FY21 Appropriations Bill

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FY21 Appropriations Bill

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EXPLANATORY STATEMENT FOR DEPARTMENTS OF LABOR,
HEALTH AND HUMAN SERVICES, AND EDUCATION, AND
RELATED AGENCIES APPROPRIATIONS BILL, 2021
SUMMARY OF BUDGET ESTIMATES AND COMMITTEE
RECOMMENDATIONS
For fiscal year 2021, the Committee recommends total budget authority of $1,177,669,848,000 for the Departments of Labor, Health
and Human Services, and Education, and Related Agencies. This
amount includes $184,472,000,000 in current year discretionary
funding subject to discretionary spending caps and $1,881,000,000
in cap adjustments for healthcare fraud and abuse control, Unemployment Insurance Trust Fund program integrity, and for program integrity at the Social Security Administration, in accordance
with the allocation for this bill.
Fiscal year 2020 levels cited in this explanatory statement reflect
the enacted amounts in Public Law 116–94, the Consolidated Appropriations Act, 2020, adjusted for comparability where noted, and
do not include fiscal year 2020 supplemental appropriations. Accordingly, any comparisons to fiscal year 2020 do not reflect fiscal
year 2020 supplemental appropriations. Fiscal year 2020 supplemental appropriations are included in the comparative statement
of new budget authority at the end of this explanatory statement
under the heading ‘‘Other Appropriations’’.
The Committee is aware of the impact the COVID-19 pandemic
has had on agency operations across the Federal Government. To
date, Congress has provided over $2,900,000,000,000 in emergency
supplemental relief to prevent, prepare for, and respond to COVID19. The Committee continues to monitor agency needs directly related to COVID-19 and, to the extent necessary, will seek to address them in future supplemental appropriations vehicles. Accordingly, funding recommended in the Committee’s regular fiscal year
2021 appropriations bill is focused on annual funding needs unrelated to the COVID-19 pandemic.
OVERVIEW

The Labor, Health and Human Services, and Education, and Related Agencies [Labor-HHS-Education] appropriations bill constitutes the largest share of non-defense discretionary spending, 29
percent of the total in fiscal year 2021. The subcommittee’s effective allocation, which includes discretionary funding offset by savings in changes in mandatory programs, is $2,768,000,000 more
than the comparable fiscal year 2020 level.
The priorities and considerations of the Committee in developing
this bill are summarized in the section below:
(1)

2
NATIONAL INSTITUTES OF HEALTH

For a sixth straight year, the Committee has provided a substantial increase for the National Institutes of Health [NIH]. The fiscal
year 2021 recommendation for NIH is $43,684,000,0000, an increase of $2,000,000,000 or 4.8 percent. Over the past 6 years, the
Committee has provided an increase of $13,600,000,000 or 45 percent. This funding has been able to transform the agency and realign the Committee’s priority toward medical research.
As recognized over this past year, medical research is a critical
component of our national security and an area of which the
United States should remain the leader. The Committee continues
to commit the funding necessary to accomplish this goal. Therefore,
the Committee ensures a net increase in funding over the previous
year for NIH, despite the second straight year of a reduction in
funding made available through the 21st Century Cures Act (Public
Law 114–255). This year’s resources are targeted toward several
specific research programs, including:
All of Us.—The Committee includes $500,000,000 in fiscal year
2021, making up for the $40,000,000 decrease in 21st Century
Cures Act (Public Law 114–255) funding for the program this year.
Alzheimer’s Research.—The Committee prioritizes finding a treatment and ultimately a cure for Alzheimer’s disease and provides an
additional $354,000,000, more than quintupling the research investment in the last 6 years. With this increase, NIH is expected
to spend $3,172,000,000 on Alzheimer’s disease and related dementia research in fiscal year 2021.
Artificial Intelligence [AI].—The Committee provides $25,000,000
to begin a new initiative on AI to bridge the gap between the biomedical and computer science communities to maximize the promise of AI in fiscal year 2021.
BRAIN Initiative.—The Committee continues to provide
$500,000,000 for the BRAIN Initiative, making up for the
$40,000,000 decrease in 21st Century Cures Act (Public Law 114–
255) funding.
Childhood Cancer Data Initiative.—The Committee continues
$50,000,000 for the second year of an initiative proposed in the
President’s budget request for targeted childhood cancer research
over the next decade.
Gene Vectors.—Gene therapy continues to show promise in developing new treatments that could enable patients to live without the
need for ongoing treatments and daily disease management. The
Committee provides $30,000,000 in new funding to expand ongoing
gene vector initiatives to address specific translational roadblocks
to vector production.
Lyme Disease and Tick-borne Illness.—Over the past 15 years,
cases of tick-borne diseases have doubled. Therefore, the Committee provides an increase of $10,000,000 for Lyme disease and
tick-borne illnesses research.
Premature Birth.—The Committee provides $50,000,000 in new
funding to the Eunice Kennedy Shriver National Institute of Child
Health and Development for research aimed at enhancing the survival and healthy development of preterm infants as proposed in
the President’s budget request.

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Regional Biocontainment Laboratories [RBL].—The Committee
provides $55,000,000 in dedicated funding for the RBLs that are
charged with being available and prepared to assist national, State,
and local public health efforts in the event of a bioterrorism or infectious disease emergency.
As important as these specific initiatives, the Committee continues to place a high value on support for all Institutes and Centers and allowing NIH to maintain flexibility to pursue unplanned
scientific opportunities and address unforeseen public health needs.
The Committee recommendation provides increases to every Institute and Center and is estimated to support over 11,500 new and
competing grants in fiscal year 2021.
Finally, the Committee provides $229,000,000 to finish the Clinical Center’s Surgery, Radiology, and Laboratory Medicine project,
which was provided funding in fiscal year 2020 to begin.
ENDING THE HIV EPIDEMIC

An estimated 38,000 Americans are newly diagnosed with HIV
every year and, since 1981, more than 700,000 Americans have lost
their lives to the disease. The United States government spends up
to $20,000,000,000 in annual direct health expenditures for HIV
prevention and care. The Committee continues its support of the
second year of the Administration’s Ending the HIV Epidemic initiative to reduce the number of new HIV infections in the United
States by 75 percent in 5 years and by 90 percent in 10 years.
According to the Department of Health and Human Services
[HHS], of the 3,007 counties in the United States, more than 50
percent of new HIV diagnoses occur in just 48 counties, Washington, D.C., and San Juan, Puerto Rico. Further, seven States—
Alabama, Arkansas, Kentucky, Mississippi, Missouri, Oklahoma,
and South Carolina—have a disproportionate share of new diagnoses in rural areas. The bill includes $518,000,000, an increase of
$207,000,000, to focus on these high-risk areas by expanding HIV
outreach, diagnoses, treatment, prevention, research, and response
activities.
The Committee provides $137,000,000, an increase of
$87,000,000, for Community Health Centers to increase outreach,
testing, care coordination, and HIV prevention services, including
the use of pre-exposure prophylaxis [PrEP]. This funding will support the participation of roughly 500 health centers in the initiative, up from 200 health centers in fiscal year 2020. Many health
centers are co-located with Ryan White-funded organizations,
roughly 150 of which are located in the high-burden geographic
areas identified by HHS.
The Committee provides $120,000,000, an increase of
$50,000,000, for the Ryan White HIV/AIDS program that provides
a wide-range of community-based services, including primary
health care, medications, and support services for individuals living
with HIV/AIDS. The Health Resources and Services Administration
[HRSA] estimates that roughly 18,000 people with HIV were
served in the first year of the initiative, and this funding will continue to expand both access to treatment for individuals living with
HIV and the use of antiretroviral therapy.

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The Committee includes $200,000,000, an increase of
$60,000,000, for Centers for Disease Control and Prevention [CDC]
activities to leverage HIV prevention infrastructure to conduct strategic testing linked to immediate treatment and engagement with
the clinical care system. This effort will expand the use of PrEP
and develop approaches to better detect and respond to clusters of
HIV cases. In addition, CDC will use resources to invest in core
HIV prevention programs at State and local health departments to
provide the foundational infrastructure in America.
The Committee provides $61,000,000, an increase of $10,000,000,
for NIH’s Centers for AIDS Research [CFAR]. The CFAR will inform HHS partners on best practices based on state-of-the-art biomedical research findings, and by collecting and disseminating data
on the effectiveness of approaches used in the Ending the HIV Epidemic initiative.
The Committee requests that the Department provide a spend
plan, broken out by State and county, 90 days after enactment.
Further, the Committee recognizes the Ending the HIV Epidemic
initiative is a multi-year program and instructs HHS to brief the
Committee within 90 days of enactment describing progress made
to date and outlining how HHS will use funds in fiscal year 2021
and beyond to end the HIV epidemic.
COMBATING OPIOID AND STIMULANT ABUSE

Between 1999 and 2018, nearly 450,000 people in the United
States died from an opioid overdose, and the number of drug overdose deaths in 2018 was four times higher than it was in 1999. The
Committee continues to regard the opioid epidemic as one of the
foremost public health issues facing the Nation. While the rate of
deaths involving opioids decreased significantly from 2017-2018,
and the rate of prescription opioid-involved deaths decreased by
13.5 percent, the Committee notes that the Federal government
must remain vigilant. For example, provisional data show that the
progress made last year may have been reversed this year. The reported number of opioid-involved drug overdose deaths in the
United States for the 12-month period ending in December 2019
was 50,042, which was a nearly 3,000 increase from the previous
year.
In particular, the Committee remains concerned about the rate
of stimulant-related deaths, which has been increasing since 2010.
The rate of deaths in 2015 and 2016 related to stimulant overdoses
increased by 52 percent and 33 percent respectively. In 2017,
opioids were involved in the majority of stimulant overdoses, and
the data suggests that increases in stimulant-involved overdose
deaths from 2012 to 2017 were largely driven by synthetic opioid
use. Among those States with enhanced drug overdose surveillance
by CDC, 84 percent of overdose deaths involved one or more of four
illicit drugs: heroin, illicitly manufactured fentanyl, cocaine, or
methamphetamine. This data shows that opioid and stimulant use
are closely linked and it is becoming increasingly more difficult for
health care professionals to address the separate use of these substances.
Therefore, the Committee continues the expansion of the use of
funds to include stimulants and the bill provides $3,866,000,000 in

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funding to fight prescription opioid abuse and heroin and stimulant
use, an increase of $88,400,000 over fiscal year 2020 and an increase of $3,595,019,000 over the past 6 years.
Centers for Disease Control and Prevention.—The Committee includes $475,579,000 for improved prevention and surveillance efforts in all 50 States and newly directs CDC to make stimulants
an eligible use of funds. In addition, the Committee includes
$15,000,000, a $5,000,000 increase, to address the alarming trend
of increased infectious diseases associated with the opioid epidemic.
Certified Community Behavioral Health Clinics.—The bill includes $250,000,000, an increase of $50,000,000, to provide grants
to clinics certified by their State to provide treatment for those
with mental health illness. The Committee expects SAMHSA will
continue to provide competitive grants to those areas also impacted
by the opioid crisis.
HRSA Behavioral and Mental Health Workforce Training.—The
bill provides $138,916,000 to support and expand the behavioral
and mental health workforce. Funding includes the second year of
funding for the Loan Repayment for Substance Use Disorder Treatment Workforce program and the Mental and Substance Use Disorder Workforce Training Demonstration.
Medication-Assisted Treatments [MATs] for Methamphetamine
and Stimulants.—The Committee is concerned with the rise in
methamphetamine and stimulant use and overdose in the United
States and provides $10,000,000 in targeted resources to the National Institute on Drug Abuse for research aimed at developing
new treatments for stimulant use disorder and its adverse effects.
National Institutes of Health.—The Committee includes
$500,000,000 for research related to opioid addiction, development
of opioid alternatives, pain management, and addiction treatment
at the National Institute of Neurological Diseases and Stroke and
the National Institute on Drug Abuse, and newly directs both ICs
to make stimulants an eligible use of funds.
Plans of Infant Safe Care.—The Committee includes $60,000,000
for Child Abuse Prevention State Grants to help States develop and
implement infant plans of safe care and improve services for infants affected by substance use disorder, and their families.
Preventive Services for Children At-Risk of Entering Foster
Care.—The Committee provides $20,000,000 in continued funding
for Kinship Navigator Programs. This program improves services
available to grandparents and other relatives taking primary responsibility for children because the child’s parent is struggling
with opioid addiction or substance use disorder. In addition, the bill
also includes $10,000,000 for Regional Partnership Grants and
family-focused residential treatment programs, to improve the coordination of services for children and families affected by opioid
and other substance use disorders and help families remain together during treatment.
Rural Communities Opioid Response Program.—The Committee
provides $110,000,000 for the Rural Communities Opioid Response
Program, which provides funding and technical assistance to local,
regional, and State-level partners to address opioid use prevention,
treatment, and recovery needs in high-risk rural communities.

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SAMHSA Programs of Regional and National Significance
[PRNS].—The Committee provides $501,677,000, an increase of
$20,000,000, for PRNS treatment programs, including: alternatives
to opioids for pain management in emergency department settings;
recovery and workforce assistance; comprehensive opioid recovery
centers; first responder training; medication-assisted treatment;
and pregnant and postpartum women.
State Opioid Response Grants.—The Committee provides
$1,500,000,000 for flexible grants dedicated to State responses to
opioid abuse, for a total of $6,500,000,000 over the past 5 fiscal
years. The bill continues the 15 percent set-aside for States with
the highest age-adjusted mortality rate related to opioid use disorders as well as the $50,000,000 for grants to Indian tribes or tribal organizations. The bill makes no changes to the funding formula,
but does provide States flexibility to use funds to address the growing trend of stimulant abuse.
In addition to the funding outlined above, States have access to
the Substance Abuse Prevention and Treatment Block Grant, funded at $1,858,079,000 in fiscal year 2021.
ADDRESSING DISPARITIES AND FOSTERING GREATER DIVERSITY IN
HEALTH CARE, EDUCATION AND THE WORKFORCE

Many populations across the country, whether defined by race,
ethnicity, or geography, experience higher rates of certain diseases
and often lack the same access to health services or the same educational and workforce opportunities as their peers. Addressing
these disparities remains one of our central challenges. Accordingly, the Committee continues its efforts to ensure that health disparities are addressed through a number of programs, including:
workforce development programs to ensure a diverse medical community; research initiatives focused on underserved communities;
programs that target health disparities; and education and workforce programs that increase opportunities for individuals from disadvantaged and underserved backgrounds. Further, the Committee
continues to increase investments and prioritize funding within
programs to improve educational opportunities for historically
underrepresented and disadvantaged populations. The Committee
provides targeted increases to the most effective programs that
support initiatives to improve health care, education, and workforce development to people who are underserved, geographically
isolated, underrepresented, or economically or medically vulnerable.
HRSA Workforce Pipeline and Diversity Programs.—These programs support initiatives aimed at increasing the diversity of the
nation’s health professions workforce, focusing, in particular, on
the geographic distribution of providers to areas where they are
needed most. Specific efforts focus on the recruitment, retention,
and support of trainees from disadvantaged and underrepresented
backgrounds leading to increased distribution of health professionals in high need areas. The Committee provides:
—Faculty Loan Repayment.—$4,190,000, an increase of
$3,000,000, for education loan repayment assistance for health
profession graduates from disadvantaged backgrounds who

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agree to serve as faculty at eligible health professions colleges
or universities; and
—Nursing Workforce Diversity.—$23,503,000, an increase of
$5,160,000, for increasing nursing education opportunities for
underrepresented populations, including racial and ethnic minorities, among registered nurses.
Institutional Development Award [IDeA].—The Committee provides $399,161,000, an increase of $12,588,000, for the IDeA program to broaden the geographic distribution of NIH funding. In addition to enhancing the competitiveness of investigators and the research capabilities in these States, the program serves their unique
populations, such as rural and medically underserved communities.
Minority Fellowship Program [MFP].—The MFP seeks to reduce
health disparities and improve behavioral health care outcomes for
racial and ethnic populations by increasing the number of racial
and ethnic minorities in our country’s behavioral health workforce.
The Committee provides $17,169,000, an increase of $3,000,000, to
continue to train and better prepare behavioral health practitioners
to more effectively treat and serve people of different cultural and
ethnic backgrounds.
National Institute on General Medical Sciences [NIGMS] Workforce Diversity Programs.—The Committee strongly supports NIH’s
efforts, across Institutes and Centers, to increase diversity in the
scientific workforce. At the center of this effort is NIGMS that
trains the next generation of scientists, enhances the diversity of
the scientific workforce, and develops research capacity throughout
the country. In fiscal year 2020, in addition to the IDeA program,
NIGMS will spend $188,432,520 on 12 programs that promote diversity of the scientific workforce and expand recruitment and retention. The Committee provides a targeted increase of
$14,132,439, or 7.5 percent, to the Institute’s diversity programs in
fiscal year 2021.
National Institute on Minority Health and Health Disparities
[NIMHD].—The Committee provides $391,747,000 an increase of
$55,935,000, to NIMHD to continue its focus on research and designing interventions to improve health outcomes to reduce and ultimately lead to the elimination of health disparities.
Rural Education.—The Committee recommendation includes
$189,840,000, an increase of $4,000,000, to provide additional support to rural school districts and schools that often face unique resource and capacity issues.
Rural Health.—The Committee recommendation continues its
commitment to funding HRSA’s rural health programs and includes $325,410,000 to support these programs. Included in this
amount is $15,000,000, an increase of $5,000,000, to support underserved rural communities in the Delta region in identifying and
better addressing their health care needs, and to help small rural
hospitals improve their financial and operational performance.
Scholarships for Disadvantaged Students.—The Committee includes $65,470,000, an increase of $14,000,000, to support scholarships where more than 25 percent of students supported by the
program are from rural backgrounds.
Science Technology Education and Math [STEM] Education.—
The Committee includes investments across elementary and sec-

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ondary education and higher education to promote diversity in
STEM education. This includes $75,000,000 for STEM education
within the Education Innovation and Research program, an increase of $10,000,000, with this funding prioritized for populations
historically underrepresented in high-quality elementary and secondary STEM programs. In addition, $15,000,000 is provided for
the Minority Science and Engineering Improvement Program, an
increase of $2,365,000, to improve the pipeline of underrepresented
populations to STEM careers.
Strengthening Historically Black Colleges [HBCUs] and Minority
Serving Institutions.—The Committee provides $784,554,000, an increase of $15,000,000, for programs to strengthen HBCUs and
other minority serving institutions, including Hispanic serving institutions, and tribally controlled colleges and universities. In addition, the Committee recommendation includes $244,018,000, an increase of $4,000,000, for Howard University.
Women in Apprenticeship.—The Committee supports the expansion of workforce opportunities for women in non-traditional industries through the Apprenticeship program and the Women in Apprenticeship and Non-Traditional Occupations grant program.
Women remain underrepresented in industries such as construction (10 percent), manufacturing (29 percent), and transportation/
utilities (24 percent) relative to their share of the workforce, according to the Bureau of Labor Statistics. Apprenticeships provide
participants with both occupational skills training and the benefit
of earning while they learn. The Committee recommendation includes $195,000,000, an increase of $20,000,000, for the Apprenticeship program and $14,050,000 for the Women’s Bureau.
PATHWAYS TO COLLEGE AND CAREERS

The Committee continues to build on the significant investments
in recent years to help students of all backgrounds enter and complete college, further their post-secondary education, develop the
skills needed for the in-demand jobs of today and the future, and
graduate with less debt. Providing all students beginning in high
school with opportunities and exposure to the full-range of post-secondary options is one of the best ways to help students succeed in
whatever path they choose. The Committee recommendation includes investments throughout the bill to support such efforts. In
addition, the bill provides funding for programs that expand workforce training to skill and up-skill American workers, provide career pathways for youth and adults, connect justice-involved individuals with employment opportunities, and open new doors for
disconnected and out-of-school youth to obtain and retain jobs.
Apprenticeship Grants.—The Committee recommendation includes $195,000,000 for the apprenticeship program, an increase of
$20,000,000. Of this amount, the Committee provides $10,000,000
to support the complementary Industry Recognized Apprenticeship
Program, intended to expand apprenticeship opportunities in high
demand industries.
Career Pathways for Youth.—The Committee recognizes that
multiple career pathways should be available to young people, and
that early employment and training opportunities help youth develop soft skills, such as workplace safety and responsibility, orga-

9
nization, and time management. Four-year-college is not for everyone, and early exposure to multiple career pathways and jobs can
provide valuable experience, expand career opportunities, and place
youth on a path to achieve life-long financial stability. The Committee provides $10,000,000, the second year of funding, for a DOL
demonstration program targeted to youth job training to expand
early career opportunities.
Career and Technical Education [CTE] State Grants.—The Committee recommendation includes $1,357,598,000, an increase of
$75,000,000, for CTE State grants. This funding helps States develop, expand, and improve their CTE programs in high school and
post-secondary settings, and create pathways beginning in highschool to in-demand jobs and careers.
Governor’s Statewide Reserve.—The bill continues to allow the
full 15 percent State training grant funding reserve for governors
to address a variety of statewide or regional training needs,
projects, expanded partnerships, emergency response, and other
services as needed throughout their State.
Pell Grants.—The Committee increases the maximum Pell grant
award by $150 or 2.2 percent, from $6,345 to $6,495 for the 2021–
22 school year. This is the fourth consecutive year the Committee
has increased the maximum Pell grant award. The Committee recommendation also includes more than sufficient funding to continue Year Round Pell, which helps students stay continuously enrolled, complete their program faster, graduate with less debt, and
enter or re-enter the workforce sooner.
Rural Postsecondary and Economic Development Program.—The
Committee recommendation includes $10,000,000 for a new initiative to improve post-secondary outcomes for rural students by promoting partnerships between school districts, institutions of higher
education, nonprofit organizations, and regional economic development or workforce development agencies. This will provide academic and career counseling and exposure to post-secondary opportunities for students beginning in middle school and continuing
through their secondary and post-secondary education, with the
goal of improving rates of postsecondary enrollment and completion
among rural students.
Targeted Youth Training.—The Committee maintains funding
from fiscal year 2020 for both the Job Corps and YouthBuild programs to provide at-risk youth with the opportunity to gain educational and occupational skills.
Veterans’ Employment and Training Service.—The Committee
recommendation includes $316,341,000 for programs targeted towards employment needs of separating service members and veterans. Within this amount, the Committee recommends
$33,679,000 for the Transition Assistance Program [TAP], an increase of $4,300,000, for the Department of Labor to continue implementation of TAP improvements required by the fiscal year
2019 National Defense Authorization Act (Public Law 115–232)
and continuation of the apprenticeship program. The bill also includes $55,000,000 to support the Homeless Veterans’ Reintegration Program for a variety of services, such as job training, social
services, and transportation.

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Workforce Innovation and Opportunity Act [WIOA] State
Grants.—The bill includes $2,819,832,000 for employment training
grants distributed by formula to States under WIOA (Public Law
113–128). These grants, which provide flexibility to State and local
governments to meet their own unique job training needs, form the
bedrock of the Federal workforce development effort.
MENTAL HEALTH

The Committee includes $3,952,015,000, an increase of
$193,536,000, for mental health activities to close the care gap between mental health and physical health. Approximately one in
five adults in the United States experience mental illness in a
given year and one in five youth aged 13–18 experiences a severe
mental health disorder. Over the past year, rates of anxiety and depression in adults have roughly tripled, with more than one in
three adults in the United States reporting symptoms, up from one
in ten in 2019. Additionally, a recent CDC study found that 13.3
percent of adults reported new or increased substance use as a way
to manage stress over the past year.
Certified Community Behavioral Health Clinics.—The Committee
includes $250,000,000, an increase of $50,000,000, to support comprehensive mental health services for youth and adults.
Mental Health Research.—The National Institute of Mental
Health receives $2,139,491,000, an increase of $96,525,000 above
fiscal year 2020, for continued NIH research on mental health disorders.
Mental and Substance Use Disorder [SUD] Workforce Training.—
The Committee provides up to $29,500,000 for HRSA to continue
the mental and SUD workforce training demonstration program.
Safe Schools.—The Committee includes investments in both HHS
and Education to improve mental health care and safety in schools.
The recommendation includes $121,000,000, an increase of
$18,999,000, for Project Aware to expand the capacity for mental
health agencies to support mental health resources in schools and
connect school-aged youth and their families to needed services.
The recommendation also includes $105,000,000 for competitive
grants to States and school districts for evidence-based activities to
improve school safety and promote safe and positive learning environments for students. In addition, the Committee recommendation
includes $1,250,000,000, an increase of $40,000,000, for Student
Support and Academic Enrichment grants, formula funding directly
to school districts that they can use for the same activities.
Suicide.—The Committee provides $103,000,000, an increase of
$13,000,000, to address the alarming 33 percent increase in the
suicide rate since 1999. Nearly every State has seen increasing suicide rates over this period. The Committee includes investments in
a variety of suicide prevention programs, including the suicide lifeline, the Zero Suicide initiative, and a CDC investment in suicide
prevention.
PROMOTING STATE AND LOCAL CONTROL OF EDUCATION, INCLUDING
EARLY CHILDHOOD EDUCATION

The Committee continues to prioritize education programs, including early childhood education programs, that provide the most

11
flexibility for local communities to address the educational needs of
children and families.
Charter Schools.—The Committee recommendation includes
$450,000,000, an increase of $10,000,000, to expand access to highquality charter schools, including replicating and expanding highquality charter school models and otherwise supporting state and
local efforts to open new high-quality charter schools.
Child Care and Development Block Grants [CCDBG].—The Committee recommendation includes $5,926,000,000, an increase of
$50,000,000, to support high-quality child care for working families. This continues the Committee’s strong support for CCDBG,
and builds on the more than doubling of funding for CCDBG over
the last 3 years.
Head
Start.—The
Committee
recommendation
includes
$10,713,095,000, an increase of $100,000,000, to help all Head
Start programs keep up with rising costs and continue to provide
high-quality early childhood education for children and families beginning before birth through age five.
IDEA.—The
Committee
recommendation
includes
$13,760,512,000, an increase of $125,000,000, for IDEA State
Grants, including an increase of $7,500,000 for Preschool Grants
and an increase of $7,500,000 for Grants for Infants and Families,
to support the educational needs of students with disabilities.
Impact
Aid.—The
Committee
recommendation
includes
$1,506,112,000, an increase of $20,000,000, for Impact Aid which
helps make up for lost local revenue because of the presence of
Federal activities and federally owned land that would otherwise
be available for local school districts.
Student Support and Academic Enrichment Grants.—The Committee includes $1,250,000,000, an increase of $40,000,000, for
grants to school districts to support a wide-range of activities focused on promoting well-rounded education, safe learning schools
and learning environments, and access to education technology.
Title
I
Grants
to
LEAs.—The
Committee
includes
$16,434,802,000, an increase of $125,000,000, for Title I grants to
school districts, to provide additional support to schools with a significant number of students living in poverty and help address the
educational needs of low-income students.
PUBLIC HEALTH PREPAREDNESS AND RESPONSE

The Committee continues to invest in HHS programs that help
America’s communities prepare for, respond to, and recover from
public health and medical disasters and emergencies. These events
include natural disasters, pandemic diseases, and man-made
threats. The Committee believes it is critical to continue investments in this area and provides $4,207,000,000, an increase of
$161,000,000. Since fiscal year 2015, the Committee has increased
public health preparedness funding by $1,389,000,000, or nearly 50
percent.
Biomedical Advanced Research and Development Authority
[BARDA].—The Committee provides $611,700,000, an increase of
$50,000,000, to continue investments in BARDA to develop late
stage medical countermeasures.

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Hospital Preparedness Program.—The Committee provides
$299,555,000, an increase of $24,000,000, for hospitals to improve
upon planning and care during emergencies and disasters.
Pandemic Influenza.—The Committee provides $310,000,000
within the Office of the Secretary, an increase of $50,000,000, to
improve the effectiveness of the flu vaccine and better respond to
late changes to flu strains.
Project BioShield.—The Committee includes $785,000,000, an increase of $50,000,000, to purchase critical medical countermeasures, such as vaccines, therapeutics, and diagnostics.
Public Health Emergency and Hospital Preparedness.—The Committee provides $705,000,000, an increase of $30,000,000, for CDC’s
Public Health Emergency Preparedness program to continue preparing communities and hospitals to respond to public health emergencies.
ALZHEIMER’S DISEASE

Alzheimer’s disease costs the U.S. taxpayer $23,500,000 every
hour, with one in three seniors dying with Alzheimer’s or another
dementia. Currently, Medicare and Medicaid spend an estimated
$206,000,000,000 caring for those with Alzheimer’s and other dementias, 67 percent of total costs, making it the most expensive
disease in America. Without a medical breakthrough to prevent,
slow, or stop the disease, by 2050 the combined Medicare and Medicaid spending on people with Alzheimer’s disease will be more
than $1,100,000,000,000.
Alzheimer’s BOLD Initiative and Healthy Aging.—The Committee provides $20,500,000, an increase of $5,000,000, to support
CDC activities implementing the BOLD Infrastructure for Alzheimer’s Act (Public Law 115–406) and the Healthy Brain road
map for State and national partnerships to monitor, evaluate, educate, and empower those fighting Alzheimer’s.
Alzheimer’s Disease Program.—The Committee provides
$27,500,000, an increase of $1,000,000, for the Alzheimer’s Disease
Program to support services for individuals with Alzheimer’s and
related dementias and their caregivers. Funding includes up to
$2,000,000 to continue support for the National Alzheimer’s Call
Center in the Administration for Community Living.
Alzheimer’s Research.—The Committee includes an increase of
$354,000,000 for Alzheimer’s disease research at NIH, bringing the
total funding available in fiscal year 2021 to approximately
$3,172,000,000, a 12.6 percent increase above fiscal year 2020.
Over the last 6 years, research funding for Alzheimer’s disease has
increased $2,541,000,000, more than quintupling the critical investment.
Brain Research through Advancing Innovative Neurotechnologies
[BRAIN].—The Committee continues to strongly support the
BRAIN Initiative and provides $500,000,000 in fiscal year 2021.
This funding level makes up the $40,000,000 lost due to a decrease
in 21st Century Cures Act (Public Law 114–255) funding in fiscal
year 2021. The BRAIN Initiative is developing a more complete understanding of brain function and has the potential to help millions
of people who suffer from a wide variety of neurological and psychiatric disorders such as Parkinson’s disease, schizophrenia, Alz-

13
heimer’s disease and dementia, depression, and traumatic brain injury.
Caregivers.—The effects of Alzheimer’s disease reach beyond the
patient to the thousands of Americans providing informal care to
a relative with dementia. The Committee provides funding to a variety of programs to support caregivers, including research at the
National Institute on Aging, the Lifespan Respite Care program,
and the National Family Caregiver Support program at the Administration for Community Living.
IMPROVING FISCAL ACCOUNTABILITY

The Committee has an obligation to promote fiscal accountability
and the effective use of U.S. taxpayer funds. The annual appropriations process affords Congress the opportunity to continuously improve and refine how Government works. Appropriations bills provide oversight of every discretionary program, every year, which
gives these bills the unique ability to react to changing needs and
unintended consequences in the intervening years of an authorization bill.
Public Health Services [PHS] Act Evaluation Transfer.—The
Committee recommendation continues to ensure that in fiscal year
2021, no funds will leave NIH via the transfer required by section
241 of the PHS Act (Public Law 104–73).
Taxpayer Transparency.—U.S. taxpayers have a right to know
how the Federal Government is spending their hard-earned taxpayer dollars-especially when that money is being spent on advertising Federal programs. The Committee recommendation continues a provision to promote Government transparency and accountability by requiring Federal agencies funded in this act to include disclaimers when advertising materials are paid for with
Federal funds. The Committee expects each agency to include in
their fiscal year 2022 CJ information detailing how much funding
was spent on advertising in fiscal year 2021.
INCREASING THE EFFICIENCY AND COST EFFECTIVENESS OF
GOVERNMENT

The Committee provides funding for a variety of activities aimed
at reducing fraud, waste, and abuse of taxpayer dollars. These program integrity initiatives have proven to be a wise Federal investment, resulting in billions of dollars of savings each year. In addition, the Committee recommendation provides direction to the Departments on opportunities to take action where Federal programs
are fragmented or duplicative. The bill advocates that longstanding
priority by reforming and transforming government in many small
ways, and several initiatives to increase the efficiency and cost effectiveness of Government, including:
Fighting Healthcare Fraud and Abuse.—The Committee includes
$807,000,000 for the Health Care Fraud and Abuse Control program at CMS. The Committee notes that the latest data demonstrates for every new $1.00 spent on fraud and abuse, $2.00 is
recovered by the U.S. Treasury.
Inspectors General.—The Committee recommendation provides
$367,130,000 for the Inspectors General funded in this act to conduct additional audits and investigations of possible waste and

14
fraud in Government programs. The Committee appreciates the
strong working relationships between the Inspectors General and
the agencies they work with under this Committee’s jurisdiction.
The Committee reiterates the strong expectation that Inspectors
General have timely and independent access to all records, reports,
audits, reviews, documents, papers, recommendations, data and
data systems, or other materials related to their responsibilities
under this act and under the Inspector General Act of 1978 (Public
95–452). Further, the Committee also expects that all agencies
funded by this act treat electronic data, records, and systems no
differently than paper-based records and files with respect to access by the Inspectors General unless particular electronic systems
are clearly and explicitly protected from Inspectors General access
by statute.
Preventing Improper Social Security Payments.—The Committee
recommendation includes $1,575,000,000 for the Social Security
Administration to conduct continuing disability reviews and Supplemental Security Income [SSI] program redeterminations of nonmedical eligibility, and other program integrity efforts. Combined,
these activities are estimated to save over $9,000,000,000 over 10
years in taxpayer dollars by reducing waste, fraud, abuse, and improper payments in the Social Security, Medicare, and Medicaid
programs.
Taxpayer Accountability.—Given the current fiscal environment,
it is imperative for Government agencies to increase efficiencies,
while fulfilling statutory requirements, to maximize the effectiveness of agency programs. Since 2011, Government Accountability
Office [GAO] has published reports showing as many as 325 areas
of potential duplication and overlap. GAO has identified over 1,000
actions to reduce, eliminate, or better manage fragmentation, overlap, or duplication; achieve costs savings; or enhance revenue.
While GAO has noted that the Nation has achieved
$429,000,000,000 in savings based on these reports, many more efficiencies may be realized. The Committee directs each agency
funded in the fiscal year 2021 bill to report to the Committee, within 1 year of enactment, on all efforts made to address the duplication identified by the annual GAO reports along with identifying
substantive challenges and legal barriers to implementing GAO’s
recommendations, as well as suggested legislative recommendations that could help the agency to further reduce duplication. The
Committee looks forward to receiving the reports.
Unemployment Insurance Trust Fund Integrity.—The Committee
provides $200,000,000 for Reemployment Services and Eligibility
Assessments [RESEA] for fiscal year 2021. The RESEA program
provides for intensive, in-person attention from specialists in the
One-Stop career center system for individuals most likely to exhaust unemployment compensation benefits, those with particular
barriers to reemployment, and others who have been difficult to
place. RESEA has significantly reduced the time participating individuals must rely on unemployment compensation payments and
has shown the benefit of reducing improper payments to ineligible
claimants, thus helping protect the fiscal solvency of the Unemployment Insurance Trust Fund. The RESEA program is based on a

15
service-delivery model that has demonstrated a return of $2.60 in
savings for every $1.00 spent on the program.
Evidence-Building Capacity.—The Committee applauds the recent enactment of the Foundations for Evidence-based Policymaking Act (Public Law 115–435). Faithful execution of the law
will enhance the evidence-building capacity of Federal agencies,
strengthen privacy protections, improve secure access to data, and
ultimately provide more and higher quality evidence to policymakers. The Committee requests that the Departments funded in
this bill provide an update on its implementation of the law and
plans for the coming year in next and subsequent years’ annual
congressional budget justifications.
BILL-WIDE DIRECTIVES

Advertising.—The Committee encourages Federal departments
and agencies to use local media in their advertising, including local
television, radio broadcast stations, and newspapers, to the greatest extent possible. The Committee further directs each department
and agency funded by this act with annual advertising budgets in
excess of $500,000 to include in its fiscal year 2022 justification details on expenditures on local media advertising for fiscal years
2020 and 2021.
Congressional Budget Justifications.—Congressional justifications [CJs] are the primary tool used for the Committee to evaluate
budget requests, agency performance, and resource requirements.
The Committee expects the fiscal year 2022 CJs to include sufficient detail to justify all programs, projects, and activities contained in each department, agency, board, corporation, or commission’s budget request. The justifications shall include a sufficient
level of detailed data, exhibits, and explanatory statements to support the appropriations requests, including tables that outline each
agency’s programs, projects, and activities for fiscal years 2021 and
2022. Specifically, every bill and report number included in either
the House of Representatives or Senate Appropriations bill, report,
or explanatory statement, or the final appropriations bill or explanatory statement of the fiscal year should be reflected within these
justifications. If a program is recommended for elimination, the justification should include information about fiscal year 2021 activities.
The Committee directs the chief financial officer of each department, agency, board, corporation, or commission funded in this
act’s jurisdiction to ensure that adequate justification is given to
support each increase, decrease, and staffing change proposed in
the fiscal year 2022 budget. When requesting additional resources,
reduced funding, or eliminations of programs, changes should be
outlined with an adequate justification. Should the final fiscal year
2021 appropriations bill be enacted within a timeframe that does
not allow it to be reflected within the congressional justifications
for fiscal year 2022, the Committee directs each department, agency, board, corporation, or commission funded in this act to submit
within 30 days of enactment updated information to the Committee
on funding comparisons to fiscal year 2021.
Congressional Reports.—Each Department and agency is directed
to provide the Committee on Appropriations of the House of Rep-

16
resentatives and the Senate, within 30 days of the date of enactment of this act and quarterly thereafter, a summary describing
each requested report to the Committees on Appropriations along
with a detailed status update that shall include, but is not limited
to: the date the Department began drafting the report, the status
of the draft, stage of clearance if applicable, and an estimated
timeline for when the report will be submitted to the Committees.
Regulation Reform.—The Committee remains concerned that
agencies may have overlapping, outdated, and restrictive regulations that increase the costs of care and are a burden on an agency.
The Committee is equally concerned by the use of guidance documents or interpretive rules by agencies to impose new requirements on regulated entities even though such documents are not
legally binding. The Supreme Court has recognized that there is a
fine line between what should be issued as a regulation for purposes of notice-and-comment rulemaking under the Administrative
Procedure Act (Public Law 79–404) and what can be issued as
guidance. The Supreme Court has also recognized that agencies
may sometimes issue guidance to circumvent the notice-and-comment rulemaking process. The Committee directs the Departments
of Labor, Health and Human Services, and Education to each submit a report to Congress no later than 180 days after enactment
with a list of guidance documents in effect and provide the agency’s
plan of action to repeal these guidance documents, or justification
for its decision to not repeal them. The Committee also directs the
agency’s report to include its plan of action to repeal or revise regulations that are duplicative, as well as its plan to streamline rules
in a manner that will reduce the costs to the private sector by at
least $1,000,000,000 and the legislation authorizing such regulation.
Trauma-informed Practices.—The Committee notes that exposure
to trauma, such as witnessing violence or substance abuse, can result in negative health, education, and employment outcomes, for
which agencies funded in this bill seek to address. The Committee
encourages the Departments and agencies funded in this bill to enhance coordination on activities that address trauma, particularly
in childhood, and to disseminate and promote through grant
awards best practices for identifying, referring, and supporting
children exposed to trauma. The Committee provides $5,000,000,
an increase of $1,000,000, to continue support for CDC’s efforts to
implement section 7131 of the SUPPORT Act (Public Law 115–271)
to improve CDC’s ability to collect data on adverse childhood experiences to better understand prevalence. Other specific initiatives
are outlined in each Department’s section.
OTHER HIGHLIGHTS OF THE BILL

Adoption Opportunities.—The Committee recommendation includes $46,100,000, an increase of $4,000,000, to help remove barriers to adoption and find permanent homes for children, particularly children with special needs.
Children’s Hospitals Graduate Medical Education [CHGME].—
The Committee recommendation includes $355,000,000 for
CHGME, an increase of $15,000,000 above fiscal year 2020. This

17
funding supports 58 freestanding children’s teaching hospitals to
provide Graduate Medical Education for physicians.
Corporation for National and Community Service [CNCS].—The
Committee recommendation includes $1,154,358,000, an increase of
$50,000,000, for national and community service programs, including an increase of $32,000,000 for AmeriCorps State and National
Grants and $8,000,000 for Senior Corps programs.
Corporation for Public Broadcasting.—The bill continues advance
funding in the amount of $465,000,000 for the Corporation for Public Broadcasting for fiscal year 2023 and an additional $20,000,000
for fiscal year 2021 to continue investments in the public broadcasting interconnection system.
Institute for Museum and Library Services [IMLS].—The Committee recommendation includes $257,000,000 for IMLS, an increase of $5,000,000 above fiscal year 2020. This funding supports
approximately 9,000 public library systems and more than 33,000
museums, ensuring that all Americans have access to essential museum, library, and information services.
Low Income Home Energy Assistance Program [LIHEAP].—The
Committee recommendation includes $3,740,304,000, the same as
the fiscal year 2020 level.
Sexual Risk Avoidance.—The Committee recommendation includes $45,000,000, an increase of $10,000,000.
Student Aid Administration.—The Committee recommendation
includes $1,868,943,000, an increase of $100,000,000, to support
the administration of Federal student aid programs and continue
efforts to improve the quality of service to students and borrowers,
including simplifying and streamlining the FAFSA process and student borrower experience.
LIST OF ABBREVIATIONS
ACA—Patient Protection and Affordable Care Act
ACL—Administration for Community Living
AHRQ—Agency for Healthcare Research and Quality
ASH—Assistant Secretary for Health
ASPR—Assistant Secretary for Preparedness and Response
BARDA—Biomedical Advanced Research and Development Authority
BCA—Budget Control Act of 2011
CDC—Centers for Disease Control and Prevention
CJ—Congressional Justification of Estimates for Appropriations
Committees
CMS—Centers for Medicare and Medicaid Services
CNCS—Corporation for National and Community Service
CPB—Corporation for Public Broadcasting
DOD—Department of Defense
DOL—Department of Labor
EBSA—Employee Benefits Security Administration
ESEA—Elementary and Secondary Education Act
ETA—Employment and Training Administration
FDA—Food and Drug Administration
FIC—Fogarty International Center
FMCS—Federal Mediation and Conciliation Service
FMSHRC—Federal Mine Safety and Health Review Commission

18
FTE—full-time equivalent
GAO—Government Accountability Office
HBCUs—Historically Black Colleges and Universities
HCFAC—Health Care Fraud and Abuse Control
HELP—Health, Education, Labor, and Pensions
HHS—Health and Human Services
HRSA—Health Resources and Services Administration
IC—Institute and Center
IDEA—Individuals with Disabilities Education Act
IMLS—Institute of Museum and Library Services
LEA—local educational agency
MACPAC—Medicaid and CHIP Payment and Access Commission
MedPAC—Medicare Payment Advisory Commission
MSHA—Mine Safety and Health Administration
NCATS—National Center for Advancing Translational Sciences
NCI—National Cancer Institute
NEI—National Eye Institute
NHGRI—National Human Genome Research Institute
NHLBI—National Heart, Lung, and Blood Institute
NIA—National Institute on Aging
NIAAA—National Institute on Alcohol Abuse and Alcoholism
NIAID—National Institute of Allergy and Infectious Disease
NIAMS—National Institute of Arthritis and Musculoskeletal and
Skin Diseases
NIBIB—National Institute of Biomedical Imaging and Bioengineering
NICHD—Eunice Kennedy Shriver National Institute of Child
Health and Human Development
NIDA—National Institute on Drug Abuse
NIDCD—National Institute on Deafness and Other Communication Disorders
NIDCR—National Institute of Dental and Craniofacial Research
NIDDK—National Institute of Diabetes and Digestive and Kidney Disease
NIDRR—National Institute on Disability and Rehabilitation Research
NIEHS—National Institute of Environmental Health Sciences
NIGMS—National Institute of General Medical Sciences
NIH—National Institutes of Health
NIMH—National Institute of Mental Health
NIMHD—National Institute on Minority Health and Health Disparities
NINDS—National Institute of Neurological Disorders and Stroke
NINR—National Institute of Nursing Research
NLM—National Library of Medicine
NLRB—National Labor Relations Board
NSF—National Science Foundation
NTID—National Technical Institute for the Deaf
OAR—Office of AIDS Research
OCR—Office for Civil Rights
ODEP—Office of Disability Employment Policy
OFCCP—Office of Federal Contract Compliance Programs
OIG—Office of the Inspector General
OLMS—Office of Labor-Management Standards

19
OMB—Office of Management and Budget
OMH—Office of Minority Health
OMHA—Office of Medicare Hearings and Appeals
ONC—Office of the National Coordinator for Health Information
Technology
ORWH—Office of Research on Women’s Health
OSHA—Occupational Safety and Health Administration
OWCP—Office of Workers’ Compensation Programs
OWH—Office of Women’s Health
PBGC—Pension Benefit Guaranty Corporation
PHS—Public Health Service
PPH Fund—Prevention and Public Health Fund
PRNS—Programs of Regional and National Significance
RSA—Rehabilitation Services Administration
SAMHSA—Substance Abuse and Mental Health Services Administration
SEA—State educational agency
SIG—School Improvement Grants
SPRANS—Special Projects of Regional and National Significance
SSA—Social Security Administration
SSI—Supplemental Security Income
STEM—science, technology, engineering, and mathematics
UI—unemployment insurance
USAID—U.S. Agency for International Development
VETS—Veterans’ Employment and Training Services
VISTA—Volunteers in Service to America
WANTO—Women in Apprenticeship and Non-Traditional Occupations
WHD—Wage and Hour Division
WIA—Workforce Investment Act
WIOA—Workforce Innovation and Opportunity Act

TITLE I
DEPARTMENT OF LABOR
Any references in this title of the report to the ‘‘Secretary’’ or the
‘‘Department’’ shall be interpreted to mean the Secretary of Labor
or the Department of Labor, respectively, unless otherwise noted.
EMPLOYMENT

AND

TRAINING ADMINISTRATION

TRAINING AND EMPLOYMENT SERVICES

Appropriations, 2020 .............................................................................
Budget estimate, 2021 ...........................................................................
Committee recommendation .................................................................

$3,611,200,000
3,358,304,000
3,585,200,000

The Training and Employment Services account provides funding
primarily for activities under the Workforce Innovation and Opportunity Act [WIOA] (Public Law 113–128), and is a decentralized,
integrated system of skill training and related services designed to
enhance the employment and earnings of economically disadvantaged and dislocated workers. Funds provided for many training
programs for fiscal year 2021 will support the program from July
1, 2021, through June 30, 2022. A portion of this account’s funding,
$1,772,000,000, is available on October 1, 2021, for the 2021 program year.
Training and Employment Services.—The Committee urges the
Department to encourage local secondary education authorities
with expertise in work-based learning to be included as part of the
required education and training organization representatives on
local Workforce Development Boards to provide guidance on work
experience, including summer employment opportunities.
Grants to States
The Committee recommends $2,819,832,000 for Training and
Employment Services Grants to States.
Under WIOA, a local board is given up to 100 percent transfer
authority between Adult and Dislocated Worker activities upon approval of the Governor.
The Committee recommendation is consistent with the WIOA authorization regarding the amount of WIOA State grant funding
that may be reserved by Governors.
Adult Employment and Training.—For adult employment and
training activities, the Committee recommends $854,649,000.
Formula funding is provided to States and further distributed to
local workforce investment areas through one-stop centers. The
program provides employment and training services to disadvantaged, low-skilled, unemployed, and underemployed adults, including veterans.
(20)

21
Funds are made available in this bill for adult employment and
training activities in program year 2021, which occurs from July 1,
2021, through June 30, 2022. The bill provides that $142,649,000
is available for obligation on July 1, 2021, and that $712,000,000
is available on October 1, 2021. Both categories of funding are
available for obligation through June 30, 2022.
Youth Training.—For youth training activities, the Committee
recommends $913,130,000. The purpose of this program is to provide low-income youth who are facing barriers to employment with
services that prepare them to succeed in the knowledge-based economy. Funds are made available for youth training activities in program year 2021, which occurs from April 1, 2021, through June 30,
2022.
Dislocated Worker Assistance.—For dislocated worker assistance,
the Committee recommends $1,052,053,000. This program is a
State-operated effort that provides training services and support to
help permanently separated workers return to productive unsubsidized employment. In addition, States must use State-wide reserve funds for rapid response assistance to help workers affected
by mass layoffs and plant closures. States must also use these
funds to carry out additional State-wide employment and training
activities, such as providing technical assistance to certain low-performing local areas, evaluating State programs, and assisting with
the operation of one-stop delivery systems. States may also use
funds for implementing innovative training programs.
Funds made available in this bill support activities in program
year 2021, which occurs from July 1, 2021, through June 30, 2022.
The bill provides that $192,053,000 is available for obligation on
July 1, 2021, and that $860,000,000 is available on October 1,
2021. Both categories of funding are available for obligation
through June 30, 2022.
Federally Administered Programs
Dislocated Worker Assistance National Reserve.—The Committee
recommends $230,859,000 for the Dislocated Worker Assistance
National Reserve, which is available to the Secretary for activities
such as responding to mass layoffs, plant and/or military base closings, and natural disasters, as well as for technical assistance,
training, and demonstration projects.
Funds made available for the National Reserve in this bill support activities in program year 2021. The bill provides that
$30,859,000 is available for obligation on July 1, 2021, and that
$200,000,000 is available on October 1, 2021. Both categories of
funding are available for obligation through September 30, 2022.
Appalachian and Delta Regions.—The Committee makes
$40,000,000, an increase of $10,000,000, available for obligation on
October 1, 2021, through September 30, 2022, to provide enhanced
worker training to promote economic recovery in the Appalachian
and Delta regions. These funds will continue the Workforce Opportunity for Rural Communities grant initiative, in which the Committee strongly encourages the Department to develop the funding
opportunity announcement and make grant awards in concordance
with the Appalachian Regional Commission and the Delta Regional
Authority. These regions have been particularly hard hit by indus-

22
trial downsizing and closures, and funding is provided to target
these underserved areas. The Department is directed to ensure
equal allocation of funds to the Appalachian and Delta regions and
broad geographic distribution of funds within these regions. Further, each award should not exceed $1,500,000.
Career Pathways for Youth Grants.—The Committee continues to
recognize that multiple career pathways should be available to
young people and the need for early workforce readiness, employment, and training opportunities that help youth develop soft
skills, such as responsibility, organization, and time management,
and to learn workplace safety. The Committee continues
$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. This programming includes soft skill development, career exploration, job readiness and certification, summer jobs, year-round job opportunities, and apprenticeships. Funding will also support partnerships between workforce investment
boards and youth serving organizations.
Demonstration Projects for At-risk Youth.—The Committee encourages the Department to use funds provided to carry out sections 168(b) and 169(c) of WIOA, which may be used for technical
assistance and demonstration projects, to support demonstration
programs that allow at-risk youth to participate in the workforce
who are out-of-school, have limited work experience, and live in
communities experiencing high rates of unemployment and high
rates of community violence.
Indian and Native American Programs.—The Committee recommends $55,000,000 for Indian and Native American Programs.
These programs are designed to improve the academic, occupational, and literacy skills of Native Americans, Alaskan Natives,
and Native Hawaiians to aid the participants in securing permanent, unsubsidized employment. Allowable training services include
adult basic education, general educational development attainment,
literacy training, English language training, as well as the establishment of linkages with remedial education.
Migrant and Seasonal Farmworker Programs.—The Committee
recommends $91,896,000 for migrant and seasonal farmworkers
programs, which serve members of economically disadvantaged
families whose principal livelihood is derived from migratory and
other forms of seasonal farm work, fishing, or logging activities.
Enrollees and their families are provided with employment, training, and related services intended to prepare them for stable, yearround employment within and outside of the agriculture industry.
The Committee recommendation provides that $85,229,000 be
used for State service area grants. The Committee recommendation
also includes bill language directing that $6,122,000 be used for migrant and seasonal farmworker housing grants, of which not less
than 70 percent shall be for permanent housing. The principal purpose of these funds is to continue the network of local farmworker
housing organizations working on permanent housing solutions for
migrant and seasonal farmworkers. The Committee recommenda-

23
tion also includes $545,000 to be used for section 167 training,
technical assistance, and related activities, including funds for migrant rest center activities.
YouthBuild.—The Committee supports the YouthBuild program
and recommends $94,534,000 to support its work to target at-risk
high school dropouts and prepare them with the skills and knowledge they need to succeed in a knowledge-based economy.
National Activities
Reentry Employment Opportunities [REO].—The Committee recommends $98,079,000 for the REO program, including $25,000,000
for national and regional intermediaries. The REO program helps
prepare and assist adult ex-offenders return to their communities
through pre-release services, mentoring, and case management.
The program also provides support, education, and training to
youth who are involved in court and on probation, in aftercare, on
parole, or who would benefit from alternatives to incarceration or
diversion from formal judicial proceedings. Programs are carried
out directly through State and local governmental entities and community-based organizations, as well as indirectly through intermediary organizations. States are encouraged to continue to support reintegration efforts for ex-offenders with resources available
through the comprehensive workforce development investment system. The Committee encourages the Department to use funding to
support efforts seeking to address relevant impacts and root causes
of civil unrest and high levels of community violence.
Workforce Data Quality Initiative.—The Committee accepts the
administration’s request to eliminate the Workforce Data Quality
Initiative.
Apprenticeship Grants.—The bill provides $195,000,000, an increase of $20,000,000, for the apprenticeship program created in
fiscal year 2016. Of this amount, $10,000,000 is for the Industry
Recognized Apprenticeship Program [IRAP] to expand apprenticeship opportunities to industries such as telecommunications,
healthcare, cyber security, and other sectors where apprenticeships
currently are not widely available. IRAPs are intended to serve as
a complement to the registered apprenticeship program.
The Committee supports the funding and development of industry or sector partnerships as a means of closing the skills gap and
expanding registered apprenticeships in in-demand industries. The
Committee supports the use of apprenticeship grants that provide
worker education in in-demand and emerging fields, including first
responder; disaster resilience, response, and recovery; utility (energy and water) and resource management; transportation and infrastructure (including green infrastructure); goods movement sectors, such as global logistics, rail, and other freight-related employment; telecommunications and wireless infrastructure to support
the expansion of 5G; and outdoor recreation economy-related employment. The Department is encouraged to make funding available to address nationwide shortages of qualified drinking water
and wastewater operation professionals. The Committee continues
to encourage the Department to prioritize State Expansion grants
to support and expand registered apprenticeships in States with
high unemployment and long-standing and demonstrably effective

24
partnerships between job training programs and employers who
seek well-qualified employees in the healthcare, maritime, construction, and oil and gas industries. The Committee directs the
Department of Labor to continue collaboration with the Department of Defense to develop a targeted apprenticeship and job training program to meet the critical national defense need for new submarine construction. Lastly, the Department is encouraged to ensure approval of apprenticeship opportunities in local communities
that have high rates of unemployment and high rates of community violence.
The Committee directs the Department to submit a report providing detail on entities awarded funding, selection criteria used,
and the funding amount for each grant or contract awarded at the
time such awards are made. No later than July 1, 2021, the Department shall provide the Committees on Appropriations of the
House of Representatives and the Senate a detailed spend plan of
anticipated uses of funds made available, including estimated administrative costs.
JOB CORPS

$1,743,655,000
1,015,897,000
1,743,655,000

The recommendation for operations of Job Corps centers is
$1,603,325,000.
The Committee recommendation for administrative costs is
$32,330,000.
The Committee recommends a total of $108,000,000 in construction, renovation, and acquisition [CRA] funds. This amount is
available from July 1, 2021, to June 30, 2022. The Committee continues bill language allowing the Secretary to transfer up to 15 percent of CRA funds, if necessary, to meet the operational needs of
Job Corps centers or to achieve administrative efficiencies. The bill
continues to require the Secretary to notify the Committees on Appropriations of the House of Representatives and the Senate at
least 15 days in advance of any transfer. The Committee expects
any notification to include a justification.
Gainesville Job Corps Center.—The Committee is aware of the
Department’s decision to deactivate the Gainesville Job Corps Center, which had been inactive since September 2017 due to damage
it sustained during Hurricane Irma. The Committee is concerned
that the closure of the Gainesville Job Corps Center has significantly reduced training opportunities to disadvantaged youth. The
Committee strongly encourages the Department to identify alternative methods to increase the capacity for Job Corps services or
job training opportunities in North Central Florida.
Gulfport Job Corps Center.—The Committee remains encouraged
by the continued progress made toward the rebuilding of the Gulfport Job Corps Center, including the significant design development work. The Committee expects the Department to remain committed to this project and directs the Department to continue to
prioritize the Gulfport Job Corps Center among pending construction cases in the CRA account. The Committee requests the con-

25
tinuation of updates every 30 days regarding progress on this
project.
Industry-standard Training.—The Committee supports the Department’s intention to make investments in Job Corps facilities to
‘‘support high-quality training that meets existing industry standards.’’ Therefore, the Committee requests a briefing within 60 days
of enactment on the costs of modernizing each Job Corps center’s
trade offerings, curricula, and equipment to meet existing industry
standards. This information is of particular interest given the realignment of Job Corps center recruitment and placement with
local workforce development areas through the National Enrollee
Assignment Plan.
Performance-based Contracting.—The Committee encourages the
Department to ensure student outcomes are not adversely affected
as the Job Corps program transitions from performance-based contracting to fixed-price contracts. The Committee requests a briefing
within 60 days of enactment on the transition to fixed-price contracting, including how the Department will assess which Job
Corps proposals will provide the best value with respect to student
outcomes, and options for incorporating performance-based incentives into Job Corps’ fixed price contracts.
Slot Utilization.—The Committee is concerned with the persistent under-utilization of Job Corps centers. The Committee requests an update in the fiscal year 2022 CJ on specific outreach
and admissions efforts that includes the most recent National Geographic Assignment Plan required by section 145(c) of WIOA. This
should include an analysis of Job Corps application and enrollment
data to evaluate the relative efficacy of different investments in
producing prospects that become Job Corps-eligible applicants, including social media advertising targeted at eligible youth, social
media advertising targeted at guardians or influencers, national
television or radio buys, and local outreach efforts.
Underserved Rural and Remote Communities.—The Committee
continues to encourage the Department to utilize savings realized
by center closures to support and incentivize high quality center
operators to develop and enhance partnerships with existing rural
training sites to enhance opportunity and work experiences for students in underserved rural or remote communities. Such rural
partners should use student-focused industry-backed curricula, prepare students for employment in high-demand fields, offer students
the opportunity to take coursework leading to college credit, and
demonstrate strong employer partnerships within the region in
which the center is located. Such partnerships will also promote
the ability of Job Corps centers to meet local workforce and cultural needs in communities far removed from their locations.
COMMUNITY SERVICE EMPLOYMENT FOR OLDER AMERICANS

Appropriations, 2020 .............................................................................
$405,000,000
Budget estimate, 2021 ........................................................................... ...........................
Committee recommendation .................................................................
305,000,000

Community Service Employment for Older Americans [CSEOA]
provides part-time employment in community service activities for
unemployed, low-income persons aged 55 and older. The Committee
recommendation includes $305,000,000 for CSEOA, a reduction of

26
$100,000,000. As noted in the budget request, CSEOA participant
completion and job placement outcomes are disappointingly low
and WIOA programs can also address the employment and workforce training needs of older Americans.
FEDERAL UNEMPLOYMENT BENEFITS AND ALLOWANCES

$680,000,000
633,600,000
633,600,000

The Committee recommendation includes mandatory funds for
the Federal unemployment benefits and allowances program that
assists trade-impacted workers with benefits and services to upgrade skills and retrain in new careers. These benefits and services
are designed to help participants find a path back into middle-class
jobs, improve earnings, and increase credential and education
rates. The Committee recommendation provides for the full operation of the Trade Adjustment Act (Public Law 114–27) program in
fiscal year 2021 consistent with current law.
The Trade Adjustment Assistance [TAA] program provides assistance to workers who have been adversely affected by international trade. TAA provides benefits and services to those who
qualify, to include job training, job search and relocation allowances, and wage supplements for workers age 50 and older.
STATE UNEMPLOYMENT INSURANCE AND EMPLOYMENT SERVICE
OPERATIONS

$3,374,649,000
3,497,280,000
3,405,649,000

The Committee recommendation includes $3,321,583,000 authorized to be drawn from the Employment Security Administration account of the Unemployment Trust Fund and $84,066,000 to be provided from the general fund of the Treasury.
The funds in this account are used to provide administrative
grants and assistance to State agencies that administer Federal
and State unemployment compensation laws and operate the public
employment service.
The Committee recommends a total of $2,565,816,000 for Unemployment Insurance [UI] activities. For UI State operations, the
Committee recommends $2,356,816,000. Additionally, the Committee includes $200,000,000 to expand intensive, individualized
reemployment assistance and to help address and prevent longterm unemployment and reduce improper payments through the
Reemployment Services and Eligibility Assessments [RESEA] initiative. This includes $117,000,000 in base funding and
$83,000,000 in cap adjustment funding allowed under the Bipartisan Budget Act of 2018 (Public Law 115–123).
As State consortia continue work to modernize their UI information technology systems, the Committee expects the Department
will continue to closely support and oversee the consortia’s efforts
and keep the Committee informed on the utilization of funds and
progress on system development.
The Committee recommendation includes $9,000,000 for the UI
Integrity Center of Excellence, including supporting an integrated

27
data hub, training modules, and data analytics capacity to help
States reduce fraud.
The Committee recommends $18,000,000 for UI national activities, which will support activities that benefit the entire FederalState UI system, including supporting the continuation of IT upgrades and technical assistance. The Committee provides an increase of $6,000,000 to help modernize the UI Interstate Connection Network hub and support States in administering the UI program.
For the Employment Service allotments to States, the Committee
recommends $668,052,000. This amount includes $21,413,000 in
general funds together with an authorization to spend
$646,639,000 from the Employment Security Administration account of the Unemployment Trust Fund.
The Committee also recommends $22,318,000 for Employment
Service national activities. The Committee provides $2,500,000 to
reduce the processing backlog for the work opportunity tax credit
program and for assisting States to modernize information technology for processing of certification requests, which may include
training and technical assistance. For carrying out the Department’s responsibilities related to foreign labor certification activities, the Committee recommends $54,528,000. In addition, 5 percent of the revenue from H–1B fees is available to the Department
for costs associated with processing H–1B alien labor certification
applications, and $14,282,000 is available for related State grants.
For one-stop career centers and labor market information, the
Committee recommends $62,653,000.
Prompt Processing of H–2B Visas.—The Committee notes the importance of the H–2B visa program in communities and industries
across the country, and the critical role of this program in a thriving economy. The Committee directs the Department to take all
necessary and appropriate steps to ensure prompt processing of H–
2B visa applications and to minimize future interruptions to the
H–2B visa program.
ADVANCES TO THE UNEMPLOYMENT TRUST FUND AND OTHER FUNDS

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

$158,656,000
171,600,000
158,656,000

The Committee recommendation of $158,656,000 for program administration includes $108,674,000 in general funds and
$49,982,000 from the Employment Security Administration account
of the Unemployment Trust Fund.
General funds in this account pay for the Federal staff needed
to administer employment and training programs under WIOA,
Older Americans Act [OAA] (Public Law 116–131), the Trade Act

28
of 1974 (Public Law 93–618), and the National Apprenticeship Act
(Public Law 308). Trust funds provide for the Federal administration of employment security, training and employment, and executive direction functions.
The Office of Apprenticeship may use a portion of its funds to
support apprenticeship opportunities outside of traditional registered apprenticeships.
The Department is encouraged to require any information publicly disclosed related to occupational and professional licenses and
certifications, as well as credentials and competencies earned
through apprenticeships, whether directly or through contracts, be
published using an open source description language that is designed to allow for public search and comparison of such data, including any such data on credentials and competencies. Such information may be published through open data formats such as the
credential transparency description language specifications or substantially similar approach.
The Committee encourages ETA to increase access and eligibility
to employment and training services for survivors of all forms of
human trafficking as required by section 107(b) of the Trafficking
Victims Protection Act (Public Law 106–386). The Committee also
encourages the development and integration of training to identify
potential signs of trafficking and referral options as a regular activity for State Farmworker Monitor Advocates, and during the provision of relevant services to particular at-risk populations, including
through the YouthBuild, Job Corps, and REO programs. The Committee also encourages the Department to continue and expand its
pilot initiative to develop and support networks of service providers
in collaboration with HHS and the Department of Justice.
EMPLOYEE BENEFITS SECURITY ADMINISTRATION
SALARIES AND EXPENSES

$181,000,000
192,738,000
181,000,000

The Committee recommends $181,000,000 for the Employee Benefits Security Administration [EBSA]. EBSA is responsible for the
enforcement of title I of the Employee Retirement Income Security
Act [ERISA] (Public Law 93–406) in both civil and criminal areas
and for enforcement of sections 8477 and 8478 of the Federal Employees’ Retirement Security Act of 1986 (Public Law 99–335).
EBSA administers an integrated program of regulation, compliance
assistance and education, civil and criminal enforcement, and research and analysis. Bill language continues to allow EBSA to obligate up to $3,000,000 for 2 fiscal years, as proposed in the budget.
The authority will be useful in situations where services may be
needed for cases extending beyond the end of the current fiscal
year.
Electronic Delivery Rule.—The Committee is concerned with the
Department’s recently adopted rule (RIN 1210–AB90) allowing
ERISA plan administrators to provide participants and beneficiaries certain mandatory disclosures through electronic means by
default. The Committee requests a report not later than 1 year

29
after enactment of the rule assessing the impact of the changes on
participants, including deferred vested participants, and beneficiaries of plans subject to ERISA, specifically individuals residing
in rural and remote areas, seniors, and other populations that either lack access to web-based communications or who may only
have access through public means.
Mental Health Parity.—The Committee encourages EBSA, in consultation with the Centers for Medicare and Medicaid Services, to
issue regular guidance to encourage compliance with the Mental
Health Parity and Addiction Equity Act [MHPAEA] (Public Law
110–343). Guidance should include recommendations for appropriate training of personnel responsible for, benefit design, benefit
authorizations, adverse benefit determinations, and payments. Informational bulletins and guidance should also provide information
regarding the appropriate consumer complaint process and that
helps patients take action when they encounter MHPAEA violations.
PENSION BENEFIT GUARANTY CORPORATION
Appropriations, 2020 .............................................................................
Budget estimate, 2021 ...........................................................................
Committee recommendation .................................................................

$452,858,000
465,289,000
465,289,000

The Pension Benefit Guaranty Corporation’s [PBGC] estimated
obligations for fiscal year 2021 include single-employer benefit payments of $7,289,000,000, multi-employer financial assistance of
$350,000,000, and consolidated administrative expenses of
$465,289,000. Administrative expenses are comprised of three activities: pension insurance activities, pension plan termination expenses, and operational support. These expenditures are financed
by permanent authority. Previously, the Committee accepted the
PBGC’s proposal to reform the previous administrative apportionment classifications from three budget activities to one budget activity to make operations more efficient and improve stewardship
of resources. That consolidated approach for the three activities is
continued, but PBGC is directed to continue providing detail every
year on the three activities in its annual CJ.
The PBGC is a wholly owned Government corporation established by ERISA. The law places it within DOL and makes the Secretary the chair of its board of directors. The Corporation receives
its income primarily from insurance premiums collected from covered pension plans, assets of terminated pension plans, collection
of employer liabilities imposed by the act, and investment earnings.
The primary purpose of the PBGC is to guarantee the payment of
pension plan benefits to participants if covered defined benefit
plans fail or go out of existence.
The bill continues authority for a contingency fund for the PBGC
that provides additional administrative resources when the number
of participants in terminated plans exceeds 100,000. When the trigger is reached, an additional $9,200,000 becomes available through
September 30, 2025, for every 20,000 additional participants in terminated plans. The bill also continues authority allowing the
PBGC additional obligation authority for unforeseen and extraordinary pre-termination expenses, after approval by the Office of

30
Management and Budget and notification of the Committees on Appropriations of the House of Representatives and the Senate.
WAGE

AND

HOUR DIVISION

SALARIES AND EXPENSES

$242,000,000
244,283,000
242,000,000

The Committee recommends $242,000,000 for the Wage and
Hour Division [WHD].
WHD is responsible for administering and enforcing laws that
provide minimum standards for wages and working conditions in
the United States. The Fair Labor Standards Act (Public Law 75–
718), employment rights under the Family and Medical Leave Act
(Public Law 103–3), and the Migrant and Seasonal Agricultural
Worker Protection Act (Public Law 97–470) are several of the important laws that WHD is charged with administering and/or enforcing.
OFFICE

LABOR-MANAGEMENT STANDARDS

SALARIES AND EXPENSES

$43,187,000
50,410,000
48,187,000

The Committee recommends $48,187,000, an increase of
$5,000,000, for the Office of Labor-Management Standards
[OLMS].
OLMS administers the Labor-Management Reporting and Disclosure Act of 1959 (Public Law 86–257) and related laws. These laws
establish safeguards for union democracy and financial integrity.
They also require public disclosure by unions, union officers, employers, and others. In addition, the Office administers employee
protections under federally sponsored transportation programs.
OFFICE

FEDERAL CONTRACT COMPLIANCE PROGRAMS
SALARIES AND EXPENSES

$105,976,000
106,412,000
105,976,000

The Committee recommends $105,976,000 for the Office of Federal Contract Compliance Programs.
This Office protects workers and potential employees of Federal
contractors from employment discrimination prohibited under Executive Order 11246, section 503 of the Rehabilitation Act of 1973
(Public Law 93–112), and the Vietnam Era Veterans’ Readjustment
Assistance Act of 1974 (Public Law 93–508).

31
OFFICE

WORKERS’ COMPENSATION PROGRAMS
SALARIES AND EXPENSES

$117,601,000
119,312,000
117,601,000

The Committee recommends $117,601,000 for the Office of Workers’ Compensation Programs [OWCP]. The bill provides authority
to expend $2,177,000 from the special fund established by the
Longshore and Harbor Workers’ Compensation Act.
OWCP administers four distinct compensation programs: the
Federal Employees’ Compensation Act [FECA] (Public Law 267),
the Longshore and Harbor Workers’ Compensation Act (Public Law
69–803), the Black Lung Benefits programs, and the Energy Employees Occupational Illness Compensation Program Act (Public
Law 106–398). In addition, OWCP houses the Division of Information Technology Management and Services.
SPECIAL BENEFITS

$234,600,000
239,000,000
239,000,000

The Committee recommends $239,000,000 for this account. This
mandatory appropriation, which is administered by OWCP, primarily provides benefits under FECA.
The Committee continues to provide authority to require disclosure of Social Security numbers by individuals filing claims under
FECA or the Longshore and Harbor Workers’ Compensation Act
(Public Law 69–803) and its extensions.
The Committee continues language that provides authority to
use FECA funds to reimburse a new employer for a portion of the
salary of a newly reemployed injured Federal worker. FECA funds
will be used to reimburse new employers during the first 3 years
of employment, not to exceed 75 percent of salary in the worker’s
first year, and declining thereafter.
The Committee continues language that allows carryover of unobligated balances to be used in the following year and provides authority to draw such sums as needed after August 15 to pay current beneficiaries. Such funds are charged to the subsequent year
appropriation.
The Committee continues language to provide authority to deposit into the special benefits account of the employees’ compensation fund those funds that the Postal Service, the Tennessee Valley
Authority, and other entities are required to pay to cover their fair
share of the costs of administering the claims filed by their employees under FECA.
Finally, the Committee maintains language consistent with longstanding interpretations and implementation of this appropriation
stating that, along with the other compensation statutes already
specifically enumerated, the appropriation is used to pay obligations that arise under the War Hazards Compensation Act (Public
Law 77–784), and the appropriation is deposited in the Employees’
Compensation Fund and assumes its attributes, namely availability without time limit as provided by 5 U.S.C. section 8147.33.

32
SPECIAL BENEFITS FOR DISABLED COAL MINERS

$20,970,000
40,970,000
40,970,000

The Committee recommends a mandatory appropriation of
$40,970,000 in fiscal year 2021 for special benefits for disabled coal
miners. This is in addition to the $14,000,000 appropriated last
year as an advance for the first quarter of fiscal year 2021, for a
total program level of $54,970,000 in fiscal year 2021.
These mandatory funds are used to provide monthly benefits to
coal miners disabled by black lung disease, their widows, and certain other dependents, as well as to pay related administrative
costs.
The Committee also recommends an advance appropriation of
$14,000,000 for the first quarter of fiscal year 2022. These funds
will ensure uninterrupted benefit payments to coal miners, their
widows, and dependents.
DIVISION OF ENERGY EMPLOYEES OCCUPATIONAL ILLNESS
COMPENSATION
SALARIES AND EXPENSES

$59,846,000
62,507,000
62,507,000

The Committee recommends $62,507,000 for the Division of Energy Employees Occupational Illness Compensation Program
[EEOICP]. This is a mandatory appropriation.
The Division administers the Energy Employees Occupational Illness Compensation Program Act [EEOICPA] (Public Law 106–398),
which provides benefits to eligible employees and former employees
of the Department of Energy, its contractors and subcontractors, or
to certain survivors of such individuals. The mission also includes
delivering benefits to certain beneficiaries of the Radiation Exposure Compensation Act (Public Law 106–245). The Division is part
of OWCP.
BLACK LUNG DISABILITY TRUST FUND

$365,240,000
382,991,000
382,991,000

The bill provides an estimated $382,991,000 as requested for this
mandatory appropriations account. This estimate is comprised of
$74,365,000 for administrative expenses and an estimated
$308,626,000 for benefit payment and interest costs.
The bill continues to provide indefinite authority for the Black
Lung Disability Trust Fund to provide for benefit payments. In addition, the bill provides for transfers from the trust fund for administrative expenses for the following Department agencies as requested: up to $40,643,000 for the part C costs of the Division of
Coal Mine Workers’ Compensation Programs; up to $33,033,000 for
Departmental Management, Salaries and Expenses; and up to
$333,000 for Departmental Management, Inspector General. The

33
bill also allows a transfer of up to $356,000 for the Department of
the Treasury.
OCCUPATIONAL SAFETY

AND

HEALTH ADMINISTRATION

SALARIES AND EXPENSES

$581,787,000
576,813,000
570,250,000

The Committee recommends $570,250,000 for the Occupational
Safety and Health Administration [OSHA], which is responsible for
enforcing the Occupational Safety and Health Act of 1970 (Public
Law 91–596) in the Nation’s workplaces.
The Committee continues bill language to allow OSHA to retain
course tuition and fees for training institute courses used for occupational safety and health training and education activities in the
private sector. The cap established by the bill is $499,000, the same
as current law.
The Committee continues bill language to exempt farms employing 10 or fewer people from the provisions of the act, with the exception of those farms having a temporary labor camp. The Committee also continues language exempting small firms in industry
classifications having a lost workday injury rate less than the national average from general schedule safety inspections.
The exemption of small farming operations from OSHA regulation has been in place since 1976. OSHA clarified the limits of its
authority to conduct enforcement on small farms in July 2014, particularly regarding post-harvest activities of a farming operation.
The continued exemption for small farms and recognition of limits
of the OSHA regulatory authority are critical for family farms. It
is also important the Department of Agriculture be consulted in
any future attempts by OSHA to redefine or modify any aspect of
the small farm exemption.
The Committee recommends $108,575,000 for grants to States
under section 23(g) of the Occupational Safety and Health Act
(Public Law 91–596). These funds primarily are provided to States
that have taken responsibility for administering their own occupational safety and health programs for the private sector and/or the
public sector. State plans must be at least as effective as the Federal program and are monitored by OSHA. The bill continues language that allows OSHA to provide grants of up to 50 percent for
the costs of State plans approved by the agency.
The Committee directs OSHA to dedicate no less than $3,500,000
per year for administering the Voluntary Protection Program [VPP]
in its Federal Compliance Assistance budget. OSHA shall not reduce funding levels or the number of employees administering the
VPP, the Safety and Health Achievement Recognition Program, or
Federal Compliance Assistance, and shall not collect any monies
from participants for the purpose of administering these programs.
The Committee recommendation does not include funding for the
OSHA Susan Harwood Training Grant program.
The Committee requests a report on the status of OSHA’s implementation of the recommendations made by the Department’s In-

34
spector General on March 28, 2019, in Report 02–19–001–10–105
within 180 days of enactment of this act.
The Committee appreciates the need to update regulations to
protect workplace safety; however, the Committee is concerned by
the additional regulations presented in OSHA’s October 2019 Notice of Proposed Rulemaking [NPRM]. The Committee urges OSHA
to work with the construction and shipyard sectors to ensure workplace safety while imposing minimal regulatory burdens on industry participants. The Committee acknowledges the NPRM took effect September 2020. The Committee requests a report by the Government Accountability Office on: (1) OSHA’s scientific or medical
findings related to the NPRM that establish substantial evidence
or a significant risk posed by trace amounts of naturally occurring
beryllium to the safety or health of construction and shipyard
workers; and (2) the economic costs this rule will impose on abrasive blasting industry, especially small businesses.
MINE SAFETY

AND

HEALTH ADMINISTRATION

SALARIES AND EXPENSES

$379,816,000
381,587,000
379,816,000

The Committee recommendation includes $379,816,000 for the
Mine Safety and Health Administration [MSHA].
MSHA enforces the Federal Mine Safety and Health Act (Public
Law 91–173) by conducting inspections and special investigations
of mine operations, promulgating mandatory safety and health
standards, cooperating with the States in developing effective State
programs, and improving training in conjunction with States and
the mining industry.
The Committee continues language authorizing MSHA to use up
to $2,000,000 for mine rescue and recovery activities. It also retains
the provision allowing the Secretary to use any funds available to
the Department to provide for the costs of mine rescue and survival
operations in the event of a major disaster. To prepare properly for
an emergency, the Committee also directs MSHA to continue to devote sufficient resources toward a competitive grant activity for effective emergency response and recovery training in various types
of mine conditions.
In addition, bill language continues to allow the National Mine
Health and Safety Academy to collect not more than $750,000 for
room, board, tuition, and the sale of training materials to be available for mine safety and health education and training activities.
Bill language also allows MSHA to retain up to $2,499,000 from
fees collected for the approval and certification of equipment, materials, and explosives for use in mines, and to utilize such sums for
these activities.
The Committee continues to emphasize the importance of mine
safety enforcement, and instructs MSHA to fully implement the requirements of Section 103 of the Federal Mine Safety and Health
Act of 1977 (Public Law 91–173). MSHA shall make inspections of
each underground coal mine in its entirety at least four times a

35
year and each surface coal or other mine in its entirety at least two
times a year.
Redistricting.—Miner safety is best protected when MSHA is
transparent and openly communicating with Congress and the regulated community about critical information related to redistricting
before changes occur. The Committee was disappointed to learn
that information about redistricting never reached some affected
operators until after the changes had occurred, which created confusion, frustration, and put miners’ lives at risk. The Committee directs MSHA to provide a written report within 60 days of enactment of this act on how it will take steps to communicate future
redistricting changes with Congress and the regulated community.
Further, MSHA is directed to provide written notification to the
Committee 30 days prior to any future redistricting changes taking
effect.
BUREAU

LABOR STATISTICS

SALARIES AND EXPENSES

$655,000,000
658,318,000
641,000,000

The Committee recommends $641,000,000 for the Bureau of
Labor Statistics [BLS]. This amount includes $68,000,000 from the
Employment Security Administration account of the Unemployment Trust Fund and $573,000,000 in Federal funds.
BLS is the principal fact finding agency in the Federal Government in the broad field of labor economics. The Committee recognizes that the Nation requires current, accurate, detailed workforce
statistics for Federal and non-Federal data users as provided by
BLS.
Within the total amount for BLS, the Committee includes
$13,000,000 to complete the relocation of the BLS headquarters,
which was initiated in fiscal year 2020.
BLS Lock-up.—The Committee is disappointed with the abrupt
discontinuation of the media lock-up and is concerned that the
timeliness and accuracy of the release of sensitive economic data is
now in jeopardy. The Department and BLS are directed to work
with stakeholders to find technological solutions to ensure the
timely, accurate, and simultaneous distribution of economic data.
The Committee provides sufficient funding through Departmental
Management for the Office of Public Affairs to adopt and implement the necessary technological upgrades to the lock-up facility
within 60 days of enactment of this act. The Committee directs the
Department to provide an update within 30 days of enactment of
this act on the agency’s progress.
Current Population Survey.—The Committee recommendation includes sufficient funding for an annual supplement to the Current
Population Survey to capture and report data on contingent and alternative work arrangements every 2 years and data on other topics related to the labor force in alternate years.
National Longitudinal Survey of Youth [NLSY].—The Committee
continues to recognize the importance of the NLSY, which has provided valuable information about labor market trends for decades.

