[Senate Report 115-150]
[From the U.S. Government Publishing Office]


                                                       Calendar No. 215
                                                       
 115th Congress }                                           { Report
                                 SENATE
 1st Session    }                                           { 115-150

======================================================================
 
  DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND 
               RELATED AGENCIES APPROPRIATION BILL, 2018
                                _______
                                

               September 7, 2017.--Ordered to be printed

                                _______
                                

           Mr. Blunt, from the Committee on Appropriations, 
                        submitted the following

                                 REPORT

                         [To accompany S. 1771]

    The Committee on Appropriations reports the bill (S. 1771) 
making appropriations for Departments of Labor, Health and 
Human Services, and Education, and related agencies for the 
fiscal year ending September 30, 2018, and for other purposes, 
reports favorably thereon without amendment and recommends that 
the bill do pass.


Amounts to new budget authority

Total of bill as reported to the Senate.................$991,867,000,000
Amount of 2017 appropriations........................... 933,945,868,000
Amount of 2018 budget estimate.......................... 964,663,824,000
Bill as recommended to Senate compared to:
    2017 appropriations................................. +57,921,132,000
    2018 budget estimate................................ +27,203,176,000


                                CONTENTS

                              ----------                              
                                                                   Page

List of Abbreviations............................................     4
Summary of Budget Estimates and Committee Recommendations........     8
    Overview.....................................................     8
    National Institutes of Health................................     8
    Combating Opioid Abuse.......................................     9
    Promoting College Affordability and Completion...............    10
    Improving Fiscal Accountability..............................    11
    Increasing the Efficiency and Cost Effectiveness of 
      Government.................................................    12
    Guidance Documents...........................................    13
    Bill-Wide Directives.........................................    14
    Other Highlights of the Bill.................................    15
Title I: Department of Labor:
    Employment and Training Administration.......................    18
    Employee Benefits Security Administration....................    28
    Pension Benefit Guaranty Corporation.........................    28
    Wage and Hour Division.......................................    29
    Office of Labor-Management Standards.........................    30
    Office of Federal Contract Compliance Programs...............    30
    Office of Workers' Compensation Programs.....................    30
    Occupational Safety and Health Administration................    33
    Mine Safety and Health Administration........................    35
    Bureau of Labor Statistics...................................    35
    Office of Disability Employment Policy.......................    36
    Departmental Management......................................    36
    General Provisions...........................................    39
Title II: Department of Health and Human Services:
    Health Resources and Services Administration.................    41
    Centers for Disease Control and Prevention...................    57
    National Institutes of Health................................    79
    National Institute for Research on Safety and Quality........   105
    Substance Abuse and Mental Health Services Administration....   115
    Agency for Healthcare Research and Quality...................   124
    Centers for Medicare and Medicaid Services...................   126
    Administration for Children and Families.....................   133
    Administration for Community Living..........................   142
    Office of the Secretary......................................   149
    General Provisions...........................................   160
Title III: Department of Education:
    Education for the Disadvantaged..............................   162
    Impact Aid...................................................   164
    School Improvement Programs..................................   165
    Indian Education.............................................   168
    Innovation and Improvement...................................   170
    Safe Schools and Citizenship Education.......................   173
    English Language Acquisition.................................   174
    Special Education............................................   175
    Rehabilitation Services......................................   177
    Special Institutions for Persons With Disabilities:
        American Printing House for the Blind....................   178
        National Technical Institute for the Deaf................   179
        Gallaudet University.....................................   179
    Career, Technical, and Adult Education.......................   179
    Student Financial Assistance.................................   180
    Student Aid Administration...................................   181
    Higher Education.............................................   185
    Howard University............................................   190
    College Housing and Academic Facilities Loans Program........   190
    Historically Black College and University Capital Financing 
      Program Account............................................   191
    Institute of Education Sciences..............................   191
    Departmental Management:
        Program Administration...................................   193
        Office for Civil Rights..................................   194
        Office of the Inspector General..........................   195
    General Provisions...........................................   195
Title IV: Related Agencies:
    Committee for Purchase From People Who Are Blind or Severely 
      Disabled...................................................   197
    Corporation for National and Community Service...............   197
    Corporation for Public Broadcasting..........................   200
    Federal Mediation and Conciliation Service...................   201
    Federal Mine Safety and Health Review Commission.............   201
    Institute of Museum and Library Services.....................   202
    Medicaid and CHIP Payment and Access Commission..............   202
    Medicare Payment Advisory Commission.........................   203
    National Council on Disability...............................   203
    National Labor Relations Board...............................   203
    National Mediation Board.....................................   203
    Occupational Safety and Health Review Commission.............   204
    Railroad Retirement Board....................................   204
    Social Security Administration...............................   205
Title V: General Provisions......................................   209
Compliance With Paragraph 7, Rule XVI of the Standing Rules of 
  the Sen- ate...................................................   211
Compliance With Paragraph 7(c), Rule XXVI of the Standing Rules 
  of the Senate..................................................   211
Compliance With Paragraph 12, Rule XXVI of the Standing Rules of 
  the Senate.....................................................   212
Budgetary Impact of Bill.........................................   216
Comparative Statement of New Budget Authority....................   217

                         LIST OF ABBREVIATIONS

    ACA--Patient Protection and Affordable Care Act
    ACL--Administration for Community Living
    ADAP--AIDS Drug Assistance Program
    AHEC--Area Health Education Center
    AHRQ--Agency for Healthcare Research and Quality
    AP--Advanced Placement
    APH--American Printing House for the Blind
    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
    BLS--Bureau of Labor Statistics
    CAN--Cures Acceleration Network
    CCAMPIS--Child Care Access Means Parents in School
    CCDBG--Child Care and Development Block Grant
    CDC--Centers for Disease Control and Prevention
    CHAFL--College Housing and Academic Facilities Loans
    CHC--Community Health Center
    CHGME--Children's Hospitals Graduate Medical Education
    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
    CSAP--Center for Substance Abuse Prevention
    CSAT--Center for Substance Abuse Treatment
    CSBG--Community Services Block Grant
    CSEOA--Community Service Employment for Older Americans
    DOD--Department of Defense
    DOL--Department of Labor
    DRA--Delta Regional Authority
    EBSA--Employee Benefits Security Administration
    EEOICPA--Energy Employees Occupational Illness Compensation 
Program Act
    ERISA--Employee Retirement Income Security Act of 1974
    ESEA--Elementary and Secondary Education Act
    ETA--Employment and Training Administration
    FDA--Food and Drug Administration
    FEMA--Federal Emergency Management Agency
    FIC--Fogarty International Center
    FIE--Fund for the Improvement of Education
    FIPSE--Fund for the Improvement of Postsecondary Education
    FMCS--Federal Mediation and Coalition Service
    FMSHRC--Federal Mine Safety and Health Review Commission
    FTE--full-time equivalent
    FWS--Federal Work Study
    GAANN--Graduate Assistance in Areas of National Need
    GAO--Government Accountability Office
    GEAR UP--Gaining Early Awareness and Readiness for 
Undergraduate Programs
    HBCUs--Historically Black Colleges and Universities
    HCFAC--Health Care Fraud and Abuse Control
    HEA--Higher Education Act
    HELP--Health, Education, Labor, and Pensions
    HHS--Health and Human Services
    HRSA--Health Resources and Services Administration
    IC--Institute and Center
    IDeA--Institutional Development Award
    IDEA--Individuals with Disabilities Education Act
    IES--Institute of Education Sciences
    IMLS--Institute of Museum and Library Services
    IOM--Institute of Medicine
    LEA--local educational agency
    LIHEAP--Low Income Home Energy Assistance Program
    MACPAC--Medicaid and CHIP Payment and Access Commission
    MCH--Maternal and Child Health
    MedPAC--Medicare Payment Advisory Commission
    MSHA--Mine Safety and Health Administration
    NAEP--National Assessment of Educational Progress
    NAGB--National Assessment Governing Board
    NCATS--National Center for Advancing Transitional Sciences
    NCBDDD--National Center on Birth Defects and Developmental 
Disabilities
    NCES--National Center for Education Statistics
    NCHS--National Center for Health Statistics
    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
    NSIP--Nutrition Services Incentives Program
    NTID--National Technical Institute for the Deaf
    NFP--Not-for-Profit
    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
    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
    ORR--Office of Refugee Resettlement
    ORWH--Office of Research on Women's Health
    OSEP--Office of Special Education Programs
    OSHA--Occupational Safety and Health Administration
    OWCP--Office of Workers' Compensation Programs
    OWH--Office of Women's Health
    PAIMI--protection and advocacy for individuals with mental 
illness
    PATH--Projects for Assistance in Transition From 
Homelessness
    PBGC--Pension Benefit Guaranty Corporation
    PHS--Public Health Service
    PPH Fund--Prevention and Public Health Fund
    PRNS--Programs of Regional and National Significance
    PROMISE--Promoting School Readiness of Minors in SSI
    RSA--Rehabilitation Services Administration
    SAMHSA--Substance Abuse and Mental Health Services 
Administration
    SAPT--Substance Abuse Prevention and Treatment
    SEA--State educational agency
    SEOG--Supplemental Educational Opportunity Grant
    SIG--School Improvement Grants
    SPRANS--Special Projects of Regional and National 
Significance
    SSA--Social Security Administration
    SSBG--Social Services Block Grant
    SSI--Supplemental Security Income
    STEM--science, technology, engineering, and mathematics
    TB--tuberculosis
    TBI--traumatic brain injury
    TIF--Teacher Incentive Fund
    TIVAS--Title IV Additional Servicers
    UAC--unaccompanied alien children
    UCEDD--University Center for Excellence in Developmental 
Disabilities
    UI--unemployment insurance
    USAID--U.S. Agency for International Development
    VETS--Veterans' Employment and Training Services
    VISTA--Volunteers in Service to America
    VR--Vocational Rehabilitation
    WANTO--Women in Apprenticeship and Non-Traditional 
Occupations
    WHD--Wage and Hour Division
    WIA--Workforce Investment Act
    WIOA--Workforce Innovation and Opportunity Act
    WIF--Workforce Innovation Fund
    WISEWOMAN--Well-Integrated Screening and Evaluation for 
Women Across the Nation

       SUMMARY OF BUDGET ESTIMATES AND COMMITTEE RECOMMENDATIONS

    For fiscal year 2018, the Committee recommends total budget 
authority of $969,052,391,000 for the Departments of Labor, 
Health and Human Services, and Education, and Related Agencies. 
This amount includes $164,066,000,000 in current year 
discretionary funding subject to discretionary spending caps 
and $1,896,000,000 in cap adjustments for healthcare fraud and 
abuse control and for program integrity at the Social Security 
Administration, in accordance with the allocation for this 
bill.
    Fiscal year 2017 levels cited in this report reflect the 
enacted amounts in Public Law 115-31, the Consolidated 
Appropriations Act, 2017, adjusted for comparability where 
noted.

                                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, 32 percent of the total in fiscal year 2018. Total 
spending in this bill subject to discretionary spending caps is 
$3,041,000,000 above the comparable fiscal year 2017 level. In 
addition, the bill includes $4,393,000,000 in spending offset 
by savings from changes in mandatory programs, $3,831,900,000 
less than the fiscal year 2017 level. This decreased funding 
level has required the Committee to make difficult funding 
decisions and consider the appropriate role and jurisdiction of 
Federal programs. The priorities and considerations of the 
Committee in developing this bill are summarized in the section 
below:

                     NATIONAL INSTITUTES OF HEALTH

    The Committee recommendation includes $36,084,000,000 for 
the NIH, an increase of $2,000,000,000. Even in a difficult 
funding environment, the Committee believes it is critical to 
prioritize funding for NIH and build on the last 2 years of 
funding increases in a predictable and consistent way. Without 
continued investment in the NIH, we jeopardize our current 
scientific progress, risk losing a generation of scientists, 
and stunt our Nation's global competitiveness.
    The Committee rejects the Administration's proposal to cap 
Facilities & Administrative [F&A] costs for NIH grantees at 10 
percent. While the Committee understands the desire to identify 
budget and administrative savings, F&A costs are not optional; 
they are a fundamental part of doing research. The Committee 
also disagrees with the proposal to eliminate the John E. 
Fogarty International Center and provides funding to maintain 
the Center at NIH. Disease knows no borders. It is critical to 
ensure that NIH continues to have the resources to build 
scientific expertise in developing countries and, as we saw 
with the Zika virus, continue its strong partnerships 
internationally to protect the health and safety of Americans.
    Finally, the Committee recommendation allocates funding to 
areas holding the most promise of scientific advancement, while 
allowing NIH to maintain flexibility to pursue unplanned 
scientific opportunities and address unforeseen public health 
needs. The Committee recommendation is estimated to support 
over 10,600 new and competing grants in fiscal year 2018.
    Alzheimer's Disease.--In 2017, Medicare and Medicaid will 
spend an estimated $175,000,000,000 caring for those with 
Alzheimer's and other dementias, 68 percent of total costs. It 
is 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 more than quadruple. The Committee 
recommendation includes an increase of $414,000,000 for 
Alzheimer's disease research, bringing the total available in 
fiscal year 2018 to approximately $1,828,000,000, a 29.3 
percent increase above fiscal year 2017. Over the last three 
years, specific funding for Alzheimer's disease research has 
increased $1,239,000,000, a 210 percent increase.
    Brain Research through Advancing Innovative 
Neurotechnologies [BRAIN].--The Committee continues to strongly 
support the BRAIN Initiative and provides $400,000,000 in 
fiscal year 2018. This is an increase of $140,000,000 above 
fiscal year 2017. The BRAIN Initiative is developing a more 
complete understanding of brain function and has the 
possibility of helping millions of people who suffer from a 
wide variety of neurological and psychiatric disorders such as 
Parkinson's disease, schizophrenia, Alzheimer's disease and 
dementia, depression, and traumatic brain injury.
    Combating Antibiotic Resistant Bacteria [CARB].--The 
Committee supports efforts to develop new antibiotics and rapid 
diagnostic tests. Given the threat posed by the spread of 
antibiotic resistant bacteria, the recommendation includes 
$513,000,000, an increase of $50,000,000 above fiscal year 
2017.
    Precision Medicine.--The Committee provides $370,000,000, 
an increase of $70,000,000 above fiscal year 2017, for the 
Precision Medicine Initiative. This includes $80,000,000 for 
the National Cancer Institute's precision medicine initiative 
that applies advances in cancer genomics and precision oncology 
to allow physicians to individualize cancer treatments to a 
patient. In addition, $290,000,000 is provided for the All of 
Us study.

                         COMBATING OPIOID ABUSE

    Nearly 2 million American adults have an opioid use 
disorder related to prescription pain relievers, and almost 
600,000 have an opioid use disorder related to heroin. 
According to the Centers for Disease Control and Prevention 
[CDC], the amount of opioids prescribed per person was three 
times higher in 2015 than in 1999, and drug overdose deaths 
have nearly tripled in the last 15 years. Even more troubling, 
prescription opioid abuse is a risk factor for heroin use, 
another form of opioids. Approximately 3 out of 4 new heroin 
users abused prescription opioids before switching to heroin. 
To stop the spread of further opioid abuse, the bill provides 
$816,210,000, an increase of $665,000,000, or 440 percent, 
since fiscal year 2016, in discretionary funding to fight both 
prescription opioid and heroin abuse:
    State Targeted Response to the Opioid Abuse Crisis 
Grants.--The Committee continues to provide $500,000,000 for 
State responses to opioid abuse, for a total of $1,000,000,000 
in the past two fiscal years. The Committee strongly encourages 
the U.S. Department of Health and Human Services [HHS] and the 
Substance Abuse and Mental Health Services Administration 
[SAMHSA] not to change requirements that would require States 
and Territories to reapply for the second year of State grant 
funding. By doing so, States could reduce administrative 
burdens and the Department could focus on promoting effective 
implementation of the already approved plans. The Department is 
directed to brief the Committee on any planned changes for 
fiscal year 2018 at least 30 days prior to any public 
announcement of such changes. Further, the Department is 
directed to brief the Committee quarterly on implementation of 
the program, including detailing obligation of such funding.
    Community Health Centers.--The Committee continues 
$50,000,000 from the prior year for grants to expand services 
for the treatment, prevention, and awareness of opioid abuse. 
This funding will help health centers support 220,000 patients 
with accessing substance abuse services.
    Opioid Prevention Grant.--The Committee includes a new 
$15,000,000 opioid prevention grant targeted to communities and 
community coalitions. The Committee directs SAMHSA to develop 
and distribute evidence-based practices to prevent opioid 
abuse.
    In total, the Department is expected to spend $910,210,000 
in discretionary and mandatory funding for targeted efforts to 
combat opioid abuse in fiscal year 2018. In addition, States 
have access to the Substance Abuse Prevention and Treatment 
Block Grant, funded at $1,858,079,000 in fiscal year 2018. 
Finally, the National Institute on Drug Abuse [NIDA] continues 
its efforts to understand addiction, fund research on 
medications to alleviate pain, support efforts to better 
understand the long-term effects of prescription opioid use, 
and research alternative ways to treat pain. NIDA receives an 
increase of $1,113,442,000 in this act.

             PROMOTING COLLEGE AFFORDABILITY AND COMPLETION

    The Committee recommendation includes a 1.7 percent 
increase in the maximum Pell grant, from a total maximum award 
of $5,920 in the 2017-18 academic year, to $6,020 for the 2018-
19 academic year. This represents the first discretionary 
increase in the maximum Pell grant award in over a decade. The 
maximum Pell grant has increased each year since the 2007-08 
award year, and automatically each year since 2013-14 based on 
increases in the Consumer Price Index, paid for with mandatory 
funding. The automatic increase in the ``mandatory add-on'' 
expires this year and the Committee recommendation ensures the 
maximum Pell grant will continue to increase for the 2018-19 
award year, helping students keep up with rising costs and 
reducing the need for student loans.
    In addition, the Committee recommendation includes more 
than sufficient funding to continue Year-Round Pell, a 
permanent law change included in the Consolidated 
Appropriations Act, 2017. The 2018-19 academic year will be the 
first full year of implementation of Year-Round Pell, which 
will allow students who have exhausted their traditional Pell 
grant award for a given academic year, to receive an additional 
Pell grant if they enroll in coursework for an additional term 
during the same academic year, traditionally the summer. This 
is expected to provide over 900,000 students an additional 
award of over $1,600 for the 2018-19 school year, which will 
help them complete their program faster, enter or re-enter the 
workforce sooner, and graduate with less debt.
    The Committee recommendation also includes new bill 
language restoring the eligibility period for Pell grants for 
those students defrauded by institutions of higher education 
and report language directing the Secretary to take additional 
actions to provide relief from fraudulently issued Federal loan 
debt, including by contacting potentially eligible borrowers.

                    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.
    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 2019 CJ information detailing how 
much funding was spent on advertising in fiscal year 2018.
    Federal Vehicle Fleet Management.--The General Services 
Administration [GSA] issues guidance on Federal fleet 
management, but the Federal vehicle fleet is decentralized, 
with each agency maintaining flexibility to manage vehicle 
utilization as appropriate. To provide greater transparency and 
accountability of funding for Federal vehicles, the Committee 
directs agencies funded in this bill to conduct an annual 
review of fleet utilization during the third quarter of each 
fiscal year. Agencies are directed to provide their Offices of 
Inspectors General [OIGs] with supporting documentation on the 
method used for determining optimal fleet inventories and 
justification for any deviation from GSA's Federal Property 
Management Regulations. OIGs shall be responsible for 
conducting annual audits of fleet management practices and 
making the subsequent results publicly available.
    Public Health Services Act [PHS] Evaluation Transfer.--The 
Committee recommendation continues to ensure that in fiscal 
year 2018, no funds will leave NIH via the transfer required by 
section 241 of the PHS Act.

     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 $745,000,000 for the Health Care Fraud and Abuse 
Control program at CMS. The Committee notes that the latest 
data demonstrates for every new $1 spent on fraud and abuse, $2 
is recovered by the U.S. Treasury.
    Inspectors General.--The Committee recommendation provides 
$350,477,000 for the Inspectors General funded in this act to 
conduct additional audits and investigations of possible waste 
and 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. 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 OIGs unless 
particular electronic systems are clearly and explicitly 
protected from Inspectors General access by statute.
    Preventing Improper Social Security Payments.--The 
Committee recommendation includes $1,735,000,000 for the Social 
Security Administration [SSA] to conduct continuing disability 
reviews and SSI program redeterminations of non-medical 
eligibility and for other program integrity efforts. Combined, 
these activities are estimated to save approximately 
$9,828,000,000 over 10 years in taxpayer dollars by reducing 
waste, fraud, abuse, and improper payments in the Social 
Security, Medicare, and Medicaid programs.
    Taxpayer Accountability.--In recent years, GAO has 
published reports showing as many as 249 areas of potential 
duplication and overlap. Since 2011, GAO has identified 724 
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 
$136,000,000,000 in savings based on these reports, many more 
efficiencies may be realized. The Committee directs each agency 
funded in this bill to report to the Committee, within 1 year 
of enactment of this act, 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. Given the current fiscal 
environment, it is imperative for Government agencies to 
increase efficiencies to maximize the effectiveness of agency 
programs.
    Tribal Coordination.--The Committee directs all Departments 
with American Indian and Alaskan Native specific programs or 
grants to coordinate with the Department of the Interior when 
possible to ensure there is no overlap or duplication of 
funding or services and to enhance the programs' effectiveness.
    Unemployment Insurance Trust Fund Integrity.--The Committee 
provides $130,000,000 for Reemployment Services and Eligibility 
Assessments [RESEA] for fiscal year 2018. 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 reduced the total amount of benefits 
paid from the Unemployment Insurance Trust Fund. The program 
has also shown the benefit of reducing improper payments to 
ineligible claimants, thus helping protect the fiscal solvency 
of the trust fund.

                           GUIDANCE DOCUMENTS

    The Committee continues to note that executive branch 
agencies may, as authorized by the Administrative Procedures 
Act, issue a variety of types of interpretive guidance 
documents that are exempt from the public notice and comment 
process. However, some have raised concerns under the last 
Administration about the use of guidance documents because, 
while such documents are not legally binding, regulated 
entities may interpret them as imposing new legally binding 
requirements. Further, the GAO has found that executive branch 
agencies could improve procedures for approving, disseminating, 
and periodically reviewing guidance documents. For example, 
after a sub-agency in the Department of Labor reviewed its 
guidance to determine if it was relevant and current, the sub-
agency was able to reduce its guidance by 85 percent.
    Consistent with GAO recommendations, the Committee believes 
Departments and agencies funded in this act need to make more 
progress in adhering to and implementing OMB's 2007 ``Final 
Bulletin for Agency Good Guidance Practices,'' which 
establishes policies and procedures for the development, 
issuance, and use of significant guidance documents by 
executive branch departments and agencies.
    The Committee recommends that guidance documents include a 
statement explaining why the agency believes it is appropriate 
to issue guidance about a matter instead of proposing a 
regulation and the specific statutory provisions or 
regulation(s) the guidance is interpreting. The Committee 
further recommends all guidance documents be posted in one 
place on its Web site as well as on the relevant sub-agency Web 
page. This information should be easily accessible for the 
public to comment on guidance. Finally, when appropriate, 
guidance should be sent to the Office of Management and Budget 
for review if it is significant.

                          BILL-WIDE DIRECTIVES

    Children Exposed to Trauma.--The Committee encourages the 
Departments and agencies funded in this bill to enhance 
coordination on activities that address child trauma, including 
data collection and awarding grants. The Committee encourages 
the Departments and agencies to examine practices already 
supported by Federal agencies and solicit public feedback in 
order to identify, recommend, and disseminate best practices 
for the identification, referral, and implementation of trauma-
informed interventions in child and youth-serving settings. The 
Committee further encourages the Departments and agencies to 
promote programs that incorporate trauma-informed best 
practices, including two-generational interventions, 
integration or co-location of mental health services, or 
training front-line service providers in understanding trauma 
and implementing appropriate responses.
    Further, the Committee is interested in the expansion of 
Performance Partnerships to identify strategies to improve the 
effectiveness of and increase opportunities for collaboration 
in Federal programs serving children exposed to trauma. The 
Committee requests that the GAO issue a report to explore the 
potential opportunities for such pilots in this area, including 
identifying significant Federal programs that are commonly used 
to provide services to children exposed to trauma; identifying 
overlapping but varying eligibility rules, allowable uses of 
funds, and other requirements, including reporting 
requirements, in such programs; and identifying barriers or 
challenges commonly faced by organizations receiving funding 
from multiple Federal programs to serve children exposed to 
trauma.
    Congressional Budget Justifications.--Congressional 
justifications are the primary tool used for the Committee to 
evaluate budget requests and resource requirements. The 
Committee expects the fiscal year 2019 congressional 
justifications 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 
2018 and 2019. Specifically, every bill and report number 
included in either the House of Representatives or Senate 
Appropriations bill or report or the final appropriations bill 
or explanatory statement of the fiscal year should be reflected 
within these justifications.
    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 2019 budget. When requesting 
additional resources, reduced funding, or eliminations of 
programs, changes should be outlined with an adequate 
justification. Should the final fiscal year 2018 appropriations 
bill be enacted within a timeframe that does not allow it to be 
reflected within the congressional justifications for fiscal 
year 2019, 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 2018.
    Two Generation Approaches to Poverty Reduction.--The 
Committee is also interested in the expansion of Performance 
Partnerships to identify strategies to increase opportunities 
for collaboration in Federal programs to carry out two-
generational approaches to poverty reduction. The Committee 
requests that GAO issue a report to explore the potential for 
pilots in this area, including identifying significant Federal 
programs that could be used for two-generational approaches to 
poverty reduction; identifying potential opportunities for 
collaboration between such programs; identifying overlapping 
but varying eligibility rules, allowable uses of funds, and 
other requirements, including reporting requirements, in such 
programs; and identifying barriers or challenges commonly 
faced, or potentially faced, by organizations receiving funding 
from multiple Federal programs in implementing two-generation 
approaches to poverty reduction.

                      OTHER HIGHLIGHTS OF THE BILL

    Children's Hospitals Graduate Medical Education [CHGME].--
The Committee recommendation includes $305,000,000 for CHGME, 
an increase of $5,000,000 above fiscal year 2017. This funding 
supports freestanding children's teaching hospitals to provide 
Graduate Medical Education for physicians.
    Community Health Centers [CHC].--The Committee 
recommendation includes $1,491,522,000 for CHC's, level with 
fiscal year 2017. The Committee's recommendation is projected 
to support 26 million patients and continues quality 
improvement activities for more than 1,400 health centers 
operating over 10,400 primary sites.
    Corporation for Public Broadcasting.--The bill continues 
advance funding in the amount of $445,000,000 for the 
Corporation for Public Broadcasting [CPB] and an additional 
$20,000,000 to continue the interconnection project.
    Corporation for National and Community Service.--The 
Committee recommendation includes $386,010,000 for AmeriCorps 
State and National Grants, $30,000,000 for NCCC, $92,364,000 
for VISTA, and $202,117,000 for Senior Corps, all the same as 
the fiscal year 2017 funding levels.
    Domestic Violence and Sexual Assault Programs.--The bill 
includes $5,000,000 for a new initiative to support clinical 
training of sexual assault nurse examiners (including 
registered nurses, nurse practitioners, and nurse midwives) to 
administer medical forensic examinations and treatments to 
victims of sexual assault in hospitals, health centers, and 
other emergency healthcare settings. The bill also includes an 
additional $5,000,000, a 30 percent increase, in the tribal 
set-aside for Family Violence Prevention and Services programs, 
as well as an increase of $5,000,000 to CDC's Rape Prevention 
and Education program. Finally, the bill provides an increase 
of $2,000,000 to the Victims of Trafficking program, which 
provides a variety of services to victims of commercial sex and 
forced labor trafficking.
    Institute for Museum and Library Services [IMLS].--The 
Committee recommendation includes $235,000,000 for IMLS, an 
increase of $4,000,000 above fiscal year 2017. This funding 
supports 123,000 libraries and 35,000 museums, ensuring that 
all Americans have access to essential museum, library, and 
information services.
    Medicare Appeals Backlog.--The Committee continues to be 
concerned that the Office of Medicare Hearing and Appeals 
[OMHA] has a current case backlog of approximately 600,000 
cases. The bill directs $10,000,000 in Recovery Audit 
Contractor [RAC] funds be available to OMHA and the 
Departmental Appeals Board to process RAC-related appeals.
    Rural Health and Telehealth.--The Committee continues to 
prioritize funding for telehealth and the impact it is having 
on access to care for medically underserved and rural 
populations. The Committee recommendation includes $160,560,000 
for Rural Health programs, an increase of $4,500,000 above 
fiscal year 2017. Included in that amount is $21,000,000 for 
the Office for the Advancement of Telehealth [OAT], an increase 
of $2,500,000 above fiscal year 2017.
    Supporting Local Control in Elementary and Secondary 
Education.--The Committee continues to prioritize funding for 
elementary and secondary education programs that provide the 
most flexibility for states, school districts, schools, and 
parents to make education decisions impacting students and 
families.
  --$15,485,210,000, an increase of $25,408,000 for title I 
        grants to LEAs
  --$450,000,000, an increase of $50,000,000 for title IV 
        Student Support and Academic Enrichment Grants
  --$1,340,112,000, an increase of $11,509,000 for Impact Aid
  --$367,172,000, an increase of $25,000,000 for the Charter 
        Schools Program
    Training Assistance to Appalachian Regional Commission 
[ARC] and Delta Regional Authority [DRA] regions.--The bill 
broadens and adapts an initiative within the Dislocated Worker 
National Reserve from the last two fiscal years. The initiative 
is intended to ensure reemployment and training assistance is 
provided to workers dislocated in rural areas of the country 
hit hardest by the recession and recovering more slowly. The 
bill devotes $30,000,000 to assist unemployed workers from any 
industry within the ARC and DRA regions to adapt existing 
skills and learn new ones demanded by growing industries.
    Veterans Employment and Training Service.--The Committee 
includes $284,041,000, an increase of $5,000,000. This amount 
includes funding to expand transition assistance for separating 
service members and to implement the Honoring Investments in 
Recruiting and Employing [HIRE] American Military Veterans Act 
of 2017.
    WIOA State Grants.--The bill includes $2,709,832,000 for 
employment training grants distributed by formula to States 
under the Workforce Innovation and Opportunity Act. These 
grants, which provide tremendous flexibility to State and local 
governments to meet their own unique job training needs, form 
the bedrock of the Federal workforce development effort.
    The Committee recommendation maintains funding for several 
other important programs including:
  --$86,125,000 for the Bureau of International Labor Affairs
  --$2,318,781,000 for Ryan White AIDS Programs
  --$660,000,000 Public Health Emergency Preparedness 
        Cooperative Agreement
  --$562,571,000 for Mental Health Block Grant
  --$3,390,304,000 for the Low Income Home Energy Assistance 
        Program [LIHEAP]
  --$2,856,000,000 for the Child Care and Development Block 
        Grant
  --$9,253,095,000 for Head Start
  --$837,753,000 for Nutrition programs, including Meals on 
        Wheels programs
  --$47,115,000 for the State Health Insurance Program
  --$254,555,000 Hospital Preparedness Program
  --$511,700,000 for Biomedical Advanced Research and 
        Development Authority
  --$510,000,000 for Project BioShield
  --$12,002,848,000 for IDEA Grants to States (Part B, Section 
        611)
  --$1,191,673,000 for 21st Century Community Learning Centers
  --$2,055,830,000 for Supporting Effective Instruction State 
        Grants
  --$1,117,598,000 for Career and Technical Education State 
        Grants
  --$733,130,000 for Supplemental Educational Opportunity 
        Grants
  --$989,728,000 for Federal Work Study
  --$274,224,000 for National Labor Relations Board

                                TITLE I

                          DEPARTMENT OF LABOR

                 Employment and Training Administration

                    TRAINING AND EMPLOYMENT SERVICES

Appropriations, 2017....................................  $3,338,699,000
Budget estimate, 2018...................................   2,053,766,000
Committee recommendation................................   3,335,199,000

    The Training and Employment Services account provides 
funding primarily for activities under the Workforce Innovation 
and Opportunity Act [WIOA], 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 2018 will support the program 
from July 1, 2018, through June 30, 2019. A portion of this 
account's funding, $1,772,000,000, is available on October 1, 
2018, for the 2018 program year.
    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.
    The Committee strongly encourages the Department to 
continue to work with other Federal agencies to align and 
streamline employment and training services. In cases where 
legislation would be required to achieve these goals, the 
President's budget request should include recommendations and 
specific proposals for consolidation of programs.
    The Committee urges the Department to continue and expand 
its efforts in preparing workers for in-demand occupations 
through a coordinated Federal, State, and local strategy. This 
strategy should include close engagement with employers by all 
levels of the workforce development system to ensure that 
provided training services align with the demands of those who 
would hire program participants.
    The Committee encourages the Employment and Training 
Administration [ETA] to expand its collaborative work with the 
Institute for Museum and Library Services to assist in the 
implementation of WIOA to assist States and local boards in 
integrating the education, employment, and training services 
provided by public libraries into the workforce investment 
system. The Committee also encourages ETA to continue to invest 
in building and strengthening partnerships between the one-stop 
system and public libraries by encouraging applicants for 
competitive grant opportunities to collaborate with public 
libraries.
    The Committee continues to believe that the Pay for 
Performance authority under WIOA is a promising, innovative 
approach to using data, evidence, and evaluation to improve 
workforce development outcomes for the most vulnerable 
citizens. The Committee encourages the Department to continue 
to provide technical assistance to States and localities to 
help them utilize Pay for Performance strategies.
    The Committee has been made aware of concerns about 
shortages nationwide of well-trained drinking water and 
wastewater management professionals. Safe and effective water 
utility management is in the national interest. The Committee 
strongly urges the Department to evaluate these concerns and to 
consider innovative ways to address the shortage of trained 
water system management professionals through the WIOA system.
Grants to States
    The Committee recommends $2,709,832,000 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 $815,556,000.
    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.
    Funds are made available in this bill for adult employment 
and training activities in program year 2018, which occurs from 
July 1, 2018, through June 30, 2019. The bill provides that 
$103,556,000 is available for obligation on July 1, 2018, and 
that $712,000,000 is available on October 1, 2018. Both 
categories of funding are available for obligation through June 
30, 2019.
    Youth Training.--For youth training activities, the 
Committee recommends $873,416,000.
    The purpose of this program is to provide low-income youth 
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 2018, 
which occurs from April 1, 2018, through June 30, 2019.
    The Department is directed to carry out an evaluation of 
the use of Youth Activities funds under WIOA to support youth 
in areas with high crime rates. This evaluation should include 
a description of the activities carried out by local workforce 
development boards in high crime areas and the number of youth 
being served in these areas. In addition, it should identify 
successful models for youth workforce development in high crime 
areas. The Department is encouraged to continue pilot or 
demonstration programs that have been demonstrated to be 
effective.
    Dislocated Worker Assistance.--For dislocated worker 
assistance, the Committee recommends $1,020,860,000.
    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 2018, which occurs from July 1, 2018, through June 
30, 2019. The bill provides that $160,860,000 is available for 
obligation on July 1, 2018, and that $860,000,000 is available 
on October 1, 2018. Both categories of funding are available 
for obligation through June 30, 2019.
Federally Administered Programs
    Dislocated Worker Assistance National Reserve.--The 
Committee recommends $220,859,000 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 that 
cannot be otherwise anticipated, 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 2018. The bill provides that 
$20,859,000 is available for obligation on July 1, 2018, and 
that $200,000,000 is available on October 1, 2018. Both 
categories of funding are available for obligation through 
September 30, 2019.
    The Committee bill makes $30,000,000 available for 
obligation on October 1, 2017, through September 30, 2019, to 
provide enhanced dislocated worker training to promote economic 
recovery in the Appalachian and Delta regions. The bill 
rescinds $30,000,000 from fiscal year 2018 Dislocated Worker 
National Reserve advances appropriated in the fiscal year 2017 
act and reappropriates it for this purpose.
    The initiative will include projects for dislocated workers 
within the Delta Regional Authority [DRA] and Appalachian 
Regional Commission [ARC] areas. These regions have been 
particularly hard hit by industrial downsizing and closures, 
and funding is provided to target these underserved areas. The 
Department is strongly urged to engage proactively with 
Workforce Development Boards and other appropriate entities at 
the State and local levels, including those typically involved 
in applying for and administering National Dislocated Worker 
Grants to ensure that they are aware of the availability of the 
targeted funds so they will be sought and utilized promptly and 
effectively to assist workers in areas hardest hit by job loss. 
The Department, DRA, and ARC are directed to jointly brief the 
Committee not later than 90 days after enactment of this Act on 
an operating plan, community engagement, and progress made on 
this program and shall update the Committee quarterly 
thereafter until all funds are expended.
    The Committee recognizes Federal infrastructure investment 
and reorganization, such as the relocation of an agency 
headquarters, can lead to major construction projects in local 
areas. Such projects result in positive regional employment 
opportunities as well as challenges to prepare new workers and 
dislocated workers to fill these jobs. This surge in need for 
job training does not arise from a negative incident like a 
natural disaster or a major industrial layoff, but it results 
in similar workforce preparation needs. In light of these 
ongoing Federal infrastructure investments, the Secretary is 
urged to find innovative ways to enhance workforce training 
capabilities in areas that have the opportunity to train and 
retrain local workforces to meet the construction needs related 
to new Federal investments.
    Indian and Native American Programs.--The Committee 
recommends $50,000,000 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, GED attainment, 
literacy training, English language training, as well as the 
establishment of linkages with remedial education.
    The Committee directs the Department to obligate funding at 
the authorized levels for activities pursuant to section 166(k) 
of subtitle D of title I of the WIOA.
    Migrant and Seasonal Farmworker Programs.--The Committee 
recommends $81,896,000 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, year-round employment within and outside of 
the agriculture industry.
    The Committee recommendation provides that $75,885,000 be 
used for State service area grants. The Committee 
recommendation also includes bill language directing that 
$5,517,000 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 recommendation also includes 
$494,000 to be used for section 167 training, technical 
assistance, and related activities, including funds for migrant 
rest center activities.
    The Committee is concerned by continued labor shortages in 
the agricultural sector. The Committee directs the Department 
to ensure that agricultural worker training programs funded 
under section 167 of WIOA prioritize the development of 
additional and enhanced skills specifically relevant to 
continued agricultural work.
    YouthBuild.--The Committee strongly supports the YouthBuild 
program and recommends $84,534,000 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. YouthBuild helps low-income young people learn 
valuable, marketable job skills by combining educational 
resources, a supportive environment, and real construction 
experience with the successful completion of more than 30,000 
units of affordable housing for low-income communities since 
1994. There are currently over 220 YouthBuild programs across 
the country serving more than 6,000 youth per year.
National Activities
    Reintegration of Ex-Offenders.--The Committee recommends 
$88,078,000 for the Reintegration of Ex-Offenders program. The 
Reintegration of Ex-Offenders 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, opportunities, 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 directs 
the Department to use funding to support efforts in high-crime, 
high-poverty areas and, in particular, communities that are 
seeking to address relevant impacts and root causes of civil 
unrest and high levels of community violence. The Committee 
directs the Department to require grantees to offer training 
and industry-recognized credentials that meet the needs of 
local, high-demand industries and to establish formal 
partnerships and job-placement services with industry 
employers.
    Evaluation.--The bill continues to use a set-aside funding 
mechanism to support the evaluation of employment and training 
programs. Instead of directly providing funds for evaluation, 
the Committee recommendation supports evaluation activities 
through a 0.75 percent set-aside on all training and employment 
programs, including the WIOA formula programs, Job Corps, 
Community Service Employment for Older Americans, the 
Employment Service, and others. The set-aside approach ensures 
that sufficient funding is available to carry out comprehensive 
evaluation and applied research activities.
    ETA will continue to conduct evaluation and applied 
research activities in consultation with the Department's chief 
evaluation officer, who oversees the evaluation program. 
Results will inform policy, advance the Department's mission, 
and improve its performance-based management initiatives.
    Workforce Data Quality Initiative.--The Committee 
recommends $5,000,000 for the Workforce Data Quality 
Initiative. Funds are used to assist States with incorporating 
comprehensive workforce information into longitudinal data 
systems being developed in part with the support of funding 
provided by the Department of Education. The initiative is also 
intended to help improve the quality and accessibility of 
performance data being produced by training providers.
    Apprenticeship Grants.--The recommendation includes 
$95,000,000 for continued support for the apprenticeship 
program that the Committee created in fiscal year 2016. This 
funding shall be for making competitive contracts and to 
continue funding grants to States and industry partnerships. 
The Department is directed to ensure approval of apprenticeship 
opportunities that engage, recruit, and serve women and other 
under-represented populations and local communities that have 
high rates of unemployment and high levels of community 
violence. The Committee also directs the Department to 
collaborate with the Delta Regional Authority to develop a 
targeted apprenticeship and job training program to meet the 
unique needs of underserved rural communities in this region. 
The Committee recognizes the role that sector partnerships play 
in organizing key stakeholders in an industry cluster to 
address the shared goals and human resources needs of the 
industry cluster. The Committee supports the funding and 
development of industry or sector partnerships as a means of 
closing the skills gap and expanding apprenticeships in in-
demand industries. The Department is encouraged to develop a 
nationally-recognized apprenticeship standard to enhance the 
skills and workforce opportunities for water utility related 
jobs. The Committee also notes the Department's proposal to use 
$100,000,000 in high-tech job training funds available under 
the authority of the American Competitiveness and Workforce 
Improvement Act to further expand the program. The Committee 
encourages the Secretary to ensure approval of apprenticeship 
opportunities that are already effective and substantially 
widespread, including, but not limited to, programs certified 
by the National Center for Construction Education and Research 
[NCCER] as Industry-Recognized Apprenticeships.

                               JOB CORPS

Appropriations, 2017....................................  $1,704,155,000
Budget estimate, 2018...................................   1,448,444,000
Committee recommendation................................   1,699,155,000

    The recommendation for operations of Job Corps centers is 
$1,699,155,000, a decrease of $5,000,000 from fiscal year 2017.
    The Committee remains deeply concerned about the issue of 
student safety on Job Corps campuses across the country as well 
as findings by the Department's Office of Inspector General 
[OIG] regarding the enforcement of Job Corps' disciplinary 
policies, potentially exposing students to unsafe environments. 
The Committee recognizes the Department has taken important 
steps toward addressing these issues and strongly urges the 
Department to take fully corrective actions to ensure the 
safety of students and staff.
    The Committee recommendation for administrative costs is 
$32,330,000.
    The Committee also recommends a total of $79,500,000 in 
construction, renovation, and acquisition [CRA] funds, a 
decrease of $5,000,000 from fiscal year 2017. This amount is 
available from July 1, 2018, to June 30, 2020. 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 House and Senate Committees on 
Appropriations at least 15 days in advance of any transfer. The 
Committee expects any notification to include a justification.
    While most Job Corps centers meet or exceed program 
standards, there are some centers that are chronically low-
performing and have remained so despite significant and long-
term Departmental intervention. The Committee expects the 
Department to use WIOA performance measures as the key 
component for developing its methodology for identifying 
centers for closure and to adhere to the process for closing a 
Job Corps center as described in section 159 of WIOA, which 
includes advance announcement to the general public of the 
proposed closure; 30 day comment period for interested parties 
to submit written comments to the Secretary; and notification 
to the Members of Congress who represent the district or State 
in which such center is located. Further, the Committee 
strongly encourages the Department to provide Job Corps 
students enrolled in a closing low-performing center the 
opportunity to transfer to another higher-performing Job Corps 
center. Finally, the Committee requests a detailed description 
of the Department's plan for identifying centers for closure, 
including a definition of a ``low-performing center,'' the 
methodology used for identifying those centers, and a timeline 
for the closure process. The Committee expects to receive this 
information no later than 180 days after the enactment of this 
act or at least 30 days prior to any public notice published in 
the Federal Register.
    The Job Corps program provides disconnected youth with the 
education and job training necessary to successfully enter the 
workforce and earn a living wage. The Committee urges the 
Office of Job Corps to increase recruitment efforts, 
particularly in areas experiencing increased levels of 
community violence.
    Technological limitations can hinder students' preparation 
for the high-tech 21st century college and work environment. 
Therefore, the Committee encourages the Department to utilize 
available funds for upgrading the telecommunications 
infrastructure of Job Corps centers to provide students access 
to online learning and job search tools in appropriate campus 
buildings.
    The Committee urges the Secretary to ensure that Job Corps 
center operators are providing effective professional 
development for their staff. Without consistent and on-going 
training, the quality of services, as well as the safety and 
security of the students and staff, can be compromised. The 
Secretary is encouraged to ensure that adequate contract funds, 
as direct contract allowable costs, are available for center 
instructor training and related travel costs to maintain a high 
level of staff qualifications and student work-based learning 
opportunities. The Department is requested to report within 120 
days of the enactment of this Act, on how professional 
development is provided to center staff by the Office of Job 
Corps and center operators, especially in the areas of safety, 
security, education, and training. Further, the Department is 
requested to report to Congress on the competitiveness of Job 
Corps teacher and instructor salaries, as well as staff 
retention and vacancy rates.
    Funds should not be used to award a new contract for 
operation of a Job Corps center, unless ETA ensures that each 
of the factors listed in section 147(a)(3) of WIOA are applied 
to the procurement process to award a new contract to operate a 
Job Corps center as well as to any decision to restrict 
competition.
    Gulfport Job Corps Center.--The Committee continues to be 
encouraged by the progress made toward rebuilding the Gulfport 
Job Corps Center, including the Memorandum of Agreement signed 
by the Department and the City of Gulfport. The Committee 
expects the Department to complete the Section 106 process, 
complete the design of the new Center, and open request for 
contracts as quickly as possible. Despite transition to a new 
Administration, the Committee expects the Department to remain 
diligently committed to ensuring that the Center is rebuilt and 
able to return to serving the number of young people that it 
once served while, in the meantime, reserving sufficient funds 
for the restoration of the facility consistent with the 
expectations of the Committee. Given that Congress provided 
emergency appropriations for this purpose shortly after the 
damage caused by Hurricane Katrina, the Committee continues to 
direct the Department to prioritize the Gulfport Job Corps 
Center among pending construction cases in the CRA. The 
Committee requests to be updated every 30 days regarding 
progress on this project.

            COMMUNITY SERVICE EMPLOYMENT FOR OLDER AMERICANS

Appropriations, 2017....................................    $400,000,000
Budget estimate, 2018...................................................
Committee recommendation................................     400,000,000

    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 $400,000,000 for CSEOA.

