FY 2020 Joint Explanatory Statement - Div A

DIVISION A-DEPARTMENTS OF LABOR, HEAL TH AND HUMAN
SERVICES, AND EDUCATION, AND RELATED AGENCIES
APPROPRIATIONS ACT, 2020

The explanatory statement accompanying this division is approved and
indicates Congressional intent. Unless otherwise noted, the language set forth in
House Report 116-62 carries the same weight as language included in this
explanatory statement and should be complied with unless specifically addressed
to the contrary in this explanatory statement. While some language is repeated for
emphasis, it is not intended to negate the language referred to above unless
expressly provided herein.
In providing the operating plan required by section 516 of this Act, the
departments and agencies funded in this Act are directed to include all programs,
projects, and activities, including those in House Report 116-62 and this
explanatory statement accompanying this Act. All such programs, projects, and
activities are subject to the provisions of this Act.
In cases where House Report 116-62 or this explanatory statement directs the
submission of a report, that report is to be submitted to the Committees on
Appropriations of the House of Representatives and the Senate. Where this
explanatory statement refers to the Committees or the Committees on
Appropriations, unless otherwise noted, this reference is to the House of
Representatives Subcommittee on Labor, Health and Human Services, Education,
and Related Agencies and the Senate Subcommittee·on Labor, Health and Human
Services, Education, and Related Agencies.

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Each department and agency funded in this Act shall follow the directions set
forth in this Act and the accompanying explanatory statement, and shall not
reallocate resources or reorganize activities except as provided herein. Funds for
individual programs and activities are displayed in the detailed table at the end of
the explanatory statement accompanying this Act. Funding levels that are not
displayed in the detailed table are identified within this explanatory statement. Any
action to eliminate or consolidate programs, projects, and activities should be
pursued through a proposal in the President's Budget so it can be considered by the
Committees on Appropriations.

Congressional Reports.-Each department and agency is directed to provide
the Committees on Appropriations, within 30 days from the date of enactment of
this Act and quarterly thereafter, a summary describing each requested report to the
Committees on Appropriations along with its status.

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TITLE I
DEPARTMENT OF LABOR
EMPLOYMENT AND TRAINING ADMINISTRATION (ETA)
TRAINING AND EMPLOYMENT SERVICES

Grants to States.-The agreement is consistent with the Workforce Innovation
and Opportunity Act (WIOA) authorization regarding the amount ofWIOA State
grant funding that may be reserved by Governors.

Adult Employment and Training.-WIOA State grant funding continues to
serve critical functions, including to assist States that continue to experience high
unemployment.

Youth Training-The Department is directed to evaluate incorporating
resilience training and trauma-informed practices into WIOA youth job training
programs and shall consult with organizations with nationally recognized expertise
in such practices. The Department is directed to provide a report to the Committees
within six months of enactment of this Act describing the findings of the
evaluation and an assessment of how WIOA youth job training programs could
adopt such practices and measure outcomes.

Dislocated Worker National Reserve
Career Pathways for Youth Grants.-The bill provides $10,000,000 to utilize
the demonstration grant authority under the dislocated worker national reserve for
grants to support national out-of-school time organizations that serve youth and
teens and place an emphasis on age-appropriate workforce readiness programming
to expand job training and workforce pathways for youth and disconnected youth,
including soft skill development, career exploration, job readiness and
certification, summer jobs, year-round job opportunities, and apprenticeships.

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Funding will also support partnerships between workforce investment boards and
youth serving organizations.
Strengthening Community College Training Grants .-The agreement provides
$40,000,000 for the Strengthening Community College Training Grant program.
The Department is directed to follow all requirements and directives in House
Report 116-62 related to this program, except that the Secretary shall make
individual grants to community colleges of at least $1,000,000, unless grants are
awarded in consortia to community colleges and other eligible institutions as
defined in section lOl(a) of the Higher Education Act and do not exceed
$5,000,000 per grant.
Woriforce Opportunity for Rural Communities.-The agreement provides
$30,000,000 to continue this program in the Appalachian and Delta regions. The
Department is directed to ensure broad geographic distribution of funds within
these regions and awards should not exceed $1,500,000 per award.
Transition to WIOA.-The agreement requests additional information regarding
use of the Secretary's 10 percent reservation of funds for technical assistance to
transition to WIOA under the dislocated worker assistance national reserve in the
fiscal year 2021 Congressional Justification.
Apprenticeship Grant Program
The agreement provides $175,000,000 to support registered apprenticeships and
includes new bill language referencing WIOA, ensuring that funds are only used to
support registered apprenticeships, and that makes funds available starting July 1,
2020 to encourage better management and oversight.
The agreement notes serious concerns regarding the Department's misuse of
registered apprenticeship funds and the Department's communication of this
misuse to the Committees, including testimony before the Committees.
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The agreement notes that funding under this program should be prioritized to
support State, regional, and local apprenticeship efforts, as well as efforts by
intermediaries to expand registered apprenticeships into new industries and for
underserved or underrepresented populations.
State expansion grants have been used to positive effect in States with high
unemployment. The agreement directs the Secretary to prioritize funding for
national, regional, and local intermediaries. The agreement directs the Secretary to
continue funding for business and labor industry partner intermediaries and ensure
that labor intermediaries are given opportunities to apply for competitive grants,
cooperative agreements, contracts, and other funding opportunities.
The Department is encouraged to support funding industry or sector
partnerships as a means of expanding registered apprenticeships in in-demand
industries. The Department should collaborate with the Department of Defense to
develop registered apprenticeships that address the critical national defense need
for new submarine construction. The Department is encouraged to support
.-programs-in-the-health-care,~maritime,- constmction,-and~oi1-and-gas~industries.--'fhe-..
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agreement notes concerns about shortages nationwide of drinking water and
wastewater management professionals and encourages the Department to address
the shortage of water system management professionals.
The agreement directs the Department to provide quarterly briefings on all
spending activities under this program to the Committees, and to comply with
directives and statements in House Report 116-62.

JOB CORPS

Job Corps .-In addition to the directives included in House Report 116-62,
the Department is directed to provide 30 days notification to the Committees in
advance of any action to close or deactivate a Job Corps Center (Center), as well as
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in advance of any action to establish a pilot program or d~monstration project at a
Center. The Department is further directed to minimize the amount of time a
Center is inactive prior to commencement of a pilot program or demonstration
project and to ensure training opportunities and slots do not decline as a result of
such pilot or demonstration. Not later than 120 days after enactment of this Act,
the Department shall provide the Committees a report on the performance of all
pilot programs and demonstration projects, including a detailed description of the
performance metrics used to evaluate the projects, and an analysis of the
performance of pilots and projects relative to other Centers. The Department is
expected to continue to comply with the directives under the heading Job Corps in
Senate Report 115-289.

Construction and Renovation.-The Department is encouraged to take into
consideration critical municipal infrastructure deficiencies when identifying
construction and renovation projects.

Unemployment Insurance Compensation
State Unemployment System Needs.-The agreement notes that State
unemployment insurance (UI) systems are critical for ensuring claimants receive
timely processing of benefits. The Department is encouraged to provide abovebase State ill funds through supplemental funding opportunities to States to the
extent that unobligated funds, not otherwise needed for workload, are available at
the end of the fiscal year. Such funds should support improving operations and
modernizing State ill systems to help ensure that workers and their families
receive fast and high-quality assistance in their time of need.

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UI Integrity Center ofExcellence.-The agreement provides $9,000,000 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.

Employment Service
National Activities.-The agreement provides $2,500,000 to reduce the
processing backlog for the work opportunity tax credit program.

Foreign Labor Certification
The agreement includes an increase of $6,500,000 for continued
implementation of the Northern Mariana Islands U.S. Workforce Act of 2018
(P.L. 115-218). The agreement urges the Department to provide careful oversight
and transparency related to the timely processing of visa applications for temporary
employment certifications. The agreement directs the Department to provide an
update on the upgrades to the foreign labor certification technical system,
including the launch of the Foreign Labor Application Gateway, in the fiscal year
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2021 Congressional Justification.

One-Stop Career Centers and Labor Market Information
Occupational Licensing-The Department is directed to provide a briefing
within 90 days of enactment of this Act to the Committees on the outcomes and
status of the occupational licensing initiative, including the impact on military
spouses, dislocated workers, and transitioning service members and a review of the
grants awarded in fiscal years 2016, 2017, and 2018.

EMPLOYEE BENEFITS SECURITY ADMINISTRATION

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(EBSA)

The agreement directs EBSA to prioritize audit resources to review the Thrift
Savings Plan's (TSP) IT operating environment, including the adequacy of controls
at contractor sites and TSP's progress in remediating previously identified issues
from past EBSA audits.

PENSION BENEFIT GUARANTY CORPORATION
The agreement includes new bill language that extends the period of availability
of funding for certain administrative expenses to five years to ensure the agency
has sufficient time to manage a large, unanticipated influx of participants or costs.

WAGE AND HOUR DNISION (WHD)
WHD is encouraged to hire additional investigators and restore WHD's
investigative capacity.
In the fiscal year 2021 Congressional Justification, WHD is directed to provide
annual and historical information on the Payroll Audit Independent Determination
(PAID) program, including administrative expenditures on PAID, amounts
recovered through PAID, and the number of businesses participating in PAID.
WHD shall collect data at the beginning of each fiscal year and submit in an
electronic format yearly reports to the authorizing and appropriations Committees
that shall include the following: (1) the name and address of each employer
holding a certificate under 29 U.S.C. 214(c); (2) the starting date and ending date
of each certificate for each employer under 29 U.S.C. 214(c); (3) information about
the certificate for each employer under 29 U.S.C. 214(c), including if the
certificate is an initial certificate or renewal and if the certificate is issued or
pending; and (4) the current number of workers paid a subminimum wage by the
employer holding the certificate under 29 U.S.C. 214(c) at the time of data
collection. WHD is further directed to brief the authorizing and appropriations
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Committees, within 90 days of enactment of this Act, on its administration,
monitoring, and enforcement of the submini!J1um wage program authorized under
section 14(c) of the Fair Labor Standards Act.
The Department is directed to provide a report within 120 days of enactment of
this Act to the Committees that shall include the data and economic analysis
supporting the inclusion of the housing policy for industries requiring a mobile
workforce in the 2015 interim final rule leading to its publication and the benefits
and costs of such policy on U.S. and guest workers and employers.

OFFICE OF WORKERS' COMPENSATION PROGRAMS (OWCP)

There is continued concern about overreliance on unobligated funds for support
of the Special Benefits for Disabled Coal Miners Program. OWCP should not take
action that could disrupt the ability of the program to ensure all beneficiaries
receive promised benefits. The agency is directed to include in the fiscal year 2021
Congressional Justification: ( 1) the number of beneficiaries each year since fiscal
year 2015 and (2) the total benefit payments and budgetary resources and
expenditures within the program each year since fiscal year 2015.

ADMINISTRATIVE EXPENSES, ENERGY EMPLOYEES OCCUPATIONAL ILLNESS
COMPENSATION FUND

The Department shall ensure the Advisory Board on Toxic Substances and
Worker Health has sufficient funding and staffing to meet its obligations.

OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION

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(OSHA)

The agreement 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. Further, the agreement directs OSHA to provide technical
assistance, guidance, and support to fiscal year 2020 applicants in order to reduce
the proportion that did not meet eligibility and program requirements included in
Funding Opportunity Notices in fiscal year 2019.
The agreement 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. The webinar shall be developed and provided
to DoD within 180 days of enactment of this Act and shall be sent to the
Committees. Further, OSHA shall explore options for gathering and entering
Employee Identification Numbers from all inspections of worksites and shall
consider exemptions for small worksites with few employees.
The agreement continues to provide no less than $3,500,000 for the Voluntary
Protection Program (VPP). In the fiscal year 2021 Congressional Justification,
OSHA is directed to include annual expenditures on VPP for each year since fiscal
year 2015 as well as planned expenditures in fiscal year 2021.

MINE SAFETY AND HEALTH ADMINISTRATION

(MSHA)

The fiscal year 2020 President's budget request proposed to allow greater
flexibility by combining the enforcement functions for coal and metal/non-metal
into a single enforcement budget activity. This flexibility shall only be exercised to
bolster MSHA's ability to enforce the Mine Safety and Health Act and provide
greater protections to miners. MSHA's Office of Accountability shall audit and
publicly report findings from reviews of crossover mine inspections and monitor
corrective actions to ensure MSHA activities adhere to its policies and procedures
and meet the requirements of such Act. In addition, the Inspector General shall
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conduct a comprehensive audit of this consolidation of enforcement programs.
Finally, the agency is directed to include in future Congressional Justifications
historical and budget year information on enforcement activities and outcomes,
distinguishing between coal and metal/non-metal mines. To promote transparency
into agency spending on its enforcement activities, MSHA will continue to
separately present annual spending on coal and metal/non-metal mines as it has in
past Congressional Justifications.
The agreement removes authority, first provided in fiscal year 2017, that
allowed State assistance grants to be used by operators for purchase and
maintenance of continuous personal dust monitors. No State has elected to use
such authority.
MSHA shall fully implement the requirements of section 103 of the Federal
Mine Safety and Health Act and make inspections of each underground mine in its
entirety at least four times a year and each surface mine in its entirety at least two
times a year. MSHA should use existing funds to equip all MSHA mine rescue
teams with next generation mine rescue communications equipment. To prepare
properly for an emergency, MSHA shall continue to devote sufficient resources
toward a competitive grant activity for effective emergency response and recovery
training in various types of mine conditions.

BUREAU OF LABOR STATISTICS

(BLS)

The agreement includes an increase of $40,000,000 to rebuild capacity at BLS
and to support a headquarters relocation to the Suitland Federal Center.
With the increase, BLS is directed to support the following critical investments:
• Provide an annual supplement to the Current Population Survey to allow
for collection of data on contingent and alternative work arrangements

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every two years and data on other topics related to the labor force in
alternate years, including an occasional veterans supplement;
• Restore the production and publication of employment, unemployment,
and labor force data under the Local Area Unemployment Statistics
program for New England Minor Civil Divisions with populations less
than 1,000; and
• Initiate spending on the planning and development of a new National
Longitudinal Survey of Youth (NLSY) cohort. BLS shall brief the
Committees on the annual costs and a five-year plan for implementing
the new NLSY cohort within 90 days of enactment of this Act.
When implementing these investments, BLS shall not reduce or eliminate
existing statistical work. Further, BLS shall not reduce the number of full-time
equivalent positions beyond the apportioned fiscal year 2019 full-time equivalent
ceiling.
Within the increase, the agreement includes $27,000,000 to relocate BLS
headquarters. BLS is strongly urged to consider the needs of its employees
throughout this transition and to work with the General Services Administration to
address any outstanding safety concerns and office space considerations for the
development of sensitive economic indicators.

DEPARTMENTAL MANAGEMENT

Bureau ofInternational Labor Affairs (!LAB) .-The agreement includes an
increase of $10,000,000, of which $7,500,000 is for grants to improve countries'
capacity to enforce labor rights agreed to under U.S. trade agreements and trade
preference programs. The remaining $2,500,000 is provided for additional
monitoring and enforcement staff at the Office of Trade and Labor Affairs and

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additional labor attaches in critical U.S. Embassies to increase field-based and
international monitoring and labor compliance facilitation.
ILAB should continue to release its annual Findings on the Worst Forms of
. Child Labor report, including its assessment ratings on Generalized System of
Preference country efforts to implement its commitments to eliminate the worst
forms of child labor, no later than it has historically.
Faithful execution of the Foundations for Evidence-based Policymaking Act
will enhance the evidence-building capacity of Federal agencies, strengthen
privacy protections, improve secure access to data, and provide more and higher
quality evidence to policymakers. The agreement directs the Department to include
in the fiscal year 2021 and future Congressional Justifications an update on the
implementation of such Act for the current and budget years.
The agreement expects the Department to prioritize the submission of timely,
accurate, quality, and complete financial and award information under existing
U.S. Treasury reporting obligations in accordance with established management
guidance, reporting processes, and data standards established under the
requirements of the Digital Accountability and Transparency Act.
The Department should continue to notify the Committees of the planned uses
of funds derived from the evaluation authority in section 107 of this Act.
The Department should continue 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.

VETERANS EMPLOYMENT AND TRAINING

Disabled Veterans.-The agreement provides $300,000 for the purposes
associated with the Disabled Veteran Program in House Report 116-62.

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Transition Assistance Program.-The agreement provides $29,379,000, an
increase of $6,000,000, for the transition assistance program (TAP). Within that
amount, the agreement provides $8,000,000 to enhance the quality of employment
support services for transitioning service members, with a focus on improved
outcomes. The agreement includes $1,500,000 for TAP course curriculum for
military spouses, who are currently eligible for the same TAP resources as service
members. Such curriculum should include resources and information on related
State and Federal license and credential portability.
\.: :

GENERAL PROVISIONS

The agreement modifies a provision related to the Treasure Island Job Corps
Center.
The agreement includes a new provision related to H-1B fees.
The agreement modifies a provision related to funds available to State
Unemployment Insurance information technology consortia.
________The_agreemenLincludes.a~newpro¥ision-related=to~Job=Corps~Civilian--- -Conservation Centers.

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TITLE II
DEPARTMENT OF HEALTH AND HUMAN SERVICES
HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA)
PRIMARY HEALTH CARE

Domestic HIV Initiative.-The agreement includes $50,000,000 for the first
year of an initiative to reduce HIV transmission. Funds will be distributed to
Health Centers in high-need jurisdictions to increase the use of pre-exposure
prophylaxis (PrEP) among high-risk groups.

HRSA Strategy to Address Intimate Partner Violence.-The agreement provides
no less than $1,000,000 for the HRSA Strategy to Address Intimate Partner
Violence to continue support for training, technical assistance, and resource
development to assist public health and healthcare professionals in better serving
impacted individuals and communities.

Native Hawaiian Health Care.-The agreement provides no less than
$19,000,000 for this program.

Technical Assistance.-The agreement includes funds to enhance technical
assistance and training activities, further quality improvement initiatives, and
continue the development of and support for health center-controlled networks so
that new and existing centers can improve patient access. The agreement provides
$1,000,000 for technical assistance grants in States with a disproportionate share of
new HIV diagnoses in rural areas.

HEALTH WORKFORCE

National Health Service Corps.-HRSA is instructed to provide a report no
later than 120 days after enactment of this Act on the data collected on maternity
care target areas, including the availability and need of maternity care health
services in health professional shortage areas (HPSAs ), and in the target areas
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within such HPSAs.

Midwife Training-Within the total for Scholarships for Disadvantaged
Students, the agreement includes no less than $2,500,000 to educate midwives to
address the national shortage of maternity care providers, and specifically to
address the lack of diversity in the maternity care workforce.

Area Health Education Centers.-The agreement encourages HR.SA to invest in
interprofessional networks that address social determinants of health and
incorporate field placement programs for rural and medically-underserved
populations.

Mental and Substance Use Disorder Workforce Training Demonstration-Within
the total for Behavioral Health Workforce Education and Training (BHWET), the
agreement includes no less than $26,700,000 to establish the Mental and Substance
Use Disorder Workforce Training Demonstration, as authorized under section 9022 of
the 21 st Century Cures Act (P.L. 114-255) and described in House Report 116-62.

Peer Support.-Within the total for BHWET, the agreement includes no less than
$10,000,000 for community-based experiential training for students preparing to
become peer support specialists and other types of behavioral health-related
paraprofessionals, as described in House Report 116-62.

Loan Repayment Program for Substance Use Disorder Treatment Workforce.Within the total for BHWET, the agreement includes no less than $12,000,000 to
establish the Loan Repayment Program for Substance Use Disorder Treatment
Workforce, as authorized under section 7071 of the SUPPORT for Patients and
Communities Act (P.L. 115-271) and described in House Report 116-62.

Nurse Education, Practice, Quality and Retention.-The agreement includes
$2,000,000 for new competitive grants to enhance nurse education and strengthen
the nursing workforce through the expansion of experiential learning opportunities.
HR.SA is directed to ensure that these grants include as an allowable use the
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purchase of simulation training equipment. HRSA shall give priority to grantees
located in a medically-underserved area in a State with an age-adjusted high
burden of stroke, heart disease, and obesity, and HRSA is encouraged to prioritize
submissions that support high poverty rate communities.
Nurse Practitioner Optional Fellowship Program.-The agreement includes

$5,000,000 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 in primary care or behavioral health, as
described in House Report 116-62.
Veterans' Bachelor ofScience Degree in Nursing.-HRSA is encouraged to

consider the successful past practice of entities that have received funding from
this nursing program in making new awards that support veterans and expand the
nursing workforce.
Nursing Worliforce Diversity.-The agreement includes no less than $1,000,000

to support a model program under section 821 of the Public Health Service Act to
increase and strengthen the eldercare workforce in rural counties where there are
health care disparities related to access and delivery of care. HRSA shall give
priority to eligible entities with training programs that serve one or more
communities that have: (1) a poverty rate exceeding 32 percent and a median
household income below $34,000 a year as reported by the Census Bureau's Small
Area Income and Poverty Estimates program for 2017; and (2) are located in a
State with an elderly population that exceeds 15 percent of the total State's
population as reported by the Census Bureau for 2018. Funding will support
education, training, and partnerships with academia; primary care delivery sites;
community-based organizations; and other healthcare delivery sites. HRSA is
directed to give priority to established and reputable nursing programs in
historically black colleges and universities that can demonstrate increased
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educational opportunities for individuals from disadvantaged backgrounds.

Advanced Education Nursing-The agreement provides $9,000,000 to award
grants for the clinical training of sexual assault nurse examiners as described in
Senate Report 115-150.

Medical Student Education.-The agreement provides up to $35,000,000 to
fund additional applications received in fiscal year 2019. Qf the remaining
amount, the agreement directs HR.SA to make supplementary grant awards to
entities funded in fiscal year 2019.

Reports.-The agreement requests that HR.SA provide the reports requested
under the Health Workforce header in House Report 116-62 within 180 days of
enactment of this Act.
MA TERNAL AND CHILD HEALTH

Alliance for Maternal Health Safety Bundles.-The agreement includes
$5,000,000 for implementation of maternal safety bundles in all U.S. States, the
District of Columbia, and U.S. territories, as well as tribal entities.

Children's Health and Development.-The agreement provides $3,500,000
within Special Projects of Regional and National Significance (SPRANS) for
another year of funding for the study focused on improving child health through a
statewide system of early childhood developmental screenings and interventions.

Hemophilia Treatment Centers.-The agreement provides level funding for
Hemophilia Treatment Centers.

Infant-Toddler Court Teams.-The agreement includes no less than
$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 the well-being of infants, toddlers, and their families, as described in
House Report 116-62.

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Set-asides within SPRANS.-The agreement includes the following set-asides
within SPRANS. Within the set-aside for Oral Health, $250,000 is provided for
activities described in House Report 116-62.

FY 2020
Agreement

Budget Activity
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 ............... .

1,000,000

Autism and Other Developmental Disorders.-The agreement includes
$52,344,000 for the Autism and Other Developmental Disorders program. Within
that total, the agreement provides not less than $35,245,000 for the Leadership
Education in Neurodevelopmental and Related Disabilities program.

Severe Combined Immunodeficiency.-Within the total for the Heritable
Disorders Program, the agreement includes no less than $3,000,000 for the third
year of a grant to support implementation, education, and awareness of newborn
screening for Severe Combined Immune Deficiency and related disorders.

Healthy Start.-Within the total, the agreement includes no less than
$15,000,000 for the initiative to reduce maternal mortality, allowing Healthy Start
grantees to support nurse practitioners, certified nurse midwives, physician
assistants, and other maternal-child advanced practice health professionals within
all program sites nationwide.

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RYAN WHITE HfV/AIDS PROGRAM

Domestic HIV Jnitiative.-The agreement includes $70,000,000 for the first
year of an initiative to reduce HIV transmission. Funds will be distributed to highneed jurisdictions to increase linkage, engagement, and retention in care with the
goal of increasing viral suppression among people living with HIV.

HEALTH CARE SYSTEMS

National Living Donor Assistance Center.-Within the total for Organ
Transplantation, the agreement includes no less than $4,500,000 for the National
Living Donor Assistance Center, as described in House Report 116-62.

Organ Allocation Policy.-HRSA and the Organ Procurement and
Transplantation Network are encouraged to ensure the process for changing organ
allocation policies is transparent, thorough, and accommodates the
recommendations of transplantation and organ donation professionals.

RURAL HEAL TH

Rural Health Outreach.-The agreement provides not more than $12,000,000
for Outreach Service Grants; not less than $12,900,000 for Rural Network
Development Grants; not less than $22,000,000 for the Delta States Network Grant
Program; not less than $1,900,000 for Network Planning Grants; and not more than
$6,400,000 for Small Health Care Provider Quality Improvement Grants.

Delta States Rural Development Network Grant Program.-The agreement
provides $10,000,000 to support HRSA's collaboration with the Delta Regional
Authority, as described under this heading in Conference Report 115-952.

Telementoring Training Center.-Within the total for Rural Health Research
and Policy Development, the agreement includes no less than $1,000,000 to
support a telementoring training center to train academic medical centers and other
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centers of excellence in the creation of technology-enabled telementoring learning
programs, as described in House Report 116-62.
Rural Hospital Flexibility Grants .-The agreement recommends HRSA give
preference in grant awards to Critical Access Hospitals, as described in Senate
Report 115-289.
Telehealth Centers ofExcellence.-The agreement provides $6,000,000 for the
Telehealth Centers of Excellence (Centers) awardees. The Centers are encouraged
to develop best practices for treating HIV through telehealth that can be replicated
across rural America and accelerate progress toward the goal of eliminating HIV
transmission.
Telehealth Evaluation.-The agreement provides $1,000,000 to support a
comprehensive evaluation of nationwide telehealth investments in rural areas and
populations, as described in House Report 116-62.
Telehealth Network Grant Program.-The Office for the Advancement of
Telehealth (OAT) is instructed to consult with the Bureau of Primary Health Care
and develop a plan for the dissemination of the work of the school-based services
clinical cohort, especially as it relates to providing assessments and referrals for
health, mental health, or substance use disorder services to students who may
struggle with behavioral or mental health issues. HRSA is instructed to provide a
report on the OAT plan, including any findings from the school-based clinical
cohort, to the Committees within 180 days of enactment of this Act.
Rural Communities Opioids Response Program.-The bill includes
$110,000,000 to continue this program. The agreement includes $10,000,000 to
continue the three Rural Centers or Excellence (Centers), as established in P.L.
115-245 and as directed by Conference Report 115-952. In addition to such
conditions, the Centers shall work with neighboring States or regionally to
implement surveillance, needs assessment, technical assistance, and educational
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outreach in the form of subgrants to non-profit entities or academic institutions to
implement demonstrated interventions.

FAMILY PLANNING

The Family Planning program administers Title X of the PHS Act. This
program supports preventive and primary healthcare services at clinics nationwide.
The agreement does not include language proposed by the House.

PROGRAM MANAGEMENT

Oral Health Literacy.-The agreement includes $300,000 for the activity
described under this heading in House Report 116-62.

CENTERS FOR DISEASE CONTROL AND PREVENTION

The agreement provides $7,974,554,000 in total program level funding for the
Centers for Disease Control and Prevention (CDC), which includes $6,895,304,000
in budget authority, $854,250,000 in transfers from the Prevention and Public
Health (PPH) Fund, and $225,000,000 from the HHS Nonrecurring Expenses
Fund.
IMMUNIZATION AND RESPIRATORY DISEASES

The agreement provides a total of $803,405,000 for Immunization and
Respiratory Diseases, which includes $433,105,000 in discretionary appropriations
and $370,300,000 in transfers from the PPH Fund. The agreement shifts
$7,222,000 from tuberculosis to global tuberculosis in Global Health to reflect
CDC's yearly administrative shift. Within this total, the agreement includes the
following amounts:

22

FY 2020
Budget Activity

Agreement

Section 31 7 Immunization Program ..... .

$615,847,000

Influenza Planning and Response ....... .

187,558,000

Acute Flaccid Myelitis.-The agreement includes funding within the
Section 31 7 Immunization Program to identify the cause, prevention, and treatment
of acute flaccid myelitis.

Immunization Rates .-CDC is directed to continue increasing awareness and
knowledge of the safety and effectiveness of vaccines, combating misinformation
about vaccines, and disseminating scientific and evidence-based vaccine-related
information, with the goal of increasing rates of vaccination across all ages,
particularly in communities with low rates of vaccination.

National Adenovirus Type Reporting System (NATRS).-CDC is directed to
submit a report no later than 180 days after enactment of this Act to the
Committees detailing impediments to NATRS reporting and outlining
recommendations to bolster the reporting.

HIV/ AIDS, VIRAL HEPATITIS, SEXUALLY TRANSMITTED DISEASES AND

TUBERCULOSIS PREVENTION

The agreement provides $1,273,556,000 for HIV/AIDS, Viral Hepatitis,
Sexually Transmitted Diseases, and Tuberculosis Prevention. Within this total, the
agreement includes the following amounts:

23

FY 2020
Budget Activity

Agreement

Domestic HIV/AIDS Prevention and Research...

$928,712,000

HIV Initiative ..................................... .

140,000,000

School Health .............................................. ..

33,081,000

Viral Hepatitis .................................................... ..

39,000,000

Sexually Transmitted Infections ........................ .

160,810,000

Tuberculosis ..... ................... ................. .. .... ......... .

135,034,000

Infectious Diseases and the Opioid Epidemic .. ..

10,000,000

Hepatitis B.-CDC is encouraged to work with stakeholders to include a plan in
the fiscal year 2021 Congressional Justification to increase immunization coverage
among adults and reduce the number of hepatitis B cases.

HIV/AIDS Data Sharing Platform.-CDC is encouraged to enhance the
Collaborative Advanced Analytics and Data Sharing system to lower overall
operating costs and reduce reporting burdens on Federal and State health
departments.

HIV Initiative.-The agreement includes increased funding to reduce new HIV
infections.

Infectious Diseases and the Opioid Epidemic.-The agreement provides an
increase to conduct the activities outlined in House Report 116-62.

Sexually Transmitted Infections {STI). - The agreement includes an increase to
reduce rising STI rates.
24

EMERGING AND ZOONOTIC INFECTIOUS DISEASES

The agreement provides $622,372,000 for Emerging and Zoonotic Infectious
Diseases, which includes $570,372,000 in discretionary appropriations and
$52,000,000 in transfers from the PPH Fund. The agreement shifts $8,000,000
from lab safety and quality into Public Health Scientific Services to account for
CDC's yearly administrative shift. Within this total, the agreement includes the
following amounts:

FY 2020

Budget Activity

Agreement

Antibiotic Resistance Initiative............................

170,000,000

Vector-Borne Diseases.........................................

38,603,000

Lyme Disease.......................................................

14,000,000

Prion Disease........................................................

6,000,000

Chronic Fatigue Syndrome...................................

5,400,000

Emerging Infectious Diseases.............................

188,797,000

Harmful Algal Blooms...............................

2,000,000

Food Safety...........................................................

63,000,000

National Healthcare Safety Network....................

21,000,000

Quarantine.............................................................

31,572,000

25

FY 2020
Budget Activity

Agreement

Advanced Molecular Detection............................

30,000,000

Epidemiology and Lab Capacity......................

40,000,000

Healthcare-Associated Infections...................

12,000,000

Antimicrobial Resistance (AMR) .-The agreement includes an increase to
address AMR through a "One Health" approach. CDC is encouraged to continue to
study effective strategies to improve antibiotic prescribing including nutritional
alternatives in healthcare settings. CDC is also encouraged to build off findings
and experiences from the AMR Challenge and provide an update in the fiscal year
2021 Congressional Justification. Of the increase provided in the agreement,
$500,000 is provided for CDC to use its broad agency agreement to fund an
innovative project that uses population-based research to define risk factors for
these pathogens in community settings.

Food Safety.-The agreement includes an increase to help address critical
unmet needs.

Harmful Algal Blooms .-The agreement includes an increase to enhance
harmful algal bloom exposure activities, with a priority given to geographic
locations subject to a state of emergency designation related to toxic algae blooms
within the past 12 months and the impact on salt and fresh water. The agreement
encourages CDC to expedite procedures to enable rapid analysis and reporting of
results to impacted State health departments.

Infectious Disease and Emerging Technology.-CDC is encouraged to provide
an update in the fiscal year 2021 Congressional Justification on challenges and

26

opportunities associated with ongoing technological advancements and a plan for
how the Vector-Borne Disease and Advanced Molecular Detection programs will
continue to maximize new technologies.

Lyme Disease and Related Tick-Borne Illnesses.-The agreement includes an
increase and encourages CDC, in coordination with NINDS and NIMH, to include
in its surveillance the long-term effects. CDC is also encouraged to coordinate with
NIH on publishing reports that assess prevention, treatment, diagnostic
advancements, and links between tick-borne disease and psychiatric illnesses. CDC
is encouraged to focus efforts in endemic areas as well as areas not yet considered
endemic.

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (MEICFS).-CDC is
encouraged to develop a plan on how it intends to foster collaboration to address
the ME/CFS clinical care crisis and to accelerate drug development following the
sunset of the Chronic Fatigue Syndrome Advisory Committee.

Mycotic Diseases .-The agreement provides an increase of $2,000,000 in
Emerging Infectious Diseases for mycotic diseases.

Sepsis.-The agreement commends CDC's ongoing efforts to work with
healthcare partners to establish ways to perform sepsis surveillance and reporting
using data from the patient's electronic health record.

Vector-Borne Diseases.-CDC is encouraged to continue efforts to fund
activities as designated under the Mosquito Abatement for Safety and Health
Programs Act.

27

CHRONIC DISEASE PREVENTION AND HEALTH PROMOTION

The agreement provides $1,239,914,000 for Chronic Disease Prevention and
Health Promotion, which includes $984,964,000 in discretionary appropriations
and $254,950,000 in transfers from the PPH Fund. Within this total, the agreement
includes the following amounts:

FY 2020
Budget Activity
Tobacco................................................................

Agreement
$230,000,000

Nutrition, Physical Activity, and Obesity..............

56,920,000

High Obesity Rate Counties........................

15,000,000

School Health.........................................................

15,400,000

Health Promotion....................................................

29,100,000

Glaucoma..........................................................

4,000,000

Vision and Eye Health....................................

1,000,000

Alzheimer's Disease..........................................

15,500,000

Inflammatory Bowel Disease...........................

1,000,000

Interstitial Cystitis.............................................

1,100,000

Excessive Alcohol Use.....................................

4,000,000

Chronic Kidney Disease...................................

2,500,000

28

FY 2020
Budget Activity

Agreement

Prevention Research Centers..................................

26,461,000

Heart Disease and Stroke........................................

142,105,000

Diabetes..................................................................

148,129,000

National Diabetes Prevention Program..................

27,300,000

Cancer Prevention and Control..............................

381,049,000

Breast and Cervical Cancer..............................

223,000,000

WISEWOMAN....... .. .. ... ... .. ........... ...... ......

26,120,000

Breast Cancer Awareness for Young Women..

4,960,000

Cancer Registries.............................................

51,440,000

Colorectal Cancer............................................

43,294,000

Comprehensive Cancer...................................

19,675,000

Johanna's Law.................................................

9,000,000

Ovarian Cancer...............................................

11,000,000

Prostate Cancer...............................................

14,205,000

Skin Cancer....................................................

4,000,000

Cancer Survivorship Resource Center............

475,000

Oral Health...........................................................

19,500,000

29

FY 2020
Budget Activity
Safe Motherhood/Infant Health............................

Agreement
58,000,000

Maternal Mortality Review Committees.......

12,000,000

Preterm Birth.................................................

2,000,000

Arthritis and Other Chronic Disease.................

29,000,000

Arthritis.........................................................

11,000,000

Epilepsy...........................................................

9,500,000

National Lupus Registry..................................

8,500,000

Racial and Ethnic Approaches to Community
Health (REACH)..................................................
Good Health and Wellness in Indian Country...

59,950,000
21,000,000

Million Hearts.......................................................

4,000,000

National Early Child Care Collaboratives.............

4,000,000

Hospitals Promoting Breastfeeding.......................

9,000,000

Alzheimer's Disease.-The agreement provides an increase to build
Alzheimer's disease and related dementias public health infrastructure across the
country, as authorized by the BOLD Infrastructure for Alzheimer's
Act (P.L. 115-406).

30

Farm-to-School.-The agreement continues $2,000,000 within Nutrition,
Physical Activity, and Obesity for research and education activities promoting
healthy eating habits for students. These grants support State farm to early
childhood programs with priority given to entities with experience running farm to
early childhood programs. CDC is directed to coordinate efforts with the Office of
Community Food Systems at the Department of Agriculture.

Heart Disease and Stroke Prevention.- The agreement includes an increase to
strengthen and expand evidence-based heart disease and stroke prevention
activities focused on high risk populations. CDC is encouraged to execute
evidence-based prevention programs in high burden areas.

Johanna's Law.-The agreement includes an increase to raise awareness in
women of all ages, races, and ethnic groups, and healthcare providers about the
five main types of gynecological cancer.

Maternal Mortality Review Committees (MMRCs) .-The agreement includes
funding for CDC to continue its technical assistance to existing State MMRCs to
build stronger data systems, improve data collection at the State level, and create
consistency in data collection.

Million Hearts 2022.-CDC is encouraged to continue implementing evidencebased approaches to improve cardiovascular health in high risk populations and
increase access to care and rehabilitation among prior heart attack and stroke
victims.

Mississippi Delta Health Collaborative (MDHC).-The agreement encourages
CDC to build on its long-standing investment in MDHC by working to replicate
the work in additional sites while maintaining the current strategy. The agreement
requests an update in the fiscal year 2021 Congressional Justification.

National Diabetes Prevention Program.-CDC is encouraged to support
organizations that are serving populations at or below the poverty level.
31

National Lupus Patient Registry.-The agreement provides an increase and
encourages CDC to continue working with existing childhood lupus registries to
generate more robust information about the prevalence of the disease in children
across the country and its impacts. The agreement also encourages CDC to build
on initiatives to partner with national voluntary health agencies.

Ovarian Cancer.-The agreement provides an increase for prevention activities.
Peripheral Arterial Disease (PAD).-The agreement encourages CDC to
support education and awareness activities that promote early diagnosis of PAD.

Pediatric Cardiomyopathy.-CDC is encouraged to develop educational
materials made available to the public about the signs, symptoms, and risk factors
of pediatric cardiomyopathy.

Pediatric Reference lntervals. - CDC is encouraged to submit a plan for
improving pediatric references intervals, including the resources necessary for
carrying out this initiative in the fiscal year 2021 Congressional Justification.

Prostate Cancer. - CDC is encouraged to work to increase the public's
awareness of prostate cancer risks, screening, and treatment, and improve
surveillance of this disease.

Skin Cancer Education and Prevention.-The agreement provides an increase
and encourages CDC to increase its collaboration and partnership with local
governments, business, health, education, community, non-profit, and faith-based
sectors.

Stakeholder Collaboration.-CDC is encouraged to continue working closely
with State health agencies in the prevention and control of chronic diseases to
achieve national goals for healthy children, healthy families, healthy workforce,
and healthy seniors.

32

State Physical Activity and Nutrition Program.-The agreement supports
funding to implement evidence-based strategies at State and local levels to address
risk factors for obesity and improve nutrition and physical activity.

Racial and Ethnic Approaches to Community Health (REACH) . -The
agreement provides an increase for additional awards.

Tobacco.-The agreement provides an increase and recognizes that the
individual elements of comprehensive tobacco control programs are synergistic
and when implemented together have the greatest effect, but also encourages
flexibility within the context of CDC's National Tobacco Control Program to
ensure State and local health departments are able to direct adequate resources to
stem the tide of youth use of e-cigarettes. CDC is encouraged to identify strategies
to promote youth cessation, within existing resources used for State quitlines.

WISEWOMAN.-The agreement provides an increase to fund additional grants
to States to provide uninsured and under-insured, low-income women with
lifesaving preventive services.

BIRTH DEFECTS AND DEVELOPMENTAL DISABILITIES

The agreement provides $160,810,000 for Birth Defects and Developmental
Disabilities. Within this total, the agreement includes the following amounts:

FY 2020

Budget Activity

Agreement

Child Health and Development.............................

$65,800,000

Birth Defects....................................................

19,000,000

33

FY 2020
Budget Activity

Agreement

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 ....................................................... .

67,660,000

Disability & Health ........................................ .

33,000,000

Tourette Syndrome ......................................... .

2,000,000

Early Hearing Detection and Intervention ..... .

10,760,000

Muscular Dystrophy ....................................... .

6,000,000

Attention Deficit Hyperactivity Disorder. ...... .

1,900,000

Fragile X ......................................................... .

2,000,000

Spina Bifida.................................................... .

6,000,000

Congenital Heart ............................................ .

6,000,000

Public Health Approach to Blood Disorders ........ .

4,400,000

Hemophilia CDC Activities ................................ .

3,500,000

34

FY 2020
Budget Activity

Agreement

Hemophilia Treatment Centers..............................