36
The Committee recommendation includes sufficient funding for the
purposes of continuing to plan and develop the new NLSY cohort
established by the Further Consolidated Appropriations Act, 2020
(Public Law 116–94). The Committee expects BLS will develop an
appropriate methodology that will maintain continuity in key
measurements across the cohorts, which will be of value to understanding our changing economy and society. The Committee intends funds to be used to support continued planning and development of the new cohort and expects BLS to continue fielding the
NLSY79 and NLSY97 cohorts.
OFFICE

DISABILITY EMPLOYMENT POLICY

$38,500,000
27,100,000
38,500,000

The Committee recommends $38,500,000 for the Office of Disability Employment Policy to provide leadership, develop policy and
initiatives, and award grants furthering the objective of eliminating
physical and programmatic barriers to the training and employment of people with disabilities and to design and implement research and technical assistance grants and contracts to develop policy that reduces barriers to competitive, integrated employment for
youth and adults with disabilities.
Tracking Workforce Outcomes for Young Adults with Autism
Spectrum Disorder [ASD].—Given the high number of young adults
on the autism spectrum who experience significant challenges to
living independently and achieving gainful employment, the Committee directs the Department, within 1 year of enactment of this
act, to conduct a study that assesses the efficacy and innovation of
demonstrated and promising practices for young adults on the autism spectrum aged 18–28. The Committee recommends that this
study include an examination of barriers to both attaining and sustaining employment and career development within this population, and the financial impact that long-term gainful employment
will have on reducing the number of young adults on the autism
spectrum who need Federal assistance. The practices and programs
examined in this study should use experiential and work-based
learning to prepare young adults on the autism spectrum to live
independently and support themselves through gainful, competitive, and integrated employment. The study should also assess the
scalability potential for adopting such approaches across the country.
DEPARTMENTAL MANAGEMENT
SALARIES AND EXPENSES

$348,364,000
271,952,000
350,364,000

The Committee recommendation includes $350,364,000 for the
Departmental Management account. Of this amount, $350,056,000
is available from general funds and $308,000 is available by transfer from the Employment Security account of the Unemployment

37
Trust Fund. In addition, $33,033,000 is available by transfer from
the Black Lung Disability Trust Fund.
The Departmental Management appropriation pays the salaries
and related expenses of staff responsible for formulating and overseeing the implementation of departmental policy and management
activities in support of that goal. In addition, this appropriation includes a variety of operating programs and activities that are not
involved in departmental management functions, but for which
other appropriations for salaries and expenses are not suitable.
The Committee directs the Department, BLS, and the Office of
the Chief Information Officer to work with media stakeholders to
find technological solutions to ensure the timely, accurate, and simultaneous distribution of sensitive economic data. The Committee
provides sufficient funding through Departmental Management for
the Office of Public Affairs to adopt and implement the necessary
technological upgrades to the lock-up facility within 60 days of enactment of this act. The Committee directs the Department to provide an update within 30 days of enactment of this act on the agency’s progress.
Forced Labor.—The Committee requests a report on Departmentwide efforts to combat forced labor. The report should include a description of any work with other Federal agencies, including the
Department of Homeland Security, Department of Justice, and Department of State. The Department shall provide the report to the
Committees on Appropriations of the House of Representatives and
the Senate within 90 days of enactment of this act.
The Committee recommendation includes $96,125,000 for the Bureau of International Labor Affairs [ILAB], of which $67,325,000 is
available for obligation through December 31, 2021. ILAB’s appropriation is available to help improve working conditions and labor
standards for workers around the world by carrying out ILAB’s
statutory mandates and international responsibilities, including in
promoting the elimination of child labor and forced labor.
The Department shall report on plans for and uses of all funds
available to DOL in the United States-Mexico-Canada Agreement
Implementation Act (Public Law 116–113) in the next and subsequent year CJs. Such plans and updates shall also include information on how funds are being used for monitoring, oversight, and
technical assistance in support of the purposes of such Act, including Mexico’s implementation of nationwide labor reforms and compliance with labor obligations.
The Committee continues to support the critical role ILAB plays
in working to eradicate child labor, forced labor, and human trafficking. ILAB should continue to release its List of Goods Produced
by Child Labor or Forced Labor and update that list to reflect
goods and products produced or manufactured, wholly or in part,
by the forced labor of ethnic minorities in the Xinjiang Uyghur Autonomous Region of the People’s Republic of China.
The Committee recommendation provides $8,040,000 for program
evaluation and allows these funds to be available for obligation
through September 30, 2022. The Committee bill also continues the
authority of the Secretary to transfer these funds to any other account in the Department for evaluation purposes. The Committee
bill continues authority to use up to 0.75 percent of certain Depart-

38
ment appropriations for evaluation activities identified by the chief
evaluation officer. The Committee expects to be notified of the
planned uses of funds derived from this authority.
The recommendation includes $28,450,000 for the Office of the
Assistant Secretary for Administration and Management.
The recommendation includes $35,000,000 for the Adjudication
activity.
The Committee recommendation provides $14,050,000 for the
Women’s Bureau. The Committee continues bill language allowing
the Bureau to award grants.
The Committee includes a new general provision requiring the
Department to submit an upcoming travel report to the Committees on Appropriations of the House of Representatives and the
Senate by the 1st and 15th day of each month. The report should
be a compilation of upcoming travel for the head of ETA, as well
as for the Secretary and Deputy Secretary. The report shall include
upcoming travel for the following 2 weeks, with details specifying
location (city and State), event, and partners where the event will
be held.
VETERANS’ EMPLOYMENT AND TRAINING

$311,341,000
312,000,000
316,341,000

The Committee recommendation of $316,341,000, an increase of
$5,000,000, for the Veterans’ Employment and Training Service
[VETS] includes $55,000,000 in general revenue funding and
$261,341,000 to be expended from the Employment Security Administration account of the Unemployment Trust Fund.
This account provides resources for VETS to maximize employment opportunities for veterans and transitioning service members,
including protecting their employment rights. VETS carries out its
mission through a combination of grants to States, competitive
grants, and Federal enforcement and oversight.
The Committee provides $180,000,000 for the Jobs for Veterans
State Grants [JVSG] program and extends the period for States to
expend funds from 15 months to 3 years. This funding will enable
Disabled Veterans’ Outreach Program specialists and Local Veterans’ Employment Representatives to continue providing intensive
employment services to veterans and eligible spouses; transitioning
service members early in their separation from military service;
wounded warriors recuperating in military treatment facilities or
transition units; and spouses and family caregivers to help ensure
the family has income to provide sufficient support. The Committee
maintains language providing authority for JVSG funding to be
used for data systems and contract support to allow for the tracking of participant and performance information.
The Committee provides $33,679,000, an increase of $4,300,000,
for the Transition Assistance Program [TAP] to support apprenticeship opportunities and employment workshops at military installations, and in virtual classrooms, worldwide for exiting service members and spouses. The Committee recommendation includes
$44,248,000 for Federal administration costs. This funding level
will support oversight and administration of the VETS grant pro-

39
grams, TAP employment workshops, and compliance and enforcement activities.
The Committee recommends $55,000,000 for the Homeless Veterans’ Reintegration Program [HVRP] to help homeless veterans
attain the skills they need to gain meaningful employment. This
funding will allow DOL to provide HVRP services to more than
18,000 homeless veterans nationwide, including homeless women
veterans. The bill allows Incarcerated Veterans’ Transition funds to
be awarded to serve veterans who have recently been released from
incarceration but are at risk of homelessness.
The Committee recommendation includes $3,414,000 for the National Veterans’ Training Institute, which provides training to Federal staff and veteran service providers.
The Committee includes funding to facilitate the Department’s
implementation of the Honoring Investments in Recruiting and
Employing [HIRE] American Military Veterans Act (Public Law
115–31). The Committee includes $500,000, level with fiscal year
2020 enacted and the fiscal year 2021 budget request, to support
the HIRE Vets Medallion Program.
INFORMATION TECHNOLOGY MODERNIZATION

$25,269,000
37,000,000
27,269,000

The Committee recommends $27,269,000 for the Information
Technology [IT] Modernization account. Funds available in this account have been used for two primary activities. The first is departmental support systems, for which $4,889,000 is provided. The second activity, IT Infrastructure Modernization, supports necessary
activities associated with the Federal Data Center Consolidation
Initiative.
The Committee continues to request that the Department submit
a report to the Committees on Appropriations of the House of Representatives and the Senate not later than 90 days after enactment
that provides an update on projects to be funded, planned activities
and associated timelines, expected benefits, and planned expenditures. The report should also include completed activities, remaining activities and associated timelines, actual and remaining expenditures, explanation of any cost overruns and delays, and corrective actions, as necessary, to keep the project on track and within budget.
OFFICE OF THE INSPECTOR GENERAL

$90,847,000
93,493,000
90,847,000

The Committee recommends $90,847,000 for the DOL Office of
the Inspector General. The bill includes $85,187,000 in general
funds and authority to transfer $5,660,000 from the Employment
Security Administration account of the Unemployment Trust Fund.
In addition, an amount of $333,000 is available by transfer from
the Black Lung Disability Trust Fund.
Through a comprehensive program of audits, investigations, inspections, and program evaluations, the Inspector General at-

40
tempts to reduce the incidence of fraud, waste, abuse, and mismanagement, and to promote economy, efficiency, and effectiveness.
The Department has reported improper payments, including
fraud, in the UI and Employee Compensation programs totaling approximately $2,855,150,000 and $73,560,000 respectively for fiscal
year 2019. The Committee strongly supports and commends the efforts of the Inspector General to identify and prosecute those who
defraud the Department’s worker benefit programs and to help protect the solvency of these important programs.
GENERAL PROVISIONS
Section 101. The bill continues a provision limiting the use of Job
Corps funding for compensation of an individual that is not a Federal employee at a rate not to exceed Executive Level II.
Section 102. The bill continues a provision providing for general
transfer authority.
Section 103. The bill continues a provision prohibiting funding
for the procurement of goods and services utilizing forced or indentured child labor in industries and host countries already identified
by the Department in accordance with Executive Order 13126.
Section 104. The bill continues a provision requiring that funds
available under section 414(c) of the American Competitiveness
and Workforce Improvement Act (Public Law 106–313) may only be
used for competitive grants that train individuals over the age of
16 who are not enrolled in school, in occupations and industries for
which employers are using H–1B visas to hire foreign workers.
Section 105. The bill continues a provision limiting the use of the
Employment and Training Administration [ETA] funds by a recipient or subrecipient for compensation of an individual at a rate not
to exceed Executive Level II.
Section 106. The bill continues a provision providing the ETA
with authority to transfer funds provided for technical assistance
services to grantees to ‘‘Program Administration’’ when it is determined that those services will be more efficiently performed by
Federal employees. The provision does not apply to section 171 of
the WIOA. In addition, authority is provided for program integrityrelated activities as requested by the administration.
Section 107. The bill continues a provision allowing up to 0.75
percent of discretionary appropriations provided in this act for all
Department agencies to be used by the Office of the Chief Evaluation Officer for evaluation purposes consistent with the terms and
conditions in this act applicable to such office.
Section 108. The bill continues a longstanding provision regarding the application of the Fair Labor Standards Act (Public Law
74–718) after the occurrence of a major disaster.
Section 109. The bill continues a longstanding provision that provides flexibility with respect to the crossing of H–2B nonimmigrants.
Section 110. The bill continues a longstanding provision related
to the wage methodology under the H–2B program.
Section 111. The bill continues a longstanding provision regarding the three-fourths guarantee and definitions of corresponding

41
employment and temporary need for purposes of the H–2B program.
Section 112. The bill continues a provision providing authority
related to the disposition of excess property related to the training
of apprentices.
Section 113. The bill continues a provision related to the Secretary’s security detail.
Section 114. The bill continues a provision related to Job Corps
property.
Section 115. The bill modifies a provision related to H–1B fees.
Section 116. The bill continues a provision related to Job Corps
Civilian Conservation Centers.
Section 117. The bill includes a new provision related to Jobs for
Veterans State Grants.
Section 118. The bill includes a new provision related to travel.

TITLE II
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Any references in this title of the explanatory statement to the
‘‘Secretary’’ or the ‘‘Department’’ shall be interpreted to mean the
Secretary of HHS or the Department of HHS, respectively, unless
otherwise noted.
HEALTH RESOURCES

AND

SERVICES ADMINISTRATION

The Health Resources and Services Administration [HRSA] activities support programs to provide healthcare services for mothers and infants; the underserved, elderly, and homeless; rural residents; and disadvantaged minorities. This agency supports cooperative programs in maternal and child health, AIDS care, healthcare
provider training, and healthcare delivery systems and facilities.
BUREAU OF PRIMARY HEALTH CARE

$1,626,522,000
1,728,522,000
1,713,522,000

The Committee recommendation for the activities of the Bureau
of Primary Health Care is $1,713,522,000.
Community Health Centers
The Committee provides $1,712,522,000, an increase of
$87,000,000, in this bill for community health centers.
Programs supported by this funding include community health
centers, migrant health centers, healthcare for the homeless,
school-based, and public housing health service grants. The Committee continues to support the ongoing effort to increase the number of people who have access to medical services at health centers.
Health centers play a vital role in ensuring access to primary care
in underserved areas of the country, including urban, rural, and
frontier areas.
In addition, within the amount provided, the Committee provides
up to $120,000,000 under the Federal Tort Claims Act [FTCA]
(Public Law 102–501 and Public Law 104–73), available until expended. These funds are used to pay judgments and settlements,
occasional witness fees and expenses, and related administrative
costs. The Committee intends FTCA coverage funded through this
bill to be inclusive of all providers, activities, and services included
within the health centers’ federally approved scope of project.
Ending
the
HIV
Epidemic.—The
Committee
provides
$137,000,000 within the health centers program for the Ending the
HIV Epidemic initiative, which includes an increase of $87,000,000
from the Nonrecurring Expenses Fund. This is the second year of
(42)

43
investment in this initiative and builds on the $50,000,000 included in fiscal year 2020.
Home Visiting.—The Committee supports HRSA’s continued promotion of expanded partnerships between health centers and evidence-based home visiting programs to improve maternal and child
health outcomes in high-need communities. Home visiting programs can also provide cost-effective benefits such as care coordination and service referrals that help health centers achieve community health goals. As such, the Committee directs HRSA to provide
information to all health centers about resources available through
the Maternal, Infant, and Early Childhood Home Visiting program.
Native Hawaiian Health Care.—The Committee provides no less
than $19,000,000 for the Native Hawaiian Health Care Program.
The Native Hawaiian Health Care Systems helps improve the
health status of Native Hawaiians by making health education,
health promotion, disease prevention, and Native Hawaiian traditional healing services available.
Technical Assistance.—The Committee believes that enhanced
funding for the technical assistance and networking functions
available for health centers through national and State cooperative
agreements and grants is critical to the successful operation and
expansion of the health centers program. Funds are available within the amount provided for health centers to enhance technical assistance and training activities, further quality improvement initiatives, and continue the development of and support for health center-controlled networks so that new and existing centers can improve patient access to quality health services. The Committee directs that $1,500,000 shall be available for technical assistance
grants in States with a disproportionate share of new HIV diagnoses in rural areas.
Free Clinics Medical Malpractice Coverage
The Committee provides $1,000,000 for payments of claims under
the FTCA to be made available for free clinic health professionals
as authorized by section 224(o) of the Public Health Service [PHS]
Act (Public Law 104–73).
This appropriation extends FTCA coverage to medical volunteers
in free clinics to expand access to healthcare services to low-income
individuals in medically underserved areas.
BUREAU OF HEALTH WORKFORCE

$1,194,506,000
370,425,000
1,225,666,000

The Committee recommendation for the activities of the Bureau
of Health Workforce is $1,225,666,000.
The Bureau of Health Workforce provides policy leadership and
grant support for health professions workforce development. The
mission of the Bureau is to identify shortage areas while working
to make them obsolete. Its programs are intended to ensure that
the Nation has the right clinicians, with the right skills, working
where they are needed.
Pain Therapeutics and Opioid Training.—Addiction is a chronic
problem in the United States and is not adequately addressed in

44
medical schools or residency training programs. This lack of attention is partially responsible for the current opioid crisis. The Committee urges HRSA to support training on best practices in opioid
prescribing, pain management, screening, and linkage to care for
individuals with opioid use disorder that could inform the development of best practices for healthcare providers and trainees.
National Health Service Corps
The Committee provides $120,000,000 for the National Health
Service Corps [Corps] to continue improving access to quality
opioid and substance use disorder [SUD] treatment in rural and
underserved areas nationwide. The Committee continues language
that expands eligibility for loan repayment awards through the
Corps to include SUD counselors.
The Committee continues to include section 206 of this act to
modify the rules governing the Corps to allow every Corps member
60 days to cancel their contract.
The Committee recognizes the success of the Corps program in
building healthy communities in areas with limited access to care.
The program has shown increases in retention of healthcare professionals located in underserved communities.
Training for Diversity
The Committee supports programs that improve the diversity of
the healthcare workforce. HRSA’s diversity pipeline programs help
advance patient care and ensure opportunity for all healthcare providers.
Centers of Excellence
The Committee recommends $23,711,000 for the Centers of Excellence Program.
The Committee supports collaborative efforts to address American Indian and Alaskan Native health, including programs to increase the number of Native Americans and Alaska Natives in the
U.S. health professions workforce.
Health Careers Opportunity Program
The Committee eliminates the Health Careers Opportunity Program as proposed by the previous and current administrations. In
its place, the Committee provides the funding to other diversity
training programs and the nursing workforce diversity program.
The Committee supports programs that improve the diversity of
the healthcare workforce, and that demonstrate better outcomes toward that goal.
Faculty Loan Repayment
The Committee provides $4,190,000, an increase of $3,000,000,
for the Faculty Loan Repayment Program.
Scholarships for Disadvantaged Students
The Committee provides $65,470,000, an increase of $14,000,000,
for Scholarships for Disadvantaged Students. The Committee supports diversity among health professionals. This program provides
grants to eligible health professions and nursing schools to award

45
scholarships to students from disadvantaged backgrounds who
have financial need.
Primary Care Training and Enhancement
The Committee provides $48,924,000 for Primary Care Training
and Enhancement programs, which support the expansion of training in internal medicine, family medicine, pediatrics, and physician
assistance. Funds may be used for developing training programs or
providing direct financial assistance to students and residents.
The Committee urges the integration of evidence-based trainings
for health professionals to screen, intervene, and refer patients to
specialized treatment for the severe mental illness of eating disorders as authorized under section 13006 of the 21st Century
Cures Act (Public Law 114–255).
Training in Oral Health Care
The Committee provides $40,673,000 for Training in Oral Health
Care programs, which includes not less than $12,000,000 each for
general and pediatric dentistry. Funds may be used to expand
training in general dentistry, pediatric dentistry, public health dentistry, dental hygiene, and other oral health access programs.
Funds may also be used to plan and operate training programs, as
well as to provide financial assistance to students and residents.
The Committee directs HRSA to provide continuation funding for
post-doctoral training and dental faculty loan repayment [DFLRP]
grants, and to initiate a new DFLRP grant cycle with a preference
for pediatric dentistry faculty supervising dental students or residents and providing clinical services in dental clinics located in
dental schools, hospitals, and community-based affiliated sites.
The Committee continues long-standing bill language that prohibits funding for section 340G–1 of the PHS Act (Public Law 111–
148).
Medical Student Education
The Committee continues to provide $50,000,000 to support colleges of medicine at public universities located in the top quintile
of States projected to have a primary care provider shortage in
2025. The Committee directs HRSA to make supplementary grant
awards to entities funded in fiscal year 2019 and fiscal year 2020
to ensure that awardees receive the same amount of funds by the
end of their total grant period, provided the awardee continues to
justify the expenditure of such funds.
Interdisciplinary, Community-Based Linkages
Area Health Education Centers
The Committee provides $45,250,000 for Area Health Education
Centers [AHECs], an increase of $4,000,000.
The program links university health science centers with community health service delivery systems to provide training sites for
students, faculty, and practitioners. The program supports three
types of projects: core grants to plan and implement programs; special initiative funding for schools that have previously received

46
AHEC grants; and model programs to extend AHEC programs with
50 percent Federal funding.
Rural Health Care Simulation Labs.—The Committee is aware of
the unique challenges faced by many rural, medically underserved
communities and the considerable difficulty they have had in recruiting and retaining healthcare professionals with significant traditional clinical experience. Therefore, to increase the number of
healthcare professionals trained to provide clinical services to highneed, underserved populations, the Committee provides $2,000,000
for competitive grants for AHEC recipients to establish simulation
labs that will provide realistic, clinical environments and scenarios
designed to educate and train healthcare professionals serving
rural, medically underserved communities. HRSA is directed to
consider and prioritize projects from AHEC recipients with a history of successfully graduating and placing graduates in rural,
medically underserved communities.
Geriatric Programs
The Committee provides $44,737,000 for Geriatric Programs, an
increase of $4,000,000.
Behavioral Health Workforce Development Programs
The Committee provides $138,916,000 for Behavioral Health
Workforce Development programs. The Committee is combining the
appropriations funding display for Behavioral Health Workforce
Education and Training [BHWET] and Mental and Behavioral
Health Education and Training for clarity since these programs
support the same authorizations. Within this total, the Committee
provides up to $29,500,000 for the Mental Health and SUD Workforce Training Demonstration, which includes funding for the Addiction Medicine Fellowship program, and $12,000,000 for the Loan
Repayment Program for SUD Treatment Workforce. The Committee encourages HRSA to ensure new funding obligations do not
detract from the core mission of establishing and expanding internships or field placement programs in behavioral health serving populations in rural and medically underserved areas.
Graduate Psychology Education [GPE].—The Committee recommendation includes $18,000,000 for the interprofessional GPE
program to increase the number of health service psychologists
trained to provide integrated services to high-need, underserved
rural and urban communities. The Committee continues to recognize the growing need for highly trained mental and behavioral
health professionals to deliver evidence-based behavioral interventions for pain management. The Committee encourages HRSA to
help integrate health service psychology trainees at federally qualified health centers.
Health Workforce Eligibility Requirements.—The Committee encourages HRSA to update eligibility requirements for the BHWET
program and the GPE program to account for accreditation changes
that have occurred since the eligibility requirements were established. The Committee notes the Council for Higher Education Accreditation, as well as the Department of Veterans Affairs, recognizes the Psychological Clinical Science Accreditation System
[PCSAS]. HRSA is encouraged to make administrative updates to

47
ensure that HRSA’s health workforce programs continue to have
access to the best qualified applicants, including those who graduate from PCSAS programs.
Health Professions Workforce Information and Analysis
The Committee provides $5,663,000 for health professions workforce information and analysis. The program provides for the collection and analysis of targeted information on the Nation’s
healthcare workforce, research on high-priority workforce questions, the development of analytic and research infrastructure, and
program evaluation and assessment.
Alzheimer’s Providers.—More than 5,800,000 Americans are living with Alzheimer’s disease, yet only 16 percent of seniors receive
regular cognitive assessments. The Committee is concerned about
access issues due to the potential lack of available healthcare workforce and facilities involved in Alzheimer’s care and diagnosis. The
Committee directs HRSA, in consultation with the Assistant Secretary for Planning and Evaluation, to provide a report to the Committees on Appropriations on the current capacity of the Nation’s
dementia specialists not later than 15 months after enactment of
this act. The report should assess provider shortages and screening
capacity, identify barriers for early detection of Alzheimer’s and
adequate access to care, and provide recommendations to address
any provider shortages and streamline the patient’s Alzheimer’s diagnostic pathway.
Public Health Workforce Development
The Committee provides $17,000,000 for Public Health Workforce
Development. This program line, also called Public Health and Preventive Medicine, funds programs that are authorized in titles III
and VII of the PHS Act (Public Law 111–148) and support awards
to schools of medicine, osteopathic medicine, public health, and integrative medicine programs.
Nursing Workforce Development Programs
The Committee provides $266,132,000 for Nursing Workforce Development programs. These programs provide funding to address
all aspects of nursing workforce demand, including education, practice, recruitment, and retention.
The Committee includes $8,000,000 for competitive grants within
the Nurse Education, Practice, Quality and Retention program to
enhance nurse education and strengthen the nursing workforce
through the expansion of experiential learning opportunities.
HRSA is encouraged to establish Center-based grants for Nursing
Simulation Research Centers. HRSA shall prioritize awards to accredited Schools of Nursing that can demonstrate plans to use
these grants to expand their nursing simulation centers to increase
enrollment by at least 40 percent from their 2019 baseline. Grants
should also feature an evaluation component to determine best
practices in the organization and use of these evolving nurse training tools. The Committee directs HRSA to ensure that these grants
include as an allowable use the purchase of simulation training
equipment. Grantees shall be located in a medically underserved

48
area in a State with an age-adjusted high burden of stroke, heart
disease, and obesity.
The Committee includes $23,503,000 for Nursing Workforce Diversity, an increase of $5,160,000 to continue funding for the
Eldercare Enhancement program.
Advanced Education Nursing
The Committee recommends $75,581,000 for the Advanced Education Nursing programs, which increases the number of qualified
nurses in the workforce by improving nursing education through
curriculum and faculty development.
Children’s Hospitals Graduate Medical Education
The Committee provides $355,000,000 for the Children’s Hospitals Graduate Medical Education [CHGME] program, an increase
of $15,000,000. The Committee strongly supports the CHGME program, which provides support for graduate medical education training programs in both ambulatory and in-patient settings within
freestanding children’s teaching hospitals. CHGME payments are
determined by a per-resident formula that includes an amount for
direct training costs added to a payment for indirect costs. Payments support training of resident physicians as defined by Medicare in both ambulatory and inpatient settings.
National Practitioner Data Bank
The Committee provides $18,814,000 for the National Practitioner Data Bank. As mandated by the Health Care Quality Improvement Act (Public Law 99–660), the National Practitioner Data
Bank does not receive appropriated funds, but instead is financed
by the collection of user fees.
The National Practitioner Data Bank collects certain adverse information, medical malpractice payment history, and information
related to healthcare fraud and abuse. The data bank is open to
healthcare agencies and organizations that make licensing and employment decisions.
MATERNAL AND CHILD HEALTH

$943,784,000
919,018,000
963,784,000

The Committee recommendation for the Maternal and Child
Health [MCH] Bureau is $963,784,000. The mission of the Bureau
is to improve the physical and mental health, safety, and wellbeing of the Nation’s women, infants, children, adolescents, and
their families. This population includes fathers and children with
special healthcare needs.
Maternal and Child Health Block Grant
The Committee provides $707,700,000 for the MCH Block Grant,
which provides a flexible source of funding that allows States to
target their most urgent maternal and child health needs. The program supports a broad range of activities, including providing prenatal care, well child services, and immunizations; reducing infant
mortality; preventing injury and violence; expanding access to oral

49
healthcare; addressing racial and ethnic disparities; and providing
comprehensive care through clinics, home visits, and school-based
health programs.
Children’s Health and Development.—The Committee provides
$3,500,000 to continue and to expand upon the work done in previous years within the Special Projects of Regional and National
Significance [SPRANS] discretionary account to address these challenges. HRSA is directed to continue funding these projects bringing systemic change in States with the highest levels of childhood
poverty. Successful programs should consider inter- and intra-cultural dynamics to yield best practices for areas across the Nation
with diverse populations, persistent poverty, and child health outcomes in need of improvement. Special attention should be given
to programs that harness technology and other connected health
assets and systems that increase access to care in rural areas and
historically underserved populations for whom services are most
needed. The programs should yield comprehensive and integrated
models for other States to utilize in improving child health and development outcomes.
Fetal Alcohol Syndrome.—The Committee provides $1,000,000
within SPRANS for screening and intervention initiatives, supporting projects training healthcare providers to assist at-risk pregnant women, and enhancing efforts to understand the prevalence
of fetal alcohol syndrome.
Hemophilia.—The Committee includes sufficient funding for the
Regional Hemophilia Network Program, which provides grant funding to the national network of Hemophilia Treatment Centers
[HTCs]. This comprehensive care program supports HTCs in providing multi-disciplinary care services, such as physical therapy assessments, social work, and case management, for people with
bleeding disorders, such as hemophilia, von Willebrand disease,
and related rare bleeding disorders.
Infant-Toddler
Court
Teams.—The
Committee
includes
$10,000,000 for the fourth year of a cooperative agreement to support research-based Infant-Toddler Court Teams to change child
welfare practices to improve well-being for infants, toddlers, and
their families.
Maternal Mortality.—The Committee continues to recognize that
the maternal mortality rate in the U.S. is a pressing public health
issue. Within SPRANS, the Committee provides $23,000,000 for
State Maternal Health Innovation Grants to implement evidencebased interventions to address critical gaps in maternity care service delivery and to reduce maternal mortality. The Committee also
provides $10,000,000, an increase of $5,000,000, within SPRANS to
support continued implementation of the Alliance for Innovation on
Maternal Health program’s maternal safety bundles to all U.S.
States, the District of Columbia, and U.S. territories, as well as
tribal entities. Maternal safety bundles are a set of targeted and
evidence-based best practices that, when implemented, improve patient outcomes and reduce maternal mortality and severe maternal
morbidity.
Regional Pediatric Pandemic Network.—The Committee provides
$15,000,000 within SPRANS to establish a regional pediatric pandemic network comprised of five children’s hospitals (centers) as

50
defined by section 340E of the PHS Act (Public Law 106–129) or
their affiliated university pediatric partners. The Network shall coordinate among the Nation’s pediatric hospitals and their communities in preparing for and responding to global health threats, including the coordination, preparation, response, and real-time dissemination of research-informed pediatric care for future
pandemics. Funding shall be equitably distributed among the five
centers and the centers shall be located in geographically diverse
areas of the country to ensure a regional approach to the network.
HRSA is urged to consider eligible pediatric quaternary hospitals
or their affiliated university pediatric partners that have participated in a recent pediatric therapeutic or vaccination clinical trial.
HRSA is directed to establish at least one such Center in a State
within both the Delta Regional Authority and Appalachian Regional Commission. HRSA is directed to establish at least one such
Center at a pediatric hospital that is part of HRSA’s Region VII.
HRSA is also directed to establish at least one such Center at a
pediatric hospital that is a primary National Institutes of Health
Clinical and Translational Science Award grantee or a partner that
contributes to the budget request of an academic medical center’s
application.
Sickle Cell Anemia
The Committee provides $5,205,000 for grants and contracts to
help coordinate service delivery for individuals with sickle cell disease, including genetic counseling and testing; long-term follow-up
and care coordination for individuals with sickle cell disease training of health professionals; and coordination of education, treatment, and continuity of care programs.
Autism and Other Developmental Disorders
The Committee provides $52,344,000 for the Autism and Other
Developmental Disorders program. The program supports surveillance, early detection, education, and intervention activities on autism and other developmental disorders, as reauthorized in the Autism Collaboration, Accountability, Research, Education and Support [Autism CARES] Act of 2019 (Public Law 116–60).
The Committee provides funding for the Leadership Education in
Neurodevelopmental and Related Disabilities [LEND] program to
train interdisciplinary professionals to screen, diagnose, and provide evidence-based interventions to individuals with autism spectrum disorder and other developmental disabilities as authorized
by the Autism CARES Act (Public Law 116–60). This funding will
enable the LEND network to fulfill its expanded statutory mandate
to train interdisciplinary providers who will serve individuals
across the lifespan, addressing a critical shortage of healthcare professionals for adults with autism and other developmental disabilities. This funding will also enable the LEND network to assist in
ongoing developmental monitoring, especially for children impacted
by pressing public health crises with resulting complications. The
Committee recognizes the role of the LEND programs in providing
direct clinical assessment and evidence-based interventions. In addition, the funding will allow these programs to develop innovative
strategies to integrate and enhance existing investments, including

51
translating research findings on interventions, guidelines, tools,
and systems management approaches to interdisciplinary training
settings, to communities, and into practice; and promote life-course
considerations—from developmental screening in early childhood to
transition to adulthood issues.
Newborn Screening for Heritable Disorders
The Committee provides $17,883,000 for the Newborn Heritable
Disorders Screening program, as described in section 1109 of the
Newborn Screening Saves Lives Act of 2008 (Public Law 113–240).
This program provides funding to improve States’ ability to provide
newborn and child screening for heritable disorders. Newborn
screening provides early identification and follow-up for treatment
of infants affected by certain genetic, metabolic, hormonal, and/or
functional conditions.
Healthy Start
The Committee provides $125,500,000 for Healthy Start. The primary purpose of Healthy Start is to reduce infant mortality and
generally improve maternal and infant health in at-risk communities. Grants are awarded to State and local health departments
and nonprofit organizations to conduct an infant mortality review,
develop a package of innovative health and social services for pregnant women and infants, and evaluate these efforts.
Universal Newborn Hearing Screening and Early Intervention
The Committee provides $17,818,000 for universal newborn hearing screening and early intervention activities. This program
awards grants to 53 States and territories that support statewide
systems of newborn hearing screening, audiologic diagnostic testing
before 3 months of age, and enrollment in early intervention programs before the age of 6 months.
Emergency Medical Services for Children
The Committee provides $22,334,000 for the Emergency Medical
Services for Children program which focuses on improving the pediatric components of the emergency medical services system and
improving the quality of care provided to children in the pre-hospital setting. Funding is available to every State emergency medical services office to improve the quality of emergency care for
children and to pay for research and dissemination of best practices.
Screening and Treatment for Maternal Depression
The Committee provides $5,000,000 for Screening and Treatment
for Maternal Depression. HRSA is directed to make grants to
States to establish, improve, or maintain programs to train professionals to screen, assess, and treat for maternal depression in
women who are pregnant or who have given birth within the preceding 12 months.

52
Pediatric Mental Health Care Access
The Committee provides $10,000,000 to expand access to behavioral health services in pediatric primary care by supporting the
development of pediatric mental healthcare telehealth access programs.
HIV/AIDS BUREAU

$2,388,781,000
2,483,781,000
2,438,781,000

The Committee recommendation includes $2,438,781,000 for the
HIV/AIDS Bureau, an increase of $50,000,000, for the Ending the
HIV Epidemic initiative. The Committee provides $120,000,000 for
the Ending the HIV Epidemic initiative, including $50,000,000
from the Nonrecurring Expenses Fund. The investment will support HIV care and treatment services; support evidence informed
practices to link, engage, and retain HIV-positive individuals in
care; and continue to build capacity into the system.
The mission of the Bureau is to address the unmet care and
treatment needs of persons living with HIV/AIDS. The Bureau administers the Ryan White Care Act (Public Law 111–87), which
provides a wide range of community-based services, including primary and home healthcare, case management, substance abuse
treatment, mental health, and nutritional services.
Emergency Assistance
The Committee provides $655,876,000 for emergency assistance
grants to eligible metropolitan areas disproportionately affected by
the HIV/AIDS epidemic.
Grants are provided to metropolitan areas meeting certain criteria. Two-thirds of the funds are awarded by formula, and the remainder is awarded through supplemental competitive grants.
Comprehensive Care Programs
The Committee provides $1,315,005,000 for HIV healthcare and
support services.
Funds are awarded to States to support HIV service delivery consortia, the provision of home- and community-based care services
for individuals with HIV disease, continuation of health insurance
coverage for low-income persons with HIV disease, and support for
State AIDS drug assistance programs [ADAP]. The Committee provides $900,313,000 for AIDS medications in ADAP.
Early Intervention Services
The Committee provides $201,079,000 for early intervention
grants. These funds are awarded competitively to primary
healthcare providers to enhance healthcare services available to
people at risk of HIV and AIDS. Funds are used for comprehensive
primary care, including counseling, testing, diagnostic, and therapeutic services.

53
Children, Youth, Women, and Families
The Committee provides $75,088,000 for grants for coordinated
services to women, infants, children, and youth.
Funds are awarded to a variety of providers, including community health centers, comprehensive hemophilia centers, county and
municipal health departments, and other nonprofit communitybased programs that provide comprehensive primary healthcare
services to populations with or at risk for HIV.
AIDS Dental Services
The Committee provides $13,122,000 for the AIDS Dental Services program. This program provides grants to dental schools, dental hygiene schools, and post-doctoral dental education programs to
assist with the cost of providing unreimbursed oral healthcare to
patients with HIV.
The Ryan White Part F program provides for the Dental Reimbursement Program, which covers the unreimbursed costs of providing dental care to persons living with HIV/AIDS. Programs that
qualify for reimbursement are dental schools, hospitals with postdoctoral dental education programs, and colleges with dental hygiene programs.
AIDS Education and Training Centers
The Committee provides $33,611,000 for AIDS Education and
Training Centers [AETCs]. AETCs train healthcare practitioners,
faculty, and students who care for AIDS patients outside of the traditional health professions education venues and support curriculum development on the diagnosis and treatment of HIV infection for health professions schools and training organizations.
Special Projects of National Significance
The Committee provides $25,000,000 for the Special Projects of
National Significance program. This program supports the development, evaluation, and dissemination of innovative models of HIV
care and treatment to improve the retention and health outcomes
of Ryan White HIV/AIDS Program clients.
The Committee encourages the acceleration of the development
of oral, ultra-long-acting, sustained-release therapies as part of the
Ending the HIV Epidemic initiative.
HEALTH CARE SYSTEMS

$123,593,000
115,418,000
130,593,000

The Committee recommendation for the Health Care Systems
Bureau is $130,593,000.
The Health Care Systems Bureau protects the public health and
improves the health of individuals through efforts to support and
enhance the systems by which healthcare is delivered in America.
Organ Donation and Transplantation
The Committee provides $28,549,000 for organ donation and
transplantation activities, an increase of $1,000,000, to expand fi-

54
nancial support for living donors and increase public education and
awareness about organ donation.
Funds support a scientific registry of organ transplant recipients
and the National Organ Procurement and Transplantation Network [OPTN] to match donors and potential recipients of organs.
A portion of the appropriated funds may be used to educate the
public and health professionals about organ donations and transplants, and to support clearinghouse and technical assistance functions.
National Living Donor Assistance Center [NLDAC].—The Committee recommends no less than $5,500,000, an increase of
$1,000,000, for the NLDAC program. The Committee supports the
expansion of NLDAC to reimburse a comprehensive range of living
donor expenses for the greatest possible number of donors, including lost wages, childcare, eldercare, and similar expenses for donor
caretakers, and removing other disincentives to donation. The Committee supports significant expansion of income eligibility for the
program to allow as many donors as possible to qualify and to ensure that financial reimbursement and monetary exchange take
place outside of the organ donor-organ recipient relationship to the
greatest extent possible.
Organ Allocation Policy.—The Committee urges HHS, HRSA,
and OPTN to increase organ utilization and reduce organ wastage.
The recent public health crisis has reduced the number of deceased
donated organs and has impacted the volume of living donor transplants in certain regions of the country. New healthcare facility
protocols may also adversely affect organ procurement, restricting
the ability of transplant programs from recovering donating organs.
Under these circumstances, it is especially important to ensure
that no donated organ is wasted. According to data from OPTN,
organ wastage increases when organs must travel further to reach
their intended recipient, especially if air travel is required. The
Committee, therefore, recommends that HHS, HRSA, and OPTN
prioritize local use of donated organs to minimize travel by both
transplant teams and organs during the public health crisis. Further, HRSA and OPTN should consider the reduction in available
air transportation, especially the dramatic reduction in commercial
flights, and provide a report to the Committees on Appropriations
within 30 days of enactment of this act on how such changes to the
airline industry affect the ability of transplant programs in smaller
cities and rural communities to accept organ offers.
Organ Availability, Recovery, and Transplant Innovation.—The
Committee supports the goal of significantly increasing kidney
transplants, established by the President’s Executive Order on Advancing American Kidney Health, and supports efforts to establish
objective outcome measures for Organ Procurement Organizations
[OPOs] as well as efforts to improve or replace underperforming
OPOs. Further, the challenges of the organ transplantation waiting
list and the organ transplantation process overall are well-known.
HRSA is encouraged to coordinate with relevant divisions of HHS,
including the Agency for Health Research and Quality, to evaluate
innovative approaches to enhance the availability of organs, encourage donation, and further improve the organ transplantation
process, including through consultation with other Federal agen-

55
cies. The Committee supports HHS’s Request for Information for
the technology system over which these organ offers are facilitated
and encourages HHS to promote innovation and the seamless continuation of these life-saving services.
National Cord Blood Inventory
The Committee provides $19,266,000 for the National Cord Blood
Inventory [NCBI], an increase of $2,000,000. The purpose of this
program is to provide funds to cord blood banks to build an inventory of the highest quality cord blood units for transplantation.
NCBI builds a racially and ethnically diverse inventory of highquality umbilical cord blood for transplantation. The Committee
applauds HRSA for increasing the number of units collected and
maintained under NCBI.
C.W. Bill Young Cell Transplantation Program
The Committee provides $31,009,000 for the C.W. Bill Young
Cell Transplantation Program, an increase of $1,000,000. The Committee continues to support cell transplantation through the use of
bone marrow, peripheral blood stem cells, and cord blood. The
Committee appreciates HRSA’s efforts to increase the diversity of
the volunteer registry and encourages it to support the program’s
efforts to improve the availability, efficiency, safety of transplants,
and improve outcomes for all transplant recipients regardless of socioeconomic status, age, ethnic ancestry, or any other individually
defining characteristic.
Office of Pharmacy Affairs
The Committee provides $10,238,000 for the Office of Pharmacy
Affairs [OPA]. OPA administers the 340B drug pricing program,
which requires drug manufacturers to provide discounts or rebates
to a set of programs and hospitals that serve a disproportionate
share of low-income patients.
Poison Control Centers
The Committee provides $25,846,000, an increase of $3,000,000,
for poison control activities. The Poison Control Centers [PCCs]
program is a national network of 55 PCCs that prevent and treat
poison exposures by providing cost effective, quality healthcare advice to the general public and healthcare providers.
In 2019, more than 1,154,000 human exposure calls managed by
PCCs involved opioids and medications. Compared to the same period last year, the case volume has increased by 396,000 calls. The
Committee continues to recognize the role PCCs have played in the
opioid crisis through management of opioid overdoses by assisting
first responders and hospital personnel through the National Poison Help Line.
National Hansen’s Disease Program
The Committee includes $13,706,000 for the National Hansen’s
Disease program. The program consists of inpatient, outpatient,
long-term care, as well as training and research in Baton Rouge,
Louisiana; a residential facility at Carville, Louisiana; and 11 out-

56
patient clinic sites in the continental United States and Puerto
Rico.
National Hansen’s Disease Program Buildings and Facilities
The Committee provides $122,000 for the repair and maintenance of buildings at the Gillis W. Long Hansen’s Disease Center.
Payment to Hawaii for Hansen’s Disease Treatment
The Committee provides $1,857,000 to Hawaii for Hansen’s Disease treatment. Payments are made to the State of Hawaii for the
medical care and treatment of persons with Hansen’s disease in
hospital and clinic facilities at Kalaupapa, Molokai, and Honolulu.
Expenses above the level of appropriated funds are borne by the
State of Hawaii.
RURAL HEALTH

$318,294,000
246,834,000
325,410,000

The Committee recommendation for Rural Health programs is
$325,410,000.
The Federal Office of Rural Health Policy [FORHP] administers
HHS rural health programs, coordinates activities related to rural
healthcare within HHS, and analyzes the possible effects of policy
on the more than 60.0 million residents of rural communities.
FORHP advises the Secretary on the effects of Medicare and Medicaid on rural citizens’ access to care, the viability of rural hospitals, and the availability of physicians and other health professionals.
Rural Communities Opioids Response.—The Committee includes
$110,000,000 to continue the Rural Communities Opioids Response
program. The Committee continues funding to support treatment
for and prevention of substance use disorder, focusing on rural
communities with the highest risk for substance use disorders.
Within the funding provided, the Committee includes $10,000,000
to continue the three Rural Centers of Excellence [Centers], as established by Public Law 115–245 and continued in Public Law
116–94. Additionally, the appropriation shall be made available for
the purpose of extending the length of the grants supporting the
Centers through the fiscal year 2023 project period and providing
support for recovery housing and treatment providers.
Rural Populations.—The Committee is aware of FORHP’s efforts
to revise the methodology for defining rural populations and notes
that the CARES Act (Public Law 116–136) reauthorized programs
under 330A of the PHS Act (Public Law 110–355) to allow rural or
urban entities to serve as the lead applicant as long as they can
demonstrate that the services will be provided in rural communities. The Committee requests an update on the agency’s progress
within 60 days of enactment of this act. For the purposes of grants
funded by this act, HRSA is also directed to consider the proximity
of an applicant’s physical location with respect to a rural designation area and the prospective population to be served by the applicant when determining eligibility.

57
Rural Health Outreach
The Committee provides $84,500,000 for the Rural Health Outreach program. This program supports projects that demonstrate
new and innovative modes of outreach in rural areas, such as integration and coordination of health services. Outreach grant programs include Outreach Service Grants, Rural Network Development Grants, Delta States Network Grant Program, Network Planning Grants, and Small Health Care Provider Quality Improvement Grants.
Delta States Rural Development Network Grant Program.—The
Committee provides not less than $27,000,000 for the Delta States
Rural Development Network Grant Program and the Delta Region
Community Health Systems Development Program. The Committee
encourages HRSA to continue to consult with the Delta Regional
Authority [DRA] on awarding, implementing, administering, and
monitoring grants under the Delta States Rural Development Network Grant Program in fiscal year 2021. The Committee continues
to encourage HRSA to align its awards as closely as possible with
DRA’s strategic vision and with DRA’s economic and community
development plans. In addition, of the funds provided, the Committee provides $15,000,000 to support HRSA’s collaboration with
DRA to continue the Delta Region Community Health Systems Development Program to help underserved rural communities identify
and better address their healthcare needs, and to help small rural
hospitals improve their financial and operational performance.
Within 90 days of enactment of this act, the Committee directs
HRSA and DRA to jointly brief the Committee on this program’s
progress.
Rural Health Research
The Committee provides $11,076,000 for the Rural Health Research program. Funds are used for rural health research centers,
the National Advisory Committee on Rural Health, and a reference
and information service. Supported activities focus on improving
the delivery of health services to rural communities and populations.
Rural Hospital Flexibility Grants
The Committee provides $54,000,000 for Rural Hospital Flexibility grants and the Small Hospital Improvement Program. Under
these grant programs, HRSA works with States to provide support
and technical assistance to Critical Access Hospitals to focus on
quality and performance improvement and to integrate emergency
medical services.
The Committee continues to recognize the importance of supporting hospitals located in rural or underserved communities and
recommends HRSA give preference in grant awards to Critical Access Hospitals serving rural communities that create community
health teams to help coordinate care among rural populations to
foster better outcomes in chronic disease management.
State Offices of Rural Health
The Committee provides $13,000,000 for State Offices of Rural
Health. These offices help States strengthen rural healthcare deliv-

58
ery systems by enabling them to coordinate care and improve support and outreach in rural areas.
Black Lung Clinics
The Committee provides $12,000,000 for the Black Lung Clinics
program. This program funds clinics that treat respiratory and pulmonary diseases of active and retired coal miners, steel mill workers, agricultural workers, and others with occupationally related
respiratory and pulmonary impairments. These clinics reduce the
incidence of high-cost inpatient treatment for these conditions.
Radiation and Exposure Screening and Education Program
The Committee provides $1,834,000 for activities authorized by
the Radiation Exposure Compensation Act (Public Law 109–482).
This program provides grants for the education, prevention, and
early detection of radiogenic cancers and diseases resulting from
exposure to uranium during mining and milling at nuclear test
sites.
Telehealth
The Committee provides $29,000,000 for the Office for the Advancement of Telehealth [OAT], which promotes the effective use
of technologies to improve access to health services for people who
are isolated from healthcare and to provide distance education for
health professionals. The Committee strongly supports OAT and
their mission to expand high quality medical care to rural communities that do not have adequate access to medical providers including many medical specialties.
Telehealth Centers of Excellence [COEs].—Within the funds provided for OAT activities, the Committee includes $6,000,000 in continued funding for the Telehealth COE awarded sites. These sites
are responsible for testing the efficacy of telehealth services in various sites and models, providing research and coordination efforts
across the Federal Government, developing best practices for telehealth, and collecting data and providing relevant telehealth training. Given the excellent performance of the current grantees, as
well as the urgent need for continuity in telehealth resources, the
Committee directs HRSA to continue funding existing sites with
the funds provided. Additionally, the Committee directs HRSA to
leverage the COEs for research and analysis of practices utilizing
telehealth in the response to public health crises. Finally, the Committee directs HHS and HRSA to continue to utilize the expertise
of the COEs in the Ending the HIV Epidemic initiative to develop
best practices for utilizing telehealth in HIV prevention, care, and
treatment.
Rural Residency Planning and Development
The Committee provides $10,000,000 for the Rural Residency
Planning and Development program. The Committee commends
FORHP for efforts to expand the physician workforce in rural areas
and supports continuation and expansion of the program to develop
new rural residency programs, or Rural Training Tracks [RTTs].
The Committee encourages HRSA to expand the current program
to include RTTs in obstetrics and gynecology. Women in rural com-

59
munities are more likely to begin prenatal care late, and are more
likely to experience maternal mortality and severe maternal morbidity. The expansion of this program would align with the agency’s goals of improving maternal health outcomes and eliminating
preventable maternal mortality.
FAMILY PLANNING

$286,479,000
286,479,000
286,479,000

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

$155,300,000
151,993,000
157,300,000

The Committee provides $157,300,000 for program management
activities, an increase of $2,000,000.
Chief Dental Officer [CDO].—The Committee is pleased that
HRSA has restored the position of CDO and looks forward to learning how the agency has ensured that the CDO is functioning at an
executive level authority with resources and staff to oversee and
lead all oral health programs and initiatives across HRSA. The
Committee requests an update within 30 days of enactment of this
act on how the CDO is serving as the agency representative with
executive level authority on oral health issues to international, national, State and/or local government agencies, universities, and
oral health stakeholder organizations.
VACCINE INJURY COMPENSATION PROGRAM TRUST FUND

$295,800,000
281,800,000
275,800,000

The Committee provides that $275,800,000 be released from the
Vaccine Injury Compensation Trust Fund in fiscal year 2021. Of
that amount, $10,200,000 is for administrative costs.
The National Vaccine Injury Compensation program provides
compensation for individuals with vaccine-associated injuries or
deaths. Funds are awarded to reimburse medical expenses, lost
earnings, pain and suffering, legal expenses, and death benefits.
The Vaccine Injury Compensation Trust Fund is funded by excise
taxes on certain childhood vaccines.
CENTERS

FOR

DISEASE CONTROL

AND

PREVENTION

The Committee recommendation provides a program level of
$7,879,954,000 in this bill for the Centers for Disease Control and
Prevention [CDC], which includes $55,358,000 in mandatory funds
under the terms of the Energy Employees Occupational Illness
Compensation Program Act [EEOICPA] (Public Law 106–398),
$856,150,000 in transfers from the Prevention and Public Health

60
[PPH] Fund, and $60,000,000 from the Nonrecurring Expenses
Fund.
The activities of CDC focus on several major priorities: providing
core public health functions; responding to urgent health threats;
monitoring the Nation’s health using sound scientific methods; assuring the Nation’s preparedness for emerging infectious diseases
and potential pandemics; and providing leadership in the implementation of nationwide prevention strategies that are conducive to
improving and maintaining health.
IMMUNIZATION AND RESPIRATORY DISEASES

$790,005,000
880,005,000
830,005,000

The Committee recommendation for the activities of the National
Center for Immunization and Respiratory Diseases is $830,005,000,
which includes $360,200,000 in transfers from the PPH Fund.
The mission of the National Center for Immunization and Respiratory Diseases is the prevention of disease, disability, and death
through immunization and by control of respiratory and related
diseases.
The Committee recommendation includes funding for the following activities in the following amounts:
[In thousands of dollars]
Budget activity

Section 317 Immunization Program ...............................................................................
Influenza Planning and Response ..................................................................................

Fiscal year 2020
appropriation

613,647
176,358

Committee
recommendation

613,647
216,358

317 Immunization Program.—The Committee expects CDC to
use the resources provided to enhance awareness and knowledge of
the safety and effectiveness of vaccines to prevent and control diseases, combat misinformation about vaccines, and disseminate scientific and evidence-based vaccine-related information, with the
goal of increasing rates of vaccination across all ages, as applicable,
particularly in communities with low rates of vaccination, to reduce
and eliminate vaccine-preventable diseases. The Committee further
urges CDC to continue identifying communities at high risk of outbreaks related to vaccine-preventable diseases and improve vaccination rates in such communities, including through improved
surveillance, culturally and linguistically appropriate interventions,
and research initiatives. Influenza vaccination for the 2020–2021
flu season will be critically important, and CDC must enhance vaccination coverage particularly to protect vulnerable populations to
flu and other infectious diseases such as nursing home residents,
pregnant women, healthcare personnel, and children who could
transmit flu to those who are at increased risk.
Advisory Committee on Immunization Practices [ACIP].—The
Committee encourages CDC to work with ACIP and the National
Vaccine Advisory Committee to provide further explanation and
guidelines around the recommendation of shared clinical decisionmaking in the context of immunizing older adult populations, and
to develop and disseminate a healthcare provider toolkit to help en-

61
sure that medical professionals and patients continue to have a
clear understanding of, and continued access to, the immunizations
they should receive across the lifespan.
Acute Flaccid Myelitis.—The Committee continues to include
funding to identify the cause, prevention, and treatment of acute
flaccid myelitis.
Cost Estimates.—The Committee looks forward to reviewing the
fiscal year 2022 report on estimated funding needs of the Section
317 Immunization Program and requests that the report be updated and submitted no later than February 1, 2021. The updated
report should also include an estimate of optimum State and local
operations funding, as well as a discussion of the evolving role of
the 317 program as expanded coverage for vaccination becomes
available from private and public sources and continues to change.
HIV, VIRAL HEPATITIS, SEXUALLY TRANSMITTED DISEASES, AND
TUBERCULOSIS PREVENTION

$1,273,556,000
1,552,556,000
1,338,556,000

The Committee recommendation for the activities of the National
Center for HIV, Viral Hepatitis, Sexually Transmitted Diseases
[STDs], and Tuberculosis Prevention [TB] is $1,338,556,000, which
includes $60,000,000 from the Nonrecurring Expenses Fund.
The Center administers CDC’s activities on HIV/AIDS, viral hepatitis, STDs, and TB, with the exception of the Global AIDS program, which is housed in the Center on Global Health.
The Committee recommends funding for the following activities
in the following amounts:
[In thousands of dollars]
Budget activity

Domestic HIV/AIDS Prevention and Research .................................................................
HIV Initiative ..........................................................................................................
School Health .........................................................................................................
Viral Hepatitis .................................................................................................................
Sexually Transmitted Infections ......................................................................................
Tuberculosis ....................................................................................................................
Infectious Diseases and the Opioid Epidemic ...............................................................

Fiscal year 2020
appropriation

928,712
140,000
33,081
39,000
160,810
135,034
10,000

Committee
recommendation

988,712
200,000
33,081
39,000
160,810
135,034
15,000

Ending
the
HIV
Epidemic.—The
Committee
includes
$200,000,000, an increase of $60,000,000 from the Nonrecurring
Expenses Fund, to support activities associated with the Ending
the HIV Epidemic initiative. As part of this initiative, CDC will
work with State and local health departments to increase intensive
testing and rapid referral to care and treatment. In addition, innovative data management solutions will be developed and deployed,
and access to PrEP increased, along with better detection and response to HIV clusters. The Committee encourages CDC to highlight the importance of rapid testing as it implements this initiative. The Committee requests a spend plan be submitted to the
Committees on Appropriations of the House of Representatives and
the Senate no more than 60 days after enactment outlining priorities for funding and how funding will be distributed to States.

62
Hepatitis A Vaccination.—The Committee is concerned that in
2016, large person-to-person outbreaks of hepatitis A began occurring among persons who use drugs and persons experiencing homelessness. CDC is encouraged to promote awareness about the importance of hepatitis A vaccination among persons who use drugs.
Hepatitis B Vaccination.—The Committee is concerned that despite the availability of an effective hepatitis B virus [HBV] vaccine, only approximately one quarter of adults age 19 and older
were vaccinated. Therefore, the Committee is pleased that CDC is
evaluating new universal HBV vaccination recommendations including a comprehensive plan to increase adult HBV vaccinations.
The Committee urges CDC to promote awareness about the importance of hepatitis B vaccination among medical and health professionals, communities at high risk, and the general public. The
Committee directs CDC to submit a report to the Committees on
Appropriations of the House of Representatives and the Senate
within 180 days of enactment detailing how CDC can increase the
rate of HBV adult vaccination to the levels necessary to eliminate
new infections of hepatitis B in the United States, and to improve
collaboration and coordination across CDC to achieve this goal.
Infectious Diseases and the Opioid Epidemic.—The Committee
provides $15,000,000, an increase of $5,000,000, to CDC to
strengthen efforts to conduct surveillance to improve knowledge of
the full scope of the burden of infectious diseases (including viral,
bacterial, and fungal pathogens) associated with substance use disorders. CDC is encouraged to take into account risk factors for hepatitis B and C, HIV, and morbidity and mortality related to substance use disorder among other factors when distributing funding.
Interventions may include increasing capacity for State and local
health departments; expanding access for syringe exchange programs; fully implementing national HIV, hepatitis B, and hepatitis
C screening guidelines; and expanding surveillance and data collection on infectious diseases related to opioid use.
Rapid HIV Self-Test.—CDC is encouraged to incorporate rapid
HIV self-testing into established activities and emerging efforts of
the Ending the HIV Epidemic initiative.
Sexually Transmitted Infections [STIs].—The Committee is concerned about the continuing rise in STI rates, including congenital
syphilis [CS], and recognizes that STIs are associated with increased risk of HIV transmission. Direct funding to States and
local health departments is critical to reversing this trend. The
Committee recommends that CDC continue to provide State and
local funding at or near the current percentage of total STI prevention funding to the extent possible given evolving public health
needs. The Committee further encourages CDC to continue support
for STI training centers. The Committee encourages CDC to work
with State and local authorities on initiatives to strengthen prenatal outreach programs. The Committee further encourages CDC
to increase awareness of CS through community organizations and
STD and drug addiction clinics of the importance of multi-testing
throughout pregnancy.

63
EMERGING AND ZOONOTIC INFECTIOUS DISEASES

$635,772,000
735,772,000
654,772,000

The Committee recommendation for the activities of the National
Center for Emerging and Zoonotic Diseases is $654,772,000, which
includes $64,000,000 in transfers from the PPH Fund.
The National Center for Emerging and Zoonotic Infectious Diseases aims to detect, prevent, and control infectious diseases from
spreading, whether they are naturally occurring, unintentional, or
the result of terrorism.
The Committee recommendation includes funding for the following activities in the following amounts:
[In thousands of dollars]
Budget activity

Antibiotic Resistance Initiative .......................................................................................
Vector-borne Diseases .....................................................................................................
Lyme Disease ..................................................................................................................
Prion Disease ..................................................................................................................
Chronic Fatigue Syndrome ..............................................................................................
Emerging Infectious Diseases ........................................................................................
Harmful Algal Blooms .....................................................................................................
Food Safety ......................................................................................................................
National HealthCare Safety Network ..............................................................................
Quarantine .......................................................................................................................
Advanced Molecular Detection ........................................................................................
Epidemiology and Lab Capacity Program ......................................................................
Healthcare-Associated Infections ...................................................................................

Fiscal year 2020
appropriation

170,000
38,603
14,000
6,000
5,400
190,997
2,000
63,000
21,000
42,772
30,000
40,000
12,000

Committee
recommendation

170,000
43,603
14,000
6,000
5,400
192,997
2,000
63,000
21,000
42,772
30,000
52,000
12,000

Antimicrobial and Antibiotic Resistance.—The Committee is concerned about recent studies that show that at least 2,800,000 million people get sick and at least 35,900 die each year from antibiotic-resistant infections in the United States. The Committee directs CDC to improve prevention efforts to reduce the emergence
and spread of resistant pathogens and improve appropriate antibiotic use. The Committee also directs CDC to utilize these funds
to improve laboratory and epidemiological surveillance of bacterial
and fungal infections, and to support State and local public health
department and laboratory reporting through CDC’s National
Healthcare Safety Network. Further, the Committee recognizes the
importance of addressing antimicrobial resistance through a ‘‘One
Health’’ approach, simultaneously combating antibiotic resistance
in human, animal, and environmental settings. The Committee encourages CDC to support funding for U.S. based and global collaborations between entities such as academic medical centers, veterinary schools, schools of public health, State public health departments, and other academic institutions whose proposals are in line
with CDC’s strategy for addressing antibiotic resistant bacteria.
Further, a multitude of pathogens identified in CDC’s Antibiotic
Resistance Threats Report have been traditionally associated with
infections in healthcare settings, but are now being identified as
causes of infections in the community. The Committee continues to
include $500,000 for CDC to use their broad agency agreement to

64
fund an innovative project that uses population-based research to
define risk factors for these pathogens in community settings.
Chronic Fatigue Syndrome [ME/CFS].—The Committee commends CDC for its recent progress in ME/CFS medical education
and in the Multisite Clinical Assessment of ME/CFS study, including the expansion of this study into pediatric research. The Committee expects CDC to continue to collaborate with interagency
partners, disease experts and stakeholders, and NIH’s Collaborative Research Consortium on patient selection criteria.
Epidemiology and Lab Capacity.—CDC provides funding to State
and local health departments around the country to improve disease surveillance and preparedness and response for infectious disease outbreaks. The Committee provides $52,000,000, an increase
of $12,000,000, to support local and State labs as they address current and future public health threats.
Lyme Disease and Related Tick-Borne Illnesses.—The Committee
recognizes the importance of prevention and control of Lyme disease and related tick-borne diseases and encourages CDC to support surveillance and prevention of Lyme disease and other high
consequence tick-borne diseases in endemic areas, as well as areas
not yet considered endemic. The Committee includes $43,603,000
for CDC’s vector-borne diseases program, which includes an increase of $5,000,000 to implement the Kay Hagan Tick Act (Public
Law 116–94), to promote a public health approach to combat rising
cases of tick-borne diseases. In distributing these funds, the Committee directs CDC to prioritize entities focused on Lyme disease
and related tick-borne diseases in the areas of surveillance, control,
prevention, diagnosis, treatment, and education. The Committee directs CDC to develop and implement methods to improve surveillance to more accurately report the disease burden, including
through the development of real time data for reporting Lyme disease and other tick-borne diseases, as well as a process for estimating the prevalence of Post-Treatment Lyme Disease Syndrome.
The Committee directs CDC to direct funding to improve early diagnosis of Lyme and related tick-borne diseases to prevent the development of late stage disease and more serious and long-term
disability. Further, the Committee directs CDC to include a spend
plan for implementation of Public Law 116–94 in the fiscal year
2022 CJ. Finally, the Committee encourages CDC to coordinate
with NIH on publishing reports that assess diagnostic advancements, methods for prevention, the state of treatment, and links
between tick-borne disease and psychiatric illnesses. The Committee urges CDC, in coordination with NIH, to include in their
surveillance the long-term effects on patients suffering from posttreatment Lyme disease syndrome, or chronic Lyme disease.
Mycotic Diseases.—There are currently more than 1,000,000 million new mycotic infections occurring annually in the United
States, most cases involving intensive care unit patients, transplant recipients, cancer patients, HIV-infected individuals, and patients receiving innovative therapies for connective tissue disease
and other highly vulnerable hosts. The Committee provides an additional $2,000,000 in Emerging Infectious Diseases for mycotic diseases and directs CDC to fully utilize its clinical trial partners and

65
the Mycoses Study Group to address the growing threat from
mycological infection in the United States and around the world.
National Healthcare Safety Network.—The Committee acknowledges CDC has made significant progress on healthcare associated
infection prevention and data collection at acute-care hospitals, but
gaps in data collection and reporting persist across outpatient,
post-acute, and long-term care facilities. The Committee recognizes
that voluntary participation in the National Healthcare Safety Network continues to grow among dialysis facilities, nursing homes,
and ambulatory surgical centers, and encourages CDC to continue
to expand its data collection efforts to these healthcare providers.
Prion Disease.—The Committee is aware of the spread of chronic
wasting disease [CWD] in deer and elk populations in the United
States. The Committee supports the work of the National Prion
Disease Pathology Surveillance Center and encourages CDC to
work to develop a real-time field test for the presence of CWD.
CHRONIC DISEASE PREVENTION AND HEALTH PROMOTION

$1,239,914,000
1,416,250,000
1,249,664,000

The Committee recommendation for the activities of the National
Center for Chronic Disease Prevention and Health Promotion is
$1,249,664,000, which includes $254,950,000 in transfers from the
PPH Fund.
The mission of the Center is to provide national leadership in
promoting health and well-being through prevention and control of
chronic diseases. Nearly one-half of all American adults have at
least one chronic illness, and such diseases account for nearly 70
percent of all U.S. deaths and over three-quarters of all healthcare
costs in the United States.
These conditions are largely preventable or improved through
evidence-based programs and strategies. The Committee encourages CDC to continue working with State and local health departments and national organizations to maximize their investments in
evidence-based programming and strategies at the community
level.
The Committee does not include the administration’s proposal to
create a new block grant and instead maintains the existing program line items, including funding mechanisms as they existed in
fiscal year 2020. The Committee believes the existing funding
structure allows for the greatest transparency, accountability, and
measured outcomes for Congress and the taxpayer.
Within the total provided for the National Center for Chronic
Disease Prevention and Health Promotion, the following amounts
are available for the following categories of funding:
[In thousands of dollars]
Budget activity

Tobacco ...........................................................................................................................
Nutrition, Physical Activity and Obesity .........................................................................
High Obesity Rate Counties (non–add) .................................................................
School Health ..................................................................................................................
Health Promotion .............................................................................................................

Fiscal year 2020
appropriation

230,000
56,920
15,000
15,400
29,100

Committee
recommendation

230,000
56,920
15,000
15,400
34,100

66
[In thousands of dollars]
Budget activity

Glaucoma ...............................................................................................................
Vision and Eye Health ............................................................................................
Alzheimer’s Disease ...............................................................................................
Inflammatory Bowel Disease .................................................................................
Interstitial Cystitis .................................................................................................
Excessive Alcohol Use ............................................................................................
Chronic Kidney Disease .........................................................................................
Prevention Research Centers ..........................................................................................
Heart Disease and Stroke ...............................................................................................
Diabetes ..........................................................................................................................
National Diabetes Prevention Program ...........................................................................
Cancer Prevention and Control .......................................................................................
Breast and Cervical Cancer ..................................................................................
WISEWOMAN (non–add) ................................................................................
Breast Cancer Awareness for Young Women ........................................................
Cancer Registries ...................................................................................................
Colorectal Cancer ...................................................................................................
Comprehensive Cancer ..........................................................................................
Johanna’s Law .......................................................................................................
Ovarian Cancer ......................................................................................................
Prostate Cancer .....................................................................................................
Skin Cancer ............................................................................................................
Cancer Survivorship Resource Center ...................................................................
Oral Health ......................................................................................................................
Safe Motherhood/Infant Health .......................................................................................
Maternal Mortality Review Committees .................................................................
Preterm Birth .........................................................................................................
Arthritis and Other Chronic Disease ..............................................................................
Arthritis ..................................................................................................................
Epilepsy ..................................................................................................................
National Lupus Registry ........................................................................................
Racial and Ethnic Approach to Community Health .......................................................
Good Health and Wellness in Indian Country .......................................................
Million Hearts ..................................................................................................................
National Early Child Care Collaboratives .......................................................................
Hospitals Promoting Breastfeeding ................................................................................

Fiscal year 2020
appropriation

4,000
1,000
15,500
1,000
1,100
4,000
2,500
26,461
142,105
148,129
27,300
381,049
223,000
26,120
4,960
51,440
43,294
19,675
9,000
11,000
14,205
4,000
475
19,500
58,000
12,000
2,000
29,000
11,000
9,500
8,500
59,950
21,000
4,000
4,000
9,000

Committee
recommendation

4,000
1,000
20,500
1,000
1,100
4,000
2,500
27,461
142,105
148,129
29,300
381,799
223,000
26,120
4,960
51,440
43,294
20,425
9,000
11,000
14,205
4,000
475
19,500
58,000
12,000
2,000
30,000
11,000
9,500
9,500
59,950
21,000
4,000
4,000
9,000

Alzheimer’s Disease.—The Committee includes $20,500,000 for
activities related to Alzheimer’s disease. Of the amount provided,
the Committee includes $15,000,000 for the BOLD Infrastructure
for Alzheimer’s Act (Public Law 115–406), an increase of
$5,000,000, to promote a public health approach to Alzheimer’s disease, cognitive decline, and brain health. The Committee includes
funding for the Alzheimer’s Disease and Related Dementias Public
Health Centers of Excellence, cooperative agreements with public
health departments to develop and implement interventions related
to Alzheimer’s disease, and continued enhanced data collection activities to improve data on State and national prevalence of Alzheimer’s disease and related dementias, as well as related cognitive
decline and caregiving.
Arthritis.—The Committee recognizes the serious issue of arthritis in communities across the country, which affects one in four
Americans and is the number one cause of disability in the United
States. The Committee commends the ongoing work of the CDC Arthritis Program to provide existing investments in data and intervention and prevention research. The Committee encourages CDC
to continue supporting State-based arthritis programs, provide access to proven arthritis self-management and physical activity pro-

67
grams, and improve data collection and surveillance. The Committee requests CDC identify gaps in arthritis public health research and data collection in the fiscal year 2022 CJ.
Breast and Cervical Cancer Early Detection Program.—The Committee notes that millions of women aged 40–64 will remain uninsured and eligible for breast and cervical cancer screening services
under the Breast and Cervical Cancer program. This critical program remains a vital lifeline for women across the country and has
shown strong success in specifically providing low-income, uninsured, and underinsured women with the lifesaving preventive
services they need.
Cancer Genomics Program.—The Committee provides $750,000
to support CDC’s Cancer Genomics Program to improve hereditary
cancer data collection. CDC shall prioritize new resources for data
collection in States with rates of annual ovarian cancer of more
than 11 new cases per 100,000 and rates of annual breast cancer
of more than 115 new cases per 100,000 according to CDC’s 2017
cancer rate statistics.
Children in Adversity.—The Committee recognizes that CDC is a
key implementing partner of the United States Government Action
Plan on Children in Adversity’s three principle objectives. The
Committee continues to direct CDC to collaborate with USAID,
PEPFAR, and DOL to ensure monitoring and evaluation is aligned
for all of the Action Plan’s objectives. The Committee asks that the
annual Public Law 109–95 report to Congress display the amount
of funding by objective to the Action Plan on Children in Adversity.
Chronic Kidney Disease [CKD].—The Committee recognizes the
work of CDC’s CKD Surveillance System which reports on the burden of CKD, including risk factors in the U.S. population over time,
and monitors the progress of efforts to prevent, detect, and manage
CKD. The Committee requests an update in the fiscal year 2022 CJ
on the incidence, prevalence, epidemiology, and health outcomes of
polycystic kidney disease.
Early Child Care Collaboratives.—The Committee provides
$4,000,000 to the National Early Child Care Collaboratives Program for direct provider-level training in implementation of healthy
eating and physical activity best practices. Funds will also support
technical assistance to States for integrating such best practices
into existing State and local systems for early care and education,
such as professional development for providers.
Epilepsy.—Approximately 3,400,000 million individuals in the
United States have epilepsy and, while new cases are most common among young children, the onset of epilepsy can occur at any
age. The Committee continues to include $9,500,000, for CDC to
support epidemiologic studies, national dissemination of evidencebased programs to improve access to care, and expand provider
education and public awareness campaigns to reduce stigma.
Farm-to-School.—The Committee continues $2,000,000 within
Nutrition, Physical Activity, and Obesity for research and education activities related to farm-to-school programs that result in
promoting healthy eating habits for students. The Committee intends that these grants support multi-agency, multi-organizational
State farm-to-early childhood programs with priority given to entities with experience running farm-to-early childhood grant pro-

68
grams. The Committee also directs CDC to coordinate farm-toschool research efforts with the Office of Community Food Systems
at the Department of Agriculture.
Glaucoma.—The Committee encourages CDC to continue its efforts to address disparities in glaucoma care and gaps in early detection, referral, and treatment for high-risk populations. An emphasis on early detection and treatment is vital in glaucoma care
because by the time vision loss or other symptoms appear, permanent and irreversible damage to the eye has already occurred and
lost vision cannot be restored.
Heart Disease and Stroke Prevention.—The Committee recognizes
the importance of CDC’s efforts to prevent and control heart disease and strokes, including through public-private initiatives, such
as Million Hearts and WISEWOMAN. The Committee urges CDC
to continue to prioritize innovative, scalable ways for communities
and the healthcare sector to execute evidence-based prevention programs in high burden areas. Recognizing that hypertension is also
a significant and common risk factor for heart disease and stroke,
the Committee supports the efforts of the National Hypertension
Control Roundtable to increase the national hypertension control
rate.
High Obesity Rate Counties.—The Committee remains concerned
about the growing body of evidence suggesting that obesity is one
of the most significant challenges facing the public health system.
The Committee continues to support the rural extension and outreach services grants for rural counties with an obesity prevalence
over 40 percent. The Committee expects CDC grantees to work
with State and local public health departments to support measurable outcomes through evidence-based obesity research, intervention, and prevention programs. Further, the Committee requests
information in the fiscal year 2022 CJ outlining how CDC might
consider childhood obesity rates in future eligibility criteria.
Incontinence Among Older Americans.—The Committee is concerned that incontinence among the growing number of older
Americans with disabilities is a predictor of functional decline and
can result in multiple comorbidities, including psychological distress and an increased risk of falls. There is much need for up-todate information on the prevalence and incidence of incontinence
with the goal to identify and support at-risk populations. The Committee directs CDC to provide an update to the June 2014 report
on the prevalence of incontinence among older Americans, including prevalence among both institutionalized and non-institutionalized populations, in the fiscal year 2023 CJ.
Inflammatory Bowel Diseases [IBD].—The Committee commends
CDC for investing in research on the epidemiology of IBD, as well
as on disparities in treatment patterns and overall health outcomes
within minority populations and underserved communities. The
Committee encourages CDC to continue supporting this research
and to develop a plan to reduce the time for persons from underserved communities to receive a diagnosis, including by increasing
understanding and awareness of IBD among these populations and
the healthcare providers who serve them.
Maternal Mortality.—The Committee continues to recognize that
the rising maternal mortality rate in the United States is a press-

69
ing public health issue. For this reason, the Committee continues
to include $12,000,000 in the Safe Motherhood and Infant Health
program for CDC to continue its technical assistance to State Maternal Mortality Review Committees [MMRCs], build stronger data
systems, improve data collection at the State level, and create consistency in data collection across State MMRCs. Further, the Committee encourages CDC to support data collection efforts to further
understand maternal heart disease and improve outcomes for pregnant women with heart conditions.
Mississippi Delta Health Collaborative [MDHC].—Within the
funds provided for Chronic Disease Prevention and Health Promotion, the Committee encourages CDC to build on its longstanding investment in MDHC by working to replicate the work in
additional sites while maintaining the current strategy. CDC shall
provide an update on these activities in the fiscal year 2022 CJ.
National Lupus Patient Registry.—The Committee includes
$9,500,000, an increase of $1,000,000, to support research efforts
under the National Lupus Patient Registry program. Significant
progress has been made to understand the epidemiology of lupus,
and the Committee is encouraged that CDC is building on this
work to support follow-up studies. The Committee also supports
CDC’s work in fiscal year 2020 to advance similar research in
childhood lupus and encourages CDC to continue this work 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 Committee applauds the Registry program’s initiatives to partner with national voluntary health agencies to expand awareness of the disease and encourages CDC to
build on these partnerships.
Nutrition, Physical Activity, and Obesity.—Evidence shows that
physical activity and nutrition help control weight; reduce risk of
cardiovascular disease, diabetes, and some cancers; and improve
other quality of life factors. The Committee recognizes CDC’s efforts through Active People, Healthy Nation, which aims to help
27,000,000 million Americans become more physically active by
2027, and encourages CDC to continue evidence-based strategies
that promote physical activity.
Office on Smoking and Health [OSH].—The Committee urges
CDC to continue its efforts to reduce disparities related to tobacco
use prevalence. Accordingly, the Committee maintains funding for
the Office on Smoking and Health so that CDC and States can use
evidence-based strategies to more robustly respond to the public
health risk caused by the dramatic increase of youth tobacco use
through e-cigarettes, enhance efforts to reduce tobacco use among
certain populations and in areas with high tobacco use rates and
tobacco-related mortality, as well as continue its highly effective
‘‘Tips from Former Smokers’’ campaign.
Pediatric Cardiomyopathy.—The Committee understands that
pediatric cardiomyopathy is a chronic disease of the heart that
may, in severe cases, lead to heart failure and sudden death. The
Committee understands the importance of elevating this health
issue among the public. Therefore, the Committee encourages CDC
to continue surveillance efforts regarding incidence and prevalence

70
of cardiomyopathy among youth and adults, including years of life
lost.
Prostate Cancer.—The Committee is aware of the recent rise in
prostate cancer deaths and strongly supports CDC’s work to increase the public’s awareness of prostate cancer risks, screening
and treatment, and improve surveillance of this disease.
School Sealant Programs.—The Committee is aware that there
are Community Dental Health Coordinators [CDHCs] that serve in
school settings where they provide oral health education,
screenings, cleanings, and dental sealants. The Committee encourages CDC’s Division of Oral Health to engage Federal partners and
external stakeholders, including current and former grantees of the
program, to determine how CDHCs can be used to continually educate and provide preventative care in school-based settings.
Skin Cancer Education and Prevention.—The Committee is concerned with the growing number of people diagnosed with preventable forms of skin cancer, which is now the most commonly diagnosed cancer in the United States. The Committee continues to
provide $4,000,000 for skin cancer education and prevention, and
encourages CDC to increase its collaboration and partnership with
local government, business, health, education, community, nonprofit, and faith-based sectors.
WISEWOMAN.—Cardiovascular disease, including heart disease
and stroke, is the leading cause of death of American women,
claiming more than 410,000 lives annually. Unfortunately, cardiovascular disease disproportionately impacts low-income women and
racial and ethnic minorities, especially African American women,
who are 34 percent more likely to die from cardiovascular disease.
The Committee supports the mission of the WISEWOMAN program, which helps uninsured and under-insured low-income women
ages 40 to 64 understand and reduce their risk for heart disease
and stroke by providing risk factor screenings and connecting them
with lifestyle programs, health counseling, and other community
resources that promote healthy behavior change.
NATIONAL CENTER ON BIRTH DEFECTS, DEVELOPMENTAL
DISABILITIES, DISABILITY AND HEALTH

$160,810,000
112,250,000
164,960,000

The Committee recommendation for the activities of the National
Center on Birth Defects, Developmental Disabilities, Disability and
Health [NCBDDD] is $164,960,000.
This Center improves the health of children and adults by preventing birth defects, developmental disabilities, and complications
of hereditary blood disorders, and by promoting optimal child development and health and wellness among children and adults living with disabilities.
Within the total provided, the following amounts are for the following categories of funding:

71
[In thousands of dollars]
Budget activity

Child Health and Development .......................................................................................
Other Birth Defects ................................................................................................
Fetal Death .............................................................................................................
Fetal Alcohol Syndrome ..........................................................................................
Folic Acid ................................................................................................................
Infant Health ..........................................................................................................
Autism ....................................................................................................................
Health and Development for People with Disabilities ...................................................
Disability and Health .............................................................................................
Tourette Syndrome .................................................................................................
Early Hearing Detection and Intervention .............................................................
Muscular Dystrophy ................................................................................................
Attention Deficit Hyperactivity Disorder .................................................................
Fragile X .................................................................................................................
Spina Bifida ...........................................................................................................
Congenital Heart Defects .......................................................................................
Public Health Approach to Blood Disorders ...................................................................
Hemophilia CDC Activities ..............................................................................................
Hemophilia Treatment Centers .......................................................................................
Thalassemia ....................................................................................................................
Neonatal Abstinence Syndrome ......................................................................................
Surveillance for Emerging Threats to Mother’s and Babies ..........................................