              FEDERAL UNEMPLOYMENT BENEFITS AND ALLOWANCES

Appropriations, 2017....................................    $849,000,000
Budget estimate, 2018...................................     790,000,000
Committee recommendation................................     790,000,000

    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 
program in fiscal year 2018 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

Appropriations, 2017....................................  $3,523,691,000
Budget estimate, 2018...................................   3,213,159,000
Committee recommendation................................   3,462,691,000

    The Committee recommendation includes $3,378,625,000 
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 account is workload 
based, and due to the improving economy, fewer unemployment 
applications are being processed. Therefore less funding is 
required for this purpose as reflected in the bill.
    The Committee recommends a total of $2,651,497,000 for UI 
activities. For UI State operations, the Committee recommends 
$2,637,600,000. Of these funds, the Committee includes 
$130,000,000, an increase of $15,000,000, to expand intensive, 
individualized reemployment assistance and to help address and 
prevent long-term unemployment and reduce improper payments 
through the Reemployment Services and Eligibility Assessments 
[RESEA] initiative.
    As State consortia continue work to modernize their UI 
information technology systems with newly-appropriated fiscal 
year 2017 funds, the Committee expects the Department to 
closely support and oversee the consortia's efforts and to keep 
the Committee on Appropriations informed on how new funds are 
utilized and progress on system development.
    The Committee recommendation includes $6,000,000 for the UI 
Integrity Center of Excellence, including supporting an 
integrated data hub, training modules, and data analytics 
capacity to help States reduce fraud.
    The Committee recommendation provides for a contingency 
reserve amount should the unemployment workload exceed an 
average weekly insured claims volume of 2,246,000.
    The Committee recommends $13,897,000 for UI national 
activities, which will support activities that benefit the 
entire Federal-State UI system, including supporting the 
continuation of IT upgrades and technical assistance.
    For the Employment Service allotments to States, the 
Committee recommends $666,413,000. This amount includes 
$21,413,000 in general funds together with an authorization to 
spend $645,000,000 from the Employment Security Administration 
account of the Unemployment Trust Fund.
    The Committee also recommends $19,818,000 for Employment 
Service national activities. The administration of the work 
opportunity tax credit program accounts for $18,485,000 of the 
recommended amount; the remainder is for technical assistance 
and training to States.
    For carrying out the Department's responsibilities related 
to foreign labor certification activities, the Committee 
recommends $48,028,000. 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, the same as the fiscal year 2017 
enacted level, is available for related State grants.
    The Committee remains concerned about efficient, effective 
management of the H-2B and H-2A programs. Unacceptable 
processing delays in the past two years have degraded the 
effectiveness of the programs for those who depend on them for 
meeting short-term, seasonal surges in demand. Authority was 
included in fiscal year 2017 to utilize H-1B fee receipts 
through fiscal year 2018 to augment processing capacity. This 
short-term authority was intended to prevent excessive labor 
certification and wage determination delays while the 
Department develops improved administrative procedures for the 
longer term. The Committee expects the Department to provide 
timely updates about the use of the fee authority and 
Department's longer-term plans to improve the efficiency of 
these programs.
    In the determination of prevailing wage for the purposes of 
the H-2B program, the Secretary shall accept private wage 
surveys even in instances where Occupational Employment 
Statistics [OES] survey data are available unless the Secretary 
determines that the methodology and data in the provided survey 
are not statistically supported. The bill continues general 
provisions related to enforcement of H-2B regulations.
    Additionally, the Committee has been informed of instances 
in which certain job duties related to seafood processing have 
been categorized by the Department into OES wage rate 
categories that may not accurately reflect the work being 
performed by workers normally placed in that category, 
resulting in inaccurate prevailing wage determinations for many 
seafood workers. Therefore, the Committee strongly urges the 
Department to establish an OES wage rate category for seafood 
processing.
    For one-stop career centers and labor market information, 
the Committee recommends $62,653,000. The Committee includes 
$2,500,000 to finalize the work of the collaborative effort 
with States to reduce unnecessary occupational licensing 
barriers. The Committee included $15,000,000 over the past two 
fiscal years to establish occupational licensing grants for 
State consortia to identify, explore, and address areas where 
licensing requirements create an unnecessary barrier to labor 
market entry or labor mobility across State lines. The 
Committee appreciates the Secretary's support of pursing 
cooperative approaches to enhance reciprocity or portability of 
occupational licenses across State lines. Such agreements would 
significantly ease barriers to opportunity and reemployment for 
thousands of Americans, especially for military spouses, 
dislocated workers, and transitioning service members. The 
Committee directs the Department to report, within 60 days of 
enactment of this Act, on progress and outcomes of the 
occupational licensing portability initiative funded in fiscal 
year 2016 and fiscal year 2017.
    These funds also support system capacity building efforts 
which allow the American Job Center network to respond to the 
needs of the job seekers and businesses in the current economy, 
including the Disability Employment Initiative. When reviewing 
investment alternatives for the Disability Employment 
Initiative in fiscal year 2018, the Committee directs that the 
Department strongly consider needs in rural, underserved States 
especially in cases where meaningful applicant partnerships 
exist with institutions of higher learning and the workforce 
investment system.

        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

Appropriations, 2017....................................    $158,656,000
Budget estimate, 2018...................................     154,265,000
Committee recommendation................................     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, OAA, the Trade Act of 1974, and the National 
Apprenticeship Act. Trust funds provide for the Federal 
administration of employment security, training and employment, 
and executive direction functions.

               Employee Benefits Security Administration


                         SALARIES AND EXPENSES

Appropriations, 2017....................................    $181,000,000
Budget estimate, 2018...................................     183,926,000
Committee recommendation................................     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 ERISA in both civil and 
criminal areas and for enforcement of sections 8477 and 8478 of 
the Federal Employees' Retirement Security Act of 1986. EBSA 
administers an integrated program of regulation, compliance 
assistance and education, civil and criminal enforcement, and 
research and analysis. New authority is provided, as requested, 
making $3,000,000 available through September 30, 2019. These 
funds may be used to facilitate procurement of expert outside 
witnesses for enforcement litigation. The authority will be 
useful in situations where services may be needed for cases 
extending beyond the end of the fiscal year.

                  Pension Benefit Guaranty Corporation

    The Pension Benefit Guaranty Corporation's [PBGC's] 
estimated obligations for fiscal year 2018 include single-
employer benefit payments of $6,770,000,000, multi-employer 
financial assistance of $169,000,000, and consolidated 
administrative expenses of $522,917,000. 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 congressional budget justification.
    Funding requested by PBGC in fiscal year 2017 to 
consolidate three separate headquarters facilities into one 
combined location was provided in full. Therefore requested 
funds are not included for that purpose in fiscal year 2018.
    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, 2019, for every 20,000 
additional participants in terminated plans. The Committee bill 
also continues authority allowing the PBGC additional 
obligation authority for unforeseen and extraordinary pre-
termination expenses, after approval by OMB and notification of 
the Committees on Appropriations of the House of 
Representatives and the Senate.
    The Committee recognizes PBGC's ``Smaller Asset Managers 
Pilot Program'' to ensure that smaller and more diverse 
investment management entities more effectively compete for 
investment allocations. The project, announced in 2015 and now 
underway, provided access to smaller allocations ranging from 
$50,000,000 to $250,000,000, creating new opportunities for 
smaller asset managers to participate. Similarly, several 
States have established programs to encourage greater 
participation by smaller and diverse asset management entities, 
and studies have found that women and minority-owned firms have 
achieved at least comparable performance, both in terms of 
absolute returns and risk-adjusted returns, as the rest of the 
market. The Committee directs the PBGC to provide by December 
31, 2017, an interim update on the performance of the pilot 
program, as well as a written account of additional steps that 
can be explored to expand opportunities for smaller and diverse 
asset management entities.

                         Wage and Hour Division

                         SALARIES AND EXPENSES

Appropriations, 2017....................................    $227,500,000
Budget estimate, 2018...................................     230,068,000
Committee recommendation................................     227,500,000

    The Committee recommends $227,500,000 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 [FLSA], 
employment rights under the Family and Medical Leave Act 
[FMLA], and the Migrant and Seasonal Agricultural Worker 
Protection Act are several of the important laws that WHD is 
charged with administering and/or enforcing.

                  Office of Labor-Management Standards

                         SALARIES AND EXPENSES

Appropriations, 2017....................................     $38,187,000
Budget estimate, 2018...................................      46,634,000
Committee recommendation................................      40,187,000

    The Committee recommends $40,187,000 for the Office of 
Labor-Management Standards [OLMS].
    OLMS administers the Labor-Management Reporting and 
Disclosure Act of 1959 [LMRDA] 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 of Federal Contract Compliance Programs

                         SALARIES AND EXPENSES

Appropriations, 2017....................................    $104,476,000
Budget estimate, 2018...................................      88,000,000
Committee recommendation................................     103,476,000

    The Committee recommends $103,476,000 for the Office of 
Federal Contract Compliance Programs [OFCCP].
    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, and the Vietnam Era Veterans' Readjustment 
Assistance Act of 1974.
    The Committee rejects the budget's proposal to begin plans 
to merge the OFCCP with the Equal Employment Opportunity 
Commission. The Committee strongly urges OFCCP to find 
efficiencies and cost savings, including the consolidation of 
offices, within its current budget structure. This should 
include a review of the current OFCCP office locations and 
infrastructure across the country and whether these offices 
align with current workload needs. OFCCP is directed to report 
to the Committee with an inventory of current infrastructure 
and a plan to consolidate and right-size the agency 180 days 
after enactment of this Act.

                Office of Workers' Compensation Programs

                         SALARIES AND EXPENSES

Appropriations, 2017....................................    $117,601,000
Budget estimate, 2018...................................     115,282,000
Committee recommendation................................     117,601,000

    The Committee recommends $117,601,000 for the Office of 
Workers' Compensation [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], the Longshore and 
Harbor Workers' Compensation Act, the Black Lung Benefits 
programs, and the Energy Employees Occupational Illness 
Compensation Program. In addition, OWCP houses the Division of 
Information Technology Management and Services.

                            SPECIAL BENEFITS

Appropriations, 2017....................................    $220,000,000
Budget estimate, 2018...................................     220,000,000
Committee recommendation................................     220,000,000

    The Committee recommends $220,000,000 for this account. 
This mandatory appropriation, which is administered by OWCP, 
primarily provides benefits under FECA.
    The Committee recommends continuation of appropriations 
language to provide authority to require disclosure of Social 
Security numbers by individuals filing claims under FECA or the 
Longshore and Harbor Workers' Compensation Act and its 
extensions.
    The Committee continues appropriations 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 that 
provides authority to draw such sums as are needed after August 
15 to pay current beneficiaries. Such funds are charged to the 
subsequent year appropriation.
    The Committee recommends continuation of appropriations 
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 
long-standing 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, 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.

               SPECIAL BENEFITS FOR DISABLED COAL MINERS

Appropriations, 2017....................................     $61,319,000
Budget estimate, 2018...................................      54,319,000
Committee recommendation................................      54,319,000

    The Committee recommends a mandatory appropriation of 
$54,319,000 in fiscal year 2018 for special benefits for 
disabled coal miners. This is in addition to the $16,000,000 
appropriated last year as an advance for the first quarter of 
fiscal year 2018, for a total program level of $70,319,000 in 
fiscal year 2018. The decrease in this account below the fiscal 
year 2017 level reflects a declining beneficiary population.
    These mandatory funds are used to provide monthly benefits 
to coal miners disabled by black lung disease and their widows 
and certain other dependents, as well as to pay related 
administrative costs.
    The Committee also recommends an advance appropriation of 
$15,000,000 for the first quarter of fiscal year 2019. These 
funds will ensure uninterrupted benefit payments to coal 
miners, their widows, and dependents.

     DIVISION OF ENERGY EMPLOYEES OCCUPATIONAL ILLNESS COMPENSATION

                         SALARIES AND EXPENSES

Appropriations, 2017....................................     $59,846,000
Budget estimate, 2018...................................      59,846,000
Committee recommendation................................      59,846,000

    The Committee recommends $59,846,000 for the Division of 
Energy Employees Occupational Illness Compensation. This is a 
mandatory appropriation.
    The Division administers the Energy Employees Occupational 
Illness Compensation Program Act [EEOICPA], which provides 
benefits to eligible employees and former employees of the 
Department of Energy [DOE], 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. The Division is part of 
OWCP.
    In fiscal year 2018, the volume of incoming claims under 
part B of EEOICPA is estimated at about 4,977 from DOE 
employees or survivors and private companies under contract 
with DOE, who suffer from a radiation-related cancer, 
beryllium-related disease, or chronic silicosis as a result of 
their work in producing or testing nuclear weapons.
    Under part E, approximately 4,754 new claims will be 
received during fiscal year 2018. Under this authority, the 
Department provides benefits to eligible DOE contractor 
employees who were found to have work-related occupational 
illnesses due to exposure to a toxic substance at a DOE 
facility, or to the employees' survivors.
    The Committee is disturbed by reports that a DOL 
whistleblower charged that DOL's Division of Energy Employees 
Compensation Program thwarted workers' attempts to seek 
compensation by ``writing regulations that made qualification 
much more stringent than Congress intended, failing to disclose 
all the application rules, changing eligibility rules 
midstream, and delaying compensation for years until the sick 
workers died.'' Outside groups also have raised concerns about 
implementation of the program. Therefore, the Secretary shall 
implement changes to assist current and former workers navigate 
the EEOICPA program. The Committee expects these steps to be 
strongly considered: establishing a 1-800 number for current 
and former workers to receive information on the EEOICPA claims 
process, including next steps after a claims is accepted or 
denied, and assistance with completing the Occupational Health 
Questionnaire; developing literature on EEOICPA and the claims 
process, such as frequently asked questions; providing current 
and former workers with a copy of their entire claims file upon 
request in electronic or paper form; allowing Industrial 
Hygienists to contact current or former workers regarding their 
claim; and extending the timeline for current or former workers 
to file an appeal in U.S. District Court from 60 days to 180 
days when a claim is denied.

                    BLACK LUNG DISABILITY TRUST FUND

Appropriations, 2017....................................    $373,041,000
Budget estimate, 2018...................................     415,162,000
Committee recommendation................................     415,162,000

    The Committee bill provides an estimated $415,162,000 as 
requested for this mandatory appropriations account. This 
estimate is comprised of $69,527,000 for administrative 
expenses and an estimated $345,635,000 for benefit payment and 
interest costs.
    The Committee 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 
$38,246,000 for the part C costs of the Division of Coal Mine 
Workers' Compensation Programs; up to $30,595,000 for 
Departmental Management, Salaries and Expenses; and up to 
$330,000 for Departmental Management, Inspector General. The 
bill also allows a transfer of up to $356,000 for the 
Department of the Treasury.
    The Trust Fund pays all black lung compensation/medical and 
survivor benefit expenses when no responsible mine operation 
can be assigned liability for such benefits or when coal mine 
employment ceased prior to 1970, as well as all administrative 
costs that are incurred in administering the benefits program 
and operating the trust fund.

             Occupational Safety and Health Administration

                         SALARIES AND EXPENSES

Appropriations, 2017....................................    $552,787,000
Budget estimate, 2018...................................     543,257,000
Committee recommendation................................     552,787,000

    The Committee recommends $552,787,000 for the Occupational 
Safety and Health Administration [OSHA], which is responsible 
for enforcing the Occupational Safety and Health Act of 1970 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 bill retains language that continues 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 bill also retains 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 $100,850,000 for grants to States 
under section 23(g) of the Occupational Safety and Health Act. 
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 Committee 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 believes that OSHA's compliance assistance 
activities are a critical and underutilized component of a 
comprehensive approach to worker protection. This approach 
includes grants made to various types of organizations 
representing employers and labor organizations for direct 
training of workers on occupational safety and health. OSHA is 
urged to enhance its industry-specific compliance assistance 
efforts, including but not limited to increased informational 
publications and training materials available through its 
website and enhanced consultation services. OSHA is also urged 
to take additional proactive steps to make small businesses and 
contractors more aware of the types of health and safety 
compliance assistance and consultation available from OSHA.
    The Committee recommendation includes $10,537,000 for the 
OSHA Susan Harwood Training Grant Program and directs OSHA to 
dedicate no less than $3,500,000 per year for the purpose of 
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 
[SHARP], or Federal Compliance Assistance, and shall not 
collect any monies from participants for the purpose of 
administering these programs.
    The Committee has created a new capacity-building setaside 
within the Susan Harwood training grant program to improve 
safety training efforts. The Committee directs OSHA to work 
with grantees and applicants under this subsection of the 
program to develop and implement a plan to achieve self-
sufficiency as required by the cited, previous application 
notice. Nothing in this provision should be construed to 
prohibit periodic recompetition of grants.
    The Committee recognizes that fewer injuries mean safer, 
more productive workers and lower worker compensation and 
healthcare costs. Statistical evidence for VPP success is 
impressive. The average VPP worksite has a Days Away Restricted 
or Transferred [DART] case rate of 52 percent below the average 
for its industry. These sites typically do not start out with 
such low rates. Reductions in injuries and illnesses begin when 
the site commits to the VPP approach to safety and health 
management and the challenging VPP application process.

                 Mine Safety and Health Administration

                         SALARIES AND EXPENSES

Appropriations, 2017....................................    $373,816,000
Budget estimate, 2018...................................     375,172,000
Committee recommendation................................     373,816,000

    The Committee recommendation includes $373,816,000 for the 
Mine Safety and Health Administration [MSHA].
    MSHA enforces the Federal Mine Safety and Health Act 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 bill 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 actual 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 is included 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 supports the significant advances MSHA has 
achieved in mine rescue and communications capabilities. To 
prepare properly for an actual mine rescue emergency, the 
Committee directs MSHA to continue to devote sufficient 
resources towards mine rescue technology by fully equipping and 
maintaining the existing MSHA mine rescue stations. Considering 
changes in economic conditions throughout the mining industry 
in recent years, the Committee urges MSHA to provide all 
necessary technical advice regarding mine rescue communications 
to State and private mine rescue teams and to ensure that all 
relevant MSHA grant programs prioritize mine rescue 
communications technology.

                       Bureau of Labor Statistics

                         SALARIES AND EXPENSES

Appropriations, 2017....................................    $609,000,000
Budget estimate, 2018...................................     607,842,000
Committee recommendation................................     609,000,000

    The Committee recommends $609,000,000 for the Bureau of 
Labor Statistics [BLS]. This amount includes $65,000,000 from 
the Employment Security Administration account of the 
Unemployment Trust Fund and $544,000,000 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.
    The Committee urges BLS to take steps to improve 
information it collects and reports related to education 
occupations in career and technical fields. This should include 
expanded sample size, survey question refinement, and enhanced 
analytical capacity for the annual supplement to the Current 
Population Survey [CPS], so it produces better information 
about occupational credentials. The Committee requests BLS to 
provide a report not later than 90 days after enactment of this 
act on the cost and design options for a new survey on 
employer-provided training.

                 Office of Disability Employment Policy

Appropriations, 2017....................................     $38,203,000
Budget estimate, 2018...................................      27,203,000
Committee recommendation................................      38,203,000

    The Committee recommends $38,203,000, the same as fiscal 
year 2017, 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.

                        Departmental Management

                         SALARIES AND EXPENSES

Appropriations, 2017....................................    $334,844,000
Budget estimate, 2018...................................     259,858,000
Committee recommendation................................     336,844,000

    The Committee recommendation includes $336,844,000 for the 
Departmental Management account. Of this amount, $336,536,000 
is available from general funds and $308,000 is available by 
transfer from the Employment Security account of the 
Unemployment Trust Fund. In addition, $30,595,000 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 recommendation includes $86,125,000 for the 
Bureau of International Labor Affairs [ILAB], of which 
$59,825,000 is available for obligation through December 31, 
2018. 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. ILAB will continue to oversee 61 
active grant projects totaling over $316,000,000 in 67 
countries around the world in fiscal year 2018 in addition to 
new grants appropriated in fiscal year 2017 which have not yet 
been awarded.
    ILAB will also continue to publish its annual List of Goods 
Produced by Child or Forced Labor that helps to identify global 
sectors where human trafficking has occurred. Funding for 
international programming to eliminate the worst forms of child 
labor should prioritize comprehensive and sustainable 
initiatives that address the root causes of the problem, 
including lack of education and vocational training 
opportunities; household poverty; lack of data and awareness of 
the scope and impact of the worst forms of child labor; gaps in 
social protection services; and weak enforcement of labor laws, 
which increase the vulnerability of households to the worst 
forms of child labor. ILAB plays an important role in 
identifying and addressing labor violations in U.S. trade 
agreements, and its work leads to greater worker rights and 
protections globally, which helps to ensure that U.S. workers 
compete on a level playing field.
    The Committee recommendation provides $8,040,000 for 
program evaluation and allows these funds to be available for 
obligation through September 30, 2019. 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 Department 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 $23,534,000 for the Office of 
the Assistant Secretary for Administration and Management. The 
reduction reflects the transfer of the Departmental Budget 
Center to the Office of the Chief Financial Officer as 
requested.
    The recommendation includes $35,000,000 for the 
Adjudication activity, level with fiscal year 2017.
    The Committee recommendation provides $12,530,000 for the 
Women's Bureau. The Committee continues bill language allowing 
the Bureau to award grants.

                    VETERANS EMPLOYMENT AND TRAINING

Appropriations, 2017....................................    $279,041,000
Budget estimate, 2018...................................     279,595,000
Committee recommendation................................     284,041,000

    The Committee recommendation of $284,041,000 for the 
Veterans Employment and Training Service [VETS] includes 
$45,000,000 in general revenue funding and $239,041,000 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 $175,000,000 for the Jobs for 
Veterans State Grants [JVSG] program. 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 $18,500,000 for the Transition 
Assistance Program [TAP], an increase of $3,900,000 over fiscal 
year 2017 to support employment workshops at military 
installations and in virtual classrooms worldwide for exiting 
service members and spouses.
    The Committee recommendation includes $42,127,000 for 
Federal administration costs. This funding level will support 
oversight and administration of the VETS grant programs, TAP 
employment workshops, and compliance and enforcement 
activities.
    The Committee recommends $45,000,000 for the Homeless 
Veterans' Reintegration Program [HVRP], level with fiscal year 
2017, to help homeless veterans attain the skills they need to 
gain meaningful employment. This funding will allow DOL to 
provide HVRP services to over 18,000 homeless veterans 
nationwide, including homeless women veterans. The bill allows 
Incarcerated Veterans' Transition funds to be awarded through 
September 30, 2018, and 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 and new authority to facilitate the 
Department's implementation of the Honoring Investments in 
Recruiting and Employing American Military Veterans Act of 
2017.

                  INFORMATION TECHNOLOGY MODERNIZATION

Appropriations, 2017....................................     $18,778,000
Budget estimate, 2018...................................      29,722,000
Committee recommendation................................      18,778,000

    The Committee recommends $18,778,000 for the IT 
Modernization account. Funds available in this account have 
been used for two primary activities. The first is departmental 
support systems, for which $4,898,000 is provided as requested. 
The second activity, IT Infrastructure Modernization, supports 
necessary activities associated with the Federal Data Center 
Consolidation Initiative.

                    OFFICE OF THE INSPECTOR GENERAL

Appropriations, 2017....................................     $87,721,000
Budget estimate, 2018...................................      86,136,000
Committee recommendation................................      87,721,000

    The Committee recommends $87,721,000 for the DOL OIG. The 
bill includes $82,061,000 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 $330,000 is available by transfer from the Black Lung 
Disability Trust Fund.
    Through a comprehensive program of audits, investigations, 
inspections, and program evaluations, OIG attempts 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 $3,850,000,000 and $106,300,000 respectively for 
fiscal year 2016. The Committee strongly supports and commends 
the efforts of the OIG to identify and prosecute those who 
defraud the Department's worker benefit programs and to help 
protect the solvency of these important programs.
    The Committee is disturbed by reports that a DOL 
whistleblower charged that DOL's Division of Energy Employees 
Compensation Program sought to thwart workers' attempts to seek 
compensation. Outside groups also have raised concerns about 
implementation of the program. Therefore, the Office of 
Inspector General shall conduct a comprehensive review of DOL's 
Division of Energy Employees Compensation Program [DEEOIC] to 
determine the impact of policy changes in the past two years 
under the Energy Employees Occupational Illness Compensation 
Program Act [EEOICPA] on workers and the fulfilling of the 
program's statutory mission.

                           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 Innovation and Opportunity Act 
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 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 amends 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 integrity-related 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 after 
the occurrence of a major disaster.
    Section 109. The Committee continues a provision rescinding 
advance appropriations in the Dislocated Workers' National 
Reserve account.
    Section 110. The bill continues a provision that provides 
flexibility with respect to the crossing of H-2B nonimmigrants.
    Section 111. The bill continues a provision related to the 
wage methodology under the H-2B program.
    Section 112. The bill continues a provision regarding the 
three-fourths guarantee and definitions of corresponding 
employment and temporary need for purposes of the H-2B program.
    Section 113. The bill includes a new provision providing 
authority related to the disposition of excess property related 
to the training of apprentices.
    Section 114. The bill includes a new provision providing 
enhanced dislocated worker training resources to support 
economic recovery in the Appalachian and the Delta regions.
    Section 115. The bill includes a new provision related to 
funds available to State Unemployment Insurance information 
technology consortia.

                                TITLE II

                DEPARTMENT OF HEALTH AND HUMAN SERVICES

    Any references in this title of the report 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

    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

Appropriations, 2017....................................  $1,491,522,000
Budget estimate, 2018...................................   1,488,687,000
Committee recommendation................................   1,491,522,000

    The Committee recommendation for the activities of the 
Bureau of Primary Health Care is $1,491,522,000.
Community Health Centers
    The Committee provides $1,491,522,000 in this bill for 
Community Health Centers, equal to the amount provided last 
year.
    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.
    The Committee is supportive of ongoing efforts to expand 
the capacity of community health centers to offer a 
comprehensive, integrated range of services, through strategic 
investment in behavioral health, substance abuse, oral health, 
and other services and capacity. The Committee also recognizes 
the need for capital resources at community health centers to 
meet increased demand and upgrade facilities.
    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 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.
    In addition, within the amount provided, the Committee 
provides up to $99,893,000 under the Federal Tort Claims Act 
[FTCA], 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.
    Native Hawaiian Health Care.--The Committee expects that no 
less than $14,400,000 be provided for the Native Hawaiian 
Health Care Program.
    Perinatal Transmission of Hepatitis B.--The Committee 
appreciates that HRSA has agreed to fund an evaluation of 
intervention strategies to eliminate the perinatal transmission 
of Hepatitis B. This is consistent with the urgings of the 
Committee for the last four fiscal years. The Committee 
recognizes that a full evaluation of intervention strategies 
will require the training of health care professionals, 
followed by service delivery, and data collection. The 
Committee directs that HRSA's funding plans accommodate these 
components and this necessary sequence of activities in order 
to accommodate a full evaluation of the recommended 
intervention strategies.
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 PHS Act.
    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 PROFESSIONS

Appropriations, 2017....................................    $838,695,000
Budget estimate, 2018...................................     382,631,000
Committee recommendation................................     856,195,000

    The Committee recommendation for the activities of the 
Bureau of Health Professions is $856,195,000.
    The Bureau of Health Professions 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.
National Health Service Corps
    The Committee recommendation does not include discretionary 
funding for the National Health Service Corps [Corps]. The 
Committee strongly supports the Corps' long and successful 
record of supporting qualified healthcare providers that are 
dedicated to working in underserved areas with limited access 
to healthcare.
    Nearly 3-in-4 Corps members choose to stay in the area in 
which they serve upon completion of their service, and it is 
essential to ensure that the Committee is supporting the 
creation and development of health care professionals in rural 
areas.
    The Committee recognizes that the Corps is an essential 
tool for recruitment and retention of health professionals at 
community health centers, especially given recent expansions of 
the program. The Committee encourages HRSA to increase the 
proportion of clinicians serving at health centers to improve 
alignment between these two programs and to best leverage 
investments in Corps health professionals. The Committee 
recognizes that the Secretary retains the authority to include 
additional disciplines in the Corps. As such, the Committee 
urges the Secretary to include pharmacists and pediatric 
subspecialists as eligible recipients of scholarships and loan 
repayments through the program.
    The Committee recognizes the importance of the Corps 
scholarship and loan-repayment programs with Corps members in 
all 50 States. The Committee encourages HRSA to ensure that 
States with fewer than ten Corps awardees in the most recent 
fiscal year, will receive at least five awards in that State 
this fiscal year, prioritizing awards to individuals for whom 
that is their home State or to those that received their 
education in that State.
    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.
Training for Diversity
    Minorities in Health Professions.--The Committee 
understands that there is a concern about the supply of 
underrepresented minorities [URM] in health professions. The 
Committee supports more attention be focused on ways to better 
address URM in areas such as pharmacy, medicine, and behavioral 
health and encourages HRSA to emphasize the importance of 
adequate industrial training space with better secured/
controlled access, bacteria free environment and temperature/
humidity control as a means to enhance the academic 
performance, support faculty development and facilitate 
research.
            Centers of Excellence
    The Committee recommends $21,711,000 for the Centers of 
Excellence [COE] Program.
    The Committee recognizes that the COE Program increases the 
supply and competencies of URM in health professions. Funds 
support programs of excellence that enhance the academic 
performance of URM students, support URM faculty development, 
and facilitate research on minority health issues.
            Health Careers Opportunity Program
    The Committee provides $14,189,000 for the Health Careers 
Opportunity Program. This program provides individuals from 
disadvantaged backgrounds who desire to pursue a health 
professions career an opportunity to develop the skills needed 
to successfully compete for, enter, and graduate from schools 
of health professions or allied health professions.
            Faculty Loan Repayment
    The Committee provides $1,190,000 for the Faculty Loan 
Repayment Program. This amount is the same as the fiscal year 
2017 enacted level.
            Scholarships for Disadvantaged Students
    The Committee provides $45,970,000 for Scholarships for 
Disadvantaged Students, equal to the fiscal year 2017 level. 
The Committee supports diversity among health professionals. 
This program provides grants to eligible health professions and 
nursing schools to award scholarships to students from 
disadvantaged backgrounds who have financial need.
            Primary Care Training and Enhancement
    The Committee provides $38,924,000 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.
Training in Oral Health Care
    The Committee provides $36,673,000 for Training in Oral 
Health Care programs, which includes not less than $10,000,000 
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 is pleased that HRSA has restored the 
position of Chief Dental Office [CDO] and looks forward to 
learning how the agency has ensured that the CDO is functioning 
at an executive level authority with resources to oversee and 
lead HRSA oral health programs and initiatives. The Committee 
directs HRSA to provide an update on how the CDO is serving as 
the agency representative on oral health issues to 
international, national, State, and local government agencies, 
universities, and oral health stakeholder organizations in the 
fiscal year 2019 CJ.
    The Nation continues to confront an oral health access 
crisis, which will not be ameliorated without better 
utilization of existing dental providers and exploration of new 
types of licensed dental providers. The Committee urges HRSA to 
convene a stakeholder meeting in order to determine how best to 
create new entry points into the oral health care delivery 
system for rural and other underserved populations, better 
utilization of existing dental personnel, and exploration of 
new types of dental providers.
    The agency is directed to provide continuation funding for 
predoctoral and postdoctoral training grants initially awarded 
in fiscal year 2015, and for Section 748 Dental Faculty Loan 
Program grants initially awarded in fiscal year 2016 with 
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.
Interdisciplinary, Community-Based Linkages
            Area Health Education Centers
    The Committee provides $32,750,000, an increase of 
$2,500,000 for Area Health Education Centers [AHEC]. The 
Committee does not support the administration's proposed 
elimination of AHEC funding.
    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 AHEC grants; and model programs to 
extend AHEC programs with 50 percent Federal funding. The AHEC 
community training model provides a uniquely appropriate 
opportunity to bring the training of community health workers 
to scale. HRSA is encouraged to provide technical assistance on 
and disseminate best practices for training community health 
workers to existing AHECs. The Committee is pleased with AHEC's 
efforts to improve access to quality healthcare in America's 
rural and underserved areas by increasing the number of primary 
healthcare professionals who practice in those areas.
            Geriatric Programs
    The Committee provides $38,737,000 for Geriatric Programs.
    The Committee recognizes the importance of geriatric 
training programs incorporating culturally sensitive training 
programs and encourages HRSA to work to ensure training 
programs are collaborative, interdisciplinary, and culturally 
competent.
            Behavioral Health Workforce Education and Training Program
    The Committee provides $50,000,000 for Behavioral Health 
Workforce Education and Training Program [BHWET]. The BHWET 
Program is focused on developing and expanding the mental 
health and substance abuse workforce serving populations across 
the lifespan. HRSA will continue to leverage SAMHSA's subject 
matter expertise in formatting new investments in fiscal year 
2018.
    The Committee supports the broadened target populations of 
people to be served by the BHWET program. The Committee 
continues to direct that eligible entities for this program 
shall include, but is not limited to, accredited programs that 
train masters and clinical doctoral level social workers, 
psychologists, counselors, marriage and family therapists, 
psychiatric mental health nurse practitioners, occupational 
therapists; psychology interns; and behavioral health 
paraprofessionals.
            Mental and Behavioral Health Education Training Programs
    The Committee provides $9,916,000 for Mental and Behavioral 
Health Education Training Programs. The programs provide grants 
to higher education institutions and accredited training 
programs to recruit and train professionals and faculty in the 
fields of social work, psychology, psychiatry, marriage and 
family therapy, substance abuse prevention and treatment, and 
other areas of mental and behavioral health.
    Graduate Psychology Education Program [GPE].--The Committee 
recognizes the growing need for highly trained behavioral 
health professionals to deliver evidence-based services to 
vulnerable populations, including the elderly, returning 
military veterans, and those suffering from trauma. The GPE 
program is the main Federal initiative dedicated to the 
education and training of psychologists. The Committee urges 
HRSA to explore evidence-based approaches to leverage workforce 
capacity through this program, to invest in geropsychology 
training programs, and to help integrate health service 
psychology trainees at Federally Qualified Health Centers.
            Screening and Treatment for Maternal Depression
    The Committee provides $5,000,000 for a new Screening and 
Treatment for Maternal Depression program as authorized in 
Section 10005 of the 21st Century Cures Act (Public Law 114-
255). 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.
Health Professions Workforce Information and Analysis
    The Committee provides $4,663,000 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.
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 and support 
awards to schools of medicine, osteopathic medicine, public 
health, and integrative medicine programs.
Nursing Workforce Development Programs
    The Committee provides $234,472,000 for Nursing Workforce 
Development programs. These programs provide funding to address 
all aspects of nursing workforce demand, including education, 
practice, recruitment, and retention.
            Advanced Education Nursing
    The Committee recommends $69,581,000 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.
    The Committee notes that in 2015, approximately 400,000 
individuals age 12 or older were reported victims of sexual 
assault according to the Bureau of Justice Statistics. Studies 
have shown that exams performed by sexual assault forensic 
examiners--medical providers trained in collecting and 
preserving forensic evidence--may result in better physical and 
mental health care for victims, better evidence collection, and 
higher prosecution rates. The Committee is concerned that a 
recent GAO report identified major gaps in access to sexual 
assault examinations at hospitals nationwide, including a lack 
of trained sexual assault nurse examiners, or SANEs, whose job 
is to provide uninterrupted compassionate care and to collect 
the evidence critical to successful prosecutions. As such, the 
Committee provides an increase of $5,000,000 to award grants 
for the clinical training of sexual assault nurse examiners to 
administer medical forensic examinations and treatments to 
victims of sexual assault in hospitals, health centers, and 
other emergency health care service provider settings, 
including Federally qualified health centers, clinics receiving 
funding under title X, and other health care providers as 
determined appropriate by the Secretary.
Children's Hospitals Graduate Medical Education
    The Committee provides $305,000,000, an increase of 
$5,000,000, for the Children's Hospitals Graduate Medical 
Education [CHGME] program. 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.
    The Committee recognizes changes made to the program that 
have increased the number of children's teaching hospitals 
eligible to apply for funding. The Committee notes the 
Secretary's use of the authority provided under the current 
authorization to make funding available for hospitals 
previously ineligible for the program, and urges the Secretary 
to continue to make such funding available in future CHGME 
application and funding cycles. The Committee encourages HRSA 
to continue its work with the Children's Hospitals on the 
development and collection of enhanced program performance 
measures.
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, 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

Appropriations, 2017....................................    $848,617,000
Budget estimate, 2018...................................     795,290,000
Committee recommendation................................     848,617,000

    The Committee recommendation for the Maternal and Child 
Health [MCH] Bureau is $848,617,000. The mission of the Bureau 
is to improve the physical and mental health, safety, and well-
being of the Nation's women, infants, children, adolescents, 
and their families. This population includes fathers and 
children with special healthcare needs.
    Virtual Pediatric Trauma Center.--The Committee recognizes 
the importance of a Virtual Pediatric Trauma Center, which 
would provide 24/7 virtual access to critical pediatric acute 
trauma care resources for providers in the United States and 
around the world, for civilian and military purposes. When 
trauma strikes a child, most of them will receive care from a 
surgeon, physician, nurse, or physician-extender with limited 
pediatric trauma experience or be distant from necessary, 
pediatric subspecialties such as pediatric surgery. The 
Committee acknowledges the work that HRSA has undertaken with 
the Uniformed Services University of the Health Sciences to 
cooperatively introduce and develop the concept of a Virtual 
Pediatric Trauma Center. Recognizing the value of the concept 
and the established conceptual framework, the Committee 
requests that HRSA provide an update on the status of the 
Virtual Pediatric Trauma Center model in the fiscal year 2019 
CJ.
Maternal and Child Health Block Grant
    The Committee provides $641,700,000 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 healthcare; addressing 
racial and ethnic disparities; and providing comprehensive care 
through clinics, home visits, and school-based health programs.
    Children's Health and Development.--Evidence shows that 
experiences in early childhood have long-term health 
consequences over the course of a person's life. These 
experiences are critical for a child's educational, social, 
physical, and economic well-being. Children living in States 
with persistently high child poverty rates experience more 
negative health outcomes than their peers elsewhere. Therefore, 
the Committee provides $3,500,000 within the Special Projects 
of Regional and National Significance program for the HRSA-
funded study focused on improving child health through a 
statewide system of early childhood developmental screenings 
and interventions. This funding shall be used to extend the 
currently-funded project for another year.
    Maternal Mortality.--The Committee is aware that many women 
in the United States suffer from maternal morbidity and the 
maternal mortality rate in the United States has more than 
doubled between 1987 and 2013. The Committee directs the 
Maternal and Child Health Bureau to submit a report to the 
Committee, no later than 180 days after the enactment of this 
act, on recommendations to reduce maternal mortality and 
morbidity rates in the United States. The report should include 
information and insights from States gathered through the 
Alliance for Innovation on Maternal Health program and other 
sources.
    Maternal, Infant and Early Childhood Home Visiting 
Program.--The Committee encourages HRSA and the Administration 
for Children and Families to continue their collaboration and 
partnerships to improve health and development outcomes for at-
risk pregnant women, parents, and young children through 
evidence-based home visiting programs.
Sickle Cell Anemia
    The Committee provides $4,455,000 for grants and contracts 
to help coordinate service delivery for individuals with sickle 
cell disease, including genetic counseling and testing; 
training of health professionals; and coordination of 
education, treatment, and continuity of care programs.
Autism and Other Developmental Disorders
    The Committee provides $47,099,000 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 
authorized in the Combating Autism Act of 2006.
    Leadership Education in Neurodevelopmental and Related 
Disabilities [LEND] Programs.--The Committee provides 
$28,990,000 for the LEND program to maintain capacity and 
expand the number of sites to train professionals to diagnose, 
treat, and provide interventions to individuals with autism 
spectrum disorder authorized by the Combating Autism Act. This 
funding will help these programs initiate or expand their work 
in the area of interdisciplinary leadership training to meet 
the needs of children with Autism Spectrum Disorders and 
related developmental disabilities. This funding will also 
enable the LEND network to assist in ongoing developmental 
monitoring, especially for children exposed to lead and other 
environmental toxins and for infants exposed to the Zika virus 
with its resulting complications. In addition, the funding will 
allow these programs to develop innovative strategies to 
integrate and enhance existing investments, including 
translating research findings on interventions, guidelines, 
tools and systems management approaches to training settings, 
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 $13,883,000 for the Newborn 
Heritable Disorders Screening program, as described in section 
1109 of the Newborn Screening Saves Lives Act of 2008. 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 $103,500,000 for the Healthy Start 
infant mortality initiative. 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 $20,162,000 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.

                            HIV/AIDS BUREAU

Appropriations, 2017....................................  $2,318,781,000
Budget estimate, 2018...................................   2,260,008,000
Committee recommendation................................   2,318,781,000

    The Committee recommendation includes $2,318,781,000 for 
the HIV/AIDS Bureau.
    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, which provides a wide 
range of community-based services, including primary and home 
healthcare, case management, substance abuse treatment, mental 
health, and nutritional services.
    Screening for Sexually Transmitted Diseases [STDs].--The 
Committee continues to support HRSA's efforts to include 
screening and treatment for all STDs as a part of the 
comprehensive clinical care provided to HIV infected 
individuals. The Committee encourages HRSA to continue to work 
with CDC's Division of STD Prevention to establish appropriate 
protocols and standards to assure that these screenings are 
fully integrated into grant recipients comprehensive clinical 
care plan.
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.
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 
community-based 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 postdoctoral 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 [DRP] which covers the unreimbursed costs 
of providing dental care to persons living with HIV/AIDS. 
Programs qualifying 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 to improve the retention and health outcomes of 
Ryan White HIV/AIDS Program clients.

                          HEALTH CARE SYSTEMS

Appropriations, 2017....................................    $104,193,000
Budget estimate, 2018...................................      99,351,000
Committee recommendation................................     101,640,000

    The Committee recommendation for the Health Care Systems 
Bureau is $101,640,000.
    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 $23,549,000 for organ donation and 
transplantation activities.
    Funds support a scientific registry of organ transplant 
recipients and the National Organ Procurement and 
Transplantation Network 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.
    Liver Transplant.--The Committee understands that HRSA is 
considering a new proposal to address liver distribution by the 
end of the year. The Committee encourages UNOS and HRSA to 
proceed carefully, taking into consideration all regional 
concerns and available analyses. The Committee directs HRSA, in 
consultation with UNOS, to submit a report the Committee no 
later than 180 days after enactment of this act on the 
following: costs to transplant programs and to liver 
recipients, transportation of livers, and health disparities, 
with a particular focus on its effects among vulnerable 
populations. The report should examine whether these effects 
vary due to a donor or patient's socioeconomic status or rural 
location.
National Cord Blood Inventory
    The Committee provides $12,266,000 for the National Cord 
Blood Inventory. 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.
C.W. Bill Young Cell Transplantation Program
    The Committee provides $22,109,000 for the C.W. Bill Young 
Cell Transplantation Program.
    The Committee continues to support cell transplantation 
through the use of cord blood, bone marrow, peripheral blood 
stem cells, and other sources of stem cells that may be 
available in the future. The Committee appreciates HRSA's 
efforts to increase the diversity of the registry and the 
program's research efforts to improve the availability, 
efficiency, safety, and cost of transplants and the 
effectiveness of program operations.
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.
    The Committee is aware that the 340B statute requires HRSA 
to make 340B ceiling prices available to covered entities 
through a secure Web site and continues to be concerned that 
OPA has failed to meet deadlines to complete work on the secure 
Web site. The Committee urges OPA to complete the development 
of a transparent system to verify the accuracy of the 340B 
discount or ceiling prices.
Poison Control Centers
    The Committee provides $19,846,000, an increase of 
$1,000,000 from fiscal year 2017, 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.
    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 $11,653,000 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 outpatient clinic sites in the continental 
United States and Puerto Rico. The decrease in this account 
below the fiscal year 2017 level reflects a declining 
beneficiary population.
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

Appropriations, 2017....................................    $156,060,000
Budget estimate, 2018...................................      74,395,000
Committee recommendation................................     160,560,000

    The Committee recommendation for Rural Health programs is 
$160,560,000, an increase of $4,500,000 above the fiscal year 
2017 level.
    The Office of Rural Health Policy [ORHP] administers HHS 
rural health programs, coordinates activities related to rural 
healthcare within HHS, and analyzes the possible effects of 
policy on the more than 42 million residents of rural 
communities. ORHP 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 Health Outreach
    The Committee provides $67,500,000 for the Rural Health 
Outreach program, $2,000,000 above the fiscal year 2017 level.
    This program supports projects that demonstrate new and 
innovative modes of outreach in rural areas, such as 
integration and coordination of health services. The Committee 
recommendation provides not more than $12,514,000 for Outreach 
Service Grants; not more than $15,000,000 for Rural Network 
Development Grants; not less than $14,000,000 for Delta States 
Network Grant Program; not more than $2,200,000 for Network 
Planning Grants; and not less than $6,500,000 for Small 
Healthcare Provider Quality Improvement Grants.
    Delta States Rural Development Network Grant Program.--The 
Committee encourages HRSA to continue to consult with the Delta 
Regional Authority [DRA] on the awarding, implementing, 
administering, and monitoring grants under the Delta States 
Network Grant Program in fiscal year 2018. The Committee 
continues to encourage HRSA to align its awards as closely as 
possible with the DRA's strategic plan and with DRA economic 
and community development plans. In addition, of the funds 
provided, the Committee provides $4,000,000 to support HRSA's 
collaboration with the DRA to continue DRA's program to help 
underserved rural communities identify and better address their 
health care needs and to help small rural hospitals improve 
their financial and operational performance. Finally, the 
Committee encourages HRSA to participate and collaborate on 
DRA's Next Health strategic plan for the Delta Region. The 
Committee believes that the information the DRA collects in the 
development of that plan will be of substantial value to HRSA, 
and encourages HRSA to provide support to DRA for the provision 
of that information. Within 90 days of enactment of this act, 
the Committee directs HRSA and DRA to jointly brief the 
Committee on this program's progress.
    Expanding Capacity for Health Outcomes.--The Committee 
notes the passage of Public Law 114-270 supporting Project ECHO 
and the efforts to deliver high-quality, professional care to 
rural and underserved communities. The Committee notes there is 
increasing demand for technical training on Project ECHO and 
encourages HRSA to support a national resource center focused 
on Project ECHO technical training.
Rural Health Research
    The Committee provides $9,351,000 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 $43,609,000 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 better coordinate care among 
rural populations to create better outcomes in chronic disease 
management.
State Offices of Rural Health
    The Committee provides $10,000,000 for State Offices of 
Rural Health. These offices help States strengthen rural 
healthcare delivery systems by enabling them to coordinate care 
and improve support and outreach in rural areas.
Black Lung Clinics
    The Committee provides $7,266,000 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.
     The Committee continues to direct the Secretary to 
evaluate funding levels for applicants based on the needs of 
the populations those applicants will serve and the ability of 
those applicants to provide health care services to miners with 
respiratory illnesses, with preference given to State agency 
applications over other applicants in that State, without 
regard to the funding tiers and overall per-applicant funding 
cap established by the Secretary in fiscal year 2014.
Radiation and Exposure Screening and Education Program
    The Committee provides $1,834,000 for activities authorized 
by the Radiation Exposure Compensation Act. 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 $21,000,000, an increase of 
$2,500,000 above the fiscal year 2017 level, 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 Center of Excellence [COE].--The Committee 
commends HRSA's OAT for providing the requested report to 
Congress and for awarding the Telehealth COE grant during 
fiscal year 2017. Within the funds provided for OAT activities, 
the Committee includes $4,000,000 for a second year of funding 
for the Telehealth COE awarded site. This site is 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, collecting data, and providing relevant telehealth 
training.
    Telehealth Network Grant Program.--The Committee remains 
encouraged by the ability of telehealth services to provide 
access to vital care for patients in underserved areas. One 
very promising area for the expansion of telemedicine is in 
stroke treatment, where patients without access to specialty 
neurological care can significantly improve their standard of 
care through telehealth. Stroke is a leading cause of death but 
remains the major cause of long-term disability, and the speedy 
access to appropriate care is the key factor in determining 
patient mortality and recovery. The Committee encourages HRSA 
to support telestroke initiatives in the Telehealth Network 
Grant Program.
    Telehealth Resource Centers Grant Program.--The Committee 
recognizes the vital role of existing Telehealth Resource 
Centers across the United States to provide support to 
healthcare organizations, providers, and networks. In addition, 
these current centers are an important part of the telehealth 
infrastructure; helping to improve access to healthcare and 
ultimately improve outcomes for underserved populations. The 
Committee recommends that part of OAT funding should be used to 
support increased outreach to providers and communities 
regarding the benefits of telehealth and the availability of 
technical assistance to support its further adoption. The 
Committee supports continued funding of the current 12 regional 
centers and two National centers in fiscal year 2018.

                            FAMILY PLANNING

Appropriations, 2017....................................    $286,479,000
Budget estimate, 2018...................................     286,479,000
Committee recommendation................................     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

Appropriations, 2017....................................    $154,000,000
Budget estimate, 2018...................................     151,993,000
Committee recommendation................................     154,000,000

    The Committee provides $154,000,000 for program management 
activities.

             VACCINE INJURY COMPENSATION PROGRAM TRUST FUND

Appropriations, 2017....................................    $247,750,000
Budget estimate, 2018...................................     277,200,000
Committee recommendation................................     247,750,000

    The Committee provides that $247,750,000 be released from 
the Vaccine Injury Compensation Trust Fund in fiscal year 2018. 
Of that amount, $7,750,000 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 
$7,175,211,000 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], and $800,900,000 in 
transfers from the Prevention and Public Health [PPH] 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

Appropriations, 2017....................................    $794,350,000
Budget estimate, 2018...................................     700,828,000
Committee recommendation................................     794,350,000

    The Committee recommendation for the activities of the 
National Center for Immunization and Respiratory Diseases is 
$794,350,000, which includes $324,350,000 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]
----------------------------------------------------------------------------------------------------------------
                                                            Fiscal year 2017  Fiscal year 2018      Committee
                      Budget activity                         appropriation        request       recommendation
----------------------------------------------------------------------------------------------------------------
Section 317 Immunization Program..........................           606,792           520,828           606,792
    National Immunization Survey (non-add)................            12,864  ................            12,864
Influenza Planning and Response...........................           187,558           180,000           187,558
----------------------------------------------------------------------------------------------------------------

    Cost Estimates.--The Committee looks forward to reviewing 
the fiscal year 2018 report on estimated funding needs of the 
Section 317 Immunization Program and requests that the report 
be updated and submitted not later than February 1, 2018, to 
reflect fiscal year 2019 cost estimates. 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 over the next 
several years.
    Immunizations.--The Committee does not support the proposed 
reduction to the Section 317 Immunization Program by the 
Administration and provides funding at last year's level. The 
Committee believes a strong public health immunization 
infrastructure is critical for ensuring high vaccination 
coverage levels, preventing vaccine-preventable diseases, and 
responding to outbreaks. The Committee acknowledges that 
immunization program investments in Immunization Information 
Systems [IIS] improve data exchange security standards and 
enhance the interface with electronic health records [EHRs] and 
other health information technology systems. IISs inform 
providers and support clinical decision making in terms of a 
patient's immunization status as well as help to identify 
recommended vaccines the patient may not have received, which 
guide public health strategies to reduce vaccine-preventable 
diseases. During the 2015 multi-State measles outbreak and the 
ongoing, multi-State mumps outbreaks, funds from this program 
supported State and local health departments in rapid response, 
public health communication, community outreach and education, 
data gathering, and laboratory testing.