5,100,000

Thalassemia.... ... ...... .. .. .. .. .. ... .. ...................... ..........

2,100,000

Neonatal Abstinence Syndrome......................

2,250,000

Surveillance for Emerging Threats to Mothers
and Babies.. .............................................

10,000,000

Cerebral Palsy (CP) .-The agreement encourages CDC to use existing
resources to improve CP surveillance and develop better understanding of the
mechanisms leading to earlier diagnosis and better outcomes. The agreement
requests that CDC share early detection guidelines with pediatric providers and
develop a U.S. implementation plan. Additionally, the agreement encourages CDC
to conduct an updated study from the 2003 report on the healthcare and societal
costs of CP in the U.S. and include in the fiscal year 2021 Congressional
Justification information on the cause, earlier diagnosis, treatment, and costs of CP
across the lifespan.

Congenital Heart Disease (CHD).-The agreement includes an increase to
further implement the screening, surveillance, research, and awareness activities
authorized by the Congenital Heart Futures Reauthorization Act (P.L. 115-342).

Disability and Health - The agreement provides an increase and directs CDC to
allocate the increase in the same manner as directed in P.L. 115-245.

35

Fragile X.-The agreement encourages CDC to explore cross-divisional
funding opportunities to accelerate data-driven public health research to reduce the
public health burdens of both Fragile X and autism.

Hemophilia. - CDC's hemophilia activities have been critical to the
advancement of care for patients with hemophilia and other bleeding disorders. ·

Sickle Cell Disease.-The agreement requests a report on the resources CDC
would require to implement P.L. 115-327, which authorized CDC to award sickle
cell disease data collection grants to States, in the fiscal year 2021 Congressional
Justification.

Tourette Syndrome.-CDC is encouraged to continue to educate physicians,
educators, clinicians, allied professionals, and the general public about the disorder
and to improve scientific knowledge on prevalence, risk factors, and co-occurring
conditions of Tourette Syndrome.

Zika Surveillance.-The agreement requests an update in the fiscal year 2021
Congressional Justification.

PUBLIC HEALTH SCIENTIFIC SERVICES

The agreement provides a total of $555,497,000 for Public Health Scientific
Services. The agreement shifts $8,000,000 from EZID lab safety and quality to
reflect CDC's yearly administrative shift. Within this total, the agreement includes
the following amounts:

36

FY 2020
Budget Activity

Agreement

Health Statistics..........................................

$160,397,000

Surveillance, Epidemiology, and
Informatics...................................................

344,100,000

Lab Safety and Quality ....... '. ..........

8,000,000

Lab Training...........................................

5,000,000

Public Health Data/IT Systems
Modernization .............................. .

50,000,000

Public Health Workforce ............................ .

51,000,000

Familial Hypercholesterolemia.-Familial hypercholesterolemia is classified as
a tier 1 genomic condition by the CDC Office of Public Health Genomics because
of the public health impact that early identification and intervention can make. The
agreement provides $100,000 within Surveillance, Epidemiology, and Informatics
and encourages CDC to raise awareness of this condition.

National Health and Nutrition Examination Survey (NHANES) .-The
agreement encourages CDC to fund childhood obesity research, prevention, and
treatment programs in non-NHANES-represented States, and their native and
underserved populations.

National Neurological Conditions Surveillance System.-In lieu of the directive
in House Report 116-62, the agreement provides a total of $5,000,000 within
Surveillance, Epidemiology, and Informatics to continue efforts on the two initial
conditions.
37

Primary Immunodeficiencies .-The agreement includes an increase of
$1,000,000 within Surveillance, Epidemiology, and Informatics for the Office of
Public Health Genomics to support existing efforts to enhance education and
awareness of primary immunodeficiencies.

Public Health Data Surveillance/IT Systems Modernization.-The agreement
includes funding for the initiative as outlined in House Report 116-62 to support
data modernization efforts and the utilization of established standards. Within this
initiative, CDC is encouraged to prioritize advancements in cancer registries. CDC
is directed to provide a multi-year plan, including at least five years of budget
projections, as well as the innovation strategy for surveys conducted by the
National Center for Health Statistics to the Committees no later than 120 days after
enactment of this Act.

ENVIRONMENTAL HEALTH

The agreement provides $213,850,000 for Environmental Health programs,
which includes $196,850,000 in discretionary appropriations and $17,000,000 in
transfers from the PPH Fund. Within this total, the agreement includes the
following amounts:

FY 2020

Budget Activity

Agreement

Environmental Health Laboratory........................................

$66,750,000

Other Environmental Health.................................

48,500,000

Newborn Screening Quality Assurance Program...........

17,000,000

38

Newborn Screening for SCID.............. ......................

1,250,000

Environmental Health Activities..........................................

46,100,000

Safe Water......................................................................

8,600,000

Amyotrophic Lateral Sclerosis Registry.........................

10,000,000

Trevor's Law..................................................

1,500,000

Climate Change..............................................................

10,000,000

All Other Environmental Health.....................................

16,000,000

Environmental and Health Outcome Tracking Network......

34,000,000

Asthma..................................................................................

30,000,000

Childhood Lead Poisoning....................................................

37,000,000

Amyotrophic Lateral Sclerosis Registry.-The agreement requests an update to
the report requested in fiscal year 2018 within one year of enactment of this Act.

Childhood Lead Poisoning-The agreement includes an increase to support
additional State and local programs.

Duchenne Muscular Dystrophy.-The agreement requests an update in the
fiscal year 2021 Congressional Justification on CDC's involvement in the ongoing
Duchenne newborn screening efforts.

National Asthma Control Program.-The agreement provides an increase to
expand the number of States. CDC is encouraged to continue to promote evidencebased asthma medical management and strategies aimed at improving access and
adherence to the 2007 National Asthma Education and Prevention Program.

39

Trevor's Law.-The agreement provides an increase to better understand the
relationship between environmental exposures and pediatric cancer, and to build
capacity to conduct cancer investigations according to the provisions in Trevor's
Law (P .L. 114-182).

INJURY PREVENTION AND CONTROL

The agreement provides $677,379,000 for Injury Prevention and Control
activities. Within this total, the agreement includes the following amounts:

FY 2020

Budget Activity

Agreement

Intentional Injury....................................

$119,050,000

Domestic Violence and Sexual
Violence ............................... ..

33,700,000

Child Maltreatment.. ...................... .

7,250,000

Child Sexual Abuse Prevention .....

1,000,000

Youth Violence Prevention ............... ..

15,100,000

Domestic Violence Community
Projects .................................. .

5,500,000

Rape Prevention ................................. .

50,750,000

Suicide Prevention ............................ ..

10,000,000

40

FY 2020
Budget Activity
Adverse Childhood Experiences.......

Agreement
4,000,000

National Violent Death Reporting
System ............ ,........................................ .

23,500,000

Unintentional Injury ................................ .

8,800,000

Traumatic Brain Injury ...................... .

6,750,000

Elderly Falls ..................................... .

2,050,000

Other Injury Prevention Activities ..... .

28,950,000

Opioid Overdose Prevention and
Surveillance ................................... .

475,579,000

Injury Control Research Centers ......... .

9,000,000

Firearm Injury and Mortality Prevention
Research ...................................... .

12,500,000

Adverse Childhood Experiences.-The agreement provides funding to inform
how adverse childhood experiences increase the risk of future substance use
disorders, suicide, mental health conditions, and other chronic illnesses as
authorized in section 7131 of the SUPPORT Act (P.L. 115-271).
Child Sexual Abuse Prevention. - The agreement includes funding to support
more proactive approaches and research for the development, evaluation, and
dissemination of effective practice and policy.
41

Concussion Surveillance.-CDC is encouraged to investigate the establishment
of a national surveillance system to accurately determine the incidence of

'

sports- and recreation-related concussions among youth aged 5 to 21 years and
provide an update in the fiscal year 2021 Congressional Justification.

Opioid Overdose Prevention and Surveillance.-The agreement directs CDC to
continue funding overdose prevention efforts in the same manner as directed in
P.L. 115-245. The agreement encourages CDC to continue to work collaboratively
with States to ensure that funding is available to all States for opioid prevention
and surveillance activities.

Firearm Injury and Mortality Prevention Research.-The agreement includes
$12,500,000 to conduct research on firearm injury and mortality prevention. Given
violence and suicide have a number of causes, the agreement recommends the
CDC take a comprehensive approach to studying these underlying causes and
evidence-based methods of prevention of injury, including crime prevention. All
grantees under this section will be required to fulfill requirements around open
data, open code, pre-registration of research projects, and open access to research
articles consistent with the National Science Foundation's open science principles.
The Director of CDC is to report to the Committees within 30 days of enactment
on implementation schedules and procedures for grant awards, which strive to
ensure that such awards support ideologically and politically unbiased research
projects.

Rape Prevention.-The agreement continues to direct that at least 75 percent of
the program's funds go to States for State and local prevention activities. CDC
should coordinate efforts with higher education institutions to reduce the incidence
of sexual assault on campus.

Suicide Prevention.-The agreement provides funding for a new effort in
recognition of the devastating impacts and increasing rates of suicide. CDC is
42

directed to focus prevention efforts on vulnerable populations that have been
identified at higher risk for suicidal behaviors than the general population.
Tribal Use of Prescription Drug Monitoring Programs (PDMP).-CDC is

directed to work with the Indian Health Service to ensure Federally-operated and
tribally-operated healthcare facilities benefit from the CDC's PDMP efforts.
Understanding the Physical and Psychological Effects of Severe Forms of
Trafficking in Persons .-The agreement encourages CDC to fund a joint study

with the National Institute of Justice as directed by section 20 of the Abolish
Human Trafficking Act of2017 (P.L. 115-392).

NATIONAL INSTITUTE FOR OCCUPATIONAL SAFETY AND HEALTH

The agreement provides a total of $342,800,000 for the National Institute for
Occupational Safety and Health (NIOSH) in discretionary appropriations. Within
this total, the agreement includes the following amounts:

FY 2020
Budget Activity

Agreement

National Occupational Research Agenda...................

$117,000,000

Agriculture, Forestry, Fishing.......................................

26,500,000

Education and Research Centers.......................................

30,000,000

Personal Protective Technology........................................

20,000,000

Mining Research................................................................

60,500,000

43

FY 2020
Budget Activity

Agreement

National Mesothelioma Registry and Tissue Bank.........

1,200,000

Firefighter Cancer Registry....................................

2,500,000

Other Occupational Safety and Health Research............

111,600,000

Total Worker Health-The agreement provides an increase of $2,000,000 to
advance the safety, health, and well-being of the diverse worker population.
Underground Mine Evacuation Technologies and Human Factors Research.The agreement provides an increase for additional grant opportunities to
universities with graduate programs in mining and explosives engineering to fund
research related to mine emergencies, to build on NIOSH's work to address
mandates in the Mine Improvement and New Emergency Response
Act of 2006 (P.L. 109-236). Research will develop new wireless communication
devices and methodologies; develop training, systems, and tools to facilitate miner
self-escape; and continue to improve the design of refuge alternatives.

GLOBAL HE ALTH

The agreement provides $570,843,000 for Global Health activities. The
agreement shifts $7,222,000 from tuberculosis prevention to account for CDC's
yearly administrative shift. Within this total, the agreement includes the following
amounts:

44

FY 2020
Budget Activity

Agreement

Global AIDS Program.............................

$128,421,000

Global Tuberculosis........................

7,222,000

Global Immunization Program............

226,000,000

Polio Eradication.................................

176,000,000

Measles and Other Vaccine
Preventable Diseases ................... .

50,000,000

Parasitic Diseases and Malaria ............... .

26,000,000

Global Public Health Protection ........... .

183,200,000

Global Disease Detection and
Emergency Response.....................

173,400,000

Global Public Health Capacity and
Development .............................. .

9,800,000

Children in Adversity.-The agreement directs CDC to collaborate with the
U.S. Agency for International Development (USAID), the President's Emergency
Plan for AIDS Relief (PEPFAR), and the Department of Labor to ensure
monitoring and evaluation is aligned for all of the objectives of the U.S.
Government Action Plan.

Global Health Security.-The agreement provides an increase of $75,000,000
to accelerate the capacity of countries to prevent, detect, and respond to infectious
45

disease outbreaks. CDC is directed to provide a spend plan to the Committees no
later than 60 days after enactment of this Act. CDC is directed to work with
USAID on a coordinated global health security effort, delineating roles and
responsibilities, and measuring progress. One year after submitting a spend plan,
CDC, in coordination with US AID, will brief the Committees on the program
status.

Malaria and Parasitic Diseases.- The agreement encourages CDC to continue
to research, monitor, and evaluate efforts for malaria and parasitic disease in
collaboration with other divisions and agencies.

Soil Transmitted Helminth and Related "Diseases of Poverty ".-The
agreement continues $1,500,000 for surveillance, source remediation, and clinical
care aimed at reducing soil transmitted helminth to extend the currently funded
projects for another year.

PUBLIC HEALTH PREPAREDNESS AND RESPONSE

The agreement provides $850,200,000 for public health preparedness and
response activities. Within this total, the agreement includes the following
amounts:

FY 2020
Budget Activity

Agreement

Public Health Emergency Preparedness
Cooperative Agreement........................

$675,000,000

Academic Centers for Public Health
Preparedness .................................................. .

46

8,200,000

FY 2020
Budget Activity
BioSense ........................................................ .
All Other CDC Preparedness .............. .

Agreement

23,000,000
144,000,000

Strategic National Stockpile.-The agreement reiterates the importance that
CDC maintain a strong and central role in the medical countermeasures enterprise.

BUILDINGS AND FAClUTIES

The agreement provides $25,000,000 in discretionary budget authority and
$225,000,000 from the HHS Nonrecurring Expenses Fund for Buildings and
Facilities.

Chamblee Research Support Building 108 and Campus Infrastructure
Improvements.-The agreement directs $225,000,000 from the Nonrecurring
Expenses Fund for these one-time projects that will result in enhanced research
collaboration and long-term lease cost avoidance.

Replacement of the Lake Lynn Experimental Mine and Laboratory.-The CDC
Director is directed to provide annual reports to the Committees detailing activities
to replace the Lake Lynn Laboratory.

47

CDC-WIDE ACTIVIT1ES

The agreement provides $358,570,000 for CDC-wide activities, which includes
$198,570,000 in discretionary appropriations and $160,000;000 in transfers from
the PPH Fund. Within this total, the agreement includes the following amounts:

FY 2020

Budget Activity

Agreement

Preventive Health and Health Services Block
Grant ................................................ .

$160,000,000

Public Health Leadership and Support ....... ..

113,570,000

Infectious Disease Rapid Response Reserve
Fund ............................................... .

85,000,000

Infectious Disease Rapid Response Reserve Fund - The agreement provides
increased funding to quickly respond to a future, imminent infectious disease crisis
that endangers American lives, including for Ebola preparedness and response,
without regard to the limitations in the third proviso in section 231 of division B of
P.L. 115-245.

Opioid Use and Infectious Diseases .-The agreement encourages CDC to work
across operating divisions to integrate interventions aimed at preventing, tracking,
and treating infectious diseases with broader efforts to address the opioid epidemic.

Preventative Health and Health Services Block Grant.- The agreement
encourages CDC to enhance reporting and accountability, including how much
funding is directed to support public health needs at the local level.

48

Tribal Advisory Committee.-The agreement encourages the Director, with
guidance from Tribal Advisory Committee, to develop best practices around
delivery of Tribal technical assistance and provide an update on written guidelines
in the fiscal year 2021 Congressional Justification.

NATIONAL INSTITUTES OF HEAL TH

The agreement provides $41,684,000,000 for the National Institutes of
Health (NIH), including $492,000,000 from the 21 st Century Cures
Act (P.L. 114-255), an increase of $2,600,000,000, or 6.7 percent, above fiscal
year 2019.
The agreement provides a funding increase of no less than 3 .3 percent above
fiscal year 2019 to every Institute and Center to continue investments in research
that will save lives, lead to new drug and device development, reduce health care
costs, and improve the lives of all Americans.
The agreement appropriates funds authorized in the 21 st Century Cures Act. Per
the authorization, $195,000,000 is transferred to the National Cancer Institute
(NCI) for cancer research; $70,000,000 to the National Institute of Neurological
Disorders and Stroke (NINOS), and $70,000,000 to the National Institute on
Mental Health (NIMH) for the BRAIN Initiative; and $157,000,000 will be
allocated from the NIH Innovation Fund for the Precision Medicine Initiative
cohort ($149,000,000) and regenerative medicine research ($8 ,000,000).
The Common Fund is supported as a set-aside within the Office of the Director
at $626,511,000. In addition, $12,600,000 is provided to support pediatric research
as authorized by the Gabriella Miller Kids First Research Act (P.L. 113-94).

49

The bill directs NIH to include updates on the following research, projects, and
programs in their fiscal year 2021 Congressional Justification:
• Alopecia Areata
• Aortic Aneurysm and Fibrosis
• Congenital Heart Disease
• Government-wide collaborations, particularly with the Departments of
Defense (DoD) and Veterans Affairs (VA)
• Gynecologic cancer clinical trials
• Liver cancer
• Melanoma
• NCI Specialized Programs of Research Excellence
• Pain management, including multi-agency partnership with NCCIH, DoD,
and VA
• Pediatric Cancer
• Pediatric MATCH
• Progress on the development and advancement of non-opioid chronic pain
therapies
• Psycho-social Distress Complications related to recommendations made in
the 2008 Institute of Medicine report Cancer Care for the Whole Patient:

Meeting Psychosocial Health Needs
• Rare cancers
• Research Project Grant, R21, PO 1, and RO 1- Equivalent Cumulative
Investigator Rates by NIH Institute and Center
•

Suicide

• Temporomandibular Disorders
• Threat of emerging infectious disease, including a progress report on the use
of machine learning and validated mechanistic models to advance critical
50

biomedical research, improve decision support for epidemiological
interventions, and enhance human health
• Traumatic Brain Injury, including information on a coordinated portfolio,
specifically regenerative medicine and neuroplasticity

NATIONAL CANCER INSTITUTE (NCI)

Cancer Moonshot.-The agreement directs NIH to transfer $195,000,000 from

the NIH Innovation Account to NCI to support the Cancer Moonshot Initiative.
Childhood Cancer Data Jnitiative.-The agreement includes the full budget

request for this fiscal year of $50,000,000 for the Childhood Cancer Data Initiative,
which will facilitate a connected data infrastructure and integrate multiple data
sources to make data work better for patients, clinicians, and researchers.
Deadliest Cancers .-The agreement directs NCI to develop a scientific

framework using the process outlined in the Recalcitrant Cancer Research Act of
2012 for stomach and esophageal cancers and urges NCI to continue to support
research with an emphasis on developing screening and early detection tools and
more effective treatments for all recalcitrant cancers. NCI is directed to provide an
update on NCI-supported research to advance these goals in the fiscal year 2021
Congressional Justification. Also, NCI is directed to add esophageal and stomach
cancers to future Research, Condition, and Disease Categorization (RCDC)
reports. Finally, the bill encourages NCI to place a high priority on researching
these cancers, which include anaplastic astrocytoma, diffuse intrinsic pontine
glioma, glioblastoma, Juvenile myelomonocytic leukemia, high-risk
neuroblastoma, recurrent osteosarcoma, rhabdomyosarcoma, and diffuse anaplastic
Wilms tumors.

51

Gynecologic Cancer Clinical Trials .-NCI is encouraged to work with
stakeholders to address priorities for the gynecologic oncology clinical trials
scientific agenda, including consideration of the availability of trials for these
patients.

NCI Paylines.-Grant applications to NCI have increased by approximately
50 percent since 2013, outpacing available funding, with requests for cancer
research ten-fold greater than other Institutes. With such a high demand for NCI
grants, only a fraction of this research is funded. To support more awards and
improve success rates, the agreement provides $212,500,000 to prioritize
competing grants and sustain commitments to continuing grants.

Precision Medicine.-The agreement strongly supports precision medicine
initiatives that are critical to delivering the right treatment to the right patient at the
right time. At its core, precision medicine aims to understand and treat the
underlying cause of disease in individual patients. Once the underlying cause of a
patient's disease is identified, this information can then be used to gain new
insights into the underlying basic biology and disease pathogenesis, which will
ultimately foster the development of medicine targeted to those patient populations
most likely to benefit. NIH needs to focus cancer precision medicine efforts
towards comprehensive drug screening and precision clinical trials and this
agreement has included sufficient funding to do so. Therefore, the bill directs NCI
to fund an initiative to foster the clinical demonstration of novel methodologies for
individualizing identification of cancer therapeutics. Programs should be at a NCIdesignated Comprehensive Cancer Center at institutions that have demonstrated
institutional investment in precision medicine, have a strong existing track record
in NIH-supported cancer funding, and have the expertise to conduct in-depth
genomic analysis of cancer tumors and do comprehensive drug repurposing
screens of all FDA-approved drugs on at least one tumor type. Additionally,
52

regional multi-institutional consortiums that serve populations with significant
health disparities and traditionally underserved populations are strongly
encouraged.
Psycho-Social Distress Complications .-NCI is encouraged to ensure that all of
its designated cancer centers are managing and measuring patients for distress as
an integral piece of their treatment and follow-up care.
Rare Cancers.-The bill supports a trans-NIH collaboration, which includes
NCATS, to accelerate therapies for rare cancers and to support broader sharing of
genomic-related rare cancers data to accelerate research and drug development for
these cancers.
STAR Act.-The agreement includes no less than $25,000,000 in funding for
continued implementation of sections of the Childhood Cancer Survivorship,
Treatment, Access, and Research (STAR) Act. Funding is in addition to the funds
allocated in fiscal year 2019 to expand existing biorepositories for childhood
cancer patients enrolled in NCI-sponsored clinical trials to collect and maintain
relevant clinical, biological, and demographic information on children,
adolescents, and young adults, with an emphasis on selected cancer subtypes (and
their recurrences) for which current treatments are least effective. Funding
provided this year will allow NCI to continue to conduct and support childhood
cancer survivorship research as authorized in the STAR Act.

NATIONAL HEART, LUNG, AND BLOOD INSTITUTE (NHLBr)

Chronic Disease Precision Medicine.-The bill directs NHLBI to fund an
initiative to address chronic diseases through translational science and the
application of a precision medicine approach and has included sufficient funding to
do so. Programs should focus on diseases and disorders relating to heart, lung,
blood, and sleep, and access to populations with significant health disparities.
53

Programs should have a proven track record of NIH funding in all of these areas,
as well as have NIH-funded programs for health disparities research. Additionally,
regional multi-institutional consortiums are strongly encouraged.

Congenital Heart Disease.-NHLBI is encouraged to prioritize congenital heart
disease (CHD) activities outlined in its strategic plan, including improving
understanding of outcomes and co-morbidities, modifying treatment options across
the lifespan, and accelerating advances by leveraging CHD registries and
networks.

Fibrotic Diseases .-The bill encourages NIH to vigorously support dedicated
funding and research into fibrotic diseases affecting different organs, including the
lungs, liver, kidneys, heart, skin, and bones. The agreement requests a report on the
current NIH Fibrosis Interest Group and its progress no later than 90 days after the
passage of this Act. The bill encourages the Interest Group to continue its efforts to
bring together key stakeholders, at the NIH and elsewhere, to develop strategic
paths forward to maximize efforts in fibrotic disease research. The bill also
encourages NIH to enhance its patient-centered clinical research into pulmonary
fibrosis to include traditional observational and interventional studies looking at
reducing healthcare utilization such as hospitalizations, improving symptoms such
as cough, and prolonging life, and directs NIH to include an update in its fiscal
year 2021 Congressional Justification on its work relating to idiopathic pulmonary
fibrosis following the November 2012 NHLBI workshop Strategic Planning/or

Idiopathic Pulmonary Fibrosis. The agreement also encourages NIH to create a
funding mechanism to fund fibrosis research across all organs, building on the
progress and leveraging data that has and may result from NHLBI funded projects.

Hemophilia.-The agreement asks NHLBI to provide the Committees with the
final report and national blueprint for future research from the May 2018 State of
the Science Workshop on Factor VIII Inhibitors and to take steps to implement the
54

research blueprint in collaboration with the hemophilia patient, provider, and
research communities.
Pediatric Cardiomyopathy.-The agreement commends NHLBI for its long-

standing commitment to the Pediatric Cardiomyopathy Registry and strongly
encourages NHLBI to continue to support cardiomyopathy research.
Postural Orthostatic Tachycardia Syndrome.-NIH is directed to submit the

report on Postural Orthostatic Tachycardia Syndrome (POTS) that was requested
in Senate Report 115-289, now overdue, no later than 30 days after enactment of
this Act. NIH is strongly encouraged to include an estimate of annual NIH funding
allocated to POTS research in its publicly available RCDC report.

NATIONAL INSTITUTE OF DENTAL AND CRANIOFACIAL RESEARCH (NIDCR)

Temporomandibular Disorders.-NIDCR is encouraged to continue

collaboration with governmental agencies and other stakeholders in the project
entitled Temporomandibular Disorders: From Research Discoveries to Clinical
Treatment and to increase funding to expand the science base in this field.

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

Chronic Diseases and Health Disparities .-Kidney disease, type 2 diabetes,

and obesity are among the most common, costly, and preventable of all health
conditions. NIH needs to focus chronic disease efforts on those populations most
affected, particularly vulnerable populations and underrepresented minorities.
Therefore, the agreement provides sufficient funding for an initiative to address
chronic diseases and health disparities in these areas. The program must focus on
kidney disease, obesity, diabetes, exercise medicine, and health disparities.
Programs should have a strong existing track record of NIH funding in all of these
areas, such as an NIH-funded Nutrition Obesity Research Center, Diabetes
55

Research Center, Obesity Health Disparities Research Center, and O'Brien Kidney
Center. Additionally, regional multi-institutional consortiums are strongly
encouraged.

Diabetes .-NIDDK is urged to support research to improve the treatment of
diabetic foot ulcers and reduce amputations. Further, the agreement urges NIDDK
to work with NIA to explore the relationship between diabetes and neurocognitive
conditions, such as dementia and Alzheimer's disease. Finally, the agreement
supports efforts to utilize adult-derived, non-embryonic pluripotent stem cells for
developing and commercializing the use of the stem cell-derived islets for both
drug discovery and testing platforms and therapeutic delivery to patients with
diabetes.

Liver Diseases.-NIDDK is encouraged to continue to feature liver diseases
research considering recent progress and improvements for liver disease patients.

Medical Foods.-The agreement encourages further incorporation of research
topics associated with medical foods and patient care into emerging research
activities.

NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKE (NINDS)

Cerebral Palsy.-The agreement strongly encourages NIH to prioritize and
implement additional FOAs to significantly strengthen, accelerate, and coordinate
Cerebral Palsy (CP) research to address priorities across the lifespan identified in
the five to 10 year Cerebral Palsy Strategic Plan developed by NINDS and
NICHD. FOAs should target basic and translational discoveries, including
genetics, regenerative medicine, and mechanisms of neuroplasticity, as well as
clinical studies aimed at early intervention, comparative effectiveness, and
functional outcomes in adults. NIH is also encouraged to coordinate with other

56

agencies, including CDC, to support additional research on preventing, diagnosing,
and treating CP.

Dystonia.-The agreement urges NINDS to follow the recommendations of the
dystonia conference, 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.

Opioid Misuse and Addiction.-The agreement includes no less than
$250,000,000 for targeted research related to opioid misuse and addiction,
development of opioid alternatives, pain management, and addiction treatment.
The agreement directs NIH to expand scientific activities related to research on
medications used to treat and reduce chronic pain, and the transition from acute to
chronic pain.

POTS.-NIH is directed to submit the report on POTS requested in Senate
Report 115-289, now overdue, no later than 30 days after enactment of this Act.
NIH is strongly encouraged to include an estimate of annual NIH funding allocated
to POTS research in its publicly available RCDC report.

NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES (NIAID)

AIDS Conference.-The agreement includes $5,100,000 for the U.S.
contribution to the AIDS2020 Conference.

Antimicrobial Resistance.-The agreement includes $511,000,000 within
NIAID for research related to combating antimicrobial resistance (AMR), an
increase of $50,000,000. In April, the United Nations issued a report that, like the
2016 review sponsored by the government of the United Kingdom and Wellcome
Trust, warned that rampant overuse of antibiotics and antifungal medicines in
humans, livestock, and agriculture could erase much of the improvement in public
57

health achieved since the development of the first antimicrobials in the 1940s. The
agreement includes $1,700,000 to fund a National Academies of Sciences,
Engineering, and Medicine (NASEM) study to examine and quantify the long-term
medical and economic impacts of increasing AMR in the U.S. The review should
examine progress made on the U.S. National Strategy and Action Plan for
Combating Antibiotic-Resistant Bacteria, including domestic and international
strategies employed by NIH, CDC, FDA, ASPR, USDA, and USAID. The
NASEM report should make recommendations to address any gaps in research and
development of therapeutics and diagnostics; efforts to move new products to
market; animal and human surveillance, prevention efforts, international
coordination and collaboration; and any other recommendations NASEM finds
relevant to stopping the spread of AMR. The agreement directs NIAID to report on
trends in AMR-related Research Project Grants, including the success rates for
such grants, and requests an update on these activities in the fiscal year 2021
Congressional Justification, including an overall assessment of the progress to date
of efforts to address AMR.

Celiac Disease.-The agreement encourages NIH to devote sufficient, focused
research to the study of celiac disease, including the autoimmune causation
underpinning the affliction. The agreement urges NIAID 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 Committees no later than 90 days after enactment of this Act.

58

Hepatitis B Virus.-The agreement urges additional targeted calls for Hepatitis
B Virus (HBV) research to fund the many critical research opportunities identified
by the scientific community in the Roadmap for a Cure. The agreement urges
active participation and leadership by NIAID in the Director's newly established
Trans-NIH Hepatitis B working group and requests that NIAID submit within 180
days of enactment of this Act, a research plan to pursue a cure for HBV in
coordination with the other Institutes and Centers.

HIVIAIDS.-The agreement provides an increase of no less than $25,000,000
over the fiscal year 2019 level for HIV/AIDS research.

Centers for AIDS Research.-As part of the domestic HIV initiative, the
agreement includes no less than $51,000,000 for the Centers for AIDS Research.

Lyme Disease and Other Tick-Borne Diseases.-The agreement encourages
NIH to issue requests for grant applications for research to investigate causes of all
forms and manifestations of Lyme disease and other high-consequence tick-borne
diseases, including post-treatment symptoms, as well as research to develop
diagnostics, preventions, and treatments for those conditions, including potential
vaccine candidates. The agreement urges NIAID, in coordination with CDC, to
study the long-term effects on patients suffering from post-treatment Lyme disease
syndrome, or "chronic Lyme disease". Specifically, the agreement urges NIAID to
evaluate the effectiveness of laboratory tests associated with the detection of

Borrelia burgdorferi to diagnose the disease early, which can improve the
treatment of patients suffering from Lyme disease. The agreement is also aware of
promising vaccine innovations to combat Borrelia and requests a report within 90
days of enactment of this Act on agency activities to support Lyme vaccine
development. The agreement also encourages NLM, in coordination with NIAID,
to update its terminology in line with new research to more accurately reflect the
long-term effects of Lyme disease.
59

Medical Countermeasures .-The agreement supports the continuation of
NIAID's medical countermeasures program, but expects the Institute to make sure
any future contractor selected for the program can refine its animal models,
particularly small animal models, to support the establishment of adequate
countermeasure efficacy to expedite approval by the FDA. This requires close
coordination with NIAID and the adequate level of technical personnel to carry out
the program's important mission.

Universal Flu Vaccine.-The agreement provides not less than $200,000,000 to
advance basic, translational, and clinical research to develop a universal influenza
vaccine, an increase of $60,000,000.

Valley Fever.-The agreement notes the recent increase in the number of
Valley Fever infections in Western States and urges NIAID to prioritize research
on this fungal disease.

NATIONAL INSTITUTE OF GENERAL MEDICAL SCIENCES (NIGMS)

Institutional Development Award-The agreement provides $386,573,000 for
the Institutional Development Award (IDeA) program, an increase of $25,000,000.

Maximizing Access to Research Careers .-The agreement recognizes the
importance of the Maximizing Access to Research Careers (MARC) program and
encourages the continuation and enhancement of efforts underway with our
Nation's HBCUs. The agreement also encourages NIH to continue and strengthen
its engagement of institutions located in rural parts of the U.S.

60

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

Impact of Technology and Digital Media o_n Children and Teens.-The
agreement recognizes that children's and teens' lives increasingly involve
widespread technology use and consumption of digital media. The agreement
encourages NIH to prioritize research into how these types of stimuli affect young
people's cognitive, physical, and socio-emotional outcomes, including attention,
sleeping routines, and anxiety.

Maternal-Fetal Medicine Units Network.-The agreement 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 multi center collaborative research continues. There is particular concern 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
agreement directs NICHD to submit a report to the Committees outlining any
potential changes being considered to the funding mechanism or structure of the
MFMU network within 90 days of enactment of this Act.

Prenatal Opioid Use Disorders and Neonatal Abstinence Syndrome.-The
agreement encourages NIH to coordinate with other agencies at HHS to support
additional research on prevention, identification, and treatment of prenatal opioid
exposure and neonatal abstinence syndrome (NAS), including the best methods for
screening and treating pregnant women for opioid use disorder and the best
methods for screening for NAS. Additionally, the agreement encourages NIH to
build on the Advancing Clinical Trials in Neonatal Opioid Withdrawal study to
enhance understanding of the impact of pharmacological and non-pharmacological
treatment techniques on costs and outcomes in the short- term and longitudinally.
61

The agreement further encourages NIH to coordinate with other agencies at HHS
to support research on innovative care models to optimize care and long-term
outcomes for families.
Research in Pregnant and Lactating Women.-The Task Force on Research
Specific to Pregnant Women and Lactating Women issued a report to the Secretary
of HHS outlining 15 recommendations to facilitate the inclusion of pregnant and
lactating women in clinical research. The agreement commends the Secretary for
extending the Task Force and believes this extension should be for at least an
additional two years to continue to work towards healthcare professionals and
consumers having accurate information on the safety and efficacy of drugs taken
by these populations. NICHD should oversee its part of the implementation of the
already released recommendations working with other relevant Institutes and
Centers, CDC, and FDA. The agreement requests a progress report be provided in
the fiscal year 2021 Congressional Justification.

NATIONAL EYE INSTITUTE (NEI)

Age-Related Macular Degeneration.-The agreement recognizes the
tremendous strides in the treatment of patients with the "dry" form of age-related
macular degeneration and commends NEI for its planned first-in-human clinical
trial that would test a stem cell-based therapy from induced pluripotent stem cells.
The agreement supports NEI's prospective international study of patients that uses
the latest advances in retinal imaging to identify biomarkers of the disease and
targets for early therapeutic interventions.

62

NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES (NIEHS)

Hurricane Harvey Research.-The agreement includes $3,000,000 for the
continued funding and expansion of research on the health effects of environmental
exposures directly related to the consequences of Hurricane Harvey in 2017. The
research should focus on the full Hurricane Harvey-affected region, conduct
follow-up health research on affected populations on registrants, link to relevant
government and non-profit intervention research programs, and provide critical
information on disaster preparedness through data sharing and analysis.

NATIONAL INSTITUTE ON AGING (NIA)

Alzheimer 's Disease and Related Dementias.-The agreement provides an
increase of $350,000,000 for Alzheimer's disease and related dementias research,
bringing the total funding level in fiscal year 2020 to no less than $2,818,000,000.

Diversity of Clinical Trials.-The agreement remains concerned about
underrepresented populations in research, particularly clinical trials for
Alzheimer's. The agreement directs NIH to report to the Committees within 180
days of enactment of this Act on how it is implementing the actions outlined in the

National Strategy for Recruitment and Participation in Alzheimer's and Related
Dementias Clinical Research, including NIA resources that have been dedicated to
these efforts.

EUREKA Prize. - The agreement requests a report within 180 days of
enactment of this Act on NIA's initial EUREKA prize competition, including the
number of submissions received and any unexpected challenges or impediments
encountered in executing the challenge, as well as lessons learned that could be
applied to future Alzheimer's or other prize challenges. The agreement also
requests that the report include any recommendations to enhance the model going
forward.
63

NATIONAL INSTITUTE ON ALCOHOL ABUSE AND ALCOHOLISM (NIAAA)

Mobile Assessment Technology Research for Addictive Behaviors .-The
agreement encourages NIAAA to support meritorious research to improve the
prevention and treatment of substance misuse, addiction, and related consequences
through the use of mobile technologies.
NATIONAL INSTITUTE ON DRUG ABUSE (NIDA)

Barriers to Research.-The agreement directs NIDA to provide a brief report
on the barriers to research that result from the classification of drugs and
compounds as Schedule I substances no later than 120 days after enactment of this
Act.

Cannabis Research.-The agreement encourages NIH to consider additional
investment in studying the medicinal effects and toxicology of cannabidiol and
cannabigerol.

Methamphetamine Medication-Assisted Treatments.-The agreement urges
NIDA to continue its ongoing trials to expeditiously find and approve a
medication-assisted treatment for methamphetamine.

Opioid Misuse and Addiction.-The agreement includes no less than
$250,000,000 for targeted research related to opioid misuse and addiction,
development of opioid alternatives, pain management, and addiction treatment.
The agreement directs NIH to expand scientific activities related to research on
medications used to treat and reduce chronic pain, and the transition from acute to
chronic pain. Further, the agreement urges NIH to: (1) continue funding research
on medication development to alleviate pain and to treat addiction, especially the
development of medications with reduced misuse liability; (2) as appropriate, work
with private companies to fund innovative research into such medications; (3)
report on what is known regarding the transition from opioid analgesics to heroin
64

and synthetic opioid use and addiction within affected populations; (4) conduct
pilot studies to create a comprehensive care model in communities nationwide to
prevent opioid misuse, expand treatment capacity, enhance access to overdose
reversal medications, and enhance prescriber practice; (5) test interventions in
justice system settings to expand the uptake of medications for treating opioid use
disorder (OUD) and methods to scale up these interventions for population-based
impact; and (6) develop evidence-based strategies to integrate screening and
treatment for OUD in emergency department and primary care settings. In
addition, NIH should continue to sponsor research to better understand the effects
of long-term prescription opioid use, especially as it relates to the prevention and
treatment of opioid misuse and addiction. Further, the agreement notes NIDA has
started to investigate the links among respiratory health, disease, and deaths from
opioids to determine if addressing underlying respiratory physiology can prevent
death due to respiratory failure during overdoses.

NATIONAL INSTITUTE OF MENTAL HEALTH (NlMH)

Suicide Prevention and Risk Detection Algorithms.-The agreement continues
to encourage NIMH to prioritize its suicide screening and prevention research
efforts to produce risk detection models that are interpretable, scalable, and
practical for clinical implementation, including mental and behavioral healthcare
interventions, to combat suicide in the U.S. In assessing research opportunities, the
agreement encourages NIMH to consider the recommendations included in the
Action Alliance for Suicide Prevention's A Prioritized Research Agenda for

Suicide Prevention.

65

NATIONAL HUMAN GENOME RESEARCH INSTITUTE (NHGRI)

Computational Genomics and RNA Molecules.-The agreement urges NHGRI
to continue to support research on RNA molecules and the mechanisms through
which they affect biological processes that cause disease.
Emerging Centers ofExcellence in Genomic Sciences .-The agreement
includes no less than $10,000,000 for a new competitively-awarded center-based
grant program for Emerging Centers of Excellence. The purpose of these awards is
to build capacity at institutions that are not prior or current grantees of the Centers
of Excellence in Genomic Sciences program. The agreement urges NHGRI to
include plans for sustainment of this capacity-building mechanism in its 2020
vision report.

NATIONAL CENTER FOR COMPLEMENTARY AND INTEGRA TNE HEALTH (NCCIH)

Pain Management.-The agreement urges NIH, along with DoD and VA, to
continue to support research on non-pharmacological treatments for pain
management to ensure the best quality of care for our Nation's veterans.

NATIONAL INSTITUTE ON MINORITY HEALTH AND HEALTH DISPARITIES (NIMHD)

Mental Health-To address the multiple causes of suicide, the agreement urges
NIMHD to develop a behavioral health approach focusing on at-risk populations
and building the mental health workforce at the community level. The proposed
model should improve mental health care access to underserved populations,
including those in rural areas, while simultaneously providing training to potential
rural behavioral health providers.

66

Neuroscience Research in African-Americans.-The agreement urges the NIH
Neurobiobank to work with NIMHD and relevant extramural partners to develop
the infrastructure needed to accelerate the discovery of novel therapeutic targets for
neuropsychiatric disorders utilizing post-mortem brain datasets from
underrepresented ethnic minority groups, including African-Americans.

Research Centers in Minority Jnstitutions.-The agreement includes
$75,000,000 for the Research Centers in Minority Institutions (RCMI) program to
support critical infrastructure development and scientific discovery in historically
minority graduate and health professional schools. The agreement also recognizes
the importance of the RCMI Coordinating Center in ensuring that collectively,
institutions can engage in multi-site collaborative research.