Fiscal year 2020
appropriation

65,800
19,000
900
11,000
3,150
8,650
23,100
67,660
33,000
2,000
10,760
6,000
1,900
2,000
6,000
6,000
4,400
3,500
5,100
2,100
2,250
10,000

Committee
recommendation

65,950
19,150
900
11,000
3,150
8,650
23,100
71,660
36,000
2,000
10,760
6,000
1,900
2,000
7,000
6,000
4,400
3,500
5,100
2,100
2,250
10,000

Cerebral Palsy [CP].—CP is the most common, lifelong motor disability caused by an early developmental brain injury. The mechanism of injury underlying CP is still not well-understood; therefore,
the Committee encourages CDC to explore cross-divisional funding
opportunities, networks, data sets, and systems to accelerate datadriven public health research to improve CP surveillance and develop better understanding of the mechanisms leading to earlier diagnosis and better outcomes to reduce the public health burden of
CP. Private partnerships in select NICU’s representing 10 percent
of high-risk infants have reduced the age of cerebral palsy diagnosis from 19.5 months to 9.5 months by creating rigorous training
and systems approach. Additionally, these methodologies have been
utilized by CDC in other countries in response to the Zika virus.
Therefore, the Committee provides an increase of $150,000 in
Other Birth Defects for two additional U.S. high risk infant follow
up sites to continue this effective reduction in age of cerebral palsy
diagnosis. Additionally, the Committee encourages CDC to conduct
an updated study from the 2003 report on the healthcare and societal costs of CP in the United States.
Duchenne Muscular Dystrophy.—The Committee is aware of the
development and dissemination of the Duchenne Muscular Dystrophy Care Considerations and encourages CDC to continue supporting dissemination of these standards. To understand their impact, the Committee encourages CDC to evaluate care considerations including how widely such considerations have been adopted
and whether there has been an improvement in patient outcomes,
particularly in rural and underserved areas. In addition, the Committee encourages CDC to consider the possible relationship between patient outcomes and the presence of a Certified Duchenne
Care Center [CDCC]. The Committee encourages CDC to conduct
an assessment of diagnostic odyssey and provider resource needs
before and after implementation of recommendations made by the

72
National Task Force for Early Identification of Childhood Neuromuscular Disorders following the Mississippi Pilot of 2005–2008.
This assessment should also focus on underserved areas and include the relationship between outcomes and the presence of a
CDCC. The Committee is also aware of CDC’s efforts to develop an
ICD–10 code for Duchenne and encourages CDC to develop a plan
to leverage the recently established ICD–10 code to shift the Muscular Dystrophy Surveillance, Tracking, and Research Network
[MD STARnet] toward a more passive surveillance effort enabling
an expansion of MD STARnet to additional sites and States. Further, the Committee encourages CDC to expand surveillance of
Duchenne/Becker via the MD STARnet and support Duchenne
newborn screening efforts.
Fetal Alcohol Spectrum Disorders [FASD].—The Committee is
concerned about the rising trend of prenatal alcohol consumption
and increased rates of FASD, and urges CDC to continue supporting prevention efforts to heighten awareness of FASD and the
risks associated with prenatal alcohol exposure, as well as
strengthen existing national community-based FASD networks to
expand access to diagnostic, treatment, intervention, and other essential services. The Committee encourages CDC to explore collaboration with State substance abuse agencies and provide information in the fiscal year 2022 CJ on resources required to establish
a partnership to disseminate best practices, provide technical assistance, and create State-to-State sharing opportunities.
Fragile X [FX].—The Committee commends CDC’s efforts to identify and define the population impacted by FX and all conditions
associated with the gene mutation with the goal of understanding
the public health impact of these conditions. To help this effort, the
Committee encourages CDC to support additional strategies to promote earlier identification of children with FX, such as newborn
screening. The Committee also encourages CDC to work to ensure
underserved populations with FX conditions are being properly diagnosed and are aware of available medical services.
Hemophilia.—The Committee maintains funding for the Division
of Blood Disorders’ hemophilia programs, which provide grants for
the collection of surveillance data by the Hemophilia Treatment
Centers and supports public health efforts related to bleeding disorders. With the anticipated publication of clinical practice guidelines on the diagnosis and management of patients with Von
Willebrand Disease in December 2020, the Committee requests
CDC to provide information on how to educate patients and providers on guideline recommendations in the fiscal year 2022 CJ.
Neonatal Abstinence Syndrome [NAS].—The Committee continues to support CDC efforts to address the rise in NAS resulting
from the overuse of opioids and other related substances during
pregnancy, including improved surveillance and data to translate
findings into improved care for mothers and babies.
Physical Activity for People with Disabilities.—The Committee includes an increase of $2,000,000 to continue to strengthen existing
programs that address healthy athletes. The Committee encourages
CDC to work with grant recipients to (1) ensure that there are systems in place to help athletes and others with intellectual disabilities connect to care in their home communities; and (2) improve

73
integration of best practices to the CDC’s State-based disability and
health programs to increase access to these types of health benefits
for those with intellectual disabilities. In addition, an increase of
$1,000,000 is provided to continue existing activities that improve
physical activity and health promotion for people with mobility disabilities. Funds for this effort include a demonstration project to
develop and implement strategies, based on and informed by scientific evidence, to reduce diabetes and obesity among the mobilityimpaired.
Sickle Cell Diseases [SCD].—The Committee supports the Division of Blood Disorders’ plan to establish a population-based data
collection system to collect and analyze longitudinal data on people
living in the United States with SCD. Data collection is necessary
to improve national prevalence data, better identify health disparities, assess the utilization of therapies, and evaluate strategies to
prevent complications and risk factors associated with SCD.
Spina Bifida.—The Committee provides $7,000,000, a $1,000,000
increase, to support the Spina Bifida Clinical Care Monitoring and
Tracking Program, which works with the National Spina Bifida
Registry to guide the healthcare community in best treatment options for people living with Spina Bifida. Further, the Committee
encourages CDC to continue dissemination of information to clinicians, parents, and families living with Spina Bifida.
Tuberous Sclerosis Complex [TSC].—The Committee encourages
CDC to take into consideration TSC as a possible cause of autism,
epilepsy, and cardiac rhabdomyomas in its surveillance network.
The Committee encourages CDC to counsel researchers and other
stakeholders to facilitate development of a viable newborn screening assay for TSC.
Zika Surveillance.—The Committee supports CDC’s continued
collaboration with State, tribal, territorial, and local health departments to monitor mothers and babies impacted by the Zika virus
during pregnancy in the highest risk jurisdictions. The Committee
requests an update on this ongoing surveillance in the fiscal year
2022 CJ.
PUBLIC HEALTH SCIENTIFIC SERVICES

$578,497,000
578,497,000
588,997,000

The Committee recommendation for Public Health Scientific
Services is $588,997,000.
This funding supports the work of all of the CDC Centers by
compiling statistical information to inform public health policy. In
particular, these activities assure the accuracy and reliability of
laboratory tests; apply digital information technology to help detect
and manage diseases, injuries, and syndromes; and develop and inform the public health community on sound public health surveillance, laboratory protocols, and epidemiological practices.
[In thousands of dollars]
Budget activity

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

Fiscal year 2020
appropriation

174,397

Committee
recommendation

176,397

74
[In thousands of dollars]
Budget activity

Surveillance, Epidemiology, and Informatics .................................................................
Biosense .................................................................................................................
Public Health Workforce ..................................................................................................

Fiscal year 2020
appropriation

353,100
23,000
51,000

Committee
recommendation

355,100
23,000
57,500

Biosurveillance Program.—Funding for the public health situational awareness and biosurveillance program supports improvements for disease detection, specifically infectious diseases. The
purpose of the program is to detect where disease outbreaks are occurring to be prepared for emerging infectious diseases and respond rapidly to prevent or mitigate the spread of such diseases.
Eating Disorders.—The Committee encourages CDC to assist
States in collecting data on unhealthy weight control practices for
eating disorders, including binge eating, through the Youth Risk
Behavior Surveillance System and the Behavioral Risk Factor Surveillance System.
Familial Hypercholesterolemia [FH].—The Committee recognizes
that an estimated 1,300,000 million people in the United States
live with FH, which leads to aggressive and premature cardiovascular disease. FH 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 have.
The Committee encourages CDC to raise awareness of this condition and to expand its work in this area.
National Center for Health Statistics.—The Committee recognizes
the essential role the National Center for Health Statistics plays
in shaping our understanding of the health of the U.S. population
through its production of timely, unbiased, and accurate statistics.
The Committee encourages CDC to ensure the National Center for
Health Statistics is a part of the long-term data modernization effort.
National Neurological Conditions Surveillance System.—The
Committee continues to provide $5,000,000 within the total for
Surveillance, Epidemiology, and Informatics to continue surveillance system implementation.
National
Health
and
Nutrition
Examination
Survey
[NHANES].—The Committee recognizes that NHANES is used to
quantify and examine the health and nutritional status of children
and adults in the United States to target program activities and
monitor progress. However, due to geographic distance and the difficulty of travel with NHANES mobile units to non-contiguous
States, certain jurisdictions are excluded from NHANES data collection. The Committee encourages CDC to fund childhood obesity
research, prevention, and treatment programs in non-NHANESrepresented States, and their native and underserved populations.
Public Health Data Surveillance/IT Systems Modernization.—
The Committee continues to include funding for public health data
modernization. Within this initiative, CDC is encouraged to
prioritize advancements in cancer registries. CDC is directed to
provide an updated multi-year spend plan to the Committees of Appropriations of the House of Representatives and the Senate within

75
120 days after enactment that outlines how all resources available
for this initiative will be utilized.
Public Safety Officer Suicide Reporting System.—The Committee
provides $1,000,000 for CDC to develop and maintain a Public
Safety Officer Suicide Reporting System to collect data on the suicide incidence among public safety officers and facilitate the study
of successful interventions to reduce suicide among public safety officers as described in the Helping Emergency Responders Overcome
Act of 2020.
Respiratory Syncytial Virus Surveillance [RSV].—The Committee
applauds the ongoing development of passive and active immunization candidates for the prevention of RSV. The Committee encourages CDC to continue investments in RSV epidemiological research
and to work with the Council of State and Territorial Epidemiologists to establish RSV as a National Notifiable Condition.
ENVIRONMENTAL HEALTH

$213,850,000
182,000,000
203,850,000

The Committee recommendation for the National Center for Environmental Health is $203,850,000. The Committee recommendation includes $17,000,000 in transfers from the PPH Fund.
The National Center for Environmental Health addresses emerging pathogens and environmental toxins that pose significant challenges to public health. The Center conducts surveillance and data
collection to determine which substances in the environment are
found in people and to what degree. The Center also determines
whether, and at what level of, exposure to these substances are
harmful to humans.
The Committee recommendation includes funding for the following activities:
[In thousands of dollars]
Budget activity

Environmental Health Laboratory ...................................................................................
Newborn Screening Quality Assurance Program ...................................................
Newborn Screening for SCID ..................................................................................
Other Environmental Health ..................................................................................
Environmental Health Activities .....................................................................................
Safe Water ..............................................................................................................
Amyotrophic Lateral Sclerosis Registry .................................................................
Trevor’s Law ...........................................................................................................
Climate Change .....................................................................................................
All Other Environmental Health .............................................................................
Environmental and Health Outcome Tracking Network ..................................................
Asthma ............................................................................................................................
Childhood Lead Poisoning Prevention ............................................................................

Fiscal year 2020
appropriation

66,750
17,000
1,250
48,500
46,100
8,600
10,000
1,500
10,000
16,000
34,000
30,000
37,000

Committee
recommendation

66,750
17,000
1,250
48,500
36,100
8,600
10,000
1,500
............................
16,000
34,000
30,000
37,000

Asthma.—The Committee supports the work of the National
Asthma Control Program, recognizing that asthma is one of the
most common and costly health conditions in the United States.
The Committee encourages CDC to continue its efforts which promote evidence-based asthma medical management and strategies
aimed at improving access and adherence to the 2007 National
Asthma Education and Prevention Program.

76
INJURY PREVENTION AND CONTROL

$677,379,000
730,159,000
678,379,000

The Committee recommendation for the National Center for Injury Prevention and Control is $678,379,000.
CDC is the lead Federal agency for injury prevention and control.
Programs are designed to prevent premature death and disability
and reduce human suffering and medical costs caused by fires and
burns, poisoning, drowning, violence, and traffic accidents. The national injury control program at CDC encompasses non-occupational injury and applied research in acute care and rehabilitation
of the injured.
The Committee recommendation includes funding for the following activities:
[In thousands of dollars]
Budget activity

Intentional Injury .............................................................................................................
Domestic Violence and Sexual Violence ................................................................
Child Maltreatment .......................................................................................
Child Sexual Abuse Prevention .....................................................................
Youth Violence Prevention .....................................................................................
Domestic Violence Community Projects .................................................................
Rape Prevention .....................................................................................................
Suicide Prevention ..................................................................................................
Adverse Childhood Experiences .............................................................................
National Violent Death Reporting System ......................................................................
Unintentional Injury .........................................................................................................
Traumatic Brain Injury ...........................................................................................
Elderly Falls ............................................................................................................
Other Injury Prevention Activities ...................................................................................
Opioid and Stimulant Overdose Prevention and Surveillance .......................................
Injury Control Research Centers .....................................................................................
Firearm Injury and Mortality Prevention Research .........................................................

Fiscal year 2020
appropriation

119,050
33,700
7,250
1,000
15,100
5,500
50,750
10,000
4,000
23,500
8,800
6,750
2,050
28,950
475,579
9,000
12,500

Committee
recommendation

120,050
33,700
7,250
1,000
15,100
5,500
50,750
10,000
5,000
23,500
8,800
6,750
2,050
28,950
475,579
9,000
12,500

Adverse Childhood Experiences [ACEs].—The Committee includes
$5,000,000, an increase of $1,000,000. The Committee commends
CDC for providing funding to States to conduct surveillance on exposure to ACEs and encourages the prioritization of such survey
data to improve understanding of the prevalence and associated
outcomes from exposure to childhood trauma, ACEs, and violence.
The Committee increases funding to better inform how ACEs increase risk of future substance use disorders, suicide, mental
health conditions, and other chronic illnesses.
Child Sexual Abuse Prevention.—In light of its harmful physical,
cognitive, and emotional effects on a child’s development, a far
more proactive approach is needed to prevent child sexual abuse.
CDC is encouraged to support research for the development, evaluation, and dissemination of effective child sexual abuse prevention
practices and policy.
Concussion Surveillance.—The Committee understands that CDC
is currently analyzing data from the national traumatic brain injury pilot survey of more than 10,000 households and requests CDC
include the results of the pilot in the fiscal year 2022 CJ.

77
Domestic Violence Statistics.—The incidence of domestic violence
and sexual violence is believed to be far greater than what is reported. The Committee encourages CDC to prioritize the collection
and reporting of data on domestic violence and sexual violence. The
Committee encourages CDC to work with State and local governments and nonprofit organizations to implement the necessary
mechanisms for sharing data, as well as provide technical assistance when needed, to ensure that the data is properly understood
and utilized correctly.
Drowning Prevention.—Drownings are the leading cause of accidental deaths among 1–4 year olds and it is the second leading
cause of all death after congenital anomalies. The Committee encourages CDC to work with organizations working with underserved youth to scale proven drowning prevention programs in
communities, support State drowning surveillance efforts, and support a national plan on water safety.
Firearm Injury and Mortality Prevention Research.—The Committee includes $12,500,000, the same level as fiscal year 2020, to
conduct research on firearm injury and mortality prevention. Given
violence and suicide have a number of causes, the Committee recommends that 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.
Opioid
Overdose
Prevention.—The
Committee
includes
$475,579,000, which reflects continued strong support of CDC’s
opioid overdose prevention activities. CDC shall use these funds to
advance the understanding of opioid overdoses and continue prevention activities across all 50 States, the District of Columbia, territories, and tribes, as well as local health departments as directed
in Public Law 115–245. The Committee directs CDC to expand prevention and surveillance efforts to stimulants. The Committee remains concerned that the CDC’s Prevention for States program and
the Data-Driven Prevention Initiative do not include some of the
States most impacted by the opioid crisis. The Committee encourages CDC to include additional States in these initiatives, focusing
primarily on States with the highest levels of opioid-related deaths.
The Committee further encourages CDC to work with States to ensure that funding reaches the local level, and requests an update
in the fiscal year 2022 CJ on how resources have been distributed
to the local level in each State.
Opioid Prescribing Guidelines.—The Committee applauds CDC’s
Guidelines for Prescribing Opioids for Chronic Pain, for use by primary care clinicians for chronic pain in outpatient settings outside
of active cancer treatment, palliative care, and end-of-life care, and
directs CDC to continue its work educating patients and providers,
and to encourage uptake and use of the guidelines. The Committee

78
urges CDC to continue coordination with the VA and DoD on implementation and related updates in safe prescribing practices to
ensure consistent, high-quality care standards across the Federal
Government.
Overdose Prevention Funding and Naloxone.—The Committee
commends CDC for its leadership in combating opioid drug
overdoses. The Committee recognizes that CDC has issued opioid
overdose prevention funding opportunities for which all States, territories, and certain localities are eligible. The Committee encourages CDC to continue working with States on naloxone education
when distributing opioid overdose prevention funds.
Pain Management.—The Committee encourages CDC to explore
the collection of epidemiological data to clarify the incidence and
prevalence of various pain syndromes differentiated by patient age,
comorbidities, socio-economic status, race, and sex. The Committee
further encourages CDC to explore the collection of resource utilization data of medical and social services on; direct healthcare
costs of pain treatment, both traditional and alternative; the effectiveness of evidence-based treatment approaches; and indirect costs
(i.e., missed work, public and private disability, reductions in productivity). Finally, the Committee encourages CDC to report on the
status of these activities in the fiscal year 2022 CJ.
Rape Prevention.—The Committee understands that involvement
of State sexual assault coalitions and underserved communities is
critical to ensure rape prevention education dollars are spent in the
most impactful way. CDC is encouraged to include grant procedures designed to ensure meaningful involvement of the State or
territorial sexual assault coalitions and representatives from underserved communities in the application for and implementation
of funding.
Suicide.—The Committee recommendation includes $10,000,000
to continue an initiative at CDC to utilize data and evaluation to
inform efforts to prevent suicide, specifically in vulnerable populations and subgroups among which suicides are increasing. These
data will be used to inform targeted prevention efforts at the local
level for comprehensive, community-based prevention efforts. The
Committee encourages CDC to expand the implementation and
evaluation of targeted, comprehensive, community-based suicide
prevention strategies to reduce risk for suicide, and to evaluate
their impact, especially among high-risk populations. The Committee also encourages CDC to enhance the completeness of data
to capture mechanisms of death and support research and evaluation projects to understand the pathways and mechanisms that
contribute to suicidal ideations and attempts.
Youth Violence Prevention.—The Committee commends CDC for
its work to prevent youth and community violence through technical assistance, research, and partnerships between community
organizations, schools, law enforcement, faith-based organizations,
and academia to evaluate effective interventions to reduce violence.
The Committee encourages continuation of existing successful partnerships that have been supported by this program and have demonstrated success in reducing youth violence in high-poverty areas
and, in particular, large urban communities that are seeking to ad-

79
dress relevant impacts and root causes of community violence, collective trauma, and civil unrest.
OCCUPATIONAL SAFETY AND HEALTH

$342,800,000
190,000,000
343,800,000

The Committee recommendation for the National Institute for
Occupational Safety and Health [NIOSH] programs is
$343,800,000. The Committee does not include the proposed funding reductions by the administration for NIOSH and recognizes
that NIOSH is the only Federal agency responsible for conducting
research and making recommendations for the prevention of workrelated illness and injury. The NIOSH mission is implemented by
conducting basic and applied scientific research and translating the
knowledge gained into products and services that impact workers
in settings from corporate offices to construction sites to coal mines.
Further, the Committee acknowledges that NIOSH continues to
protect American workers through its work-related illness and injury research. The Committee encourages NIOSH to continue its
objectivity so as to ensure the highest professional and ethical
standards are maintained.
The Committee recommendation includes funding for the following activities at the following amounts:
[In thousands of dollars]
Budget activity

National Occupational Research Agenda .......................................................................
Agriculture, Forestry, Fishing (non–add) ...............................................................
Education and Research Centers ...................................................................................
Personal Protective Technology .......................................................................................
Mining Research .............................................................................................................
National Mesothelioma Registry and Tissue Bank .........................................................
Firefighter Cancer Registry .............................................................................................
Other Occupational Safety and Health Research ...........................................................

Fiscal year 2020
appropriation

117,000
26,500
30,000
20,000
60,500
1,200
2,500
111,600

Committee
recommendation

117,000
26,500
30,000
20,000
61,500
1,200
2,500
111,600

Coal Workers’ Health Surveillance Program Mobile Medical
Unit.—The Committee is concerned about the recent increase in
cases of coal workers’ pneumoconiosis, also known as black lung.
Early screening and detection of black lung can improve health
outcomes and reduce mortality. However, a NIOSH report has
identified several potential barriers to screening for miners—including the ability to participate in screening. The Committee encourages CDC to continue maintenance of existing mobile medical
units and purchase an additional mobile medical unit as current
funding allows.
Firefighter Cancer Registry.—The Committee supports CDC’s action to solicit input in developing the voluntary firefighter cancer
registry. This voluntary, anonymous registry system will enable researchers to better understand why firefighters are at an increased
risk of developing certain types of cancer, and identify ways to
mitigate firefighters’ risk of cancer through best practices and advanced equipment.
Protect Critical Health Care Worker Safety Through a Closed System Transfer Device Testing Protocol.—The Committee commends

80
NIOSH for its efforts to advance guidelines that will protect hospital and other healthcare workers from being exposed inadvertently to hazardous drugs in healthcare settings. The Committee encourages NIOSH to expedite a final decision on protocol to guide
hospitals and pharmacies in testing the use of closed system transfer devices.
Underground Mine Evacuation Technologies and Human Factors
Research.—The Committee provides $2,000,000, an increase of
$1,000,000 to the NIOSH Mining Program for 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 MINER Act of 2006
(Public Law 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.
ENERGY EMPLOYEES OCCUPATIONAL INJURY COMPENSATION ACT

$55,358,000
55,358,000
55,358,000

The Committee recommendation for the Energy Employees Occupational Illness Compensation Program Act [EEOICPA] (Public
Law 106–398) is $55,358,000. This mandatory funding supports
NIOSH scientists who reconstruct radiation dose levels to inform
compensation decisions. The Committee does not accept the administration’s proposal to move EEOICPA to NIH.
GLOBAL HEALTH

$570,843,000
620,843,000
615,843,000

The Committee recommends $615,843,000 for global health-related activities at CDC.
The Center for Global Health leads international programs and
coordinates CDC’s global efforts with the goal of promoting health
and preventing disease in the United States and abroad. The Center has a particular focus on ensuring rapid detection and response
to emerging health threats.
The Committee recommendation includes funding for the following activities in the following amounts:
[In thousands of dollars]
Budget activity

Global HIV/AIDS Program ................................................................................................
Global Tuberculosis .........................................................................................................
Global Immunization Program ........................................................................................
Polio Eradication ....................................................................................................
Measles and Other Vaccine Preventable Diseases ...............................................
Parasitic Diseases and Malaria .....................................................................................
Global Public Health Protection ......................................................................................
Global Disease Detection and Emergency Response ............................................
Global Public Health Capacity Development .........................................................

Fiscal year 2020
appropriation

128,421
7,222
226,000
176,000
50,000
26,000
183,200
173,400
9,800

Committee
recommendation

128,421
7,222
226,000
176,000
50,000
26,000
228,200
218,400
9,800

81
Global Health Security and Global Health Research.—The Committee includes $218,400,000, an increase of $45,000,000, to continue to support CDC’s work to protect American and global health
security through programs that detect, prevent, and respond to infectious diseases and other health threats. As emerging infectious
diseases represent profound challenges for our health system and
national security, the Committee supports continued and enhanced
work in research and development aimed at creating new tools to
respond to health threats at home and abroad. The Committee
notes the urgent need for new disease detection and diagnostic
tools to accurately measure progress towards the U.S. Government’s disease control and elimination goals, and supports CDC’s
leadership role in the development of those tools and in the application of next-generation approaches to disease sequencing and diagnosis. CDC is directed to work with USAID to continue a coordinated global health security effort, delineate roles and responsibilities, and measure progress. 180 days after enactment, CDC, in coordination with USAID, will brief the Committees on Appropriations of the House of Representatives and the Senate on the current status of the program.
Global Water Strategy.—The Committee encourages CDC to work
with other Federal partners to continue assessing and supporting
water sanitation and hygiene [WASH] improvements in healthcare
facilities, aligned with the 2017 U.S. Global Water Strategy. Further, the Committee encourages CDC to continue to contribute to
the elimination of cholera and to support areas where neglected
tropical diseases are endemic. The Committee encourages CDC to
conduct research on innovative WASH interventions and to improve disease surveillance for WASH-related illness among refugees, displaced persons, and emergency affected populations. The
Committee encourages CDC to support global WASH activities by
providing laboratory support as practicable.
Malaria and Parasitic Diseases.—The Committee recognizes the
important role the Center for Global Health plays in the fight
against malaria and parasitic diseases. CDC’s monitoring and surveillance of transmission, evaluation of interventions for effectiveness, and testing of tools in a real world setting are critical to understanding how to scale up global health programs and ensure
that our global health investments are smarter and better. The
Committee encourages CDC to continue to research, monitor, and
evaluate efforts for malaria and parasitic disease in collaboration
with other divisions and agencies.
Polio.—CDC is the lead U.S. agency in the global effort to eradicate polio and currently works with various organizations by providing expertise in training, vaccines, epidemiology, laboratory capacity, and surveillance. Currently, polio is endemic in only two
countries, Afghanistan and Pakistan. The Committee commends
CDC’s efforts to help eradicate this disease.
Soil Transmitted Helminth [STH] and Related ‘‘Diseases of
Poverty″.—The Committee continues $1,500,000 for surveillance,
source remediation, and clinical care aimed at reducing STH to extend the currently funded projects for another year.

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PUBLIC HEALTH PREPAREDNESS AND RESPONSE

$827,200,000
927,200,000
852,200,000

The Committee recommendation for the Office of Public Health
Preparedness and Response [PHPR] is $852,200,000.
The mission of PHPR is to build and strengthen national preparedness for public health emergencies including natural, biological, chemical, radiological, and nuclear incidents. PHPR administers national response programs and assets, as well as grants to
States and localities to enhance preparedness efforts across the
country.
The Committee recommendation includes funding for the following activities in the following amounts:
[In thousands of dollars]
Budget activity

Public Health Emergency Preparedness Cooperative Agreement ...................................
Academic Centers for Public Health Preparedness ........................................................
CDC Preparedness and Response Capability .................................................................

Fiscal year 2020
appropriation

675,000
8,200
144,000

Committee
recommendation

705,000
8,200
139,000

Academic Centers for Public Health Preparedness.—The Committee continues to support CDC’s collaboration with academic centers and encourages CDC to explore additional opportunities to improve the coordination of partnerships to implement emerging disease surveillance and research to respond to emerging and reemerging disease threats.
Emergency Preparedness.—The Committee continues to request
detailed information on how PHEP funding is distributed at the
local level by States. The Committee requests that CDC provide in
the fiscal year 2022 CJ an update on how much of the Federal
PHEP funding is being allocated to local health departments and
what basis or formula each State is using to make such allocations.
BUILDINGS AND FACILITIES

$25,000,000
30,000,000
30,000,000

The Committee recommendation for Buildings and Facilities is
$30,000,000.
NIOSH Facility.—The Committee is aware that CDC plans to
consolidate the NIOSH Cincinnati research facilities, which are
more than 50 years old, into one modern laboratory to reduce operational costs and strengthen scientific collaboration. The Committee understands that CDC plans to support this facility replacement through the Department’s Nonrecurring Expenses Fund. The
Secretary and CDC are directed to continue prioritizing obligations
for this facility and obligate such funds as quickly as possible.
Replacement of the Lake Lynn Experimental Mine and Laboratory.—The Committee is aware of CDC’s recent purchase of a Lake
Lynn Mine and Laboratory replacement. The Committee requests
that CDC provide an update within 180 days on timeline for the

83
eventual opening of a new facility and any additional funding that
may be needed to complete work on the replacement facility.
CDC-WIDE ACTIVITIES

$358,570,000
373,570,000
273,570,000

The Committee provides $273,570,000 for public health leadership and support activities at CDC.
The recommendation includes $160,000,000 in transfers from the
PPH Fund.
The Committee recommendation includes funding for the following activities in the following amounts:
[In thousands of dollars]
Fiscal year 2020
appropriation

Budget activity

Preventive Health and Health Services Block Grant ......................................................
Public Health Leadership and Support ..........................................................................
Infectious Disease Rapid Response Reserve Fund ........................................................

160,000
113,570
85,000

Committee
recommendation

160,000
113,570
............................

Infectious Disease Reserve Fund.—The Committee notes that
CDC has more than $600,000,000 available, appropriated through
a combination of annual and supplemental appropriations. The
Committee continues to direct CDC to provide a report to the Committees on Appropriations of the House of Representatives and the
Senate every 14 days that details commitment and obligation information for the Reserve Fund during the prior two weeks, as long
as such report would detail obligations in excess of $5,000,000.
Preventive Health and Health Services Block Grant.—The Committee does not eliminate the block grant as requested in the budget request and continues to provide $160,000,000. These grants
provide the flexibility necessary to resolve emerging health issues
at the local level while tailoring those activities to best address the
local community. The Committee encourages CDC to enhance reporting and accountability, including how much funding is directed
to support public health needs at the local level.
Tribal Advisory Committee [TAC].—The Committee understands
that CDC is beginning to gather information and work with the
TAC. The Committee continues to direct the Director, in consultation with the TAC, to develop written guidelines for each CDC center, institute, and office on best practices around delivery of Tribal
technical assistance and consideration of unique Tribal public
health needs in the work of each respective center, institute, and
office’s initiatives. The Director shall report on the status of development of these written guidelines in the fiscal year 2022 CJ.
NATIONAL INSTITUTES

HEALTH

The Committee provides $43,684,000,000, an increase of
$2,000,000,000, for the National Institutes of Health. With this investment, the Committee will have provided $13,600,000,000, or a
45 percent increase over the past 6 years.
More than 80 percent of the NIH’s funding is awarded for extramural research, mostly through almost 50,000 competitive grants

84
to more than 300,000 researchers at more than 2,500 universities,
medical schools, and research institutions in every State across the
Nation. This year’s increase provides resources for over 11,500 additional research project grants. This investment has allowed NIH
to continue its mission to support world-class research to increase
the understanding of the fundamental nature of disease. Over the
past 6 years, sustained, consistent funding has dramatically increased the number of early-stage investigators, improved the funding rate of at-risk investigators, and increased the number of
trained academic entrepreneurs through Small Business Innovation Research and Small Business Technology programs.
Within the total appropriation, the Committee provides
$404,000,000 in budget authority authorized in the 21st Century
Cures Act (Public Law 114–255). The Committee also provides an
additional $88,000,000 to make-up for the funding reduction to
NIH in the 21st Century Cures Act (Public Law 114–255) in fiscal
year 2021. The total also includes $1,585,847,000 in transfers available under section 241 of the PHS Act (Public Law 78–410 as
amended).
As in previous years, the Committee has targeted NIH funding
to areas holding the most extraordinary promise of scientific advancement, while allowing NIH to maintain flexibility to pursue
unplanned scientific opportunities and address unforeseen public
health needs. The Committee maintains its commitment to finding
a treatment and a cure for Alzheimer’s disease, and to that end,
increases funding by $354,000,000 to a total of $3,172,000,000 in
fiscal year 2021; continues the President’s childhood cancer data
initiative; fully funds the STAR Act (Public Law 115–180) dedicated to childhood cancer research and survivorship; provides
$50,000,000 to a new initiative focused on premature birth; restores funding by $40,000,000 for the All of Us precision medicine
initiative to ensure that enrollment in this groundbreaking study
is not lost due to a reduction in 21st Century Cures Act (Public
Law 114–255) funding; supports a new $25,000,000 initiative on artificial intelligence; begins $10,000,000 in targeted funding for research for Lyme disease and related tick-borne illnesses; provides
$55,000,000 for NIAID’s Regional Biocontainment laboratories; and
funds a $30,000,000 new program focused on developing and designing the next generation of gene vectors as gene therapy and
gene editing become more promising treatments.
In addition, every Institute and Center receives an increase
above fiscal year 2021 to continue investments in innovative research that will advance fundamental knowledge and speed the development of new therapies, diagnostics, and preventive measures
to improve the health of all Americans. The Committee recognizes
that many revolutionary discoveries often come from unexpected,
untargeted research. The Committee continues to support these
basic advances through the general increase to all Institutes and
Centers and also targets investment toward clinical and
translational research that moves basic discoveries from ‘‘bench-tobedside.’’
The Committee rejects the budget’s request to create a new National Institute for Research on Safety and Quality by consolidating
the Agency for Healthcare Research and Quality into NIH. It also

85
rejects the budget’s proposal to cap the percentage of an investigator’s salary that can be paid with NIH grant funds at 90 percent.
NATIONAL CANCER INSTITUTE

$6,440,438,000
5,881,173,000
6,722,656,000

The Committee recommendation includes $6,722,656,000 for the
National Cancer Institute [NCI], including $195,000,000 appropriated from the NIH Innovation Account. Of this amount,
$30,000,000 is available for repairs and improvements to the NCI
facility in Frederick, Maryland.
Barriers to Participation in Cancer Clinical Trials.—The Committee is concerned that only a small percent of patients participate in cancer clinical trials, even though most express an interest
in clinical research; and that ultimately, about one in five cancer
clinical trials fails because of lack of patient enrollment. Groups
that are generally underrepresented in clinical trials include racial
and ethnic minorities, older Americans, lower-income individuals,
as well as those from rural communities. As such, the Committee
directs the Government Accountability Office to conduct a review
of what actions Federal agencies have taken to help address barriers to participate in federally funded cancer clinical trials by populations that have been traditionally underrepresented in such
trials, and to identify challenges, if any, to implementing such actions.
Cancer Immunotherapy.—The Committee commends NCI for its
longstanding support of research on cancer immunotherapy. As the
number of single-agent and combination therapies grows for an expanding list of cancers, more work is needed to learn how to accurately predict whether a given cancer immunotherapy is likely to
improve outcomes or cause undesirable side effects in individual
patients. While many research programs have been focused on defining biomarkers that could accomplish this goal, validation and
eventual standardization of specific biomarkers would greatly enhance the field’s understanding of how to design more effective,
less toxic treatments. The Committee, therefore, urges NCI to
prioritize support for studies on the clinical validation of potential
biomarkers that predict clinical outcomes in patients receiving
tumor immunotherapy.
Childhood Cancer Data Initiative.—The agreement includes the
full budget request of $50,000,000 for the second year of 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.—For fiscal year 2020, Congress directed NCI
to develop a scientific framework using the process outlined in the
Recalcitrant Cancer Research Act of 2012 (Public Law 112–239) for
stomach and esophageal cancers. The Committee expects that outlining the state of the science and foremost research questions for
both of these diseases will provide a roadmap for future research.
The Act defined ‘‘recalcitrant cancers’’ as those for which the 5 year
survival rate is below 50 percent. According to NCI, the 5 year survival rates for stomach and esophageal cancers are 32 and 20 per-

86
cent, respectively. The Committee expects to be kept informed of
NCI’s efforts, alongside the research and advocacy communities, to
convene working groups of experts to develop scientific frameworks
for both cancers; and to be kept informed of ways in which NCI is
supporting research into all recalcitrant cancers. The deadliest cancers, which also include cancers of the brain, liver, lung, ovary,
pancreas, and mesothelioma, among others, account for nearly half
of all U.S. cancer deaths. While steady advances have made it possible to reduce the overall rate of cancer deaths for more than 2
decades, there has been little progress reducing mortality for these
diseases. The Committee recognizes that advances in treating what
were once thought of as incurable diseases has previously occurred
in unexpected ways, and is encouraged by NCI’s continued support
for research related to the deadliest cancers. In particular, the
Committee notes the promising focus on diagnostics to make earlier
identification possible when successful treatment might still be possible. Given the toll all recalcitrant cancers exact on society and the
lack of diagnostic and treatment resources currently available to
help patients, the Committee directs NCI to provide an update on
its work over the past year for each of the seven deadliest cancers
in the fiscal year and to identify future goals for each in the fiscal
year 2022 CJ.
Endometrial Cancer.—The Committee is concerned by rising
rates of the incidence and mortality for endometrial cancer, with a
survival disparity for black women. The Committee believes that a
continued emphasis by NCI on endometrial cancer research is
needed to facilitate early detection, optimal treatments, and outcomes for all women including minority populations. The Committee encourages NCI to study endometrial cancer disparities
while at the same time conducting clinical trials to better define an
appropriate therapy for a precision medicine approach to
endometrial cancer. The Committee requests an update on NCI’s
activities regarding endometrial cancer in the fiscal year 2022 CJ.
Gastric Cancer.—The Committee continues to be concerned about
the deadly outcomes of gastric cancer, particularly among young
adults. The 5 year survival rate for stomach cancer is 30 percent.
The Committee looks forward to seeing NCI’s update on developing
a scientific framework for stomach and esophageal cancers, as well
as ways in which it is supporting research into all recalcitrant cancers, as directed in the fiscal year 2020 conference report.
Glioblastoma [GBM].—GBM is a recalcitrant cancer with less
than a 5 percent 5 year relative survival rate and the average survival time from diagnosis has improved by only 6 months over the
last 30 years. To date, there have only been five drugs and one
medical device approved by the FDA for the treatment of GBM.
With prior Congressional investment in NCI programs, glioblastoma is now one of the most molecularly characterized cancers.
This has resulted in promising new clinical agents, trial designs,
and technologies in the imaging and pathology space. Given this
progress, and in an effort to continue to advance toward cures and
improved quality of life, the Committee commends NCI for taking
steps to establish a GBM Therapeutics Network of cross-cutting
teams capable of pre-clinical and early-phase clinical trials necessary to rapidly evaluate potential treatments, including but not

87
limited to drugs, biologics, radiation, and devices. The Committee
urges NCI to continue its implementation of the GBM Therapeutics
Network and other research consistent with NCI’s Glioblastoma
Working Group 2019 recommendations.
Liver Cancer.—The Committee notes that liver cancer is a devastating cancer with a 5 year survival rate of only 20 percent. The
Committee commends NCI for the creation of a Specialized Center
of Research Excellence focused on liver cancer and encourages NCI
to continue to support research opportunities for investigators that
focus on a better understanding of the biology of liver cancer and
new therapeutic targets. Additionally, the Committee commends
NCI for its support of the inter-Institute effort to develop the NIH
Strategic Plan to Cure Hepatitis B. In view of the well-established
fact that up to 60 percent of global liver cancer cases are caused
by the hepatitis B virus, NCI is encouraged to continue close collaboration with NIAID and NIDDK and as active participants in
the Director’s Trans-NIH Hepatitis B Working Group. The Committee requests an update on NCI’s activities in these areas in the
fiscal year 2022 CJ.
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 Committee provides $300,000,000, an increase of
$87,500,000, to prioritize competing grants and to sustain commitments to continuing grants.
Office of Cancer Survivorship.—The Committee recognizes the
vital work performed by the Office of Cancer Survivorship, as well
as NCI’s efforts to implement the sections of the Childhood Cancer
STAR Act (Public Law 115–180) related to pediatric cancer survivorship. The Committee requests an update on NCI’s efforts to support research that evaluates the unique needs of the youngest of
cancer survivors.
Pancreatic Cancer.—The Committee appreciates NCI’s recent
submissions of the 5 year Review and Update report required by
the Recalcitrant Cancer Research Act of 2012 (Public Law 112–
239). This year, the Committee looks forward to the report on the
effectiveness of the scientific framework, including research efforts
on improvements in pancreatic cancer prevention, detection, diagnosis and treatment. While progress has been made, the Committee encourages NCI to continue to support research efforts to
advance discoveries and improve treatment options for patients diagnosed with pancreatic cancer.
Pediatric Cancer.—The Committee continues $30,000,000 for the
implementation of the STAR Act (Public Law 115–180) 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 all children, adolescents, and young adults with cancer. As part of this funding, the
Committee expects NCI to carry out childhood cancer survivorship
research and programs as authorized, such as developing best practices for the treatment of late effects of childhood cancers. In addition, the Committee recognizes NCI’s efforts to develop a new

88
Childhood Cancer Data Initiative and continues to support and expand new and innovative research efforts to advance progress for
children with cancer. These include the Pediatric MATCH precision
medicine trial and a pediatric immunotherapy translational science
network established through the Cancer Moonshot, in addition to
NCI’s long-standing support for the Children’s Oncology Group, the
Childhood Cancer Survivor Study, the Pediatric Preclinical Testing
Consortium, and several other critical programs. The Committee
also commends NIH for its efforts to coordinate pediatric research
across its Institutes and Centers through the recently established
Trans-NIH Pediatric Research Consortium. The Committee understands NCI participates in the Consortium, and that childhood cancer research is an important part of the pediatric research portfolio
across NIH. The Committee requests an update in the fiscal year
2022 CJ on opportunities to enhance childhood cancer research efforts, including coordination efforts already underway through the
Trans-NIH Pediatric Research Consortium.
Psycho-social Distress Complications.—The Committee encourages NCI to include measurements of psycho-social distress in cancer research as an integral piece of clinical treatment and follow up
care. With the passage of the 21st Century Cures Act (Public Law
114–255) in 2016 and the Food and Drug Administration Reauthorization Act (Public Law 115–52) in 2017, Congress heightened the
importance of collecting patient experience data that not only includes the physical impacts of a condition, therapy, or clinical investigation/trial, but also the psycho-social impacts. The Committee
requests an update on NCI’s research activities in the area of psycho-social distress in the fiscal year 2022 CJ.
Rare Cancers.—Rare cancers, as defined by NCI, are those cancers that occur in fewer than 15 out of 100,000 people each year.
All forms of pediatric cancers are considered rare. Rare cancers
present unique research challenges for many reasons, including the
difficulty in accruing enough patients to clinical trials, and the lack
of industry focus on these cancers due to the relatively small number of patients diagnosed with each cancer. The Committee commends NCI’s investment in the Rare Tumor Patient Engagement
Networks, including NCI CONNECT and MyPART, and in particular in the NCI Experimental Therapeutics Program, with a
focus on supporting the most promising new drug discovery and development projects, with priority given for development of therapeutic agents for pediatric cancers. The Committee is particularly
interested in the preliminary results of the NCI DART trial (‘‘Dual
Anti-CTLA–4 & Anti-PD–1 blockade in Rare Tumors Trial’’), the
first federally-funded immunotherapy study devoted entirely to
rare cancers, with over 35 cohorts targeting very rare to exceedingly rare types of cancers. The Committee requests an update on
the DART study in the fiscal year 2022 CJ. Finally, the Committee
encourages NCI and NCATS to continue to collaborate on rare cancer research 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.
Rare Cancer Therapeutic Research and Development Program.—
The Committee recognizes that nearly 500,000 Americans are diagnosed with a rare form of cancer every year. The Committee re-

89
quests an update in the fiscal year 2022 CJ on progress in treatment for rare cancers and how the Federal Government can accelerate the development of rare cancer therapies, including expanding the availability of biorepository resources for rare cancers, and
improving clinical trial participation for rare cancer patients.
Specialized Programs of Research Excellence Cancer [SPORE].—
The Committee recognizes that the SPORE program is a key component of NCI’s efforts to translate basic research into the prevention, early detection, diagnosis, and treatment of cancer. The Committee commends NCI for its recent funding opportunity announcement regarding the development of SPOREs that are focused on
cancer health disparities, and it encourages additional research in
this area. The Committee urges NCI to prioritize the use of multicenter SPOREs, which allow greater opportunities for collaborative,
interdisciplinary research.
Surveillance, Epidemiology, and End Results [SEER] Registry.—
The Committee encourages NCI to continue to advance efforts to
modernize the SEER Registry and better capture key data points,
such as metastatic recurrence and cancer migration. The Committee requests an update on plans to implement these enhancements to the SEER registry in the fiscal year 2022 CJ.
NATIONAL HEART, LUNG, AND BLOOD INSTITUTE

$3,625,258,000
3,298,004,000
3,728,307,000

The Committee recommendation includes $3,728,307,000 for the
National Heart, Lung, and Blood Institute [NHLBI].
Alzheimer’s Disease and Vascular Dementia.—The Committee
recognizes the value that well-characterized, longitudinal, population-based cohort studies provide in bringing to light more information about the risk factors related to dementia. By studying participants over time, much can be learned about cognitive decline
and early biomarkers that will help us understand the role of environmental and genetic factors in disease development and progression. In time, however, mature cohorts naturally dwindle as participants pass away, requiring that the research mission be adjusted
to continue to leverage the previous science and build upon it.
Therefore, the Committee urges NHLBI and NIA to fund research
into next generation cohorts, with a focus on understanding the development and progression of risk factors and detection of early
signs of cognitive decline. Preference should be given to applicants
that have diversity among cohort participants, broad geographic
representation, and a demonstrated record of high research productivity.
Congenital Heart Disease [CHD].—The Committee commends
NHLBI for its continued work to better understand causation, improve treatments and outcomes, support the growth of the clinical
workforce, and integrate registry data and research datasets to facilitate research on congenital heart disease across the lifespan, including through the Pediatric Health Network and the Pediatric
Cardiac Genomics Consortium. The Committee encourages NHLBI
to prioritize CHD activities outlined in its strategic plan, including
improving understanding of outcomes and co-morbidities, modifying

90
treatment options across the lifespan, and accelerating discovery,
analysis, and translation by leveraging CHD registries and networks.
Exploring Airway Screening Efforts of Childhood Asthma in the
Rural Community.—The Committee continues to be concerned
about childhood asthma, which affects over 9,000,000 million
school-aged children and leads to many preventable emergency department visits, hospitalizations, and missed school days. NHLBI
is strongly urged to develop a multidisciplinary project to examine
inflammation in children with uncontrolled asthma. This research
should build upon previous findings to explore asthma control and
inflammation in children with persistent asthma in rural communities. Ultimately, this research could improve access to care and
reduce the costs associated with uncontrolled asthmas by identifying early inflammatory signs.
Heart Disease.—Heart disease continues to be the leading cause
of death in the United States, claiming hundreds of thousands of
lives and costing billions of dollars every year. The Committee is
concerned that this largely preventable disease disproportionately
affects racial and ethnic minorities and those living in rural communities and supports ongoing population studies that seek to address these disparities. Further, the Committee is concerned that
heart disease is the leading cause of death of pregnant women and
that one in five American women experiences some type of cardiovascular complication during pregnancy. The Committee supports
the NHLBI’s Strategic Vision Objective to address maternal health
and reduce the risk of cardiovascular disease for women before,
during, and after pregnancy.
Hypertension.—The Committee remains concerned about the significant incidence of hypertension in non-Hispanic black males and
females compared to their non-Hispanic white male and female
counterparts. These racial differences emerge as early as the third
decade of life. For these reasons, the Committee supports efforts to
identify the underlying causes of this racial disparity in hypertension, and to develop and evaluate interventions to reduce this
disparity. The Committee strongly encourages a focus on interventions to reduce systematic and blood vessel-specific inflammation in
individuals with elevated blood pressure, but not yet hypertensive,
that would be scalable to the community level.
Pulmonary Fibrosis [PF].—The Committee recognizes that PF is
a family of more than 200 different lung diseases that all look very
much alike, despite having a variety of causes. This heterogeneity
presents significant challenges for diagnosis and treatment. Therefore, the Committee commends the Institute for its recent efforts
to apply the principles of precision medicine to PF research, especially by funding a major new study that will evaluate a promising
treatment for a subset of patients with a particular gene variant.
This study, known as PRECISIONS, also aims to identify genetic
variants that play a role in certain forms of PF. The Committee
urges the Institute to prioritize basic research on PF, particularly
to better understand the causes and process of scarring and the
varying impacts upon patients. In addition, the Committee recognizes that recent developments in multiple basic sciences (structural biology, molecular modeling, receptor biology, and pharma-

91
cology) have greatly accelerated the rate of discovery of ways to
treat and prevent pulmonary fibrosis. The rate of discovery now
strains the ability of academic laboratories to test, in a timely manner, the efficacy of these treatment options in physiologically and
disease-relevant systems. Cardiovascular, lung, and blood diseases
remain among the most important and costly diseases that would
benefit from a new generation of treatment options. Accordingly,
the Committee urges NHLBI to prioritize support for academic laboratories, as both singular and networked or collaborative entities,
to accelerate the pace of research into critical life-saving and affordable treatment options for PF.
NATIONAL INSTITUTE OF DENTAL AND CRANIOFACIAL RESEARCH

$477,679,000
434,559,000
493,234,000

The Committee recommendation includes $493,234,000 for the
National Institute of Dental and Craniofacial Research [NIDCR].
Temporomandibular Disorders [TMD].—The Committee is encouraged by the work of the National Academy of Medicine [NAM]
report on TMD and supports efforts to guide the direction of new
research and funding related to TMD to improve patient care. The
Committee encourages NIH to collaborate with other governmental
agencies, as well as public and private stakeholders. Further, the
Committee notes that the NAM report states that action is urgently needed to improve care for individuals with TMD, and that
multiple basic scientific and clinical disciplines are needed to advance research to improve patient care. Given the number of individuals suffering from TMD, the severity of some of the disorders,
and the substantial public health burden of TMD, there is a compelling opportunity for NIH and other biomedical research institutions to continue supporting TMD research to spark new discoveries, and the Committee supports efforts to ensure that TMD research is incorporated into NIH-wide initiatives. To continue to
build on advances in coordinated research and treatment, the Committee requests NIDCR provide an update on NIH-wide activities
on TMD research in its fiscal year 2022 CJ.
NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY
DISEASES

$2,115,146,000
1,924,211,000
2,169,021,000

The Committee recommendation includes $2,169,021,000 for the
National Institute of Diabetes and Digestive and Kidney Diseases
[NIDDK].
Diabetes.—The Committee commends the efforts of NIDDK to
prioritize the discovery and validation of biomarkers and urges
NIDDK to continue to prioritize this important work that will accelerate the designing and conducting of clinical trials to prevent,
treat, and cure type 1 diabetes. Given the growing prevalence of diabetes, the Committee is concerned that additional research is
needed to determine how to improve the treatment of a common
complication, diabetic foot ulcers to reduce amputations, and urges

92
NIDDK to support such efforts. Further, given the aging population, the Committee urges NIDDK to work with NIA to explore
the relationship between diabetes and neurocognitive conditions,
such as dementia and Alzheimer’s disease.
End-Stage Renal Disease [ESRD].—The Committee notes the
work in supporting critical kidney research, including ESRD, that
NIDDK has accomplished. This research has led to new developments for possible treatments and the Committee continues to encourage NIDDK to work with stakeholders to facilitate new opportunities for research.
Glomerular Diseases.—The Committee continues to support the
important work that the Cure Glomeruloneuropathy initiative has
accomplished, which has led to breakthroughs for critical clinical
trials. The Committee encourages NIDDK to continue supporting
research that has proven to lead to new therapies.
Inflammatory Bowel Diseases [IBD].—The Committee recognizes
NIDDK’s leadership in supporting research into Crohn’s disease
and ulcerative colitis. The Committee also recognizes the importance of patient-centered, bedside-to-bench approaches to understand complex, chronic diseases such as IBD, and the need to better understand the impact of diet on IBD. The Committee directs
NIDDK to pursue research on the interactions among food, the gut,
and the brain/nervous system in people with IBD and other chronic
gastrointestinal diseases. The Committee notes that this bedsideto-bench approach has been successful in other disease areas, including type 2 diabetes and oncology, and encourages NIDDK to
use a similar approach focused on IBD.
Polycystic Kidney Disease.—The Committee commends NIDDK
for its continued commitment to Polycystic Kidney Disease Research and Translation Centers, and the Pediatric Centers of Excellence in Nephrology, both of which improve our understanding
of the causes of autosomal dominant polycystic kidney disease and
autosomal recessive polycystic kidney disease. The Committee continues to encourage NIDDK to work with stakeholders to facilitate
new opportunities for research and promote the development of
new therapeutic strategies.
NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKE

$2,446,577,000
2,245,110,000
2,526,245,000

The Committee recommendation includes $2,526,245,000 for the
National Institute of Neurological Disorders and Stroke [NINDS],
including $50,000,000 appropriated from the NIH Innovation Account. NINDS’ funding level includes $250,000,000 in targeted
funding for research related to opioid addiction, development of
opioid alternatives, pain management, and addiction treatment,
and newly expands the use of these funds to include research related to stimulant misuse and addiction.
Brain Aneurysm.—The Committee continues to be concerned that
an estimated 1 out of 50 individuals in the United States has a
brain aneurysm, and an estimated 30,000 Americans suffer from a
brain aneurysm rupture each year. The Committee is concerned

93
that not enough research is focused on prevention of brain aneurysm ruptures.
Cerebral Palsy [CP].—The Committee commends NINDS for implementing Funding Opportunity Announcements for clinical research supporting observational studies that are well-suited for the
study of CP. The Committee strongly encourages NIH to prioritize
and implement additional opportunities to significantly strengthen,
accelerate, and coordinate cerebral palsy research to address priorities across the lifespan identified in the 5 to 10-year CP Strategic
Plan developed by NINDS and NICHD. Research 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 agencies, including CDC, to support additional research
on preventing, diagnosing, and treating CP.
Data Resource Optimization.—The Committee is aware of the
NICHD Data and Specimen Hub [DASH] project to create a centralized resource to store and access de-identified data from
NICHD-supported studies. The Committee encourages NINDS to
work with NICHD to explore utilizing the DASH site for NINDS
studies.
Frontotemporal Degeneration Research [FTD].—The Committee
encourages NIH to maintain and expand a multi-site infrastructure
and network of clinical sites to extend the study of genetic and sporadic FTD cohorts. By supporting this research, researchers may
increase the body of knowledge of the natural history of the disease, and build an infrastructure for biomarker discovery and clinical trials in defined FTD cohorts. A key component of this will be
to leverage recent advances in information technology to create an
infrastructure for FTD research that will collect and record data
and samples in a uniform manner, incorporate patient-reported
data, and take advantage of new technologies that enable remote
monitoring. Development of a data biosphere that supports broad
sharing of robust datasets, generated with powerful-omic platforms,
will enable the broader community of researchers, including younger investigators and scientists from a wide array of fields, to bring
their expertise and intellectual curiosity to bear on the challenges
currently confronting Alzheimer’s disease and related dementia disorders. In this way, the understanding of basic disease mechanisms
that may be common across forms of dementia may be accelerated
and translated into much-needed therapeutics.
HEAL Initiative.—The Committee continues to be extremely concerned about the crisis of prescription opioids, heroin, and illicit
synthetic opioid use, misuse, addiction, and overdose in the United
States. In addition, the Committee notes the rising use of stimulants, with the rate of deaths in 2015 and 2016 related to stimulant
overdoses increasing by 52 percent and 33 percent, respectively.
Therefore, the bill includes $250,000,000 for the HEAL Initiative
targeted at opioid misuse and addiction, and has newly expanded
uses of the HEAL Initiative to include research related to stimulant misuse and addiction.
Parkinson’s Disease.—Parkinson’s disease is the second most
commonly diagnosed neurogenerative disease in the United States.

94
It is a chronic neurodegenerative disease that gradually worsens
over time and there is no treatment to slow, stop, or reverse its
progression. Parkinson’s disease impacts more than 1,000,000
Americans, 90 percent of whom are insured through Medicare. Parkinson’s costs the United States $52,000,000,000 every year—more
than $25,000,000,000 of which is shouldered by the Federal Government through the Medicare program. Despite Parkinson’s disease’s designation as the second most common neurodegenerative
disease in the United States, Federal funding directed to Parkinson’s disease research is 0.0625 percent of the funding directed to
the most common neurodegenerative disease. As the population of
the United States continues to age, the economic burden of Parkinson’s is expected to continue to increase rapidly. The Committee
urges NINDS to maximize funding for Parkinson’s disease-related
research where appropriate.
Stroke.—Despite remarkable progress to reduce the stroke mortality rate, it is still the number one cause of severe long-term disability. The Committee supports continued research to improve the
scientific understanding of stroke and clinical trials that are developing new treatments and improved approaches to stroke recovery
and rehabilitation through the NIH funded clinical trials network
StrokeNet. The Committee supports continued stroke related research conducted through the BRAIN Initiative that seeks to discover how brain circuits rewire themselves to repair damage that
occurs during a stroke and that may lead to effective treatments
to mitigate this damage in the future. Understanding that stroke
is a largely preventable disorder, the Committee supports ongoing
population studies that seek to reveal the reasons for stroke disparities found in communities, especially in rural States found in
the stroke belt. The Committee further supports additional research exploring how, and the extent to which, the accumulation of
white matter lesions in the brain are related to stroke and dementia, and urges continued collaborative research among NIH Institutes related to vascular dementia.
Traumatic Brain Injury Mitigation.—The Committee understands that research on regenerative medicine, including the use of
adult stem cells and neuroplasticity, may play an important role in
developing treatments and identifying therapeutic targets for
neuroprotection pre/post TBI. The Committee urges NINDS to
work with all relevant Institutes and Centers, including NIA, to
support a robust and coordinated portfolio of TBI research that explores all promising avenues to facilitate functional repair of damaged circuitry in TBI. Such analysis should include research on regenerative medicine and neuroplasticity, inclusive to preventive approaches in reducing risk or to eliminate vulnerabilities from a
TBI. A potential mitigation approach is to develop interventions
that protect from the delayed effects of TBI and associated pathology before they occur. The Committee expects an update regarding
these specific areas of TBI research in the fiscal year 2022 CJ.
NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES

$5,876,195,000
5,885,470,000
6,142,540,000

95
The Committee recommendation includes $6,142,540,000 for the
National Institute of Allergy and Infectious Diseases [NIAID].
Antimicrobial Resistance [AMR].—The Committee recommendation includes $511,000,000 within NIAID to support research related to combatting antimicrobial resistance. The Committee remains concerned by the growing threat posed by antimicrobial resistant pathogens. While antibiotics are necessary to treat secondary infections, their expanded usage is causing concern that a
lasting consequence of the virus could be increased global antibiotic
resistance rates. The Committee supports NIAID’s efforts to encourage innovative approaches to AMR, and directs NIH to brief
the House and Senate Committees on Appropriations no later than
30 days after the enactment of this act, detailing the focus of its
initiatives for fiscal years 2021–2022. The Committee also requests
an update on AMR-related research activities in the fiscal year
2022 CJ.
Celiac Disease.—The Committee includes sufficient funding for
NIH to devote focused research to the study of Celiac disease, including the autoimmune causation underpinning the affliction.
Today, the only known treatment for this disease is a gluten-free
diet; however, recent public and private sector research has revealed that such a ‘‘treatment’’ is insufficient for many who suffer
from Celiac disease. Therefore, the Committee urges NIAID to support new research on celiac disease to better coordinate existing research and focus new research efforts toward causation, and ultimately, a cure of this disease. The Committee encourages NIAID
to coordinate with other Institutes and Centers including NIDDK
as appropriate and to submit its plan for coordination and execution of this research to the Committees on Appropriations of the
House of Representatives and the Senate no later than 90 days
after enactment of this act.
Centers for AIDS Research.—The Committee includes
$61,000,000, an increase of $10,000,000, for Centers for AIDS Research as part of the President’s request for the Ending the HIV
Epidemic initiative.
Fecal Microbiota Transplantation [FMT] National Registry.—The
Committee recognizes that FDA has exercised enforcement discretion to allow continued patient access to FMT for recurrent C.
difficile infections not responsive to standard therapies. To help inform clinicians and patients regarding the safety and effectiveness
of FMT in these patients, the Committee encourages NIH to continue to support the FMT National Registry and related research
efforts to better understand the short- and long-term safety profile
and efficacy of FMT.
Food Allergies.—The Committee recognizes the serious issue of
food allergies which affect approximately 8 percent of children and
10 percent of adults in the United States. The Committee commends the ongoing work of NIAID in supporting a total of 17 clinical sites for this critical research, including seven sites as part of
the Consortium of Food Allergy Research. The Committee encourages NIAID to expand its clinical research network to add new centers of excellence in food allergy clinical care and to select such centers from those with a proven expertise in food allergy research.

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Hepatitis B.—The Committee applauds NIAID for its leadership
of the inter-Institute initiative to develop a NIH Strategic Plan for
Trans-NIH Research to Cure Hepatitis B released in December
2019. It is noted that infection with the hepatitis B virus [HBV] is
a serious public health threat and that 1 in 20 Americans has been
infected while more than 2,000,000 Americans are chronically infected, increasing by 70,000 a year. This serious public health
threat results in over 780,000 worldwide deaths each year. The
Committee appreciates the Institute’s use of contracts, program announcements, and research resources initiatives to stimulate new
research applications and facilitate ongoing work. The Committee
urges NIAID to issue new targeted calls for research through Program Project, R01, and U01 Cooperative Research Agreements,
such as those successfully used to discover cures for hepatitis C.
The Committee also urges NIAID to consider cooperative research
to implement the Strategic Plan and the ‘‘Roadmap for a Cure,’’ reported from the Hepatitis B Foundation, to close the gap in our understanding of HBV and hepatitis delta virus molecular biology and
develop effective therapeutics. The Committee notes that the
Trans-NIH Strategic Plan was specific enough to provide guidance
for program announcements without stifling innovation. The Committee requests that NIAID submit, within 90 days of enactment
of this act, a specific plan to pursue a cure for hepatitis B in coordination with the Trans-NIH Hepatitis B Working Group.
Lyme Disease and Related Tick-borne Illnesses.—The incidence of
Lyme and other tick-borne diseases has increased significantly
since CDC reporting began in 1991. From 2004 to 2018, reported
cases of tick-borne diseases more than doubled from 22,527 to
47,743 cases. In fiscal year 2020, NIH is expected to spend
$71,000,000 on Lyme disease and related tick-borne disease research. The Committee understands the importance of research
into Lyme disease and related tick-borne illnesses and provides an
increase of $10,000,000 in fiscal year 2021. Further, the Committee
supports the implementation of the NIH Strategic Plan for Tickborne Disease Research, which will build on current trans-NIH efforts to better understand the complex interplay among host, tick,
and pathogen factors that contribute to tick-borne diseases and the
body’s defenses against them. The Committee urges NIH to leverage this understanding to develop new tools that can more effectively prevent, diagnose, and treat Lyme disease, including its longterm effects and other tick-borne diseases. The Committee further
urges NIH to evaluate the effectiveness of laboratory tests associated with the detection of Borrelia burgdorferi to diagnose the disease early, which can improve the effectiveness of treatment. The
Committee encourages the promotion and development of potential
vaccine candidates for Lyme disease and other tick-borne diseases.
The Committee urges NIH to conduct research to better understand modes of transmission for Lyme and other tick-borne diseases. The Committee further urges NIH to incentivize new investigators to enter the field of Lyme disease and other tick-borne disease research. The Committee recommends that NIH coordinate
with CDC on publishing reports that assess diagnostic advancements, methods for prevention, the state of treatment, and links
between tick-borne disease and neuropsychiatric illnesses. Finally,

97
the Committee encourages NIAID to issue requests for grant applications for research to investigate causes and manifestations of
Lyme disease and other tick-borne diseases, including post-treatment symptoms, as well as research to develop diagnostics, prevention methods, and treatment for those conditions, including potential vaccine candidates.
Microbicides.—The Committee recognizes that with NIH and
USAID leadership, research has shown the potential for
antiretroviral [ARV] drugs to prevent HIV infection in women. The
Committee encourages NIH to continue coordination with USAID,
the State Department, and others to advance ARV-based
microbicide development efforts with the goal of enabling regulatory approval of the first safe and effective microbicide for
women.
Multidisciplinary Grants for Vector-Borne Disease Research.—
NIH’s new strategy to address tick-borne diseases aims to examine
the complex interplay among host, tick, and pathogen factors that
contribute to these diseases and the body’s defenses against them.
It is precisely this complexity, combined with the growing incidence
and threat to human health and life, that make new multi-disciplinary research approaches necessary. The Committee encourages investment in multi-year center core grants that support shared resources and facilities for multidisciplinary research. This approach
allows research groups to develop understandings of how pathogens
persist, evolve, and cause outbreaks, and also models the risk of exposure as climate and socioeconomic conditions change, which leads
to future innovations in diagnostic tools and preventive medicines.
Surveillance efforts should be part of these grants, and priority
shall be given to grants focused on vector borne diseases requiring
arthropod biosafety levels 2 and 3.
Regional Biocontainment Laboratories [RBL].—RBLs are charged
with being available and prepared to assist national, State, and
local public health efforts in the event of a bioterrorism or infectious disease emergency. The Committee directs $55,000,000 to be
evenly divided among the 12 RBLs to support efforts to prevent,
prepare for, and respond to infectious disease outbreaks, including,
but not limited to: (1) conducting research on developing testing for
antiviral compounds, new vaccines, and point of care tests; (2) conducting research on validating methods for identifying suitable convalescent plasma for screening donors and other prophylactic methods to prevent infections; (3) supporting operations costs and facilities upgrades for purchase of equipment to speed drug discovery
and testing; and (4) training new researchers in biosafety level 3
practices.
Sexually Transmitted Infections.—The Committee continues to be
concerned about the increased cases of gonorrhea, syphilis, and the
rise of congenital syphilis. The Committee commends NIAID for its
work in this area, specifically developing new antibiotics, and encourages acceleration in the development of screening tests, vaccines for prevention, and new treatment options, for both adults
and newborns, to provide a fast and efficient way to diagnose and
define the stages of these infections.

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NATIONAL INSTITUTE OF GENERAL MEDICAL SCIENCES

$2,937,218,000
2,672,074,000
3,046,962,000

The Committee recommendation includes $3,046,962,000 for the
National Institute of General Medical Sciences [NIGMS], which includes $1,585,847,000 in transfers available under section 241 of
the PHS Act (Public Law 104–73 as amended).
Institutional Development Award [IDeA].—The Committee provides $399,161,000 for the IDeA program, an increase of
$12,588,000. The Committee believes the IDeA program has made
significant contributions to biomedical research and has led to the
creation of a skilled workforce and made the IDeA program an essential component of NIH’s research portfolio. The Committee recognizes the IDeA program’s significant contributions to biomedical
research and to the development of our Nation’s biomedical research infrastructure and workforce. The Committee supports this
important investment, which extends NIH’s reach nationwide. Further, the Committee recognizes the importance of the Centers of
Biomedical Research Excellence and the IDeA Networks of Biomedical Research Excellence programs and expects funding to be
maintained for both. These programs are essential to the overall
success of the program.
Maximizing Access to Research Careers [MARC].—The Committee recognizes the importance of the MARC program and encourages the continuation and enhancement of efforts underway
with our Nation’s HBCUs. The Committee also recognizes the important work of those HBCUs located in rural parts of the United
States in educating significant numbers of underserved students in
STEM fields, and encourages NIH to continue and strengthen its
engagement of institutions located in this region.
Small Business Innovation Research [SBIR]/Small Business
Technology Transfer [STTR].—The Committee remains concerned
with the lower rates of NIH STTR funding in IDeA States compared to non-IDeA States. In response to this discrepancy, NIGMS
funded four STTR Regional Accelerator Hubs to help build entrepreneurial cultures in IDeA States by increasing STTR funding opportunities, entrepreneurial training, and technology transfer acceleration. The Committee encourages NIGMS to renew the existing
hubs through Phase 0 Awards within the SBIR program.
Training the Next Generation of Physician-Scientists.—The Committee is concerned about the shrinking number of physician-scientists in the nation’s biomedical workforce. As noted in a perspective piece in the August 1, 2019, New England Journal of Medicine,
the proportion of U.S. physicians engaged in research has declined
from a peak of 4.7 percent in the 1980s to roughly 1.5 percent
today. These highly-trained researchers with clinical expertise
often discover the critical connections between what is discovered
in the laboratory with their patients’ conditions in the clinic. They
play a critical role in translating scientific and laboratory advances
into improved diagnoses, treatments, devices, procedures, and
cures. The Committee commends NIGMS for its highly competitive
Medical Scientist Training Program [MSTP], whereby students

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enter a combined, integrated MD–PhD program when they start
medical school. The Committee strongly urges NIGMS to continue
its support of promising physician-scientists being trained at research-intensive medical schools with high-quality laboratory and
clinical training. The Committee commends NIH for its work to improve the physician-scientist pipeline. The Committee requests an
update on the enhanced pathways for physicians both to pursue research training and be competitive for NIH awards, as recommended by the Advisory Committee to the NIH Director’s Working Group on the Physician-Scientist Workforce. The update should
highlight current activities in this area, including increasing the diversity of physician-scientists, support provided during the transition from senior trainee to junior faculty member, and future plans
for action. Additionally, the update should describe how feedback
has been incorporated from current MSTP physician-scientist trainees, research-intensive medical schools, and biomedical industry
representatives.
Workforce Diversity Programs.—The Committee strongly supports NIH’s efforts, across Institutes and Centers, to increase diversity in the scientific workforce. At the center of this effort is
NIGMS that trains the next generation of scientists, enhances the
diversity of the scientific workforce, and develops research capacity
throughout the country. In fiscal year 2020, in addition to the IDeA
program, NIGMS will spend $188,432,520 on 12 programs that promote diversity of the scientific workforce and expands recruitment
and retention. These programs include the SCORE program that
focuses on the competitiveness of faculty at institutions with a mission or historical record in graduating students from groups nationally underrepresented in biomedical research; the SEPA initiative
that supports interactive partnerships between biomedical researchers and K–12 teachers and schools to provide opportunities
for students from underserved communities to consider careers in
research; and the new MOSAIC program designed to transition
promising postdoctoral researchers from diverse backgrounds into
independent research faculty. The Committee strongly supports
NIGMS’ work in this area and provides $202,564,959, an increase
of $14,132,439 or 7.5 percent, to the Institute’s diversity programs
in fiscal year 2021.
EUNICE KENNEDY SHRIVER NATIONAL INSTITUTE OF CHILD HEALTH
AND HUMAN DEVELOPMENT

$1,556,909,000
1,416,366,000
1,657,606,000

The Committee recommendation includes $1,657,606,000 for the
Eunice Kennedy Shriver National Institute of Child Health and
Human Development [NICHD].
Child Development.—The Committee believes there is insufficient
focus in NICHD’s 2020 Strategic Plan on behavioral health, cognition, development of young children, language, learning differences, and school readiness. NICHD has had a long history of
funding critical and meritorious work in these areas. The Committee encourages NICHD to consider otherwise qualified grants in

100
these areas on the same basis as any other areas of focus as it
works to implement its strategic plan.
Congenital Syphilis.—The Committee continues to be concerned
about the rise of congenital syphilis and the lifelong health effects
the disease can have on a child. The Committee encourages NICHD
to prioritize research in this area and to work with NIAID on new
testing, diagnosis, and treatment efforts.
Endometriosis.—The Committee is aware that endometriosis is a
chronic disease originating in the female reproductive system affecting 10 percent of women of reproductive age worldwide. Endometriosis is most often misdiagnosed as irritable bowel disease.
Endometriosis has been linked to ovarian cancer. The Committee
also recognizes that endometriosis is the third-leading cause of female infertility in the United States. The Committee urges NICHD
to support research to increase early and more accurate
diagnostics, and develop new treatment methods.
Impact of Technology and Digital Media on Children and
Teens.—The Committee remains concerned about the effects of
technology use and media consumption on infants, children, and
adolescents and appreciates NIH’s continued engagement on these
important topics. The Committee encourages NIH to prioritize research into the cognitive, physical, and socio-emotional repercussions of young people’s use of technologies including mobile devices,
computers, and virtual reality tools, as well as their consumption
of social-media content, video games, and television programming.
Maternal-Fetal Medicine Units [MFMU] Network.—The Committee supports the critical work of the MFMU Network in improving health outcomes for pregnant women and their babies, and
leveraging existing infrastructure to address maternal mortality
and severe maternal morbidity in the U.S. is critical. NICHD is
currently considering several models of infrastructure for its networks. The Committee encourages NICHD to maintain the features
that made the MFMU Network successful and cost-effective including the renewal process that maximizes efficiency and ability to
conduct multiple large trials with long-term follow-up over many
years. Such an infrastructure is essential for maintaining a collective repository of knowledge and skills, as well as a stable foundation for data sharing and workforce development. The Committee
expects to be updated on the process for restructuring and final
outcomes once a final decision has been made with respect to the
new infrastructure.
Pelvic Floor Disorders.—The Committee recognizes that Pelvic
Floor Disorders, including such conditions as urinary incontinence,
accidental bowel leakage, and pelvic organ prolapse, have a significant negative impact on more than 25,000,000 women annually in
the United States. The Committee supports a trans-NIH collaboration, including NICHD, NIDDK, and NIA, to promote the development of disorder specific data sets and biorepositories for the advancement of research studies on patient outcomes of current and
future therapies used to treat pelvic floor disorders and the pathogenesis of these conditions. The Committee requests a report on
current research and future initiatives to address pelvic floor disorders in the fiscal year 2022 CJ.

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Population Research.—The Committee recognizes the Institute
for supporting innovative population research and research training programs, longitudinal surveys, research on the social determinants of health, and on the development of low-cost data
archiving, data curation, and data sharing strategies that both protect survey participants and provide unparalleled access for researchers. The Committee encourages NICHD to highlight these
strategies as it works with the NIH leadership to implement its
data sharing and management policy. Further, the Committee
urges NICHD to continue supporting large-scale data collection activities, especially prospective, population-representative longitudinal studies, and to continue its leadership in supporting research
on the social determinants of health, morbidity, and mortality
across the lifespan, including maternal and infant health.
Premature Birth.—Infants who are born preterm can face a
range of health challenges throughout their lives, and yet the
mechanisms that lead to preterm birth remain poorly understood.
The Committee has provided an increase to NICHD of $50,000,000,
the full budget request, for research aimed at enhancing the survival and healthy development of preterm infants. These studies
may include research efforts to identify and understand the causes
of preterm birth, and the development of evidenced-base strategies
to address the short- and long-term complications in children born
preterm, including children with intellectual, developmental, and
physical disabilities. The Committee especially urges NICHD to
support studies that address health disparities in preterm birth
and its consequences, and requests an update on these efforts in
the fiscal year 2022 CJ.
NATIONAL EYE INSTITUTE

$823,325,000
749,003,000
850,135,000

The Committee recommendation includes $850,135,000 for the
National Eye Institute [NEI].
NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES

$802,598,000
730,147,000
828,733,000

The Committee recommendation includes $828,733,000 for the
National Institute of Environmental Health Sciences [NIEHS].
NATIONAL INSTITUTE ON AGING

$3,545,869,000
3,225,782,000
4,015,333,000

The Committee recommendation includes $4,015,333,000 for the
National Institute on Aging [NIA].
Alzheimer’s Disease.—The Committee provides an increase of
$354,000,000 for Alzheimer’s disease research, bringing the total
funding level in fiscal year 2021 to $3,172,000,000. Over the past
6 years, targeted funding for research for Alzheimer’s disease and

102
related dementias has more than quintupled. NIA is encouraged to
continue addressing the research targets outlined in the fiscal year
2021 Professional Judgment Budget.
Alzheimer’s Disease Cohort Studies.—The Committee commends
NIA for its leadership in supporting longitudinal, population-based
cohort studies into the causes of dementia. Since rural, poor and
minority populations may be at enhanced risk for dementia, the
value and application of these studies are enhanced when they include individuals from various geographic, ethnic, socio-economic,
and generational backgrounds. The Committee directs NIA to support diversity in its cohort studies, with the specific goal of better
understanding disease burden and biomarkers by race and geographic region. The Committee believes this could be accomplished
through enhanced partnerships between existing NIA-funded Alzheimer’s Disease Research Centers [ADRC] and non- ADRC centers
in high-risk geographic regions, or through the creation of new
long-term cohorts in underrepresented groups/regions.
Alzheimer’s Disease and Dementia Screening Tools.—The Committee remains very interested in opportunities to detect cognitive
impairment that may be caused by Alzheimer’s disease and related
dementias as early as possible. The Committee directs NIH to update its analysis of validated screening tools, including digital
screening tools that are able to reliably detect mild cognitive impairment. This review should focus on identifying tools that have
been developed since the last assessment was conducted and on
providing information to assist healthcare providers in regularly
using such tools to assess the cognitive health of their patients.
Diversity of Alzheimer’s Clinical Trials.—The Committee appreciates NIH taking actions to address the underrepresentation of
minority populations in clinical trials for Alzheimer’s disease and
related dementias. To build upon this work, the Committee directs
NIH, in collaboration with NIA and NIMHD, to examine the language accessibility of its Alzheimer’s clinical trials and report back
on opportunities to strengthen access to clinical research for volunteers who are not fluent in English. Further, the Committee encourages NIH to enhance the functionality of ClincalTrials.gov to
include ways to more easily identify trials that accept participants
in different languages.
Population Research.—The Committee recognizes the NIA National Advisory Council on Aging [NACA] for conducting a recent
review of the Institute’s Division of Behavioral and Social Research. The review reinforced the value of the Institute’s investment in an array of population aging research activities, including
large-scale, longitudinal studies, such as the Health and Retirement Study, which is the Nation’s leading source of combined data
on health and socioeconomic circumstances of Americans over age
50, and its center programs, such as the Centers on the Demography and Economics of Aging, which are conducting research on
the demographic, economic, social, and health consequences of U.S.
and global aging at 11 universities and organizations nationwide.
The Committee urges NIA to sustain its investment in these activities in fiscal year 2021 and to consider, as the NACA review recommended, expanding research opportunities that will advance our
understanding of the factors throughout the life course that con-

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tribute to the poor overall health of older people in America and
the growing disparities in some parts of the country, as well as the
disparities between the United States and other countries.
NATIONAL INSTITUTE OF ARTHRITIS AND MUSCULOSKELETAL AND SKIN
DISEASES

$624,889,000
568,480,000
645,237,000

The Committee recommendation includes $645,237,000 for the
National Institute of Arthritis and Musculoskeletal and Skin Diseases [NIAMS].
Musculoskeletal Research.—NIH has made significant progress in
terms of diversity in musculoskeletal research and NIAMS has included diversity as a priority in its 2020–2024 strategic plan. The
Committee supports additional research on musculoskeletal diseases and treatments, specifically related to disparities and in
terms of activity limitations and complications due to limited access to or usage of specialty care.
NATIONAL INSTITUTE ON DEAFNESS AND OTHER COMMUNICATION
DISORDERS

$490,692,000
446,397,000
506,670,000

The Committee recommendation includes $506,670,000 for the
National Institute on Deafness and Other Communication Disorders [NIDCD].
NATIONAL INSTITUTE OF NURSING RESEARCH

$172,363,000
156,804,000
177,976,000

The Committee recommendation includes $177,976,000 for the
National Institute of Nursing Research [NINR].
NATIONAL INSTITUTE ON ALCOHOL ABUSE AND ALCOHOLISM

$546,696,000
497,346,000
564,498,000

The Committee recommendation includes $564,498,000 for the
National Institute on Alcohol Abuse and Alcoholism [NIAAA].
Research on Polysubstance Use.—The Committee is pleased to
see that NIH supports research on polysubstance use, but urges
the Director of NIAAA to continue to support research in this area
across the United States. Given the increasing prevalence of
polysubstance deaths, particularly amongst rural and minority
communities, the Committee also encourages the Director to support studies on rural and minority communities with high rates of
polysubstance use mortality.