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

Appropriations, 2017....................................  $1,117,278,000
Budget estimate, 2018...................................     934,000,000
Committee recommendation................................   1,117,278,000

    The Committee recommendation for the activities of the 
National Center for HIV, Viral Hepatitis, Sexually Transmitted 
Diseases [STDs], and TB Prevention is $1,117,278,000.
    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]
----------------------------------------------------------------------------------------------------------------
                                                            Fiscal year 2017  Fiscal year 2018      Committee
                      Budget activity                         appropriation        request       recommendation
----------------------------------------------------------------------------------------------------------------
Domestic HIV/AIDS Prevention and Research.................           788,712           640,065           788,712
    HIV Prevention by Health Department...................           397,161               N/A           397,161
    HIV Surveillance......................................           119,861               N/A           119,861
    Activities to Improve Program Effectiveness...........           103,208               N/A           103,208
    National, Regional, Local, Community & Other                     135,401               N/A           135,401
     Organizations........................................
    School Health.........................................            33,081               N/A            33,081
Viral Hepatitis...........................................            34,000            33,935            34,000
Sexually Transmitted Infections...........................           152,310           130,000           152,310
Tuberculosis..............................................           142,256           130,000           142,256
----------------------------------------------------------------------------------------------------------------

    Hepatitis B.--The Committee is concerned that even with a 
Hepatitis B vaccine that is 95 percent effective, CDC estimates 
that there are at least 850,000 Americans infected with 
Hepatitis B, with an estimated 21,900 infections occurring in 
2015. The Committee notes that as a result of the opioid 
epidemic, infections are on the rise, with significant spikes 
in those areas that suffer from widespread opioid abuse. 
Additionally, the Committee highlights that the link between 
hepatitis B infection and primary liver cancer is well 
established with up to 15 percent of liver cancer cases in the 
United States caused by HBV. Many of these liver cancer cases 
are preventable with early detection, treatment, and 
vaccination. The Committee encourages CDC to prioritize the 
acceleration of Hepatitis B interventions within its Viral 
Hepatitis program commensurate with its disease burden.
    Hepatitis C.--The Committee recognizes the rising rates of 
hepatitis C virus [HCV] infection among American Indians [AI] 
and Alaska Natives [AN], which surpasses many other 
populations. The Committee encourages CDC to work in 
collaboration with the Indian Health Service to support 
increased prevention, HCV screening, and access to treatment 
for AI and AN tribes.
    HIV Screening.--The Committee continues to support CDC 
grant programs that work to improve awareness of HIV status and 
linkage to care. The Committee requests an update in the fiscal 
year 2019 CJ on CDC action to improve testing rates and reduce 
late stage diagnosis in States that scored low on these 
measures of effectiveness.
    Sexually Transmitted Infections [STIs].--The Committee 
encourages CDC to sustain public health infrastructure, support 
surveillance, and continue initiatives to address STI 
elimination with a special focus on congenital syphilis, 
gonorrhea disease reduction, and the use of technology to reach 
at-risk populations.
    Viral Hepatitis Screening.--The Committee continues to 
support hepatitis screening activities and encourages CDC to 
prioritize screening programs in medically-underserved and 
minority communities. Point-of-care testing allows for 
utilization of effective and innovative screening technology in 
a variety of health care settings.

               EMERGING AND ZOONOTIC INFECTIOUS DISEASES

Appropriations, 2017....................................    $584,922,000
Budget estimate, 2018...................................     514,000,000
Committee recommendation................................     584,922,000

    The Committee recommendation for the activities of the 
National Center for Emerging and Zoonotic Diseases is 
$584,922,000, which includes $52,000,000 in transfers from 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]
----------------------------------------------------------------------------------------------------------------
                                                            Fiscal year 2017  Fiscal year 2018      Committee
                      Budget activity                         appropriation        request       recommendation
----------------------------------------------------------------------------------------------------------------
Core Infectious Diseases..................................           396,350           379,684           396,350
    Antibiotic Resistance Initiative......................           163,000           137,000           163,000
    Lab Safety and Quality................................             8,000             7,985             8,000
    Vector-borne Diseases.................................            26,410            38,816            26,410
    Lyme Disease..........................................            10,700            10,643            10,700
    Prion Disease.........................................             6,000  ................             6,000
    Chronic Fatigue Syndrome..............................             5,400  ................             5,400
    Emerging Infectious Diseases..........................           147,000           155,457           147,000
    All Other Infectious Diseases.........................            29,840            29,783            29,840
Food Safety...............................................            54,000            51,901            54,000
National HealthCare Safety Network........................            21,000            20,960            21,000
Quarantine................................................            31,572            31,512            31,572
Advanced Molecular Detection..............................            30,000            29,943            30,000
Epidemiology and Lab Capacity Program.....................            40,000  ................            40,000
Healthcare-Associated Infections..........................            12,000  ................            12,000
----------------------------------------------------------------------------------------------------------------

    Catheter Associated Urinary Tract Infections.--Each year, 
hospital-acquired, catheter-associated urinary tract infections 
[CAUTIs] result in the death of 15,000 patients. When CDC's 
Healthcare Infection Control Practices Advisory Committee last 
updated its guidelines for prevention of CAUTIs in 2009, it 
recommended additional research on the use of urinary stents to 
reduce infection. The Committee encourages CDC to examine 
existing evidence regarding the use of stents to address CAUTIs 
and issue appropriate communications to hospitals, up to and 
including an update to its 2009 Guidelines.
    Combating Antibiotic Resistant Bacteria [CARB].--The 
Committee continues to support the CARB initiative and provides 
$163,000,000 for this effort. The Committee recognizes the 
importance of addressing antibiotic-resistant bacteria through 
a ``One Health'' approach, simultaneously combating antibiotic 
resistance in human, animal, and environmental settings. The 
Committee encourages CDC to competitively award research 
activities that address aspects of antibiotic resistance 
related to ``One Health'' among entities, including public 
academic medical centers, veterinary schools with agricultural 
extension services, and State public health departments whose 
proposals are in line with CDC's strategy for addressing 
antibiotic resistant bacteria. CDC shall include an update on 
these efforts in the fiscal year 2019 CJ.
    Healthcare-Associated Infections [HAIs].--The Committee 
acknowledges CDC has made significant progress on HAIs 
prevention and data collection at acute-care hospitals, but 
gaps in data collection and reporting on HAIs 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.
    Lyme Disease and Related Tick-Borne Illnesses.--The 
Committee 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. 
CDC should work closely with States to advance the use of 
Integrated Pest Management for prevention and control of tick-
borne diseases. The Committee encourages CDC to coordinate with 
NIH, NIMH, and NINDS on publishing reports that assess 
diagnostic advancements, methods for prevention, the state of 
treatment, and links between tick-borne disease and psychiatric 
illnesses. Further, the Committee is concerned by reports that 
cases of Lyme disease are under-reported and encourages CDC to 
re-evaluate surveillance criteria used to track cases of the 
disease while assisting States to more accurately evaluate 
prevalence. The Committee requests a report within 180 days of 
enactment of this act on how CDC is examining the potential 
misuse of the Lyme disease case definition. The report should 
also include updates on the implementation of the Lyme disease 
program, including advancing more sensitive diagnostic tests 
and details of how Lyme disease funds were spent in fiscal year 
2017.
    Responding to Emerging Threats.--The Committee maintains 
funding for the Epidemiology and Laboratory Capacity [ELC] 
Infectious Diseases Program which strengthens the epidemiologic 
and laboratory capacity in 50 States, six local health 
departments, and eight territories. This funding provides 
critical support to epidemiologists and laboratory scientists 
who are instrumental in discovering and responding to various 
food and vector-borne outbreaks. The Committee provides funding 
for ELC grants to sustain core surveillance capacity and ensure 
that State and local epidemiologists are equipped to respond 
rapidly to emerging threats including antimicrobial resistant 
superbugs and the Zika virus.
    Sepsis.--The Committee is encouraged that CDC has addressed 
sepsis as a priority within the CARB initiative and has also 
improved its online sepsis awareness and prevention resources. 
The Committee supports CDC's goals to scale up the evaluation 
of sepsis surveillance to help track national sepsis rates, 
assess the impact of prevention and treatment initiatives, and 
enable comparisons between health care facilities to identify 
problem areas. In addition, the Committee encourages CDC to 
continue to monitor the effectiveness of State-based sepsis 
prevention and treatment protocols.
    Urinary Tract Infections.--The Committee notes that UTIs 
are one of the most common diagnoses leading to antibiotic 
prescriptions. Since recent research indicates that E. coli and 
other leading causes of UTIs are becoming resistant to many 
antibiotics, the Committee encourages CDC to examine the role 
that nutrient-dense food products, such as cranberries, may 
play in reducing the risk of illness and recurrent infections. 
The Committee also requests that CDC provide an update on this 
effort and actions to address antibiotic resistant pathogens 
linked to UTI in its fiscal year 2019 CJ.
    Vector-Borne Diseases.--The Committee requests a report 180 
days after enactment of this act that details how CDC worked 
and is continuing to work with the States most vulnerable to 
Zika and other vector-borne diseases. Further, the Committee 
encourages CDC to provide a progress update in the fiscal year 
2019 CJ on meeting goals and performance indicators to prevent 
new infections, improve health outcomes, and reduce disease-
related disparities.
    Zika Virus.--The Committee continues to support CDC's 
preparedness and response efforts to control outbreaks of Zika 
virus infection. The Committee encourages CDC to examine 
innovative vector control technologies to enhance current 
vector-borne disease control efforts. CDC should continue to 
work closely with the vector control unit in Puerto Rico and 
the most vulnerable States to address not only basic 
surveillance and research but also the use of new approaches to 
limit the spread of infected mosquitoes through innovative 
vector control technologies which can be effective in 
environments and locations not amenable to traditional 
pesticides.

            CHRONIC DISEASE PREVENTION AND HEALTH PROMOTION

Appropriations, 2017....................................  $1,115,596,000
Budget estimate, 2018...................................     952,250,000
Committee recommendation................................   1,065,146,000

    The Committee recommendation for the activities of the 
National Center for Chronic Disease Prevention and Health 
Promotion is $1,065,146,000, which includes $247,550,000 in 
transfers from the PPH Fund.
    The mission of the National Center for Chronic Disease 
Prevention 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; such diseases account for nearly 70 
percent of all U.S. deaths and three-quarters of all healthcare 
costs in the United States.
    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 2017. The Committee believes the 
existing funding structure allows for the greatest 
transparency, accountability, and measured outcomes for 
Congress and the taxpayer. Chronic diseases, such as arthritis, 
cancer, diabetes, heart disease, stroke, and obesity are the 
leading causes of death and disability in the United States and 
account for 86 cents of every dollar spent on health care. 
Therefore, a robust investment in the prevention and control of 
chronic diseases, including chronic conditions like Alzheimer's 
disease, epilepsy, lupus, and colorectal, prostate, and skin 
cancers is essential to curb health spending and improve health 
and quality of life for millions of Americans.
    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]
----------------------------------------------------------------------------------------------------------------
                                                            Fiscal year 2017  Fiscal year 2018      Committee
                      Budget activity                         appropriation        request       recommendation
----------------------------------------------------------------------------------------------------------------
Tobacco...................................................           205,000  ................           205,000
Nutrition, Physical Activity and Obesity..................            49,920  ................            49,920
    High Obesity Rate Counties (non-add)..................            10,000  ................            10,000
School Health.............................................            15,400            15,371            15,400
Health Promotion..........................................            14,025             3,493            14,025
    Glaucoma..............................................             3,300  ................             3,300
    Visual Screening Education............................               525  ................               525
    Alzheimer's Disease...................................             3,500             3,493             3,500
    Inflammatory Bowel Disease............................               750  ................               750
    Interstitial Cystitis.................................               850  ................               850
    Excessive Alcohol Use.................................             3,000  ................             3,000
    Chronic Kidney Disease................................             2,100  ................             2,100
Prevention Research Centers...............................            25,461  ................            25,461
Heart Disease and Stroke..................................           130,037  ................           130,037
Diabetes..................................................           140,129  ................           140,129
National Diabetes Prevention Program......................            22,500            19,962            22,500
Cancer Prevention and Control.............................           356,674           337,424           356,674
    Breast and Cervical Cancer............................           210,000           210,000           210,000
        WISEWOMAN (non-add)...............................            21,120            21,120            21,120
    Breast Cancer Awareness for Young Women...............             4,960             4,960             4,960
    Cancer Registries.....................................            49,440            49,346            49,440
    Colorectal Cancer.....................................            43,294  ................            43,294
    Comprehensive Cancer..................................            19,675            67,143            19,675
    Johanna's Law.........................................             5,500             5,500             5,500
    Ovarian Cancer........................................             8,000  ................             8,000
    Prostate Cancer.......................................            13,205  ................            13,205
    Skin Cancer...........................................             2,125  ................             2,125
    Cancer Survivorship Resource Center...................               475               475               475
Oral Health...............................................            18,000            17,000            18,000
Safe Motherhood/Infant Health.............................            46,000            46,000            46,000
Arthritis and Other Chronic Disease.......................            25,500            13,000            26,000
    Arthritis.............................................            11,000               N/A            11,000
    Epilepsy..............................................             8,500               N/A             8,500
    National Lupus Registry...............................             6,000               N/A             6,500
Racial and Ethnic Approach to Community Health............            50,950  ................  ................
Million Hearts............................................             4,000  ................             4,000
National Early Child Care Collaboratives..................             4,000  ................             4,000
Hospitals Promoting Breastfeeding.........................             8,000  ................             8,000
America's Health Block Grant..............................  ................           500,000  ................
----------------------------------------------------------------------------------------------------------------

    Alzheimer's and Healthy Aging.--The Committee includes 
$3,500,000 for activities related to Alzheimer's disease and 
commends the Healthy Brain Initiative for its leadership in 
bringing attention to the public health crisis of Alzheimer's 
disease. The Committee encourages CDC to continue implementing 
the action steps listed in the updated Road Map, including 
working towards a consensus on the mortality burden of the 
disease.
    Breast and Cervical Cancer Screening.--The Committee 
encourages CDC to continue to strengthen access to preventive 
screenings for women who are uninsured or underinsured and at 
high risk for breast and cervical cancer through the Breast and 
Cervical Cancer program. Of women aged 21-64, 5,700,000 or 14.6 
percent, will remain eligible for cervical cancer screening 
through this program.
    Cancer Survivorship.--Recognizing there are nearly 15 
million cancer survivors in the United States, the Committee 
encourages CDC to invest in evidence-based physical activity 
and wellness programs for cancer survivors. Evidence-based 
physical activity programs have been shown to improve 
survivors' overall quality of life, increase cardiovascular 
endurance, decrease cancer-related fatigue, and help them meet 
or exceed recommended amounts of physical activity.
    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 fully supports the use of funds 
provided to CDC through this act for activities that the agency 
has identified as being necessary to link representative data 
to effective, sustainable, and scalable action and thus ensure 
that: (1) the percentage of children achieving age-appropriate 
growth and developmental milestones is increased; (2) the 
percentage of children living outside of family care is 
reduced; and (3) the percentage of children experiencing 
violence, exploitation, abuse, and neglect is reduced. The 
Committee continues to direct CDC to collaborate with USAID, 
PEPFAR, and the Department of Labor 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 Fatigue Syndrome.--The Committee applauds CDC's 
efforts to collaborate with disease experts in its multi-site 
study to resolve the case definition issues and urges CDC to 
complete that effort. The Committee encourages CDC to partner 
with other HHS agencies, disease experts, and key medical 
societies to implement a proactive dissemination plan that 
counters medical misinformation and stigma and addresses other 
key barriers to clinical care.
    Chronic Pain.--The Committee commends CDC for including 
chronic pain in the Healthy People 2020 initiative. The 
Committee encourages CDC to analyze data collected from the 
chronic pain questions included in the 2017 National Health 
Interview Survey and to clarify the incidence and prevalence of 
various pain syndromes differentiated by patient age, 
comorbidities, socioeconomic status, race, and gender. The 
Committee further encourages CDC to collect data on direct and 
indirect costs of pain treatment and effectiveness of evidence-
based treatment approaches and include this information in the 
fiscal year 2019 CJ.
    Diabetes Prevention Program.--The Committee recommendation 
includes $22,500,000, level with fiscal year 2017, for the 
Diabetes Prevention Program. This program promoting lifestyle 
interventions has proven to reduce the risk of developing 
diabetes by 58 percent in individuals at high risk.
    Division of Diabetes Translation [DDT].--The Committee 
recognizes the work of CDC's DDT to address the diabetes 
epidemic and encourages CDC to continue to ensure that the 
prevention needs of those Americans with, and at risk for, 
diabetes and prediabetes are met. The Committee believes these 
activities must include clear outcomes and ensure transparency 
and accountability that demonstrate how funding was used to 
support diabetes prevention and specifically how diabetes 
funding reached State and local communities. Additionally, the 
Committee encourages CDC to support the translation of research 
into better prevention, care, and surveillance. The Committee 
encourages CDC to explore opportunities to expand virtual 
delivery of the National Diabetes Prevention Program's 
lifestyle change program in rural areas where patients have 
provider care access challenges.
    Early Child Care Collaboratives.--The Committee recognizes 
that the early care and education setting is important for 
promoting healthy habits in young children. The Committee 
provides $4,000,000 to the National Early Child Care 
Collaboratives to enable training of early care and education 
providers in implementation of healthy eating and physical 
activity best practices, including strategies for engaging 
families. Funds will also support technical assistance for 
integration of healthy eating and physical activity best 
practices into existing State and local professional 
development systems' early care and education settings, and 
health initiatives. The Committee also encourages the program 
to serve a mix of rural, suburban and urban areas, including 
areas with high childhood obesity rates.
    Electronic Cigarettes.--The Committee notes a rise in usage 
of electronic cigarettes, or e-cigarettes, among U.S. middle 
and high school students. The Committee is aware of an ongoing 
NAM study on the health effects from e-cigarettes that is due 
out at the end of 2017, which will include recommendations for 
future federally funded research. The Committee encourages CDC 
to examine the recommendations from the NAM study and report to 
the Committee on opportunities that may exist for further 
research.
    Epilepsy in Rural Areas.--The Committee encourages CDC to 
continue telehealth and educational training programs for rural 
and underserved areas that reach school nurses, child care 
personnel, first responders, and care providers for seniors in 
order to recognize and respond appropriately to seizures caused 
by epilepsy or resulting from trauma and other acute chronic 
illness.
    Heart Disease and Stroke Prevention.--While largely 
preventable, cardiovascular disease, including heart disease 
and stroke, continues to inflict the highest burden on our 
Nation's long-term health and economic stability. The Committee 
continues funding to support, strengthen, and expand heart 
disease and stroke prevention and control activities within 
State, local, and tribal public health departments and to 
enhance surveillance and research to target high burden 
populations and guide public health strategies. The Committee 
encourages CDC to prioritize these funds to communities with 
the highest disease burden of heart disease and stroke to 
identify and disseminate novel and innovative evidence-based 
strategies, including scientifically valid risk factor 
reduction measures, through competitive awards.
    Heart Valve Disease.--The Committee understands that heart 
valve disease can be debilitating and if not treated properly 
can result in heart failure, sudden cardiac arrest, and death. 
The Committee encourages CDC to include information on valve 
disease on its website and to help bring public awareness to 
this disease. The Committee encourages CDC to engage with 
patient and research organizations to explore collaborative 
ways to integrate information about the warning signs, 
symptoms, and risk factors of valve disease into CDC's existing 
programs.
    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. If this epidemic continues unabated, 
obesity and the many complications it causes will increase the 
disease burden among Americans, particularly youth. The 
Committee continues to include $10,000,000 to support the rural 
extension and outreach services grants for rural counties with 
an obesity prevalence of over 40 percent. The Committee expects 
CDC to work with State and local public health departments to 
support measurable outcomes through evidenced-based obesity 
research, intervention, and prevention programs. Grants should 
combine basic, clinical, and population research to better 
understand and treat the metabolic, medical, surgical, 
environmental, and societal implications of obesity in 
cooperation with partners that have existing outreach capacity 
to develop and implement educational and intervention programs. 
Preference should be given to States where at least 10 percent 
of counties meet the requirements of this program. In addition, 
CDC shall focus its efforts in areas of the country with the 
highest burden of obesity and with the comorbidities of 
hypertension, cardiac disease, and diabetes from county level 
data in the Behavioral Risk Factor Surveillance System. The 
Committee encourages CDC to support only activities that are 
supported by scientific evidence.
    Inflammatory Bowel Diseases [IBD].--The Committee commends 
CDC for its commitment to the study of IBD epidemiology and is 
concerned by the results of the recent Morbidity and Mortality 
Weekly Report which demonstrates that IBD affects 3,300,000 
Americans, almost three times the number of adults previously 
estimated to have IBD. The Committee is particularly concerned 
that IBD is increasingly recognized in minority and underserved 
communities and encourages CDC to complement its existing 
epidemiological study with a focus on these populations.
    Interstitial Cystitis [IC].--The Committee recommendation 
for IC activities provides support for the ongoing epidemiology 
study, as well as education, outreach, and public awareness 
activities.
    Lupus Registry.--The Committee continues to support 
research efforts under the National Lupus Patient Registry 
program, but acknowledges that challenges still remain. Burden 
of illness studies are needed to better understand and evaluate 
issues such as the disease impact on quality of life, 
productivity, frequency of clinical events, natural history, 
and the direct and indirect costs associated with lupus. The 
Committee encourages CDC to support the lupus cohort and burden 
of illness studies.
    Million Hearts 2022.--The Committee supports Million Hearts 
2022 and encourages CDC to capitalize on the solid foundation, 
best practices, evidence, shared tools, and progress made on 
this public-private initiative to prevent heart attacks and 
strokes. Continued funding will allow implementation of 
evidence-based interventions to prevent heart disease and 
stroke in areas with the highest burden by implementing the 
ABCS: aspirin when appropriate, blood pressure control, 
cholesterol management, and smoking cessation; supporting 
innovative strategies to increase physical activity; using 
cardiac rehabilitation; and developing innovative, scalable 
approaches to improve cardiovascular health.
    Mississippi Delta Health Collaborative [MDHC].--The 
Committee commends CDC's ongoing efforts to support the MDHC. 
The program has developed key partnerships at the local level 
and has implemented team-based approaches designed to link 
communities with clinical care. 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. As it has in past years, CDC 
shall consider using lifestyle change intervention models like 
the Diabetes Prevention Program; utilizing local pharmacy 
schools with existing community-based research programs that 
could focus on screenings, medication reviews, medication 
therapy management, comprehensive medication management, and 
disseminating prevention strategies; and working with 
communities to establish health networks to better coordinate 
and manage community based health initiatives. To reach the 
target population, the Committee encourages CDC to take 
advantage of rapidly evolving healthcare technology by 
leveraging the resources of States with recognized leadership 
in areas of electronic medical records, telehealth, and 
innovative delivery of education tools. CDC shall provide an 
update on these activities in the fiscal year 2019 CJ.
    Psoriasis and Psoriatic Arthritis.--The Committee 
recognizes the growing body of evidence linking psoriatic 
disease, which impacts more than 8,000,000 Americans, to other 
comorbidities such as cardiovascular disease, mental health and 
substance abuse challenges, kidney disease, and other 
conditions. The Committee encourages CDC to develop an action 
plan not later than 6 months after the enactment of this act as 
to how it can leverage existing programs and resources to build 
upon the agency's Public Health Agenda for Psoriasis and 
Psoriatic Arthritis.
    Pulmonary Hypertension [PH].--The Committee understands 
that PH causes heart failure and death. CDC is encouraged to 
support education, outreach, and awareness activities that 
promote early and accurate diagnosis of PH.
    Racial and Ethnic Approach to Community Health [REACH].--
The Committee eliminates the REACH program due to funding 
constraints. Funding continues to be provided to other programs 
that conduct outreach to reduce ethnic disparities in health 
status.
    Safe Motherhood Initiative.--Preterm birth affects more 
than 500,000 babies each year in the United States and is the 
leading cause of neonatal mortality. The Committee commends CDC 
for funding State-based perinatal collaboratives that focus on 
improving birth outcomes using known preventative strategies 
such as reducing early elective deliveries.
    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. Every year in 
the United States, nearly 5,000,000 people are treated for skin 
cancer. Melanoma causes more deaths than any other type of skin 
cancer, resulting in over 9,000 deaths each year. The Committee 
encourages CDC to provide increased collaboration and 
partnership with local governments, business, health, 
education, community, nonprofit and faith-based sectors in this 
effort.
    Sleep Surveillance.--The Committee is pleased by CDC's work 
on a national public health awareness campaign for sleep. The 
Committee encourages CDC to ensure that funding for 
surveillance activities on sleep disorders and sleep health is 
maintained in addition to these awareness efforts.
    Stroke Prevention.--States in the Stroke Belt have age-
adjusted stroke mortality rates that are significantly higher 
than the national average. The Committee encourages the 
Division to further focus its resources in the Stroke Belt, 
including the development of a comprehensive strategy to 
address stroke mortality and morbidity in the region. CDC shall 
provide an update on these efforts in the fiscal year 2019 CJ.
    WISEWOMAN.--The Committee lauds the WISEWOMAN program that 
helps uninsured and under-insured low-income women ages 40 to 
64 decrease, prevent, or control heart disease and stroke by 
providing preventive health services, referrals to local health 
care providers, lifestyle programs, and health counseling 
services tailored to identified risk factors to promote 
lasting, healthy behavior change. Between July 2013 and June 
2016, WISEWOMAN provided an estimated 74,000 health behavioral 
support services and 51,000 blood pressure screenings. The 
Committee recognizes the critical role screening and referral 
programs play in reducing cardiovascular disease and directs 
CDC to explore innovative approaches to expand the number of 
women served through WISEWOMAN and report the results to the 
Committee no later than September 30, 2018.

     NATIONAL CENTER ON BIRTH DEFECTS, DEVELOPMENTAL DISABILITIES, 
                         DISABILITY AND HEALTH

Appropriations, 2017....................................    $137,560,000
Budget estimate, 2018...................................     100,000,000
Committee recommendation................................     139,560,000

    The Committee recommendation for the activities of the 
National Center on Birth Defects and Developmental Disabilities 
[NCBDDD] is $139,560,000.
    This Center improves the health of children and adults by 
preventing birth defects, developmental disabilities, and 
complications of heredity 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 
provided for the following categories of funding:

 
                                            [In thousands of dollars]
----------------------------------------------------------------------------------------------------------------
                                                            Fiscal year 2017  Fiscal year 2018      Committee
                      Budget activity                         appropriation        request       recommendation
----------------------------------------------------------------------------------------------------------------
Total Birth Defects.......................................           137,560           100,000           139,560
    Child Health and Development..........................            65,800               N/A            65,800
        Other Birth Defects...............................            19,000               N/A            19,000
        Fetal Death.......................................               900               N/A               900
        Fetal Alcohol Syndrome............................            11,000               N/A            11,000
        Folic Acid........................................             3,150               N/A             3,150
        Infant Health.....................................             8,650               N/A             8,650
        Autism............................................            23,100               N/A            23,100
    Health and Development with Disabilities..............            56,660               N/A            58,660
        Disability and Health.............................            24,000               N/A            26,000
        Tourette Syndrome.................................             2,000               N/A             2,000
        Early Hearing Detection and Intervention..........            10,760               N/A            10,760
        Muscular Dystrophy................................             6,000               N/A             6,000
        Attention Deficit Hyperactivity Disorder..........             1,900               N/A             1,900
        Fragile X.........................................             2,000               N/A             2,000
        Spina Bifida......................................             6,000               N/A             6,000
        Congenital Heart Defects..........................             4,000               N/A             4,000
    Public Health Approach to Blood Disorders.............             4,400               N/A             4,400
    Hemophilia CDC Activities.............................             3,500               N/A             3,500
    Hemophilia Treatment Centers..........................             5,100               N/A             5,100
    Thalassemia...........................................             2,100               N/A             2,100
----------------------------------------------------------------------------------------------------------------

    Blood Safety Monitoring.--Facing an increase in infectious 
diseases that have a known or potential risk of transmission 
via blood transfusion, patients with thalassemia, anemia, and 
other diseases that impact blood production often face a lack 
of information about transmission modes and rates of infectious 
diseases, including new or emerging viruses like the Zika 
virus. The Committee encourages CDC to provide specific 
information to assist blood centers in responding to emerging 
infectious diseases that may be transmitted by blood 
transfusion.
    Cerebral Palsy [CP].--The Committee encourages CDC to build 
upon existing surveillance and research applications of CP 
surveillance within the established 11 Autism and Developmental 
Disabilities Monitoring Network surveillance sites. The 
Committee recognizes and supports CDC's efforts to include CP 
surveillance in three existing sites and encourage CDC to 
expand this effort within current resources to additional sites 
allowing for a more nationally representative sample.
    Congenital Heart Disease [CHD].--CHD is the number one 
category of birth defects in the United States. The Committee 
notes that children and adults with CHD require ongoing, 
specialized cardiac care, and there remain gaps in data as 
children and adolescents transition to adult care. The 
Committee commends NCBDDD for its leadership in addressing CHD 
and adult CHD surveillance efforts and requests a report in the 
fiscal year 2019 CJ on CDC surveillance and research efforts 
regarding CHD across the lifespan, age-specific prevalence, and 
factors associated with those patients who may have dropped out 
of appropriate specialty care.
    Disability and Health Officer.--The Committee encourages 
CDC to re-appoint a Chief Disability and Health Officer and re-
establish the Disability and Health Work Group to provide 
leadership, coordination, and collaboration among Centers in 
order to expand and improve efforts to enhance the health of 
individuals with disabilities.
    Fragile X and Associated Disorders.--The Committee commends 
CDC's efforts to identify and define the population impacted by 
FX and FXD with the goal of understanding the public health 
impact of these conditions. The Committee acknowledges 
significant progress made by the NCBDDD Fragile X Clinical and 
Research Consortium in growing its FORWARD Database and its 
Patient Registry. CDC is encouraged to continue this effort. 
The Committee also supports the public-private partnership 
which resulted in the ``Future of Fragile X: Setting the Public 
Health Research Agenda'' meeting in 2014 and the resulting 
Funding Opportunity Announcement which seeks to use 
longitudinal data to characterize the natural history of 
Fragile X to improve services and outcomes. The Committee 
encourages the NCBDDD to continue data-driven public health 
research to reduce the public health burden of both FX and 
autism.
    Health and Development for Those With Disabilities.--The 
Committee supports CDC awards under the National Centers on 
Health Promotion for People with Disabilities and its goal of 
promoting better health for adults and children with 
disabilities. By mobilizing national networks to provide 
technical assistance, provide community leaders and community 
organizations with health promotion training, and by 
disseminating effective strategies and tools for disability 
service providers, these awards play an important role in 
encouraging a healthier lifestyle for Americans with 
disabilities.
    Hemophilia.--The Committee has included sufficient funding 
to maintain the Center's hemophilia programs, which provide 
critical information to better understand risk factors for 
complications and identify high-risk populations for prevention 
measures. The Committee recognizes the importance of CDC's 
research on inhibitors and recommends that CDC enhance the 
inhibitor surveillance program and further prevention and 
eradication activities. The Committee encourages CDC, working 
with stakeholders and the network of hemophilia treatment 
centers, to implement inhibitor testing across the United 
States and support further research to better understand 
inhibitors and how they can be prevented.
    Improving the Health of People With Intellectual 
Disabilities Through Physical Activity.--People with 
disabilities have a high risk of poor health outcomes such as 
obesity, hypertension, and mood disorders such as depression. 
Therefore, the Committee includes $8,700,000 for the Healthy 
Athletes program.
    Marfan Syndrome.--The Committee remains concerned that 
structural cardiovascular disorders, such as Marfan syndrome, 
continue to claim the lives of high school athletes across the 
country who received a sports physical prior to competition. 
CDC is encouraged to work with patient and professional 
stakeholders to develop minimum screening guidelines that 
ensure all young athletes are appropriately screened for 
potentially life-threatening structural cardiovascular 
disorders.
    Muscular Dystrophy Surveillance.--The Committee is aware of 
CDC's established surveillance efforts through the Muscular 
Dystrophy Surveillance, Tracking, and Research Network [MD 
STARnet] and encourages CDC to continue its work to enhance the 
quality and quantity of the data being collected through MD 
STARnet. Additionally, the Committee is interested in CDC's 
plans to disseminate and implement the updated care standards, 
including for adults with Duchenne and for other forms of 
muscular dystrophy. The Committee also supports CDC's 
engagement of multiple Divisions and Centers in the development 
of a Duchenne newborn screening program along with the 
refinement of an International Classification of Disease code 
for Duchenne and Becker Muscular Dystrophy.
    Sickle Cell Disease [SCD].--SCD is a lifelong inherited 
blood disorder affecting nearly 100,000 Americans who are 
unable to access specialized quality care and effective 
treatment options. The Committee encourages CDC to continue and 
expand its SCD surveillance program to better understand and 
address long term health outcomes, complications, and unmet 
health care access and to initiate a public health awareness 
campaign for people with SCD and a sickle cell trait.
    Spina Bifida.--While spina bifida and related neural tube 
defects are highly preventable through education and adequate 
daily folic acid consumption, they are the most common 
permanently disabling birth defect in the United States. The 
Committee supports the continuation of the Spina Bifida 
Clinical Care Monitoring and Tracking program and commends the 
National Spina Bifida Program in serving as a model for 
programs assisting other individuals living with similar 
complex conditions. The Committee encourages CDC to continue 
the dissemination of information to clinicians, parents, and 
families living with spina bifida.
    Tuberous Sclerosis Complex [TSC].--The Committee encourages 
CDC to take into consideration all the major manifestations of 
TSC in its surveillance network.

                   PUBLIC HEALTH SCIENTIFIC SERVICES

Appropriations, 2017....................................    $489,397,000
Budget estimate, 2018...................................     460,000,000
Committee recommendation................................     489,397,000

    The Committee recommendation for Public Health Scientific 
Services is $489,397,000.
    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.
    The Committee recommendation includes funding for the 
following activities in the following amounts:

 
                                            [In thousands of dollars]
----------------------------------------------------------------------------------------------------------------
                                                            Fiscal year 2017  Fiscal year 2018      Committee
                      Budget activity                         appropriation        request       recommendation
----------------------------------------------------------------------------------------------------------------
Health Statistics.........................................           160,397           155,000           160,397
Surveillance, Epidemiology, and PH Informatics............           279,000           260,000           279,000
Public Health Workforce...................................            50,000            45,000            50,000
----------------------------------------------------------------------------------------------------------------

    Alzheimer's Disease and Dementia.--The Committee is aware 
of recent peer-reviewed studies suggesting that more than 
500,000 U.S. deaths each year are attributable to Alzheimer's 
disease and dementia, far in excess of the deaths reported by 
the Center each year. Such statistics would elevate Alzheimer's 
disease from the sixth leading cause of death to the third 
leading cause of death. The Committee looks forward to 
receiving CDC recommendations on ways to ensure the accuracy 
and completeness of measurements of the Alzheimer's disease and 
dementia death rate and to develop a consensus on the mortality 
burden of the disease.
    Digital Bridge.--The Committee remains interested in an 
integrated public health surveillance strategy to improve real-
time surveillance and situational awareness. The Committee is 
encouraged by efforts underway at CDC and by public-private 
partnerships such as the Digital Bridge initiative that connect 
the health care system, electronic health record vendors, and 
public health authorities at all levels to reduce reporting 
burden and scientific, administrative, and fiscal 
inefficiencies.
    Modernizing Vital Statistics Collection.--While most States 
have or will soon have operational electronic birth and death 
registration systems, many do not have the resources to 
maximize electronic death reporting or to modernize their 
systems to keep pace with new technology. The Committee 
encourages CDC to support States in upgrading antiquated 
systems and improving the quality and accuracy of vital 
statistics reporting.

                          ENVIRONMENTAL HEALTH

Appropriations, 2017....................................    $215,750,000
Budget estimate, 2018...................................     157,000,000
Committee recommendation................................     180,750,000

    The Committee recommendation for the National Center for 
Environmental Health is $180,750,000. The Committee 
recommendation includes $17,000,000 in transfers from the PPH 
Fund. This does not include $35,000,000 in one-time multi-year 
lead poisoning prevention and registry funding for Flint, 
Michigan provided in fiscal year 2017.
    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 
these substances are harmful to humans.
    The Committee recommendation includes funding for the 
following activities:

 
                                            [In thousands of dollars]
----------------------------------------------------------------------------------------------------------------
                                                            Fiscal year 2017  Fiscal year 2018      Committee
                      Budget activity                         appropriation        request       recommendation
----------------------------------------------------------------------------------------------------------------
Environmental Health Laboratory...........................            56,150            55,894            56,150
    Newborn Screening Quality Assurance Program...........             8,400               N/A             8,400
    Newborn Screening for SCID............................             1,250               N/A             1,250
    Other Environmental Health............................            46,500               N/A            46,500
Environmental Health Activities...........................            44,600            34,106            44,600
    Safe Water............................................             8,600               N/A             8,600
    Amyotrophic Lateral Sclerosis Registry................            10,000               N/A            10,000
    Climate Change........................................            10,000               N/A            10,000
    All Other Environmental Health........................            16,000               N/A            16,000
Environmental and Health Outcome Tracking Network.........            34,000            25,000            34,000
Asthma....................................................            29,000            25,000            29,000
Childhood Lead Poisoning..................................            17,000            17,000            17,000
Lead Poisoning Prevention.................................            15,000  ................  ................
Lead Exposure Registry....................................            20,000  ................  ................
----------------------------------------------------------------------------------------------------------------

    Amyotrophic Lateral Sclerosis [ALS] Registry.--The 
Committee continues to support the purpose of the National ALS 
Registry and seeks to understand how to build upon current 
efforts to improve data collection. The Committee directs CDC 
to review the ALS registry and submit a report to the 
Committees on Appropriations of the House of Representatives 
and Senate within one year of enactment of this act to 
determine the compliance of the ALS registry with Congressional 
intent as laid out in Public Law 110-373. The report should 
include the cost of maintaining the registry, a review of how 
the National ALS registry interacts with State, local, and 
Federal registries to build upon existing data, and 
recommendations on how to improve the surveillance quality of 
the registry.
    Asthma.--The Committee continues to support 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 understands that better coordination of 
public health and health systems interventions are necessary to 
reduce the burden caused by asthma and encourages CDC to 
continue its collaboration with payers and health systems.
    Environmental Health Activities.--The Committee is 
concerned about the increasing health effects on people with 
asthma, cardiovascular disease, and other chronic diseases 
caused by increased spread of vector-borne disease, air 
pollution, extreme weather events, and longer allergy seasons. 
The Committee directs CDC to continue to help state and local 
health departments plan for these public health threats and to 
focus on protecting the most vulnerable individuals and 
communities.
    Hormone Standardization.--The Committee is encouraged by 
the work CDC's Environmental Health Laboratory has done to date 
to help ensure the accuracy and reliability of testing for 
certain hormones through its standardization program. The 
Committee recognizes that gaps still remain in hormone 
standardization to ensure reliable and actionable results. The 
Committee requests a report in the fiscal year 2019 CJ 
outlining what is necessary for the agency to increase the 
standardization of clinical laboratory testing to help prevent 
misdiagnoses and reduce unnecessary health expenses.
    Lead Poisoning.--The Committee notes that the fiscal year 
2017 Omnibus provided an additional $35,000,000 in multi-year 
lead poisoning prevention efforts for a lead exposure registry 
and an advisory committee. CDC is directed to provide a status 
update on these activities in the fiscal year 2019 CJ.
    Newborn Screening.--The Committee requests CDC provide an 
update in the fiscal year 2019 CJ on actions planned and on-
going to work with States on ways to ensure screening of 
infants for diseases for which there is a preventable and/or 
effective treatment. Further, the update should note what steps 
can be taken to encourage States to adopt and implement new 
Recommended Uniform Screening Panel conditions within one year 
of their addition.

                     INJURY PREVENTION AND CONTROL

Appropriations, 2017....................................    $286,059,000
Budget estimate, 2018...................................     216,165,000
Committee recommendation................................     291,059,000

    The Committee recommendation for the National Center for 
Injury Prevention and Control is $291,059,000.
    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]
----------------------------------------------------------------------------------------------------------------
                                                            Fiscal year 2017  Fiscal year 2018      Committee
                      Budget activity                         appropriation        request       recommendation
----------------------------------------------------------------------------------------------------------------
Intentional Injury........................................            97,730            97,730           102,730
    Domestic Violence and Sexual Violence.................            32,700            32,700            32,700
        Child Maltreatment................................             7,250             7,250             7,250
    Youth Violence Prevention.............................            15,100            15,100            15,100
    Domestic Violence Community Projects..................             5,500             5,500             5,500
    Rape Prevention.......................................            44,430            44,430            49,430
National Violent Death Reporting System...................            16,000            15,970            16,000
Unintentional Injury......................................             8,800             6,737             8,800
    Traumatic Brain Injury................................             6,750               N/A             6,750
    Elderly Falls.........................................             2,050               N/A             2,050
Injury Prevention Activities..............................            28,950            20,293            28,950
Prescription Drug Overdose................................           112,000            75,435           112,000
Illicit Opioid Use Risk Factors...........................            13,579  ................            13,579
Injury Control Research Centers...........................             9,000  ................             9,000
----------------------------------------------------------------------------------------------------------------

    Biosurveillance Program.--The Committee continues to be 
very concerned about the high rate of opioid abuse and 
understands data can facilitate forecasting of overdose risk by 
geographic region. Therefore, the Committee instructs CDC to 
begin using data from the Enhanced State Surveillance of 
Opioid-Involved Morbidity and Mortality program to provide such 
forecasts that public health officials can use to intervene and 
prevent overdoses. CDC should focus on States experiencing the 
highest rates of opioid related overdosing then expand into a 
national system.
    Combating Opioid Abuse.--CDC Prescription Drug Overdose 
Prevention [PDO] activities fund critical work in all 50 States 
and Washington, DC. Activities support rigorous monitoring, 
evaluation, and improvements in data quality at a national 
level, including data collection and analysis on heroin-related 
overdose deaths. These funds provide States with the greatest 
burden of opioid abuse the ability to implement prevention 
activities and improve interventions that monitor prescribing 
and dispensing practices. This includes maximizing the use of 
State-based Prescription Drug Monitoring Programs [PDMPs] as a 
public health tool to assist in clinical decision-making and in 
conducting surveillance. The Committee expects CDC to continue 
to expand and evaluate an innovative model to coordinate care 
for high-risk opioid patients to ensure safer, more effective 
care. Further the Committee strongly encourages CDC to support 
local prevention activity to determine the effectiveness of 
naltrexone in treating heroin and prescription drug abuse and 
reducing diversion of buprenorphine for illicit purposes
    Concussion Surveillance.--The 2013 NAS study ``Sports-
Related Concussions in Youth: Improving the Science, Changing 
the Culture'' recommended that CDC establish and oversee a 
national surveillance system to accurately determine the 
incidence of sports-related concussions, including youth ages 5 
to 21. The Committee is aware of the promising progress CDC has 
made in creating a comprehensive survey instrument which the 
agency will be piloting in the coming months to prepare for a 
national survey in the future. The Committee supports CDC's 
work in this area and urges the agency to increase its efforts.
    Opioid Prescribing Guidelines.--The Committee commends CDC 
for building awareness about responsible opioid prescribing 
practices by publishing the Guideline for Prescribing Opioids 
for Chronic Pain. The Committee notes that opioid prescribing 
for acute pain remains a significant driver of initial opioid 
prescriptions, especially for youth. The Committee encourages 
CDC to continue its leadership in prevention of the opioid 
epidemic by developing prescribing guidelines for acute pain, 
including those which are applicable to emergency physicians, 
surgeons, and dentists. CDC is encouraged to coordinate with 
the Office of the National Coordinator for Health Information 
Technology to develop and disseminate clinical decision support 
tools derived from the opioid prescribing guidelines. CDC is 
also urged to work with the VA and the DOD on implementing 
these guidelines to ensure consistent, high-quality care 
standards across the Federal Government.
    Pain Reporting.--The Committee notes that pain is a public 
health problem that causes tremendous burden on the health care 
system. The Committee notes CDC's prior reports focusing on 
pain, but recognizes that more complete and comprehensive 
epidemiological data is needed. CDC is urged to investigate the 
collection of data that clarifies the incidence and prevalence 
of various pain syndromes differentiated by patient age, 
comorbidities, socio-economic status, profession, race and 
gender.
    Rape Prevention.--The Committee recognizes that 25 percent 
of rape prevention programs currently have a wait time of over 
a month. The Committee therefore has provided an increase of 
$5,000,000 for CDC's rape prevention and education program and 
directs that at least 75 percent of the program's funds go to 
States for State and local prevention activities.
    Trauma Surveillance.--The Committee commends CDC for 
providing funding to States to conduct surveillance on youth 
and adult behavioral risk factors. The Committee encourages CDC 
to prioritize collection and reporting of data on adverse 
childhood experiences, including exposure to violence. The 
Committee also encourages CDC to report on the prevalence of 
adverse childhood experiences across geography, race and 
ethnicity, and socioeconomic status and to examine ways to 
target such areas or populations with high rates of measured 
adverse childhood experiences.

                     OCCUPATIONAL SAFETY AND HEALTH

Appropriations, 2017....................................    $335,200,000
Budget estimate, 2018...................................     200,000,000
Committee recommendation................................     335,200,000

    The Committee recommendation for National Institute for 
Occupational Safety and Health [NIOSH] programs is 
$335,200,000.
    NIOSH is the only Federal agency responsible for conducting 
research and making recommendations for the prevention of work-
related 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.
    Total Worker Health.--The Committee commends CDC's Total 
Worker Health Program, which aims to promote and protect the 
health and productivity of the American workforce through 
research and dissemination of innovative and cost-effective 
tools and interventions for American businesses. The Committee 
commends CDC's work in this area and encourages CDC to continue 
dissemination of these tools.
    The Committee recommendation includes funding for the 
following activities at the following amounts:

 
                                            [In thousands of dollars]
----------------------------------------------------------------------------------------------------------------
                                                            Fiscal year 2017  Fiscal year 2018      Committee
                      Budget activity                         appropriation        request       recommendation
----------------------------------------------------------------------------------------------------------------
Total NIOSH...............................................           335,200           200,000           335,200
    National Occupational Research Agenda.................           116,000               N/A           116,000
        Agriculture, Forestry, Fishing (non-add)..........            25,500               N/A            25,500
    Education and Research Centers........................            29,000               N/A            29,000
    Personal Protective Technology........................            20,000               N/A            20,000
    Mining Research.......................................            59,500               N/A            59,500
    National Mesothelioma Registry and Tissue Bank........             1,100               N/A             1,100
    Other Occupational Safety and Health Research.........           109,600               N/A           109,600
----------------------------------------------------------------------------------------------------------------

         ENERGY EMPLOYEES OCCUPATIONAL INJURY COMPENSATION ACT

Appropriations, 2017....................................     $55,358,000
Budget estimate, 2018...................................      55,358,000
Committee recommendation................................      55,358,000

    The Committee recommendation for the Energy Employees 
Occupational Illness Compensation Program Act [EEOICPA] is 
$55,358,000. This mandatory funding supports NIOSH scientists 
who reconstruct radiation dose levels to inform compensation 
decisions.