Research Endowment Program.-The agreement urges NIMHD to move
forward with the recommendations made by the Advisory Council workgroup to
restore endowment eligibility for the Research Endowment Program (REP) to the
original Congressional intent, which includes both current and former centers of
excellence. NIMHD is requested to report to the Committees on progress made to
implement these recommendations prior to issuing its next FOA for REP.

JOHN E. FOGARTY INTERNATIONAL CENTER FOR ADV AN CED STUDY IN THE HEALTH
SCIENCES (FIC)

Global Infectious Diseases.-The agreement urges FIC to continue its
important work of building relationships with scientists abroad to foster a stronger,
more effective science workforce and health research capacity on the ground,
helping to detect infectious diseases and building the capacity to confront those
diseases while improving the image of the U.S. though health diplomacy in their
countries.

67

NATIONAL CENTER FOR ADVANCING TRANSLATIONAL SCIENCES (NCA TS)

Clinical and Translational Science Awards.-The agreement provides
$578,141,000 for Clinical and Translational Science Awards (CTSAs) and
encourages NCATS to fund, through the existing CTSA hubs, programs to address
disparities and the significant burden of diseases and other conditions that
disproportionately affect minority and special populations. Accelerating this
capacity will reduce the burden of disease and promote health equity. Applying the
CTSA model to address long-standing regional health disparities can provide
innovative, multi-disciplinary approaches to reducing the burden of disease among
vulnerable populations.

Cures Acceleration Network.-The agreement provides up to $60,000,000 for
the Cures Acceleration Network.

OFFICE OF THE DIRECTOR (OD)

7ql 1.23 Duplication Syndrome.-Duplication 7 syndrome is a rare
chromosomal abnormality and those affected by this chromosomal duplication are
likely to experience severe behavioral and developmental disabilities requiring
consistent medical treatments and therapies. NIH is strongly encouraged to expand
research on rare genetic and chromosomal abnormalities such as 7q 11.23
duplication syndrome.

Adult Cellular Therapies.-The agreement encourages NIH, in coordination
with FDA, to explore the feasibility and utility of an outcomes database for adult
cellular therapies that are either FDA-approved or are being administered under
FDA Investigational New Drug or Investigational Device Exemption protocols.

All of Us Precision Medicine Initiative.-The agreement includes $500,000,000
for the All of Us precision medicine initiative. Funding provided in the 21st
Century Cures Act is reduced by $37,000,000 in fiscal year 2020. Ensuring
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sustained, consistent funding for this study is important. Therefore, the agreement
has chosen to replace this reduction and increase base funding for the program.
The agreement directs NIH to continue its efforts to recruit and retain participants
from historically underrepresented populations in biomedical research so that the
All of Us scientific resources reflect the rich diversity of our country.
Further, the agreement encourages NIH to continue to work with a broad array
of children's hospitals and networks to leverage their expertise and ensure greater
diversity in pediatric recruitment and enrollment.

Amyotrophic Lateral Sclerosis.-The agreement directs the NIH Director to
facilitate further efforts involving, at a minimum, NINDS and NIA, to study
Amyotrophic Lateral Sclerosis (ALS) disease mechanisms and identify genes to
facilitate the expeditious development of targeted therapies. These trans-NIH
efforts shall bring together research results that will be available to academic
researchers, non-profit 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 TBI, Parkinson's, and Alzheimer's. The agreement directs NIH to report
to the Committees within 180 days of enactment of this Act on progress in
furthering these research areas, specifically on key areas of focus for fiscal years
2020-2024.

Autism.-The agreement encourages NIH to continue to aggressively invest in
research on autism consistent with the objectives outlined in the Strategic Plan.
The agreement also encourages NIH to support greater investment in research and
collaborations focused on addressing the gaps outlined in the Strategic Plan,
including studies to understand the intersection of biology, behavior, and the
environment.

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Autoimmune Conditions.-Autoimmune diseases are more common in women
than in men, typically manifesting in their childbearing years. They include
conditions such as rheumatoid arthritis, multiple sclerosis, lupus, celiac disease,
inflammatory bowel disease, and type 1 diabetes and together affect an estimated
five to seven percent of Americans. Many affected women live with a second
autoimmune illness or other condition. Despite the impact of these diseases and
conditions on a domestic population ranging between 15,000,000-25,000,000,
there is no single office within NIH tasked with coordinating research across the
agency, or examining the complex interplay among these diseases and conditions.
The 2010 NASEM study on Women's Health Research identified autoimmune
conditions as "the leading cause of morbidity in women, greatly affecting quality
of life." Despite their impact, the report found that "little progress has been made
in understanding the conditions better, in identifying the risk factors, or in
developing diagnostic tools, better treatments, or cures." The agreement includes
$1,500,000 for NIH to contract with NASEM to identify and review NIH's
research efforts in this broad area of predominantly women's health. The review
should explore NIH's research in autoimmune and coexisting disorders, including
any barriers to such research, and the most promising areas for future research that
would benefit the greatest number of patients. The review should also identify
trends among the population suffering from these conditions, and any significant
barriers to accurate diagnoses. Finally, the NASEM report should make
recommendations for how NIH could improve and better coordinate research into
these diseases and conditions, including the potential effects of establishing
dedicated research entities within or external to NIH.

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Big Data.-Despite launching its STRIDES and Data Commons initiatives,
NIH has little yet to show in the area of working with data. NIH has struggled to
recruit the talent to lead efforts to build an analysis platform. NIH leadership
recognizes it needs additional focus on how to consolidate and deliver data to the
research community in a more usable and computationally minable form, but is
challenged in how to do so. Part of the problem appears to be the salary restrictions
of a civil service structure that never contemplated the costs of recruiting highly
sought after elite technology talent. The Government Accountability Office (GAO)
is directed to identify and assess the options available to NIH for securing the
talent it needs to lead these efforts. GAO should consider how other agencies meet
similar challenges, and whether statutory changes are necessary. The agreement
also directs GAO to review how NIH funds computational talent in its grant
awards and whether its funding models adequately reflect the cost of these skillsets
to grantees. GAO should assess NIH's guidance for the resource-sharing plan it
requires for the typical grantee, and whether these plans are sufficient and can be
sustained for ongoing analysis. NIH is urged to engage industry, academic, and
other Federal partners to take advantage of cross-enterprise artificial intelligence
products, research, and tools. Artificial Intelligence could play a vital role toward
advancing the goals of the strategic plan by organizing, managing, and making
data usable to researchers, institutions, and the public to drive outcomes. Finally,
the agreement includes $30,000,000 to support the Chief Data Strategist's work in
fiscal year 2020, and expects NIH to provide a spending plan for these funds
within 30 days of enactment of this Act.

Biomedical Research Facilities.-The bill provides $50,000,000 for grants to
public and/or not-for-profit entities to expand, remodel, renovate, or alter existing
research facilities or construct new research facilities as authorized under 42
U.S.C. section 283k. The agreement also directs NIH to allocate no less than 25
71

percent of funding for this program to Institutions of Emerging Excellence to
ensure geographic and institutional diversity. Finally, the agreement urges NIH to
consider recommendations made by the NIH Working Group on Construction of
Research Facilities, including making awards that are large enough to underwrite
the cost of a significant portion of newly constructed or renovated facilities.

Brain Research through Advancing Innovative Neurotechnologies Initiative. The agreement provides $500,000,000 for the BRAIN initiative, finally achieving
the initial BRAIN 2025 report recommendation of $500,000,000 per year by fiscal
year 2019. The agreement provides additional resources to significantly expand
efforts to working with the BRAIN data. Neuroscience, and biosciences in general,
need additional focus on how to consolidate and deliver data to the research
community in a more usable and computationally minable form. The agreement
expects to receive a report in the fiscal year 2021 Congressional Justification on
the initiative's achievements in its first five years of operation and its objectives for
the next five years, including NIH's plans to address the challenge of making large
datasets usable.

Clinical Research Professional Competency.-The agreement encourages NIH
to continue considering the training needs of the clinical research workforce when
determining best practices in conducting clinical trials.

Clinical Trials Policy.-The agreement supports NIH's recent announcement to
delay the implementation of certain registering and reporting requirements for
basic experimental studies with humans. The agreement urges NIH to continue its
efforts, including working with the basic research community, to achieve a

\

balanced registration and reporting strategy that meets the interests of study
participants, investigators, and taxpayers. NIH is directed to report to the

72

Committees no less than 60 days prior to moving forward with any new proposals
for registering basic experimental studies with humans as clinical trials.

Ethnic and Racial Diversity in Cancer Development and Outcomes.-The
agreement urges NIH, including NIMHD and NCI, to continue to support research
on the cause, prevention, and treatment of cancer in populations with diverse
cultural, racial, and ethnic composition. The agreement also encourages NCI to
continue to consider an institution's research efforts that specifically address the
cancer burden, risk factors, incidence, morbidity, mortality, and inequities in the
geographic area it serves, when considering applications from cancer centers for
NCI designation.

Firearm Injury and Mortality Prevention Research.- The agreement includes
$12,500,000 to conduct research on firearm injury and mortality prevention. Given
violence and suicide have a number of causes, the agreement recommends the NIH
take a comprehensive approach to studying these underlying causes and evidencebased methods of prevention of injury, including crime prevention. All grantees
under this section will be required to fulfill requirements around open data, open
code, pre-registration of research projects, and open access to research articles
consistent with the National Science Foundation's open science principles. The
Director of NIH is to report to the Committees within 30 days of enactment on
implementation schedules and procedures for grant awards, which strive to ensure
that such awards support ideologically and politically unbiased research projects.

Foreign Threats to Research.-There remains concern about foreign threats to
the research infrastructure in the U.S. In particular, the Chinese government has
started a program to recruit NIH-funded researchers to steal intellectual property,
cheat the peer-review system, establish shadow laboratories in China, and help the
Chinese government obtain confidential information about NIH research grants. As
the Federal Bureau of Investigation, HHS, and NIH continue to investigate the
73

impact the Thousand Talents and other foreign government programs have had on
the NIH research community, the agreement directs NIH to notify the Committees
quarterly on the progress of the investigation, as well as institutions, scientists, and
research affected. Further, the agreement directs NIH to carefully consider the NIH
Advisory Committee's recommendations, including to implement a broad
education campaign about the requirement to disclose foreign sources of funding
and develop enhanced cybersecurity protocols. As recommended, NIH should use
this campaign to help institutions develop best practices for how to handle these
challenges, including training, communications materials, and how to improve
vetting, education, and security. Further, NIH shall evaluate the peer-review
system and their internal controls through a lens that takes into account national
security threats. This includes holding those accountable who inappropriately share
information from the peer-review process or illegally share intellectual property.
The agreement notes the partnership between NIH and HHS' Office of National
Security (ONS) on this issue and ONS's implementation of a formal NIH
CI/Insider Threat program on NIH' s behalf. The agreement believes this work
should be expanded in fiscal year 2020 and directs NIH to allocate no less than
$5,000,000 for this work that ONS does on behalf of NIH.

Frontotemporal Degeneration Research-The agreement encourages NIH to
continue to support a multi-site network of clinical centers to study genetic and
sporadic cases of frontotemporal degeneration (FTD) and maintain progress toward
biomarker discovery and drug development in clinical trials using these welldefined FTD cohorts. A key component of this network will be the development of
a data biosphere that supports wide sharing of robust datasets, generated with
powerful -omic platforms. Data sharing will enable the broader community of
researchers outside of the clinical networks, particularly early career scientists, to
take on the challenges currently confronting Alzheimer's disease and related

74

dementias disorders with a wider array of expertise. Research has revealed that all
forms of dementia may have a variety of root causes and display multiple
underlying pathologies. Research on the related dementias is critical for
understanding basic disease mechanisms that may be common across multiple
forms of dementia and therefore speed the translation of this information into
much-needed therapeutics. While the continued support of biomedical research
offers hope for the future, too many families and individuals living with dementia
cannot find the help they need today. Therefore, the agreement also urges NIH to
support research on the development of new and improved dementia care practices
and long-term supports and services. By supporting both types of research, NIH
may advance progress toward future therapies and treatments while also helping
people get the appropriate and effective care and support they need today.

Harassment Policies .-The NASEM report released last year found that sexual

harassment is rampant in the labs and institutions supported by NIH. The
Committees believe NIH must play a more active role in changing the culture that
has long perpetuated the problem. The Committees direct NIH to require
institutions to notify the agency when key personnel named on an NIH grant award
are removed because of sexual harassment concerns and to submit to the
Committees 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 Committees also direct 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 Committees direct NIH to collaborate with NASEM to develop
best practices for developing more diverse and inclusive cultures in the grantee
research environments, including training individuals in institutions that receive
75

NIH funds to recognize and address sexual harassment, and evaluating the efficacy
of various sexual harassment training programs.

Hepatitis C.-The agreement urges NIH to prioritize research aimed at
supporting hepatitis C elimination.

Human Microbiome Project.-The agreement encourages OD to continue
working collaboratively with NIDDK and other relevant Institutes and Centers to
expand and advance Human Microbiome Project research.

IDeA States Pediatric Clinical Trials Network-The agreement commends
NIH for establishing the IDeA States Pediatric Clinical Trials Network (ISPCTN)
to provide medically-underserved and rural populations with access to state-of-theart clinical trials, apply findings from relevant pediatric cohort studies to children
in IDeA State locations, and enhance pediatric research capacity to address unmet
pediatric research needs in underserved areas. The agreement provides
$15,000,000 in additional funding for the Environmental Influences on Child
Health Outcomes Program to continue the ISPCTN program.

Increasing Diversity in NIH Clinical Trials. - The agreement recognizes efforts
by NIH to reduce health disparities by addressing significant barriers to clinical
trial participation and directs the agency to ensure eligibility criteria for clinical
trials funded by NIH do not create unintentional barriers to participation for racial
and ethnic minorities as well as for patients with certain health conditions. The
agreement directs NIH to revise existing protocol templates and guidelines for
clinical trials that receive funding by the agency to include eligibility criteria that
avoids inappropriate exclusions of racial and ethnic minorities by taking steps to
account for variations in health status across racial and ethnic minority groups
when determining eligibility criteria as well as ensuring exclusions based on health
status are scientifically justified and appropriate.

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Induced Pluripotent Stem Cells.-The agreement directs NIH to provide
funding to support translational research, as well as promote regional, collaborative
consortiums to advance scientific knowledge in the area of induced pluripotent
stem cells basic research. The agreement further instructs NIH to conduct an
assessment of agency efforts to: (1) address the existing funding gap between basic
science and clinical trial research; and (2) develop a framework that provides both
new and existing grantees with funded opportunities for translational research. The
agreement expects this information to be included in the fiscal year 2021
Congressional Justification.

Intellectual Property.-The agreement encourages the Director to work with the

HHS Assistant Deputy Secretary for National Security to improve the security of
intellectual property derived from NIH-funded research. In particular, NIH is
encouraged to: improve the security of the peer review system; augment the
application process to identify funding that applicants receive from a foreign
government; and assist the HHS Inspector General and appropriate law
enforcement agencies to identify violations of U.S. law or policy.

Intramural Nonhuman Primate Research.-The agreement recognizes the use
of nonhuman primate research for the advancement of biomedical research. It also
understands that NIH continues to seek scientific alternatives to reduce and replace
nonhuman primate use in biomedical research. NIH reviews every project that
uses nonhuman primates in research to ensure both the welfare of the animal and
that there are no scientific alternatives that could replace an animal model. The
agreement requests a report to the Committees no later than one year after
enactment of this Act that includes a discussion of nonhuman primate use and
efforts to reduce such research use specifically, an assessment of research
alternatives, including benefits and limitations of such alternatives, cost estimates,
and areas of further need for innovative alternatives. In the fiscal year 2021

77

Congressional Justification, the agreement requests NIH include a discussion of
research alternatives in use and those in development.

Mucopolysaccharide Diseases.-The agreement encourages expanded research
of treatments for neurological, chronic.inflammation, cardiovascular, and skeletal
manifestations of mucopolysaccharide (MPS) and ML diseases, with an emphasis
on gene therapy. The agreement also encourages NIH to increase funding to
grantees to incentivize MPS research, particularly given the age and small
population of current researchers. Understanding the manifestations and treatments
of both the skeletal and neurological disease continue to be the greatest areas of
unmet need.

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome.-The agreement
commends NIH on its new Myalgic Encephalomyelitis/Chronic Fatigue Syndrome
(ME/CFS) efforts, including its 2019 conference on accelerating research into
ME/CFS, the formation of the National Advisory Neurological Disorders and
Stroke (NANDSC) Council Working Group, and the unanimous adoption of the
working group's report and recommendations on September 4, 2019. The
agreement strongly encourages NIH to implement the recommendations in the
NANDSC report, in particular to accelerate the identification of ME/CFS subtypes
through the development of an ME/CFS Registry and Biorepository and to increase
the number of ME/CFS research grant applications by investing in early career
investigators as recommended in the NANDSC report. The agreement also
recommends that NIH expand ME/CFS efforts, for example, by developing: (1)
new ME/CFS disease specific funding announcements, including those with setaside 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.

78

National Commission on Lymphatic Diseases.-OD and NHLBI are applauded
for facilitating the 2015 Trans-NIH Lymphatics Symposium. Lymphatics research
has the scientific potential to treat a variety of severe diseases, including heart
disease, diabetes, rheumatoid arthritis, and cancer. The Director is encouraged to
establish a National Commission on Lymphatic Diseases or other appropriate
mechanism to explore and make recommendations on the ongoing expansion and
coordination of lymphatic diseases research NIH-wide.

News Briefings.-Until recently, NIH provided the Committees with a summary
of the day's news articles on itself, health and medical news, global health updates,
and other topics affecting its operations. The agreement directs NIH to resume
providing daily NIH news briefings within 14 days of enactment of this Act.

Organ Donation and Transplantation.-The agreement includes $1,500,000 to
contract with and fund a NASEM study to examine and recommend improvements
to research, policies, and activities related to organ donation and transplantation.
The report shall include: ( 1) identification of current challenges involved in
modeling proposed organ allocation policy changes and recommendations to
improve modeling; (2) recommendations about how costs should be factored into
the modeling of organ allocation policy changes; (3) a review of scoring systems
(e.g., CPRA, EPTS, KDPI, LAS, MELD, etc.) or other factors that determine organ
allocation and patient prioritization and recommendations to assure fair and
equitable practices are established, including reducing inequities affecting
socioeconomically disadvantaged patient populations; (4) recommendations to
update the OPTN's policies and processes to ensure that organ allocation decisions
take into account the viewpoints of expert OPTN committees; and (5) such other
issues as may be identified.

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Osteopathic Medical Schools.-The agreement notes concern about a lack of
access to research funding for osteopathic medical schools through NIH, as
osteopathic medicine is one of the fastest growing healthcare professions in the
country, and realizes its vital role in treating our Nation's rural, underserved, and
socioeconomically challenged populations.

Pediatric Clinical Trials Authorized under Best Pharmaceuticals for Children
Act.-The agreement directs that no less than $25,000,000 be used toward research
in preparation for clinical trials authorized by the Best Pharmaceuticals for
Children Act.

Platform Technologies.-The agreement directs NIH to provide a report in the
fiscal year 2021 Congressional Justification that identifies: (1) the challenges that
currently limit NIH' s ability to support the development of platform technologies,
and how these might be addressed. Potential examples include: (a) low levels of
engagement with researchers in the physical sciences, engineering, math, and
computer science; (b) a culture that prioritizes hypothesis-driven as opposed to
technology-driven proposals; (c) the structure of the NIH, which is organized
primarily around specific diseases or organs of the body; (d) a typical size and
duration of research grants that may not be aligned with the level of investment
required for advances in platform technologies; and (e) difficulty in supporting
high-risk, high-return ideas; (2) the specific unmet needs for basic, clinical and
translational research that might motivate investment in transformational platform
technologies that could be high-impact and timely, given recent scientific and
technological advances and unmet medical needs; and (3) changes that NIH and
Congress should consider with respect to its ability to identify and fund promising
research proposals for platform technologies. Examples include: (a) recruiting NIH
personnel and members of study sections with relevant expertise; (b) supporting
'

workshops and the development of roadmaps for platform technologies; (c)

80

increasing funding mechanisms that are appropriate for platform technologies that
are relevant to multiple NIH Institutes, such as the Common Fund or NIBIB; ( d)
increasing NIH' s capacity to partner with industry on the development of platform
technologies, such as use of Other Transactions authorities; (e) experimentation
with different models for funding and managing research, such as the DARPA
model for recruiting and empowering world-class program managers; (f) use of
incentive prizes, milestone payments and open innovation techniques; and (g)
funding non-profit research institutes that have an increased capacity to manage
more complex research projects that require professional scientists, engineers, and
product managers, not just graduate students and postdoctoral researchers. The
agreement encourages NIH to engage the research community and industry as it
develops its response to these questions and options.

Precision Medicine and the Pediatric Population.-The agreement recognizes
the potential that precision medicine holds for all populations, including children,
and encourages NIH to prioritize timely and meaningful enrollment for the
pediatric population, including healthy children and those with rare disease, in the
All of Us program. The agreement requests an update within 60 days on the timing
for the Special Populations Committee to provide recommendations regarding the
practical considerations of child enrollment and data collection involving children.
Additionally, the agreement directs that NIH provide an update on plans to ensure
that the research cohort includes a sufficient number of children to make
meaningful studies possible, the target date for enrollment to commence and how
enrollment strategies will include input from pediatric stakeholders across the
country with experience in pediatric clinical trial enrollment.

Rare Diseases.-There is concern with unknown costs resulting from
undiagnosed and untreated rare diseases. As a result, the agreement directs GAO to
study what is known about the total impact rare diseases have on the U.S.
81

economy, including direct medical costs, non-medical costs, loss of income, and
the societal consequence of undiagnosed and untreated rare disease. No later than
two years after the date of enactment of this Act, GAO shall provide a report on its
findings to the Committees.
Regenerative Medicine.-NIH is encouraged, in collaboration with FDA and
HR.SA, to engage experts and stakeholders to define data types and standards
necessary to collect data and measure outcomes related to regenerative cell
therapies and conduct real-world testing through a pilot outcomes database for
regenerative adult cell therapies, including products administered under FDA
Investigational New Drug or Investigational Device Exemption protocols.
Spina Bifida.-The agreement encourages NIA, NIDDK, NICHD, and NINDS
to study the causes and care of the neurogenic bladder and kidney disease to
improve the quality of life of children and adults with Spina Bifida; to support
research to address issues related to the treatment and management of Spina Bifida
and associated secondary conditions, such as hydrocephalus; and to invest in
understanding the myriad co-morbid conditions experienced by individuals with
Spina Bifida, including those associated with both paralysis and developmental
delay. The agreement supports the specific efforts ofNICHD to understand early
human development; set the foundation for healthy pregnancy, and lifelong
wellness of women and children; and promote the gynecological, andrological and
reproductive health for people with Spina Bifida. Additionally, NICHD is
encouraged to identify sensitive time periods to optimize health interventions;
improve health during transition from adolescence to adulthood; and ensure safe
and effective therapeutics and devices.

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Stimulating Peripheral Activity to Relieve Conditions Initiative.-The

agreement applauds NIH for its cross-cutting Simulating Peripheral Activity to
Relieve Conditions Initiative and is pleased by the Initiative's attention to research
that aims to address gaps in treatments for patients suffering from gastrointestinal,
genitourinary, cardiac, and other disorders. NIH is encouraged to work
collaboratively across its Institutes and Centers on innovative ways to expand
treatment options for these often burdensome conditions.
Temporomandibular Disorders.-For the first time, the nation's leaders in

health and medicine are enlisting experts to review all aspects of TMD, generating
recommendations for research, regulation, and policy. To continue to build on
advances in coordinated research and treatment, the agreement asks OD, as it
continues to work with NASEM on the study, to explore the creation of a NIH
inter-Institute TMD working group and to report to the Committees within 90 days
following the publication of the final report.
Traumatic Brain Injury. - The agreement directs NIH to enhance its research

efforts on alternative treatment methods for TBI and post-traumatic stress disorder
(PTSD), including·hyperbaric oxygen treatment (HBOT). The agreement
encourages NIH to partner with DoD and VA to research treatment alternatives
such as HBOT for veterans living with PTSD and/or TBI.
Trisomy 21. - The agreement includes $60,000,000 for support of the

Investigation of Co-Occurring Conditions Across the Lifespan to Understand
Down Syndrome (INCLUDE) Initiative. It is expected that this multi-year, transNIH 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. The agreement requests the Director provide a
plan within 60 days of enactment of this Act that includes a timeline description of
potential grant opportunities and deadlines for all expected funding opportunities

83

so that young investigators and new research institutions may be further
encouraged to explore research in this space. This plan should also incorporate
pipeline research initiatives specific to Down syndrome.

Tuberous Sclerosis Complex.-The agreement encourages the Director to apply
recommendations from two recent NIH-sponsored workshops on Tuberous
Sclerosis Complex (TSC): the Neurodevelopmental Disorders Biomarkers
Workshop held in December 2017 involving TSC and related neurodevelopmental
disorders to take advantage of biomarker expertise and lessons learned across
disease groups, and the workshop entitled Accelerating the Development of
Therapies for Anti-Epileptogenesis and Disease Modification held in August 2018
for which TSC is a model disorder with the ability to diagnose TSC prior to onset
of epilepsy.

Urinary Tract Infections .-The agreement commends NIH for supporting
research across the lifespan to better understand the genitourinary microbiome, the
role of inflammation in bladder health, and the impact of these factors in urinary
tract infections (UTis ). NIH should continue research in the development of new
and novel therapies to treat and prevent UTis, including small molecule candidates
and other approaches that can disrupt infection and new antibiotics against
extensively drug-resistant bacterial strains. The agreement supports the
development of preventive therapies and new treatment strategies.

Inclusion in Clinical Research.-The agreement directs NIH to fund a NASEM
study examining and quantifying the long-term medical and economic impacts of
the inclusion of women and racial and ethnic minorities in biomedical research and
subsequent translational work, and has provided $1,200,000 to fund this effort.
NIH is directed to report to the Committees on this issue and it should include a
review of the existing research on the long-term economic benefits of increasing
the participation of women and racial and ethnic minorities in clinical trials and
84

biomedical research, including an analysis of fiscal implications of inclusion on the
nation's overall healthcare costs; examine new programs and interventions in
medical centers that are currently working to increase participation of women of
lower socioeconomic status and women who are members of racial and ethnic
minority groups; identify programs that are positively addressing issues of
underrepresentation; and analyze whether and how those programs are replicable
and scalable; and identify more inclusive institutional and informational policies
and procedures to improve health outcomes for racial and ethnic minorities,
including health referral forms, continuing education classes, and more.

BUILDINGS AND FACILITIES

The bill includes $225 ,000,000 from HHS' Nonrecurring Expenses Fund for
buildings and facilities. The agreement directs NIH to provide a report with the
fiscal year 2021 Congressional Justification describing the steps it has taken and
· will take to implement the recommendations in the 2019 NASEM report Managing

the NIH Bethesda Campus' Capital Assets in a Highly Competitive Global
Biomedical Research Environment. There is a particular interest in the actions NIH
is taking to apply the recommendations to update the Buildings and Facilities
prioritization model, develop an annual budget request for Backlog of Maintenance
and Repair, and strengthen its internal governance process, including assigning and
empowering a senior leader to manage capital planning.
In addition, the agreement directs NIH to provide quarterly briefings of its
Buildings and Facilities maintenance and construction plans, including specific
milestones for advancing projects, status of the project, cost, and priority. These
updates should also highlight and explain any potential cost and schedule changes
affecting projects.
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SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION (SAMHSA)
The agreement encourages SAMHSA to exercise maximum flexibility when
developing funding opportunity announcements to ensure that all eligible
applicants may apply.

MENTAL HEALTH

Certified Community Behavioral Health Clinics.-The agreement includes
increased funding and directs SAMHSA to prioritize resources to entities within
States that are part of the section 223(a) of the Protecting Access to Medicare Act
of 2014 (P.L. 113-93) demonstration and to entities within States that were
awarded planning grants.

Mental Health-The agreement directs SAMHSA to provide a comprehensive
plan to the Committees no later than 60 days after enactment of this Act
identifying current gaps in mental health care programs, highlighting how
programs can help close those gaps, and providing recommendations to meet the
needs of those experiencing mental illness.

National Child Traumatic Stress Initiative.- The agreement intends that
$13,000,000 is for a new competitive process to expand support for universities,
hospitals, and community-based programs, of which at least $4,000,000 is to be
prioritized for mental health services for unaccompanied alien children. The
agreement also provides an additional $2,000,000 for activities authorized under
section 582(d) and (e) of the Public Health Service Act.
Within the total provided for Mental Health Programs of Regional and National
Significance (PRNS), the agreement includes the following amounts:

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FY 2020
Agreement

Budget Activity
Capacity:
Seclusion and Restraint.. ............................................ .

$1,147,000

Project A WARE ..................................................... .

102,001,000

Mental Health Awareness Training ........................... .

22,963,000

Healthy Transitions ................................................... .

28,951,000

Infant and Early Childhood Mental Health ............ .

7,000,000

Children and Family Programs ................................. .

7,229,000

Consumer and Family Network Grants ..................... .

4,954,000

Project LAUNCH ...................................................... .

23,605,000

Mental Health System Transformation ................. .

3,779,000

Primary and Behavioral Health Care Integration ..... .

49,877,000

National Strategy for Suicide Prevention .............. .

18,200,000

Zero Suicide ... ........................................... .
American Indian and Alaska Native ......... .

Suicide Lifeline ......................................................... .

16,200,000
2,200,000

19,000,000

Garrett Lee Smith-Youth Suicide PreventionStates ........................................................................... .

87

35,427,000

FY 2020
Agreement

Budget Activity
Garrett Lee Smith-Youth Suicide PreventionCampus ....................................................... .

6,488,000

American Indian and Alaskan Native Suicide
Prevention Initiative ................................................... .

2,931,000

Tribal Behavioral Grants .................................. .

20,000,000

Homelessness Prevention Programs ........................... .

30,696,000

Minority AIDS ............................................................ .

9,224,000

Criminal and Juvenile Justice Programs ..................... .

6,269,000

Assisted Outpatient Treatment ........................... .

19,000,000

Assertive Community Treatment for Individuals with
Serious Mental Illness ................................... .

7,000,000

Comprehensive Opioid Recovery Centers .............. .

2,000,000

Science and Service:
Garrett Lee Smith-Suicide Prevention Resource
Center ........................................................ .

7,988,000

Practice Improvement and Training .................... .

7,828,000

Primary and Behavioral Health Integration Technical
Assistance ..................................................... .

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1,991,000

FY 2020
Budget Activity

Agreement

Consumer & Consumer Support Technical Assistance
Centers ...... . ... . .. ... ... ................... .. .. ............. .

1,918,000

Minority Fellowship Program .................................... .

9,059,000

Disaster Response ...................................................... .

1,953,000

Homelessness ........................................................... .

2,296,000

Comprehensive Opioid Recovery Centers.-The agreement includes funding to
provide grants, as authorized by section 7121 of the SUPPORT Act
(P.L. 115-271 ), to previous recipients of HRSA Rural Communities Opioid
Response Program Planning Grants that provide comprehensive treatment and
recovery services in rural communities, including Tribal communities.

Criminal Justice Activities.-The agreement prioritizes funding for centers that
provide assistance to those with severe mental health needs who are at risk of
recidivism. The agreement encourages SAMHSA to prioritize applications from
areas with high rates of uninsured individuals, poverty, and substance use
disorders.

Infant and Early Childhood Mental Health - The agreement includes an
increase to fund additional grants. The agreement continues to recommend
providing grants to entities such as State agencies, Tribal communities, and
university or medical centers.

89

Mental Health Awareness Training.-SAMHSA is directed to include as
eligible grantees local law enforcement agencies, fire departments, and emergency
medical units with a special emphasis on training for crisis de-escalation
techniques. SAMHSA is also encouraged to allow training for veterans and armed
services personnel and their family members within the Mental Health First Aid
program.

Project AWARE.-The agreement includes an increase and encourages
SAMHSA to expand the identification of children and youth in need of mental
health services, increase access to mental health treatment, promote mental health
literacy among teachers and school personnel, and provide mental health services
in schools and for school aged youth. Of the amount provided, the agreement
directs $10,000,000 for discretionary grants to support efforts in high-crime,
high-poverty areas and, in particular, communities that are seeking to address
relevant impacts and root causes of civil unrest, community violence, and
collective trauma. These grants should maintain the same focus as fiscal year 2019
grants. The agreement requests a report on progress of grantees 180 days after
enactment of this Act.

Suicide Prevention-The agreement includes increased funding to expand and
enhance access to suicide prevention resources of the Suicide Lifeline, the Zero
Suicide program, and Garrett Lee Smith Suicide Prevention Resource Center.

SUBSTANCE ABUSE TREATMENT

State Opioid Response Grants.- The agreement includes bill language to make ·
addressing stimulant abuse an allowable use of funds while maintaining the
existing formula. The agreement directs SAMHSA to ensure funds reach
communities and counties with the greatest unmet need. Additionally, the

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- - - - - · - - - - -- - - - -

agreement urges the Assistant Secretary to ensure the formula avoids a significant
cliff between States with similar mortality rates. SAMHSA is also directed to
provide State agencies with technical assistance concerning how to enhance
outreach and direct support to providers and underserved communities. Consistent
with the objective of Comprehensive Opioid Recovery Centers, the agreement
encourages long-term care and support services that dramatically improve
outcomes and contribute to best practices. The agreement notes concern that the
report requested under this heading in fiscal year 2018 has not been transmitted to
the Committees. In addition, the agreement urges transmittal of SAMHSA' s
evaluation of the program to the Committees by April 2020. SAMHSA is directed
to make such report and evaluation available on SAMHSA' s website.
Within the total provided for Substance Abuse Treatment Programs of Regional
and National Significance, the agreement includes the following amounts:

FY 2020

Budget Activity

Agreement

Capacity:
Opioid Treatment Programs/Regulatory
Activities ...................................................................... .

$8,724,000

Screening, Brief Intervention, Referral, and
Treatment ................................................ ..

30,000,000

PHS Evaluation Funds .................................... .

2,000,000

Targeted Capacity Expansion - General.. ................. .

100,192,000

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FY 2020
Agreement

Budget Activity
Medication-Assisted Treatment for Prescription
Drug and Opioid Addiction ... ......... ......... .

89,000,000

Grants to Prevent Prescription Drug/Opioid Overdose.

12,000,000

First Responder Training .................... .. .............. .

41,000,000

Rural Focus .. . ....... ..... .......... .. .... ............. ....... .

23,000,000

Pregnant and Postpartum Women .............................. .. .

31,931,000

Recovery Community Services Program ..................... .

2,434,000

Children and Families .................................................. .

29,605,000

Treatment Systems for Homeless ................................. .

36,386,000

Minority AIDS ............................................................. .

65,570,000

Criminal Justice Activities ........................................... .

89,000,000

Drug Courts ... ................... ...... ......... ............. .

70,000,000

Improving Access to Overdose Treatment. ........ ..... .

1,000,000

Building Communities of Recovery ...................... .

8,000,000

Peer Support Technical Assistance Center .............. .

1,000,000

Emergency Department Alternatives to Opioids ........ .

5,000,000

Treatment, Recovery, and Workforce Support ......... .

4,000,000

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FY 2020
Budget Activity

Agreement

Science and Service:
Addiction Technology Transfer Centers ...................... .

9,046,000

Minority Fellowship Program ...................................... .

4,789,000

Adolescent Substance Use Screening, BriefIntervention, and Referral to
Treatment (SBIRT).-The agreement encourages SAMHSA to use funds for the
adoption of SBIRT protocols in primary care and other appropriate settings that
serve youth 12 to 21 years of age as well as on the adoption of system-level
approaches to facilitate the uptake of SBIRT into routine healthcare visits for
adults. Further, the agreement encourages SAMHSA to consider using existing
resources for grants to pediatric healthcare providers in accordance with the
specifications outlined in section 9016 of the Sober Truth in Preventing Underage
Drinking Reauthorization (P. L. 114-255).

Building Communities ofRecovery.-The agreement provides an increase for
enhanced long-term recovery support principally governed by people in recovery
from substance use disorders. Such support reflects the community being served
and encourages the role of recovery coaches. SAMHSA is encouraged to ensure
that grants employing peers comply with the highest standards within their
respective States.

Emergency Department Alternatives to Opioids .-The agreement includes
funding to award new grants to hospitals and emergency departments as authorized
in section 7091 of the SUPPORT Act (P.L. 115-271).

93

First Responder Training.-Of the funding provided, the agreement provides
an additional $5,000,000 to make new awards to rural public and non-profit fire
and EMS agencies as authorized in the Supporting and Improving Rural
Emergency Medical Services Needs (SIREN) Act, included in the Agriculture
Improvement Act of 2018 (P.L. 115-334). The agreement directs SAMHSA to
coordinate with the Federal Office of Rural Health Policy in HRSA.
Medication-Assisted Treatment for Prescription Drug and Opioid Addiction.Within the amount, the agreement includes $10,000,000 for grants to Indian
Tribes, Tribal Organizations, or consortia.
Neonatal Abstinence Syndrome.-The agreement supports the continued efforts
of expanded implementation of SBIRT and its possible impact on reducing the
costs of neonatal abstinence syndrome.
Opioid Abuse in Rural Communities .-The agreement encourages SAMHSA to
support initiatives to advance opioid abuse prevention, treatment, and recovery
objectives, specifically focusing on addressing the needs of individuals with
substance use disorders in rural and medically-underserved areas, as well as
-

programs that emphasize a comprehensive community-based approach involving
academic institutions, healthcare providers, and local criminal justice systems.
Peer Support Technical Assistance Center.-The agreement provides funding
for the creation of the Center, as authorized by section 7152 of the SUPPORT
Act (P.L. 115-271).
Pregnant and Postpartum Women.-The agreement encourages SAMHSA to
prioritize States that support best-practice collaborative models for the treatment
and support of pregnant women with opioid use disorders.

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Telehealth Medication-Assisted Treatment (MAT) for Opioid Treatment.-The
agreement notes that some State Opioid Response grant funding has been used to
fund MAT through telehealth and requests a report in the fiscal year 2021
Congressional Justification on efficacy and sustainability of this effort.

Treatment Assistance for Localities.-The agreement recognizes the use of peer
recovery specialists and mutual aid recovery programs that support MAT and
encourages SAMHSA to support these activities as applicable in its current grant
programs.

Treatment, Recovery, and Woriforce Support.-The agreement includes
funding to implement section 7081 of the SUPPORT Act (P.L. 115-271).
SAMHSA is directed to, in consultation with the Secretary of Labor, award
competitive grants to entities to carry out evidence-based programs to support
individuals in substance use disorder treatment and recovery to live independently
and participate in the workforce.

SUBSTANCE ABUSE PREVENTION

Within the total provided for Substance Abuse Prevention Programs of
Regional and National Significance, the agreement includes the following
amounts:

FY 2020
Budget Activity
Capacity:

95

Agreement

FY 2020
Budget Activity

Agreement

Strategic Prevention Framework/
Partnerships for Success .............................. .

$119,484,000

Strategic Prevention Framework Rx ... ........... . .

10,000,000

Federal Drug-Free Workplace .. ... ................................... .

4,894,000

Minority AIDS ......................................... ................. .

41,205,000

Sober Truth on Preventing Underage Drinking
(STOP Act) ..................... ................... ..... .

9,000,000

National Adult-Oriented Media Public Service
Campaign ......... ....... .......... .... ...................... .. ...

1,000,000

Community-based Coalition Enhancement Grants .. .

7,000,000

Intergovernmental Coordinating Committee on the
Prevention of Underage Drinking ... ............. .. ...

1,000,000

Tribal Behavioral Health Grants ......................... .

20,000,000

Science and Service:
Center for the Application of Prevention Technologies ..

7,493,000

Science and Service Program Coordination ................... .

4,072,000

Minority Fellowship Program ........................................ .

321,000

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Sober Truth on Preventing Underage Drinking Act (STOP Act).-The
agreement provides an increase for community-based coalition enhancement
grants.

Strategic Prevention Framework-Partners hips for Success Program .-The
agreement encourages the program to support comprehensive, multi-sector
substance use prevention strategies to stop or delay the age of initiation of each
State's top three substance use issues for 12 to 18 year old youth as determined by
the State's epidemiological data. The agreement directs SAMHSA to ensure that
State alcohol and drug agencies remain eligible to apply along with communitybased organizations and coalitions.

HEALTH SURVEILLANCE AND PROGRAM SUPPORT

Within the total provided for health surveillance and program support, the
agreement includes the following amounts:

FY 2020

Budget Activity

Agreement

Health Surveillance.................................

$47,258,000

PHS Evaluation Funds.................................

30,428,000

Program Management.......................................

79,000,000

Performance and Quality Information Systems...

10,000,000

Drug Abuse Warning Network.....................

10,000,000

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FY 2020
Budget Activity

Agreement

Public Awareness and Support .................... .

13,000,000

Behavioral Health Workforce Data ............... .