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NATIONAL INSTITUTE ON DRUG ABUSE

$1,457,724,000
1,431,770,000
1,505,192,000

The Committee recommendation includes $1,505,192,000 for the
National Institute on Drug Abuse [NIDA]. This includes
$250,000,000 in targeted funding for research related to opioid addiction, development of opioid alternatives, pain management, addiction treatment, and newly expands the use of these funds to include research related to stimulant misuse and addiction.
Addressing the Opioid Crisis in Rural Regions.—The Committee
encourages NIDA to continue its partnership with CDC, SAMHSA,
and the Appalachian Regional Commission in support of research
to help communities develop comprehensive approaches to prevent
and treat consequences of opioid injection, including substance use
disorders, overdose, HIV, hepatitis A, B, and C virus infections, as
well as sexually transmitted diseases. These projects will serve as
models for addressing opioid injection epidemics that can be implemented by health systems in similar rural communities in the
United States.
Barriers to Research.—The Committee is concerned that restrictions associated with Schedule I of the Controlled Substance Act
(Public Law 91–513) effectively limit the amount and type of research that can be conducted on certain Schedule I drugs, especially opioids, marijuana or its component chemicals, and new synthetic drugs and analogs. At a time when as much information as
possible is needed about these drugs to find antidotes for their
harmful effects, as well as regulatory and other barriers to conducting this research should be addressed.
Flavored THC.—The Committee appreciates the important data
collected in the annual NIDA-funded Monitoring the Future [MTF]
survey. The Committee recommends the inclusion of questions on
consumption of flavored marijuana vapes and marijuana edibles
flavored to appeal to adolescents in the annual MTF survey.
HEAL Initiative.—The Committee continues to be extremely concerned about the crisis of prescription opioids, heroin, and illicit
synthetic opioid use, misuse, addiction, and overdose in the United
States. In addition, the Committee notes the rising use of stimulants, with the rate of deaths in 2015 and 2016 related to stimulant
overdoses increasing by 52 percent and 33 percent, respectively.
Therefore, the bill includes $250,000,000 for the HEAL Initiative
targeted at opioid misuse and addiction and has newly expanded
the use of the HEAL Initiative to include research related to stimulant misuse and addiction. Further, while NIH has previously studied the effectiveness and risks associated with long-term opioid use
for chronic pain, HEAL is investigating new and alternative options to treat chronic pain. The Committee urges NIH to expand
scientific activities related to research on medications used to treat
and reduce chronic pain, and the transition from acute to chronic
pain. Further, the Committee urges NIH to: (1) continue funding
research on medication development to alleviate pain and to treat
addiction, especially the development of medications with reduced
misuse liability; (2) as appropriate, work with private companies to

105
fund innovative research into such medications; (3) report on what
is known regarding the transition from opioid analgesics to heroin
and synthetic opioid use and addiction within affected populations;
(4) continue 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 improve prescriber practices; (5) continue testing 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.
Housing Supports and Substance Use Treatment Outcomes and
Costs.—The Committee acknowledges growing anecdotal evidence
that suggest a strong correlation between successful substance
abuse treatment outcomes and stable housing arrangements, especially for those facing mental health challenges or those of limited
economic means. The Committee encourages NIDA to support research to assess how housing impacts substance abuse treatment
outcomes and costs in acutely affected regions like New England
where, according to the Federal Reserve Bank of Boston, each State
in the region spends more per capita on opioid related costs, including criminal justice, medical treatment, and medical complications
than other States.
Medication Assisted Treatments [MATs] for Methamphetamine
and Stimulants.—The Committee is concerned with the rise in
methamphetamine and stimulant use and addiction in the United
States. According to the latest data released by CDC, the number
of deaths from the drug categories that include methamphetamine
and cocaine more than doubled from 2015–2018, leading some to
refer to stimulant overdoses as the ‘‘fourth wave’’ of the current
drug addiction crisis in America following the rise of opioid-related
deaths involving prescription opioids, heroin, and fentanyl-related
substances. While there are currently approved MATs for alcohol
and opioid addiction there remains no approved MAT for methamphetamine or stimulant addictions. Therefore, the Committee
provides $10,000,000 in targeted funding for research aimed at developing new treatments for stimulant use disorder and its adverse
effects. This research may include studies to develop and evaluate
new and repurposed compounds, neurostimulation and other devices, behavioral intervention, and interventions to reduce the effects of methamphetamine toxicity on mood and cognition. Finally,
the Committee urges NIDA to continue its ongoing trials to expeditiously find and facilitate an approval of a MAT for methamphetamine.
Prenatal Opioid Use Disorders and Neonatal Abstinence Syndrome [NAS].—The Committee recognizes the growing burden of
NAS and the healthcare costs associated with it. The Committee is
aware of the need for more information regarding long-term health
and developmental outcomes related to NAS, the wide variation in

106
clinical practice and health systems support, as well as the challenges associated with post-discharge care. The Committee encourages NIH to coordinate with other agencies at HHS to support additional research on prevention, identification, and treatment of
prenatal opioid exposure and NAS, including the best methods for
screening and treating pregnant women for opioid use disorder and
the best methods for screening for NAS. Additionally, the Committee encourages NIH to build on the ACT NOW study to enhance
understanding of the impact of pharmacological and non-pharmacological treatment techniques on costs and outcomes in the shortterm and longitudinally. The Committee further encourages NIH to
coordinate with other agencies at HHS to support research on innovative care models to optimize care and long-term outcomes for
families.
Opioid Research, Education, and Outreach.—The United States
continues to suffer from a complex public health crisis related to
opioid misuse. The Committee strongly recommends NIDA continue
to support research to better understand opioid use disorder, focusing on detection, prevention, and treatment, and that NIDA continue to provide high-level education for healthcare professionals to
prevent, recognize, and assist in treatment and referral for opioid
use disorder within their practice.
Raising Awareness and Engaging the Medical Community in
Drug Use and Addiction Prevention and Treatment.—Education is
a critical component of any effort to curb drug use and addiction,
and it must target every segment of society, including healthcare
providers (doctors, nurses, dentists, and pharmacists), patients,
and families. Medical professionals must be in the forefront of efforts to curb the opioid crisis. The Committee continues to be
pleased with the NIDAMED initiative, targeting physicians-intraining, including medical students and resident physicians in primary care specialties (e.g., internal medicine, family practice, and
pediatrics). NIDA should continue its efforts in this space, providing physicians and other medical professionals with the tools
and skills needed to incorporate substance use and misuse screening and treatment into their clinical practices.
NATIONAL INSTITUTE OF MENTAL HEALTH

$2,042,966,000
1,844,865,000
2,139,491,000

The Committee recommendation includes $2,139,491,000 for the
National Institute of Mental Health [NIMH], including $50,000,000
appropriated from the NIH Innovation Account.
State of Bereavement Care.—The Committee is aware of research
indicating that individuals and families suffer severe health, social,
and economic declines following the death of a loved one—be it a
child, sibling, spouse, or parent. The Committee encourages OMH,
ACF, CDC, CMS, HRSA, IHS, NIH, and SAMSHA to examine their
activities to advance bereavement care for families, including prevalence of bereavement events and the details of those events (what
relationships are impacted, how the loved one died and at what
age), risk factors and associated health events or outcomes, biologi-

107
cal or physiological changes in wellbeing, and what interventions,
or programs could help functional coping or adaptive processing.
Suicide Prevention.—The Committee continues to be alarmed by
the growing rates of suicide across the country, with CDC reporting
a 30 percent increase since 1999. Suicide is currently the tenth
leading cause of death for all ages and the second leading cause of
death for young people aged 10–34. The Committee commends
NIMH for consistently increasing the resources dedicated to suicide
screening and prevention research over the last 3 fiscal years and
encourages NIMH to provide an additional increase for this purpose in fiscal year 2021, with special emphasis on producing models that are interpretable, scalable, and practical for clinical implementation, including healthcare and other systems, including education and criminal justice, that serve populations at risk. In addition, the Committee encourages NIMH to partner with NIDA and
NIAAA to examine the multifaceted relationship between suicide
and substance use disorder, including opioid abuse. Enhanced research into these relationships could provide critical knowledge regarding common risk factors, as well as preventive and intervention efforts that reduce morbidity associated with suicide risk. The
Committee requests that NIMH provide an update on these efforts
in the fiscal year 2022 CJ.
NATIONAL HUMAN GENOME RESEARCH INSTITUTE

$604,118,000
550,116,000
623,862,000

The Committee recommendation includes $623,862,000 for the
National Human Genome Research Institute [NHGRI].
Emerging Centers of Excellence in Genomic Sciences.—The Committee continues the Emerging Centers of Excellence in Genomic
Sciences grant program and maintains prior direction that current
awardees of the Centers for Excellence in Genomic Sciences program shall not be eligible to receive these grants.
NATIONAL INSTITUTE OF BIOMEDICAL IMAGING AND BIOENGINEERING

$404,638,000
368,111,000
417,815,000

The Committee recommendation includes $417,815,000 for the
National Institute of Biomedical Imaging and Bioengineering
[NIBIB].
Rapid Acceleration of Diagnostics [RADX].—The Committee
strongly supports the RADX program to speed innovation in the development, commercialization, and implementation of technologies
for testing. Given the rapid acceleration of testing technologies, the
Committee expects NIH to take best practices from RADX and use
them to accelerate other areas of research. The Committee directs
NIBIB to provide an update on RADX in the fiscal year 2022 CJ
and NIH to provide a broader update in the CJ on efforts to expand
methods learned through RADX into other areas of research to
move technologies swiftly through the development pipeline toward
broad availability.

108
NATIONAL CENTER FOR COMPLEMENTARY AND INTEGRATIVE HEALTH

$151,877,000
138,167,000
156,823,000

The Committee recommendation includes $156,823,000 for the
National Center for Complementary and Integrative Health
[NCCIH].
National Center for Complementary and Integrative Health.—The
Committee urges NIH, along with DOD and VA, to continue to support research on non-pharmacological treatments for pain management and comorbidities including opioid misuse, abuse, and disorder in military personnel, veterans, and their families. The VA
has made some notable progress in advancing more appropriate
opioid prescribing practices. The Committee is encouraged by
NCCIH’s work to support research on behavioral strategies to manage chronic pain and improve adherence to the medical treatment
of opioid use disorders, and reduce the psychological and physical
cravings to use opioids, which is especially important in patients
who have pain and need strategies for pain management that will
not increase their likelihood of relapse. However, opioid abuse continues to persist among young veterans and the Committee believes
it is critical that we continue to support research on non-pharmacological treatments to ensure the best quality of care for our Nation’s veterans and servicemembers. The Committee urges NIH,
VA, and DOD to continue to expand this research. The Comprehensive Addiction and Recovery Act (Public Law 114–198) calls for an
expansion of research and education on and delivery of complementary and integrative health to veterans. NCCIH can play an important role in coordinating efforts with VA, DOD, and other relevant
agencies.
NATIONAL INSTITUTE ON MINORITY HEALTH AND HEALTH DISPARITIES

$335,812,000
305,498,000
391,747,000

The Committee recommendation includes $391,747,000 for the
National Institute on Minority Health and Health Disparities
[NIMHD].
Chronic Diseases and Health Disparities.—In fiscal year 2020,
NIH launched initiatives to address chronic diseases and health
disparities in the areas of diabetes, kidney disease, and obesity.
Chronic diseases and conditions are among the most common, costly, and preventable of all health conditions and disproportionately
affect minority populations. These diseases can often leave those
suffering from them more vulnerable to other diseases. While the
Committee is pleased with the initiatives undertaken by NIDDK,
a more comprehensive and holistic effort is needed to ensure that
efforts to better address health disparities and co-morbidity encapsulate the full continuum of chronic diseases and their lethality in
disparate communities. To this end, the Committee has included
sufficient funding for NIMHD, working in concert with NIDDK,
NHLBI, NCI, and NCATS, to establish a comprehensive center initiative aimed at a wide variety of chronic diseases and their links

109
to health disparities. As these diseases are often multi-faceted and
often regionally linked, NIMHD is encouraged to consider funding
mechanisms that would support regional multi-institutional consortiums that produce collaboration, research, and translational
science on a wide and broad scale.
Focal Segmental Glomerulosclerosis [FSGS].—The Committee
notes the continued commitment of NIMHD in researching health
disparities. The Committee continues to encourage collaboration
with other ICs and stakeholders to expand research opportunities
on the APOL1 gene that causes African Americans and Latinos to
be disproportionately affected by FSGS.
Hispanic/Latino Junior Faculty Research Accelerator.—The Committee encourages NIMHD to consider a Hispanic/Latino Junior
Faculty Research Accelerator program to support efforts related to
scientific workforce diversification. A program could help ensure
better health outcomes and reduce healthcare disparities affecting
the Hispanic/Latino community, as well as the various heritage
groups classified as Hispanic/Latino.
Research Centers in Minority Institutions [RCMIs].—This Committee recognizes the important role of the RCMI Program in developing the infrastructure required to enhance biomedical research conducted at historically minority serving institutions. This
infrastructure is critical to supporting the development of new investigators and sustaining an established workforce to conduct
world-class biomedical research that emphasizes the advancement
of minority health and the reduction of health disparities through
basic research in disease areas impacting minority communities at
abnormally high rates, as well as behavioral and clinical research
in these same areas. Therefore, the Committee includes no less
than the fiscal year 2020 level for RCMIs. The Committee also recognizes the importance of the RCMI Translational Research Network in ensuring that collectively institutions can engage in multisite collaborative research.
JOHN E. FOGARTY INTERNATIONAL CENTER FOR ADVANCED STUDY IN
THE HEALTH SCIENCES

$80,827,000
73,531,000
83,460,000

The Committee recommendation includes $83,460,000 for the
Fogarty International Center [FIC].
NATIONAL LIBRARY OF MEDICINE

$456,911,000
415,665,000
471,789,000

The Committee recommends $471,789,000 for the National Library of Medicine [NLM]. Of the funds provided, $4,000,000 is for
the improvement of information systems, to remain available until
September 30, 2022.

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NATIONAL CENTER FOR ADVANCING TRANSLATIONAL SCIENCES

$832,888,000
787,703,000
890,009,000

The Committee recommendation includes $890,009,000 for the
National Center for Advancing Translational Sciences [NCATS].
The Committee includes bill language allowing up to $60,000,000
of this amount to be used for the Cures Acceleration Network
[CAN].
Clinical and Translational Science Awards [CTSA].—The Committee provides $596,967,000, an increase of $18,826,000, and encourages NCATS to fund, through the existing CTSA hubs, expanded programs that address the disparities and significant burden of disparities, the significant burden of diseases, and other conditions that disproportionally 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.
Collaboration with Business Incubators.—The Committee urges
NCATS to explore potential collaborations or funding opportunities
with business incubators that host small to mid-size science, research, and pharmaceutical companies that use service-based approaches to nurture and guide the member companies to success.
The Committee believes that such collaborations offer an effective
way to advance translational science and meet the NCATS mission
to deliver more treatment to more people faster. Priority consideration should be given to nonprofit life science incubators with a
track record of success in new drug discovery, biomarker discovery,
and translational biotechnology with common research themes.
Full Spectrum of Medical Research.—The Committee applauds
NIH efforts to support and advance the full spectrum of medical research, which ensure breakthroughs in basic science are translated
into therapies and diagnostic tools that benefit patient care while
disseminating cutting-edge information to the professional community. The Committee notes the importance of flagship initiatives,
including the CTSA program, to these important efforts.
Gene Vector Initiative.—The Committee recognizes the importance and promise of gene therapy in developing new treatments
for a number of diseases and conditions. The Committee provides
$30,000,000 to NCATS to expand ongoing gene vector initiatives by
creating a Consortium for Innovation in Large-Scale Gene Vector
Production where NCATS, along with other partners, can address
specific translational roadblocks to vector production. The proposed
Consortium will develop innovative technologies to increase the efficiency of vector production, therapeutic effects, and clinical trial
design, with the goal of maximizing the number of patients who
benefit from gene therapy.
Rare Cancer Therapeutic Research.—Approximately one in four
adult cancers, and all childhood cancers, are considered rare cancers, and account for approximately 25 percent of cancer deaths
each year. The Committee encourages both NCATS and NCI to

111
continue to collaborate and to continue to inform the development
of treatments for rare cancers to help patients who often have limited options.
OFFICE OF THE DIRECTOR

$2,252,387,000
2,099,063,000
2,390,659,000

The Committee recommendation includes $2,390,659,000 for the
Office of the Director [OD]. Within this total, $646,912,000 is provided for the Common Fund and $12,600,000 is included for the
Gabriella Miller Kids First Research Act (Public Law 113–94).
Advanced Collaborative Robots in the Health Care Setting.—The
Committee encourages NIH to support research on advanced
robotic and automation technologies to help nurses complete remote physical tasks for patients affected by infectious diseases and
to limit caregivers’ exposure and/or reduce burden on the
healthcare system. Also, this technology could be used for novel
neuroadaptive learning control to offer physical assistance for fall
prevention, pain assessment, and pain management for patients.
All of Us Precision Medicine Initiative.—The Committee includes
$500,000,000 in fiscal year 2021, making up for the $40,000,000 decrease in 21st Century Cures Act (Public Law 114–255) funding for
the program this year.
Amyotrophic Lateral Sclerosis [ALS].—To leverage the research
work done thus far in a meaningful way and make measurable
progress towards a cure for ALS patients, the Committee believes
it is necessary to bring together researchers to capitalize on recent
advancements, augment existing efforts by bringing into the fight
against ALS leading researchers from other far more developed disciplines, and expedite the drive towards a cure the ALS community
so desperately needs. The Committee encourages NIH to
incentivize the continued exploration of novel therapeutic pathways
and support additional clinical trials, thereby ensuring that the
progress of the last decade can germinate into cures with the next
decade.
Artificial Intelligence [AI].—The Committee is encouraged by
NIH’s efforts to leverage the revolution in data analysis to maximize the return on the vast amounts of data the agency and its
grantees produce. Advancing life sciences is increasingly dependent
on data computation and infrastructure, machine learning [ML],
and collaborative scientific initiatives. The Committee commends
NIH for leveraging the potential of ML to accelerate the pace of
biomedical innovation, especially in NCI, NIGMS, NIMH, NIBIB,
NHGRI, and NLM. NIH has taken important steps through such
efforts as its BRAIN and All of Us initiatives to develop experience
and build capacity. The Committee commends the Office of Data
Science Strategy [ODSS], for collaborating with NLM to ensure
new research datasets meet the international Fast Healthcare
Interoperability Resources [FHIR] standard requirements, developing principles for consent, and providing opportunities for data
experts to work in the field of biomedicine. Making full use of these
opportunities, which rely on scale and collaboration across areas of
expertise, presents unique challenges to NIH. The Committee in-

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cludes $25,000,000 in targeted funding to bridge the gap between
the biomedical and computer science communities to maximize the
promise of AI in fiscal year 2021. The Committee encourages ODSS
to coordinate NIH activities on ethics, bias, and training in the context of AI and ML, as well as continue its work to increase the
adoption and use of existing data standards and improve data discovery. ODSS is also encouraged to create AI-ready data sets and
algorithms, with robust metadata and standards, and with explainable guidelines transparently addressing ethics and bias. There is
a growing consensus in the research community that more training
is needed for the use of FHIR in clinical and biomedical research,
and the Committee encourages expanded training, including for
underrepresented and underserved groups. The Committee requests that NIH provide an update to the Committee on its reaction to the ACD’s recommendations, and where there is agreement,
its plans in fiscal years 2021–2022 to implement those recommendations no later than 90 days after enactment of this act.
Further, NIH should closely examine ways it can facilitate participation by more universities in the national AI effort. In particular,
should university consortia establish one or more regional supercomputing centers, NIH should seek ways to leverage this investment to augment in-house supercomputing capability and continue
to leverage existing cloud computing resources to partially meet its
rapidly expanding computational needs. This would allow NIH to
have more supercomputing capacity available in the near-term to
meet some of its emerging AI computational-intensive requirements and address biomedical research computational requirements not being satisfied today. Finally, the Committee supports
AI, modeling, and simulation at supercomputing scale to respond
to epidemics to include global disease detection, transmission methods, public health data surveillance and analytical infrastructure,
diagnosing the disease, and developing countermeasures for prevention and treatment, infection control and mitigation, faster development and manufacturing of vaccines, therapeutics, and
diagnostics to prevent or treat the virus, and combatting antimicrobial resistance and antibiotic resistant bacteria as a result of
secondary infections. The Committee encourages CDC, NIH, and
BARDA to maximize use of the national supercomputing capabilities in other Federal agencies.
Autism.—The Committee encourages NIH to continue to aggressively invest in research on autism consistent with the recommendations and objectives outlined in the Interagency Autism
Coordinating Committee’s Strategic Plan. The Committee 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.
Biomedical Research Facilities.—Much of the Nation’s biomedical
research infrastructure, including laboratories and research facilities at academic institutions and nonprofit research organizations,
is outdated or insufficient. For taxpayers to receive full value from
their considerable investments in biomedical research, scientists
must have access to appropriate research facilities. Therefore,
$50,000,000 is provided for grants to public, nonprofit, and not-for-

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profit entities to expand, remodel, renovate, or alter existing research facilities, or to construct new research facilities as authorized under 42 U.S.C. section 283k. The Committee urges NIH to
consider recommendations made by the NIH Working Group on
Construction of Research Facilities, including making awards that
are large enough to underwrite the cost of a significant portion of
newly constructed or renovated facilities.
BRAIN Initiative.—The Committee continues to strongly support
the BRAIN initiative and provides $500,000,000, making up for the
$20,000,000 decrease in NINDS and the $20,000,000 decrease in
NIMH from the reduction in funding from the 21st Century Cures
Act (Public Law 114–255). One of the greatest goals of the 21st
century is to understand the structure and function of the human
brain. As the seat of consciousness and cognition, the brain presents unique challenges to the fields of science and medicine, especially given disorders of the brain such as Alzheimer’s disease, addiction, and depression, which represent an enormous cost to the
American people. Because great progress has been made as a direct
result of projects funded by the BRAIN Initiative, the recent
BRAIN Initiative Advisory Committee 2.0 report noted that ‘‘transformative projects’’ are now possible at a scale and level of completeness that were previously not imaginable. The five transformative projects outlined in the scientific report, including the
Cell Type-Specific Armamentarium for Understanding Brain Function and Dysfunction, the Human Brain Cell Atlas, and the Brain
Connectivity Map, serve as examples of projects that could generate data that would provide the clearest view possible of the
human brain, and be the foundation upon which the future of neuroscience will depend. To be successful, transformative projects will
require focused, large-scale efforts with multidisciplinary teams
and capabilities spanning biological sciences, engineering, and data
storage and computation, with open platforms for dissemination of
the tools and knowledge realized through these projects. Therefore,
the Committee requests that NIH move forward with plans for
transformative projects and report to the Committee within 90
days of enactment specific steps taken to advance each project.
Cannabis Research.—The Committee believes that cannabidiol
[CBD] and cannabigerol [CBG], compounds found in cannabis, may
provide beneficial medicinal effects. However, there is insufficient
scientific information about the long-term effects of these compounds. Additional, coordinated research on a national scale could
help determine the toxicology and medicinal effects of CBD and
CBG. The Committee encourages NIH to consider additional investment in studying the medicinal effects and toxicology of CBD
and CBG including clinical trials.
Chimpanzee Maintenance Care and Transportation.—The Committee is aware that NIH has a statutory duty under the CHIMP
Act (Public Law 106–551) to retire eligible chimpanzees to the national sanctuary system. It is important to note that chimpanzees
assessed to be terminally ill or exhibiting the symptomatic final
stages of life should not be relocated and those chimpanzees should
be allowed to age in place, consistent with the Chimpanzee Health
Categorization Framework. The Committee encourages NIH to reconsider transport of Alamogordo Primate Facility [APF] eligible

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chimpanzees to Chimp Haven, consistent with NIH’s responsibility
under all Federal animal welfare laws. Movement of governmentowned and supported eligible chimpanzees from Southwest National Primate Research Center [SNPRC] and Keeling Center for
Comparative Medicine and Research [KCCMR] should follow transport of the APF eligible chimpanzees to Chimp Haven. The Committee also expects NIH to provide a written report to the Committee every 180 days, beginning no later than December 31, 2020,
that shall include: (1) the number of chimpanzees transported to
the national sanctuary over the last quarter; (2) a census of all government-owned and supported chimpanzees remaining, if any, at
APF, SNPRC or KCCMR; and (3) a list of any chimpanzee deaths
that have occurred at any time after January 1, 2020, at either
APF, SNPRC, KCCMR, or the national sanctuary system.
Chronic Fatigue Syndrome [ME/CFS].—The Committee commends NIH on its ongoing ME/CFS efforts, including the unanimous adoption of the National Advisory Neurological Disorders and
Stroke [NANDS] Council Working Group report by the full NANDS
Council, the ‘‘Thinking the Future: A Workshop for Young/Early
Career ME/CFS Investigators’’ and the continued investment in the
Collaborative Research Centers Consortium. The Committee remains concerned that these initiatives are not making progress fast
enough to meet the urgent needs of millions of American adults
and children suffering with ME/CFS today. The Committee encourages NIH to accelerate and expand efforts for ME/CFS, such as: (1)
accelerating the progress of the NIH ME/CFS Intramural Study by
publishing and sharing data; (2) issuing new ME/CFS disease specific funding announcements; (3) coordinating an initiative to develop consensus on the selection criteria for study participants involved in ME/CFS research; and (4) implementing mechanisms to
incentivize new and early career researchers to enter and contribute data to the ME/CFS scientific field.
Continuous Physiologic Electronic Monitoring.—The Committee
directs NIH to conduct research to examine the efficacy and benefits of continuous physiologic electronic monitoring that measures
adequacy of respiration of patients taking opioids in the hospital.
Department of Energy [DOE]-NIH Partnership for Radiopharmaceutical Production and Use.—The Committee encourages NIH to
explore novel applications for radiopharmaceuticals and leverage
next-generation advanced manufacturing techniques for isotope
production being made by DOE-funded research universities and
National Laboratories.
Dual Purpose/Dual Benefit Research.—The Dual Purpose with
Dual Benefit Research Program in Biomedicine and Agriculture
Using Agriculturally Important Domestic Species was a recently
sunsetted interagency grant program funded by United States Department of Agriculture National Institute of Food and Agriculture
[NIFA] and NIH. Both NIFA and NIH are commended for developing this important interagency program that enhanced the use of
farm animals as research models and resulted in scientific breakthroughs tangibly benefiting both animal agriculture and human
health. As authorized and encouraged in the 2018 Farm Bill (Public Law 115–334, section 7404), the Committee strongly urges a
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Federal research and development agencies to develop a next generation interagency program using agriculturally important large
animal species. Domesticated farm animals are recognized as a
strongly relevant dual purpose model that can be employed to understand the complex problems/challenges in both agriculture and
biomedicine. Those problems/challenges include, but are not limited
to, immunity and infection, nutrition and neonatal health,
microbiome and health, assisted reproductive technologies and
pregnancy health, developmental origins of adult health and disease, and development and testing of new diagnostic, genetic, and
cell based therapies to identify and treat diseases/disorders. The
Committee strongly supports continuation of this important cooperative program to further strengthen ties between human medicine,
veterinary medicine, and animal sciences, with the goal to improve
animal and human health and provide enhanced applicability and
return on investment in research.
Duchenne Muscular Dystrophy Research Models.—In recent
years, more Duchenne drug trials have failed than succeeded despite promising results from pre-clinical animal models. These results lead to years of inefficient drug development and few approved treatments. The Committee urges NIH to convene a multistakeholder workshop to evaluate pre-clinical animal models used
frequently in Duchenne treatment research and to consider whether alternative models or strategies may improve therapy development outcomes.
7q11.23 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 prioritize funding to
expand research on rare genetic and chromosomal abnormalities
such as 7q11.23 duplication syndrome. The Committee requests an
update on these activities in the fiscal year 2022 CJ.
Eating Disorders.—The Committee commends NIH for supporting multi-Institute research on the chronic, fatal, and serious
mental illnesses encompassing eating disorders that affect
30,000,000 Americans during their lifetimes, and its association
with other conditions such as diabetes, infertility, heart disease,
post-traumatic stress disorder, substance use, polycystic ovary syndrome, and tooth decay. The Committee recognizes that eating disorders are a deadly bio-psycho-social illness and that multiple research topics must be explored to understand, prevent, and treat
eating disorders, including psychosocial issues; health disparities
and food insecurity; environmental factors such as weight stigma;
the complex interplay of metabolic processes; and maternal health.
The Committee encourages NIH to continue to support a multi-Institute approach and to report on current research efforts related
to the prevention, diagnosis, and treatment of eating disorders in
the fiscal year 2022 CJ.
Environmental Influences on Child Health Outcomes [ECHO].—
The Committee provides $180,000,000, the same level as fiscal year
2020, for the ECHO program. The OD is directed to provide an update in the fiscal year 2022 CJ on progress made by ECHO-funded
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Fetal Tissue.—The Committee directs OD to provide an update
in the fiscal year 2022 CJ detailing how alternatives to fetal tissue
acquired after an elective abortion can be used in fetal tissue research. Specifically, the CJ should detail how the use of donated
tissue from a spontaneous abortion (miscarriage) or stillbirth would
impact fetal tissue research.
Firearm Injury and Mortality Prevention Research.—The Committee includes $12,500,000, the same level as fiscal year 2020, to
conduct research on firearm injury and mortality prevention. Given
violence and suicide have a number of causes, the Committee recommends NIH 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 is to report to the Committee
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.
Forecasting and Modeling Partnerships for Countering Infectious
Diseases.—The Committee believes that emerging viral threats
highlight the need for innovative and real-time forecasting and
modeling techniques to ensure the United States is best positioned
to respond to emerging public health threats. The Committee encourages NIGMS and FIC to continue to support emerging infectious disease forecasting and modeling methods and monitoring
data developed by university and private partners. The Committee
encourages NIGMS and FIC to prioritize funding and explore partnerships to improve our ability to respond to public health and national security threats through emerging infectious disease modeling and forecasting.
Foreign Threats to Research.—The Committee remains concerned
about foreign threats to the research infrastructure in the United
States and supports the efforts by NIH, HHS, and the Inspector
General to combat this threat. In particular, the Chinese government continues 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, NIH, and the Inspector General continue to investigate the impact the Thousand Talents and other foreign government programs have had on the NIH research community, the Committee expects to be notified quarterly on the progress
of the investigation, as well as institutions, scientists, and research
affected. NIH reported in June 2020 that of the 189 scientists at
87 institutions investigated by NIH, 93 percent received undisclosed support from the Chinese government. Approximately threequarters of those under investigation had active NIH grants, and
nearly half had at least two grants. Further, approximately 70 percent of the researchers failed to disclose to NIH the receipt of a foreign grant, and 54 percent had failed to disclose participation in a
foreign talent program. The Committee appreciates the partnership
between NIH and HHS’ Office of National Security [ONS] on this

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issue and ONS’s implementation of a formal NIH CI/Insider Threat
program on NIH’s behalf. The Committee believes this work should
be expanded in fiscal year 2021 and directs NIH to allocate no less
than $5,000,000 for this work that ONS does on behalf of NIH. In
addition, the Committee continues to direct NIH, in bill language,
to provide $5,000,000 to the Inspector General to continue additional investigations and review into the issue.
Fragile X.—The Committee commends NIH for completing the
Strategic Plan for Research on FMR1–Related Conditions. The
Committee notes the importance of expanding the base of researchers and clinicians who are familiar with and trained in the Fragile
X-associated disorders and promoting collaboration between basic
scientists and clinicians to enable researchers to better understand
phenotypes, document variations in how the disorder presents
itself, identify potential biomarkers and outcome measures, and develop new interventions. The Committee also commends NIH for
recognizing the ethical, legal, and social issues in permutation
screening and testing and encourages NIH to look at existing pilot
studies that are looking at innovative ways to screen newborns,
and to remain in close communication with the CDC about their efforts and research as they look at screening solutions for FMR1-related conditions.
Gabriella Miller Kids First Research Act (Public Law 113–94).—
The Committee continues to provide $12,600,000 to support the
seventh year of the 10-year pediatric research initiative.
Generalized Arterial Calcification of Infancy.—The Committee
notes the importance of rare disease research and the NIH Clinical
Center, including the natural history study on Generalized Arterial
Calcification of Infancy.
Governmentwide Collaborations.—NIH, VA, and DOD collaborate
frequently and successfully on various research activities. The
Committee looks forward to the report in the fiscal year 2022 CJ
focusing on the cooperative and strategic approach the agencies
take in areas of biomedical research that overlap to maximize the
potential of the research.
Headache Disorders.—The Committee recognizes: (1) that migraine is the second leading cause of global disability; and (2) that
migraine and other headache disorders are poorly responsive to
opioids, but that these drugs are often inappropriately prescribed
for these disorders. Under the HEAL Initiative, NIH recently
issued funding opportunity announcements for research relevant to
all types of pain, including migraine and headache disorders, and
a few specific announcements that focus specifically on increasing
research on back pain and hemodialysis-related pain. The Committee strongly urges the Director of NIH to consider funding applications on fundamental, translational, and clinical research on
headache disorders, including migraine, post-traumatic headache,
the trigeminal autonomic cephalalgias, and intracranial hypo/hypertension that align with the HEAL Initiative’s goal to achieve
rapid and long-lasting solutions to the opioid crisis.
IDeA States Pediatric Clinical Trials Network [ISPCTN].—The
Committee recognizes that pediatric research requires focus on the
special needs of neonates, infants, children, and adolescents across
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atric research has been and continues to be an NIH priority. The
Committee commends NIH for establishing the ISPCTN to provide
medically underserved and rural populations with access to stateof-the-art 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 Committee provides no less than the fiscal year 2020 level to continue the ISPCTN program.
Induced Pluripotent Stem Cell [iPSC].—The Committee continues
to stress iPSC technology as a critical tool in the realm of personalized medicine. The Committee notes that iPSCs are derived from
adults or skin-sourced biopsies, providing increased opportunities
to tailor human medicine, reduce clinical trial costs, and pre-screen
for patient-specific efficacy. The Committee encourages NIH to support the translation of iPSC research into new therapeutics,
diagnostics, and cures. The Committee is especially concerned that
a funding gap between basic science and clinical trials may hinder
the timely discovery of treatments for a wide range of diseases that
currently lack clinical solutions. Accordingly, the Committee urges
NIH to support translational research, as well as to promote regional, collaborative consortiums to advance scientific knowledge in
the area of iPSC basic research. The Committee further requests
that NIH: (1) prioritize efforts to strengthen the connection between basic science and clinical trial research; and (2) identify additional opportunities for translational research. The Committee
expects an update regarding these specific areas in the fiscal year
2022 CJ.
Inflammatory Bowel Disease [IBD].—The Committee commends
NIH for leading cross-Institute initiatives focused on nutrition, including a Strategic Plan for Nutrition Research and a precision nutrition initiative within the NIH Common Fund. To advance these
efforts with a focus on inflammatory bowel disease and related
chronic inflammatory autoimmune diseases, the Committee encourages multiple Institutes and Centers to focus on current and
emerging IBD disease research priorities, including the impact of
diet/nutrition on mucosal immunity, the impact of nutrition on the
mind-gut relationship, and the role of the gut in underlying mechanisms of disease.
Intellectual Property.—The Committee encourages the NIH Director to work with the HHS Assistant Deputy Secretary for National Security to improve the security of intellectual property derived from NIH-funded research. In particular, NIH is encouraged
to: (1) improve the security of the peer review system; (2) augment
the application process to ensure applicants properly identify funding received from foreign government entities (governments, organizations, and components); and (3) assist the HHS Inspector General and appropriate law enforcement agencies to identify and investigate potential violations of U.S. law or policy.
Mitochondrial Disease Research Coordination.—The Committee
is aware that NIH has spearheaded a number of initiatives to identify new mitochondrial disorders, discover the linkages between
mitochondrial disorders, and translate advances in mitochondrial
research to treatments, cures, and other medical interventions for
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heimer’s disease, Parkinson’s disease, and cancer. The Committee
is supportive of NIH’s efforts through the formation of the North
American Mitochondrial Disease Consortium and its associated
registry, as well as coordination among NIH Institutes, to support
the Mitochondrial Disease Sequence Data Resource Consortium,
which serves as a robust central repository for genomic sequencing
data for mitochondrial disorders. Given the advancements seen
through peer-reviewed research into mitochondrial disorders, the
Committee urges NIH to expand its research through available
mechanisms. In addition, the Committee is aware that multiple
Federal agencies and outside stakeholders are invested in
mitochondrial disorder research, including CDC, FDA, DOD, and
the patient advocacy and medical research communities, among
others, many of which participated in scientific workshops held in
2018 and 2019. The Committee requests that NIH provide an update in the fiscal year 2022 CJ on areas of cooperation and collaboration regarding mitochondrial disorder research.
Mucopolysaccharidosis [MPS].—MPS causes progressive damage
to the bones, heart, respiratory system, and brain. The Committee
continues to urge NIH, NCATS, and NINDS to put a high priority
on better understanding and treating MPS and mucolipidosis diseases. The Committee commends NIH for funding research to discover, develop, define, and make animal models available for research of human genetic disease. The Committee encourages expanded research of treatments for neurological, inflammatory, cardiovascular, and skeletal manifestations of MPS, with an emphasis
on gene therapy. The Committee thanks NINDS, NIDDK, and
ORDR for again funding the Lysosomal Disease Network through
the Rare Disease Clinical Research Network and for funding
lysosomal research meetings. The Committee encourages NIH, specifically NCATS and NINDS, to incentivize MPS research, particularly given the aging and small population of current researchers.
Understanding the manifestations and treatments of both the skeletal and neurological disease continues to be the greatest areas of
unmet need.
National Commission on Lymphatic Diseases.—The Committee
encourages NIH to work with relevant stakeholders to establish a
National Commission on Lymphatic Diseases or another appropriate mechanism that will make critical recommendations on coordinating NIH-wide lymphatic disease research. The Committee
requests an update in the fiscal year 2022 CJ on efforts to improve
the visibility of the lymphatic disease portfolio across the NIH.
Neurodegenerative Disorders in Diverse Populations.—In the context of NIH’s robust neurological disease research portfolio, the
Committee commends the leadership of NIH in advancing the relevant objectives of the 21st Century Cures Act (Public Law 114–
255) and the BRAIN Initiative. The Committee is concerned about
and recognizes the need to better understand the interactions between genetic and environmental factors, in particular with older
adults and diverse populations of African Americans and Latinos.
The Committee encourages NIH to accelerate collaborative research across relevant Institutes and the research community to
address the goal of determining the role of the interaction between
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impact on neurodegenerative disorders in diverse populations of African Americans and Latinos, to allow for earlier diagnosis and
subsequent treatment to arrest the progression of these devastating neurodegenerative disorders.
Neurofibromatosis [NF].—The Committee supports efforts to increase funding and resources for NF research and treatment at
multiple Institutes, including NCI, NINDS, NIDCD, NHLBI,
NICHD, NIMH, NCATS, and NEI. Children and adults with NF
are at significant risk for the development of many forms of cancer;
the Committee encourages NCI to continue to support a robust NF
research portfolio in fundamental laboratory science, patient-directed research, and clinical trials focused on NF-associated benign
and malignant cancers. Because NF causes brain and nerve tumors
and is associated with cognitive and behavioral problems, the Committee urges NINDS to continue to aggressively fund fundamental
basic science research on NF relevant to nerve damage and repair.
Based on emerging findings from numerous researchers worldwide
demonstrating that children with NF are at significant risk for autism, learning disabilities, motor delays, and attention deficits, the
Committee encourages NINDS, NIMH, and NICHD to continue to
support their investments in laboratory-based and patient-directed
research investigations in these areas. Since NF2 accounts for some
genetic forms of deafness, the Committee encourages NIDCD to
continue its investment in NF2 basic and clinical research. Since
NF1 can cause vision loss due to optic gliomas, the Committee encourages NEI to expand its investment in NF1 basic and clinical
research.
Pediatric Clinical Trials Authorized under Best Pharmaceuticals
for Children Act.—The Committee directs that funding authorized
by the Best Pharmaceuticals for Children Act (Public Law 107–109)
include research to prepare for and conduct clinical trials.
Platform Technologies.—The Committee is encouraged by the
growing body of evidence demonstrating the critical role that platform technologies play in accelerating the pace of biomedical innovation and improving our ability to prevent disease and disability.
The Committee previously directed NIH to consider new approaches and potential for increasing funding mechanisms for development of these crosscutting technologies that impact many NIH
Institutes and mission areas.
Post-Research Adoption of Animals in Research.—The Committee
commends NIH and other agencies for instituting policies and procedures to facilitate the placement of animals no longer needed for
research. However, the Committee is concerned about creating additional regulatory burden and prescriptive requirements for extramural research facilities across the country. While the Committee
encourages NIH to develop non-binding guidelines, such as the Research Dogs and Cats Adoption Policy of the American Veterinary
Medical Association for extramural research facilities, the Committee remains concerned about the potential financial impact of
an unfunded mandate imposed on the facilities with mandatory
‘‘one size fits all’’ adoption policies. The Committee requests that
NIH provide a written update on these items in the fiscal year
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Postural Orthostatic Tachycardia Syndrome [POTS].—The Committee requests an update on the recent NIH report ‘‘Postural Orthostatic Tachycardia Syndrome: State of the Science, Clinical
Care, and Research,’’ which was submitted to the House and Senate Appropriations Committees on January 31, 2020. While NIH
did convene a distinguished group of POTS experts in July 2019,
many critical questions and knowledge gaps remain regarding the
causes and mechanisms of POTS and potentially effective treatments. The Committee encourages NIH to continue a dialogue with
the POTS experts who attended the June 2019 NIH meeting regarding the evolving state of science on POTS. The Committee directs NIH to: (1) update the January 31, 2020, report after further
consultation with POTS experts and submit a revised report to the
Committee; (2) implement the research priorities described in the
revised report; and (3) provide a progress update to the Committee
90 days after enactment documenting progress towards implementation.
Pre-clinical Research.—The Committee recognizes that pre-clinical research is an essential part of the translational research pathway and drug discovery process. To take full advantage of essential
resources that include a state-of-the-art cyclotron located on the
premises for translational, pre-clinical research, and infrastructure
conducive to developing novel radiopharmaceuticals and imaging
markers, the Committee encourages NIH to prioritize pre-clinical
research utilizing molecular imaging.
Primate Research.—The Committee recognizes the importance of
nonhuman primates in biomedical research in America for developing vaccines and treatments for public health threats. The Committee remains concerned about efforts to mandate the reduction of
nonhuman primate models in both intramural and extramural research while Congress has simultaneously mandated research that
requires these models. Further, the Committee has concerns about
the long-term availability and transportation issues regarding
nonhuman primates that is putting American biomedical research
in jeopardy. Accordingly, the Committee directs that NIH provide
a written update on the critical necessity of nonhuman primates to
biomedical research, specific areas of research in which nonhuman
primates are used, and how NIH plans to address future availability and transportation of this critical model in the fiscal year
2022 CJ.
Research Transparency.—As demonstrated over the past 6 years,
the Committee remains committed to funding NIH research and
ensuring that our nation’s researchers, particularly our young scientists, have the support to make the scientific breakthroughs that
may transform healthcare. However, it is critical that NIH can ensure funds are used for the best possible research that fulfill the
core research mission of NIH. Therefore, NIH is directed to justify,
in writing and make available on a publicly accessible website, that
each grant or agreement promotes efforts to seek fundamental
knowledge about the nature and behavior of living systems and/or
the application of that knowledge to enhance health, lengthen life,
and reduce illness and disability.
Scientific Workforce Diversity.—The Committee encourages NIH
to expand efforts to diversify its scientific workforce. The Com-

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mittee urges the Director to increase the participation of underrepresented minority researchers and continue its support of underrepresented junior faculty in research programs.
Spina Bifida.—The Committee 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 sudden
death in the adult Spina Bifida population; to invest in understanding the myriad co-morbid conditions experienced by individuals with Spina Bifida, including those associated with both paralysis and developmental delay; and provide an update on research
related to Spina Bifida in the fiscal year 2022 CJ. The Committee
supports the specific efforts of NICHD to understand early human
development; set the foundation for healthy pregnancy, and lifelong
wellness of women and children; and promote the gynecological,
andrological and reproductive health for people with Spina Bifida.
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 for adults, as well as children.
Study to Assess Feasibility and Impact of Wound Care Center of
Excellence.—Chronic wound care—from common ulcers, bedsores,
and related issues to complicated wounds—costs billions of dollars
to the U.S. healthcare system every year. These problems are especially problematic in patients whose healing outcomes are complicated or prolonged by other health factors such as diabetes,
cardio-vascular disease, obesity, and old age. The cost of chronic
wound care to the American taxpayer and healthcare system is
high, but often underappreciated—and a study of the issue to eventually reduce costs of care and improve outcomes is needed. Therefore, the Committee urges NIH to examine and consider the feasibility, value, and positive impact of a research facility or center of
excellence dedicated to the study of chronic wound care in America.
Swine Research.—The Committee is aware of the growing value
of large animal models for use in expediting the translation of basic
research to find cures and new therapeutics for many human diseases. Pigs are an ideal animal model for human health and disease research given the similarities to their anatomy and physiology to humans. Additionally, their genomic structure is three
times closer to that of humans than is the mouse genome. The
Committee strongly encourages NIH to elevate the pig to model organism status. In addition, NIH should identify how Institutes can
evaluate the appropriateness of swine as a model for disease or system specific investigation. The Committee directs OD to include an
update on the progress of elevating the pig to model organism status in the fiscal year 2022 CJ.
Trisomy 21.—The Committee commends NIH for its continuing
support of the Investigation of Co-occurring conditions across the
Lifespan to Understand Down Syndrome Initiative. The Committee
expects that this multi-year, trans-NIH research initiative may advance scientific discoveries that will dramatically improve the
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well as millions of typical individuals. The Committee requests the
Director provide a plan within 60 days of enactment of this act that
includes a timeline description of potential grant opportunities and
deadlines for all expected funding opportunities so that young investigators and new research institutions may be further encouraged to explore research in this space. This plan should also incorporate and increase pipeline research initiatives specific to Down
syndrome. In addition, the Committee encourages this project to
consider research applications related to complementary and integrative health approaches to address co-occurring conditions in individuals with Down syndrome, such as traditional Chinese medicine on development and Applied Behavioral Analysis and Applied
Verbal Analysis on development and language acquisition.
Tuberous Sclerosis Complex [TSC].—The Committee is encouraged by NIH’s updated TSC Research Plan published in 2016 and
progress advancing the plan with both public and private support.
NIH should encourage research opportunities in the five key areas
prioritized by workshop participants: (1) understanding phenotypic
heterogeneity in TSC; (2) gaining a deeper knowledge of TSC signaling pathways and the cellular consequences of TSC deficiency;
(3) improving TSC disease models; (4) developing clinical biomarkers of TSC; and (5) facilitating therapeutics and clinical trials research. Because TSC impacts multiple organ systems, the Committee encourages the Director to coordinate the participation of
multiple ICs on a research strategy aimed at addressing the numerous medical and neuropsychological burdens associated with
TSC while deciphering the biology underlying phenotypic heterogeneity. Manifestations of TSC are highly variable among affected
individuals, and TSC can be a model condition for developing precision medicine approaches to treat each individual’s symptoms to
maximize the benefit-risk ratio. The Committee encourages NICHD
to counsel researchers and other stakeholders to facilitate development of a viable newborn screening assay for TSC. The Committee
encourages the Director to apply recommendations from three recent NIH-sponsored workshops: 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; 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 given the ability to diagnose
TSC prior to onset of epilepsy; and the January 2021 Curing the
Epilepsies workshop, which highlights TSC as one of the best opportunities to prevent epilepsy.
Women’s Health Research Priorities.—The Committee believes
that more focus on research related to obstetrics and gynecology is
required to address the rising maternal morbidity and mortality
rates; rising rates of chronic debilitating conditions in women; and
stagnant cervical cancer survival rates. The Committee encourages
NIH to convene a consensus conference to include representatives
from the Office of Research on Women’s Health, NICHD, and NCI,
as well as any other relevant NIH Institutes and Centers and public stakeholders, to evaluate research currently underway related to
women’s health. As part of the consensus conference, the Com-

124
mittee directs NIH to provide an update in the fiscal year 2022 CJ
that identifies priority areas for additional study to advance women’s health research, including reproductive sciences.
BUILDINGS AND FACILITIES

$425,000,000
300,000,000
429,000,000

The Committee recommendation includes $429,000,000 for NIH
buildings and facilities, including an increase of $229,000,000 from
HHS’ Nonrecurring Expenses Fund. This funding will remain
available for obligation for 5 years.
Last year, the National Academies of Sciences, Engineering, and
Medicine [NASEM] released a report that stated there is a
$1,300,000,000 backlog in capital needs at NIH’s Bethesda Campus. In the fiscal year 2020 bill, the Committee provided
$225,000,000 from HHS’ Nonrecurring Expenses Fund for buildings
and facilities at NIH. In fiscal year 2021, the Committee provides
$229,000,000 from HHS’ Nonrecurring Expenses Fund to finish the
Clinical Center’s Surgery, Radiology, and Laboratory Medicine
project. In addition, the Committee has included new bill language
to allow the Institutes and Centers of NIH to use up to 1 percent
of IC funding for facility maintenance and construction. All 27 IC
Directors have agreed to this funding structure.
The Committee directs NIH to provide a report with the fiscal
year 2022 CJ describing the steps it has and will take to continue
implementation of NASEM’s recommendations. In addition, the
Committee directs NIH to provide biannual updates of its Buildings and Facilities maintenance and construction plans, including
specific milestones for advancing projects, status of the project,
cost, and priorities. These updates should also highlight and explain any potential cost and schedule changes affecting projects.
NIH INNOVATION ACCOUNT, CURES ACT

$157,000,000
109,000,000
109,000,000

The Committee recommendation includes $109,000,000 to be
spent from the NIH Innovation Account for the All of Us program.
The Committee report reflects distribution of the remainder of
funding from the NIH Innovation Account to NCI, NINDS, and
NIMH, and expects NIH to transfer funding shortly after enactment of this act.
NATIONAL INSTITUTE FOR RESEARCH ON SAFETY AND QUALITY

Appropriations, 2020 ............................................................................. ...........................
Budget estimate, 2021 ...........................................................................
256,660,000
Committee recommendation ................................................................. ...........................

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

125
SUBSTANCE ABUSE

AND

MENTAL HEALTH SERVICES ADMINISTRATION

The Committee recommends $5,999,507,000 for the Substance
Abuse and Mental Health Services Administration [SAMHSA]. The
recommendation includes $133,667,000 in transfers available under
section 241 of the PHS Act (Public Law 78–410 as amended) and
$12,000,000 in transfers from the PPH Fund.
SAMHSA is responsible for supporting mental health programs
and alcohol and other drug abuse prevention and treatment services throughout the country, primarily through categorical grants
and block grants to States.
Eligible applicants under SAMHSA’s programs of regional and
national significance [PRNS] authorities include States, political
subdivisions of States, Indian Tribes or tribal organizations, health
facilities, or programs operated by or in accordance with a grant or
contract with the Indian Health Service, and other public or private nonprofit entities. The Committee strongly encourages
SAMHSA to exercise maximum flexibility allowed when developing
funding opportunity announcements to ensure that all eligible applicants are included.
The Committee recommendation continues bill language that instructs the Assistant Secretary of SAMHSA and the Secretary to
exempt the Mental Health Block Grant [MHBG], the Substance
Abuse Prevention and Treatment [SAPT] Block Grant, and the
State Opioid Response Grant from being used as a source for the
PHS evaluation set-aside in fiscal year 2021.
MENTAL HEALTH

$1,676,013,000
1,696,145,000
1,773,024,000

The Committee recommends $1,773,024,000 for mental health
services. The recommendation includes $21,039,000 in transfers
available under section 241 of the PHS Act (Public Law 78–410 as
amended) and $12,000,000 in transfers from the PPH Fund. Included in the recommendation is funding for PRNS, the MHBG,
children’s mental health services, Projects for Assistance in Transition from Homelessness [PATH], Protection and Advocacy for Individuals with Mental Illness [PAIMI], and the National Child Traumatic Stress Initiative.
Programs of Regional and National Significance
The Committee recommends $505,785,000 for PRNS within the
Center for Mental Health Services. The Committee recommendation includes $12,000,000 in transfers to PRNS from the PPH
Fund. These programs address priority mental health needs by developing and applying evidence-based practices, offering training
and technical assistance, providing targeted capacity expansion
grants, and changing the delivery system through family, client-oriented, and consumer-run activities.
Within the total provided for PRNS, the Committee recommendation includes funding for the following activities:

126
[In thousands of dollars]
Budget activity

Fiscal year 2020
appropriation

Committee
recommendation

CAPACITY:
Seclusion & Restraint ............................................................................................
Project AWARE State Grants ..................................................................................
Mental Health Awareness Training ........................................................................
Healthy Transitions ................................................................................................
Children and Family Programs ..............................................................................
Consumer and Family Network Grants ..................................................................
Mental Health System Transformation ..................................................................
Project LAUNCH ......................................................................................................
Primary and Behavioral Health Care Integration ..................................................
National Strategy for Suicide Prevention ..............................................................
Zero Suicide ..................................................................................................
American Indian and Alaska Native ....................................................
Suicide Lifeline .......................................................................................................
GLS—Youth Suicide Prevention—States ..............................................................
GLS—Youth Suicide Prevention—Campus ...........................................................
AI/AN Suicide Prevention Initiative ........................................................................
Homelessness Prevention Programs ......................................................................
Tribal Behavioral Grants ........................................................................................
Minority AIDS ..........................................................................................................
Criminal and Juvenile Justice Programs ...............................................................
Assisted Outpatient Treatment ..............................................................................
Infant and Early Childhood Mental Health ...........................................................
Assertive Community Treatment for Ind. with SMI ...............................................

1,147
102,001
22,963
28,951
7,229
4,954
3,779
23,605
49,877
18,200
18,400
2,200
19,000
35,427
6,488
2,931
30,696
20,000
9,224
6,269
19,000
7,000
7,000

1,147
121,000
23,963
29,951
7,229
4,954
3,779
23,605
49,877
23,200
23,400
2,200
24,000
37,427
6,488
2,931
30,696
20,000
9,224
6,269
24,000
11,000
9,000

SCIENCE AND SERVICE:
GLS—Suicide Prevention Resource Center ...........................................................
Practice Improvement and Training ......................................................................
Primary and Behavioral Health Care Integration TA .............................................
Consumer & Consumer Support TA Centers .........................................................
Minority Fellowship Program ..................................................................................
Disaster Response .................................................................................................
Homelessness .........................................................................................................

7,988
7,828
1,991
1,918
9,059
1,953
2,296

9,000
7,828
1,991
1,918
11,059
1,953
2,296

Garrett Lee Smith Suicide Prevention Resource Center.—The
Committee is encouraged by the significant accomplishments
achieved by the center, which provides support to the National Action Alliance for Suicide Prevention, a public-private partnership
advancing suicide prevention efforts in the United States. The
Committee recommends $9,000,000, a $1,012,000 increase, for the
center which will support the national efforts to advance implementation of the National Strategy for Suicide Prevention.
Infant and Early Childhood Mental Health.—The Committee provides $9,000,000, an increase of $2,000,000, for grants to entities
such as State agencies, Tribal communities, universities, or medical
centers that are in different stages of developing infant and early
childhood mental health services. These entities should have the
capacity to lead partners in systems-level change, as well as building or enhancing the basic components of such early childhood
services, including an appropriately trained workforce. The Committee directs SAMHSA to allow a portion of additional funds provided for technical assistance to existing grantees, to better integrate infant and early childhood mental health into State systems.
Mental Health Awareness Training.—The Committee provides
$23,963,000, an increase of $1,000,000, to continue existing activities, including Mental Health First Aid. Mental Health First Aid
has trained more than 1,000,000 Americans to recognize the signs

127
and symptoms of common mental disorders. With recent support
from the International Association of Fire Chiefs, Mental Health
First Aid has also been implemented by first responders including
local fire departments and emergency medical units. In continuing
competitive funding opportunities, SAMHSA is directed to include
as eligible grantees local law enforcement agencies, fire departments, and emergency medical units with a special emphasis on
training for crisis de-escalation techniques. SAMHSA is also encouraged to allow training for veterans, armed services personnel,
and their family members within the Mental Health Awareness
Training program.
Minority Fellowship Program.—The Committee includes
$11,059,000, a $2,000,000 increase, to support new grants that will
increase the number of culturally competent behavioral health professionals who teach, administer, conduct services research, and
provide direct mental illness services for underserved minority populations.
National Suicide Prevention Hotline.—The Committee provides
$24,000,000, an increase of $5,000,000. The Committee recognizes
the National Suicide Prevention Lifeline’s important role in suicide
prevention and encourages SAMHSA to continue its commitment to
this program. Further, the Committee requests that SAMHSA update its report to the Committees on Appropriations of the House
of Representatives and the Senate within 6 months from the date
of enactment on the level of funding required to meet the needs of
the hotline, to include updated data to assess how the pandemic
has impacted suicide rates and attempts.
Primary and Behavioral Healthcare Integration [PBHCI].—The
Committee does not eliminate the program as requested in the
President’s Budget, but instead provides $49,877,000 for PBHCI to
support communities to coordinate and integrate primary care services into community-based behavioral health settings. PBHCI helps
improve the health outcomes of adults with serious mental illness
who receive integrated screening for co-occurring illnesses like diabetes, coronary heart disease, and high blood pressure. Over the
life of the program, over 200 grantee sites have served more than
114,000 individuals.
Project AWARE.—The Committee provides $121,000,000, an increase of $18,999,000, for Project AWARE. This program increases
awareness of mental health issues and connects young people that
have behavioral health issues and their families with needed services. The Committee encourages SAMHSA to continue using funds
to provide mental health services in schools and for school aged
youth, and provide an update on these efforts in the fiscal year
2022 CJ. Of the amount provided for Project AWARE, the Committee directs SAMHSA to use $15,000,000, an increase of
$5,000,000, for discretionary grants to support efforts in highcrime, 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 2020 grants. SAMHSA is
encouraged to continue consultation with the Department of Education in administration of these grants. The Committee requests
a report on progress of grantees 180 days after enactment.

128
Suicide Lifeline.—The Committee understands SAMHSA has recently added the ability to text to the suicide lifeline. Texting for
individuals experiencing a mental health crisis is important, particularly among young people for whom texting is often a preferable
means of communication to voice calls. As SAMHSA considers expanding this service, the Committee encourages SAMHSA to leverage existing infrastructure to the extent practicable to provide effective counsel to those using the service. SAMHSA is directed to
provide a report to the Committees on Appropriations of the House
of Representatives and the Senate within 180 days of enactment
detailing call and text volume over the past 3 years as applicable.
The report shall also include an assessment of whether other services such as emails, videos, or other digital modes of communications would improve service of the lifeline. The Committee further
urges SAMHSA to provide specific training programs for counselors
to increase competency in serving at-risk youth through the utilization of existing specialized resources.
Suicide Prevention.—The Committee includes $23,200,000, an increase of $5,000,000. The Committee urges SAMHSA to provide
specific training programs for National Suicide Prevention Lifeline
counselors to increase competency in serving high-risk youth
through the utilization of existing specialized resources. The increase is provided for the Zero Suicide initiative, which is a comprehensive, multi-setting approach to suicide prevention that includes applying evidence-based approaches to screening, care protocols, safety planning, treatment, and care continuity during high
risk periods.
Community Mental Health Services Block Grant
The Committee recommends $722,571,000 for the Mental Health
Block Grant. The recommendation includes $21,039,000 in transfers available under section 241 of the PHS Act (Public Law 78–
410 as amended).
The MHBG distributes funds to 59 eligible States and territories
through a formula based on specified economic and demographic
factors. Grant applications must include an annual plan for providing comprehensive community mental health services to adults
with a serious mental illness and children with a serious emotional
disturbance. The Committee encourages SAMHSA to support State
efforts to provide long-acting-injectable medications approved for
the treatment of serious mental illness and assistance to those with
severe mental health needs who are at risk of recidivism.
The Committee recommendation continues bill language requiring that at least 10 percent of the funds for the MHBG program
be set-aside for evidence-based programs that address the needs of
individuals with early serious mental illness, including psychotic
disorders. The Committee commends SAMHSA for its collaboration
with NIMH on the implementation of this set-aside. The Committee notes that it usually takes 14 to 17 years to translate research findings into practice and hopes that the joint effort between NIMH and SAMHSA may be a model for how to reduce this
timeframe. The Committee directs SAMHSA to continue its collaboration with NIMH to ensure that funds from this set-aside are only
used for programs showing strong evidence of effectiveness and

129
that target the first episode of psychosis. SAMHSA shall not expand the use of the set-aside to programs outside of the first episode psychosis. The Committee directs SAMHSA to include in the
fiscal year 2022 CJ a detailed table showing at a minimum each
State’s allotment, name of the program being implemented, and a
short description of the program.
Children’s Mental Health Services
The Committee recommends $125,000,000 for the Children’s
Mental Health Services program. This program provides grants
and technical assistance to support comprehensive, communitybased systems of care for children and adolescents with serious
emotional, behavioral, or mental disorders. Grantees must provide
matching funds and services must be coordinated with the educational, juvenile justice, child welfare, and primary healthcare systems. The Committee continues to include a 10 percent set-aside
for an early intervention demonstration program with persons not
more than 25 years of age at clinical high risk of developing a first
episode psychosis. SAMHSA is directed to work with NIMH on the
implementation of this set-aside.
Projects for Assistance in Transition From Homelessness
The Committee recommends $64,635,000 for PATH, which addresses the needs of individuals with serious mental illness who
are experiencing homelessness or are at risk of homelessness.
Funds are used to provide an array of services, such as screening
and diagnostic services, emergency assistance, case management,
and referrals to the most appropriate housing environment.
Protection and Advocacy for Individuals With Mental Illness
[PAIMI]
The Committee recommends $36,146,000 for PAIMI. This program helps ensure that the rights of mentally ill individuals are
protected while they are patients in all public and private facilities
or while they are living in the community, including in their own
homes. Funds are allocated to States according to a formula based
on population and relative per capita incomes.
National Child Traumatic Stress Initiative
The Committee recommends $68,887,000 for the National Child
Traumatic Stress Initiative, which develops and promotes effective
treatment and services for children and adolescents exposed to a
wide array of traumatic events. The Committee strongly supports
the National Child Traumatic Stress Network for building, evaluating, disseminating, and delivering evidence-based best practices,
including through universities, hospitals, and front-line providers,
to prevent and mitigate the impact of exposure to trauma among
children and families.
Certified Community Behavioral Health Clinics
The Committee includes $250,000,000, an increase of
$50,000,000. The Committee continues to direct SAMHSA to
prioritize resources to entities within States that are able to quickly stand-up a Certified Community Behavioral Health Clinic, in-

130
cluding those part of the section 223(a) of the Protecting Access to
Medicare Act of 2014 (Public Law 113–93) demonstration and to
entities within States that were awarded planning grants.
SAMHSA is directed to coordinate these resources with its efforts
focusing on areas of high incidence of substance use disorders. The
Committee requests an updated report on the program 6 months
after enactment.
SUBSTANCE ABUSE TREATMENT

$3,839,756,000
3,807,756,000
3,859,756,000

The Committee recommends $3,859,756,000 for substance abuse
treatment programs, including PRNS and the substance abuse prevention and treatment block grant to the States. The recommendation includes $81,200,000 in transfers available under section 241
of the PHS Act (Public Law 78–410 as amended).
Programs of Regional and National Significance
The Committee recommends $501,677,000 for PRNS within the
Center for Substance Abuse Treatment. The recommendation includes $2,000,000 in transfers available under section 241 of the
PHS Act (Public Law 78–410 as amended).
PRNS include activities to increase capacity by implementing
service improvements using proven evidence-based approaches, as
well as science-to-services activities that promote the identification
of practices thought to have potential for broad service improvement.
The Committee shifts the Comprehensive Opioid Recovery Centers program from Mental Health PRNS to Treatment PRNS.
Within the total provided for PRNS, the Committee recommendation includes funding for the following activities:
[In thousands of dollars]
Budget activity

CAPACITY:
Opioid Treatment Programs/Regulatory Activities .................................................
Screening, Brief Intervention, amd Referral to Treatment ....................................
Target Capacity Expansion ....................................................................................
Medication-Assisted Treatment for Prescription Drug and Opioid Addiction
(non-add) ..................................................................................................
First Responder Training .......................................................................................
Rural Set-aside .............................................................................................
Grants to Prevent Prescription Drug/Opioid Overdose ..........................................
Pregnant & Postpartum Women ............................................................................
Recovery Community Services Program .................................................................
Children and Families ...........................................................................................
Treatment Systems for Homeless ..........................................................................
Minority AIDS ..........................................................................................................
Criminal Justice Activities .....................................................................................
Drug Courts ...................................................................................................
Building Communities of Recovery ........................................................................
Improving Access to Overdose Treatment .............................................................
Peer Support TA Center .........................................................................................
Emergency Department Alternatives to Opioids ....................................................
Treatment, Recovery, and Workforce Support ........................................................
Comprehensive Opioid Recovery Centers ...............................................................

Fiscal year 2020
appropriation

Committee
recommendation

8,724
30,000
100,192

8,724
30,000
106,192

89,000
41,000
23,000
12,000
31,931
2,434
29,605
36,386
65,570
89,000
70,000
8,000
1,000
1,000
5,000
4,000
2,000

95,000
44,000
24,000
12,000
33,931
2,434
29,605
36,386
65,570
89,000
70,000
10,000
1,000
1,000
7,000
6,000
4,000

131
[In thousands of dollars]
Budget activity

SCIENCE AND SERVICE:
Addiction Technology Transfer Centers .................................................................
Minority Fellowship Program ..................................................................................

Fiscal year 2020
appropriation

9,046
4,789

Committee
recommendation

9,046
5,789

Adolescent Substance Use Screening, Brief Intervention, and Referral to Treatment [SBIRT].—The Committee understands that
substance use disorders, including opioid use, typically begin in
adolescence, and that preventing early substance use is a cost-effective strategy in preventing costly problems later in life. The Committee is also aware that SBIRT has been shown to be a cost-effective model for reducing and preventing underage drinking and
other substance abuse, but that many health providers, especially
pediatricians, have not been trained to use the method effectively.
The Committee encourages SAMHSA to use funds for the adoption
of SBIRT protocols in primary care and other appropriate settings
that serve youth 12 to 21 years of age, as well as on the adoption
of system-level approaches to facilitate the uptake of SBIRT into
routine healthcare visits for adults.
Building Communities of Recovery.—The Committee provides
$10,000,000, an increase of $2,000,000. The Committee appreciates
SAMHSA’s implementation of new funding for community-based
networks assisting individuals with substance use disorder recovery, and encourages SAMHSA to continue supporting recovery support programs principally governed by people in recovery from substance use disorders. The Committee notes that Peer Support Networks focus on long-term, sustainable recovery and incorporate a
full range of services such as case management, counseling, and
community supports. SAMHSA is encouraged to ensure that grants
employing peers comply with the highest standards within their respective States.
Combating Opioid Abuse.—The Committee provides $12,000,000
within PRNS for grants to prevent opioid overdose related deaths.
This program will help States equip and train first responders and
other community partners with the use of devices that rapidly reverse the effects of opioids. The Committee also provides
$44,000,000, an increase of $3,000,000, for First Responder Training grants. Of this amount, $24,000,000, an increase of $1,000,000,
is set aside for rural communities with high rates of substance
abuse. SAMHSA is directed to ensure applicants outline how proposed activities in the grant would work with treatment and recovery communities, in addition to first responders. $5,000,000 of this
funding is to continue awards to rural public and non-profit fire
and EMS agencies to train and recruit staff, provide education, and
purchase equipment (including medications such as naloxone) as
authorized in the Supporting and Improving Rural EMS Needs Act,
included in the Agriculture Improvement Act of 2018 (Public Law
115–334).
Comprehensive Opioid Recovery Centers.—The Committee includes $4,000,000, an increase of $2,000,000, to help ensure that
people with substance use disorders can access proper treatment,

132
as authorized by section 7121 of the SUPPORT Act (Public Law
115–271).
Drug Courts.—The Committee directs SAMHSA to ensure that
all funding for Drug Treatment activities is allocated to serve people diagnosed with a substance use disorder as their primary condition. SAMHSA is further directed to ensure that all drug court recipients work with the corresponding State alcohol and drug agency
in the planning, implementation, and evaluation of the grant. The
Committee further directs SAMHSA to expand training and technical assistance to drug treatment court grant recipients to ensure
evidence-based practices are fully implemented.
Emergency Department Alternatives to Opioids.—The Committee
includes $7,000,000, an increase of $2,000,000, to award new
grants to hospitals and emergency departments to develop, implement, enhance, or study alternatives to opioids for pain management in such settings as authorized in section 7091 of the SUPPORT Act (Public Law 115–271).
Hepatitis.—The Committee is concerned that despite the availability of effective hepatitis A and B vaccines, acute cases of both
infections are increasing rapidly among people who use drugs, resulting in hospitalizations, deaths, and long-term risk of liver cancer development. The Committee encourages SAMHSA to work
with CDC to develop a plan to increase hepatitis A and B vaccinations among people it reaches through overdose prevention and
substance use treatment activities. SAMHSA is further encouraged
to promote awareness about the importance of hepatitis A and B
vaccination among medical and health professionals, communities
at high risk, and the general public. The Committee requests an
update on these efforts in the fiscal year 2022 CJ.
Maternal Mortality and Neonatal Abstinence Syndrome [NAS].—
The Committee recognizes the rising prevalence of maternal mortality and NAS in the United States as a pressing public health
issue with significant healthcare costs. The Committee is aware of
the need for more information regarding long-term health and developmental outcomes related to NAS, the wide variation in clinical
practice and health systems support, as well as the challenges associated with post-discharge care. Further, the Committee supports
the continued efforts of expanded implementation of SBIRT and its
possible impact on reducing the costs of NAS. The Committee encourages SAMHSA to conduct a study on existing pilot programs
on treatment related to maternal mortality and NAS to determine
if such programs can be scaled to address this important issue.
Medication-Assisted
Treatment.—The
Committee
includes
$95,000,000, an increase of $6,000,000, for medication-assisted
treatment, of which $10,000,000 continues to be for grants to Indian Tribes, tribal organizations, or consortia. SAMHSA is directed
to give preference in grant awards to treatment regimens that are
less susceptible to diversion for illicit purposes. These grants
should target States with the highest age adjusted rates of admissions, including those that have demonstrated a dramatic age adjusted increase in admissions for the treatment of opioid use disorders. The Committee continues to direct CSAT to ensure that
these grants include as an allowable use the support of medicationassisted treatment and other clinically appropriate services to

133
achieve and maintain abstinence from all opioids, including programs that offer low-barrier or same day treatment options.
Minority Fellowship Program.—The Committee includes
$5,789,000, a $1,000,000 increase, to support new grants that will
increase the number of culturally competent behavioral health professionals who teach, administer, conduct services research, and
provide direct substance use disorder treatment services for minority populations that are underserved.
Opioid Abuse in Rural Communities.—The Committee is aware
that response to the opioid abuse crisis continues to pose unique
challenges for rural America due to limited access to care to identify, diagnose, and treat patients with substance use disorders, as
well as assisting individuals in recovery. The Committee encourages SAMHSA to support initiatives to advance opioid abuse prevention, treatment, and recovery objectives, including by improving
access through telehealth. SAMHSA is encouraged to focus 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. In addition, the Committee understands that a timely
medical response is essential in reversing opioid overdoses and encourages SAMHSA to take into account early interventions, such as
co-prescription of overdose medications with opioids, as a way to reduce overdose deaths in rural areas.
Opioid Detoxification.—The Committee is concerned that relapse
following opioid detoxification is a contributing factor to the overdose crisis. The Committee appreciates SAMHSA’s efforts to address this within the Federal grant population by emphasizing that
opioid detoxification should be followed by medication to prevent
relapse to opioid dependence and encourages SAMHSA to disseminate and implement this policy in all settings where detoxification
is offered, including rehabilitation and criminal justice settings.
Pregnant and Postpartum Women Program.—The Committee
continues to recognize SAMHSA for its work managing the Pregnant and Postpartum Women program, which utilizes a family-centered approach to provide comprehensive residential substance use
disorder treatment services for pregnant and postpartum women,
their minor children, and other family members. The Committee
encourages SAMHSA to prioritize States that support best-practice
collaborative models for the treatment and support of pregnant
women with opioid use disorders.
State Opioid Response Grants.—The Committee provides
$1,500,000,000 for grants to States to address the opioid crisis. Bill
language continues to provide $50,000,000 for grants to Indian
Tribes or Tribal organizations and a 15 percent set-aside for States
with the highest age-adjusted mortality rate related to opioid overdose deaths. Activities funded with this grant may include bona
fide treatment, prevention, and recovery support services. States
receiving these grants should ensure that comprehensive, effective,
universal prevention, and recovery strategies are prioritized to account for comprehensive services to individuals. The Committee
continues to direct SAMHSA to make prevention and treatment of,
and recovery from, stimulant use an allowable use of these funds.

134
The Committee directs SAMHSA to ensure funds reach communities and counties with the greatest unmet need. Additionally, the
Committee urges the Assistant Secretary to ensure the formula
avoids a significant cliff between States with similar mortality
rates and is concerned that the fiscal year 2020 grant amounts resulted in unusually large changes in certain States when compared
to prior year allocation. SAMHSA is also directed to provide State
agencies with technical assistance concerning how to enhance outreach and direct support to providers and underserved communities. The Committee continues to direct SAMHSA to conduct a
yearly evaluation of the program to be transmitted to the Committees on Appropriations of the House of Representatives and Senate
no later than 180 days after enactment. Such evaluation shall include an accounting of current balances in each State. SAMHSA is
directed to make such evaluation publicly available on SAMHSA’s
website.
Treatment, Recovery, and Workforce Support.—The Committee
includes $6,000,000, an increase of $2,000,000, for SAMHSA to continue implementation of section 7183 of the SUPPORT Act (Public
Law 115–271). SAMHSA is directed in consultation with the Secretary of Labor to 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. Eligible grantees include entities that offer
treatment or recovery services for individuals with substance use
disorders, and partners with one or more local or State stakeholders that support recovery, independent living, and participation
in the workforce.
Substance Abuse Prevention and Treatment Block Grant
The Committee recommends $1,858,079,000 for the Substance
Abuse Prevention and Treatment Block Grant. The recommendation includes $79,200,000 in transfers available under section 241
of the PHS Act (Public Law 78–410 as amended). The Committee
recognizes the importance of the block grant given its flexibility to
allow States to direct resources based on their own unique needs.
This funding stream is also critical in assisting States to address
all substance use disorders, including, but not limited to, those related to alcohol, cocaine, and methamphetamine. The Committee
also recognizes the importance of the block grant’s 20 percent primary prevention set-aside, which represents close to 70 percent of
prevention dollars managed by State alcohol and drug agencies.
The block grant provides funds to States to support alcohol and
drug abuse prevention, treatment, and rehabilitation services.
Funds are allocated to States according to a formula.
SUBSTANCE ABUSE PREVENTION

$206,469,000
96,985,000
206,469,000

The Committee recommends $206,469,000 for the Center for Substance Abuse Prevention [CSAP], the sole Federal organization
with responsibility for improving accessibility and quality of substance abuse prevention services.

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The Committee directs that all of the money appropriated explicitly for Substance Abuse Prevention purposes both in CSAP’s
PRNS lines, as well as the funding from the 20 percent prevention
set-aside in the SABG, be used only for bona fide substance abuse
prevention activities and not for any other purpose.
Programs of Regional and National Significance
The Committee provides $206,469,000 for PRNS within CSAP.
Through these programs, CSAP supports: development of new practice knowledge on substance abuse prevention; identification of
proven effective models; dissemination of science-based intervention information; State and community capacity building for implementation of proven, effective substance abuse prevention programs; and programs addressing new needs in the prevention system.
Within the total provided for PRNS, the Committee recommendation includes funding for the following activities:
[In thousands of dollars]
Budget activity

CAPACITY:
Strategic Prevention Framework/Partnership for Success .....................................
Strategic Prevention Framework Rx .......................................................................
Federal Drug Free Workplace .................................................................................
Minority AIDS ..........................................................................................................
Sober Truth on Preventing Underage Drinking (STOP Act) ...................................
National Adult-Oriented Media Public Service Campaign ...........................
Community-based Coalition Enhancement Grants .......................................
Intergovernmental Coordinating Committee on the Prevention of Underage
Drinking ....................................................................................................
Tribal Behavioral Health Grants ............................................................................
SCIENCE AND SERVICE:
Center for the Application of Prevention Technologies .........................................
Science and Service Program Coordination ..........................................................
Minority Fellowship Program ..................................................................................

Fiscal year 2020
appropriation

Committee
recommendation

109,484
10,000
4,894
41,205
9,000
1,000
7,000

1,000
20,000

7,493
4,072
321

Strategic Prevention Framework-Partnerships for Success Program.—The Committee supports this program which is designed to
prevent the onset of substance misuse while strengthening prevention capacity and infrastructure at the State, community, and tribal levels. The Committee intends that this program 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 Committee directs SAMHSA to ensure that
State alcohol and drug agencies remain eligible to apply along with
community-based organizations and coalitions.
Tribal Behavioral Health Grants.—SAMHSA has administered
Tribal Behavioral Health Grants for mental health and substance
abuse prevention and treatment for Tribes and Tribal organizations since fiscal year 2014. In light of the continued growth of this
program, as well as the urgent need among Tribal populations, the
Committee urges the Assistant Secretary for SAMHSA to engage
with Tribes on ways to maximize participation in this program.

136
HEALTH SURVEILLANCE AND PROGRAM SUPPORT

$160,258,000
139,457,000
160,258,000

The Committee recommends $160,258,000 for Health Surveillance and Program Support activities. The recommendation includes $31,428,000 in transfers available under section 241 of the
PHS Act (Public Law 78–410 as amended).
This activity supports Federal staff and the administrative functions of the agency. It also provides funding to SAMHSA’s surveillance and data collection activities, including national surveys such
as the National Survey on Drug Use and Health.
Within the total provided for Health Surveillance and Program
Support, the Committee recommendation includes funding for the
following activities:
[In thousands of dollars]
Budget activity

Fiscal year 2020
appropriation

Health Surveillance .........................................................................................................
Program Management .....................................................................................................
Performance & Quality Information Systems .................................................................
Drug Abuse Warning Network .........................................................................................
Public Awareness and Support .......................................................................................
Behavioral Health Workforce Data ..................................................................................

