Committee encourages
HHS to advance multiple technologies that can produce a vaccine
within 12 weeks of a pandemic influenza declaration.
General Provisions
Sec. 201. The Committee continues a provision to limit the
amount available for official reception and representation
expenses.
Sec. 202. The Committee continues a provision to limit the
salary of an individual through an HHS grant or other
extramural mechanism to not more than the rate of Executive
Level II.
Sec. 203. The Committee continues a provision to prohibit
the Secretary from using evaluation set-aside funds until the
Committees on Appropriations receive a report detailing the
planned use of such funds.
Sec. 204. The Committee continues 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.
Sec. 206. The Committee modifies 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 2021 budget request.
Sec. 220. The Committee continues specific report
requirements for CMS's Health Insurance Exchange activities in
the fiscal year 2021 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 2020, the level appropriated for the fund is $893,950,000
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 2020
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 10,000,000
Grants (Hospitals
Promoting
Breastfeeding).
CDC............................. Diabetes........... 72,275,000
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............ 129,600,000
CDC............................. Section 317 347,800,000
Immunization
Grants.
CDC............................. Lead Poisoning 17,000,000
Prevention.
CDC............................. Early Care 4,500,000
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 includes a new provision rescinding
unobligated funds from prior-year Children's Health Insurance
Program State allotments.
Sec. 231. The Committee modifies a provision relating to
Members of Congress and oversight of facilities responsible for
the care of unaccompanied alien children.
Sec. 232. The Committee includes a new provision ensuring
that efforts are taken to place unaccompanied alien children
who are siblings together.
Sec. 233. The Committee includes a new provision
prohibiting funds from being used to facilitate the Secretary
of Homeland Security taking certain actions against sponsors of
unaccompanied alien children, except under certain conditions.
Sec. 234. The Committee includes a new provision
prohibiting funds from being used to house unaccompanied alien
children in certain facilities, unless the Secretary grants
limited-duration waivers.
Sec. 235. The Committee includes a new provision requiring
a weekly report 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. 236. The Committee includes a new provision
prohibiting funds from being awarded to an organization that
does not comply with Federal nondiscrimination regulations.
Sec. 237. The Committee includes a new 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 other
territories or possessions of the United States.
Sec. 238. The Committee includes a new provision
prohibiting funds from being used to implement, enforce, or
otherwise give effect to certain revisions of the Code of
Federal Regulations.
Sec. 239. The Committee includes a new provision
prohibiting funds from being used to publish a proposed rule
relating to a nonemergency medical transportation benefit for
Medicaid beneficiaries.
Sec. 240. The Committee includes a new provision
prohibiting funds from being used to finalize, implement, or
enforce a rule related to conscience rights.
TITLE III--DEPARTMENT OF EDUCATION
EDUCATION FOR THE DISADVANTAGED
Appropriation, fiscal year 2019....................... $16,543,790,000
Budget request, fiscal year 2020...................... 16,376,790,000
Committee Recommendation.............................. 17,563,802,000
Change from enacted level........................... +1,020,012,000
Change from budget request.......................... +1,187,012,000
This account provides foundational funding to help ensure
all children receive a fair, equitable and high-quality
education.
Of the total amount available, $6,638,625,000 is
appropriated for fiscal year 2020 for obligation on or after
July 1, 2021 and $10,841,177,000 is appropriated for fiscal
year 2020 for obligation on or after October 1, 2021.
Grants to Local Educational Agencies
For fiscal year 2020, the Committee recommends
$16,859,802,000 for Title I grants to LEAs, an increase of
$1,000,000,000 over the fiscal year 2019 enacted level and the
fiscal year 2020 budget request, reflecting the largest
increase to the program in more than a decade. 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 both the fiscal year 2019 enacted level and the fiscal
year 2020 budget request. Basic grants are awarded to school
districts with at least 10 low-income children who make up more
than two percent of the school-age population.
Within the amount for Title I Basic Grants, up to
$5,000,000 is made available to the Secretary of Education
(Secretary) on October 1, 2019, to obtain annually-updated LEA-
level poverty data from the Bureau of the Census.
The Committee recommends $1,362,301,000 for Title I
Concentration Grants, which is the same as both the fiscal year
2019 enacted level and the fiscal year 2020 budget request.
Concentration Grants target funds to school districts in which
the number of low-income children exceeds 6,500 or 15 percent
of the total school-age population.
The Committee recommends $4,519,050,000 for Title I
Targeted Grants, which is $500,000,000 above the fiscal year
2019 enacted level and the 2020 budget request. Targeted Grants
provide higher payments to school districts with high numbers
or percentages of low-income students.
The Committee recommends $4,519,050,000 for Title I
Education Finance Incentive Grants (EFIGs), which is
$500,000,000 above the fiscal year 2019 enacted level and the
2020 budget request. EFIGs provide payments to States and
school districts that incorporate equity and effort factors to
improve the equity of State funding systems.
Our nation's public schools serve more than 50 million
children, more than 50 percent of whom come from low-income
families. Research shows that low-income students are more
likely to struggle academically and often attend high-need
schools with fewer resources, less-experienced teachers, and
more limited access to advanced coursework. Unfortunately,
support for federal K-12 formula programs has been relatively
stagnant over the past decade, allowing inflation to erode the
value of this vital assistance. The Committee is concerned by
research from the Center on Budget and Policy Priorities that
finds that 29 States spent less per student in 2015 than they
had in the 2008 school year, before the Great Recession. The
Committee intends for this historic increase for Title I, and
for other K-12 programs, to help reverse a decade of
disinvestment and austerity for our schools and communities.
The Committee is encouraged by recent research on community
school models, including findings that well-implemented
community schools lead to improved student and school outcomes
while meeting the needs of low-income students. The Committee
notes that under Schoolwide Programs in the Elementary and
Secondary Education Act (ESEA), schools may describe efforts,
and use funds, to support strategies to address schools' needs
that include a community schools approach, such as the use of a
community schools coordinator, expanded and enriched learning
time opportunities, active family and community engagement,
collaborative leadership practices, and integrated student
supports.
The Committee is concerned by the Department's proposed
Supplement not Supplant Non-Regulatory Informational Document
for leaving a key fiscal requirement unregulated and without a
meaningful standard against which the Department can enforce
compliance. The Committee is concerned the informational
guidance will lead to the abuse of flexibility and an erosion
of the effectiveness of the federal investment in public
education. Therefore, the Committee urges the Department to
abandon its proposal and engage in negotiated rulemaking and
robust public comment to promulgate a meaningful standard for
compliance with the requirements of ESEA.
Comprehensive Literacy Development Grants
The Committee recommends $195,000,000 for Comprehensive
Literacy Development Grants, which is $5,000,000 above the
fiscal year 2019 enacted level. The fiscal year 2020 budget
request proposes to eliminate this program. Funds are awarded
to States to subgrant to school district and/or early education
programs to improve literacy instruction for disadvantaged
students.
Innovative Approaches to Literacy
The Committee recommends $29,000,000 for Innovative
Approaches to Literacy, a $2,000,000 increase over the fiscal
year 2019 enacted level. The fiscal year 2020 budget 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.
State Agency Programs: Migrant
The Committee recommends $380,000,000 for the State Agency
Program for Migrant Education, which is $5,249,000 above the
fiscal year 2019 enacted level and the fiscal year 2020 budget
request. This program supports special educational and related
services for children of migrant agricultural workers and
fishermen, including: (1) Supplementary academic education; (2)
remedial or compensatory instruction; (3) English for limited
English proficient students; (4) testing; (5) guidance
counseling; and (6) other activities to promote coordination of
services across States for migrant children whose education is
interrupted by frequent moves.
State Agency Programs: Neglected and Delinquent
For the State Agency Program for Neglected and Delinquent
Children, the Committee recommends $50,000,000, which is
$2,386,000 about the fiscal year 2019 enacted level and the
fiscal year 2020 budget request. This formula grant program
supports educational services for children and youth under age
21 in State-run institutions, attending community day programs,
and in correctional facilities. A portion of these funds is
provided for projects that support the successful re-entry of
youth offenders into postsecondary and vocational programs.
Special Programs for Migrant Students
The Committee recommends $50,000,000 for the Special
Programs for Migrant Students, which is $5,377,000 above the
fiscal year 2019 enacted level and the fiscal year 2020 budget
request. These programs make grants to colleges, universities,
and nonprofit organizations to support educational programs
designed for students who are engaged in migrant and other
seasonal farm work. The High School Equivalency Program (HEP)
recruits migrant students age 16 and over and provides academic
and support services to help those students obtain a high
school equivalency certificate and subsequently to gain
employment or admission to a postsecondary institution or
training program. The College Assistance Migrant Program (CAMP)
provides tutoring and counseling services to first-year,
undergraduate migrant students and assists those students in
obtaining student financial aid for their remaining
undergraduate years.
IMPACT AID
Appropriation, fiscal year 2019....................... $1,446,112,000
Budget request, fiscal year 2020...................... 1,371,799,000
Committee Recommendation.............................. 1,498,112,000
Change from enacted level........................... +52,000,000
Change from budget request.......................... +126,313,000
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 $1,351,242,000 for Basic Support
Payments to LEAs, which is $50,000,000 above the fiscal year
2019 enacted level and the fiscal year 2020 budget request.
Basic Support Payments compensate school districts for lost tax
revenue and are made on behalf of Federally-connected children,
such as children of members of the uniformed services who live
on Federal property.
Payments for Children with Disabilities
The Committee recommends $48,316,000 for Payments for
Children with Disabilities, which is the same as both the
fiscal year 2019 enacted level and the fiscal year 2020 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 2019
enacted level and the fiscal year 2020 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 2019 enacted
level and the fiscal year 2020 budget request. Funding is
allocated by formula to eligible LEAs for school construction
activities under section 7007(a) of ESEA.
Payments for Federal Property
The Committee recommends $76,313,000 for Payments for
Federal Property, which $2,000,000 above the fiscal year 2019
enacted level. The fiscal year 2020 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 2019....................... $5,246,967,000
Budget request, fiscal year 2020...................... 675,614,000
Committee Recommendation.............................. 6,016,470,000
Change from enacted level........................... +769,503,000
Change from budget request.......................... +5,340,856,000
The Committee recommendation includes $6,016,470,000 for
the School Improvement Programs account.
Supporting Effective Instruction State Grants
The Committee recommends $2,555,830,000 for Supporting
Effective Instruction State Grants (Title II-A), which is
$500,000,000 above fiscal year 2019 enacted level. The fiscal
year 2020 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. Title II-A represents the
only dedicated funding stream for teacher professional
development for many States and districts. The Committee's
recommended funding level, which provides a 24 percent
increase, would be the program's first increase since fiscal
year 2010. Taking into account the impact previous cuts to
Title II-A have had on support for educator professional
development, the Committee prioritizes additional resources to
strengthen and highlight the importance of the teaching
profession.
The Committee also notes the role Title II-A funds can play
in helping educators incorporate vital social and emotional
learning (SEL) strategies. For instance, Title II-A can be used
to develop educator competencies in supporting student social,
emotional, and cognitive development into licensing and
accreditation requirements for teachers, school leaders,
administrators, and counseling staff. In addition, LEAs can use
Title II-A funds for professional development that helps
educators continually build on and refine student-centered
practices that support student social, emotional, and academic
learning. These can include learning to use data about school
climate and a wide range of student outcomes to undertake
continuous improvement, problem solving around the needs of
individual students and engaging in schoolwide initiatives in
collegial teams and professional learning communities, and
learning from other schools through networks, site visits, and
documentation of successes.
The Committee is supportive of the Department's recognition
of effective teaching and SEL as a vital, evidence-based field
and is interested in how its newly established Office of
Effective Teaching and Social and Emotional Learning will
provide technical assistance to State Educational Agencies
(SEAs) and LEAs in implementing the Every Student Succeeds Act
(ESSA). In addition, the Committee is interested in how the
office will disseminate knowledge of evidence-based SEL
strategies from the Department's newly established Center to
Improve Social and Emotional Learning and School Safety to
external stakeholders and to Department offices responsible for
competitive grant competitions. Therefore, within 60 days of
enactment of this Act, the Committee directs the Department to
brief the Committees on Appropriations on the Office of
Effective Teaching and Social and Emotional Learning's plans
for disseminating the Center to Improve Social and Emotional
Learning and School Safety's clearinghouse of evidence-based
strategies to internal and external stakeholders, including
SEAs and LEAs, and the office's plans for leveraging the
Center's knowledge of evidence-based SEL strategies to inform
fiscal year 2020 grant competitions.
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 2019 enacted level and the fiscal year 2020 budget
request. The Compact of Free Association Amendments Act of 2003
(PL 108-188) authorizes these entities to receive funding for
general education assistance.
21st Century Community Learning Centers
The Committee recommends $1,321,673,000 for 21st Century
Community Learning Centers, $100,000,000 more than the fiscal
year 2019 enacted level. The fiscal year 2020 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 $100,000,000 increase over fiscal year 2019 will help
communities providing after-school programs serve 1.5 million
students, approximately 120,000 more than in fiscal year 2019.
State Assessments
The Committee recommends $378,000,000 for State
Assessments, which is the same as the fiscal year 2019 enacted
level and the fiscal year 2020 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.
Culturally Relevant Assessments.--The Committee supports
efforts by the Department to ensure tribal populations have
access to quality culturally relevant assessments.
Education for Homeless Children and Youth
The Committee recommends $100,000,000 for the Education for
Homeless Children and Youth program, which is $6,500,000 more
than the fiscal year 2019 enacted level and the 2020 budget
request. 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 2019 enacted
level and the fiscal year 2020 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 $40,000,000 for the Education for
Native Hawaiian program, which is $3,603,000 more than the
fiscal year 2019 enacted level. The fiscal year 2020 budget
request proposes to eliminate this program. Funds are used to
provide competitive awards for supplemental education services
to the Native Hawaiian population.
Alaska Native Education Equity
The Committee recommends $36,453,000 for the Alaska Native
Education Equity program, which is $1,000,000 more than the
fiscal year 2019 level. The fiscal year 2020 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 $180,840,000 for Rural Education
programs, which is the same as the fiscal year 2019 enacted
level and the fiscal year 2020 budget request. There are two
programs to assist rural school districts with improving
teaching and learning in their schools: the Small, Rural
Schools Achievement program, which provides funds to rural
districts that serve a small number of students; and the Rural
and Low-Income Schools program, which provides funds to rural
districts that serve concentrations of poor students,
regardless of the number of students served by the district.
Funds appropriated for Rural Education shall be divided equally
between these two programs.
Comprehensive Centers
The Committee recommends $60,400,000 for Comprehensive
Centers, which is $8,400,000 above the fiscal year 2019 enacted
level. The fiscal year 2020 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 ESSA and provide children with a high-quality
education.
Student Support and Academic Enrichment State Grants
The Committee recommends $1,320,000,000 for Student Support
and Academic Enrichment (SSAE) State Grants, which is
$150,000,000 above the fiscal year 2019 enacted level. The
fiscal year 2020 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 notes 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.
Arming Teachers.--The Committee notes there is no evidence
to suggest that arming teachers would make schools safer.
Instead, there are serious concerns about the unintended
consequences and negative impacts such a policy could have on
the well-being and safety of students. The Committee is deeply
concerned by the Department's internal July 2018 memo that
indicated its Office of the General Counsel believes the
Secretary has discretion to interpret the ESEA ``as to its
permissiveness regarding the purchase of firearms and training
on the use of firearms.'' However, the memo also indicates that
``it is reasonable for the Secretary not to allow this use of
funds absent specific Congressional authorization, and it is
unlikely that this interpretation would be subject to a
successful legal challenge.'' Seeing as Congress never intended
for SSAE funds to be used to purchase firearms or for firearms
training in schools, and given the Department's Office of the
General Counsel view that it would be reasonable, and legally
sound, for the Secretary to disallow such expenditures, the
Committee directs the Secretary, within 30 days of enactment of
this Act, to issue guidance clarifying that SSAE funds are not
allowed to be used for the purchase of firearms or for firearms
training.
Digital Divide.--The Committee is concerned by the impact
of the digital divide on low-income, minority, and historically
underrepresented students. For instance, a recent analysis
found that 54 percent of households in Detroit, Michigan lacked
fixed broadband connections. Lack of access to broadband for
children and families places significant burdens on schools and
libraries to help students connect in order to complete
coursework. To address this challenge, the Committee notes that
LEAs may use SSAE grants to help expand broadband technology in
schools as a use of funds to build technological capacity and
infrastructure.
Engineering Education.--The Committee is aware that among
science, technology, engineering and mathematics (STEM) topics,
there is a relatively limited focus on engineering education;
however, engineering is important in its application of
scientific and mathematical principles to innovation, analysis,
design, evaluation, and manufacturing processes and systems.
Therefore, the Committee is supportive of efforts by LEAs to
use SSAE funds to support rigorous academic coursework or
educator professional learning in engineering education
programs and encourages the expansion of engineering
initiatives in elementary and secondary schools through public-
private partnerships.
Computer Science.--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.
INDIAN EDUCATION
Appropriation, fiscal year 2019....................... $180,239,000
Budget request, fiscal year 2020...................... 176,239,000
Committee Recommendation.............................. 186,374,000
Change from enacted level........................... +6,135,000
Change from budget request.......................... +10,135,000
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 2019
enacted level and the fiscal year 2020 budget request. This
program provides assistance through formula grants to school
districts and schools supported or operated by the Bureau of
Indian Education. The purpose of this program is to improve
elementary and secondary school programs that serve American
Indian students, including preschool children. Grantees must
develop a comprehensive plan and ensure that the programs they
carry out will help Indian students reach the same challenging
standards that apply to all students. This program supplements
the regular school program to help American Indian children
sharpen their academic skills, bolster their self-confidence,
and participate in enrichment activities that would otherwise
be unavailable.
Special Programs for Indian Children
The Committee recommends $67,993,000 for Special Programs
for Indian Children, which the same as the fiscal year 2019
enacted level and $4,000,000 more than the fiscal year 2020
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 $13,000,000 for National
Activities, which is $6,135,000 above the fiscal year 2019
enacted level and the fiscal year 2020 budget request. Within
this account, no less than $4,340,000 is provided for grants to
Tribes for education administrative planning, development, and
coordination, and no less than $4,340,000 is provided for
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 2019....................... $1,035,556,000
Budget request, fiscal year 2020...................... 1,107,000,000
Committee Recommendation.............................. 1,223,815,000
Change from enacted level........................... +188,259,000
Change from budget request.......................... +116,815,000
The Committee recommends $1,223,815,000 for programs within
the Innovation and Improvement account.
Education Innovation and Research
The Committee recommends $300,000,000 for the Education
Innovation and Research program. This amount is $170,000,000
above the fiscal year 2019 enacted level and the same as the
fiscal year 2020 budget request. 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 $170,000,000 to provide grants for evidence-based,
field-initiated innovations that address student social,
emotional, and cognitive needs.
The competition is part of the Committee's new initiative
on SEL interventions and ``whole child'' approaches to
education. 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 meet
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. 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.
In addition, within the total for EIR, the Committee
recommendation includes $125,000,000 for States, school
districts, and school-based afterschool programs to provide or
strengthen instruction in science, technology, engineering,
arts, and mathematics (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 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 encourages the
Department to support Pre-K-12 computer science education to
schools across the country.
Finally, within the total for EIR, the Committee includes
$5,000,000 for the Department to fulfill dissemination and
evaluation technical assistance contracts.
The Committee rejects the Administration's proposal to fund
professional development vouchers for teachers and directs that
no funds are to be used for that purpose.
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 2019 enacted level and the 2020 budget request.
This program provides grants to States, school districts, and
partnerships to develop, implement, improve, or expand human
capital management systems or performance-based compensation
systems in schools.
American History and Civics Academies
The Committee recommends $1,815,000 for American History
and Civics Academies, which the same as the fiscal year 2019
enacted level. The fiscal year 2020 budget request proposes to
eliminate this program.
American History and Civics National Activities
The Committee recommends $3,000,000 for American History
and Civics National Activities, the same as the fiscal year
2019 enacted level. The fiscal year 2020 budget request
proposes to eliminate this program.
Competitive grants under Sections 2232 and 2233 of ESEA are
the only dedicated Federal funding for civics and American
history, helping to spur innovation and assist underserved
students. The Committee urges the Secretary to conduct a
competition and make awards in a timely manner.
Supporting Effective Educator Development
The Committee recommends $100,000,000 for the Supporting
Effective Educator Development (SEED) grant program, which is
$25,000,000 above the fiscal year 2019 level. The fiscal year
2020 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.
Within SEED, $25,000,000 is provided for a new initiative
to support professional development that helps educators
incorporate SEL practices into teaching, and for pathways into
teaching that provide a strong foundation in child development
and learning, including skills for implementing SEL strategies
in the classroom. The Committee recognizes the importance of
integrating SEL into educator professional preparation and
ongoing professional support and provides resources to expand
access to these competencies. 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 SEED
competition. In addition, the Department shall provide notice
to the Committees at least seven days before grantees are
announced.
Further, the Committee directs the Department to ensure
that SEED grants are awarded to a diverse set of eligible
entities, including national non-profit organizations
implementing evidence-based activities (as defined in section
8101(21)(A)(i) of 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 of
Education, 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.
Charter Schools Grants
The Committee recommends $400,000,000 for Charter School
Program (CSP) Grants, which is $40,000,000 below the fiscal
year 2019 enacted level and $100,000,000 below the fiscal year
2020 budget request. The Committee recommends an allocation of
funds within this program that aligns with ESSA.
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 is concerned by a recent report by the
Network for Public Education, which finds that as much as
$1,000,000,000 of CSP funds have been wasted on schools that
never opened or precipitously closed due to mismanagement. In
particular, the Committee is concerned by the ED-OIG September
2018 report, ``Nationwide Audit of Oversight of Closed Charter
Schools,'' which found that the Department did not provide
effective oversight of processes performed by the States that
receive CSP funding when their charter schools close. The
Committee is deeply concerned that the Department does not
intend to be a responsible steward of taxpayer dollars when it
comes to CSP funding, as it has rejected the multiple ED-OIG
audit recommendations. Therefore, the Committee directs the
Department, within 180 days of the enactment of this Act, to
implement all of the recommendations included in the September
2018 ED-OIG report and brief the Committees on Appropriations
on plans for implementation within 30 days of enactment of this
Act.