                             GLOBAL HEALTH

Appropriations, 2017....................................    $435,121,000
Budget estimate, 2018...................................     350,000,000
Committee recommendation................................     433,621,000

    The Committee recommends $433,621,000 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]
----------------------------------------------------------------------------------------------------------------
                                                            Fiscal year 2017  Fiscal year 2018      Committee
                      Budget activity                         appropriation        request       recommendation
----------------------------------------------------------------------------------------------------------------
Global HIV/AIDS Program...................................           128,421            69,547           128,421
Global Immunization Program...............................           224,000           206,000           224,000
    Polio Eradication.....................................           174,000           165,000           174,000
    Measles and Other Vaccine Preventable Diseases........            50,000               N/A            50,000
Parasitic Diseases and Malaria............................            24,500            24,453            26,000
Global Public Health Protection...........................            58,200            50,000            55,200
    Global Disease Detection and Emergency Response.......            48,400               N/A            45,400
    Global Public Health Capacity Development.............             9,800               N/A             9,800
----------------------------------------------------------------------------------------------------------------

    CDC Global Health Security and Global Health Research.--The 
Committee supports CDC's work to protect American and global 
health security through the Center for Global Health, the 
National Center for Emerging and Zoonotic Infectious Diseases, 
and other programs that detect, prevent, and respond to 
infectious disease and other health threats. The Committee 
supports continued work in health research, innovation, 
capacity building for disease research, detection, and 
surveillance, and robust monitoring and evaluation systems at 
home and abroad.
    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 crucial 
monitoring and surveillance of transmission, evaluation of 
interventions for effectiveness and impact, 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, better, and not wasteful. 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 three countries, Nigeria, Afghanistan, and 
Pakistan. The Committee commends these efforts to help 
eradicate this disease.
    Soil Transmitted Helminth and Related ``Diseases of 
Poverty'' [STH].--STH infections when found in the United 
States are most frequently seen in poverty stricken, rural 
populations. Surveillance studies through school-based clinics 
have been successful in providing safe treatments and public 
health interventions to reduce infection burden, but in some 
areas with high STH-infection, there is no surveillance or 
remediation effort underway. Therefore, within the funds 
provided, the Committee includes $1,500,000 to CDC for 
surveillance, source remediation, and clinical care aimed at 
reducing STH-infection in an area not being addressed by 
current CDC outreach. The clinical care effort shall be led by 
an academic medical center with collaboration from State health 
agencies, universities, and public health entities and shall be 
located in a rural, agrarian area with high incidence of STH-
infection, poverty, and chronic disease, especially among 
children.

                PUBLIC HEALTH PREPAREDNESS AND RESPONSE

Appropriations, 2017....................................  $1,405,000,000
Budget estimate, 2018...................................   1,266,000,000
Committee recommendation................................   1,405,000,000

    The Committee recommendation for the Office of Public 
Health Preparedness and Response [PHPR] is $1,405,000,000.
    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]
----------------------------------------------------------------------------------------------------------------
                                                            Fiscal year 2017  Fiscal year 2018      Committee
                      Budget activity                         appropriation        request       recommendation
----------------------------------------------------------------------------------------------------------------
Public Health Emergency Preparedness Cooperative Agreement           660,000           551,000           660,000
Academic Centers for Public Health Preparedness...........             8,200  ................             8,200
BioSense..................................................            23,000               N/A            23,000
All Other CDC Preparedness................................           138,800           140,000           138,800
Strategic National Stockpile..............................           575,000           575,000           575,000
----------------------------------------------------------------------------------------------------------------

    Emergency Preparedness.--The Committee recognizes the 
importance of the Public Health Emergency Preparedness program 
[PHEP] in helping States and territories strengthen their 
public health system capacity. In doing so, the Committee does 
not include the proposed cut to the program and instead 
provides the same level of funding as fiscal year 2017. The 
Committee continues to request detailed information on how PHEP 
funding is distributed at the local level by States. CDC is 
encouraged to provide in the fiscal year 2019 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.
    Strategic National Stockpile.--The Committee encourages CDC 
to evaluate the latest approved advances in influenza 
prevention and antiviral treatment for inclusion in the SNS in 
preparation for pandemic influenza. Further, the Committee 
encourages BARDA and CDC to better coordinate the handoff of 
new countermeasures being purchased for the Strategic National 
Stockpile and, as appropriate, maintain BARDA involvement to 
negotiate technical details of future procurement. The 
Committee requests a report within 90 days of enactment of this 
act detailing the number of potential FDA-approved MCMs that 
will be needed in the SNS over the next 3 fiscal years 
(including new products or products currently in the SNS that 
will require replenishment), and the anticipated costs to 
purchase these products while maintaining current SNS products.

                        Buildings and Faciltiies

Appropriations, 2017....................................     $10,000,000
Budget estimate, 2018...................................      20,000,000
Committee recommendation................................      10,000,000

    The Committee recommendation for Buildings and Facilities 
is $10,000,000.
    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 in order to 
reduce operational costs and strengthen scientific 
collaboration. The Committee understands that CDC plans to 
support this facility replacement through the Department's 
Nonrecurring Expense Fund. The Secretary and CDC are directed 
to prioritize obligations for this facility and obligate such 
funds as quickly as possible in fiscal year 2018.
    Replacement of the Lake Lynn Experimental Mine and 
Laboratory.--The Secretary is directed to provide quarterly 
reports to the Committees on Appropriations of the House of 
Representatives and Senate detailing activities to replace the 
Lake Lynn Laboratory. The Committee continues to support CDC 
efforts to find a replacement facility.

                          CDC-WIDE ACTIVITIES

Appropriations, 2017....................................    $273,570,000
Budget estimate, 2018...................................     105,000,000
Committee recommendation................................     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 2017  Fiscal year 2018      Committee
                      Budget activity                         appropriation        request       recommendation
----------------------------------------------------------------------------------------------------------------
Preventive Health and Health Services Block Grant.........           160,000  ................           160,000
Public Health Leadership and Support......................           113,570           105,000           113,570
----------------------------------------------------------------------------------------------------------------

    Preventative Health and Health Services Block Grant.--The 
Committee continues to oppose this administration's and the 
previous administration's proposal to eliminate this program. 
The Committee provides $160,000,000, the same level as in 
fiscal year 2017. These grants are crucial for States because 
they provide enough flexibility necessary to resolve any 
emerging health issues at the local level while tailoring those 
activities to best address the diverse, complex, and constantly 
changing local community.
    The Committee does not include bill language requested by 
the administration to provide additional transfer authority to 
the Director beyond that which is already provided to the 
Secretary.

                     National Institutes of Health

    The National Institutes of Health [NIH] is the global 
leader in medical research and the Committee provides an 
increase of $2,000,000,000 for a third year in a row after a 
decade of stagnant funding. The Committee provides 
$36,084,000,000 for NIH activities within the jurisdiction of 
this bill, an increase of 5.9 percent above fiscal year 2017. 
This includes $1,074,443,000 in transfers available under 
section 241 of the PHS Act. The Committee continues a reform to 
section 241 allocations such that no NIH funding will be 
removed from NIH under this authority. This reform ensures that 
section 241 transfers are a benefit to NIH rather than a 
liability. In addition, it improves the transparency of NIH's 
budget, so that the enacted total is truly the amount the 
Committee expects to be used for biomedical research.
    The Committee continues its commitment to funding research 
on Alzheimer's disease and increases funding by $414,000,000 to 
a total of approximately $1,828,000,000 in fiscal year 2018; 
increases funding for the Precision Medicine Initiative by 
$10,000,000; increases funding for antibiotic resistance 
research by $50,000,000; and increases funding for the BRAIN 
Initiative by $140,000,000. In addition, funding is provided to 
ensure that every Institute and Center receives an increase 
above fiscal year 2017 to continue investments in innovative 
research that will advance the fundamental knowledge and speed 
the development of new therapies, diagnostics, and preventive 
measures to improve the health of all Americans. Revolutionary 
discoveries often come from unexpected, untargeted research. 
The Committee continues to support these basic advances as well 
as the clinical and translational research that moves basic 
discoveries from ``bench-to-bedside.''
    The Committee rejects the administration's proposals to: 
cap Facilities and Administrative costs; eliminate the John E. 
Fogarty International Center; and create the National Institute 
for Research on Safety and Quality.

                       NATIONAL CANCER INSTITUTE

Appropriations, 2017....................................  $5,671,926,000
Budget estimate, 2018...................................   4,474,222,000
Committee recommendation................................   5,858,270,000

    The Committee recommendation includes $5,858,270,000 for 
the National Cancer Institute [NCI], including $300,000,000 
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.
    Cancer Kinome.--The Committee is aware that research into 
the role of kinases--enzymes in the human genome that regulate 
an immense variety of cellular function--holds the promise to 
drive the development of new treatments and cures for a variety 
of cancers, including ovarian cancer. The challenge today is to 
collectively investigate the role of the kinome in triggering 
cancer and gaining a better understanding of which kinases play 
a role in cancer development in particular patients, and how 
kinome ``reprogramming'' contributes to resistance to anti-
cancer drugs. NCI is asked to support this type of promising 
personalized medicine research.
    Cancer and Mitochondria.--The Committee commends the NCI 
for its work in establishing a Mitochondrial Model Organisms 
and Cellular Systems Working Group and for its work to identify 
needs, barriers, and opportunities pertaining to mitochondrial 
biology relevant to addressing mechanistic questions in cancer. 
The Committee encourages the NCI to continue to support 
qualified research studies that examine the mechanisms by which 
cancer cells utilize oxidative stress in stromal cells to fuel 
their growth.
    Deadliest Cancers.--The Committee remains concerned that 
while more effective screening methods and treatments have 
lowered overall cancer incidence and death rates, some forms of 
cancer remain extremely difficult to diagnose and treat. 
Defined in statute as ``recalcitrant cancers''--those whose 5-
year survival rate is below 50 percent--they account for nearly 
half of all cancer deaths in the U.S. and include cancers of 
the pancreas, liver, ovary, brain, stomach, esophagus, and 
lung. Given the toll these types of cancer exact on society, 
the Committee urges NIH and NCI to continue to support research 
with an emphasis on developing improved screening and early 
detection tools and more effective treatments. The Committee 
expects to receive an update in the fiscal year 2019 CJ of how 
NCI is advancing these goals.
    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 notes that research on gastric cancer is 
less advanced than that of many other cancers. The lack of 
research funding makes it difficult to attract researchers to 
the field and make progress toward curative treatments. The 
Committee therefore encourages NCI to consider developing a 
scientific framework, as specified by the Recalcitrant Cancer 
Research Act of 2012 (Public Law 112-239, section 1083), for 
advancing stomach cancer research.
    Gynecologic Cancer Clinical Trials.--Clinical trials have 
significantly improved survival for women with gynecologic 
cancers, including ovarian, endometrial, cervical, and vulvar 
cancers. The Committee urges the NCI to continue to work with 
stakeholders through the NCI National Clinical Trials Network 
Gynecologic Cancers Steering Committee to address priorities 
for the gynecologic oncology clinical trials scientific agenda, 
including increasing the availability of trials for these 
patients. The Committee requests that NCI provide an update to 
the Committee in the fiscal year 2019 CJ.
    IDeA States and Cancer Clinical Trials.--The Committee 
recognizes that NCI supports clinical trials across the country 
through its National Clinical Trials Network [NCTN] and the NCI 
Community Oncology Research Program [NCORP]. The Committee 
understands that there are more than 270 NCORP component sites 
and 14 NCORP awardees across the country located in IDeA 
States, and that NCI supports several NCI-designated cancer 
centers in IDeA States. At the same time, the Committee 
recognizes that there are still opportunities for academic 
medical centers in IDeA States to become more engaged in these 
networks. Therefore, the Committee encourages NCI to coordinate 
with NIGMS in helping Clinical and Translational Research award 
sites in IDeA States that do not currently have NCORP or NCTN 
awards build capacity in these regions to conduct cancer 
clinical trials. The Committee also encourages NCI to continue 
to support NCORP in its mission to increase diversity among 
patients participating in NCI clinical trials, especially with 
regard to rural and minority populations. Finally, the 
Committee urges NCI, in consultation with NIGMS, to encourage 
collaboration between IDeA awardees and existing NCI designated 
cancer centers, NCTN lead sites, and NCORP sites.
    Immunotherapy.--NCI-funded research on the immune system's 
ability to find and destroy tumors has led to a new wave of 
promising treatments for many forms of cancer. Yet much remains 
unknown about how immunotherapy works on a cellular level, and 
especially why such treatments are successful for some patients 
but not for others. Without a better understanding of the 
immune system's response to cancer and knowing how cancer 
escapes immune-based therapy, further advances in this field 
will be slowed. Therefore, the Committee urges NCI to continue 
to prioritize basic research on the mechanisms of action 
involved in immunotherapy, including a focus on tumor 
resistance to immunotherapy. The Committee also recognizes the 
need for more basic and clinical researchers who have the 
necessary education to develop new breakthroughs in 
immunotherapy. The Committee encourages NCI to continue to 
support fellowships and T32 training awards for both young and 
mid-career researchers interested in immunotherapy.
    Liver Cancer.--The Committee notes that in the U.S. liver 
cancer is the second deadliest cancer, with a 5-year survival 
rate of less than 15 percent, and according to the CDC, unlike 
many other cancers, the rates of liver cancer deaths and 
incidence are rising. In spite of its growing mortality, 
research spending focused on liver cancer is not even among the 
20 largest NCI cancers research programs; NCI has few liver 
cancer-oriented grants in its portfolio, and it does not have a 
Specialized Program of Research Excellence [SPORE] for liver 
cancer. To increase the 5-year survivability of liver cancer, 
the Committee urges that NCI support liver cancer research 
across its portfolio using a variety of methods to stimulate 
research proposals. The Committee also notes that the link 
between hepatitis B infection and primary liver cancer is well 
established with up to 60 percent of global liver cancer cases 
caused by the hepatitis B virus [HBV] and, therefore, urges 
close collaboration with NIAID and NIDDK on issues related to 
HBV research.
    Lung Cancer.--The Committee encourages NCI to continue to 
prioritize support for meritorious research for lung cancer 
generally, as well as for research specifically related to 
early detection and continued advances in treatment with 
personalized medicine, immunotherapy, and other innovative 
treatments. The Committee requests an update in the fiscal year 
2019 CJ on these efforts.
    Metastatic Brain Tumor Research.--Metastatic brain tumors 
are the most common brain tumor in adults. While the exact 
incidence of metastatic brain tumors is not known, it is 
estimated at between 200,000 and 300,000 people per year. The 
Cancer Moonshot Initiative has helped to raise awareness of 
this often neglected form of cancer, and the Committee urges 
NCI to continue working with stakeholder organizations to 
advance research into improving brain imaging technologies and 
developing treatments to increase survivorship.
    Neuroblastoma.--The Committee encourages NCI to expand its 
support for research on high-risk neuroblastoma, including the 
detection and treatment of central nervous system metastases. 
The Committee requests an update on these activities in the 
fiscal year 2019 CJ.
    Pancreatic Cancer.--In 2016, pancreatic cancer rose to 
become the third-leading cause of cancer-related death in the 
U.S., claiming the lives of nearly 42,000 Americans. Despite 
progress in combating other forms of cancer, pancreatic cancer 
remains the only major cancer with a 5-year survival rate in 
the single digits, at nine percent, in large part because there 
are no reliable early detection methods nor effective treatment 
options. To help turn the tide against this deadly cancer, 
Congress in 2012 passed the Recalcitrant Cancer Research Act 
(Public Law 112-239), calling for the development of scientific 
frameworks for certain cancers. The Committee requests an 
update on pancreatic cancer in the fiscal year 2019 CJ.
    Pediatric Cancer.--The Committee remains concerned about 
the lack of child-specific solutions for pediatric cancer 
patients and the consistent overall rise in rate of incidence 
(35 percent increase since 1975). The Committee acknowledges 
that the needs of pediatric cancer patients are unique and 
different from the needs of adults with cancer. The majority of 
cancers in children are not seen in the adult population, but 
the vast majority of solutions continue to be adopted and 
adapted from adult cancer drugs for use in children, despite 
the toxicity of the drugs for their small developing bodies. 
The consequences continue to leave two-thirds of childhood 
cancer survivors with serious lifelong complications and one-
third of childhood cancer survivors dead by the age of 36. As a 
result, cancer continues to kill more children than all other 
diseases combined. The Committee notes that childhood cancer is 
unique from adult cancer and should be approached from a child-
specific perspective. Accordingly, the Committee urges the NCI 
to continue to support research that addresses the unique 
characteristics of childhood cancers and the unique needs of 
childhood survivors. There are some encouraging efforts 
currently focusing on child-specific solutions, and there 
should continue to be parallel efforts to determine the 
efficacy of adult research and treatments for childhood cancer; 
however, they should not be the primary focus. Just as adult 
research hopes to benefit children, it is more likely childhood 
cancer research may benefit adults. Therefore, the Committee 
encourages the continuation of important pediatric oncology 
research, including clinical trials for children with brain 
tumors and preclinical testing program evaluating new agents 
for treating pediatric malignancies. Within the additional 
resources provided for cancer research, the Committee requests 
a report within 120 days after enactment of this act on how the 
NCI is focusing on the unique needs of children. The Committee 
also encourages NCI to continue its investments in the novel 
pediatric Molecular Analysis for Therapy Choice [MATCH] study. 
The Committee requests an update on the progress of MATCH 
implementation for children with cancer, with specific 
information on issues such as accrual, participating 
institutions, and the scope and progress of the trials in the 
fiscal year 2019 CJ.
    Precision Medicine Initiative [PMI].--The Committee 
continues its strong support of NCI PMI and provides no less 
than $80,000,000 to continue its efforts to develop 
individualized treatments for cancer patients. The Committee 
recognizes the potential for significant advancements in cancer 
treatments from the NCI MATCH trial. It remains the central 
pillar of the precision medicine research focused on oncology 
for cancers that are unresponsive to standard interventions. 
The Committee urges NCI to continue to expand precision 
oncology trials. NCI should also continue to focus on launching 
the important pediatric MATCH trial as pediatric oncology 
mechanisms are very different from mutations seen in adults. 
Further, the Committee continues to believe in the necessity of 
NCI-funded clinical trials in the area of immuno-oncology, 
where a patient's engineered T-cells are used in combination 
with the immune system to fight late stage disease and commends 
NCI for its continued leadership in this area. Of particular 
interest is the use of precision medicine to develop therapies 
for late stage cancers and for those forms of the disease for 
which meaningful conventional treatments have proved largely 
ineffective for long term survival of the patients. NCI shall 
provide an update on these activities in the fiscal year 2019 
CJ.
    Prostate Cancer.--The Committee is aware of NCI's ongoing 
investment in prostate cancer research and is concerned that 
prostate cancer lacks treatments for men with advancing disease 
as well as adequate diagnostic and imaging methodologies common 
in other hormone-driven cancers with similar disease burden. To 
ensure Federal resources are leveraged to the greatest extent 
possible, the Committee encourages NCI to continue to 
coordinate its response to these needs with other Federal 
agencies, including DOD, as well as private research 
foundations and advocacy groups.
    Psycho-Social Distress Complications.--According to the 
Institute of Medicine, nearly 50 percent of all cancer patients 
experience distress. Further, studies suggest that distress in 
cancer patients leads to higher healthcare costs, less 
compliance with treatment pathways, and poorer health outcomes. 
While significant advancements have been made in biomedical 
treatments in cancer care, the Committee is concerned that the 
unaddressed psycho-social needs of patients are adversely 
impacting the effectiveness and cost of care, as well as the 
individuals' overall well-being. The Committee encourages NCI 
to continue to implement distress screenings in the NIH 
Clinical Center and in NCI-funded clinical trials as 
appropriate, coordinate and share information on this effort 
with the FDA, and provide an update on such activities in the 
fiscal year 2019 CJ.
    Research Initiative on Ethnic and Racial Diversity in 
Cancer.--The Committee recognizes that the NIH's Cancer 
Moonshot initiative aims to accelerate the discovery of new 
ways to cure cancers, including through an understanding and 
application of cancer genetic information to the prevention and 
treatment of cancer. The Committee urges the NIH, through the 
NIMHD and NCI, to continue to support research on the cause, 
prevention, and treatment of cancer in populations with diverse 
cultural, racial, and ethnic composition. To further support 
such collaborations, the NCI is encouraged to consider research 
expertise in ethnic and racial diversity and its impact on 
cancer development and outcomes in evaluating applications for 
NCI-designated cancer centers.
    Sleep Health and Cancer.--The Committee understands the 
complex intersection between sleep health and cancer 
development, cancer progression, and remission. The Committee 
encourages NCI to continue to explore the role of sleep health 
in cancer development and progression.
    Translational Research Program.--The Committee notes the 
SPORE program is NCI's cornerstone effort to promote 
collaborative, interdisciplinary translational cancer research. 
The Committee continues robust support for the SPORE grant 
program as it works to bring basic research into practical 
treatments. The Committee requests an update in the fiscal year 
2019 CJ on the SPORE program.
    Translational Science of Natural Products for Cancer.--The 
Committee has recognized the importance of moving natural 
products and their derivatives through development and testing, 
with the goal of accelerating the designation of 
Investigational New Drug to promising natural products that can 
treat cancer. The Committee directs NCI to continue to support 
this work.

               NATIONAL HEART, LUNG, AND BLOOD INSTITUTE

Appropriations, 2017....................................  $3,217,081,000
Budget estimate, 2018...................................   2,534,803,000
Committee recommendation................................   3,322,774,000

    The Committee recommendation includes $3,322,774,000 for 
the National Heart, Lung, and Blood Institute [NHLBI].
    Alzheimer's Disease and Vascular Dementia.--The Committee 
recognizes the importance of well characterized, longitudinal, 
population-based cohort studies in providing insights into risk 
factors related to dementia, with special focus on minority 
populations where disease burden is greatest. As the 
participants in these studies have aged, much has been learned 
about cognitive decline and the role of mid-life risk factors, 
but key challenges remain, particularly in the identification 
of biomarkers and in understanding the role of environmental 
versus genetic factors. Therefore, within the provided funds, 
the Committee directs NHLBI to recruit and examine the 
subsequent generations of such cohorts, as studying the adult 
children of these extensively characterized cohort members may 
provide new insights into risk identification and accelerated 
prevention efforts. The project shall conduct clinical 
examinations, including brain imaging, of this second 
generation of participants.
    Asthma.--The Committee notes with concern the evidence 
suggesting a causal link between air pollution and the 
development of asthma. The Committee urges NHLBI and the NIEHS 
to explore this potential causal link and any interventions 
necessary to prevent the development of asthma.
    Congenital Heart Disease [CHD].--The Committee commends 
NHLBI for its continued work to better understand causation and 
appropriate treatments for those with the most life threatening 
congenital heart defects through its biomedical research 
program `Bench to Bassinet' and the critical multi-centered 
infrastructure of the Pediatric Heart Network. NHLBI should 
also explore how the new adult CHD accreditation program, that 
advances and sets quality standards for care, can inform its 
work in this area. The Committee urges NHLBI to continue its 
work with other Federal agencies and professional and patient 
organizations to expand collaborative activities targeted 
toward prevention and treatment of the diverse lifelong needs 
of children and adults living with CHD. The Committee requests 
a report on these efforts in the fiscal year 2019 CJ.
    Cystic Fibrosis [CF].--The Committee applauds the work of 
NIH to support translational research tools that spur the 
development of new therapies for rare diseases like cystic 
fibrosis. Animal models are critical tools for understanding 
disease progression and identifying potential new treatments. 
The National Swine Resource and Research Center [NSRRC], funded 
by the NIH and hosted at the University of Missouri, provides 
services to develop swine models of many genetic conditions, 
like cystic fibrosis, to facilitate research and drug 
development for these diseases. The Committee encourages the 
continuation of jointly funded clinical research programs 
occurring at CF care centers in Missouri and across the 
country. One such project, the OPTIMIZE study, has brought 
together hospital systems in nearly 30 States to compare 
treatments for lung infections in those with CF to determine if 
a commonly used combination of antibiotics is safe and 
effective. Real world clinical trials such as this one are 
often only supported by NIH and non-profit organizations, and 
they may significantly improve care and treatment for people 
with serious, life-threatening diseases such as cystic 
fibrosis.
    Fibrotic Diseases.--The Committee encourages NIH to 
continue to vigorously support research into fibrotic diseases 
affecting different organs, including the lungs, liver, 
kidneys, heart, skin, and bones and to ensure enhanced 
coordination among its Institutes as they conduct necessary, 
expanded single organ or cross-organ fibrotic disease research 
to save lives and reduce healthcare expenses in future years. 
The Committee also encourages NIH to explore naturally 
occurring fibrotic disease in domestic animals to investigate 
opportunities to improve human and animal lives. Since many 
fibrotic diseases are individually rare diseases, a strategy 
that provides collaboration across disease and organ areas is 
recommended. Furthermore, the Committee encourages NIH to 
continue to provide oversight and direction through coordinated 
multi-institute activities to improve research efforts and 
avoid redundancy. The Committee requests a report on the 
current NIH Fibrosis Interest Group and its progress, which 
brings together key stakeholders at the NIH and elsewhere, to 
evaluate current research efforts and develop strategic paths 
forward to maximize efforts in fibrotic disease research. The 
Committee also directs NIH to include an update in its fiscal 
year 2019 CJ on its work relating to idiopathic pulmonary 
fibrosis following the November 2012 NHLBI workshop, 
``Strategic Planning for Idiopathic Pulmonary Fibrosis''.
    Heart Disease.--The Committee is concerned that heart 
disease continues to impose an enormous burden on our Nation's 
long-term health and economic stability and directs an NIH-wide 
prioritization of heart research to significantly increase, 
expand, intensify, and stimulate its investment commensurate 
with the impact on public health, the economy, and innovative 
scientific opportunities. The Committee commends NHLBI for its 
leadership in launching a Strategic Vision and directs the 
Institute to accelerate the implementation of the heart 
research recommendations and priorities, including heart 
failure and cardiac rehabilitation.
    Hemophilia.--The Committee encourages NHLBI to bring 
together leading hemophilia researchers and clinicians, as well 
as its Federal partners from CDC, FDA, and HRSA to create a 
national scientific agenda for clinical and translational 
research for the prevention and eradication of inhibitors, a 
costly complication affecting people with hemophilia.
    Longitudinal Study of Cardiovascular Health in African 
Americans.--The Committee commends NHLBI for accomplishments 
made by its longitudinal study of cardiovascular health in 
African Americans. This 16-year study has provided new insights 
into and better understanding of the burden of cardiovascular 
disease among African Americans in the United States. With this 
increased understanding comes knowledge of the gaps in a number 
of other health conditions that affect African Americans 
disproportionally, such as obesity, diabetes, hypertension, 
chronic kidney disease, and heart failure. Additionally, 
research has revealed that some of these chronic conditions may 
have an impact on healthy aging, including cognition and risk 
of dementia and may have transgenerational effects. Therefore, 
the Committee encourages NHLBI to continue to follow-up with 
all current study participants, conduct broader examinations 
for these participants, and explore enrollment of a new group 
of participants, including children and grandchildren of 
current study participants. An expanded study will provide 
researchers more information about the roles of familial 
factors and shared environments in the development and 
progression of cardiovascular disease and other conditions. The 
new round of examinations should include measurements that 
utilize the latest technology, such as Magnetic Resonance 
Imaging, to assess the status of the heart, muscles, and 
adiposity and to evaluate structural brain changes that may be 
related to hypertension, diabetes, and other chronic disorders.
    National Center on Sleep Disorders Research [NSCDR].--The 
Committee commends NHLBI and NSCDR for recent efforts to 
reinvigorate collaborations on important research in sleep, 
sleep disorders, and circadian rhythms. NHLBI and NSCDR are 
encouraged to continue to show leadership in this area and 
further incorporate sleep into relevant research activities 
across NIH Institutes and Centers.
    Postural Orthostatic Tachycardia Syndrome [POTS].--With an 
estimated 1,000,000 to 3,000,000 Americans suffering from POTS, 
a neurological disorder that affects mostly adolescent and 
adult women, there are no effective treatments to address this 
often misdiagnosed and debilitating condition. The level of 
disability resulting from POTS can be similar to that occurring 
in multiple sclerosis and congestive heart failure, but little 
research funding has been dedicated to date to improving 
understanding of POTS. Due to the lack of effective treatments, 
many patients are unable to attend school or work, resulting in 
significant impacts to the U.S. economy. The World Health 
Organization recently approved the first unique ICD code for 
POTS, which when implemented, will hopefully enable more 
precise epidemiological research on the disease. The Committee 
expects NHLBI and NINDS to work with stakeholders to stimulate 
the field and develop strategies that will increase our 
understanding of POTS and lead to effective treatments.
    Pulmonary Hypertension [PH].--The Committee applauds NHLBI 
for identifying the study of underlying mechanisms of disease 
of PH as one of its areas of focus within its recent strategic 
vision plan for research. The Committee encourages NHLBI to 
continue its focus in this area, particularly on idiopathic 
pulmonary arterial hypertension, so that additional gains can 
be made that benefit patient outcomes and further improve 
survivability for affected individuals.
    Sickle Cell Disease.--The Committee encourages NHLBI to 
prioritize the study of sickle cell disease. Academic medical 
centers located in States with significant populations of 
sickle cell patients have made progress in treating the disease 
through NIH sponsored clinical trials and through blood and 
marrow transplantation for sickle cell disease, which is 
currently the only therapy that can cure the disease. However, 
more research dollars are needed to augment the limited 
treatment options available if we are to have a real impact on 
sickle cell disease.
    Sleep Phenotypes.--The health consequences of sleep 
disorders such as obstructive sleep apnea and insomnia include 
increased risk of hypertension, cardiovascular disease and 
obesity. The Committee is encouraged by the Institute's efforts 
to improve our understanding of sleep disorders and urges the 
Institute to partner with other NIH Institutes to continue 
advancing research for sleep phenotypes and biomarkers that 
further explore health disparities and the intersection between 
chronic diseases and sleep.
    Thoracic Aortic Disease.--The Committee is concerned about 
sudden, preventable death caused by thoracic aortic aneurysm 
and dissection attributed to structural cardiovascular 
disorders, such as Marfan syndrome, and encourages NHLBI to 
further study the mechanisms of disease and opportunities to 
improve patient health.

         NATIONAL INSTITUTE OF DENTAL AND CRANIOFACIAL RESEARCH

Appropriations, 2017....................................    $425,751,000
Budget estimate, 2018...................................     320,749,000
Committee recommendation................................     439,738,000

    The Committee recommendation includes $439,738,000 for the 
National Institute of Dental and Craniofacial Research [NIDCR].
    Temporomandibular Disorder [TMD].--The Committee recognizes 
NIDCR's leadership in TMD pain research, which has led to 
establishing TMD as a multisystem disorder with overlapping 
pain and non-pain conditions. The Committee encourages NIDCR to 
continue its leadership as a critical member of the Trans-NIH 
Working Group on Chronic Overlapping Pain Conditions by 
promoting and advancing integrated research on these 
conditions. In addition, as the oral disability associated with 
TMD affects a patient's nutritional health status, the 
Committee encourages NIDCR to improve research on orofacial 
function relevant to the nutritional implications of TMD. 
Finally, the Committee is aware of the scientific meetings on 
an integrated systems approach of precision medicine related to 
cellular-molecular-genetic-epigenetic mechanisms related to 
diagnosis and treatment of TMD and its comorbid conditions. In 
2013, several Institutes co-sponsored a workshop on the topic 
of the temporomandibular joint. The Committee requests an 
update on initiatives that resulted from the recommendations 
that came forth from these meetings in the fiscal year 2019 CJ.

    NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASES

Appropriations, 2017....................................  $1,874,028,000
Budget estimate, 2018...................................   1,449,534,000
Committee recommendation................................   1,935,597,000

    The Committee recommendation includes $1,935,597,000 for 
the National Institute of Diabetes and Digestive and Kidney 
Diseases [NIDDK].
    Biomarkers.--The Committee encourages NIDDK to accelerate 
the discovery and validation of biomarkers to aid in designing 
and conducting clinical trials to prevent, treat, and cure type 
1 diabetes. The Committee also encourages NIDDK to work with 
NIAID to develop biomarkers specifically related to immune 
interventions for multiple autoimmune diseases, including type 
1 diabetes.
    Diabetes.--The Committee recognizes the important work of 
NIDDK, the lead Federal agency conducting research to find a 
cure for diabetes and improve diabetes care. Individuals with 
and at risk for diabetes benefit from life-sustaining 
advancements in preventing and treating diabetes that result 
from NIDDK studies. The Committee also recognizes the success 
of the NIDDK-supported research in the development of essential 
tools to manage diabetes, including insulin pumps and blood 
glucose monitors, ongoing development of artificial pancreas 
technologies, and new and better medications to treat diabetes. 
The Committee urges NIDDK to commit resources commensurate with 
the severity and escalating costs of the epidemic to further 
diabetes research that will build upon these past successes, 
improve prevention and treatment, and bring the Nation closer 
to a cure.
    Drug-Induced Liver Injury Network [DILIN].--The Committee 
commends NIDDK for including analyses of liver injury caused by 
alternative medicines, such as herbal products and supplements, 
within its DILIN. However, the Committee is concerned with the 
limited scope of the current work. Therefore, the Committee 
directs NIDDK to work to expand to a broader sample of herbal 
products and supplements associated with liver injury cases to 
ascertain with greater certainty the causal agents and their 
prevalence. These samples exist within the DILIN Repository and 
afford an opportunity to analyze products for unlabeled 
ingredients, along with current analyses. This work can help 
generate a database to help identify signals to prevent future 
liver injury. The Committee requests that NIDDK provide an 
update to the Committee in the fiscal year 2019 CJ.
    Glomerular Diseases.--The Committee encourages continued 
support for the Cure Glomeruloneuropathy initiative which has 
enrolled over 1,500 clinical research participants to further 
the understanding of rare forms of kidney diseases.
    Inflammatory Bowel Diseases [IBD].--The Committee is 
pleased by NIDDK's support of research into inflammatory bowel 
diseases. The Committee urges NIDDK to respond to these 
findings by providing additional support for research on IBD. 
Research should include a focus on the environmental triggers 
and epigenetics of IBD as well as interventions for the rising 
prevalence of IBD. The research should also be targeted at both 
pediatric and adult patients.
    Interstitial Cystitis.--The Committee is pleased with the 
evolving research on interstitial cystitis and encourages NIDDK 
to work with stakeholders on a comprehensive scientific 
conference to examine mechanisms for scientific opportunity.
    Multidisciplinary Approach to the Study of Chronic Pelvic 
Pain [MAPP].--The Committee is pleased with the progress of the 
MAPP Research Network and encourages collaborations with 
stakeholders to ensure proper dissemination of information.
    National Commission on Digestive Disease Research.--The 
Committee continues to value and support the implementation of 
the 2009 National Commission on Digestive Disease Research 
report entitled ``Opportunities & Challenges in Digestive 
Diseases.'' The Committee requests an update on the 
implementation of the recommendations of the National 
Commission.

        NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKE

Appropriations, 2017....................................  $1,782,582,000
Budget estimate, 2018...................................   1,355,998,000
Committee recommendation................................   1,904,666,000

    The Committee recommendation includes $1,904,666,000 for 
the National Institute of Neurological Disorders and Stroke 
[NINDS], including $43,000,000 appropriated from the NIH 
Innovation Account.
    Brain Aneurysm Research.--The Committee is concerned that 
an estimated 1 out of every 50 individuals in the United States 
has a brain aneurysm and an estimated 30,000 Americans suffer a 
brain aneurysm rupture each year, with little to no warning. 
Ruptured brain aneurysms are fatal in about 40 percent of 
cases. Despite the widespread prevalence of this condition and 
the high societal cost it imposes on our Nation, the Federal 
Government only spends approximately $0.83 per year on brain 
aneurysm research for each person afflicted with a brain 
aneurysm. The Committee is concerned that not enough research 
is focused on prevention and requests a report regarding the 
annual support level for brain aneurysm research funding over 
the past 5 years, including the types of grants supported in 
the fiscal year 2019 CJ.
    Brain Research through Advancing Innovative 
Neurotechnologies [BRAIN] Initiative.--The Committee continues 
its strong support for the BRAIN Initiative and provides 
$400,000,000 in fiscal year 2018. The Committee commends the 
NIH for its leadership to date on the BRAIN Initiative and the 
progress made in several areas. The BRAIN Initiative is 
developing a more complete understanding of brain function and 
has the possibility of helping millions of people who suffer 
from a wide variety of neurological and psychiatric disorders 
such as Parkinson's disease, schizophrenia, Alzheimer's 
disease, depression, and traumatic brain injury. Powerful new 
technologies and tools are allowing for the study of anatomical 
and functional abnormalities in neuro-psychiatric diseases, 
which is the key to understanding these diseases and developing 
therapies and cures.
    Cerebral Palsy [CP].--The Committee commends NINDS for 
developing the CP 5-year Strategic Plan and urges NINDS to 
implement Funding Opportunity Announcements in support of the 
top priorities and increase its CP research efforts for 
prevention, treatment, and cure through the lifespan. The 
Committee encourages funding for basic and translational 
research (including regenerative medicine) for improved 
outcomes for patients with CP, and recommends collaboration 
with the research and advocacy community. Furthermore, the 
Committee recommends that NIH form a trans-NIH working group of 
program officers who manage their Institute's CP portfolio and 
that this group regularly interact with CP patient advocacy 
groups.
    Duchenne Muscular Dystrophy.--The Committee is aware of 
stakeholder efforts to achieve validated and qualified 
biomarkers for Duchenne Muscular Dystrophy. The Committee 
supports these activities and urges NINDS to work with other 
Institutes and with the FDA to provide the necessary guidance 
and to assemble a workshop of all stakeholders to advance this 
work. The Committee is also concerned about a lack of access to 
federally funded data, such as imaging and biomarker data, that 
could support qualification of an MRI imaging biomarker and 
directs NIH to ensure all federally funded investigators, 
including Duchenne investigators, are in full compliance with 
the data sharing requirements included in the 21st Century 
Cures Act.
    Dystonia.--The Committee encourages NINDS to continue to 
expand the dystonia research portfolio. NINDS is encouraged to 
work with stakeholders in support of a conference to examine 
evolving scientific opportunities in dystonia research and to 
foster sharing of resources and collaboration among 
investigators.
    Parkinson's Disease.--The Committee commends NINDS for 
taking critical steps in identifying priority research 
recommendations to advance research on Parkinson's disease, 
which impacts between 500,000 and 1,500,000 Americans and is 
the second most prevalent neurodegenerative disease in the 
United States. The ultimate success of these recommendations 
will depend upon targeted research initiatives and increased 
research capacity, even if innovative support and funding 
mechanisms are required. The Committee recognizes that NINDS is 
prioritizing public health concerns with severe gaps in unmet 
medical needs and believes any funding increase for NINDS in 
fiscal year 2018 should include support for the research 
recommendations set forth by the NINDS planning strategy to 
bring us closer to better treatments and a cure for Parkinson's 
disease. The Committee also encourages NINDS to submit a report 
of its progress on implementing these recommendations at the 
conclusion of fiscal year 2018.
    Peripheral Neuropathies.--The Committee is pleased at the 
progress of ongoing research into Guillain-Barre syndrome 
[GBS], chronic inflammatory demyelinating polyneuropathy, and 
related conditions, and notes the important connection between 
Zika and GBS. The Committee encourages NINDS to continue work 
to advance emerging research in a meaningful way.
    Postural Orthostatic Tachycardia Syndrome [POTS].--With an 
estimated 1,000,000 to 3,000,000 Americans suffering from POTS, 
a neurological disorder that affects mostly adolescent and 
adult women, there are no effective treatments to address this 
often misdiagnosed and debilitating condition. The level of 
disability resulting from POTS can be similar to that occurring 
in multiple sclerosis and congestive heart failure, but little 
research funding has been dedicated to date to improving 
understanding of POTS. Due to the lack of effective treatments, 
many patients are unable to attend school or work, resulting in 
significant impacts to the U.S. economy. The World Health 
Organization recently approved the first unique ICD code for 
POTS, which when implemented, will hopefully enable more 
precise epidemiological research on the disease. The Committee 
expects NIHLBI and NINDS to work with stakeholders to stimulate 
the field and develop strategies that will increase our 
understanding of POTS and lead to effective treatments.
    Stroke.--The Committee is concerned that stroke continues 
to enact a massive burden on our Nation's long-term health and 
economic stability, and encourages NIH to expand its investment 
commensurate with the impact on public health, the economy, and 
innovative scientific opportunities. NINDS shall continue to 
implement top priorities identified in the 2012 planning 
initiative for stroke prevention, treatment, and recovery 
research, particularly augmentation of the Stroke Clinical 
Trials Network, including early stroke recovery. The Committee 
lauds the NINDS for its leadership in convening a workshop on 
``Translational Stroke Research: Vision and Opportunities'' and 
directs the Institute to accelerate implementation of key 
recommendations and other findings.
    Traumatic Brain Injuries [TBI].--The Committee understands 
regenerative medicine research and the use of adult stem cells 
may play an important role in the treatment of TBI. The 
Committee strongly encourages NINDS, with other Institutes and 
Centers, to ensure a robust and coordinated portfolio of TBI 
research is supported with a focus on how to leverage 
regenerative medicine research and the use of adult stem cells 
in the treatment of TBI. The Committee requests an update in 
the fiscal year 2019 CJ on efforts in these specific areas of 
TBI research.

         NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES

Appropriations, 2017....................................  $4,916,346,000
Budget estimate, 2018...................................   3,782,670,000
Committee recommendation................................   5,127,866,000

    The Committee recommendation includes $5,127,866,000 for 
the National Institute of Allergy and Infectious Diseases 
[NIAID].
    Autoimmune Neuropathies.--The Committee encourages NIAID to 
work with NINDS and other Institutes and Centers to support 
efforts to gauge the state-of-the-science of autoimmune 
neuropathies research into conditions like Guillain-Barre 
syndrome and chronic inflammatory demyelinating polyneuropathy, 
and to establish a cross-cutting research plan for this 
portfolio.
    Combating Antibiotic Resistant Bacteria [CARB].--The 
Committee remains deeply concerned about the threat posed by 
the increasing prevalence of antibiotic resistant bacteria. In 
fiscal years 2016 and 2017, NIAID used funding appropriated by 
the Committee to expand its support for basic, translational, 
and applied research on antibiotic-resistant pathogens and the 
molecular mechanisms of antimicrobial resistance. The Committee 
strongly supports NIAID's efforts to continue these efforts, 
and includes $513,000,000, an increase of $50,000,000, to fund 
clinical trials of new antibiotics and novel uses of licensed 
antibiotics meant to limit the development of antibiotic 
resistance, as well as the development of diagnostics to 
quickly identify bacterial pathogens to inform antibacterial 
stewardship. These funds will also make it possible for NIAID 
to partner with Federal, academic, and industry researchers to 
develop diagnostics, immunoprophylactics, therapeutics, and 
vaccines that target multiple antibiotic-resistant bacteria. 
The Committee encourages NIH to continue to expand its 
collaboration with USDA and CDC to increase our understanding 
of antibiotic resistance and improve the responsible use of 
antibiotics in agriculture. The Committee requests an update on 
these activities in the fiscal year 2019 CJ.
    Hepatitis B [HBV].--The Committee notes that infection with 
HBV is a serious public health threat and is associated with 
approximately 887,000 deaths each year worldwide, making it a 
leading cause of death in the world. In the United States, 1 in 
20 Americans has been infected with HBV and up to 2,200,000 are 
chronically infected. Left undiagnosed and untreated, 1 in 4 of 
those with chronic HBV infection will die prematurely from 
cirrhosis, liver failure, and/or liver cancer. In light of this 
public health threat, the Committee is concerned that NIH 
research spending on HBV research was only $49,000,000 in 2016 
and has declined by almost 16 percent since fiscal year 2011. 
With Hepatitis C now curable and study of the entire HBV life 
cycle now possible, NIAID is urged to intensify its current 
efforts to find a cure for HBV. To meet this goal, the 
Committee urges NIAID to issue targeted calls for HBV research 
proposals in fiscal year 2018 focused upon therapeutic 
development and the many research opportunities identified by 
the scientific community.
    Lyme Disease.--With more than 300,000 Americans suffering 
from Lyme disease, especially in rural States across the United 
States, an improved understanding and treatment of the disease 
is essential for the health and well-being of Americans. The 
Committee encourages NIH to issue requests for grant 
applications for research to investigate causes of all forms 
and manifestations of Lyme disease, including post-treatment 
symptoms, as well as research to develop diagnostics, 
preventions, and treatments for those conditions and for 
complications caused by co-infection by other tick-transmitted 
bacteria, viruses, and parasites. The Committee notes that in 
patients who suffer from long-term complications associated 
with Lyme disease, clear treatment pathways are often missed as 
a result of inaccurate and incomplete testing. The Committee 
urges the NIAID, in coordination with CDC, to study the long-
term effects on patients suffering from post-treatment Lyme 
disease syndrome, or ``chronic Lyme disease.'' Specifically, 
the Committee urges NIAID to evaluate the effectiveness of 
laboratory tests associated with the detection of Borrelia 
burgdorferi to diagnose the disease early, which can improve 
the treatment of patients suffering from chronic Lyme disease. 
The Committee also encourages the National Library of Medicine, 
in coordination with NIAID, to update its terminology in line 
with new research to more accurately reflect the long-term 
effects of chronic Lyme disease. The Committee requests that 
NIH report on its Lyme disease program. The report should 
include: (1) A summary of ongoing or upcoming efforts to 
advance more sensitive and accurate diagnostic tests capable of 
distinguishing between active and past infection, including an 
analysis of obstacles hindering adoption of direct detection 
tests for Lyme disease that are currently available or in the 
pipeline; (2) An assessment of the science on persistent 
infection following antibiotic treatment, with a review of 
recent research on biofilms and persistent forms of Lyme 
bacteria that can tolerate standard antibiotic treatment; (3) A 
summary of NIH research on prevention of Lyme disease and 
related tick-borne diseases, information on the effectiveness 
of currently available methods for prevention, and a 
description of methods for prevention NIH plans to further 
investigate; and (4) Details on progress achieving NIH 
Strategic Plan objectives relevant to Lyme disease as well as 
plans to address any shortfalls in meeting goals.
    Malaria.--The Committee urges NIAID to continue its efforts 
to understand the biology of the malaria parasite and to 
develop tools needed for effective and sustainable malaria 
prevention, treatment, and control, including vaccines.
    Sexually Transmitted Diseases [STDs].--The Committee is 
aware of the most recent STD Surveillance Report that found 
that the total combined reported cases of chlamydia, gonorrhea, 
and syphilis reached a record high and that the CDC estimates 
20,000,000 new STDs occur every year. The Committee encourages 
NIAID to work in collaboration with CDC to develop effective 
strategies for prevention and treatment approaches, including 
vaccine development, to combat STDs, and to increase research 
to understand the evolution and structure of STDs and the 
inter-relationship with HIV/AIDS to better control for these 
diseases.
    Translational Vaccinology.--The Committee notes a very 
promising area in the field of vaccine and immunology is 
translational vaccinology, in which researchers use innovative 
principles of vaccine design and enhancement to generate novel, 
experimental vaccines suitable for assessment and development 
through pre-clinical studies and clinical trials. The Committee 
strongly encourages NIAID to support a robust portfolio of 
extramural, highly meritorious translational vaccine research 
that focus on an interdisciplinary approach to this research. 
The Committee requests NIAID provide an update in the fiscal 
year 2019 CJ on expansion opportunities for interdisciplinary 
translational vaccinology research.
    Vector-borne Disease.--The Committee continues to support 
NIAID's ongoing research on a variety of vector-borne diseases 
including Zika, chikungunya, and dengue, and the Institute's 
development of effective countermeasures and strategies. The 
Committee supports NIAID developing new and expanded research 
efforts to enhance the array of innovative vector control 
technologies to counter transmission of Zika and other vector-
borne infectious disease threats.
    Zika-Related Conditions.--The Committee encourages NIAID, 
along with other Institutes and Centers, to establish cross-
cutting research activities to combat Zika-related conditions, 
including Guillain-Barre syndrome.

             NATIONAL INSTITUTE OF GENERAL MEDICAL SCIENCES

Appropriations, 2017....................................  $2,650,128,000
Budget estimate, 2018...................................   2,185,509,000
Committee recommendation................................   2,887,194,000

    The Committee recommendation includes $2,887,194,000 for 
the National Institute of General Medical Sciences [NIGMS], 
which includes $1,074,443,000 in transfers available under 
section 241 of the PHS Act.
    Institutional Development Award [IDeA].--The Committee 
provides $344,313,000 for the IDeA program, an increase of 
$10,952,000. 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 program an 
essential component of NIH's research portfolio. 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.
    Science Education Partnership Awards [SEPA].--SEPA fosters 
important connections between biomedical researchers and K-12 
teachers and their students. These connections establish an 
education pipeline to careers in biomedical sciences, which is 
one of the most important areas of workforce development for 
the U.S. economy. SEPA has been level funded for a number of 
years and the Committee encourages NIGMS to provide additional 
resources for the program within their general increase for 
fiscal year 2018. Additional funding should be used to award 
additional innovative K-12 science, technology, engineering and 
mathematics educational projects.