47,258
79,000
10,000
10,000
13,000
1,000

Committee
recommendation

47,258
79,000
10,000
10,000
13,000
1,000

Interagency Task Force on Trauma-Informed Care.—The Committee notes that childhood exposure to trauma, such as witnessing
violence or substance abuse, can result in negative health, education, and employment outcomes for which agencies funded in this
bill seek to address. The SUPPORT Act (Public Law 115–271) established the Interagency Task Force on Trauma-Informed Care.
The Committee supports the Task Force’s authorized activities, including the dissemination of trauma-informed best practices and
the promotion of such models and training strategies through all
relevant grant programs.
Non-Federal Workplace Substance Abuse Prevention.—The Committee recognizes the lack of workplace information designed to
support evidence-based substance abuse prevention education and
encourages SAMHSA to coordinate with OSHA to disseminate materials for the workplace.
AGENCY

FOR

HEALTHCARE RESEARCH

AND

QUALITY

Appropriations, 2020 .............................................................................
$338,000,000
Budget estimate, 2021 ........................................................................... ...........................
Committee recommendation .................................................................
256,660,000

The Committee provides $256,660,000 for the Agency for
Healthcare Research and Quality [AHRQ], which is combined with
the $98,400,000 in mandatory funding from the Patient-Centered
Outcomes Research Trust Fund. AHRQ was established to enhance
the quality, appropriateness, and effectiveness of health services,
as well as access to such services. AHRQ conducts, supports, and
disseminates scientific and policy-relevant research on topics, such

137
as promoting high-quality care, eliminating healthcare disparities,
using information technology, and evaluating the effectiveness of
clinical services.
The Committee does not support the administration’s proposal to
consolidate AHRQ into NIH and instead continues to fund the
agency as an independent operating division within the Department.
HEALTH COSTS, QUALITY, AND OUTCOMES

The Committee provides $7,400,000 for research on health costs,
quality, and outcomes [HCQO]. The HCQO research activity is focused upon improving clinical practice, improving the healthcare
system’s capacity to deliver quality care, and tracking progress toward health goals through monitoring and evaluation.
Within the total provided for HCQO, the Committee recommendation includes funding for the following activities:
[In thousands of dollars]
Budget activity

Health Costs, Quality, and Outcomes:
Prevention/Care Management ................................................................................
Health IT .................................................................................................................
Patient Safety Research ........................................................................................
Health Services Research, Data, and Dissemination ............................................
Medical Expenditure Panel Survey ..................................................................................
Program Support .............................................................................................................

Fiscal year 2020
appropriation

11,613,000
16,449,000
73,052,000
99,985,000
69,991,000
71,910,000

Committee
recommendation

7,400,000
............................
65,900,000
57,918,000
69,991,000
55,451,000

Center for Primary Care Research.—The Committee supports primary care clinical research and dissemination as a core function of
AHRQ, which includes: translating science into patient care, better
organizing healthcare to meet patient and population needs, evaluating innovations to provide the best healthcare to patients, and
engaging patients, communities, and practices to improve health.
The Committee supports the Center for Primary Care Research
and encourages AHRQ to prioritize the work of the Center.
Diagnostic Outcomes Research.—The Committee supports
AHRQ’s continued work in diagnostics outcomes studies for infectious diseases, including those assessing patient outcomes, lengths
of stay, changes in antibiotic use, rates of antibiotic use for certain
patient populations, and costs of care. The Committee encourages
AHRQ to develop metrics to measure and track the effectiveness
and outcomes of diagnostic interventions to improve clinical uptake, enhance stewardship efforts, and reduce the healthcare and
economic burden of antimicrobial resistance in the United States as
recommended by the Presidential Advisory Council on Combating
Antibiotic-Resistant Bacteria.
Heart Disease Research.—Heart disease is the leading cause of
death for Americans. Understanding how to reduce the rate of cardiac events and to control the metabolic processes that lead to such
events is needed. The Committee supports AHRQ studying and assessing the current evidence for lipid control and cardiovascular
event reduction, quality measures for the improvement of clinical
outcomes, and to develop and disseminate education resources and
materials about improving cardiovascular clinical outcomes for cor-

138
onary heart disease death, myocardial infarction, ischemic stroke,
and urgent coronary revascularization procedure.
Opioid Prescribing Research.—The Committee encourages AHRQ
to conduct a systematic review of the literature to assess the impact of evidence-based clinical practice opioid prescribing guidelines
(not limited to CDC’s Guideline for Prescribing Opioids for Chronic
Pain) on the quantity and duration of opioid prescriptions.
Organ Availability.—The Committee has provided $600,000 for
AHRQ to evaluate innovative approaches to enhance the availability of organs, otherwise encourage donation, and further improve the organ transplantation process, including through consultation with other Federal agencies.
Patient Safety.—The Committee continues to support improving
diagnosis in medicine, including a multiyear competitive grant program to address diagnostic errors, which may include the establishment of Research Centers of Diagnostic Excellence to develop systems, measures, and new technology solutions to improve diagnostic safety and quality.
Psychosocial Best Practices.—The Committee is encouraged by
the progress made by HHS and ARHQ in implementing section 203
of the STAR Act (Public Law 115–180). The Committee encourages
ARHQ to include consideration of best practices for psychosocial
care in addition to biomedical care in developing recommendations
to meet the requirements of section 203.
Rural and Underserved Populations.—The Committee supports
the work of AHRQ to better serve the health needs of rural and
underserved minorities through such programs as the ‘‘Evidence
Now’’ network. The Committee encourages the agency to expand its
efforts to include additional health extension program sites connected to public academic health centers in States with high populations of underserved minorities, rural communities, and tribal
populations.
MEDICAL EXPENDITURES PANEL SURVEYS

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

The Committee recommends $55,451,000 for program support.
This activity funds the overall management of AHRQ, including
salaries, benefits, and overhead costs, such as rent.
CENTERS

FOR

MEDICARE

AND

MEDICAID SERVICES

GRANTS TO STATES FOR MEDICAID

Appropriations, 2020 .............................................................................$273,188,478,000
Budget estimate, 2021 ........................................................................... 313,904,098,000
Committee recommendation ................................................................. 313,904,098,000

139
The Committee recommends $313,904,098,000 in mandatory
funding for Grants to States for Medicaid.
The fiscal year 2021 recommendation excludes $139,903,075,000
in fiscal year 2020 advance appropriations for fiscal year 2021. As
requested by the administration, $148,732,315,000 is provided for
the first quarter of fiscal year 2022.
The Medicaid program provides medical care for eligible low-income individuals and families. It is administered by each of the 50
States, the District of Columbia, and the U.S. territories. Federal
funds for medical assistance are made available to the States according to a formula that determines the appropriate Federal
matching rate for State program costs. This matching rate is based
on the State’s average per capita income relative to the national
average and cannot be less than 50 percent.
PAYMENTS TO HEALTHCARE TRUST FUNDS

Appropriations, 2020 .............................................................................$410,796,100,000
Budget estimate, 2021 ........................................................................... 439,514,000,000
Committee recommendation ................................................................. 439,514,000,000

The Committee recommends $439,514,000,000 in mandatory
funding for payments to healthcare trust funds.
This entitlement account includes the general fund subsidy to
the Federal Supplementary Medical Insurance Trust Fund for
Medicare Part B benefits and for Medicare Part D drug benefits
and administration, plus other reimbursements to the Federal Hospital Insurance Trust Fund for Part A benefits and related administrative costs that have not been financed by payroll taxes or premium contributions.
The Committee provides $325,500,000,000 for the Federal payment to the Supplementary Medical Insurance Trust Fund. This
payment provides matching funds for premiums paid by Medicare
Part B enrollees.
The Committee further provides $111,800,000,000 for the general
fund share of benefits paid under the Medicare Prescription Drug,
Improvement and Modernization Act of 2003 (Public Law 108–173).
As in previous years, the Committee continues bill language requested by the administration providing indefinite authority for
paying the general revenue portion of the Part B premium match
and provides resources for the Part D drug benefit program in the
event that the annual appropriation is insufficient.
The Committee recommendation also includes $882,000,000 to be
transferred to the Supplementary Insurance Trust Fund as the
general fund share of Part D administrative expenses. The Committee recommendation includes $328,000,000 in reimbursements
to the Health Care Fraud and Abuse Control [HCFAC] fund, which
reflects the portion of the HCFAC spending to be reimbursed by
the General Fund.
PROGRAM MANAGEMENT

$3,669,744,000
3,693,548,000
3,669,744,000

The Committee recommends $3,669,744,000 for CMS program
management, which includes funding for research, program oper-

140
ations, survey and certification programs, and Federal administration.
Research, Demonstrations and Evaluations.—The Committee recommends $20,054,000 for research, demonstrations, and evaluation
activities.
Program Operations
The Committee recommends $2,472,356,000 for the Program Operations account, which covers a broad range of activities including
claims processing and program safeguard activities, performed by
Medicare contractors. These contractors also provide information,
guidance, and technical support to both providers and beneficiaries.
ACA Notifications.—The Committee continues bill language requiring the administration to provide detailed enrollment figures to
the Committees on Appropriations of the House of Representatives
and the Senate not less than 2 full business days before any public
release of the information.
Access to Mental Health Care.—The Committee strongly urges
CMS to pursue initiatives that expand access to quality care and
increase parity for mental health services.
Adult Immunization.—The Committee is concerned about the underutilization of vaccinations for adults and in particular high-risk
adults. The Committee encourages CMS to work towards achievement of the Healthy People 2030 goals aimed at reducing the incidence of vaccine preventable illnesses, such as invasive pneumococcal infections and increase the percentage of adults aged 65 or
older who are vaccinated against pneumococcal disease. CMS is encouraged to support development and implementation of strategies,
such as reminder recall programs, and emphasize the importance
of adherence to the recommendations to beneficiaries and their providers.
At-risk Youth Medicaid Protection.—The Committee encourages
CMS to consider rulemaking related to section 1001 of the SUPPORT for Patients and Communities Act (Public Law 115–271) and
include an update on these activities in the fiscal year 2022 CJ.
Autism Treatment and Supportive Services.—The Committee encourages CMS to identify the supportive services that are most
beneficial to improved outcomes for autism patients, and to begin
reviewing existing coverage policies for these services. CMS is directed to report to the Committees on Appropriations of the House
of Representatives and the Senate on its interim findings in the fiscal year 2022 CJ.
Biological and Gene Therapies.—The Committee understands
that 1 in 10 Americans is impacted by a rare disease and that the
Orphan Drug Act (Public Law 97–414) incentivizes the discovery of
diagnostics and treatments that confirm prognosis, prolong life, and
realize health system savings. The Committee encourages CMS to
support access to biologic and gene therapies, including through
pilot programs that eliminate specialty tiers and allow Medicaid to
pay for gene therapies over a defined period of time instead of a
lump sum payment.
Blue Button.—The Committee is concerned about low participation rates and lack of awareness of the Blue Button program from
beneficiaries. The Committee directs CMS to submit a report to the

141
Committees on Appropriations of the House of Representatives and
the Senate not less than 180 days after enactment on the active
participant levels in Blue Button since its inception and detailed
information about what the agency is doing to promote participation in this patient access and safety program.
Bundled Payment for Care Improvement [BPCI].—The Committee commends CMS for its implementation of the BPCI models,
including its work to partner with outside conveners to lower Medicare costs via bundled payments tied to financial and performance
accountability requirements. The subcommittee encourages the
Center for Medicare and Medicaid Innovation to continue its focus
on increasing quality and care coordination in both acute and postacute settings by continuing to bring in other payers, providers,
and patient populations to potentially increase savings to the Medicare program.
Certified Transplant Centers.—The Committee strongly urges
CMS to remove the disincentive for Medicare Certified Transplant
Centers to transfer their braindead patients to organ recovery centers operated by organ procurement organizations without a financial penalty.
Chief Dental Officer.—The Committee is concerned that CMS has
not appointed a permanent the Chief Dental Officer position since
October 2017.
Claim Payment Coordination.—The Committee requests updated
information in the fiscal year 2022 CJ that provides options to reform the current system for 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.
Committee Requests.—The Committee is concerned that CMS
does not provide timely responses to bill and report language directives, Committee staff requests, or Member inquiries. The Committee expects the agency leadership to support CMS staff efforts
to respond both to the Committee and to Members of the Senate
in a timely and helpful manner.
Continuous Electronic Monitoring.—The Committee encourages
CMS to study the potential efficacy and benefits of continuous
physiologic electronic monitoring with measure-through motion and
low-perfusion pulse oximetry of all patients taking opioids in the
hospital.
Creative Ideas to Lower Health Care Costs.—The Committee encourages CMS to develop creative projects to lower the cost of care
among older populations, including projects that could leverage
international collaborations. CMS is directed to provide a progress
update on these efforts in the fiscal year 2022 CJ.
CT Colonography.—Due to the proven life and cost savings of
preventive screening for colorectal cancer, the Committee encourages CMS to consider covering CT Colonography as a Medicare-covered colorectal cancer screening test under section 1861(pp)(1) of
the Social Security Act.
Data Transparency.—CMS has released unparalleled levels of
data to researchers, however the absence of a complete file of available non-institutional provider claims creates blind spots in determining the pattern of care delivery, access to care, and delivery of

142
care in non-institutional settings. The Committee encourages CMS
to make all of the non-institutional provider claims file data available for researchers in accordance with the manner in which CMS
made the Medicare fee for service hospital, Medicare Advantage,
and Transformed Medicaid Statistical Information System data
available.
Detecting Cognitive Impairment.—The Committee remains concerned about the underutilization of the cognitive impairment detection component of the Medicare Annual Wellness Visit, and is
aware of multiple efforts to address this challenge. To support this
effort, the Committee urges CMS to update educational materials
for Medicare beneficiaries as to the availability of this benefit and
the importance of regular assessments of cognitive health. The
Committee also encourages CMS to develop similarly updated materials for healthcare providers including information on the importance of baseline and regular assessments, as well as tools available to conduct such assessments.
Diabetes Technology.—The Committee is aware that people with
diabetes seeking access to new technology face many financial and
administrative barriers due to benefit category designations by
CMS. The Committee encourages CMS to coordinate with FDA on
efforts regarding these technologies that can help prevent a lack of
coverage and separate payment. The Committee encourages CMS,
in consultation with FDA as appropriate, to provide a report to
Congress within 120 days of enactment on CMS’ efforts to address
these barriers to diabetes technologies and discuss how CMS will
ensure that coverage is available for all FDA approved hybridclosed loop technologies, including separate payment for the software algorithms.
Direct and Indirect Remuneration Fees.—The Committee commends CMS for exploring options to address this issue through administrative rulemaking. The Committee continues to urge administrative action to address this issue through the rulemaking process to the extent current statutory authorities provide.
Evaluation and Management Services.—The Committee recognizes CMS’ efforts to reduce unnecessary medical record documentation and reevaluate the adequacy of payments for officebased evaluation and management [E/M] services finalized in the
Calendar Year 2020 Medicare Physician Fee Schedule [MPFS] as
a way to reduce regulatory burden and ensure continued access to
non-procedural services. The Committee encourages CMS to consider how existing budget neutrality requirements will affect access
to various sections of the provider community, such as surgery, pathology, radiology, allied health, and other areas projected to receive sizable payment reductions to accommodate the E/M service
payment increases. The Committee encourages CMS to consider
the impact this will have before the E/M policies take effect on January 1, 2021, as it is important to appropriately value E/M services
and to preserve access to the full range of services paid under the
MPFS.
Expanding Support for Screening and Diagnostic Testing in Cancer Treatment.—The Committee understands that the use of pretreatment interventions, such as screening for signs of cancer or
testing with a companion diagnostic to determine a specific cancer

143
type, can help healthcare providers select treatment options with
a greater probability of success. The Committee also recognizes
that the use of these interventions can reduce unnecessary costs in
the current healthcare system by avoiding ineffective treatments,
and that awareness of genetic risk factors can encourage preventive care and early diagnosis. The Committee urges CMS to identify ways to expand access to screening and testing that involves
appropriate utilization of a companion diagnostic and ensures the
upmost protection of Americans’ healthcare data.
federally Qualified Health Centers [FQHC] Billing.—A December
2019 white paper by the National Association of Community
Health Centers notes that FQHCs can face significant delays in reimbursement for influenza and pneumococcal vaccines. The Committee encourages CMS to promote the ability of FQHCs to bill
Part B directly for these vaccines at the time the service is furnished, with reconciliation of payments at the time of the cost report settlement, as it does for other items and services reimbursed
at reasonable cost.
Fire Safety Code.—The Committee encourages CMS to reflect any
changes made to fire safety standards in a timely manner to help
ensure hospitals have access to products that provide the highest
level of safety to their facilities, employees, and patients.
Frontier Communities.—The Committee recognizes the unique
challenges of providing care in frontier communities. The Frontier
Community Health Integration Project [FCHIP] Demonstration is
one example of an important investment to help rural critical access hospitals [CAHs] with low patient volumes continue to test
interventions to enhance care in these extremely remote communities and guarantee the sustainability of CAHs. Therefore, the
Committee supports the continued extension of the FCHIP program.
Health Insurance Exchange Transparency.—The Committee continues bill language that requires CMS to provide cost information
for the following categories: Federal Payroll and Other Administrative Costs; Exchange related Information Technology [IT]; Non-IT
Program Costs, including Health Plan Benefit and Rate Review,
Exchange Oversight, Payment and Financial Management, Eligibility and Enrollment; Consumer Information and Outreach, including the Call Center, Navigator Grants and Consumer Education and Outreach; Exchange Quality Review; Small Business
Health Options Program and Employer Activities; and Other Exchange Activities. Cost information should be provided for each fiscal year since the enactment of the Patient Protection and Affordable Care Act (Public Law 111–148). CMS is also required to include the estimated costs for fiscal year 2022.
Home Visiting.—The Committee directs CMS to build upon its
2016 Joint Informational Bulletin to clearly articulate how Medicaid dollars can be blended and braided appropriately in home visiting programs to reach eligible families, provide streamlined coverage options for home visiting services, and cover specific components of home visiting programs. Additionally, once CMS has finalized its 2018 Managed Care rule, the Committee encourages CMS
to update its November 2017 Informational Bulletin on Delivery
System and Provider Payment Initiatives under Medicaid Managed

144
Care Contracts to explain how States can use the revised managed
care authority to address priority health issues, including the use
of these initiatives to increase the capacity of evidence-based home
visiting programs to support State efforts to improve maternal and
infant health outcomes.
Hospital-Acquired Pressure Ulcers and Injuries.—In November
2019, the International Pressure Injury Prevention and Treatment
Clinical Practice Guidelines were released, which include the
Standardized Pressure Injury Prevention Protocol [SPIPP], a
checklist that simplifies the guidelines into actionable steps. The
Committee urges HHS and CMS to take specific steps to promote
and incentivize the use of the SPIPP. The Committee requests an
update in the fiscal year 2022 CJ with a timeline and steps taken
to promote the use of the SPIPP to reduce the number of hospitalacquired pressure ulcers and injuries among Medicare beneficiaries.
ICD–10 Breakthrough Designation.—To ensure timely access to
FDA-designated breakthrough products, the Committee urges CMS
to use its existing authority to review ICD–10 diagnosis codes in
an expedited manner.
Improving Nuclear Medicine Injection Quality.—Extravasations
of diagnostic radiopharmaceuticals may negatively affect the sensitivity and quantification of nuclear medicine scans. The Committee
encourages CMS to consider adding required monitoring and reporting of injection quality for providers. The Committee is pleased
CMS is engaging with outside stakeholders to consider using a variety of levers, including Joint Commission accreditation, Conditions of Participation, Hospital Compare, incentive payments and
penalties, and the Radiation Oncology Alternative Payment Model,
to encourage providers to engage in nuclear medicine injection
quality control and assurance. The Committee requests an update
on this issue in the fiscal year 2022 CJ.
Lowering the Cost of Care.—The Committee encourages CMMI to
consider creative pilot projects to lower the cost of care among older
populations, specifically involving international collaborations
where the quality of care is comparable and less expensive. CMS
shall provide an update on this effort in the fiscal year 2022 CJ.
Lymphatic System Failure.—The Committee encourages the Secretary to promulgate rules for covering prescribed compression garments as acknowledged by CMS’ 2001 decision memorandum
[CAG–00016N] in the treatment of lymphatic system failure.
Malnutrition.—Malnutrition in older adults remains a serious
health problem in the United States. One in two older adults is either malnourished or at risk of becoming malnourished. The Committee remains concerned that CMS has declined to include malnutrition quality measurements in the Hospital Inpatient Quality
Reporting Program and again encourages CMS to include quality
measurements, as well as evaluate, other potential policy levers,
such as integrating malnutrition into CMS Innovation Center Pilots, Advanced Payment Models, Population Health Initiatives, and
the Oncology Care Model, to address malnutrition in the Medicare
population.
Measuring Incidence and Prevalence of Multiple Cognitive Domain.—The Committee remains interested in better understanding

145
the impact of mild cognitive impairment [MCI], Alzheimer’s disease, and other related dementias on Medicare beneficiaries to ensure the Medicare program is able to address current and future
needs. To gather such information, the Committee encourages CMS
to develop and incorporate a module within the Medicare Current
Beneficiary to address questions pertaining to MCI, Alzheimer’s,
and other related dementias including if beneficiaries have received
a diagnosis of either condition, how long it took for them to receive
such a diagnosis, whether their providers have used the cognitive
detection component of the Annual Wellness Visit, and whether the
beneficiaries have been advised about Alzheimer’s and dementia
care planning services that are covered under Medicare.
Medicare Part D.—The Committee notes that the rising cost of
prescription drugs continues to be a critical issue for all Americans,
including the millions of seniors enrolled in Medicare. The Committee encourages CMS to take further steps to reduce patients’
out-of-pocket costs. The Committee encourages CMS to limit product placement of the proposed lower cost-sharing preferred specialty tier to only generics and biosimilars.
Medicare Physician Fee Schedule.—The Committee has been
made aware that a misvalued code associated with vaccine administration reimbursement under Medicare threatens access to vaccinations, particularly in rural and medically underserved areas.
The Committee encourages CMS to work with the relative values
scale update committee [RUC] to decouple the current procedural
terminology [CPT] code for vaccine administration for the practice
expense relative value units [RVU] from therapeutic injection. Further, the Committee encourages CMS to utilize the RUC-recommended direct practice expense inputs for practice expense
RVUs for CPT immunization administration codes.
Medicare Program Integrity Demonstrations Using Advanced
Technology-The Committee notes that CMS issued a Request for
Information in October 2019 to obtain input on how the agency can
better use emerging technologies to ensure proper claims payment,
reduce provider burden, and generally conduct program integrity
activities in a more efficient manner. Given the complexity of
healthcare payment oversight, the Committee encourages CMS to
consider pilot programs using AI-enabled documentation and coding technology to address CMS’ top program integrity priorities and
reduce administrative burden.
Mental Health Parity.—The Committee encourages CMS to coordinate with the Department of Labor to ensure compliance with
Mental Health Parity and Addiction Equity Act [MHPAEA] (Public
Law 110–343) by regularly issuing guidance to insurers, covered
healthcare plans, and managed care organizations that outlines
how compliance with MHPAEA is to be achieved. Guidance should
include recommendations for appropriate training of personnel responsible for benefit authorizations, adverse benefit determinations, and payments. These agencies should ensure that such informational bulletins also provide an appropriate consumer complaint
process that alerts agencies, insurers, and health plans when
MHPAEA violations are identified and reported, and that helps patients take action when they encounter MHPAEA violations.

146
National Fire Protection Association’s Life Safety Code.—The
Committee is aware that CMS previously permitted the use of categorical waivers, including allowances for healthcare organizations
to comply with specific sections of the 2012 Life Safety Code before
the entire code document was adopted. The Committee encourages
CMS to consider reinstating the categorical waivers previously permitted to ensure hospitals have access to products that provide the
highest level of safety to their facilities, employees, and patients.
Non-Emergency Medical Transportation [NEMT].—The Committee continues to direct CMS to delay publishing any proposed
regulation or other solicitation of information on changes to NEMT
benefits until the study requested in MACPAC in Public Law 116–
94 has been completed and submitted to the Committee.
Obesity Continuum of Care.—The Committee encourages CMS to
provide access to the full continuum of care with obesity, including
to anti-obesity medications under Medicare Part D, consistent with
regulatory authority. The Committee also encourages CMS to update its Medicare Part B national coverage determination for intensive behavioral therapy [IBT] for obesity to be consistent with current United States Preventive Services Task Force recommendations that IBT for obesity can be provided, through referral, outside
of the primary care setting and by a broader range of qualified providers than are currently permitted to bill under Part B for this
service.
Osteoporotic Fractures.—The Committee is concerned that
2,000,000 older Americans suffer 2,300,000 bone fractures related
to osteoporosis. The Committee encourages CMS to consider options to lower osteoporotic fracture risks by incentivizing greater
utilization of model fracture liaison care coordination services by
beneficiaries who have suffered an osteoporosis-related fracture
and are thus at higher risk for another fracture. Fracture liaison
service post-fracture care models reduce fracture risk through a
care coordination intervention that improves rates of osteoporosis
screening, treatment initiation and adherence, patient and caregiver education and counseling, and comprehensive falls prevention
strategies.
Program Integrity Programs.—The Committee encourages CMS
to explore expanding programs, such as the Recovery Audit Validation Contractor [RVC] program, to other parts of Medicare and
Medicaid. In addition, the Committee supports efforts to ensure accurate physician payments through the National Correcting Coding
Initiative [NCCI] and encourages CMS to continue moving away
from the pay-and-chase model. The Committee requests an update
in the fiscal year 2022 CJ on implementation of the RVC, NCCI,
and related integrity programs, data reporting standards around
these programs, and the feasibility of expanding these programs to
other public payer programs.
Quality Care for Cancer.—The Committee recognizes the importance of voluntary accreditation by the American College of Surgeons Cancer Programs and supports accreditation efforts that improve performance evaluation and inform quality care improvements.
Reimbursement Coding for Reducing Opioid Consumption.—The
Committee urges CMS to undertake aggressive efforts to guarantee

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reimbursement of FDA-approved devices and therapies for unique
post-surgery patient populations that use alternative means for effective pain management. In addition, given the national opioid addiction crisis, CMS should take steps by which healthcare providers
should track patient pain scores and reductions in opioid consumption using such alternative means for effective pain management.
Risk Corridor Program.—The Committee continues bill language
to prevent the CMS Program Management appropriation account
from being used to support risk corridor payments. The agreement
directs CMS to provide a report starting with plan year 2014 and
continuing through the duration of the program to the Committees
on Appropriations of the House of Representatives and the Senate
detailing the receipts and transfer of payments for the Risk Corridor Program.
Robotic Stereotactic Radiosurgery.—The Committee remains concerned that payment for robotic stereotactic radiosurgery and
robotic stereotactic body radiation therapy may threaten viability
of these services in both the hospital and freestanding center setting. The Committee encourages CMS and contractors administering the Medicare Part B program not to make changes to these
services in the freestanding or hospital outpatient setting as CMS
implements the planned Radiation Oncology Payment Model. The
Committee encourages CMS to maintain stable payment for these
services performed in Core-Based Statistical Areas that are not
randomly selected to participate in the model.
Rural Hospitals.—The Committee notes that more than 120
rural hospitals have closed in the past decade and many others are
vulnerable to closure. When hospitals do close, they rarely reopenrural patients lose access to care, compounding health disparities.
The Committee directs CMS to study and propose administrative
and legislative solutions that would allow vulnerable, rural hospitals to receive relief in the near-term, as well as explore payment
options that can ensure that more hospitals serving rural and underserved populations can operate in a more financially sustainable
way. Theses legislative and administrative recommendations
should be provided to the Committees on Appropriations of the
House of Representatives and the Senate, the Senate Committee on
Finance, the House Committee on Ways and Means, and the House
Committee on Energy and Commerce 180 days after enactment.
Sepsis.—The Committee is pleased that CMS and the National
Quality Forum plan to update the SEP–1 measure. A CMS study
published in February reported an alarming 40 percent increase in
the number of Medicare patients hospitalized with sepsis over the
past 7 years. The Committee encourages CMS to issue a Request
for Information as part of the update to the SEP–1 measure review
to collect broad stakeholder input to help ensure the new SEP–1
measure improves health outcomes. The Committee requests an
update on these activities in the fiscal year 2022 CJ.
Service Models Utilizing Pharmacist-Provided Patient Care Services.—The Committee encourages CMS to test a model that
incentivizes pharmacist involvement across relevant Medicare service lines, including in value-based models such as the Comprehensive Primary Care Plus primary care model. This advanced primary care model integrates pharmacists as part of the care team

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to provide medication management services that include evaluating
medication regimens, providing medication self-management support for patients to help them adhere to their prescribed therapies,
and promoting clinically-sound, cost-effective medication therapies.
Therapeutic Foster Care.—The Committee remains concerned
about the lack of a uniform definition within the Medicaid program
for therapeutic foster care services. A uniform definition would improve the ability for more consistent care and treatment. The Committee requests an update in the fiscal year 2022 CJ on the study
requested in House Report 114–699.
Total Parenteral Nutrition Cancer Access.—The Committee requests that CMS provide the Committees on Appropriations of the
House of Representatives and the Senate an update 180 days after
enactment on its plans to revise the Durable Medical Equipment
local policies to allow for parenteral nutrition as first line therapy
for patients with head, neck, and gastrointestinal cancers.
Vaccine Utilization.—The Committee is concerned about the underutilization of vaccinations and strongly encourages CMS to work
toward achievement of the Healthy People 2021 goals to increase
the percentage of adults aged 65 or older who receive recommended
vaccinations. The Committee encourages CMS to explore opportunities to support the implementation of technologies and best practices. Underutilization of the Medicare Annual Wellness Visit may
also be addressed via increased focus on such visits in Medicare
member materials and further emphasis on preventive interventions, such as vaccines, in provider communications.
State Survey and Certification
The Committee recommends $407,334,000, an increase of
$10,000,000, for State Survey and Certification activities, which ensure that institutions and agencies providing care to Medicare and
Medicaid beneficiaries meet Federal health, safety, and program
standards. On-site surveys are conducted by State survey agencies,
with a pool of Federal surveyors performing random monitoring
surveys.
Federal Administration
The Committee recommends $770,000,000, an increase of
$37,467,000, for Federal Administration, which funds the majority
of CMS’ staff and operating expenses for routine activities, such as
planning, implementing, evaluating, and ensuring accountability in
the programs administered by CMS. This funding level accounts for
the fiscal year 2020 reprogramming to support CMS’ workforce and
other administrative functions.
HEALTHCARE FRAUD AND ABUSE CONTROL

$786,000,000
813,000,000
807,000,000

The Committee recommends $807,000,000, to be transferred from
the Medicare trust funds, for Health Care Fraud and Abuse Control [HCFAC] activities. The latest data demonstrate for every
$1.00 spent on fraud and abuse, $2.00 is recovered by the Treasury.

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The Committee recommendation includes a base amount of
$311,000,000 and an additional $496,000,000 through a budget cap
adjustment authorized by section 251(b) of the Balanced Budget
and Emergency Deficit Control Act of 1985 (Public Law 99–117).
Healthcare waste, fraud, and abuse costs our Nation nearly
$70,000,000,000 a year, according to some estimates. Proactively
identifying these issues continues to be a priority for the Committee. Therefore, CMS is directed to incorporate AI software to examine waste, fraud, and abuse in the healthcare setting. This technology should allow for the rapid interpretation of complex health
data and quickly identify patterns associated with waste, fraud,
and abuse from the perspective of both the patient and a facility.
Program Integrity.—The Committee is supportive of the ongoing
work that the CMS Center for Program Integrity is undergoing to
tackle waste, fraud, and abuse. The Committee encourages CMS to
continue working with Oak Ridge National Laboratory to leverage
Department of Energy’s computational facilities to bring state-ofthe-art computational and data analytics capabilities to address
complex issues in CMS to reduce waste, fraud, and abuse.
ADMINISTRATION

FOR

CHILDREN

AND

FAMILIES

PAYMENTS TO STATES FOR CHILD SUPPORT ENFORCEMENT AND
FAMILY SUPPORT PROGRAMS

$2,890,000,000
3,039,000,000
3,039,000,000

The Committee recommendation includes $3,039,000,000 in fiscal
year 2021 mandatory funds for Child Support Enforcement and
Family Support programs. In addition, the Committee recommends
$1,400,000,000 in advance funding for the first quarter of fiscal
year 2022.
These funds support States’ efforts to promote the self-sufficiency
and economic security of low-income families, including administrative expenses matching funds and incentive payments to States for
child support enforcement; grants to States to help establish and
administer access and visitation programs between noncustodial
parents and their children; payments to territories for benefits to
certain aged, blind, or disabled individuals; and temporary benefits
for certain repatriated citizens.
LOW INCOME HOME ENERGY ASSISTANCE PROGRAM

Appropriations, 2020 ............................................................................. $3,740,304,000
Budget estimate, 2021 ........................................................................... ............................
Committee recommendation .................................................................
3,740,304,000

The Committee recommendation includes $3,740,304,000 for the
Low Income Home Energy Assistance Program [LIHEAP], which
provides home heating and cooling assistance to low-income households, generally in the form of payments to energy vendors on behalf of the recipient. Within the total, the Committee recommendation includes up to $2,988,000 for program integrity and oversight
efforts, the same as the fiscal year 2020 level.
Sudden, significant, and unexpected decreases in annual funding
for States, even when based in large part on changes in home en-

150
ergy costs, can be difficult for States to manage. Accordingly, the
Committee recommendation continues a provision included in the
Further Consolidated Appropriations Act, 2020 (Public Law 116–
94) that limits year-to-year fluctuations in allocations to States and
requires HHS to submit a report evaluating the current LIHEAP
formula. The Committee strongly encourages HHS to take steps to
further expand transparency over the LIHEAP formula, including
formula factors that contribute to changes in State allocations. Further, while some data used in calculating State allocations are not
available until late in the year, the Committee strongly encourages
HHS to take steps to decrease uncertainty for States related to
changes in formula factors. The Committee directs HHS to include
recommendations in the fiscal year 2022 CJ for administrative and
legislative actions that could be taken to reduce uncertainty while
continuing to allocate funding based on need.
REFUGEE AND ENTRANT ASSISTANCE

$1,908,201,000
2,456,380,000
1,832,760,000

The Committee recommends $1,832,760,000 for Refugee and Entrant Assistance [REA] programs. These programs provide a variety of benefits and services to refugees, asylees, Cuban and Haitian
entrants, immigrants arriving on Special Immigrant Visas [SIV],
trafficking victims, and torture victims (collectively referred to
below as ‘‘refugees’’). These programs also provide temporary care
and services for unaccompanied children apprehended by the Department of Homeland Security or other law enforcement agencies,
who have no lawful immigration status in the U.S. until they can
be placed with a parent, guardian, or other sponsor while awaiting
adjudication of their immigration status.
The Committee continues the directive to provide monthly updates to the Committees on Appropriations of the House of Representatives and the Senate of arrivals each month by category, including refugees, asylees, Cuban and Haitian Entrants, SIVs, and
unaccompanied alien children. Further such updates shall include
any changes in estimated funding needs as a result of changing
trends.
The U.S. refugee admission program [USRAP] reflects U.S. humanitarian and strategic interests. The USRAP provides for the
safe resettlement of some of the most vulnerable refugees and not
only saves lives, but also strengthens national and global security
by providing support and shared responsibility for strategic allies
and regions. The Committee notes that appropriate consultation
with Congress is required by statute in advance of the President’s
determination on the number of refugees to be admitted during the
coming fiscal year.
The Committee affirms the community consultation process embedded in USRAP, which is grounded in its public-private partnerships and thrives on cooperation among local, State, and Federal
stakeholders. Changes to USRAP and reductions in domestic resettlement sites may impact Office of Refugee Resettlement [ORR]
programming. The Committee encourages HHS, to the extent practicable, to ensure that resettlement agencies are able to maintain

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their infrastructure and capacity at a level to continue to serve new
refugees, previously arrived refugees, and others who remain statutorily eligible for integration services, and to ensure future arrivals
are adequately served. The Committee directs ORR to submit a report within 180 days of enactment on efforts ORR is taking to ensure that ORR and its grantees are able to continue to serve such
populations, prevent barriers to individuals’ ability to seek protection and receive services, and ensure ORR is able to carry out its
mission.
Transitional and Medical Services
The Committee recommendation includes $278,559,000 for Transitional and Medical Services. This program provides grants to
States and nonprofit organizations to provide up to 8 months of
cash and medical assistance to arriving refugees, as well as foster
care services to unaccompanied minors.
This program largely reimburses States and nonprofit organizations for providing financial and medical assistance to newly arrived refugees and in recent years HHS has carried over significant
unobligated balances. The Committee recommendation is based on
HHS estimates and will allow HHS to at least maintain the current level and scope of services provided to eligible arrivals, including maintaining the number of months refugees are eligible for
benefits.
The Committee continues to strongly encourage HHS to give
matching grant organizations flexibility in administering their programs, including, when justified, carrying over unexpended funding
and slots and providing exemptions to the 31 day enrollment period.
Refugee Support Services
The Committee recommendation includes $207,201,000 for Refugee Support Services. This program provides a combination of formula and competitive grants to States and nonprofit organizations
to help refugees become self-sufficient and address barriers to employment.
The Committee continues to expect that activities previously
funded under the Social Services, Targeted Assistance, and Preventive Health programs will continue at the same level as before
these programs were consolidated.
Victims of Trafficking
The Committee recommendation includes $27,755,000 for Victims
of Trafficking programs. These programs support a national network of organizations that provide a variety of services-including
case management, counseling, benefit coordination, and housing assistance-for victims of commercial sex and forced labor trafficking.
Within the total, the Committee recommendation includes
$19,500,000 for services for foreign national victims and $8,255,000
to improve services available for U.S. citizens and legal permanent
residents. Within these amounts the Committee recommendation
includes no less than $3,500,000 for the national human trafficking
resource center.

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Unaccompanied Alien Children
The Committee recommendation includes $1,303,245,000 for the
Unaccompanied Alien Children [UAC] program. The UAC program
provides temporary shelter and basic services to children who have
no lawful immigration status in the United States and who have
been apprehended by the Department of Homeland Security [DHS]
without a parent or a guardian. HHS takes custody of the children
until they can be placed with a parent or other sponsor living in
the United States pending resolution of their immigration status,
or until their immigration status otherwise changes.
The Committee continues to note that HHS is responsible for the
temporary care of UACs specifically to ensure the welfare of such
children, many of whom have experienced significant trauma in
their home country and in travelling to the United States.
The Committee recommendation combined with supplemental
funding provided in fiscal year 2018 helps ensure HHS can maintain sufficient capacity in State-licensed shelters that provide care
according to recognized State child welfare standards, and otherwise provide care for children consistent with applicable laws,
other requirements, and ORR policies. This, in turn, helps ensure
that children can be referred and transferred from DHS to HHS
care as soon as possible within 72 hours. The Committee will continue to work closely with HHS on estimated funding needs for this
program.
The Committee continues to direct HHS to submit to Congress,
and make publicly available online, a report with respect to children who were separated from a parent or legal guardian, including the number and ages of children separated by sector and the
documented cause of separation as reported by DHS when each
child was referred.
Legal Services, Child Advocates, and Post Release Services.—The
Committee directs ORR to continue funding for legal services, child
advocates, and post-release services at no less than the levels and
for the purposes provided for in fiscal year 2020 and as specified
in the fiscal year 2020 explanatory statement. Further, the Committee expects ORR to continue to provide post-release services for
children qualifying for such services under the Trafficking Victims
Protection Reauthorization Act [TVPRA] (Public Law 110–457) and
for children otherwise identified by case managers.
Records Requests.—The Committee continues to expect ORR to
maintain records and respond to records requests consistent with
the requirements of section 552 of title 5, United States Code, for
information related to all UACs in ORR’s custody, 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. The Committee further notes that the Department should not withhold records from disclosure unless the
Department reasonably foresees that disclosure would harm an interest protected by an exemption described in section 552(b) of title
5, or is otherwise prohibited by law.
Reporting and Notification Requirements.—The Committee appreciates HHS’ work to provide the Committee with timely information and data on the UAC program. The Committee also appreciates the ‘‘Latest UAC Data’’ available on HHS’ website and di-

153
rects the Department to continue updating those monthly totals
with the length of stay by facility type (including influx facilities),
in addition to information currently available. The Committee directs ORR to continue to provide reports, data, and notifications as
required in fiscal year 2020, but supports any efforts to streamline
duplicative or overlapping notification and reporting requirements
as long as the level and detail of information is unchanged.
Spend Plan.—The Committee directs ORR to incorporate all
funding provided in this act into a comprehensive spend plan that
must be submitted to the Committees on Appropriations of the
House of Representatives and the Senate every 60 days in accordance with section 410 of the Emergency Supplemental Appropriations for Humanitarian Assistance and Security at the Southern
Border Act, 2019 (Public Law 116–26).
State Licensed Shelters.—The Committee continues to direct
HHS to prioritize licensed, community-based placements (including
foster care and small group homes) over large-scale institutions,
and to notify the Committee prior to releasing any funding opportunity announcements grants or contract awards, or plans to lease
or acquire real property.
Temporary Influx Shelters.—The Committee notes that HHS did
not have to utilize influx facilities in fiscal year 2020 and continues
to expect that such facilities are only used as a last resort when
there is not sufficient capacity in state-licensed facilities. The Committee continues statutory requirements related to the operation of
influx facilities, if needed, included in Public Law 116–94. The
Committee continues to direct HHS to submit periodic reports, as
applicable, on any operational influx facility, including a detailed
cost breakdown, the capacity and number of children at the facility
by month, the average length of stay and length of care, the reasons children were at the facility for more than 60 days, the barriers to State-licensing, including any State child welfare laws and
regulations that could not be met, and the projected timeline of the
contract or cooperative agreement.
Victims of Torture
The Committee recommendation includes $16,000,000 for the
Victims of Torture program to provide support to non-profit organizations providing direct support to torture survivors and their families.
PAYMENTS TO STATES FOR THE CHILD CARE AND DEVELOPMENT
BLOCK GRANT

$5,826,000,000
5,826,000,000
5,876,000,000

The Committee recommends $5,876,000,000, an increase of
$50,000,000, for the Child Care and Development Block Grant
[CCDBG], a formula grant to States that provides financial assistance to families to help pay for child care, and otherwise improve
the quality of child care programs.

154
SOCIAL SERVICES BLOCK GRANT

Appropriations, 2020 ............................................................................. $1,700,000,000
Budget estimate, 2021. .......................................................................... ...........................
Committee recommendation .................................................................
1,700,000,000

The Committee recommends $1,700,000,000 in mandatory funds
for the Social Services Block Grant [SSBG], a flexible source of
funding that allows States to provide a diverse array of services to
low-income children and families, the disabled, and the elderly.
The Committee continues to note that SSBG funding can be used
for a very wide-range of activities and encourages HHS to ensure
that States are aware that funding can be used to support child
support programs by providing job training and employment services for non-custodial parents.
CHILDREN AND FAMILIES SERVICES PROGRAMS

Appropriations, 2020 ............................................................................. $12,876,652,000
Budget estimate, 2021 ........................................................................... 11,856,130,000
Committee recommendation ................................................................. 12,962,269,000

The Committee recommends $12,962,269,000 for Children and
Families Services programs. These funds support a variety of programs for children, youth, and families; Native Americans; victims
of child abuse, neglect, and domestic violence; and other vulnerable
populations.
Head Start
The Committee recommendation includes $10,713,095,000, an increase of $100,000,000, for Head Start. Head Start provides grants
directly to local organizations to provide comprehensive early childhood education services to children and their families, from before
birth to age 5.
Within the total, the Committee recommendation includes a
$100,000,000 cost of living adjustment for all Head Start grantees
to help keep up with rising costs, to recruit and retain highly qualified staff, and to continue to provide high-quality services to children and families.
Designation Renewal System [DRS].—The Committee continues
to encourage HHS to continue to consider the unique challenges
faced by Head Start grantees in remote and frontier areas when reviewing such grantees’ compliance with health and dental screening requirements as part of the DRS.
Early Head Start [EHS] Expansion and EHS-Child Care Partnerships.—The Committee continues to expect that any funds used
for EHS-Expansion and EHS-Child Care-Partnership grants that
are re-competed will continue to be used for such purposes. Finally,
the Committee continues to direct HHS to include in future CJs
the actual and estimated number of slots in each of Head Start,
Early Head Start, and EHS-Child Care Partnerships.
Facility Improvement Funding.—The Committee continues to
strongly encourage ACF to ensure that all Head Start grantees are
aware of any funding opportunities, or funding otherwise available,
for making capital improvements to their facilities. Further, the
Committee continues to encourage ACF to standardize this process

155
so all grantees have equal opportunity to apply and are aware of
priorities and eligible uses of such funds.
Preschool Development Grants
The Committee recommendation includes $275,000,000 for Preschool Development Grants. This program, as authorized in the
Every Student Succeeds Act (Public Law 114–95), provides competitive grants to States to improve the coordination, collaboration,
and quality of existing early childhood programs; improve the transition from early childhood programs to kindergarten; implement
evidence-based practices; improve professional development for
early childhood providers; and generally improve educational opportunities for children.
Consolidated Runaway and Homeless Youth Program
The Committee recommendation includes $113,780,000 for the
Consolidated Runaway and Homeless Youth program. This program supports the Basic Centers program, which provides temporary shelter, counseling, and after-care services to runaway and
homeless youth under age 18 and their families; the Transitional
Living Program, which provides longer-term shelter and services
for older youth; and a national toll-free runaway and homeless
youth crisis hotline.
Where allowable, the Committee continues to support the ability
of grantees to provide prevention services, such as counseling and
case management, regardless of their enrollment in residential
services.
Family and Youth Homelessness.—The Committee commends
ACF for holding regional listening sessions in 2019 on youth and
family homelessness. ACF’s programs are uniquely able to support
children, youth, and families experiencing homelessness in moving
toward the goals of self-sufficiency, health, and wellness. In particular, the Family and Youth Services Bureau, Office of Head
Start, Office of Child Care, Office of Family Assistance, and the
Children’s Bureau offer critical services to interrupt generational
poverty and homelessness, and promote economic mobility. In its
summary report on the 2019 listening sessions, ACF noted that it
is considering recommendations from local providers on how individual ACF programs might be improved to better serve families
and youth experiencing homelessness, and how ACF, as an agency,
can support community efforts on family homelessness. The Committee strongly encourages ACF to select and implement promising
recommendations that emerged from the listening sessions and to
expand its work on family and youth homelessness, including
through intra-agency and program-specific Information Memoranda, Program Instructions, data collection, incentives for serving
homeless families and youth in requests for applications, conventions, and training and technical assistance.
Education and Prevention Grants To Reduce Sexual Abuse of Runaway Youth
The Committee recommendation includes $18,641,000 for Education and Prevention Grants to Reduce Sexual Abuse of Runaway
and Homeless Youth. This program provides competitive grants for

156
street-based outreach and education services for runaway and
homeless youth who are subjected to, or are at risk of being subjected to, sexual abuse or exploitation.
Child Abuse Prevention and Treatment State Grants
The Committee recommendation includes $90,091,000 for the
Child Abuse Prevention and Treatment State Grant program. This
program provides formula grants to States to improve their child
protective service systems.
Infant Plans of Safe Care.—Within the total, the Committee recommendation includes $60,000,000 to help States continue to develop and implement plans of safe care as required by section
106(b)(2)(B)(iii) of the Child Abuse Prevention and Treatment Act
(Public Law 93–247). The incidence of NAS has increased as the
opioid crisis has worsened, and this funding will help States improve their response to infants and families affected by a substance
use disorder. The Committee continues to strongly encourage HHS
to encourage States to include in their plans specialized services for
parents whose children may be at risk of abuse or neglect to reduce
the need for child welfare or foster care system involvement. Finally, the Committee continues to direct HHS to provide technical
assistance to States on best-practices and evidence-based interventions in this area to help address the health, safety, and substance
use disorder treatment needs of the child and family, including
guidance on the requirements and key terms in section 106(b)(2)(B)
clauses (ii) and (iii), and to evaluate State’s activities on plans of
safe care. The Committee also directs the Department to provide
an update within 90 days of enactment regarding HHS’ and States’
efforts around plans of safe care.
Child Abuse Discretionary Activities
The Committee recommendation includes $35,000,000 for Child
Abuse Discretionary Activities. This program supports discretionary grants for research, demonstration, and technical assistance to increase the knowledge base of evidence-based practices
and to disseminate information to State and local child welfare programs.
Child Abuse Hotline.—Within the total, the Committee includes
$1,000,000 to continue support for an innovation grant to develop
and research text and online chat-based intervention and education
services through a national child abuse hotline for child abuse victims and concerned adults.
Child Advocacy Studies Training.—The Committee recognizes
that workforce development is needed to ensure that professionals
are trained to respond to incidences of child abuse. Effective responses to child abuse involve a wide array of professionals, including social workers, teachers, law enforcement, prosecutors,
healthcare providers, lawyers, and faith-based leaders, among others. All of these individuals need to be trained in how to properly
handle the unique circumstances around responding to child abuse
and child mistreatment. Therefore, the Committee provides
$2,000,000 to fund the first year of a pilot project to develop best
practices for a statewide child advocacy studies training program
network to provide training both through institutions of higher

157
learning and through continuing education. Preference shall be
given to States that have both existing infrastructure built to train
a large number of individuals and existing partnerships with a
high percentage of the State’s public and private higher education
institutions, including community colleges, 4-year universities, and
professional schools. A successful project shall include collaboration
among the State’s Child Advocacy Centers, the State child welfare
agency, and the State’s Attorney General’s office.
Child Fatalities and Near Fatalities Due to Child Abuse and Neglect.—The Committee directs the Department to provide a report
to the Committee within 6 months of enactment of this act assessing the validity and reliability of national and State-level data submitted through the National Child Abuse and Neglect Data System
on child fatalities and near-fatalities due to child abuse and neglect. The Committee expects the report to contain the Department’s recommendations to improve this data collection to increase
the accuracy of national and State-level child abuse and neglect
statistics, including examining State variance in whether child fatalities or near-fatalities due to child abuse and neglect records are
comprehensively submitted through this data collection. The Committee recognizes the importance of collecting comparable and quality data on child fatalities and near-fatalities and publically disclosing such data, to improve State and local child welfare systems
to prevent child abuse deaths from occurring in the first place.
Community-based Child Abuse Prevention
The Committee recommendation includes $55,660,000 for the
Community-based Child Abuse Prevention program. This program
provides formula grants to States that then disburse funds to local,
community-based organizations to improve local child abuse prevention and treatment efforts, including providing direct services
and improving the coordination between State and communitybased organizations.
Child Welfare Services
The Committee recommendation includes $268,735,000 for Child
Welfare Services. This formula grant program helps State and
Tribal public welfare agencies improve their child welfare services
with the goal of keeping families together. These funds help States
and Tribes provide a continuum of services that prevent child neglect, abuse or exploitation; allow children to remain with their
families, when appropriate; promote the safety and permanence of
children in foster care and adoptive families; and provide training
and professional development to the child welfare workforce.
Child Welfare Research, Training, and Demonstration
The Committee recommendation includes $19,984,000 for child
welfare research, training, and demonstration projects. This program provides grants to public and nonprofit organizations for
demonstration projects that encourage experimental and promising
types of child welfare services, as well as projects that improve
education and training programs for child welfare service providers.

158
National Survey of Child and Adolescent Well-being.—The Committee recommendation includes funding for HHS to continue the
National Survey of Child and Adolescent Well-being.
Adoption Opportunities
The Committee recommends $46,100,000 for the Adoption Opportunities program, an increase of $4,000,000. This program funds
discretionary grants to help facilitate the elimination of barriers to
adoption and provide technical assistance to help States increase
the number of children adopted, particularly children with special
needs.
The Committee recommendation includes $1,000,000 to continue
the National Adoption Competency Mental Health Training Initiative. This supports ongoing resources for a national organization
with the capacity and expertise to continuously evaluate and update the training curriculums, and 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.
Adoption and Legal Guardianship Incentive Payments
The Committee recommends $75,000,000 for the Adoption and
Legal Guardianship Incentive Payments program. This program
provides formula-based incentive payments to States to encourage
them to increase the number of adoptions of children from the foster care system, with an emphasis on children who are the hardest
to place.
The Committee recommendation continues to make up a shortfall
in funding owed to States. ACF estimates States will earn approximately $65,000,000 in incentive payments in fiscal years 2020 and
2021. The Committee recommendation will pay for approximately
$21,500,000 of the balance owed to States from fiscal year 2020
and $43,500,000 of the amount earned in fiscal year 2021. The
Committee continues to direct HHS to include in budget justifications an estimate of amounts earned by States per year, and the
total estimated amount owed to States for the budget year, including any funding owed from prior fiscal years.
Social Services and Income Maintenance Research
The Committee recommends $7,012,000 for Social Services and
Income Maintenance Research. These funds support research and
evaluation of cost-effective programs that increase the stability and
economic independence of families and contribute to the healthy
development of children and youth.
Native American Programs
The Committee recommends $56,050,000 for Native American
programs. These funds support a variety of programs to promote
self-sufficiency and cultural preservation activities among Native
American, Native Hawaiian, Alaska Native, and Pacific Islander
organizations and communities.
Native American Language Preservation.—Within the total, the
Committee recommendation includes $12,500,000 for Native American language preservation activities, including no less than

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$4,500,000 for Native American language nests and survival
schools, as authorized by sections 803C(b)(7)(A)-(B) of the Native
American Programs Act (Public Law 88–452). The Committee directs HHS to give priority to programs with rigorous immersion
programs.
Community Services Block Grant
The Committee recommendation includes $740,000,000 for the
Community Services Block Grant [CSBG]. The CSBG is a formula
grant to States and Indian Tribes to provide a wide-range of services to alleviate causes of poverty in communities and to assist lowincome individuals in becoming self-sufficient. States are required
to pass on at least 90 percent of these funds to local communitybased organizations, the vast majority of which are community action agencies.
Supporting Community Action Agencies’ Response to Opioid
Abuse and Misuse.—Individuals and families in poverty face
daunting challenges as they work toward substance use recovery
and addressing the opioid epidemic requires a multi-pronged, community-based response. The Committee recognizes that community
action agencies are uniquely positioned to help fight the opioid crisis and provide essential support and services for individuals and
families who experience poverty, and that these entities deliver a
wide range of services to address immediate needs while supporting long-term goals, which make recovery sustainable.
Community Economic Development
Due to budget constraints, the Committee recommendation does
not include funding for the Community Economic Development program.
Rural Community Facilities
The Committee recommendation includes $10,000,000 for the
Rural Community Facilities program, which provides grants to regional non-profit organizations to provide technical assistance to
small, low-income rural communities, that are not served by other
similar Federal programs, to help manage, develop, and improve
safe drinking and waste water facilities.
National Domestic Violence Hotline
The Committee recommendation includes $12,000,000 for the National Domestic Violence Hotline. This national, toll-free hotline
provides critical emergency assistance and information to victims of
domestic violence 24 hours a day.
The Committee recommendation includes continued support for
the StrongHearts Native Helpline, which provides critical support
and resources to meet the unique legal and cultural needs of American Indians and Alaska Natives affected by domestic violence.
Family Violence Prevention and Services
The Committee recommendation includes $175,000,000 for Family Violence Prevention and Services programs. These funds support programs to prevent family violence and provide immediate

160
shelter and related assistance for victims of domestic violence and
their dependents.
Chafee Education and Training Vouchers
The Committee recommendation includes $43,257,000 for the
Chafee Education and Training Voucher program. This program
supports vouchers to foster care youth to help pay for expenses related to postsecondary education and vocational training.
Disaster Human Services Case Management
The Committee recommends $1,864,000 for Disaster Human
Services Case Management. This program assists States in establishing the capacity to provide case management services in a timely manner in the event of a disaster. It ensures that States are able
to meet social service needs during disasters by helping disaster
victims prepare recovery plans, referring them to service providers
and Federal Emergency Management Agency contacts to identify
needed assistance, and providing ongoing support and monitoring
through the recovery process.
Program Administration
The Committee recommendation includes $206,000,000 for the
Federal costs of administering ACF programs.
PROMOTING SAFE AND STABLE FAMILIES

$437,515,000
404,765,000
437,515,000

The Committee recommends $437,515,000 for the Promoting Safe
and Stable Families program. The Committee recommendation includes $345,000,000 in mandatory funds authorized by the Social
Security Act (Public Law 74–271) and $92,515,000 in discretionary
appropriations.
This program supports activities that can prevent the emergence
of family crises that might require the temporary or permanent removal of a child from his or her home. Grants allow States to operate coordinated programs of family preservation services, time-limited family reunification services, community-based family support
services, and adoption promotion and support services.
Kinship Navigator Programs.—The Committee recommendation
includes $20,000,000, the same as the fiscal year 2020 funding
level, for Kinship Navigator Programs to improve services for
grandparents and other relatives taking primary responsibility for
children, particularly children and families affected by opioid addiction and substance use disorder. The Committee encourages HHS
to encourage States to collaborate with agencies with experience
servicing kinship families both inside and outside foster care, and
to demonstrate how they are preparing their navigator programs to
meet evidence-based kinship navigator standards included in the
Family First Prevention Services Act (Public Law 115–123). Similar to Regional Partnership Grants and family-focused residential
treatment programs, this funding helps build the evidence base in
anticipation of mandatory funding being available for similar activities under the Family First Prevention and Services Act.

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Regional Partnership Grants [RPGs] and Family-Focused Residential Treatment Programs.—Within the total for discretionary
funding, the Committee recommendation includes $10,000,000 for
RPGs that promote coordination and collaboration between local
child welfare and substance abuse treatment agencies, and other
related organizations, to improve services and outcomes for children and families affected by substance use disorder, particularly
opioid use. The Committee strongly encourages ACF to prioritize
applicants that will focus on preparing programs to qualify as evidence-based foster care prevention services under the Family First
Prevention Services Act (Public Law 115–123), including family-focused residential treatment programs, which help families remain
together safely while parents receive treatment. The Committee
also recommends priority be given to programs that mitigate the
traumatic impact of parental incarceration.
PAYMENTS FOR FOSTER CARE AND PERMANENCY

$5,744,000,000
7,012,000,000
7,012,000,000

The Committee recommends $7,012,000,000 in mandatory funds
for Payments for Foster Care and Permanency. In addition, the
Committee recommends $3,000,000,000 in advance mandatory
funding for the first quarter of fiscal year 2022. These funds support programs that assist States with the costs of maintaining eligible children in foster care, prepare children for living on their
own, assist relatives with legal guardianship of eligible children,
and find and support adoptive homes for children with special
needs.

ADMINISTRATION

FOR

COMMUNITY LIVING

AGING AND DISABILITY SERVICES PROGRAMS

$2,250,815,000
2,108,207,000
2,262,915,000

The Committee recommends $2,262,915,000 for the Administration for Community Living [ACL], which includes $27,700,000 to be
transferred to ACL from the PPH Fund.
ACL was created with the goal of increasing access to community
support for older Americans and people with disabilities. It is
charged with administering programs authorized under the Older
Americans Act [OAA] (Public Law 116–131) and the Developmental
Disabilities Act (Public Law 106–402), as well as promoting community living policies throughout the Federal Government for older
Americans and people with disabilities.
Home- and Community-Based Supportive Services
The Committee recommends $390,074,000 for the Home- and
Community-Based Supportive Services program. This program provides formula grants to States and territories to fund a wide-range
of social services that enable seniors to remain independent and in
their homes for as long as possible. State agencies on aging award
funds to designated area agencies on aging that, in turn, make
awards to local service providers. This activity supports services
such as transportation, adult day care, physical fitness programs,
and in-home assistance, such as personal care and homemaker assistance.
Preventive Health Services
The Committee recommends $24,848,000 for Preventive Health
Services. This program funds activities such as medication management and enhanced fitness and wellness programs. These programs
help seniors stay healthy and avoid chronic disease, thus reducing
the need for costly medical interventions. The Committee maintains bill language that requires States to use these funds to support evidence-based models that enhance the wellness of seniors.
Protection of Vulnerable Older Americans
The Committee recommends $22,658,000 for grants to States for
the Long-term Care Ombudsman program and the Prevention of
Elder Abuse program. Both programs provide formula grants to
States to prevent the abuse, neglect, and exploitation of older individuals. The Ombudsman program focuses on the needs of residents of nursing homes and other long-term care facilities, while
the elder abuse prevention program targets the elderly community
at large.
(162)

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National Family Caregiver Support Program
The Committee recommends $186,036,000 for the National Family Caregiver Support program. Funds appropriated for this activity
establish a multifaceted support system in each State for family
caregivers, allowing them to care for their loved ones at home for
as long as possible. States may use funding to provide information
to caregivers about available services, assistance to caregivers in
gaining access to services, caregiver counseling and training, respite care to enable caregivers to be temporarily relieved from their
caregiving responsibilities, and limited supplemental services that
fill remaining service gaps.
National Family Caregiver Strategy.—The Committee notes that
the RAISE Family Caregivers Act (Public Law 115—119) requires
HHS to establish a Family Caregiving Advisory Council and develop a new national strategy to support family caregivers, including resources, best practices, challenges, and programs to enhance
the long-term care caregiving workforce. The Committee includes
$100,000 to continue to support the work of the Council in the development of a national family caregiving strategy.
Native American Caregiver Support Program
The Committee recommends $10,306,000 to carry out the Native
American Caregiver Support program. This program provides
grants to tribes for the support of American Indian, Alaskan Native, and Native Hawaiian families caring for older relatives with
chronic illness or disability, as well as for grandparents caring for
grandchildren.
Congregate and Home-Delivered Nutrition Services
The Committee recommends $510,342,000 for congregate nutrition services and $266,342,000 for home-delivered meals. These
programs address the nutritional needs of older individuals, thus
helping them to stay healthy and reduce their risk of disability.
Funded projects must make home-delivered and congregate meals
available at least once per day, 5 days a week, and each meal must
meet a minimum of one-third of daily dietary requirements. While
States receive separate allotments of funds for congregate meals,
home-delivered meals, and supportive services, they have flexibility
to transfer funds between these programs.
Nutrition Services Incentives Program [NSIP].—The Committee
recommends $160,069,000 for NSIP. NSIP augments funding for
congregate and home-delivered meals provided to older adults.
States and tribes may choose to receive all or part of their funding
in the form of commodities from the U.S. Department of Agriculture.
Aging Grants to Indian Tribes and Native Hawaiian Organizations
The Committee recommends $34,708,000 for grants to Native
Americans. This program provides grants to eligible tribal organizations for the delivery of nutrition and supportive services to Native Americans.

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Aging Network Support Activities
The Committee recommends $17,461,000 for Aging Network Support activities. These funds support activities that expand public
understanding of aging and the aging process, apply social research
and analysis to improve access to and delivery of services for older
individuals, test innovative ideas and programs, and provide technical assistance to agencies that administer programs authorized
by the OAA.
Care Corps Grants.—The Committee recognizes the growing demand for services and supports to help seniors and individuals
with disabilities live independently in their homes, and the need to
support family caregivers who facilitate that independence. Therefore, the Committee provides $5,000,000 to continue the grant provided in fiscal year 2019 to support innovative local models in
which volunteers assist family caregivers or directly assist older
adults or adults with disabilities in maintaining their independence.
Holocaust Survivor Assistance.—The Committee provides
$5,000,000 for the Holocaust Survivor Assistance program.
Alzheimer’s Disease Program Demonstration Grants to States
The Committee recommends $27,500,000, an increase of
$1,000,000, for Alzheimer’s Disease Program which includes Demonstration Grants to States and the Alzheimer’s Disease Initiative.
Within this funding, the Committee supports the continuation of
the National Alzheimer’s Call Center, which is available in all
States, 24 hours a day, 7 days a week, year-round, to provide expert advice, crisis counseling, care consultation and information referral services in at least 140 languages, for persons with Alzheimer’s disease, their family members and informal caregivers.
The Committee recommends up to $2,000,000 to continue the National Alzheimer’s Call Center.
Lifespan Respite Care
The Committee recommends $7,110,000, an increase of
$1,000,000, for the Lifespan Respite Care program. The Lifespan
Respite Care program provides grants to States to expand respite
care services to family caregivers, improve the local coordination of
respite care resources, and improve access to and quality of respite
care services, thereby reducing family caregiver strain.
Chronic Disease Self-Management Program
The Committee recommends $8,000,000 to be transferred from
the PPH Fund to ACL for the Chronic Disease Self-Management
Program [CDSMP]. This program assists those with chronic disease
with education to manage their conditions and improve their
health status. Topics covered by the program include nutrition; appropriate use of medications; fitness; and effective communications
with health care providers. Multiple studies have shown CDSMP to
result in significant and measurable improvements in health and
quality of life, as well as reductions in hospitalizations and emergency room visits.

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Elder Falls Prevention
The Committee recommends $5,000,000 to be transferred from
the PPH Fund for Elder Falls Prevention activities at ACL. Preventing falls will help seniors stay independent and in their homes
and avoid costly hospitalizations and hip fractures, which frequently lead to nursing home placement.
Elder Rights Support Activities
The Committee recommends $15,874,000 for Elder Rights Support activities, including $12,000,000 for the Elder Justice Initiative. These activities support programs that provide information,
training, and technical assistance to legal and aging services organizations in order to prevent and detect elder abuse and neglect.
Aging and Disability Resource Centers
The Committee recommendation includes $8,119,000 for Aging
and Disability Resource Centers. These centers provide information, one-on-one counseling, and access for individuals to learn
about their long-term services and support options with the goal of
allowing seniors and individuals with disabilities to maintain their
independence.
State Health Insurance Assistance Program
The Committee recommends $52,115,000 for State Health Insurance Assistance Programs, which provide accurate and understandable health insurance information to Medicare beneficiaries and
their families.
Paralysis Resource Center
The Committee recommends $9,700,000 for the National Paralysis Resource Center [PRC]. This program has long provided essential, comprehensive information, and referral services that promote
independence and quality of life for the nearly 5,400,000 people living with paralysis and their families. The Committee directs ACL
to continue support for the national PRC at not less than
$8,700,000.
The Committee is concerned that ACL’s PRC State pilot programs may be duplicative of Federal grant making, and requests
that ACL assess whether State pilot programs meet additional
needs beyond the work of the national PRC and provide a report
to the Committee on Appropriations of the House of Representatives and the Senate within 120 days of enactment of this act.
Limb Loss
The Committee recommends $4,000,000 for the Limb Loss program, which supports programs and activities to improve the
health of people with limb loss and promote their well-being, quality of life, prevent disease, and provide support to their families
and caregivers. Maintaining these programs is critical to support
independent living within the disability community across their life
course.

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Traumatic Brain Injury
The Committee provides $11,321,000 for the Traumatic Brain Injury program. The program supports implementation and planning
grants to States for coordination and improvement of services to individuals and families with traumatic brain injuries. Such services
can include pre-hospital care, emergency department care, hospital
care, rehabilitation, transitional services, education, employment,
long-term support, and protection and advocacy services.
The Committee includes not less than the fiscal year 2020 funding level for protection and advocacy services, as authorized under
section 1305 of Public Law 106—310.
Developmental Disabilities State Councils
The Committee recommends $78,000,000 for State councils on
developmental disabilities. These councils work to develop, improve, and expand the system of services and supports for people
with developmental disabilities at the State and local level. Councils engage in activities such as training, educating the public,
building capacity, and advocating for change in State policies with
the goal of furthering the inclusion and integration of individuals
with developmental disabilities in all aspects of community life.
Technical Assistance.—The Committee instructs the Department
to provide not less than $700,000 for technical assistance and
training for the State Councils on Developmental Disabilities.
Developmental Disabilities Protection and Advocacy
The Committee recommends $40,784,000 for protection and advocacy programs for people with developmental disabilities. This formula grant program provides funds to States to establish and
maintain protection and advocacy systems that protect the legal
and human rights of persons with developmental disabilities who
are receiving treatment, services, or rehabilitation.
Intermediate Care Facilities.—There is a nationwide trend toward deinstitutionalization of patients with intellectual or developmental disabilities in favor of community-based settings. The Department is strongly urged to consider 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
(Public Law 106–402).
Voting Access for Individuals with Disabilities
The Committee recommends $7,463,000 to improve voting access
for individuals with disabilities. This program provides grants to
protection and advocacy organizations to ensure that individuals
with disabilities have the opportunity to participate in every step
of the electoral process, including registering to vote, accessing polling places, and casting a vote.
Developmental Disabilities Projects of National Significance
The Committee recommends $12,250,000 for projects of national
significance to assist persons with developmental disabilities. This
program funds grants and contracts that develop new technologies
and demonstrate innovative methods to support the independence,

167
productivity, and integration into the community of persons with
developmental disabilities.
University Centers for Excellence in Developmental Disabilities
The Committee recommends $41,619,000 for the University Centers for Excellence in Developmental Disabilities, a network of 67
centers that are interdisciplinary education, research, and public
service units of a university system or public or nonprofit entities
associated with universities.
Independent Living
The Committee recommends $116,183,000 for the Independent
Living Program. This program helps ensure that individuals with
disabilities can live productive and independent lives in society.
Funding helps States sustain, improve, and expand independent
living services and establish and support a network of centers for
independent living.
National Institute on Disability, Independent Living, and Rehabilitation Research
The Committee recommends $114,470,000 for the National Institute on Disability, Independent Living, and Rehabilitation Research [NIDILRR], including an increase of $2,500,000 for the ADA
National Network Centers. NIDILRR supports research and activities that help to maximize the full potential of individuals with disabilities in employment, independent living, and social activities.
The Committee recognizes that there is a significant opportunity
over the next decade for the Department to simultaneously lower
health care costs and improve quality of life for the older adult and
disabled populations by embracing the rapidly growing shift to
technology solutions for daily living. These solutions are poised to
extend the ability to live independently into advanced age and ‘‘age
in place,’’ helping to bridge the ‘‘care gap’’ so that older and disabled adults might avoid nursing homes and other institutionalized
care for as long as possible, while also remaining connected to their
families and communities.
The Committee maintains funding to support research and activities that help older or disabled adults, including those in rural
and tribal communities, to increase, maintain, or improve their
functional capabilities. To that end, the Committee directs
NIDILRR to maintain investments in university research to harness technological advances that improve health, maximize community engagement, encourage productivity, and preserve independence among older individuals and their families. Special emphasis
should be given to research projects that seek to develop technologies that allow for independent living, address aging and disabled populations, and target rural, frontier, and tribal communities, as they stand to benefit the most from home and community-delivered technologies that reduce isolation, increase safety
and well-being, prevent falls and related injuries, and maximize
mobility.

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Assistive Technology
The Committee recommends $38,500,000, an increase of
$1,500,000, for Assistive Technology [AT]. AT provides States with
funding to support individuals with disabilities of all ages to obtain
devices and services that will increase, maintain, or improve their
functional capabilities.
Program Administration
The Committee recommends $42,063,000 for program administration at ACL. These funds support salaries and related expenses
for program management and oversight activities.
OFFICE

OF THE

SECRETARY

GENERAL DEPARTMENTAL MANAGEMENT

$544,457,000
420,945,000
554,707,000

The Committee recommends $554,707,000 for General Departmental Management [GDM]. The recommendation includes
$64,828,000 in transfers available under section 241 of the PHS
Act (Public Law 78–410 as amended).
This appropriation supports activities that are associated with
the Secretary’s role as policy officer and general manager of the
Department. It supports health activities performed by the Office
of the Assistant Secretary for Health [ASH], including the Office of
the Surgeon General. GDM funds also support the Department’s
centralized services carried out by several Office of the Secretary
staff divisions, including personnel management, administrative
and management services, information resources management,
intergovernmental relations, legal services, planning and evaluation, finance and accounting, and external affairs.
Appropriate Nurse Staffing.—The Committee directs HHS to provide in its fiscal year 2022 CJ information on the Department’s efforts to integrate violence prevention strategies across its safety
and quality oversight activities. The Committee encourages the
Secretary to consider such strategies in ongoing Medicare initiatives to safeguard patient safety, improve quality and care, and reward high-performing providers.
Bereavement Care.—The Committee is aware of research indicating that individuals and families suffer severe health, social,
and economic declines following the death of a loved one—be it a
child, sibling, spouse, parent, or other caregiver. The Committee
encourages the Secretary to examine HHS activities to advance bereavement care for families, including prevalence of bereavement
events, risk factors and associated health events or outcomes, biological or physiological changes in wellbeing, and policies or programs in place that help or hinder functional coping or adaptive
processing.
Best Practices for Cancer Survivorship Care.—The Committee encourages HHS to complete the identification of best practices for
childhood and adolescent cancer survivorship care, as directed by
the STAR Act (Public Law 115–180). The Committee encourages
the Department to consult with individuals who have expertise in

169
late effects of disease and treatment of childhood and adolescent
cancers such as oncologists, primary care providers, childhood and
adolescent cancer survivors, parents of survivors, nurses, social
workers, mental health professionals, physical and occupational
therapists, childhood cancer patient organizations, and other experts.
Cerebral Cavernous Angioma.—The Committee encourages HHS
Operating Divisions to work together as a consortium, with at least
one patient advocacy organization, to increase the efficiency and effectiveness of the research and clinical drug trials effort.
Chronic Fatigue Syndrome Advisory Committee.—The Committee
looks forward to reviewing HHS’ plan regarding myalgic
encephalomyelitis/chronic fatigue syndrome [ME/CFS]. In the interim, the Committee encourages HHS to foster interagency and
stakeholder collaboration in addressing the crisis in ME/CFS clinical care and accelerating drug development for ME/CFS.
Chronic Kidney Disease [CKD].—The Committee is concerned by
the significant and growing burden of CKD, which affects an estimated 37,000,000 Americans. Unfortunately, 90 percent of individuals with CKD are unaware they have the illness. The progression
of kidney disease and its comorbidities can decrease with timely
awareness, diagnosis, and treatment. The Committee encourages
the Secretary to use available funds to support a public awareness
initiative, building on the Administration’s July 2019 Advancing
American Kidney Health Initiative, which provides education about
kidney disease to providers and at-risk Americans and promotes
early detection, treatment, and management of kidney disease to
improve patient outcomes.
Clinical Psychological Training for Public Health Service Commissioned Corps.—The Committee supports the review by the Surgeon General’s office to update HHS Commissioned Corps regulations to permit the additional graduates in clinical psychology to be
employed by the Public Health Service Commissioned Corps. The
Committee encourages the Surgeon General’s office to finalize and
implement these changes as soon as possible.
Data Sharing Agreements.—The Committee directs the Department’s National Directory of New Hires, in coordination with the
Department of Housing and Urban Development and the Social Security Administration, to update their joint data-sharing agreement
to provide public housing authorities with improved up-front income verifications through the Enterprise Income Verification system, and to eliminate the hardship of compiling documents for
homeless populations.
Disease X Medical Countermeasures.—The Committee encourages
HHS to work with the Department of Defense to implement a dedicated medical countermeasures program focused on achieving
seamless development, testing, large scale manufacturing, regulatory approval, distribution, and administration of safe and effective medical countermeasures to address emerging, re-emerging,
and previously unknown epidemic pathogens. Achieving these goals
would enhance our ability to save lives immediately with classes of
medical countermeasures that are broadly applicable or have a delivery mechanism. The Committee requests an update in the fiscal
year 2022 CJ.