The Committee notes that ESSA requires the Department to
conduct regular evaluations of State entity CSP grants. ESSA
took critical steps toward strengthening oversight of charter
schools by requiring State entities receiving grant funds to
allocate not less than seven percent of funding received under
the program to provide technical assistance to grantees to
expand, open, and prepare for the operation of high-quality
charter schools, including by increasing charter school and
authorizer quality initiatives. ESSA reinforced that a vital
part of being a high-quality charter school is ``demonstrated
success in increasing student academic achievement . . . for
each of the subgroups of students, as defined in section
1111(c)(2) (20 U.S.C. 7221i).'' ESSA also places responsibility
on the State entity for ensuring that all charter schools
receiving grants ``meet the educational needs of their
students, including children with disabilities.'' The Committee
directs the Department to include in their evaluation of State
entity Charter School grant programs the extent to which State
entities are utilizing this seven percent to ensure that
charter schools receiving CSP grants are equipped to
appropriately serve students with disabilities and, by
extension, prepared to become high-quality charter schools.
Further, the Committee directs the Department to include a
summary of its findings in its fiscal year 2021 Congressional
Budget Justification.
In addition, the Committee notes widespread findings of
waste and abuse in the for-profit virtual charter school sector
and directs the Department to provide the Committees on
Appropriations, within 180 days of enactment of this Act, the
amount of CSP funding this sector received between fiscal years
2014 through fiscal year 2019. In addition, the Department
shall provide the total funding for all of the agency's
programs that goes to for-profit, virtual charter schools.
Magnet Schools Assistance
The Committee recommends $125,000,000 for the Magnet
Schools Assistance program, which is $18,000,000 more than the
fiscal year 2019 enacted level and the fiscal year 2020 budget
request. This program makes competitive grants to support the
establishment and operation of magnet schools that are a part
of a court-ordered or Federally-approved voluntary
desegregation plan.
This year marks the 65th anniversary of the Supreme Court's
landmark ruling in Brown v. Board that 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 supports 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. Therefore,
the Committee urges the Secretary to work with Congress 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 $2,259,000 more than the fiscal year 2019
enacted level. The fiscal year 2020 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.
The Ready to Learn program's broadcast mission remains
vital, particularly for children in rural and low-income
communities where access to broadband internet is often sparse
or non-existent. For the program's fiscal year 2020 grant
competition, the Committee expects the Department to issue a
Notice Inviting Applications as early in fiscal year 2020 as
possible. The Committee is strongly supportive of programming
specially designed for nationwide distribution over public
television stations' digital broadcasting channels.
Arts in Education
The Committee recommends $35,000,000 for Arts in Education,
which is $6,000,000 more than the fiscal year 2019 level. The
fiscal year 2020 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 $2,000,000 more than
the fiscal year 2019 enacted level. The fiscal year 2020 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 $15,000,000 for Statewide Family
Engagement Center grants, which is $5,000,000 above fiscal year
2019 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 2019....................... $190,754,000
Budget request, fiscal year 2020...................... 200,000,000
Committee Recommendation.............................. 240,000,000
Change from enacted level........................... +49,246,000
Change from budget request.......................... +40,000,000
The Committee recommends a total of $240,000,000 for
activities to promote safe schools, healthy students, and
citizenship education, which is $49,246,000 over the fiscal
year 2019 enacted level and $40,000,000 over the fiscal year
2020 budget request.
Promise Neighborhoods
The Committee recommends $80,000,000 for Promise
Neighborhoods, which is $1,746,000 more than the fiscal year
2019 enacted level. The fiscal year 2020 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 $120,000,000 for School Safety
National Activities, $25,000,000 above the fiscal year 2019
enacted level, and $80,000,000 less than the fiscal year 2020
budget request. The Committee's recommendation provides up to
$10,000,000 for the Project School Emergency Response to
Violence (Project SERV) program.
Within School Safety National Activities, the Committee
includes sufficient funding to continue a demonstration program
initiated in fiscal year 2019 to test and evaluate innovative
partnerships between institutions of higher education and
States or high-need local educational agencies to train school
counselors, social workers, psychologists, or other mental
health professionals qualified to provide school-based mental
health services, with the goal of expanding the pipeline of
these workers into low-income public elementary schools and
secondary schools in order to address the shortages of mental
health service professionals in such schools.
The Committee supports efforts to train school-based mental
health professionals; however, more must be done to directly
increase the number of well-trained mental health professionals
in school districts across the country. Research shows that
building the capacity of students to develop social and
emotional skills, and take responsibility for their community,
can reduce bullying, violence, and aggressive behaviors, making
schools safer. Increasing the number of qualified mental health
professionals in schools is central to this work. With the goal
of immediately addressing this urgent national need, the
Committee directs the Secretary to provide no less than
$25,000,000 in awards to SEAs, LEAs, or consortia of LEAs to
increase the number of well-trained school counselors, social
workers, psychologists, or other mental health professionals
qualified to provide school-based mental health services. This
competition, which would expand the number of mental health and
child development experts in schools, is part of the
Committee's new initiative to provide resources for SEL. To
promote the sustainability of these services, the Secretary
shall require that awards include a 25 percent match from
grantees and require that the awards do not supplant existing
mental health funding. Within 90 days of enactment of this Act,
the Department is directed to brief the Committees on
Appropriations on plans for carrying out the competition. In
addition, the Department shall provide notice to the Committees
at least seven days before grantees are announced.
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, and 2019 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
Department shall brief the Committees within 30 days of
enactment of this Act on how it plans to carry out this
directive.
The Committee is disappointed that the Department issued a
Federal School Safety Commission Report about how to prevent
school shootings that failed to look at the role of our
nation's permissive gun laws. Further, the Committee is
dismayed that the Department relied on racially-biased
conclusions to justify the rescission of the 2014 ``Rethink
School Discipline'' guidance. The Committee directs the
Department, within 30 days of enactment of this Act, to remove
references to the report entitled: ``Prior problem behavior
accounts for the racial gap in school suspensions'' from all
materials on the Department's website, guidance, or reports.
Furthermore, the Committee directs the Department to reconsider
the rescission of this guidance.
Full-Service Community Schools
The Committee recommends $40,000,000 for Full-Service
Community Schools, which is $22,500,000 more than the fiscal
year 2019 level. The fiscal year 2020 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 new 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 2019....................... $737,400,000
Budget request, fiscal year 2020...................... 737,400,000
Committee Recommendation.............................. 980,400,000
Change from enacted level........................... +242,600,000
Change from budget request.......................... +242,600,000
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 Committee recommends $980,000,000 for English Language
Acquisition in fiscal year 2020, a historic increase of
$242,600,000 over both the fiscal year 2019 enacted level and
the fiscal year 2020 budget request. Federal data shows that
significant achievement gaps exist between English learners
(ELs) and their peers; however, the funding to support these
students has been flat for many years. This comes at a time
when many States and school districts have experienced rapid
growth in their EL populations. Providing increased resources
to improve educational quality for EL students is a top
priority for the Committee.
The Committee is aware that the statutory formula used to
make English Language Acquisition allotments to States, set
forth in Section 3111(c) of ESEA, does not fully capture
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. The Committee recommended funding is intended to help
in addressing this need.
SPECIAL EDUCATION
323Appropriation, fiscal year 2019.................... $13,468,728,000
Budget request, fiscal year 2020...................... 13,451,145,000
Committee Recommendation.............................. 14,523,544,000
Change from enacted level........................... +1,054,816,000
Change from budget request.......................... +1,072,399,000
Of the total amount available, $4,975,709,000 is available
for obligation on July 1, 2020, and $9,283,383,000 is available
for obligation on October 1, 2020. 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 $13,364,392,000 for Part B Grants
to States, which is $1,000,000,000 above the fiscal year 2019
enacted level and the fiscal year 2020 budget request,
reflecting the largest increase to the program in more than a
decade. The Committee is concerned that the federal share of
the excess cost of educating students with disabilities has
declined and notes the critical role this increase will play in
helping to reverse this trend.
In March 2019, the courts ruled that the Department's delay
of the 2016 Significant Disproportionality rule, which requires
States to address racial disparities and discrimination in
special education programs, was arbitrary and capricious, and
thus illegal. The Committee is deeply concerned that the
Department has not communicated to stakeholders or Congress how
it is enforcing the rule, per the recent court decision.
Therefore, within 30 days of enactment of this Act, the
Committee directs the Department to submit a report to the
Committees on Appropriations, the House Committee on Education
and Labor, and the Senate Committee on Health, Education,
Labor, and Pensions on how it is implementing the 2016
Significant Disproportionality rule. The report shall include
which data the Department is collecting to ensure compliance
and all detailed guidance provided by the Department to help
States comply with provisions of the regulation. The Committee
notes that its SEL initiative, as described in the School
Improvement Programs, Innovation and Research, and Safe Schools
and Citizenship Education accounts, aims to provide schools,
school districts, and States with critical tools so that they
can support all students and prevent misidentification.
The Committee includes new bill language, as requested in
the fiscal year 2020 budget request, that permits States to
subgrant funds that they reserve under section 611(e)(2) of the
IDEA to more efficiently carry out authorized State-level
activities. The Committee continues to include bill language
excluding any amount by which a State's allocation is reduced
for failure to meet the maintenance of effort threshold from
being used to calculate the State's allocation under section
611(d) of the (IDEA) in subsequent years. The Committee also
continues to include bill language directing the Secretary to
distribute any reduction in a State's allocation under said
section to all other States based on the formula established
under section 611(d), excluding those States that are
penalized.
Preschool Grants
The Committee recommends $403,400,000 for Preschool Grants,
which is $12,280,000 above the fiscal year 2019 enacted level
and the fiscal year 2020 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 $491,300,000 for Grants for
Infants and Families, which is $21,300,000 more than the fiscal
year 2019 enacted level and the fiscal year 2020 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 includes new bill language, as requested in the
fiscal year 2020 budget request, to resolve implementation
challenges related to funding for State Incentive Grants, a
program that offers States the flexibility to expand services
for children with disabilities beyond age 3.
IDEA National Activities
The Committee recommends $264,452,000 for the IDEA National
Activities program, which is $21,236,000 above the fiscal year
2019 enacted level and $38,819,000 above the fiscal year 2020
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 $30,047,000 for Educational Technology,
Media, and Materials, which is $2,000,000 more than the fiscal
year 2019 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.
Parent Information Centers.--The Committee recommends
$30,000,000 for Parent Information Centers, which is $2,589,000
more than fiscal year 2019 enacted level and the fiscal year
2020 budget request. This program makes awards to parent
organizations to support Parent Training and Information
Centers, including community parent resource centers. These
centers provide training and information to meet the needs of
parents of children with disabilities living in the areas
served by the centers, particularly underserved parents and
parents of children who may be inappropriately identified.
Technical assistance is also provided under this program for
developing, assisting, and coordinating centers receiving
assistance under this program. The Committee acknowledges
States with significant rural areas can be harder to engage due
to distance barriers and encourages the Department to assist
with their efforts to support parents of children with
disabilities.
Personnel Preparation.--The Committee recommends
$98,310,000 for Personnel Preparation, which is $11,110,000
above both the fiscal year 2019 enacted level and the fiscal
year 2020 budget request. This program supports competitive
awards to help address State-identified needs for qualified
personnel to work with children with disabilities, and to
ensure that those personnel have the necessary skills and
knowledge to serve children with special needs. Awards focus on
addressing the need for leadership and personnel to serve low-
incidence populations. Funds are included to fully support
continuation costs for grants made in prior years. The
Committee notes the critical role the Personnel Preparation
program plays in helping to address the nation's shortage of
teachers for students with disabilities.
State Personnel Development.--The Committee recommends
$40,630,000 for State Personnel Development, which is
$2,000,000 more than the fiscal year 2019 enacted level and the
fiscal year 2020 budget request. This program supports grants
to States to assist with improving personnel preparation and
professional development related to early intervention and
educational and transition services that improve outcomes for
students with disabilities. Funds are included to fully support
continuation costs for grants made in prior years.
Technical Assistance and Dissemination.--The Committee
recommends $65,465,000 for Technical Assistance and
Dissemination, which is $3,537,000 above the fiscal year 2019
enacted level and $21,120,000 above the 2020 budget request.
The increase over fiscal year 2019 is provided for the Special
Olympics education programs, as authorized by the Special
Olympics Sport and Empowerment Act of 2004, for which the
Committee recommends a funding level of $21,120,000. The fiscal
year 2020 budget request proposes to eliminate Special
Olympics. The other programs within Technical Assistance and
Dissemination provide funding for technical assistance,
demonstration projects, and information dissemination. These
funds support efforts by State and local educational agencies,
IHEs, and other entities to build State and local capacity to
make systemic changes and improve results for children with
disabilities. Funds are included to fully support continuation
costs for grants made in prior years.
Outlying Areas and Freely Associated States.--The Committee
is aware that the Outlying Areas (OA) and Freely Associated
States (FAS) may experience significant challenges in funding
the excess cost of educating students with disabilities.
Therefore, the Committee directs the Department to explore how
it could better support OA and FAS students with disabilities,
including a consideration of how secretarial discretion is used
to determine OA and FAS allocations. The Department shall
update the Committee on its findings, along with data on OA and
FAS allocations in the fiscal year 2021 Congressional
Justification.
REHABILITATION SERVICES
Appropriation, fiscal year 2019....................... $3,657,189,000
Budget request, fiscal year 2020...................... 3,719,527,000
Committee Recommendation.............................. 3,752,076,000
Change from enacted level........................... +94,887,000
Change from budget request.......................... +32,549,000
The programs in this account are authorized by the
Rehabilitation Act of 1973 and the Helen Keller National Center
Act.
Vocational Rehabilitation State Grants
The Committee recommends $3,610,040,000 in mandatory
funding for Vocational Rehabilitation (VR) State Grants, which
is $88,050,000 above the fiscal year 2019 enacted level and the
same as the fiscal year 2020 budget request.
This program supports basic vocational rehabilitation
services through formula grants to States. These grants support
a wide range of services designed to help persons with physical
and mental disabilities prepare for and engage in gainful
employment to the extent of their capabilities. Emphasis is
placed on providing vocational rehabilitation services to
persons with the most significant disabilities. The Committee's
recommendation provides the cost-of-living adjustment for
Vocational Rehabilitation Grants to States, as authorized.
Client Assistance State Grants
The Committee recommends $15,000,000 for Client Assistance
State Grants, which is $2,000,000 more than the fiscal year
2019 enacted level and the fiscal year 2020 budget request.
Client Assistance State Grants support services for eligible
individuals and applicants of the VR State Grants program, and
other programs, projects, and services funded under the
Rehabilitation Act. These formula grants are used to help
persons with disabilities overcome problems with the service
delivery system and improve their understanding of services
available to them under the Rehabilitation Act.
Training
The Committee recommends $30,188,000 for the Training
program, which is $800,000 more than the fiscal year 2019
enacted level and the fiscal year 2020 budget request. The
program supports long-term and short-term training, in-service
personnel training, and training of interpreters for deaf
persons. Projects in a broad array of disciplines are funded to
ensure that skilled personnel are available to serve the
vocational needs of persons with disabilities. Funds are
included to fully support continuation costs for grants made in
prior years.
Demonstration and Training Programs
The Committee recommends $7,333,000 for Demonstration and
Training Programs, which is $1,537,000 more than the fiscal
year 2019 enacted level and the fiscal year 2020 budget
request. These programs support activities designed to increase
employment opportunities for individuals with disabilities by
expanding and improving the availability and provision of
rehabilitation and other services. The Committee recommendation
includes no less than the fiscal year 2019 enacted level for
parent information and training programs.
Protection and Advocacy of Individual Rights
The Committee recommends $17,650,000 for Protection and
Advocacy of Individual Rights, which is the same as both the
fiscal year 2019 enacted level and the fiscal year 2020 budget
request. Grants are awarded to entities that have the authority
to pursue legal, administrative, and other appropriate remedies
to protect and advocate for the rights of persons with
disabilities.
Supported Employment State Grants
The Committee recommends $22,548,000 for Supported
Employment State Grants, which is the same as the fiscal year
2019 enacted level. The fiscal year 2020 budget request
proposes to eliminate this program. These formula grants assist
States in developing collaborative programs with public
agencies and nonprofit agencies for training and post-
employment services leading to supported employment. In
supported employment programs, persons with the most
significant disabilities are given special supervision and
assistance to enable them to work in an integrated settings.
Independent Living Services for Older Individuals Who Are Blind
The Committee recommends $33,317,000 for Independent Living
Services for Older Individuals Who Are Blind, which is the same
as both the fiscal year 2019 enacted level and the fiscal year
2020 budget request. Funds are distributed to States according
to a formula based on the population of individuals who are 55
or older and provide support for services to persons 55 years
old or over, whose severe visual impairment makes gainful
employment extremely difficult to obtain, but for whom
independent living goals are feasible.
Helen Keller National Center
The Committee recommends $16,000,000 for the Helen Keller
National Center for Deaf-Blind Youth and Adults, which is
$2,500,000 above the fiscal year 2019 enacted level and
$5,664,000 above the fiscal year 2020 budget request. These
funds are used for the operation of a national center that
provides intensive services for deaf-blind individuals and
their families at Sands Point, New York, and a network of ten
regional offices that provide referral, counseling, transition
services, and technical assistance to service providers.
SPECIAL INSTITUTIONS FOR PERSONS WITH DISABILITIES
Appropriation, fiscal year 2019....................... $242,292,000
Budget request, fiscal year 2020...................... 216,722,000
Committee Recommendation.............................. 257,361,000
Change from enacted level........................... +15,069,000
Change from budget request.......................... +40,639,000
The Committee recommends $257,361,000 for Special
Institutions for Persons with Disabilities, which is
$15,069,000 above the fiscal year 2019 enacted level and
$40,639,000 above the fiscal year 2020 budget request.
AMERICAN PRINTING HOUSE FOR THE BLIND
Appropriation, fiscal year 2019....................... $30,431,000
Budget request, fiscal year 2020...................... 25,431,000
Committee Recommendation.............................. 39,000,000
Change from enacted level........................... +8,569,000
Change from budget request.......................... +13,569,000
This funding subsidizes the production of educational
materials for legally blind persons enrolled in pre-college
programs. The American Printing House for the Blind (Printing
House), which is chartered by the Commonwealth of Kentucky,
manufactures and maintains an inventory of educational
materials in accessible formats that are distributed free of
charge to schools and States based on the number of blind
students in each State. The Printing House also conducts
research and field activities to inform educators about the
availability of materials and how to use them.
The Committee commends the Printing House for ensuring that
students who are blind and visually impaired are able to
benefit from the latest educational technologies. The Committee
intends the recommended increase to assist in increasing the
per-pupil expenditure.
NATIONAL TECHNICAL INSTITUTE FOR THE DEAF
Appropriation, fiscal year 2019....................... $77,500,000
Budget request, fiscal year 2020...................... 70,016,000
Committee Recommendation.............................. 80,000,000
Change from enacted level........................... +2,500,000
Change from budget request.......................... +9,984,000
Congress established the National Technical Institute for
the Deaf (Institute) in 1965 to provide a residential facility
for postsecondary technical training and education for deaf
persons with the purpose of promoting the employment of these
individuals. The Institute also conducts applied research and
provides training related to various aspects of deafness. The
Secretary of Education administers these activities through a
contract with the Rochester Institute of Technology in
Rochester, New York.
GALLAUDET UNIVERSITY
Appropriation, fiscal year 2019....................... $134,361,000
Budget request, fiscal year 2020...................... 121,275,000
Committee Recommendation.............................. 138,361,000
Change from enacted level........................... +4,000,000
Change from budget request.......................... +17,086,000
Gallaudet is a private, non-profit educational institution
Federally chartered in 1864 providing elementary, secondary,
undergraduate, and continuing education for deaf persons. In
addition, the University offers graduate programs in fields
related to deafness for deaf and hearing students, conducts
research on deafness, and provides public service programs for
deaf persons.
CAREER, TECHNICAL, AND ADULT EDUCATION
Appropriation, fiscal year 2019....................... $1,925,686,000
Budget request, fiscal year 2020...................... 1,842,159,000
Committee Recommendation.............................. 2,003,133,000
Change from enacted level........................... +77,447,000
Change from budget request.......................... +160,974,000
This account includes vocational education programs
authorized by the Carl D. Perkins Career and Technical
Education Act of 2006, as recently reauthorized by the
Strengthening Career and Technical Education for the 21st
Century Act, and the Adult Education and Family Literacy Act
(AEFLA).
Career and Technical Education: State Grants
The Committee recommends $1,310,000,000 for Career and
Technical Education (CTE) State Grants, which is $47,402,000
above the fiscal year 2019 enacted level and the fiscal year
2020 budget request. Of these funds, $519,000,000 will become
available on July 1, 2020, and $791,000,000 will become
available for obligation on October 1, 2020.
State Grants support a variety of career and technical
education programs developed in accordance with the State plan.
This program focuses Federal resources on institutions with
high concentrations of low-income students. The populations
assisted by State Grants range from secondary students in
prevocational courses to adults who need retraining to adapt to
changing technological and labor markets. Funding for State
Grants will continue support for state-of-the-art career and
technical training to students in secondary schools and
community and technical colleges.
National Programs
The Committee recommends $7,421,000 for National Programs,
which is the same as the fiscal year 2019 enacted level and
$12,579,000 less than the fiscal year 2020 budget request. In
keeping with the purpose of the National Programs, the
Committee recommendation includes sufficient funding to support
the conduct and dissemination of research in career and
technical education.