  EUNICE KENNEDY SHRIVER NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN 
                              DEVELOPMENT

Appropriations, 2017....................................  $1,379,684,000
Budget estimate, 2018...................................   1,032,029,000
Committee recommendation................................   1,426,092,000

    The Committee recommendation includes $1,426,092,000 for 
the Eunice Kennedy Shriver National Institute of Child Health 
and Human Development [NICHD].
    Congenital Syphilis.--The Committee urges the NICHD to 
coordinate efforts with NIAID and CDC to identify potential 
risk factors, increase prevention, improve newborn screening 
techniques, and provide treatment to improve outcomes in women 
and infants infected with Syphilis, with special focus on 
infants infected with HIV and Congenital Syphilis.
    Fragile X [FX].-- The Committee commends NIH for the NICHD-
led effort that has resulted in significant progress in mapping 
the molecular, physiological, biological, and genetic 
connections among Fragile X, the FX protein, and autism. Given 
the inextricable connection between the FX protein and autism, 
the Committee urges the Director and his counterparts at each 
Institute with Fragile X and autism portfolios to explore ways 
to create greater efficiency and synergy between these two 
research tracks to accelerate translational research toward a 
better understanding of both conditions and to shorten the time 
to bring effective treatments for both conditions to market.
    Population Research.--The NICHD Population Dynamics Branch 
fosters scientific understanding of changes in human health and 
development at the population level by supporting research and 
research training in demography, especially through the 
Population Dynamics Centers Research Infrastructure Program, 
which promotes efficient use of research funding, innovative 
research, data sharing, and the development of young 
scientists. The Branch also spurs scientific innovation in 
demographic, or population, research by wisely investing in 
large-scale longitudinal studies, including the Fragile 
Families and Child Well Being study and the National Survey of 
Family Growth, the latter which revealed the decline of 
unintended pregnancies in the United States. The Committee 
urges NICHD to sustain its investment in the full spectrum of 
population research activities to advance our understanding of 
how the demography and health of our Nation are fundamentally 
intertwined.
    Sports Related Head Impact Research.--The Committee is 
concerned about the growing prevalence of head impacts, 
concussion, and the associated risk of concussive morbidities 
among participants in youth sports. The Committee strongly 
encourages NICHD to bolster pediatric sports-related concussion 
research, including investing in research focused on behavioral 
interventions and other preventative strategies that can reduce 
head impacts and concussion among young athletes.

                         NATIONAL EYE INSTITUTE

Appropriations, 2017....................................    $732,855,000
Budget estimate, 2018...................................     549,847,000
Committee recommendation................................     758,552,000

    The Committee recommendation includes $758,552,000 for the 
National Eye Institute [NEI].
    Age-Related Macular Degeneration [AMD].--The Committee 
recognizes NEI-funded research in which combinations of FDA-
approved drugs used to treat a variety of conditions from 
lowering blood pressure to treating prostate disease may 
eventually offer an option for preventing vision loss 
associated with degeneration of cells in the retina from AMD 
and Stargardt disease, the most common form of inherited 
juvenile macular degeneration. Discovering new uses for these 
already-approved drugs--which act on G protein coupled 
receptors, a family of signaling proteins in various cell types 
throughout the body--provides the quickest possible transition 
from bench to bedside.
    Audacious Goals Initiative [AGI].--The Committee commends 
NEI's leadership through its AGI, which aims to restore vision 
within the next decade through regeneration of the retina by 
replacing cells that have been damaged by disease and injury 
and restoring their visual connections to the brain. The 
Committee is pleased that NEI has proceeded with two rounds of 
grants to date that relate to novel imaging technologies to 
help clinicians observe the function of individual neurons in 
human patients and follow them over time as they test new 
therapies, as well as identifying new factors that control 
regeneration and comparing the regenerative process among model 
organisms, rodents, and non-human primates.
    Glaucoma.--The Committee recognizes the identification of 
three new genes by the NEI Glaucoma Human Genetics 
Collaboration Heritable Overall Operational Database 
[NEIGHBORHOOD] Consortium that are strongly associated with 
primary open-angle glaucoma [POAG], the most common form of the 
disease. The finding that variants of these genes may alter the 
protection of the optic nerve from degeneration due to 
oxidative stress increases the total number of genes associated 
with POAG to 15, demonstrating that the underlying mechanisms 
of the disease may involve the interaction of many genes with 
environmental influences.
    Usher Syndrome.--The Committee continues to urge NIH to 
prioritize Usher syndrome research at NEI and NIDCD. The 
Committee requests an update in the fiscal year 2019 CJ. The 
update should include efforts to stimulate the field and to 
accelerate viable human treatment options for those with Usher 
syndrome.

          NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES

Appropriations, 2017....................................    $714,261,000
Budget estimate, 2018...................................     533,537,000
Committee recommendation................................     737,727,000

    The Committee recommendation includes $737,727,000 for the 
National Institute of Environmental Health Sciences [NIEHS].

                      NATIONAL INSTITUTE ON AGING

Appropriations, 2017....................................  $2,052,487,000
Budget estimate, 2018...................................   1,303,541,000
Committee recommendation................................   2,535,539,000

    The Committee recommendation includes $2,535,539,000 for 
the National Institute on Aging [NIA].
    Alzheimer's Disease.--The bill includes $1,828,000,000, an 
increase of $414,000,000 above fiscal year 2017 for high-
quality research on Alzheimer's disease, subject to the 
scientific opportunity presented in the peer review process. 
The Committee commends NIA for its leadership in supporting 
longitudinal, population-based cohort studies into the causes 
of dementia. Because rural, poor, and minority populations may 
be at enhanced risk for dementia, the value and application of 
these studies is enhanced when they include individuals from 
various geographic, ethnic, socio-economic, and generational 
backgrounds. Therefore, the Committee directs NIA to diversify 
its cohort studies, with the specific goal of capturing a 
diverse sample of Americans whose inclusion would promote a 
better understanding of the factors underlying variation and 
disparities in dementia risk and ultimately lead to improved 
diagnostic, treatment, and prevention strategies in high risk 
populations.
    Population Research.--The Committee recognizes the 
Institute's leadership in making data, especially longitudinal 
data, available to the broader research community. NIA's 
investments in data infrastructure, such as the ground-breaking 
Health and Retirement Study [HRS], have spurred significant 
scientific research findings as well as important interagency 
and international collaborations. In fiscal year 2018, the 
Committee urges NIA and SSA to continue working jointly to 
support the HRS. The Committee also encourages the Institute to 
consider recommendations recently issued by an outside expert 
Committee regarding NIA's major surveys and to adopt 
innovations that will enhance data quality and accessibility. 
The Committee also urges NIA to pursue data collection and 
dissemination and research activities via its support of the 
prestigious Centers of Demography and Economics of Aging.
    Sleep Health and Alzheimer's.--The Committee recognizes 
that poor sleep health and sleep disorders promote or influence 
the development of diseases that impair cognitive functioning, 
such as Alzheimer's. The Committee encourages research to 
explore the linkages between the sleep cycle, cardiovascular 
system, and Alzheimer's in an effort to inform prevention.

 NATIONAL INSTITUTE OF ARTHRITIS AND MUSCULOSKELETAL AND SKIN DISEASES

Appropriations, 2017....................................    $557,851,000
Budget estimate, 2018...................................     417,898,000
Committee recommendation................................     576,178,000

    The Committee recommendation includes $576,178,000 for the 
National Institute of Arthritis and Musculoskeletal and Skin 
Diseases [NIAMS].
    Epidermolysis Bullosa.--The Committee recognizes the 
promising scientific gains and applauds private partners 
advancing research in pursuit of treatments for Epidermolysis 
Bullosa. The Committee encourages NIH to continue to support 
the intensification of such research at NIAMS. The Committee 
further encourages NIAMS to leverage Federal funds with public-
private partnerships in the areas of Epidermolysis Bullosa and 
related disorders.
    Scleroderma.--The Committee applauds NIAMS for its support 
of research into diseases that cause fibrosis in various organ 
systems, such as scleroderma. The Committee encourages NIAMS to 
prioritize research in this area and pursue collaborative 
opportunities with other ICs investigating fibrotic diseases.

    NATIONAL INSTITUTE ON DEAFNESS AND OTHER COMMUNICATION DISORDERS

Appropriations, 2017....................................    $436,875,000
Budget estimate, 2018...................................     325,846,000
Committee recommendation................................     451,768,000

    The Committee recommendation includes $451,768,000 for the 
National Institute on Deafness and Other Communication 
Disorders [NIDCD].
    Usher Syndrome.--The Committee continues to urge the NIH to 
prioritize Usher syndrome research at NEI and NIDCD. The 
Committee requests an update in the fiscal year 2019 CJ. The 
update should include efforts to stimulate the field and to 
accelerate viable human treatment options for those with Usher 
syndrome.

                 NATIONAL INSTITUTE OF NURSING RESEARCH

Appropriations, 2017....................................    $150,273,000
Budget estimate, 2018...................................     113,688,000
Committee recommendation................................     155,210,000

    The Committee recommendation includes $155,210,000 for the 
National Institute of Nursing Research [NINR].

           NATIONAL INSTITUTE ON ALCOHOL ABUSE AND ALCOHOLISM

Appropriations, 2017....................................    $483,525,000
Budget estimate, 2018...................................     361,356,000
Committee recommendation................................     500,491,000

    The Committee recommendation includes $500,491,000 for the 
National Institute on Alcohol Abuse and Alcoholism [NIAAA].

                    NATIONAL INSTITUTE ON DRUG ABUSE

Appropriations, 2017....................................  $1,073,320,000
Budget estimate, 2018...................................     864,998,000
Committee recommendation................................   1,113,442,000

    The Committee recommendation includes $1,113,442,000 for 
the National Institute on Drug Abuse [NIDA].
    Adolescent Brain Development [ABCD].--The Committee 
recognizes and supports the ABCD study. This study will help 
the understanding of the dramatic brain development that takes 
place during adolescence and how the various experiences people 
are exposed to during this time interact with each other and 
their biology to affect brain development and, ultimately, 
social, behavioral, health, and other outcomes. The Committee 
requests an update be included in the fiscal year 2019 CJ on 
the ABCD study.
    Barriers to Research.--The Committee is concerned that 
restrictions associated with Schedule 1 of the Controlled 
Substance Act effectively limit the amount and type of research 
that can be conducted on certain schedule 1 drugs, especially 
marijuana or its component chemicals and certain synthetic 
drugs. At a time when we need as much information as possible 
about these drugs, we need to review lowering regulatory and 
other barriers to conducting this research. The Committee 
directs NIDA to provide an update in the fiscal year 2019 CJ on 
the barriers to research that result from the classification of 
drugs and compounds as Schedule 1 substances.
    Drug Treatment in Justice System Settings.--The Committee 
understands that providing evidence-based treatment for 
substance use disorders offers the best alternative for 
interrupting the drug use/criminal justice cycle for offenders 
with drug problems. Untreated substance-using offenders are 
more likely to relapse into drug use and criminal behavior, 
jeopardizing public health and safety and taxing criminal 
justice system resources. Treatment has consistently been shown 
to reduce the costs associated with lost productivity, crime, 
and incarceration caused by drug use. The Committee applauds 
NIDA's focus on adult and juvenile justice populations in its 
research, supports this important work, and asks for a progress 
report in the fiscal year 2019 CJ.
    National Testing Program for Schedule I Marijuana-Derived 
Products in U.S. Distribution.--The Committee appreciates 
NIDA's work in marijuana research, but is concerned that NIDA 
ceased funding for analysis of marijuana samples seized by law 
enforcement in 2014. Without dedicated funding for this 
activity, the number of analyzed seized samples has plummeted, 
meaning that available data is no longer current or robust. The 
Committee believes that such research, along with analysis of 
marijuana and marijuana-derived products sold commercially in 
dispensaries or online, is essential for informing substance 
abuse prevention efforts, public health policy, and law 
enforcement tactics across the Federal Government. Therefore, 
the Committee directs NIDA to work with law enforcement, 
including the Drug Enforcement Agency, to facilitate and 
ultimately fund a National Testing Program for Schedule I 
Marijuana-Derived Products in U.S. distribution to conduct such 
analysis of both samples seized by law enforcement and of 
samples collected from non-DEA approved sources to provide 
robust reliable data that can inform policy.
    Opioid Misuse and Addiction.--The Committee continues to be 
extremely concerned about the epidemic of prescription opioids, 
heroin, and synthetic opioid use, addiction, and overdose in 
the United States. Approximately 144 people die each day in 
this country from opioid overdose, making it one of the most 
common causes of non-disease-related deaths for adolescents and 
young adults. This crisis has been exacerbated by the 
availability of fentanyl and its analogs in many communities. 
The Committee appreciates the important role that research can 
and should play in the various Federal initiatives aimed at 
this crisis. Although NIDA has studied the effectiveness and 
risks associated with long-term opioid use for chronic pain, 
little research has been done to investigate new and 
alternative treatment options. The Committee urges NIDA to 
expand scientific activities related to research on medications 
used to treat and reduce chronic pain. The Committee encourages 
NIDA to coordinate with the agencies of the NIH Pain 
Consortium, the pharmaceutical industry, experts in the field 
of pain research and addiction, and the medical research 
community at large to identify gaps in scientific research 
related to opioid abuse and addiction, and the treatment of 
chronic pain, especially the development of medications with 
reduced abuse liability. NIDA is encouraged, as appropriate, to 
work with private companies to fund innovative research into 
such medications and 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 abuse and 
addiction. Finally, the Committee also requests an update for 
the NIH's plan of action to implement Section 108 of the 
Comprehensive Addiction and Recovery Act, directing the NIH to 
consider recommendations made by the Interagency Pain Research 
Coordinating Committee in concert with the Pain Management Best 
Practices Inter-Agency Task Force, and in accordance with the 
National Pain Strategy, the Federal Pain Research Strategy, and 
the NIH-Wide Strategic Plan for Fiscal Years 2016-2020, the 
latter of which calls for the relative burdens of individual 
diseases and medical disorders to be regarded as crucial 
considerations in balancing the priorities of the Federal 
research portfolio.
    Raising Awareness and Engaging the Medical Community in 
Drug Abuse and Addiction Prevention and Treatment.--Education 
is a critical component of any effort to curb drug use and 
addiction, and it must target every segment of society, 
including healthcare providers (doctors, nurses, dentists, and 
pharmacists), patients, and families. Medical professionals 
must be in the forefront of efforts to curb the opioid crisis. 
The Committee continues to be pleased with the NIDAMeD 
initiative, targeting physicians-in-training, including medical 
students and resident physicians in primary care specialties 
(i.e., 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 drug abuse screening and treatment 
into their clinical practices.

                  NATIONAL INSTITUTE OF MENTAL HEALTH

Appropriations, 2017....................................  $1,608,212,000
Budget estimate, 2018...................................   1,244,901,000
Committee recommendation................................   1,724,568,000

    The Committee recommendation includes $1,724,568,000 for 
the National Institute of Mental Health [NIMH], including 
$43,000,000 appropriated from the NIH Innovation Account.
    Autism Spectrum Disorder [ASD].--The Committee encourages 
NIH's continued funding of ASD research. The estimated lifetime 
cost of supporting an individual with autism and intellectual 
disability is $2,400,000, and the cost of supporting an 
individual with autism without intellectual disability is 
$1,400,000. Based on these estimates, the yearly cost of ASD to 
the United States is $236,000,000,000. Medicaid covers autism 
treatments for nearly half of all children with autism and pays 
for the majority of residential and day programs serving adults 
with developmental disabilities. NIH-funded research presents 
an opportunity to mitigate the disabling effects of autism and 
reduce the Federal costs associated with it in the future for 
children and adults.
    Tick-Borne Diseases.--Lyme disease and other tick-borne 
diseases are known to cause a wide range of psychiatric 
manifestations. Published research has shown a higher 
prevalence of antibodies to Borrelia burgdorferi in psychiatric 
patients than in healthy subjects. Other tick-borne diseases, 
such as Bartonella have also been reported to cause 
neurological and neurocognitive dysfunction, as well as causing 
agitation, panic disorder, and treatment resistant depression. 
It is therefore plausible that a certain number of cases of 
severe psychiatric presentations are due to underlying 
infections, especially since Lyme disease is the number one 
spreading vector-borne disease in the world. To further 
investigate this hypothesis, the Committee urges NIMH to review 
the published literature on links between tick-borne diseases 
and psychiatric illnesses, and provide an update in the fiscal 
year 2019 CJ.

                NATIONAL HUMAN GENOME RESEARCH INSTITUTE

Appropriations, 2017....................................    $529,537,000
Budget estimate, 2018...................................     399,622,000
Committee recommendation................................     546,934,000

    The Committee recommendation includes $546,934,000 for the 
National Human Genome Research Institute [NHGRI].

      NATIONAL INSTITUTE OF BIOMEDICAL IMAGING AND BIOENGINEERING

Appropriations, 2017....................................    $357,777,000
Budget estimate, 2018...................................     282,614,000
Committee recommendation................................     371,151,000

    The Committee recommendation includes $371,151,000 for the 
National Institute of Biomedical Imaging and Bioengineering 
[NIBIB].
    In Silico Clinical Trials.--The Committee appreciates the 
work of NIBIB in facilitating technology to move the science of 
in silico clinical trials forward. The Committee directs NIBIB 
to continue and expand this work and to involve other relevant 
Institutes in furthering this effort.
    Traumatic Brain Injury.--Neurotrauma is the umbrella term 
for two primary pathologies, spinal cord injuries and traumatic 
brain injuries. These injuries are unique in that they affect 
how we are and who we are, with incredible variation between 
patients. The sizable incidence of injury and prevalence of 
disability resulting from neurotrauma results in significant 
human and economic burden. As befits the complexity of the 
challenges from neurotrauma, multiple NIH Institutes and 
Centers coordinate research, which ranges across a wide 
spectrum, from understanding the cellular mechanisms of 
immediate and delayed damage, though development of better 
prevention, treatment, and rehabilitation, and engages 
scientists, engineers, and clinicians from a broad range of 
disciplines. The Committee recognizes the need for cross-
disciplinary collaboration to meet these challenges and 
strongly encourages NIH to support such research through all 
appropriate support mechanisms.

        NATIONAL CENTER FOR COMPLEMENTARY AND INTEGRATIVE HEALTH

Appropriations, 2017....................................    $134,689,000
Budget estimate, 2018...................................     101,793,000
Committee recommendation................................     139,654,000

    The Committee recommendation includes $139,654,000 for the 
National Center for Complementary and Integrative Health 
[NCCIH].
    Non-Pharmacological Approaches to Pain Management.--The 
Committee is encouraged by the ongoing collaboration between 
NCCIH, VA, DOD, and other Institutes across the NIH to develop 
and test efficacious non-pharmacological approaches to pain 
management and comorbidities--including opioid misuse, abuse, 
and disorder--in military personnel, veterans, and their 
families. As opioid prescribing rates have increased at the VA 
in recent years, and opioid abuse has risen among young 
veterans, the Committee believes it is critical that we support 
research on non-pharmacological treatments to ensure the best 
quality of care for our Nation's veterans and servicemembers, 
and urges the NIH, VA, and DOD to continue this vital research. 
The Comprehensive Addiction and Recovery Act (Public Law 114-
198) calls for an expansion of research and education on and 
delivery of complimentary and integrative health to veterans, 
and the NCCIH can play an important role in coordinating 
efforts with the VA, DOD, and other relevant Federal agencies.
    Translational Science of Natural Products.--The FDA has 
opened new pathways for development and testing of botanical 
compounds for medical applications, advancing complementary and 
integrative health through the use of natural products and 
their derivatives in treating disease. The Committee directs 
the NCCIH to consider the use of natural products in its 
research portfolio with the goal of speeding the development 
and testing of natural products and their derivatives.

      NATIONAL INSTITUTE ON MINORITY HEALTH AND HEALTH DISPARITIES

Appropriations, 2017....................................    $288,312,000
Budget estimate, 2018...................................     214,723,000
Committee recommendation................................     297,784,000

    The Committee recommendation includes $297,784,000 for the 
National Institute on Minority Health and Health Disparities 
[NIMHD].
    African American Males and Mental Health.--The Committee is 
concerned with the prevalence of mental health issues which go 
undiagnosed, especially in African American males. Despite 
developments to diagnose and treat conditions, stigma allows 
many to go without the help that is needed. The Committee 
encourages the NIMH to work collaboratively with community 
partners to develop treatments for the populations that are in 
need.
    Center of Excellence [COE] in Health Disparities.--The 
Committee has identified a need for additional research into 
the varying social, biological, economic, and cultural factors 
that contribute to health disparities between racial groups. 
The rates of premature death from stroke and coronary heart 
disease are higher among African Americans than among Whites. 
African Americans have higher rates of diabetes, hypertension, 
and heart disease than other groups. Additionally, African 
Americans experience higher mortality rates from many cancers. 
Minorities are underrepresented in clinical trials and are less 
likely to survive prostate cancer, breast cancer, and lung 
cancer than their White counterparts. The Committee requests a 
written report on NIMHD's COEs within 120 days of enactment of 
this act.
    Focal Segmental Glomerulosclerosis [FSGS].--The Committee 
encourages NIMHD to continue research collaboration with NIDDK 
to address the connection between the APOL1 gene and the onset 
of FSGS.
    Research Centers in Minority Institutions [RCMI].--The 
Committee continues to recognize the critical role played by 
minority institutions, especially at the graduate level, in 
addressing the health research and training needs of minority 
populations. In particular, the RCMI program fosters the 
development of new generations of minority scientists for the 
Nation and provides support for crucial gaps in the biomedical 
workforce pipeline, with each dollar invested being leveraged 
to generate an additional five to six dollars in competitive 
research funding. The RCMI program has the capability to 
promote solutions to the significant gap in R01 grant funding 
among black and other minority researchers when compared to 
non-minority researchers. The Committee expects NIMHD to engage 
stakeholders and the Committee if any changes to the RCMI 
program are being considered, and prior to any Funding 
Opportunity Announcement release.
    Research Endowment Program.--The Committee commends NIMHD 
for its unique Research Endowment Program, funding to help 
institutions build research infrastructure and recruit, train, 
and maintain a diverse student body and faculty. The Committee 
remains concerned that NIMHD changed the eligibility 
requirements for the program without community consultation in 
the FOA released June 4, 2015. However, the Committee is 
encouraged that in April 2017 NIMHD established a special 
workgroup composed of representatives from its Advisory Council 
and the broader community to review eligibility. The Committee 
requests that the workgroup undertake a thorough review, 
including a review of the maximum endowment qualification 
limits, and provide recommendations on how to evaluate the 
program and consider eligibility criteria, given the program is 
now in its 17th year. The Committee requests that NIMHD submit 
the results of the deliberations and the recommendations to the 
Committee prior to NIMHD issuing the next FOA, no later than 
120 days after enactment of this act.

 JOHN E. FOGARTY INTERNATIONAL CENTER FOR ADVANCED STUDY IN THE HEALTH 
                                SCIENCES

Appropriations, 2017....................................     $72,014,000
Budget estimate, 2018...................................................
Committee recommendation................................      74,380,000

    The Committee recommendation includes $74,380,000 for the 
Fogarty International Center [FIC].
    The Committee recommendation maintains support for FIC, 
which coordinates global health research and training conducted 
by U.S. and international investigators, and helps build 
relationships between health research institutions here and 
abroad. During the Ebola outbreak in West Africa in 2014, 
Fogarty graduates played an important role in efforts to 
contain the spread of virus in Nigeria and Mali, where Fogarty 
has invested for decades in research training. FIC is now 
focused on strengthening institutions in Guinea, Liberia, and 
Sierra Leone, countries that possessed little scientific 
expertise before the pandemic and consequently suffered the 
most. The Committee directs NIH to provide an update on these 
efforts in its fiscal year 2019 CJ.

                      NATIONAL LIBRARY OF MEDICINE

Appropriations, 2017....................................    $407,510,000
Budget estimate, 2018...................................     373,258,000
Committee recommendation................................     420,898,000

    The Committee recommends $420,898,000 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, 2019.

          NATIONAL CENTER FOR ADVANCING TRANSLATIONAL SCIENCES

Appropriations, 2017....................................    $705,903,000
Budget estimate, 2018...................................     557,373,000
Committee recommendation................................     729,094,000

    The Committee recommendation includes $729,094,000 for the 
National Center for Advancing Translational Sciences [NCATS]. 
The Committee includes bill language allowing up to $24,496,593 
of this amount to be used for the Cures Acceleration Network 
[CAN].
    Clinical and Translational Science Awards [CTSA] Program.--
The Committee includes $533,076,000, an increase of 
$16,956,000, for the CTSA Program. The Committee is deeply 
concerned about NCATS' management of the CTSA program. The 
Committee has provided robust support for the CTSA program over 
the past several years and NCATS appears to be both ignoring 
congressional intent regarding the number of CTSA hubs as well 
as attempting to erode financial support for the hubs. 
Specifically, the Committee rejects the recent move to reduce 
some CTSA awards from a 5 year grant cycle to 4 years. Prior 
notification or justification of this significant change was 
not provided to the Committee, the CTSA community, or in any 
written document. The Committee expects NCATS to rectify this 
change immediately and directs all awards made in fiscal year 
2017 and moving forward to be for 5 years. In addition, the 
Committee strongly supports efforts by NIH to train the next 
generation of biomedical researchers by supporting key training 
programs like the ``K'' and ``T'' awards. As stated in the 
National Academies of Sciences, Engineering, Medicine report in 
2013, the CTSA program should build on these and other 
innovative training and education programs that are helping to 
bridge the gap between the basic and clinical sciences. 
Further, the Committee is concerned NCATS is considering 
changing CTSA's configuration and funding structure without 
adequate congressional notification or stakeholder input. 
Therefore, the Committee directs NCATS to maintain the existing 
support structure, including maintaining the number of CTSA hub 
awards at no less than the fiscal year 2016 level, and to 
continue funding CTSA hub awards for 5 years. NCATS is directed 
to provide an update to the Committee no later than 120 days 
after enactment of this act on any proposed changes to the 
program and prior to any changes being implemented. In 
addition, the Committee expects the Director to provide 
quarterly updates to the principal investigators of CTSA hubs 
and the Committee, jointly, beginning within 30 days of 
enactment of this act. Finally, the Committee shall be provided 
written notification at least 3 days in advance of any public 
release of CTSA grant awards.

         National Institute for Research on Safety and Quality

Appropriations, 2017....................................................
Budget estimate, 2018...................................    $272,000,000
Committee recommendation................................................

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

                         OFFICE OF THE DIRECTOR

Appropriations, 2017....................................  $1,667,610,000
Budget estimate, 2018...................................   1,329,833,000
Committee recommendation................................   1,796,970,000

    The Committee recommendation includes $1,796,970,000 for 
the Office of the Director [OD]. Within this total, 
$575,290,000 is provided for the Common Fund. The Committee 
moves the All of Us study from the Common Fund to OD and 
provides $290,000,000, an increase of $60,000,000 above fiscal 
year 2017.
    Academic Research Enhancement Award [AREA] Program.--The 
Committee believes that biomedical discoveries can occur 
anywhere, and continues to support programs that foster 
biomedical research and opportunities for students at 
institutions who may not receive significant NIH funding. In 
particular, the Committee continues its long-standing support 
of the IDeA program. However, the Committee notes that many 
institutions that may benefit from the IDeA program are 
ineligible because they reside in States that are not IDeA 
States. The Committee encourages NIH to enhance support for the 
AREA program and is urged to develop ways to improve ties 
between institutions that receive significant NIH funding and 
AREA-eligible institutions.
    All of Us Precision Medicine Initiative.--The Committee 
recommendation supports the All of Us Precision Medicine 
Initiative and has provided $290,000,000 in support of this 
Initiative. The Committee is encouraged by the enormous 
potential of precision medicine for all populations, including 
children, since much of adult health is rooted in the earliest 
years. The Committee is aware that at an All of Us Research 
Program stakeholder briefing, NIH announced plans to develop 
working groups to address inclusion of the pediatric population 
and has also indicated plans to host a pediatric stakeholder 
convening. The Committee requests an update within 90 days 
after enactment of this act on the status and timeline for the 
working groups to release findings regarding pediatric 
enrollment in the All of Us Research Program and the expected 
timeline for beginning enrollment of children from diverse 
backgrounds in the program. The Committee expects NIH to ensure 
that the research cohort includes a sufficient number of 
children to make meaningful studies possible.
    Amyloidosis.--The Committee recommends that NIH continue to 
expand its research efforts into amyloidosis, a group of rare 
diseases characterized by abnormally folded protein deposits in 
tissues. Amyloidosis is often fatal and there is no known cure. 
Current methods of treatment are risky and unsuitable for many 
patients. The Committee directs NIH to keep the Committee 
informed on the steps it takes to increase the understanding of 
the causes of amyloidosis and measures that improve the 
diagnosis and treatment of this devastating group of diseases.
    Angiogenesis.--The Committee recommends that NIH study the 
regulation of vascular growth and its interactions with the 
immune system, stem cells, DNA repair, and microbiome. Further, 
the Committee urges the NIH to research the impact of 
metabolism and dietary factors on endothelial cells, 
specifically to support normal physiology and oppose disease, 
and to study biomarkers of vascular health.
    Autism Spectrum Disorder [ASD].--The Committee commends NIH 
for its commitment to the study of ASD recognizing that there 
are many different subtypes of autism and that the full range 
of potential treatments, appropriate to each subtype, have not 
yet been developed. The Committee encourages NIH to explore a 
collaborative approach to gain a systematic and comprehensive 
understanding of each subtype, and to translate this 
understanding to develop individualized treatments. Such an 
approach would harness information from academia and industry, 
as well as individuals and families impacted by ASD. The 
European Union has a similar integrated research effort 
underway to focus on this issue, the European Autism 
Interventions--A Multicentre Study for Developing New 
Medications. The Committee encourages the NIH to explore this 
approach and provide an update in the fiscal year 2019 CJ.
    Basic Molecular Science.--The Committee understands basic 
science is the foundation of the research pyramid that support 
biomedical and translational research efforts. The Committee is 
concerned with the recent decrease in the proportion of basic 
research. The Committee encourages NIH to expand its basic 
science efforts, with a specific focus on basic molecular 
research to increase scientific understanding at the molecular 
level in an effort to support translational molecular medicine 
research of tomorrow. The Committee requests an update in the 
fiscal year 2019 CJ on the percentage of spending on basic 
science for the past 10 years and specific efforts to promote 
basic research that supports molecular medicine and 
regenerative medicine using induced pluripotent stem cells.
    Big Data Infrastructure.--Biomedical research has become 
increasingly reliant on growing amounts of digital data, a 
development with tremendous and potentially disruptive promise 
if this data can be used effectively to enable major scientific 
breakthroughs. Figuring out how to make this possible is one of 
the biggest obstacles facing NIH. In 2012, NIH began an 
extramural program to provide a framework of pilot programs, 
centers of excellence, and grant opportunities to advance 
thinking in how to organize, share, and use big data. NIH is 
using the results from these programs to inform the next phase 
of development of big data infrastructure, including the 
ongoing Data Commons Pilot. The second phase is expected to 
also build off of several other major initiatives including 
those in cancer, Alzheimer's disease, the human brain, and the 
All of Us research program. The Committee wants to ensure that 
these efforts are coordinated and overseen to ensure all of NIH 
benefits from them. In its fiscal year 2017 report, the 
Committee directed NIH to work with its external partners and 
stakeholders to provide the Committees on Appropriations of the 
House of Representatives and the Senate a detailed strategic 
plan by May 5, 2018, spelling out it how intends to make big 
data sustainable, interoperable, accessible, and usable. The 
plan is to include a roadmap to achieve these objectives, as 
well as milestones and estimates of the resources that will be 
necessary. The Committee expects to receive the strategic plan, 
which was first identified in the Senate report dated June 9, 
2016, by the May deadline. The unanticipated delay in 
completing the fiscal year 2017 appropriations process means 
NIH will have had almost 2 years to prepare its plan, extra 
time that should make it possible to draft a comprehensive 
blueprint to help guide future investments in data science. In 
the interim, the Committee directs NIH to provide a status 
report in the fiscal year 2019 CJ describing the current status 
of the strategic plan and its progress in finding a suitable 
candidate to fill the Associate Director for Data Science 
[ADDS] vacancy. The Committee recognizes the importance of the 
ADDS to provide strategic vision and coordinate as an honest 
broker across NIH on data science issues, and encourages NIH to 
locate this position within the Office of the Director.
    Botanical Products and Opioid Addiction.--The Committee 
commends the FDA for establishing guidelines and opening 
pathways for Investigational New Drug [IND] applications for 
botanical drugs. Over the past two decades, the dramatic 
increase in abuse of prescription opioids, non-synthetic 
opioids, and illicit synthetic opioids has grown to epidemic 
proportions. Scientific rationale and laboratory studies 
suggest a decrease in addictive potential when botanical 
derivatives, including cannabidiol extracts, are used with an 
opioid in treating patients. The Committee supports study of 
this integrative approach to treatment and urges NIH, including 
NIDA, NCCIH, and OCCAM, to support and facilitate trials aimed 
at reducing addiction under appropriate IND applications.
    Brain Research through Application of Innovative Neuro-
technologies [BRAIN] Initiative.--The Committee continues to 
strongly support the BRAIN initiative. The bill provides 
$400,000,000 an increase of $140,000,000 above fiscal year 
2017, to expand the initiative consistent with the BRAIN 2025 
report issued in 2014.
    Children in NIH Research.--The inclusion of children in 
clinical research is essential to ensure that children benefit 
from important scientific advances. The Committee appreciates 
provisions of the 21st Century Cures Act that will now require 
NIH to systematically track enrollment data to determine if 
children are actually being enrolled appropriately in clinical 
research. The Committee recognizes that without better data 
collection and reporting it is unable to fully exercise its 
oversight role, and researchers and other stakeholders are 
unable to determine whether children as a whole, or particular 
pediatric subpopulations, are appropriately represented in 
federally funded biomedical research. The Committee directs NIH 
to expeditiously implement these new requirements.
    Chronic Fatigue Syndrome [ME/CFS].--The Committee is 
pleased that NIH has begun to expedite research into ME/CFS, 
including its intramural study and the RFAs for the 
collaborative research centers. However, the Committee is 
concerned that the level of funding is still very low 
considering the burden of disease and the current plan to 
expand research will take too long to produce FDA-approved 
treatments and diagnostic tests. The Committee urges NIH to 
collaborate with disease experts and the patient community to 
identify additional opportunities to expedite progress on this 
understudied disease. Specifically, the Committee recommends 
that NIH consider increasing research funding to be 
commensurate with disease burden and use that funding to 
further accelerate the research field through a set of 
intramural and extramural investments such as: (1) RFAs for 
biomarkers and treatment trials, (2) additional funding for 
investigator initiated studies and early stage investigator 
awards, (3) an initiative to reach consensus on the case 
definition, and (4) mechanisms to incentivize researchers to 
enter the field.
    Chronic Overlapping Pain Conditions.--The Committee notes 
the strong evidence base demonstrating deleterious outcomes for 
patients with Chronic Overlapping Pain Conditions, which 
include hit-or-miss, ineffective, or even harmful treatments, 
poor health and quality of life outcomes, markedly increased 
disability rates and personal and societal financial burdens. 
The Committee is pleased with NIH's efforts to develop a 
chronic overlapping pain conditions screening tool. However, an 
expanded, coordinated, and collaborative initiative is needed 
to maximize the Federal research investment, reduce spending, 
and improve clinical practice. There is an urgent need to 
analyze the state of science on Chronic Overlapping Conditions, 
which will identify both research gaps and future research 
directions and collaborations. As such, the Committee urges the 
Director to consider the relevant recommendations of the 
Federal Pain Research Strategy to guide the development of a 
comprehensive effort that spans the basic, translational, and 
clinical research continuum to advance scientific understanding 
of chronic overlapping pain conditions, as well as the 
development and discovery of safe and effective treatments.
    Facilities and Administrative Costs [F&A].--Central to the 
Administration's proposal to reduce Federal investments in 
biomedical research is its proposal to cap the F&A costs of 
grants, so-called ``indirect costs,'' at 10 percent. The F&A 
cost of a grant is intended to cover the indirect costs of 
biomedical research, ranging from administration and facilities 
to the cost of equipment shared across multiple researchers. 
For example, at research facilities focused on making the next 
breakthrough in cancer treatment, indirect costs supply the air 
handlers that provide the precise conditions needed to generate 
therapeutic T cells for immunotherapy trials, complex data 
systems to analyze and protect patients' genomic data, and 
support for the next generation of scientific leaders. The 
methodology for negotiating indirect costs has been in place 
since 1965, and rates have remained largely stable across NIH 
grantees for decades. The Administration's proposal would 
radically change the nature of the Federal Government's 
relationship with the research community, abandoning the 
Government's long-established responsibility for underwriting 
much of the Nation's research infrastructure, and jeopardizing 
biomedical research nationwide. The Committee has not seen any 
details of the proposal that might explain how it could be 
accomplished without throwing research programs across the 
country into disarray. To avoid this possibility, the Committee 
has included bill language to prohibit HHS from developing or 
implementing a modified approach to funding F&A costs.
    Fetal Tissue Donation Trial.--The Committee acknowledges 
the many differing views on the merits of human fetal tissue 
research. New bill language is included to direct NIH to begin 
a pilot to determine the adequacy of a fetal tissue donor 
network for supporting all related clinical research from human 
fetal tissue donated solely from stillbirths and spontaneous 
abortion.
    Gabriella Miller Kids First Research Act.--The Committee 
provides the full budget request of $12,600,000. The Committee 
requests that NIH provide information on how it has disbursed 
funding, including any personnel that are responsible for 
overseeing the allocation of designated research dollars, the 
criteria that NIH employed to ensure awards will advance the 
objectives of the act, and a description of the research 
projects that were funded in the fiscal year 2019 CJ.
    Gestational Diabetes.--The Committee recognizes the 
importance of research funded by NIH related to gestational 
diabetes, a disease affecting up to 9.2 percent of all pregnant 
women. Given that both women with gestational diabetes and 
their babies face long-term health consequences as a result of 
the disease, such as increased risk of developing type 2 
diabetes, the Committee urges NIH to explore additional 
opportunities for research on gestational diabetes.
    Government-Wide Collaborations.--NIH, VA, and DOD 
collaborate frequently and successfully on various research 
activities. The Committee looks forward to the report in the 
fiscal year 2019 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.
    Hepatitis B [HBV].--The Committee recognizes that HBV 
infection is a serious public health threat. Though infection 
rates are less than one percent in the United States, Asian 
Americans and Pacific Islanders experience about 60 percent of 
the chronic HBV burden. Left undiagnosed and untreated, one in 
four of those with chronic HBV infection will die prematurely 
from cirrhosis, liver failure, and/or liver cancer. The 
Committee also notes that the link between HBV infection and 
primary liver cancer is well established, with up to 60 percent 
of global liver cancer cases caused by HBV. The Committee 
requests that OD ensure that NCI, NIAID, NIMHD, and NIDDK 
coordinate their strategic research agendas to work toward 
finding a cure for HBV. The Committee further requests an 
update on these efforts be included in the fiscal year 2019 CJ.
    Imaging.--The Committee notes that imaging research occurs 
in multiple Institutes throughout the NIH and is an integral 
component of the Cancer Moon Shot, the Precision Medicine 
Initiative, and the BRAIN Initiative. The Committee requests 
that the Director produce an overview of imaging research 
across the NIH, including in the focused research fields 
mentioned above, and assess the quality of interactions in 
imaging research within NIH, and report the results in the 
fiscal year 2019 CJ.
    Induced Pluripotent Stem Cell [iPSC] Technology.--The 
Committee understands that unlike the controversy linked with 
embryonic stem cells, iPSCs are derived from adult skin cells 
making them an acceptable alternative therapeutic. iPSCs have 
many of the therapeutic properties of embryonic stem cells, but 
with the additional advantage that they can be derived from 
patient skin cells for personalized medicine. This establishes 
iPSCs as a source of cells with great value and potential for 
curing human disease and injury. iPSCs could potentially be 
used to treat a wide range of human disease, repair damaged 
tissue (regenerative medicine), and serve as a platform to 
develop new therapeutics (small molecule drugs). However, the 
Committee notes that additional basic research is essential to 
realize the full biomedical potential of this technology. The 
Committee encourages NIH to support basic research in this area 
that leads to pre-clinical trials, cures, diagnostics, and 
treatments. The Committee requests an update in the fiscal year 
2019 CJ on expansion opportunities being considered related to 
iPSC technology.
    Inflammatory Bowel Diseases [IBD].--The Committee is 
concerned with the increasing prevalence of IBD. The Committee 
urges the Director's office to utilize an overarching 
mechanism, such as the Common Fund, to study the cause of this 
increase in prevalence, including environmental triggers and 
epigenetics.
    Interagency Pain Research.--Consistent with the 
Comprehensive Addiction and Recovery Act (Public Law 114-198), 
the Committee encourages the Director to intensify and 
coordinate fundamental, translational, and clinical research of 
the NIH with respect to the understanding of pain, the 
discovery and development of therapies for chronic pain, and 
the development of alternatives to opioids for effective pain 
treatments. In doing so, the Committee urges the NIH to 
consider recommendations of the Federal Pain Research Strategy. 
The Committee requests an update in the fiscal year 2019 CJ on 
this initiative.
    Lymphatic System.--The Committee supports building on the 
momentum of the 2015 NIH Lymphatic Symposium by growing the 
cadre of lymphatic researchers through the establishment of 
extramural interdisciplinary research training programs 
relevant to the lymphatic system in health and disease and by 
incorporating more reviewer expertise in lymphatic biology/
disease in the pertinent standing study sections within the 
Center for Scientific Review. This research will be 
instrumental in understanding the pivotal role of the lymphatic 
system in the pathogenesis and/or treatment of cancer 
metastasis, AIDS, auto-immune diseases, obesity, cardiovascular 
disease, and organ transplantation as well as those affected by 
lymphatic conditions after cancer or those with congenital 
conditions.
    Mitochondrial Disease Research.--The Committee understands 
that no less than 17 Institutes and offices are involved in a 
variety research efforts related to mitochondrial disease and 
dysfunction. The Committee appreciates the NIH's support of the 
trans-NIH Mitochondrial Disorders Working Group, the North 
American Mitochondrial Disease Consortium, the Mitochondrial 
Disease Sequence Data Resource Consortium, and its support for 
investigator initiated intramural and extramural studies, and 
urges the NIH to expand upon its November 2016 research agenda 
on nutritional interventions in primary mitochondrial 
disorders. The Committee understands that the NIH has 
established the Environmental influences on Child Health 
Outcomes program, which supports longitudinal studies to 
investigate the effects of environmental exposures--in 
conjunction with genetic influences--on children's health and 
development. The Committee encourages the Director to explore 
whether the longitudinal cohort studies included within ECHO 
can shed light on any of the mitochondrial diseases occurring 
in children. The Committee further encourages the Director to 
competitively fund basic and clinical research on mitochondrial 
disease.
    Mucopolysaccharide [MPS].--MPS diseases are inherited, with 
death occurring for many in early childhood. This systemic 
disease causes progressive damage to the bones, heart, 
respiratory system, and brain. The Committee continues to urge 
NIH to put a high priority on better understanding and treating 
MPS and mucolipidosis diseases. The Committee commends NIH for 
allocating funds to discover, develop, define, and make 
available for research animal models of human genetic disease. 
The Committee encourages expanded research of treatments for 
neurological, chronic inflammation, cardiovascular and skeletal 
manifestations of MPS, with an emphasis on gene therapy. The 
Committee thanks NINDS, NIDDK, and ORDR for funding the 
Lysosomal Disease Network through the Rare Disease Clinical 
Network and for funding lysosomal research meetings. The 
Committee encourages the NIH to increase funding to grantees 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 Laboratories.--NIH is encouraged to enter into 
collaborative research programs with the Secretary of Energy, 
National Laboratories, and others determined to be appropriate 
by the Director, to utilize the broader scientific and 
technological capabilities of the Department of Energy [DOE] 
and National Laboratories. In particular, DOE and NIH should 
work together to support access for biomedical researchers to 
cutting-edge technology resources.
    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 increase its NF research 
portfolio in fundamental basic science, translational research, 
and clinical trials focused on NF. The Committee also 
encourages NCI to support NF centers, clinical trials 
consortia, preclinical mouse models consortia, and associated 
tumor sequencing efforts. 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 expand their investments in laboratory-based 
and clinical investigations in these areas. Since NF2 accounts 
for approximately 5 percent of genetic forms of deafness, the 
Committee encourages NIDCD to expand its investment in NF2 
basic and clinical research. NF1 can cause vision loss due to 
optic gliomas. The Committee encourages NEI to expand its 
investment in NF1 basic and clinical research.
    Next Generation Researchers Initiative.--The Committee 
supports robust implementation of the Next Generation 
Researchers Initiative within the Office, as established in the 
21st Century Cures Act, and is encouraged by NIH's continued 
work in this space. The Committee directs NIH to prioritize 
improving opportunities for our next generation of researchers 
by working through the Initiative to coordinate all current and 
new NIH policies to promote opportunities for new scientists 
and earlier research independence, including enhancing training 
and mentorship programs for researchers, and enhancing 
workforce diversity. As required by the 21st Century Cures Act, 
the Committee directs NIH to consider the recommendations made 
by the National Academies of Science study under Public Law 
114-113 in carrying out the activities of the Initiative.
    Pediatric Clinical Trials.--The Committee supports the 
pediatric clinical trials conducted under the Best 
Pharmaceutical Practices for Children Act [BPCA], and strongly 
encourages the NIH to continue to support this program. BPCA 
has made significant steps in closing the knowledge gap on the 
efficacy of drugs being used on children and encourages 
enhanced coordination of BPCA activities with other NIH 
pediatric research and initiatives, including, but not limited 
to, pediatric cancer, the pediatric MATCH study, muscular 
dystrophy, the IDeA States Pediatric Clinical Trials Network 
Program, and the All of Us Precision Medicine Initiative. The 
Committee requests an update in the fiscal year 2019 CJ on the 
status of research related to this topic.
    Phelan-McDermid Syndrome.--Phelan-McDermid Syndrome is a 
genetic disorder caused by a partial deletion of chromosome 22 
and loss of the SHANK3 gene. The Committee continues to support 
a multi-Institute approach to support research into Phelan-
McDermid Syndrome, examining in particular the disorder's 
correlation with autism, epilepsy and other developmental 
disabilities. The Committee requests an update in the fiscal 
year 2019 CJ on the status of research related to this topic.
    Population Health Training.--The Committee acknowledges the 
growing understanding that the living systems that produce 
health and disease encompass health determinants ``from cells 
to society.'' The Office of Behavioral and Social Science 
Research should continue to work with NIH Institutes and 
Centers to encourage interdisciplinary population health 
science training to enhance our understanding of how social, 
cultural, genetic, biological, and environmental factors 
combine to influence outcomes in health and human development.
    Rehabilitation Research.--The Committee encourages NIH to 
fully implement Section 2040 of the 21st Century Cures Act to 
enhance the stature, visibility, and coordination of medical 
rehabilitation research conducted at NIH. The Committee is 
encouraged by the release of NIH's new Rehabilitation Research 
Plan, looks forward to reviewing its first annual progress 
report, and is encouraged by its ongoing efforts to ensure that 
reporting of rehabilitation research is consistent with the 
definition of ``rehabilitation research'' included in the 
legislation.
    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, $25,000,000 is provided for 
grants or contracts to public, nonprofit, and not-for-profit 
entities to expand, remodel, renovate, or alter existing 
research facilities or construct new research facilities as 
authorized under 42 U.S.C. section 283k. 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.
    Sleep Disorders.--The Committee recognizes sleep disorders 
as a serious public health concern. Sleep disorders affects 
approximately 70,000,000 Americans and contribute to lost 
productivity, increase the risk for accidents, and are 
associated with other chronic illnesses, such as hypertension 
and mental health conditions. The Committee encourages the NIH 
to advance the work of the National Center on Sleep Disorders 
Research, which coordinates research activities across 
Institutes and Centers. The Committee also encourages NIH to 
facilitate implementation of the ongoing NIH Sleep Disorders 
Research Plan.
    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 of Spina Bifida and 
associated secondary conditions, such as hydrocephalus; and to 
invest in understanding the myriad co-morbid conditions 
experienced by individuals with Spina Bifida.
    Temporomandibular Disorders [TMD].--The Committee 
understands that NIH-funded research has demonstrated that 
temporomandibular disorders [TMD] are primarily a multisystem 
disorder with overlapping conditions influenced by multiple 
biological and environmental factors rather than solely an 
orofacial pain condition. However, diagnosis and care of 
patients have not changed to reflect this major paradigm shift, 
with many patients continuing to receive treatments solely 
focused on teeth and jaws. Moreover, the medical community 
lacks education regarding the complexity and systemic aspects 
of TMD as well as its many comorbid medical conditions. 
Patients are treated by a multitude of practitioners across 
numerous disciplines with treatments that have the potential to 
cause harm. To address these issues, the Committee requests 
that NIH provide an update on the state of TMD research, 
activities related to TMD education, and clinical studies of 
TMD in the fiscal year 2019 CJ.
    Trans-NIH Working Group on Fibrosis.--The Committee 
recognizes that fibrosis can occur across body systems and 
applauds NIH for establishing a trans-NIH working group on 
fibrosis. The Committee encourages NIH to continue the cross-
cutting coordination of research between ICs in this area.
    Trauma Research.--To ensure that our Nation's trauma 
response network and workforce remain adequately prepared, the 
Committee recommends an increased focus by NIH on trauma 
research, including to establish a NIH-led trauma research 
agenda coordinated with the extensive, and often 
groundbreaking, DOD activities on trauma. This research is 
critical to minimize the loss of human life, disability, and 
injury by ensuring that patient-specific trauma care is based 
on scientifically validated findings.
    Trisomy 21.--The Committee recognizes that the presence of 
a third copy of human chromosome 21 may be linked to 
significant immune dysregulation and Alzheimer's disease, while 
protecting against most cancers and cardiovascular disease 
among individuals with Down syndrome. The Committee strongly 
encourages NIH to pursue an initiative on this topic that will 
yield scientific learnings that could significantly improve the 
health of individuals with Down syndrome as well as millions of 
typical individuals.