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Disparity Populations.—The Committee recognizes the importance of understanding and addressing the needs of disparity populations. To ensure underserved and disadvantaged populations continue to be best served by programs and offices within the Department, the Committee directs the Secretary to continue the collection of data on disparity populations, as defined by Healthy People
2021, in surveys administered with funding in this act.
Drug-Free Communities.—The Committee urges the Secretary to
ensure that fiscal year 2021 Drug-Free Communities Support program funds are administered in a timely manner. The Secretary
should also seek to ensure that the funds are not awarded and announced incrementally.
Global Health Research.—The Committee requests an update in
the fiscal year 2022 CJ on how CDC, FDA, BARDA, and NIH jointly coordinate global health research activities with specific measurable metrics used to track progress toward agreed upon health
goals.
Improving the Health of America’s Children.—The Committee encourages the Surgeon General to release a report on improving the
health of America’s children. Too many children still live in poverty, compromising their ability to be healthy, to succeed in school,
and to raise healthy families themselves. A current report by the
Surgeon General on improving the health of children could increase
awareness and generate additional effort on ameliorating this public health problem.
Lung Cancer in Women.—The Committee understands that lung
cancer has a disparate impact on women, particularly those who
have never smoked. The Committee encourages the Secretary, in
consultation with the Secretary of Defense and the Secretary of
Veterans Affairs, to conduct an interagency study to evaluate the
status of research on women and lung cancer and make recommendations for additional research on the disparate impact of
lung cancer in women who have never smoked. The study should
also make recommendations regarding increased access to lung
cancer preventive services, and strategic public awareness and education campaigns related to lung cancer. The Committee requests
an update on these activities in the fiscal year 2022 CJ.
Nonrecurring Expenses Fund.—The Committee directs HHS to
continue implementing previously notified projects and prioritize
obligations for the following projects: Indian Health Service facilities, Cybersecurity, FDA laboratory renovations, and a CDC
NIOSH facility.
Obligation Reports.—The Committee directs the Secretary to submit electronically to the Committee an Excel table detailing the obligations made in the most recent quarter for each office and activity funded under this appropriation not later than 30 days after the
end of each quarter.
One Health Approach to Infectious Diseases.—The Committee
recognizes the interconnection of human health, animal health, and
environmental health, and the threat of novel and emerging
zoonotic diseases. The Committee encourages the Secretary to continue coordination with other Federal agency partners to support
collaboration of research and other actions to prepare for and pre-

171
vent emerging infectious disease pandemics and provide a progress
report to the Committee in the fiscal year 2022 CJ.
Operation Warp Speed [OWS].—The Committee strongly supports the OWS initiative to speed innovation and development of
medical countermeasures. The Committee expects the Secretary to
take best practices from OWS and use them to accelerate other
areas of medical countermeasures research. The Committee directs
the Secretary to provide an update on OWS in the fiscal year 2022
CJ and the Secretary to provide a broader update in the CJ on efforts to expand methods and lessons learned through OWS into
other areas of medical countermeasures research.
Opioid Response Resources.—The Committee continues to be concerned by the number of deaths and hospitalizations caused by the
opioid epidemic. As such, the Committee encourages the Secretary
to consider data regarding the burden of opioid overdose such as
fatality and hospitalization rates caused by the misuse of opioids
and stimulants when considering applications for grant opportunities addressing this crisis.
Organ Availability and Donation Innovation.—The Committee
directs the Secretary to coordinate with relevant divisions of HHS
to evaluate innovative approaches to enhance the availability of organs, otherwise encourage donation, and further improve the organ
transplantation process. The Secretary is directed to provide a report, including any authorizing changes that may be necessary, to
the Committees on Appropriations of the House of Representatives
and the Senate 90 days after enactment.
Pain Management Taskforce Report.—The Committee is pleased
with the Department’s release of the HHS Pain Management Best
Practices Inter-Agency Task Force Report and encourages the Secretary to widely disseminate the report to public health stakeholders, especially primary care clinicians, and update relevant
pain management policies and educational tools to reflect Task
Force recommended best practices across all relevant HHS Operating Divisions. The Committee requests an update on dissemination of these materials in the fiscal year 2022 CJ.
Prematurity and Maternal Mortality.—Preterm birth and its
complications continue to be the leading cause of death for infants
in the United States and around the world. The Committee is
aware that the PREEMIE Reauthorization Act of 2018 (Public Law
115–328) enables the Secretary to establish an interagency working
group to improve coordination of programs and activities within the
Department to prevent preterm birth, infant mortality, and related
adverse birth outcomes. The Committee requests an update in the
fiscal year 2022 CJ regarding activities to create the interagency
workgroup and activities to-date to accomplish the duties outlined
in the PREEMIE Reauthorization Act of 2018 (Public Law 115–
328). Additionally, the Committee recognizes the disparities in outcomes by race, ethnicity, geography, and income related to maternal mortality and prematurity, and appreciates the work of many
agencies in addressing these disparities.
Public Health in Indian Country.—The Committee recommends
that the Secretary examine current public health initiatives within
the Department that address public health crises such as viral hepatitis, HIV/AIDS, and opioids that impact Indian Country. The

172
Committee requests that HHS provide an update on these efforts
in the fiscal year 2022 CJ.
Rapid HIV Self-Test.—The Committee notes the important role
that rapid HIV self-testing can play towards meeting the public
health objectives outlined by the Ending the HIV Epidemic initiative, particularly in regards to rural and otherwise hard to reach
populations. HHS is encouraged to incorporate rapid HIV self-testing into emerging efforts.
Rural Communities.—The Committee encourages the Secretary
to ensure that rural concerns and challenges are adequately represented in the Department’s policies, programs, and activities, including policies related to the opioid epidemic. The Committee requests that the Secretary include a status of these activities in the
fiscal year 2022 CJ.
Safety in Health Care Facilities.—The Committee remains concerned about safety in health care facilities and looks forward to
continued conversations with HHS on this important matter.
Screening Framework for Providers of Synthetic Double-stranded
DNA.—The Committee is pleased that the Department is working
to update its 2010 Screening Framework Guidance for Providers of
Synthetic Double-stranded DNA. Given the scientific advancements
that have been made with producing synthetic genetic material in
recent years, coupled with its potential to be used as a threat to
national security, the Committee urges HHS to prioritize its work
with other relevant Federal departments and agencies to update
this document, factoring in ways to secure the bioeconomy and to
prevent illicit DNA synthesis and misuse. The Committee requests
that the Department provide a progress report on these efforts to
the Committees on Appropriations of the House of Representatives
and the Senate 180 days after enactment.
Sexually Transmitted Infections [STIs].—The Committee is aware
of the recent statistics regarding the rise in STIs across the nation
and is pleased that the ASH is creating a National STD Action
Plan to address increasing rates in these diseases. The Department
is directed to provide a report to the Committees on Appropriations
of the House of Representatives and the Senate 180 days after enactment of this act on such an Action Plan.
Staffing Reports.—The Committee includes a general provision
requiring the Department to submit a biannual staffing report to
the Committee. The Excel table will include: the names, titles,
grades, agencies, and divisions of all of the political appointees,
special government employees, and detailees that were employed
by or assigned to the Department during the previous month.
Study on Impact of Wildlife Markets on the Emergence of Novel
Viral Pathogens.—The Committee directs GAO to conduct a study
to evaluate the impact Chinese wildlife and wet-markets have on
the emergence of novel viral and microbial pathogens. Such report
shall examine the impact Chinese wildlife and wet-markets have
on the transmission of novel viral and microbial pathogens and
evaluate the role close contacts between human and food animals
have in the transmission of microbes from animals to humans.
Travel Reports.—The Committee includes a general provision requiring the Department to submit an upcoming travel report to the
Committees on Appropriations of the House of Representatives and

173
the Senate by the 1st and 15th day of each month. The report
should be a compilation of upcoming travel for the head of HRSA,
CDC, NIH, SAMHSA, AHRQ, CMS, ACF, ASPR, as well as for the
Secretary, Deputy Secretary, and Assistant Secretary. The report
shall include upcoming travel for the following two weeks, with details specifying location (city and state), event, and partners where
the event will be held.
Teen Pregnancy Prevention
The Committee recommendation includes $107,800,000 for the
Teen Pregnancy Prevention program. This program supports competitive grants to public and private entities to replicate evidencebased teen pregnancy prevention approaches. The recommendation
includes $6,800,000 in transfers available under section 241 of the
PHS Act (Public Law 78–410 as amended).
Office of Minority Health [OMH]
The Committee recommends $58,670,000 for the Office of Minority Health. The Office focuses on strategies designed to decrease
health disparities and to improve the health status of racial and
ethnic minority populations in the United States. OMH establishes
goals and coordinates all departmental activity related to improving health outcomes for disadvantaged and minority individuals.
Center for Indigenous Innovation and Health Equity.—The Committee recognizes the health and socioeconomic disparities facing
Indigenous communities in the United States and the need to support Indigenous innovation to draw on deeply-rooted values and
practices to address these challenges. The Committee encourages
the Office of Minority Health to support efforts including research,
education, service, and policy development related to advancing Indigenous solutions. The Committee directs HHS to submit information in the fiscal year 2022 CJ on how the Department is supporting these efforts.
Lupus Initiative.—The Committee continues to support the OMH
National Lupus Outreach and Clinical Trial Education program
and the goal of increasing minority participation in lupus clinical
trials, and provides an additional $250,000, and not less than
$2,000,000, for these efforts. The program has developed multiple
resources that can be used by the broader lupus community to enhance trial enrollment. The Committee encourages OMH to continue to develop public-private partnerships with organizations representing lupus patients, implement, action plans, and engage the
lupus community to increase participation in clinical trials for all
minority populations at highest risk of lupus.
Sexual Risk Avoidance
The Committee recommends $45,000,000, an increase of
$10,000,000, for sexual risk avoidance education. This is a competitive grant program that funds evidence-based abstinence models
for adolescents.
Funding for competitive grants for sexual risk avoidance shall
use medically accurate information referenced in peer-reviewed
publications by educational, scientific, governmental, or health organizations; implement an evidence-based approach; and teach the

174
benefits associated with self-regulation, success sequencing for poverty prevention, healthy relationships, goal setting, and resisting
sexual coercion, dating violence, and other youth risk behaviors.
Office of Women’s Health
The Committee recommends $33,640,000 for the Office of Women’s Health. This office develops, stimulates, and coordinates women’s health research, health care services, and public and health
care professional education across the Department. It advances important crosscutting initiatives and develops public-private partnerships, providing leadership and policy direction to address the disparities in women’s health.
The Committee recommendation includes $4,100,000 to combat
violence against women through the State partnership initiative.
This program provides funding to State-level public and private
health programs to partner with domestic and sexual violence organizations to improve health care providers’ ability to help victims
of violence and improve prevention programs.
OFFICE OF MEDICARE HEARINGS AND APPEALS

$191,881,000
196,381,000
191,881,000

The Committee provides $191,881,000 for the Office of Medicare
Hearings and Appeals [OMHA]. This Office is responsible for hearing Medicare appeals at the Administrative Law Judge [ALJ] level,
which is the third level of Medicare claims appeals. OMHA ensures
that Medicare beneficiaries who are dissatisfied with the initial decisions about their benefits or eligibility can appeal and exercise
their right to a hearing in front of an ALJ.
Appeals Backlog.—The Committee commends OMHA for making
progress on the cases that are still pending before ALJs at OMHA,
including the improvements to work flow by implementing electronic claims processing. The Committee remains concerned about
the backlog of just over 200,000 appeals. OMHA shall provide an
update to the Committee 180 days after enactment on the progress
and continued challenges with reducing the caseload backlog.
OFFICE OF THE NATIONAL COORDINATOR FOR HEALTH INFORMATION
TECHNOLOGY

$60,367,000
50,717,000
60,367,000

The Committee makes available $60,367,000 to the Office of the
National Coordinator for Health Information Technology [ONC].
ONC is responsible for coordinating Federal health information
systems and collaborating with the private sector to develop standards for a nationwide interoperable health information technology
infrastructure.
Standards for Interoperability.—The Committee includes
$5,000,000 within existing resources to support HL7 fast
healthcare interoperable resource standards-related activities needed to successfully achieve interoperability and information sharing
for better health and health care.

175
OFFICE OF INSPECTOR GENERAL

$80,000,000
90,000,000
80,000,000

The Committee recommends $80,000,000 for the HHS Office of
Inspector General [OIG]. In addition to discretionary funds provided in this act, the Health Insurance Portability and Accountability Act of 1996 (Public Law 104–191) provides a permanent appropriation of $334,097,000 for OIG.
OIG conducts audits, investigations, and evaluations of the programs administered by the Department’s operating and staff divisions, including the recipients of the Department’s grant and contract funds. In doing so, OIG addresses issues of waste, fraud, and
abuse and makes recommendations to improve the efficiency and
effectiveness of the Department’s programs and operations.
OFFICE FOR CIVIL RIGHTS

$38,798,000
30,286,000
38,798,000

The Committee recommends $38,798,000 for the Office for Civil
Rights [OCR] in budget authority. OCR is responsible for enforcing
civil rights-related statutes in health care and human services programs. To enforce these statutes, OCR investigates complaints of
discrimination, conducts program reviews to correct discriminatory
practices, and implements programs to generate voluntary compliance among providers and constituency groups of health and
human services.
Office for Civil Rights [OCR].—The Committee requests a report
180 days after enactment detailing what actions the OCR Conscience and Religious Freedom Division has taken to protect conscience rights. Specifically, the report should include the number of
complaints made to HHS in regard to violations of conscience as
well as the current status or outcome of those complaints.
RETIREMENT PAY AND MEDICAL BENEFITS FOR COMMISSIONED
OFFICERS

$623,591,000
653,023,000
653,023,000

The Committee provides an estimated $653,023,000 in mandatory funds for Retirement Pay and Medical Benefits for Commissioned Officers of the U.S. Public Health Service [PHS]. This account provides for retirement payments to PHS officers who are retired due to age, disability, or length of service; payments to survivors of deceased officers; and medical care to Active Duty and retired officers, as well as their dependents.
PUBLIC HEALTH AND SOCIAL SERVICES EMERGENCY FUND

$2,737,458,000
2,641,465,000
2,739,458,000

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The Committee recommends $2,739,458,000 for the Public
Health and Social Services Emergency Fund which includes
$174,000,000 from the Nonrecurring Expenses Fund. This appropriation supports the activities of the Assistant Secretary for Preparedness and Response [ASPR] and other components within the
Office of the Secretary to prepare for the health consequences of
bioterrorism and other public health emergencies, including pandemic influenza. It also provides funding for the Department’s cybersecurity efforts.
Office of the Assistant Secretary for Preparedness and Response
The Committee recommendation includes $2,537,128,000 for activities administered by ASPR. This level includes $124,000,000
from the Nonrecurring Expenses Fund. This Office was created to
lead the Department’s activities regarding preventing, preparing
for, and responding to public health emergencies, including disasters and acts of terrorism.
Development of Health Technologies.—The Committee provides
an increase of $2,000,000 to establish a bilateral cooperative program with the Government of Israel for the development of health
technologies, including but not limited to the following: artificial intelligence, biofeedback, sensors, monitoring devices, and kidney
care. The program should also emphasize collaboratively advancing
the use of technology, personalized medicine, and data in relation
to aging.
Medical Innovation for Disaster Response.—The Committee supports the development 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 to increase innovation
and report findings to the Committees on Appropriations of the
House of Representatives and the Senate within 180 days of enactment.
Hospital Preparedness Program
The Committee’s recommendation includes $299,555,000, an increase of $24,000,000, from the Nonrecurring Expenses Fund for
the Hospital Preparedness Program [HPP]. This program provides
grants to States to build health care coalitions that enhance regional and local hospital preparedness and improve overall surge
capacity in public health emergencies. The Committee recognizes
the vital importance of this program in helping communities respond to tragic events. The Committee believes this funding should
be carefully coordinated within communities to continue to provide
our Nation’s hospitals and emergency responders the necessary
tools to respond quickly and collaboratively to these and other public health emergencies that are inevitable in our Nation’s communities.
National Emerging Special Pathogens Training and Education
Centers.—The Committee maintains $11,000,000 to support the
continued efforts of these centers and recognizes their contributions

177
to preventing, preparing for, and responding to Ebola and other
special pathogen incidents.
Notification Requirements.—The Committee directs the Assistant
Secretary to notify the Committees on Appropriations of the House
of Representatives and the Senate 30 days in advance of any announcement of a modification to the HPP formula. In addition, the
Committee notes that funding for HPP is provided for HPP cooperative agreements and administrative activities that directly support the mission of the program. The Committee directs the Assistant Secretary to notify the Committees on Appropriations of the
House of Representatives and the Senate 30 days in advance of
funding any new activity or pilot program.
Biomedical Advanced Research and Development Authority
[BARDA]
The Committee recommendation includes $611,700,000, an increase of $50,000,000, from the Nonrecurring Expenses Fund, for
advanced research and development. BARDA is directed to notify
the Committees on Appropriations of the House of Representatives
and Senate no later than 2 days after any obligation of contracts
or interagency agreements in excess of $20,000,000.
Infectious Diseases.—The Committee commends BARDA for supporting advanced efforts to develop vaccines, diagnostics, drugs,
and therapeutics to minimize serious threats of infectious diseases.
BARDA is encouraged to continue to proactively prepare for emerging infectious disease outbreaks, including investing in rapid
screening technology. The Committee encourages ASPR to delineate information on emerging infectious diseases, pandemic influenza, and antimicrobial resistance investments in its annual 5 year
budget plan for medical countermeasure [MCM] development to
clarify how ASPR is considering such naturally occurring threats in
relation to other priority areas of MCM development.
Public Health Emergency Preparedness.—The Committee encourages the Secretary to explore opportunities to prioritize funding
multi-use diagnostic testing platforms for the purpose of public
health and biodefense. The Secretary is encouraged to review platforms that can 1) perform multiple types of testing, including the
ability to identify the source of the infection, the type of pathogen
(bacterial and/or fungal), and/or antimicrobial drug susceptibility
profile; 2) profile multiple clinical specimen types such as urine,
blood, respiratory, and wound fluid; 3) provide high accuracy vs.
current testing methods; and 4) deliver expedited and actionable
results at the point-of-care, in advance of antibiotic prescription.
The Committee directs the Secretary to provide an update on these
efforts, including an assessment of the effectiveness of current technologies, in the fiscal year 2022 CJ.
Tuberculosis.—The National Strategy for CARB identified drug
resistant TB as a serious threat level pathogen and called for new
diagnostic, treatment, and prevention tools to address this global
health threat. The Committee encourages BARDA to support the
development of new TB diagnostic tests, drugs, and vaccines, and
directs the Assistant Secretary to submit a report to the Committees on Appropriations of the House of Representatives and the
Senate 180 days after enactment of this act.

178
Project BioShield Special Reserve Fund
The Committee recommendation includes $785,000,000, an increase of $50,000,000 from the Nonrecurring Expenses Fund, for
the Project BioShield Special Reserve Fund. The Committee is committed to ensuring the Nation is adequately prepared against
chemical, biological, radiological, and nuclear attacks. The Committee recognizes a public-private partnership to develop MCMs is
required to successfully prepare and defend the Nation against
these threats. Where there is little or no commercial market, the
Committee supports the goal of Government financing providing a
market guarantee.
Strategic National Stockpile
The Committee includes $705,000,000 for the Strategic National
Stockpile.
Report on Strategic National Stockpile [SNS].—The June 2017
OIG report on the readiness of the SNS found that ‘‘systemic issues
could place at risk approximately $7,000,000,000 of Stockpile inventory and negatively affect Stockpile readiness during a national
emergency.’’ The Committee notes recent events have exposed
shortcomings in the SNS, including inventory and distribution concerns. The Committee requests the OIG to conduct a comprehensive audit of the SNS, including performance of the automated inventory system, distribution to States, and availability of needed
supplies. The Committee requests that such audit include recommendations on preventing future shortfalls in the SNS and its
response to a national emergency, as well as recommendations on
preventing future mistakes and oversights in the Department’s
larger response. The Committee also notes that the Department
has not provided the report requested in Public Law 116–94 regarding maintaining appropriate coordination and support for
State and local public health departments. The Committee directs
the Secretary to report to Congress within 30 days of enactment.
SNS Inventory Management.—The Committee is committed to
improving and modernizing our Nation’s pandemic influenza preparedness and ensuring first responders are protected. The Committee encourages ASPR to work toward novel stockpiling concepts,
such as Vendor Managed Inventory, which will reduce the overhead required to maintain the pandemic stockpile, and will ensure
that a safe, reliable supply of pandemic countermeasures are available from vaccine manufacturers.
Other Activities
The Committee recommendation includes the following amounts
for the following activities within ASPR:
—Operations.—$30,938,000;
—Preparedness and Emergency Operations.—$24,654,000;
—National Disaster Medical System.—$57,404,000; and
—Policy and Planning.—$14,877,000.
Office of the Assistant Secretary for Administration
The Committee recommends $58,860,000 for information technology cybersecurity in the Office of the Assistant Secretary for Administration. These funds provide for continuous monitoring and

179
security incident response coordination for the Department’s computer systems and networks.
Office of the Assistant Secretary for Health/Medical Reserve Corps
The Committee recommendation includes $6,000,000 for the
Medical Reserve Corps [MRC] program in ASH. This program is a
national network of local volunteers who work to strengthen the
public health infrastructure and preparedness capabilities of their
communities.
The Committee maintains funding at last year’s level for the
MRC, which is composed of volunteer doctors, dentists, nurses,
pharmacists, and other community members. The Committee notes
that the MRC provides an important community service, assisting
in emergency response during a natural disaster, terrorist attack,
or disease outbreak, and conducting staffing exercises to test local
capacity to quickly dispense medicines and vaccines in an emergency.
Office of the Secretary
The Committee recommendation includes $267,470,000 for activities within the Office of the Secretary.
Pandemic Influenza Preparedness
The Committee recommendation includes $310,000,000, an increase of $50,000,000 from the Nonrecurring Expenses Fund, for
Pandemic Influenza Preparedness. Of the total, $35,000,000 is provided in annual funding and $275,000,000 in no-year funding, including $50,000,000 from the Nonrecurring Expenses Fund.
T Cell-mediated Immunity.—T cell-mediated immunity plays a
central role in controlling viral infections. To create a universal influenza vaccine it is necessary that HHS prioritize research, development, and rapid manufacturing technologies that enable application of T cell vaccines as a complementary yet alternative approach
to the use of vaccines containing live attenuated or killed micro-organisms.
Office of Security and Strategic Information
The Committee includes $7,470,000 for the Office of Security and
Strategic Information to maintain the security of the Department’s
personnel, systems, and critical infrastructure.
PREVENTION AND PUBLIC HEALTH FUND

In fiscal year 2021, the level transferred from the PPH Fund
after accounting for sequestration is $895,850,000. The Committee
includes bill language in section 222 of this act that requires that
funds be transferred within 45 days of enactment of this act to the
following accounts, for the following activities, and in the following
amounts:

180
[In thousands of dollars]
Account

Program

Aging and Disability Services Programs ...................

Alzheimer’s Disease Prevention Education and Outreach.
Chronic Disease Self Management ...........................
Falls Prevention ........................................................
Section 317 Immunization Grants ............................
Epidemiology and Laboratory Capacity Grants ........
Healthcare Associated Infections .............................
Office of Smoking and Health (Tobacco Prevention/
Media & Quit Lines).
Breast Feeding Grants (Hospitals Promoting
Breastfeeding).
Million Hearts Program .............................................
Heart Disease & Stroke Prevention Program ............
Diabetes ....................................................................
Early Care Collaboratives .........................................
Lead Poisoning Prevention ........................................
Preventive Health and Health Services Block Grants
Suicide Prevention (Garrett Lee Smith) ....................

Aging and Disability Services Programs ...................
Aging and Disability Services Programs ...................
Immunization and Respiratory Diseases ...................
Emerging and Zoonotic Infectious Diseases .............
Emerging and Zoonotic Infectious Diseases .............
Chronic Disease Prevention and Health Promotion ..
Chronic Disease Prevention and Health Promotion ..
Chronic Disease Prevention and Health Promotion ..
Chronic Disease Prevention and Health Promotion ..
Chronic Disease Prevention and Health Promotion ..
Chronic Disease Prevention and Health Promotion ..
Environmental Health ................................................
CDC-Wide Activities ...................................................
Mental Health ............................................................

Committee
recommendation

14,700
8,000
5,000
360,200
52,000
12,000
128,600
9,000
4,000
57,075
52,275
4,000
17,000
160,000
12,000

GENERAL PROVISIONS
Section 201. The bill continues a provision placing a $50,000 ceiling on official representation expenses.
Section 202. The bill continues a provision limiting the use of
certain grant funds to pay individuals more than an annual rate
of Executive Level II or capping NIH investigator salaries.
Section 203. The bill continues a provision restricting the Secretary’s use of taps for program evaluation activities unless a report is submitted to the Committees on Appropriations of the
House of Representatives and the Senate on the proposed use of
funds.
Section 204. The bill modifies a provision authorizing the transfer of up to 3 percent of PHS Act (Public Law 78–410) funds for
evaluation activities.
Section 205. The bill continues a provision restricting transfers
of appropriated funds and requires a 15-day notification to the
Committees on Appropriations of the House of Representatives and
the Senate.
Section 206. The bill continues a general provision allowing National Health Service Corps contracts to be canceled up to 60 days
after award.
Section 207. The bill continues a provision regarding requirements for family planning applicants.
Section 208. The bill continues language which States that no
provider services under title X of the PHS Act (Public Law 78–410)
may be exempt from State laws regarding child abuse.
Section 209. The bill continues language which restricts the use
of funds to carry out the Medicare Advantage Program if the Secretary denies participation to an otherwise eligible entity.
Section 210. The bill continues a provision prohibiting the use of
funds for lobbying activities related to gun control.
Section 211. The bill continues a provision that limits the assignment of certain public health personnel.

181
Section 212. The bill continues a provision which facilitates the
expenditure of funds for international health activities.
Section 213. The bill continues a provision permitting the transfer of up to 3 percent of AIDS funds among ICs by the Director of
NIH and the Director of the Office of AIDS Research at NIH.
Section 214. The bill continues language which requires that the
use of AIDS research funds be determined jointly by the Director
of NIH and the Director of the Office of AIDS Research and that
those funds be allocated directly to the Office of AIDS Research for
distribution to the ICs consistent with the AIDS research plan.
Section 215. The bill continues a provision authorizing the Director of NIH to enter into certain transactions to carry out research
in support of the NIH Common Fund.
Section 216. The bill modifies a provision permitting NIH to use
up to 1 percent of IC funding for construction, improvements, and
repairs of facilities.
Section 217. The bill continues a provision that transfers funds
from NIH to HRSA and AHRQ, to be used for National Research
Service Awards.
Section 218. The bill continues a provision that provides BARDA
with authority to enter into a multiyear contract for up to 10 years
and to repurpose unused termination costs to pay contract invoices.
Section 219. The bill continues a provision requiring CJs to include certain FTE information with respect to the ACA.
Section 220. The bill continues a provision related to ACA exchange funding transparency.
Section 221. The bill continues a provision prohibiting funds for
the Risk Corridor program.
Section 222. The bill continues a provision requiring the Secretary to transfer Prevention and Public Health Fund resources
within 45 days.
Section 223. The bill modifies a provision related to breast cancer
screening recommendations.
Section 224. The bill continues a provision on NIH indirect costs.
Section 225. The bill modifies a provision requiring Congressional notification prior to NIH transfers of opioid funds internally.
Section 226. The bill continues a provision related to notifications
for ACA enrollment and Community Health Centers awards.
Section 227. The bill continues a provision for Medicare and
Medicaid expenses.
Section 228. The bill continues a provision on staffing reports.
Section 229. The bill continues a provision on HHS staff travel
for medical care.
Section 230. The bill continues a provision allowing private donations for the care of unaccompanied alien children.
Section 231. The bill continues a provision limiting the use of
funds for changes to policy directives related to the unaccompanied
alien children program.
Section 232. The bill continues a provision limiting the use of
funds for unlicensed shelters for unaccompanied alien children.
Section 233. The bill continues a provision requiring Congressional notification prior to the use of influx facilities as shelters for
unaccompanied alien children.

182
Section 234. The bill continues a provision regarding Member access to unaccompanied alien children facilities.
Section 235. The bill continues a provision requiring monthly reporting of unaccompanied alien children.
Section 236. The bill continues a provision for CDC employees
dependents’ schooling of CDC employees stationed in a U.S. territory.
Section 237. The bill modifies a provision allocating the Nonrecurring Expenses Fund.
Section 238. The bill includes a new provision related to travel.
Section 239. The bill includes a new provision naming a building
on CDC’s Chamblee Campus and amends the purpose of Nonrecurring Expenses Fund resources made available in Public Law
116–94.

TITLE III
DEPARTMENT OF EDUCATION
Any references in this title of the explanatory statement to the
‘‘Secretary’’ or the ‘‘Department’’ shall be interpreted to mean the
Secretary of Education or the Department of Education, respectively, unless otherwise noted.
IMPROVING ELEMENTARY

AND

SECONDARY EDUCATION

Appropriations, 2020 ............................................................................. ...........................
Budget estimate, 2021 ........................................................................... $19,363,430,000
Committee recommendation ................................................................. ...........................

The Committee recommendation does not include funding for the
administration’s proposal for a new Elementary and Secondary
Education for the Disadvantaged Block Grant.
EDUCATION

FOR THE

DISADVANTAGED

Appropriations, 2020 ............................................................................. $16,996,790,000
Budget estimate, 2021 ........................................................................... ...........................
Committee recommendation ................................................................. 17,121,790,000

The Committee recommends $17,121,790,000 for programs in the
Education for the Disadvantaged account. Funds appropriated in
this account primarily support activities in the 2021—2022 school
year.
Grants to Local Educational Agencies
The Committee recommends $16,434,802,000 for the title I
grants to local educational agencies [LEAs] program. Title I grants
to LEAs provide supplemental education funding, especially in
high-poverty areas, for local programs that provide extra academic
support to help raise the achievement of eligible students or, in the
case of school-wide programs, help all students in high-poverty
schools meet challenging State academic standards. Title I grants
are distributed through four formulas as prescribed by this act:
basic, concentration, targeted, and education finance incentive
grant.
Of the funds available for title I grants to LEAs, up to $5,000,000
shall be available on October 1, 2020, for transfer to the Census
Bureau for poverty updates; $5,588,625,000 will become available
on July 1, 2021; and $10,841,177,000 will become available on October 1, 2021. The funds that become available on July 1, 2021, and
October 1, 2021, will remain available for obligation through September 30, 2022.
(183)

184
Comprehensive Literacy State Development Grants
The Committee recommendation includes $192,000,000 for the
Comprehensive Literacy State Development Grants program. This
program provides competitive grants to State educational agencies
[SEAs] that then subgrant at least 95 percent of such funds to eligible entities to support efforts to improve literacy instruction in
high-need schools and early education programs in a State for each
of several age bands ranging from birth through 12th grade.
Innovative Approaches to Literacy
The Committee recommendation includes $27,000,000 for the Innovative Approaches to Literacy program. This program provides
competitive grants to national not-for-profit organizations and
school libraries for providing books and childhood literacy activities
to children and families living in high-need communities.
The Committee continues to direct the Department to reserve no
less than 50 percent of funds under this program for grants to develop and enhance effective school library programs, which may include providing professional development to school librarians,
books, and up-to-date materials to high-need schools. School library
programs increase access to a wide range of print and electronic resources and provide learning opportunities for all students, particularly those who are less likely to have access to such materials at
home. Further, the Committee continues to direct the Department
to ensure that grants are distributed among eligible entities that
will serve geographically diverse areas, including rural areas.
Migrant Education Program
The Committee recommends $374,751,000 for the title I Migrant
Education program. This funding supports grants to SEAs to ensure that migratory children receive full and appropriate opportunities to meet the same challenging State academic standards that
all children are expected to meet and help such children overcome
educational disruption and other factors that inhibit the ability of
such children to succeed in school. Funding also supports activities
to improve interstate and intrastate coordination of migrant education programs, as well as identify and improve services to the migrant student population.
Neglected and Delinquent
The Committee recommends $47,614,000 for the title I Neglected
and Delinquent program. This program provides financial assistance to SEAs for education services to neglected and delinquent
children and youth in State-run institutions and for juveniles in
adult correctional institutions. States are authorized to set aside at
least 15 percent, but not more than 30 percent, of their Neglected
and Delinquent funds to help students in State-operated institutions make the transition into locally operated programs, and to
support the successful reentry of youth offenders who are age 20
or younger and have received a secondary school diploma or its recognized equivalent.

185
Special Programs for Migrant Students
The Committee recommends $45,623,000 for Special Programs
for Migrant Students, which consist of the High School Equivalency
Program [HEP] and the College Assistance Migrant Program
[CAMP]. HEP projects are 5-year grants to institutions of higher
education and other nonprofit organizations to recruit migrant students ages 16 and older and provide the academic and support
services needed to help them obtain a high school equivalency certificate and subsequently gain employment, attain admission to a
postsecondary institution or a job training program, or join the
military. CAMP projects are 5-year grants to institutions of higher
education and nonprofit organizations to provide tutoring, counseling, and financial assistance to migrant students during their
first year of postsecondary education.
IMPACT AID
Appropriations, 2020 .............................................................................
Budget estimate, 2021 ...........................................................................
Committee recommendation .................................................................

$1,486,112,000
1,410,799,000
1,506,112,000

The Committee recommends $1,506,112,000, an increase of
$20,000,000, for the Impact Aid program. Impact Aid provides financial assistance to school districts affected by the presence of
Federal activities and federally owned land. These school districts
face unique challenges because they must educate children living
on federally owned land, such as military bases, while federally
owned property is also exempt from local taxes, a primary source
of revenue for local school districts.
Basic Support Payments
The Committee recommends $1,359,242,000 for the Basic Support Payments program. Under this statutory formula, payments
are made on behalf of all categories of federally-connected children,
with a priority placed on making payments first to heavily impacted school districts and providing any remaining funds for regular basic support payments.
Payments for Children With Disabilities
The Committee bill includes $48,316,000 for Payments for Children With Disabilities. Under this program, additional payments
are made for certain federally connected children eligible for services under the Individuals with Disabilities Education Act [IDEA]
(Public Law 101–476).
Facilities Maintenance
The Committee recommends $4,835,000 for Facilities Maintenance. This activity provides funding for emergency repairs and
comprehensive capital improvements to certain school facilities
owned by the Department and used by LEAs to serve federally connected military dependent students. Funds appropriated for this
purpose are available until expended.

186
Construction
The Committee recommends $17,406,000 for eligible LEAs for
school construction activities allocated competitively under section
7007(b) of the Elementary and Secondary Education Act [ESEA]
(Public Law 89–10).
Payments for Federal Property
The Committee recommends $76,313,000 for Payments for Federal Property. These payments compensate LEAs specifically for
revenue lost due to the removal of Federal property from local tax
rolls, regardless of whether any federally connected children attend
schools in the district. The budget request proposed eliminating
this program. The Committee recommendation again rejects this
elimination and continues to note that this funding represents a
key component of fulfilling the Federal Government’s commitment
to school districts impacted by the presence of federally-owned
land.
SCHOOL IMPROVEMENT PROGRAMS
Appropriations, 2020 .............................................................................
Budget estimate, 2021 ...........................................................................
Committee recommendation .................................................................

$5,404,967,000
392,374,000
5,449,967,000

The Committee recommendation includes $5,449,967,000 for the
School Improvement Programs account.
Supporting Effective Instruction State Grants
The Committee recommends $2,131,830,000 for Supporting Effective Instruction State Grants. States and LEAs may use funds for
a range of activities related to the certification, recruitment, professional development, and support of teachers and administrators.
Activities may include reforming teacher certification and licensure
requirements, addressing alternative routes to State certification of
teachers, recruiting teachers and principals, improving equitable
access to effective teachers, and implementing teacher mentoring
systems, evaluation and support systems, merit pay, and meritbased performance systems. These funds may also be used by districts to hire teachers to reduce class sizes.
The appropriation for this program primarily supports activities
associated with the 2021—2022 academic year. Of the funds provided, $450,389,000 will become available on July 1, 2021, and
$1,681,441,000 will become available on October 1, 2021. These
funds will remain available for obligation through September 30,
2022.
Supplemental Education Grants
The Committee recommendation includes $16,699,000 for supplemental education grants to the Republic of Marshall Islands [RMI]
and the Federated States of Micronesia [FSM]. This grant program
was authorized by the Compact of Free Association Amendments
Act of 2003 (Public Law 99–239). These funds will be transferred
from the Department to the Secretary of the Interior for grants to
these entities. The Committee bill includes language requested in
the budget that allows the Secretary of Education to reserve 5 per-

187
cent of these funds to provide FSM and RMI with technical assistance.
21st Century Community Learning Centers
The Committee recommends an appropriation of $1,249,673,000
for the 21st Century Community Learning Centers program. Funds
are allocated to States by formula, which in turn, award at least
95 percent of their allocations to LEAs, community-based organizations, and other public and private entities. Grantees use these resources to establish or expand community learning centers that
provide activities offering significant extended learning opportunities, such as before and after-school programs, recreational activities, drug and violence prevention, and family literacy programs for
students and related services to their families. Centers must target
their services to students who attend schools that are eligible to operate a school-wide program under title I of the ESEA or serve
high percentages of students from low-income families.
State Assessments Grants
The Committee recommends $378,000,000 for the State Assessments Grants program. This program provides formula grants to
States for developing and implementing standards and assessments
required by the ESEA and helping States and LEAs carry out audits of their assessment systems to eliminate low-quality or duplicative assessments. It also provides competitive grants to States,
including consortia of States, to improve the quality, validity, and
reliability of academic assessments.
Education for Homeless Children and Youth
The Committee recommends $101,500,000 for carrying out education activities authorized by title VII, subtitle B of the McKinneyVento Homeless Assistance Act. This program provides assistance
to each State to support an office of the coordinator of education
for homeless children and youth to develop and implement State
plans for educating homeless children, and to make subgrants to
LEAs to support the education of those children. Grants are made
to States based on the total that each State receives in title I
grants to LEAs. Under the McKinney-Vento Homeless Children
and Youth Program, SEAs must ensure that homeless children and
youth have equal access to the same free public education, including a public preschool education, as is provided to other children
and youth.
Training and Advisory Services
For Training and Advisory Services authorized by title IV of the
Civil Rights Act (Public Law 88–352), the Committee recommends
$6,575,000. The funds provided will support awards to operate regional equity assistance centers [EACs]. EACs provide services to
school districts upon request. Activities include disseminating information on successful practices and legal requirements related to
nondiscrimination on the basis of race, color, sex, or national origin
in education programs.
The Committee directs the Department to brief House and Senate authorizing and appropriations committees not later than 30

188
days prior to publishing a notice inviting applications for new
awards. Further, the Committee encourages the Department to expand its outcome reporting in next year’s and future CJs on how
EACs are supporting measurable outcomes in changed policies and
practices by EACs’ customers.
Native Hawaiian Education
The Committee recommendation includes $36,897,000 for Native
Hawaiian Education.
The Committee bill continues a provision that allows funding
provided by this program to be used for construction. The Committee recommendation includes sufficient funding for the Native
Hawaiian Education Council.
Alaska Native Education
The Committee recommends $36,953,000 for the Alaska Native
Education. These funds help address the unique educational needs
of Alaska Native schoolchildren. Funds are used for the development of supplemental educational programs to benefit Alaska Natives.
The Committee continues language that allows funding provided
by this program to be used for construction and overriding the authorizing statute’s requirement to make noncompetitive awards to
certain organizations.
The Committee directs the Department to make every effort to
ensure that grants are awarded well in advance of the school year,
to maximize grantees’ ability to hire the necessary staff and have
their programs ready to go with the start of Alaska’s school year
in mid-August. The Committee continues to direct the Department
to ensure that Alaska Native tribes, Alaska Native regional nonprofits, and Alaska Native corporations have the maximum opportunity to successfully compete for grants under this program by
providing these entities multiple opportunities for technical assistance in developing successful applications for these funds, both in
Alaska and via various forms of telecommunications. The Committee also encourages the Department to include as many peer reviewers as possible who have experience with Alaska Native education and Alaska generally on each peer review panel.
Rural Education
The Committee recommends $189,840,000, an increase of
$4,000,000, for rural education programs. The Committee expects
that rural education funding will be equally divided between the
Small, Rural School Achievement Program, which provides funds to
LEAs that serve a small number of students, and the Rural and
Low-Income School Program, which provides funds to LEAs that
serve concentrations of poor students, regardless of the number of
students served.
Earlier this year, the Department announced that some LEAs
were erroneously using alternative poverty measure data to demonstrate their eligibility for the Rural Education Achievement Program in place of U.S. Census Bureau’s Small Area Income and Poverty Estimates, as required by section 5221(b)(1)(A)(i) of the ESEA.
However, the Department had routinely accepted this data without

189
question prior to this year. Because of this longstanding practice,
the Department allowed this alternative poverty data to continue
to be used in fiscal year 2020 as it was in prior years but announced it would not allow it beginning in fiscal year 2021. The
Committee understands this creates very significant challenges for
a small number of LEAs and States, at no fault of their own, and
will continue discussions with the relevant authorizing committees
in an effort to address this issue going forward.
Comprehensive Centers
The Committee recommends $52,000,000 for the Comprehensive
Centers program. These funds provide support to a network of comprehensive centers that are operated by research organizations,
agencies, institutions of higher education, or partnerships thereof,
and provide training and technical assistance on various issues to
States, LEAs, and schools as identified through needs assessments
undertaken in each region.
Student Support and Academic Enrichment Grants
The Committee recommendation includes $1,250,000,000, an increase of $40,000,000, for Student Support and Academic Enrichment [SSAE] Grants. This program provides formula grants to
States, which then sub-grant to LEAs, to help support activities
that provide students with a well-rounded education, ensure safe
and supportive learning environments, and use technology to improve instruction.
Report on Use of Funds.—The Committee continues to encourage
the Department to examine State and local expenditures, outlined
by specific authorized activities, and provide detailed information
about the most common uses of funds, as well as information about
how LEAs plan to evaluate the effectiveness of their activities. Additionally, the Committee encourages the Department to periodically 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 agencies are meeting the
objectives and outcomes described in their applications.
Technical Assistance and Capacity Building.—The Committee
continues to expect 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. The Committee directs the Department to include in its fiscal year 2022 CJ
and each subsequent CJ information on current and planned expenditures for the 2 percent set-aside for technical assistance and
capacity building, including 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.
INDIAN EDUCATION
Appropriations, 2020 .............................................................................
Budget estimate, 2021 ...........................................................................
Committee recommendation .................................................................

$180,739,000
180,739,000
180,739,000

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The Committee recommends $180,739,000 for Indian education
programs.
Grants to Local Educational Agencies
For grants to LEAs, the Committee recommends $105,381,000.
These funds provide financial support to elementary and secondary
school programs that serve Indian students, including preschool
children. Funds are awarded on a formula basis to LEAs, schools
supported and operated by the Department of the Interior/Bureau
of Indian Education, and in some cases directly to Indian tribes.
Special Programs for Indian Children
The Committee recommends $67,993,000 for special programs for
Indian children. Funds are used for demonstration grants to improve Indian student achievement from early childhood education
through college preparation programs, and for professional development grants for training Indians who are preparing to begin careers in teaching and school administration.
National Activities
The Committee recommends $7,365,000 for national activities.
Funds are used to expand efforts to improve research, evaluation,
and data collection on the status and effectiveness of Indian education programs, and to continue grants to tribal educational departments for education administration and planning.
The Committee continues to note that there are significant cognitive, psychological, and academic benefits that result from Native
American language immersion programs, and that language education programs are essential for tribal self-determination. Within
the total, the Committee recommendation includes no less than
$2,811,000 for Native American language immersion programs authorized under section 6133 of ESEA. The Committee intends that
these funds be allocated to all types of eligible entities, including
both new and existing language immersion programs and schools,
to support the most extensive possible geographical distribution
and language diversity. Further, the Committee directs the Department to give the same consideration to applicants that propose to
provide partial immersion schools and full immersion schools, as
the local tribes, schools, and other applicants know best what type
of program will most effectively assist their youth to succeed.
INNOVATION

AND IMPROVEMENT

Appropriations, 2020 ............................................................................. $1,103,815,000
Budget estimate, 2021 ........................................................................... ...........................
Committee recommendation .................................................................
1,058,815,000

The Committee recommends $1,058,815,000 for programs within
the Innovation and Improvement account.
Education Innovation and Research
The Committee recommendation includes $130,000,000 for the
Education Innovation and Research [EIR] program. This program
supports the creation, development, implementation, replication,
and scaling up of evidence-based, field-initiated innovations designed to improve student achievement and attainment for high-

191
need students. EIR incorporates a tiered evidence framework that
provides early-phase, mid-phase, and expansion and replication
grants. This supports interventions throughout the pipeline, from
smaller grants for early stage projects that are willing to undergo
rigorous evaluation to test their efficacy to larger grants to scaleup proven-effective interventions that have demonstrated significant impacts through multiple rigorous evaluations.
Grant Priorities.—The Committee notes 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. The Committee expects funds to continue to support diverse
and field-initiated interventions, rather than a single nationwide
program or award focused solely on one area of educational innovation. The Committee directs the Department to brief the Committees on Appropriations of the House of Representatives and the
Senate on the fiscal year 2021 funding opportunities available
under this program, including any specified priorities, not less than
30 days prior to releasing a notice inviting applications.
Publicly Releasing and Disseminating Findings.—The Committee
strongly encourages the Department to take stronger steps to publicly release and widely publicize the research findings from this
critical program, and its predecessor the Investing in Innovation
program, to stakeholders at the Federal, State, and local level. Specifically, the Committee strongly encourages the Department to
publicly release evaluation findings within 6 months of the conclusion of a grant. The Committee believes results from the EIR program, with its focus on rigorous evaluation, can be better leveraged
by other Federal programs, including by widely publicizing results
and prioritizing interventions with rigorously evaluated and proven
effective results.
Rural Set-Aside.—The Committee supports the 25 percent setaside within EIR for rural areas and encourages the Department
to take steps necessary to ensure the set-aside is met and that EIR
funds are awarded to diverse geographic areas.
Science, Technology, Education and Math [STEM] and Computer
Science Education.—The Committee recommendation includes
$75,000,000, an increase of $10,000,000, for STEM and computer
science education. Within this amount, the Committee directs the
Department to prioritize funding for computer science education
and applicants seeking to improve diversity and address disparities
in access to participation in high-quality STEM education programs.
In addition, the Committee encourages the Department to fund
activities that will help inspire the next generation of STEM professionals, including engaging students in space exploration.
Charter School Program
The Committee recommends $450,000,000, an increase of
$10,000,000, for the Charter School Program [CSP]. This program
supports the start-up, replication, and expansion of high-quality
charter schools.
Within the total, the Committee recommendation includes
$215,000,000 for State Entity Grants to support high-quality charter schools under section 4303 of ESEA; not less than $150,000,000

192
for Charter Management Organization Grants for the replication
and expansion of high-quality charter schools under section
4305(b); not less than $70,000,000 for Facilities Grants under section 4304, of which not less than $60,000,000 shall be for the Credit Enhancement program; and $15,000,000 for national activities to
provide technical assistance, disseminate best practices, and evaluate the impact of the charter school program. In addition to standard reprogramming requirements, the Committee directs the Department to notify and brief the Committees on Appropriations of
the House of Representatives and the Senate as soon as possible
of any need to reprogram funds between the activities specified
above.
The Committee appreciates information included in the fiscal
year 2021 CJ on activities to strengthen charter school authorizing
and oversight practices, including through monitoring of and technical assistance on the use of State entity set-aside funds. The
Committee requests that the Department effectively review the extent to which State entities are using such funds to ensure that
charter schools receiving CSP grants are equipped to appropriately
serve all students, including students with disabilities, and include
a summary of findings of such reviews in the fiscal year 2022 CJ.
In addition, the Committee encourages the Department to ensure
that technical assistance and dissemination activities funded elsewhere at the Department, as appropriate, support the provision
and oversight of special education services in charter schools.
Magnet Schools Assistance
The Committee recommends $107,000,000 for the Magnet
Schools Assistance program [MSAP]. This program supports grants
to LEAs to establish and operate magnet schools that are part of
a court-ordered or federally approved voluntary desegregation plan.
Magnet schools are designed to attract substantial numbers of students from different social, economic, ethnic, and racial backgrounds. Grantees may use funds for planning and promotional
materials; salaries of instructional staff; transportation, as long as
such expenses are sustainable beyond the grant period and not a
significant portion of the grant; and the purchase of technology,
educational materials, and equipment.
The Committee strongly encourages the Department to include a
priority for a portion of new grant funds in fiscal year 2021 for
Magnet Schools Assistance applications that are connected to a
nearby public housing redevelopment project, including developments funded through the HUD Choice Neighborhoods Initiative
and the HUD Rental Assistance Demonstration. The notice inviting
applications [NIA] shall prioritize MSAP applications that seek to
provide an opportunity for children in the public housing redevelopment to attend a racially and economically integrated school in or
near their neighborhood. The Department of Education is, to the
extent feasible, directed to coordinate with HUD and the HUD
Choice Neighborhoods Initiative, and to issue any 2021 MSAP NIA
on or about the same date as the HUD Choice Neighborhoods notice of funding availability.

193
Arts in Education
The Committee recommendation includes $29,000,000 for the
Arts in Education program. The funding is used for competitive
awards for national nonprofit organizations engaged in arts education, professional development activities, and model arts education programs. Funds also are used for evaluation and dissemination activities.
The Committee recommendation includes funding for each activity within this program at no less than the fiscal year 2020 level.
Javits Gifted and Talented Students
The Committee recommendation includes $13,000,000 for the
Javits Gifted and Talented Students Education program. Funds are
used for awards to State and local educational agencies, institutions of higher education, and other public and private agencies for
research, demonstration, and technical assistance activities designed to enhance the capability of elementary and secondary
schools to meet the special educational needs of gifted and talented
students, including those from disadvantaged and underrepresented populations.
American History and Civics Education
The Committee recommendation includes $4,815,000 for American History and Civics Education, including $1,815,000 for Presidential and Congressional Academies for American History and
Civics and $3,000,000 for American History and Civics Education
National Activities.
Presidential Academies for the Teaching of American History and
Civics offer residential workshops to elementary and secondary
school teachers to strengthen their knowledge through instruction
and interaction with primary scholars and accomplished teachers
in these fields. The Congressional Academies for Students of American History and Civics provide similar workshops to students to
enrich their understanding of American history and civics.
Teacher and School Leader Incentive Grants
The Committee recommendation includes $200,000,000 for
Teacher and School Leader Incentive Grants. This program provides competitive grants to eligible entities to develop, implement,
improve, or expand human capital management systems or performance-based compensation systems in schools. Funds can be
used for a wide-range of activities, including developing or improving evaluation and support systems that are based in part on student achievement; providing principals with necessary tools to
make school-level decisions; implementing a differentiated salary
structure based on a variety of factors; improving the recruitment
and retention of effective teachers, principals, and other school
leaders; and instituting career advancement opportunities that reward effective teachers, principals and other school leaders.
Ready-To-Learn Television
The Committee recommendation includes $29,000,000 for the
Ready-to-Learn Television program. This program is designed to facilitate student academic achievement by leveraging the power and

194
reach of public television to develop and distribute educational
video programming for preschool and elementary school children
and their parents, caregivers, and teachers.
Supporting Effective Educator Development
The Committee recommendation includes $80,000,000 for the
Supporting Effective Educator Development [SEED] program.
SEED provides competitive grants to improve teacher and principal
effectiveness by supporting pathways that help teachers, principals,
or other school leaders with non-traditional preparation and certification obtain employment in underserved LEAs; providing evidence-based professional development; and making services and
learning opportunities freely available to LEAs.
Effective School Leaders.—The Committee recognizes the significant impact of effective principals and other school leaders on student achievement and other student outcomes. The SEED program
is an ideal vehicle for helping ensure that more highly trained
school leaders are available to serve in traditionally underserved
LEAs and directs the Secretary to use a portion of funds made
available for SEED to support the preparation of principals and
other school leaders.
Programs of National Significance.—The Committee directs the
Department to ensure grants are awarded to a diverse set of eligible entities operating programs of national significance, consistent
with Congressional intent. The Committee strongly encourages the
Department to include National non-profits and institutes of higher
education that implement high evidence-based activities (as defined
in section 8101(21)(A)(i) of the ESEA) that support a significant
number of educators in multiple States and a number of sites to
help bring to scale evidence-based programs of National significance and ensure a significant number of educators and students
across the country are served by this program.
Statewide Family Engagement Centers
The Committee recommendation includes $15,000,000, an increase of $5,000,000, for Statewide Family Engagement Centers.
This program provides competitive grants to statewide organizations to promote and implement evidence-based family engagement
activities in education programs, and provide training and technical assistance to SEAs, LEAs, schools, and other organizations
for carrying out such activities.
SAFE SCHOOLS

AND

CITIZENSHIP EDUCATION

Appropriations, 2020 .............................................................................
$210,000,000
Budget estimate, 2021 ........................................................................... ...........................
Committee recommendation .................................................................
210,000,000

The Committee recommends a total of $210,000,000 for activities
to promote safe schools, healthy students, and citizenship education.
Promise Neighborhoods
The Committee recommendation includes $80,000,000 for the
Promise Neighborhoods program. This program awards competitive
grants to not-for-profit, community-based organizations for the de-

195
velopment of comprehensive neighborhood programs designed to
combat the effects of poverty and improve educational and life outcomes for children and youth, from birth through college. Each
Promise Neighborhood grantee serves a high-poverty urban neighborhood or rural community.
School Safety National Activities
The Committee recommendation includes $105,000,000 for the
School Safety National Activities, including up to $5,000,000 for
Project SERV. This funding supports activities to improve student
safety and well-being, including improving school climates, access
to mental healthcare, and emergency management response; preventing school violence; and addressing the consequences of school
violence or other traumatic events such as natural disasters.
Mental Health Services Professional Development and Schoolbased Mental Health Services.—The Committee recommendation
includes sufficient funding to continue current grants awarded to
carry out these activities.
Opioid Abuse and Prevention.—The Committee notes the continued need for mental health counseling for students and their families affected by opioid abuse. School transformation grants supported under this program have supported strategies for preventing
or mitigating the effects of opioid abuse. The Committee supports
a continued focus on funding to help SEAs and LEAs implement
evidence-based opioid use prevention strategies for schools in communities impacted by the opioid crisis.
Social Emotional Learning.— The Committee directs the Department to prioritize SEAs and LEAs whose applications describe how
they will develop, adopt, and teach social and emotional skills in
awarding grants pertaining to school safety.
Trauma-informed Care.—The Committee directs the Department
to ensure activities within this account 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 schools’ capacity to identify, refer, and provide services to
students; improves staff retention and helps keep kids in school;
and supports learning environments where students feel safe, supported, and ready to learn.
Full Service Community Schools
The Committee recommendation includes $25,000,000 for FullService Community Schools. This programs provides support for
the planning, implementation, and operation of full-service community schools that improve the integration, accessibility, and effectiveness of services for children and families, particularly for children attending high-poverty schools, including high-poverty rural
schools.
ENGLISH LANGUAGE ACQUISITION
Appropriations, 2020 .............................................................................
$787,400,000
Budget estimate, 2021 ........................................................................... ...........................
Committee recommendation .................................................................
787,400,000

196
The Committee recommends an appropriation of $787,400,000 for
the English Language Acquisition program.
The Department makes formula grants to States based on each
State’s share of the Nation’s limited-English-proficient and recent
immigrant student population. The program is designed to increase
the capacity of States and school districts to address the needs of
these students. The authorizing statute requires that 6.5 percent of
the appropriation be used to support national activities, which include professional development activities designed to increase the
number of highly qualified teachers serving limited-English-proficient students; and a National Clearinghouse for English Language Acquisition and Language Instructional Programs. National
activities funds shall be available for 2 years.
SPECIAL EDUCATION
Appropriations, 2020 ............................................................................. $13,885,228,000
Budget estimate, 2021 ........................................................................... 13,985,228,000
Committee recommendation ................................................................. 14,012,728,000

The Committee recommends an appropriation of $14,012,728,000
for special education programs.
Grants to States
The Committee recommendation includes $12,874,392,000 for
IDEA Part B Grants to States. This program provides formula
grants to assist States, outlying areas, and other entities in meeting the costs of providing special education and related services for
children with disabilities. States pass along most of these funds to
LEAs, but may reserve some for program monitoring, enforcement,
technical assistance, and other activities.
The appropriation for this program primarily supports activities
associated with the 2021—2022 academic year. Of the funds available for this program, $3,591,009,000 will become available on July
1, 2021, and $9,283,383,000 will become available on October 1,
2021. These funds will remain available for obligation through September 30, 2022.
Preschool Grants
The Committee recommends $401,620,000 for Preschool Grants.
This program provides formula grants to States to assist them in
making available special education and related services for children
with disabilities aged 3 through 5. States distribute the bulk of the
funds to LEAs. States must serve all eligible children with disabilities aged 3 through 5 and have an approved application under the
IDEA.
Grants for Infants and Families
The Committee recommends $484,500,000 for the Grants for Infants and Families program under part C of the IDEA. Part C of
IDEA authorizes formula grants to States, outlying areas, and
other entities to implement State-wide systems for providing early
intervention services to all children with disabilities, ages 2 and
younger, and their families. IDEA also gives States the option of
extending eligibility for part C services to children 3 and older if

197
they were previously served under part C and will continue to be
served until entrance to kindergarten.
State Personnel Development
The Committee recommends $38,630,000 for the State Personnel
Development program. Ninety percent of funds must be used for
professional development activities. The program supports grants
to SEAs to help them reform and improve their personnel preparation and professional development related to early intervention,
educational, and transition services that improve outcomes for students with disabilities. The bill includes language in the budget request that continues to allow funds under the program to be used
for program evaluation.
Technical Assistance and Dissemination
The Committee recommends $66,928,000 for Technical Assistance and Dissemination. This program supports awards for technical assistance, model demonstration projects, the dissemination
of useful information, and other activities. Funding supports activities that are designed to improve the services provided under the
IDEA.
Special Olympics.—Within the total, the Committee recommendation includes $22,583,000, an increase of $2,500,000, to
support activities authorized by the Special Olympics Sport and
Empowerment Act, including Project UNIFY. This funding supports efforts to expand Special Olympics programs and the design
and implementation of Special Olympics education programs that
can be integrated into classroom instruction and are consistent
with academic content standards.
Personnel Preparation
The Committee recommends $89,700,000 for the Personnel Preparation program. Funds support competitive awards to help address State-identified needs for personnel who are qualified to work
with children with disabilities, including special education teachers
and related services personnel. The program is required to fund
several other broad areas, including training leadership personnel
and personnel who work with children with low-incidence disabilities, and providing enhanced support for beginning special educators.
The Committee recognizes that children of all ages who have
been affected by the opioid crisis often face difficult challenges that
can include neurodevelopmental effects of intrauterine exposure,
toxic stress from the heavy toll of addiction on family dynamics,
and trauma from the devastation of losing parents and caregivers
to incarceration and death. Special education personnel, including
those with expertise in early childhood, would benefit from additional evidence-based training to support children with developmental delays, trauma informed care, and positive behavior interventions and supports. Therefore, within the funds provided for
this program, the Committee strongly urges the Department to
prioritize such training and support related to addressing the challenges presented by the opioid crisis.

198
Parent Information Centers
The Committee recommends $27,411,000 for Parent Information
Centers. This program makes awards to parent organizations to
support parent training and information centers, including community parent resource centers. These centers provide training and information to meet the needs of parents of children with disabilities
living in the areas served by the centers, particularly underserved
parents, and parents of children who may be inappropriately identified.
Technology and Media Services
The Committee recommends $29,547,000 for Technology and
Media Services. This program makes competitive awards to support the development, demonstration, and use of technology and
educational media activities of value to children with disabilities.
Education Materials in Accessible Formats for Students with Visual Impairments.—The Committee continues to recognize the ongoing progress made with the tools and services provided under this
program that have allowed more than 705,000 students with disabilities free access to more than 700,000 books in digitally accessible formats. The Committee strongly encourages continued effort
to expand this program’s reach to K–12 students in underserved
areas.
REHABILITATION SERVICES
Appropriations, 2020 .............................................................................
Budget estimate, 2021 ...........................................................................
Committee recommendation .................................................................

$3,747,739,000
3,782,952,000
3,805,500,000

Vocational Rehabilitation State Grants
The Committee recommends $3,667,801,000 in mandatory funding for Vocational Rehabilitation [VR] State Grants. State Grants
assist States in providing a range of services to help persons with
physical and mental disabilities prepare for and engage in meaningful employment.
Client Assistance State Grants
The Committee recommends $13,000,000 in discretionary funds
for Client Assistance State Grants. This program funds State formula grants to help VR clients or client applicants understand the
benefits available to them. States must operate client assistance
programs to receive VR State Grant funds.
Training
The Committee recommends $29,388,000 for training rehabilitation personnel. This program supports grants to provide training to
new VR staff or upgrade the qualifications of existing staff.
Demonstration and Training Programs
The Committee recommendation includes $5,796,000 for demonstration and training programs. These programs support activities designed to increase employment opportunities for individuals

199
with disabilities by expanding and improving the availability and
provision of rehabilitation and other services.
The Committee recommendation includes no less than the fiscal
year 2020 level for parent information and training programs.
Protection and Advocacy of Individual Rights
The Committee recommends $17,650,000 for the Protection and
Advocacy of Individual Rights program. This program provides
grants to agencies to protect and advocate for the legal and human
rights of persons with disabilities who are ineligible for the protection and advocacy services available through the Developmental
Disabilities Assistance and Bill of Rights Act (Public Law 106–402)
or the Protection and Advocacy for Individuals with Mental Illness
Act (Public Law 99–319).
Supported Employment State Grants
The Committee recommendation includes $22,548,000 for the
Supported Employment State Grants Program. This program provides grants to States to provide supported employment services for
individuals with the most significant disabilities, including youth
with disabilities.
Independent Living Services for Older Individuals Who Are Blind
The Committee recommends $33,317,000 for Independent Living
State Grants. This program supports assistance to individuals over
age 55 to help them adjust to their blindness and continue to live
independently, including daily living skills training, counseling,
community integration information and referral, the provision of
low-vision and communication devices, and low-vision screening.
Helen Keller National Center
The Committee recommends $16,000,000 for the Helen Keller
National Center for Deaf-Blind Youth and Adults. The Helen Keller
National Center consists of a national headquarters in Sands
Point, New York, with a residential training and rehabilitation facility where deaf-blind persons receive intensive specialized services; a network of 10 regional field offices that provide referral and
counseling assistance to deaf-blind persons; and an affiliate network of agencies.
SPECIAL INSTITUTIONS

FOR

PERSONS

WITH

DISABILITIES

AMERICAN PRINTING HOUSE FOR THE BLIND

$32,431,000
32,431,000
34,431,000

The Committee recommends $34,431,000 to help support American Printing House for the Blind [APH].
APH provides educational materials to students who are legally
blind and enrolled in programs below the college level. The Federal
subsidy provides approximately 65 percent of APH’s total sales income. Materials are distributed free of charge to schools and States
through per capita allotments based on the total number of students who are blind. Materials provided include textbooks and

200
other educational aids in Braille, large type, recorded form, and
computer applications. Appropriated funds may be used for staff
salaries and expenses, as well as equipment purchases and other
acquisitions, consistent with the purpose of the Act to Promote the
Education of the Blind (Public Law 45–186).
Center for Assistive Technology Training.—Within the total, the
Committee recommendation includes $3,000,000, an increase of
$1,000,000, to continue and expand the Center for Assistive Technology Training regional partnership established in fiscal year
2019. APH is continually developing new products and technologies
to help ensure students who are blind and visually impaired have
access to the education materials they need to succeed in school.
This partnership pairs the provision of assistive technology with
training for students, families, and teachers to help them fully utilize available products and technology.
NATIONAL TECHNICAL INSTITUTE

FOR THE

DEAF

$79,500,000
79,500,000
81,500,000

The Committee recommends $81,500,000 for the National Technical Institute for the Deaf [NTID].
NTID, located on the campus of the Rochester Institute of Technology in Rochester, New York, was created by Congress in 1965
to provide a residential facility for postsecondary technical training
and education for persons who are deaf. NTID also provides support services for students who are deaf, trains professionals in the
field of deafness, and conducts applied research.
Regional STEM Center.—The Committee recommendation includes $6,500,000, an increase of $1,000,000, for NTID’s Regional
STEM Center [NRSC]. The NRSC, first established with fiscal year
2016 funds, expands NTID’s geographical reach and improves access to postsecondary STEM education and employment for students who are deaf or hard of hearing in underserved areas. This
has included professional development for teachers, developing relationships with business and industry to promote employment opportunities, and preparing students to be successful in STEM
fields. The Committee recommendation supports the expansion of
the current NRSC.
GALLAUDET UNIVERSITY
Appropriations, 2020 .............................................................................
Budget estimate, 2021 ...........................................................................
Committee recommendation .................................................................

$137,361,000
137,361,000
140,361,000

The Committee recommends $140,361,000 for Gallaudet University.
Gallaudet University is a private, not-for-profit institution offering undergraduate and continuing education programs for students
who are deaf, as well as graduate programs in fields related to
deafness for students who are hearing and deaf. The university
conducts basic and applied research related to hearing impairments and provides public service programs for the deaf community.

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This funding also supports the Model Secondary School for the
Deaf, which serves as a laboratory for educational experimentation
and development; disseminates curricula, materials, and models of
instruction for students who are deaf; and prepares adolescents
who are deaf for postsecondary academic or vocational education or
the workplace. The university’s Kendall Demonstration Elementary
School develops and provides instruction for children from infancy
through age 15.
Early Language Acquisition Project [ELAP].—Within the total,
the Committee recommendation includes $3,500,000, an increase of
$500,000, to expand the current regional partnership through the
ELAP. The ELAP supports early language acquisition for children
from birth through age three who are deaf or hard of hearing. The
existing partnership includes activities to improve early language
acquisition training for early educators, caretakers, and other professionals. This partnership allows Gallaudet to expand and build
on its current research in this area, and test and evaluate interventions in diverse geographic areas.
CAREER, TECHNICAL,

AND

ADULT EDUCATION

$1,960,686,000
2,723,265,000
2,035,686,000

Career and Technical Education
The Committee recommends $2,035,686,000 for the Career and
Technical Education [CTE] account.
State Grants.—The Committee recommends $1,357,598,000 for
CTE State grants. Funds provided under the State grant program
assist States, localities, and outlying areas to expand and improve
their CTE program and help ensure equal access to CTE for populations with special needs. Persons assisted range from secondary
students in pre-vocational courses through adults who need retraining to adapt to changing technological and labor market conditions. Per the authorization of the program, after reservations for
required set-asides and small State minimums, funds are distributed to a baseline level of the amount awarded to each State in fiscal year 2018, with any remaining funds allocated according to a
formula based on State population and State per capita income.
Under the Indian and Hawaiian Natives programs, competitive
grants are awarded to federally recognized Indian Tribes or Tribal
organizations and to organizations primarily serving and representing Hawaiian Natives for services that are additional to what
these groups receive under other provisions of the Perkins Act
(Public Law 109–270).
Of the funds available for this program, $566,598,000 will become available July 1, 2021, and $791,000,000 will become available on October 1, 2021. These funds will remain available for obligation until September 30, 2022.
National Activities.—The Committee recommends $7,421,000 to
support research, development, demonstration, dissemination, evaluation, and assessment of activities aimed at improving the quality
and effectiveness of CTE.

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Adult Education
The Committee recommends $670,667,000 for Adult Education
programs.
Adult Education State Grants.—The Committee recommendation
includes $656,955,000 for Adult Education State Grants which provide funding for States for programs that assist adults in becoming
literate and in obtaining the skills necessary for employment and
self-sufficiency.
National Leadership Activities.—The Committee recommends
$13,712,000 for adult education national leadership activities.
STUDENT FINANCIAL ASSISTANCE
Appropriations, 2020 ............................................................................. $24,520,352,000
Budget estimate, 2021 ........................................................................... 22,975,352,000
Committee recommendation ................................................................. 24,520,352,000

The Committee recommends an appropriation of $24,520,352,000
for programs under the Student Financial Assistance account.
Federal Pell Grant Program
The Committee recommends $22,475,352,000 in current year discretionary funding for the Pell grant program. Pell grants provide
need-based financial assistance that helps undergraduate students
and their families defray a portion of the costs of postsecondary
education. Awards are determined according to a statutory needanalysis formula that takes into account a student’s family income
and assets, household size, and the number of family members, excluding parents, attending postsecondary institutions.
The Committee recommendation includes $5,435 for the discretionary portion of the maximum Pell grant award, an increase of
$150. Combined with mandatory funding, this would provide a
total maximum award of $6,495 for the 2021–2022 award year, an
increase of 2.4 percent.
Federal Supplemental Educational Opportunity Grant Program
The Committee recommends $865,000,000 for the Supplemental
Educational Opportunity Grant [SEOG] program. The SEOG program provides funds to approximately 3,600 postsecondary institutions for need-based grants to more than 1,500,000 undergraduate
students. Institutions must contribute at least 25 percent toward
SEOG awards. Students qualify for grants of up to $4,000 by demonstrating financial need. Priority is given to Pell grant recipients
with exceptional need.
Federal Work-Study Program
The Committee bill provides $1,180,000,000 for the Federal
Work-Study [FWS] program. This program provides grants to approximately 3,200 institutions and helps over 600,000 undergraduate, graduate, and professional students meet the costs of
postsecondary education through part-time employment. Institutions must provide at least 25 percent of student earnings.
Within the total for FWS, the Committee recommendation includes $10,051,000, level with fiscal year 2020, for the Work Col-

203
leges program authorized under section 448 of the Higher Education Act (Public Law 89–329), as amended.
FEDERAL DIRECT STUDENT LOAN PROGRAM ACCOUNT
Appropriations, 2020 .............................................................................
$50,000,000
Budget estimate, 2021 ........................................................................... ...........................
Committee recommendation ................................................................. ...........................

The Committee recommendation does not include additional discretionary funding for the Federal Direct Student Loan Program
Account. Since fiscal year 2018, $750,000,000 has been appropriated for this account, which provides for student loan borrower
loan forgiveness under Temporary Expanded Public Service Loan
Forgiveness Program [TEPSLF]. As of the end of fiscal year 2020,
approximately $675,000,000 of that amount remains available,
which is more than sufficient funding to forgive loans for borrowers
that become eligible under the TEPSLF program in fiscal year 2021
and in coming years.
The Committee directs the Department to provide quarterly updates beginning no later than 30 days after enactment to the Committees on Appropriations of the House of Representatives and the
Senate; the Senate Committee on Health, Education, Labor, and
Pensions; and the House Committee on Education and Labor, on
actions taken to implement GAO’s recommendations and to comply
with other requirements in this and prior appropriations acts establishing this program.
STUDENT AID ADMINISTRATION
Appropriations, 2020 .............................................................................
Budget estimate, 2021 ...........................................................................
Committee recommendation .................................................................

$1,768,943,000
1,883,309,000
1,868,943,000

The Committee recommends $1,868,943,000 for the Student Aid
Administration account. These funds are available until September
30, 2022, and support the Department’s student aid management
expenses. The Committee recommendation includes an increase in
funding to support increased costs associated with servicing Federal student loans, predominantly because the number of Federal
Direct Loans continues to increase, enhance IT and cyber security,
and support the continued transition to the Next Generation Processing and Servicing Environment [NextGen].
The Committee directs the Department to continue to provide
quarterly reports detailing its obligation plan by quarter for student aid administrative activities, broken out by servicer and activity, and detailing performance metrics, total loan volume, and number of accounts, broken out by servicer and for each private collection agency.
Ability to Benefit.—The Committee reiterates the directive included in the fiscal year 2020 explanatory statement and directs
the Department to issue guidance within 60 days of enactment that
serves as a simple and clear resource for implementing Ability to
Benefit at institutions of higher education [IHE].
Free Application for Federal Student Aid [FAFSA] and Opioid
Crisis.—The Committee encourages the Department to provide support for students who, due to substance use disorders, are unable

204
to include parental information in the FAFSA. This could include
further efforts to ensure students and financial aid administrators
are aware of current options for students, providing specific information and examples of how students whose parents have substance use disorders can utilize current options, and exploring
other administrative changes to help address the unique needs of
such students.
FAFSA Simplification.—The Committee supports efforts to simplify and streamline the FAFSA. The FUTURE Act (Public Law
116–91) was an important step toward this goal and the Committee
looks forward to working with the Department and authorizing
Committees on its implementation and other efforts to simplify and
modernize the FAFSA and Federal Student Aid.
Monitoring and Oversight.—The Committee directs the Department to include information in the fiscal year 2022 budget justification on its efforts to improve effective monitoring and oversight of
FSA contractors.
Return of Title IV Funds.—The Committee continues to strongly
encourage the Department to pursue efforts to simplify and streamline the Return of Title IV Funds process for institutions of higher
education and students.
State-based and Non-profit Servicing Organizations.—The Committee strongly encourages the Department to ensure a role for
State-based and non-profit servicing organizations in the NextGen
Financial Services Environment. Many such organizations have
demonstrated expertise in helping struggling borrowers avoid default and may be uniquely positioned to assist borrowers who reside in or attend school in the same State or region. The Committee encourages the Department to consider such factors in the
current performance-based allocation system and in developing student loan servicing partnerships as part of Next Gen.
Student Loan Servicing.—The Committee recommendation continues all requirements from the Further Consolidated Appropriations Act, 2020 (Public Law 116–94). The Committee notes there
are significant concerns with the Department’s current plan and
contract solicitation for an Interim Servicing Solution [ISS] that
was released on October 28, 2020. The Committee appreciates the
Department’s periodic briefings on NextGen, including specifically
on ISS. However, there are significant concerns ISS limits competition; could result in two vendors servicing all Federal student loans
for an indefinite period of time during the ISS initial state; and is
an interim step to an eventual Optimal Processing Solution [OPS]
that would require transferring Federal student loan accounts multiple times. The Committee expects the Department to thoroughly
consider options to move more quickly to OPS, including extending
current contracts to avoid the need for this interim step. The Committee expects to work with the Department to address bipartisan
concerns with ISS as part of a final fiscal year 2021 appropriations
bill. The Committee recommendation includes an increase for Student Aid Administration Servicing Activities to address increased
student loan servicing costs, which are expected to continue to increase as the number of Federal Direct Loans continues to increase.

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HIGHER EDUCATION
Appropriations, 2020 .............................................................................
Budget estimate, 2021 ...........................................................................
Committee recommendation .................................................................

$2,475,792,000
1,788,634,000
2,488,157,000

The Committee recommends an appropriation of $2,488,157,000
for higher education programs.
Aid for Institutional Development
The Committee recommends $774,359,000, an increase of
$14,805,000 in discretionary funding for Aid for Institutional Development. These totals do not include separately authorized and
appropriated mandatory funding.
Strengthening
Institutions.—The
Committee
recommends
$109,956,000 to provide competitive, 1-year planning and 5-year
development grants for institutions with a significant percentage of
financially needy students and low educational and general expenditures per student in comparison with similar institutions. Applicants may use these funds to develop faculty, strengthen academic programs, improve institutional management, and expand
student services.
Hispanic-Serving Institutions [HSIs].—The Committee recommends $145,870,000 for competitive grants to institutions at
which Hispanic students make up at least 25 percent of enrollment. Funds may be used for acquisition, rental, or lease of scientific or laboratory equipment; renovation of instructional facilities; development of faculty; support for academic programs; institutional management; and purchase of educational materials.
Promoting Postbaccalaureate Opportunities for Hispanic Americans.—The Committee recommends $13,088,000 for competitive, 5year grants to HSIs to help Hispanic Americans gain entry into
and succeed in graduate study. Institutions may use funding to
support low-income students through outreach programs; academic
support services; mentoring and financial assistance; acquisition,
rental, or lease of scientific or laboratory equipment; construction
and other facilities improvements; and purchase of educational materials.
Strengthening Historically Black Colleges and Universities
[HBCUs].—The Committee recommends $331,123,000 for the
Strengthening HBCUs program. The program makes formula
grants to HBCUs that may be used to purchase equipment; construct and renovate facilities; develop faculty; support academic
programs; strengthen institutional management; enhance fundraising activities; provide tutoring and counseling services to students; and conduct outreach to elementary and secondary school
students.
Strengthening
Historically
Black
Graduate
Institutions
[HBGIs].—The Committee recommends $85,632,000 for the
Strengthening HBGIs program. This program provides 5-year
grants to provide scholarships for low-income students and academic and counseling services to improve student success. Funds
may also be used for construction, maintenance, and renovation activities; the purchase or lease of scientific and laboratory equipment; and the establishment of an endowment.

206
Strengthening Predominately Black Institutions [PBIs].—The
Committee recommends $13,454,000 for the Strengthening PBIs
program. This program provides 5-year grants to PBIs to plan and
implement programs to enhance the institutions’ capacities to serve
more low- and middle-income students. Funding may be used for
establishing or enhancing a program of teacher education designed
to qualify students to teach in a public elementary school or secondary school in the State that shall include, as part of such program, preparation for teacher certification or licensure.
Strengthening Asian American and Native American Pacific Islander-Serving Institutions [AANAPISIs].—The Committee recommends $4,531,000 for competitive grants to AANAPISIs that
have an enrollment of undergraduate students that is at least 10
percent Asian American or Native American Pacific Islander students. Grants may be used to improve their capacity to serve Asian
American and Native American Pacific Islander students and lowincome individuals.
Strengthening Alaska Native and Native Hawaiian-Serving Institutions [ANNHs].—The Committee recommends $18,677,000 for the
Strengthening ANNHs program.
The purpose of this program is to improve and expand the capacity of institutions serving Alaska Native and Native Hawaiian students and low-income individuals. Funds may be used to plan, develop, and implement activities that encourage faculty and curriculum development; improve administrative management; renovate educational facilities; enhance student services; purchase library and other educational materials; and provide education or
counseling services designed to improve the financial and economic
literacy of students or their families.
Strengthening Native American-Serving Non-Tribal Institutions.—The Committee recommends $4,531,000 for this program,
which serves institutions that enroll at least 10 percent Native
American students and at least 50 percent low-income students.
This program helps institutions plan, develop, and implement activities that encourage faculty and curriculum development; improve administrative management; renovate educational facilities;
enhance student services; and purchase library and other educational materials.
Strengthening Tribally Controlled Colleges and Universities.—
The Committee recommends $37,347,000 for this program. Tribal
colleges and universities rely on a portion of the funds provided to
address developmental needs, including faculty development, curriculum, and student services.
The Committee recognizes the importance of this investment
which is a lifeline for the development of Tribal Colleges and Universities. The Committee also is aware that title III, part F of HEA
mandatory funding supports nearly half of the funding available to
Tribal Colleges and Universities and has been used for critical investments, including the development and implementation of career training programs, vitally needed facilities and laboratory
modernization, information and technology maintenance and expansion, and student support services.
Strengthening Master’s Degree Programs at Historically Black
Colleges
and
Universities.—The
Committee
recommends

207
$10,150,000 for this program, authorized by section 723 of the
HEA. This program provides grants to specified colleges and universities making a substantial contribution to graduate education
opportunities at the master’s level in mathematics, engineering,
the physical or natural sciences, computer science, information
technology, nursing, allied health, or other scientific disciplines.
International Education and Foreign Language Studies
The bill includes a total of $76,164,000 for International Education and Foreign Language Studies programs. Funds are used to
increase the number of experts in foreign languages and area or
international studies to meet national security needs through visits
and study in foreign countries.
Domestic Programs.—The Committee recommends $68,103,000
for domestic program activities related to international education
and foreign language studies under title VI of the HEA. Funds are
used to support centers, programs, and fellowships. The Committee
urges the Secretary to preserve the program’s longstanding focus
on activities and institutions that address the Nation’s need for a
strong training and research capacity in foreign languages and
international studies, including increasing the pool of international
experts in areas that are essential to national security and economic competitiveness.
Overseas Programs.—The Committee recommends $8,061,000 for
overseas programs authorized under the Mutual Educational and
Cultural Exchange Act of 1961 (Public Law 87–256), popularly
known as the Fulbright-Hays Act. Funding is provided for group,
faculty, or doctoral dissertation research abroad, as well as special
bilateral projects. Grants focus on training American instructors
and students to improve foreign language and area studies education in the United States.
Model Comprehensive Transition and Postsecondary Programs for
Students With Intellectual Disabilities
The Committee recommendation includes $13,800,000 for the
Transition Programs for Students with Intellectual Disability
[TPSID] Model Demonstrations and TPSID National Coordinating
Center [NCC]. The Department awards competitive grants to institutions of higher education or consortia of institutions of higher
education to enable them to create or expand high quality, inclusive model comprehensive transition and postsecondary programs
for students with intellectual disabilities. The program also supports an NCC.
The Committee recommendation includes $2,000,000 to establish
a technical assistance center to translate and disseminate research
and best practices for all institutions of higher education, including
those not participating in the TPSID program, for improving inclusive postsecondary education for students with intellectual disabilities. This center will help ensure that knowledge and products
gained through research and development, including through the
TPSID program, will reach more IHEs and more students and improve postsecondary opportunities for students with intellectual
disabilities.

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Minority Science and Engineering Improvement
The Committee recommends $15,000,000, an increase of
$2,365,000, for the Minority Science and Engineering Improvement
program. Funds are used to provide discretionary grants to institutions with minority enrollments greater than 50 percent to purchase equipment, develop curricula, and support advanced faculty
training. Grants are intended to improve science and engineering
education programs and increase the number of minority students
in the fields of science, mathematics, and engineering.
Tribally Controlled Postsecondary Career and Technical Institutions
The Committee recommends $10,195,000 for tribally controlled
postsecondary vocational institutions. This program provides
grants for the operation and improvement of tribally controlled
postsecondary vocational institutions to ensure continued and expanding opportunities for Indian students.
Federal TRIO Programs
The Committee recommends $1,090,000,000 for Federal TRIO
programs, which provide a variety of services to improve postsecondary education opportunities for low-income individuals and
first-generation college students.
Upward Bound offers disadvantaged high school students academic services to develop the skills and motivation needed to pursue and complete a postsecondary education; Student Support
Services provides developmental instruction, counseling, summer
programs, and grant aid to disadvantaged college students to help
them complete their postsecondary education; Talent Search identifies and counsels individuals between ages 11 and 27 regarding opportunities for completing high school and enrolling in postsecondary education; Educational Opportunity Centers provide information and counseling on available financial and academic assistance to low-income adults who are first-generation college students;
and the Ronald E. McNair Postbaccalaureate Achievement Program supports research internships, seminars, tutoring, and other
activities to encourage disadvantaged college students to enroll in
doctoral programs.
The Committee directs the Department to allocate any grant
funding not needed for non-competitive continuation awards or for
programs up for re-competition in fiscal year 2021 to provide inflationary increases for current grantees, and to increase the number
and size of new awards in the fiscal year 2021 Talent Search and
Educational Opportunity Centers grant competitions. The Committee directs the Department to include proposed funding levels
for each of the TRIO programs in the operating plan required
under section 516 of this act, and to brief the Committees on Appropriations of the House of Representatives and the Senate prior
to issuing a Notice Inviting Applications.
The Committee continues to not support the budget proposal to
transform TRIO into a single State formula grant, which is an
issue that is more appropriately considered as part of the reauthorization of HEA.

209
Gaining Early Awareness and Readiness for Undergraduate Programs [GEAR UP]
The Committee recommends $365,000,000 for GEAR UP, which
provides grants to States and partnerships of colleges, middle and
high schools, and community organizations to assist cohorts or students in middle and high schools serving a high percentage of lowincome students. Services provided help students prepare for and
pursue a postsecondary education.
The Committee directs the Department to announce Notices Inviting Applications for New Awards for State Grants and Partnership Grants in the Federal Register. In such notice for State
grants, the Committee directs the Department to uphold the longstanding guidance that States may only administer one active
State GEAR UP 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 GEAR UP grant, or States
that have an active State GEAR UP grant that is scheduled to end
prior to October 1, 2021, will be eligible to receive a new State
GEAR UP award funded in whole or in part by this appropriation.
The Secretary is further directed to ensure that no request from a
State Grant applicant to receive an exception to the GEAR UP
scholarship described in Sec. 404E(b)(2) of the HEA shall be denied
on the basis of 34 CFR 694.14(c)(3).
Graduate Assistance in Areas of National Need and Javits Fellowships
The Committee recommends $23,047,000 to support the Graduate Assistance in Areas of National Need [GAANN] program.
GAANN supports fellowships through 3-year competitive grants to
graduate academic departments and programs in scientific and
technical fields and other areas of national need as determined by
the Secretary. Fellowship recipients must have excellent academic
records and high financial need and must be pursuing doctoral degrees or the highest graduate degrees in their academic field. Each
fellowship consists of a student stipend to cover living costs and an
institutional payment to cover each fellow’s tuition and other expenses. Institutions of higher education must match 25 percent of
the grant amount.
Teacher Quality Partnership Program
The Committee recommends $50,092,000 for the Teacher Quality
Partnership [TQP] program. The TQP program helps improve the
quality of teachers working in high-need schools and early childhood education programs by creating model teacher preparation
and residency programs.
Child Care Access Means Parents in Schools
The Committee recommendation includes $53,000,000 for the
Child Care Access Means Parents in Schools program. This program provides competitive grants to institutions of higher education to establish or support campus-based child care programs, to
help support needs and participation of low-income parents in postsecondary education.