Cybersecurity
The Committee recognizes the cybersecurity threats facing
our nation's critical infrastructure sectors and the need for
workers in these industries, including those who operate cyber
physical systems, to be equipped with skills to keep systems
secure. The Committee acknowledges that many of these operators
are educated through CTE programs that prominently feature a
culture of physical safety but do not incorporate cybersecurity
skills. Therefore, the Committee encourages the Secretary to
explore opportunities to support CTE programs that integrate
cybersecurity into curricula used by students preparing for
careers in critical infrastructure sectors.
Adult Basic and Literacy Education State Grants
The Committee recommends $672,000,000 for Adult Basic and
Literacy Education State Grants, which is $30,045,000 more than
the fiscal year 2019 enacted level and $186,151,000 above the
fiscal year 2020 budget request. State formula-grants,
authorized under the AEFLA, support programs to enable all
adults to acquire basic literacy skills, to enable those who so
desire to complete secondary education, and to make available
to adults the means to become more employable, productive, and
responsible citizens.
Adult Education National Leadership Activities
The Committee recommends $13,712,000 for National
Leadership Activities, which is the same as the fiscal year
2019 enacted level and $60,000,000 below the fiscal year 2020
budget request. This program supports applied research,
development, dissemination, evaluation, and program improvement
efforts to strengthen the quality of adult education services.
The Committee recommendation does not include language or
funding, as requested in the budget request, to support a new
pre-apprenticeship grants initiative. It is unclear whether
these programs would articulate to registered apprenticeship
programs or another untested, low-quality apprenticeship model.
STUDENT FINANCIAL ASSISTANCE
Appropriation, fiscal year 2019....................... $24,445,352,000
Budget request, fiscal year 2020...................... 22,975,352,000
Committee Recommendation.............................. 24,937,352,000
Change from enacted level........................... +492,000,000
Change from budget request.......................... +1,962,000,000
Pell Grants
The Committee recommends $22,475,352,000 in discretionary
funding for the Pell Grant program, which is the same as both
the fiscal year 2019 enacted level and the fiscal year 2020
budget request. These funds will support Pell grants to
students for the 2020-2021 academic year.
Combined with mandatory funding streams, the Committee
recommendation supports a maximum Pell Grant in academic year
2020-2021 of $6,345, a $150 increase over fiscal year 2019 and
the fiscal year 2020 budget request to help the award keep up
with inflation.
Pell Grants help to ensure access to educational and
economic opportunities for low- and middle-income students by
providing need-based financial assistance. Grants are
determined according to a statutory formula, which considers
income, assets, household size, and the number of family
members in college, among other factors. Pell Grants are the
foundation of Federal postsecondary student aid programs.
The Committee recognizes the importance of programs that
support Pell-eligible community college students and offer non-
academic support services, including comprehensive case
management and strategic emergency financial assistance, to
help them complete their education. The Committee encourages
the Department to look for opportunities to support these types
of programs and requests an update in the fiscal year 2021
Congressional Budget Justification on options available to
provide support services for these students.
The Committee is deeply concerned about high recidivism
rates and a shortage of postsecondary education opportunities
for low-income, incarcerated individuals in the U.S. Since
1994, States have been forced to reduce or permanently remove
postsecondary correctional education programs. According to the
American Correctional Association, States offering such
postsecondary correctional education programs dropped from 37
in 1994 to only 12 in 2015. This is particularly troubling as
our nation's federal prison population has increased by nearly
50 percent over the same period.
The Committee recognizes that access to postsecondary
correctional education programs significantly reduces
recidivism, helps break down racial barriers that are a common
cause of disciplinary problems in the prison system, and
increases access to employment for individuals who have been
incarcerated. The Committee supports the work of the
Department's Second Chance Pell Experiment, which is testing
how expanding access to financial aid improves outcomes for
individuals who are incarcerated. The Committee encourages the
Department to continue the experiment and directs the
Department to conduct a rigorous evaluation of the Second
Chance Pell Experiment, so that Congress and stakeholders may
examine the benefits of providing members of society a second
chance through the Pell Grant program. To that end, the
Committee recommendation includes up to $2,000,000 within the
Research, Development and Dissemination program at the
Institute of Education Sciences (IES) solely for the rigorous
evaluation of the Second Chance Pell Experiment as announced in
the Federal Register (Volume 80, Number 148 on Monday, August
3, 2015). The Committee directs the Department's Policy and
Program Studies Service to work with IES on this effort.
Federal Supplemental Educational Opportunity Grants
The Committee recommends $1,028,000,000 for this program,
which is $188,000,000 more than the fiscal year 2019 enacted
level. The fiscal year 2020 budget request proposes to
eliminate this program.
Supplemental Educational Opportunity Grants (SEOG) provide
funds to postsecondary institutions for need-based grants of up
to $4,000 to undergraduate students, with priority given to
students who are Pell-eligible. Approximately 68 percent of
dependent recipients have annual family incomes under $30,000
and nearly 71 percent of independent SEOG recipients have
annual family incomes under $20,000. Institutions must
contribute a 25 percent match toward their SEOG allocation.
Federal Work-Study
The Committee recommends $1,434,000,000 for the Federal
Work-Study program, which is $304,000,000 more than the fiscal
year 2019 enacted level and $934,000,000 above the fiscal year
2020 budget request.
Federal Work-Study funds are provided through institutions
to students who work part-time. The funds assist with paying
for the cost of education. Approximately 3,200 colleges and
universities receive funding, according to a statutory formula,
and may allocate it for job location and job development
centers. Work-study jobs must pay at least the Federal minimum
wage and institutions must provide 25 percent of student
earnings.
The Committee recommendation continues funding for the Work
Colleges program, which supports institutions that require all
resident students to participate in a work-learning program.
While the Federal Work-Study program currently requires
participating institutions to set aside seven percent of
funding for community service-based employment opportunities,
the Committee is aware that some institutions of higher
education are not adequately informing their students about
community service-based opportunities, nor making use of
employment opportunities in this sector. The Committee
encourages the Department to work with institutions of higher
education to ensure that schools are providing this information
to students and that community service jobs provide
experiential education and college-credit for students
preparing for careers working with community-based
organizations in low- and middle-income communities. The
Committee also encourages the Department to increase the number
and scope of learning partnerships between community-based
nonprofits, community and/or four-year colleges and other
programs that offer educational pathways to careers in
community organizing and community change, especially for first
generation college students.
Resources for First Generation College Students.--First
generation students comprise nearly a third of all college
students, yet there is a lack of dedicated support services to
ensure successful outcomes for such students. Given the
Department's vested interest in ensuring successful outcomes
for first generation students, the Committee directs the
Department to provide a report to the Committees on
Appropriations, within 180 days of enactment of this Act, on
improving the effectiveness of current federal policy in
supporting first generation students.
For-Profit Colleges.--On March 12, 2019, the Subcommittee
on Labor-HHS-Education-Related Agencies held an oversight
hearing on predatory for-profit colleges. For-profit colleges
receive nearly 14 percent of all Pell Grant funding, and while
accounting for only 9 percent of all students enrolled in
postsecondary education, they account for more than a third of
all defaults. A 2012 Senate Committee on Health, Education,
Labor and Pensions for-profit college investigation uncovered
internal recruiting documents from institutions, including
lists of who they targeted, such as ``welfare moms with kids,''
``pregnant ladies,'' ``military-active and retired,'' those who
``experienced a recent death'' and those who were ``physically/
mentally abused,'' among other groups. Another document the
investigation uncovered was a ``pain funnel'' that was used to
train employees on techniques to wear down prospective students
and coerce them into enrolling into their institutions.
During the Subcommittee's oversight hearing, a disabled
veteran testified that a for-profit college assured him that he
would not take out any student loans to enroll and would only
use grant aid and GI Bill benefits to attend; however, he came
to find out that he now owes approximately $100,000 in student
loan debt and was unable to find employment in his field of
study after graduating the for-profit institution.
For-profit colleges prey on servicemembers and veterans
with aggressive marketing and recruiting because of a loophole
that allows for-profit colleges to exclude from the cap on
federally derived institutional revenue any federal aid and
educational benefits from sources other than the Department of
Education. In addition, a recent study of for-profit
institutions receiving GI Bill benefits found that these
institutions spend little of their revenue on academic
instruction, with the leading recipients spending fifteen
percent or less of their revenue on instruction. The Committee
directs the Secretary to submit a report to the Committees on
Appropriations, within 90 days of enactment of this Act,
providing an analysis of all for-profit institutions who would
exceed the 90/10 federal funding limits if revenue from the VA
and DoD were included in the 90/10 calculation, the same way
that Title IV funds are included for the most recent academic
year. In addition, the report should also include all schools
that receive between 85 percent or more of their revenue from
Title IV, VA and DoD sources in the most recent academic year.
In addition, the Committee is deeply concerned with the
Secretary's efforts to undermine regulations designed to
protect students and taxpayers, such as the Gainful Employment
and Borrower Defense to Repayment regulations. While a Federal
court determined that the Department illegally delayed
implementation of the Borrower Defense to Repayment rule, the
Committee is troubled by the Department's failure to provide
relief to students who were misled and defrauded by their
respective institutions.
To ensure implementation of the regulation and to provide
sufficient oversight, the Committee directs the Secretary to
update the Borrower Defense to Repayment Report on FSA's Data
Center on a monthly basis, beginning no later than 30 days
after enactment of this Act. The Committee also directs the
Secretary to submit a report to the Committees on
Appropriations, within 60 days of enactment of this Act,
providing the number of claims and the total amount of the
loans covered by those claims by school and institutional type.
Furthermore, the Committee is concerned with the
Department's failure to act in the face of precipitous school
closures or to mitigate the resulting harm to students. While
the Department has many tools at its disposal to prevent such
closures (e.g., Heightened Cash Monitoring, letters of credit,
pre-acquisition reviews, the denial of tax status conversions),
it has made inadequate use of these tools. The Department
failed to prevent the Dream Center Education Holdings' (DCEH)
acquisition of Argosy University and the Art Institutes,
resulting in the loss of approximately $16,000,000 in federal
student aid, shuttered campuses, and harm to students. It
failed to protect taxpayers by returning a portion of a letter
of credit for the continued operation of an institution that
still shut its doors on students and their educational
pursuits, and it failed to protect students when it did not
require a teach-out agreement for every school covered by the
DCEH acquisition but still permitted continued access to
taxpayer funding for these schools.
To correct these errors, the Committee directs the
Department to submit a report to the Committees on
Appropriations, within 90 days of enactment of this Act,
outlining its plan to prevent precipitous closures in the for-
profit sector. In addition, the Committee directs the
Department to publish, on FSA's Data Center, the list of
schools with a letter of credit in fiscal years 2017 through
2019. The Committee also directs the Department to issue a
report to the Committees on Appropriations, within 90 days of
enactment of this Act, outlining the process through which it
approves or disapproves of a for-profit institution's
conversion to not-for-profit status and a list of any staff
involved in such decisions. The report must also include all
institutions of higher education that have changed their for-
profit status in the past three fiscal years and any action the
Department has made with respect to those institutions. The
Committee directs the Department to begin, within 90 days of
enactment of this Act, maintaining a list of for-profit
institution conversions on FSA's Data Center and to update that
list on a quarterly basis.
Federal Direct Student Loan Program Account
The Committee recommendation includes $350,000,000 for the
Federal Direct Student Loan Program Account program (also known
as Temporary Expanded Public Service Loan Forgiveness or
TEPSLF). Congress created the Public Service Loan Forgiveness
(PSLF) program in 2007 to provide relief to borrowers pursuing
careers in public service. After making 120 qualifying
payments, the equivalent of ten years, borrowers first became
eligible for forgiveness under the program in 2017. While
53,749 borrowers believed they qualified for forgiveness and
submitted applications, as of December 2018, only 338 borrowers
have had their discharges processed by the Department.
TEPSLF was established to address the administrative
failures of the Department and student loan servicers, who did
not provide accurate information to borrowers seeking to
qualify under the PSLF program. This account provides funding
for loan forgiveness for borrowers who were led to believe they
qualified for PSLF by their loan servicers but were denied
forgiveness. Unfortunately, the Department has failed to
effectively administer this program as well. According to
recent data from the Department, over 38,000 borrowers applied
for relief under TEPSLF, but only 262 applications were
approved.
The Committee is also concerned with the Department's
reversal of employment certifications under the program. The
Committee directs the Department to develop comprehensive
guidance and instructions regarding PSLF and require loan
servicers in the current servicing environment to provide
consistent and accurate information to borrowers. Furthermore,
the Committee directs the Department to refrain from reversing
qualifying employment determinations, except for administrative
error, and further directs the Department to calculate multiple
payments made to a loan servicer, within 15 days of the
scheduled payment due date, that combine to result in the
payment amount total required for the payment period, to be
counted as a qualifying payment toward the 120 payments
required by the program.
The Committee directs the Secretary to update the PSLF
Report on FSA's Data Center on a monthly basis within 30 days
after enactment of this Act. The Committee also directs the
Secretary to include updates for TEPSLF within the updated
reports.
To help improve implementation of the program, the
Committee recommendation includes new bill language to ease a
bureaucratic hurdle that requires borrower's most recent
monthly payments and the monthly payments made a year before
they applied be greater than what their monthly payment would
have been under an income-driven repayment plan. The bill also
requires the Secretary to increase awareness of the program and
inform all borrowers repaying their loans under PSLF and in the
incorrect repayment program about TEPSLF requirements.
Student Aid Administration
Appropriation, fiscal year 2019....................... $1,678,943,000
Budget request, fiscal year 2020...................... 1,812,000,000
Committee Recommendation.............................. 1,678,943,000
Change from enacted level........................... - - -
Change from budget request.......................... -133,057,000
Programs administered under the Student Aid Administration
(SAA) include Pell Grants, campus-based programs, Teacher
Education Assistance for College and Higher Education grants,
and Federal student loan programs.
Salaries and Expenses.--Within the total provided for SAA,
the Committee recommends $698,943,000 for salaries and
expenses, which is the same as the fiscal year 2019 enacted
level and $582,338,000 below the fiscal year 2020 request.
Loan Servicing Activities.--Within the total provided for
SAA, the Committee recommends $980,000,000 for Loan Servicing
Activities, which is the same as the fiscal year 2019 enacted
level and $449,281,000 above the fiscal year 2020 request.
On March 6, 2019, the Subcommittee on Labor-HHS-Related
Agencies held an oversight hearing on loan servicing, during
which the Subcommittee heard from a panel of experts, including
the Assistant Inspector General for Audit in the Office of the
Inspector General at the Department. The Assistant Inspector
General testified regarding its February 2019 audit report on
Federal Student Aid (FSA) that between 2015 and 2017, loan
servicers were out of compliance in 61 percent of the
monitoring reports analyzed. According to the OIG report, ``FSA
management rarely used available contract accountability
provisions to hold servicers accountable for instances of
noncompliance,'' and ``by not holding servicers accountable for
instances of noncompliance with Federal loan servicing
requirements, FSA did not provide servicers with an incentive
to take actions to mitigate the risk of continued servicer
noncompliance that could harm students.''
Noncompliance has serious consequences for borrowers. Such
noncompliance includes loan servicers failing to provide
borrowers with accurate information about their repayment
options, miscalculating how much students should be paying
through income-driven repayment, and putting borrowers into
forbearance without first informing them of other, less costly
options.
The Committee is concerned regarding FSA's lack of rigorous
oversight of student loan servicers and that FSA does not
utilize all tools at its disposal to safeguard taxpayer dollars
nor prioritize the best interests of student loan borrowers.
Therefore, the Committee recommendation includes new bill
language requiring the Department to award student loan
servicer contracts on the basis of their past performance and
compliance with Federal and state law. It also requires the
Department to prioritize services to help borrowers avoid
delinquency or default in the FSA Next Generation Processing
and Servicing Environment. New bill language is also included
to require the Department to include accountability measures
that account for the performance of the portfolio and
contractor compliance with FSA guidelines.
As outlined in the Department's July 2016 memorandum on
Federal student loan servicing policy direction (also known as
the Mitchell memo), the Committee directs the Department to
require that servicers ``take the necessary steps to ensure
internal processes support robust oversight and
accountability,'' ``that borrowers can expect their servicers
to support external compliant handling functions administered
by other federal and state agencies,'' and to strengthen
``transparency through expanded publication of aggregate data
on student loan and servicer performance.'' As part of the
Department's efforts to strengthen transparency, the Committee
directs the Department to work with the National Center for
Education Statistics (NCES) to create a public-facing website--
similar to the NCES DataLab--that allows for the automatic
crosstabulation of data and the calculation of other
statistics, including aggregate student loan outcomes,
portfolio composition, repayment rates, and the disposition of
complaints.
As the Department continues to implement its new servicing
environment, the Committee also directs FSA to develop new
oversight procedures for loan servicers' communications with
borrowers, including e-mail and text message interactions, and
online chat functions.
In addition, the Committee directs the Secretary, within 90
days of enactment of this Act, to make publicly available on
its website a detailed list of all individual requests made to
the Department under the ``Enforcement Disclosure'' provision
of the Statement of Records Notice for the Direct Loan Program
(Common Services For Borrowers, 18-11-16), the Department's
policy that governs this disclosure, and a description of the
Department's response to those requests, including the number
of days it took the Department to acknowledge such a request
and the number of days it took the Department to respond to
such a request in full.
Federal Student Loan Consolidation to Private Loans.--The
Committee is concerned by the aggressive marketing materials
private lenders send to Federal student loan borrowers that
advertise loan consolidation services without also mentioning
the repayment and forgiveness benefits that may be lost by
consolidating a Federal student loan into a private loan. The
Committee encourages the Department to examine this issue and
submit a report to the Committees on Appropriations within 90
days of enactment of this Act, containing language for possible
disclaimers that the Department may include in its materials,
alerting Federal student loan borrowers to the potential loss
of benefits should they consolidate Federal loans with a
private lender.
Federal Perkins Loan Cancellations.--The Committee is
concerned with the Department's implementation of the wind-down
of the Federal Perkins Loan program and directs the Department
to issue guidance to institutions of higher education regarding
loan cancellations and reimbursements no later than January 1,
2020.
State and Nonprofit Subcontracting--The Committee believes
that State and nonprofit organizations can assist the current
federal student loan servicers in providing important services
to struggling borrowers who need access to more specialized
support services throughout their postsecondary education to
help them understand their financial decisions, and can
appropriately act as advocates to help struggling borrowers
understand the student loan repayment process and options that
may be available to them to help mitigate delinquencies and
defaults. The Committee urges the Department of Education to
explore incentives for federal student loan servicers to
subcontract with qualified State and nonprofit organizations as
well as small businesses.
HIGHER EDUCATION
Appropriation, fiscal year 2019....................... $2,312,356,000
Budget request, fiscal year 2020...................... 1,534,487,000
Committee Recommendation.............................. 2,748,533,000
Change from enacted level........................... +436,177,000
Change from budget request.......................... +1,214,046,000
Strengthening Institutions
The Committee recommends $110,000,000 for the Part A,
Strengthening Institutions program, which is $10,125,000 more
than the fiscal year 2019 enacted level. The fiscal year 2020
budget request proposes to eliminate this program. Funding
supports competitive grants for general operating subsidies to
institutions with below average educational and general
expenditures per student and significant percentages of low-
income students. Funds may be used for faculty and academic
program development, management, joint use of libraries and
laboratories, acquisition of equipment, and student services.
Developing Hispanic-Serving Institutions
The Committee recommends $150,000,000 for the Hispanic-
Serving Institutions program, which is $25,585,000 more than
the fiscal year 2019 enacted level. The fiscal year 2020 budget
request does not include funding for this program and proposes
to consolidate it and the following programs into a single
grant program for Minority Serving Institutions (MSI): (1)
Strengthening Alaska Native and Native Hawaiian Serving
Institutions, (2) Strengthening Predominantly Black
Institutions, (3) Strengthening Asian American and Native
American Pacific Islander Serving Institutions, (4)
Strengthening Native American Serving Nontribal Institutions,
and (6) Promoting Postbaccalaureate Opportunities for Hispanic
Americans. The Committee rejects this budget proposal and does
not include funds for such purpose.
The Hispanic-Serving Institutions program provides
operating subsidies to schools that serve at least 25 percent
Hispanic students. Funds may be used for faculty and academic
program development, management, joint use of libraries and
laboratories, acquisition of equipment, and student services.
Promoting Postbaccalaureate Opportunities for Hispanic Americans
The Committee recommends $30,000,000 for the Promoting
Postbaccalaureate Opportunities for Hispanic Americans program,
which is $18,837,000 more than the fiscal year 2019 enacted
level. The fiscal year 2020 budget request does not include
funding for this program and proposes to consolidate it into a
single MSI grant program, which the Committee does not support.
This program provides expanded postbaccalaureate educational
opportunities for the academic attainment of Hispanic and low-
income students. In addition, it expands academic offerings and
enhances program quality at IHEs educating the majority of
Hispanic college students.
Strengthening Historically Black Colleges and Universities
The Committee recommends $375,000,000 for Strengthening
Historically Black Colleges and Universities (HBCUs), which is
$92,580,000 more than the fiscal year 2019 enacted level and
the fiscal year 2020 budget request. This program provides
operating subsidies to accredited HBCUs that were established
prior to 1964, with the principal mission of educating black
Americans. Funds are distributed through a formula grant based
on the enrollment of Pell Grant recipients, number of
graduates, and the number of graduates entering graduate or
professional schools in which blacks are underrepresented.
Physician Assistant Education.--The Committee encourages
the Secretary to explore strategies for expanding Physician
Assistant (PA) programs at HBCUs, Predominantly Black
Institutions (PBIs) and HSIs. Developing PA programs at these
higher education institutions will ensure a more diverse PA
workforce to promote health equity and more effectively provide
care in recognition of the changing demographics of the
nation's patient populations. The Committee directs the
Secretary to provide a report to Committees on Appropriations,
no later than 180 days after enactment of this Act, detailing
recommendations for promoting PA programs at HBCUs, PBIs, and
HSIs through the Department's grant initiatives.