                        BUILDINGS AND FACILITIES

Appropriations, 2017....................................    $128,863,000
Budget estimate, 2018...................................      98,615,000
Committee recommendation................................     128,863,000

    The Committee recommendation includes $128,863,000 for NIH 
buildings and facilities. This funding will remain available 
for obligation for 5 years.

                   NIH INNOVATION ACCOUNT, CURES ACT

Appropriations, 2017....................................     $52,000,000
Budget estimate, 2018...................................     110,000,000
Committee recommendation................................     110,000,000

    The Committee recommendation includes $110,000,000 to be 
spent from the NIH Innovation Account for the following 
activities:
    All of Us.--$100,000,000.
    Regenerative Medicine.--$10,000,000.
    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.

       Substance Abuse and Mental Health Services Administration

    The Committee recommends $3,777,592,000 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 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 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 Administrator of SAMHSA and the Secretary to 
exempt the Mental Health Block Grant [MHBG] and the Substance 
Abuse Prevention and Treatment [SAPT] Block Grant from being 
used as a source for the PHS evaluation set-aside in fiscal 
year 2018.

                             MENTAL HEALTH

Appropriations, 2017....................................  $1,181,037,000
Budget estimate, 2018...................................     912,347,000
Committee recommendation................................   1,181,037,000

    The Committee recommends $1,181,037,000 for mental health 
services. The recommendation includes $21,039,000 in transfers 
available under section 241 of the PHS Act and $12,000,000 in 
transfers from the PPH Fund. Included in the recommendation is 
funding for programs of regional and national significance 
[PRNS], the MHBG, children's mental health services, Projects 
for Assistance in Transition from Homelessness [PATH], and 
Protection and Advocacy for Individuals with Mental Illness 
[PAIMI].
Programs of Regional and National Significance
    The Committee recommends $398,659,000 for PRNS within the 
Center for Mental Health Services [CMHS]. 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:

 
                                            [In thousands of dollars]
----------------------------------------------------------------------------------------------------------------
                                                            Fiscal year 2017  Fiscal year 2018      Committee
                      Budget activity                         appropriation        request       recommendation
----------------------------------------------------------------------------------------------------------------
CAPACITY:
    Seclusion & Restraint.................................             1,147             1,145             1,147
    Youth Violence Prevention.............................  ................            23,055  ................
    Project AWARE State Grants............................            57,001  ................            57,001
    Mental Health First Aid...............................            14,963  ................            14,963
    Healthy Transitions...................................            19,951  ................            19,951
    National Traumatic Stress Network.....................            48,887            46,798            48,887
    Children and Family Programs..........................             7,229             6,446             7,229
    Consumer and Family Network Grants....................             4,954             4,945             4,954
    MH System Transformation and Health Reform............             3,779             3,772             3,779
    Project LAUNCH........................................            23,605            34,489            23,605
    Primary and Behavioral Health Care Integration........            49,877  ................            49,877
    Suicide Prevention
        National Strategy for Suicide Prevention..........            11,000             1,996            11,000
            Zero Suicide..................................             7,000  ................             7,000
            American Indian and Alaska Native set-aside...             2,000  ................             2,000
    Suicide Lifeline......................................             7,198             7,184             7,198
    GLS--Youth Suicide Prevention--States.................            35,427            35,382            35,427
    GLS--Youth Suicide Prevention--Campus.................             6,488             6,476             6,488
    AI/AN Suicide Prevention Initiative...................             2,931             2,925             2,931
    Homelessness Prevention Programs......................            30,696            30,638            30,696
    Tribal Behavioral Grants..............................            15,000            14,971            15,000
    Minority AIDS.........................................             9,224             4,206             9,224
    Criminal and Juvenile Justice Programs................             4,269             4,261             4,269
    Assisted Outpatient Treatment.........................            15,000            14,971            15,000
    Assertive Community Treatment for Ind. With SMI.......  ................             5,000  ................
 
SCIENCE AND SERVICE:
    GLS--Suicide Prevention Resource Center...............             5,988             5,977             5,988
    Practice Improvement and Training.....................             7,828             7,813             7,828
    Primary and Behavioral Health Care Integration TA.....             1,991  ................             1,991
    Consumer & Consumer Support TA Centers................             1,918             1,914             1,918
    Minority Fellowship Program...........................             8,059             8,044             8,059
    Disaster Response.....................................             1,953             1,949             1,953
    Homelessness..........................................             2,296             2,292             2,296
    HIV/AIDS Education....................................  ................               770  ................
----------------------------------------------------------------------------------------------------------------

    Infant and Early Childhood Mental Health.--The Committee 
recognizes the importance of building mental health services 
for children under age 6, particularly infants and toddlers 
whose unique needs are often overlooked. Early mental health 
prevention, identification, and treatment may reduce the need 
for treatment later in life when it becomes more difficult, 
time intensive, and expensive. The Committee encourages SAMHSA 
to explore opportunities to expand these efforts.
    Mental Health First Aid.--The Committee is pleased with the 
progress of Mental Health First Aid. In issuing new 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 
prioritize training for veterans, armed services personnel, and 
their family members within the Mental Health First Aid 
program.
    Practice Improvement and Training.--The Committee 
recognizes the critical need for programs such as 
Rehabilitation Research and Training Centers, which advance the 
current knowledge base of the mental health delivery system by 
supporting evaluation, training, technical assistance, and 
knowledge translation activities that help adults with serious 
mental health conditions achieve their life goals.
    Primary and Behavioral Healthcare Integration [PBHCI].--The 
Committee provides $49,877,000 for PBHCI to support communities 
to coordinate and integrate primary care services into 
community-based behavioral health settings.
    Project AWARE.--The Committee continues to fund Project 
AWARE which increases awareness of mental health issues and 
connects young people that have behavioral health issues and 
their families with needed services. Of the amount provided for 
Project AWARE, the Committee directs SAMHSA to use $10,000,000 
for discretionary grants to support efforts in high-crime, 
high-poverty areas and, in particular, communities that are 
seeking to address relevant impacts and root causes of civil 
unrest. These grants should maintain the same focus as fiscal 
year 2017 grants. The Committee requests a report on progress 
of fiscal year 2017 grantees 180 days after the enactment of 
this act.
Community Mental Health Services Block Grant
    The Committee recommends $562,571,000 for the MHBG. The 
recommendation includes $21,039,000 in transfers available 
under section 241 of the PHS Act.
    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 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 14-17 
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 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 2019 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 $119,026,000 for the Children's 
Mental Health Services program. This program provides grants 
and technical assistance to support comprehensive, community-
based 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 includes 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
    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.

                       SUBSTANCE ABUSE TREATMENT

Appropriations, 2017....................................  $2,212,506,000
Budget estimate, 2018...................................   2,196,435,000
Committee recommendation................................   2,212,506,000

    The Committee recommends $2,212,506,000 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.
Programs of Regional and National Significance
    The Committee recommends $354,427,000 for PRNS within the 
Center for Substance Abuse Treatment [CSAT]. The recommendation 
includes $2,000,000 in transfers available under section 241 of 
the PHS Act.
    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.
    Within the total provided for PRNS, the Committee 
recommendation includes funding for the following activities:

 
                                            [In thousands of dollars]
----------------------------------------------------------------------------------------------------------------
                                                            Fiscal year 2017  Fiscal year 2018      Committee
                      Budget activity                         appropriation        request       recommendation
----------------------------------------------------------------------------------------------------------------
CAPACITY:
    Opioid Treatment Programs/Regulatory Activities.......             8,724             8,708             8,724
    Screening, Brief Intervention, Referral, & Treatment..            30,000            46,804            30,000
    Target Capacity Expansion.............................            67,192            36,234            67,192
        Medicated Assisted Treatment for Prescription Drug            55,800            24,952            55,800
         and Opioid Addiction (non-add)...................
    Pregnant & Postpartum Women...........................            19,931            19,931            19,931
    Recovery Community Services Program...................             2,434             2,429             2,434
    Children and Families.................................            29,605            29,549            29,605
    Treatment Systems for Homeless........................            36,386            41,225            36,386
    Minority AIDS.........................................            65,570            65,445            65,570
    Criminal Justice Activities...........................            78,000            77,852            78,000
    Improving Access to Overdose Treatment................             1,000  ................             1,000
    Building Communities of Recovery......................             3,000             1,000             3,000
 
SCIENCE AND SERVICE:
    Addiction Technology Transfer Centers.................             9,046             9,029             9,046
    Minority Fellowship Program...........................             3,539             3,532             3,539
----------------------------------------------------------------------------------------------------------------

    Building Communities of Recovery.--The Committee 
appreciates SAMHSA's implementation of new funding for 
communities of recovery in fiscal year 2017 and continues to 
encourage SAMHSA to promote the expansion of recovery support 
services as well as reduce stigma associated with addictions.
    Combating Opioid Abuse.--Of the amount provided for 
Targeted Capacity Expansion, the Committee includes $55,800,000 
for discretionary grants to States for the purpose of expanding 
treatment services to those with heroin or opioid dependence. 
The Committee continues to direct CSAT to ensure that these 
grants include as an allowable use the support of medication 
assisted treatment and other clinically appropriate services. 
These grants should target States with the highest age adjusted 
rates of admissions and that have demonstrated a dramatic age 
adjusted increase in admissions for the treatment of opioid use 
disorders.
    Drug Courts.--SAMHSA is directed to ensure that all drug 
treatment court funding is allocated to serve people diagnosed 
with a substance use disorder as their primary condition. 
SAMHSA is further directed to ensure that all drug treatment 
court grant recipients work directly with the corresponding 
State substance abuse agency in the planning, implementation, 
and evaluation of the grant. SAMHSA should expand training and 
technical assistance to drug treatment court grant recipients 
to ensure evidence-based practices are fully implemented.
    Handheld Analyzers.--The Committee understands the role 
played by handheld drug analyzers, particularly for police 
officers and other first responders. These instruments can 
identify various drugs and assist first responders in treatment 
referral. They also keep officers safe by minimizing the 
exposure to toxic drugs, while reducing the overall cost and 
backlog of cases at crime labs. The Committee encourages SAMHSA 
to support the use of block grant funds and funds authorized 
under section 1003 of the 21st Century Cures Act for handheld 
analyzers. SAMHSA shall provide an update on these efforts in 
the fiscal year 2019 CJ.
    Oral Fluid Guidelines.--The Committee is pleased with 
SAMHSA's recommendation of oral fluid as an alternative 
specimen for drug testing and commends SAMHSA for the progress 
made on issuing oral fluid guidelines for the Federal Workplace 
Drug Testing Programs. The Committee encourages SAMHSA to 
publish the guidelines expeditiously and to implement the 
guidelines in partnership with stakeholders and other agencies.
    Peer Counseling.--The Committee is aware of the benefits of 
peer-to-peer programs to assist in addiction treatment and 
counseling, and encourages SAMHSA's continued support for this 
approach. However, the Committee also believes that it is 
important for people suffering from addiction and substance 
abuse to have access to peer counseling and connection to 
community resources in hospital settings. Accordingly, the 
Committee encourages SAMHSA to support counseling and addiction 
recovery programs focused on clinical medical providers to 
engage peer-to-peer counseling support and services in 
inpatient hospital and emergency department settings.
    Pregnant & Postpartum Women.--The Committee continues to 
support the continuation of the pilot program for State 
substance abuse agencies to address identified gaps in the 
continuum of care furnished to pregnant and postpartum women. 
The Committee encourages the Department to prioritize States 
that support best-practice collaborative models for the 
treatment and support of pregnant women with opioid use 
disorders.
    School-based Opioid Prevention.--When awarding opioid 
research and response grants, the Committee encourages SAMHSA, 
in coordination with CDC, to include school-based intervention 
programs that provide parents and teachers with the knowledge 
to monitor students and provide an opportunity for early 
intervention. Further, SAMHSA is encouraged to include 
screening and referral to treatment for primary, middle and 
high school students and young adults at universities and to 
put in place support systems to help prevent influence from 
drug-using peers.
    State Targeted Response to the Opioid Abuse Crisis 
Grants.--The Committee continues to provide $500,000,000 for 
State Targeted Response Grants [STR], for a total of 
$1,000,000,000 in the past two fiscal years. The Committee 
encourages HHS to ensure that these grants are focused on 
activities that can continue to provide opioid related 
treatment and abuse prevention services after Federal funding 
has ended. It is critical that the Federal and state response 
to this epidemic continues to prioritize local efforts to 
support communities facing unmet opioid treatment, prevention, 
and recovery needs. The Committee strongly encourages HHS and 
SAMHSA to refrain from any action that would require States and 
Territories to resubmit a grant proposal for the second year of 
State grant funding. By doing so, States could reduce 
administrative burdens and the Department could focus on 
promoting and implementing already approved plans. The 
Committee directs the agency to ensure States provide funds 
directly to local communities and counties to address the 
opioid crisis in areas of unmet need, and to report the 
Committee on such plans 1 year after enactment. SAMHSA is also 
directed to provide State agencies with technical assistance 
concerning how to enhance outreach and direct support to rural 
and underserved communities and providers in addressing this 
crisis. Further, the Committee is concerned that SAMHSA has 
restricted State flexibility for addressing the opioid crisis 
by limiting the amount of funding that can be used for opioid 
prevention activities.
    Treatment Facility Expansion.--The Committee is deeply 
concerned about the devastating impact that the opioid epidemic 
is having on families and communities throughout the country 
and recognizes the need to increase access to treatment 
facilities. The Committee requests that SAMHSA explore ways 
that grantees could access Federal funding for the capital 
costs of new treatment facilities, including planning, 
construction, repair, preventive maintenance, environmental 
support, improvement, extension, alteration, purchase of fixed 
equipment or facilities, as well as the acquisition of land. 
SAMHSA shall provide an update on these efforts, including any 
recommendations, in the fiscal year 2019 CJ.
    Viral Hepatitis Screening.--The Committee applauds SAMHSA 
for encouraging grantees to screen for viral hepatitis, 
including the use of innovative strategies like rapid testing 
and urges SAMHSA to continue these efforts. The Committee notes 
the disproportionate impact of viral hepatitis among minority 
populations and the co-infection rate among individuals with 
HIV/AIDS. The Committee urges SAMHSA to work with minority AIDS 
grantees to incorporate hepatitis screening into programmatic 
activities.
Substance Abuse Prevention and Treatment Block Grant
    The Committee recommends $1,858,079,000 for the Substance 
Abuse Prevention and Treatment Block Grant [SABG]. The 
recommendation includes $79,200,000 in transfers available 
under section 241 of the PHS Act. According to SAMHSA, at 
discharge from SABG funded programs, 70 percent of individuals 
demonstrate abstinence from illegal drugs and 83 percent 
demonstrate abstinence from alcohol use. 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

Appropriations, 2017....................................    $223,219,000
Budget estimate, 2018...................................     149,703,000
Committee recommendation................................     238,219,000

    The Committee recommends $238,219,000 for the Center for 
Substance Abuse Prevention [CSAP], the sole Federal 
organization with responsibility for improving accessibility 
and quality of substance abuse prevention services.
    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 to ensure the work in school-based settings is as 
robust as possible.
Programs of Regional and National Significance
    The Committee provides $238,219,000 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]
----------------------------------------------------------------------------------------------------------------
                                                            Fiscal year 2017  Fiscal year 2018      Committee
                      Budget activity                         appropriation        request       recommendation
----------------------------------------------------------------------------------------------------------------
CAPACITY:
    Strategic Prevention Framework/Partnership for Success           109,484            48,427           109,484
    Strategic Prevention Framework Rx.....................            10,000            10,000            10,000
    Grants to Prevent Prescription Drug/Opioid Overdose...            12,000            11,977            12,000
    First Responder Grants................................            12,000            12,000            12,000
    Opioid Prevention Grants..............................  ................  ................            15,000
    Mandatory Drug Testing................................             4,894             4,885             4,894
    Minority AIDS.........................................            41,205            28,843            41,205
    Sober Truth on Preventing Underage Drinking (STOP Act)             7,000             6,986             7,000
        National Adult-Oriented Media Public Service                   1,000  ................             1,000
         Campaign.........................................
        Community-based Coalition Enhancement Grants......             5,000  ................             5,000
        ICCPUD............................................             1,000  ................             1,000
    Tribal Behavioral Health Grants.......................            15,000            14,971            15,000
 
SCIENCE AND SERVICE:
    Center for the Application of Prevention Technologies.             7,493             7,479             7,493
    Science and Service Program Coordination..............             4,072             4,064             4,072
    Minority Fellowship Program...........................                71                71                71
----------------------------------------------------------------------------------------------------------------

    Alternatives to Opioids.--The Committee is aware of 
programs that provide innovative approaches to preventing 
opioid addiction and dependency by using evidenced-based 
treatment options and alternatives to the uses of opioids. The 
Committee is encouraged that these programs can help reduce 
dependence on opioids and encourages SAMHSA to develop and 
disseminate best practices in preventing opioid abuse.
    Combating Opioid Abuse.--The Committee provides $12,000,000 
for grants to prevent opioid overdose related deaths. As part 
of the initiative to combat opioid abuse, 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 agreement also provides $12,000,000 
for First Responder Training grants. Of this amount, $6,000,000 
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. 
Furthermore, the Committee provides $10,000,000 for the 
Strategic Prevention Framework Rx program to increase awareness 
of opioid abuse and misuse in communities.
    Opioid Prevention Grants.--The Committee understands that 
efforts to address the opioid crisis must include community-
based strategies to prevent opioid abuse. Therefore, the bill 
provides $15,000,000 for a new opioid prevention program. 
SAMHSA shall award opioid prevention grants to communities and 
community coalitions based on the current state of evidence-
based and promising practices. Of the amounts provided, the 
Committee directs that no more than $1,000,000 be used to 
conduct an evaluation of these grants to determine 
effectiveness. Further, the Committee directs SAMHSA to 
continue providing technical assistance to communities and 
coalitions by developing and distributing a list of best 
practices to prevent opioid abuse. SAMHSA is directed to work 
with NIDA, other Federal agencies, appropriate stakeholder 
groups, and States, in implementing these grants and developing 
best practices. Furthermore, SAMHSA should update this list 
based on new research findings, including the evaluation of the 
opioid prevention program grants.

                HEALTH SURVEILLANCE AND PROGRAM SUPPORT

Appropriations, 2017....................................    $148,258,000
Budget estimate, 2018...................................     132,348,000
Committee recommendation................................     145,830,000

    The Committee recommends $145,830,000 for Health 
Surveillance and Program Support activities. The recommendation 
includes $31,428,000 in transfers available under section 241 
of the PHS Act.
    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]
----------------------------------------------------------------------------------------------------------------
                                                            Fiscal year 2017  Fiscal year 2018      Committee
                      Budget activity                         appropriation        request       recommendation
----------------------------------------------------------------------------------------------------------------
Health Surveillance.......................................            47,258            33,842            47,258
Program Management........................................            77,000            73,043            76,000
Performance & Quality Information Systems.................            10,000            12,893            10,000
Public Awareness and Support..............................            13,000            11,572            11,572
Behavioral Health Workforce Data..........................             1,000             1,000             1,000
----------------------------------------------------------------------------------------------------------------

    Methamphetamine Abuse.--The Committee requests that SAMHSA, 
in partnership with the National Center for Health Statistics 
at CDC, investigate the establishment of a comprehensive survey 
of the rates of methamphetamine abuse and its related 
indicators. Such a survey would include rates of 
methamphetamine use, treatment admissions due to 
methamphetamine use, rates of overdose and morality, incidence 
of births of methamphetamine-addicted infants, interactions 
with law enforcement and child protective services related to 
methamphetamine use, and any other indicators recommended by 
SAMHSA and CDC. The Committee requests an update on the 
feasibility of such a survey in the fiscal year 2019 CJ.
    The Committee does not include bill language requested by 
the administration that would provide additional transfer 
authority to the Administrator beyond that which is already 
provided to the Secretary.

               Agency for Healthcare Research and Quality

Appropriations, 2017....................................    $324,000,000
Budget estimate, 2018...................................................
Committee recommendation................................     324,000,000

    The Committee provides $324,000,000 for the Agency for 
Healthcare Research and Quality [AHRQ], which is combined with 
the $106,500,000 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 as promoting high-quality care, 
eliminating healthcare disparities, using information 
technology, and evaluating the effectiveness of clinical 
services.

                  HEALTH COSTS, QUALITY, AND OUTCOMES

    The Committee provides $187,156,000 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]
----------------------------------------------------------------------------------------------------------------
                                                            Fiscal year 2017  Fiscal year 2018      Committee
                      Budget activity                         appropriation        request       recommendation
----------------------------------------------------------------------------------------------------------------
Research on Health Costs, Quality, and Outcomes:
    Prevention/Care Management............................            11,649  ................            11,649
    Health Information Technology.........................            16,500  ................            16,500
    Patient Safety Research...............................            70,276  ................            70,276
    Health Services Research, Data and Dissemination......            88,731  ................            88,731
----------------------------------------------------------------------------------------------------------------

    Diagnostic Quality & Safety.--The Committee is concerned 
about the lack of dedicated research into improving how we 
diagnose medical conditions, especially given the magnitude of 
the public health burden of diagnostic failures that lead to 
patient harm. According to the 2015 report, ``Improving 
Diagnosis in Healthcare'', from the National Academy of 
Sciences, Engineering, and Medicine [NASEM], diagnostic errors 
have been a ``blind spot'' for health care delivery and 
improving diagnosis is a pressing ``moral, professional, and 
public health imperative.'' The Committee requests that AHRQ 
convene a cross-agency working group that will propose a 
strategy to enhance scientific research to improve diagnosis in 
healthcare, as outlined in the 2015 NASEM report. This should 
include a review of current research, as well as consideration 
of opportunities for public-private partnerships and the 
development of centers of excellence to propel research forward 
to improve diagnostic quality and safety while reducing 
healthcare costs. The Committee requests this information be 
provided in the fiscal year 2019 CJ.
    Evidence-Based Practice.--The Committee encourages AHRQ to 
include in its research portfolio a focus on disabilities and 
chronic conditions, including disability as a health disparity. 
The Committee encourages AHRQ to use all three levels of 
evidence stratification and assessment recognized by the U.S. 
Preventative Services Task Force and recognize that the absence 
of randomized controlled trials does not equate to the absence 
of evidence. Similarly, the Committee encourages AHRQ to 
recognize that the inability to draw conclusions about the 
comparative effectiveness of a treatment does not mean the 
treatment is ineffective.
    Health IT Safety.--The Committee recommendation includes 
$16,500,000 for AHRQ's work on safe health IT practices 
specifically related to the design, implementation, usability, 
and safe use of health IT systems. The Committee believes this 
investment will generate new evidence regarding safe health IT 
practices that will ultimately be used by ONC, FDA, CMS, and 
others to inform policy interventions.
    Health Services Research.--Health services research 
provides decisionmakers critical information to improve health 
care quality, increase efficiency, and inform personal health 
care choices. The Committee does not support the 
administration's proposal to consolidate AHRQ into the NIH and 
instead continues to fund the agency as an independent 
operating division within the Department. However, the 
Committee is concerned that AHRQ and the other Federal agencies 
conducting health services research do not sufficiently 
coordinate their efforts to optimize Federal investments in 
this science. The recommendation includes $1,000,000 for AHRQ 
to contract with an independent entity to study health services 
research supported by Federal agencies since fiscal year 2012. 
This study should identify research gaps and areas for 
consolidation, as well as propose strategies for better 
coordination of the Federal health services research 
enterprise. The Committee requests a report on the findings of 
this study to the Committee not later than 180 days after the 
enactment of this act.
    Healthcare-Associated Infections.--Within the Patient 
Safety portfolio, the Committee provides $36,000,000, the same 
level as in fiscal year 2017, for healthcare-associated 
infection activities. Within this funding level, the Committee 
includes $10,000,000 for activities as part of the CARB 
initiative. These funds will support the development and 
expansion of antibiotic stewardship programs specifically 
focused on ambulatory and long-term care settings.
    Healthcare Delivery Systems.--Within the Patient Safety 
portfolio, the Committee includes $10,000,000 for Healthcare 
Delivery Systems grants, or ``patient safety learning labs.'' 
The purpose of these grants is to test new ways of addressing 
entrenched patient safety issues by using a systems engineering 
approach.
    Investigator-Initiated Research.--The Committee reiterates 
its strong support for investigator-initiated research and 
believes this research should not target any specific area of 
health services research but should reflect the best 
unsolicited ideas from the research community. The Committee is 
aware that enhanced utilization of independent academic medical 
centers could lead to innovative and pragmatic solutions that 
improve clinical practices.
    U.S. Preventative Services Task Force [USPSTF].--The 
Committee notes the USPSTF's inclusion of additional 
stakeholders and physician experts during its recent process 
for drafting the updated prostate cancer screening 
recommendation. However, the Committee remains concerned about 
the lack of transparency in the process and directs the USPSTF 
to include a description of comments received on the draft 
recommendation statement and relevant recommendations of other 
Federal agencies and organizations in any final recommendation.

                   MEDICAL EXPENDITURES PANEL SURVEYS

    The Committee provides $66,000,000 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 $70,844,000 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, 2017

                                                        $262,003,967,000

Budget estimate, 2018

                                                         284,798,384,000
Committee recommendation
                                                         284,798,384,000

    The Committee recommends $284,798,384,000 in mandatory 
funding for Grants to States for Medicaid.
    The fiscal year 2018 recommendation excludes 
$125,219,452,000 in fiscal year 2017 advance appropriations for 
fiscal year 2018. As requested by the administration, 
$134,847,759,000 is provided for the first quarter of fiscal 
year 2019.
    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, Puerto Rico, and 
the 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, 2017

                                                        $299,187,700,000

Budget estimate, 2018

                                                         323,497,300,000
Committee recommendation
                                                         323,497,300,000

    The Committee recommends $323,497,300,000 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 $245,396,000,000 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 $76,133,000,000 for the 
general fund share of benefits paid under Public Law 108-173, 
the Medicare Prescription Drug, Improvement and Modernization 
Act of 2003. As in previous years, the Committee includes 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 $422,000,000 to 
be transferred to the Supplementary Insurance Trust Fund as the 
general fund share of Part D administrative expenses. The 
Committee recommendation includes $307,000,000 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

Appropriations, 2017....................................  $3,669,744,000
Budget estimate, 2018...................................   3,587,996,000
Committee recommendation................................   3,669,744,000

    The Committee recommends $3,669,744,000 for CMS program 
management, which includes funding for research, program 
operations, 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 $2,519,823,000 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 two 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.
    Adverse Drug Events.--To improve patient safety and the 
efficiency of the Medicare Program, the Committee encourages 
CMS to prioritize the adoption of approved quality measures 
related to drugs that are associated most frequently with 
adverse drug events that may result in significant patient harm 
in the over 65 population. This should be consistent with the 
Department's National Action Plan for Adverse Drug Event 
Prevention.
    Caregiver Counseling and Supportive Services.--The 
Committee is aware of a body of evidence that suggests defined 
counseling and supportive services delivered to family (non-
paid) caregivers of Medicare beneficiaries with Alzheimer's 
disease and dementia can substantially delay beneficiary 
placement in an institutional care setting and reduce Federal 
expenditures associated with such care. The Committee is 
concerned about the current and anticipated Medicare and 
Medicaid costs associated with Alzheimer's disease and 
recommends that CMS, in consultation with ACL, consider a pilot 
or demonstration program to evaluate the impact of such 
evidence-based Alzheimer's caregiver support models could have 
on the Medicare and Medicaid programs.
    CT Colonography.--Due to the proven life and cost-savings 
of preventative 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.
    Diabetes Prevention and Telehealth.--The Committee commends 
CMS's 2017 announcement that the Center for Medicare and 
Medicaid Innovation will test virtual care for the Medicare 
Diabetes Prevention Program. The Committee encourages CMS to 
consider additional ways in which Medicare will cover remote 
patient monitoring and urges CMS to evaluate how telehealth can 
be an effective way to prevent and manage diabetes and other 
chronic diseases, specifically for beneficiaries in rural 
settings and for those without access to specialized chronic 
disease care.
    Direct and Indirect Remuneration Fees.--The Committee is 
concerned about the dramatic increase of pharmacy direct and 
indirect remuneration [DIR] fees in Medicare Part D. The 
Committee requests a report from CMS within 180 days after 
enactment of this act on how to best address this issue, 
including consideration of options to require that all DIR fees 
be accounted for a point of sale; as part of negotiated price; 
and that any incentive fees be paid separately.
    Electrodiagnostic [EDX] Tests.--The Committee appreciates 
that CMS provided additional guidance regarding the 
recommendations in the 2014 OIG Report: ``Questionable Billing 
for Medicare Electrodiagnostic Tests.'' The Committee notes 
that utilization of codes for EDX testing continues to increase 
and remains interested in comprehensive solutions that advance 
quality care and cost savings by ensuring patients do not 
receive unnecessary EDX tests.
    Falls Prevention.--The Committee recognizes the importance 
of injury prevention in seniors and the impact that falls can 
have on morbidity and mortality, as well as the rising aging 
population in the United States. The Committee also recognizes 
the significant positive outcomes in terms of averted morbidity 
and mortality, as well as cost savings, from models such as the 
Community Aging in Place--Advancing Better Living for Elders 
[CAPABLE] program. Funded through the Center for Medicare and 
Medicaid Innovation's Health Care Innovation Awards, the 
CAPABLE program utilized occupational therapists, nurses, and 
home repair handymen to focus on beneficiary-directed home 
functional improvements, with the aim of delaying entry to 
skilled nursing facilities. The Committee encourages CMS to 
look for opportunities to test models related to injury and 
fall prevention.
    Fraudulent Billing.--During fiscal year 2018, the Committee 
encourages CMS to investigate diagnostic laboratories' use of a 
fraudulent billing practice commonly known as fee forgiveness 
schemes and evaluate what role the agency can have in 
minimizing this practice. These illegal practices can often 
result in increased Medicare and Medicaid expenditures and can 
cause undue burden on our Nation's healthcare system.
    Graduate Medical Education.--The Committee recommends that 
the Comptroller General of the United States conduct a study on 
the potential of making graduate medical education payments 
under the Medicare program for mid-level health providers (such 
as physician assistants and nurse practitioners) to allow 
physicians and other health care providers to perform to their 
full scope of practice; and to identify the current, actual 
costs involved in training residents in different residency 
specialty types. The Comptroller General shall provide the 
report within one year of the enactment of this act and shall 
consult with the Committees on Appropriations of the House of 
Representatives and the Senate as well as the Senate Finance 
Committee and House Committee on Ways and Means and keep the 
Committees apprised of progress quarterly.
    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 [SHOP] 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 2019.
    Immunization Information System Interoperability.--The 
Committee is aware that HHS has made HITECH funding available 
to support connectivity and interoperability between Medicaid 
providers and Immunization Information Systems [IIS]. The 
Committee encourages the Secretary to work with the Office of 
Management and Budget to evaluate how waiving match 
requirements, as applicable, may encourage many State and local 
health departments to take advantage of this funding 
opportunity. The Committee requests data from CMS on State and 
local health departments' expenditures on IIS interoperability 
within 18 months after enactment of this act.
    Intrathecal Pain Pumps.--The Committee continues to be 
concerned that changes to Medicare billing practice may 
restrict patient access to intrathecal pain pumps as an option 
for pain management in States where the boards of pharmacy 
prohibit sale of compounded solutions from a pharmacist to a 
physician. The Committee looks forward to receiving the study 
requested in fiscal year 2017 of the effect of this billing 
practice change on patient access in these States.
    Medicare Advantage.--The Committee continues to be 
concerned that the formula to determine Medicare Advantage 
reimbursement rates is calculated based on the per capita cost 
of coverage to beneficiaries enrolled in Medicare Part A and/or 
Part B. The Committee is concerned that CMS has not made 
progress on these payment adjustments, and encourages CMS to 
consider more accurate adjustments for fiscal year 2018.
    Medicare Clinical Laboratory Fees.--Before finalizing 
implementation of the final regulation (CMS-1621-F) 
implementing the Protecting Access to Medicare Act of 2014, the 
Committee encourages CMS to continue to work with stakeholders 
to address data accuracy concerns and ensure that the reported 
data appropriately represents the full spectrum of 
laboratories, including hospital, independent, and physician-
office laboratories, that are paid under the Medicare Clinical 
Laboratory Fee Schedule.
    Medicare Prescription Drug Plan [PDP] Standardized 
Reporting.--The Committee requests CMS to provide an update in 
the 2019 CJ on how they plan to require standardized reporting 
by PDP sponsors of all price concession received from, and 
incentive payments made to, network pharmacies except those 
contingent price concessions or incentive payments that cannot 
reasonably be determined at the point of sale.
    Plan Finder.--The Committee encourages CMS to enhance the 
Medicare Plan Finder web site to strengthen beneficiary's 
ability to shop for and choose plans that best meet their 
needs. CMS should consider improvements such as improving 
navigation on mobile devices, providing information on the 
estimated out-of-pocket costs for Medicare beneficiaries for 
common services, and providing searchable up-to-date provider 
network directories. The Committee encourages CMS to solicit 
input from relevant stakeholders to help inform and facilitate 
such changes. The Committee requests that an update of these 
efforts be provided in the fiscal year 2019 CJ.
    Recovery Audit Contractors [RAC].--The Committee directs 
the Medicare appeals intra-agency working group to provide 
quarterly updates to the Committees on Appropriations of the 
House of Representatives and the Senate reflecting the total 
number of appeals filed, appeals pending, and appeals disposed 
of for all four levels of the appeals process. The quarterly 
updates should include a breakout of RAC and non-RAC claims, an 
update on RAC contracting and how new RAC requirements have 
affected the rate of appeals.
    Risk Corridor Program.--The agreement 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.
    Rural Health.--While nearly a quarter of the U.S. 
population lives in rural areas, access to CAHs continues to be 
a challenge for many residents as these hospitals face 
significant financial challenges. The majority of rural 
residents are older, poorer, and less likely to have employer 
sponsored health plans. As a result, if a rural hospital 
closes, many patients end up driving long distances to see a 
doctor, forgo seeking medical care, or even worse, wait until 
it is too late to seek proper medical attention. These patients 
spend more money out of pocket to travel and miss routine 
preventative care which will end up increasing healthcare costs 
in the long run. The Committee appreciates the ongoing work of 
CMS and HRSA to analyze the impact of proposed regulations on 
rural hospitals and other providers and is pleased with the 
recent establishment of the Rural Health Council to address the 
unique needs of rural communities. The Committee continues to 
direct CMS to work with HRSA's Office of Rural Health and 
provide an update in the fiscal year 2019 CJ on actions taken 
to alleviate the disproportionate impact of regulations, 
reimbursement cuts, and workforce issues on rural hospitals.
    Telehealth.--The Committee directs the Administrator, in 
consultation with the relevant agencies and stakeholders, to 
submit a report within 1 year after enactment of this act to 
the Committees of Appropriations of the House of 
Representatives and the Senate evaluating the use of telehealth 
and remote patient monitoring under all programs and pilots 
under the Medicare program under title XVIII of the Social 
Security Act and the Medicaid program under title XIX of such 
Act with a waiver of telehealth restrictions otherwise 
applicable under such titles of the Social Security Act (42 
U.S.C. 1395m(m)). The report shall include an assessment of: 
(A) the number of providers and payers using telehealth and 
remote patient monitoring under such programs and pilots; (B) 
the cost impact among the beneficiaries receiving telehealth 
and remote patient monitoring under such programs and pilots, 
including with respect to preventable hospitalizations, 
hospital readmissions, and emergency room visits, and the total 
cost of items and services under the Medicare and Medicaid 
programs; (C) beneficiary and family caregiver satisfaction 
with the use of telehealth and remote patient monitoring under 
such programs and pilots; and (D) a comparison of the 
utilization of, and expenditures for, the same services 
furnished under the Medicare and Medicaid programs in the usual 
clinical setting.
    Therapeutic Foster Care.--The Committee remains concerned 
about the lack of a uniform definition within the Medicaid 
program for therapeutic foster care [TFC] services. A uniform 
definition would improve the ability for more consistent care 
and treatment. The Committee requests an update in the fiscal 
year 2019 CJ on the study requested in House Report 114-699 
under this heading.
    Use of Opioid Drugs to Manage Chronic Pain.--The Committee 
understands that opioid pain medications are used and are often 
essential in the appropriate management of acute and chronic 
pain. Given the national problem of misuse and abuse of 
prescription opioid pain medications, the Committee encourages 
CMS to increase awareness of alternative pain management 
strategies to opioids to reduce opioid monotherapy in 
appropriate cases.
    Use of Social Security Numbers on Medicare Beneficiaries' 
Cards.--The Committee is encouraged by CMS plans to start 
sending new Medicare cards with a Medicare Beneficiary 
Identifier to Medicare beneficiaries by October 2018. The 
Committee directs CMS to provide an update on the progress of 
this initiative in their fiscal year 2019 CJ.
    Vaccine Utilization.--The Committee is concerned about the 
underutilization of vaccinations, particularly pneumococcal 
vaccines and encourages CMS to continue to require that 
electronic health records communicate with immunization 
registries, so that clinicians accessing the registries have 
the most complete immunization history available and to 
continue efforts to remind beneficiaries and their providers to 
adhere to the recommendations.
State Survey and Certification
    The Committee recommends $397,334,000 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.
    The Committee continues to support CMS collecting and 
analyzing the findings from this surveillance tool to inform 
the agency's education and surveillance efforts moving forward.
Federal Administration
    The Committee recommends $732,533,000 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.

                  HEALTH CARE FRAUD AND ABUSE CONTROL

Appropriations, 2017....................................    $725,000,000
Budget estimate, 2018...................................     751,000,000
Committee recommendation................................     745,000,000

    The Committee recommends $745,000,000, 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.
    The Committee recommendation includes a base amount of 
$311,000,000 and an additional $434,000,000 through a budget 
cap adjustment authorized by section 251(b) of the Balanced 
Budget and Emergency Deficit Control Act of 1985.

                Administration for Children and Families


  PAYMENTS TO STATES FOR CHILD SUPPORT ENFORCEMENT AND FAMILY SUPPORT 
                                PROGRAMS

Appropriations, 2017....................................  $3,010,631,000
Budget estimate, 2018...................................   2,995,400,000
Committee recommendation................................   2,995,400,000

    The Committee recommendation includes $2,995,400,000 in 
fiscal year 2018 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 2019.
    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, 2017....................................  $3,390,304,000
Budget estimate, 2018...................................................
Committee recommendation................................   3,390,304,000

    The Committee recommendation includes $3,390,304,000 for 
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 2017 level.

                     REFUGEE AND ENTRANT ASSISTANCE

Appropriations, 2017....................................  $1,674,691,000
Budget estimate, 2018...................................   1,456,755,000
Committee recommendation................................   1,506,691,000

    The Committee recommends $1,506,691,000 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, 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 United States until they can be placed with a parent, 
guardian, or other sponsor while awaiting adjudication of their 
immigration status.
    The U.S. refugee protection and admission programs reflect 
U.S. humanitarian and strategic interests. The U.S. refugee 
resettlement program provides for the safe resettlement of some 
of the most vulnerable refugees and not only saves lives, but 
also strengthens our national security by providing support and 
shared responsibility for strategic allies and regions.
    The Committee affirms the community consultation process 
embedded in the U.S. refugee resettlement program, which is 
grounded in its public-private partnerships and thrives on 
cooperation among local, State, and Federal stakeholders. In 
times of sudden reductions in refugee arrivals, the Committee 
encourages HHS, to the extent practicable, to ensure that 
resettlement agencies are able to maintain their infrastructure 
and capacity at a level to continue to serve new refugees, 
previously arrived refugees, and others who remain statutorily 
eligible for integration services, and to ensure future 
arrivals are adequately served.
Transitional and Medical Services
    The Committee recommendation includes $320,000,000 for 
Transitional and Medical Services [TAMS]. 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.
    In fiscal year 2018, HHS estimates the number of eligible 
arrivals will significantly decrease relative to fiscal years 
2016 and 2017. This is due to a significant estimated reduction 
in eligible Cuban entrants because of the change in 
administration policy in January 2017 that ended the so called 
``wet-foot/dry-foot'' policy, and an assumed reduction in the 
refugee admissions ceiling to 50,000, which will be set by the 
State Department later this year. Accordingly, the Committee 
recommendation includes a decrease in funding for TAMS, 
consistent with current HHS estimates and expects the funding 
level provided will allow HHS to at least sustain the current 
level and scope of services provided to eligible arrivals, 
including maintaining the number of months refugees are 
eligible for benefits. Further, the Committee notes that there 
is considerable uncertainty in the estimates of the costs for 
this program, and expects HHS to closely monitor this account 
and promptly notify the Committee of any shortfalls so they can 
be addressed. The Committee will consider revised funding needs 
as necessary. To that end, the Committee directs HHS to provide 
monthly updates of eligible arrivals by category to the 
Committees on Appropriations of the House of Representatives 
and the Senate. Finally, the Committee directs HHS, in future 
budget justifications, to include actual and estimated costs 
broken out by major category, including for the unaccompanied 
refugee minor program, matching grant program, cash assistance, 
medical care, and other categories as appropriate.
    The Committee continues to support the matching grant 
program and strongly encourages HHS to increase the percentage 
of eligible arrivals served by the program. Further, the 
Committee strongly encourages 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. The budget request proposes to 
consolidate funding for Social Services, Preventive Health, and 
Targeted Assistance into this new program. The Committee 
supports this consolidation which should simplify 
administration of refugee services at the Federal, State, and 
local level. This funding would be allocated in a similar 
manner as currently funded programs, by a combination of 
formula and competitive grants, based on recent refugee and 
arrival data, including accounting for secondary migration, and 
to address other critical needs.
    The Committee continues to support the services currently 
provided by the Social Services program, as well as the 
Targeted Assistance Grant program, which addresses the critical 
needs of counties with high arrival patterns and high 
concentrations of refugees facing difficulties achieving self-
sufficiency. Within the total for Refugee Support Services, the 
Committee recommendation includes $4,600,000 for Refugee Health 
Promotion competitive grants, the same as the fiscal year 2017 
funding level.
Victims of Trafficking
    The Committee recommendation includes $20,755,000 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 
$15,000,000 for services for foreign national victims, and 
$5,755,000 to improve services available for U.S. citizens and 
legal permanent residents. The Committee directs HHS to use the 
increase in funding provided for the Victims of Trafficking 
program to help address unmet needs in foreign national victim 
assistance programs. The Committee recommendation also includes 
no less than the fiscal year 2017 level for the national human 
trafficking resource center.
Social Services
    The Committee recommendation consolidates funding for this 
program into a new Refugee Support Services program, as 
requested by the administration.
Preventive Health
    The Committee recommendation consolidates funding for this 
program into a new Refugee Support Services program.
Targeted Assistance
    The Committee recommendation consolidates funding for this 
program into a new Refugee Support Services program, as 
requested by the administration.
Unaccompanied Children
    The Committee recommendation includes $948,000,000 for the 
Unaccompanied Children [UC] program. The UC program provides 
temporary shelter and basic services to children who have no 
lawful immigration status in the United States and who have 
been apprehended in the United States by the Department of 
Homeland Security or other law enforcement agencies without a 
parent or guardian. HHS takes custody of the children until 
they can be placed with a parent or guardian living in the 
United States pending resolution of their immigration status, 
or until their immigration status otherwise changes.
    There is significant uncertainty in the cost estimates for 
this program, which depend heavily on the number of 
unaccompanied children coming to the United States and referred 
to HHS. This year, the number of children coming to the United 
States and referred to HHS has significantly decreased. As a 
result, based on current estimates and funding levels, HHS 
estimates it will carry over unobligated balances from fiscal 
year 2017 that were not expected to be available when 
formulating the fiscal year 2018 budget request. Further, if 
the number of arrivals continue at roughly this level, HHS may 
need less funding in fiscal year 2018 than in fiscal year 2017, 
or as requested for fiscal year 2018. The Committee will 
continue to work closely with HHS on estimated needs in this 
program as more data becomes available throughout the year to 
ensure HHS has sufficient resources to properly care for 
children in their custody and to continue to provide all post-
release services at least at the level as provided in fiscal 
year 2017.
    In addition to the fiscal year 2018 funding provided here, 
the Committee recommendation includes a rescission of 
$140,000,000 in prior-year unobligated balances.
Victims of Torture
    The Committee recommendation includes $10,735,000 for the 
Victims of Torture program. This program provides treatment, 
social, and legal services to victims of torture and training 
to healthcare providers on treating the physical and 
psychological effects of torture.

   PAYMENTS TO STATES FOR THE CHILD CARE AND DEVELOPMENT BLOCK GRANT

Appropriations, 2017....................................  $2,856,000,000
Budget estimate, 2018...................................   2,761,000,000
Committee recommendation................................   2,856,000,000

    The Committee recommends $2,856,000,000 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.
    The CCDBG Act allows HHS to offer guidance to States on 
child-to-provider ratios. Accordingly, the Committee directs 
the Department to report to the Committees on Appropriations of 
the House of Representatives and the Senate no later than 60 
days after the date of enactment of this Act on the effect of 
child-to-provider ratio requirements on the average cost of 
child care, the quality and safety of child care programs, and 
the steps HHS has taken to provide guidance to States on child-
to-provider ratios.

                      SOCIAL SERVICES BLOCK GRANT

Appropriations, 2017....................................  $1,700,000,000
Budget estimate, 2018...................................................
Committee recommendation................................   1,700,000,000

    The Committee recommends $1,700,000,000 in mandatory funds 
for 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.