210
Fund for the Improvement of Post-Secondary Education
The Committee recommendation includes $17,500,000 for the
Fund for the Improvement of Post-Secondary Education.
National Center for Information and Technical Support for Postsecondary Students with Disabilities.—The bill 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.
Open Textbook Pilot.—The recommendation includes $7,000,000
to continue the Open Textbook Pilot and support a new grant competition in fiscal year 2021. The Committee directs the Department
to issue a notice inviting applications and allow for a 60-day application period. This funding should support a significant number of
grant awards under the same terms and conditions as specified for
this activity in fiscal year 2020.
Rural Postsecondary and Economic Development Grant Program.—The Committee recommendation includes $10,000,000 for
competitive grants to institutions of higher education and other
public and private non-profit organizations and agencies for innovative approaches to improve rates of postsecondary enrollment and
completion among rural students. Programs that provide academic
and career counseling and exposure to post-secondary opportunities
to students as early as 8th grade and continuing through secondary
and post-secondary education, have been shown to significantly increase rates of post-secondary enrollment and completion among
rural students. In awarding grants, the Department should give
priority to applications that include partnerships with regional economic development or workforce agencies, regional employers, or
other relevant nonprofit organizations. Further, the Department
should prioritize applications that include strategies for developing
and maintaining long-term college and career advising relationships with middle and high school students to support them
through their transition to postsecondary education, including potential transitions from 2- to 4-year programs; support alignment
of academic programs with, and development of, career pathways
to high-need occupations in the region; and include a sustainability
plan to maintain programs and services after completion of the
grant.
HOWARD UNIVERSITY
Appropriations, 2020 .............................................................................
Budget estimate, 2021 ...........................................................................
Committee recommendation .................................................................

$240,018,000
240,018,000
244,018,000

The Committee recommends an appropriation of $244,018,000,
an increase of $4,000,000, for Howard University. Located in the
District of Columbia, Howard offers undergraduate, graduate, and
professional degrees through 12 schools and colleges. The university also administers the Howard University Hospital. Federal
funds from this account support approximately 38 percent of the
university’s operating costs. The Committee recommends, within
the funds provided, not less than $3,405,000 for the endowment
program.

211
Howard University Hospital.—Within the funds provided, the
Committee recommends $27,325,000 for Howard University Hospital. The hospital provides inpatient and outpatient care, as well
as training in the health professions. It also serves as a major
acute and ambulatory care center for the District of Columbia and
functions as a major teaching facility attached to the university.
The Federal appropriation provides partial funding for the hospital’s operations.
COLLEGE HOUSING

AND

ACADEMIC FACILITIES LOANS PROGRAM

$435,000
435,000
435,000

Federal Administration.—The Committee bill includes $435,000
for Federal administration of the CHAFL, College Housing Loans,
and Higher Education Facilities Loans programs. Prior to fiscal
year 1994, these programs provided financing for the construction,
reconstruction, and renovation of housing, academic, and other educational facilities. While no new loans have been awarded since fiscal year 1993, costs for administering the outstanding loans will
continue through 2030. These funds will be used to reimburse the
Department for administrative expenses incurred in managing the
existing loan portfolio.
HISTORICALLY BLACK COLLEGE AND UNIVERSITY CAPITAL
FINANCING PROGRAM ACCOUNT
Appropriations, 2020 .............................................................................
Budget estimate, 2021 ...........................................................................
Committee recommendation .................................................................

46,484,000
40,484,000
46,484,000

The Committee recommends $46,484,000 for the HBCU Capital
Financing Program. The HBCU Capital Financing Program makes
capital available to HBCUs for construction, renovation, and repair
of academic facilities by providing a Federal guarantee for private
sector construction bonds. Construction loans will be made from
the proceeds of the sale of the bonds.
The Committee recommendation includes $20,150,000 for loan
subsidy costs in guaranteed loan authority under this program (not
including subsidy costs related to specific funding available for loan
deferments described below). This will support an estimated
$220,000,000 in new loan volume in fiscal year 2021. In addition,
the Committee recommendation includes $16,000,000 and
$10,000,000 respectively for the costs of deferring loans made
under this program for private and public HBCUs with demonstrated financial need. Finally, the Committee recommendations
includes $334,000 for administrative expenses.
INSTITUTE

EDUCATION SCIENCES

$623,462,000
565,440,000
635,462,000

The Committee recommends $635,462,000 for the Institute of
Education Sciences [IES]. This account supports education re-

212
search, development, dissemination, and evaluation; data collection
and analysis activities; and the assessment of student progress.
Under the Education Sciences Reform Act of 2002 (Public Law
107–279), Congress established IES to provide objective and valid
research-driven knowledge that was free of political influence or
bias so as to better inform effective education practices at the State
and local levels. The act required IES, in carrying out its mission,
‘‘to compile statistics, develop products, and conduct research, evaluations, and wide dissemination activities in areas of demonstrated
national need and ensure that such activities conform to high
standards of quality, integrity, and accuracy and are objective, secular, neutral, and nonideological and are free of partisan political
influence.’’
The Committee directs the Director to submit an operating plan
within 90 days of enactment to the Committees on Appropriations
of the House of Representatives and the Senate detailing how IES
plans to allocate funding available to the Institute for research,
evaluation, and other activities authorized under law.
The Committee continues to direct the Department to ensure
that its employees, contractors, and grantees, including States that
receive funds from Statewide Longitudinal Data System grants, adhere to the strictest and highest standards for protecting personally
identifiable information.
RESEARCH, DEVELOPMENT, AND DISSEMINATION

The Committee recommends $195,877,000 for education research,
development, and national dissemination activities. Funds are
available for obligation for 2 fiscal years. These funds support activities that are aimed at expanding fundamental knowledge of
education and promoting the use of research and development findings in the design of efforts to improve education.
Student Financial Aid.—The Committee encourages IES to conduct a study on whether cost of living is accurately reflected in
IHE’s costs of attendance, and a study on how family income affects students’ application rates and participation in Federal student financial aid programs.
STATISTICS

The Committee recommends $110,500,000 for data gathering and
statistical analysis activities at the National Center for Education
Statistics [NCES].
NCES collects, analyzes, and reports statistics on education in
the United States. Activities are carried out directly and through
grants and contracts. The Center collects data on educational institutions at all levels, longitudinal data on student progress, and
data relevant to public policy. NCES also provides technical assistance to SEAs, LEAs, and postsecondary institutions.
REGIONAL EDUCATIONAL LABORATORIES

The Committee recommends $56,022,000 to continue support for
the Regional Educational Laboratories program. Funds available in
this bill will continue to support a network of 10 laboratories. The
laboratories are responsible for promoting the use and development

213
of knowledge and evidence in broad-based systemic strategies to increase student learning and further school improvement efforts.
The Committee urges IES to continue its efforts to strengthen the
connections between practitioners and the research community, so
that federally supported research is timely, relevant, and responsive to the needs of the field.
RESEARCH AND INNOVATION IN SPECIAL EDUCATION

The Committee recommends $56,500,000 for research and innovation in special education conducted by the National Center for
Special Education Research [NCSER].
The Center addresses gaps in scientific knowledge to improve
special education and early intervention services and outcomes for
infants, toddlers, and children with disabilities. Funds provided to
the Center are available for obligation for 2 fiscal years.
The Committee continues to believe that NCSER should manage
its appropriation to be able to conduct research and training grant
competitions annually.
SPECIAL EDUCATION STUDIES AND EVALUATIONS

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

The Committee recommendation includes $33,000,000 for the
Statewide Data Systems program.
This program supports competitive grants to SEAs to enable
such agencies to design, develop, and implement Statewide, longitudinal data systems to manage, analyze, disaggregate, and use individual data for students of all ages. Early childhood, postsecondary, and workforce information systems may be linked to such
systems or developed with program funds. The Committee believes
the Department should continue its efforts to ensure every State
has the base support necessary to develop effective systems. Funds
are available for obligation for 2 fiscal years.
ASSESSMENT

The Committee recommends $172,745,000 to provide support for
the National Assessment of Educational Progress [NAEP], a congressionally mandated assessment created to measure and report
the educational achievement of American students in a range of
subjects and analyze trends over time.
Within the funds appropriated, the Committee recommends
$7,745,000 for the National Assessment Governing Board, which is
responsible for formulating policy for NAEP.

214
DEPARTMENTAL MANAGEMENT
PROGRAM ADMINISTRATION

$430,000,000
448,723,000
430,000,000

The Committee recommends $430,000,000 for program administration.
Funds support personnel compensation and benefits, travel, rent,
communications, utilities, printing, equipment and supplies, automated data processing, and other services required to award, administer, and monitor Federal education programs. Support for
program evaluation and studies and advisory councils is also provided under this account.
Competitive Grant Priorities for Rural Areas.—The Committee
continues to encourage the Department to continue efforts to ensure competitive grants are reaching rural areas so that support
and solutions developed with Federal funding are relevant to and
available in such areas.
Disclosures of Foreign Gifts and Contracts.—The Committee appreciates the Department’s report on Intuitional Compliance with
Section 117 of the HEA. The Committee directs the Department to
provide periodic updates to this report to the Committees on Appropriations of the House of Representatives and the Senate to help
ensure IHEs are complying with their requirements under the law,
and to work with IHEs to ensure they are aware of such requirements.
Evidence-based Grant Making.—The Committee directs the Department to 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. Further, non-competitive formula
grant funds have a range of evidence requirements and preferences
and the Committee directs the Department to support entities receiving funding through those programs through enhancements to
its technical assistance and support activities.
Integrated Postsecondary Education Data System [IPEDS] Finance Survey.—Inconsistencies in how institutions report certain
expenditure data to IPEDS can make it difficult to compare across
institutions. The Committee encourages the Department to explore
options for improving this data collection, including specifically
whether better definitions of key expenditure categories including
instruction, academic support, and student services, could lead to
more accurate and consistent reporting of institutional expenditures.
Performance Partnerships.—The Committee recommendation
continues authority for Performance Partnerships as included in
prior appropriations acts. Performance Partnerships allow States
and localities to demonstrate better ways of improving outcomes for
disconnected youth by giving them additional flexibility in using
discretionary funds across multiple Federal programs. The Committee also continues to encourage the administration to enhance
its efforts working with existing and potential sites on the full

215
range of flexibilities that could be employed to help better serve
disconnected youth.
Pooled Evaluation Authority.—The Committee requests that the
Department provide a report to the Committee on the planned use
of pooled evaluation funds under section 8601 of the ESEA, consistent with the required plan under such section, not later than
15 days prior to any transfer of funds.
Post-Secondary Transfer Articulation Agreements.—Transfer articulation agreements between community colleges and 4-year colleges and universities can play an important role in promoting access, affordability, and completion in higher education. The Committee encourages the Department to gather input from States to
develop and disseminate best practices on implementing and scaling up comprehensive statewide systems on articulation agreements.
Reorganization Plans.—The Committee recommendation continues all directives included in the Consolidated Appropriations
Act, 2020 (Public Law 116–94) and the accompanying explanatory
statement.
Spatial Computing.—According to BLS, technology-related industries are projected to be among the fastest growing industries within the United States over the next 10 years. However, due to the
lack of qualified individuals within the labor pool, many of these
jobs result in outsourcing to foreign nationals. Not only does this
present a threat to this Nation’s economy, it also poses a threat to
our national security. Therefore, it is imperative to further policies
ensuring the United States continues to be unsurpassed as the
world’s leader in technological innovation. Presently, the United
States is the leader in spatial computing, the next step in the evolution of computing. Therefore, the Committee directs the Department to conduct a feasibility report on the establishment of a Center of Excellence designation for spatial computing. This designation would assist higher education institutions in their efforts to
teach and train students within the field of spatial computing. The
Department is directed to include within this report a timeline,
cost, and recommendations in the creation of this Center of Excellence designation. The Committee encourages the Department to
work with the Departments of Labor and Commerce for their input
and recommendations. Within 180 days of enactment the Department is directed to provide a report with its recommendations to
the Committees of Appropriations of the House of Representatives
and the Senate.
Staffing Reports.—The Committee requests the Department 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.
Travel Notifications.—The Committee includes a general provision requiring the Department to submit an upcoming travel report
to the Committees on Appropriations of the House of Representatives and the Senate by the 1st and 15th day of each month. The
report shall include upcoming official travel by the Secretary,
Under Secretary, Assistant Secretary for the Office of Elementary
and Secondary Education, Assistant Secretary for the Office of
Postsecondary Education, and Assistant Secretary for the Office of

216
Career, Technical, and Adult Education for the following two
weeks, with details specifying location (city and state), event, and
partners where the event will be held.
Work-based Learning.—The Committee notes that quality workbased learning opportunities in high school can play a critical role
in preparing students for future careers. The Committee supports
efforts in the Every Student Succeeds Act (Public Law 114–95) and
Strengthening Career and Technical Education for the 21st Century Act (Public Law 115–224) that allow States to include workbased learning indicators as part of their statewide accountability
systems.
OFFICE FOR CIVIL RIGHTS

$130,000,000
130,000,000
130,000,000

The Committee recommends $130,000,000 for the Office of Civil
Rights [OCR].
OCR is responsible for the enforcement of laws that prohibit discrimination on the basis of race, color, national origin, sex, disability, and age in all programs and institutions that receive financial assistance from the Department. To carry out this responsibility, OCR investigates and resolves discrimination complaints,
monitors desegregation and equal educational opportunity plans,
reviews possible discriminatory practices by recipients of Federal
education funds, and provides technical assistance to recipients of
funds to help them meet these civil rights requirements.
OFFICE OF INSPECTOR GENERAL

$63,000,000
68,019,000
63,000,000

The Committee recommends $63,000,000 for OIG.
OIG has the authority to investigate all departmental programs
and administrative activities, including those under contract or
grant, to prevent and detect fraud and abuse, and to ensure the
quality and integrity of those programs. The Office investigates alleged misuse of Federal funds and conducts audits to determine
compliance with laws and regulations, efficiency of operations, and
effectiveness in achieving program goals.
GENERAL PROVISIONS
Section 301. The bill continues a provision prohibiting the use of
funds to prevent the implementation of programs of voluntary
prayer and meditation in public schools.
Section 302. The bill continues a provision giving the Secretary
authority to transfer up to 1 percent of any discretionary funds between appropriations.
Section 303. The bill continues a provision making evaluation
funds pooled under section 8601 of the ESEA available for obligation from July 1, 2021, through September 30, 2022.

217
Section 304. The bill continues a general provision allowing certain institutions to continue to use endowment income for student
scholarships.
Section 305. The bill continues a provision extending authorization of the National Advisory Committee on Institutional Quality
and Integrity.
Section 306. The bill continues a provision extending authority to
provide account maintenance fees to guarantee agencies.
Section 307. The bill continues a provision regarding servicing of
Federal Perkins Loans.
Section 308. The bill modifies a provision rescinding fiscal year
2021 mandatory funding to pay for mandatory costs of increasing
the maximum discretionary Pell award.
Section 309. The bill modifies a provision rescinding prior year
unobligated Pell grant discretionary funding.
Section. 310. The bill continues a provision regarding administrative costs for Public Service Loan Forgiveness.
Section. 311. The bill includes a new provision establishing a
Nonrecurring Expenses Fund for the Department of Education.
Section. 312. The bill includes a new provision related to travel.

TITLE IV
RELATED AGENCIES
COMMITTEE

FOR

PURCHASE FROM PEOPLE WHO ARE BLIND
SEVERELY DISABLED

SALARIES AND EXPENSES

$10,000,000
13,930,000
12,000,000

The Committee recommends $12,000,000, an increase of
$2,000,000, for the Committee for Purchase from People Who Are
Blind or Severely Disabled, of which no less than $2,500,000 shall
be made available for the Office of Inspector General.
The Commission provides approximately 45,000 blind or severely
disabled Americans with employment opportunities each year. The
primary purpose of this program is to increase the employment opportunities for people who are blind or have other severe disabilities and, whenever possible, to prepare them to engage in competitive employment. Encompassing more than $3,600,000,000 in contracts, it is the Federal Government’s largest employment program
for the severely disabled. The Committee is encouraged by the
steps the Commission has taken to address concerns regarding the
oversight of the central nonprofit agencies [CNA], the independent
contracted organizations which administer the program.
The Committee for Purchase From People Who Are Blind or Severely Disabled shall submit in an electronic format quarterly reports on CNA Fees and CNA Expenditures, due no later than 60
days after the end of the fiscal quarter, to the Committees on Oversight and Government Reform and Education and the Workforce of
the House of Representatives, Committees on Homeland Security
and Governmental Affairs and Health, Education, Labor, and Pensions of the Senate, and Committees on Appropriations of the
House of Representatives and the Senate.
CORPORATION

FOR

NATIONAL

AND

COMMUNITY SERVICE

The Corporation for National and Community Service [CNCS], a
corporation owned by the Federal Government, was established to
enhance opportunities for national and community service. CNCS
administers programs authorized under the Domestic Volunteer
Service Act (Public Law 93–113), the National and Community
Service Trust Act (Public Law 103–82), and the SERVE America
Act (Public Law 111–13). Grants are awarded to States, public and
private nonprofit organizations, and other entities to create service
opportunities for students, out-of-school youth, adults, and seniors.
(218)

219
The Committee recommendation for CNCS provides a total program level of $1,154,358,000.
OPERATING EXPENSES

$806,529,000
30,105,000
848,529,000

The Committee recommends $848,529,000 for the operating expenses of CNCS.
Volunteers in Service to America [VISTA]
The Committee recommends $93,364,000 for VISTA. This program provides capacity building for small, community-based organizations with a mission of combating poverty. VISTA members
raise resources, recruit and organize volunteers, and establish and
expand programs in housing, employment, health, and economic
development activities.
National Senior Volunteer Corps
The Committee recommends $229,017,000, an increase of
$8,000,000, for the National Senior Volunteer Corps programs, a
collection of programs that connect Americans older than the age
of 55 with opportunities to contribute their job skills and expertise
to community projects and organizations. These programs include
the Retired Senior Volunteer Program, the Foster Grandparent
Program, and the Senior Companion Program.
AmeriCorps State and National Grants
The Committee recommends $460,510,000, an increase of
$32,000,000, for AmeriCorps State and National Grants, which provide funds to local and national organizations and agencies to address community needs in education, public safety, health, and the
environment. Each of these organizations and agencies, in turn,
uses its AmeriCorps funding to recruit, place, and supervise
AmeriCorps members. AmeriCorps members receive a modest living allowance and other benefits proportional to their level of time
commitment.
Commission Investment Fund [CIF].—The Committee recommendation includes no less than $8,500,000, the same as the fiscal year 2020 level, for CIF, which provides funds to State commissions for training and technical assistance activities to expand the
capacity of current and potential AmeriCorps programs, particularly in underserved areas.
Fixed Amount Grants.—The Committee continues to encourage
CNCS to expand opportunities for AmeriCorps programs to utilize
fixed amount grants, which could reduce unnecessary administrative burdens on current and potential AmeriCorps programs. The
Committee encourages CNCS to increase the current maximum
cost per member service year of fixed amount grants to make it
more comparable to cost reimbursement grant levels and allow new
AmeriCorps programs to be eligible to apply for full-time fixed
amount grants, while also ensuring that fixed amount grantees
provide a comparable amount of matching funds and that there is
sufficient oversight and accountability of fixed amount grantees.

220
Professional Corps.—The Committee continues to direct CNCS to
include a determination of need by the local community among the
factors that a professional corps program may use to demonstrate
an inadequate number of professional in a community. Further, the
Committee continues to strongly encourage CNCS to increase the
maximum amount of operating funds per member service year that
a professional corps program may request as part of their grant application. The Committee continues to direct CNCS to provide professional corps programs flexibility in justifying the need for operating funds to ensure that these programs are able to provide highquality services in all communities.
Transformation and Sustainability Plan [TSP].—The Committee
continues to direct CNCS to ensure that TSP does not create any
degradation in services, technical assistance, or support for local
community service programs, particularly those operating in underserved and rural areas, and to provide periodic briefings to the
Committees on Appropriations of the House of Representatives and
the Senate on steps taken to ensure that.
National Civilian Community Corps [NCCC]
The Committee recommendation includes $33,500,000 for NCCC,
a full-time, team-based residential program for men and women
ages 18 to 24. Members are assigned to one of five campuses for
a 10-month service commitment.
Innovation, Demonstration, and Assistance Activities
The Committee recommendation includes $9,600,000 for innovation, demonstration, and assistance activities.
Volunteer Generation Fund.—Within the total, the Committee
recommendation includes $6,400,000 for the Volunteer Generation
Fund authorized under section 198P of the SERVE America Act
(Public Law 111–13), the same as the comparable fiscal year 2020
funding level.
National Days of Service.—The Committee recommendation includes $3,200,000 for National Days of Service including the September 11th National Day of Service and Remembrance and the
Martin Luther King, Jr. National Day of Service.
Evaluation
The Committee recommendation includes $4,000,000 for CNCS
evaluation activities.
State Commission Grants
The Committee recommendation includes $18,538,000 for State
Commission Grants.
PAYMENT TO THE NATIONAL SERVICE TRUST

$208,342,000
10,000,000
213,342,000

The Committee recommends an appropriation of $213,342,000 for
making payments to the National Service Trust.
The National Service Trust makes payments of Segal education
awards, pays interest that accrues on qualified student loans for

221
AmeriCorps participants during terms of service in approved national service positions, and makes other payments entitled to
members who serve in the programs of CNCS.
SALARIES AND EXPENSES

$83,737,000
47,333,000
86,237,000

The Committee recommends an appropriation of $86,237,000 for
CNCS salaries and expenses. The salaries and expenses appropriation provides funds for staff salaries, benefits, travel, training, rent,
equipment, and other operating expenses necessary for management of CNCS programs and activities.
OFFICE OF INSPECTOR GENERAL

$5,750,000
4,258,000
6,250,000

The Committee recommends an appropriation of $6,250,000 for
the CNCS OIG. The OIG’s goals are to increase organizational efficiency and effectiveness within the Corporation and to prevent
fraud, waste, and abuse.
ADMINISTRATIVE PROVISIONS

The Committee recommendation includes the following general
provisions for CNCS: requiring CNCS to make any significant
changes to program requirements or policy through rule making
(section 401); stipulating minimum share requirements (section
402); requiring that donations supplement and not supplant operations (section 403); aligning requirements regarding the use of
Education Awards at GI bill-eligible institutions (section 404); allowing the required background check of certain applicants to be
processed by States under terms of the National Child Protection
Act (Public Law103–209) (section 405); and allowing CNCS to fund
1,200 hour member service positions (section 406).
CORPORATION FOR PUBLIC BROADCASTING

Appropriations, 2022 .............................................................................
$465,000,000
Budget estimate, 2023 ........................................................................... ...........................
Committee recommendation .................................................................
465,000,000

The Committee recommends $465,000,000 for the Corporation for
Public Broadcasting [CPB] as an advance appropriation for fiscal
year 2023.
The majority of these funds go directly to local public television
and radio stations to support their programming. CPB funds also
support the creation of content for radio, television, and other platforms; system support activities that benefit the entire public
broadcasting community; and CPB’s administrative costs. This
funding supports America’s local public television and radio stations and their mission of developing and ensuring universal access
to noncommercial, high-quality programming and telecommunications services for the American public.

222
Technology and distribution systems have greatly evolved since
Congress established the practice of funding public broadcasting
interconnection. Recognizing technology’s power in creating further
cost efficiencies across the public media system, the Committee recommendation includes $20,000,000 for continued support of CPB in
replacing and upgrading the public broadcasting interconnection
system and further investing in system-wide infrastructure and
services that benefit the American people.
FEDERAL MEDIATION

AND

CONCILIATION SERVICE

SALARIES AND EXPENSES

$47,200,000
48,600,000
47,200,000

The Committee recommends $47,200,000 for the Federal Mediation and Conciliation Service [FMCS]. FMCS provides mediation,
conciliation, and arbitration services to labor and management organizations to prevent and minimize work stoppages and promote
stable labor-management relationships. FMCS is also authorized to
provide dispute resolution consultation and training to all Federal
agencies.
Within the total, FMCS may utilize up to $900,000 for labormanagement partnership grants. These grants support innovative
approaches to collaborative labor-management relationships to resolve potential problems, explore ways to improve productivity, and
avert serious work stoppages.
FEDERAL MINE SAFETY

AND

HEALTH REVIEW COMMISSION

SALARIES AND EXPENSES

$17,184,000
17,184,000
17,184,000

The Committee recommends $17,184,000 for the Federal Mine
Safety and Health Review Commission [FMSHRC], which provides
administrative trial and appellate review of legal disputes under
the Federal Mine Safety and Health Act of 1977 (Public Law 91–
173). Most cases involve civil penalties proposed by MSHA.
FMSHRC’s administrative law judges [ALJs] decide cases at the
trial level and the five-member Commission provides review of the
ALJ’s decisions.
The Committee continues to direct FMSHRC to prioritize the allocation of resources and assignment of staff to reducing the time
substantive cases on appeal are awaiting a decision.
INSTITUTE

MUSEUM

AND

LIBRARY SERVICES

OFFICE OF MUSEUM AND LIBRARIES: GRANTS AND ADMINISTRATION

$252,000,000
23,000,000
257,000,000

The Committee recommends $257,000,000, an increase of
$5,000,000, for the Institute of Museum and Library Services

223
[IMLS]. This agency supports programs for museums and libraries
that encourage innovation, provide lifelong learning opportunities,
promote cultural and civic engagement, and improve access to a variety of services and information.
The Committee reiterates its support for IMLS to provide assistance to entities whose sole focus is promoting women in the arts.
Reopening Archives, Libraries, and Museums [REALM].—The
Committee provides $1,000,000 for the REALM project.
Within the total for IMLS, the Committee recommendation includes the amounts below:
[In thousands of dollars]
Fiscal year 2020
appropriation

Budget activity

Fiscal year 2021
request

Committee
recommendation

Library Services Technology Act [LSTA]:
Grants to States ...................................................................
Native American Library Services .........................................
National Leadership: Libraries ..............................................
Laura Bush 21st Century Librarian ......................................

166,803,000
5,263,000
13,406,000
10,000,000

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

169,803,000
5,263,000
13,406,000
10,000,000

Subtotal, LSTA ..............................................................

195,472,000

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

198,472,000

Museum Services Act:
Museums for America ...........................................................
Native American/Hawaiian Museum Services ......................
National Leadership: Museums ............................................

25,899,000
1,772,000
8,113,000

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

26,899,000
1,772,000
8,113,000

Subtotal, MSA ..............................................................

35,784,000

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

36,784,000

African American History and Culture Act ....................................
Administration ................................................................................
Research, Analysis and Data Collection .......................................

2,731,000
15,000,000
3,013,000

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

2,731,000
15,000,000
4,013,000

IMLS, Total ...................................................................

252,000,000

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

257,000,000

MEDICAID

AND

CHIP PAYMENT

AND

ACCESS COMMISSION

SALARIES AND EXPENSES

$8,780,000
9,265,000
8,780,000

The Committee recommends $8,780,000 for the Medicaid and
CHIP Payment and Access Commission [MACPAC]. This commission was established in the Children’s Health Insurance Program
Reauthorization Act of 2009 (Public Law 111–3) and is tasked with
reviewing State and Federal Medicaid and Children’s Health Insurance Program access and payment policies and making recommendations to Congress, the Secretary of HHS, and the States
on a wide range of issues affecting those programs. The Committee
recommendation will allow MACPAC to continue to carry out these
activities.
MEDICARE PAYMENT ADVISORY COMMISSION
SALARIES AND EXPENSES

$12,545,000
13,575,000
12,545,000

224
The Committee recommends $12,545,000 for the Medicare Payment Advisory Commission, which provides independent policy and
technical advice on issues affecting the Medicare program.
NATIONAL COUNCIL

DISABILITY

SALARIES AND EXPENSES

$3,350,000
3,350,000
3,350,000

The Committee recommends $3,350,000 for the National Council
on Disability [NCD]. NCD is mandated to make recommendations
to the President, Congress, the Rehabilitation Services Administration, and the National Institute on Disability and Rehabilitation
Research on issues of concern to individuals with disabilities. The
Council gathers information on the implementation, effectiveness,
and impact of the Americans with Disabilities Act (Public Law
101–336) and examines emerging policy issues as they affect persons with disabilities and their ability to enter or re-enter the Nation’s workforce and to live independently.
NATIONAL LABOR RELATIONS BOARD
SALARIES AND EXPENSES

$274,224,000
246,876,000
264,224,000

The Committee recommends $264,224,000, a decrease of
$10,000,000, for the National Labor Relations Board [NLRB],
which administers and enforces the National Labor Relations Act
of 1935 (Public Law 74–198) and protects employee and employer
rights provided under that act. The Committee notes that total
caseload for the NLRB has steadily declined. Case intake is down
in fiscal year 2020 by more than 15 percent through the third quarter for the same period in fiscal year 2019; 14,684 total cases in
July 2020 compared to 17,344 in July 2019. As such, the Committee instructs NLRB to ensure staffing levels are commensurate
with the agency’s workload.
ADMINISTRATIVE PROVISIONS

The Committee maintains language restricting the use of electronic voting (section 407).
NATIONAL MEDIATION BOARD
SALARIES AND EXPENSES

$14,050,000
13,900,000
14,050,000

The Committee recommends $14,050,000 for the National Mediation Board [NMB], which mediates labor-management relations in
the railroad and airline industries under the Railway Labor Act
(Public Law 88–542). The NMB mediates collective bargaining disputes, conducts elections to determine the choice of employee bar-

225
gaining representatives, and administers arbitration of employee
grievances.
OCCUPATIONAL SAFETY

AND

HEALTH REVIEW COMMISSION

SALARIES AND EXPENSES

$13,225,000
13,721,000
13,225,000

The Committee recommends $13,225,000 for the Occupational
Safety and Health Review Commission [OSHRC]. OSHRC serves as
a court to resolve disputes between OSHA and employers charged
with violations of health and safety standards enforced by OSHA.
RAILROAD RETIREMENT BOARD
The Railroad Retirement Board [RRB] administers the retirement/survivor and unemployment/sickness insurance benefit programs for railroad workers and their families under the Railroad
Retirement Act (Public Law 93–445) and Railroad Unemployment
Insurance Act (Public Law 100–647).
DUAL BENEFITS PAYMENTS ACCOUNT

$16,000,000
13,000,000
13,000,000

The Committee recommends $13,000,000 for the Dual Benefits
Payments Account. This amount includes an estimated $1,000,000
derived from income taxes on vested dual benefits. This appropriation provides for vested dual benefit payments to beneficiaries covered under both the railroad retirement and Social Security systems.
FEDERAL PAYMENTS TO THE RAILROAD RETIREMENT ACCOUNTS

$150,000
150,000
150,000

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

$123,500,000
120,225,000
120,225,000

The Committee recommends $120,225,000 for RRB’s costs associated with the administration of railroad retirement/survivor and
unemployment/sickness benefit programs, including $5,725,000 for
information technology modernization. This account limits the
amount of funds in the railroad retirement and railroad unemployment insurance trust funds that may be used by the Board for administrative expenses.

226
Since fiscal year 2018, the Committee has provided $35,725,000
within the Limitation on Administration account for the implementation of information technology systems modernization efforts. The
Committee directs RRB to provide a comprehensive update on the
project status, including timelines to completion, total anticipated
cost of development, funding obligations, and contracts no later
than 60 days after enactment and quarterly updates thereafter.
The Committee maintains bill language giving RRB the authority to hire new attorneys in the excepted service.
LIMITATION ON THE OFFICE OF THE INSPECTOR GENERAL

$11,000,000
11,499,000
11,000,000

The Committee recommends $11,000,000 for RRB Office of the
Inspector General. This Office conducts audits and investigations to
protect the integrity of the RRB trust funds and provides comprehensive oversight of all RRB operations and programs.
SOCIAL SECURITY ADMINISTRATION
PAYMENTS TO SOCIAL SECURITY TRUST FUNDS

$11,000,000
11,000,000
11,000,000

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

Appropriations, 2020 ............................................................................. $41,714,889,000
Budget estimate, 2021 ........................................................................... 40,308,177,000
Committee recommendation ................................................................. 40,136,324,000

The Committee recommends $40,136,324,000 in fiscal year 2021
mandatory funds for the SSI program. This is in addition to the
$19,900,000,000 provided in the fiscal year 2020 appropriations act
for the first quarter of fiscal year 2021. In addition, the Committee
recommends $19,600,000,000 in advance funding for the first quarter of fiscal year 2022. The SSI program guarantees a minimum
level of income to individuals who are disabled, blind, or older than
age 65, and meet certain income and resource limitations.
Federal Benefit Payments
The Committee recommendation includes a fiscal year 2021 program level of $55,451,434,000 for Federal benefit payments. This
will support an average monthly benefit of approximately $602 for
7,875,000 recipients.

227
Beneficiary Services
The Committee recommendation includes $45,000,000 in new
mandatory budget authority for beneficiary services.
These funds reimburse vocational rehabilitation [VR] agencies for
successfully rehabilitating disabled SSI recipients by helping them
achieve and sustain productive, self-supporting work activity.
Funds also support the Ticket to Work program that provides SSI
recipients with a ticket to offer employment networks [ENs], including VR agencies, in exchange for employment and support services. Instead of reimbursing ENs for specific services, the Ticket to
Work program pays ENs based on recipients achieving certain
milestones and outcomes.
Research and Demonstration
The Committee recommendation includes $86,000,000 in mandatory funds for research and demonstration projects conducted
under sections 1110, 1115, and 1144 of the Social Security Act
(Public Law 74–271), as amended. These funds support a variety
of research and demonstration projects designed to improve the disability process, promote self-sufficiency and assist individuals in returning to work, encourage savings and retirement planning
through financial literacy, and generally provide analytical and
data resources for use in preparing and reviewing policy proposals.
Administrative Expenses
The Committee recommendation includes $4,453,890,000 for SSI
program administrative expenses. This appropriation funds the SSI
program’s share of administrative expenses incurred through the
Limitation on Administrative Expenses [LAE] account.
LIMITATION ON ADMINISTRATIVE EXPENSES

Appropriations, 2020 ............................................................................. $12,869,945,000
Budget estimate, 2021 ........................................................................... 13,349,473,000
Committee recommendation ................................................................. 12,866,945,000

This account provides resources for SSA to administer the OASI,
DI, and SSI programs, and to support CMS in administering the
Medicare program. The LAE account is funded by the Social Security and Medicare trust funds for their share of administrative expenses, the general fund for the SSI program’s share of administrative expenses, and applicable user fees. These funds support core
administrative activities including processing retirement and disability claims, conducting hearings to review disability determination appeals, issuing Social Security numbers and cards, processing
individuals’ annual earnings information, and ensuring the integrity of Social Security programs through continuing disability reviews [CDR] and SSI redeterminations of non-medical eligibility.
The Committee recommendation includes $1,575,000,000 for program integrity activities, including CDRs, SSI redeterminations of
non-medical eligibility, and Cooperative Disability Investigations
units. This includes $273,000,000 in base funding and
$1,302,000,000 in cap adjustment funding. Combined, these activities are estimated to save approximately $9,000,000,000 over 10

228
years for the Social Security, Medicare, and Medicaid programs by
preventing waste, fraud, abuse, and improper payments.
Continuing Disability Reviews.—The Committee notes that after
years of sustained funding, SSA eliminated its CDR backlog in fiscal year 2018 and expects to remain current on CDRs going forward. The Committee continues to direct SSA to include in its annual CDR Report to Congress an evaluation of its CDR
prioritization models and a detailed cost-benefit analysis of how it
uses estimated savings in determining which beneficiaries receive
a full-medical CDR.
Disability Case Processing System.—The Committee continues to
note cost overruns in efforts to modernize the Disability Case Processing System [DCPS]. The Committee continues to encourage SSA
to engage with States to explore all possible options for modernization of the case processing system, to align with the needs of each
State. The Committee continues to request regular updates on the
effort to upgrade DCPS, the cost and anticipated timeline of the
project, and efforts by SSA to engage stakeholders, including any
barriers to implementation.
Disability Hearings Backlog.—The Committee continues to
strongly encourage SSA to work with ALJs and other stakeholders
to evaluate and implement changes, as appropriate, to streamline
and improve the efficiency of the disability adjudication process
while maintaining the integrity of disability programs. The Committee continues to direct SSA to include comprehensive information in its existing reports to Congress on the specific policies SSA
has implemented or considered to streamline the disability determination and adjudication process.
Medical Evidence.—The Committee strongly encourages SSA to
evaluate implementation of a national shared service model for
medical evidence data collection. Standardizing and centralizing
medical evidence data collection could make it more secure and efficient while improving the disability determination process from
initial claim through appeal.
Muscular Dystrophy.—The Committee continues to note that
SSA is included in the Muscular Dystrophy Coordinating Committee under the Muscular Dystrophy CARE Act (Public Law 107–
84) and continues to expect SSA make data available on the rate
at which persons with Duchenne and Becker Muscular Dystrophy
utilize SSA programs, particularly those focused on promoting employment and community independence such as the Ticket to Work
program.
Occupational Information System [OIS] and Medical Vocational
Guidelines.—The Committee appreciates SSA’s progress in implementing OIS and continues to direct SSA to include in its annual
report on OIS sufficient details on plans to fully implement OIS in
coming years. Similarly, the Committee supports SSAs efforts to
update medical vocational guidelines through the rulemaking process, which are used to decide more than half of adult disability
claims. Implementing OIS and updating medication vocational
guidelines represents significant steps forward in modernizing the
disability determination process.
Social Security Advisory Board.—The Committee recommendation includes not less than $2,500,000 for the Social Security Advi-

229
sory Board. This board advises the Commissioner of Social Security
and makes recommendations to Congress and the President on
policies relating to the OASI, DI, and SSI programs.
User Fees.—Within the total for LAE, the Committee recommendation includes up to $136,000,000 for administrative activities funded from user fees. This includes up to $135,000,000 in fees
collected from States that request SSA to administer State SSI
supplementary payments and up to $1,000,000 from fees collected
from non-attorney claimant representatives.
Vocational Experts.—The Committee directs SSA to provide an
update within 90 days of enactment on its plan to ensure that vocational experts have the necessary qualifications and expertise.
Work Incentives Planning and Assistance [WIPA] and Protection
and Advocacy for Beneficiaries of Social Security [PABSS].—The
Committee recommendation includes $23,000,000 for WIPA and
$7,000,000 for PABSS, the same as the comparable fiscal year 2020
levels, respectively. These programs provide valuable services to
help Social Security disability beneficiaries return to work.
OFFICE OF INSPECTOR GENERAL

$105,500,000
116,000,000
105,500,000

The Committee recommends $105,500,000 for SSA’s OIG. This
includes $75,500,000 funded from the OASI and DI trust funds for
those programs’ share of OIG’s expenses and $30,000,000 funded
from general revenues for the SSI program’s share of expenses.
Combating Social Security Impersonation Scams.—There has
been a significant increase in Social Security impersonation scams
in recent years. According to the SSA OIG, reports of this scam increased tenfold between August 2018 and August 2019. The Committee commends the work that the SSA OIG has done thus far to
combat these scams, and encourages the SSA OIG to continue to
prioritize working with SSA to increase awareness of this scam and
to pursue the criminals perpetrating this fraud.

TITLE V
GENERAL PROVISIONS
Section 501. The bill continues a provision authorizing transfers
of unexpended balances.
Section 502. The bill continues a provision limiting funding to 1year availability unless otherwise specified.
Section 503. The bill continues a provision limiting lobbying and
related activities.
Section 504. The bill continues a provision limiting official representation expenses.
Section 505. The bill continues a provision clarifying Federal
funding as a component of State and local grant funds.
Sections 506 and 507. The bill continues provisions limiting the
use of funds for abortion.
Section 508. The bill continues a provision restricting human embryo research.
Section 509. The bill continues a provision limiting the use of
funds for promotion of legalization of controlled substances.
Section 510. The bill continues a provision prohibiting the use of
funds to promulgate regulations regarding the individual health
identifier.
Section 511. The bill continues a provision limiting the use of
funds to enter into or review contracts with entities subject to the
requirement in section 4212(d) of title 38, United States Code, if
the report required by that section has not been submitted.
Section 512. The bill continues a provision prohibiting the transfer of funds made available in this act to any department, agency,
or instrumentality of the U.S. Government, except as otherwise
provided by this or any other act.
Section 513. The bill continues a provision prohibiting Federal
funding in this act for libraries unless they are in compliance with
the Children’s Internet Protection Act (Public Law 106–554).
Section 514. The bill continues a provision maintaining a procedure for reprogramming of funds.
Section 515. The bill continues a provision prohibiting candidates
for scientific advisory committees from having to disclose their political activities.
Section 516. The bill continues a provision requiring each department and related agency to submit an operating plan.
Section 517. The bill continues a provision requiring the Secretaries of Labor, Health and Human Services, and Education to submit a report on the number and amounts of contracts, grants, and
cooperative agreements awarded by the Departments on a noncompetitive basis.
Section 518. The bill continues a provision prohibiting SSA from
processing earnings for work performed under a fraudulent social
(230)

231
security number if based on a conviction for a violation under section 208(a)(6) or (7) of the Social Security Act (Public Law 74–271).
Section 519. The bill continues a provision prohibiting SSA from
establishing a totalization agreement with Mexico.
Section 520. The bill continues a provision requiring computer
networks to block pornography.
Section 521. The bill continues a provision prohibiting funding
from going to the Association of Community Organizations for Reform Now [ACORN], or any of its affiliates, subsidiaries, allied organizations, or successors.
Section 522. The bill continues a provision related to reporting
requirements for conference spending.
Section 523. The bill continues a provision related to advertisement costs.
Section 524. The bill continues a provision on Performance Partnerships.
Section 525. The bill continues a provision regarding reporting
status of balances of appropriations.
Section 526. The bill continues a provision on grant notifications.
Section 527. The bill continues a provision regarding funding for
programs that carry out distribution of sterile needles or syringes.
Section 528. The bill continues a provision requiring agencies to
respond to Questions for the Record within 45 business days.
Section 529. The bill modifies a provision rescinding funds from
the Children’s Health Insurance Program child enrollment contingency fund.

COMPLIANCE WITH PARAGRAPH 7, RULE XVI, OF THE
STANDING RULES OF THE SENATE
Paragraph 7 of rule XVI requires that Committee reports on general appropriations bills identify each Committee amendment to
the House bill ‘‘which proposes an item of appropriation which is
not made to carry out the provisions of an existing law, a treaty
stipulation, or an act or resolution previously passed by the Senate
during that session.’’
The Committee is filing an original bill, which is not covered
under this rule, but reports this information in the spirit of full disclosure.
The Committee recommends funding for the following programs
and activities which currently lack authorization: Institute of Education Sciences; parts C and D of the Individuals with Disabilities
Education Act; Nurse Education Loan Repayment; Education and
Training Related to Geriatrics; Mental and Behavioral Health
Training; Children’s Hospital Graduate Medical Education; Title
XVII of the PHS Act; Ryan White CARE Act; Universal Newborn
Hearing Screening; Organ Transplantation; Family Planning;
Rural Health programs; Traumatic Brain Injury programs; Autism
Collaboration, Accountability, Research, Education, and Support
Act; Public Health Improvement Act; Healthy Start; Telehealth;
Health Professions Education Partnership Act; Children’s Health
Act; Women’s Health Research and Prevention Amendments of
1998; Birth Defects Prevention, Preventive Health Amendments of
1993; Substance Abuse and Mental Health Services programs; Low
Income Home Energy Assistance Program; Refugee and Entrant
Assistance programs (except for Victims of Trafficking); Head Start;
Runaway and Homeless Youth programs; Adoption Incentives; Developmental Disabilities programs; Voting Access for Individuals
with Disabilities; Native American Programs; Community Services
Block Grant Act programs; National Institutes of Health; Assets for
Independence; Alzheimer’s Disease Demonstration Grants; Office of
Disease Prevention and Health Promotion; YouthBuild Transfer
Act; Assistive Technology Act; Carl D. Perkins Career and Technical Education Improvement Act; Corporation for Public Broadcasting; National Council on Disability; Older Americans Act; Second Chance Act; Work Incentive Planning and Assistance; and Protection and Advocacy for Beneficiaries of Social Security.
COMPLIANCE WITH PARAGRAPH 7(C), RULE XXVI OF THE
STANDING RULES OF THE SENATE
Pursuant to paragraph 7(c) of rule XXVI, on September 00, 2020,
the Committee ordered favorably reported an original bill (S. 0000)
making appropriations for the Departments of Labor, Health and
Human Services, and Education, and related agencies for the fiscal
year ending September 30, 2021, and for other purposes, provided,
(232)

233
that the bill be subject to amendment and that the bill be consistent with its budget allocation, and provided that the Chairman
of the Committee or his designee be authorized to offer the substance of the original bill as a Committee amendment in the nature
of a substitute to the House companion measure, by a recorded vote
of 00–00, a quorum being present. The vote was as follows:
COMPLIANCE WITH PARAGRAPH 12, RULE XXVI OF THE
STANDING RULES OF THE SENATE
Paragraph 12 of rule XXVI requires that Committee reports on
a bill or a joint resolution repealing or amending any statute include ‘‘(a) the text of the statute or part thereof which is proposed
to be repealed; and (b) a comparative print of that part of the bill
or joint resolution making the amendment and of the statute or
part thereof proposed to be amended, showing by stricken through
type and italics, parallel columns, or other appropriate typographical devices the omissions and insertions which would be
made by the bill or joint resolution if enacted in the form recommended by the committee.’’
The Committee bill as recommended contains no such provisions.

1,052,053
860,000
¥860,000
1,052,053
2,819,832
(1,247,832)
(1,572,000)

Subtotal, available this fiscal year .....................................................................................................

Advance appropriation, fiscal year 2022 .................................................................................................
Less prior year appropriations .................................................................................................................

Subtotal, appropriated in this bill ......................................................................................................

Total, Grants to States .................................................................................................................................

Current year appropriations .................................................................................................................
Advance appropriations .......................................................................................................................

854,649

854,649
913,130
192,053
860,000

Subtotal, appropriated in this bill ......................................................................................................

Youth Training ...................................................................................................................................................
Dislocated Worker Assistance, current year appropriations .............................................................................
Available from prior year appropriations .................................................................................................

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

2,819,832

1,052,053

860,000
¥860,000

1,052,053

913,130
192,053
860,000

854,649
712,000
¥712,000

Subtotal, available this fiscal year .....................................................................................................

142,649
712,000

Budget estimate

142,649
712,000

2020 appropriation

Grants to States:
Adult Training, current year appropriations .....................................................................................................
Available from prior year appropriations .................................................................................................

Training and Employment Services

EMPLOYMENT AND TRAINING ADMINISTRATION

TITLE I—DEPARTMENT OF LABOR

Item

[In thousands of dollars]

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

2,819,832

1,052,053

860,000
¥860,000

1,052,053

913,130
192,053
860,000

854,649

712,000
¥712,000

854,649

142,649
712,000

Committee
recommendation

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

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

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

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

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

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

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

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

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

2020 appropriation

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

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

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

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

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

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

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

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

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

Budget estimate

Senate Committee recommendation
compared with (∂ or ¥)

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2020 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL
FOR FISCAL YEAR 2021

234

1,743,655
405,000
680,000

Total, Job Corps ............................................................................................................................................

Community Service Employment For Older Americans ..............................................................................................
Federal Unemployment Benefits and Allowances (indefinite) ...................................................................................

Job Corps
1,603,325
108,000
32,330

591,368
200,000

791,368

Total, National Programs ..............................................................................................................................

3,611,200

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

(1,839,200)
(1,772,000)

1,322,912

Total, Dislocated Worker Assistance .............................................................................................................

Native American programs ................................................................................................................................
Migrant and Seasonal Farmworker programs ...................................................................................................
YouthBuild activities .........................................................................................................................................
Reintegration of Ex-Offenders ...........................................................................................................................
Workforce Data Quality Initiative ......................................................................................................................
Apprenticeship programs ..................................................................................................................................

1,212,912

270,859

Subtotal, appropriated in this bill ......................................................................................................

Total, Training and Employment Services ....................................................................................................

160,859

200,000
¥200,000

Advance appropriations, fiscal year 2022 ...............................................................................................
Less prior year appropriations .................................................................................................................

............................
633,600

1,015,897

883,334
100,016
32,547

(1,646,304)
(1,712,000)

3,358,304

398,472
140,000

538,472

............................
............................
84,534
93,079
............................
200,000

140,000
¥200,000

220,859

270,859

Subtotal, available this fiscal year .....................................................................................................

20,859
200,000

70,859
200,000

National Programs:
Dislocated Worker Assistance National Reserve:
Current year appropriations .....................................................................................................................
Available from prior year appropriations .................................................................................................

305,000
633,600

1,743,655

1,603,325
108,000
32,330

(1,813,200)
(1,772,000)

3,585,200

565,368
200,000

765,368

55,000
91,896
94,534
98,079
............................
195,000

1,282,912

230,859

200,000
¥200,000

230,859

30,859
200,000

∂70,000

¥40,000

∂226,896

¥26,000

∂727,758
∂305,000
............................

¥100,000
¥46,400

∂719,991
∂7,984
¥217
............................

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

(∂166,896)
(∂60,000)

¥26,000
............................

(¥26,000)
............................

∂226,896
∂166,896
∂60,000

¥26,000

∂55,000
∂91,896
∂10,000
∂5,000
............................
¥5,000

∂70,000

¥40,000

............................
............................
............................
............................
¥6,000
∂20,000

∂60,000
............................

∂10,000

¥40,000
............................
............................

∂10,000
............................

¥40,000
............................

235

18,000

21,413
646,639

12,000

21,413
646,639
668,052
22,318
690,370
(21,413)
(668,957)
54,528
............................
14,282
............................
68,810

Subtotal, Grants to States ...................................................................................................................

ES National Activities (trust fund) ...................................................................................................................

Subtotal, Employment Service ......................................................................................................................

Foreign Labor Certifications:
Federal Administration ......................................................................................................................................
Federal Funds ...........................................................................................................................................
Grants to States ................................................................................................................................................
Federal Funds ...........................................................................................................................................

Subtotal, Foreign Labor Certification ..................................................................................................

79,898

56,616
6,000
14,282
3,000

(21,413)
(666,457)

687,870

19,818

668,052

2,646,686

2,540,816

Subtotal, Unemployment Compensation ..............................................................................................

Federal–State UI National Activities (trust fund) ......................................................................................................
Employment Service [ES]:
Grants to States:
Federal Funds ...........................................................................................................................................
Trust Funds ..............................................................................................................................................

2,440,686
117,000
83,000
6,000

Budget estimate

2,356,816
117,000
58,000
9,000

2020 appropriation

Unemployment Compensation (trust fund):
State Operations ................................................................................................................................................
Reemployment eligibility assessments—UI integrity .......................................................................................
Program integrity (cap adjustment) .................................................................................................................
UI Integrity Center of Excellence .......................................................................................................................

State Unemployment Insurance and Employment Service Operations

Item

[In thousands of dollars]

68,810

54,528
............................
14,282
............................

(21,413)
(668,957)

690,370

22,318

668,052

21,413
646,639

18,000

2,565,816

2,356,816
117,000
83,000
9,000

Committee
recommendation

∂6,000

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

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

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

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

¥11,088

¥2,088
¥6,000
............................
¥3,000

............................
(∂2,500)

∂2,500

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

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

¥80,870
............................

∂25,000

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

¥83,870
............................
............................
∂3,000

Budget estimate

............................
............................
∂25,000
............................

2020 appropriation

Senate Committee recommendation
compared with (∂ or ¥)

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2020 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL
FOR FISCAL YEAR 2021—Continued

236

3,374,649
(84,066)
(3,290,583)

62,040
8,639
3,440
39,264
36,160
7,034
2,079

Total, State Unemployment Insurance and Employment Service Operations ..............................................

Training and Employment ..........................................................................................................................................
Trust Funds .......................................................................................................................................................
Employment Security ..................................................................................................................................................
Trust Funds .......................................................................................................................................................
Apprenticeship Services .............................................................................................................................................
Executive Direction .....................................................................................................................................................
Trust Funds .......................................................................................................................................................

9,973,160
6,690,595
(4,918,595)
(1,772,000)
3,340,565

Total, Employment and Training Administration ..........................................................................................

Pension Benefit Guaranty Corporation Fund

Consolidated Administrative budget ..........................................................................................................................

(452,858)

181,000

Total, Employee Benefits Security Administration ........................................................................................
Pension Benefit Guaranty Corporation (PBGC)

147,400
26,901
6,699

Enforcement and Participant Assistance ...................................................................................................................
Policy and Compliance Assistance ............................................................................................................................
Executive Leadership, Program Oversight and Administration .................................................................................

Salaries and Expenses

Employee Benefits Security Administration [EBSA]

158,656
(108,674)
(49,982)

Total, Program Administration ......................................................................................................................

Program Administration

62,653

One-Stop Career Centers/Labor Market Information ..................................................................................................

(465,289)

192,738

156,748
26,641
9,349

5,307,347
(3,595,347)
(1,712,000)
3,452,334

8,676,681

(121,307)
(50,293)

171,600

74,377
8,693
3,461
39,507
36,390
7,079
2,093

(95,239)
(3,402,041)

3,497,280

64,826

(465,289)

181,000

147,400
26,901
6,699

6,543,195
(4,771,195)
(1,772,000)
3,371,565

9,831,760

(108,674)
(49,982)

158,656

62,040
8,639
3,440
39,264
36,160
7,034
2,079

(84,066)
(3,321,583)

3,405,649

62,653

¥91,631

∂1,235,848
(∂1,175,848)
(∂60,000)
¥80,769

¥147,400
(¥147,400)
............................
∂31,000

(∂12,431)

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

¥11,738

¥9,348
∂260
¥2,650

∂1,155,079

¥141,400

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

(¥12,633)
(¥311)

¥12,944

¥12,337
¥54
¥21
¥243
¥230
¥45
¥14

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

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

(¥11,173)
(¥80,458)

∂31,000
............................
(∂31,000)

¥2,173

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

237

232,600
2,000
234,600

16,000
4,970
20,970

Federal Employees’ Compensation Benefits ..............................................................................................................
Longshore and Harbor Workers’ Benefits ...................................................................................................................

Total, Special Benefits ..................................................................................................................................

Benefit Payments .......................................................................................................................................................
Administration ............................................................................................................................................................

Subtotal, Direct appropriation ......................................................................................................................

Special Benefits for Disabled Coal Miners

Special Benefits

117,601
(115,424)
(2,177)

Total, Salaries and Expenses .......................................................................................................................

115,424
2,177

105,976

43,187

242,000

2020 appropriation

Salaries and Expenses ...............................................................................................................................................
Trust Funds .......................................................................................................................................................

Office of Workers’ Compensation Programs

Salaries and Expenses ...............................................................................................................................................

Office of Federal Contract Compliance Programs

Salaries and Expenses ...............................................................................................................................................

Office of Labor–Management Standard

Salaries and Expenses ...............................................................................................................................................

Wage and Hour Division

Item

[In thousands of dollars]

40,970

36,000
4,970

239,000

237,000
2,000

(114,962)
(4,350)

119,312

114,962
4,350

106,412

50,410

244,283

Budget estimate

40,970

36,000
4,970

239,000

237,000
2,000

(115,424)
(2,177)

117,601

115,424
2,177

105,976

48,187

242,000

Committee
recommendation

(∂462)
(¥2,173)

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

∂4,400
............................
∂4,400

∂20,000
............................
∂20,000

¥1,711

∂462
¥2,173

¥436

¥2,223

¥2,283

Budget estimate

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

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

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

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

∂5,000

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

2020 appropriation

Senate Committee recommendation
compared with (∂ or ¥)

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2020 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL
FOR FISCAL YEAR 2021—Continued

238

34,970

59,846

Total, appropriated in this bill .....................................................................................................................

Administrative Expenses ............................................................................................................................................

356
365,240
812,257
810,080
(796,080)
(14,000)
2,177

Total, Black Lung Disability Trust Fund .......................................................................................................

Total, Workers’ Compensation Programs ......................................................................................................

Safety and Health Standards .....................................................................................................................................
Federal Enforcement ...................................................................................................................................................
Whistleblower enforcement .........................................................................................................................................
State Programs ...........................................................................................................................................................
Technical Support .......................................................................................................................................................
Compliance Assistance:
Federal Assistance ............................................................................................................................................

Salaries and Expenses

Occupational Safety and Health Administration (OSHA)

382,635

364,884

Subtotal, Black Lung Disability Trust Fund .................................................................................................

Treasury Department Administrative Costs ...............................................................................................................

18,133
223,848
20,231
108,575
24,622
75,410

18,000
221,711
18,564
108,575
24,469
74,481

854,430
(840,430)
(14,000)
4,350

858,780

382,991

356

308,626
40,643
33,033
333

62,507

54,970

14,000
¥14,000

54,970

14,000

293,464
38,246
32,844
330

Benefit Payments and Interest on Advances .............................................................................................................
Workers’ Compensation Programs, Salaries and Expenses .......................................................................................
Departmental Management, Salaries and Expenses .................................................................................................
Departmental Management, Inspector General .........................................................................................................

Black Lung Disability Trust Fund

Energy Employees Occupational Illness Compensation Fund

34,970
14,000
¥14,000

Subtotal, available this fiscal year ..............................................................................................................

Advance appropriations, fiscal year 2022, 1st quarter ............................................................................................
Less prior year advance appropriations ....................................................................................................................

14,000

Advance from prior year appropriations ....................................................................................................................

74,481

18,000
221,711
18,564
108,575
24,469

854,892
(840,892)
(14,000)
2,177

857,069

382,991

356

382,635

308,626
40,643
33,033
333

62,507

54,970

14,000
¥14,000

54,970

14,000

∂462
(∂462)
............................
¥2,173

∂44,812
(∂44,812)
............................
............................

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

¥929

¥133
¥2,137
¥1,667
............................
¥153

¥1,711

∂44,812

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

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

∂17,751

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

∂17,751
............................

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

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

∂2,661

∂15,162
∂2,397
∂189
∂3

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

∂20,000

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

∂20,000
............................
............................

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

239

581,787

Total, Occupational Safety and Health Administration ................................................................................

260,500
4,500
6,627
39,320
35,041
17,990
15,838
379,816
1,651,367
(1,649,190)
(2,177)

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

Salaries and Expenses

Mine Safety and Health Administration

32,900
10,050
............................

(1,667,205)
(4,350)

1,671,555

381,587

256,988
5,416
7,555
38,834
34,548
21,693
16,553

576,813

34,950
9,544
............................

136,910

147,518

Subtotal, Compliance Assistance .................................................................................................................

Safety and Health Statistics ......................................................................................................................................
Executive Direction and Administration .....................................................................................................................
Floor Amendment unspecified ....................................................................................................................................

Budget estimate

61,500
............................

2020 appropriation

61,500
11,537

State Consultation Grants .................................................................................................................................
Training Grants .................................................................................................................................................

Item

[In thousands of dollars]

(1,642,653)
(2,177)

1,644,830

379,816

260,500
4,500
6,627
39,320
35,041
17,990
15,838

570,250

32,900
10,050
............................

135,981

61,500
............................

Committee
recommendation

¥26,725
(¥24,552)
(¥2,173)

¥6,537
(¥6,537)
............................

¥1,771

∂3,512
¥916
¥928
∂486
∂493
¥3,703
¥715
............................

¥6,563

¥11,537

¥929
¥2,050
∂506
............................

¥11,537
............................
............................
............................

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

Budget estimate

............................
¥11,537

2020 appropriation

Senate Committee recommendation
compared with (∂ or ¥)

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2020 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL
FOR FISCAL YEAR 2021—Continued

240

655,000
587,000
68,000

38,500

Total, Bureau of Labor Statistics .................................................................................................................

Salaries and Expenses ...............................................................................................................................................

180,000
29,379
43,548

State Administration, Grants .....................................................................................................................................
Transition Assistance Program ..................................................................................................................................
Federal Administration ...............................................................................................................................................

Veterans’ Employment and Training

348,364
(348,056)
(308)

Total, Salaries and Expenses .......................................................................................................................

30,250
8,040
123,745
308
96,125
28,450
35,000
14,050
6,880
5,516

Executive Direction .....................................................................................................................................................
Departmental Program Evaluation .............................................................................................................................
Legal Services ............................................................................................................................................................
Trust Funds .......................................................................................................................................................
International Labor Affairs .........................................................................................................................................
Administration and Management ...............................................................................................................................
Adjudication ................................................................................................................................................................
Women’s Bureau .........................................................................................................................................................
Civil Rights Activities .................................................................................................................................................
Chief Financial Officer ...............................................................................................................................................

Salaries and Expenses

Department Management

Office of Disability Employment Policy

221,000
68,000
210,000
83,500
10,500
62,000

Employment and Unemployment Statistics ...............................................................................................................
Labor Market Information (trust fund) ......................................................................................................................
Prices and Cost of Living ..........................................................................................................................................
Compensation and Working Conditions .....................................................................................................................
Productivity and Technology .......................................................................................................................................
Executive Direction and Staff Services ......................................................................................................................

Salaries and Expenses

Bureau of Labor Statistics

180,000
29,379
44,207

(271,644)
(308)

271,952

32,342
8,040
130,371
308
18,660
29,158
37,081
3,525
6,927
5,540

27,100

590,318
68,000

658,318

228,261
68,000
218,503
84,031
11,295
48,228

180,000
33,679
44,248

(350,056)
(308)

350,364

32,250
8,040
123,745
308
96,125
28,450
35,000
14,050
6,880
5,516

38,500

573,000
68,000

641,000

221,000
68,000
210,000
83,500
10,500
48,000

¥14,000
............................

∂78,412

............................
∂4,300
∂700

............................
∂4,300
∂41

(∂78,412)
............................

∂2,000
(∂2,000)
............................

¥92
............................
¥6,626
............................
∂77,465
¥708
¥2,081
∂10,525
¥47
¥24

∂2,000
............................
............................
............................
............................
............................
............................
............................
............................
............................

∂11,400

¥17,318
¥17,318
............................

¥14,000

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

¥7,261
............................
¥8,503
¥531
¥795
¥228

............................
............................
............................
............................
............................
¥14,000

241

311,341
55,000
256,341

4,889
20,380
25,269

85,187
5,660
90,847
5,660

Total, Veterans’ Employment and Training ..................................................................................................

Departmental support systems ..................................................................................................................................
Infrastructure technology modernization ....................................................................................................................

Total, IT Modernization .................................................................................................................................

Program Activities ......................................................................................................................................................
Trust Funds .......................................................................................................................................................

Total, Office of Inspector General ................................................................................................................

Trust funds ..........................................................................................................................................

775,821
513,512
262,309
5,354,855
(3,582,855)
(1,772,000)

Total, Departmental Management ................................................................................................................

Total, Workforce Investment Act Programs ..................................................................................................

Office of Inspector General

IT Modernization

3,414
55,000

2020 appropriation

National Veterans’ Employment and Training Services Institute ..............................................................................
Homeless Veterans Programs (trust fund) ................................................................................................................

Item

[In thousands of dollars]

(2,662,201)
(1,712,000)

4,374,201

451,477
262,968

714,445

5,660

93,493

87,833
5,660

37,000

4,889
32,111

55,000
257,000

312,000

3,414
55,000

Budget estimate

(3,556,855)
(1,772,000)

5,328,855

517,512
267,309

784,821

5,660

90,847

85,187
5,660

27,269

4,889
22,380

55,000
261,341

316,341

3,414
55,000

Committee
recommendation

∂4,341

¥2,646

∂954,654
(∂894,654)
(∂60,000)

¥26,000
(¥26,000)
............................

∂70,376
∂66,035
∂4,341

∂9,000
∂4,000
∂5,000

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

¥2,646
............................

¥9,731

∂2,000

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

............................
¥9,731

............................
∂2,000

............................
∂4,341

∂5,000
............................
∂5,000

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

Budget estimate

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

2020 appropriation

Senate Committee recommendation
compared with (∂ or ¥)

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2020 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL
FOR FISCAL YEAR 2021—Continued

242

120,000
23,711
............................
............................
............................

............................
............................
............................
............................
36,916
102,000

1,000
1,626,522

120,000
23,711
15,000
1,190
51,470
91,371
48,924
40,673
41,250
40,737
36,916
102,000

Free Clinics Medical Malpractice ...............................................................................................................................

Total, Primary Health Care ...........................................................................................................................

National Health Service Corps ...................................................................................................................................
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 ..................................................................................................................
Oral Health Training ...................................................................................................................................................
Interdisciplinary Community-Based Linkages:
Area Health Education Centers .........................................................................................................................
Geriatric Programs ............................................................................................................................................
Mental and Behavorial Health ..........................................................................................................................
Behavioral Health Workforce Education and Training ......................................................................................

Health Workforce

5,625,522

Total, Community Health Centers .................................................................................................................

23,711

1,728,522

1,000

5,727,522

1,625,522
(4,000,000)
............................

1,727,522
(4,000,000)
............................

8,699,915
(6,973,915)
(1,726,000)
3,787,652

12,487,567

Community Health Centers ........................................................................................................................................
Mandatory budget authority (Public Law 115–123) .........................................................................................
Transfers from Nonrecurring Expenses Fund ....................................................................................................

Primary Health Care

HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA)

TITLE II—DEPARTMENT OF HEALTH AND HUMAN SERVICES

13,788,504
10,115,453
(8,329,453)
(1,786,000)
3,673,051

Total, Title I, Department of Labor ...............................................................................................................

45,250
44,737
............................
138,916

48,924
40,673

93,371

23,711
............................
4,190
65,470

120,000

1,626,522

1,000

5,712,522

1,625,522
(4,000,000)
(87,000)

9,971,328
(8,185,328)
(1,786,000)
3,709,051

13,680,379

∂48,924
∂40,673
∂45,250
∂44,737
¥36,916
∂36,916

∂4,000
∂4,000
¥36,916
∂36,916

∂69,660

∂2,000
............................
............................

............................
............................
∂4,190
∂65,470

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

¥102,000

............................
¥15,000
∂3,000
∂14,000

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

¥15,000

∂87,000
............................

¥102,000
............................
(∂87,000)

∂1,271,413
(∂1,211,413)
(∂60,000)
¥78,601

¥144,125
(¥144,125)
............................
∂36,000

............................
............................
(∂87,000)

∂1,192,812

¥108,125

243

75,581
43,913
5,000
18,343
88,635
28,500
259,972
340,000
50,000
18,814
¥18,814
1,194,506

687,700
5,205
52,344
17,883
125,500
17,818

Total, Nursing programs ...............................................................................................................................

Children’s Hospitals Graduate Medical Education ....................................................................................................
Medical Student Education ........................................................................................................................................
National Practitioner Data Bank ................................................................................................................................
User Fees ...........................................................................................................................................................

Total, Health Workforce .................................................................................................................................

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

Maternal and Child Health

167,290

424,534

Subtotal, Health Professions Education and Training .................................................................................

Nursing Programs:
Advanced Education Nursing ............................................................................................................................
Nurse Education, Practice, and Retention ........................................................................................................
Nurse Practitioner Optional Fellowship Program ..............................................................................................
Nursing Workforce Diversity ..............................................................................................................................
Nurse Corps Scholarship and Loan Repayment Program .................................................................................
Nursing Faculty Loan Program ..........................................................................................................................

760,700
............................
............................
............................
125,500
17,818

370,425

............................
............................
18,814
¥18,814

83,135

............................
............................
............................
............................
83,135
............................

4,663
............................

5,663
17,000

Workforce Assessment ................................................................................................................................................
Public Health and Preventive Medicine programs .....................................................................................................

138,916

Budget estimate

220,903

2020 appropriation

Total, Interdisciplinary Community Linkages ...............................................................................................

Item

[In thousands of dollars]

707,700
5,205
52,344
17,883
125,500
17,818

1,225,666

355,000
50,000
18,814
¥18,814

266,132

75,581
49,913
............................
23,503
88,635
28,500

434,534

5,663
17,000

228,903

Committee
recommendation

∂75,581
∂49,913
............................
∂23,503
∂5,500
∂28,500
∂182,997
∂355,000
∂50,000
............................
............................
∂855,241

¥53,000
∂5,205
∂52,344
∂17,883
............................
............................

∂6,160
∂15,000
............................
............................
............................
∂31,160

∂20,000
............................
............................
............................
............................
............................

∂267,244

∂10,000
............................
∂6,000
¥5,000
∂5,160
............................
............................

∂1,000
∂17,000

∂89,987

∂8,000
............................
............................

Budget estimate

2020 appropriation

Senate Committee recommendation
compared with (∂ or ¥)

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2020 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL
FOR FISCAL YEAR 2021—Continued

244

943,784

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

27,549
............................
27,549
17,266
30,009
10,238
............................
............................
22,846
13,706
122
1,857
123,593

Total, Maternal and Child Health .................................................................................................................

Emergency Assistance (Part A) ..................................................................................................................................
Comprehensive Care Programs (Part B) ....................................................................................................................
AIDS Drug Assistance Program [ADAP] (NA) ....................................................................................................
Early Intervention Program (Part C) ..........................................................................................................................
Children, Youth, Women, and Families (Part D) .......................................................................................................
AIDS Dental Services (Part F) ....................................................................................................................................
Education and Training Centers (Part F) ..................................................................................................................
Special Projects of Regional and National Significance (SPRNS) ............................................................................
Domestic HIV/AIDS Initative .......................................................................................................................................
Transfers from Nonrecurring Expenses Fund ....................................................................................................

Total, Ryan White HIV/AIDS program ............................................................................................................

Total, Ryan White HIV/AIDS program level ...................................................................................................

Organ Transplantation ...............................................................................................................................................
PHS Eval ............................................................................................................................................................

Total, Organ Transplantation ........................................................................................................................

National Cord Blood Inventory ...................................................................................................................................
CW Bill Young Cell Transplantation ..........................................................................................................................
340B Drug Pricing program/Office of Pharmacy Affairs ...........................................................................................
304B Drug Pricing ......................................................................................................................................................
User Fees ...........................................................................................................................................................
Poison Control Centers ...............................................................................................................................................
Hansen’s Disease Program ........................................................................................................................................
Hansen’s Disease Program—Buildings and Facilities ..............................................................................................
Payment to Hawaii, Treatment of Hansen’s ..............................................................................................................

Subtotal, Health Care Systems Bureau, appropriation ................................................................................

Health Care Systems

Ryan White HIV/AIDS Program

22,334
5,000
10,000

Emergency Medical Services for Children ..................................................................................................................
Screening and Treatment for Maternal Depression ...................................................................................................
Pediatric Mental Health Care Access ........................................................................................................................

102,033

8,266
30,009
10,238
24,000
¥24,000
22,846
11,653
............................
1,857

30,549

17,164
(13,385)

2,483,781

655,876
1,315,005
(900,313)
201,079
75,088
13,122
33,611
25,000
165,000
............................

919,018

............................
5,000
10,000

130,593

19,266
31,009
10,238
............................
............................
25,846
13,706
122
1,857

28,549

28,549
............................

2,438,781

2,388,781

655,876
1,315,005
(900,313)
201,079
75,088
13,122
33,611
25,000
70,000
(50,000)

963,784

22,334
5,000
10,000

¥95,000
¥45,000

∂11,385
(¥13,385)
¥2,000
∂11,000
∂1,000
............................
¥24,000
∂24,000
∂3,000
∂2,053
∂122
............................
∂28,560

............................
∂50,000

∂1,000
............................
∂1,000
∂2,000
∂1,000
............................
............................
............................
∂3,000
............................
............................
............................
∂7,000

............................
............................
............................
............................
............................
............................
............................
............................
¥95,000
(∂50,000)

∂44,766

∂20,000

∂22,334
............................
............................

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

245

123,593

Subtotal, Health Care Systems, program level ............................................................................................

318,294
286,479
155,300
7,037,259

285,600
10,200
295,800
7,333,059

Total, Rural Health .......................................................................................................................................

Family Planning ..........................................................................................................................................................
Program Management ................................................................................................................................................

Total, Health resources and services (HRS) .................................................................................................

Post–FY 1988 Claims .................................................................................................................................................
HRSA Administrative expenses ...................................................................................................................................

Total, Vaccine Injury Compensation Trust Fund ..........................................................................................

Total, Health Resources and Services Administration .................................................................................

Vaccine Injury Compensation Program Trust Fund

79,500
10,351
53,609
12,500
11,500
1,834
29,000
110,000
10,000

Rural Outreach Grants ...............................................................................................................................................
Rural Health Research/Policy Development ...............................................................................................................
Rural Hospital Flexibility Grants ................................................................................................................................
State Offices of Rural Health ....................................................................................................................................
Black Lung Clinics .....................................................................................................................................................
Radiation Exposure Screening and Education Program ............................................................................................
Telehealth ...................................................................................................................................................................
Rural Communities Opioid Response .........................................................................................................................
Rural Residency Program ...........................................................................................................................................

Rural Health

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

2020 appropriation

PHS Eval Funding .....................................................................................................................................

Item

[In thousands of dollars]

6,570,885

281,800

265,600
16,200

6,289,085

286,479
151,993

246,834

89,500
5,000
............................
............................
11,500
1,834
29,000
110,000
............................

115,418

(13,385)

Budget estimate

7,380,335

275,800

265,600
10,200

7,104,535

286,479
157,300

325,410

84,500
11,076
54,000
13,000
12,000
1,834
29,000
110,000
10,000

130,593

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

Committee
recommendation

............................
∂5,307
∂815,450

............................
¥6,000
¥6,000
∂809,450

∂67,276

¥20,000
............................
¥20,000
∂47,276

∂78,576

∂7,116
............................
∂2,000

¥5,000
∂6,076
∂54,000
∂13,000
∂500
............................
............................
............................
∂10,000

∂15,175

∂7,000

∂5,000
∂725
∂391
∂500
∂500
............................
............................
............................
............................

(¥13,385)

Budget estimate

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

2020 appropriation

Senate Committee recommendation
compared with (∂ or ¥)

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2020 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL
FOR FISCAL YEAR 2021—Continued

246

(302,845)
880,005

419,705
(370,300)

Subtotal .........................................................................................................................................................

Prevention and Public Health Fund 1 ................................................................................................................

578,497

160,810

196,850
(17,000)

1,239,914

Subtotal .........................................................................................................................................................

Birth Defects, Developmental Disabilities, Disabilities and Health ..........................................................................

Subtotal (including transfers) ......................................................................................................................

984,964
(254,950)

Environmental Health .................................................................................................................................................
Prevention and Public Health Fund 1 ................................................................................................................

112,250

635,772

Subtotal (including transfers) ......................................................................................................................

Chronic Disease Prevention and Health Promotion ...................................................................................................
Prevention and Public Health Fund 1 ................................................................................................................

160,810

(52,000)

555,497
............................
(23,000)

112,250

583,772

Subtotal .........................................................................................................................................................

Prevention and Public Health Fund 1 ................................................................................................................

Subtotal .........................................................................................................................................................

1,416,250

570,372
(13,400)

Public Health Scientific Services ...............................................................................................................................
Evaluation Tap Funding ....................................................................................................................................
Administrative Transfer from Public Health Preparedness and Response ......................................................

962,145
(454,105)

1,273,556

Subtotal (including transfers) ......................................................................................................................

Emerging and Zoonotic Infectious Diseases ..............................................................................................................
Administrative transfer from Immunization and Respiratory Diseases ...........................................................

182,000
............................

578,497

115,497
(463,000)
............................

735,772

(137,000)

598,772

598,772
............................

1,552,556

1,552,556
............................

790,005
1,273,556
............................

Subtotal .........................................................................................................................................................

HIV/AIDS, Viral Hepatitis, Sexually Transmitted Diseases, and Tuberculosis Prevention .........................................
Transfers from Nonrecurring Expenses Fund ....................................................................................................

577,160

577,160
............................

433,105
(¥13,400)

CENTERS FOR DISEASE CONTROL AND PREVENTION

Immunization and Respiratory Diseases ....................................................................................................................
Administrative transfer to Emerging and Zoonotic Infectious Diseases ..........................................................

(13,385)

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

(Evaluation Tap Funding) ....................................................................................................................

186,850
(17,000)

588,997

588,997
............................
............................

164,960

1,249,664

994,714
(254,950)

654,772

(64,000)

590,772

590,772
............................

1,338,556

1,278,556
(60,000)

830,005

(360,200)

469,805

469,805
............................

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

¥107,355

∂50,100

∂52,710

∂10,500
∂4,850
(∂17,000)

∂10,500
¥10,000
............................

∂52,710

∂4,150

∂473,500
(¥463,000)
............................

¥166,586

∂9,750

∂4,150

∂32,569
(¥199,155)

∂33,500
............................
(¥23,000)

¥81,000

∂7,000

∂9,750
............................

¥8,000

∂20,400
(¥13,400)

∂19,000

¥8,000
............................

∂65,000

(¥73,000)

¥214,000

∂5,000
(∂60,000)

(∂12,000)

¥50,000
¥274,000
(∂60,000)

∂40,000

(∂57,355)

¥107,355
............................

∂36,700
(∂13,400)

(¥10,100)

(¥13,385)

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

247

927,200
............................
927,200
30,000
30,000

570,843
850,200
(¥23,000)
827,200
25,000
25,000
(160,000)
113,570
85,000

Subtotal .........................................................................................................................................................

Public Health Preparedness and Response ...............................................................................................................
Administrative transfer to Public Health Scientific Services ...........................................................................

Subtotal .........................................................................................................................................................

Buildings and Facilities .............................................................................................................................................

Subtotal .........................................................................................................................................................

CDC-Wide Activities and Program Support:
Prevention and Public Health Fund 1 ................................................................................................................
Office of the Director ........................................................................................................................................
Infectious Diseases Rapid Response Reserve Fund .........................................................................................

6,839,946

620,843

55,358
570,843

Discretionary ........................................................................................................................................

55,358
620,843

342,800

Subtotal, National Institute for Occupational Safety and Health, program level .......................................

Energy Employees Occupational Illness Compensation Program ..............................................................................
Global Health ..............................................................................................................................................................

358,570

190,000

342,800
............................

6,895,304

730,159
111,362
(78,638)

677,379

Subtotal .........................................................................................................................................................

National Institute for Occupational Safety and Health .............................................................................................
EvaluationTap Funding ......................................................................................................................................

Total, Centers for Disease Control and Prevention ......................................................................................

730,159

677,379

Subtotal .........................................................................................................................................................

182,000

213,850

Subtotal .........................................................................................................................................................

Injury Prevention and Control ....................................................................................................................................

6,893,514

6,948,872

373,570

............................
323,570
50,000

Budget estimate

2020 appropriation

Item

[In thousands of dollars]

6,908,446

6,963,804

273,570

(160,000)
113,570
............................

30,000

852,200

852,200
............................

615,843

55,358
615,843

343,800

343,800
............................

678,379

203,850

Committee
recommendation

∂153,800

(∂160,000)
¥210,000
¥50,000
¥100,000
∂14,932
∂14,932

¥85,000
∂68,500
∂68,500

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

∂5,000
............................
............................
¥85,000

¥75,000
............................

∂5,000

∂2,000
(∂23,000)
∂25,000

¥5,000
¥75,000
............................

∂45,000

............................
¥5,000

∂1,000
............................
∂45,000

¥51,780
∂232,438
(¥78,638)

¥51,780

∂1,000

∂1,000
............................

∂21,850

¥10,000

∂1,000

Budget estimate

2020 appropriation

Senate Committee recommendation
compared with (∂ or ¥)

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2020 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL
FOR FISCAL YEAR 2021—Continued

248

5,686,173
195,000
5,881,173
3,298,004
3,298,004

1,924,211
(150,000)
1,924,211

5,885,470
5,885,470
1,931,074
(741,000)
2,672,074
1,416,366
1,416,366

6,245,438
195,000
6,440,438
3,625,258
3,625,258
477,679
477,679
2,115,146
(150,000)
2,115,146
2,376,577
70,000
2,446,577
5,876,195
5,876,195
1,706,397
(1,230,821)
2,937,218
1,556,909
1,556,909
823,325

Subtotal, NCI .................................................................................................................................................