Strengthening Historically Black Graduate Institutions
The Committee recommends $125,000,000 for the Strengthening
Historically Black Graduate Institutions (HBGIs) program, which
is $51,963,000 more than the fiscal year 2019 enacted level and
the fiscal year 2020 budget request. The program provides five-
year grants to 18 postsecondary institutions that are specified
in section 326(e)(1) of the Higher Education Act. Institutions
may use funds to build endowments, provide scholarships and
fellowships, and to assist students with the enrollment and
completion of postbaccalaureate and professional degrees.
The Committee is concerned with the historic decline of
African-Americans pursuing doctorate degrees in the health
professions. HBGIs have awarded the vast majority of all
doctoral degrees in medicine, dentistry, pharmacy, veterinary
medicine, and engineering to African Americans and are well
poised to mitigate the adverse effects stemming from the lack
of African American doctors. The Committee urges the
Department, through the White House Initiative on HBCUs, to
convene a summit of HBGI grantees to assess how to increase the
number of African Americans receiving doctoral level degrees in
the health sciences. The Committee urges the Secretary to
develop a plan for increasing such representation, including
how it will assist HBGI stakeholders in carrying out this work,
and to submit this plan to the Committees on Appropriations
within 180 days after enactment of this Act.
Strengthening Predominantly Black Institutions
The Committee recommends $22,000,000 for the Strengthening
Predominantly Black Institutions (PBIs) program, which is
$10,525,000 more than the fiscal year 2019 enacted level. The
fiscal year 2020 budget request does not include funding for
this program and proposes to consolidate it into a single MSI
grant program, which the Committee does not support. This
program provides grants to PBIs to increase their capacity to
serve the academic needs of students.
Strengthening Asian American and Native American Pacific-Islander-
Serving Institutions
The Committee recommends $17,864,000 for the Asian American
Pacific-Islander program, which is $14,000,000 more than the
fiscal year 2019 enacted level. The fiscal year 2020 budget
request does not include funding for this program and proposes
to consolidate it into a single MSI grant program, which the
Committee does not support. This program provides grants to
undergraduate institutions that have an undergraduate student
enrollment of at least 10 percent Asian American or Native
American Pacific-Islander.
Strengthening Alaska Native and Native Hawaiian-Serving Institutions
The Committee recommends $18,100,000 for the Strengthening
Alaska Native and Native Hawaiian-Serving Institutions program,
which is $2,170,000 more than the fiscal year 2019 enacted
level. The fiscal year 2020 budget request does not include
funding for this program and proposes to consolidate it into a
single MSI grant program, which the Committee does not support.
Through the Strengthening Alaska Native and Native Hawaiian-
Serving Institutions program, the Department provides grants to
assist institutions of higher education in serving Alaska
Native and Native Hawaiian students.
Native American Serving Non-Tribal Institutions
The Committee recommends $5,000,000 for the Native American
Serving Non-Tribal Institutions program, which is $1,136,000
more than the fiscal year 2019 enacted level. The fiscal year
2020 budget request does not include funding for this program
and proposes to consolidate it into a single MSI grant program,
which the Committee does not support. This program makes grants
to IHEs at which enrollment is at least 10 percent Native
American students and that are not Tribally Controlled Colleges
or Universities.
Strengthening Tribally Controlled Colleges and Universities
The Committee recommends $51,000,000 for the Strengthening
Tribally Controlled Colleges and Universities (TCCUs) program,
which is $19,146,000 more than the fiscal year 2019 enacted
level and $23,401,000 above the fiscal year 2020 budget
request. This program makes grants to TCCUs to increase their
capacity to serve the academic needs of students.
Strengthening HBCU Masters Programs
The Committee recommends $13,500,000 for the Strengthening
HBCU Masters Programs, which is $4,843,000 more than the fiscal
year 2019 enacted level and the fiscal year 2020 budget
request. This program provides grants to specified colleges and
universities making a substantial contribution to graduate
education opportunities at the Masters level in mathematics,
engineering, the physical or natural sciences, computer
science, information technology, nursing, allied health, or
other scientific disciplines.
International Education and Foreign Language Studies
Domestic Programs.--The Committee recommends $80,400,000
for the Domestic Programs of the International Education and
Foreign Languages Studies program, which is $15,297,000 more
than the fiscal year 2019 enacted level. The fiscal year 2020
budget request proposes to eliminate this program. Authorized
by title VI of the Higher Education Act, these programs include
National resource centers, foreign language and area studies
fellowships, undergraduate international studies and foreign
language programs, international research and studies projects,
business and international education projects, international
business education centers, language resource centers, American
overseas research centers, and technological innovation and
cooperation for foreign information access.
Overseas Programs.--The Committee recommends $8,730,000 for
the Overseas Programs, which is $1,669,000 more than the fiscal
year 2019 enacted level. The fiscal year 2020 budget request
proposes to eliminate this program. Funding for these programs
support group projects, faculty research, special bilateral
research, and doctoral dissertation research conducted abroad.
The Committee recognizes the importance of study abroad
programs for the necessary preparation and development of
American students enrolled in institutions of higher education
to be effective members of a globally competitive 21st century
workforce. Study abroad programs provide these students with
critical knowledge, skills, and experiences in leadership,
intercultural understanding, global learning, and foreign
languages.
Postsecondary Programs for Students with Intellectual Disabilities
The Committee recommends $11,800,000 for Postsecondary
Programs for Students with Intellectual Disabilities, which is
the same as both the fiscal year 2019 enacted level and the
fiscal year 2020 budget request. This program supports grants
to create model transition programs into higher education for
students with intellectual disabilities.
Minority Science and Engineering Improvement
The Committee recommends $13,000,000 for the Minority
Science and Engineering Improvement Program, which is
$1,865,000 more than the fiscal year 2019 enacted level and
$3,352,000 above the fiscal year 2020 budget request. This
program awards grants to improve mathematics, science, and
engineering programs at institutions serving primarily minority
students and to increase the number of minority students who
pursue advanced degrees and careers in those fields.
Tribally Controlled Postsecondary Career and Technical Institutions
The Committee recommends $10,000,000 for this program,
which is $436,000 more than the fiscal year 2019 enacted level
and $1,714,000 above the fiscal year 2020 budget request. This
program provides competitive grants to Tribally controlled
postsecondary career and technical institutions to provide
career and technical education to Native American students.
Federal TRIO Programs
The Committee recommends $1,160,000,000 for TRIO programs,
which is $100,000,000 above the fiscal year 2019 enacted level
and $210,000,000 above the fiscal year 2020 budget request. The
TRIO programs provide a variety of outreach and support
services to encourage low-income, often first-generation
college students to enter and complete college. Discretionary
grants of up to four or five years are awarded competitively to
IHEs and other nonprofit organizations. At least two thirds of
the eligible participants in TRIO must be low-income, first-
generation college students.
The Committee rejects the fiscal year 2020 budget proposal
to move the TRIO programs from competitive grant programs to a
single State formula program. Further, the Committee directs
the Department to allocate funds such that all current grantees
receive an increase in their grant award and to avoid imposing
additional requirements as a condition for grantees to receive
such increases. Additionally, the Department is directed to
allocate a substantial portion of the funding to increase the
number and size of the new grants awarded in the Student
Services Support competition that will occur in fiscal year
2020.
Gaining Early Awareness and Readiness for Undergraduate Programs
The Committee recommends $395,000,000 for Gaining Early
Awareness and Readiness for Undergraduate Programs (GEAR UP),
which is $35,000,000 more than the fiscal year 2019 enacted
level. The fiscal year 2020 budget request proposes no funds
for this program and to consolidate it into a new State
formula-based TRIO program. The Committee rejects this
proposal. GEAR UP provides grants to States and partnerships of
low-income middle and high schools, IHEs, and community
organizations to target entire grades of students and give them
the skills, encouragement, and scholarships to pursue
successfully postsecondary education.
The Committee continues bill language allowing the
Department to maintain the GEAR UP evaluation set-aside at 1.5
percent to work with the GEAR UP community and grantees to
standardize data collection, including through the use of
third-party data systems.
Graduate Assistance in Areas of National Need
The Committee recommends $24,047,000 for the Graduate
Assistance in Areas of National Need (GAANN) program, which is
$1,000,000 more than the fiscal year 2019 enacted level. The
fiscal year 2020 budget request proposes to eliminate this
program. GAANN provides fellowships through grants to degree
granting postsecondary institutions, for students of high
financial need studying in areas of national need. The
Department consults with appropriate other agencies and
organizations to designate the fields of study ``in areas of
national need.'' Recent examples include computer and
informational sciences, engineering, nursing, and physics.
Teacher Quality Partnership Grants
The Committee recommends $53,092,000 for the Teacher
Quality Partnerships (TQP) program, which is $10,000,000 more
than the fiscal year 2019 enacted level. The fiscal year 2020
budget proposes to eliminate this program. The TQP program
helps improve the quality of teachers working in high-need
schools and early childhood education programs by creating
model teacher preparation and residency programs.
The Committee recognizes the importance of state teaching
fellowship programs and encourages the Department to continue
to work with eligible state teaching fellowship programs that
wish to apply for Teacher Quality Partnership program.
The Committee recognizes the needs of the nation's growing
English learner (EL) student population, including a robust
teacher workforce equipped to teach them. The Committee is
concerned by the shortage of EL teachers in the majority of
States, as well the academic achievement gap between ELs and
their native English-speaking peers and the Committee
encourages the Secretary to work with grantees in strengthening
and developing high-quality teacher preparation programs that
enable graduates to meet the needs of EL students.
Child Care Access Means Parents in School
The Committee recommends $60,000,000 for the Child Care
Access Means Parents in School program, which is $10,000,000
more than the fiscal year 2019 enacted level and $44,866,000
above the fiscal year 2020 budget request. This program makes
competitive grants to colleges and universities to support or
establish a campus-based childcare program, primarily serving
the needs of low-income students enrolled at these
institutions.
Fund for the Improvement of Postsecondary Education
The Committee recommendation includes $10,000,000 for the
Centers of Excellence for Veterans Student Success Program, as
authorized by section 873 of the Higher Education Act. Funding
will support the first competition for this program since
fiscal year 2015. The fiscal year 2020 budget request does not
include funding for this program. Over one million veterans
attend college every year and often need assistance receiving
their benefits or transitioning to student life. Veteran
Student Centers provide a one-stop-shop for academic support,
networking opportunities, peer mentorship, financial
assistance, counseling, and career services.
Of these funds, the Committee directs the Secretary to
issue grants to institutions of higher education or consortia
of institutions of higher education seeking to establish,
maintain, or improve Veteran Student Centers--a dedicated
physical meeting space on the campus of an institution of
higher education that provides student veterans, members of the
Armed Forces serving on active duty, or members of a reserve
component of the Armed Forces with a centralized office for
veteran student support services, including comprehensive
academic and tutoring services, peer-to-peer tutoring and
academic mentorship, and is staffed by at-least one trained
veteran employee.
Such centers must also provide student-veterans with
assistance relating to transitioning from the military to
student life or civilian workforce, networking opportunities
with other veterans in the community, understanding and
obtaining benefits provided by the institution of higher
education, federal government, and State for which such
students may be eligible, understanding how to succeed in the
institution of higher education, including by understanding
academic policies, the course selection process, and
institutional policies and practices related to the transfer of
academic credits, and provide an understanding of disability-
related rights and protections under the Americans with
Disabilities Act of 1990 and section 504 of the Rehabilitation
Act of 1973. The Committee directs the Department to brief the
Committees on Appropriations no later than 60 days after
enactment of this Act on its plan to carry out this competition
and to notify the Committees no later than 15 days in advance
of making awards to grantees.
In additon, the Committee includes $5,000,000 to continue
the Open Textbooks Pilot program. The Secretary is directed to
award funds through a new competition, with individual grants
amounting to not less than $100,000 and not more than
$1,000,000.
HOWARD UNIVERSITY
Appropriation, fiscal year 2019....................... $236,518,000
Budget request, fiscal year 2020...................... 221,821,000
Committee Recommendation.............................. 250,000,000
Change from enacted level........................... +13,482,000
Change from budget request.......................... +28,179,000
Howard University is a ``Research I'' university located in
the District of Columbia and provides undergraduate liberal
arts, graduate and professional instruction to students.
Within the amount provided, the Committee recommends
$27,325,000 for the Howard University Hospital, which is the
same as both the fiscal year 2019 enacted level and the fiscal
year 2020 budget request. The hospital serves as a major acute
and ambulatory care center for the District of Columbia, and
functions as a teaching facility.
COLLEGE HOUSING AND ACADEMIC FACILITIES LOANS PROGRAM
Appropriation, fiscal year 2019....................... $435,000
Budget request, fiscal year 2020...................... 435,000
Committee Recommendation.............................. 435,000
Change from enacted level........................... - - -
Change from budget request.......................... - - -
Previously, these programs helped to ensure that
postsecondary institutions were able to make necessary capital
improvements to maintain and increase their ability to provide
a high-quality education. Since 1994, no new loans have been
made, and the Department's role has been to manage the
outstanding loans.
HISTORICALLY BLACK COLLEGE AND UNIVERSITY CAPITAL FINANCING PROGRAM
ACCOUNT
Appropriation, fiscal year 2019....................... $40,484,000
Budget request, fiscal year 2020...................... 40,484,000
Committee Recommendation.............................. 50,484,000
Change from enacted level........................... +10,000,000
Change from budget request.......................... +10,000,000
The Committee recommends $50,484,000 for the HBCU Capital
Financing program, which is $10,000,000 above the fiscal year
2019 enacted level and the fiscal year 2020 budget request.
This program is authorized under part D of Title III of the HEA
and makes capital available for the repair and renovation of
facilities at historically black colleges and universities. In
exceptional circumstances, capital provided under the program
can be used for construction or acquisition of facilities.
Within the total provided for this program, the Committee
recommendation includes $334,000 for the administrative
expenses to carry out the program and $20,150,000 for loan
subsidy costs that will be sufficient to guarantee up to
$212,100,000 in new loans in fiscal year 2020.
The Committee recommendation also includes $20,000,000 to
continue loan deferments requested in fiscal year 2018 for
private HBCUs and includes new bill language and an increase of
$10,000,000 over fiscal year 2019 enacted level and the fiscal
year 2020 budget request to provide loan deferments for public
HBCUs.
INSTITUTE OF EDUCATION SCIENCES
Appropriation, fiscal year 2019....................... $615,462,000
Budget request, fiscal year 2020...................... 521,563,000
Committee Recommendation.............................. 650,000,000
Change from enacted level........................... +34,538,000
Change from budget request.......................... +128,437,000
The Committee recommends $650,000,000 for the Institute of
Education Sciences (IES), an increase of $34,538,000 over the
fiscal year 2019 enacted level and $128,437,000 more than the
fiscal year 2020 budget request.
Research, Development, and Dissemination
The Committee recommends $205,400,000 for Research,
Development, and Dissemination, which is $12,705,000 more than
the fiscal year 2019 enacted level and $17,900,000 above the
fiscal year 2020 budget request. Of the increase, the Committee
recommendation includes up to $2,000,000 solely for the
rigorous evaluation of the Second Chance Pell Experiment as
announced in the Federal Register (Volume 80, Number 148 on
Monday, August 3, 2015). The Committee also directs IES to work
with the Department's Policy and Program Studies on this
effort. The Committee also directs IES to submit the evaluation
to the Committees on Appropriations, within 30 days of
completing the evaluation. This account supports research,
development, and national dissemination activities that are
aimed at expanding fundamental knowledge of education and
promoting the use of research and development findings in the
design of efforts to improve education.
Statistics
The Committee recommends $117,500,000 for the activities of
the National Center for Education Statistics (NCES), which is
$8,000,000 more than the fiscal year 2019 enacted level and
$5,000,000 more than the fiscal year 2020 budget request.
Statistics activities are authorized under title I of the
Education Sciences Reform Act of 2002. The Center collects,
analyzes, and reports statistics on all levels of education in
the United States. Activities are carried out directly and
through grants and contracts and include projections of
enrollments, teacher supply and demand, and educational
expenditures. NCES also provides technical assistance to State
and local educational agencies and postsecondary institutions.
Data for Puerto Rico.--The Committee recommends that NCES
collect and publish data for Puerto Rico in the same manner it
collects and publishes data for States.
Regional Educational Laboratories
The Committee recommends $60,400,000 for Regional
Educational Laboratories (RELs), which is $4,977,000 more than
the fiscal year 2019 enacted level. The fiscal year 2020 budget
request proposes to eliminate this program. This program
supports a network of 10 laboratories that promote the use and
development of knowledge and evidence to increase student
learning and further school improvement efforts.
The Committee notes the critical role RELs play in helping
to translate education research to policymakers and
practitioners, which assists SEAs and LEAs in implementing ESSA
and providing a high-quality education for more children.
Research in Special Education
The Committee recommends $61,000,000 for Research in
Special Education, which is $5,000,000 more than the fiscal
year 2019 enacted level and $7,000,000 above the fiscal year
2020 budget request. This program supports competitive awards
to produce and advance the use of knowledge to improve services
and results for children with disabilities. The program focuses
on producing new knowledge, integrating research and practice,
and improving the use of knowledge.
Special Education Studies and Evaluations
The Committee recommends $11,674,000 for Special Education
Studies and Evaluations, which is $856,000 more than the fiscal
year 2019 enacted level and the fiscal year 2020 budget
request. This program awards competitive grants, contracts and
cooperative agreements to assess the implementation of the IDEA
and the effectiveness of State and local efforts to provide
special education and early intervention programs and services
to infants, toddlers, and children with disabilities.
Statewide Data Systems
The Committee recommends $35,281,000 for Statewide Data
Systems, which is $3,000,000 more than the fiscal year 2019
enacted level. The fiscal year 2020 budget proposes to
eliminate this program. Competitive grants under this authority
are made to SEAs to help them manage, analyze, disaggregate and
use student data consistent with the ESEA.
Assessment
The Committee recommends $158,745,000 for Assessment, which
is the same as the fiscal year 2019 enacted level and
$2,000,000 above the fiscal year 2020 budget request. This
amount includes $7,745,000 for the National Assessment
Governing Board (NAGB), which is the same as both the fiscal
year 2019 enacted level and the fiscal year 2020 budget
request.
The National Assessment of Educational Progress (NAEP) is
the only nationally representative and continuing survey of
educational ability and achievement of American students. The
primary goal of the assessment is to determine and report the
status and trends of the knowledge and skills of students,
subject by subject. Subject areas assessed in the past have
included reading, writing, mathematics, science, history,
citizenship, literature, art, and music. The NAEP is operated
by contractors through competitive awards made by the NCES. The
NAGB formulates the policy guidelines for the program.
DEPARTMENTAL MANAGEMENT
Appropriation, fiscal year 2019....................... $616,143,000
Budget request, fiscal year 2020...................... 635,418,000
Committee Recommendation.............................. 623,418,000
Change from enacted level........................... +7,275,000
Change from budget request.......................... -12,000,000
These activities are authorized by the Department of
Education Organization Act (P.L. 96-88) and include costs
associated with the management and operation of the Department
as well as separate costs associated with the Office for Civil
Rights and the Office of Inspector General.
Program Administration
The Committee recommends $430,000,000 for Program
Administration, which is the same as the fiscal year 2019
enacted level and $17,000,000 below the fiscal year 2020 budget
request. These funds support the staff and other costs of
administering programs and activities at the Department. Items
include personnel compensation, health, retirement, and other
benefits as well as travel, rent, telephones, utilities,
postage fees, data processing, printing, equipment, supplies,
technology training, consultants, and other contractual
services.
Communication with the Committee.--There are concerns about
the breakdown of the normal flow of information from some areas
of the Department to the Committee. The Committee expects the
Department to correct these shortcomings. If no improvement is
made, the Committee will evaluate the resources spent on the
offices and staff involved in the unacceptable delays regarding
the transmission of information to the Committee and whether
the resources are better allocated to other areas of the bill.
Acting Inspector General.--The Committee is concerned by
the Department's recent effort to replace its Acting Inspector
General (IG) with a career attorney from the Department,
especially when that attorney served as the Acting Secretary of
Education. While this decision was reversed after the
Administration received correspondence from Members of
Congress, questions about the process by which the replacement
of the Acting IG occurred remain. The Committee directs the
Department to respect the independence of the OIG, to refrain
from influencing or undermining any audit or investigation
conducted by the OIG, and to respond promptly to all
Congressional inquiries concerning the replacement of the
Acting IG.
Accrediting Council for Independent Colleges and Schools.--
Accrediting agencies provide an important role in guarding
access to federal student aid and ensuring that students
receive a quality education. The Committee is therefore deeply
concerned with the Secretary's decision to recognize the
Accrediting Council for Independent Colleges and Schools
(ACICS). ACICS has a history of certifying predatory for-profit
institutions, and an extensive review conducted in 2018 by
Department staff showed that ACICS failed to meet 57 of 93
federal standards. Within 90 days of enactment of this Act, the
Committee directs the Secretary to certify in a report to the
Committees on Appropriations, with detailed justifications,
citing relevant supporting documents, that ACICS demonstrated
compliance with all 57 of those standards before recognizing
ACICS beyond the current 12-month conditional period.
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 the
Department to include the following information in its fiscal
year 2021 Congressional Budget Justification: Expenditures for
fiscal year 2019 and expected expenditures for fiscal years
2020 and 2021, 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.
Randolph-Sheppard Act.--The Committee is aware that the
Department is facing challenges in meeting its responsibilities
to administer and oversee the Randolph-Sheppard program as
prescribed by the Randolph-Sheppard Act of 1936. These
challenges include convening arbitration panels in a timely
manner, reviewing and approving state licensing agencies'
policy changes, and working with state licensing agencies to
approve routine expenditures associated with the program. The
Department shall report to the Committees on Appropriations no
later than one year from the date of enactment of this Act on
the status of all pending arbitration, state licensing agency
policy reviews, and prior approval procedures.
