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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.

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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

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 Chapter 2--Qualifications for Admission of Aliens; Travel Control of 
Citizens and Aliens

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                       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 sufficient surety in such sum and containing such 
conditions as the Attorney General shall prescribe, to insure 
that at the expiration of such time or upon failure to maintain 
the status under which he was admitted, or to maintain any 
status subsequently acquired under section 248, such alien will 
depart from the United States. No alien admitted to Guam or the 
Commonwealth of the Northern Mariana Islands without a visa 
pursuant to section 212(l) may be authorized to enter or stay 
in the United States other than in Guam or the Commonwealth of 
the Northern Mariana Islands or to remain in Guam or the 
Commonwealth of the Northern Mariana Islands for a period 
exceeding 45 days from date of admission to Guam or the 
Commonwealth of the Northern Mariana Islands. No alien admitted 
to the United States without a visa pursuant to section 217 may 
be authorized to remain in the United States as a nonimmigrant 
visitor for a period exceeding 90 days from the date of 
admission.
  (2)(A) The period of authorized status as a nonimmigrant 
described in section 101(a)(15)(O) shall be for such period as 
the Attorney General may specify in order to provide for the 
event (or events) for which the nonimmigrant is admitted.
  (B) The period of authorized status as a nonimmigrant 
described in section 101(a)(15)(P) shall be for such period as 
the Attorney General may specify in order to provide for the 
competition, event, or performance for which the nonimmigrant 
is admitted. In the case of nonimmigrants admitted as 
individual athletes under section 101(a)(15)(P), the period of 
authorized status may be for an initial period (not to exceed 5 
years) during which the nonimmigrant will perform as an athlete 
and such period may be extended by the Attorney General for an 
additional period of up to 5 years.
  (b) Every alien (other than a nonimmigrant described in 
subparagraph (L) or (V) of section 101(a)(15), and other than a 
nonimmigrant described in any provision of section 
101(a)(15)(H)(i) except subclause (b1) of such section) shall 
be presumed to be an immigrant until he establishes to the 
satisfaction of the consular officer, at the time of 
application for a visa, and the immigration officers, at the 
time of application for admission, that he is entitled to a 
nonimmigrant status under section 101(a)(15). An alien who is 
an officer or employee of any foreign government or of any 
international organization entitled to enjoy privileges, 
exemptions, and immunities under the International 
Organizations Immunities Act, or an alien who is the attendant, 
servant, employee, or member of the immediate family of any 
such alien shall not be entitled to apply for or receive an 
immigrant visa, or to enter the United States as an immigrant 
unless he executes a written waiver in the same form and 
substance as is prescribed by section 247(b).
  (c)(1) The question of importing any alien as a nonimmigrant 
under subparagraph (H), (L), (O), or (P)(i) of section 
101(a)(15) (excluding nonimmigrants under section 
101(a)(15)(H)(i)(b1)) in any specific case or specific cases 
shall be determined by the Attorney General, after consultation 
with appropriate agencies of the Government, upon petition of 
the importing employer. Such petition shall be made and 
approved before the visa is granted. The petition shall be in 
such form and contain such information as the Attorney General 
shall prescribe. The approval of such a petition shall not, of 
itself, be construed as establishing that the alien is a 
nonimmigrant. For purposes of this subsection with respect to 
nonimmigrants described in section 101(a)(15)(H)(ii)(a), the 
term ``appropriate agencies of Government'' means the 
Department of Labor and includes the Department of Agriculture. 
The provisions of section 218 shall apply to the question of 
importing any alien as a nonimmigrant under section 
101(a)(15)(H)(ii)(a).
  (2)(A) The Attorney General shall provide for a procedure 
under which an importing employer which meets requirements 
established by the Attorney General may file a blanket petition 
to import aliens as nonimmigrants described in section 
101(a)(15)(L) instead of filing individual petitions under 
paragraph (1) to import such aliens. Such procedure shall 
permit the expedited processing of visas for admission of 
aliens covered under such a petition.
  (B) For purposes of section 101(a)(15)(L), an alien is 
considered to be serving in a capacity involving specialized 
knowledge with respect to a company if the alien has a special 
knowledge of the company product and its application in 
international markets or has an advanced level of knowledge of 
processes and procedures of the company.
  (C) The Attorney General shall provide a process for 
reviewing and acting upon petitions under this subsection with 
respect to nonimmigrants described in section 101(a)(15)(L) 
within 30 days after the date a completed petition has been 
filed.
  (D) The period of authorized admission for--
          (i) a nonimmigrant admitted to render services in a 
        managerial or executive capacity under section 
        101(a)(15)(L) shall not exceed 7 years, or
          (ii) a nonimmigrant admitted to render services in a 
        capacity that involves specialized knowledge under 
        section 101(a)(15)(L) shall not exceed 5 years.
  (E) In the case of an alien spouse admitted under section 
101(a)(15)(L), who is accompanying or following to join a 
principal alien admitted under such section, the Attorney 
General shall authorize the alien spouse to engage in 
employment in the United States and provide the spouse with an 
``employment authorized'' endorsement or other appropriate work 
permit.
  (F) An alien who will serve in a capacity involving 
specialized knowledge with respect to an employer for purposes 
of section 101(a)(15)(L) and will be stationed primarily at the 
worksite of an employer other than the petitioning employer or 
its affiliate, subsidiary, or parent shall not be eligible for 
classification under section 101(a)(15)(L) if--
          (i) the alien will be controlled and supervised 
        principally by such unaffiliated employer; or
          (ii) the placement of the alien at the worksite of 
        the unaffiliated employer is essentially an arrangement 
        to provide labor for hire for the unaffiliated 
        employer, rather than a placement in connection with 
        the provision of a product or service for which 
        specialized knowledge specific to the petitioning 
        employer is necessary.
  (3) The Attorney General shall approve a petition--
          (A) with respect to a nonimmigrant described in 
        section 101(a)(15)(O)(i) only after consultation in 
        accordance with paragraph (6) or, with respect to 
        aliens seeking entry for a motion picture or television 
        production, after consultation with the appropriate 
        union representing the alien's occupational peers and a 
        management organization in the area of the alien's 
        ability, or
          (B) with respect to a nonimmigrant described in 
        section 101(a)(15)(O)(ii) after consultation in 
        accordance with paragraph (6) or, in the case of such 
        an alien seeking entry for a motion picture or 
        television production, after consultation with such a 
        labor organization and a management organization in the 
        area of the alien's ability.
In the case of an alien seeking entry for a motion picture or 
television production, (i) any opinion under the previous 
sentence shall only be advisory, (ii) any such opinion that 
recommends denial must be in writing, (iii) in making the 
decision the Attorney General shall consider the exigencies and 
scheduling of the production, and (iv) the Attorney General 
shall append to the decision any such opinion. The Attorney 
General shall provide by regulation for the waiver of the 
consultation requirement under subparagraph (A) in the case of 
aliens who have been admitted as nonimmigrants under section 
101(a)(15)(O)(i) because of extraordinary ability in the arts 
and who seek readmission to perform similar services within 2 
years after the date of a consultation under such subparagraph. 
Not later than 5 days after the date such a waiver is provided, 
the Attorney General shall forward a copy of the petition and 
all supporting doc