National Heart, Lung, and Blood Institute (NHLBI) ...................................................................................................

Subtotal, NHLBI .............................................................................................................................................

National Institute of Dental and Craniofacial Research (NIDCR) .............................................................................

Subtotal, NIDCR ............................................................................................................................................

National Institute of Diabetes and Digestive and Kidney Diseases [NIDDK] ............................................................
Juvenile Diabetes (mandatory) ..........................................................................................................................

Subtotal, NIDDK ............................................................................................................................................

National Institute of Neurological Disorders and Stroke (NINDS) .............................................................................
NIH Innovation Account, CURES Act 2 ...............................................................................................................

Subtotal, NINDS ............................................................................................................................................

National Institute of Allergy and Infectious Diseases (NIAID) ..................................................................................

Subtotal, NIAID ..............................................................................................................................................

National Institute of General Medical Sciences (NIGMS) ..........................................................................................
Evaluation Tap Funding ....................................................................................................................................

Subtotal, NIGMS ............................................................................................................................................

National Institute of Child Health and Human Development (NICHD) .....................................................................

Subtotal, NICHHD ..........................................................................................................................................

National Eye Institute (NEI) .......................................................................................................................................

NATIONAL INSTITUTES OF HEALTH

National Cancer Institute (NCI) .................................................................................................................................
NIH Innovation Account, CURES Act 2 ...............................................................................................................

749,003

2,245,110

2,195,110
50,000

434,559

(8,384,460)

(7,749,554)

Total, Centers for Disease Control Program Level .......................................................................................

893,950
............................

854,250
............................

Prevention and Public Health Fund 1 ...........................................................................................................
Transfers from Nonrecurring Expenses Fund ...............................................................................................

850,135

1,657,606

3,046,962

1,461,115
(1,585,847)

6,142,540

2,526,245

2,476,245
50,000

2,169,021

2,169,021
(150,000)

493,234

3,728,307

6,722,656

6,527,656
195,000

(7,879,954)

856,150
60,000

∂430,303
∂58,675

∂103,049
∂15,555

∂281,135
∂257,070
∂257,070
¥469,959
(∂844,847)
∂374,888
∂241,240
∂241,240
∂101,132

∂79,668
∂266,345
∂266,345
¥245,282
(∂355,026)
∂109,744
∂100,697
∂100,697
∂26,810

∂244,810
∂281,135
............................

∂53,875
∂99,668
¥20,000

∂58,675

∂430,303

∂103,049

∂244,810
............................

∂841,483

∂282,218

∂53,875
............................

∂841,483
............................

∂282,218
............................

∂15,555

(¥504,506)

¥37,800
∂60,000

(∂130,400)

∂1,900
∂60,000

249

446,397
446,397
156,804
156,804
497,346
497,346
1,431,770
1,431,770

3,545,869
624,889
624,889
490,692
490,692
172,363
172,363
546,696
546,696
1,457,724
1,457,724
1,972,966
70,000
2,042,966

Subtotal, NIA .................................................................................................................................................

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) .....................................................

Subtotal, NIAMS ............................................................................................................................................

National Institute on Deafness and Other Communication Disorders (NIDCD) ........................................................

Subtotal, NIDCD ............................................................................................................................................

National Institute of Nursing Research (NINR) .........................................................................................................

Subtotal, NINR ..............................................................................................................................................

National Institute on Alcohol Abuse and Alcoholism (NIAAA) ...................................................................................

Subtotal, NIAAA .............................................................................................................................................

National Institute on Drug Abuse (NIDA) ...................................................................................................................

Subtotal, NIDA ...............................................................................................................................................

National Institute of Mental Health (NIMH) ...............................................................................................................
NIH Innovation Account, CURES Act 2 ...............................................................................................................

Subtotal, NIMH ..............................................................................................................................................

730,147

1,844,865

1,794,865
50,000

568,480

3,225,782

802,598
3,545,869

730,147

749,003

Subtotal, NIEHS .............................................................................................................................................

802,598

Budget estimate

National Institute on Aging (NIA) ..............................................................................................................................

823,325

Subtotal, NEI .................................................................................................................................................

2020 appropriation

National Institute of Environmental Health Sciences (NIEHS) ..................................................................................

Item

[In thousands of dollars]

2,139,491

2,089,491
50,000

1,505,192

564,498

177,976

506,670

645,237

4,015,333

828,733

850,135

Committee
recommendation

∂60,273

∂15,978

∂73,422
∂294,626
............................
∂294,626

∂96,525

∂73,422

∂47,468
∂47,468

∂67,152

∂17,802

∂116,525
¥20,000

∂21,172
∂67,152

∂5,613
∂17,802

∂60,273

∂76,757

∂20,348

∂21,172

∂76,757

∂20,348

∂5,613

∂789,551

∂469,464

∂15,978

∂98,586
∂789,551

∂98,586

∂26,135
∂26,135

∂101,132

∂26,810

∂469,464

Budget estimate

2020 appropriation

Senate Committee recommendation
compared with (∂ or ¥)

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2020 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL
FOR FISCAL YEAR 2021—Continued

250

368,111
368,111
138,167
138,167

415,665
415,665
256,660
787,703
787,703
2,086,463
(583,867)
............................
12,600
2,099,063

404,638
404,638
151,877
151,877
335,812
335,812
80,827
80,827
456,911
456,911
............................
832,888
832,888
2,239,787
(626,511)
(38,925)
12,600
2,252,387
157,000
200,000
(225,000)
425,000
40,228,179

Subtotal, NIBIB .............................................................................................................................................

National Center for Complementary and Integrative Health (NCCIH) .......................................................................

Subtotal, NCCIH ............................................................................................................................................

National Institute on Minority Health and Health Disparities (NIMHD) ....................................................................

Subtotal NIMHD .............................................................................................................................................

John E Fogarty International Center (FIC) .................................................................................................................

Subtotal, FIC .................................................................................................................................................

National Library of Medicine (NLM) ...........................................................................................................................

Subtotal, NLM ...............................................................................................................................................

National Institute for Research on Safety and Quality (NIRSQ) ...............................................................................
National Center for Advancing Translational Sciences (NCATS) ...............................................................................

Subtotal, NCATS ............................................................................................................................................

Office of the Director .................................................................................................................................................
Common Fund (non-add) ..................................................................................................................................
Office for Research on Women’s Health (non-add) ..........................................................................................
Gabriella Miller Kids First Research Act (Common Fund add) ........................................................................

Subtotal, Office of the Director Program Level ............................................................................................

NIH Innovation Account, CURES Act 2 ........................................................................................................................
Buildings and Facilities .............................................................................................................................................
Transfers from Nonrecurring Expenses Fund ....................................................................................................

Subtotal, Buildings and Facilities ................................................................................................................

Total, National Institutes of Health (NIH) ....................................................................................................

38,070,075

300,000

109,000
300,000
............................

73,531

305,498

550,116

604,118

Subtotal, NHGRI ............................................................................................................................................

National Institute of Biomedical Imaging and Bioengineering (NIBIB) ....................................................................

550,116

604,118

National Human Genome Research Institute (NHGRI) ...............................................................................................

41,869,153

429,000

109,000
200,000
(229,000)

2,390,659

2,378,059
(646,302)
(38,925)
12,600

890,009

............................
890,009

471,789

83,460

391,747

156,823

417,815

623,862

∂56,124

∂129,000
∂3,799,078

∂4,000
∂1,640,974

∂291,596
............................
¥100,000
(∂229,000)

∂138,272
¥48,000
............................
(∂4,000)

∂102,306
∂291,596
(∂62,435)
(∂38,925)
............................

∂57,121
∂138,272
(∂19,791)
............................
............................

¥256,660
∂102,306
............................
∂57,121

∂14,878

∂9,929

∂2,633

∂9,929

∂86,249

∂55,935

∂56,124

∂86,249

∂2,633

∂18,656

∂4,946
∂55,935

∂14,878

∂49,704
∂18,656

∂49,704

∂13,177

∂4,946

∂73,746

∂19,744

∂13,177

∂73,746

∂19,744

251

41,459,000
(225,000)
41,684,000

Total, NIH Program Level ..............................................................................................................................

Transfers from Nonrecurring Expenses Fund ....................................................................................................

Total, NIH Program Level (with transfer) .....................................................................................................

440,906
736,532
(21,039)
757,571

458,774
701,532
(21,039)
722,571
200,000
68,887
125,000
64,635
36,146
1,642,974
21,039
1,676,013

Subtotal .........................................................................................................................................................

Community Mental Health Services Block Grant (MHBG) .........................................................................................
Evaluation Tap Funding ....................................................................................................................................

Subtotal .........................................................................................................................................................

Certified Community Behavioral Health Clinics ........................................................................................................
National Child Traumatic Stress Initiative ................................................................................................................
Children’s Mental Health Services .............................................................................................................................
Projects for Assistance in Transition from Homelessness (PATH) ............................................................................
Protection and Advocacy for Individuals with Mental Illness (PAIMI) ......................................................................

Subtotal, Mental Health ................................................................................................................................

(Evaluation Tap Funding) ....................................................................................................................

Subtotal, Mental Health program level ........................................................................................................

1,696,145

21,039

1,675,106

225,000
68,887
125,000
64,635
14,146

440,906
............................

38,811,075

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

38,811,075

(741,000)

Budget estimate

446,774
(12,000)

Programs of Regional and National Significance .....................................................................................................
Prevention and Public Health Fund 1 ................................................................................................................

Mental Health

SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION (SAMHSA)

(1,230,821)

2020 appropriation

(Evaluation Tap Funding) ....................................................................................................................

Item

[In thousands of dollars]

1,773,024

21,039

1,739,985

250,000
68,887
125,000
64,635
36,146

722,571

701,532
(21,039)

505,785

493,785
(12,000)

43,684,000

(229,000)

43,455,000

(1,585,847)

Committee
recommendation

∂64,879

∂76,879

∂97,011

∂64,879

∂97,011

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

∂25,000
............................
............................
............................
∂22,000

∂50,000
............................
............................
............................
............................

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

¥35,000
............................

∂47,011
............................
............................

∂52,879
(∂12,000)

∂4,872,925

∂2,000,000

∂47,011
............................

(∂229,000)

∂4,643,925

∂1,996,000
(∂4,000)

(∂844,847)

Budget estimate

(∂355,026)

2020 appropriation

Senate Committee recommendation
compared with (∂ or ¥)

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2020 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL
FOR FISCAL YEAR 2021—Continued

252

1,858,079

1,858,079
1,500,000
3,758,556
81,200
3,839,756

Subtotal block grant .....................................................................................................................................

State Opioid Response grants ...................................................................................................................................

Subtotal, Substance Abuse Treatment .........................................................................................................

(Evaluation Tap Funding) ....................................................................................................................

Subtotal, Program level ................................................................................................................................

(5,882,496)

Total, SAMHSA Program Level ......................................................................................................................

Healthcare Research and Quality

Research on Health Costs, Quality, and Outcomes:
Federal Funds ....................................................................................................................................................

196,709

(133,667)
12,000

(Evaluation Tap Funding) ....................................................................................................................
(Prevention and Public Health Fund 1) ................................................................................................

AGENCY FOR HEALTHCARE RESEARCH AND QUALITY (AHRQ) 3

160,258
5,736,829

128,830
(31,428)

Health Surveillance and Program Support ................................................................................................................
Evaluation Tap Funding (NA) ............................................................................................................................

Total, SAMHSA ...............................................................................................................................................

206,469

Total, Substance Abuse Prevention ..............................................................................................................

Subtotal .........................................................................................................................................................

206,469

Programs of Regional and National Significance .....................................................................................................

Substance Abuse Prevention

364,677
1,778,879
(79,200)

481,677
1,778,879
(79,200)

Subtotal .........................................................................................................................................................

Substance Abuse Prevention and Treatment Block Grant .........................................................................................
Evaluation Tap Funding ....................................................................................................................................

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

(5,740,343)

(142,692)
............................

5,597,651

139,457

97,004
(42,453)

96,985

3,807,756

79,200

3,728,556

1,585,000

364,677
............................

479,677
(2,000)

Substance Abuse Treatment

Programs of Regional and National Significance .....................................................................................................
Evaluation Tap Funding ....................................................................................................................................

131,218

(5,999,507)

(133,667)
12,000

5,853,840

160,258

128,830
(31,428)

206,469

3,859,756

81,200

3,778,556

1,500,000

1,858,079

1,778,879
(79,200)

501,677

499,677
(2,000)

∂137,000

¥65,491

(∂117,011)

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

∂131,218

(∂259,164)

(¥9,025)
∂12,000

∂20,801
∂256,189

∂117,011

∂31,826
(¥11,025)

∂109,484

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

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

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

∂109,484

∂52,000

∂20,000

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

∂2,000

∂50,000

∂20,000
............................

¥85,000

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

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

∂20,000
............................
............................

∂135,000
(∂2,000)

∂20,000
............................

253

(338,000)
60,531,371
(63,212,109)

Total, Public Health Service (PHS) appropriation ........................................................................................

Total, Public Health Service Program Level .................................................................................................

411,120,275
139,903,075
¥137,931,797
273,188,478
413,091,553

304,044,600

Total, Medicaid Program Level, available this fiscal year ..........................................................................

New advance, 1st quarter, fiscal year 2022 ......................................................................................
Less appropriations provided in prior years .......................................................................................

Total, Grants to States for Medicaid ............................................................................................................

Total, Grants to States for Medicaid, appropriated in this bill ..................................................................

Supplemental Medical Insurance ...............................................................................................................................

Payments to Health Care Trust Funds

383,836,264
22,522,603
4,761,408

Medicaid Current Law Benefits ..................................................................................................................................
State and Local Administration .................................................................................................................................
Vaccines for Children .................................................................................................................................................

Grants to States for Medicaid

CENTERS FOR MEDICARE AND MEDICAID SERVICES

(338,000)

325,500,000

462,636,414

313,904,099

148,732,315
¥139,903,075

453,807,174

425,687,169
23,168,636
4,951,369

(59,533,533)

57,187,483

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

71,300

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

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

Budget estimate

69,991

2020 appropriation

Federal funds 3 .....................................................................................................................................

Total, AHRQ Program

Level 3

Medical Expenditures Panel Surveys:
Federal Funds ....................................................................................................................................................
Program Support:
Federal Funds ....................................................................................................................................................

Item

[In thousands of dollars]

325,500,000

462,636,414

313,904,099

148,732,315
¥139,903,075

453,807,174

425,687,169
23,168,636
4,951,369

(65,566,456)

62,323,792

(256,660)

55,451

69,991

Committee
recommendation

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

∂41,850,905
∂646,033
∂189,961
∂42,686,899
∂8,829,240
¥1,971,278
∂40,715,621
∂49,544,861

∂21,455,400

(∂6,032,923)

∂5,136,309

∂1,792,421
(∂2,354,347)

(∂256,660)

(¥81,340)

(∂256,660)

∂55,451

¥15,849
(¥81,340)

∂69,991

Budget estimate

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

2020 appropriation

Senate Committee recommendation
compared with (∂ or ¥)

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2020 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL
FOR FISCAL YEAR 2021—Continued

254

410,796,100

20,054
2,519,823
397,334
732,533
3,669,744

610,000
93,000
83,000

Total, Payments to Trust Funds ...................................................................................................................

Research, Demonstration, Evaluation ........................................................................................................................
Program Operations ....................................................................................................................................................
State Survey and Certification ...................................................................................................................................
Federal Administration ...............................................................................................................................................

Total, Program management ........................................................................................................................

Centers for Medicare and Medicaid Services ............................................................................................................
HHS Office of Inspector General ................................................................................................................................
Department of Justice ................................................................................................................................................

828,343,397
823,887,653
(683,984,578)
(139,903,075)
4,455,744

Program integrity (cap adjustment) ....................................................................................................

Total, Centers for Medicare and Medicaid Services ....................................................................................

Federal funds .......................................................................................................................................
Current year .....................................................................................................................................
FY 2022 Advance ............................................................................................................................
Trust Funds ..........................................................................................................................................

33,000
1,000
34,000

Payments to Territories ..............................................................................................................................................
Repatriation ................................................................................................................................................................

Subtotal .........................................................................................................................................................

Payments to States for Child Support Enforcement and Family Support Programs

ADMINISTRATION FOR CHILDREN AND FAMILIES (ACF)

786,000
(475,000)

Total, Health Care Fraud and Abuse Control (Trust funds) ........................................................................

Health Care Fraud and Abuse Control Account

Program Management

109,000
913,000
104,539,500
861,000
324,000
5,000

Federal Uninsured Payment .......................................................................................................................................
Program Management ................................................................................................................................................
General Revenue for Part D Benefit ..........................................................................................................................
General Revenue for Part D Administration ..............................................................................................................
HCFAC Reimbursement ...............................................................................................................................................
State Low-Income Determination for Part D ..............................................................................................................

34,000

33,000
1,000

902,150,414
(753,418,099)
(148,732,315)
4,506,548

906,656,962

(496,000)

813,000

628,356
101,644
83,000

3,693,548

............................
2,478,823
442,192
772,533

439,514,000

95,000
904,000
111,800,000
882,000
328,000
5,000

34,000

33,000
1,000

902,150,414
(753,418,099)
(148,732,315)
4,476,744

906,627,158

(496,000)

807,000

617,000
100,000
90,000

3,669,744

20,054
2,472,356
407,334
770,000

439,514,000

95,000
904,000
111,800,000
882,000
328,000
5,000

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

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

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

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

¥29,804
............................
............................
............................
¥29,804

∂78,283,761
∂78,262,761
(∂69,433,521)
(∂8,829,240)
∂21,000

¥6,000

∂21,000

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

¥11,356
¥1,644
∂7,000

∂7,000
∂7,000
∂7,000

(∂21,000)

¥23,804
............................

∂20,054
¥6,467
¥34,858
¥2,533

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

∂28,717,900

............................
¥47,467
∂10,000
∂37,467

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

¥14,000
¥9,000
∂7,260,500
∂21,000
∂4,000
............................

255

4,290,000
4,290,000

3,740,304
3,740,304

354,000
207,201
27,755
1,303,245
16,000
1,908,201

Total, Family Support Payments, available in this bill ...............................................................................

Formula Grants ...........................................................................................................................................................

Total, LIHEAP, Program Level .......................................................................................................................

Transitional and Medical Services .............................................................................................................................
Refugee Support Services ..........................................................................................................................................
Victims of Trafficking .................................................................................................................................................
Unaccompanied Alien Children (UAC) ........................................................................................................................
Victims of Torture .......................................................................................................................................................

Total, Refugee and Entrant Assistance ........................................................................................................

Refugee and Entrant Assistance

Low Income Home Energy Assistance Program (LIHEAP)

4,290,000
1,400,000
¥1,400,000

4,256,000

Subtotal, Child Support Enforcement ...........................................................................................................

Total, Family Support Payments Program Level, available this fiscal year ................................................

3,648,494
597,506
10,000

2020 appropriation

Child Support Enforcement:
State and Local Administration ........................................................................................................................
Federal Incentive Payments ..............................................................................................................................
Access and Visitation ........................................................................................................................................

Item

[In thousands of dollars]

2,456,380

278,559
150,821
27,755
1,983,245
16,000

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

4,439,000

1,400,000
¥1,400,000

4,439,000

4,405,000

3,788,273
606,727
10,000

Budget estimate

1,832,760

278,559
207,201
27,755
1,303,245
16,000

3,740,304

4,439,000

1,400,000
¥1,400,000

4,439,000

4,405,000

3,788,273
606,727
10,000

Committee
recommendation

∂3,740,304

............................
∂56,380
............................
¥680,000
............................
¥623,620

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

¥75,441
............................
............................
............................
............................
¥75,441

∂3,740,304

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

∂149,000

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

∂149,000

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

∂149,000

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

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

∂149,000

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

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

Budget estimate

∂139,779
∂9,221
............................

2020 appropriation

Senate Committee recommendation
compared with (∂ or ¥)

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2020 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL
FOR FISCAL YEAR 2021—Continued

256

5,826,000
1,700,000

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

740,000
20,383
10,000
770,383
12,000
175,000
43,257
1,864
206,000
12,876,652
345,000
92,515
437,515

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

Promoting Safe and Stable Families .........................................................................................................................
Discretionary Funds ...........................................................................................................................................

Total, Promoting Safe and Stable Families .................................................................................................

404,765

345,000
59,765

11,856,130

12,000
175,000
43,257
4,000
209,000

10,613,095
............................
113,780
18,641
90,091
51,000
55,660
268,735
20,984
42,100
75,000
6,512
57,275

5,826,000
............................

2,412,625

10,613,095
275,000
113,780
18,641
90,091
35,000
55,660
268,735
17,984
42,100
75,000
7,012
56,050

Programs for Children, Youth and Families:
Head Start .........................................................................................................................................................
Preschool Development Grants ..........................................................................................................................
Runaway and Homeless Youth Program ...........................................................................................................
Service Connection for Youth on the Streets ....................................................................................................
Child Abuse State Grants .................................................................................................................................
Child Abuse Discretionary Activities .................................................................................................................
Community Based Child Abuse Prevention .......................................................................................................
Child Welfare Services ......................................................................................................................................
Child Welfare Training, Research, or Demonstration projects .........................................................................
Adoption Opportunities ......................................................................................................................................
Adoption Incentive Grants .................................................................................................................................
Social Services and Income Maintenance Research .................................................................................................
Native American Programs .........................................................................................................................................
Community Services:
Community Services Block Grant Act programs:
Grants to States for Community Services ...............................................................................................
Economic Development .............................................................................................................................
Rural Community Facilities ......................................................................................................................

Children and Families Services Programs

1,864,446

Subtotal, Sections 414, 501, 462, 235 ........................................................................................................

Payments to States for the Child Care and Development Block Grant ....................................................................
Social Services Block Grant (Title XX) .......................................................................................................................

437,515

345,000
92,515

12,962,269

12,000
175,000
43,257
1,864
206,000

750,000

740,000
............................
10,000

10,713,095
275,000
113,780
18,641
90,091
35,000
55,660
268,735
19,984
46,100
75,000
7,012
56,050

5,876,000
1,700,000

1,789,005

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

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

∂32,750

............................
∂32,750

∂1,106,139

∂85,617

∂750,000
............................
............................
............................
¥2,136
¥3,000

¥20,383
............................
............................
............................
............................
............................

∂740,000
............................
∂10,000
............................
¥20,383
............................

∂100,000
∂275,000
............................
............................
............................
¥16,000
............................
............................
¥1,000
∂4,000
............................
∂500
¥1,225

∂50,000
∂1,700,000

∂100,000
............................
............................
............................
............................
............................
............................
............................
∂2,000
∂4,000
............................
............................
............................

¥623,620

¥75,441
∂50,000
............................

257

39,522,672

Total, ACF Program Level .............................................................................................................................

390,074
24,848
22,658
437,580

Grants to States:
Home and Community-based Supportive Services ...........................................................................................
Preventive Health ..............................................................................................................................................
Protection of Vulnerable Older Americans—Title VII .......................................................................................

Subtotal ................................................................................................................................................

Aging and Disability Services Programs

ADMINISTRATION FOR COMMUNITY LIVING

39,522,672

Total, Payments to States, available in this bill .........................................................................................

(35,122,672)
(4,400,000)

8,744,000

Total, Payments for foster care and permanency ........................................................................................

5,744,000

Advance appropriations, 1st quarter, fiscal year 2022 ......................................................................
Less appropriations provided in prior years .......................................................................................

Total, Administration for Children and Familiies .........................................................................................

8,544,000
3,000,000
¥2,800,000

Total, Payments to States, available this fiscal year ..................................................................................

5,253,000
2,931,000
217,000
143,000

2020 appropriation

Foster Care .................................................................................................................................................................
Adoption Assistance ...................................................................................................................................................
Guardianship ..............................................................................................................................................................
Independent Living .....................................................................................................................................................

Payments for Foster Care and Permanency

Item

[In thousands of dollars]

435,550

390,074
24,848
20,628

34,993,812

(30,593,812)
(4,400,000)

34,993,812

10,011,537

7,011,537

3,000,000
¥3,000,000

10,011,537

5,795,634
3,802,045
270,858
143,000

Budget estimate

437,580

390,074
24,848
22,658

40,999,848

(36,599,848)
(4,400,000)

40,999,848

10,012,000

7,012,000

3,000,000
¥3,000,000

10,012,000

5,796,000
3,802,000
271,000
143,000

Committee
recommendation

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

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

∂2,030

............................
............................
∂2,030

∂6,006,036

∂1,477,176

∂6,006,036

∂1,477,176

(∂6,006,036)
............................

∂463

∂1,268,000

(∂1,477,176)
............................

∂463

∂1,268,000

∂463

∂1,468,000

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

∂366
¥45
∂142
............................

∂543,000
∂871,000
∂54,000
............................

............................
¥200,000

Budget estimate

2020 appropriation

Senate Committee recommendation
compared with (∂ or ¥)

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2020 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL
FOR FISCAL YEAR 2021—Continued

258

510,342
266,342
160,069
936,753

510,342
266,342
160,069

34,708
11,503
26,500
............................
3,360
............................
............................
17,874
6,119
36,115
9,700
4,000
11,321
56,000
38,734
7,463
1,050
32,546
135,793

34,708
12,461
11,800
(14,700)
6,110
(8,000)
(5,000)
15,874
8,119
52,115
9,700
4,000
11,321
78,000
40,784
7,463
12,250
41,619
180,116
116,183
111,970
37,000
265,153

Grants for Native Americans ......................................................................................................................................
Aging Network Support Activities ...............................................................................................................................
Alzheimer’s Disease Program .....................................................................................................................................
Prevention and Public Health Fund 1 ................................................................................................................
Lifespan Respite Care ................................................................................................................................................
Prevention and Public Health Fund 1 ................................................................................................................
Prevention and Public Health Fund 1 ................................................................................................................
Elder Rights Support Activities ..................................................................................................................................
Aging and Disability Resources .................................................................................................................................
State Health Insurance Program ................................................................................................................................
Paralysis Resource Center ..........................................................................................................................................
Limb Loss Resource Center ........................................................................................................................................
Traumatic Brain Injury ...............................................................................................................................................
Developmental Disabilities Programs:
State Councils ...................................................................................................................................................
Protection and Advocacy ...................................................................................................................................
Voting Access for Individuals with Disabilities ................................................................................................
Developmental Disabilities Projects of National Significance ..........................................................................
University Centers for Excellence in Developmental Disabilities .....................................................................

Subtotal, Developmental Disabilities Programs ...........................................................................................

Workforce Innovation and Opportunity Act:
Independent Living ............................................................................................................................................
National Institute on Disability, Independent Living, and Rehabilitation Research ........................................
Assistive Technology ..........................................................................................................................................

Subtotal, Workforce Innovation and Opportunity Act ...................................................................................

235,956

113,646
90,371
31,939

1,533,195

936,753
1,570,575

Subtotal ................................................................................................................................................

Subtotal, Grants to States ............................................................................................................................

160,892

196,242

Subtotal, Caregivers ............................................................................................................................

Nutrition:
Congregate Meals .....................................................................................................................................
Home Delivered Meals ..............................................................................................................................
Nutrition Services Incentive Program .......................................................................................................

150,586
10,306

185,936
10,306

Family Caregivers ..............................................................................................................................................
Native American Caregivers Support ................................................................................................................

269,153

116,183
114,470
38,500

180,116

78,000
40,784
7,463
12,250
41,619

34,708
17,461
12,800
(14,700)
7,110
(8,000)
(5,000)
15,874
8,119
52,115
9,700
4,000
11,321

1,570,675

936,753

510,342
266,342
160,069

196,342

186,036
10,306

∂37,480

∂2,537
∂24,099
∂6,561
∂33,197

∂4,000

∂44,323

∂22,000
∂2,050
............................
∂11,200
∂9,073

............................
∂2,500
∂1,500

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

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

............................
∂5,958
¥13,700
(∂14,700)
∂3,750
(∂8,000)
(∂5,000)
¥2,000
∂2,000
∂16,000
............................
............................
............................

∂100
............................
∂5,000
∂1,000
............................
∂1,000
............................
............................
............................
............................
............................
............................
............................
............................

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

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

∂35,450

∂100
............................
............................
............................

∂35,450
............................

∂100
............................

259

2,171,000
(52,115)
(27,700)
2,250,815

Federal funds .......................................................................................................................................
Trust Funds ..........................................................................................................................................
(Prevention and Public Health Fund 1) .........................................................................................................

Total, ACL program level ..............................................................................................................................

479,629
479,629
(64,828)
544,457

Federal Funds ......................................................................................................................................
(Evaluation Tap Funding) ....................................................................................................................

Total, General Departmental Management program level ...........................................................................

35,000
58,670
33,640
53,900
1,000
(58,028)

Total, General Departmental Management ...................................................................................................

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

107,800

Subtotal, Grants ............................................................................................................................................

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

420,945

347,105
(73,840)

347,105

............................
58,670
33,640
53,900
............................
(73,840)

200,895
............................
............................

2,108,207

2,072,092
(36,115)
............................

2,108,207

42,063

Budget estimate

196,419
101,000
(6,800)

General Departmental Management, Federal Funds .................................................................................................
Teen Pregnancy Prevention Community Grants .........................................................................................................
Evaluation Tap Funding ....................................................................................................................................

General Departmental Management

OFFICE OF THE SECRETARY

41,063
2,223,115

Total, Administration for Community Living ................................................................................................

2020 appropriation

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

Item

[In thousands of dollars]

554,707

489,879
(64,828)

489,879

45,000
58,670
33,640
53,900
1,000
(58,028)

107,800

196,669
101,000
(6,800)

2,262,915

2,183,100
(52,115)
(27,700)

2,235,215

42,063

Committee
recommendation

∂111,008
(∂16,000)
(∂27,700)
∂154,708

∂12,100

∂107,800
∂45,000
............................
............................
............................
∂1,000
(¥15,812)
∂142,774
∂142,774
(¥9,012)
∂133,762

............................
∂10,000
............................
............................
............................
............................
............................
∂10,250
∂10,250
............................
∂10,250

¥4,226
∂101,000
(∂6,800)

∂127,008

∂12,100
............................
............................

∂250
............................
............................

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

∂1,000

Budget estimate

∂12,100

2020 appropriation

Senate Committee recommendation
compared with (∂ or ¥)

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2020 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL
FOR FISCAL YEAR 2021—Continued

260

623,591

Total, Benefits for Commissioned Officers ...................................................................................................

257,555
............................
257,555
561,700
............................
561,700
19,877
535,000
............................
535,000

275,555
............................
275,555
561,700
............................
561,700
14,877
735,000
............................
735,000
705,000
6,000

Subtotal, Hospital Preparadness program level ...........................................................................................

Biomedical Advanced Research and Development Authority (BARDA) ......................................................................
Transfers from Nonrecurring Expenses Fund ....................................................................................................

Subtotal, BARDA ...........................................................................................................................................

Policy and Planning ...................................................................................................................................................
Project BioShield ........................................................................................................................................................
Transfers from Nonrecurring Expenses Fund ....................................................................................................

Subtotal, BioShield .......................................................................................................................................

Strategic National Stockpile .......................................................................................................................................
Medical Reserve Corps ...............................................................................................................................................

705,000
3,900

30,938
27,154
88,404

653,023

524,818
31,925
96,280

30,286

90,000

196,381
50,717

30,938
24,654
57,404

Operations ..................................................................................................................................................................
Preparedness and Emergency Operations ..................................................................................................................
National Disaster Medical System .............................................................................................................................
Hospital Preparedness Cooperative Agreement Grants:
Formula Grants ..................................................................................................................................................
Transfers from Nonrecurring Expenses Fund ....................................................................................................

Assistant Secretary for Preparedness and Response

Public Health and Social Services Emergency Fund (PHSSEF)

491,090
31,650
100,851

Retirement Payments .................................................................................................................................................
Survivors Benefits ......................................................................................................................................................
Dependents’ Medical Care .........................................................................................................................................

Retirement Pay and Medical Benefits for Commissioned Officers

Federal Funds .............................................................................................................................................................

Office for Civil Rights
38,798

80,000

Inspector General Federal Funds ...............................................................................................................................

Office of Inspector General

191,881
60,367

Medicare Hearings and Appeals ................................................................................................................................
Office of the National Coordinator for Health Information Technology .....................................................................

705,000
6,000

785,000

14,877
735,000
(50,000)

611,700

561,700
(50,000)

299,555

275,555
(24,000)

30,938
24,654
57,404

653,023

524,818
31,925
96,280

38,798

80,000

191,881
60,367

∂250,000
............................
∂2,100

∂50,000
............................
............................

¥5,000
∂200,000
(∂50,000)

∂50,000
............................
............................
(∂50,000)

∂50,000

∂42,000
............................
(∂50,000)

∂24,000
............................
(∂50,000)

∂18,000
(∂24,000)
............................
(∂24,000)

............................
¥2,500
¥31,000

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

∂29,432

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

∂8,512

¥10,000

¥4,500
∂9,650

∂33,728
∂275
¥4,571

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

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

261

67,053
67,053
8,884
8,884

58,860
58,860
7,470

Assistant Secretary for Administration, Cybersecurity ...............................................................................................

Subtotal .........................................................................................................................................................

Office of Security and Strategic Information .............................................................................................................

260,000
............................
260,000

Pandemic Influenza Preparedness .............................................................................................................................
Transfers from Nonrecurring Expenses Fund ....................................................................................................

Subtotal, Pandemic Influenza Preparedness .......................................................................................

1,297,458
2,737,458
4,211,724
4,019,843
191,881
(64,828)
4,276,552

Subtotal, Non-pandemic flu/BioShield/SNS ..................................................................................................

Total, PHSSEF ................................................................................................................................................

Total, Office of the Secretary .......................................................................................................................

Federal Funds ......................................................................................................................................
Trust Funds ..........................................................................................................................................
(Evaluation Tap Funding) ....................................................................................................................

Total, Office of the Secretary Program Level ...............................................................................................

Public Health and Science

7,470
............................

Subtotal (including transfer) ........................................................................................................................

Office of the Assistant Secretary of Health ...............................................................................................................

Assistant Secretary for Administration

2,411,128

Subtotal, Preparedness and Response .........................................................................................................

4,082,817

3,812,596
196,381
(73,840)

4,008,977

2,641,465

1,401,465

310,000

310,000
............................

11,000

2,244,528

15,000

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

Preparedness and Response Innovation ....................................................................................................................

Budget estimate

2020 appropriation

Item

[In thousands of dollars]

4,492,234

4,061,525
191,881
(64,828)

4,253,406

2,739,458

1,249,458

310,000

260,000
(50,000)

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

7,470

58,860

2,413,128

2,000

Committee
recommendation

∂2,000

¥8,193

∂244,429

∂409,417

∂215,682

∂97,993

∂2,000

∂248,929
¥4,500
(¥9,012)

¥152,007

¥48,000

∂41,682
............................
............................

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

∂50,000

∂41,682

¥50,000
(∂50,000)

¥11,000

¥1,414

............................
(∂50,000)

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

¥8,193

¥13,000
∂168,600

∂2,000

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

Budget estimate

2020 appropriation

Senate Committee recommendation
compared with (∂ or ¥)

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2020 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL
FOR FISCAL YEAR 2021—Continued

262

Federal Funds ......................................................................................................................................
Current year appropriations ............................................................................................................
Advance appropriations ...................................................................................................................
Trust Funds ..........................................................................................................................................
CURES Act 2 .........................................................................................................................................
Prevention and Public Health Fund 1 ...........................................................................................................
Transfers from Nonrecurring Expenses Fund ...............................................................................................

990,776
............................
............................
............................
............................
¥990,776
............................
1,362,301
............................
¥1,362,301
............................

1,440,776
5,463,625
5,000
5,468,625
990,776
¥1,440,776
6,459,401
1,362,301
1,362,301
¥1,362,301
1,362,301
4,019,050
4,244,050

Grants to Local Educational Agencies (LEAs):
Basic Grants:
Appropriations from prior year advances ................................................................................................
Forward funded ........................................................................................................................................
Current appropriation ...............................................................................................................................

Subtotal, Basic grants available this fiscal year ...............................................................................

Advance appropriations, fiscal year 2022 ........................................................................................................
Less appropriations available from prior year advances .................................................................................

Subtotal, Basic grants, appropriated in this bill ...............................................................................

Concentration Grants:
Appropriations from prior year advances ................................................................................................
Advance appropriations, fiscal year 2022 ...............................................................................................
Less appropriations provided from prior year advances .........................................................................

Subtotal, Concentration grants, appropriated in this bill ..................................................................

Targeted Grants:
Appropriations from prior year advances ................................................................................................
Advance appropriations, fiscal year 2022 ...............................................................................................

EDUCATION FOR THE DISADVANTAGED

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

Total ..............................................................................................................................................................

4,244,050
............................

19,363,430

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

6,840,812
12,522,618

999,796,197
(846,663,882)
(153,132,315)
(4,755,244)
(404,000)
(893,950)
............................

1,004,955,441

Elementary and Secondary Education for the Disadvantaged Block Grant ..............................................................
Advance appropriations, fiscal year 2022 ........................................................................................................

IMPROVING ELEMENTARY AND SECONDARY EDUCATION

TITLE III—DEPARTMENT OF EDUCATION

934,832,279
929,630,339
(785,327,264)
(144,303,075)
(4,709,940)
(492,000)
(893,950)
(450,000)

Total, Title II, Department of Health and Human Services .........................................................................

1,016,439,419

4,244,050
4,306,550

1,362,301

1,362,301
1,362,301
¥1,362,301

6,459,401

865,776
¥990,776

5,593,625

990,776
5,588,625
5,000

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

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

1,011,304,479
(858,172,164)
(153,132,315)
(4,730,940)
(404,000)
(895,850)
(829,000)

∂865,776
............................

¥125,000
∂450,000

∂225,000
∂62,500

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

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

............................
∂4,306,550

∂1,362,301

............................
∂1,362,301
............................

∂6,459,401

∂5,593,625

∂125,000

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

............................
∂5,588,625
∂5,000

¥19,363,430

¥450,000
∂125,000
............................

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

¥6,840,812
¥12,522,618

∂11,508,282
(∂11,508,282)
............................
(¥24,304)
............................
(∂1,900)
(∂829,000)

∂81,674,140
(∂72,844,900)
(∂8,829,240)
(∂21,000)
(¥88,000)
(∂1,900)
(∂379,000)

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

∂11,483,978

∂81,607,140

263

4,244,050
4,019,050
4,244,050
¥4,019,050
4,244,050
16,309,802
27,000
192,000
374,751
47,614
422,365
45,623
16,996,790
(6,155,613)
(6,077,990)
(10,841,177)
(¥10,841,177)

1,340,242
48,316

Subtotal, Targeted Grants, appropriated in this bill ..........................................................................

Education Finance Incentive Grants:
Appropriations from prior year advances ................................................................................................
Advance appropriations, fiscal year 2022 ...............................................................................................
Less appropriations provided from prior year advances .........................................................................

Subtotal, Education Finance Incentive Grants, appropriated in this bill ...........................................

Subtotal, Grants to LEAs, program level appropriated in this bill ....................................................

Innovative Approaches to Literacy .............................................................................................................................
Comprehensive literacy development grants .............................................................................................................
State Agency Programs:
Migrant ..............................................................................................................................................................
Neglected and Delinquent/High Risk Youth ......................................................................................................

Subtotal, State Agency programs .................................................................................................................

Special Programs for Migrant Students ....................................................................................................................

Total, Education for the disadvantaged .......................................................................................................

Current Year appropriations ................................................................................................................
(Forward Funded) ............................................................................................................................
FY 2022 Advances ...............................................................................................................................
Less appropriations made in prior years ............................................................................................

Basic Support Payments ............................................................................................................................................
Payments for Children with Disabilities ....................................................................................................................

IMPACT AID

¥4,244,050

¥4,019,050

Less appropriations provided from prior year advances .........................................................................

1,340,242
48,316

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

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

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

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

Budget estimate

2020 appropriation

Item

[In thousands of dollars]

1,359,242
48,316

(6,280,613)
(6,202,990)
(10,841,177)
(¥10,841,177)

17,121,790

45,623

422,365

374,751
47,614

27,000
192,000

16,434,802

4,306,550

4,244,050
4,306,550
¥4,244,050

4,306,550

¥4,244,050

Committee
recommendation

∂16,434,802

∂125,000

(∂6,280,613)
(∂6,202,990)
(∂10,841,177)
(¥10,841,177)

∂19,000
............................

∂17,121,790

∂125,000
(∂125,000)
(∂125,000)
............................
............................

∂45,623

∂422,365

∂374,751
∂47,614

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

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

∂27,000
∂192,000

∂4,306,550

∂62,500

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

∂4,244,050
∂4,306,550
¥4,244,050

∂4,306,550
∂225,000
∂62,500
¥225,000

............................
∂62,500

Budget estimate

¥225,000

2020 appropriation

Senate Committee recommendation
compared with (∂ or ¥)

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2020 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL
FOR FISCAL YEAR 2021—Continued

264

............................
1,681,441
............................
¥1,681,441
............................

450,389
1,681,441
1,681,441
¥1,681,441
2,131,830
16,699
1,249,673
378,000
101,500
6,575
36,897
35,953
185,840
52,000
1,210,000

Subtotal, Supporting Effective Instruction State Grants, program level appropriated in this bill .............

Supplemental Education Grants ................................................................................................................................
Nita M Lowey 21st Century Community Learning Centers ........................................................................................
State Assessments .....................................................................................................................................................
Education for Homeless Children and Youth .............................................................................................................
Training and Advisory Services (Civil Rights) ...........................................................................................................
Education for Native Hawaiians ................................................................................................................................
Alaska Native Education Equity .................................................................................................................................
Rural Education ..........................................................................................................................................................
Comprehensive Centers ..............................................................................................................................................
Student Support and Academic Enrichment grants ..................................................................................................

105,381
67,993
7,365

105,381
67,993
7,365
75,358

Subtotal, Federal Programs .................................................................................................................

INDIAN EDUCATION

Grants to Local Educational Agencies .......................................................................................................................
Federal Programs:
Special Programs for Indian Children ..............................................................................................................
National Activities .............................................................................................................................................

392,374

75,358

(392,374)
(369,100)
............................

5,404,967
(3,723,526)
(3,575,402)
(1,681,441)

Current Year appropriations ................................................................................................................
(Forward Funded) ............................................................................................................................
Advance appropriations .......................................................................................................................

16,699
............................
369,100
............................
6,575
............................
............................
............................
............................
............................

Total, School Improvement Programs ...........................................................................................................

SCHOOL IMPROVEMENT PROGRAMS

Supporting Effective Instruction State Grants ...........................................................................................................
Appropriations from prior year advances .........................................................................................................
Advance appropriations, fiscal year 2022 ........................................................................................................
Less appropriations provided from prior year advances ..................................................................................

1,410,799

1,486,112

Total, Impact aid ..........................................................................................................................................

4,835
17,406
............................

4,835
17,406
75,313

Facilities Maintenance (Sec. 8008) ...........................................................................................................................
Construction (Sec. 8007) ...........................................................................................................................................
Payments for Federal Property (Sec. 8002) ...............................................................................................................

75,358

67,993
7,365

105,381

(3,768,526)
(3,619,402)
(1,681,441)

5,449,967

16,699
1,249,673
378,000
101,500
6,575
36,897
36,953
189,840
52,000
1,250,000

2,131,830

450,389
1,681,441
1,681,441
¥1,681,441

1,506,112

4,835
17,406
76,313

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

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

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

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

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

(∂3,376,152)
(∂3,250,302)
(∂1,681,441)

∂5,057,593
(∂45,000)
(∂44,000)
............................

∂45,000

∂2,131,830
............................
∂1,249,673
∂8,900
∂101,500
............................
∂36,897
∂36,953
∂189,840
∂52,000
∂1,250,000

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

∂450,389
............................
∂1,681,441
............................

∂95,313

∂20,000

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

............................
............................
∂76,313

............................
............................
∂1,000

265

190,000
1,815
3,000
440,000
107,000
200,000
29,000
80,000
30,000
13,000
10,000
............................
1,103,815

80,000
105,000
25,000
210,000

51,181
736,219

Education Innovation and Research ..........................................................................................................................
American History and Civics Academies ...................................................................................................................
American History and Civics National Activities .......................................................................................................
Charter Schools Grants ..............................................................................................................................................
Magnet Schools Assistance ........................................................................................................................................
Teacher and School Leader Incentive Grants ............................................................................................................
Ready-to-Learn Television ..........................................................................................................................................
Supporting Effective Educator Development (SEED) .................................................................................................
Arts in Education .......................................................................................................................................................
Javits Gifted and Talented Students .........................................................................................................................
Statewide Family Engagement Centers .....................................................................................................................
Floor Amendments: Unspecified .................................................................................................................................

Total, Innovation and Improvement ..............................................................................................................

Promise Neighborhoods ..............................................................................................................................................
School Safety National Activities ...............................................................................................................................
Full-Service Community Schools ................................................................................................................................

Total, Safe Schools and Citizenship Education ...........................................................................................

Current funded ...........................................................................................................................................................
Forward funded ..........................................................................................................................................................

ENGLISH LANGUAGE ACQUISITION

SAFE SCHOOLS AND CITIZENSHIP EDUCATION

INNOVATION AND IMPROVEMENT

180,739

2020 appropriation

Total, Indian Education ................................................................................................................................

Item

[In thousands of dollars]

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

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

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

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

180,739

Budget estimate

51,181
736,219

210,000

80,000
105,000
25,000

1,058,815

130,000
1,815
3,000
450,000
107,000
200,000
29,000
80,000
30,000
13,000
15,000
............................

180,739

Committee
recommendation

∂1,058,815

¥45,000

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

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

∂51,181
∂736,219

∂210,000

∂80,000
∂105,000
∂25,000

∂130,000
∂1,815
∂3,000
∂450,000
∂107,000
∂200,000
∂29,000
∂80,000
∂30,000
∂13,000
∂15,000
............................

¥60,000
............................
............................
∂10,000
............................
............................
............................
............................
............................
............................
∂5,000
............................

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

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

Budget estimate

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

2020 appropriation

Senate Committee recommendation
compared with (∂ or ¥)

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2020 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL
FOR FISCAL YEAR 2021—Continued

266

3,481,009
(9,283,383)
9,283,383
12,764,392
394,120
477,000
13,635,512

38,630
44,345
20,083
89,700
27,411
29,547
249,716
13,885,228
(4,601,845)
(4,352,129)
(9,283,383)
(¥9,283,383)

3,610,040
13,000
29,388
5,796
17,650
22,548

State Grants:
Grants to States Part B current year ...............................................................................................................
Part B advance from prior year ...............................................................................................................
Grants to States Part B (FY 2022) ...................................................................................................................

Subtotal, program level ................................................................................................................................

Preschool Grants ...............................................................................................................................................
Grants for Infants and Families .......................................................................................................................

Subtotal, program level ................................................................................................................................

IDEA National Activities (current funded):
State Personnel Development ............................................................................................................................
Technical Assistance and Dissemination .........................................................................................................
Special Olympics Education Programs .............................................................................................................
Personnel Preparation .......................................................................................................................................
Parent Information Centers ...............................................................................................................................
Educational Technology, Media, and Materials .........................................................................................................

Subtotal, IDEA National Activities ................................................................................................................

Total, Special education ...............................................................................................................................

Current Year appropriations ................................................................................................................
(Forward Funded) ............................................................................................................................
Advance appropriations .......................................................................................................................
Advance appropriations .......................................................................................................................

Vocational Rehabilitation State Grants .....................................................................................................................
Client Assistance State grants ..................................................................................................................................
Training ......................................................................................................................................................................
Demonstration and Training programs ......................................................................................................................
Protection and Advocacy of Individual Rights [PAIR] ...............................................................................................
Supported Employment State grants .........................................................................................................................

REHABILITATION SERVICES

SPECIAL EDUCATION

787,400

Total, English Language Acquisition ............................................................................................................

3,667,801
13,000
29,388
5,796
17,650
............................

(4,701,845)
(4,452,129)
(9,283,383)
(¥9,283,383)

13,985,228

249,716

38,630
44,345
20,083
89,700
27,411
29,547

13,735,512

394,120
477,000

12,864,392

3,581,009
(9,283,383)
9,283,383

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

3,667,801
13,000
29,388
5,796
17,650
22,548

(4,729,345)
(4,477,129)
(9,283,383)
(¥9,283,383)

14,012,728

252,216

38,630
44,345
22,583
89,700
27,411
29,547

13,760,512

401,620
484,500

12,874,392

3,591,009
(9,283,383)
9,283,383

787,400

............................
............................
............................
............................
............................
∂22,548

∂57,761
............................
............................
............................
............................
............................

∂27,500
(∂27,500)
(∂25,000)
............................
............................

∂127,500
(∂127,500)
(∂125,000)
............................
............................

∂2,500

∂25,000

∂125,000

∂2,500

∂7,500
∂7,500

............................
............................
∂2,500
............................
............................
............................

∂10,000

∂110,000

............................
............................
∂2,500
............................
............................
............................

∂10,000
............................
............................

∂787,400

∂110,000
............................
............................

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

267

32,431
79,500
137,361

32,431
79,500
137,361
137,361
249,292

491,598
791,000
1,282,598
791,000
¥791,000

American Printing House for the Blind ......................................................................................................................
National Technical Institute for the Deaf [NTID]:
Operations .........................................................................................................................................................
Gallaudet University:
Operations .........................................................................................................................................................

Total, Gallaudet University ...........................................................................................................................

Total, Special Institutions for Persons with Disabilities ..............................................................................

Career Education:
Basic State Grants/Secondary & Technical Education State Grants ...............................................................
Appropriations available from prior year advances ................................................................................

Total, available this fiscal year ...................................................................................................................

Advance appropriations, fiscal year 2022 ........................................................................................................
Less appropriations provided in prior years .....................................................................................................

CAREER, TECHNICAL, AND ADULT EDUCATION

SPECIAL INSTITUTIONS FOR PERSONS WITH DISABILITIES

137,699
3,610,040

(Discretionary) ......................................................................................................................................
(Mandatory) ..........................................................................................................................................

791,000
¥791,000

1,962,598

1,171,598
791,000

249,292

137,361

115,151
3,667,801

3,782,952

3,747,739

Total, Rehabilitation Services .......................................................................................................................

33,317
16,000

Budget estimate

33,317
16,000

2020 appropriation

Independent Living:
Services for Older Blind Individuals .................................................................................................................
Helen Keller National Center for Deaf/Blind Youth and Adults ................................................................................

Item

[In thousands of dollars]

791,000
¥791,000

1,357,598

566,598
791,000

256,292

140,361

81,500

34,431

137,699
3,667,801

3,805,500

33,317
16,000

Committee
recommendation

∂3,000
∂7,000

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

¥605,000

∂3,000

∂75,000

∂2,000

¥605,000
............................

∂2,000

∂75,000
............................

∂22,548
............................

∂22,548

∂57,761
............................
∂57,761

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

Budget estimate

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

2020 appropriation

Senate Committee recommendation
compared with (∂ or ¥)

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2020 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL
FOR FISCAL YEAR 2021—Continued

268

(5,285)
22,475,352
865,000
1,180,000
24,520,352
50,000

Pell Grants—maximum grant (NA) ...........................................................................................................................
Pell Grants ..................................................................................................................................................................
Federal Supplemental Educational Opportunity Grants .............................................................................................
Federal Work Study .....................................................................................................................................................

Total, Student Financial Assistance .............................................................................................................

FEDERAL DIRECT STUDENT LOAN PROGRAM ACCOUNT .............................................................................................

1,768,943

107,854
143,081
12,838
............................

Total, Student Aid Administration ................................................................................................................

Aid for Institutional Development:
Strengthening Institutions .................................................................................................................................
Hispanic Serving Institutions ............................................................................................................................
Promoting Post-Baccalaureate Opportunities for Hispanic Americans ............................................................
Conslidated MSI Grant ......................................................................................................................................

HIGHER EDUCATION

878,943
890,000

Salaries and Expenses ...............................................................................................................................................
Servicing Activities .....................................................................................................................................................

STUDENT AID ADMINISTRATION

STUDENT FINANCIAL ASSISTANCE

1,960,686
(1,169,686)
(1,169,686)
(791,000)

670,667

Subtotal, Adult education .............................................................................................................................

Current Year appropriations ................................................................................................................
(Forward Funded) ............................................................................................................................
Advance appropriations .......................................................................................................................

656,955
13,712

Total, Career, Technical, and Adult Education ............................................................................................

2,052,598

1,290,019

Subtotal, Career Education ...........................................................................................................................

Adult Education:
State Grants/Adult Basic and Literacy Education:
State Grants, forward funded ..................................................................................................................
National Leadership Activities ...................................................................................................................................

............................
............................
............................
196,324

1,883,309

1,148,604
734,705

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

22,975,352

(5,285)
22,475,352
............................
500,000

(1,932,265)
(1,932,265)
(791,000)

2,723,265

670,667

656,955
13,712

90,000

7,421

1,962,598

1,282,598

Subtotal, Basic State Grants, program level, appropriated in this bill ......................................................

National Programs .............................................................................................................................................

109,956
145,870
13,088
............................

1,868,943

878,943
990,000

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

24,520,352

(5,435)
22,475,352
865,000
1,180,000

(1,244,686)
(1,244,686)
(791,000)

2,035,686

670,667

656,955
13,712

1,365,019

7,421

1,357,598

¥687,579

∂109,956
∂145,870
∂13,088
¥196,324

¥14,366

∂100,000

∂2,102
∂2,789
∂250
............................

¥269,661
∂255,295

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

¥50,000

............................
∂100,000

∂1,545,000

(∂150)
............................
∂865,000
∂680,000
............................

(∂150)
............................
............................
............................

(¥687,579)
(¥687,579)
............................

∂75,000
(∂75,000)
(∂75,000)
............................

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

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

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

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

¥687,579

∂75,000

¥605,000
¥82,579

∂75,000
............................

269

209,288
3,405

Academic Program .....................................................................................................................................................
Endowment Program ..................................................................................................................................................

HOWARD UNIVERSITY

2,475,792

Total, Higher Education ................................................................................................................................

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

76,164
11,800
12,635
10,000
1,090,000
365,000
23,047
50,092
53,000
24,500

Subtotal, International Education and Foreign Language ...........................................................................

Postsecondary Program for Students with Intellectual Disabilities ..........................................................................
Minority Science and Engineering Improvement ........................................................................................................
Tribally Controlled Postsec Voc/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) ...........................................................................................

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

68,103
8,061

209,288
3,405

1,788,634

11,800
150,000
10,000
950,000
............................
............................
............................
15,134
............................

651,700

759,554

Subtotal, Aid for Institutional development ........................................................................................

International Education and Foreign Language:
Domestic Programs ...........................................................................................................................................
Overseas Programs ............................................................................................................................................

324,792
83,995
............................
............................
............................
............................
36,633
9,956

Budget estimate

324,792
83,995
13,197
4,444
18,320
4,444
36,633
9,956

2020 appropriation

Strengthening Historically Black Colleges (HBCUs) .........................................................................................
Strengthening Historically Black Graduate Institutions ...................................................................................
Strengthening Predominantly Black Institutions ..............................................................................................
Asian American Pacific Islander .......................................................................................................................
Strengthening Alaska Native and Native Hawaiian-Serving Institutions .........................................................
Strengthening Native American-Serving Nontribal Institutions ........................................................................
Strengthening Tribal Colleges ...........................................................................................................................
Strengthening HBCU Masters programs ...........................................................................................................

Item

[In thousands of dollars]

213,288
3,405

2,488,157

13,800
15,000
10,195
1,090,000
365,000
23,047
50,092
53,000
17,500

76,164

68,103
8,061

774,359

331,123
85,632
13,454
4,531
18,677
4,531
37,347
10,150

Committee
recommendation

∂122,659

∂14,805

∂76,164
∂2,000
¥135,000
∂195
∂140,000
∂365,000
∂23,047
∂50,092
∂37,866
∂17,500
∂699,523

∂4,000
............................

............................
∂2,000
∂2,365
∂195
............................
............................
............................
............................
............................
¥7,000
∂12,365

∂4,000
............................

∂68,103
∂8,061

∂6,331
∂1,637
∂13,454
∂4,531
∂18,677
∂4,531
∂714
∂194

∂6,331
∂1,637
∂257
∂87
∂357
∂87
∂714
∂194

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

Budget estimate

2020 appropriation

Senate Committee recommendation
compared with (∂ or ¥)

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2020 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL
FOR FISCAL YEAR 2021—Continued

270

240,018
435

Total, Howard University ...............................................................................................................................

COLLEGE HOUSING AND ACADEMIC FACILITIES LOANS PROGRAM ............................................................................

195,877
113,500
............................
56,500
10,818
............................
181,000
7,745

195,877
110,500
56,022
56,500
10,818
33,000
153,000
7,745
160,745
623,462

430,000
............................
430,000
130,000
63,000

Research, Development and Dissemination ...............................................................................................................
Statistics ....................................................................................................................................................................
Regional Educational Laboratories ............................................................................................................................
Research in Special Education ..................................................................................................................................
Special Education Studies and Evaluations ..............................................................................................................
Statewide Data Systems ............................................................................................................................................
Assessment:
National Assessment .........................................................................................................................................
National Assessment Governing Board .............................................................................................................

Subtotal, Assessment ..........................................................................................................................

Total, Institute of Education Sciences .........................................................................................................

DEPARTMENTAL MANAGEMENT
Program Administration:
Salaries and Expenses ......................................................................................................................................
Building Modernization ......................................................................................................................................

Total, Program administration ......................................................................................................................

Office for Civil Rights ................................................................................................................................................
Office of Inspector General ........................................................................................................................................

INSTITUTE OF EDUCATION SCIENCES (IES)

46,484

Total, HBCU Capital Financing Program ......................................................................................................

130,000
68,019

448,723

433,723
15,000

565,440

188,745

40,484

334
46,150

334
40,150

435

240,018

27,325

HBCU Federal Administration .....................................................................................................................................
HBCU Loan Subsidies .................................................................................................................................................

CAPITAL FINANCING PROGRAM ACCOUNT

HISTORICALLY BLACK COLLEGE AND UNIVERSITY (HBCU)

27,325

Howard University Hospital ........................................................................................................................................

130,000
63,000

430,000

430,000
............................

635,462

172,745

165,000
7,745

195,877
110,500
56,022
56,500
10,818
33,000

46,484

334
46,150

435

244,018

27,325

¥16,000
∂70,022

∂12,000
∂12,000

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

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

............................
¥5,019

¥18,723

¥3,723
¥15,000

¥16,000
............................

∂12,000
............................

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

............................
¥3,000
∂56,022
............................
............................
∂33,000

∂6,000

............................
∂6,000

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

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

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

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

∂4,000

∂4,000
............................

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

271

10,000
(2,500)

Current Year appropriations ................................................................................................................
Advance appropriations .......................................................................................................................

COMMITTEE FOR PURCHASE FROM PEOPLE WHO ARE BLIND OR SEVERELY DISABLED ...........................................
(Office of Inspector General) .............................................................................................................................

111
111
111
333
4,998

118,799
50,863
51,355
221,017
314,381
428,510
9,600
4,000
32,500
17,538

Subtotal, Senior Volunteer Corps .........................................................................................................

Subtotal, Domestic Volunteer Service ...........................................................................................................

National and Community Service Programs:
AmeriCorps State and National Grants ............................................................................................................
Innovation, Assistance, and Other Activities ....................................................................................................
Evaluation ..........................................................................................................................................................
National Civilian Community Corps (NCCC)(subtitle E) ...................................................................................
State Commission Support Grants ....................................................................................................................

2,224
............................
............................
22,883
............................

4,665

93,364

13,930
(2,300)

(47,631,492)
(22,597,001)

70,228,493

646,742

Budget estimate

Domestic Volunteer Service Programs:
Volunteers in Service to America [VISTA] .........................................................................................................
National Senior Volunteer Corps:
Foster Grandparents Program ..................................................................................................................
Senior Companion Program ......................................................................................................................
Retired Senior Volunteer Program ............................................................................................................

Operating Expenses

CORPORATION FOR NATIONAL AND COMMUNITY SERVICE

TITLE IV—RELATED AGENCIES

76,361,254
(53,764,253)
(22,597,001)

Total, Title III, Department of Education ......................................................................................................

623,000

2020 appropriation

Total, Departmental management ................................................................................................................

Item

[In thousands of dollars]

460,510
9,600
4,000
33,500
18,538

322,381

229,017

122,799
52,863
53,355

93,364

12,000
(1,650)

(54,254,879)
(22,597,001)

76,851,880

623,000

Committee
recommendation

∂228,684
∂317,383

∂8,000
∂8,000

∂458,286
∂9,600
∂4,000
∂10,617
∂18,538

∂122,688
∂52,752
∂53,244

∂4,000
∂2,000
∂2,000

∂32,000
............................
............................
∂1,000
∂1,000

∂88,699
............................

¥1,930
(¥650)

∂2,000
(∂850)

∂6,623,387
(∂6,623,387)
............................

∂490,626
(∂490,626)
............................

¥23,742

Budget estimate

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

2020 appropriation

Senate Committee recommendation
compared with (∂ or ¥)

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2020 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL
FOR FISCAL YEAR 2021—Continued

272

13,000
¥1,000
12,000

1,104,358

445,000
............................
445,000
465,000
¥445,000
20,000
47,200
17,184
252,000
8,780
12,545
3,350
274,224
14,050
13,225

16,000
¥1,000
15,000
150
123,500
11,000

Total, Corporation for National and Community Service .............................................................................

Appropriation available from fiscal year 2019 advance ...........................................................................................
Rescission ..........................................................................................................................................................

Total, available this fiscal year ...................................................................................................................

Advance appropriation, fiscal year 2023 ..........................................................................................................
Less appropriations provided in prior years .....................................................................................................
Public television interconnection system ..........................................................................................................
FEDERAL MEDIATION AND CONCILIATION SERVICE ....................................................................................................
FEDERAL MINE SAFETY AND HEALTH REVIEW COMMISSION ......................................................................................
INSTITUTE OF MUSEUM AND LIBRARY SERVICES .......................................................................................................
MEDICAID AND CHIP PAYMENT AND ACCESS COMMISSION .......................................................................................
MEDICARE PAYMENT ADVISORY COMMISSION ...........................................................................................................
NATIONAL COUNCIL ON DISABILITY ............................................................................................................................
NATIONAL LABOR RELATIONS BOARD .........................................................................................................................
NATIONAL MEDIATION BOARD .....................................................................................................................................
OCCUPATIONAL SAFETY AND HEALTH REVIEW COMMISSION .....................................................................................

Dual Benefits Payments Account ...............................................................................................................................
Less Income Tax Receipts on Dual Benefits .............................................................................................................

Subtotal, Dual Benefits ................................................................................................................................

Federal Payments to the Railroad Retirement Accounts ...........................................................................................
Limitation on administratiive expenses .....................................................................................................................
Limitation on the Office of Inspector General ...........................................................................................................

RAILROAD RETIREMENT BOARD

CORPORATION FOR PUBLIC BROADCASTING:

208,342
83,737
5,750

National Service Trust ................................................................................................................................................
Salaries and Expenses ...............................................................................................................................................
Office of Inspector General ........................................................................................................................................

150
120,225
11,499

............................
¥445,000
............................
48,600
17,184
23,000
9,265
13,575
3,350
246,876
13,900
13,721

30,000

445,000
¥415,000

91,696

10,000
47,333
4,258

30,105

806,529

Total, Operating expenses ............................................................................................................................

25,107

492,148

Subtotal, National and Community Service ........................................................................................

150
120,225
11,000

12,000

13,000
¥1,000

465,000
¥445,000
20,000
47,200
17,184
257,000
8,780
12,545
3,350
264,224
14,050
13,225

445,000

445,000
............................

1,154,358

213,342
86,237
6,250

848,529

526,148

∂203,342
∂38,904
∂1,992
∂1,062,662

∂5,000
∂2,500
∂500
∂50,000

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

¥3,000

............................
............................
¥499

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

¥3,000
............................

............................
¥3,275
............................

∂465,000
............................
∂20,000
¥1,400
............................
∂234,000
¥485
¥1,030
............................
∂17,348
∂150
¥496

∂415,000
............................
............................
............................
............................
............................
∂5,000
............................
............................
............................
¥10,000
............................
............................

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

............................
∂415,000

∂818,424

∂42,000

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

∂501,041

∂34,000

273

35,682,434

5,447,159
2,833,410
2,700
3,357,204
11,640,473

37,428,000
19,900,000
99,042,889

5,715,042
2,458,514
2,500
2,981,889
11,157,945
130,000
............................

Subtotal, Mandatory ......................................................................................................................................

Advance appropriations, 1st quarter, fiscal year 2022 ............................................................................................

Total, SSI program appropriated in this bill ................................................................................................

OASI/DI Trust Funds ...................................................................................................................................................
HI/SMI Trust Funds .....................................................................................................................................................
Social Security Advisory Board ...................................................................................................................................
SSI ..............................................................................................................................................................................

Subtotal .........................................................................................................................................................

User Fees:
SSI User Fee activities ......................................................................................................................................
CBO adjustment .......................................................................................................................................

Limitation on Administrative Expenses

40,308,177

41,714,889

Subtotal, current year appropriation ............................................................................................................

135,000
¥1,000

95,590,611

19,600,000

60,208,177
¥19,900,000

61,414,889
¥19,700,000

Subtotal, available this fiscal year ..............................................................................................................

55,451,434
45,000
86,000
4,625,743

11,000

Budget estimate

Less appropriations provided from prior year advances ...........................................................................................

56,982,000
45,000
101,000
4,286,889

11,000

2020 appropriation

Federal Benefit Payments ..........................................................................................................................................
Beneficiary Services ...................................................................................................................................................
Research and Demonstration .....................................................................................................................................
Administration ............................................................................................................................................................

Supplemental Security Income Program

Payments to Social Security Trust Funds ..................................................................................................................

SOCIAL SECURITY ADMINISTRATION

Item

[In thousands of dollars]

135,000
¥1,000

11,157,945

5,239,286
2,730,808
2,500
3,185,351

95,418,758

19,600,000

35,682,434

40,136,324

¥19,900,000

60,036,324

55,451,434
45,000
86,000
4,453,890

11,000

Committee
recommendation

............................
¥171,853

¥207,873
¥102,602
¥200
¥171,853

¥300,000
¥3,624,131

¥475,756
∂272,294
............................
∂203,462

∂5,000
¥1,000

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

¥482,528

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

¥1,745,566

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

¥171,853

¥1,578,565

¥171,853
............................

¥1,378,565
¥200,000

............................
............................
............................
¥171,853

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

Budget estimate

¥1,530,566
............................
¥15,000
∂167,001

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

2020 appropriation

Senate Committee recommendation
compared with (∂ or ¥)

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2020 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL
FOR FISCAL YEAR 2021—Continued

274

277,000
1,305,000
1,582,000
(273,000)
(1,309,000)
12,869,945
12,739,945
............................

Subtotal, Program integrity funding .............................................................................................................

Base Program Integrity ........................................................................................................................
Program Integrity (cap adjustment) ....................................................................................................

Total, Limitation on Administrative Expenses ..............................................................................................

Total, Limitation on Administrative Expenses (less user fees) ...................................................................

Special Benefits for WW II Veterans ..........................................................................................................................

70,314,445
61,785,889
(41,885,889)
(19,900,000)
8,528,556
72,706,011
64,030,410
(43,665,410)
(19,900,000)

Total, Title IV, Related Agencies ..................................................................................................................

60,165,849
(40,565,849)
(19,600,000)

68,983,878

60,087,177
(40,487,177)
(19,600,000)
8,672,730

68,759,907

¥4,286,889

Adjustment: Trust fund transfers from general revenues .........................................................................................

Federal funds .......................................................................................................................................
Current year .....................................................................................................................................
New advances, 1st quarter, fiscal year 2022 ................................................................................
Trust funds ..........................................................................................................................................

¥4,625,743

105,500

Total, Office of Inspector General ................................................................................................................

Total, Social Security Administration ...........................................................................................................

116,000

30,000
75,500

33,000
83,000

1,000

13,215,473

13,349,473

(273,000)
(1,302,000)

1,575,000

Federal Funds .............................................................................................................................................................
Trust Funds ................................................................................................................................................................

Office of Inspector General

11,774,473

11,287,945

Subtotal, Limitation on administrative expenses .........................................................................................

Program Integrity:
OASDI Trust Funds ............................................................................................................................................
SSI .....................................................................................................................................................................
306,461
1,268,539

134,000

130,000

Subtotal, User fees ..............................................................................................................................

1,000
¥1,000

SSPA User Fee Activities ...................................................................................................................................
CBO adjustment .......................................................................................................................................

62,199,845
(42,134,845)
(19,600,000)

70,698,170

59,911,324
(40,311,324)
(19,600,000)
8,354,555

68,265,879

¥4,453,890

105,500

30,000
75,500

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

12,732,945

12,866,945

(273,000)
(1,302,000)

1,575,000

306,461
1,268,539

11,291,945

134,000

1,000
¥1,000

∂171,853
¥494,028
¥175,853
(¥175,853)
............................
¥318,175
∂1,714,292
∂2,033,996
(∂1,568,996)
............................

¥2,048,566
¥1,874,565
(¥1,574,565)
(¥300,000)
¥174,001
¥2,007,841
¥1,830,565
(¥1,530,565)
(¥300,000)

¥10,500

¥3,000
¥7,500

¥167,001

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

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

¥1,000

¥482,528

¥7,000
............................

¥482,528

¥3,000

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

............................
(¥7,000)

¥7,000

¥482,528

∂4,000

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

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

∂4,000

∂29,461
¥36,461

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

275

3,400,000
(¥100,000)

(100,000)

Public Health and Social Services Administration (emergency) ...............................................................................
Transfer out (emergency) ..................................................................................................................................

Primary Health Care (by transfer) (emergency) .........................................................................................................

Section 306:
Public Health and Social Services Emergency Fund (transfer out) (emergency) ............................................
Office of the Inspector General (by transfer) (emergency) ..............................................................................

General Provision

Health Resources and Services Administration

Office of the Secretary

(¥2,000)
(2,000)

836,000
(¥10,000)
(10,000)

National Institute for Allergy and Infectious Diseases (emergency) .........................................................................
Transfer out (emergency) ..................................................................................................................................
National Institute of Environmental Health (by transfer) (emergency) .....................................................................

National Institute of Health

2,200,000
(¥300,000)
(300,000)

(465,000)
8,675,601

2020 appropriation

CDC-Wide Activities and Program Support (emergency) ...........................................................................................
Transfer out (emergency) ..................................................................................................................................
Infectious Diseases Rapid Response Reserve Fund (by transfer) (emergency) ........................................................

Centers for Disease Control and Prevention

DEPARTMENT OF HEALTH AND HUMAN SERVICES

CORONAVIRUS PREPAREDNESS AND RESPONSE SUPPLEMENTAL APPROPRIATIONS ACT, 2020
(PUBLIC LAW 116–123 DIV A)

OTHER APPROPRIATIONS

FY 2023 Advance ............................................................................................................................
Trust Funds ..........................................................................................................................................

Item

[In thousands of dollars]

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

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

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

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

............................
8,818,029

Budget estimate

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

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

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

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

(465,000)
8,498,325

Committee
recommendation

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

¥3,400,000
(∂100,000)

(∂2,000)
(¥2,000)

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

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

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

¥836,000
(∂10,000)
(¥10,000)

(¥100,000)

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

(∂465,000)
¥319,704

Budget estimate

¥2,200,000
(∂300,000)
(¥300,000)

............................
¥177,276

2020 appropriation

Senate Committee recommendation
compared with (∂ or ¥)

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2020 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL
FOR FISCAL YEAR 2021—Continued

276

1,250,000

Total, Second Coronavirus Prepardedness and Response Supplemental ....................................................

(1,000,000)

CDC-Wide Activities and program support (by transfer) (emergency) ......................................................................

(306,000)
(500,000)
(1,000,000)
............................

National Cancer Institute (by transfer) (emergency) .................................................................................................
National Institute of Biomedical Imaging and Bioengineering (by transfer) (emergency) .......................................
Office of the Director (by transfer) (emergency) .......................................................................................................

Total, National Institutes of Health ..............................................................................................................

National Institutes of Health

Centers for Disease Control and Prevention

75,000,000
25,000,000
(¥1,000,000)
(¥306,000)
(¥500,000)
(¥1,000,000)
(¥22,000)
(¥600,000)
(¥6,000)

Public Health and Social Services Emergency Fund .................................................................................................
Public Health and Social Services Emergency Fund (emergency) ............................................................................
(Transfer out) (emergency) ................................................................................................................................
(Transfer out) (emergency) ................................................................................................................................
(Transfer out) (emergency) ................................................................................................................................
(Transfer out) (emergency) ................................................................................................................................
(Transfer out) (emergency) ................................................................................................................................
(Transfer out) (emergency) ................................................................................................................................
(Transfer out) (emergency) ................................................................................................................................

Office of the Secretary

DEPARTMENT OF HEALTH AND HUMAN SERVICES

ADDITIONAL EMERGENCY APPROPRIATIONS FOR CORONAVIRUS RESPONSE
(PUBLIC LAW 116–139 DIV B)

1,000,000

250,000

6,436,000

Public Health and Social Services Emergency Fund (emergency) ............................................................................

Office of the Secretary

Aging and Disability Services Programs (emergency) ...............................................................................................

Administration for Community Living

DEPARTMENT OF HEALTH AND HUMAN SERVICES

SECOND CORONAVIRUS PREPAREDNESS AND RESPONSE SUPPLEMENTAL APPROPRIATIONS ACT, 2020
(PUBLIC LAW 116–127 DIV A)

Total, Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020 .........................

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

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

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

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

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

(¥306,000)
(¥500,000)
(¥1,000,000)

(¥1,000,000)

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

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

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

¥1,250,000

¥75,000,000
¥25,000,000
(∂1,000,000)
(∂306,000)
(∂500,000)
(∂1,000,000)
(∂22,000)
(∂600,000)
(∂6,000)

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

¥1,000,000

¥250,000

¥6,436,000

277

(6,000)
100,000,000
(3,412,000)
(¥3,434,000)

Office of the Secretary—Office of the Inspector General (Sec. 103) (by transfer) (emergency) .............................

Total, Additional Emergency Appropriations for Coronavirus Response ......................................................

(By transfer) (emergency) ....................................................................................................................
(Transfer out) (emergency) ..................................................................................................................

15,000
(¥1,000)
(1,000)
15,000
360,000

Salaries and Expenses (emergency) ..........................................................................................................................
(Transfer out) (emergency) ................................................................................................................................
Inspector General (by transfer) (emergency) .............................................................................................................

Total, Department Management ...................................................................................................................

Total, Department of Labor ..........................................................................................................................

Departmental Management

Training and Employment Services ............................................................................................................................

Employment and Training Administration

DEPARTMENT OF LABOR

EMERGENCY APPROPRIATIONS FOR CORONAVIRUS HEALTH RESPONSE AND AGENCY OPERATIONS
(PUBLIC LAW 116–136 DIV B)

General Provisions

345,000

(600,000)

Primary Health Care (by transfer) (emergency) .........................................................................................................

Health Resources and Services

(1,806,000)

2020 appropriation

(By transfer) (emergency) ....................................................................................................................

Item

[In thousands of dollars]

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

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

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

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

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

Budget estimate

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

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

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

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

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

Committee
recommendation

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

¥15,000
¥360,000

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

¥15,000
(∂1,000)
(¥1,000)

¥345,000

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

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

¥100,000,000
(¥3,412,000)
(∂3,434,000)

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

Budget estimate

(¥6,000)

(¥600,000)

(¥1,806,000)

2020 appropriation

Senate Committee recommendation
compared with (∂ or ¥)

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2020 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL
FOR FISCAL YEAR 2021—Continued

278

425,000

Health Surveillance and Program Support (emergency) ............................................................................................

6,274,000

955,000

Total, Administration for Children and Families ..........................................................................................

Aging and Disability Services Programs (emergency) ...............................................................................................

140,388,900

30,750,000

Total, Department of Health and Human Services ......................................................................................

State Fiscal Stabilization Fund (emergency) .............................................................................................................

DEPARTMENT OF EDUCATION

127,289,500

Public Health and Social Services Emergency Fund (emergency) ............................................................................

Office of the Secretary

Administration for Community Living

900,000
3,500,000
1,874,000

Low Income Home Energy Assistance (emergency) ...................................................................................................
Payments to States for the Child Care and Development Block Grant (emergency) ...............................................
Children and Family Services Programs (emergency) ...............................................................................................

Administration for Children and Families

Program Management (emergency) ...........................................................................................................................

Centers for Medicare and Medicaid Services
200,000

945,400

Total, National Institutes of Health ..............................................................................................................

Substance Abuse and Mental Health Services Administration

103,400
706,000
60,000
36,000
10,000
30,000

4,300,000

National Heart, Lung, and Blood Institute (emergency) ............................................................................................
National Institute for Allergy and Infectious Diseases (emergency) .........................................................................
National Institute for Biomedical Imaging and Bioengineering (emergency) ...........................................................
National Center for Advancing Translational Sciences (emergency) ........................................................................
National Library of Medicine (emergency) .................................................................................................................
Office of the Director (emergency) .............................................................................................................................

National Institutes of Health

CDC-Wide Activites and Program Support (emergency) ............................................................................................

Centers for Disease Control and Prevention

DEPARTMENT OF HEALTH AND HUMAN SERVICES

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

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

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

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

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

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

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

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

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

¥425,000

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

¥140,388,900

¥30,750,000

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

¥955,000

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

¥6,274,000

¥127,289,500

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

¥900,000
¥3,500,000
¥1,874,000

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

¥945,400

¥200,000

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

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

¥103,400
¥706,000
¥60,000
¥36,000
¥10,000
¥30,000

¥4,300,000

279

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

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

8,000
7,000
30,925,000

75,000
50,000
5,000

Total, Department of Education ...................................................................................................................

Corporation for Public Broadcasting (emergency) .....................................................................................................
Institute of Museum and Library Services (emergency) ............................................................................................
Railroad Retirement Board:
Limitation on Administrative Expenses (emergency) ........................................................................................

172,103,900

Total, Emergency Appropriations for Coronavirus Health Response and Agency Operation .......................

DEPARTMENT OF LABOR

Bureau of International Labor Affairs (emergency) ...................................................................................................

210,000

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

General Provisions
Assistance (by transfer) (emergency) ........................................................................................................................
Title III of Public Law 116–123 (transfer out) (emergency) ............................................................................

USMCA SUPPLEMENTAL APPROPRIATIONS ACT, 2019

300,000

Limitation on Administrative Expenses (emergency) .................................................................................................

Social Security Administration

RELATED AGENCIES

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

7,000
40,000
13,000

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

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

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

Budget estimate

100,000

2020 appropriation

Safe Schools and Citizenship Education (emergency) ..............................................................................................
Special Institutions for Persons With Disabilities:
Gallaudet University (emergency) .....................................................................................................................
Student Aid Administration (emergency) ...................................................................................................................
Howard University (emergency) ..................................................................................................................................
Departmental Management:
Program Administration (emergency) ................................................................................................................
Office of the Inspector ......................................................................................................................................

Item

[In thousands of dollars]

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

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

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

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

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

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

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

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

Committee
recommendation

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

¥8,000
¥7,000
¥30,925,000

¥75,000
¥50,000
¥5,000

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

¥172,103,900

¥210,000

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

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

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

¥7,000
¥40,000
¥13,000

¥300,000

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

Budget estimate

¥100,000

2020 appropriation

Senate Committee recommendation
compared with (∂ or ¥)

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2020 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL
FOR FISCAL YEAR 2021—Continued

280

1,377,687,948

Grand Total ...................................................................................................................................................

279,999,900

Total, Other Appropriations ...........................................................................................................................

4002 of Public Law 111–148.
2 21st Century CURES Act (Public Law 114–255).

1 Sec.

210,000

Total, USMCA Supplemental Appropriations Act, 2019 ................................................................................

1,156,655,379

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

1,177,669,848

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

............................
............................
∂21,014,469

¥210,000
¥279,999,900
¥200,018,100

281

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