Open Data Reporting.--The Committee encourages the
Secretary, to the extent practicable, to disclose information
through the College Navigator website, or its successor
website, and to publish such information using an open source
description language for the purpose of comparing institutions
of higher education, programs and credentials.
Teacher Shortages.--The Committee is concerned by the wide-
ranging teacher shortages experienced in many States and
districts across the country. In particular, the Committee is
concerned by national research which shows that rural
districts, where salaries are lower and districts are forced to
rely on provisionally licensed teachers, can be hit
particularly hard by teacher shortages. Similarly, in school
districts with higher minority student populations, shortages
have necessitated lower standards for teacher certification and
other professional qualifications. Accordingly, the Committee
directs the Policy and Program Studies Service of the
Department, in partnership in the Department of Labor, to
provide no later than 270 days after enactment of this Act, a
report on teacher shortages. The report should examine trends
in teacher shortages and factors contributing to challenges
with teacher recruitment and retention. The analysis should
include, but not be limited to an examination of the following
factors: personnel to support students with disabilities;
geography; the characteristics of communities impacted,
including student demographics, area median income, or per-
pupil spending; the diversity of the educator workforce; and
issues related to licensure. The report shall also include
information on shortages of educational support staff, which
may include school leaders. The report shall also identify
areas of chronic teacher shortages and their underlying causes.
The report shall examine ways to improve the effectiveness of
current federal policy in preventing and responding to teacher
shortages as well as make recommendations on potential federal
interventions to improve teacher recruitment and retention.
Lead Testing in Schools.--The Committee strongly agrees
with recommendations from a 2018 GAO report, Lead Testing of
School Drinking Water Would Benefit from Improved Federal
Guidance, that the Assistant Secretary for Elementary and
Secondary Education should collaborate with the Environmental
Protection Agency (EPA) to disseminate guidance related to lead
testing and remediation in schools. The Committee is aware that
EPA has made available updated guidance and web-based toolkits
for lead testing and remediation in schools. The Committee is
also aware that EPA is soliciting applications from education
officials to provide grant funds to assist States and local
education agencies with testing and remediation efforts. The
Committee directs the Department to coordinate with EPA in
disseminating this new guidance and resources within 90 days of
enactment of this Act. Further, the Committee encourages the
Department to assist school systems seeking to remediate lead
contamination in working with EPA. Further, the Committee is
aware that many States and local jurisdictions may have their
own requirements and guidance in place regarding lead testing
in schools. The Committee encourages the Department to
coordinate and assist in the sharing of best practices among
States and local school systems. The Committee expects the
Department to provide biannual reports on the Department's
efforts in these regards.
Military Student Identifier--The Committee notes that ESSA
recognized 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 experience separations from a
parent/guardian due to their parents' service to the U.S.
Military. The Military Student Identifier provides educators,
school leaders and policy makers with critical information to
personalize attention and direct resources to better support
military dependent children. Current law directs the military
student identifier towards 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 component.
Youth Apprenticeship Programs.--The Committee directs the
Department to submit a report to the Committees on
Appropriations on high school youth apprenticeship programs
within 180 days of enactment of this Act. The report should
include a focus on registered apprenticeship programs that have
a documented industry partnership, that incorporate practical
and classroom-based instruction oriented towards industry
standards, and that culminate in a portable, industry-
recognized credential or postsecondary credit. The report
should also be made publicly available on the Department's
website.
Evidence-based Grant Making.--The Committee is supportive
of efforts by the Department to consider evidence of
effectiveness in grant competitions.
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 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 2017, 2018 and 2019 and estimates for fiscal year
2020 to serve students 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, and high-
poverty areas, as defined as any census tract with a poverty
rate of at least 20 percent as measured by the 2013-2017 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.
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.
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.
Resources for Foster and Homeless Youth--The Committee
understands that foster and homeless youth experience increased
burdens in accessing and completing higher education. The
Committee is deeply concerned that access to the Free
Application for Federal Student Aid (FAFSA), federal financial
aid, and other existing resources and programs, including TRIO
and the Chafee Education and Training Voucher program, are not
consistently available and that many children are not aware of
these resources. Therefore, the Committee urges the Department
of Education and the Department of HHS to work together with
State and tribal welfare systems and runaway and homeless youth
programs to conduct further outreach and disseminate
information on financial aid, TRIO, and the Chafee program to
these audiences. The Committee also requests that these
resources be made available online so that foster youth can
also access them.
OFFICE FOR CIVIL RIGHTS
Appropriation, fiscal year 2019....................... $125,000,000
Budget request, fiscal year 2020...................... 125,000,000
Committee Recommendation.............................. 130,000,000
Change from enacted level........................... +5,000,000
Change from budget request.......................... +5,000,000
The Office for Civil Rights (OCR) is responsible for
enforcing laws that prohibit discrimination on the basis of
race, color, national origin, sex, disability, and age in all
programs and institutions that receive funds from the
Department. These laws extend to State educational agencies,
local educational agencies, and institutions of higher
education, including proprietary schools. They also extend to
State rehabilitation agencies, libraries, museums, and other
institutions receiving Federal funds.
The Committee recommendation includes $130,000,000, an
increase of $5,000,000 over the fiscal year 2019 enacted level
and fiscal year 2020 budget request. The Committee directs OCR
to use this appropriation to increase its level of full-time
equivalent (FTE) employment in order to effectively and timely
investigate complaints; execute and accurately report the civil
rights data collection; thoroughly monitor corrective actions
of institutions and meet other critical workloads.
The Joint Statement accompanying the Department of
Education Appropriations Act, 2019, directed the Department to
submit quarterly reports on FTE levels and attrition. The first
report was submitted to the Committees on Appropriations on
February 11, 2019. In the report, OCR showed 510 FTE for the
first quarter of 2019. Yet, the fiscal year 2020 budget request
shows the number of FTE in fiscal year 2019 at 625. The
Committee is concerned about this discrepancy and expects the
Department to explain how it onboarded 115 FTE between the time
the first report was submitted and the end of fiscal year 2019
in the fiscal year 2021 Congressional Budget Justification.
FTE and Attrition Report.--The Committee directs the
Department to provide the Committees on Appropriations 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.
Expulsions and Suspensions.--The Committee is deeply
concerned about expulsions and suspensions that occur in
preschool settings and K-3 classrooms, particularly given the
racial and gender disparities that exist. These outcomes are
problematic given the research that indicates these practices
can adversely affect development, health, and education
outcomes. The Committee strongly urges the Office for Civil
Rights (OCR) to collect data annually on expulsions and
suspensions in preschool, elementary and secondary school
settings, disaggregated by race/ethnicity, sex, disability
status, and English Learner status.
OCR should also submit to the Committees on Appropriations,
no later than 180 days after the enactment of this Act, and
annually thereafter, a report detailing school discipline in
all preschool and K-3 classrooms, including disaggregated data
and any disparities by subgroup in disciplinary rates. The
report should also include specific recommendations given to
schools on expulsions and suspensions--including evidence-based
interventions, consumer education specific to each school, and
opportunities to improve school climate. The Committee urges
OCR to provide technical assistance to help prevent or severely
limit expulsion and suspension practices in preschool settings
and K-3 classrooms, eliminate disparities in the provision of
discipline, and ensure the safety and well-being of all young
children.
Data Collection on Access to Computer Science Education in
K-12.--The Committee encourages OCR to obtain data through the
Civil Rights Data Collection on access to K-12 computer science
education and computational thinking education, and to submit a
report of its findings, within 180 days of enactment of this
Act, to the Committees on Appropriations and the authorizing
committees of jurisdiction. The data obtained should include
the number of computer science and computational thinking
classes offered in elementary and secondary schools, the number
of students enrolled in these classes disaggregated by race,
sex, disability according to the Individuals with Disabilities
Education Act, and English Learner status, and the number of
teachers in elementary and secondary schools with computer
science certifications.
Title IX.--The Committee recognizes that the Department
failed to fully estimate the burden of the Notice of Proposed
Rulemaking on Title IX, Nondiscrimination on the Basis of Sex
in Education Programs or Activities Receiving Federal Financial
Assistance, as required by law, and omitted significant costs
to students and schools. The Committee further recognizes that
OCR failed to engage in required consultation with
stakeholders. The proposed changes to Title IX go against
Congressional intent of the civil rights law and the mission of
the OCR.
English Learners.-- The Committee encourages the Department
to conduct and publish a study, within 180 days of enactment of
this Act, on the effectiveness of English Learner (EL) programs
in delivering adequate services and accommodations to qualified
students as guaranteed under civil rights provisions. The
Committee encourages the Department, within 180 days of
enactment of this Act, to report outcomes in English language
acquisition, proficiency levels in math and reading nationwide,
and other State accountability indicators in each of the 50
States, the District of Columbia, and the U.S. Territories, as
required through Section 1111(h)(1)(C) of the ESEA, with data
disaggregated by the major race and ethnicity categories in the
Decennial Census as compared to students never eligible for EL
designation. Where such data is available, the Committee
encourages the Department to include disaggregated data by EL
subgroups (current, long-term, former, opt-out, recent arriving
and late arriving ELs) and note in which States gaps in the
data exist. The Committee is also concerned about the high
volume of Title VI complaints related to ELs.
OFFICE OF INSPECTOR GENERAL
Appropriation, fiscal year 2019....................... $61,143,000
Budget request, fiscal year 2020...................... 63,418,000
Committee Recommendation.............................. 63,418,000
Change from enacted level........................... +2,275,000
Change from budget request.......................... - - -
This Office has authority to inquire into all program and
administrative activities of the Department as well as into
related activities of grant and contract recipients. It
conducts audits and investigations to determine compliance with
applicable laws and regulations, to check alleged fraud and
abuse, efficiency of operations, and effectiveness of results.
Use of Resources.--The Committee urges the Office of
Inspector General to ensure its focus remains on the primary
missions of the Office. The Committee cautions the Office, when
receiving requests from the Department for investigations, to
consider the most effective and best use of its resources.
General Provisions
Sec. 301. The Committee continues a provision related to
the implementation of programs of voluntary prayer and
meditation in public schools.
(TRANSFER OF FUNDS)
Sec. 302. The Committee modifies a provision providing the
Secretary of Education with the authority to transfer up to one
percent of discretionary funds between appropriations, provided
that no appropriation is increased by more than three percent
by any such transfer. This transfer authority is available only
to meet emergency needs, and may not be used to create any new
program or fund a project or activity that is not otherwise
funded in this Act. All transfers are subject to notification
to the Committees on Appropriations of the House of
Representatives and the Senate.
Sec. 303. The Committee modifies a provision allowing ESEA
funds consolidated for evaluation purposes to be available from
July 1, 2020 through September 30, 2021.
Sec. 304. The Committee continues a provision allowing
certain institutions to continue to use endowment income for
student scholarships.
Sec. 305. The Committee modifies a provision extending the
authorization of the National Advisory Committee on
Institutional Quality and Integrity.
Sec. 306. The Committee modifies a provision extending the
authority to provide account maintenance fees to guaranty
agencies for Federal student loans.
Sec. 307. The Committee continues a provision allowing
administrative funds to cover outstanding Perkins loans
servicing costs.
(RESCISSION)
Sec. 308. The Committee modifies a provision rescinding
fiscal year 2020 mandatory funding to offset the mandatory
costs of increasing the discretionary Pell award.
Sec. 309. The Committee continues a provision clarifying
current law regarding data sharing with organizations assisting
students in applying for financial aid.
Sec. 310. The Committee modifies a provision regarding
Public Service Loan Forgiveness.
Sec. 311. The Committee continues a provision regarding
outreach to borrowers and the Public Service Loan Forgiveness
program.
TITLE IV--RELATED AGENCIES
Committee for Purchase From People Who Are Blind or Severely Disabled
SALARIES AND EXPENSES
Appropriation, fiscal year 2019....................... $8,250,000
Budget request, fiscal year 2020...................... 9,400,000
Committee Recommendation.............................. 9,000,000
Change from enacted level........................... +750,000
Change from budget request.......................... -400,000
The Committee believes oversight is necessary to ensure the
program is operating in accordance with statutory requirements
that blind or other severely disabled individuals provide at
least 75 percent of hours or direct labor required for the
production or provision of the products or services to Federal
government agencies. To ensure the Committee for Purchase from
People Who Are Blind or Severely Disabled (AbilityOne
Commission) maintains its oversight capacity, the Committee
continues bill language requiring the AbilityOne Commission to
establish written agreements with central nonprofit agencies.
The written agreements ensure the AbilityOne Commission can
conduct appropriate audit, oversight, and reporting functions
in accordance with standard Federal procurement policies.
The Committee supports opportunities for the Commission to
assert its authority in the oversight of the AbilityOne
program, however, is concerned about language in the
cooperative agreements between the Commission and the Central
Nonprofit Agencies (CNAs) requiring CNAs to report to the
Commission any meetings with key stakeholders, including
Congressional members and staff. The Committee requests
additional information on the justification for and necessity
of this language.
Requested Reports.--The Committee continues to request the
reports listed under this heading in House Report 115-244. Such
reports shall be submitted to the Committee no later than 60
days after the end of each fiscal quarter.
Office of Inspector General.--The Committee recommends not
less than $1,650,000 for the Office of Inspector General.
Corporation for National and Community Service
OPERATING EXPENSES
Appropriation, fiscal year 2019....................... $1,082,958,000
Budget request, fiscal year 2020...................... 103,663,000
Committee Recommendation.............................. 1,138,106,000
Change from enacted level........................... +55,148,000
Change from budget request.......................... +1,034,443
Volunteers in Service to America
The Committee recommends $95,000,000 for Volunteers in
Service to America (VISTA), which is an increase of $2,636,000
over the fiscal year 2019 enacted level and $90,335,000 above
the fiscal year 2020 budget request. This program provides
capacity building for small, community-based organizations with
a mission of combating poverty. VISTA members raise resources,
recruit, and organize volunteers, and establish and expand
programs in housing, employment, health, and economic
development.
National Senior Volunteer Corps
The Committee recommends $221,517,000 for the National
Senior Volunteer Corps programs, which is $13,400,000 more than
the fiscal year 2019 enacted level and $221,184,000 above the
fiscal year 2020 budget request. Senior Corps is a collection
of programs that connect Americans older than the age of 55
with opportunities to contribute their job skills and expertise
to community projects and organizations.
The Committee intends for all funding to be used to support
programs and volunteers. The recommendation provides sufficient
funding to increase the stipend for the Foster Grandparents
Program and Senior Companion Program to $3.00/hour for the
first time. The Committee notes that the last stipend increase
to the current level of $2.65/hour occurred in 2002.
The funding breakout by program is as follows:
------------------------------------------------------------------------
National Senior Volunteer Corps: FY 2020 Committee
------------------------------------------------------------------------
Foster Grandparents Program.......................... $118,799,000
Senior Companion Program............................. 50,863,000
Retired Senior Volunteer Program..................... 51,855,000
------------------------------------------------------------------------
AmeriCorps State and National Grants
The Committee recommends $450,010,000 for AmeriCorps State
and National Grants, which is $25,000,000 more than the fiscal
year 2019 enacted level and $447,786,000 above the fiscal year
2020 budget request. This program provides funds to local and
national organizations and agencies to address community needs
in education, public safety, health, and the environment.
Innovation, Assistance, and Other Activities
The Committee recommends $8,600,000 for Innovation,
Assistance, and Other Activities, which is $1,000,000 more than
the fiscal year 2019 enacted level and $8,600,000 more than the
fiscal year 2020 budget request.
The Committee acknowledges the value of the Volunteer
Generation Fund (VGF) in supporting State service commissions
to identify effective approaches to increase the number of
volunteers, strengthening the capacity of volunteer connector
organizations to recruit and retain volunteers, and
prioritizing support for service-learning and youth service
opportunities from kindergarten to college, and develop
strategies to effectively engage volunteers to solve local
problems. The Committee recommendation includes an additional
$1,000,000 for the VGF.
The Committee continues to support the September 11
National Day of Service and Remembrance and the Martin Luther
King, Jr. National Day of Service--two important national
events.
Evaluation
The Committee recommends $4,000,000 for evaluation, which
is the same as the fiscal year 2019 enacted level. The fiscal
year 2020 budget request does not include funding for this
purpose and proposes to eliminate the agency. These funds
support research on program effectiveness.
National Civilian Community Corps
The Committee recommends $33,000,000 for National Civilian
Community Corps, which is $1,000,000 more than the fiscal year
2019 enacted level and $10,117,000 above the fiscal year 2020
budget request. This program supports residential, team-based
service opportunities for individuals aged 18-24.
State Commission Administrative Grants
The Committee recommends $17,538,000 for State Commission
Support Grants, which is the same as the fiscal year 2019
enacted level and $17,538,000 above the fiscal year 2020 budget
request. Funds are used for formula grants to support State
oversight of service programs.
Payment to the National Service Trust
Appropriation, fiscal year 2019....................... $206,842,000
Budget request, fiscal year 2020...................... 10,000,000
Committee Recommendation.............................. 218,691,000
Change from enacted level........................... +11,849,000
Change from budget request.......................... +208,691,000
The National Service Trust makes payments for Segal
education awards, pays interest that accrues on qualified
student loans for AmeriCorps participants during terms of
service in approved national service positions, and makes other
payments entitled to members who serve in the programs of the
Corporation for National and Community Service.
SALARIES AND EXPENSES
Appropriation, fiscal year 2019....................... $83,737,000
Budget request, fiscal year 2020...................... 59,300,000
Committee Recommendation.............................. 83,737,000
Change from enacted level........................... - - -
Change from budget request.......................... +24,437,000
Evidence-based Grant Making.--The Committee is supportive
of efforts by the Corporation to consider evidence of
effectiveness in grant competitions.
Transformation and Sustainability Plan.--The Committee
remains concerned over the Corporation's plan to drastically
alter and consolidate 46 State offices into eight regional
offices. The Committee has heard many concerns from various
stakeholders, including Members of Congress, about the hasty
implementation of the plan and the disruption of support for
grantees and services in local communities.
The Committee is deeply concerned that such a significant
undertaking is occurring at a time when the fiscal year 2020
budget request proposes to eliminate the Corporation, which the
Committee rejects. The fiscal years 2019 and 2020 budget
requests do not provide sufficient explanation or rationale for
the restructuring, making it difficult to conduct oversight.
The Committee notes that the Corporation's OIG also has
concerns regarding the Corporation's capacity to execute the
proposed changes in the 18 month timeframe and the risks of
doing so. In a separate message to the Committees on
Appropriations regarding the fiscal year 2020 budget request,
the OIG stated, ``Aspects of this plan present heightened risks
of fraud, waste and mismanagement that warrant particularly
close oversight.''
The Committee is disappointed that the Corporation is
moving forward with its regionalization plan despite opposition
among stakeholders and serious concerns from the OIG. The
Committee directs the Corporation to cease implementation of
the regionalization plan until it participates in meaningful
engagement with those impacted; conducts a cost-benefit
analysis of piloting the regionalization plan compared to full-
scale implementation; and, conducts an analysis of the impact
of State office closures on grantees, current services and
staff in each respective State where a closure occurs,
including an analysis of whether there is reasonable proximity
between each State that has experienced a closure and the new
regional office serving that State and submits the information,
including details on further stakeholder engagement, to the
Committees on Appropriations within 30 days of enactment of
this Act.
OFFICE OF INSPECTOR GENERAL
Appropriation, fiscal year 2019....................... $5,750,000
Budget request, fiscal year 2020...................... 4,258,000
Committee Recommendation.............................. 6,013,000
Change from enacted level........................... +263,000
Change from budget request.......................... +1,755,000
ADMINISTRATIVE PROVISIONS
Sec. 401. The Committee continues a provision requiring
CNCS to make any significant changes to program requirements or
policy through rulemaking.
Sec. 402. The Committee continues a provision related to
National Service Trust minimum share requirements.
Sec. 403. The Committee continues a provision related to
donations.
Sec. 404. The Committee continues a provision related to
veterans.
Sec. 405. The Committee continues a provision related to
criminal history background checks.
Sec. 406. The Committee continues a provision related to
1,200 hour service positions.
Corporation for Public Broadcasting
Appropriation, fiscal year 2021....................... $445,000,000
Budget request, fiscal year 2022...................... - - -
Committee Recommendation.............................. 495,000,000
Change from enacted level........................... +50,000,000
Change from budget request.......................... +495,000,000
The Committee recommends $495,000,000 as an advance
appropriation for fiscal year 2022, an increase of $50,000,000
over the fiscal year 2021 advance. The fiscal year 2020 budget
request proposes to eliminate the Corporation for Public
Broadcasting (CPB) and requests $30,000,000 for this purpose.
In addition, the Committee recommendation includes $20,000,000
in fiscal year 2020 for continued support of CPB in replacing
and upgrading the public broadcasting interconnection system
and further investing in system-wide infrastructure and
services.
National Minority Consortia.--According to the Public
Broadcasting Act, one of the greatest priorities of public
broadcasting is to address the ``needs of unserved and
underserved audiences, particularly children and minorities.''
Programming that reflects the histories and perspectives of
diverse racial and ethnic communities is a core value and
responsibility of public broadcasting, therefore the Committee
supports continued investment in the National Minority
Consortia to help accomplish this goal.
Continued Access to Public Broadcasting.--The Committee
recognizes the importance of continued access to public
broadcasting in local communities. The Committee encourages
federally-funded public radio stations to engage in public-
private partnerships with state and local entities, including
nonprofits, in this effort. The Committee requests CPB include
in its fiscal years 2021/2023 Congressional Budget
Justification information on how public private partnerships
may be used to ensure continued access to public broadcasting
in underserved areas.
Historic Preservation.--The Committee encourages the
Corporation to provide opportunities for documentaries that
promote the importance of and educate the public on the
historic preservation process.