1,000,000

PHS Evaluation Funds ................................. .

1,000,000

Interagency Task Force on Trauma-Informed Care.-The agreement supports
the authorized activities of the Interagency Task Force on Trauma-Informed Care,
including the dissemination of trauma-informed best practices and the promotion of
such models and training strategies through all relevant grant programs.

Post-Traumatic Stress Disorder in First Responders .-The agreement
encourages SAMHSA to examine post-traumatic stress disorder among individuals
working in the civilian first responder disciplines to provide information on this
effort in the fiscal year 2021 Congressional Justification.

AGENCY FOR HEALTHCARE RESEARCH AND QUALITY (AHRQ)
HEALTHCARE RESEARCH AND QUALITY

Antimicrobial Resistance.-The agreement provides no less than $10,000,000
for combating antibiotic-resistant bacteria.

Diabetes .-AHRQ is encouraged to consider a pilot or demonstration program
to support safety net clinics in increasing health literacy and preventing diabetes,
with the goal of reducing long-term costs.

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Diagnostic Errors.-The agreement includes no less than $3,000,000 for the
Partners Enabling Diagnostic Excellence research program. Such grants will help
establish the incidence of and understanding of factors contributing to diagnostic
errors and examine the association between diagnostic safety and quality and
outcomes such as patient harms, costs, expenditures, and utilization.

Kratom.-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. The agreement recommends no less than
$1,000,000 for this research and directs AHRQ to make center-based grants. Such
research should lead to clinical trials in geographic regions which are among the
hardest hit by the opioid crisis.

Malnutrition.-AHRQ is requested to convene a technical expert panel charged
with creating a malnutrition-related readmissions quality measure to help prevent
malnutrition in hospitals.

Primary Care Research.-Congress supports primary care clinical research and
dissemination as a core function of AHRQ. AHRQ has proven to be uniquely
positioned to support high-quality primary care clinical and practice research,
especially in rural and underserved areas, where primary care physicians are the
main providers of care.

State Primary Care Demonstrations .-Congress understands that a number of
States are taking steps to improve the delivery of primary care. Congress believes
that these actions could provide a model for primary care nationally. The
agreement includes no less than $1,000,000 to support a study of those States'
actions, to be shared with the Committees.

99

CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS)
PROGRAM MANAGEMENT

Air Ambulance Costs.-The agreement requests CMS report to the Committees
no later than one year after enactment of this Act on any evidence of air ambulance
base closures in rural areas which may have affected patients' access to care, and
to consider relevant factors that have affected air ambulance transportation costs
when setting appropriate air ambulance payments, and consider whether costs
currently align with payments.

Assistive Technology Act Programs Reutilization Program.-The agreement
encourages CMS to support State Medicaid programs in partnering with State
Assistive Technology Act programs to develop and implement reutilization
programs with a goal of containing Medicaid costs.

At-risk Youth Medicaid Protection.-The agreement encourages CMS to
consider rulemaking related to section 1001 of the SUPPORT for Patients and
Communities Act (P.L. 115-271) and include an update on these activities in the
fiscal year 2021 Congressional Justification.

Certified Community Behavioral Health Clinics .-The agreement directs CMS
to provide available cost information to the Committees no later than 30 days after
enactment of this Act. CMS should include a preliminary analysis summarizing
cost data, as well as compare actual data to the Congressional Budget Office
estimate.

Claim Payment Coordination.-The agreement requests information in the
fiscal year 2021 Congressional Justification that provides options to reform the
identification of Medicare beneficiaries enrolled in Medicare Advantage or Part D
plans by third party payers in situations where no-fault or liability insurance, or
workers' compensation is involved.

100

Colorectal Cancer Screenings .-The agreement encourages CMS to use its
existing authority to increase access to colorectal cancer screenings by exploring
options to reduce out-of-pocket costs associated with screening colonoscopies
when a polyp or lesion is found and removed.

Computed Tomography (CT) Colonography.-The agreement encourages CMS
to consider existing evidence to determine whether CMS should cover CT
colonography as a Medicare-covered colorectal cancer screening test under section
1861(pp)(l) of the Social Security Act.

Data Collection Process for Laboratory Testing.-The agreement encourages
CMS to continue to work with laboratory stakeholders to further refine and
evaluate the data collection process under section 216 of the Protecting Access to
Medicare Act of 2014 (P.L. 113-93) to ensure that the information collected
accurately reflects the national laboratory market, including physician office
laboratories and hospital outreach laboratories.

Detecting Cognitive Impairment.-The agreement encourages CMS to evaluate
and update its definition of the "detection of any cognitive impairment" element to
the Annual Wellness Visit with reference to cognitive impairment detection tools
available at NIA's Alzheimer's and Dementia Resources for Professionals website
and to do so within one year of enactment of this Act.

Direct and Indirect Remuneration Fees.-The agreement encourages CMS to
work with stakeholders, including community pharmacies and beneficiary groups,
to develop standardized performance metrics that can be adopted to move the Part
D program toward better patient outcomes and quality.

Durable Medical Equipment.-The agreement encourages CMS to consider
whether implementation of the next round of competitive acquisition program
reforms should be fully completed before adding ventilator equipment, supplies,
and services to the competitive bidding program.
101

Emergency Triage, Treat, and Transport (ET3) Model.-The agreement
encourages CMS to work with applicants to ensure interested parties are able to
participate in the ET3 payment model.

Frontier Communities .-The agreement supports an extension of the Frontier
Community Health Integration Project program beyond its original three years.

Genome and Exome Sequencing.-CMS has yet to provide the report requested
.in section 251 of division B of H.R. 6157. CMS shall submit this required report
no later than 30 days after enactment of this Act.

Graduate Medical Education Program.-In conjunction with new medical
residency programs language included in House Report 116-62, the agreement
encourages CMS to extend the time described in section 413.79(e) of title 42, Code
of Federal Regulations, for new residency programs before a full-time equivalent
resident cap is applied as authorized in P.L. 105-33.

Health Insurance Exchange Transparency.-The agreement continues bill
language requiring CMS to continue to provide cost information for the health
insurance exchange, including all categories described under this heading in the
explanatory statement accompanying division B of P.L. 115-245, as well as
estimated costs for fiscal year 2021.

Hospital-Acquired Pressure Ulcers .-The agreement requests an update in the
fiscal year 2021 Congressional Justification on reducing pressure ulcer discharges.

Immunization Information Systems .-The agreement encourages CMS to work
with CDC and other relevant stakeholders to establish greater consistency and
interoperability between electronic health records and State and local
immunization information systems.

Limited Wraparound Coverage.-The agreement 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
102

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 agreement directs the Department to
submit a report within 90 days of enactment of this Act on the status of the
program.

Transparency.-The agreement encourages the Center for Medicare and
Medicaid Innovation to engage with stakeholders and Congress during the project
development process and requests an update on such efforts in the fiscal year
2021 Congressional Justification.

Lymphatic System Failure.-The agreement encourages the Secretary to
promulgate rules for covering prescribed compression garments as acknowledged
by CMS's 2001 decision memorandum in the treatment of lymphatic system
failure.

Medical Claims Databases .-The agreement urges CMS, in consultation with
the Secretaries of Labor and Treasury, to, once enacted, move swiftly to implement
legislation creating a secure Federal database and support States in collecting data
and claims that will enable analysis of the utilization and prices of healthcare items
and services.

Medicare Coverage ofInnovative Drugs and Products .-The agreement
encourages CMS to explore different ways to reimburse for innovative drugs
approved by FDA in a manner that protects beneficiary access and encourages
continued innovation while preserving the Medicare trust funds.

Medicare Coverage ofln-lfome Intravenous lmmunoglobulin. - The agreement
is aware of a demonstration evaluating bundled payment covering items and
services needed to administer intravenous immunoglobulin (IVIG) into
beneficiaries with primary immunodeficiency diseases. The agreement is also
103

aware of ongoing rulemaking pertaining to the permanent Medicare home infusion
services payment for therapies like IVIG. As CMS continues with rulemaking for
the permanent home infusion therapy benefit, the agreement encourages CMS to
articulate this position in future rulemaking.
Medicare Diabetes Prevention Program.-The agreement encourages CMS to

minimize the regulatory barriers impeding potential or existing suppliers from
delivering the Diabetes Prevention Program (DPP) to Medicare beneficiaries, and
to allow the full range of CDC-recognized DPP providers to participate as
Medicare DPP suppliers.
Medicare Area Wage Index.-The agreement directs CMS to provide a report

to the Committees on its methodology for calculating the labor-related share (LRS)
percentage used in the proposed rule entitled "The Inpatient Prospective Payment
System and the Long-Term Care Hospital Prospective Payment System for fiscal
year 2020". The report shall fully describe all methodologies, allocations, and
assumptions; and provide a schedule(s) of the calculation used to derive the LRS
percent.
Nonemergency Medical Transportation (NEMT).-The agreement directs HHS

to take no regulatory action on availability of NEMT service until the study
described under the "Medicaid and CHIP Payment and Access Commission"
header of this joint explanatory statement is complete.
Oral Health.-The agreement is concerned that CMS has implemented policies

that prevent consumers from purchasing stand-alone dental benefits and
encourages CMS to permit the purchase of stand-alone dental plans separate from
the purchase of qualified health plans beginning with the 2020 plan year. The
agreement encourages CMS to report annually on State-level oral health and dental
benefits available to adult populations, including pregnant women.

104

Program Integrity.-The agreement notes the Committees have yet to receive
the briefing on program integrity requested in Senate Report 115-289. The
agreement requests the briefing from CMS' s Center for Program Integrity within
60 days of enactment of this Act.

Recovery Audit Program.-The agreement directs CMS to conduct an internal
review of their Recovery Audit program in an effort to identify inefficiencies in the
current system. CMS shall include their findings in the annual report to Congress.

Reimbursement Coding/or ReducingOpioid Consumption.-The agreement
urges CMS to collaborate with the FDA and consider approved devices and
therapies for unique post-surgery patient populations for effective pain
management. In addition, CMS should take steps to improve tracking of patient
pain scores and opioid consumption using alternative means for effective pain
management.

Revisions to Office Visit Services .-The agreement notes that the CMS final
2019 Medicare Physician Fee Schedule rule outlines significant changes to how
evaluation and management services will be documented and paid for beginning
in 2021. The agreement encourages CMS to ensure that payment changes do not
further exacerbate workforce shortages.

Risk Corridor Program.-CMS is directed to provide a yearly report to the
Committees detailing any changes to the receipt and transfer of payments.

Robotic Stereotactic Radiosurgery.-The agreement encourages CMS not to
make payment changes to robotic stereotactic radiosurgery (SRS) and robotic
stereotactic body radiation therapy (SBRT) in the freestanding or hospital
outpatient setting as CMS complies with the Patient Access and Medicare
Protection Act and the Bipartisan Budget Act of 2018. The agreement
encourages CMS to maintain stable payment for robotic SRS and robotic SBRT

105

performed in Core-Based Statistical Areas that are not randomly selected to
participate in the alternative payment model.
Rural Healthcare Facilities.-The agreement encourages CMS to continue
working with States and State hospital associations on alternative payment models
for rural medical centers that support future financial stability and announce
potential models in 2020 with participants who demonstrate clear community
support for engaging these new programmatic flexibilities.
Telehealth.-To address inconsistency with billing and coding across Medicaid,
the agreement encourages CMS to issue guidance outlining a recommended, but
voluntary, set of billing codes, modifiers and/or place of service designations for
use in State Medicaid programs.
Therapeutic Foster Care.-The agreement requests an update in the .
fiscal year 2021 Congressional Justification on the study requested in House
Report 114-699.
Underperforming Healthcare Facilities .-Within six months of enactment of
this Act, the agreement directs CMS to provide the Committees a report on the
resources the agency requires to ensure all nominees for the program become full
participants, subject to the special focus facility (SFF) program's enhanced
surveying and progressive enforcement standards. The agreement further directs
CMS to disclose the names of nursing homes that are eligible for the SFF program,
but are not officially part of SFF, on the Nursing Home Compare website.
Workforce Capacity for Infectious Diseases and the Opioid Epidemic.-The
agreement continues to encourage CMS to collaborate with SAMHSA, CDC, and
HRSA to support education and training for medical providers on the frontlines of
the opioid epidemic to help expand access to comprehensive, coordinated care for
opioid addiction and related infectious diseases.

106

ADMrNISTRA TION FOR CHILDREN AND FAMILIES (ACF)
LOW INCOME HOME ENERGY ASSISTANCE
The agreement includes a new provision limiting annual decreases in State
allocations, preventing States from receiving less than 97 percent of what they
received the prior fiscal year.
Within 120 days of enactment of this Act, the agreement directs ACF to submit
to the Committees and make publicly available a report evaluating the program's
formula and allocations of funding among States, including an assessment of
available data, how the formula currently addresses annual fluctuations in formula
factors, and the percentage of eligible households served, average assistance
amount, and percentage of home energy costs covered by that amount by State.

REFUGEE AND ENTRANT ASSISTANCE
The agreement notes that appropriate consultation with Congress is required by
statute in advance of the Administration's determination on the number of refugees
to be admitted during the coming fiscal year. In times of reductions in refugee
arrivals, the agreement encourages HHS, to the extent practicable, to ensure that
resettlement agencies can maintain their infrastructure and capacity at a level to
continue to serve all refugees and to ensure future arrivals are adequately served.
The agreement strongly encourages the Office of Refugee Resettlement (ORR) to
continue to meet, on no less than a bi-monthly basis, with outside organizations
with expertise in ORR programs to provide updates and hear the perspective of
these stakeholders.

Transitional and Medical Services.-The agreement strongly encourages ORR
to increase the percentage of eligible arrivals served by the matching grant
program and to provide flexibility to carry over unexpended funding and slots
when justified, including by providing exemptions to the 31 day enrollment period.
107

Refugee Support Services.-Within 30 days of enactment of this Act, the
agreement directs the Department to provide a list of competitive grants and setasides within Refugee Support Services and to include their corresponding funding
levels in fiscal years 2016 through 2020.

Victims of Trafficking-The agreement includes $19,500,000 for services for
foreign national victims and $8,255,000 for services for U.S. citizens and legal
permanent residents. The agreement includes no less than $3,500,000 for the
National Human Trafficking Hotline and urges extension of the cooperative
agreement from 3 to 5 years to align with other Federally-funded hotlines.

Unaccompanied Alien Children (UA CJ
Children Separated from a Parent or Legal Guardian.-The agreement
includes a public reporting requirement with respect to children who have been
separated from a parent or legal guardian. In addition, the agreement notes HHS
has not yet complied with the reporting requirements included in Senate Report
115-289 regarding the demographics of separated children and expects the
Department to begin providing this information.

Facility Oversight.-ORR is expected to maintain strict oversight of all
ORR-funded care provider facilities and to report and correct violations of Federal,
State, or local codes related to standards of childcare or the wellbeing of children.
Within 60 days of enactment of this Act, ORR is directed to submit to the
Committees a report detailing the number and nature of violations by facility, and
steps taken to address such infractions.

Indigenous Languages .-ORR is encouraged, to the extent possible, to provide
culturally competent, in person education and translation services to children in
custody.

108

Length of Care.-The agreement directs ORR to provide a briefing to the
Committees within 120 days of enactment of this Act on options and plans for
children who have been in ORR custody for extended periods of time. In addition,

ORR is directed to continue to prioritize case management services and staffing,
including Federal Field Specialists, lowering the ratio of children per case
coordinator.
The agreement includes language continuing current law regarding the
operational directives issued to modify sponsor suitability requirements, which
significantly reduced the length of time children spend in care. The agreement
expects HHS to continue to work on efforts to reduce time in care and to consider
additional policy changes that can be made to release children to suitable sponsors
as safely and expeditiously as possible. The agreement does not provide further
direction on this issue.

Mental Health Services.-The agreement encourages ORR to continue
collaborating with the National Child Traumatic Stress Network and notes that no
less than $4,000,000 is included in this agreement through SAMHSA for such
efforts. ACF is directed to keep the Committees informed of additional resources
necessary to support children and families who may need access to these services.
In addition, the agreement directs ORR to provide a briefing to the Committees
within 120 days of enactment of this Act on HHS' and grantees' coordination of
health and mental health services, including training requirements for staff
providing those services and any challenges to providing adequate care for
children.

109

New Models of Care Delivery.-ORR is urged to include in the fiscal year 2021
Congressional Justification information about any plans being considered for new
models of care delivery, along with a justification for how new models could best
meet the needs of children in ORR care. When exploring the feasibility of such
models, ORR is expected to prioritize community engagement, the use of pilot
projects with short-term duration to demonstrate proof of concept before making
significant or long-term investments, and a collaborative and transparent
communications strategy with external stakeholders and Congress.
Office ofInspector General Report Recommendations .-The agreement
requests an update in the fiscal year 2021 Congressional Justification on the status
of ORR' s implementation of recommendations made in recent inspector general
reports.
Records Requests.-The agreement expects ORR to maintain records and
respond to records requests consistent with the requirements of section 552 of
title 5, U.S. Code, for information related to all children in care, regardless of
whether such children are housed in Federal facilities or, to the extent possible,
non-Federal facilities managed by contractors or other private entities.
Services for Children.-The agreement includes an increase in funding for legal
services, child advocates, and post-release services to support the expansion of
State-licensed shelters, and to allow for the resumption and expansion of services
to children released from ORR care. Using funds provided in this agreement,
combined with funding from the Emergency Supplemental Appropriations for
Humanitarian Assistance and Security at the Southern Border Act, 2019 (P.L. 116-·
26), ORR is directed to continue to expand such services beyond currently
estimated levels, including for children released in high-release communities.

110

The agreement strongly encourages ORR to notify legal service providers at the
time new grant awards are made and prior to opening a shelter, and to provide
monthly estimates of funded capacity by shelter. Additionally, the agreement
strongly encourages ORR to ensure that all UAC shelters provide space for legal
service providers to meet with children.
Within amounts provided for post-release services in this agreement and
combined with funds from P.L 116-26, ORR is directed to expand post-release
services capacity to eliminate the waitlist of children qualifying for Trafficking
Victims Protection Reauthorization Act-mandated services, and to expand services
to children that case managers identify would benefit from such services.

Sibling Placement.-The agreement directs ORR to place siblings in the same
facility, or with the same sponsor, to the extent practicable, and so long as
it is appropriate and in the best interest of the child.

Spend Plan.-The agreement directs ORR to incorporate all funding provided
in this Act into a comprehensive spend plan that must be submitted to the
Committees every 60 days in accordance with section 410 of the Emergency
Supplemental Appropriations for Humanitarian Assistance and Security at the
Southern Border Act, 2019 (P.L. 116-26).

Sponsorship Suitability Determination Process.-The Department is directed to
ensure all grantees are provided clear guidance to communicate with potential
sponsors regarding current law regarding the use of personal information collected
as part of the sponsor suitability determination process. The agreement expects
consistent monitoring to ensure program policies are applied appropriately by all
grantees in an effort to place children with sponsors as safely and expeditiously as
practicable.

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State Licensed Shelters. - The agreement directs ORR to prioritize licensed,
community-based residential care placements (including long-term and transitional
foster care and small group homes) over large-scale institutions and to notify the
Committees prior to all new funding opportunity announcements, grant or contract
awards, or plans to lease or acquire property. Such notification should include
associated timelines and costs.

Temporary Influx Shelters.-The agreement includes language continuing
current law conditions on the use of temporary influx shelters, strengthens
oversight and monitoring of facilities, and requires Congressional notifications and
reporting requirements if a shelter is operationalized. The agreement requests HHS
submit a report to the Committees within 90 days of enactment of this Act
detailing the barriers to State-licensing, including any State child welfare laws and
regulations, that could not be met for any influx facility operational in fiscal year
2019. If an influx shelter is opened in fiscal year 2020, ORR shall submit a report
to the Committees with the same information within 90 days. In addition, the
agreement notes that the spend plan required every 60 days must include a detailed
cost breakdown of any facility, regardless of its operational status.

Tender Age Children.-The agreement directs ORR to include in the fiscal year
2021 Congressional Justification information on efforts to ensure developmentally
appropriate care for tender age children, including placement options, services and
staff training, as well as an assessment of circumstances under which very young
children are referred to ORR.

112

CHILDREN AND FAMlLIES SERVICES PROGRAMS

Early Head Start Expansion (EHS) and EHS-Child Care Partnerships.-The
agreement modifies bill language to simplify the administration ofEHS Expansion
and EHS-Child Care Partnerships (EHS-CCP) grants, but does not otherwise
change the use of funds provided for such purposes. The agreement continues to
strongly support EHS Expansion and EHS-CCPs, and accordingly, the agreement
includes at least $905,000,000 for such purposes, an increase of $100,000,000.
Since fiscal year 2014, these funds have supported both the expansion of
traditional EHS and the establishment of partnerships between EHS providers and
local child care programs. The agreement directs ACF to continue to prioritize
equally EHS Expansion and EHS-CCP, as determined by the needs of local
communities. The agreement expects that any funds used for EHS Expansion and
EHS-Child Care-Partnership grants that are re-competed would continue to be used
for such purposes. Finally, the agreement directs ACF to include in the fiscal year
2021 Congressional Justification and each Congressional Justification thereafter,
the actual and estimated number of funded slots for each of the following: Head
Start, EHS, and EHS-Child Care Partnerships.

Quality Improvement Funding for Trauma-Informed Care. - The agreement
provides $250,000,000 in quality improvement funding, including a prioritization
on addressing the rise of adverse childhood experiences attributable to increased
prevalence of substance use, economic hardship, home and community violence,
and other traumatic experiences that can negatively impact child development and
lead to disruptions in classroom environments. The agreement directs the
Administration to allow flexibility to meet local needs while focusing these funds
on staff training for trauma-informed care and identification of signs of addiction
and hardship; mental health consultation services to provide expert care and
counseling to families and the Head Start workforce; and additional staffing to
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Head Start classes in high-risk substance use communities to maintain high-quality
learning environments while providing individualized care to children expressing
disruptive and challenging behaviors.
Designation Renewal System.-ACF is encouraged to continue to consider the

unique challenges faced by Head Start grantees in remote and frontier areas when
reviewing such grantees' compliance with health and dental screening
requirements as part of the designation renewal system.
Preschool Development Grants .-The agreement includes an increase of

$25,000,000 for Preschool Development Grants and expects these additional funds
to be managed in conjunction with funds appropriated in fiscal year 2019 that will
be awarded in December 2019.
Runaway and Homeless Youth.-The agreement includes $132,421,000 for

Runaway and Homeless Youth programs. Within 120 days of enactment of this
Act, ACF is directed to brief the Committees on the feasibility of coordinating with
the Department of Housing and Urban Development's ongoing study on the
incidence, prevalence, needs, and characteristics of youth homelessness and
housing instability, including geographic differences and vulnerable populations
that have not yet been studied.
Child Abuse Prevention and Treatment Act Infant Plans ofSafe Care.-The

agreement continues $60,000,000 to help States develop and implement plans of
safe care as required by section 106(b)(2)(B)(iii) of the Child Abuse Prevention
and Treatment Act. The agreement directs ACF to enhance its coordination with
States, especially those with high or increasing rates of neonatal abstinence
syndrome, and to brief the Committees on such effort within 90 days of enactment
of this Act.

114

Child Abuse Discretionary Activities.-The agreement includes $1,000,000 for
an additional year of grant funding for text- and online chat-based intervention and
education services through the Child Abuse Hotline.

Child Welfare Research, Training and Demonstration. - The agreement
continues the National Survey of Child and Adolescent Well-Being (NSCA W) and
encourages ACF to expand data collection as part of the current NSCA W cohort to
include information necessary to evaluate the impact of opioid and substance use
on children.

Adoption Opportunities .-The agreement includes an additional $1,000,000 to
continue the National Adoption Competency Mental Health Training Initiative,
and directs ACF to provide ongoing resources to a national organization with the
capacity and expertise to continuously evaluate and update the training
curriculums, that will provide all States, Tribes and territories the necessary
technical assistance to ensure that the curriculums are appropriately used by State
child welfare and mental health professionals.

Native American Programs.-The agreement includes $12,500,000 for Native
American language preservation activities, and not less than $4,500,000 for
language immersion programs 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.
Additionally, ACF is encouraged to convene a working group of Federal early
childhood program administrators, tribal early childhood stakeholders, and tribal
leaders to examine coordination issues that may be impacting early childhood
initiatives in tribal communities.

Community Services Block Grant.-The agreement notes that community action
agencies are well positioned to help address substance use disorders and provide
essential support and services for individuals and families who experience poverty.
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National Domestic Violence Hotline.· The agreement includes continued
support for the StrongHearts Native Helpline.

Program Administration.-The agreement expects ACF to work with the
Committees to develop a quarterly status of balances report at the level of detail
displayed in the table at the end of this statement.

PROMOTING SAFE AND STABLE FAMILIES

Kinship Navigator Programs.-The agreement includes $20,000,000 for
Kinship Navigator Programs to help build the evidence base in order for programs
to become eligible for mandatory funding available under the Family First
Prevention and Services Act (FFPSA).

Prevention Services Clearinghouse.-The agreement includes $2,750,000 for
the clearinghouse to increase the capacity to review research and evaluations of
programs intended to provide enhanced support to children and families and
prevent foster care placements. This in tum will increase the number of such
programs that may be eligible for funding under title IV-E of the Social Security
Act.

Regional Partnership Grants .-The agreement includes $10,000,000 for
Regional Partnership Grants (RPGs) and strongly encourages ACF to prioritize
applicants that will focus on preparing programs to qualify as evidence-based
foster care prevention services under FFPSA, including family-focused, residential
treatment programs and programs that mitigate the traumatic impact of parental
incarceration.

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ADMINISTRATION FOR COMMUNITY LIVING (ACL)
AGING AND DISABILITY SERVICES PROGRAMS

Protection of Vulnerable Older Americans.-The agreement includes a
$1,000,000 increase for expansion of the ombudsman program to assisted living
facilities.

National Family Caregiver Strategy.-The agreement includes $100,000 for the
Family Caregiving Advisory Council.

Aging Network Support Activities .-Within the total, the agreement provides
not less than $5,000,000 for the Holocaust Survivor's Assistance program.

Alzheimer's Disease Program.-The agreement includes up to $2,000,000 for
the National Alzheimer's Call Center and a $3,000,000 increase for expanding
direct services, including respite care, for paid and unpaid caregivers.

Elder Rights Support Activities .-Within the total, the agreement provides
$12,000,000 for the Elder Justice and Adult Protective Services program.

Paralysis Resource Center.-The agreement includes $9,700,000 for the
Paralysis Resource Center (PRC) and directs ACL to continue support for the
National PRC at not less than $8,700,000.

Developmental Disabilities State Councils. - ACL is instructed to provide not
less than $700,000 for technical assistance and training for the State Councils on
Developmental Disabilities.

Developmental Disabilities Protection and Advocacy.-Within 90 days of
enactment of this Act, ACL is directed to provide a report to the Committees, for
which the agreement provides sufficient funding, on the extent to which protection
and advocacy grantees currently provide legal, administrative, and other human
rights services to help individuals with disabilities understand and navigate their
respective State's Medicaid system, including rural and urban States with Medicaid
managed care arrangements.
117

Intermediate Care Facilities.-The Department is encouraged to factor the
needs and desires of patients, their families, caregivers, legal representatives, and
other stakeholders, as well as the need to provide proper settings for care, into its
enforcement of the Developmental Disabilities Act.

University Centers for Excellence in Developmental Disabilities.-The
agreement includes $1,000,000 to establish a pilot program to support partnerships
between existing University Centers for Excellence in Developmental Disabilities
and highly-qualified, non-profit service providers to develop models that offer
individuals with Intellectual and Developmental Disabilities and their families with
community-based adult transition and daytime services to support independent
living.

National Institute on Disability, Independent Living, and Rehabilitation
Research-The agreement provides $2,000,000 to continue projects as established
by Senate Report 115-289. Funding is provided to encourage investment in
research by universities and other eligible entities that seek to develop technologies
that allow for independent living, address the disabled aging populations, and
target rural, frontier, and tribal communities.

Assistive Technology.-The agreement includes a $1,000,000 increase for
formula grant funding through section 4 of the Assistive Technology Act.

118

OFFICE OF THE SECRETARY
GENERAL DEPARTMENTAL MANAGEMENT

Antibiotic Development.-The agreement encourages HHS to be closely
involved with the update of the National Action Plan for Combating Antibiotic
Resistant Bacteria. HHS shall include in the fiscal year 2021 Congressional
Justification a detailed update on progress implementing such plan.

Emergency Room Utilization.-HHS is encouraged to submit a report that
analyzes emergency room utilization at the State and national levels to be provided
to the Committees no later than one year after enactment of this Act. The report
should focus on non-emergency services while in the emergency room setting.

Evidence-based Grants and Policy.-The agreement requests an update in the
fiscal year 2021 Congressional Justification on implementation of the Foundations
for Evidence-based Policymaking Act and implementation plans for the coming
year.

Guidelines for Hair Testing.-The agreement directs the Secretary to report to
the Committees no later than 30 days after enactment of this Act on progress
establishing these guidelines.

Health Disparities .-Within 180 days of enactment of this Act, HHS shall
submit to the Committees an update of the Action Plan to Reduce Racial and
Ethnic Health Disparities. The update should include barriers to full
implementation and proposed remedies. The report should include the extent that
HHS programs collect, report, and analyze health disparities data based on race,
ethnicity, disability, and other characteristics for the population HHS programs
serve. The updated report shall include specific efforts to improve birth outcomes
for African-American women and children, including how to address implicit bias
in healthcare delivery and the health impacts of trauma associated with racism.

119

HIV Jnitiative.-The agreement fully funds the HIV Initiative and directs HHS
to provide a spend plan to the Committees no later than 60 days after enactment of
this Act, to include resource allocation by State. The agreement further directs
HHS to submit an initial evaluation of the program to the Committees no later than
one year after enactment of this Act.

Hospital Acquired Conditions .-The agreement supports an evaluation of the
efforts to reduce Hospital Acquired Conditions, outlined in House report 116-62,
and directs the Secretary to include the results of the evaluation in the
fiscal year 2021 Congressional Justification.

KidneyX - The agreement includes $5,000,000 for KidneyX and directs the
Secretary to submit a multi-year plan to the Committees, outlining possible prize
competitions in future years, no later than 180 days after enactment of this Act.

Lung Cancer in Women.-The agreement encourages the Secretary, in
consultation with DoD and VA, to conduct an interagency study to evaluate the
status of research on women and lung cancer and make recommendations for
additional research on the disparate impact oflung cancer in women who have
never smoked. The study should make recommendations regarding increased
access to lung cancer preventive services and strategic public awareness and
education campaigns related to lung cancer.

Maternal Mental Health-The agreement directs the Secretary to submit the
report requested under this heading in House Report 116-62 to the Committees no
later than 180 days after enactment of this Act.

National Alzheimer's Disease Plan.-The agreement encourages the Secretary
to prioritize the Advisory Council work to make recommendations to Congress and
to assist in coordinating the work of Federal agencies involved in Alzheimer's
research, care, and services.

120

National Vaccine Program Office.-The agreement urges the Secretary to
ensure that National Vaccine Program Office activities continue without
interruption within the Office of the Assistant Secretary for Health.

Nonrecurring Expenses Fund.-The agreement directs HHS to continue
implementing previously notified projects and prioritize obligations for the
following projects: Indian Health Services facilities, Cybersecurity, Food and Drug
Administration laboratory renovations, and the CDC National Institute for
Occupational Safety and Health facility.

Obligation Reports .-The agreement directs the Secretary to submit
electronically to the Committees an Excel table detailing the obligations made in
the most recent quarter for each office and activity funded under this appropriation
no later than 30 days after the end of each quarter.

Pediatric Kidney Disease.-The agreement encourages HHS to conduct a study
of pediatric dialysis costs to ensure that the data being collected by CMS is
accurate and report findings in the fiscal year 2021 Congressional Justification.

Prescription Drug Disposal.-The agreement supports expanded public access
to in-home methods to deactivate and dispose of prescription drugs that render the
controlled substance either unavailable or unusable for all practical purposes.

Regulation Reform.-The agreement directs the Secretary to include in the
fiscal year 2021 Congressional Justification any plan to repeal guidance documents
or any plans to repeal or revise regulations that the Department believes are
duplicative.

Research on Poverty.- The agreement includes sufficient funding to continue
the existing Poverty Research Center cooperative agreement and 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.
121

Safety in Health Care Facilities.-The agreement remains concerned about
safety in health care facilities and looks forward to continued conversations on this
matter.

Office of Minority Health (OMH)
Hispanic Serving Institutions .-The agreement urges OMH to enter into
cooperative agreements with Hispanic Serving Institution medical schools in
addition to existing agreements with Historically Black Colleges and Universities
medical schools. OMH shall submit a report on these efforts to the Committees
within 180 days of enactment of this Act.

Lupus Jnitiative.-The agreement provides an additional $250,000 for this
initiative. The agreement encourages OMH to continue to develop public-private
partnerships, validate existing action plans, and engage the lupus community in
order to facilitate the use and development of action plans to increase participation
in clinical trials for all minority populations at highest risk of lupus.

Office on Women's Health (OWH)
The agreement includes $4,100,000 to combat violence against women through
the State partnership initiative, an increase of $1,000,000 above the fiscal year
2019 enacted level. This program provides funding to State-level public and
private health programs to partner with domestic and sexual violence organizations
to improve healthcare providers' ability to help victims of violence and improve
prevention programs. The agreement directs OWH to account for geographical
diversification in decisions on additional awards.

122

Menstrual Hygiene Products .-The agreement directs OWH to commission the
study described in House report 116-62 in time to be submitted to Congress no
later than 180 days after enactment of this Act.

MEDICARE HEARINGS AND APPEALS

Appeals Backlog.-The agreement revises existing bill language to provide
flexibility for the Department to address current backlogs of appeals hearings, as well
as retain and recruit Administrative Law Judges at both agencies.

OFFICE OF THE NATIONAL COORDINATOR FOR HEALTH INFORMATION TECHNOLOGY
(ONC)

Patient Matching.-The general provision limiting funds for actions related
to promulgation or adoption of a standard providing for the assignment of a unique
health identifier does not prohibit efforts to address the growing problems faced by
health systems with patient matching. The agreement encourages HHS to continue
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. Additionally, the agreement directs
ONC, in coordination with other appropriate Federal agencies, to provide a report
to the Committees one year after enactment of this Act studying the current
technological and operational methods that improve identification of patients. The
report shall evaluate the effectiveness of current methods and recommend actions
that increase the likelihood of an accurate match of patients to their health care
data. Such recommendations may or may not include a standard for a unique
patient health identifier. The report shall include the risks and benefits to privacy
and security of patient information.
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PUBLIC HEALTH AND SOCIAL SERVICES EMERGENCY FUND

The agreement includes a program level of $2,737,458,000 for the Public
Health and Social Services Emergency Fund. This funding will support a
comprehensive program to prepare for and respond to the health and medical
consequences of all public health emergencies, including bioterrorism, and support
the cybersecurity efforts of HHS.

Infectious Diseases .-The agreement encourages the Assistant Secretary for
Preparedness and Response (ASPR) to delineate information on emerging
infectious diseases, pandemic influenza, and antimicrobial resistance investments
in its annual five-year budget plan for medical countermeasure development to
clarify how ASPR is considering such naturally occurring threats in relation to
other priority areas.

Medical Innovation for Disaster Response.-The agreement supports the
consideration of a Federally-funded research and development center, led by an
academic medical center, to improve medical response, training, and innovation,
specifically utilizing health information technology, unmanned aerial systems,
countermeasure delivery, and remote patient assessment and triage. ASPR shall
evaluate the potential for this mechanism and report findings to the Committees
within 180 days of enactment of this Act.

Small Molecule Anti-toxin Drugs .-The agreement urges the Department to
continue the development, clinical testing, and stockpiling of small molecule
anti-toxin drugs.

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Hospital Preparedness Program
High Consequence, Emerging, Infectious Disease Threats.-The agreement
provides $11,000,000 to continue the National Ebola Training and Education
Center and the ten regional Ebola and other special pathogen treatment centers.

Notification Requirements .-The agreement directs ASPR to notify the
Committees 30 days in advance of any announcement of a modification to the
hospital preparedness program (HPP) formula or funding for new activities or pilot
programs. The agreement notes that funding for HPP is provided for HPP
cooperative agreements and administrative activities that directly support the
mission of the program.

Regional Disaster Health Response System Demonstration Pilots .-The
agreement continues funding for current pilots. Before program expansion, and no
later than 90 days after enactment of this Act, the agreement directs HHS to
provide an evaluation of the pilot program and a plan for the Regional Disaster
Health Response System that does not duplicate current services.

Strategic National Stockpile
Public Health Emergency Medical Countermeasures Enterprise (PHEMCE).The agreement expects the next annual PHEMCE multiyear budget to include the
full costs of requirements, including baseline costs, new/anticipated requirements,
and replenishment costs associated to PHEMCE programs.

Strategic National Stockpile. - The agreement includes an increase and expects
that decisions continue to be approved by PHEMCE which provides an opportunity
for CDC and other Federal partners to maintain a strong and central role in the
medical countermeasures enterprise. The agreement directs ASPR to submit the
report requested in Senate Report 115-289 regarding maintaining coordination and
support for State and local public health departments within 60 days of enactment
of this Act. Further, ASPR is encouraged to work toward novel stockpiling
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concepts, to reduce the overhead required to maintain the pandemic stockpile, and
ensure that a safe, reliable supply of pandemic countermeasures is available.

GENERAL PROVISIONS

Prevention and Public Health Fund.-The agreement includes the following
allocation of amounts from the Prevention and Public Health Fund.

PREVENTION AND PUBLIC HEALTH FUND

FY 2020

Agency

Budget Activity

Agreement

ACL

Alzheimer's Disease Program...............................

$14,700,000

ACL

Chronic Disease Self-Management.......................

8,000,000

ACL

Falls Prevention..........................................

5,000,000

CDC

Breast Feeding Grants (Hospitals Promoting
Breastfeeding)....................................................

9,000,000

CDC

Diabetes.......................................................

52,275,000

CDC

Epidemiology and Laboratory Capacity Grants.....

40,000,000

CDC

Healthcare Associated Infections...........................

12,000,000

CDC

Heart Disease & Stroke Prevention Program.........

57,075,000

CDC

Million Hearts Program.....................................

4,000,000

CDC

Office of Smoking and Health................................

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128,600,000

FY 2020
Budget Activity

Agency
CDC

Agreement

Preventative Health and Health Services Block
Grants...........................................................

160,000,000

CDC

Section 317 Immunization Grants..........................

370,300,000

CDC

Lead Poisoning Prevention .............................. .

17,000,000

CDC

Early Care Collaboratives .......................... .

4,000,000

SAMHSA Garrett Lee Smith-Youth Suicide Prevention ......

12,000,000

The agreement modifies a provision related to salary caps.
The agreement modifies a provision related to contracts under section 338B of
the Public Health Service Act.
The agreement modifies a provision related to a report on staffing.
The agreement modifies a provision relating to donations for unaccompanied
alien children.
The agreement includes a provision limiting the use of funds for chang~s to
policy directives related to the unaccompanied alien children program.
The agreement includes a provision limiting the use of funds for unlicensed
shelters for unaccompanied alien children.
The agreement includes a provision requiring Congressional notification prior
to the use of influx facilities as shelters for unaccompanied alien children.
The agreement modifies a provision relating to Members of Congress and
oversight of facilities responsible for the care of unaccompanied alien children.

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The agreement includes a provision requiring monthly reporting of
unaccompanied alien children.
The agreement includes a new provision related to primary and secondary
school costs for eligible dependents of CDC personnel stationed in a U.S. territory.
The agreement includes a new provision for facilities and infrastructure
improvements for the National Institutes of Health.
The agreement includes a new provision for facilities and infrastructure
improvements for the Centers for Disease Control and Prevention.
The agreement includes a provision for Infectious Disease Rapid Response
Reserve Fund within CDC.
The agreement includes a provision rescinding unobligated balances.