                CHILDREN AND FAMILIES SERVICES PROGRAMS

Appropriations, 2017.................................... $11,294,368,000
Budget estimate, 2018...................................  10,204,293,000
Committee recommendation................................  11,284,368,000

    The Committee recommends $11,284,368,000 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 $9,253,095,000 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.
    The Committee continues to direct HHS to ensure that as 
part of the effort to expand the duration of Head Start 
services, grantees continue to have flexibility to meet the 
needs of their local community and to fund other quality 
improvement activities that may be necessary to improve the 
quality of programs prior to expanding the duration of 
services.
    The Committee recommendation includes, in addition to funds 
otherwise available for Early Head Start, $640,000,000, the 
same as the fiscal year 2017 level, for Early Head Start 
Expansion and Child Care Partnerships grants. The Committee 
continues to direct HHS to give equal priority to grantees 
providing more traditional Early Head Start services and those 
forming child care partnerships. The Committee continues to 
support this partnership model but such partnerships will not 
be viable in every community and in many places it may be more 
appropriate to simply provide traditional Early Head Start 
services.
    Within the total for Head Start, the Committee 
recommendation includes up to $25,000,000, the same as the 
comparable fiscal year 2017 level, for transition-related costs 
associated with the Head Start Designation Renewal System 
[DRS]. In addition, 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.
Preschool Development Grants
    The Committee recommendation includes $250,000,000 for 
Preschool Development Grants. This program, as authorized in 
the Every Student Succeeds Act, 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. All funding provided in fiscal year 
2018 will support new grants, under the new authorization of 
the program.
Consolidated Runaway and Homeless Youth Program
    The Committee recommendation includes $101,980,000 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.
Education and Prevention Grants To Reduce Sexual Abuse of Runaway Youth
    The Committee recommendation includes $17,141,000 for 
Education and Prevention Grants to Reduce Sexual Abuse of 
Runaway and Homeless Youth. This program provides competitive 
grants for 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 $25,310,000 for the 
Child Abuse Prevention and Treatment State Grant program. This 
program provides formula grants to States to improve their 
child protective service systems.
Child Abuse Discretionary Activities
    The Committee recommendation includes $33,000,000 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.
    Quality Improvement Center for Research-based Infant-
Toddler Court Teams [QIC-CT].--The Committee supports continued 
funding for a national resource center to preserve, 
disseminate, and amplify the work of the QIC-CT by providing 
training and technical assistance in support of such court 
teams' efforts across the country. These efforts should build 
upon and continue the work of sites established through the 
QIC-CT initiative, which have brought together the court 
system, child welfare agencies, health professionals, and 
community leaders to improve current practices in the child 
welfare system and make better-informed decisions on behalf of 
the child.
Community-Based Child Abuse Prevention
    The Committee recommendation includes $39,764,000 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 community-based 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 $17,984,000 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.
    National Survey of Child and Adolescent Well-Being.--The 
Committee recommendation includes funding within this program 
for HHS to continue the National Survey of Child and Adolescent 
Well-Being.
Adoption Opportunities
    The Committee recommends $39,100,000 for the Adoption 
Opportunities program. 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 supports ACF's efforts in fiscal year 2017 to 
fund activities to improve hospital-based adoption support 
services for pregnant and expectant mothers, including training 
for hospital staff and doctors. The Committee supports the 
continued funding of such activities, which will help ensure 
that mothers who wish to make an adoption have access to 
trained staff and comprehensive supports throughout the 
adoption process.
Adoption Incentives
    The Committee recommends $37,943,000 for the Adoption 
Incentives 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.
Social Services and Income Maintenance Research
    The Committee recommends $6,512,000 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 $52,050,000 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 $12,000,000 for Native 
American language preservation activities, including no less 
than $4,000,000 for Native American language nests and survival 
schools, as authorized by sections 803C(b)(7)(A)-(B) of the 
Native American Programs Act. The Committee directs HHS to give 
priority to programs with rigorous immersion programs.
    Native American Early Education.--The Committee is 
concerned that some Federal programs that support early 
childhood development in American Indian and Alaska Native 
communities are not well-coordinated and, therefore, reduce the 
abilities of these tribal communities to develop and implement 
community-wide early childhood initiatives. The Committee 
encourages the Secretary of HHS (through the Assistant 
Secretary for ACF) to convene a working group of Federal early 
childhood program administrators, tribal early childhood 
stakeholders, and tribal leaders to examine this issue.
Community Services Block Grant
    The Committee recommendation includes $700,000,000 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 low-income individuals in becoming self-sufficient. 
States are required to pass on at least 90 percent of these 
funds to local community-based organizations, the vast majority 
of which are community action agencies.
Community Economic Development
    The Committee recommendation includes $19,883,000 for the 
Community Economic Development [CED] program, which provides 
grants to community development corporations to support 
employment and business opportunities for low-income 
individuals. Community development corporations leverage on 
average $10 in private capital to every $1 in Federal funds, 
and the job creation standards required by the Office of 
Community Services are among the most stringent in the Federal 
system.
    The Committee recognizes the value in providing communities 
with the tools necessary to create sustainable economic 
development to help low-income families living in those 
communities. In awarding funds under this program, the 
Committee encourages ACF to give priority to rural communities, 
to help them identify community service needs and improve upon 
the services provided to low-income individuals and families in 
such communities.
Rural Community Facilities
    The Committee recommendation includes $7,500,000 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 $8,250,000 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.
Family Violence Prevention and Services
    The Committee recommendation includes $156,000,000 for 
Family Violence Prevention and Services programs. These funds 
support programs to prevent family violence and provide 
immediate shelter and related assistance for victims of 
domestic violence and their dependents.
    The Committee recommendation is $5,000,000 more than the 
fiscal year 2017 level. The Committee directs HHS to use the 
increase to supplement existing funding for Native American 
Tribes and Tribal Organizations, and recognizes the importance 
of providing supports that are culturally appropriate to the 
populations they serve.
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 FEMA contacts to identify needed 
assistance, and providing ongoing support and monitoring 
through the recovery process.
Program Administration
    The Committee recommendation includes $205,000,000 for the 
Federal costs of administering ACF programs.

                   PROMOTING SAFE AND STABLE FAMILIES

Appropriations, 2017....................................    $384,765,000
Budget estimate, 2018...................................     404,651,000
Committee recommendation................................     384,765,000

    The Committee recommends $384,765,000 for the Promoting 
Safe and Stable Families program. The Committee recommendation 
includes $325,000,000 in mandatory funds authorized by the 
Social Security Act and $59,765,000 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.
    The Committee notes that the authorization for Promoting 
Safe and Stable Families expired in fiscal year 2016. Mandatory 
funding for certain court improvement programs funded within 
this account were continued in division M of the Consolidated 
Appropriations Act, 2017 but are not assumed to continue in the 
CBO baseline for fiscal year 2018. Accordingly, the Committee 
recommendation does not include continued funding for those 
activities in fiscal year 2018.

                PAYMENTS FOR FOSTER CARE AND PERMANENCY

Appropriations, 2017....................................  $5,764,000,000
Budget estimate, 2018...................................   6,225,000,000
Committee recommendation................................   6,225,000,000

    The Committee recommends $6,225,000,000 in mandatory funds 
for Payments for Foster Care and Permanency. In addition, the 
Committee recommends $2,700,000,000 in advance mandatory 
funding for the first quarter of fiscal year 2019. 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.
    Foster Care Data Collection.--The Committee directs ACF to 
submit a report to Congress on multigenerational foster care 
data. The Committee is interested in data that may be used to 
better target programs to ensure foster care involvement does 
not continue from generation to generation. The report shall 
include what data is currently available on whether biological 
parents of children placed in foster care were themselves in 
foster care at any time, at what age, for how long, and if they 
emancipated from the foster care system. The report should also 
recommend the best method for collecting data on 
multigenerational foster care.

                  Administration for Community Living


                 AGING AND DISABILITY SERVICES PROGRAMS

Appropriations, 2017....................................  $1,993,815,000
Budget estimate, 2018...................................   1,851,450,000
Committee recommendation................................   1,993,815,000

    The Committee recommends an appropriation of $1,993,815,000 
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] and the 
Developmental Disabilities Act, 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 an appropriation of $350,224,000 
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. The Committee 
directs ACL to work with States to prioritize innovative 
service models, like naturally occurring retirement communities 
[NORCs], which help older Americans remain independent as they 
age. The Committee notes that NORCs, and similar settings, are 
a more cost-effective alternative to long-term care that 
enables older Americans to be more engaged in their communities 
while living at home.
Preventive Health Services
    The Committee recommends $19,848,000 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 $20,658,000 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.
National Family Caregiver Support Program
    The Committee recommends $150,586,000 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.
Native American Caregiver Support Program
    The Committee recommendation includes $7,556,000 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 an appropriation of $450,342,000 
for congregate nutrition services and $227,342,000 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 a 
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.--The Committee 
recommendation includes $160,069,000 for the Nutrition Services 
Incentives Program [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 USDA.
Aging Grants to Indian Tribes and Native Hawaiian Organizations
    The Committee recommends $31,208,000 for grants to Native 
Americans. This program provides grants to eligible tribal 
organizations for the delivery of nutrition and supportive 
services to Native Americans.
Aging Network Support Activities
    The Committee recommends $9,961,000 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.
    Within funding for the Aging Network Support Activities, 
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 also includes $2,500,000 to help provide 
supportive services for aging Holocaust survivors in the United 
States.
Alzheimer's Disease Demonstration Grants to States
    The Committee recommendation includes $4,800,000 for 
Alzheimer's Disease Demonstration Grants to States. This 
program funds competitive grants to States to test and 
implement new models of care for individuals with Alzheimer's 
disease.
Alzheimer's Disease Initiative
    The Committee recommends $14,700,000 in mandatory funding 
be transferred from the PPH Fund to ACL for the Alzheimer's 
Disease Initiative. Of the total, $10,500,000 is provided to 
expand the availability of home- and community-based dementia 
services and supports. The remaining $4,200,000 is provided for 
a public awareness outreach campaign regarding Alzheimer's 
disease.
Lifespan Respite Care
    The Committee recommends $3,360,000 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 be transferred from the 
PPH Fund to ACL for the Chronic Disease Self-Management Program 
[CDSMP]. This program assists those with chronic disease 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 
healthcare providers. CDSMP has been shown through multiple 
studies to result in significant and measurable improvements in 
health and quality of life, as well as reductions in 
hospitalizations and emergency room visits.
Elder Falls Prevention
    The Committee recommends that $5,000,000 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. The 
Committee intends that these funds should be used in 
coordination with CDC for public education about the risk of 
these falls, as well as implementation and dissemination of 
community-based strategies that have been proven to reduce the 
incidence of falls among seniors.
Elder Rights Support Activities
    The Committee recommends $13,874,000 for Elder Rights 
Support activities, including $10,000,000 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 $6,119,000 for Aging 
and Disability Resource Centers [ADRCs]. 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. The Committee 
urges ACL to improve coordination among ADRCs, area agencies on 
aging, and centers for independent living to ensure that there 
is ``no wrong door'' to access services.
State Health Insurance Assistance Program
    The Committee recommendation includes $47,115,000 for State 
Health Insurance Assistance Programs [SHIPs], which provide 
accurate and understandable health insurance information to 
Medicare beneficiaries and their families.
Paralysis Resource Center
    The Committee recommendation includes $6,700,000 for the 
Paralysis Resource Center, which has long provided essential, 
comprehensive information and referral services to people 
living with paralysis and their families. Since 2002, the 
program has expanded to include a network of information 
specialists, a substantial quality of life grant program, a 
Peer and Family support program, a one of a kind Paralysis 
Resource Guide, and a NeuroRecovery Rehabilitation Network. 
These resources and services focus on the promotion of 
independence and quality of life for the more than 6,000,000 
Americans across the country living with paralysis.
Limb Loss
    The Committee provides $2,500,000 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.
Traumatic Brain Injury
    The Committee provides $9,321,000 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 2017 
funding level for protection and advocacy services, as 
authorized under section 1305 of Public Law 106-310.
Developmental Disabilities State Councils
    The Committee recommendation includes $73,000,000 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.
Partnerships for Innovation, Inclusion, and Independence
    The Committee does not consolidate the State Councils on 
Developmental Disabilities, State Independent Living Councils, 
and State Advisory Boards on Traumatic Brain Injury. The 
Committee recognizes the unique role played by each program and 
believes consolidation into one program will not serve the 
needs of the people living with a disability.
Developmental Disabilities Protection and Advocacy
    The Committee recommendation includes $38,734,000 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.
Voting Access for Individuals With Disabilities
    The Committee recommendation includes $4,963,000 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 recommendation includes $10,000,000 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, productivity, 
and integration into the community of persons with 
developmental disabilities.
    Technical Assistance.--The Committee includes $643,000 for 
technical assistance and training for the State Councils on 
Developmental Disabilities.
    Transportation.--The Committee includes $1,000,000 to fund 
transportation assistance activities for older adults and 
persons with disabilities. These activities should focus on the 
most cost-effective and sustainable strategies that can be 
replicated to other communities. The Committee is pleased with 
the Inclusive Community Transportation program's efforts to 
integrate rural transit systems for individuals with 
disabilities and older adults to access health care services, 
paratransit, multiple transportation providers, and other 
critical community based supports. These small community 
demonstration grants should be designed to include the 
perspectives of individuals with disabilities and older adults 
in the transportation system and service design.
University Centers for Excellence in Developmental Disabilities
    The Committee recommendation includes $38,619,000 for the 
University Centers for Excellence in Developmental Disabilities 
[UCEDDs], 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. The funding will keep the national network of 
Centers strong and able to assist States to initiate 
collaborative research, education, training, and service 
efforts that help States to implement ESSA and WIOA, thereby 
ensuring that youth with disabilities successfully complete 
elementary school and transition from school to postsecondary 
education and/or integrated employment. The funding also allows 
the Centers to continue to respond to emerging and emergent 
national issues such as assisting in ongoing developmental 
monitoring, especially for children exposed to lead and other 
environmental teratogens, and for infants exposed to the Zika 
virus with its resulting complications. This funding also 
allows the University Centers to continue to address the needs 
of the rising numbers of individuals on the autism spectrum; 
demonstrate cost effective long term services and supports for 
adults with disabilities and those aging with disabilities; 
support returning veterans; and provide technical assistance to 
strengthen and support the national network of Centers as the 
disseminate research and best practices nationwide.
Independent Living
    The Committee recommendation includes $101,183,000 for the 
Independent Living Program. This program helps ensure that 
individuals with disabilities can live a productive and 
independent life 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 recommendation includes $103,970,000 for the 
National Institute on Disability, Independent Living, and 
Rehabilitation Research [NIDILRR]. The 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 healthcare costs and improve quality of 
life for the older adult and disabled population 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 as long as possible, while also remaining connected to 
their families and communities.
    The Committee encourages NIDILRR to continue to support 
research and activities that help older or disabled adults to 
increase, maintain, or improve their functional capabilities 
and allow for independent living. To that end, the Committee 
supports increased investment in public university research to 
harness technological advances, including wireless sensors, 
smart materials, and body wearables; movers and protective 
devices; and companion and quality of life robotics, which have 
the potential to enable mobility, improve health, protect 
against falls and injuries, 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 address medically 
underserved areas in rural and frontier regions with high 
populations of older adults, disabled populations, and tribal 
communities.
Assistive Technology
    The Committee recommendation includes $34,000,000 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 $40,063,000 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

Appropriations, 2017....................................    $525,457,000
Budget estimate, 2018...................................     361,966,000
Committee recommendation................................     535,457,000

    The Committee recommends $535,457,000 for General 
Departmental Management [GDM]. The recommendation includes 
$64,828,000 in transfers available under section 241 of the PHS 
Act.
    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.
    Alzheimer's Education Campaign.--The Committee continues to 
be interested in the Secretary's progress in implementing a 
comprehensive outreach and education campaign and directs the 
Secretary to submit to the Committees on Appropriations of the 
House of Representatives and Senate, the Committee on Finance, 
the Committee on Ways and Means, and the Committee on Energy 
and Commerce an annual report describing the activities carried 
out the preceding fiscal year, and an evaluation of the extent 
to which such activities have been effective in improving the 
health and well-being of racial and ethnic minority groups.
    Antibiotic Resistance.--The Committee supports the CARB 
initiative that strengthens efforts to prevent, detect, and 
control illness and deaths related to infections caused by 
antibiotic resistant bacteria. The Committee directs the 
Department to continue to work with DOD, USDA, VA, and FDA to 
broaden and expand efforts to track and store both antibiotic 
resistant bacteria genes and the mobile genetic elements from 
antibiotic resistant bacteria along with metadata. The 
Committee also recognizes the importance of basic and applied 
research toward the development of new vaccines as a way to 
prevent future antibiotic resistance through infection 
prevention and control. The Committee encourages the Secretary 
to prioritize this research as part of its strategy to combat 
antibiotic resistance. The Committee also urges the Secretary 
to consider the use of existing vaccines in antibiotic 
stewardship efforts to help mitigate new resistance 
development. The Department shall include in the fiscal year 
2019 CJ a detailed update on the progress being made to 
implement the CARB national strategy.
    Breast Density.--The Committee encourages the Department to 
expand and intensify applied research on breast density and 
improved screening tools to detect cancer in patients with 
dense tissue. The Secretary is encouraged to explore whether 
mammography reports should indicate to patients if they have 
dense breast tissue.
    Chronic Fatigue Syndrome [ME/CFS].--The Committee supports 
the Department's ME/CFS Advisory Committee [CFSAC] and is 
concerned that those with ME/CFS have very limited access to 
clinical care and there are no FDA approved treatments for 
them. HHS is encouraged to use the CFSAC to accelerate progress 
on research, education, training, care, and services to better 
address the needs of over one million Americans suffering from 
ME/CFS.
    Chronic Pain.--The Committee remains concerned about the 
public health epidemic of chronic pain. The Committee is 
pleased with the Department's release of the National Pain 
Strategy and encourages the Secretary to implement efforts 
across all relevant HHS agencies and in coordination with the 
DOD and VA. Given the seriousness of this public health 
epidemic and its relationship to the opioid crisis, the 
Committee requests an update on implementation efforts within 
180 days of enactment of this Act.
    Diabetes.--The Committee urges the Secretary to convene a 
commission comprised of healthcare providers, patient advocates 
and Federal agencies that operate programs that impact the care 
of people with pre-diabetes and diabetes. The goal of such a 
commission would be to make recommendations about developing 
improved clinical resources and tools, innovative care models, 
quality measures and registries, diabetes screening programs 
and other prevention activities.
    Drug Resistant Tuberculosis [TB].--The Committee notes the 
release of the President's National Action Plan for Combating 
Multi Drug Resistant TB in December 2016. The Committee 
encourages the Secretary to prioritize implementation of the 
plan in coordination with the Federal TB Task Force, CDC and 
NIH.
    Evidence-Based Programming.--The Committee is concerned 
about the uneven capacity of HHS operating divisions to apply 
and to build evidence that will improve program effectiveness. 
The Committee believes that the Assistant Secretary of Planning 
and Evaluation [ASPE] can play a central role in improving 
evaluation and evidence-based policymaking across the 
Department by helping all HHS components develop capacity to 
meet the standards set forth in ACF's Evaluation Policy. The 
Committee encourages ASPE to help operating divisions adopt 
cost-effective approaches to building evidence through use of 
innovative grant designs that support partnerships between 
service delivery projects and researchers; by leveraging 
emerging opportunities to use linked data to measure 
performance and conduct comprehensive, rigorous evaluations at 
a reasonable cost; and by partnering with philanthropic 
organizations that focus on improving the use of rigorous 
research to inform policy.
    Eye Health.--The Committee commends the National Academies 
of Sciences, Engineering, and Medicine for the September 2016 
release of its report ``Making Eye Health a Population Health 
Imperative: Vision for Tomorrow'' which includes 
recommendations regarding continued leadership by HHS to reduce 
the burden of vision impairment. The Committee requests an 
update from the Secretary regarding HHS' progress in 
implementing these recommendations in the fiscal year 2019 CJ.
    Geroscience.--The Committee commends NIA's leadership of 
the Trans-NIH Geroscience Interest Group, which promotes 
coordinated discussion and action on NIH-funded geroscience 
research to reduce the burden of age-related diseases. The 
Committee remains concerned over the rates of chronic disease 
in the older adult population and recognizes that accelerated 
breakthroughs from geroscience research into the biological 
basis of aging is essential to targeting changes that take 
place as a result of aging. The Committee urges the Secretary 
to consider establishing an Interagency Geroscience Research 
Coordination Committee [IGRCC] comprised of representatives 
from the NIA, NIAMS, NCI, NEI, NHLBI, NINDS, NIGMS, NHGRI, CDC, 
FDA, DOD, VA, and EPA. The goal of the IGRCC would be to 
identify and direct grants for new geroscience research.
    Global Health Research Strategy.--The Committee requests an 
update 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.
    Opioid Medical Record Reporting.--The Committee is deeply 
concerned about the devastating impact that the opioid epidemic 
is having on families throughout the country, and recognizes 
that medical providers must have access to information about 
their patients' past opioid addiction if that information is 
provided by the patient. The Committee encourages the Secretary 
to develop and disseminate standards that would allow hospitals 
and physicians to access the history of opioid addiction in 
medical records (including electronic health records) of any 
patient who has provided information about such addiction to a 
healthcare provider.
    Opioid Response.--The Committee believes that the Federal 
response to the opioid epidemic will be most effective if 
resources made available through the Comprehensive Addiction 
and Recovery Act [CARA] and related programs are directed to 
strategies that are backed by strong evidence or to innovative 
and promising approaches that will be rigorously evaluated to 
learn their impact. In implementing new and existing programs 
that address the opioid epidemic, the Department is encouraged 
to utilize evidence-based policymaking principles, tools, and 
program designs such as those disseminated by the Evidence-
Based Policymaking Collaborative. The Committee encourages HHS 
to collaborate with outside researchers and philanthropic 
organizations that focus on improving the use of rigorous 
research to inform policy.
    Pharmacy Dispensing.--The Committee is concerned by recent 
reports about the rate at which dangerous drug combinations are 
dispensed, especially in the context of the opioid epidemic, 
and encourages the Department to research as part of its 
National Action Plan for Adverse Drug Event Prevention how 
pharmacy practices can prevent harmful drug interactions. 
Further, the Committee encourages collaboration between the 
CDC, FDA, DEA, AHRQ, pharmacy regulatory and oversight 
organizations, and patient safety organizations on the 
prevention of harmful drug interactions.
    Prenatal Opioid Use Disorders and Neonatal Abstinence 
Syndrome.--The Committee is aware that the Protecting Our 
Infants Act of 2015 requires the Secretary to conduct a review 
of the Department's planning and coordination activities 
related to prenatal opioid use disorders and neonatal 
abstinence syndrome, as well as address gaps in research and 
treatment. The act also requires the Secretary to develop 
recommendations for preventing and treating prenatal opioid use 
disorders and neonatal abstinence syndrome. The Committee 
requests an update on these activities in the fiscal year 2019 
CJ.
    Public Access.--The Committee commends HHS Operating 
Divisions that have issued plans in response to the directive 
issued by the White House Office of Science and Technology 
Policy to support increased public access to the results of 
research funded by the Federal Government. The Committee 
encourages the Department to continue its efforts towards full 
implementation of the directive, and requests that an update on 
progress made be included in its fiscal year 2019 CJ.
    Public Health in Indian Country.--The Committee supports 
the Secretary's current initiatives to address public health 
crises such as viral hepatitis, HIV/AIDS and opioids, that 
disproportionally impact Indian County. The Committee requests 
that HHS provide an update on these efforts in the fiscal year 
2019 CJ.
    Pulmonary Hypertension [PH].--The Committee remains 
concerned that most PH patients are not diagnosed for many 
years until the condition has reached a catastrophic stage, 
which leads to significant disability, greatly increased 
mortality, and the need for costly and dramatic medical 
interventions, such as heart-lung transplantation. Given the 
availability of effective therapies for early-stage PH, the 
Department is encouraged to work across agencies and with the 
patient and professional community to prepare recommendations 
to improve early diagnosis and treatment of PH.
    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 2019 CJ.
    Surgeon General Report on Poverty.--The Committee notes 
that too many children still live in poverty, compromising 
their ability to be healthy, succeed in school and raise 
healthy families themselves. A report by the Surgeon General on 
improving the health of children could increase awareness and 
generate additional effort on ameliorating this public health 
problem.
    Technical Assistance [TA].--The Committee and the 
Department's budget office have had a long-standing 
relationship that allows the Committee to receive legal and 
technical feedback on funding proposals. The Committee relies 
on TA to ensure that programs and funding initiatives can be 
implemented as intended. The Committee expects its TA requests 
to be dealt with in a manner that is consistent with past 
precedent, including timely answers that respond to the 
Committee's specific inquiries.
    United States/Mexico Border.--The Committee urges the 
Department to continue its efforts to conduct border infectious 
disease surveillance in order to identify and implement needed 
prevention and treatment. The Department could focus on 
priority surveillance, epidemiology and preparedness activities 
along the borders in order to be able to respond to potential 
outbreaks and epidemics, including those caused by potential 
bioterrorism agents.
    Vector Control.--The Committee continues to support HHS's 
preparedness and response efforts to control outbreaks of Zika 
virus infection and the Committee supports continued 
collaboration amongst the CDC, NIH, FDA, BARDA, DOD, USAID, 
USDA, DHS, and VA. The Committee notes recent reports showing 
some infants born without microcephaly develop it later in life 
or develop other neurological problems. HHS should continue to 
research and monitor these infants and work closely with the 
vector control units across the country to limit the spread of 
infected Aedes aegypti mosquitoes. In an effort to foster 
greater coordination, collaboration and transparency across 
agency lines, the Committee urges the Secretary to establish a 
coordinating office to facilitate and expedite the Government's 
response to vector-borne disease threats, including combating 
the spread of disease through innovative vector control 
technologies.
    Zika.--The Committee remains concerned about the multiple 
threats posed by the Zika virus, including health threats to 
infants exposed to the virus. The Committee encourages the 
Secretary to continue surveillance of the disease along with 
efforts to further develop diagnostics and a vaccine.
Teen Pregnancy Prevention
    The Committee recommendation includes $101,000,000 for the 
Teen Pregnancy Prevention [TPP] program. This program supports 
competitive grants to public and private entities to replicate 
evidence-based teen pregnancy prevention approaches.
Office of Minority Health
    The Committee recommends $56,670,000 for the Office of 
Minority Health [OMH]. This 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.
    Health Disparities.--The Committee believes that a 
comprehensive coordinated focus by OMH, HRSA and NIMHD will 
increase the probability of reducing health disparities. This 
coordinated focus should examine the factors that lead to 
health disparities, including but not limited to age, 
nutrition, medical conditions, and availability of medical 
support and an appropriate healthcare workforce in both 
underserved urban and rural settings. HHS is encouraged to 
partner with community-based organizations that are currently 
providing medical and nutritional support.
    HIV Community-Based Testing Programs.--The Committee 
recognizes that several community-based programs have 
encouraged individuals at risk for HIV/AIDS to utilize FDA-
approved home-based HIV testing technology to monitor their HIV 
status. The Committee continues to urge the OMH to consider a 
pilot or demonstration program within existing resources to 
gauge the effectiveness of this approach.
    HIV/AIDS and Hepatitis C.--The Committee continues to be 
concerned about the HIV/AIDS epidemic in the African American 
community, and is aware of the concurrent high rates of co-
infection with Hepatitis C as outlined by the HHS 2015 Forum on 
Hepatitis C in African American Communities. The Committee 
encourages OMH to work aggressively to address opportunities to 
reduce the burden of HIV/AIDS and Hepatitis C by exploring 
partnerships for screening and implementing community 
engagement programs.
    Lupus Initiative.--The Committee continues to support the 
OMH National Health Education Lupus Program and its efforts to 
develop a clinical trial education and implementation plan for 
lupus. The action plan will focus on developing public-private 
and community partnerships, evaluating current minority 
clinical trial education and participation programs, and 
developing a research plan for creating new clinical trial 
education models in lupus. This will inform the development of 
the broader actionable lupus clinical trial education plan.
Sexual Risk Avoidance
    The Committee recommends $25,000,000 for sexual risk 
avoidance education. This is a competitive grant program that 
funds evidenced based abstinence models for adolescents.
    Funding for competitive grants for sexual risk avoidance 
shall use medically accurate information referenced to peer-
reviewed publications by educational, scientific, governmental, 
or health organizations; implement an evidence-based approach; 
and teach the 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 $32,140,000 for the Office of 
Women's Health [OWH]. This office develops, stimulates, and 
coordinates women's health research, healthcare services, and 
public and healthcare 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 $3,100,000 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 healthcare providers' ability 
to help victims of violence and improve prevention programs.

  ACCOUNT FOR THE STATE RESPONSE TO THE OPIOID ABUSE CRISIS, CURES ACT

Appropriations, 2017....................................    $500,000,000
Budget estimate, 2018...................................     500,000,000
Committee recommendation................................     500,000,000

    The Committee provides $500,000,000 for the State Response 
To Opioid Abuse Crisis Grants.

                OFFICE OF MEDICARE HEARINGS AND APPEALS

Appropriations, 2017....................................    $107,381,000
Budget estimate, 2018...................................     117,177,000
Committee recommendation................................     117,381,000

    The Committee provides $117,381,000 for the Office of 
Medicare Hearings and Appeals [OMHA], including $10,000,000 in 
Recovery Audit contractor recoveries. 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 continues to be concerned 
over the substantial backlog in the number of cases pending 
before ALJs at OMHA. The Committee directs that $10,000,000 in 
Recovery Audit Contractor [RAC] recoveries retained by the 
Secretary for adjudications related to RACs shall be used as 
additional funds for the necessary expenses of OMHA and the 
Departmental Appeals Board to process RAC-related appeals. The 
Committee directs OMHA to use the additional funds provided to 
address the current backlog and requests a spend plan within 30 
days after enactment of this Act. This spend plan should 
include an estimate of total appeals that will be processed in 
fiscal years 2017-2019 with the resources available. This 
estimate should include the effect of administrative actions 
taken to reduce the backlog.

  OFFICE OF THE NATIONAL COORDINATOR FOR HEALTH INFORMATION TECHNOLOGY

Appropriations, 2017....................................     $60,367,000
Budget estimate, 2018...................................      38,381,000
Committee recommendation................................      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.
    Electronic Health Records [EHR].--The Secretary is 
encouraged to study approaches to improve person-centered 
healthcare through patient access to health information. This 
work should examine accurate and timely record matching so that 
all EHR systems are collecting the information necessary for a 
fully interoperable system that protects patients from identity 
mismatch errors, but also considers patient privacy and 
security.

                      OFFICE OF INSPECTOR GENERAL

Appropriations, 2017....................................     $80,000,000
Budget estimate, 2018...................................      68,085,000
Committee recommendation................................      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 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

Appropriations, 2017....................................     $38,798,000
Budget estimate, 2018...................................      32,530,000
Committee recommendation................................      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 healthcare 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.

     RETIREMENT PAY AND MEDICAL BENEFITS FOR COMMISSIONED OFFICERS

Appropriations, 2017....................................    $630,408,000
Budget estimate, 2018...................................     618,689,000
Committee recommendation................................     618,689,000

    The Committee provides an estimated $618,689,000 in 
mandatory funds for Retirement Pay and Medical Benefits for 
Commissioned Officers of the U.S. Public Health Service. 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

Appropriations, 2017....................................  $1,532,958,000
Budget estimate, 2018...................................   1,662,616,000
Committee recommendation................................   1,552,958,000

    The Committee recommends $1,552,958,000 for the Public 
Health and Social Services Emergency 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 $1,396,628,000 for 
activities administered by ASPR. This Office was created by the 
Pandemic and All-Hazards Preparedness Act [PAHPA] to lead the 
Department's activities regarding preventing, preparing for, 
and responding to public health emergencies, including 
disasters and acts of terrorism.
    National Disaster Medical System.--The Committee continues 
bill language providing coverage under the Federal Employees 
Compensation Act for National Disaster Medical System 
intermittent employees who are activated for training or 
deployment.
Hospital Preparedness Program
    The Committee's recommendation includes $254,555,000 for 
the Hospital Preparedness Program [HPP]. This program provides 
grants to States to build healthcare 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, for this reason the 
Committee includes the same funding level as fiscal year 2017. 
While the Committee acknowledges the need to incorporate risk, 
the Committee rejects the administration proposal to change the 
allocation formula that would leave 26 States and territories 
without HPP funding. 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.
    Rural Areas.--The Committee encourages ASPR to ensure that 
hospital systems in remote and rural areas are benefiting from 
this program and are prepared in cases of emergencies, 
epidemics, or natural disasters.
Biomedical Advanced Research and Development Authority [BARDA]
    The Committee recommendation includes $511,700,000 for 
advanced research and development.
    The Committee commends BARDA for supporting advanced 
development efforts of industry to develop vaccines, 
diagnostics, drugs, and therapeutics to minimize serious 
threats of infectious disease and urges BARDA to continue to 
invest in the development of countermeasures for infectious 
diseases through the CARB initiative and the Emerging 
Infectious Disease program.
    Blood Platelet.--The Committee is aware of BARDA's 
investigation into blood platelet-derived medical counter-
measures as a hemostatic agent, and urges BARDA to expand its 
research to address the opportunities that cell stabilization 
of blood platelets provides, including radiation exposure 
remediation, acute burn healing, drug delivery, hemorrhagic 
fevers, and diagnostic imaging.
    Infectious Diseases.--The Committee commends BARDA for 
supporting advanced development 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.
    Tuberculosis.--The National Strategy for CARB identified 
drug resistant TB as a serious threat level pathogen and new 
diagnostic, treatment and prevention tools are urgently needed 
to address this global health threat. The Committee encourages 
BARDA to support the development of new TB diagnostic tests, 
drugs and vaccines through the CARB initiative, and the 
Emerging Infectious Disease program.
    Vector-Borne Disease Control.--The Committee is aware that 
since the enactment of the Pandemic and All-Hazards 
Preparedness Act, BARDA has led efforts to define, develop, and 
acquire medical countermeasures to reduce the threats of public 
health emergencies such as Zika. The Committee encourages BARDA 
to explore innovative vector control technologies that provide 
immediate opportunities for countermeasure development to 
address the non-native Zika-carrying Aedes aegypti mosquito 
population in ways that are environmentally friendly and that 
may reach places where many pesticides cannot.
Project BioShield Special Reserve Fund
    The Committee recommendation includes $510,000,000 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 
medical countermeasures [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.
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.--$49,904,000 and
  --Policy and Planning.--$14,877,000.
Office of the Assistant Secretary for Administration
    The Committee recommends $50,860,000 for information 
technology cybersecurity in the Office of the Assistant 
Secretary for Administration. These funds provide for 
continuous monitoring and security incident response 
coordination for the Department's computer systems and 
networks.
Office of the Assistant Secretary for Health/Medical Reserve Corps
    The Committee recommendation includes $6,000,000 for the 
Medical Reserve Corps 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.
Office of the Secretary
    The Committee recommendation includes $99,470,000 for 
activities within the Office of the Secretary.
Pandemic Influenza Preparedness
    The Committee recommendation includes $92,000,000 for 
Pandemic Influenza Preparedness. Of the total, $17,000,000 is 
provided in annual funding and $75,000,000 in no-year funding.
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 2018, the level transferred from the fund 
after accounting for sequestration is $840,600,000. The 
Committee includes bill language in section 219 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:

 
                                            [In thousands of dollars]
----------------------------------------------------------------------------------------------------------------
                                                                                                    Committee
                 Agency                            Account                    Program            recommendation
----------------------------------------------------------------------------------------------------------------
ACL....................................  Aging and Disability        Alzheimer's Disease                  14,700
                                          Services Programs.          Prevention Education and
                                                                      Outreach.
ACL....................................  Aging and Disability        Chronic Disease Self                  8,000
                                          Services Programs.          Management.
ACL....................................  Aging and Disability        Falls Prevention.........             5,000
                                          Services Programs.
CDC....................................  Immunization and            Section 317 Immunization            324,350
                                          Respiratory Diseases.       Grants.
CDC....................................  Emerging and Zoonotic       Epidemiology and                     40,000
                                          Infectious Diseases.        Laboratory Capacity
                                                                      Grants.
CDC....................................  Emerging and Zoonotic       Healthcare Associated                12,000
                                          Infectious Diseases.        Infections.
CDC....................................  Chronic Disease Prevention  Office of Smoking and               126,000
                                          and Health Promotion.       Health (Tobacco
                                                                      Prevention/Media & Quit
                                                                      Lines).
CDC....................................  Chronic Disease Prevention  Breast Feeding Grants                 8,000
                                          and Health Promotion.       (Hospitals Promoting
                                                                      Breastfeeding).
CDC....................................  Chronic Disease Prevention  Million Hearts Program...             4,000
                                          and Health Promotion.
CDC....................................  Chronic Disease Prevention  Heart Disease & Stroke               53,275
                                          and Health Promotion.       Prevention Program.
CDC....................................  Chronic Disease Prevention  Diabetes.................            52,275
                                          and Health Promotion.
CDC....................................  Chronic Disease Prevention  Early Care Collaboratives             4,000
                                          and Health Promotion.
CDC....................................  Environmental Health......  Lead Poisoning Prevention            17,000
CDC....................................  CDC-Wide Activities.......  Preventive Health and               160,000
                                                                      Health Services Block
                                                                      Grants.
SAMHSA.................................  Mental Health.............  Suicide Prevention                   12,000
                                                                      (Garrett Lee Smith).
----------------------------------------------------------------------------------------------------------------

                           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.
    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 Appropriations Committees 
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 2.9 percent of PHS Act 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 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.
    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 continues a provision permitting NIH 
to use up to $45,000,000 per project for 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 transferring 
mandatory funds from section 4002 of the Patient Protection and 
Affordable Care Act to accounts within the Department for 
activities outlined under the heading ``Prevention and Public 
Health Fund'' in this report.
    Section 220. The bill continues a provision requiring CJs 
to include certain FTE information with respect to ACA.
    Section 221. The bill continues a provision related to ACA 
exchange funding transparency.
    Section 222. The bill continues a provision related to 
notifications for ACA enrollment and Community Health Centers 
awards.
    Section 223. The bill continues a provision prohibiting 
funds for the Risk Corridor program.
    Section 224. The bill continues a provision for Medicare 
and Medicaid expenses.
    Section 225. The bill restates a requirement for HHS to 
conduct an analysis of the ACA's impact on eligibility for 
certain discretionary programs.
    Section 226. The bill continues a provision related to 
breast cancer screening recommendations.
    Section 227. The bill includes a new provision on NIH 
indirect costs.
    Section 228. The bill includes a new provision rescinding 
unobligated funds from the Nonrecurring Expenses Fund.
    Section 229. The bill includes a new provision rescinding 
unobligated funds under the heading ``Refugee and Entrant 
Assistance''.

                               TITLE III

                        DEPARTMENT OF EDUCATION

                    Education for the Disadvantaged

Appropriations, 2017.................................... $16,143,790,000
Budget estimate, 2018...................................  16,347,558,000
Committee recommendation................................  16,169,198,000

    The Committee recommends an appropriation of 
$16,169,198,000 for education for the disadvantaged.
    The programs in the Education for the Disadvantaged account 
provide a foundation of support to help ensure that all 
children receive a high-quality education. Funds appropriated 
in this account primarily support activities in the 2018-2019 
school year.
Grants to Local Educational Agencies
    Title I grants to local educational agencies [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: basic, 
concentration, targeted, and education finance incentive grant.
    The Committee recommends $15,485,210,000 for the title I 
grants to LEAs program. Of the funds available for title I 
grants to LEAs, up to $5,000,000 shall be available on October 
1, 2017 for transfer to the Census Bureau for poverty updates; 
$5,251,398,000 will become available on July 1, 2018; and 
$10,841,177,000 will become available on October 1, 2018. The 
funds that become available on July 1, 2018, and October 1, 
2018, will remain available for obligation through September 
30, 2019.
    Further Opportunities for Children to Unlock Success 
[FOCUS].--The Committee recommendation does not include funding 
for a new FOCUS grants program or new language requested that 
would authorize the Department to establish new requirements on 
local educational agencies interested in participating in the 
Flexibility for Equitable Per-Pupil Funding authority in Part F 
of Title I of ESEA. The Committee believes significant changes 
such as this to this recently-reauthorized law should be made 
as needed through legislation considered by the authorizing 
Committees of Congress.
    Neglected, Delinquent, and At-Risk Youth.--On any given 
day, tens of thousands of young people are in the custody of 
the juvenile justice system. The Committee believes ESSA made 
significant progress in addressing the needs of neglected, 
delinquent, and at-risk youth and ensuring greater access to 
educational services upon re-entry. While the Committee 
believes ESSA was a strong step towards a better re-entry 
system for youth who encounter the juvenile justice system, it 
is essential that the Department monitor and ensure compliance 
with the re-entry activities required under ESSA. Within 180 
days of enactment of this act, the Secretary is directed to 
submit a report to the Committee describing how each State is 
meeting the re-entry requirements for youth included in ESSA.
Comprehensive Literacy State Development Grants
    The Committee recommendation includes $190,000,000 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. 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 for programs to meet 
the special educational needs of the children of migratory 
agricultural workers or migratory fishworkers. 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.
Special Programs for Migrant Students
    The Committee recommends $44,623,000 for Special Programs 
for Migrant Students, which consist of HEP and 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, 2017....................................  $1,328,603,000
Budget estimate, 2018...................................   1,236,435,000
Committee recommendation................................   1,340,112,000

    The Committee recommends $1,340,112,000 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.
    The Committee bill retains language that provides for 
continued eligibility for students affected by the deployment 
or death of their military parent, as long as these children 
still attend schools in the same school district.
    Basic Support Payments.--The Committee recommends 
$1,200,242,000 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 IDEA.
    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.
    Construction.--The Committee recommends $17,406,000 for 
eligible LEAs for school construction activities allocated by 
formula under section 7007(a) of ESEA.
    Payments for Federal Property.--The Committee recommends 
$69,313,000 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, 2017....................................  $4,408,567,000
Budget estimate, 2018...................................     697,231,000
Committee recommendation................................   4,458,567,000

    The Committee recommendation includes $4,458,567,000 for 
the School Improvement Programs account.
Supporting Effective Instruction State Grants
    The Committee recommends $2,055,830,000 for Supporting 
Effective Instruction State Grants. The appropriation for this 
program primarily supports activities associated with the 2018-
2019 academic year. Of the funds provided, $374,389,000 will 
become available on July 1, 2018, and $1,681,441,000 will 
become available on October 1, 2018. These funds will remain 
available for obligation through September 30, 2019.
    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, 
and implementing teacher mentoring systems, teacher testing, 
merit pay, and merit-based performance systems. These funds may 
also be used by districts to hire teachers to reduce class 
sizes.
    The Committee continues to strongly encourage the 
Department to issue clear guidance specifically on the 
importance of strong school leadership, and how States can use 
existing title II-A resources, including through the optional 3 
percent State set-aside, to support principals and school 
leadership, including examples of best practices.
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. 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 percent of these funds to 
provide FSM and RMI with technical assistance.
21st Century Community Learning Centers
    The Committee recommends an appropriation of $1,191,673,000 
for the 21st Century Community Learning Centers [21st CCLC] 
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 $369,100,000 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
    For carrying out education activities authorized by title 
VII, subtitle B of the McKinney-Vento Homeless Assistance Act, 
the Committee recommends $77,000,000.
    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, the Committee recommends $6,575,000.
    The funds provided will support awards to operate regional 
equity assistance centers [EACs]. Each EAC provides 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.
Native Hawaiian Education
    The Committee recommendation includes $33,397,000 for 
Native Hawaiian Education.
    The Committee bill continues a provision that allows 
funding provided by this program to be used for construction.
Alaska Native Education
    The Committee recommends $32,453,000 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 bill continues language that 
allows funding provided by this program to be used for 
construction. The Committee bill also includes language 
overriding the authorizing statute's requirement to make 
noncompetitive awards to certain organizations.
    The Committee continues to direct the Department to ensure 
that Alaska Native tribes, Alaska Native regional non-profits, 
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. Further, 
the Committee continues to direct the Department to make every 
effort to ensure that Alaska Natives and Alaskans represent a 
significant proportion of peer reviewers for grant applications 
submitted under this program.
Rural Education
    The Committee recommends $175,840,000 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.
    The Committee recognizes that the Department's new 
application requirement for local education agencies to access 
Rural Education Achievement Program [REAP] funding in fiscal 
year 2017 prevented some eligible LEAs from accessing grant 
funding under this program. The Committee directs the 
Department to simplify the REAP application process, eliminate 
unnecessary administrative burdens, and directly engage with 
eligible LEAs and other relevant stakeholders to ensure that 
the Department's requirements accommodate the unique needs of 
these small, rural, and remote schools. Additionally, the 
Committee encourages the Department to use any unobligated 
available funding to make awards to LEAs who received a grant 
in fiscal year 2016, but failed to initially submit an 
application for fiscal year 2017 due to demonstrable 
administrative burden, provided they submit an application for 
funding.
Comprehensive Centers
    The Committee recommends $50,000,000 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. The system currently 
includes 15 regional centers, which are charged with providing 
intensive technical assistance to SEAs to increase their 
capacity to assist LEAs and schools with meeting the goals of 
the ESEA, and 8 content centers, which are organized by topic 
area.
    In selecting priorities for a new cohort of comprehensive 
centers, the Committee continues to direct the Department to 
recognize the unique challenges, emphasized in ESSA, affecting 
rural schools. The Committee strongly encourages the Department 
to establish at least one university-led center in a State with 
a significant percentage of students in rural schools. Such a 
center could focus on rural education and provide assistance to 
rural districts that serve high poverty and minority students.
     The Committee recommendation includes continued support 
for a comprehensive center, first funded in fiscal year 2016 
and as authorized in ESSA, on students at risk of not attaining 
full literacy skills due to a disability, including dyslexia, 
or developmental delay.
Student Support and Academic Enrichment Grants
    The Committee recommendation includes $450,000,000 for 
Student Support and Academic Enrichment Grants. This program 
provides formula grants to States, which then sub-grant to 
LEAs, to help support activities to provide students with a 
well-rounded education, ensure safe and supportive learning 
environments, and use technology to improve instruction.
    The Committee recommendation maintains bill language 
included in fiscal year 2017 giving States the option to 
subgrant funds to LEAs, or a consortia of LEAs, on a 
competitive basis.

                            Indian Education

Appropriations, 2017....................................    $164,939,000
Budget estimate, 2018...................................     143,665,000
Committee recommendation................................     165,239,000

    The Committee recommends $165,239,000 for Indian education 
programs.
Grants to Local Educational Agencies
    For grants to LEAs, the Committee recommends $100,381,000. 
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 $57,993,000 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.
    Within the total, the Committee recommendation includes 
$43,952,000 for the Native Youth Community Projects initiative, 
the same as the fiscal year level.
National Activities
    The Committee recommends $6,865,000 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. Schools where 
the indigenous language is the primary language of instruction 
have a strong, positive effect on the educational and social 
outcomes of American Indian, Alaska Native, and Native Hawaiian 
students compared to schools where Native students are taught 
in English. In addition, language education programs are 
essential for tribal self-determination. Within the total, the 
Committee recommendation includes no less than $1,908,000, an 
increase of $300,000 above the fiscal year 2017 funding level, 
for Native American language immersion programs authorized 
under section 6133 of ESSA. The Committee also intends that 
funds available for carrying out Section 6133 be allocated to 
all types of eligible entities in a way that supports the most 
extensive possible distribution across geography and language 
diversity and supports both existing and new Native language 
immersion programs and schools. Further, the Committee directs 
the Department to give the same consideration to applicants 
that propose to provide partial immersion schools and programs 
as to full immersion, as the local tribes, schools, and other 
applicants know best what type of program will most effectively 
assist their youth to succeed.
    The Committee notes that Native American languages hold a 
unique place in our nation and that the Native American 
Languages Act of 1990 [NALA] articulates U.S. policy toward 
Native American languages. Since its passage, Native American 
languages have increasingly become the object of school and 
community revitalization and retention efforts aligned with 
NALA. Educating students in the medium of a Native American 
language has demonstrated the same benefits as study in other 
world languages, including improved learning outcomes and 
enhanced cognitive ability. In the case of Native American 
students, however, the outstanding results in student 
achievement, high school graduation, and college attainment 
rates produced through access to Native American language 
medium education schools and programs are lifting some of the 
most disadvantaged youth in the U.S. to the ranks of the most 
academically successful. The Committee recognizes that the 
establishment of a Native American Language Center to function 
as a consortium for institutions of higher education that have 
significant experience and expertise in Native American 
languages and Native American language medium education would 
be a strong way to provide nationwide coordination for Native 
American language activities. In addition, it could promote 
best practices, develop curricular materials for Native 
American languages, disseminate high-quality research on the 
efficacy of programs of instruction in these languages, and 
serve as an information clearinghouse and hub for distance 
learning and continuing professional development in Native 
American language education. Further, such a center could 
provide benefits to practitioners at schools from the Pre-K to 
PhD levels who teach through the medium of a Native American 
language, and include Native American scholars and staff who 
are fluent in Native American languages and have the 
demonstrated capacity to reach out and collaborate with Native 
American communities. The Committee therefore directs the 
Department to provide to the Committee a report on the 
feasibility of designating such a center and the potential 
associated costs.