Federal Mediation and Conciliation Service
SALARIES AND EXPENSES
Appropriation, fiscal year 2019....................... $46,650,000
Budget request, fiscal year 2020...................... 47,200,000
Committee Recommendation.............................. 48,200,000
Change from enacted level........................... +1,550,000
Change from budget request.......................... +1,000,000
The Federal Mediation and Conciliation Service promotes
labor-management cooperation through mediation and conflict
resolution services to industry, government agencies, and
communities.
Federal Mine Safety and Health Review Commission
SALARIES AND EXPENSES
Appropriation, fiscal year 2019....................... $17,184,000
Budget request, fiscal year 2020...................... 17,184,000
Committee Recommendation.............................. 17,184,000
Change from enacted level........................... - - -
Change from budget request.......................... - - -
The Federal Mine Safety and Health Review Commission is an
independent adjudicative agency that provides administrative
trial and appellate review of legal disputes arising under the
Federal Mine Safety and Health Act of 1977.
Institute of Museum and Library Services
OFFICE OF MUSEUM AND LIBRARY SERVICES: GRANTS AND ADMINISTRATION
Appropriation, fiscal year 2019....................... $242,000,000
Budget request, fiscal year 2020...................... 23,000,000
Committee Recommendation.............................. 267,000,000
Change from enacted level........................... +25,000,000
Change from budget request.......................... +244,000,000
Within the total for the Institute of Museum and Library
Services (IMLS), the Committee recommends the following
amounts:
------------------------------------------------------------------------
FY 2020
Budget Activity Committee
------------------------------------------------------------------------
Library Services Technology Act:
Grants to States................................. $177,803,000
Native American Library Services................. 5,063,000
National Leadership: Libraries................... 13,406,000
Laura Bush 21st Century Librarian................ 10,000,000
Museum Services Act:
Museums for America.............................. 28,899,000
Native American/Hawaiian Museum Service.......... 1,772,000
National Leadership: Museums..................... 8,313,000
African American History and Culture Act:
Museum Grants for African American History and 2,731,000
Culture.........................................
Museum and Library Services Act General Provisions:
Research, Analysis and Data Collection........... 3,013,000
Program Administration............................... 15,000,000
------------------------------------------------------------------------
Library Services and Technology
The Grants to State Library Agencies program provides funds
to State Library Administrative Agencies using a population-
based formula.
Program Administration
The Committee recommends $15,000,000 for Program
Administration, which is the same as the fiscal year 2019
enacted level. The fiscal year 2020 budget request proposes to
eliminate IMLS. These funds provide administrative and
management support for all programs administered by IMLS. The
Committee also includes $3,013,000 for IMLS' activities in
policy, research, and data collection, including functions
formerly conducted by the National Commission on Libraries and
Information Science.
Women in the Arts.--The Committee encourages IMLS to
provide assistance to major, independent, non-profit
organizations that are qualified to support and whose sole
purpose is dedicated to promoting women in the arts. To remain
independent, such organizations should be unaffiliated with
universities or their museums and should have a proven track
record of advocating for women in the arts through the receipt
of private funds.
Holocaust Education and Survivor Stories.--The Committee
acknowledges that preserving and presenting the living memories
of Holocaust survivors in an interactive format can educate
future generations about the atrocities of the Holocaust. The
Committee is aware that the number of survivors in the United
States is diminishing every month due to the advanced age of
the survivors, and studies have shown that memories and
understanding of the Holocaust are fading from culture. Given
the rising trends of hate and intolerance, the Committee
commends and supports the work Museums are doing across the
country to preserve the memories and to educate the public of
the Holocaust.
Community Wellbeing.--The Committee recognizes the reach
and impact of libraries and museums in their communities.
Programs such as the Community Catalyst Initiative, Applying
Promising Practices for Small Libraries, Museums Inspired, and
the Understanding the Social Wellbeing Impacts of the Nation's
Libraries and Museums, provide essential and actionable
information so that more Americans are able to benefit from the
economic, social, and educational services of museums and
libraries. The Committee encourages the Institute of Museum and
Library Services to continue its essential grantmaking,
research, and evaluation activities in a manner that improves
community wellbeing, especially in rural and under-served
areas.
Medicare Payment Advisory Commission
SALARIES AND EXPENSES
Appropriation, fiscal year 2019....................... $12,545,000
Budget request, fiscal year 2020...................... 12,645,000
Committee Recommendation.............................. 12,645,000
Change from enacted level........................... +100,000
Change from budget request.......................... - - -
The Medicare Payment Advisory Commission (MedPAC) is an
independent agency tasked with advising the Congress on issues
affecting the Medicare program. In addition to advising on
payments to private health plans participating in Medicare and
providers in Medicare's traditional fee-for-service program,
MedPAC is also responsible for providing analysis on access to
care, quality of care, and other issues affecting Medicare.
Medicaid and CHIP Payment and Access Commission
SALARIES AND EXPENSES
Appropriation, fiscal year 2019....................... $8,480,000
Budget request, fiscal year 2020...................... 9,000,000
Committee Recommendation.............................. 8,480,000
Change from enacted level........................... - - -
Change from budget request.......................... -520,000
The Medicaid and CHIP Payment and Access Commission
(MACPAC) is an independent agency tasked with advising the
Congress on issues affecting Medicaid and the State Children's
Health Insurance Program (CHIP). MACPAC conducts policy and
data analysis on Medicaid and CHIP to support policymakers and
support program accountability.
National Council on Disability
SALARIES AND EXPENSES
Appropriation, fiscal year 2019....................... $3,250,000
Budget request, fiscal year 2020...................... 3,450,000
Committee Recommendation.............................. 3,450,000
Change from enacted level........................... +200,000
Change from budget request.......................... - - -
The National Council Disability (NCD) is an independent
Federal agency charged with advising the President, Congress,
and other Federal agencies regarding policies, programs,
practices, and procedures that affect people with disabilities.
NCD is comprised of a team of Presidential and Congressional
appointees, an Executive Director appointed by the Chair, and a
full-time professional staff.
National Labor Relations Board
SALARIES AND EXPENSES
Appropriation, fiscal year 2019....................... $274,224,000
Budget request, fiscal year 2020...................... 241,550,000
Committee Recommendation.............................. 341,500,000
Change from enacted level........................... +67,276,000
Change from budget request.......................... +99,950,000
The National Labor Relations Board (NLRB) is an independent
agency responsible for enforcing U.S. labor law related to
collective bargaining and unfair labor practices, including the
National Labor Relations Act (NLRA) of 1935.
The Committee is concerned that NLRB field staff have
declined by 17 percent over just two years. Further, the
Committee is concerned that multiple regional director
positions remain unfilled. To restore the ability of the NLRB
to fulfill its statutory mission, the Committee provides an
increase of $67,276,000 over fiscal year 2019 and $99,950,000
over the fiscal year 2020 budget request. With this increase,
the Committee directs the NLRB to hire at least 300 additional
regional field staff and fill all open regional director
positions.
The Committee is also concerned by questions of conflicts
of interest surrounding NLRB board members. The Committee
requests a report no less than 90 days from the enactment of
this Act from the NLRB on the findings, recommendations, and
implementation of its Comprehensive Internal Ethics and Recusal
Review, specifically all actions that have been taken to ensure
case decisions and rulemakings are compliant with all
applicable ethics standards and any failures to comply with
those standards.
To protect public trust in NLRB's work and decision-making,
the Committee directs the board to make board member recusal
obligations publicly available within 60 days of the enactment
of this Act and updated monthly thereafter. In addition, within
the funding increase for NLRB, $1,000,000 above amounts
provided in fiscal year 2019 is directed to the NLRB Office of
Inspector General (OIG) to investigate the process, findings,
and recommendations surrounding the board's comprehensive
internal ethics and recusal review. The Committee expects the
increase in funds to help support an additional FTE to assist
with this investigation.
The Committee is deeply concerned that the current board
majority routinely breaks with the NLRB's traditional practice
of providing public notice and an invitation to file briefs
before reconsidering significant precedent. To restore public
participation in critical NLRB matters and to promote informed-
decision making, the Board shall immediately resume its long-
standing practice of providing public notice and an invitation
to file briefs before issuing decisions unless, within 90 days
of enactment of this Act, it provides a report to the
Committees on Appropriations with an explanation of the Board's
current method for deciding to invite public notice and
briefing.
On March 13, 2019, the NLRB Office of the General Counsel
(OGC) issued Operations-Management Memorandum 19-05, which
discouraged Regional Directors from issuing subpoenas when
investigating whether to issue a complaint. The General Counsel
has a Congressional mandate to investigate unfair labor
practices by collecting documentary evidence, summoning
witnesses, and taking testimony--a statutory responsibility,
which includes and often requires the issuance of subpoenas.
Therefore, within 90 days of enactment of this Act, the
Committee directs the General Counsel, along with the Divisions
of Operations Management and Legal Counsel, to provide the
Committees on Appropriations with an impact analysis of the
memorandum's policies on the quality of NLRB investigations of
charges.
The Committee is deeply concerned about the impact of
Presidential Executive Order 13843 on the judicial independence
of administrative law judges (ALJs). The Order eliminates the
competitive hiring process for ALJs and has the potential
impact of converting independent adjudicators to political
appointees, undermining longstanding principles of fair and
unbiased consideration of matters of vital importance to the
American people. ALJs must be independent decision-makers and
it is the Committee's expectation that NLRB maintain the
highest standards for appointment of ALJs. Within 60 days of
enactment of this Act, NLRB is directed to provide to the
Committees on Appropriations and Oversight and Government and
Reform of the House of Representatives a report explaining the
process, qualification standards, and criteria used to recruit,
evaluate and hire ALJs under the executive order.
The Committee is deeply concerned by several recent
decisions that weaken workers' collective bargaining rights.
PCC Structurals (365 NLRB No. 160; Dec. 15, 2017) allows
employers to more easily gerrymander union elections by
requiring the NLRB to include employees who did not previously
express an interest in the union. Further, SuperShuttle DRW,
(367 NLRB No. 75; Jan. 25, 2019) allows employers to more
easily classify their workers as independent contractors
instead of employees by deviating from the common law standard
for determining an employee and instead focusing on whether the
worker has ``entrepreneurial opportunity.'' This test has no
basis in the NLRA or the common law. In addition, the Committee
is concerned by the NLRB's joint employer proposed rulemaking,
which will make it easier for unscrupulous employers to
sidestep their legal responsibility to bargain with their
employees. The Committee strongly urges the NLRB to abandon any
proposal that weakens workers' rights while protecting bad
actors from liability. The Committee is also deeply concerned
that the NLRB failed to hold any public hearings as part of its
joint employer rulemaking process and strongly urges the Board
to do so prior to publishing any final rule.
National Mediation Board
SALARIES AND EXPENSES
Appropriation, fiscal year 2019....................... $13,800,000
Budget request, fiscal year 2020...................... 13,800,000
Committee Recommendation.............................. 15,800,000
Change from enacted level........................... +2,000,000
Change from budget request.......................... +2,000,000
The National Mediation Board is an independent agency that
coordinates labor-management relations within the U.S.
railroads and airlines industries.
The Committee recognizes the continued success of the
National Mediation Board in mediating collectively bargained
contracts in the rail and air travel industries. The Committee
is concerned that there is a lag in mediating cases, increasing
the length of time cases are being addressed and cleared. The
Committee recommends an additional $2,000,000 over the fiscal
year 2019 enacted level and the fiscal year 2020 budget
request, of which $1,000,000 is directed for the administration
of the agency and its staffing needs. The remaining $1,000,000
is to be used specifically to supplement, not supplant,
existing resources devoted to Section 3 arbitrator salaries and
expenses and address the backlog of Section 3 arbitration cases
at the NMB. The Committee has prioritized these additional
funds in order to allow the Board to accomplish its statutory
mission in a timelier manner. The funding increase is not
intended to support rulemaking activities or the development of
regulatory changes.
Occupational Safety and Health Review
Commission
SALARIES AND EXPENSES
Appropriation, fiscal year 2019....................... $13,225,000
Budget request, fiscal year 2020...................... 13,225,000
Committee Recommendation.............................. 13,225,000
Change from enacted level........................... - - -
Change from budget request.......................... - - -
The Occupational Safety and Health Review Commission is an
independent Federal agency, providing administrative trial and
appellate review, created to decide contests of citations or
penalties resulting from OSHA inspections of American work
places.
Railroad Retirement Board
DUAL BENEFITS PAYMENTS ACCOUNT
Appropriation, fiscal year 2019....................... $19,000,000
Budget request, fiscal year 2020...................... 16,000,000
Committee Recommendation.............................. 16,000,000
Change from enacted level........................... -3,000,000
Change from budget request.......................... - - -
This appropriation is authorized by the Railroad Retirement
Act of 1974 to fund vested dual benefits received by railroad
retirees who, under prior law, would have become covered by
both the railroad retirement system and the Social Security
system because railroad retirement was not fully coordinated
with Social Security from 1937 to 1974. The Committee includes
a provision permitting a portion of these funds to be derived
from income tax receipts on dual benefits as authorized by law.
The Railroad Retirement Board estimates that approximately
$1,000,000 may be derived in this manner.
FEDERAL PAYMENT TO THE RAILROAD RETIREMENT ACCOUNTS
Appropriation, fiscal year 2019....................... $150,000
Budget request, fiscal year 2020...................... 150,000
Committee Recommendation.............................. 150,000
Change from enacted level........................... - - -
Change from budget request.......................... - - -
LIMITATION ON ADMINISTRATION
Appropriation, fiscal year 2019....................... $123,500,000
Budget request, fiscal year 2020...................... 137,216,000
Committee Recommendation.............................. 135,500,000
Change from enacted level........................... +12,000,000
Change from budget request.......................... -1,716,000
The Committee includes $13,460,000 for the implementation
of information technology systems modernization efforts. Within
180 days of enactment of this Act, the Railroad Retirement
Board is directed to submit a comprehensive update to the
Committees on Appropriations of the House of Representatives
and the Senate on project status, timelines to completion, and
total cost of development.
LIMITATION ON THE OFFICE OF INSPECTOR GENERAL
Appropriation, fiscal year 2019....................... $11,000,000
Budget request, fiscal year 2020...................... 11,000,000
Committee Recommendation.............................. 11,500,000
Change from enacted level........................... +500,000
Change from budget request.......................... +500,000
Social Security Administration
PAYMENTS TO SOCIAL SECURITY TRUST FUNDS
Appropriation, fiscal year 2019....................... $11,000,000
Budget request, fiscal year 2020...................... 11,000,000
Committee Recommendation.............................. 11,000,000
Change from enacted level........................... - - -
Change from budget request.......................... - - -
This appropriation provides reimbursement to the Social
Security trust funds for non-trust fund activities.
SUPPLEMENTAL SECURITY INCOME PROGRAM
Appropriation, fiscal year 2019....................... $41,366,203,000
Budget request, fiscal year 2020...................... 41,832,000,000
Committee Recommendation.............................. 41,938,540,000
Change from enacted level........................... +572,337,000
Change from budget request.......................... +106,540,000
The Committee recommends $19,900,000,000 in advance funding
for the first quarter of fiscal year 2021, as requested.
Research and Demonstration
Section 1110 of the Social Security Act provides authority
to the Social Security Administration (SSA) for conducting
research and demonstration projects related to SSA's programs.
Within the appropriation for Supplemental Security Income
(SSI), the Committee recommends $101,000,000 for research and
demonstration activities, which is the same as the fiscal year
2019 enacted level and the fiscal year 2020 budget request.
Administration
Within the appropriation for SSI, the Committee recommends
$4,510,540,000, which is $412,663,000 below the fiscal year
2019 enacted level and $106,540,000 above the fiscal year 2020
budget request. This funding is for payment to the Social
Security trust funds for SSI's share of the administrative
expenses of SSA.
LIMITATION ON ADMINISTRATIVE EXPENSES
Appropriation, fiscal year 2019....................... $11,058,945,000
Budget request, fiscal year 2020...................... 11,060,000,000
Committee Recommendation.............................. 11,358,945,000
Change from enacted level........................... +300,000,000
Change from budget request.......................... +298,945,000
The Limitation on Administrative Expenses (LAE) funds the
administrative and operational costs for administering the Old
Age and Survivors Insurance, Disability Insurance, and
Supplemental Security Income programs, and associated costs for
support to the Centers for Medicare and Medicaid Services in
administering their programs.
The Committee includes an increase of $300,000,000 for
additional hires and resources to improve public service at SSA
field offices and direct service operations, with $22,000,000
specifically for hiring at teleservice center operations. The
Committee remains concerned about the excessive waiting times,
benefit delays, and service problems faced every day by
Americans who are trying to access their earned benefits. It is
the Committee's expectation that this funding will be
sufficient to replace all losses in the field offices,
teleservice and processing centers, and build additional
capacity so that offices can function at appropriate levels.
The Committee acknowledges SSA's progress in reducing
excessive and harmful delays for people waiting for a hearing
before an Administrative Law Judge and is pleased to hear that
SSA is on track to eliminate its hearing backlog in fiscal year
2021. This progress has been facilitated by $290,000,000 in
dedicated funding provided in fiscal years 2017 through 2019,
and the Committee designates $50,000,000 in this bill for
activities that will continue to address the disability hearing
backlog.
The bill continues to provide $45,000,000 in dedicated
funding for Information Technology Modernization.
Administrative Law Judge Selection.--The Committee is
deeply concerned about the impact of Presidential Executive
Order 13843 on the judicial independence of administrative law
judges (ALJs). The Order eliminates the competitive hiring
process for ALJs and has the potential impact of converting
independent adjudicators to political appointees, undermining
longstanding principles of fair and unbiased consideration of
matters of vital importance to the American people. ALJs must
be independent decision-makers and it is the Committee's
expectation that SSA maintain the highest standards for
appointment of ALJs. The Committee directs SSA to submit a
report within 60 days of enactment of this Act to the
Committees on Appropriations, Ways and Means, and Oversight and
Reform, explaining the process, qualification standards, and
criteria used to recruit, evaluate and hire ALJs under the
executive order.
Beneficiary Education.--The Committee recommends SSA
include more complete information on the basic coverage
decision individuals must make when turning age 65 and
enrolling in Medicare. Notifications and informational
materials shared with individuals as they become Medicare-
eligible or re-enroll in Medicare should clearly explain the
basic decision that must be made when electing Medicare
coverage. This information currently presents information on
Medicare Parts A and B (or ``Original Medicare'') but falls
short in explaining the full options available to beneficiaries
under Medicare, such as the opportunity to enroll in Part C and
D, as well as supplemental coverage options (Medigap) should
beneficiaries select Original Medicare. The Committee also
recommends SSA include additional language to clarify the basic
coverage options available to individuals provided on its
website, www.ssa.gov/benefits/medicare and refer beneficiaries
to CMS for more information on the benefits and limitations of
coverage options.
Collective Bargaining.--The Committee strongly supports the
rights of federal employees to bargain collectively.
Presidential Executive Orders 13836, 13837, and 13839 undermine
those rights, which is why a Federal court invalidated many
provisions of those executive orders and enjoined Federal
agencies from implementing them. The Committee is very
concerned about reports that SSA, during recent contract
negotiations with its union, insisted on proposals that closely
resemble the invalidated provisions of the executive orders.
The Committee understands that several of the articles still in
dispute have been referred to the Federal Service Impasses
Panel (FSIP) and are awaiting a final determination. Within 30
days of enactment of this Act, the Committee directs SSA to
submit a report and brief the Committees on Appropriations,
Ways and Means, and Oversight and Reform on all articles in
dispute with the unions as of April 16, 2019. The report shall
include the modifications SSA made to each of the articles in
dispute in order to comply with the court order.
Additionally, it is the Committee's understanding that
parties can continue to discuss open matters while awaiting a
final determination from FSIP. The Committee directs SSA to do
so and to engage the Federal Mediation and Conciliation Service
(FMCS) in order to address these issues through mediation.
SSA is directed to resume contract negotiations with its
union in good faith and to present proposals that do not mirror
District Court discredited provisions of the aforementioned
executive orders. If after a reasonable period of good faith
bargaining has been conducted, FMCS determines that a contract
impasse exists, the parties will jointly select an independent
mediator-arbitrator from a list of mediators-artibrators
supplied by the FMCS. Such mediator-arbitrator will conduct
mediatiion and, if needed, an arbitration hearing with the
authority to decide the final contract.
Headache Disorders.--The Committee supports efforts to
ensure consistent decision-making with regard to how to
appropriately and correctly apply the current Listing of
Impairments to headache disorders-related impairments.
Information Technology.--The Committee continues to monitor
the Information Technology Modernization Plan and remains
concerned that while SSA undertakes information technology
upgrades and improvements, the agency must also maintain an
appropriate balance between SSA's various service delivery
options. As the agency continues to focus on modernizing
information technology and systems, the Committee strongly
encourages SSA to focus on enhancements that positively affect
service to the public and add efficiency to administration of
its programs. In addition, the Committee encourages involvement
of agency front-line staff, those most familiar with the use of
such programs, in all aspects of development, testing and
deployment. The Committee requests an update of the plan
referenced under this heading in House Report 114-699.
Mailing Paper Statements.--The Committee is concerned that
SSA is not mailing Social Security benefits and earning
statements to all contributors aged 25 and older not yet
receiving benefits, in accordance with Section 1143 of the
Social Security Act (42 U.S.C. 1320b-13). The Administration is
directed to brief the Committee within 60 days of enactment of
this Act on progress to date on implementing the law as
written, and to include in its fiscal year 2021 Congressional
Budget Justification an estimate of costs associated with the
mailing of paper statements as required by law.
Muscular Dystrophy.-- The Committee requests SSA include in
the fiscal year 2021 Congressional Budget Justification the
rate at which persons with Duchenne and Becker Muscular
Dystrophy utilize SSA programs, particularly those focused on
promoting employment and community independence such as the
Ticket to Work Program.
Occupational Information System.--SSA is developing a new
Occupational Information System (OIS) that will replace the
Dictionary of Occupational Titles as the primary source of
occupational information used in SSA's disability adjudication
process. The Committee directs SSA to continue to include in
its annual Report on the Occupational Information System
Project the estimated costs for each future fiscal year until
the project is expected to be completed, as well as the
estimated cost for a five-year data refresh cycle.