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TITLE III
DEPARTMENT OF EDUCATION
SCHOOL IMPROVEMENT PROGRAMS

Homeless Children and Youth-The Department implemented a reorganization
of offices which in part altered the administration of the McKinney-Vento
program, recently strengthened in the reauthorization of the Elementary and
Secondary Education Act (ESEA). The Department shall brief the Committees no
later than 60 days after enactment of this Act on the resources currently being
devoted to monitoring compliance with ESEA accountability and State and local
report card provisions related to homeless children and youth and supporting State
educational agencies (SEA) and local educational agencies (LEA) in achieving and
maintaining compliance with such provisions; the internal support within other
program offices in the Department being provided to assist with administration of
the Education for Homeless Children and Youth (EHCY) program; and the
resources available for monitoring compliance with EHCY program requirements
at the SEA and LEA level.
Education for Native Hawaiians.-The agreement includes sufficient funding
for the Native Hawaiian Education Council.
Alaska Native Education Equity.-The Department is directed to make every
effort to ensure that grants are awarded well in advance of the school year, to
maximize grantees' ability to hire the necessary staff and have their programs in
place by the start of Alaska's school year in mid-August. The Department is
directed to ensure that Alaska Native Tribes, Alaska Native regional non-profits,
and Alaska Native corporations have the maximum opportunity to compete
successfully for grants under this program by providing these entities multiple
opportunities for technical assistance in developing successful applications for
these funds, both in Alaska and through various forms of telecommunications.
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Finally, the Department is encouraged to include as many peer reviewers as
possible who have experience with Alaska Native education and Alaska generally
on each peer review panel.
Student Support and Academic Enrichment (SSAE) Grants. - The Department
should examine State and local expenditures, outlined by specific authorized
activities, and provide information about the most common uses of funds, as well
as information about how LEAs plan to evaluate the effectiveness of their
activities. The Department also should study how SEAs are collecting data from
LEAs, including how States are verifying that funds are being used in an
authorized manner and, as applicable, in accordance with required comprehensive
needs assessments, and that LEAs are meeting the objectives and outcomes
described in their applications. The Department should publish reports on these
studies publicly and is encouraged to conduct such studies periodically as
appropriate. Finally, the agreement does not provide direction regarding guidance
on allowable uses of funds.
SSAE Technical Assistance and Capacity Building-The agreement expects
funds reserved for technical assistance and capacity building to be used strictly to
support SEAs and LEAs in carrying out authorized activities under this program.
In the fiscal year 2021 Congressional Justification, the Department shall provide
current and planned expenditures, and include a plan for how resources will be
spent to build the capacity of SEAs and LEAs and provide technical assistance.
The plan should include how resources will be spent helping SEAs and LEAs vet
evidence, implement evidence-based interventions, and incorporate evidence-based
SSAE activities into school improvement strategies.

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IND IAN EDUCATION

National Activities.-Within the total, the agreement includes no less than

$2,811,000 for Native American language immersion programs authorized under
section 6133 of ESEA. These funds should be allocated to all types of eligible
entities, including both new and existing language immersion programs and
schools, to support the most extensive possible geographical distribution and
language diversity. Further, the Department is directed to give the same
consideration to applicants that propose to provide partial immersion schools and
programs as to full immersion, as the local Tribes, schools, and other applicants
know best what type of program will most effectively assist their youth to succeed.
Special Programs for Indian Children - The President's budget request

includes up to $10,000,000 to expand the ability of families to choose high-quality
educational opportunities to meet the needs of Native youth. The Department shall
only pursue this initiative if supported by Tribes after Tribal consultation.
Accordingly, the Department is directed to include information on the planned use
of funds under the Special Programs for Indian Children program in the operating
plan required under section 516 of this Act, and to brief the Committees not less
than 3 0 days prior to posting any notice inviting applications under this program.

INNOVATION AND IMPROVEMENT

Education Innovation and Research (EIR). - Within the total for EIR, the

agreement includes $65,000,000 to provide grants for social and emotional
learning (SEL). Within 90 days of enactment of this Act, the Department is
directed to brief the Committees 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.

131

In addition, within the total for EIR, the agreement includes $65,000,000 for
Science, Technology, Education, and Math (STEM) and computer science
education activities. This could also include grants to SEAs, including in
partnership with non-profit organizations, for State-led efforts to implement,
replicate, or expand Statewide professional development programs. Within the
STEM and computer science set-aside, awards should expand opportunities for
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.
The agreement supports the Department's prioritization of computer science
education in fiscal year 2019 EIR grant competitions and the Department should
continue this in fiscal year 2020.

Grant Priorities.-There is significant demand from the field to test many types
of strategies and to examine promising techniques that can be scaled-up in
different settings. EIR should continue to support diverse and field-initiated
interventions. The Department is directed to brief the Committees on the fiscal
year 2020 funding opportunities available under this program, including any
specified priorities, not less than 30 days prior to releasing a notice inviting
applications.

Rural Set-Aside.-The Department is encouraged to take steps necessary to
ensure the set-aside is met and that EIR funds are awarded to diverse geographic
areas.

Charter Schools Program.-The agreement includes $140,000,000 for
replicating and expanding high-quality charter school models; $225,000,000 for
grants to State entities to support high-quality charter schools; and $60,000,000 for
facilities financing assistance, of which not less than $50,000,000 shall be for the
Credit Enhancement program. In addition, the agreement continues support for
developer grants to establish or expand charter schools in underserved,
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high-poverty, rural areas, as referenced in the joint explanatory statement
accompanying P.L. 115-245.

Arts in Education.-The agreement provides funding for each activity within
this program at no less than the fiscal year 2019 level.

Ready to Learn. - In addition to language in House Report 116-62, the
Department should refrain from making changes to the Ready to Learn program
that would impede or impair production and nationwide distribution of television
content, digital content, and supplemental materials through local public
telecommunications entities.

Supporting Effective Educator Development (SEED).-Within SEED, the
Department is directed to support professional development that helps educators
incorporate SEL practices into teaching, and to support pathways into teaching that
provide a strong foundation in child development and learning, including skills for
implementing SEL strategies in the classroom. Within 90 days of enactment of this
Act, the Department is directed to brief the Committees on plans for supporting
SEL within SEED. In addition, the Department shall provide notice to the
Committees at least seven days before grantees are announced.
In addition, the SEED program is an ideal vehicle for helping ensure that more
highly trained school leaders are available to serve in traditionally underserved
LEAs. Therefore, the Secretary shall use a portion of funds made available for
SEED to support the preparation of principals and other school leaders.
Finally, students in rural public schools and public schools serving high
percentages of Native students have particularly inequitable access to
accomplished teachers. The Department should strongly consider establishing a
priority for SEED projects addressing this issue and to increase the number of
teachers in such schools who have earned a nationally recognized advanced
credential.
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SAFE SCHOOLS AND CITIZENSHIP EDUCATION

Promise Neighborhoods.-The agreement includes $6,000,000 for additional
extension awards for grantees that received extension grants in fiscal year 2018
and have demonstrated positive and promising results. This funding is intended to
support the final phase-out of Federal support.

School Safety National Activities.-For fiscal year 2020, $10,000,000 is
provided for awards to SEAs, LEAs, or consortia of LEAs to increase the number
of qualified, well-trained counselors, social workers, psychologists, or other mental
health professionals that provide school-based mental health services to students.
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 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 Department is also directed to continue a demonstration project initiated in
fiscal year 2019 to test and evaluate innovative partnerships to train school-based
mental health professionals.
Demonstration projects and competitions to train and increase the number of
school-based mental health professionals support the implementation of
trauma-informed practices and other mental health supports in schools. Fostering
trauma-informed cultures in schools helps both students and staff succeed by
addressing the impacts of trauma; improves school capacity to identify, refer, and
provide services to students; can improve staff retention and help keep students in
school; and support learning environments where students feel safe, supported, and
ready to learn.
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Opioid Substance Use Disorder and Prevention.-The Department has
implemented a priority in grant competitions for projects addressing opioid
substance use disorder and prevention. More must be done to prevent opioid
substance use disorder by students and address the mental health needs of students
affected by opioid substance use disorder in their families or communities.

Project SERV-The Department should ensure that funding made available for
Project SERV grants is promptly awarded to eligible entities located in areas with
high rates of community violence to restore any learning environment that was
disrupted by a violent or traumatic crisis.

School Safety and Climate.-The Department is encouraged to partner with
outside experts and other Federal agencies as appropriate to develop best-practices
to improve school safety and school climate.

State and Federal Coordination on School Safety and Climate.-Many States
have researched and in some cases provided reports on the local needs and
solutions to maintain safe and welcoming school climates. The Department is
encouraged to review such reports and support SEAs, as authorized in ESEA.

School Safety Clearinghouse and Mental Health Services for Students.-The
Department is directed to brief the Committees within 90 days of enactment of this
Act on: (1) the progress made by the Department in identifying, assessing, and
disseminating evidence-based approaches to maintaining safe schools and positive
learning environments for all students, including establishing a clearinghouse for
such approaches; and (2) improving and expanding access to mental health
services for students.

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ENGLISH LANGUAGE ACQUISITfON
The Department is encouraged to help SEAs and LEAs make the best use of
funding within this program and other Department programs to support English
learners.
SPECIAL EDUCATION

Education Materials in Accessible Formats for Students with Visual
Impairments.-The agreement provides an increase of $500,000 and recognizes
the ongoing progress made with the tools and services provided under Educational
Technology, Media, and Materials that have allowed more than 620,000 students
with disabilities free access to more than 700,000 books in digitally accessible
formats. The Department is encouraged to continue to expand this program's reach
to K-12 students in underserved areas.

Promoting Development of Social Skills for Students with Disabilities.-Within
the total for Educational Technology, Media, and Materials, the agreement
includes $1,000,000 for a demonstration project to facilitate the development of
new educational strategies and programming for students with disabilities who
could benefit from social skills instruction. This should include utilizing new
technologies and evidence-based curriculums in instructional settings, including
advanced social robotics that integrate evidence-based practices to improve social
skills and generate positive educational outcomes in students with disabilities.

Medicaid Services. - Opportunities exist to streamline access to and improve
the quality of special education services, and steps should be taken to reduce
ad.ministrative barriers for providing health services in and in coordination with
schools. The Office of Special Education and Rehabilitative Services should
coordinate with the Centers for Medicare & Medicaid Services to develop training
and provide technical assistance to assist with billing and payment administration
for Medicaid services in schools.
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Special Olympics.-Within the total for Technical Assistance and
Dissemination, the agreement includes $20,083,000, an increase of $2,500,000
above the fiscal year 2019 funding level, to support activities authorized by the
Special Olympics Sport and Empowerment Act, including Project UNIFY.

REHABILITATION SERVICES

Vocational Rehabilitation State Grants.-The agreement directs the Secretary
to submit a report within 90 days of enactment of this Act to the Committees
evaluating any changes in trends in employment outcomes for individuals with
disabilities served by State vocational rehabilitation programs before and after the
implementation of the WIOA. The agreement directs the Secretary to ensure
appropriate State level implementation of the Rehabilitation Act, which may
include the Department providing technical assistance as necessary.

SPECIAL INSTITUTIONS FOR PERSONS WITH DISABILITIES

American Printing House for the Blind - The agreement includes $2,000,000,
an increase of $1,000,000, to continue and expand the Center for Assistive
Technology Training regional partnership established in fiscal year 2019.
National Technical Institute for the Deaf-The agreement includes $5,500,000
to continue the National Technical Institute for the Deaf s (NTID) existing regional
partnership in fiscal year 2020, intended to expand NTID's geographical reach and
improve access to postsecondary STEM education and employment for students
who are deaf or hard of hearing in underserved areas.
Gallaudet University.-The agreement includes $3,000,000, an increase of
$1,000,000, to continue the regional partnership established in fiscal year 2019
focused on early language acquisition for children from birth through age three
who are deaf or hard of hearing.
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CAREER, TECHNICAL, AND ADULT EDUCATION
The Department is encouraged to establish the on-line portal for career and
technical education students described in section 114(e)(7)(K) of the Carl D.
Perkins Career and Technical Education Act.
The Department is encouraged to work with the Departments of Defense,
Labor, and Commerce to develop a pilot project to increase the quality of and
participation in career and technical education programs that would help develop
the skilled workforce needed for new submarine construction.

STUDENT FINANCIAL ASSISTANCE

Pell Grants.-The agreement increases the maximum award by $150, to $6,345
in academic year 2020-2021.

Federal Work Study.-Within the total for Federal Work Study, the agreement
includes $10,051,000, for the Work Colleges program authorized under section
448 of the Higher Education Act (HEA).

FEDERAL DIRECT STUDENT LOAN PROGRAM ACCOUNT
The Department shall brief the Committees of jurisdiction within 45 days of
enactment of this Act on actions planned or taken: (1) to address and implement
recommendations outlined in a GAO report titled "Public Service Loan

Forgiveness: Improving the Temporary Expanded Process Could Help Reduce
Borrower Confusion" (GA0-19-595); (2) to simplify the Temporary Expanded
Public Service Loan Forgiveness (TEPSLF) application process so borrowers can
apply for TEPSLF at the same time as they apply for Public Service Loan
Forgiveness (PSLF); (3) to provide more information to borrowers denied TEPSLF
on the reason for the denial; (4) to conduct outreach to borrowers who may be
138

eligible for TEPSLF; and (5) to improve administration of the PSLF program,
including by implementing GAO's recommendations for that program.
STUDENT AID ADMINISTRATION

Ability to Benefit.-The Department shall issue guidance that serves as a simple
and clear resource for implementing Ability to Benefit at IHEs, which should
restate the updated definition of a career pathway program and contain answers to
frequently asked questions about program eligibility.

Student Loan Servicing.-The agreement includes $1,768,943,000 for Student
Aid Administration. The Department has stated that the implementation of the
Next Generation Servicing Environment (Next Gen) will address problems with
the current student loan servicing environment and improve accountability and
services for students, borrowers and families. However, full implementation of
Next Gen will take several years. In the interim, the Department should continue
to take steps to improve the current servicing environment.
In addition to continuing statutory requirements from fiscal year 2019, the
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agreement includes new provisions directing the Department to hold servicers
accountable for high-quality outcomes, noncompliance with Federal Student Aid
(FSA) guidelines, contract requirements (e.g., an understanding of Federal and
State law), and applicable laws, including misinformation provided to borrowers.
In addition to provisions ensuring accountability and high-quality service from

student loan servicers, the agreement also includes a new provision ensuring
similar expectations, as applicable, for all ofFSA's contractors. As part of this
effort, it is expected that FSA will monitor performance and service delivery at the
point of contact between contractors and borrowers, as applicable, to ensure such
accountability and high-quality service.

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The Department should ensure, consistent with current statutory requirements,
that the transition to Next Gen, including the Enhanced Processing Solution, does
not rely on a single-servicer model. In addition to the directives in House
Report 116-62, the agreement directs FSA to provide a detailed strategic plan for
Next Gen to the Committees within 180 days of enactment of this Act, accounting
for the cost of all activities associated with the full implementation of Next Gen,
including transition costs, and to conduct semiannual briefings to the authorizing
and Appropriations Committees.
The agreement directs the Department to continue to provide to the Committees
quarterly reports detailing its obligation plan by quarter for student aid
administrative activities broken out by servicer, Next Gen contractor and activity
and detailing performance metrics, total loan volume and number of accounts,
broken out by servicer, Next Gen contractor and for each private collection agency.

Free Application/or Federal Student Aid (FAFSA) Simplification and Data
Linkages. - The agreement supports efforts to further simplify the F AFSA and
verification process to reduce the burden on students and IHEs, including swift
implementation of recent legislative changes to the sharing of information between
the Department and Internal Revenue Service and ensuring all service members
and veterans can identify their status when they apply for student aid separate from
the dependency determination.

Return of Title IV Funds.-The Department is encouraged to pursue efforts to
simplify and streamline the return of title IV funds process for IHEs and students.

Student Aid Enforcement.-The Department shall include information in its
fiscal year 2021 Congressional Justification on staffing levels of the Student Aid
Enforcement Unit and actions taken by the unit, including the number and type of
actions opened, pending, and closed annually.

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Student Loan Cancellations and Discharges Reporting.-The Department
should continue to bolster transparency through the Federal Student Aid Data
Center by supplementing current reporting with, at a minimum, semiannual reports
beginning no later than 90 days after enactment of this Act, on each of the Federal
student loan cancellation and discharge programs. Each report should include the
total number of unique borrowers who have applied for a program or have been
identified under an applicable data match ("borrowers"), unique borrowers in
each applicable status (received, pending, approved, and denied), total loan balance
in each applicable status (received, pending, approved, and denied), median
amount discharged for each program, and percentage of unique borrowers subject
to any partial discharge. The Department should publish disaggregated information
by State, as possible, and make such information available publicly on the
Department's website.

Total and Permanent Disability. - The agreement directs the Department to
provide a report to the Committees within 180 days of enactment of this Act on
steps taken or planned to be taken to improve information provided to students
who are eligible for total and permanent disability discharge of Federal student
loans or service obligations, including strategies used to improve outreach to all
eligible borrowers and increase the number of qualifying individuals receiving
discharges.

Veterans Affairs Data Matching.-The Secretary shall provide a report not later
than 90 days after enactment of this Act to the Committees on the implementation
of the data matching system with the Department of Veterans Affairs to facilitate
the discharge of student loans for veterans with total and permanent disabilities.
Such report should include information about the number of veterans identified
through the matching program, the number of loans automatically discharged as
the result of the matching program, the number of loans discharged overall, and a
141

description of the barriers for veterans who may be eligible for a student loan
discharge for total and permanent disability but who have not received one, and
planned actions for eliminating such barriers for veterans.

HIGHER EDU CA TJON

Aid/or Institutional Development
Strengthening lnstitutions.-The Department is encouraged to support
programs at Institutions of Higher Education (IHE) that offer training programs
that lead to certificates or industry-recognized credentials in high-demand fields;
provide educational experiences that are closely aligned to actual workforce needs;
provide customizable and quality educational opportunities; and connect students
to comprehensive educational offerings that provide students with other essential
skills.
Postsecondary Programs for Students with Intellectual Disabilities
The agreement includes $11,800,000 to carry out activities under title VII,
part D, subparts 2 and 4 of the HEA. Funds will be used by the Department to hold
a new competition to build on the important work that has been done to develop
postsecondary opportunities for students with intellectual disabilities through
model projects and the National Coordinating Center (NCC), and to expand the
work of the NCC to conduct research to identify effective strategies used by
postsecondary programs for students with intellectual disabilities that lead to
positive employment and independent living outcomes.

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Federal TRIO Programs
The Department is directed to allocate any grant funding not needed for
non-competitive continuation awards or for programs up for re-competition in
fiscal year 2020 to provide inflationary increases for current grantees and to
increase the number and size of new awards in the Student Support Services grant
competition. The Department is further directed to include proposed funding levels
for each of the TRIO programs in the operating plan required under section 516 of
this Act. There is great concern and disappointment that the Department has yet to
issue a notice inviting applications for new awards for TRIO Student Support
Services grants. The Department is directed to publish such notice inviting
applications for new awards for TRIO Student Support Services grants no later
than December 30, 2019 and take steps necessary to award funding as early as
possible before the beginning of the academic year.

Gaining Early Awareness and Readiness for Undergraduate Programs (GEAR
UP)
The agreement notes concerns over the competition schedule for GEAR UP
State and partnership grants. The agreement directs the Department to uphold the
long-standing guidance that States may only administer one active State grant at a
time. The Secretary is directed to provide written guidance in the Federal Register
notifying applicants that only States without an active State grant, or States that
have an active State grant that is scheduled to end prior to October 1, 2020, will be
eligible to receive a new State award funded in whole or in part by this
appropriation. The agreement directs the Department to provide a briefing to the
Committees within 90 days of enactment of this Act on this program and any
planned competitions for fiscal year 2020.
143

Fund for the Improvement of Postsecondary Education
The agreement includes $24,500,000 for FIPSE, to remain available through
December 31, 2020, for the following activities.

Career Pathways.-The agreement includes $10,000,000 for grants to expand
and improve career pathways opportunities for students beginning in high school.
These grants should support the creation of sustainable, evidence-based career
exploration and guidance systems that promote multiple pathways to
postsecondary and career success.

Centers ofExcellence for Veterans Student Success Program.-The agreement
includes $7,000,000 for the activity described under the heading "Fund for the

Improvement of Postsecondary Education " and as set out in the paragraphs
associated with the Centers of Excellence for Veterans Student Success Program in
House Report 116-62.

Open Textbook Pilot.-The agreement includes $7,000,000 to continue the
Open Textbook Pilot and fund a new grant competition in fiscal year 2020. The
Department shall issue a notice inviting applications consistent with notice and
comment procedures and allow for a 60-day application period. This funding
should support a significant number of grant awards to IHEs as defined by 20
U.S.C. 1001, a group ofIHEs, or State higher education agencies that lead the
activities of (and serve as fiscal agent for) a consortium. Funding should be used to
create new open textbooks and expand the use of open textbooks in courses that
are part of a degree granting program, and particularly those with high enrollments.
Allowable uses of funds should include professional development for faculty and
staff, including relating to the search for and review of open textbooks; the creation
or adaptation of open textbooks; development or improvement of tools and
informational resources that support the use of open textbooks, including
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accessible instructional materials for students with disabilities; and research
evaluating the efficacy of the use of open textbooks for achieving savings for
students and the impact on instruction and student learning outcomes. The
Secretary shall require that any open textbooks created with these funds shall be
released to the public under a non-exclusive, royalty-free, perpetual, and
irrevocable license to exercise any of the rights under copyright conditioned only
on the requirement that attribution be given as directed by the copyright owner.
Further, any tools, technologies, or other resources that are created, developed, or
improved wholly or in part with these funds for use with any open textbook must
be similarly licensed. Any eligible entity receiving a grant through the Open
Textbooks Pilot, upon completion of the supported project, shall report to the
Secretary regarding the effectiveness of the project in expanding the use of open
textbooks and in achieving savings for students; the impact of the project on
expanding the use of open textbooks at IHEs outside of the institution receiving the
grant; open textbooks created or adapted under the grant, including instructions on
where the public can access each open textbook; the impact of the project on
instruction and student learning outcomes; and all project costs, including the value
of any volunteer la!Jor and institutional capital used for the project. The Secretary
shall make such reports publicly available.

National Center for Information and Technical Support for Postsecondary
Students with Disabilities .-The agreement includes $500,000 for the operation of
the National Center for Information and Technical Support for Postsecondary
Students with Disabilities authorized under section 777(a) of the HEA.

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HISTORICALLY BLACK COLLEGE AND UNIVERSITY
CAPITAL FINANCING PROGRAM ACCOUNT
The agreement includes $46,484,000 for the Historically Black College and
University (HBCU) Capital Financing program account. Using updated economic
assumptions from the Department of Education, the funding provided for private
loan deferments more accurately reflects those needs and continues all current loan
deferments. The agreement includes additional funding and new bill language for
the deferment of outstanding loans for public HBCUs. Further, the agreement
directs the Department to provide such funding based on the quality of applications
received and to prorate funds across all eligible schools.

INSTITUTE OF EDUCATION SCIENCES (IES)

Assessment.- The agreement supports assessments for students in United States
History and Civics. The National Assessment Governing Board (NAGB) is
directed to continue administering assessments in these two areas, at least every
4 years, in accordance with the current National Assessment of Educational
Progress (NAEP) schedule. The agreement notes concern with recent changes to
the proposed NAEP schedule, some of which differ from the schedule outlined in
the fiscal year 2020 budget request, which proposed a reduction in funding for
assessments that is part of the explanation for the modified assessment schedule.
The Department and NAGB are directed to provide a briefing to the Committees
within 45 days of enactment of this Act on the proposed changes and estimated
funding needed to maintain the schedule outlined in the fiscal year 2020 budget
request.

Second Chance Pell.-The agreement directs IES to conduct a rigorous
evaluation of the Second Chance Pell Experiment as announced in the Federal
Register (Volume 80, Number 148 on Monday, August 3, 2015) and work with the
146

Department's Policy and Program Studies on this effort. The agreement directs IES
to submit the evaluation to the Committees within 30 days of completing the
evaluation. The agreement also directs the Department to report no later than 90
days after the enactment of this Act on the implementation of GAO's
recommendation in its April 2019 report, "Federal Student Aid: Actions Needed to

Evaluate Pell Grant Pilot for Incarcerated Students" (GA0-19-130).

DEPARTMENTAL MANAGEMENT

Bureau ofIndian Education (BIE) Compliance with ESEA. - The Department
shall provide a report to the committees of jurisdiction within 180 days of
enactment of this Act on how it evaluates the BIE's compliance with ESEA.

Civil Rights Data Collection (CRDC).-The agreement is concerned with the
proposed elimination of key data elements from the 2019-20 CRDC that could
impede efforts to identify and address inequities in educational resources and
outcomes. Further, the agreement is concerned that the Department did not first
review or evaluate the 2017-18 CRDC collection before proposing the elimination
of these elements. As the CRDC is used to monitor and enforce equal opportunity
in education, the agreement is concerned that the Department's rationale for
elimination focused on reducing regulatory burden while not including a
comprehensive analysis of whether eliminating certain data elements would
negatively impact the ability to understand or address civil rights issues in our
nation's schools. The agreement directs the Department to provide a briefing to
the appropriations and authorizing Committees within 90 days of enactment of this
Act on the proposed changes, how the changes reflect civil rights enforcement
needs, information on the comments received on the proposal, an evaluation of the
2017-18 CRDC, and any impact on the mission and purpose of the CRDC and the
Office for Civil Rights.
147

Competitions.-The agreement notes long-standing concern regarding the
Department's failure to issue notices inviting applications for competitive grant
competitions in a timely manner. Such delays often result in a significant number
of programs awarding grants in the final weeks of the fiscal year. Moreover, these
delays have occurred for enduring, authorized programs for which there is
sufficient funding history to believe appropriations will continue. The Department
is directed to brief the Committees no later than 60 days after enactment of this Act
on steps it has taken or will take to issue notices earlier in fiscal year 2020 and
subsequent years.

Computer Science Education.-The agreement supports the Department's
prioritization of computer science education in fiscal year 2019 grant competitions
and supports this focus in fiscal year 2020.

Department ofInterior Schools.-The Departments of Education and Interior
are commended for their efforts to improve the lives of American Indian students
through a quality education. However, more should be done to improve the
long-documented issues facing Department of Interior schools. The Departments
of Education and Interior are encouraged to continue to work together to improve
the quality of education opportunities offered to Indian youth.

Disaster Recovery.- Funding awarded under the Bipartisan Budget Act of
2018 (P .L. 115-123) is available for obligation through fiscal year 2022, in part to
address potentially lengthy recovery efforts. As grantees have experienced both
expected and unexpected challenges that have slowed the expenditure of funds , the
agreement strongly encourages the Department to extend the time grantees
awarded funds in 2018 currently have to expend funds, as applicable, consistent
with the terms of section 21208(b) of such Act.

Disclosures ofForeign Gifts and Contracts.-The agreement notes that
section 11 7 of the HEA requires IHEs to disclose certain gifts from or contracts
148

with foreign entities and that the Department makes such information publicly
available on its website. Such disclosures are critical to ensure adequate oversight
and transparency. The agreement directs the Department to engage with IHEs to
ensure requirements under section 117 are clear and to provide guidance to IHEs to
ensure they are aware of their responsibilities. As the Department provides
guidance on this issue or modifies reporting methods or requirements, IHEs should
be given adequate time to ensure proper reporting. The Department should brief
the Committees within 45 days of enactment of this Act on efforts to engage with
the stakeholder community, efforts to provide greater guidance and clarity on
reporting requirements, and any additional information on agency efforts to
comply with such section.

Diverse Geographical Distribution of Grants.-The Department is encouraged
to continue efforts to ensure that competitive grants are distributed among eligible
entities that serve geographically diverse areas, including urban, suburban, and
rural areas. It is critical that support and solutions developed with Federal funding
are relevant to and available in all areas consistent with authorizations of Federal
programs.

Evidence-Based Grant Making-The Secretary should use demonstrated
evidence of effectiveness as part of the selection criteria through its Education
Department General Administrative Regulations, consistent with authorizations,
for all competitive grant programs. Non-competitive formula grant funds have a
range of evidence requirements and preferences which the Department is directed
to support through enhancements to its technical assistance and support
activities.

Foundations for Evidence-Based Policymaking-Faithful execution of the
Foundations for Evidence-based Policymaking Act will enhance the evidencebuilding capacity of Federal agencies, strengthen privacy protections, improve
149

secure access to data, and ultimately provide more and higher quality evidence to
policymakers. The Department shall provide updates on its implementation of the
law and plans for the coming year in its next and subsequent Congressional
\

Justifications.

GAO Report on Teacher Shortages.-The agreement requests GAO provide a
report to the Committees on trends and factors contributing to school districts' '
challenges with teacher recruitment and retention. The report should include a
review and analysis of challenges recruiting and retaining special education
teachers, paraprofessionals, and teacher aides; the extent to which licensure
requirements are waived or modified to address shortages; and geographic and
demographic characteristics of districts facing the greatest challenges or shortages,
including rural and urban areas. 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.

Human Resources.-The agreement is concerned about the full-time equivalent
employment differences between the Department's Congressional Justifications
and actual on-board staffing reports. The agreement notes an increase in the
number of separations and hiring challenges at the Department. The agreement
requests an update in the fiscal year 2021 Congressional Justification on the
activities the Department has undertaken or will undertake to ensure adequate
staffing levels are achieved for the Department to meet its obligations. The
Committees request periodic updates on this effort.

Seclusion and Restraint Data.-The agreement strongly urges the Assistant
Secretary for the Office for Civil Rights to take immediate steps in the ongoing
2017-2018 CRDC to improve the accuracy of the data, to remind and clarify for all
schools and school districts to only report zero incidents of seclusion and' restraint
150

when no incidents have occurred, to leave cells blank for missing or incomplete
data, and to contact schools and school districts that already submitted data for the
2017-2018 CRDC and verify the accuracy of the data. Finally, the agreement
strongly urges the Assistant Secretary to monitor compliance with action plan
requirements for missing data, and ensure plans are submitted and address all
missing data. The agreement requests an update on these efforts in the
fiscal year 2021 Congressional Justification.

GENERAL PROVISIONS

The agreement continues authority for pooled evaluation authority.
The agreement modifies a provision regarding endowment income.
The agreement continues authority for the National Advisory Committee on
Institutional Quality and Integrity.
The agreement continues authority for account maintenance fees.
The agreement modifies a provision rescinding unobligated discretionary
balances previously appropriated for the Pell grant program.
The agreement modifies a provision rescinding fiscal year 2020 mandatory
funding to offset the mandatory costs of increasing the discretionary Pell award.
The agreement includes a new provision modifying the name of the 21st
Century Community Leaming Centers program.
The agreement includes a new provision modifying existing authority relating
to cohort default rates for a period of two years.
The agreement includes a new provision related to the Department of Education
Organization Act.
The agreement modifies a provision related to loan forgiveness opportunities
for borrowers.

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TITLE IV
RELATED AGENCIES
COMMITTEE FOR PURCHASE FROM PEOPLE WHO ARE BLIND OR SEVERELY DISABLED
The agreement includes an additional $1,350,000 for the one-time costs
associated with a move of the headquarters office.

CORPORATION FOR NATIONAL AND COMMUNITY SERVICE (CNCS)
OPERA TING EXPENSES

Innovation, Assistance, and Other Activities.-The agreement includes
$9,600,000 for innovation, assistance, and other activities. The agreement includes
$6,400,000 for the Volunteer Generation Fund, $2,100,000 for the
September 11th National Day of Service and Remembrance and $1,100,000 for the
Martin Luther King, Jr. National Day of Service.

Commission Investment Fund.-The agreement includes no less
than $8,500,000.

Fixed Amount Grants .-CNCS is encouraged to expand opportunities for
AmeriCorps programs to utilize fixed amount grants, which could reduce
unnecessary administrative burdens on current and potential AmeriCorps
programs. Further, CNCS is encouraged to increase the current maximum cost per
member service year of fixed amount grants to make it more comparable to cost
reimbursement grant levels and allow new AmeriCorps programs to be eligible to
apply for full-time fixed amount grants, while also ensuring that fixed amount
grantees provide a comparable amount of matching funds and that there is
sufficient oversight and accountability of fixed amount grantees.

Professional Corps .-CNCS is directed to include a determination of need by
the local community among the factors that a professional corps program may use
to demonstrate an inadequate number of professionals in a community. Further,
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CNCS is strongly encouraged to increase the maximum amount of operating funds
per member service year a professional corps program may request as part of their
grant application. Finally, CNCS is directed to provide professional corps
programs flexibility in justifying the need for operating funds to ensure that these
programs are able to provide high-quality services in all communities.

Transformation and Sustainability Plan.-There is concern with CNCS'
transformation and sustainability plan (TSP), particularly related to moving from a
State office to regional office structure. CNCS is directed to ensure that TSP does
not create degradation in services, technical assistance, or support for local
community service programs, particularly those operating in under-served and rural
areas, and to provide periodic briefings to the Committees on steps taken to ensure
that service is maintained. Further, the CNCS is directed to provide a report within
30 days of enactment of this Act to the Committees. Such report should contain
information on the metrics used and factors considered in determining the new
regions and the location of regional offices; a complete analysis of all costs and
savings associated with the transition to regional offices, including any increased
travel or training costs; a description of other field structures considered; and a
detailed response to each of the risk factors identified by the OIG. Finally, CNCS is
encouraged to evaluate and consider adding additional regional offices as
appropriate if it is determined that offices would enhance support for local
community service programs.

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CORPORATION FOR PUBLIC BROADCASTING (CPB)
The bill removes unnecessary language related to the Television Future Fund as
no such fund exists. All operation of the Television Future Fund ceased after a
2004 GAO report titled "Issues Related to Federal Funding for Public Television

by the Corporation/or Public Broadcasting" (GA0-04-284) determined activities
were done in an unauthorized manner. The agreement expects CPB to fully comply
with all statutory requirements for the allocation and distribution of appropriated
funds.

INSTITUTE OF MUSEUM AND LIBRARY SERVICES
Within the total for the Institute of Museum and Library Services, the
agreement includes funds for the following activities:
FY 2020
Agreement

Budget Activity
Library Services Technology Act:
Grants to States ............................ ........ ........... .

$166,803 ,000

Native American Library Services .............. ... .

5,263,000

National Leadership: Libraries ....................... .

13 ,406,000

Laura Bush 21 st Century Librarian ........ ......... .

10,000,000

Museum Services Act:
Museums for America ....... ............... .............. .

25 ,899,000

Native American/Hawaiian Museum
Services ............................ .............................. .

1,772,000

National Leadership: Museums ...................... .

8,113,000

African American History and Culture Act:
154

FY 2020
Agreement

Budget Activity
Museum Grants for African American
History & Culture ....................................... ..

2,731,000

Research, Analysis, and Data Collection .......... .

3,013,000

Program Administration ........................... .

15,000,000

TOTAL ............................................... .

252,000,000

MEDICAID AND CillP PAYMENT AND ACCESS CO:MMISSION (MACPAC)

Non-Emergency Medical Transportation (NEMT).-Within the amount
provided, the agreement provides $300,000 for MACPAC to examine, to the extent
data are available, the benefits ofNEMT from State Medicaid programs on
Medicaid beneficiaries, including beneficiaries with chronic diseases including end
stage renal disease (ESRD), substance abuse disorders, pregnant mothers, and
patients living in remote, rural areas, and to examine the benefits of improving

-- - 1ocarcoorclimit'ion ofNEMT witfi pu6licfransportatioii-aii3-otliefF efferally=-=----- "----assisted transportation services. The agreement directs HHS to take no regulatory
action on availability of NEMT service until the study is completed.

NATIONAL LABOR RELATIONS BOARD (NLRB)

The agreement notes concern regarding NLRB personnel and obligation
practices. Such practices have contributed to significant underspending on
personnel costs. As a result of these practices, NLRB has had higher than historical
funding lapses for the past two fiscal years. The October 2019 Inspector General

"Top Management and Pe,formance Challenges" memorandum included in NLRB
fiscal year 2019 Performance and Accountability Report identifies NLRB' s current
155

methodology for determining the workforce capacity needed to process cases as a
key challenge to the Board's ability to ensure the quality of its investigative work
product and maintain a highly motivated workforce.
The agreement directs NLRB to address this challenge by posting position
openings to restore critical field staff capacity and to more aggressively fill
vacancies in fiscal year 2020, including the remaining open regional director
positions. To ensure NLRB makes progress toward addressing this issue, the
agreement directs the Board to expand the number of regional full-time equivalent
staff beyond the amount on-board at the end of the fourth quarter of fiscal
year 2019. Within 90 days of enactment of this Act, NLRB is directed to brief the
Committees on its plans for addressing these critical hiring challenges.
Further, NLRB is directed to submit a report to the Committees within 90 days
of enactment of this Act detailing the resources dedicated to regional offices. Such
report should include actual and planned data, as applicable, for fiscal years 2011
through 2021 : ( 1) the number of employees stationed in each regional office and
(2) administrative expenses by object class for each regional office. In addition, the
agreement directs the Board to provide monthly staffing reports to the Committees.
Such staffing reports should include the total number of employees in each
position for each regional office, attrition for each office, new hires for each office,
and any information on plans to incentivize or encourage employee separations.

156

RAILROAD RETIREMENT BOARD
LIMITATION ON ADMINISTRATION

The agreement includes $10,000,000 for the implementation of information
technology systems modernization efforts.

GAO Review.-The agreement requests GAO conduct a management review of
the Railroad Retirement Board, including, financial management practices,
regional office structure and workforce planning needs, oversight of programs, and
any other matters GAO considers relevant.

SOCIAL SECURITY ADMINISTRATION

(SSA)

LfMITATION ON ADMIN ISTRATIVE EXPENSES

The agreement includes an increase of $100,000,000 for SSA's base
administrative expenses for additional hires and resources to improve public
service at SSA field offices and direct service operations.

Continuing Disability Reviews.-The agreement directs SSA to include in its
next continuing disability review (CDR) report to Congress an evaluation of its
CDR prioritization models and a cost-benefit analysis of how it uses estimated
savings in determining which beneficiaries receive a full-medical CDR.
Additionally, the agreement requests in the fiscal year 2021 Congressional
Justification, the process by which SSA intends to pace its CDR workload to
properly manage Limitation on Administrative Expenses funding.

Disability Case Processing System (DCPS) .-SSA is encouraged to engage
with States to explore all possible options for modernization of the case processing
system, to align with the needs of each State, so long as such options have similar
or better functionality as DCPS, similar or lower costs to DCPS, and are consistent
with Federal procurement and security standards. SSA should continue to provide
regular updates on the effort to upgrade DCPS, including the cost and anticipated
157

timeline of the project, and efforts by SSA to engage stakeholders, including any
barriers to implementation.

Disability Hearings Backlog-The agreement encourages SSA to include
comprehensive information in its existing reports to Congress on the specific
policies SSA has implemented, or has considered, to streamline the disability
determination and adjudication process. When considering or implementing
changes, SSA should ensure due process, and that applicants have a full and
adequate opportunity to present their claims.

Field Office Closures.-While SSA's Inspector General reviews decisions to
close field offices, the Commissioner is strongly encouraged to take every action
possible to maintain operations at the offices under review. SSA is expected to
support front line operations. As part of the fiscal year 2021 Congressional
Justification, SSA should include a plan to identify opportunities for improved
field office operations. Finally, SSA is strongly encouraged to ensure its policies
and procedures for closing field offices include at least 120 days advance notice to
the public, SSA employees, Congress, and other stakeholders. Such notice should
include a rationale for the proposed closure and an evaluation of the effects on the
public and SSA operations.

Mail and Printing Systems.-SSA is encouraged to consider and evaluate
modernization of its mail and printing systems and contracts that could result in
budgetary savings while improving fraud prevention. The agreement requests a
briefing for the Committees within 180 days of enactment of this Act on current
mailing and printing systems and contracts, including systems or contracts relating
to Social Security Cards, and any ongoing efforts to modernize or otherwise
improve such systems.

158

Medical Vocational Guidelines.-The agreement directs SSA to provide a
report to the Committees within 90 days of enactment of this Act on its plan and
timetable for updating and modernizing medical vocational guidelines and to
engage appropriate Committees of jurisdiction prior to making any changes to such
guidelines.

Telework.-SSA is urged to develop a telework plan for Operations employees
as quickly as practicable and to brief the Committees on the status of efforts to
reinstate telework within 60 days of enactment of this Act.

Video Hearings.-The agreement reiterates the language included under this
heading in House Report 116-62, and directs SSA to provide an update in the fiscal
year 2021 Congressional Justification detailing the extent to which SSA meets best
practices outlined by the Administrative Conference of the U.S., and the extent to
which SSA video hearings, policies, and practices are accessible to individuals
with disabilities.

Work Incentives Planning and Assistance (WIPA) and Protection and Advocacy
for Beneficiaries of Social Security (PABSS).-The agreement includes
$23,000,000 for WIPA and $7,000,000 for PABSS.

159

TITLE V
GENERAL PROVISIONS

The agreement modifies a provision related to reports on non-competitive
contracts, grants and cooperative agreements.
The agreement modifies a provision related to Performance Partnerships.
The agreement includes a new provision related to grant notifications.
The agreement includes a new provision related to questions for the record.
The agreement includes a provision rescinding various unobligated balances.

160

LABOR , HEALTH AND HUMAN SERVICES , EDUCATION, AND RELATED AGENCIES APPROPRIATIONS ACT , 2020
(Am ounts in thousands)
FY 2019
Ena c ted

FY 2020
Request

Final Bill

133,556
(712,000)
712,000

133,556
(712,000)
712,000

142 , 649
(712,000)
712 , 000

845 , 556

845,556

854 , 649

903 , 416

903 , 416

913 , 130

+9,714

+9 , 714

180 , 860
( 860 , 000)
860 , 000

180 , 860
(860 , 000)
860 , 000

192,053
( 860,000)
860,000

+11, 193

+11 , 193

Final Bill
vs Enacted

Final Bill
vs Request

TITLE I - -DEPARTMENT OF LABOR
EMPLOYMENT AND TRAINING ADMINISTRATION

Training and Employment Services
Grants to States :

Adult Training , c urrent year .
Advance from prior year ...... . . . . . . . . .. . . . . . . .
FY 2021 advance ..

-------- ------ -------------- ------- --- ---Subtotal ....... . •• .• . .. . . . •.. .. . .• .. • • . •• .

Youth Training .

Di s located Worker As sistance, c urrent year .
Advan ce from prior year .
FY 2021 advanc e . . .

-------------- -- -- --- --- --- - -------- -- -- -Subtotal .... .

1 , 040 , 860

1 , 040,860

1 , 052 , 053

-------------- -- ---- -------- ----- -- -- --- -Subtotal , Grants to States ...
Current Ye ar.
FY 2021 advance .

2,789,832
(1 , 217 , 832)
( 1 , 572, 000)

2 , 789,832
(1,217,832)
(1 , 572 , 000)

2 , 819 , 832
(1,247,832)
(1 , 572,000)

+9 , 093

+9,093

-------------- -------------+9,093

+9 , 093

----------- --- ---------- ---+11 , 193

+11, 193

-------------- -------------+30,000
(+30 , 000)

+30,000
( +30, 000)

'

LABOR , HEALTH AND HUMAN SERVICES, EDUCATION, AND RELATED AGENCIES APPROPRIATIONS ACT, 2020
(Amounts in thousands)
FY 2019
Enacted

FY 2020
Request

Final Bill

20,859
(200,000)
200 , 000

20,859
(200 , 000)
113,858

70,859
(200,000)
200 . 000

+50,000

Final Bill
vs Enacted

Final Bill
vs Request

National Programs :

Dislocated Worker Assistance National Reserve :
Current year .. ...
Advance from prior year.
FY 2021 advance .

---- ---------- -------------- -------------Subtotal . . .. .

Subtotal , Dislocated Worker Assistance.
Native Ameri c an programs . .......... .

Mi grant and Seasonal Farmworker programs.
YouthBuild activities ....
Reintegration of Ex-Offenders . . .
Workforce Data Quality Initiative ... ..... .
App rent iceshi p programs.
Total , National Programs . .
Current Year .
FY 2021 advance .... .. . . . . • ..• . . .. .. • .. • ...

+50 , 000
+86,142

220,859

134,717

270 . 859

+50,000

+136 , 142

1,261 , 719

1 , 175,577

1,322,912

+61 , 193

+147 , 335

54,500
88,896
89 , 534
93 , 079
6,000
160,000

84 , 534
78,324

+500
+3,000
+5 , 000
+5,000

160,000

55,000
91,896
94,534
98 , 079
6,000
175 , 000

+55,000
+91,896
+10 , 000
+19,755
+6 , 000
+15,000

712 , 868
(512,868)
(200,000)

457,575
(343,717)
(113,858)

791,368
(591 , 368)
(200,000)

-------------- -------------- --------------

+15 , 000
+78 , 500
(+78 , 500)

+333 , 793
(+247 , 651)
(+86, 142)

/G 2

LABOR , HEALTH AND HUMAN SERVICES, EDUCATION , AND RELATED AGENCIES APPROPRIATIONS ACT , 2020
(Amounts in thousands)
FY 2019
Enacted

Total , Training and Employment Services ( TES ) ...
Current Year . ............
........
FY 2021 advance .. . . .
....... .

FY 2020
Request

Final 8111

---·· ------ -- - -------------- -------------3,502, 700
(1,730,700)
( 1 , 772 , 000)

3,247,407
(1,561,549)
(1,685,858)

3 , 611 , 200
( 1 , 839,200)
(1 , 772 , 000)

Final Bill
vs Ena cted

Final Bill
vs Request

-------------- -------------+108 , 500
(+108,500)

+363,793
(+277, 651)
(+86 , 142)

Job Corps

Operations .
. .... . .. . . .
Construction, Rehabilitation and Acquisition . .....
Admi ni st rat ion.
..............

1 , 603,325
83,000
32,330

908,457
75,016
32,110

1,603,325
108,000
32,330

1 , 015,583

1 , 743,655

+25,000

+728,072

405,000

+5,000

+405 , 000

680,000

-110,000

---------- ---- -------------- --------------

Total, Job Corps.

1,718 , 655

Community Service Emp1 oyment For 01 der Ameri cans.

400 , 000

Federal Unemployment Benefits and Allowan c es
(indefinite) .... ..... .
.......

790 , 000

.. . . . .

680,000

+25 , 000

+694 , 868
+32,984
+220

-------------- --------------

IG3

LABOR , HEALTH AND HUMAN SERVICES, EDUCATION , AND RELATED AGENCI ES APPROPRIATIONS ACT , 2020
(Amounts in thousands)
FY 2019
Enacted

FY 2020
Request

Final Bill
Final Bill

vs Enacted

Final Bi 11
vs Request

State Unemployment Insu ranee and Employment
Service Ope rat i ans
Unemployment Compensation (UI):
State Operations.
Ree mploy ment eligibility assessments- - UI integrity
Permissible cap adjustment ... . ..
. ........ .
UI Integrity Center of Excellence . .

2 , 356,816
117,000
33,000
9,000

2,434,230
117 , 000
58,000
6,000

2 , 356 , 816
117,000
58,000
9,000

------- ------- ----- -- ------- --- ----------Subtotal , Unemp 1oyment Campen sat ion . ..

Federal-State UI

Natio nal Activities.

Employment Service (ES):
Grants to States:
Federal Funds.
Trust Funds ...
Subtotal, Grants to States.
ES National Activities . .. .

2 , 515 , 816

2,615,230

2,540,816

12,000

48,000

12 , 000

21,413
641 , 639

------------- 663,052
19,818

21 , 413
641 , 639
---- -- -------663,052
19 , 818

21,413
646,639

---- ---- -- ---668,052
22 , 318

--- --- ------- - ------------ -- ------------ -Subtotal , Employment Service.
Federal Funds.
Tr ust Funds ..... . .

682,870
(21,413)
(661 , 457)

682,870
(21,413)
(661 , 457)

690,370
(21,413)
(668,957)

-77, 414
+25 , 000
+3 , 000

-- ------------ ----------- --+25,000

- 74,414
-36,000

+5,000
---------- - --+5 , 000
+2,500

+5 , 000

--------- ----+5,000
+2,500

-- ------- ----- ------- ------+7,500

+7,500

(+7 , 500)

(+7,500)

(Ge;

LABOR, HEALTH AND HUMAN SERVICES , EDUCATION , AND RELATED AGENCIES APPROPRIATIONS ACT , 2020
(Amounts in thousands)
FY 2019
Enacted

Foreign Labor Certifications and Related Activities :
Federal Administration .,.
Grants to States .

48 , 028
14,282

-------------Subtota l , Fo r eign Labor Cert i fi cat 1 on .
One-Stop Career Centers/Labor Market Information.

62,310
62,653

FY 2020
Request

56 , 278
14 , 282

Final Bill

Final Bill
vs Enac ted

Final Bi 11

vs Request

54,528
14,282

+6,500

-1, 750

70 , 560

68,810

+6 , 500

-1, 750

59, 326

62,653

----- ---- -----

---- ----------

-------------- ----- ------- -- ---- ----------

Total, State Unemployment Insurance and
Emp 1oyment Service Ope rat i ans . .. .
Feder a 1 Funds .
Trust Funds. . . . . . ...... .. .... .. . . . .. . .. • . . .

3,335,649
( 84,066)
(3 , 251 , 583)

3 ,475,986
(80 , 739 )
( 3 , 395,247)

3 , 374,649
(84,066 )
(3,290,583)

+39 , 000
(+39,000)

-101 , 337
(+3 , 327)
(-104 , 664)

!Gs

LABOR , HEAL TH AND HUMAN SERVICES, EDUCATION, AND RELATED AGENCIES APPROPRIATIONS ACT , 2020
(Amounts in thousands)
FY 2019
Enacted

FY 2020
Request

62 , 040
8 , 639
3 , 440
39 , 264
36,160
7,034
2 , 079

59,973
8,351
3 , 317
37 , 864
35,914
6,828
2,018

Final Bill

Final Bill
vs Enacted

Final Bill
vs Request

Program Administration
Training and Employment ........... .
Trust Funds .
. . .. • .. •.
Employment Security ... ..... •. .
Trust Funds ........ ... ... •. . • .. • .. .. . .. .. .. . . .. ..

Apprenticeship Services.
Executive Direction.
Trust Funds .

Total , Program Admi ni st ration.
. ..... . .. .
Federa 1 Funds. . . . . . . .
. .. .. . .. .. . . . • . .
Trust Funds .. ... ......... .
Total , Emp 1oyment and Training Admi ni strati on .
Federal Funds .
. .... . .... . . .
Current Year .
FY 2021 Advances . .
Trust Funds ..

62,040
8,639
3,440
39,264
36 .160
7,034
2,079

-------------- -------------- -------------158,656
(108,674)
(49,982)

154,265
(106,032)
(48,233)

158,656
(108 , 674)
(49,982)

9,905 , 660
6. 604 , 095
(4 , 832 , 095)
( 1 , 772 , 000)
3 , 301,565

8 , 573,241
5 , 129,761
(3,443,903)
(1,685,858)
3,443,480

9. 973 , 160
6 , 632 , 595
(4,860,595)
(1,772,000)
3,340,565

==========---- ---=========== ==============

+2 , 067
+288
+123
+1,400
+246
+206
+61

-------------- ---- ---------+4,391
(+2,642)
(+1. 749)

============== ==============
+67 , 500
+28,500
(+28,500)
+39,000

+1,399,919
+1,502 , 834
(+1 , 416,692)
(+86, 142)
-102, 915

~

LABOR, HEAL TH ANO HUMAN SERVICES , EDUCATION, AND RELATED AGENCIES APPROPRIATIONS ACT, 2020
(Amounts 1 n thousands)
FY 2019
Enacted

FY 2020
Request

Final Bill
Final Bill

vs Enacted

Final Bi 11
vs Request

EMPLOYEE BENEFITS SECURITY ADMINISTRATION ( EBSA)

Salaries and Expenses
Enforcement and Participant Assistance.
Policy and Compliance Assistance ... . .. .
Executive Leadership, Program Oversight and
Administration.
Total , EBSA ... . . .

147,400
26,901

157,696
29 , 105

147,400
26,901

6 , 699

6,699

6,699

181,000

193 , 500

181,000

(445,363)

(452 , 858)

(452,858)

229,000

232 , 568

242 , 000

+13,000

+9,432

41,187

49,134

43,187

+2,000

-5,947

103 , 476

103,576

105,976

+2,500

+2,400

-10,296
-2,204

-12, 500

PENSION BENEFIT GUARANTY CORPORATION (PBGC)

Pension Benefit Guaranty Corporation Fund

Consolidated Administ rative budget ..

(+7,495)

WAGE AND HOUR DIVISION

Salaries and Expenses . ........ . .
OFFICE OF LABOR-MANAGMENT STANDARDS
Sa 1 ari es and Expenses . ..
OFFICE OF FEDERAL CONTRACT COMPLIANCE PROGRAMS

Salaries and Expenses . ............ .

t~,-

LABOR, HEALTH AND HUMAN SERVICES , EDUCATION, AND RELATED AGENCIES APPROPRIATIONS ACT , 2020
(Amounts in thousands)
FY 2019
Enacted

FY 2020
Request

Final Bill

Fi nal Bill
vs Enacted

Final Bi 11
vs Request

-------------------------------------------------------------------- --- ------------- -- ---------------------------------------------OFFICE OF WORKERS' COMPENSATION PROGRAMS

Salaries and Expen ses.
Trust Funds ....... .

Total, Sal arias and Expenses .
Federal Funds.
Trust Fund s.

115 , 424
2 , 177

115 , 609
2,173

115,424
2,177

i17,601
(115,424)
(2,177)

117,782
(115,609)
(2,173)

117,601
(115,424)
(2,177)

227,000
3,000

232,600
2,000

232,600
2,000

-------------- -------------- --------------

-185
+4

-------------- --------------181
(-185)
(+4)

Special Benefits
Federa l Employees ' Compensation Benefits.

Longshore and Harbor Workers' Benefit s .
Total, Special Benefits.

-------------- ·····--------- -------------230,000

234,600

234,600

+5,600
-1 , 000

-------------- -------------+4,600

/6 8

LABOR, HEALTH ANO HUMAN SERVICES, EDUCATION, AND RELATED AGENCIES APPROPRIATIONS ACT , 2020
(Amounts in thousands)
FY 2019
Enacted

FY 2020
Request

20,000
5,319

30 , 000
4 , 970

30,000
4,970

+10,000
-349

25,319

34,970

34,970

+9 ,651

-15,000

-14,000

-14,000

+1,000

10,319

20,970

20 , 970

+10,651

Final Bill

Final Bill
vs Enacted

Final Bill
vs Request

Special Benefits for Disabled Coal Miners
Benefit Pa yments ..

Administration.
Subtotal, FY 2020 program level . . . .
Less funds advanced in prior year

appropriations.
Total , Current Year . .
FY2021 advances, 1st quarter.
Total, Special Benefits for Disabled Coal Miners
Energy Employees Occupational I 11 ness Compensation
Fund
Administrative Expenses.

14,000

14,000

14 ,000

24,319

34,970

34,970

+10,651

59,098

59,846

59,846

+748

!Ge'/

LABOR, HEALTH AND HUMAN SERVICES , EDUCATION, ANO RELATED AGENCIES APPROPRIATIONS ACT , 2020
(Amounts 1 n thousands)
FY 2019
Enacted

FY 2020
Request

Final Bill
Final Bil 1

vs Enacted

Final Bill
vs Request

Black Lung 01 sabil ity Trust Fund

Benefit Payment s and Interest on Advances . ..
Workers' Compensation Programs , Salaries and Expenses .
Departmental Management, Salaries and Expenses.

Departmental Management , Inspector General .
Subtotal , Black Lung 01 sab111 ty Trust Fund.

Treasury Department Administrative Costs ....... .
Total , Black Lung 01 sabil ity Trust Fund.
Total, Workers' Compensation Programs . . .
Federal Fund s . ......................... • .

Current year ... ......... . . . .
FY 2021 Advances .... . . . .. , . . , .. . . . . • .. • ...
Trust Funds . .... .

257,256
38 , 246
31,994
330

293 , 464
38 , 246
32,844
330

293,464
38 , 246
32,844
330

+36,208

327,826

364,884

364,884

+37,058

+850

356

356

356

328, 182

365,240

365 , 240

+37,058

759,200
757 , 023
(743,023)
(14,000)
2 , 177

812,438
810 , 265
(796,265)
(14,000)
2 , 173

812 , 257
810 , 080
(796 , 080)
(14 , 000)
2 , 177

+53 , 057
+53,057
(+53,057)

-181
-185
( -185)
+4

/ro

LABOR, HEALTH AND HUMAN SERVICES, EDUCATION, AND RELATED AGENCIES APPROPRIATIONS ACT, 2020
(Amounts in thousands)
FY 2019
Enacted

FY 2020
Request

Final Bi 11

Final Bill
vs Enacted

Final Bi 11
vs Request

OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION (OSHA)
Sa 1ari es and Expenses

Safety and Heal th Standards .

Federal Enforcement . . ........... , . . . .. . .. .
Whistleblower enforcement.
. . .....
State Programs . ..... . .... . ... . . . . . .. . .. . .
Technical Support .. .... . ..... • .. • , . • . .

18,000
209,000
17,500
102,350
24,469

18 , 000
212,780
18,624
102,350
24,469

18,000
221,711
18 , 564
108 , 575
24,469

+12,711
+1 , 064
+6 , 225

+8,931
-60
+6,225

73,481
59,500
10 , 537

73,914
59 , 500

74,48 1
61 , 500
11,537

+1 , 000
+2,000
+1 , 000

+567
+2 , 000
+11 ,537

143,518

133, 414

147,518

+4,000

+14 , 104

32,900
10,050

38 , 400
9 , 496

32,900
10,050

Com pl i a nee Assistance:

Federal Assistance .
State Consultation Grants . .
Training Grants . ...... .

------ -------- -- --- --------- -------------Subtotal , Complianc e Assistance ..
Safety and Health Stati sti e s .

. ....... . .... .. .

Exec utive Direction and Ad ministration .
Total , OSHA.

============== =============- ---===========
557, 787

557 , 533

581,787

----------- --- ---- ----------5 , 500
+554

---=-========= ----==========
+24,000

+24,254

/~)

LABOR , HEALTH AND HUMAN SERVICES, EDUCATION, AND RELATED AGENCIES APPROPRIATIONS ACT, 2020
(Amounts in thousands)
FY 2019
Enacted

FY 2020
Request

Final Bill

Final Bill
vs Enacted

Final Bill
vs Request

MINE SAFETY AND HEALTH ADMINISTRATION

Salaries and Expenses
Coal Enforcement . .
Metal / Non-Metal Enforcement . . . . ............•.. , .
Mine Safety and Health Enforcement .... . • .. • . . .. ..• .. • .
Standards Development .. . . .. .. .. .
Assessments . . ...... .

Educational Policy and Development .
Technical Support .
Program Evaluation and Information Resources (PEIR).

Program Administration ...
Total , Mine Safety and Health Administration .

Total , Worker Protection Agencies .
Federal Fund s . ............. .
Trust Funds .

160,000
94,500
4 , 500
6,627
39 , 320
35 , 041
17,990
15,838

252,640
5,382
7,445
38,559
34,079
21,583
16,355

373 , 816

376,043

1 , 603 , 867
(1,601 , 690)
(2 , 177)

1,630, 136
(1,627,963)
(2,173)

260 , 500
4 , 500
6,627
39,320
35 , 041
17 , 990
15 , 838
====::::;:
379 , 816
1 , 651 , 367
( 1 , 649 , 190)
(2,177)

- 160,000
-94,500
+260,500

+7,860
-882
-818
+761
+962
-3,593
-517

=====:: :

+6 , 000
+47,500
(+47 , 500)

+3 , 773

======

+21 , 231
(+21 , 227)
(+4)

/ 7-2.

LABOR, HEALTH ANO HUMAN SERVICES, EDUCATION , AND RELATED AGENCIES APPROPRIATIONS ACT, 2020
(Amounts in thousands)
FY 2019
Enacted

FY 2020
Request

Final Bill

Final Bi 11
vs Enacted

Final Bill
vs Request

BUREAU OF LABOR STATISTICS
Sa 1 ari es and Expenses

Employment and Unemployment Statistics.
Labor Market Information.

Prices and Cost of Living .. .
Compensation and Working Conditions.
Productivity and Technology.
Executive Direction and Staff Services . .

Total , Bureau of Labor Statistics.
Federal Funds ......... .
Trust Funds .

211,000
65,000
210,000
83,500
10,500
35,000

211,000
65,000
210,000
83,500
10,500
75,000

221,000
68,000
210,000
83,500
10,500
62,000

+10,000
+3,000

+10,000
+3,000

+27,000

-13,000

550 , 000
65,000

590,000
65,000

587,000
68,000

+37,000
+3 , 000

-3,000
+3,000

38,203

27,000

38 , 500

+297

+11,500

-----------------------------------------------------------------615 , 000
655,000
655 , 000
+40,000

OFFICE OF DISABILITY EMPLOYMENT POLICY
Salaries and Expenses . .. .

/ 7-3

LABOR , HEALTH AND HUMAN SERVICES , EDUCATION , AND RELATED AGENCIES APPROPRIATIONS ACT , 2020
(Amoun t s in th ousand s)
FY 2019
Ena c ted

FY 2020
Request

Final Bill

Fi nal Bil l
vs Enacted

Final Bill
vs Reque st

DEPARTMENTAL MANAGEMENT

Salarie s and Expense s
Execut i ve Direc tion . . .
Departmental Pr ogram Evaluation . .

Legal Services . .. . ....... . .. .
Trust Funds . ..... . . . .

International Labor Affair s.
Administration and Manag e ment . . ... .. . . . .
Adjud ic ation .

..........

. . •.. • .. . • . . • . . • • . • • . .

Women 's Bureau .

Ci v il Ri ghts Ac tivit i e s .
Chie f Finan c ial Offi ce r .

30 , 250
8,040
123,745
308
86 , 125
28 , 450
35,000
13 , 750
6 , 880
5,516

32,027
8,040
128 , 066
308
18 , 500
29 , 004
35,000
3 , 525
6,880
5,516

30 , 250
8 , 040
123,745
308
96 , 125
28 , 450
35 , 000
14 , 050
6 , 880
5,516

---------- -- -- ------ -------- -- ------- --- --

-1 , 777
-4 , 321
+10,000

+77 , 625
-554

+300

+10 , 525

------------- - --- -- ---- --- --

Total , Depart menta l Manag e me nt Sa l a r ie s and
e xpen ses .
Federal Fund s ..... .
Trust Funds .. .... . . . ...... . .

338 , 064
(337 , 756 )
(308 )

266 , 866
(266 , 558)
(308 )

348,364
(348 , 056 )
(308 )

+10 , 300
(+10 , 300)

+81 , 498
( +81 , 498 )

1-;z.4

LABOR, HEALTH AND HUMAN SERVICES, EDUCATION , AND RELATED AGENCIES APPROPRIATIONS ACT , 2020
(Amounts in thousands)

FY 2019
Enacted

FY 2020
Request

Final Bill
Final Bi 11

vs Enacted

Final Bi 11
vs Request

Veterans Employment and Training

State Administration, Grants ...
Transition Assistance Program . .
Federal Administration.
. . ..... .
National Veterans' Employment and Training Services
Institute.
Homeless Veterans Programs.

180,000
23,379
43,248

180,000
29,379
43,248

180,000
29 , 379
43,548

3,414
50 , 000

3,414
50,000

3,414
55,000

-------------- -------------- -------------Total , Veterans Employment and Training.
Federal Funds.
Trust Funds .

+6,000
+300

+300

+5,000

+5,000

+11,300
+5,000
+6,300

+5,300
+5,000
+300

-------------- --------------

300,041
50 , 000
250,041

306,041
50,000
256,041

311,341
55,DOO
256,341

4,889
18,380

4,889
32,111

4,889
20,380

+2 , 000

-11, 731

23,269

37,000

25,269

+2,000

-11, 731

IT Modernization

Departmental support systems.
Infrastructure technology modernization . ... . . .. . . . . .. .
Total , IT Modernization ..... .

/?-5

LABOR, HEAL TH ANO HUMAN SERVICES , EDUCATION, ANO RE LA TEO AGENCIES APPROPRIATIONS ACT, 2020
(Amounts in thousa nds )
FY 2019
Enacted

FY 2020
Request

B3, 4B7
5 , 660

64 , 461
5,660

Final B1ll

Final Bi 11
vs Enacted

Final Bi 11
vs Request

Office of Inspector General

Program Activities .
Trust Funds . .

Total , Office of Inspector General ...

69 , 147

90,121

65,167
5,660
90,647

+1,700

+1 , 700

+726

+726

====:::=

Total, Departmental Management ..... .. . . . . . .. •..
Federal Fund s ...
Current Year .
Trust Funds . .... .. . ..... .... ...... .

Total , Workforce Investment Act Programs.
Current Year .
FY 2021 Ad va nces ....
Total, Title I , Department of Labor ...... . .. . .. .
Federal Funds . . . . .
Current Year .
FY 2021 Advances ...... ... . • .. . . . . . .. . . . .
Trust Funds ... .......... • .. • .

750,521
494,512
(494,512)
256,009

700,026
436,019
(436,019)
262 , 009

5 . 221,355
(3, 449 , 355)
( 1,772,000)

4 , 262,990
(2,577,132)
(1,665,656)

13 , 554 , 650
9,930,099
(6,144,099)
(1,766,000)
3 ,624 , 751

12, 260,061
6 , 507,399
(6,607,541)
(1,699,656)
3 , 772,662

-----------

-----------

775,621
513 , 512
(513 , 512)
262 ,309

+25,300
+19,000
(+19,000)
+6,300

5, 354 , 655
(3 , 562,655)
( 1 , 772 , 000)

+133 , 500
(+133,500)

13,766 , 504
10 , 115,453
(6,329,453)
( 1,766 , 000)
3,673,051

+233 , 654
+165 ,354
(+165,354)

---------

-----------

=========

+75,793
+75 , 493
(+75 , 493)
+300

--=======

+1 , 091 , 665
(+1 , 005,723)
(+66, 142 )

------------

+46,300

+1 ,506,443
+1 ,606,054
(+1,52 1 , 912)
(+66, 142)
-99 , 611

/ 7-(;,

LABOR, HEALTH AND HUMAN SERVICES , EDUCATION , AND RELATED AGENCIES APPROPRIATIONS ACT , 2020
(Amount s 1 n thousands)
FY 2019
Enac t ed

FY 2020
Request

Final Bill

1 , 625,522
(4,000 , 000)

1 , 625,522
(4,000,000)

1,625,522
(4,000,000)

Final Bi 11
vs Enacted

Final Bill
vs Request

TIT LE II --DEPARTMENT OF HEALTH AND HUMAN SERVI CES
HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA )
Primary Health Care

Community Health Centers .. . .
Mandatory budget authority (Public Law 115-123) (NA) .

-- -- -·- -· · · ··- -· ------- ----- ----- --------Total, Community Health Center s .

Free Clinics Medical Malpractice ...
Total , Primary Health Care (e xc luding
mandatory funds ) . . ..

(5 , 625 , 522)
1 , 000

(5 , 625 , 522)
1 , 000

-------------- --------------

(5 , 625,522)
1 , 000

-------------- ----- -- ------- ---- ----- ----1 , 626 , 522

1 , 626 , 522

1 , 626 , 522

105 , 000

105 , 000

120 , 000

--------- -- --- ------------- -

Heal th Workforce

National Health Servi c e Corp s.
Training for Diversity :
Centers of Excellence .
Health Careers Opportunity Program ..
Faculty Loan Repayment .
Scholarships for Disadvantaged Students ..

Total, Training for Diversity .. .. ... ....... . . . . .
Primary Care Training and Enhancement .

23, 711
14 , 189
1 , 190
48,970

23 , 711
15 , 000
1 , 190
51,470

-------------- -------------- -------------88,060

91 , 371

48 , 924

48,924

+15,000

+811
+2 , 500

+15,000
+23 , 711
+15 , 000
+1, 190
+51,470

-------------- -------------+3 , 311

+91,371
+48 , 924

Ir 'r-

LABOR , HEAL TH ANO HUMAN SERVICES , EDUCATION , ANO RELATED AGENCIES APPROPRIATIONS ACT, 2020
(Amounts in thousands)
FY 2019
Enacted

FY 2020
Request

Final Bill

Oral Health Training .

40 ,6 73

40 , 673

Interdisciplinary Community-Based Linkages :
Area Health Education Centers .
Geriatric Programs ...
Mental and Behavori al Heal th.
Behavioral Health Workforce Education and Training

39,250
40, 737
36,916
75,000

36,916
75,000

41,250
40 , 737
36,916
102,000

191,903

111,916

220,903

5 , 663
17 , 000

4,663

5,663
17 , 000

-------------- -------------- -------------Total , Interdisciplinary Community Linkages.
Workfor ce Assessment . .

Public Heal th and Preventive Medi c ine programs . .

-------------- -- -- -- -- -- -- -- -------------Subtotal, Health Professions Education and
Training . ..

392,223

116,579

424,534

Final Bill

Final Bill

vs Enacted

vs Request

+40,673
+2,000

+41 ,250
+40 , 737

+27,000

+27,000

+29 , 000

+108 , 987

-------------- -------------+1,000
+17 , 000

-------------- ----- -- ------+32 , 311

+307 , 955

LABOR, HEALTH AND HUMAN SERVICES , EDUCATION, AND RELATED AGENCIES APPROPRIATIONS ACT , 2020
(Amounts in thousands)
FY 2019
Enacted

Nursing Programs :
Advanced Education Nursing .

Nurse Education , Practice , and Retention.
Nurse Practitioner Optional Fellowship Program ....
Nursing Workforce Diversity ....... . . .
Nursing Corps Scholarship and Loan Repayment
Program. . .
. .... . ...... .
Nursing Faculty Loan Program .. .

FY 2020
Request

74,581
41 , 913

Final Bi l l
vs Enacted

+1,000
+2,000
+5,000
+1,000

+75 , 581
+43,913
+5,000
+18 , 343

88,635
28,500

+1 , 500

+5 , 500
+28 , 500

83,135

259,972

+10,500

+176 , 837

+15,000
+25 , 000

+340,000
+50 , 000

18,814
-18,814

340,000
50,000
18 , 814
-18 , 814

1 , 194 , 506

+97 , 811

+889 , 792

83,135

--- ----------- -------------- -- -----------Total , Nursing programs.
Children's Hospitals Graduate Medi c al Education.
Medical Student Education
............ .

National Practitioner Data Bank .
User Fees .. .

Total , Health Work fo r c e ...

249 , 472
325 , 000
25,000
18,814
-18 , 814

-- --- --- -- ---1,096,695

Final Bill
vs Request

75 , 581
43 , 913
5 , 000
18,343

17 , 343
87 , 135
28 , 500

Final Bill

-------------- --- ---- --- ---304 , 714

Ir~

LABOR, HEAL TH AND HUMAN SERVICES , EDUCATION, AND RELATED AGENCIES APPROPRIATIONS ACT , 2020
(Amounts in thousands)
FY 2019
Enacted

FY 2020
Request

Final Bill
Final Bill

vs Enacted

Final Bill
vs Request

Maternal and Child Health
Maternal and Child Health Block Grant .. .... .... , .. , ...
Sickle Cell Disease Treatment Program .
. . . . . .. . ...
Autism and Other Developmental Disabilities.
Heritable Disorders in Newborns and Children.
Healthy Start.
. . .......
........... . .. .. .

.

Universal Newborn Hearing Screening.

Emergency Medical Services for Children ..
Screening
Pediatric

.......

Total, Maternal and Child Health ........• .. . . ..•
Ryan White HIV / AIDS Program
Emergency Assistance (Part A).
Comprehensive Care Programs (Part B) ..
AIDS Drug Assistance Program (ADAP)
Early Intervention Program (Part CJ ...
Children, Youth , Women , and Families ( Part D).
AIDS Dental Services (Part F) .................
Education and Training Centers (Part F) .
Special Projects of National Significance .
Domestic HIV / AIDS Initative .. .

.. .... ... .

Total , Ryan White HIV / AIDS program .

677, 700
4,455
50 , 599
16,383
122,500
17,818
22,334
5,000
10,000

660 .700

122,500

687,700
5,205
52 , 344
17 , 883
125,500
17,818
22 , 334
5,000
10,000

·····---- -- --- -------------- -------------926,789

655,876
1 , 315,005
(900,313)
201,079
75 , 088
13,122
33 , 611
25 , 000

783 , 200

943, 784

655,876
1 , 315,005
(900,313)
201,079
75,088
13 , 122
33 , 611
25 , 000
70,000

655,876
1,315,005
(900 , 313)
201,079
75,088
13,122
33 , 611
25,000
70,000

2,388,781

2,388,781

-------------- -------------- -------------2,318,781

+10 , 000
+750
+1,745
+1,500
+3,000

+27 , 000
+5,205
+52 , 344
+17,883
+3,000
+17,818
+22,334
+5 , 000
+10 , 000

-- -- ---------- ------------ -+16 , 995

+160 , 584

+70,000

-------------- -------------+70,000

ef'o

LABOR, HEALTH AND HUMAN SERVICES, EDUCATION, AND RELATED AGENCIES APPROPRIATIONS ACT, 2020
(Amounts in thousands)
FY 2019
Enacted

FY 2020
Request

Final Bi 11

Final Bill
vs Enacted

Final Bill
vs Request

Heal th Care Systems

Organ Transpl an tat ion. . . . . . . . .

. . .. . .. . .. .

National Cord Blood Inventory.
C.W . Bill Young Cell Transplantation . .. ... . ... .
340B Drug Pricing program / Office of Pharmacy Affairs.
304B Drug Pricing User fees.
User Fees.
Hansen's Disease Program .

Hansen's Disease Program - Bui 1dings and Facilities .
Payment to Hawaii , Treatment of Hansen's.

Total , Health Care Systems ...

25,549
16,266
24 , 609
10,238

22,846
13,706
122
1 , 857

27,549
12,266
24 , 609
10,238
19 , 000
-19, 000
22,846
11 , 653
1,857

27,549
17 , 266
30,009
10,238

111,018

+5,000
+5,400
-19,000
+19,000

22,846
13,706
122
1,857

-------------- -------------- -------------115,193

+2,000
+1 , 000
+5,400

123,593

+2,053
+122

-------------- -------------+8,400

+12 , 575

/8/

LABOR, HEALTH AND HUMAN SERVICES, EDUCATION, AND RELATED AGENCIES APPROPRIATIONS ACT, 2020
(Amounts in thousands)
FY 2019
Enacted

Rural Health
Rural Outreach Grants ...
... . . .. ....
Rural Health Research/Policy Development . ..... . ...
Rural Hospital Fl exi bil ity Grants .
... . . . ...
State Offices of Rural Health ..
Black Lung Clinics.
..........
Radiation Exposure Screening and Edu cation Program.
Telehealth.
Rural Communities Opioid Response .........
Rural Residency Program .

.... . . . . . . . . .

Total , Rural Health ...... • ... • .. • ..•.

..

77,500
9 , 351
53,609
10,000
11,000
1,834
24 , 500
120 , 000
10,000

FY 2020
Request

40,811
5,000

11,000
1,834
10,000
120,000

Final Bill
Final Bill

79 , 500
10,351
53,609
12,500
11,500

188,645

+2,000
+1,000
+2,500
+500

Final Bi 11
vs Request

+38 , 689
+5, 351
+53,609
+12 , 500
+500

1,834

29,000
110,000
10 , 000

-------------- -- ----- ------- -------------317,794

vs Enacted

318,294

+4,500
-10 ,000

+19,000
-10,000
+10,000

-------------- -------------+500

+129 , 649

I '67-

LABOR , HEALTH AND HUMAN SERVICES , EDUCATION, AND RELATED AGENCIES APPROPRIATIONS ACT , 2020
(Amounts in thousands)
FY 2019
J:nacted

Family Planning . . .. ..... ...•. . • .. • • . • •..• .. . . . . . .. • ...

Program Management .
Total , Health resources and services (HRS).

FY 2020
Request

Final Bill

Final Bill
vs Enacted

Final Bill
vs Request

286 , 479
155 ,250

286,479
151,993

286 , 479
155,300

+50

+3,307

6 , 843,503

5,841,352

7,037,259

+193 , 756

+1, 195,907

308,000
9,200

285,600
11,200

285,600
10,200

-22,400
+1,000

-1 , 000

317,200

296,800

295,800

-21,400

-1 ,000

7 , 160 , 703

6 , 138 , 152

7 , 333,059

+172,356

+1 , 194 , 907

Vaccine Injur y Compensat1 on Program Trust Fund
Post-FY 1988 Claims ....... .
HRSA Administrative expenses . .

Total , Vaccine Injury Compensation Trust Fund .

Total , Health Resources and Services
Administration .

8"3

LABOR, HEAL TH AND HUMAN SERVICES , EDUCATION, AND RELATED AGENCIES APPROPRIATIONS ACT , 2020
(Amounts in thousands)
FY 2019
Enacted

FY 2020
Request

Final Bill

Final Bill
vs Enacted

Final Bill
vs Request

477, B55
(320,550)

577 , 3B6
(152 , 845)

433 , 105
(370 , 300)

-44, 750
(+49,750)

-144,281
(+217 , 455)

(730,231)

(803 , 405)

(+5,000)

(+73, 174)

CENTERS FOR DISEASE CONTROL AND PREVENTION

Immunization and Respiratory Diseases . ...
Prevention and Public Health Fund 1 / .

-------------- -------------- ------------- Subtotal .

(798,405)

HIV / AIDS, Viral Hepatitis, Sexually Transmitted
Di seas es, and Tuberculosis Prevention . .. .

Administrative transfer to Global Health ....

1,132 , 278
( -7 , 222)

1,318,056

1 , 273,556

-------------- -------------- --------- ----Subtotal (including transfers) .

Emerging and Zoo not i c Infectious Diseases.

-------------- -------------+141,278
(+7 , 222)

-44,500

-------------- --------------

1,125 , 056

1,318,056

1,273,556

+148,500

-44,500

568 , 372

372,472

570,372

+2 , 000

+197,900

(-8 , 000)
(52 , 000)

(137,000)

(52,000)

612 , 372
932,821
(254,950)

509,472
347,145
(604,105)

622,372
984,964
(254,950)

Administrative transfer to Public Health

Scientific Services .
Prevention and Public Hea 1th Fund 1 / .

(+8,000)

-------------- -------------- -------------Subtotal

(including transfers).

Chronic Disease Prevention and Heal th Promotion .
Prevention and Public Heal th Fund 1 / .

-------------- ------- ------- -------------Subtotal .

1,187 , 771

951,250

1,239,914

(-85, 000)

-------------- -------------+10 , 000
+52,143

+112 , 900
+637,819
(-349, 155)

-------------- -------------+52, 143

+288,664

&:~

LABOR , HEALTH AND HUMAN SERVICES , EDUCATION , AND RELATED AGENCIES APPROPRIATIONS ACT , 2020
(Amounts in thousands)
FY 2019
Enacted

Birth Defects , Developmental Disabilities,
Disabilities and Hea 1th . .
Subtotal .

Public Health Scientific Services.
Evaluation Tap Funding .
Administrative Transfer from Emerging and Zoonotic
Infectious Di seas es.
Subtotal (including transfers).
Environmental Heal th .. ...... .
Prevention and Public Heal th Fund 1 / .

FY 2020
Request

Final Bill

Final Bill

Final Bill

vs Enacted

vs Request

155 , 560

112,000

160 , 810

+5,250

+48 , 810

155 , 560

112,000

160,810

+5 , 250

+48,810

496,397

45,000
(423,000)

555 , 497

+59 , 100

(504,397)

(468,000)

(555,497)

(+51, 100)

(+87 , 497)

192,350
(17,000)

157 , 000

196,850
(17,000)

+4,500

+39 , 850
(+17 , 000)

(8,000)

(-8,000)

------------- - -------------- -------------Subtotal.

Injury Prevention and Control .
National Institute for Occupational Safety and Health .
Energy Employees Occupational Illness
Compensation Program.

+510,497
(-423 , 000)

209,350

157,000

213,850

+4,500

+56 , 850

648,559
336 , 300

628,839
190,000

677,379
342,800

+28,820
+6 , 500

+48 , 540
+152, 800

55,358

55 , 358

55,358

/&'5

LABOR , HEAL TH AND HUMAN SERVICES, EDUCATION, AND RELATED AGENCIES APPROPRIATIONS ACT , 2020
(Amounts in thousands)
FY 2019
Enacted

Global Health .
Global Health transfer ..
Subtotal (i ncluding transfers) .
Public Health Preparedness and Response .
Buildings and Facilities ... .... .
Transfers from Nonrecurring Expenses Fund . .. ... , ..
Subtotal.
CDC-Wide Activities and Program Support
Prevention and Public Hea 1th Fund 1 / . .
Offi ce of the Di rector ....
Infectious Diseases Rapid Response Reserve Fund .

Subtotal . . . .

Total , Centers for Di sease Control and
Prevention . ....
Discretionary.
. ... .... .
Prevention and Public Health Fund 1 /.

FY 2020
Request

Final Bill
vs Enacted

Fi nal Sill
vs Request

488,621
(7,222)

456,984

570,843

+82 ,222
(-7 , 222)

+113 , 859

495,843

456 ,984

570,843

+75 , 000

+113 , 859

855 ,200

825,000

850 ,200

-5,000

+25,200

30,000

30,000

25 , 000
(225,000)

-5,000
(+225, 000)

-5,000
( +225,000)

30,000

30,000

250,000

+220,000

+220 , 000

(160,000)
113 , 570
50,000

105,000
50,000

(160,000)
113,570
85 , 000

+35,000

(323 , 570)

(155,000)

(358,570)

(+35,000)

(+203,570)

6,533,241
6 , 477 , 883
(804 , 500)

5,270,240
5 , 214 , 882
(893,950)

6,895,304
6,839,946
(854,250)
(225,000)

+362,063
+362 , 063
(+ 49 , 750)
(+225,000)

+1,625,064
+1 , 625,064
(-39,700)
(+225 , 000)

(7,337,741)

(6 , 587 , 190)

(7,974 , 554)

(+636,813)

(+1 , 387 , 364)

Transfers from Nonrecurring Expenses Fund .