Pilot Program Metrics.--The Committee appreciates the
information on pilot program metrics provided in the fiscal
year 2020 Congressional Budget Justification. The Committee
expects that, prior to undertaking any new pilots, SSA will
ensure that it has developed a research design that identifies
a clear purpose for the pilot, key objectives and an evaluation
plan, including adequate metrics to determine the pilot's
effectiveness. Metrics should be specific, quantifiable
measures--accompanied by specific goals for the measures--that
can be used to evaluate success. The Committee reminds SSA that
it uses the term ``pilot'' to encompass all efforts to test the
effects of process changes, including ``initiatives'' and
``tests.''
The Committee directs SSA to submit a report to the
Committees on Appropriations, the Committee on Ways and Means,
and the Committee on Finance not later than 90 days after the
enactment of this Act with a description of all pilots
conducted in fiscal years 2019 and 2020, or proposed for fiscal
year 2021; the purpose and key objectives of each pilot; its
start date and timeline; which SSA components are involved in
the pilot; the evaluation plan; the measures or metrics the SSA
will use to evaluate the pilot; and a specific goal for each
metric that will be used to determine the pilot's
effectiveness. Similar information should be provided in the
fiscal year 2021 Congressional Budget Justification. All SSA
pilots should be included in the requested report and
justification, including those undertaken as part of the
Compassionate and Responsive Service (CARES) plan and in other
parts of the agency. The report (and section in the
justification) does not need to include programmatic
demonstrations, such as those involving changes in program
eligibility rules.
Reconsideration.--The Committee is concerned that SSA is
reinstating reconsideration in ten States despite bipartisan,
bicameral concern about the quality of the reconsideration
process and the delays it causes, and without any plan to
improve decision-making at the initial or reconsideration
levels. The Committee directs SSA to provide a plan to the
Committee on Appropriations and the Committee on Ways and Means
within 180 days of enactment of this Act to improve the
Disability Determination Services processes, including research
topics and potential pilots to improve the disability process,
including the reconsideration appeal step, to help ensure the
correct decision is made as early as possible, avoiding the
need for eligible individuals to seek a hearing in order to
receive the benefits for which they are eligible.
Replacement Card Fees.--The Committee considers the
proposal to charge a fee to replace a lost or stolen Social
Security card incomplete and ill-considered. It is an
inappropriate attempt to circumvent the Federal rulemaking
process and the agency is directed not to move forward with
this proposal.
Report on LAE Expenditures.--The Committee continues to
request that the data referenced under this heading in House
Report 114-699 be included in future budget justifications. In
addition, the Committee requests the fiscal year 2021
Congressional Budget Justification include a historical table
of costs and fiscal year 2021 requests for personnel and
benefits, by major SSA component to include Operations (field
offices, teleservice centers, processing centers, and regional
offices); Office of Hearings Operations; Systems; Office of
Analytics, Review, and Oversight; and Headquarters.
Social Media.--The Committee is concerned about the
proposal in the budget request to permit SSA disability
adjudicators to use social media postings and other Internet-
based sources as part of evaluating whether the individual
meets the disability eligibility criteria. The reliability of
social media is often low and hard to determine and SSA
adjudicators lack the time, resources, and expertise to
properly review, evaluate, and corroborate social media posts.
SSA should not pursue this strategy, but instead continue with
its existing process of referring cases of suspected fraud to
investigators at SSA's Office of Inspector General, who are
trained to investigate information found on the Internet or
social media and corroborate it against other sources.
Video Hearings.--The Committee is concerned that SSA's
proposal in the Notice of Proposed Rulemaking ``Setting the
Manner for the Appearance of Parties and Witnesses at a
Hearing'' (83 Fed. Reg. 57368, November 15, 2018) eliminates an
individual's right to an in-person hearing before an SSA
Administrative Law Judge (ALJ). This change would deprive
millions of Americans of their right to due process and could
result in hearings which are less fair and less efficient. The
Committee strongly urges SSA to maintain its current policy,
which allows claimants to choose to use video hearings on a
voluntary basis or to have an in-person hearing or proceeding
if the party chooses to do so.
Vocational Experts.--The Committee directs SSA to provide
an update to the Committee on Appropriations and the Committee
on Ways and Means within 90 days of enactment of this Act on
the status of its plans to strengthen Vocational Expert (VE)
qualification standards and to pay fees that are sufficient to
hire VEs with the necessary expertise and current knowledge.
The Committee directs SSA to ensure that anyone testifying as a
vocational expert under a Blanket Purchase Agreement meets the
qualification standards; and explain how SSA's new fees will
reflect VE qualification standards and take into account the
fees paid for VE services by other Federal agencies and the
private sector. The plan should be developed in consultation
with knowledgeable stakeholders, including VEs.
Vocational Factors.--The Committee considers the recent
Notice of Proposed Rulemaking ``Removing Inability to
Communicate in English as an Education Category'' (84 Fed. Reg
1006, February 1, 2019) to be a harmful and unjustified attempt
to deny Social Security and SSI disability benefits to older
workers with long-term or fatal medical impairments who are
severely limited in their functional capacity and who cannot
communicate in English. The rule does not provide any valid
evidence that there is a sufficient occupational base of jobs
that this narrow group of severely disabled individuals can
perform despite their pervasive limitations. The Committee
understands that of the 157 organizations who submitted or
signed comments, all but one commented in opposition to the
rule. In light of the harm that would be caused by this policy
change, the Committee strongly urges SSA to withdraw this
proposed rule.
Social Security Advisory Board
The Committee recommends $2,400,000 for the Social Security
Advisory Board (SSAB), equal to the fiscal year 2019 enacted
level and the fiscal year 2020 budget request.
User Fees
In addition to the other amounts provided, the Committee
recommends $131,000,000 for administrative activities funded
from user fees. Of this amount, $130,000,000 is derived from
fees collected from States that request SSA to administer State
SSI supplementary payments. The remaining $1,000,000 is derived
from fees charged to non-attorneys who apply for certification
to represent claimants under titles II and XVI of the Social
Security Act.
Continuing Disability Reviews and Redeterminations
The Committee recommends $1,582,000,000 for program
integrity activities. This includes the maximum cap adjustment
authorized in the Budget Control Act. The Committee continues
bill language allowing for the transfer of up to $10,000,000 to
the Office of the Inspector General for the cost of jointly
operating co-operative disability investigation units.
OFFICE OF THE INSPECTOR GENERAL
Appropriation, fiscal year 2019....................... $105,500,000
Budget request, fiscal year 2020...................... 105,500,000
Committee Recommendation.............................. 105,500,000
Change from enacted level........................... - - -
Change from budget request.......................... - - -
The Office of the Inspector General (OIG) is responsible
for meeting the statutory mission of promoting economy,
efficiency, and effectiveness in the administration of SSA
programs and operations and to prevent and detect fraud, waste,
abuse, and mismanagement in such programs and operations. To
accomplish this mission, the OIG directs, conducts, and
supervises audits, evaluations, and investigations relating to
SSA's programs and operations. In addition, the OIG searches
for and reports on systemic weaknesses in SSA programs and
operations, and makes recommendations for needed improvements
and corrective actions.
TITLE V--GENERAL PROVISIONS
(TRANSFER OF FUNDS)
Sec. 501. The Committee continues a provision allowing the
Secretaries of Labor, Health and Human Services, and Education
to transfer unexpended balances of prior appropriations to
accounts corresponding to current appropriations to be used for
the same purposes and for the same periods of time for which
they were originally appropriated.
Sec. 502. The Committee continues a provision prohibiting
the obligation of funds beyond the current fiscal year unless
expressly so provided.
Sec. 503. The Committee continues a provision prohibiting
funds from being used to support or defeat legislation.
Sec. 504. The Committee continues a provision limiting the
amount available for official reception and representation
expenses for the Secretaries of Labor and Education, the
Director of the Federal Mediation and Conciliation Service, and
the Chairman of the National Mediation Board.
Sec. 505. The Committee continues a provision requiring
grantees receiving Federal funds to clearly state the
percentage of the total cost of the program or project that
will be financed with Federal money.
Sec. 506. The Committee continues a provision prohibiting
the use of federal funds for abortion services.
Sec. 507. The Committee continues a provision providing
exceptions to section 506 if the pregnancy is the result of an
act of rape or incest, or in the case of a threat to the life
of the woman; a provision to clarify that section 506 does not
apply to State, locality, or private funds; and a provision to
ensure that health care entities are not required to cover
abortion services.
Sec. 508. The Committee continues a provision prohibiting
use of funds for certain research involving human embryos.
Sec. 509. The Committee continues a provision prohibiting
use of funds for any activity that promotes the legalization of
any drug or substance included in schedule I of the schedules
of controlled substances.
Sec. 510. The Committee continues a provision prohibiting
use of funds to promulgate or adopt any final standard
providing for a unique health identifier until legislation is
enacted specifically approving the standard.
Sec. 511. The Committee continues a provision related to
annual reports to the Secretary of Labor.
Sec. 512. The Committee continues a provision prohibiting
transfer of funds made available in this Act except by
authority provided in this Act or another appropriations Act.
Sec. 513. The Committee continues a provision to limit
funds in the bill for public libraries to those that comply
with the requirements of the Children's Internet Protection
Act.
Sec. 514. The Committee modifies a provision regarding
procedures for reprogramming of funds.
Sec. 515. The Committee continues a provision pertaining to
appointments to scientific advisory committees.
Sec. 516. The Committee continues a provision requiring
each department and related agency funded through this Act to
submit an operating plan within 45 days of enactment, detailing
any funding allocations that are different than those specified
in this Act, the accompanying detailed table, or budget
request.
Sec. 517. The Committee modifies a provision requiring the
Secretaries of Labor, Health and Human Services, and Education
to submit a quarterly report to the Committees on
Appropriations containing certain information on noncompetitive
contracts, grants, and cooperative agreements exceeding
$500,000 in value.
Sec. 518. The Committee continues a provision prohibiting
the use of funds to process claims for credit for quarters of
coverage based on work performed under a Social Security number
that was not the claimant's number, where the performance of
such work under such number has formed the basis for a
conviction of the claimant of a violation of section 208(a)(6)
or (7) of the Social Security Act.
Sec. 519. The Committee continues a provision prohibiting
the use of funds to implement a Social Security totalization
agreement with Mexico.
Sec. 520. The Committee continues a provision prohibiting
the use of funds for the downloading or exchanging of
pornography.
Sec. 521. The Committee continues a provision relating to
reporting requirements for conference expenditures.
Sec. 522. The Committee continues a provision relating to
disclosure of U.S. taxpayer funding for programs used in
advertising.
Sec. 523. The Committee modifies a provision relating to
performance partnership pilots.
Sec. 524. The Committee continues provision requesting
quarterly reports on the status of balances of appropriations
from the Departments of Labor, Health and Human Services and
Education.
Sec. 525. The Committee includes a new provision making
funds from the Children's Health Insurance Program Performance
Bonus Fund unavailable for obligation in fiscal year 2020.
Sec. 526. The Committee includes a new provision requiring
that H-2B visas be allocated on a quarterly basis, with varying
allotments by quarter and in proportion to need in certain
circumstances.
Sec. 527. The Committee includes a new provision
prohibiting funds from being used to replace or diminish the
quality of care provide by Medicare Advantage or TRICARE.
House of Representatives Reporting Requirements
The following materials are submitted in accordance with
various requirements of the Rules of the House of
Representatives:
STATEMENT OF GENERAL PERFORMANCE GOALS AND OBJECTIVES
Pursuant to clause 3(c)(4) of rule XIII of the Rules of the
House of Representatives, the following is a statement of
general performance goals and objectives for which this measure
authorizes funding: The Committee on Appropriations considers
program performance, including a program's success in
developing and attaining outcome-related goals and objectives,
in developing funding recommendations.
RESCISSION OF FUNDS
Pursuant to clause 3(f)(2) of rule XIII of the Rules of the
House of Representatives, the following lists the rescissions
of unexpended balances included in the accompanying bill:
RESCISSIONS RECOMMENDED IN THE BILL
------------------------------------------------------------------------
Account Amount
------------------------------------------------------------------------
Department of Health and Human Services
Children's Health Insurance Program.............. $4,300,000,000
Department of Education
Pell Grants...................................... 50,000,000
------------------------------------------------------------------------
TRANSFER OF FUNDS
Pursuant to clause 3(f)(2) of rule XIII of the Rules of the
House of Representatives, the following lists the transfers of
unexpended balances included in the accompanying bill:
TITLE I
Language is included under ``Job Corps'' permitting the
transfer of funds for Job Corps Center construction,
rehabilitation and acquisition to meet the operational needs of
Job Corps Centers or to achieve administrative efficiencies.
Language is included under ``Special Benefits'' which
provides for the transfer of such sums as necessary from the
``Postal Service'' account.
Language is included under ``Black Lung Disability Trust
Fund'' which provides for the transfer of funds to the
``Department of Labor, Office of Workers' Compensation Program,
Salaries and Expenses.''
Language is included under ``Black Lung Disability Trust
Fund'' which provides for the transfer of funds to the
``Department of Labor, Departmental Management, Salaries and
Expenses.''
Language is included under ``Black Lung Disability Trust
Fund'' which provides for the transfer of funds to the
``Department of Labor, Departmental Management, Office of
Inspector General.''
Language is included under ``Black Lung Disability Trust
Fund'' which provides for the transfer of funds to the
``Department of the Treasury.''
Language is included under ``Departmental Management,
Salaries and Expenses'' authorizing the transfer of funds
available for program evaluation to any other account within
the Department to carry out evaluation activities.
A general provision is included permitting up to one
percent of any discretionary appropriation to be transferred
between a program, project, or activity of the Department of
Labor, provided that no such program, project, or activity is
increased by more than three percent by any such transfer.
A general provision is included that provides for the
transfer of funds from the ``Employment and Training
Administration'' for technical assistance services to grantees
to ``Program Administration''. The provision does not apply to
section 171 of the WIOA. The general provision also authorizes
the transfer of up 0.5 percent of each discretionary
appropriation for ``Employment and Training Administration'' to
carry out program integrity activities subject to certain
limitations related to ``Job Corps.''
A general provision is included that provides for the
transfer of up to 0.75 percent of appropriated funds to carry
out program evaluations of ``Training and Employment
Services'', ``Job Corps'', ``Community Service Employment for
Older Americans,'' ``State Unemployment Insurance and
Employment Service Operations'', ``Employee Benefits Security
Administration'', ``Office of Workers Compensation Programs'',
``Wage and Hour Division'', ``Office of Federal Contract
Compliance Programs'', ``Office of Labor-Management
Standards'', ``Occupational Safety and Health Administration'',
``Mine Safety and Health Administration'', ``Office of
Disability Employment Policy'', funding made available to the
``Bureau of International Labor Affairs'' and ``Women's
Bureau'' within the Departmental Management, Salaries and
Expenses'' account, and ``Veterans Employment and Training''
for use by the Office of the Chief Evaluation Officer.
TITLE II
Language is included under ``Centers for Disease Control
and Prevention, Buildings and Facilities'' to allow the
transfer of prior year unobligated Individual Learning Account
funds to be transferred to this account to carry out the
purpose of this account.
Language is included under ``Centers for Disease Control
and Prevention, Buildings and Facilities'' for funds to be
transferred from the HHS Nonrecurring Expenses Fund.
Language is included under ``Centers for Disease Control
and Prevention, CDC-Wide Activities and Program Support'' for
funds to be transferred to and merged with the Infectious
Disease Rapid Response Reserve Fund.
Language is included under ``National Institutes of Health,
Innovation Account'' to allow the transfer of funds to other
Institutes and Centers to support activities authorized in the
21st Century Cures Act (PL 114-255).
Language is included under ``Administration for Community
Living, Aging and Disability Services Programs'' for transfer
to the Secretary of Agriculture to carry out section 311 of the
Older Americans Act of 1965.
A general provision is included that allows not to exceed
one percent of any discretionary funds to be transferred
between appropriation accounts of the ``Department of Health
and Human Services'', provided that no appropriation account is
increased by more than three percent by such transfer.
A general provision is included that allows the transfer of
up to three percent among the institutes and centers of the
``National Institutes of Health'' from amounts identified as
pertaining to the human immunodeficiency virus.
A general provision is included that allows the transfer of
funding determined to be related to the human immunodeficiency
virus to the ``Office of AIDS Research''.
A general provision is included that transfers one percent
of the amount made available for ``National Research Service
Awards'' at the ``National Institutes of Health'' to the
``Health Resources and Services Administration''.
A general provision is included to direct the transfer of
the ``Prevention and Public Health Fund'' as specified in the
committee report accompanying this Act.
TITLE III
A general provision is included that allows not to exceed
one percent of any discretionary funds to be transferred
between appropriation accounts of the Department of Education,
provided that no appropriation account is increased by more
than three percent by such transfer.
TITLE IV
Language is included under Payment to the National Service
Trust authorizing the transfer of funds from the ``Corporation
for National and Community Service, Operating Expenses'' to
support the activities of national service participants.
Language is included under ``Social Security
Administration'' authorizing the transfer funds from the Social
Security Administration's ``Limitation on Administration
Expenses'' account to be available for purposes of the Office
of Inspector General.
TITLE V
A general provision is included that allows the Secretaries
of Labor, Health and Human Services, and Education to transfer
balances of prior appropriation to accounts corresponding to
current appropriations.
DISCLOSURE OF EARMARKS AND CONGRESSIONALLY DIRECTED SPENDING ITEMS
Neither the bill nor the report contains any Congressional
earmarks, limited tax benefits, or limited tariff benefits as
defined in clause 9 of rule XXI.
Compliance With Rule XIII, Cl. 3(e) (Ramseyer Rule)
In compliance with clause 3(e) of rule XIII of the Rules of
the House of Representatives, changes in existing law made by
the bill, as reported, are shown as follows (existing law
proposed to be omitted is enclosed in black brackets, new
matter is printed in italics, existing law in which no change
is proposed is shown in roman):
HIGHER EDUCATION ACT OF 1965
* * * * * * *
TITLE I--GENERAL PROVISIONS
* * * * * * *
PART B--ADDITIONAL GENERAL PROVISIONS
* * * * * * *
SEC. 114. NATIONAL ADVISORY COMMITTEE ON INSTITUTIONAL QUALITY AND
INTEGRITY.
(a) Establishment.--There is established in the Department a
National Advisory Committee on Institutional Quality and
Integrity (in this section referred to as the ``Committee'') to
assess the process of accreditation and the institutional
eligibility and certification of institutions of higher
education (as defined in section 102) under title IV.
(b) Membership.--
(1) In general.--The Committee shall have 18 members,
of which--
(A) six members shall be appointed by the
Secretary;
(B) six members shall be appointed by the
Speaker of the House of Representatives, three
of whom shall be appointed on the
recommendation of the majority leader of the
House of Representatives, and three of whom
shall be appointed on the recommendation of the
minority leader of the House of
Representatives; and
(C) six members shall be appointed by the
President pro tempore of the Senate, three of
whom shall be appointed on the recommendation
of the majority leader of the Senate, and three
of whom shall be appointed on the
recommendation of the minority leader of the
Senate.
(2) Qualifications.--Individuals shall be appointed
as members of the Committee--
(A) on the basis of the individuals'
experience, integrity, impartiality, and good
judgment;
(B) from among individuals who are
representatives of, or knowledgeable
concerning, education and training beyond
secondary education, representing all sectors
and types of institutions of higher education
(as defined in section 102); and
(C) on the basis of the individuals'
technical qualifications, professional
standing, and demonstrated knowledge in the
fields of accreditation and administration in
higher education.
(3) Terms of members.--Except as provided in
paragraph (5), the term of office of each member of the
Committee shall be for six years, except that any
member appointed to fill a vacancy occurring prior to
the expiration of the term for which the member's
predecessor was appointed shall be appointed for the
remainder of such term.
(4) Vacancy.--A vacancy on the Committee shall be
filled in the same manner as the original appointment
was made not later than 90 days after the vacancy
occurs. If a vacancy occurs in a position to be filled
by the Secretary, the Secretary shall publish a Federal
Register notice soliciting nominations for the position
not later than 30 days after being notified of the
vacancy.
(5) Initial terms.--The terms of office for the
initial members of the Committee shall be--
(A) three years for members appointed under
paragraph (1)(A);
(B) four years for members appointed under
paragraph (1)(B); and
(C) six years for members appointed under
paragraph (1)(C).
(6) Chairperson.--The members of the Committee shall
select a chairperson from among the members.
(c) Functions.--The Committee shall--
(1) advise the Secretary with respect to
establishment and enforcement of the standards of
accrediting agencies or associations under subpart 2 of
part H of title IV;
(2) advise the Secretary with respect to the
recognition of a specific accrediting agency or
association;
(3) advise the Secretary with respect to the
preparation and publication of the list of nationally
recognized accrediting agencies and associations;
(4) advise the Secretary with respect to the
eligibility and certification process for institutions
of higher education under title IV, together with
recommendations for improvements in such process;
(5) advise the Secretary with respect to the
relationship between--
(A) accreditation of institutions of higher
education and the certification and eligibility
of such institutions; and
(B) State licensing responsibilities with
respect to such institutions; and
(6) carry out such other advisory functions relating
to accreditation and institutional eligibility as the
Secretary may prescribe by regulation.
(d) Meeting Procedures.--
(1) Schedule.--
(A) Biannual meetings.--The Committee shall
meet not less often than twice each year, at
the call of the Chairperson.
(B) Publication of date.--The Committee shall
submit the date and location of each meeting in
advance to the Secretary, and the Secretary
shall publish such information in the Federal
Register not later than 30 days before the
meeting.
(2) Agenda.--
(A) Establishment.--The agenda for a meeting
of the Committee shall be established by the
Chairperson and shall be submitted to the
members of the Committee upon notification of
the meeting.