Total , Centers for Disease Control Program Level

Final Bi 11

(+160,000)
+8,570
+35 , 000

----------

----------

----------

-----------

/8~

LABOR , HEALTH ANO HUMAN SERVICES , EDUCATION, AND RELATED AGENCIES APPROPRIATIONS ACT , 2020
(Amounts 1 n thousands)
FY 2019
Enacted

FY 2020
Request

Final Bi 11

Final Bill
vs Enacted

Final Bi 11
vs Request

NATIONAL INSTITUTES OF HEAL TH
National Cancer Institute (NCI).
NIH Innovation Account , CURES Act2 / . .
Subtotal , NCI
National Heart, Lung, and Blood Institute (NHLBI).

5,743 ,892
400 , 000

5,051,737
195,000

6,245 , 442
195 , 000

+501,550
-205,000

+1 , 193 , 705

6,143,892

5,246, 737

6,440 , 442

+296,550

+1 , 193, 705

3,488,335

3,002,696

3,624,258

+135, 923

+621 , 562

477,429

National Institute of Dental and Craniofacial Research
(NIDCR) ..

461 , 781

397,493

+15 , 648

+79,936

2 , 029 , 823
( 150 , 000 )

1 , 746,493
(150,000)

2 , 114 , 314
(150 , 000)

+84 , 491

+367 , 821

2 , 179 , 823

1 , 896,493

2 , 264 ,3 14

+84 , 491

+367 , 821

2 ,2 16 , 913
57 , 500

1 , 956 , 031
70,000

2 , 374 , 687
70 , 000

+157 , 774
+12 , 500

+418,656

2, 274,413

2 , 026 , 031

2,444,687

+170 , 274

+418,656

5 , 523 , 324

4 , 754,379

5,885,470

+362 , 146

+1, 131 , 091

National Institute of Diabetes and Digestive and
Kidney Diseases (NIDDK) .
Juvenile Diabetes (mandatory) . . .. .
Subtotal , NIDDK program 1 eve l ... .

-- -- -- --- -- --- ------ -------- ------ --------

National Institute of Neurological Disorders and
Stroke (NINOS) ............ ..... .
NIH Innovation Ac c ount , CURES Act2 /.
Subtotal , NINOS .
National Institute of Allergy and Infectious Diseases
(NIAID).
.. .......... .

--- ----------- --- ------ -----

-- -- -- -- --- -- -

----- --------- --------------

I?-:;..

LABOR, HEALTH ANO HUMAN SERVICES , EDUCATION, AND RELATED AGENCIES APPROPRIATIONS ACT , 2020
(Amoun t s in t housands)

National In s titute of General Hedi cal Sciences (NIGHS)
Evaluation Tap Funding ........ . .. . .. . ... .
Subtotal , NIGHS program level .. .
Eunice Kennedy Shriver National Institute of Child
Health and Human Development (NICHD).
National Eye Institute (NEI).
National Institute of Environmental Heal th Sci enc es
(NIEHS) .. . .
National Institute on Aging (NIA) .
National Institute of Arthritis and Huscul oskel etal
and Skin Diseases (NIAHS) .
National Institute on Deafness and Other Communication
Disorders ( NIDCD) . . ... .. . . .
National Institute of Nursing Re s earch (NINR) ..
National Institute on Alcohol Abu s e and Alcoholism
( NIAAA ). .
. . ... . .. . ... . ....... . . . . .
Nat i onal Institute on Drug Abuse (NIDA) .
National Institute of Mental Health ( NIHH) .
NIH Innovation Account , CURES Act 2/ ........ . . .. . . , . . • .
Subtotal, NIHH.
Nat onal Human Genome Research Institute (NHGRI).
Nat anal Institute of Biomedical Imaging and
B oengineering (NIBIB) .. .

FY 2019
Enacted

FY 2020
Request

Final Bill

Final Bill
vs Enacted

Final Bill
v s Request

1 , 725 , 959
( 1 , 146 , 821)

1 , 731 , 838
( 741 , 000)

1 , 706,397
(1 , 230 , 821 )

- 19 , 562
(+84,000)

-25 , 441
( +489,821)

2 , 872 , 780

2 , 472 , 838

2 , 937 , 218

+64 , 438

+464,380

1,506,458
796,536

1 , 296 , 732
685,644

1 , 556 , 879
824,090

+50, 421
+27, 554

+260 , 147
+138 , 446

774, 707
3 , 083 , 410

666 , 854
2 , 654 , 144

802 , 598
3,543,673

+27 , 891
+460 , 263

+135 , 744
+889 , 529

605 , 065

520,829

624 , 889

+19,824

+104 , 060

474 , 404
162, 992

408 , 358
140 , 301

490 , 692
169,113

+16 , 288
+6, 121

+82,334
+28,81 2

525 , 59 1
1 , 419 , 844
1 , 812 , 796
57 , 500

452 , 419
1 , 296,379
1,560,422
70,000

545 , 373
1 , 462 , 016
1,968 , 374
70 , 000

+19,782
+42, 172
+155 , 578
+12,500

+92,954
+165 , 637
+407 , 952

1 , 870 , 296

1 , 630,422

2,038 , 374

+168, 078

+407,952

575 , 579

495,448

606,349

+30, 770

+110,901

389,464

335,986

403,638

+14 , 174

+67,652

/ ~8

LABOR, HEALTH AND HUMAN SERVICES, EDUCATION, AND RELATED AGENCIES APPROPRIATIONS ACT, 2020
(Amounts in thousands)
FY 2019
Enacted

National Center for Complementary and Integrative
Health ( NCCIH) .. ...... .. . ...
National Institute on Minority Health and Health
Disparities (NIM HD ) .. ......
John E. Fogarty International Center (F IC ) ..
National Library of Medicine (NLM).
Nati ona 1 Center for Advancing Trans 1at i ona l Sciences
(NCATS) .....
National Institute for Research on Safety and Quality
(NIRSQ)3/ .. .... ... . ..
Office of the Di rector .
Common Fund (non-add) .
Gabriella Miller Kids First Research Act (Co mmon
Fund add ) .......................................
NIH Innovation Account, CURES Act2 /.
Buildings and Facilities ........

FY 2020
Request

Final Bill
vs Request

126,081

151 , 740

+5,267

+25,659

314,679
78,109
441 , 997

270 , 870
67,235
380,463

335,812
80 , 760
456,911

+21, 133
+2,651
+14,914

+64,942
+13 , 525
+76 , 448

806,373

694,112

832,888

+26,515

+138,776

+330,712
(+19,945)

- 255 , 960
+483 , 243
(+106, 144)

1 , 909 , 075
(606,566)
12,600
196,000
200,000

255,960
1 , 756,544
( 520,367)
12,600
157,000
200,000

2,239,787
(626 , 511)
12 , 600
157,000
200 , 000
(225,000)

---==--=--==== ============== ==============
37,937,179
(1,146 , 821)

33,410,048
(741,000)

40,228,179
(1 , 230 , 821)
225,000

-- ------------ ---- ---------- -------------Total , NIH Program Level . ... . . . . ,, . .• . .• .. . . . . • .

vs Enacted

146 , 473

Transfers from Nonrecurring Expen ses Fund.

Total , National Institutes of Health (NIH) ..
(Evaluation Tap Funding) . . .
Transfer from Nonrecurring Expenses Funds . ... .. .

Final Bill
Final Bill

(39,084,000)

(34,151,048)

(41,684 , 000)

-39 , 000
(+225 , 000)

(+225,000)

+2 , 291 , 000
( +84, 000)
+225 , 000

+6 , 818, 131
(+489,821)
+225 , 000

----=-======== ==============

-------------- -------------(+2 , 600,000)

( +7 , 532 , 952)

I

LABOR , HEALTH AND HUMAN SERVICES, EDUCATION , AND RELATED AGENCIES APPROPRIATIONS ACT , 2020
(Amounts in thousands)
FY 2019
Enacted

FY 2020
Request

Final Bill
Final Bill

vs Enacted

Final Bill
vs Request

SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES
ADMINISTRATION (SAMHSA)
Mental Health
Programs of Regional and National Significance.
Prevention and Public Health Fund 1 /.

363,774
(12,000)

365,647

395 , 774

365,647

460 , 774

701,532
(21,039)

701 , 532
(21,039)

701,532
(21,039)

(722,5 71)

(722,571)

(722,571)

150 , 000
63 , 667
125,000

150 ,000
63,667
125,000

200 , 000
66 , 667
125 , 000

64,635

64,635

64,635

36,146

14,146

36 , 146

446,774
(12,000)

-------------- -------------- -------------Subtotal ..
Community Mental Health Services Block Grant ( MHBG) ...
Evaluation Tap Funding .
Subtotal .
Certified Community Behav iora l Health Clinics.
National Child Traumati c Stress Initiative ..
Children's Mental Health Services ..

-------------- -------------- --------------

+65,000

+62 ,927
(+12,000)

-------------- ----- ---- ----+65,000

--------- ----+50 , 000
+5 , 000

+94 ,927

----- -- ------+50 , 000
+5 , 000

Projects for Assi sta nce in Transition from
Homelessness (PATH) ... .
Protectio n and Advo cacy for Individuals with Mental
Illness (PAIMI) . .

-------------- --- -- --------- -------------Subtotal, Mental Health .
(Evaluation Tap Funding) ..
(Prevention and Public Health Fund 1/) .

1,524,974
(21,039)
(12,000)

1 , 465,047
(21 , 039)

1,644,974
(21,039)
(12,000)

-------------- -------------- ------- -- ----Subtotal, Mental Health program level ... . .. • .

(1,556,013)

(1,506,066)

(1,676,013)

+22 , 000

-------------- -------------+120,000

+159,927
(+12,000)

-------------- -------------(+120,000)

( +171 , 927)

/tiO

LABOR , HEAL TH AND HUMAN SERVICES, EDUCATION, AND RELATED AGENCIES APPROPRIATIONS ACT, 2020
(Amounts in thousands)
FY 2019
Enacted

FY 2020
Request

Final Bi 11

Final Bi 11
vs Enacted

Final 8111
vs Request

Substance Abuse Treatment

Programs of Regional and National Significance ..
Evaluation Tap Funding .
Subtotal . . .

Substance Abuse Prevention and Treatment Block Grant.
Evaluation Tap Funding ... .
Subtotal . block grant ..... . .
State Opioid Response grants .

...... . .....

.......... ... . . . .. . .. . . .

Subtotal , Substance Abuse Treatment ...
(Evaluation Tap Funding) .
Subtotal , Program level

458 , 677
(2 , 000)

429,888

477 , 677
(2,000)

+19,000

+47, 789
(+2 , 000)

(+19,000)

(+49,789)

(460,677)

(429,888)

(479,677)

1,778,879
(79 , 200)

1 , 778 , 879
(79,200)

1,778,879
(79,200)

(1 , 858 , 079)

(1 , 858 , 079)

(1 , 858,079)

1,500,000

1 , 500 , 000

1 , 500,000

-------------- -------------- --------------------------- -------------- -------------3,737,556
(81 , 200)
(3,818,756)

3 , 708 , 767
(79,200)
(3,787,967)

3 , 756,556
(81 , 200)
(3,837,756)

-------------- --- ---- ------------- ------- --- --- -- -----+19 , 000
(+19,000)

+47 , 789
(+2,000)
(+49,789)

/91'

LABOR, HEAL TH AND HUMAN SERVICES, EDUCATION, AND RELATED AGENCIES APPROPRIATIONS ACT , 2020
(Amounts in thousands)
FY 2019
Enacted

FY 2020
Request

Final Bill
Final Bi 11

vs Enacted

Final Bill
vs Request

Substance Abuse Prevention

Programs of Regional and Nati anal Si gni fi ca nee.

205,469

244 , 090

206,469

Health Survei 11 ance and Program Support.
Evaluation Tap Funding (NA).

128 , 830
(31,428)

97,004
(42,453)

128,830
(31,428)

+31 , 826
( -11 ,025)

160 , 258

139,457

160,258
+140,000

+20, 801
=======
+201,921
( -9, 025)
(+12,000)

(+140,000)

( +204 , 896)

Subtotal.
Total' SAMHSA . .
(Evaluation Tap Funding) .
(Prevention and Pub 1 i c Hea 1th Fund 1 / ) .

5,596 , 829
(133 , 667)
(12 , 000)

5,534,908
(142 , 692)

5,736,829
(133,667)
(12 , 000)

(5,677,600)

(5,882 , 496)

-------- --

---------Total , SAMHSA Program Level ..

(5 , 742,496)

+1 , 000

-37, 621

/q2..

LABOR, HEALTH ANO HUMAN SERVICES, EDUCATION, AND RELATED AGENCIES APPROPRIATIONS ACT , 2020
(Amounts in thousands)
FY 2019
Enacted

FY 2020
Request

Final Bi 11

Final Bill
vs Enacted

Final Bi 11

vs Request

AGENCY FOR HEALTHCARE RESEARCH AND QUALITY (AHRQ)3 /
Healthcare Research and Quality
Research on Health Costs, Quality , and Outcomes:
Federal Funds .
Medi cal Expenditures Panel Surveys :
Federal Funds.
Program Support:
Federal Funds . . ....... .
Total , AHRQ Program Level 3 / .

196,709

196,709

+196,709

69,991

69 , 991

+69,991

71,300

71 , 300

(3 38 , 000)

(338 , 000)

+71 , 300
(+338 , 000)

/q~

LABOR , HEALTH AND HU HAN SERVICES , EDUCATION , AND RELATED AGENCIES APPROPRIATIONS ACT , 2020
(Amounts in thousands)
FY 2019
Enacted

FY 2020
Request

Final Bill

Final Bill
vs Enacted

Final Bill
vs Request

CENTERS FOR MEDICARE AND MEDICAID SERVICES
Grants to States for Medi ca id

Medicaid Current Law Benefits ..
State and Local Administration .... . . .. . .. ... . .. . . .. . . .
Vaccines for Children . .

384,882,625
21,474,885
4 , 726,461

383,836,264
22,522,603
4 , 761,408

383,836,264
22,522,603
4,761,408

411,083,971
-1 34,847 , 7 59

411,120,275
-137,931 ,797

411 , 120,275
-137, 931 , 797

276,236,2 12
137 ,931,797

273 , 188,478
139,903,075

273,188,478
139 ,903,075

-3,0 47,734
+1 , 971,278

284 , 288 , 300
127 , 000
898 , 000
92 , 070,000
642,000
315,000
3 , 500

304 , 044,600
109,000
913,000
104 , 539,500
861 , 000
324,000
5,000

304 , 044,600
109,000
913,000
104,539,500
B61 ,000
324,000
5,000

+19,756,300
-18,000
+15 ,000
+12,469 , 500
+219 ,000
+9,000
+1,500

41 0 ,796, 1 00

410,796,100

-------------- --- ----------- -------- -----Subtotal, Medicaid Program Level ..

Less funds advanced in prior year.

-------------- -------------- ------ ------ -Total , Grants to States for Hed i cai d.
New advance, 1st quarter , FY 2020 ... . .

-1,046,361
+1,047,718
+34 , 947

-------------- -------- -----+36,304
-3,084 , 038

-------------- ------ -- ------

Payments to Health Care Trust Funds

Supplemental Medical Insurance .
Federal Uninsured Payment . ..... .

Program Management . ... .. ...... .
General Revenue for Pa rt D Benefit .

General Revenue for Part D Administration .
HCFAC Reimbursement.

State Low - Income Determi nation for Part D.

-- --- --------- -------------- --- ----------Total, Payments to Trust Funds, Program Level .

378,343,800

----- --------- -------------+32,452,300

/9'(

LABOR , HEALTH AND HUMAN SERVICES , EDUCATION , AND RELATED AGENCIES APPROPRIATIONS ACT , 2020
(Amount s in thousands)
FY 2019
Enacted

FY 2020
Request

Final Bill

Final Bill
vs Enacted

Final Bill
vs Request

Program Management

Research , Demon stration , Evaluation ... .. . . .. . ... . . . . . .
Program Operations . ....
State Survey and Certification.
Fede ral Administration .....
Total, Program management ....

20 , 054
2 , 519,B23
397,334
732,533

2. 389 .702
442 , 192
747,533

20 , 054
2,519 , 823
397. 334
732 ,533

3,669.744

3. 579. 427

3,669,744

599 , 389
87 , 230
78 ,381

614,000
98 , 000
80 , 000

610 , 000
93,000
83 , 000

765,000

792 ,000

786 , 000

------ -------- -------------- -------- ------

+20,054
+130, 121
-44,858
-15. 000

--------- ----- -------------+90, 317

Heal th Care Fraud and Abuse Control Accou nt

Centers for Medi care an d Medi c aid Services . .... .
HHS Office of Inspector General .

Department of Justice ... .... . . .
Tota l . Health Care Fraud and Abuse Control . . .. . .

Total, Centers for Medicare and Medicaid Services
Federal f unds .

. .....

Current year ..... .
FY 2021 Advan ce.
Tr ust Funds .

. . . .. .. • . .

-------------- ------- ---- --- -------------============== ============== ==============
796. 946. 553
792 , 511.809
(654,580,012)
(13 7 , 931 , 797)
4,434,744

628,259,080
823,887,653
(683 , 984,578)
(139,903,075)
4,371,427

828 , 343,397
823,887,653
(683,984, 578)
( 139 . 903. 075)
4 , 455.744

+10 , 611
+5 . 770
+4,619

-4,000
-5.000
+3 , 000

-- -- ---------- -------------+21 , 000

-6 , 000

============== ==============
+31,396,844
+31, 375 , 844
(+29,404 , 566)
(+1, 971. 278)
+21 , 000

+84,317

+84 , 317

19

LABOR, HEAL TH ANO HUMAN SERVICES , EOUCATION , ANO RE LA TEO AGENCIES APPROPRIATIONS ACT, 2020
(Amounts in thousands)
FY 2019
Enacted

FY 2020
Request

33,000
1,000

33,000
1,000

33,000
1,000

34,000

34,000

34 , 000

3,689,574
588,673
10 , 000

3 , 648,494
597 , 506
10 , 000

3,648 , 494
597 , 506
10,000

4 , 256,000

4,256 , 000

-32,247

4,290 , 000
-1 ,400,000

4 , 290 , 000
-1,400 , 000

-32,247

2 , 890,000
1,400,000

2 , 890,000
1 , 400 , 000

-32,247

Final Bill
Final Bill

vs Enacted

Final Bil 1
vs Request

AOMINISTRATION FOR CHILOREN ANO FAMILIES (ACF)
Payments to States for Chi 1d Support Enforcement and
Family Support Programs

Payments to Territories.
Repatriation.
Subtotal .
Chi 1d Support Enforcement :
State and Loca 1 Admi ni strati on.
Federal Incant i ve Payments .

Access and Visitation ... .

-41,080
+8,833

--- -·- --·--- -- ------------ -- -------------Subtotal, Chi 1 d Support Enforcement ....

4 , 288 , 247

------ --- ---- - -------------- ---- --- -- --- -Total , Fami 1 y Support Payments Program Level.
Less funds advanced in previous years . . .

4,322 , 247
-1 , 400 , 000

------------- - -------------- ------ -------Total , Fami 1 y Support Payments, current year ..
New advance, 1st quarter , FY 2021 .

2,922,247
1,400 , 000

~

LABOR , HEALTH AND HUMAN SERVICES, EDUCATION , AND RELATED AGENCIES APPROPRIATIONS ACT, 2020
(Amounts in thousands)
FY 2019
Enacted

FY 2020
Request

Final Bi 11

Final Bill
vs Enacted

3,740 , 304

+50,000

+3, 740,304

+1,000

+35,000
+56,380
+10,755

Final Bill
vs Request

Low Income Home Energy Assistance Program ( LI HEAP)
Formu1 a Grants .

3,690,304

Refugee and Entrant Assistance

Transitional and Medical Services.
Refugee Support Services.
Victims of Trafficking ...
Unaccompanied Alien Children (UAC) .

Victims of Torture ..... . . . . ....... .

354 , 000
207 , 201
26, 755
1 , 303 , 245
14 , 000

319,000
150,821
17,000
1,303,245
14,000

354,000
207,201
27, 755
1 , 303,245
16,000

1 , 905 , 201

1,804,066

1,908 , 201

-------------- -- ------------ ----------- --Tota 1 , Refugee and Ent rant Assistance .

-- -- -- ---- --- - -------------- ------- ------Subtotal , Sections 414 , 501 , 462 , 235 . .

1,864,446

1 , 773 , 066

1 , 864,446

+2 , 000

+2 , 000

-------------- -------------+3,000

+104 , 135

-------------- --- -- ---- ----+91 , 380

q~

LABOR , HEALTH ANO HUMAN SERVICES, EDUCATION, AND RELATED AGENCIES APPROPRIATIONS ACT, 2020
(Amounts in thousands)
FY 2019
Enacted
Payments to States for the Child Care and Development
Block Grant.
. ............. .

5, 2 76,000

Social Services Block Grant (Title XX).

1,700,000

FY 2020
Request

5 , 276,000

Final Bill

Final Bill

Final Bill

vs Enacted

vs Request

5 , 826,000

+550,000

1 , 700 , 000

+550,000
+1 , 700 , 000

Chi 1 dren and Fami 1 i es Services Programs

Programs for Children, Youth and Fami 1 i es:

Head Start ...
Preschool Dave 1 opment Grants . . . .... . .. .
Runaway and Homeless Youth Program .

Service Connection for Youth on the Streets.
Ghil d Abuse State Grants .......... .
Child Abuse Discretionary Activities.
Community Based Ghil d Abuse Prevention ..... .
Child Welfare Services ..
Child Welfare Training , Research , or Demonstration
projects.
Adoption Opportunities .
Adoption Incant i ve Grants . .......... . .. . ...... . .

10 , 063 , 095
250 , 000
110 , 280
17 , 141
85,310
33,000
39, 764
268 , 735

10,063,095

85,310
33,000
39,764
268 , 735

10,613 , 095
275 , 000
113,780
18 , 641
90 , 091
35 , 000
55,660
268,735

17,984
39,100
75,000

17 , 984
39 , 100
37,943

17 , 984
42,100
75,000

119,121

+550 , 000
+25 , 000
+3,500
+1 , 500
+4 , 781
+2, 000
+15 , 896

+550,000
+275 , 000
-5 , 341
+18,641
+4 , 781
+2,000
+15,896

+3,000

+3 , 000
+37 , 057

lt:i'e

LABOR, HEALTH AND HUMAN SERVICES, EDUCATION , AND RELATED AGENCIES APPROPRIATIONS ACT, 2020
(Amounts in thousands)

Soci a1 Services and Income Maintenance Research .
Native American Programs.

FY 2019
Enacted

FY 2020
Request

6,512
54,550

6,512
52,050

Final Bill

Final Bill

Final Bill

vs Enacted

vs Request

7,012
56 , 050

+500
+1,500

+500
+4,000

725,000
19,883
9,000

740,000
20,383
10,000

+15,000
+500
+1 ;ooo

+740,000
+20,383
+10, 000

753,883

770,383

+16 , 500

+770 , 383

+1,750
+10,500

+1, 750
+10 , 500

Community Services:

Community Services Block Grant Act programs:

Grants to States for Community Services.
Economic Development.

Rural Community Facilities.

Subtotal, Community Services .

-------------- -------------- --------------

.... ........

Domestic Violence Hotline . ..........
Family Violence Prevention and Services .
Chafee Education and Training Vouchers ......... . .
Disaster Human Services Case Management .

Program Direction . ... .

.. . . . .

.........

.

. . .

Total, Children and Families Services Programs .

10,250
164 , 500
43,257
1,864
205 , 000

10,250
164,500
43,257
1 , 864
205 , 000

12,000
175 , 000
43,257
1,864
206,000

12,239,225

11 , 187,485

12,876,652

-------------- -------------- --------------

-------------- --------------

+1,000

+1 , 000

+637,427

+1 , 689,167

--··---------- ---··---------

7

LABOR, HEALTH AND HUMAN SERVICES, EDUCATION, AND RELATED AGENCIES APPROPRIATIONS ACT, 2020
(Amounts in thousands)
FY 2019
Enacted
Promoting Safe and Stab 1e Families .. . ... .
Discretionary Funds.

345 , 000
99 , 765

FY 2020
Request

345,000
59 , 765

Final Bill

345 , 000
92 , 515

-------------- -------------- ---- ------- --Total, Promoting Safe and Stable Families ...

Final Bi 11

Final Bill

vs Enacted

vs Request

-7,250

+32,750

-------------- --------------

444,765

404,765

437,515

-7, 250

5,329,000
3,063,000
203,000
140,000

5,253,000
2,931,000
217,000
143,000

5,253,000
2,931,000
217 , 000
143,000

- 76,000
-132, 000
+14,000
+3,000

+32,750

Payments for Foster Care and Permanency

Foster Care.
Adoption Assistance.
Guardianship . ....... . .. .. . .... . . .. . . .. .. . ... ..... . . .. .
Independent Living.

------ -------- -------------- -------------Total , Payments to States.
Less Advances from Prior Year.

Total, payments, current year.
FY 2021 Ad vances, 1st quarter.
Total, Administration for Children and
Famil ii es.
Current year . .. , . .
FY 2021 Advan ce .

8,735,000
-2 ,700 , 000

8 , 544,000
-2, 800,000

8,544 , 000
-2 , 800,000

-------------- -------------- -------------6 , 035 , 000
2 , 800 , 000

5,744,000
2,800,000

5 , 744 , 000
3 , 000,000

============== ============== ==============
38,412 , 742
(34,212,742)
(4 , 200 , 000)

31,506,316
(27,306,316)
( 4 , 200,000)

39,522,6 72
(35,122,672)
(4,400,000)

-------------- --------------191 ,000
-100,000

-- --------- --- --------------291,000
+200,000

+200,000

============== ==============
+1,109,930
(+909,930)
(+200,000)

+8,016,356
(+7,816,356)
(+200,000)

2.e>"

LABOR , HEALTH ANO HUMAN SERVICES , EDUCATION , AND RELATED AGENCIES APPROPRIATIONS ACT, 2020
(Amount s in thousands)
FY 2019
Ena c ted

FY 2020
Request

Final Bill

Final Bill
vs Enacted

Final Bill
vs Request

ADMINISTRATION FOR COMMUNITY LIVING

Aging and Disability Servi c e s Programs

Grants to States :
Home and Community-based Supportive Services.
Preventive Health .
. ........ .
Protection of Vulnerable Older Americans-Title VII

385,074
24 , 848
21 , 658

385 , 074
24,848
20,628

390 , 074
24,848
22,658

+5 , 000

+5,000

+1,000

+2,030

431 , 580

430 , 550

437 , 580

+6,000

+7 , 030

181 , 186
10 , 056

150 , 586
7 , 556

185,936
10 , 306

+4 , 750
+250

+35 , 350
+2 , 750

191 , 242

158,142

196 , 242

+5 , 000

+38 , 100

495 , 342
251 , 342
160,069

495,342
251,342
160 , 069

510,342
266 , 342
160,069

+15,000
+15,000

+15,000
+15 , 000

906 , 753

906,753

936,753

+30,000

+30,000

1,529,575

1 , 495,445

1 , 570 , 575

+41,000

+75,130

---------- ---- -------------- ------------- Subtotal ..

Family Caregivers .

. ... .. . . .. . . . . . .

Native American Ca regivers Suppo rt .
Subtotal , Careg i vers .

------------- - ---- ---------- ---- ----------

Nutrition :

Congregate Meal s ..
Home Delivered Meals .
Nutrition Services Incent i ve Program ..

------------ -- ------ -------- -------------Subtotal .......... .
Subtotal , Grants to States . ..

-------------- -------------- --------------

-zo ,

LABOR, HEAL TH AND HUMAN SERVICES , EDUCATION , AND RELATED AGENCIES APPROPRIATIONS ACT, 2020
(Amounts in thousands)
FY 2019
Enacted

Grants for Native Americans ......... .. .. . . . . .. .. .. . .. .
Aging Network Support Activities.
Alzheimer's Disease Program.
Prevention and Public Health Fund 1 / .. .. . . , . .... . •
Lifespan Respite Care ..... . . . ....... . .
Chronic Disease Self-Management Program . .
Prevention and Public Health Fund 1/.

Elder Fa 11 s Prevention . ......... .
Prevention and Public Health Fund 1 /.
Elder Rights Support Activities .
Aging and Disability Resources . .
State Heal th Insurance Program .
Paralysis Resource Center . . . .
Limb Loss Resource Center ... .
Traumatic Brain Injury.

34 , 208
17,461
8,800
(14 , 700)
4,110

FY 2020
Request

34,208
11,503
19,490
3,360

(8,000)
(5,000)
15,874
8,119
49 , 115
8 , 700
3 , 500
11,321

13 , 874
6 , 119
36,115

9 , 321

Final Bill

34,708
12,461
11 , 800
(14 , 700)
6,110

Final Bill
vs Enacted

+500
-5,000
+3 , 000
+2, 000

Final Bill
vs Request

+500
+958
-7 , 690
(+14 , 700)
+2 , 750

(8,000)

(+8,000)

(5,000)
15,874
8 , 119
52 , 115
9 , 700
4,000
11,321

(+5 , 000)
+2,000
+2,000
+16,000
+9,700
+4,000
+2 , 000

+3,000
+1,000
+500

-z. o

LABOR, HEALTH AND HUMAN SERVICES , EDUCATION , AND RELATED AGENCIES APPROPRIATIONS ACT, 2020
(Amounts in thousands)

Oeve l opmental Disabilities Programs:
State Councils .
Protect ion and Advo c acy . ..
Voting Access for Individuals with Di sabilities .
Developmental Disabilit i e s Projects of National

Significance.
University Centers for Excellence in Developmental
Disabilities . .
Subtotal, Developmental Disabilities Programs ...
Workfor c e Innovation and Opportunity Act
Independent Li vi ng .
National Institute on Disability, Independent
Living , and Rehabilitation Research . .. .
Assist i ve Technology . .............. .
Subtotal , Workfor ce Innovation and Opportunity
Act.

FY 2019
Enacted

FY 2020
Request

76 , 000
40 , 734
6 , 963

56,000
38,734
4 , 963

Final Bill
Final Bill

78 , 000
40,784
7,463

vs Enacted

Final Bill
vs Request

+2 , 000
+50
+500

+22, 000
+2 , 050
+2 , 500

12 , 000

1,050

12 , 250

+250

+11, 200

40,619

32,546

41,619

+1,000

+9,073

-------------- -------------- -------------176,316

133 , 293

180 , 116

116 , 183

108,646

116 , 183

108,970
36,000

90 , 371
31,939

111 , 970
37 , 000

----- ----- ---- -------------- ---- --- ----- -261 , 153

230 , 956

265 , 153

-------------- -------------+3 , 800

+46 , 823

+7 , 537
+3 , 000
+1 , 000

+21 , 599
+5,061

--- ----------- ------ -- -----+4 , 000

+34 , 197

0~

LABOR , HEALTH ANO HUMAN SERVICES , EDUCATION , AND RELATED AGENCIES APPROPRIATIONS ACT , 2020
(Amounts in thousands)
FY 2019
Enacted

Program Administration ...
Total, Administration for Community Living .
Federal funds .. . . . . . . . . ...... .
Trust Funds .
(Prevention and Public Health Fund 1/).
Total, AGL program level.

41 , 063

FY 2020
Request

3B , 987

Final Bill

Final Bill
vs Enacted

Final Bill
vs Request

41,063

+2,076

======

2,169,315
( 2 , 120 , 200)
(49,115)
(27,700)

2 , 032 , 671
( 1 ,996,556)
(36,115)

2,223,115
(2,171,000)
(52,115)
(27 , 700)

+53,800
(+50,800)
(+3,000)

+190,444
(+174 , 444)
(+16,000)
(+27,700)

2,197,015

2 , 032 , 671

2,250,815

+53,800

+218,144

206,895

196,419

-4 , 500
+9,500

OFFICE OF THE SECRETARY
Genera l Departmental Management

General Departmental Management, Federal Funds.
Departmental Appeals Board (administrative transfer) ..
Teen Pregnancy Prevention Community Grants . ..
Evaluation Tap Funding .
Subtotal , Grants .. .

200,919
-9 , 500
101,000
(6,800)

-- --- --------(107,800)

101 , 000
(6,800)

-10,476
+101,000
(+6,800)

-------------- --------------

-------------- --------- -----

(107 , 800)

(+107,800)

~ 0'4

LABOR, HEALTH ANO HUMAN SERVICES, EDUCATION , AND RELATED AGENCIES APPROPRIATIONS ACT, 2020
(Amounts in thousands)
FY 2019
Enacted

Sexual Risk Avoidance . .
Office of Minority Health ....
Office on Women's Health .
Minority HIV / AIDS prevention and treatment.
Embryo Adoption Awareness Campaign.
Planning and Evaluation, Evaluation Tap Funding ., .. , ..

FY 2020
Request

Final Bill

Total, General Departmental Management program
level.
Medi care Hearings and Appeals . .... .
Departmental Appeals Board ( Departmental
Management) ............... .

Subtotal ..

Office of the National Coordinator for Health
Information Technology ...... .

Final Bi 11
vs Request

35,000
56,670
32 , 140
53 , 900
1,000
(58,028)

(68,840)

35 , 000
58 , 670
33,640
53,900
1 , 000
(58,028)

471 , 129
(64,828)

339 , 909
(68,840)

479,629
(64,828)

535,957

408,749

544,457

+8,500

+135,708

182 , 381

182 , 381

191 , 881

+9,500

+9,500

51,798
27 , 316
53,900

---------- --- - -------------- -------------Total, General Departmental Management.
(Evaluation Tap Funding) .

Final Bill
vs Enacted

------ -------· -------------- --------------

9 , 500

-------------- -------------- -------- ----- -

+2 , 000
+1,500

+35 , 000
+6 , 872
+6 , 324
+1,000
(-10, 812)

-------------- -------------+8,500

+139, 720
(-4,012)

---- ---------- -------- ------

-9,500

-- ------------ -- --- -- -------

191 , 881

182,381

191 , 881

+9 , 500

60,367

43,000

60 , 367

+17 , 367

o5

LABOR , HEALTH AND HUMAN SERVICES, EDUCATION, AND RELATED AGENCIES APPROPRIATIONS ACT, 2020
(Amounts in thousands)
FY 2019
Enacted

FY 2020
Request

Inspector General Federal Funds ..... .
Office for Civil Rights

80,000

80,000

80 , 000

Federal Funds .

38,798

30,286

38,798

469,246
31,756
128 , 207

491 , 090
31,650
100,651

491,090
31 , 650
100,851

Final Bi 11
Final Bill

vs Enacted

Final Bill
vs Request

Office of Inspector General

+8 , 512

Retirement Pay and Medical Benefits for
Commissioned Officers
Retirement Payments . .

Sur vi vars Benefits . ..... .
Dependents ' Medical Care.

-------------- -------------- ------- ------Total , Benefits for Commissioned Officers.

629,209

623,591

623,591

+21 , 844
-106
-27,356

-------------- --------------5,618

2f>(;

LABOR, HEAL TH AND HUMAN SERVICES , EDUCATION, AND RELAT ED AGENCIES APPROPRIATIONS ACT, 2020
(Amounts in thousands)
FY 2019
Enacted

FY 2020
Request

30,938
24,654
57,404

30,938
24,654
77,404

Final Bill

Final Bill

Final Bill

vs Enacted

vs Request

Public Health and Social Services Emergency Fund
(PHSSEF)
Assistant Secretary for Preparedness and Response

Operations .......... . .. .
Preparedness and Emergency Ope rat i ens . .

National Disaster Medi ca l System.
Hospital Preparedness Cooperative Agreement Grants:
Formula Grants . ......... .

30,938
24,654
57,404

264,555

257,555

275 , 555

561,700
14,877
735,000
610,000
6 , 000

561,700
19,877
735,000
620 , 000
3,900

561 , 700
14 , 877
735,000
705,000
6,000

- 20,000
+11,000

+18,000

Biomedical Advanced Research and Development

Authority (BARDA).
Policy and Planning .
Project BioShield .
Strategic National Stockpile.
Medi cal Reserve Corps . ....... .

..... .

------ -- ----- - ------ ---- ---- ---- -- -------Subtotal, Preparedness and Response.

2,305,128

2 , 331,028

2,411 , 128

-5,000
+95,000

+85,000
+2, 100

------- ----- -- -------------+106 , 000

+80, 100

,zo

LABOR, HEALTH AND HUMAN SERVICES , EDUCATION , AND RELATED AGENCIES APPROPRIATIONS ACT , 2020
(Amounts in thousands)
FY 2019
Enacted

FY 2020
Request

58 , 860
7,470

68,093
7,470

58 , 860
7,470

260,000

260,000

260,000

Final Bill
Final Bill

vs Enacted

Final Bill
vs Request

Assistant Secretary for Admini stration

Assistant Secretary for Administration , Cybersecurity.
Office of Security and Strategic Information ....

-9 , 233

Public Health and Science

Pandemic Influenza Preparedness .
Subtotal, Non-pandemic flu/B1oSh1eld/SNS.

1 , 026, 458

1,051,591

1,037,458

+11,000

-14, 133

Total ' PHSSEF ...... .

2,631 , 458

2 , 666 , 591

2,737,458

+106 , 000

+70 ,86 7

Total , Office of the Secretary ...... . .. . .
Federal Funds. .
. .... ..• . . , , ..•....
Trust Funds .
(Evaluation Tap Funding) ..

4,102,842
3 , 920,461
182 ,381
(64 ,828)

3,965,758
3,783,377
182,381
(68, 840)

4,211 , 724
4,019 , 843
191 , 881
(64 , 828)

+108,882
+99,382
+9,500

+245 ,966
+236,466
+9,500
(-4,012)

Total, Office of the Secretary Program Level .

4,167,670

4,034,598

4 , 276,552

+108,882

+241 ,954

'2..0i

LABOR , HEALTH ANO HUMAN SERVICES , EDUCATION , ANO RELATED AGENCIES APPROPRIATIONS ACT , 2020
(Amounts 1 n thousands)

Tota l, Title II , Health and Human Services.
Federal Funds .

Current year . ...... .
FY 2021 .
Trust Funds . ............... .
Total , CURES Act2 / .. .
Total , Prevention and Publi c Health Fund 1 /.
Total, Transfers from Nonrecurring Expenses Fund

FY 2019
Enacted

FY 2020
Request

69 6 , 466 , 404
693,610,964
(751,679,167)
(142 , 131 , 797)
4,675,440
(711,000)
(644,200)

915 , 625 , 173
911,024,050
(766 , 920,975)
(144 , 103,075)
4 , 601,123
(492,000)
(693,950)

Final Bill

Final Bill
vs Enacted

Final Bill
vs Reque st

934,340,279
929,630 , 339
(7B5 ,327 , 264)
(144,303 , 075)
4,709,940
(492,000)
(693 , 950)
(450,000)

+35 , 653,675
+35,619 , 375
(+33,646,097)
( +2, 171,276)
+34 , 500
(-219,000)
(+49,750)
(+450,000)

+16,715, 106
+16,606 , 269
(+16,406,269)
( +200, 000)
+106 , 617

(+450 , 000)

Title II Footnotes :
1/ Sec.4002 of Public Law 111 -148
2 / 21St Century CURES Act (Public Law 114 -2 55)
3/ FY2020 budget request propo se s co n so l i dating the
Agency for Healthcare Research and Quality within
the National Institutes o f Health as the National
In stitute for Research on Safety and Quality

oGl.

LABOR, HEALTH ANO HUMAN SERVICES, EOUCATION , AND RELATED AGENCIES APPROPRIATIONS ACT, 2020
(Amounts in thousands)
FY 2019
Enacted

FY 2020
Request

Final Bill

(1,540,776)
5,013,625
5 , 000

(1 , 440,776)
4 , 172,904
5,000

( 1 , 440 , 776)
5 , 463 , 625
5 , 000

5,018,625
(6 , 559,401)

4 , 177,904
( 5 , 618,680)

5 , 468 , 625
(6 ,909 ,401)

Final Bill
vs Enacted

Final Bill
vs Request

TITLE III - DEPARTMENT OF EDUCATION
EDUCATION FOR THE DISADVANTAGED
Grants to Local Edu cational Agen cies ( LEAs)

Basic Grants :
Advance from prior year ....
Forward funded ............. . . •.. •• . . • . .• •. • • .
Current funded .

Subtotal , Bas i c grants current year approp . .
Subtotal , Ba sic grants total funds available
Ba si c Grants FY 2021 Advance .. .

---------- -- -- -- --- --------- --- ----------1,440 , 776

2,281,497

990,776

6,459,401

6,459,401

6,459,401

( 1 , 362, 301 )
1 ,362,301

( 1 , 362,301)
1 , 362 , 301

(1,362,30 1)
1 , 362 , 301

------------- - --- ----------- -------------Subtotal , Ba sic grants, program 1evel ..

Concentration Grants:
Advance from prior year ...
FY 2021 Advance .

------------- - -------------- -- --- --------Sub tot a 1 ......... . .. . . . .. . . .. . • . . • . .. . . .. . . •

1,362 , 301

1 , 362 , 301

1 , 362,301

(-100,000)
+450,000

+1, 290, 721

------- ------- ------ -------+450,000
(+350,000)

+1 , 290 , 721
(+1,290, 721)

-450,000

-1 ,290 , 721

-------------- --------------

------ ------- - ----- ----- ----

fO

LABOR , HEALTH AND HUMAN SERVICES , EDUCATION , AND RELATED AGENCIES APPROPRIATIONS ACT, 2020
(Amounts in thousands)
FY 2019
Enacted

FY 2020
Request

Final Bill

Final Bill
vs Enacted

Final Bill
vs Request

( 3 ,969 , 050)
4,019,050

(4,019,050)
4 , 019,050

( 4,019,050)
4,244,050

( +50,000)
+225 , 000

+225 , 000

4,019,050

4,019,050

4,244,050

+225, 000

+225 , 000

(3,969,050)
4,019,050

(4,019,050)
4,019,050

(4,019,050)
4 , 244,050

(+50 , 000)
+225,000

+225,000

4 , 019,050

4,019,050

4,244 , 050

+225,000

+225,000

+450 , 000

+450,000

Targeted Grants :

Ad vance from prior year .....

. ....... . .

FY 2021 Advance . .......... .. •..•. . • . . .. . . . .. • .
Subtotal .

Edu cation Finance Incentive Grants:
Advance from prior year.
FY 2021 Advance.

. .. . .....• .. • . ..... • .

Subtotal .
Subtotal , Grants to LEAs , program level ...

--------15 , 859 , 802

Student-Centered Funding Incentive Grants .....

--------15,859 , 802

--------16,309,802

50 , 000

- 50 , 000

Innovative Approaches to Literacy.
Comprehensi ve litera cy deve 1opment grants .

27,000
190,000

State Agency Programs :
Mi grant ..... .
Neglected and Delinquent/High Risk Youth . .

374, 751
47,614

374,751
47 , 614

374,751
47,614

Subtotal, State Agency programs ....

422 , 365

422,365

422,365

27,000
192,000

+2,000

+27,000
+192,000

~

\'

LABOR, HEALTH AND HUMAN SERVICES , EDUCATION , AND RELATED AGENCIES APPROPRIATIONS ACT , 2020
(Amounts in thousands)
FY 2019
Enacted

Spec ial Programs for Mi grant Student s.
Total, Education for the disadvantaged .

Current Year . ... .. ........ .
FY 2021 Advances .
Subtotal , Forward Funded ....

44 , 623

FY 2020
Request

44 , 623

Final Bill
Final Bi 11

45 , 623

============== ============-- --============
16 , 543,790
(5,702 , 613)
(10 , B41 , 177)
(5,625 , 990 )

16 , 376 , 790
(4 , 694 , B92)
(11,6B1 ,898)
(4 , 595,269)

1,301 , 242
48 . 316
4 . 835
17 , 406
74 , 31 3

1 , 301 , 242
48,316
4 , 835
17 , 406

16,996,790
(6,155,613)
(10,841,177)
(6,077,990)

vs Enacted
+1,000

Final Bill
vs Request

+1 , 000

============== --============
+453 , 000
(+453 , 000)
(+452 , 000)

+620 , 000
(+1,460 , 721)
(-840 ,721)
( +1, 482 , 721)

IMPACT AID
Ba s i c Support Payments .
Payments for Children with Di sabilities.
Fac ilities Maintenance (S ec. 8008 ).
Construction (Sec . 8007) ......
. . .. . ..... .
Pa y ments for Federal Property (Sec. 8002) ... .
Total , Impact aid .................. .

--------1 , 446 , 112

1,371, 799

1 , 340 , 242
48,316
4 , 835
17,406
75,313

--------1 , 486 , 112

+39 , 000

+39 , 000

+1,000

+75,313

+40,000

+114 , 313

\'l-

LABOR , HEALTH AND HUMAN SERVICES, EDUCATION , AND RELATED AGENCIES APPROPRIATIONS ACT, 2020
(Amounts in thousands)
FY 2019
Ena c ted

FY 2020
Request

374 , 389
(1 , 681 , 441)
1,681,441

(1 , 681 , 441)

Final Bill

Final Bill
vs Enacted

Final Bill
vs Request

SCHOOL IMPROVEMENT PROGRAMS
Supporting Effective Instruction State Grants.

Advance from prior year ...
FY 2021 Advance .
. ... .... .
Subtotal, Supporting Effective Instruction State
Grants , program level ....... .
Supp 1ementa 1 Education Grant s . .
Ni ta M. Lowey 21st Century Community Learning Centers .

State Assessments ........

............ .

Educ ation for Home 1ess Ghil dren and Youth .
Training and Advisory Ser v i ces ( Civil Rights ) ..

Education for Native Hawaiians ..
Ala ska Native Education Equity .
Rural Edu c ation .

Comprehensive Centers .
Student Support and Aca demi c Enri c hment grants .

Total , School Improvement Programs .
Current Year . . .
FY 2021 Advance . . . . . . . . .
. ....• . . • ..• ...
Subtotal , Forward Funded ....•...... . .

2,055,830
16,699
1,221,673
378,000
93 , 500
6,575
36 , 397
35,453
180,840
52 , 000
1 , 170 , 000

16 , 699
378 , 000
93 , 500
6 , 575

180 , 840

450 , 389
(1 , 681 , 441 )
1,681 , 441

+76 , 000

2,131,830

+76,000

+2 , 131 , 830

+2B,OOO

+1 , 249 , 673

+8 , 000

+8 , 000

+500
+500
+5 , 000

+36 , 897
+35,953
+5,000
+52,000
+1 , 210,000

16 , 699
1,249 , 673
378 , 000
101,500
6 , 575
36,897
35,953
185,840
52 , 000
1 , 210 , 000

============== ============== ==============
5 , 246 , 967
(3 , 565 , 526)
(1 , 681 , 441)
(3 , 418 , 402)

675,614
(675 , 614)

(652,340)

5 , 404 , 967
(3 , 723 , 526)
(1,681,441)
(3,575 , 402)

+450 , 389
+1 , 681 , 441

+40 , 000

============== ===----------+158 , 000
( +158,000 )

(+157,000)

+4 , 729 , 353
(+3 , 047,912)
(+1 , 681 , 441)
(+2 , 923,062)

t3

LABOR , HEAL TH AND HUMAN SERVICES , EDUCATION , AND RELATED AGENCIES APPROPRIATIONS ACT , 2020
(Amounts in th ou sands)
FY 2019
Enacted

FY 2020
Request

Final Bill

Final Bill
vs Enacted

Final Bi 11
vs Request

INDIAN EDUCATION

Grants to Local Educational Agencie s.
Federal Programs :
Special Program s for Indian Children.

National Activitie s.
Subtotal. Federal Programs .
Total . Indian Education .

105 ,381

105,381

105 , 381

67 , 993
6 , 865

63,993
6,865

67 , 993
7,365

+500

+4,000
+500

74 . 858

70,858

75,358

+500

+4,500

180,239

176,239

180 , 739

+500

+4,500

130 , 000
1 , 815
3 , 000
440 , 000
107 , 000
200 , 000
27 , 741
75 , 000
29. 000

300 , 000

190 , 000
1,815
3,000
440,000
107,000
200 , 000
29 , 000
80,000
30. 000

+60 , 000

- 110,000
+1 , 815
+3 , 000
-60 , 000

+1 , 259
+5,000
+1 , 000

+29 , 000
+80 , 000
+30 , 000

-------------- -------------- --------------

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

====:;:::: :

INNOVATION AND IMPROVEMENT

Edu c ation lnnovat ion and Res earch . ........... .
Ame r i c an Hi stor y and Ci vi cs Academie s.

Ameri c an History and Civ ics National Activities .. . .. . .
Cha r ter Sc hools Grants .
Magnet Schools Assistance .
Teacher and School Leader Incentive Grants .

Re ady-to-Learn Television .
Supporting Effec tive Educ ator Development ( SEED) .

Arts in Education.

500,000
107,000
200,000

ILC

LABOR , HEALTH ANO HUMAN SERVICES , EDUCATION , AND RELATED AGENCIES APPROPRIATIONS ACT , 2020
(Amounts in thousand s )
FY 2019
Enacted

Javits Gifted and Talented Students . .. . . • . .• . . . • . . •. . .
Statewide Family Engagement Cent e rs .

Total , Innovation and Improvement . ..

FY 2020
Request

12,000
10 , 000

Final Bill

Final Bill
vs Enacted

Final Bill
vs Request

13 , 000
10 , 000

+1 , 000

+13,000
+10 , 000

1,035 , 556

1 , 107 , 000

1,103,815

+68,259

-3, 185

78, 254
95,000
17,500

200,000

80,000
105,000
25,000

+1,746
+10 , 000
+7, 500

+80,000
-95,000
+25,000

190,754

200,000

210 , 000

+19,246

+10,000

47 , 931
689 , 469

47,931
689,469

51,181
736 , 219

+3,250
+46,750

+3,250
+46,750

737,400

737 , 400

787 , 400

+50 , 000

+50,000

SAFE SCHOOLS AND CITIZENSHIP EDUCATION

Promise Neighborhood s . .
School Safety National Activities.
Full-Servi c e Community Schools .
Total, Safe Schools and Citizenship Edu c ation.
ENGLISH LANGUAGE ACQUISITION
Current funded .
Forward funded.

Total , English Language Acquisition .

ZIS

LABOR , HEAL TH AND HUMAN SERVICES, EDUCATION, AND RELATED AGENCIES APPROPRIATIONS ACT , 2020
(Amounts in thousands)
FY 2019
Enacted

FY 2020
Request

Final Bill

3,081,009
(9,283,383)
9,283,383

2,240,289
(9,283,383)
10,124,103

3,481,009
(9,283,383)
9,283,383

+400,000

+1 , 240,720

Final Bill
vs Enacted

Final Bill
vs Request

SPECIAL EDUCATION
State Grants:

Grants to States Part B current year . .
Part B advance from prior year ....... . .. . .. . . .
Grants to States Part B ( FY 2021).
Subtotal, program level.

Preschool Grants.
Grants for Infants and Fami 1 i es .
Subtotal, program level .
IDEA National Activities (current funded) :
State Personne 1 Development ........ .

-840, 720

----------

----------

----------

12 , 364,392

12,364,392

12,764,392

+400 , 000

+400 , 000

394,120
477,000

+3,000
+7 ,000

+3 ,000
+7 , 000

+410, 000

+410 ,000

+2,500
+2,500

+2,500
+2,500

391,120
470,000

391,120
470,000

----------

----------

----------

13,225,512

13,225,512

13,635,512

38,630

38,630

38 , 630

61,928
87,200
27,411

61,928
87,200
27,411

64,428
89,700
27 , 411

Technical Assistance and Dissemination (including
Special Olympics Education) .

Personnel Preparation .
Parent Information Centers ....

Z. IG

LABOR , HEALTH AND HUMAN SERVICES , EDUCATION , AND RELATED AGENCIES APPROPRIATIONS ACT, 2020
(Amounts in thousands )
FY 2019
Enacted

Edu c ationa l Tec hnology, Media , a nd Materials ....
Subtotal , IDEA National Activities .
Total , Special education .
Current Year.

FY 2021 Advance .
Subtotal , Forward Funded ....

. .. . • ... . .. . ..

. . .. . . .. . • , . • . . .

FY 2020
Request

Final Bill

26 , 047

26,047

29,547

243,216

243,216

249,716

Final Bill

Final Bi 11

vs Enacted

vs Request

+1 , 500

+1 , 500

+6,500

+6,500

---- -- -------- --- -------- --- ----- ---- -----

-------------- ---- ----------

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

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

13 , 466 , 726
( 4, 165 , 345)
(9,263,363)
( 3, 942 , 129)

13 , 466 , 726
(3,344,625)
(10,124,103)
(3,101,409)

13 , 665,226
(4 , 601 , 645)
(9,26 3 ,363)
(4,352,129)

+416 , 500
(+416,500)

(+410 , 000)

+416,500
(+1,257,220)
( -640 ,720)
(+1 , 250 , 720)

REHABILITATION SERVICES
Vocational Rehabilitation State Grants . .........•..•..
Client Assistance State g rants .. .. .
Tr aining .
. ...... .
Demonstration and Training programs . .
Protec tion and Advo c acy of Indiv i dual Rights (PAIR) .
Supported Employment State grants ..
Independent Li vi ng :

Services for Older Blind Individuals .
Helen Kell er National Center for Deaf I Blind Youth and
Adults... ..
. .... . .............. .

Total , Reha bi 1 i tat ion services.

3 , 521 , 990
13,000
29 , 366
5 , 796
17 , 650
22, 546

3 , 610 , 040
13 , 000
29,366
5 , 796
17,650

3 , 610 , 040
13,000
29 , 366
5 , 796
17,650
22, 546

+66 , 050

+22 , 546

33 ,3 17

33,317

33, 317

13,500

10 , 336

16 , 000

+2,500

+5 , 664

3, 657 , 169

3,719,527

3,747,739

+90 , 550

+26 , 212

l

.)

LABOR , HEALTH ANO HUMAN SERVICES , EDUCATION , ANO RELATED AGENCIES APPROPRIATIONS ACT, 2020
(Amounts ; n thousands)
FY 2019
Enacted

FY 2020
Request

30 , 431

25 , 431

F;nal Bill

Final Bill
vs Enacted

F; nal Bi 11
vs Request

SPECIAL INSTITUTIONS FOR PERSONS WITH OISABILITIES

American Printing House for the Blind . ...
Nat;onal Technical Institute for the Deaf (NTI D):
Operations.
Gall audet Un; vers; ty:
Ope rat; ans.

32,431

+2, 000

+7 , 000

77 , 500

70,016

79 , 500

+2,000

+9 , 484

134,361

121,275

137,361

+3,000

+16 , 086

242,292

216 , 722

249,292

+7 , 000

+32 , 570

471 , 598
(791,000)
791 , 000

471,598
(791,000)
791 , 000

491,598
(791,000)
791 , 000

+20,000

+20 , 000

Total, Special Institutions for Persons with

o; sabil it; es .. ..

.

.. .......... ..

CAREER , TECHNICAL , ANO ADULT EDUCATION

Career Education:
Basic State Grants/Secondary & Technical Education
State Grants, current funded.
Advance from prior year ...
FY 2021 .
. ........ .
Subtotal , Bas; c State Grants , program level .

National Progr ams ............. .

·-----·------1,262,598
7,421

-------- -- ---Subtotal, Career Education.

1,270,019

-----·-------- -------------1 , 262,598

1,282,598

20,000

7,421

1,282,598

1 , 290,019

-------------- --------------

-- ------------ -------------+20,000

+20 , 000
-12,579

--------- -- --- -------------+20 , 000

+7, 421

l~

LABOR , HEALTH ANO HUMAN SERVICES , EDUCATION, ANO RELATED AGENCIES APPROPRIATIONS ACT, 2020
(Amounts in thousands)
FY 2019
Enacted

FY 2020
Request

Final Bill

Final Bill
vs Enacted

Final Sill
vs Request

Adult Education :

State Grants/Adult Ba sic and Literacy Education :
State Grants , current funded .

National Leadership Activities.

641,955
13,712

485 , 849
73,712

656,955
13,712

+15 , 000

+171, 106
-60,000

559,561

670 , 667

+15,000
+35 , 000
( +35,000)

+111, 106
========
+118 , 527
(+118,527)

( +35 , 000)

(+118 , 527)

(+150)

(+150)

--- --- -- ---- -- --- ----------- ---------- ---Subtotal , Adult education ....... .
Total, Career , Technical, and Adult Education.
Current Year.
FY 2021.
Subtotal, Forward Funded . .

655,667

============== ============== ==============
1,925,686
( 1 , 1 34, 686)
(791,000)
( 1 , 134, 686)

1 , 842 , 159
(1,051,159)
(791,000)
(1,051,159)

1,960,686
(1,169,686)
(791,000)
(1,169,686)

(5,135)
22,475,352
840 , 000
1,130 , 000

(5,135)
22,475,352

(5,285)
22,475 ,352
865 , 000
1 , 180 , 000

STU DENT FINANCIAL ASSISTANCE
Pell Grants -- maximum grant (NA) . ... .
Pell Grants.
. ............. .
Federal Supplemental Educational Opportunity Grants .
Federal Work Study .
Total, Student Financial Assistance (SFA) . .
FEDERAL OIRECT STUDENT LOAN PROGRAM ACCOUNT ..

---------24,445,352
350,000

500,000

---------- ==============
22,975 , 352

24,520,352
50,000

+25 , 000
+50 , 000

+865,000
+680,000

+75,000

+1 , 545 , 000

-300,000

+50 , 000

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

,tG

LABOR, HEALTH AND HUMAN SERVICES , EDUCATION, AND RELATED AGENCIES APPROPRIATIONS ACT , 2020
(Amounts in thousands)
FY 2019
Enacted

FY 2020
Request

Final Bill

Final Bill

Final Bill

vs Enacted

vs Request

+180 , 000
-90 , 000

-402 , 338
+359, 281

STUDENT AID ADMINISTRATION

Salaries and Expenses .. . ....... . .. .
Servicing Activities ...... .. .. .... .
Total , Student Aid Admi ni strati on . .

698 , 943
980,000

1,281,281
530,719

878,943
890,000

============== ============== ==============
1,678,943

1 , 812,000

============== --------------

1,768,943

+90 , 000

-43,057

107 , 854
143,081

+7,979
+18,666

+107 , 854
+143,081

HIGHER EDUCATION
Aid for Institutional Development:
Strengthening Institutions ... . . .

Hispanic Serving Institutions .
Promoting Post-Baccalaureate Opportunities for
Hispanic Americans . ................... .
Cons l i dated MSI Grant .
Strengthening Historically Black Colleges (HBCUs) .
Strengthening Hi stori call y Black Graduate
Institutions.
Strengthening Predominantly Black Institutions.
Asian American Pacific Islander .
Strengthening Alaska Native and

Native Hawaiian - Serving Institutions.

99,875
124 , 415
11 , 163

12 , 838

+1 , 675

324 , 792

+42 , 372

+12,838
-147 , 906
+42 , 372

83 , 995
13,197
4 , 444

+10,958
+1 , 722
+580

+10,958
+13 , 197
+4 , 444

15,930

18,320

+2,390

+18 , 320

3,864
31,854
8 , 657

27,599
8,657

4,444
36,633
9,956

+580
+4,779
+1,299

+4 , 444
+9, 034
+1 , 299

666 , 554

539,619

759 , 554

282,420
73,037
11,475
3 , 864

147 , 906
282 , 420
73,037

Strengthening Native American-Serving Nontribal

Institutions ..... .
Strengthening Tribal Co 11 eges ...... .
Strengthening HBCU Masters programs.
Subtotal, Aid for Institutional development .

--- --- -------- -------------- ------ --------

-------------- -------------+93,000

+219 , 935

-z__~

LABOR, HEAL TH AND HUMAN SERVICES , EDUCATION, AND RELATED AGENCIES APPROPRIATIONS ACT, 2020
(Amounts in thousands)
FY 2019
Enacted

FY 2020
Request

Final Bill
Final Bill

vs Enacted

Final Bill
vs Request

Internat i anal Education and Fore1 gn Language:
65,103
7 , 061

68 , 103
8,061

+3,000
+1,000

+68, 103
+8,061

Subtotal, International Edu cation & Foreign Lang

72,164

76 , 164

+4,000

+76, 164

Postsecondary Program for Students with Intel l actual
Disabilities.
Minority Science and Engineering Improvement.
Tribally Controlled Postsec Voe/Tech Institutions.
Federal TRIO Programs ...... .
GEAR UP.
. . ........ .
Graduate Assistance in Areas of National Need.
Teacher Quality Partnerships ....... .
Child Care Access Means Parents in School .
Fund for the Improvement of Postsecondary Ed . ( FIPSE ) .

11,800
11,135
9 , 564
1 , 060,000
360 , 000
23 , 047
43 , 092
50 , 000
5 , 000

+1,500
+436
+30,000
+5,000
+7 , 000
+3 , 000
+19 , 500

+2 , 987
+1, 714
+140 , 000
+365 , 000
+23,047
+50,092
+37 , 866
+24,500

+163,436

+941 , 305

Domestic Programs.

Overseas Programs . ... . . ,, ...... .

Total, Higher Education ...... .

--------2,312 , 356

11,800
9,648
8,286
950,000

15 , 134

1,534,487

11 , 800
12 , 635
10 , 000
1,090 , 000
365 , 000
23 , 047
50 , 092
53 , 000
24 , 500

--------2, 475,792

"2. ~ \

LABOR , HEALTH ANO HUMAN SERVICES, EDUCATION, ANO RELATED AGENCIES APPROPRIATIONS ACT , 2020
(Amounts in th ou sands)
FY 2019
Enacted

FY 2020
Request

Final Bill

Fi nal Bill
vs Enacted

Final Bill
vs Request

HOWARD UNIVERSITY

Acad emi c Program .
Endowment Program .
Howard University Hospital .

Total, Howard University.
COLLEGE HOUSING AND ACADEMIC FACILITIES LOANS PROGRAM.

205 , 768
3,405
27 , 325

191,091
3 , 405
27,325

209,288
3 ,405
27 , 325

+3 , 500

+18 , 197

236 , 518

221 , 821

240,018

+3,500

+18, 197

435

435

435

334
40,150

334
40,150

334
46,150

+6 , 000

+6 , 000

40 , 484

40,484

46,484

+6 , 000

+6 , 000

HISTORICALLY BLACK COLLEGE AND UNIVERSITY (HBCU)
CAPITAL FINANCING PROGRAM ACCOUNT
HBCU Federal Admini s tration .
HBCU Loan Subsidies .
Total , HBCU Capital Financing Program .

'ZZ.'2

LABOR , HEALTH AND HUMAN SERVICES , EDUCATION, AND RELATED AGENCIES APPROPRIATIONS ACT, 2020
(Amounts in thousands)
FY 2019
Enacted

FY 2020
Request

Final Bill

Final Bill
vs Enacted

Final Bi 11
vs Request

INSTITUTE OF EDUCATION SCIENCES (IES)
187,500
112,500

. ........ .

192 , 695
109,500
55 , 423
56,000
10 , 818
32 , 281

Assessment :
National Assessment.
National Assessment Governing Board .. .

151 , 000
7,745

149,000
7,745

Research , Development and Dissemination .

Statistics.

.. ..........

Regional Educational Laboratories.
Research in Special Education.
Special Education Studies and Evaluations .. . . . ... . . . .

Statewide Data Systems .

54,000
10,818

195,877
110 , 500
56,022
56,500
10,818
33 , 000

+3, 182
+1,000
+599
+500

+8 , 377
·2 , 000
+56,022
+2, 500

+719

+33,000

153,000
7,745

+2,000

+4,000

-- ------- ---- - -------------- -------------Subtotal , Assessment . ................ . . .... . ... .

Total , IES ...

158,745

156,745

160 , 745

+2,000

+4,000

615,462

521,563

623,462

+8,000

+101 , 899

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

'Z '2 *'"s

LABOR, HEAL TH AND HUMAN SERVICES , EDUCATION , AND RELATED AGENCIES APPROPRIATIONS ACT, 2020
(Amounts 1 n thousands)
FY 2019
Enacted

FY 2020
Request

Final 8111

Final Bill
vs Enacted

Final Bill
vs Request

DEPARTMENTAL MANAGEMENT

Program Administration :
Salaries and Expenses .
Building Modernization ..... .
Total, Program administration .
Office for Civil Rights .
Office of Inspector General .

Total , Departmental management . .
Total , Title I II , Department of Education.

Current Year .
FY 2021 .... ... ...... .. .. .

433 , 500
13 , 500

430 , 000

430,000

447,000

430,000

125,000

125,000

130 , 000

+5,000

61 , 143

63 , 418

63,000

+1,857

-418

616 , 143

635,418

623 , 000

+6 , 857

- 12 , 418

430 , 000

-------------- -------------- --------------

======

74 , 970 , 406
(52 , 373 , 405)
(22 , 597,001)

67 , 633 , 538
(45,036,537)
(22,597 , 001)

76 , 361 , 254
(53,764 , 253)
(22,597 , 001)

-3,500
-13, 500

------------- - ·-------------17, 000

+1 , 390,848
( +1,390,848)

+5, 000

+8 , 727,7 16
(+8,727 , 716)

4

LABOR, HEAL TH AND HUMAN SERVICES , EDUCATION, AND RELATED AGENCIES APPROPRIATIONS ACT , 2020
(Amounts in thousands)
FY 2019
Enacted

FY 2020
Request

8,250

9,400

10,000

(1,250)

(1,650)

(1,650)

Final Bill

Final Bill
vs Enacted

Final Bill
vs Request

TITLE IV- -RELATED AGENCIES
COMMITTEE FOR PURCHASE FROM PEOPLE WHO ARE BLIND OR
SEVERELY DISABLED .
(Office of Inspector General).
. ....... .
CORPORATION FOR NATIONAL AND COMMUNITY SERVICE

+1,750

+600

(+400)

Operating Expenses

Domesti c Volunteer Serv ice Programs :
Volunteers in Service to America (VISTA) ..

National Senior Volunteer Corps :
Foster Grandparent s Program . .
Senior Companion Program .. ..... .

Retired Senior Volunteer Program .
Subtotal, Sen1or Volunteers .

Subtotal , Dome s tic Vo 1 unteer Service.

92,364

4 , 665

93,364

+1 , 000

+88,699

110,899
46,863
50,355

111
111
111

118,799
50,863
51,355

+7,900
+4,000
+1,000

+118,688
+50 , 752
+51 , 244

208,117

333

221,017

4 , 998

314,381

-------------- -------------- ---------- -- ------- -------- -------------- -------------300,481

-------- ------ -------------+12 , 900

+220 , 684

--- ---- ------- ---- -- --- ----+13 , 900

+309,383

7

LABOR , HEALTH AND HUMAN SERVICES , EDUCATION , AND RELATED AGENCIES APPROPRIATIONS ACT, 2020
(Amounts in thousands)
FY 2019
Enacted

FY 2020
Request

Final Bill

Final Bi 11
vs Enacted

Final Bill
vs Request

Nat i onal and Community Servi c e Programs :
Ame r iCorps State and Nati anal Grants . .

Innovation, Assistance , and Other Activities ..
Evaluation . ............................. .
National Civilian Community Corps (NCCC)(subtitle
E) .......
. ....... .
State Commission Support Grants.
Subtotal, National and Community Service .
Total , Operating expenses .

National Service Trust .
Salaries and Expense s . .
Offi ce of Inspec tor General . .. .... .

Total, Corp . for National and Community Service .

425 , 010
7 , 600
4,000

2,224

428 , 510
9 , 600
4 , 000

+3 , 500
+2,000

+426 , 286
+9 , 600
+4 , 000

32 , 000
17,538

22,883

32,500
17,538

+500

+9 , 617
+17,538

-- ------------ -------------- -------------486 , 148

25,107

492,148

+6,000

+467 , 041

786 , 629

30,105

806 , 529

+19,900

+776,424

206 , 842
83 , 737
5,750

10 , 000
59,300
4 , 258

208 , 342
83 , 737
5 , 750

+1 , 500

+198 , 342
+24 , 437
+1 , 492

1 , 082,958

103,663

1 , 104 , 358

+21 , 400

+1 ,000,695

------- -------

-------------- ------------ --

LABOR, HEALTH ANO HUMAN SERVICES, EDUCATION, AND RELATED AGENCIES APPROPRIATIONS ACT , 2020
(Amounts in thousands)
FY 2019
Enacted

CORPORATION FOR PUBLIC BROADCASTING:
FY 2022 (current) with FY 2020 comparable.
FY 2021 advance with FY 2019 comparable (N A) ..
Re sci ss ion of FY 2021 funds ..

445,000
(445,000)

FY 2020
Request

(445,000)
( -4 15 , 000)

Final Bill

465,000
(445,000)

Final Bill
vs Enacted

+20,000

....•..

FY 2020 advance with FY 2018 comparable (NA) ..
Rescission of FY 2020 funds (NA).

445,000
(445,000)

30 000
(445,000)
(-415 ,000)

+465,000
(+415 , 000)

-------------- -------------- -------- -----Subtotal, FY 2021 program level.

Final Bill
vs Request

445,000
(445,000)

-------------- -------------- ------------ -Subtotal , FY 2020 program level.

..............

445,000

Public television interconnection system (current )

20 , 000

20,000

465,000

485,000

Total Corpat ion for Public Broadcasting ...

30 000

445,000
+20,000
+20 , 000

+485 , 000

LABOR, HEALTH ANO HUMAN SERVICES , EDUCATION , ANO RELATED AGENCIES APPROPRIATIONS ACT, 2020

(Amounts in thousands)

FEDERAL MEDIATION ANO CONCILIATION SERVICE.
FEDERAL MINE SAFETY ANO HEALTH REVIEW COMMISSION.
INSTITUTE OF MUSEUM ANO 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 HEAL TH REVIEW COMMISSION ...

FY 2019

FY 2020

Enacted

Request

Final Bi 11

Final Bill

Final Bill

vs Enacted

vs Request

46 , 650
17 ,184
242,000
8,480
12 , 545
3,250
274,224
13,800
13,225

47,200
17,184
23,000
9,000
12,645
3,450
241,550
13,800
13,225

47,200
17,184
252 , 000
8,780
12,545
3,350
274,224
14,050
13 , 225

19 , 000
-1,000

16,000
-1,000

16,000
-1,000

-3 , 000

18,000

15,000

15,000

-3 , 000

150
123 , 500
11,000

150
116,225
11,000

150
123,500
11,000

+550
+10,000
+300
+100
+250

+229 , 000
-220
-100
-100
+32,674
+250

RAILROAD RETIREMENT BOARD
Dual Benefits Payments Account .................. .
Less Income Tax Receipts on Dual Benefits .

Subtotal , Dual Benefits . .
Federal Payments to the Rai 1 road Retirement Accounts.
Limitation on Administrat ion ...... .
Limitation on the Office of Inspector General.

+7,275

-z. 7. ~

LABOR , HEALTH AND HUMAN SERVICES , EDUCATION, AND RELATED AGENCIES APPROPRIATIONS ACT , 2020
(Amounts in thousands)
FY 2019
Enacted

FY 2020
Request

11 , 000

11,000

11 , 000

55,716 , 000
126 , 000
101,000
4,923,203

56,982,000
45,000
101,000
4,404,000

56,982 , 000
45,000
101,000
4,286,889

Final Bill

Final Bill
vs Enacted

Final Bi 11
vs Request

SOCIAL SECURITY ADMINISTRATION
Payments to Social Security Trust Funds ..
Supplemental Security Income Program
Federal Benefit Payments ........ .

Beneficiary Services ........... . . .
Research and Demonstration.
Administration .

-------------- -------------- -------------Subtotal, SSI program level.

Less funds advanced in pr ior year .

60,866,203

61,532 , 000

61,414,889

-19, 500,000

-19 ,700, 000

-19 , 700,000

-------------- -------------- -------------Subtotal, regular SSI current year ...
New advance, 1st quarter, FY 2021 .... .... . . .

41,366,203
19,700,000

41,832,000
19 , 900,000

41 , 714,889
19,900,000

-------------- -------------- -------------Total , SSI program.

61 , 066,203

61,732 , 000

61,614,889

+1 , 266 , 000
-81 , 000
-636 , 314

-117, 111

-------------- -------------+548,686

-117, 111

-200,000

-------------- -------------+348,686
+200,000

-117, 111

-------------- -------------+548,686

-117 , 111

'22Q

LABOR, HEALTH AND HUMAN SERVICES , EDUCATION , AND RELATED AGENCIES APPROPRIATIONS ACT, 2020
(Amounts in thousands)
FY 2019
Enacted

FY 2020
Request

Final Bill

Final Bill
vs Enacted

vs Request

5 , 715,042
2 , 458,514
2 , 500
2,981,889

+595 , 294
+136 , 920
+100
-633,314

+207,642
+7,314
+100
-117, 111

Final Bill

Limitation on Administrative Expenses
OASI/DI Trust Funds .
HI / SMI Trust Funds . . . ... . .. ....... . . .. . .... . . . . . . . .. . .
Social Sec urity Advisory Board .... . .
SSI. .
Subtotal, regular LAE.

5,119,748
2,321,594
2,400
3,615,203

5,507,400
2,451,200
2 , 400
3,099,000

-------------- --------- ----- -------------11,058,945

11,060,000

11,157,945

134,000
-5,000
1 , 000
-1,000

130,000

130,000

1,000
-1, 000

1,000
-1,000

-------------- -------------+99 , 000

+97 , 945

User Fees :

SSI User Fee activities.
CBO adjustment .... .
SSPA User Fee Activities .
CBO adjustment ....
Subtotal , User fees .

-------------- -------------- -------------129,000

130,000

130,000

11,187,945

11 , 190,000

11,287,945

---------- ---- -------------- -------------Subtotal , Li mi tat ion on admi ni strati ve expenses.

-4 , 000
+5,000

-------------- -------------+1,000

------------- - -------------+100,000

+97,945

.-z~o

LABOR, HEALTH ANO HUMAN SERVICES, EDUCATION , AND RELATED AGENCIES APPROPRIATIONS ACT, 2020
(Amounts in thousands)
FY 2019
Enacted
Program Integrity :
OASDI Tr ust Funds .
SSI.
Subtotal , Program integrity funding .
Base Prog r am Integrity .

Total, Limitation on Administrative Expenses
(less Base progra m i ntegrit y ) .

FY 2020
Request

Final Bill

Final Bill

Final Bill

vs Enacted

v s Reque st

375 , 000
1 , 308 , 000

277 , 000
1,305,000

277 , 000
1,305 , 000

- 98,000
-3 , 000

1,683 , 000

1 , 582,000

1 , 582,000

-101,000

(273,000)

1,410,000

(273 , 000)

(273 , 000)

1,309,000

1 ,309,000

-101 , 000

Total, Limitation on Admini s trative Expenses . .

--------12 , 870 , 945

12 , 772,000

12, 869 , 945

-1,000

+97,945

Tota 1 , Li mi tat ion o n Admi ni strati ve Expenses
( less user fee s) ...

12 ,741 , 945

12 , 642,000

12,739,945

- 2,000

+97 , 945

---------

---------

~ 6\

LABOR, HEALTH ANO HUMAN SERVICES, EDUCATION, AND RELATED AGENCIES APPROPRIATIONS ACT, 2020
(Amounts in thousands)
FY 2019
Enacted

FY 2020
Request

30,000
75,500

30,000
75,500

30,000
75,500

105 , 500

105,500

-4,404,000

-4,286,889

Final Bi 11

Final Bill
vs Enacted

Final Bill
vs Request

Office of Inspector General
Federal Funds.
Trust Funds .. ........................ .

-------------- -- ----- ------- -------------Total , Office of Inspector General ...

Adjustment: Trust fund transfers from general revenues
Total , Social Security Administration.
Federal funds.

Current year.
New advances, 1st quarter, FY 2021 .
Trust funds ..
Total, Title IV, Related Agencies.
Federal Funds ..... .
Current Year . . .
FY 2021 Advance.
FY 2022 Advance .... . •..• . . . . .. . . . .. .. .. .
Trust Funds.

105,500
-4, 923,203

============== ============-= ==============
69,130,445
61 , 236,203
(41,536,203)
(19,700,000)
7,894,242

70,216,500
61,903,000
(42,003,000)
(19,900,000)
8,313,500

70 , 314,445
61,785,889
(41,885,889)
(19,900,000)
8,528,556

70,852 , 992
62,399,622
(42,499,622)
(19,900,000)

72,706,011
64,030 , 410
(43,665,410)
(19,900,000)
(465,000)
8,675,601

============== ============== ==============
71,470,661
63,429,374
(43 ,284,374)
(19,700,000)
(445,000)
8,041,287

8,453 , 370

-------------- ------------- +636,314

+117, 111

============== ==============
+1, 184,000
+549,686
(+349,686)
(+200,000)
+634, 314

+97,945
- 117 , 111
(-117, 111)
+215 , 056

============== ==============
+1 , 235,350
+601,036
(+381,036)
(+200,000)
(+20,000)
+634,314

+1,853,019
+1 ,630, 788
(+1 , 165,788)
(+465,000)
+222,231

'2'32..

LABOR , HEAL TH AND HUMAN SERVICES, EDUCATION , AND RELATED AGENCIES APPROPRIATIONS ACT , 2020
(Amount s in thousands )
FY 2019

FY 2020

Ena c ted

Request

Final Bill

Final Bill

Final Bill

vs Enacted

vs Request

RECAP
Mandator y, tot a 1 in bill .
Less advances for sub sequent years .
Pl us advances provided in prior years . ..... .

Total, mandatory, current year ........ .. .. . . . .
Discretionary, total in bill ................ .
Less advances for subsequent years.

........•. ..

Pl us advances provided in prior years .

Subtotal , discretionary , c urrent year.
Discretionary Scorekee pi ng adjustments :
Average Weekly Ins ured Unemployment (AWIU)
Contingent . . . . . . . . . . . . . . . . . . .
. . . ... . .
Medicare Eligible Accruals
(permanent, i ndef i ni te) 1 / .
. . . . ... .. . .. . .. .
Surplus property ( Department of Labor) . .. . . • ..•.. .

869 , 814 , 362
-161,845,797
158 , 462,759

900,355,046
-164,017,075
161,845,797

902 , 255,048
-164 , 217 , 075
161 , 845,797

+32,440,666
-2,371,276
+3 , 383,038

+1,900,000
-200,000

-----------

-----------

-----------

-----------

866, 431 , 324

898 , 183, 770

899,883 , 770

+33,452 , 446

+1 , 700,000

189,378,959
-24 , 814 , 001
24,814 , 001

166,528,716
-24,282,859
24 , 814,001

195,433,000
-24 , 834 , 001
24 , 614 , 001

+6 , 054, 041
-20,000

+26 , 904 , 284
-551, 142

195 , 413 , 000

+6 , 034, 041

+28 , 353 , 142

-5 , 000

---- ---- ---- -189,378 , 959

-- -- -- -------- -------------167 , 059,858

10 , 000

25 , 000

20 , 000

+10,000

30 , 041
2 , 000

30,000
2,000

30 , 000
2 , 000

-41

'?~~

LABOR , HEALTH AND HUMAN SERVICES, EDUCATION, AND RELATED AGENCIES APPROPRIATIONS ACT , 2020
(Amounts in thousands)
FY 2019
Enacted

Dislocated Workers assistance National Reserve
(rescission) ........ . ................ .
Foreign Labor Certification Processing (DOL).
H-1B (rescission).
Nonrecurring expenses fund (rescission) ..

-53 , 000
6 , 250
-6 , 250
-400, 000

CMS program management reel assifi cation (sec. 235)
Childrens Health Insurance Program performance

Student loan medical deferment .
Pell unobligated balances (rescission) ...... .. .

Final Bill

Final Bill

Final Bil l

vs Enacted

vs Request

-150,000
-350,000

+53 , 000
-6 , 250
-141 , 750
+50,000

-66, 142

-400,000
3,000
-1 0, 052, 661

bonus (rescission).

Chi l drens Heal th Insurance Program Annual
Allotment to States (rescission).
Child Enrollment contingency fund (rescission) .

FY 2020
Request

-2, 061 , 000
-5, 654,000
5,000
- 600 , 000

+66 , 142
-150, 000
+50,000
-3,000
+10,052,661

-5,296,763
-4,396,000

-3,169 , 619
-6,093,161

-3,671,026

-500 , 000

-1, 106,619
-439, 161
-5,000
+100,000

+2 , 126,944
-1 , 697 , 161
+3 , 371 ,026

2~t.. t

LABOR, HEALTH ANO HUMAN SERVICES , EDUCATION, AND RELATED AGENCIES APPROPRIATIONS ACT , 2020
(Amounts in thousands)
FY 2019
Enacted

Pel 1 : Increase maxi mum award.

Pell mandatory funds (rescission) .
SSA proposed fee for issuance of new Social
Sec urity charge ..
SSI User Fee Collection.
CBO adjustment . .. . . . ............• . .....• . .. . . ...
SSA SSPA User Fee Collection .... ... .. .. ... ... .. .. .
CBO adjustment.

Traditional Medi care program .
CNCS National Service Trust unobl i gated balances
(rescission) . .
Corporation for Public Broadcasting FY2020 advance
(rescission) .
21ST Century Cures Act adjustment (PL 114-255).

Total , discretionary . . .

FY 2020
Request

39,000
-39,000

-134,000
5,000
-1 ,000
1,000
305,000

-66 , 000
-130 , 000
-1,000
-1,000
1,000

Final Bi 11

Final Bill
vs Enacted

50,000
- 50 , 000

+11 , 000
-11,000

-130 , 000
-1,000

+4,000
- 6,000
+1,000
-1,000

305,000

-150 , 000

-40 , 000

-711 ,000

-415,000
-492 , 000

-492,000

+219,000

179,973,000

141,869 , 044

184,884,000

+4,911,000

1,046,404,324

1,040,052,814

+50,000
-50,000
+6B,OOO

+150,000

+1, 000
-1 , 000
+305,000
+40 , 000
+415,000

-- -------Grand Total, current year .. .

Final Bill
vs Request

1,084,767 , 770

+38,363,446

+43,014,956

-----------

+44,714,956

1>'6