(B) Opportunity for public comment.--The
agenda shall include, at a minimum, opportunity
for public comment during the Committee's
deliberations.
(3) Secretary's designee.--The Secretary shall
designate an employee of the Department to serve as the
Secretary's designee to the Committee, and the
Chairperson shall invite the Secretary's designee to
attend all meetings of the Committee.
(4) Federal advisory committee act.--The Federal
Advisory Committee Act (5 U.S.C. App.) shall apply to
the Committee, except that section 14 of such Act shall
not apply.
(e) Report and Notice.--
(1) Notice.--The Secretary shall annually publish in
the Federal Register--
(A) a list containing, for each member of the
Committee--
(i) the member's name;
(ii) the date of the expiration of
the member's term of office; and
(iii) the name of the individual
described in subsection (b)(1) who
appointed the member; and
(B) a solicitation of nominations for each
expiring term of office on the Committee of a
member appointed by the Secretary.
(2) Report.--Not later than the last day of each
fiscal year, the Committee shall make available an
annual report to the Secretary, the authorizing
committees, and the public. The annual report shall
contain--
(A) a detailed summary of the agenda and
activities of, and the findings and
recommendations made by, the Committee during
the fiscal year preceding the fiscal year in
which the report is made;
(B) a list of the date and location of each
meeting during the fiscal year preceding the
fiscal year in which the report is made;
(C) a list of the members of the Committee;
and
(D) a list of the functions of the Committee,
including any additional functions established
by the Secretary through regulation.
(f) Termination.--The Committee shall terminate on September
30, [2019] 2020.
* * * * * * *
TITLE IV--STUDENT ASSISTANCE
Part A--Grants to Students in Attendance at Institutions of Higher
Education
* * * * * * *
Subpart 1--Federal Pell Grants
SEC. 401. FEDERAL PELL GRANTS: AMOUNT AND DETERMINATIONS; APPLICATIONS.
(a) Program Authority and Method of Distribution.--(1) For
each fiscal year through fiscal year 2017, the Secretary shall
pay to each eligible institution such sums as may be necessary
to pay to each eligible student (defined in accordance with
section 484) for each academic year during which that student
is in attendance at an institution of higher education, as an
undergraduate, a Federal Pell Grant in the amount for which
that student is eligible, as determined pursuant to subsection
(b). Not less than 85 percent of such sums shall be advanced to
eligible institutions prior to the start of each payment period
and shall be based upon an amount requested by the institution
as needed to pay eligible students until such time as the
Secretary determines and publishes in the Federal Register with
an opportunity for comment, an alternative payment system that
provides payments to institutions in an accurate and timely
manner, except that this sentence shall not be construed to
limit the authority of the Secretary to place an institution on
a reimbursement system of payment.
(2) Nothing in this section shall be interpreted to prohibit
the Secretary from paying directly to students, in advance of
the beginning of the academic term, an amount for which they
are eligible, in cases where the eligible institution elects
not to participate in the disbursement system required by
paragraph (1).
(3) Grants made under this subpart shall be known as
``Federal Pell Grants''.
(b) Purpose and Amount of Grants.--(1) The purpose of this
subpart is to provide a Federal Pell Grant that in combination
with reasonable family and student contribution and
supplemented by the programs authorized under subparts 3 and 4
of this part, will meet at least 75 percent of a student's cost
of attendance (as defined in section 472), unless the
institution determines that a greater amount of assistance
would better serve the purposes of this section.
(2)
(A) The amount of the Federal Pell Grant for a
student eligible under this part shall be--
(i) the maximum Federal Pell Grant, as
specified in the last enacted appropriation Act
applicable to that award year, plus
(ii) the amount of the increase calculated
under paragraph (7)(B) for that year, less
(iii) an amount equal to the amount
determined to be the expected family
contribution with respect to that student for
that year.
(B) In any case where a student attends an institution of
higher education on less than a full-time basis (including a
student who attends an institution of higher education on less
than a half-time basis) during any academic year, the amount of
the Federal Pell Grant to which that student is entitled shall
be reduced in proportion to the degree to which that student is
not so attending on a full-time basis, in accordance with a
schedule of reductions established by the Secretary for the
purposes of this division, computed in accordance with this
subpart. Such schedule of reductions shall be established by
regulation and published in the Federal Register in accordance
with section 482 of this Act.
(3) No Federal Pell Grant under this subpart shall exceed the
difference between the expected family contribution for a
student and the cost of attendance (as defined in section 472)
at the institution at which that student is in attendance. If,
with respect to any student, it is determined that the amount
of a Federal Pell Grant plus the amount of the expected family
contribution for that student exceeds the cost of attendance
for that year, the amount of the Federal Pell Grant shall be
reduced until the combination of expected family contribution
and the amount of the Federal Pell Grant does not exceed the
cost of attendance at such institution.
(4) No Federal Pell Grant shall be awarded to a student under
this subpart if the amount of that grant for that student as
determined under this subsection for any academic year is less
than ten percent of the maximum amount of a Federal Pell Grant
award determined under paragraph (2)(A) for such academic year.
(5) Notwithstanding any other provision of this subpart, the
Secretary shall allow the amount of the Federal Pell Grant to
be exceeded for students participating in a program of study
abroad approved for credit by the institution at which the
student is enrolled when the reasonable costs of such program
are greater than the cost of attendance at the student's home
institution, except that the amount of such Federal Pell Grant
in any fiscal year shall not exceed the maximum amount of a
Federal Pell Grant award determined under paragraph (2)(A), for
which a student is eligible during such award year. If the
preceding sentence applies, the financial aid administrator at
the home institution may use the cost of the study abroad
program, rather than the home institution's cost, to determine
the cost of attendance of the student.
(6) No Federal Pell Grant shall be awarded under this subpart
to any individual who is incarcerated in any Federal or State
penal institution or who is subject to an involuntary civil
commitment upon completion of a period of incarceration for a
forcible or nonforcible sexual offense (as determined in
accordance with the Federal Bureau of Investigation's Uniform
Crime Reporting Program).
(7) Additional funds.--
(A) In general.--There are authorized to be
appropriated, and there are appropriated (in
addition to any other amounts appropriated to
carry out this section and out of any money in
the Treasury not otherwise appropriated) the
following amounts--
(i) $2,030,000,000 for fiscal year
2008;
(ii) $2,090,000,000 for fiscal year
2009;
(iii) to carry out subparagraph (B)
of this paragraph, such sums as may be
necessary for fiscal year 2010 and each
subsequent fiscal year to provide the
amount of increase of the maximum
Federal Pell Grant required by clauses
(ii) and (iii) of subparagraph (B); and
(iv) to carry out this section--
(I) $13,500,000,000 for
fiscal year 2011;
(II) $13,795,000,000 for
fiscal year 2012;
(III) $7,587,000,000 for
fiscal year 2013;
(IV) $588,000,000 for fiscal
year 2014;
(V) $0 for fiscal year 2015;
(VI) $0 for fiscal year 2016;
(VII) $1,320,000,000 for
fiscal year 2017;
(VIII) $1,334,000,000 for
fiscal year 2018;
(IX) $1,370,000,000 for
fiscal year 2019;
(X) [$1,430,000,000]
$1,380,000,000 for fiscal year
2020; and
(XI) $1,145,000,000 for
fiscal year 2021 and each
succeeding fiscal year.
(B) Increase in federal pell grants.--The
amounts made available pursuant to clauses (i)
through (iii) of subparagraph (A) of this
paragraph shall be used to increase the amount
of the maximum Federal Pell Grant for which a
student shall be eligible during an award year,
as specified in the last enacted appropriation
Act applicable to that award year, by--
(i) $490 for each of the award years
2008-2009 and 2009-2010;
(ii) $690 for each of the award years
2010-2011, 2011-2012, and 2012-2013;
and
(iii) the amount determined under
subparagraph (C) for each succeeding
award year.
(C) Adjustment amounts.--
(i) Award year 2013-2014.--For award
year 2013-2014, the amount determined
under this subparagraph for purposes of
subparagraph (B)(iii) shall be equal
to--
(I) $5,550 or the total
maximum Federal Pell Grant for
the preceding award year (as
determined under clause
(iv)(II)), whichever is
greater, increased by a
percentage equal to the annual
adjustment percentage for award
year 2013-2014, reduced by
(II) $4,860 or the maximum
Federal Pell Grant for which a
student was eligible for the
preceding award year, as
specified in the last enacted
appropriation Act applicable to
that year, whichever is
greater; and
(III) rounded to the nearest
$5.
(ii) Award years 2014-2015 through
2017-2018.--For each of the award years
2014-2015 through 2017-2018, the amount
determined under this subparagraph for
purposes of subparagraph (B)(iii) shall
be equal to--
(I) the total maximum Federal
Pell Grant for the preceding
award year (as determined under
clause (iv)(II)), increased by
a percentage equal to the
annual adjustment percentage
for the award year for which
the amount under this
subparagraph is being
determined, reduced by
(II) $4,860 or the maximum
Federal Pell Grant for which a
student was eligible for the
preceding award year, as
specified in the last enacted
appropriation Act applicable to
that year, whichever is
greater; and
(III) rounded to the nearest
$5.
(iii) Subsequent award years.--For
award year 2018-2019 and each
subsequent award year, the amount
determined under this subparagraph for
purposes of subparagraph (B)(iii) shall
be equal to the amount determined under
clause (ii) for award year 2017-2018.
(iv) Definitions.--For purposes of
this subparagraph--
(I) the term ``annual
adjustment percentage'' as
applied to an award year, is
equal to the estimated
percentage change in the
Consumer Price Index (as
determined by the Secretary,
using the definition in section
478(f)) for the most recent
calendar year ending prior to
the beginning of that award
year; and
(II) the term ``total maximum
Federal Pell Grant'' as applied
to a preceding award year, is
equal to the sum of--
(aa) the maximum
Federal Pell Grant for
which a student is
eligible during an
award year, as
specified in the last
enacted appropriation
Act applicable to that
preceding award year;
and
(bb) the amount of
the increase in the
maximum Federal Pell
Grant required by this
paragraph for that
preceding award year.
(D) Program requirements and operations
otherwise unaffected.--Except as provided in
subparagraphs (B) and (C), nothing in this
paragraph shall be construed to alter the
requirements and operations of the Federal Pell
Grant Program as authorized under this section,
or authorize the imposition of additional
requirements or operations for the
determination and allocation of Federal Pell
Grants under this section.
(E) Ratable increases and decreases.--The
amounts specified in subparagraph (B) shall be
ratably increased or decreased to the extent
that funds available under subparagraph (A)
exceed or are less than (respectively) the
amount required to provide the amounts
specified in subparagraph (B).
(F) Availability of funds.--The amounts made
available by subparagraph (A) for any fiscal
year shall be available beginning on October 1
of that fiscal year, and shall remain available
through September 30 of the succeeding fiscal
year.
(8)(A) Effective in the 2017-2018 award year and
thereafter, the Secretary shall award an eligible
student not more than one and one-half Federal Pell
Grants during a single award year to permit such
student to work toward completion of an eligible
program if, during that single award year, the
student--
(i) has received a Federal Pell Grant
for an award year and is enrolled in an
eligible program for one or more
additional payment periods during the
same award year that are not otherwise
fully covered by the student's Federal
Pell Grant; and
(ii) is enrolled on at least a half-
time basis while receiving any funds
under this section.
(B) In the case of a student receiving more
than one Federal Pell Grant in a single award
year under subparagraph (A), the total amount
of Federal Pell Grants awarded to such student
for the award year may exceed the maximum basic
grant level specified in the appropriate
appropriations Act for such award year.
(C) Any period of study covered by a Federal
Pell Grant awarded under subparagraph (A) shall
be included in determining a student's duration
limit under subsection (c)(5).
(D) In any case where an eligible student is
receiving a Federal Pell Grant for a payment
period that spans two award years, the
Secretary shall allow the eligible institution
in which the student is enrolled to determine
the award year to which the additional period
shall be assigned, as it determines is most
beneficial to students.
(c) Period of Eligibility for Grants.--(1) The period during
which a student may receive Federal Pell Grants shall be the
period required for the completion of the first undergraduate
baccalaureate course of study being pursued by that student at
the institution at which the student is in attendance except
that any period during which the student is enrolled in a
noncredit or remedial course of study as defined in paragraph
(2) shall not be counted for the purpose of this paragraph.
(2) Nothing in this section shall exclude from eligibility
courses of study which are noncredit or remedial in nature
(including courses in English language instruction) which are
determined by the institution to be necessary to help the
student be prepared for the pursuit of a first undergraduate
baccalaureate degree or certificate or, in the case of courses
in English language instruction, to be necessary to enable the
student to utilize already existing knowledge, training, or
skills. Nothing in this section shall exclude from eligibility
programs of study abroad that are approved for credit by the
home institution at which the student is enrolled.
(3) No student is entitled to receive Pell Grant payments
concurrently from more than one institution or from the
Secretary and an institution.
(4) Notwithstanding paragraph (1), the Secretary may allow,
on a case-by-case basis, a student to receive a basic grant if
the student--
(A) is carrying at least one-half the normal full-
time work load for the course of study the student is
pursuing, as determined by the institution of higher
education; and
(B) is enrolled or accepted for enrollment in a
postbaccalaureate program that does not lead to a
graduate degree, and in courses required by a State in
order for the student to receive a professional
certification or licensing credential that is required
for employment as a teacher in an elementary school or
secondary school in that State,
except that this paragraph shall not apply to a student who is
enrolled in an institution of higher education that offers a
baccalaureate degree in education.
(5) The period during which a student may receive Federal
Pell Grants shall not exceed 12 semesters, or the equivalent of
12 semesters, as determined by the Secretary by regulation.
Such regulations shall provide, with respect to a student who
received a Federal Pell Grant for a term but was enrolled at a
fraction of full-time, that only that same fraction of such
semester or equivalent shall count towards such duration
limits.
(d) Applications for Grants.--(1) The Secretary shall from
time to time set dates by which students shall file
applications for Federal Pell Grants under this subpart.
(2) Each student desiring a Federal Pell Grant for any year
shall file an application therefor containing such information
and assurances as the Secretary may deem necessary to enable
the Secretary to carry out the functions and responsibilities
of this subpart.
(e) Distribution of Grants to Students.--Payments under this
section shall be made in accordance with regulations
promulgated by the Secretary for such purpose, in such manner
as will best accomplish the purpose of this section. Any
disbursement allowed to be made by crediting the student's
account shall be limited to tuition and fees and, in the case
of institutionally owned housing, room and board. The student
may elect to have the institution provide other such goods and
services by crediting the student's account.
(f) Calculation of Eligibility.--(1) Each contractor
processing applications for awards under this subpart
(including a central processor, if any, designated by the
Secretary) shall, in a timely manner, furnish to the student
financial aid administrator (at each institution of higher
education which a student awarded a Federal Pell Grant under
this subpart is attending), as a part of its regular output
document, the expected family contribution for each such
student. Each such student financial aid administrator shall--
(A) examine and assess the data used to calculate the
expected family contribution of the student furnished
pursuant to this subsection;
(B) recalculate the expected family contribution of
the student if there has been a change in circumstances
of the student or in the data submitted;
(C) make the award to the student in the correct
amount; and
(D) after making such award report the corrected data
to such contractor and to a central processor (if any)
designated by the Secretary for a confirmation of the
correct computation of amount of the expected family
contribution for each such student.
(2) Whenever a student receives an award under this subpart
that, due to recalculation errors by the institution of higher
education, is in excess of the amount which the student is
entitled to receive under this subpart, such institution of
higher education shall pay to the Secretary the amount of such
excess unless such excess can be resolved in a subsequent
disbursement to the institution.
(3) Each contractor processing applications for awards under
this subpart shall for each academic year after academic year
1986-1987 prepare and submit a report to the Secretary on the
correctness of the computations of amount of the expected
family contribution, and on the accuracy of the questions on
the application form under this subpart for the previous
academic year for which the contractor is responsible. The
Secretary shall transmit the report, together with the comments
and recommendations of the Secretary, to the Committee on
Appropriations of the Senate, the Committee on Appropriations
of the House of Representatives, and the authorizing
committees.
(g) Insufficient Appropriations.--If, for any fiscal year,
the funds appropriated for payments under this subpart are
insufficient to satisfy fully all entitlements, as calculated
under subsection (b) (but at the maximum grant level specified
in such appropriation), the Secretary shall promptly transmit a
notice of such insufficiency to each House of the Congress, and
identify in such notice the additional amount that would be
required to be appropriated to satisfy fully all entitlements
(as so calculated at such maximum grant level).
(h) Use of Excess Funds.--(1) If, at the end of a fiscal
year, the funds available for making payments under this
subpart exceed the amount necessary to make the payments
required under this subpart to eligible students by 15 percent
or less, then all of the excess funds shall remain available
for making payments under this subpart during the next
succeeding fiscal year.
(2) If, at the end of a fiscal year, the funds available for
making payments under this subpart exceed the amount necessary
to make the payments required under this subpart to eligible
students by more than 15 percent, then all of such funds shall
remain available for making such payments but payments may be
made under this paragraph only with respect to entitlements for
that fiscal year.
(i) Treatment of Institutions and Students Under Other
Laws.--Any institution of higher education which enters into an
agreement with the Secretary to disburse to students attending
that institution the amounts those students are eligible to
receive under this subpart shall not be deemed, by virtue of
such agreement, a contractor maintaining a system of records to
accomplish a function of the Secretary. Recipients of Pell
Grants shall not be considered to be individual grantees for
purposes of subtitle D of title V of Public Law 100-690.
(j) Institutional Ineligibility Based on Default Rates.--
(1) In general.--No institution of higher education
shall be an eligible institution for purposes of this
subpart if such institution of higher education is
ineligible to participate in a loan program under part
B or D as a result of a final default rate
determination made by the Secretary under part B or D
after the final publication of cohort default rates for
fiscal year 1996 or a succeeding fiscal year.
(2) Sanctions subject to appeal opportunity.--No
institution may be subject to the terms of this
subsection unless the institution has had the
opportunity to appeal the institution's default rate
determination under regulations issued by the Secretary
for the loan program authorized under part B or D, as
applicable. This subsection shall not apply to an
institution that was not participating in the loan
program authorized under part B or D on the date of
enactment of the Higher Education Amendments of 1998,
unless the institution subsequently participates in the
loan programs.
* * * * * * *
PART D--WILLIAM D. FORD FEDERAL DIRECT LOAN PROGRAM
* * * * * * *
SEC. 458. FUNDS FOR ADMINISTRATIVE EXPENSES.
(a) Administrative Expenses.--
(1) Mandatory funds for fiscal year 2006.--For fiscal
year 2006, there shall be available to the Secretary,
from funds not otherwise appropriated, funds to be
obligated for--
(A) administrative costs under this part and
part B, including the costs of the direct
student loan programs under this part; and
(B) account maintenance fees payable to
guaranty agencies under part B and calculated
in accordance with subsections (b) and (c),
not to exceed (from such funds not otherwise
appropriated) $820,000,000 in fiscal year 2006.
(3) Authorization for administrative costs beginning
in fiscal years 2007 through 2014.--For each of the
fiscal years 2007 through 2014, there are authorized to
be appropriated such sums as may be necessary for
administrative costs under this part and part B,
including the costs of the direct student loan programs
under this part.
(4) Continuing mandatory funds for account
maintenance fees.--For each of the fiscal years 2007
through [2019] 2020, there shall be available to the
Secretary, from funds not otherwise appropriated, funds
to be obligated for account maintenance fees payable to
guaranty agencies under part B and calculated in
accordance with subsection (b).
(5) Account maintenance fees.--Account maintenance
fees under paragraph (3) shall be paid quarterly and
deposited in the Agency Operating Fund established
under section 422B.
(6) Technical assistance to institutions of higher
education.--
(A) Provision of assistance.--The Secretary
shall provide institutions of higher education
participating, or seeking to participate, in
the loan programs under this part with
technical assistance in establishing and
administering such programs.
(B) Funds.--There are authorized to be
appropriated, and there are appropriated, to
carry out this paragraph (in addition to any
other amounts appropriated to carry out this
paragraph and out of any money in the Treasury
not otherwise appropriated), $50,000,000 for
fiscal year 2010.
(C) Definition.--In this paragraph, the term
``assistance'' means the provision of technical
support, training, materials, technical
assistance, and financial assistance.
(7) Additional payments.--
(A) Provision of assistance.--The Secretary
shall provide payments to loan servicers for
retaining jobs at locations in the United
States where such servicers were operating
under part B on January 1, 2010.
(B) Funds.--There are authorized to be
appropriated, and there are appropriated, to
carry out this paragraph (in addition to any
other amounts appropriated to carry out this
paragraph and out of any money in the Treasury
not otherwise appropriated), $25,000,000 for
each of the fiscal years 2010 and 2011.
(8) Carryover.--The Secretary may carry over funds
made available under this section to a subsequent
fiscal year.
(b) Calculation Basis.--Account maintenance fees payable to
guaranty agencies under subsection (a)(4) shall be calculated
on the basis of 0.06 percent of the original principal amount
of outstanding loans on which insurance was issued under part
B.
(c) Budget Justification.--No funds may be expended under
this section unless the Secretary includes in the Department of
Education's annual budget justification to Congress a detailed
description of the specific activities for which the funds made
available by this section have been used in the prior and
current years (if applicable), the activities and costs planned
for the budget year, and the projection of activities and costs
for each remaining year for which administrative expenses under
this section are made available.
* * * * * * *
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IMMIGRATION AND NATIONALITY ACT
* * * * * * *
TITLE II--IMMIGRATION
* * * * * * *
Chapter 2--Qualifications for Admission of Aliens; Travel Control of
Citizens and Aliens
* * * * * * *
admission of nonimmigrants
Sec. 214. (a)(1) The admission to the United States of any
alien as a nonimmigrant shall be for such time and under such
conditions as the Attorney General may by regulations
prescribe, including when he deems necessary the giving of a
bond with suffi