                       Innovation and Improvement

Appropriations, 2017....................................    $887,575,000
Budget estimate, 2018...................................   1,208,026,000
Committee recommendation................................     880,375,000

    The Committee recommends $880,375,000 for programs within 
the Innovation and Improvement account.
Education Innovation and Research
    The Committee recommendation includes $95,000,000 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-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 scale-up proven-
effective interventions that have demonstrated significant 
impacts through multiple rigorous evaluations.
    The Committee notes that the EIR program is authorized to 
fund evidence-based, field-initiated innovations to improve 
student achievement for high-need students. Accordingly, the 
Committee directs the Department to ensure that funds are used 
for projects in a range of topic areas, based on the needs of 
local communities as determined by field initiated proposals, 
and that funds are not focused or designated for any particular 
intervention. Further, the Committee recommendation does not 
include new bill language requested under this program and 
believes changes proposed to the recently reauthorized ESEA 
should be made as needed through legislation considered by the 
authorizing Committees of Congress.
    The Committee supports the 25 percent set-aside in ESSA for 
EIR grants to benefit rural areas. Further, the Committee 
encourages the Department to invest in early-phase grants that 
benefit the expansion of education and experiences for 
educators and students located in rural schools with limited 
access to advanced science courses. Programs could include 
professional development for teachers, lessons taught by 
scientific experts, and hands-on experience with technology.
School Leader Recruitment and Support
    The Committee recommendation does not include funding for 
the School Leader Recruitment and Support program, which funds 
activities to improve the recruitment, placement, support, and 
retention of effective principals and other school leaders in 
high-need schools. ESSA included new provisions to promote the 
use of title I and title II-A funds to support principals and 
school leaders, including an optional 3 percent State set-aside 
of title II-A funds for such activities. These State formula 
funds, as well as funding through other competitive grant 
programs such as the Supporting Effective Educator Development 
[SEED] program, can be used to support similar activities as 
those previously funded by this program.
Charter School Program
    The Committee recommends $367,172,000 for the Charter 
School Program. This program supports the start-up, 
replication, and expansion of high-quality charter schools.
    Within the total, the Committee recommendation includes 
$212,872,000 for grants to State entities to support high-
quality charter schools, including for grants directly to 
charter school developers in a State if no State entity 
receives a grant; $110,000,000 for grants to charter management 
organizations for the replication and expansion of high-quality 
charter schools; $31,000,000 for facilities financing 
assistance, of which not less than $21,000,000 shall be for the 
Credit Enhancement program; and not less than $11,000,000 for 
national activities to provide technical assistance, 
disseminate best practices, and evaluate the impact of the 
charter school program.
    Within the total for grants to SEAs, the Committee 
recommendation includes no less than $5,000,000 for developer 
grants to establish or expand charter schools in underserved, 
high-poverty, rural areas. This could include grants to 
institutions of higher education, or non-profit organizations 
in partnership with institutions of higher education, which are 
located in the region and committed to improving educational 
outcomes for underserved rural students. Rural areas present a 
host of challenges for all types of schools, including charter 
schools. Institutions of higher education located in the area 
may be uniquely suited to help address some of these 
challenges, and to give students opportunities to learn in non-
traditional settings. Further, dedicated funding to expand 
charter schools in rural areas could help expand the evidence-
base, including developing curriculum, for charter schools in 
rural areas. The Committee also notes that establishing charter 
schools in rural, particularly underserved areas, will likely 
require more start-up costs than in some other areas, and 
encourages the Department to consider these factors in 
determining grant award levels.
Magnet Schools Assistance
    The Committee recommends $97,647,000 for the Magnet Schools 
Assistance program.
    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.
Arts in Education
    The Committee recommendation includes $27,000,000 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.
Javits Gifted and Talented Students
    The Committee recommendation includes $12,000,000 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 $1,815,000 for 
Presidential and Congressional Academies for American History 
and Civics. 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.
    The Committee recommendation does not include funding for 
National Activities authorized under section 2233 of ESSA.
Teacher and School Leader Incentive Grants
    The Committee recommendation includes $187,000,000 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 
retaining 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 $27,741,000 for the 
Ready-to-Learn Television program.
    This program is designed to facilitate student academic 
achievement by leveraging the power and reach of public 
television to develop and distribute educational video 
programming for preschool and elementary school children and 
their parents.
    The Consolidated Appropriations Act, 2017 requires the 
Department to transfer $2,000,000 to the Ready to Learn program 
in fiscal year 2017 to address a shortfall in funding relative 
to initial grant award amounts. The Committee recommendation 
continues that funding in the Ready to Learn program in fiscal 
year 2018. This funding will help grantees meet their project 
objectives and successfully produce the high quality 
educational programming intended by Congress. The Department 
shall provide each grantee a proportional share of such funds 
based on the grantees' initial budget submissions.
Supporting Effective Educator Development
    The Committee recommendation includes $65,000,000 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.

                 Safe Schools and Citizenship Education

Appropriations, 2017....................................    $151,254,000
Budget estimate, 2018...................................     134,857,000
Committee recommendation................................     131,254,000

    The Committee recommends a total of $131,254,000 for 
activities to promote safe schools, healthy students, and 
citizenship education.
Promise Neighborhoods
    The Committee recommendation includes $73,254,000 for the 
Promise Neighborhoods program. This program awards competitive 
grants to not-for-profit, community-based organizations for the 
development 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.
    The Committee recommendation modifies bill language 
included last year regarding Promise Neighborhood extension 
grants and directs the Department to award two-year extension 
grants on a competitive basis no later than March 31, 2018 to 
high quality Promise Neighborhood programs that have 
demonstrated positive and promising results through their 
initial implementation grant and that propose to continue 
pursuing ambitious goals through an extension of that grant. 
The Committee expects that grantees would be eligible for 
extension grants in an amount to allow them to continue to 
pursue ambitious goals while also supporting sustainability 
planning. Further, the Committee expects that a funding 
opportunity announcement will be published promptly with 
funding awarded as soon as possible, no later than March 31, 
2018, to limit disruption and uncertainties for grantees. 
Finally, the Committee encourages the Department to prioritize 
funding for programs operating in particularly underserved 
areas.
School Safety National Activities
    The Committee recommendation includes $58,000,000 for the 
School Safety National Activities, including up to $5,000,000 
for Project SERV. This funding will help schools address the 
consequences of their students witnessing or being the victim 
of violence and other root causes of unhealthy school climates.
Full Service Community Schools
    The Committee recommendation does not include funding for 
Full Service Community Schools.

                      English Language Acquisition

Appropriations, 2017....................................    $737,400,000
Budget estimate, 2018...................................     735,998,000
Committee recommendation................................     737,400,000

    The Committee recommends an appropriation of $737,400,000 
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; a 
National Clearinghouse for English Language Acquisition and 
Language Instructional Programs. National activities funds 
shall be available for 2 years.
    The Committee strongly encourages the Department to help 
make States, school districts, and schools aware of funding 
available, through this program and others, to improve the 
English language proficiency and academic achievement of 
English language learners. The Committee notes the Department 
issued non-regulatory guidance on this issue in 2016.

                           Special Education

Appropriations, 2017.................................... $13,064,358,000
Budget estimate, 2018...................................  12,942,126,000
Committee recommendation................................  13,066,858,000

    The Committee recommends an appropriation of 
$13,066,858,000 for special education programs.
Grants to States
    The Committee recommendation includes $12,002,848,000 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 2018-2019 academic year. Of the 
funds available for this program, $2,719,465,000 will become 
available on July 1, 2018, and $9,283,383,000 will become 
available on October 1, 2018. These funds will remain available 
for obligation through September 30, 2019.
    The Committee recommendation continues bill language 
continuing several provisions relating to MOE requirements, as 
requested by the administration.
Preschool Grants
    The Committee recommends $368,238,000 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 $458,556,000 for the Grants for 
Infants and Families program under part C of the IDEA. Part C 
of the 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. The IDEA 
also gives States the option of extending eligibility for part 
C services to children 3 and older if 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 proposed in the budget request that allows 
funds under the program to be used for program evaluation.
Technical Assistance and Dissemination
    The Committee recommends $59,428,000 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.
    Within the total, the Committee recommendation includes 
$15,083,000, an increase of $2,500,000 above the fiscal year 
2017 funding level, 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.
    The Committee strongly encourages the Department to fund a 
demonstration program, of up to $2,000,000, to test early 
screening for dyslexia for students in kindergarten and first 
grade. This could allow for the screening of students in 
multiple school districts and in multiple states to test for 
the potential benefits of providing early screening for 
students, including helping to ensure that students with 
dyslexia are identified early and receive the resources and 
evidence-based interventions needed to help them succeed in 
school.
Personnel Preparation
    The Committee recommends $83,700,000 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.
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 $28,047,000 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.
    The Committee continues to recognize the ongoing progress 
made with the tools and services provided under the Educational 
Technology, Media and Materials program that have allowed more 
than 440,000 students with disabilities free access to more 
than 515,000 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, 2017....................................  $3,535,589,000
Budget estimate, 2018...................................   3,563,008,000
Committee recommendation................................   3,562,418,000

Vocational Rehabilitation State Grants
    The Committee recommends $3,452,931,000 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.
    The Rehabilitation Act requires that not less than 1 
percent and not more than 1.5 percent of the appropriation for 
VR State Grants be set aside for Grants for American Indians.
    The Committee recommendation continues bill language 
allowing the Department to use unobligated VR State grant funds 
that remain available subsequent to the reallottment process, 
to be used for innovative activities to improve outcomes for 
individuals with disabilities.
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 with disabilities by expanding and improving the 
availability and provision of rehabilitation and other 
services.
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 or the Protection and 
Advocacy for Individuals with Mental Illness Act.
Supported Employment State Grants
    The Committee recommendation does not include funding for 
the Supported Employment State Grants Program.
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 $10,336,000 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

Appropriations, 2017....................................     $25,431,000
Budget estimate, 2018...................................      25,383,000
Committee recommendation................................      25,431,000

    The Committee recommends $25,431,000 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 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.
    The Committee continues to commend APH for the significant 
progress being made through the Resources with Enhanced 
Accessibility for Learning [REAL] Plan toward developing new 
technologies to translate educational materials for delivery to 
students who are blind and visually impaired. The Committee 
continues to support implementation of the REAL plan, and 
includes no less than the fiscal year 2017 level for such 
activities.

               NATIONAL TECHNICAL INSTITUTE FOR THE DEAF

Appropriations, 2017....................................     $70,016,000
Budget estimate, 2018...................................      69,883,000
Committee recommendation................................      70,016,000

    The Committee recommends $70,016,000 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.
    The Committee strongly supports NTIDs existing partnership 
with regional institutions, first established with fiscal year 
2016 funds, to expand NTID's geographical reach and the 
availability of services for individuals who are deaf or hard 
of hearing in underserved areas. The Committee believes this 
partnership has been successful in its first year of 
implementation. Accordingly, the Committee recommendation 
includes $2,000,000, the same as the fiscal year 2017 level, to 
continue this partnership, without significant modifications, 
in fiscal year 2018.

                          GALLAUDET UNIVERSITY

Appropriations, 2017....................................    $121,275,000
Budget estimate, 2018...................................     121,044,000
Committee recommendation................................     121,275,000

    The Committee recommends $121,275,000 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.
    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.

                 Career, Technical, and Adult Education

Appropriations, 2017....................................  $1,720,686,000
Budget estimate, 2018...................................   1,476,441,000
Committee recommendation................................   1,720,686,000

Career and Technical Education
    The Committee recommends $1,125,019,000 for the Career and 
Technical Education [CTE] account.
    State Grants.--The Committee recommends $1,117,598,000 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 prevocational courses through adults who need 
retraining to adapt to changing technological and labor market 
conditions. Funds are distributed 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.
    Of the funds available for this program, $326,598,000 will 
become available July 1, 2018, and $791,000,000 will become 
available on October 1, 2018. These funds will remain available 
for obligation until September 30, 2019.
    National Programs.--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.
Adult Education
    The Committee recommends $595,667,000 for Adult Education 
programs.
    Adult Education State Grants.--The Committee recommendation 
includes $581,955,000 for Adult Education State Grants, which 
provides grants to 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, 2017.................................... $24,198,210,000
Budget estimate, 2018...................................  22,932,626,000
Committee recommendation................................  24,198,210,000

    The Committee recommends an appropriation of 
$24,198,210,000 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 need-analysis 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 a 1.7 percent 
increase in the maximum Pell grant award, from $5,920 to $6,020 
for the 2018-2019 award year. This is the first discretionary 
increase in the max award since fiscal year 2007. The Committee 
recommended funding level for the Pell grant program is also 
more than sufficient to continue Year-Round Pell [YRP], which 
was permanently reinstated in the Consolidated Appropriations 
Act, 2017.
    The Committee recommendation also includes a rescission of 
$2,600,000,000 in prior year unobligated balances. In recent 
years, Congress has consistently appropriated more funding than 
needed for the Pell grant program, including funding a critical 
expansion of the program with the reinstatement of YRP in 
fiscal year 2017. Based on current CBO estimates of program 
costs, including costs of reinstating YRP last year, and after 
including the increase in the max award and rescission of 
unobligated balances included in this bill, there will be 
approximately $6,000,000,000 in unobligated balances remaining 
at the end of fiscal year 2018.
Federal Supplemental Educational Opportunity Grant Program
    The Committee recommends $733,130,000 for the Supplemental 
Educational Opportunity Grant [SEOG] program.
    The SEOG program provides funds to approximately 3,700 
postsecondary institutions for need-based grants to more than 
1.5 million 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 $989,728,000 for the Federal 
Work-Study [FWS] program.
    This program provides grants to approximately 3,300 
institutions and helps nearly 700,000 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 $8,390,000, the same as the fiscal year 2017 level, 
for the Work Colleges program authorized under section 448 of 
the HEA.

                       Student Aid Administration

Appropriations, 2017....................................  $1,576,854,000
Budget estimate, 2018...................................   1,697,711,000
Committee recommendation................................   1,576,854,000

    The Committee recommends $1,576,854,000 for the Student Aid 
Administration account. These funds are available until 
September 30, 2019, and support the Department's student aid 
management expenses.
    The Committee recommendation includes $696,643,000 for 
administrative costs and $880,211,000 for loan servicing 
activities.
    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. Further, any reallocation of funds between 
administrative costs and servicing activities within this 
account should be treated as a reprogramming of funds, and the 
Committee should be notified in advance of any such changes.
    Benefits for Servicemembers and Veterans.--The Committee 
notes that too many veterans and servicemembers eligible for 
certain student loan benefits have not taken advantage of these 
benefits due to a lack of communication between the Departments 
of Education, Defense, and Veterans Affairs, and Federal 
student loan servicers. In accordance with section 455(o) of 
the Higher Education Act of 1965 [HEA], eligible military 
borrowers should not accrue interest on their Federal student 
loans while serving in an area of hostilities. Under the Higher 
Education Relief Opportunities for Students Act of 2003, 
servicemembers enrolled in income-driven repayment programs are 
eligible for a waiver from annual recertification obligations 
of their income. Servicemembers with Federal Perkins Loans are 
also eligible for a cancellation of a percentage of their debt, 
based on qualifying years of military service, in accordance 
with Section 465 of the Higher Education Opportunity Act of 
2008. Further, many veterans are eligible for a full discharge 
of their Federal student loan debt due to a service-connected 
disability under the Total and Permanent Disability Discharge 
provisions of Section 437 of the HEA. Therefore, the Committee 
directs the Secretary of Education to enter into a Memorandum 
of Understanding with the Secretaries of Defense and Veterans 
Affairs to automate the application of loan benefits to 
eligible servicemembers and veterans using information in 
existing Federal databases in a timely manner so that 
servicemembers and veterans can receive the benefits due under 
law. The Committee further directs the Secretary of Education 
to brief the Committees on Appropriations of the House of 
Representatives and the Senate, Senate Committee on Health, 
Education, Labor, and Pensions, and the House Committee on 
Education and the Workforce on the plan for implementing this 
automation process within 90 days of enactment of this act.
    Cohort Default Rates.--The Committee is concerned that some 
public institutions of higher education operating in 
economically distressed communities have faced challenges in 
meeting statutory requirements to manage and prevent student 
loan defaults because of community-wide factors where the 
institution operates. The Committee strongly encourages the 
Secretary to use any authority available, including under 
section 435(a)(2)(iii) of the HEA, to provide flexibility in 
applying section 435(a) to institutions of higher education in 
severely distressed communities in the United States, including 
institutions operating in counties ranking in the bottom 5 
percent of all counties in the Distressed Designation and 
County Economic Status Classification System of the Appalachian 
Regional Commission, or based on other commonly used indices or 
measures. The Committee directs the Secretary to report 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 
the Workforce on any additional statutory authority the 
Secretary may need to provide flexibility to such institutions.
    Electronic Sharing of Tax Data.--Within the total for the 
Student Aid Administration account, the Committee 
recommendation includes sufficient funding to fully implement 
the Memorandum of Understanding establishing a framework 
regarding the requirements for electronically sharing tax data 
over multiple years for federal student loan borrowers 
participating in Income-Driven Repayment (IDR) plans, as 
announced by the Departments of Treasury and Education on 
January 17, 2017.
    Extension of Provisional Institutional Eligibility.--By 
providing language that extends the time period the Secretary 
may allow an institution of higher education to remain in 
provisional status, the Committee is addressing concerns that 
institutional applications for recognition by another 
accreditor have not been processed in part due to a lack of 
staff resources. As such, the extension of this time period 
does not permit institutions to remain with the same accreditor 
or relieve the Secretary of her responsibility to ensure that 
institutions are making timely progress with their applications 
currently being processed by another accrediting agency.
    Loan Counseling.--The Committee notes that Preferred Lender 
List requirements enacted in 2008 are intended to protect 
students and families from unfair lending practices in higher 
education. The implementation of these requirements have 
affected State-based organizations--including State agencies or 
authorities, or nonprofit organizations that are authorized, 
established, or chartered by State statute--in ways that were 
not intended by Congress. State-based organizations report 
difficulty in partnering with institutions of higher education 
to advise students on their individual education financing 
decisions, including student loan repayment and forgiveness 
options, even when such advising is requested by the 
institution's financial aid administrator. The Committee 
directs the Department within 180 days of enactment to issue 
guidance to clarify how colleges and universities can allow 
state-based organizations to participate in advising students 
on campus without violating Preferred Lender List rules. 
Pursuant to statutory restrictions, such guidance should not 
permit institutions of higher education or State-based 
organizations to directly market or advertise State-based 
education loan programs to students.
    Public Service Loan Forgiveness Program.--The Committee 
notes that there has been significant concern from borrowers 
over the Department's consistency and reliability in 
administering the Public Service Loan Forgiveness [PSLF] 
program. The Committee encourages the Department, in 
coordination with its Federal loan servicers, to update 
guidance, information, and processes regarding borrower 
eligibility for PSLF. Further, the Committee encourages the 
Department to provide further clarity regarding employer 
eligibility under the program, particularly for applicants 
employed by non-profit organizations that provide certain types 
of public service, but are not categorized under section 
501(c)(3) of the Internal Revenue Code. This information should 
be publicly accessible and include real-world examples of 
organizations that qualify in certain fields.
    The Committee also notes that there has been concern with 
the level of service provided to borrowers that intend to seek 
PSLF. The Committee encourages the Department to provide to 
borrowers more regular and current information about the status 
of processing their PSLF employment certification, the number 
of qualifying payments made, and the projected date of their 
forgiveness. Further, the Committee encourages the Department 
to expand the use of digital technology in the PSLF program, to 
allow for employment certifications and PSLF applications to be 
completed electronically, and with each student loan servicer. 
Finally, to ensure consistency for applicants, the Committee 
encourages the Department to revisit decisions to rescind 
employment certification for borrowers who were previously 
approved.
    Student Loan Discharges.--The Committee recognizes that 
there is ongoing disruption to and burden on the lives of 
students from the closure of and misconduct by Corinthian 
Colleges, Inc. [CCi]. Former students who enrolled in many 
programs of study at more than 100 CCi campuses were provided 
with highly misleading job placement rate information. At least 
45,000 former CCi students have pending applications with the 
Department for a discharge and refund of their fraudulently 
issued federal loan debt, and the Committee believes that many 
more students have not applied. The Committee directs the 
Secretary to process applications as expeditiously as possible, 
and ensure students are aware of their potential eligibility 
for relief by identifying and contacting borrowers who may 
qualify to assert a defense to repayment utilizing the program-
level enrollment information provided to the Department by 
states in 2016.
    Student Loan Servicing.--The Committee recommendation 
includes new bill language prohibiting the Department from 
moving forward with a new student loan servicing contract 
unless the new student loan servicing solution includes the 
participation of multiple student loan servicers that contract 
directly with the Department of Education and allocates student 
loan borrower accounts to participating servicers based on 
performance. The Committee strongly believes relying on one 
servicer will decrease accountability and add risk to borrowers 
and taxpayers. Instead, providing for the participation of 
multiple servicers, utilizing common practices, policies and 
performance metrics, will promote accountability and 
incentivize servicers to provide high-quality service to 
borrowers. The Committee expects that each servicer would be 
responsible for managing the full life-cycle of loans, from 
disbursement to pay-off, with exceptions for common origination 
and disbursement, specialty servicing for at-risk borrowers, 
and other unique servicing needs, to ensure competition between 
servicers. Further, while the Department considers the future 
of the servicing environment, the Committee encourages the 
Department to continue pursuing the development of a simple, 
consistent, and unified experience for all student borrowers 
through a universal web portal. During the collaborative 
information gathering and stakeholder engagement effort related 
to the new servicing environment that was announced on August 
1, 2017, the Department is directed to engage with 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 
the Workforce to gather input from Congress on the design of 
this environment.
    Further, the Committee reiterates the directive included 
last year and again directs the Department to issue a common 
policies and procedures manual, including voluntary best 
practices, to help improve the consistency of servicing for 
student loan borrowers. The manual should include best 
practices related to how borrowers should be counseled about 
repayment options and benefits. The Department should utilize 
expertise and resources from its servicers in developing this 
manual which can also serve as the guide for servicing 
standards in the future servicing environment.
    In addition, the Committee reiterates the directive 
included in bill language in the Consolidated Appropriations 
Act, 2017, and included again in this bill, requiring the 
Department to allow borrowers, when consolidating student 
loans, to select from any of the existing servicers to service 
their new consolidated loan. The Committee is deeply concerned 
with how the Department has adhered to congressional directives 
in this area, including its plan to ignore this directive, as 
part of their proposal to move to a single-servicer model.

                            Higher Education

Appropriations, 2017....................................  $2,055,439,000
Budget estimate, 2018...................................   2,038,126,000
Committee recommendation................................   2,048,439,000

    The Committee recommends an appropriation of $2,048,439,000 
for higher education programs.
Aid for Institutional Development
    The Committee recommends $577,514,000 in discretionary 
funding for Aid for Institutional Development. These totals do 
not include separately authorized and appropriated mandatory 
funding.
    Strengthening Institutions.--The Committee bill recommends 
$86,534,000 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 $107,795,000 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 $9,671,000 for 
competitive, 5-year 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.--The Committee recommends $244,694,000 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 $63,281,000 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.
    Strengthening Predominately Black Institutions [PBIs].--The 
Committee recommends $9,942,000 for the Strengthening PBIs 
program. This program provides 5-year grants to PBIs to plan 
and implement programs to enhance the institutions' capacity to 
serve more low- and middle-income Black American students.
    Strengthening Asian American and Native American Pacific 
Islander-Serving Institutions [AANAPISIs].--The Committee 
recommends $3,348,000 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 low-income individuals.
    Strengthening Alaska Native and Native Hawaiian-Serving 
Institutions [ANNHs].--The Committee recommends $13,802,000 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 $3,348,000 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 $27,599,000 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.
    Strengthening Masters Degree Programs at Historically Black 
Colleges and Universities.--The Committee recommends $7,500,000 
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 masters level in mathematics, engineering, 
the physical or natural sciences, computer science, information 
technology, nursing, allied health, or other scientific 
disciplines.
International Education and Foreign Language Studies
    The bill includes a total of $72,164,000 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 $65,103,000 
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 $7,061,000 for 
overseas programs authorized under the Mutual Educational and 
Cultural Exchange Act of 1961, 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 $11,800,000 for 
competitive grants to postsecondary institutions to support 
model programs that help students with intellectual 
disabilities transition to and complete college, as authorized 
by section 767 of the HEA. Funds may be used for student 
support services; academic enrichment, socialization, or 
independent living; integrated work experiences; and 
partnerships with LEAs to support students with intellectual 
disabilities participating in the model program who are still 
eligible for special education and related services under the 
IDEA.
Minority Science and Engineering Improvement
    The Committee recommends $9,648,000 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 $8,286,000 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 $953,000,000 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 recommendation includes no less than the 
fiscal year 2017 level for each of the TRIO programs, and 
rejects the administration's proposed elimination of the McNair 
Postbaccalaureate and Educational Opportunity Centers programs.
    The Committee directs the Secretary to peer review fiscal 
year 2017 Upward Bound applications that were initially 
determined ineligible for further review based on minor 
technical issues with their grant application. Further, after 
such review, the Committee directs the Secretary to award 
funding to any applicants that would have received funding in 
the fiscal year 2017 grant competition had they been allowed to 
be reviewed then. The Committee recommendation includes an 
increase for TRIO to ensure that current grantees are not 
adversely impacted by any grant awards that result.
    The Committee continues to be concerned with the timeliness 
of the Department's announcement of TRIO grant awards and the 
impact on grantees. The Committee directs the Department 
conduct a review of all grant award deadlines related to 
Federal TRIO programs and implement recommendations for 
upholding these deadlines, or modifying them to better-align 
with grantees' program year and to prevent disruption among 
grantees and the services they provide.
    The Committee is concerned with the Department's plan to 
abruptly end certain grants under the Education Opportunity 
Centers [EOC] program after just one year, and without advance 
notification or warning. While the Committee expects grantees 
to be held to high standards, absent violation of law or 
regulation, grantees should not have their funding terminated 
mid-grant without significant advance notice and an opportunity 
to provide corrective actions. Except in extraordinary 
circumstances, the Committee directs the Secretary to ensure 
that grantees are notified at least 90 in advance that they are 
in danger of not having their grant continued unless they take 
specific corrective actions. Further, the Committee directs the 
Secretary to provide particular flexibility to new grantees, 
grantees operating in particularly underserved areas, and 
grantees facing other extenuating circumstances. Accordingly, 
the Department shall provide continuation grants to EOC 
programs according to their initial grant awards.
Gaining Early Awareness and Readiness for Undergraduate Programs
    The Committee recommends $339,754,000 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 low-income students. Services provided help 
students prepare for and pursue a postsecondary education.
    The Committee directs the Secretary to announce in the 
Federal Register a Notice for Application for New Awards for 
State grants for this fiscal year and establish a maximum award 
for such awards that accommodates the larger grants made to 
States under previous grant competitions. The Department is 
strongly encouraged to publish the notice inviting applications 
as soon as possible. The Committee believes that the rejection 
of the budget's proposed cut to GEAR UP enables the Department 
to prevent State grantees that received higher annual grant 
amounts based on prior competition maximum award amounts from 
reducing services as a result of a potential lower maximum 
award for a State grant competition in 2018.
    The Committee continues bill language allowing the 
Department to set aside up to 1.5 percent of the total provided 
for evaluation purposes. Further, the Committee directs the 
Department to work with the GEAR UP community and grantees to 
standardize data collection, including through the use of 
third-party data systems.
Graduate Assistance in Areas of National Need 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 $38,092,000 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 $15,134,000 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 post-secondary education.

                           Howard University

Appropriations, 2017....................................    $221,821,000
Budget estimate, 2018...................................     221,399,000
Committee recommendation................................     221,821,000

    The Committee recommends an appropriation of $221,821,000 
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.
    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

Appropriations, 2017....................................        $435,000
Budget estimate, 2018...................................         434,000
Committee recommendation................................         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, 2017....................................     $20,484,000
Budget estimate, 2018...................................      20,445,000
Committee recommendation................................      20,484,000

    The Committee recommends $20,484,000 for the HBCU Capital 
Financing Program.
    The Committee recommendation includes $20,150,000 to pay 
the loan subsidy costs in guaranteed loan authority under this 
program. This amount will support an estimated $314,000,000 in 
new loan volume in fiscal year 2018. The remaining $334,000 
will be used for administrative expenses.
    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.

                    Institute of Education Sciences

Appropriations, 2017....................................    $605,267,000
Budget estimate, 2018...................................     616,839,000
Committee recommendation................................     600,267,000

    The Committee recommends $600,267,000 for the Institute of 
Education Sciences [IES]. This account supports education 
research, development, dissemination, and evaluation; data 
collection and analysis activities; and the assessment of 
student progress.
    Under the Education Sciences Reform Act of 2002, 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 of this act 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 supports IES's plans in fiscal year 2018 to 
select a National Research and Development Center on Improving 
Rural Education. The Committee understands that this center 
will build the capacity of rural schools to use high-quality, 
scientific research to improve student outcomes, as envisioned 
by ESSA. The Committee is particularly interested in research 
that addresses the specific needs of diverse rural schools. The 
Committee strongly encourages IES to establish a research and 
development center specifically designed for research 
collaboration between university experts and underperforming 
LEAs in rural districts that serve high poverty and minority 
students with high dropout rates. Further, the research center 
should address the needs of rural schools in relation to early 
childhood education, teacher education, school needs 
assessment, and transition to post-secondary education. 
Priority should be given to applicants who create a network of 
partnerships that touch various geographic regions of the 
Nation.
    To address concerns about the privacy of student data, 
particularly personally identifiable information, 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. The Committee notes the 
Department is planning, pursuant to Senate Committee Report 
114-274, to report to the Committees on Appropriations of the 
House of Representatives and the Senate, as well as to the 
Senate Health, Education, Labor, and Pensions Committee and the 
House Education and the Workforce Committee, on the actions it 
has taken to comply with this directive.

                RESEARCH, DEVELOPMENT, AND DISSEMINATION

    The Committee recommends $185,000,000 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.

                               STATISTICS

    The Committee recommends $107,000,000 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 $54,423,000 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 of knowledge and evidence in broad-
based systemic strategies to increase student learning and 
further school improvement efforts. The Committee appreciates 
the efforts of IES 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 $54,000,000 for research and 
innovation in special education conducted by the National 
Center for Special Education Research.
    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.

               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 $32,281,000 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 $156,745,000 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 [NAGB], 
which is responsible for formulating policy for NAEP.
    The Committee continues to support assessments for students 
in United States History, Civics, and Geography. The Committee 
directs NAGB to continue administering assessments in these 
three areas, at least every four years, in accordance with the 
current NAEP schedule. According to this schedule, the next 
administration will be in 2018 for 8th grade students.

                        Departmental Management

                         PROGRAM ADMINISTRATION

Appropriations, 2017....................................    $432,000,000
Budget estimate, 2018...................................     438,000,000
Committee recommendation................................     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.
    Borrower Defense Claims Reporting.--The Committee directs 
the Department to report on a quarterly basis to the Committees 
on Appropriations of the House of Representative and the 
Senate, the Senate Committee on Health, Education, Labor, and 
Pensions, and the House Committee on Education and the 
Workforce, on the receipt and processing by the Department of 
borrower defense claims made pursuant to section 455(h) of the 
HEA. This should include information on the total number of 
pending borrower defense claims, total number of approved 
borrower defense claims, total dollar amount of relief, and 
total number of denied claims, including disaggregated by 
State. The report shall also include specific actions taken and 
planned to process this workload in a timely manner. The 
Committee strongly encourages the Department to make the 
reports publicly available on its website.
    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 range of flexibilities that could 
be employed to help better serve disconnected youth. Finally, 
the Committee is interested in expanding Performance 
Partnerships to other populations and programs, and has 
requested reports from GAO to help explore this possibility.
    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.
    Competitive Grant Priorities for Rural Areas.--The 
Committee continues to encourage the Department to continue 
efforts to ensure that competitive grants are reaching rural 
areas and States so that support and solutions developed with 
Federal funding are relevant to and available in such areas.

                        OFFICE FOR CIVIL RIGHTS

Appropriations, 2017....................................    $108,500,000
Budget estimate, 2018...................................     106,797,000
Committee recommendation................................     117,000,000

    The Committee recommends $117,000,000 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.
    In reviewing, investigating, or deciding whether there has 
been a violation of Title VI of the Civil Rights Act of 1964, 
on the basis of race, color, or national origin, based on an 
individual's actual or perceived shared Jewish ancestry or 
Jewish ethnic characteristics, the Committee strongly 
encourages OCR to take into consideration the definition and 
examples of anti-Semitism set forth by the State Department's 
Special Envoy to Monitor and Combat Anti-Semitism when 
assessing whether a practice was motivated by anti-Semitic 
intent.

                      OFFICE OF INSPECTOR GENERAL

Appropriations, 2017....................................     $59,256,000
Budget estimate, 2018...................................      61,143,000
Committee recommendation................................      59,256,000

    The Committee recommends $59,256,000 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 for the transportation of students or teachers in 
order to overcome racial imbalance.
    Section 302. The bill continues a provision prohibiting the 
involuntary transportation of students other than to the school 
nearest to the student's home.
    Section 303. 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 304. The bill continues a provision giving the 
Secretary authority to transfer up to 1 percent of any 
discretionary funds between appropriations.
    Section 305. The bill continues a provision that allows the 
Republic of Palau to receive certain Federal funds.
    Section 306. The bill continues a provision making 
evaluation funds pooled under section 8601 of the ESEA 
available for obligation from July 1, 2018 through September 
30, 2019.
    Section 307. The bill continues a general provision 
allowing certain institutions to continue to use endowment 
income for student scholarships.
    Section 308. The bill continues a provision extending 
authorization of the National Advisory Committee on 
Institutional Quality and Integrity.
    Section 309. The bill continues a provision extending 
authority to provide account maintenance fees to guarantee 
agencies.
    Section 310. The bill modifies a provision rescinding 
fiscal year 2018 mandatory funding to pay for mandatory costs 
of increasing the maximum discretionary Pell award.
    Section 311. The bill modifies a general provision 
rescinding discretionary unobligated balances from the Pell 
grant program.
    Section 312. The bill includes a new provision restoring 
Pell eligibility for certain students.
    Section 313. The bill includes a new provision giving the 
Secretary authority to extend provisional eligibility status 
for certain institutions of higher education.

                                TITLE IV

                            RELATED AGENCIES

 Committee for Purchase From People Who Are Blind or Severely Disabled

                         SALARIES AND EXPENSES

Appropriations, 2017....................................      $8,000,000
Budget estimate, 2018...................................       6,117,000
Committee recommendation................................       8,000,000

    The Committee recommends $8,000,000 for the Committee for 
Purchase from People Who Are Blind or Severely Disabled, of 
which no less than $1,250,000 shall be made available for the 
Office of Inspector General.
    The AbilityOne program provides more than 46,000 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 approximately 
$3,300,000,000 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 implement the recommendations outlined in the May 2013 GAO 
report addressing the concerns regarding the oversight of the 
Central Nonprofit Agencies, the independent contracted 
organizations which administer the program. The Committee 
directs the Commission to provide an update on these efforts to 
the Committees on Appropriations of the House of 
Representatives and the Senate within 120 days of enactment of 
this act.

             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, the National and Community Service Trust 
Act, and the SERVE America Act. 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.
    The Committee recommendation for CNCS provides a total 
program level of $1,018,916,000.

                           OPERATING EXPENSES

Appropriations, 2017....................................    $736,029,000
Budget estimate, 2018...................................      31,689,000
Committee recommendation................................     736,429,000

    The Committee recommends $736,429,000 for the operating 
expenses of CNCS.
Volunteers in Service to America [VISTA]
    The Committee recommends $92,364,000 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 $202,117,000 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 [RSVP], the Foster Grandparent 
Program, and the Senior Companion Program.
AmeriCorps State and National Grants
    The Committee recommends $386,010,000 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.
    The Committee strongly supports CNCS' efforts and 
initiatives in several areas, including but not limited to, 
supporting activities in communities experiencing civil unrest 
and significant violence, including strengthening relationships 
between communities and law enforcement; helping address the 
opioid epidemic; and responding to natural disasters. 
AmeriCorps programs are uniquely situated to respond to such 
crises that impact communities across the country and the 
Committee strongly encourages CNCS to expand on these efforts.
    Commission Investment Fund [CIF].--The Committee 
recommendation includes no less than $7,500,000, the same as 
the fiscal year 2017 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 encourages 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.
    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 strongly encourages CNCS to 
increase the maximum amount of operating funds per member 
service year 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 high-quality services in all 
communities.
    Reduced Full-Time Service Position.--The Committee includes 
a new general provision to allow CNCS to establish a new 1,200 
hour service position, including a proportional reduction in 
the education award. This will provide AmeriCorps programs 
increased flexibility, and more closely align member service 
positions with the needs of local communities.
National Civilian Community Corps [NCCC]
    The Committee recommendation includes $30,000,000 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 $5,400,000 for 
innovation, demonstration, and assistance activities.
    Volunteer Generation Fund.--Within the total, the Committee 
recommendation includes $3,800,000 for the Volunteer Generation 
Fund authorized under section 198P of the SERVE America Act, 
the same as the comparable fiscal year 2017 funding level.
    National Days of Service.--The Committee recommendation 
includes a total of $1,600,000, an increase of $600,000, for 
National Days of Service to include the September 11 National 
Day of Service and Remembrance and the Martin Luther King, Jr. 
National Day of Service, to be allocated equally by CNCS to 
support these National Days of Service.
Evaluation
    The Committee recommendation includes $4,000,000 for CNCS 
evaluation activities.
State Commission Grants
    The Committee recommendation includes $16,538,000 for State 
Commission Grants.

                 PAYMENT TO THE NATIONAL SERVICE TRUST

Appropriations, 2017....................................    $206,842,000
Budget estimate, 2018...................................................
Committee recommendation................................     195,000,000

    The Committee recommends an appropriation of $195,000,000 
for making payments to the National Service Trust, as requested 
by the administration.
    The National Service Trust makes payments of Segal 
education awards, pays interest that accrues on qualified 
student loans for AmeriCorps participants during terms of 
service in approved national service positions, and makes other 
payments entitled to members who serve in the programs of CNCS.
    The Committee recommendation reflects the estimated funding 
needed for the Trust at overall Committee recommended funding 
levels for CNCS.

                         SALARIES AND EXPENSES

Appropriations, 2017....................................     $81,737,000
Budget estimate, 2018...................................      99,735,000
Committee recommendation................................      81,737,000

    The Committee recommends an appropriation of $81,737,000 
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

Appropriations, 2017....................................      $5,750,000
Budget estimate, 2018...................................       3,568,000
Committee recommendation................................       5,750,000

    The Committee recommends an appropriation of $5,750,000 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 (section 405); and allowing CNCS 
to establish a new 1,200 hour member service position (section 
406).

                  Corporation for Public Broadcasting

Appropriations, 2019....................................    $445,000,000
Budget estimate, 2020...................................................
Committee recommendation, 2020..........................     445,000,000

    The Committee recommends $445,000,000 for the Corporation 
for Public Broadcasting [CPB] as an advance appropriation for 
fiscal year 2020.
    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.
    The Committee recommendation includes an additional 
$20,000,000 in fiscal year 2018 for the replacement and upgrade 
of the public broadcasting interconnection system.
    The Committee supports the Corporation's move to an annual 
interconnection appropriation from a periodic lump sum request. 
Since fiscal year 1991, Congress has provided the Corporation 
with a separate appropriation for interconnection, recognizing 
its essential role in providing every American the quality and 
quantity of public media services, including educational, 
informational and cultural content of national, regional and 
local interest.
    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 supports CPB in replacing and upgrading 
the public broadcasting interconnection system and further 
investing in systemwide infrastructure and services that 
benefit the American people.

               Federal Mediation and Conciliation Service

                         SALARIES AND EXPENSES

Appropriations, 2017....................................     $46,650,000
Budget estimate, 2018...................................      48,655,000
Committee recommendation................................      46,650,000

    The Committee recommends $46,650,000 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 
labor-management 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

Appropriations, 2017....................................     $17,184,000
Budget estimate, 2018...................................      17,053,000
Committee recommendation................................      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. 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 directs the Federal Mine Safety 
and Health Review Commission to continue providing priority to 
reducing the excessive time substantive cases on appeal are 
awaiting a decision.

                Institute of Museum and Library Services

       OFFICE OF MUSEUM AND LIBRARIES: GRANTS AND ADMINISTRATION

Appropriations, 2017....................................    $231,000,000
Budget estimate, 2018...................................      23,000,000
Committee recommendation................................     235,000,000

    The Committee recommends $235,000,000, an increase of 
$4,000,000, for the Institute of Museum and Library Services 
[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.
    Within the total for IMLS, the Committee recommendation 
includes the amounts below:

                                            [In thousands of dollars]
----------------------------------------------------------------------------------------------------------------
                                                            Fiscal year 2017  Fiscal year 2018      Committee
                      Budget activity                         appropriation        request       recommendation
----------------------------------------------------------------------------------------------------------------
Library Services Technology Act [LSTA]:
    Grants to States......................................           156,103  ................           160,103
    Native American Library Services......................             4,063  ................             4,063
    National Leadership: Libraries........................            13,406  ................            13,406
    Laura Bush 21st Century Librarian.....................            10,000  ................            10,000
                                                           -----------------------------------------------------
        Subtotal LSTA.....................................           183,572  ................           187,572
 
Museum Services Act:
    Museums for America...................................            21,149  ................            21,149
    Native American/Hawaiian Museum Services..............               972  ................               972
    National Leadership: Museums..........................             8,113  ................             8,113
                                                           -----------------------------------------------------
        Subtotal, MSA.....................................            30,234  ................            30,234
 
African American History and Culture Act..................             1,481  ................             1,481
Administration............................................            14,000            23,000            14,000
Research, Analysis and Data Collection....................             1,713  ................             1,713
        IMLS Total........................................           231,000            23,000           235,000
----------------------------------------------------------------------------------------------------------------

            Medicaid and CHIP Payment and Access Commission

                         SALARIES AND EXPENSES

Appropriations, 2017....................................      $7,765,000
Budget estimate, 2018...................................       8,700,000
Committee recommendation................................       7,765,000

    The Committee recommends $7,765,000 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 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

Appropriations, 2017....................................     $11,925,000
Budget estimate, 2018...................................      12,295,000
Committee recommendation................................      11,925,000

    The Committee recommends $11,925,000 for the Medicare 
Payment Advisory Commission [MedPAC], which provides 
independent policy and technical advice on issues affecting the 
Medicare program.

                     National Council on Disability

                         SALARIES AND EXPENSES

Appropriations, 2017....................................      $3,250,000
Budget estimate, 2018...................................       3,211,000
Committee recommendation................................       3,250,000

    The Committee recommends $3,250,000 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 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

Appropriations, 2017....................................    $274,224,000
Budget estimate, 2018...................................     258,000,000
Committee recommendation................................     274,224,000

    The Committee recommends $274,224,000 for the National 
Labor Relations Board [NLRB or ``the Board''], which 
administers and enforces the National Labor Relations Act and 
protects employee and employer rights provided under that act.

                       ADMINISTRATIVE PROVISIONS

    The Committee maintains language from the fiscal year 2017 
appropriations act restricting the use of electronic voting 
(section 407).

                        National Mediation Board

                         SALARIES AND EXPENSES

Appropriations, 2017....................................     $13,800,000
Budget estimate, 2018...................................      13,205,000
Committee recommendation................................      13,800,000

    The Committee recommends $13,800,000 for the National 
Mediation Board [NMB], which mediates labor-management 
relations in the railroad and airline industries under the 
Railway Labor Act. The NMB mediates collective bargaining 
disputes, conducts elections to determine the choice of 
employee bargaining representatives, and administers 
arbitration of employee grievances.

            Occupational Safety and Health Review Commission

                         SALARIES AND EXPENSES

Appropriations, 2017....................................     $13,225,000
Budget estimate, 2018...................................      12,615,000
Committee recommendation................................      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 and Railroad Unemployment Insurance 
Act.

                     DUAL BENEFITS PAYMENTS ACCOUNT

Appropriations, 2017....................................     $25,000,000
Budget estimate, 2018...................................      22,000,000
Committee recommendation................................      22,000,000

    The Committee recommends $22,000,000 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

Appropriations, 2017....................................        $150,000
Budget estimate, 2018...................................         150,000
Committee recommendation................................         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

Appropriations, 2017....................................    $113,500,000
Budget estimate, 2018...................................     111,225,000
Committee recommendation................................     114,500,000

    The Committee recommends $114,500,000 for RRB's costs 
associated with the administration of railroad retirement/
survivor and unemployment/sickness benefit programs. 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.
    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

Appropriations, 2017....................................     $10,000,000
Budget estimate, 2018...................................       8,437,000
Committee recommendation................................      11,000,000

    The Committee recommends $11,000,000 for the RRB OIG. 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

Appropriations, 2017....................................     $11,400,000
Budget estimate, 2018...................................      11,400,000
Committee recommendation................................      11,400,000

    The Committee recommends $11,400,000 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, 2017.................................... $43,618,163,000
Budget estimate, 2018...................................  38,556,526,000
Committee recommendation................................  38,450,927,000

    The Committee recommends $38,450,927,000 in fiscal year 
2018 mandatory funds for the SSI program. This is in addition 
to the $15,000,000,000 provided in the fiscal year 2017 
appropriations act for the first quarter of fiscal year 2018. 
In addition, the Committee recommends $19,500,000,000 in 
advance funding for the first quarter of fiscal year 2019. 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 2018 
program level of $48,236,000,000 for Federal benefit payments. 
This will support an average monthly benefit of approximately 
$569 for 8,100,000 recipients.
Beneficiary Services
    The Committee recommendation includes $159,000,000 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 $101,000,000 in 
mandatory funds for research and demonstration projects 
conducted under sections 1110, 1115, and 1144 of the Social 
Security Act. 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 $4,954,927,000 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, 2017.................................... $12,480,945,000
Budget estimate, 2018...................................  12,453,000,000
Committee recommendation................................  11,988,945,000

    Due to budget constraints, the Committee recommends 
$11,988,945,000 for SSA's LAE account. 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 $1,735,000,000 for 
program integrity activities, including CDRs and SSI 
redeterminations of non-medical eligibility. This includes 
$273,000,000 in base funding and $1,462,000,000 in cap 
adjustment funding allowed under the Budget Control Act [BCA]. 
The Committee recommendation is a $84,000,000 decrease from the 
fiscal year 2017 funding level, as specified in the BCA. 
Combined, these activities are estimated to save approximately 
$9,828,000,000 over 10 years for the Social Security, Medicare, 
and Medicaid programs by preventing waste, fraud, abuse, and 
improper payments.
    The Committee is supportive of efforts to reduce improper 
payments and improve program integrity in the SSA's disability 
and Supplemental Security Income benefits programs. As part of 
the Bipartisan Budget Act of 2015, Congress empowered SSA to 
enter into an information exchange with a payroll data provider 
to prevent improper payments of such benefits. These programs 
have proven to be beneficial in reducing improper payments for 
other Federal and State benefits programs, and the Committee 
urges SSA to prioritize the utilization of these opportunities.
    Within the funds provided to SSA for continuing disability 
reviews under titles II and XVI of the Social Security Act and 
conducting redeterminations of eligibility, the Committee 
encourages SSA to utilize all of the tools available to it from 
commercial and non-commercial entities that collect and 
maintain data regarding employment and wages, to ensure that 
disability and SSI benefits are properly paid and to reduce 
fraud and abuse. The Committee requests an update in the fiscal 
year 2019 CJ on the progress that SSA has made in utilizing 
additional tools to identify improper payments, as well as 
progress it has made in those efforts.
    Disability Insurance.--The Committee recognizes that the 
purpose of the Ticket to Work and Self-Sufficiency Program 
[Ticket Program] is to provide the assistance disabled 
beneficiaries need to return to work. The Committee is aware 
that the SSA OIG found that employment impacts may have been 
similar for beneficiaries, whether they had participated in the 
Ticket Program or other employment assistance programs. The 
Committee directs SSA to submit a report no later than 90 days 
after the enactment of this act determining if the Ticket 
Program is having the desired measurable results and if it is 
or is not cost effective to continue the Ticket Program.
     Medical Vocational Guidelines.--The Committee is dedicated 
to ensuring that the disabled have access to needed benefits, 
and strongly encourages SSA to work with us to achieve that 
goal. The Committee continues to be concerned that SSA uses 
outdated rules to determine whether or not a claimant meets 
SSA's definition of disability. The Committee is encouraged by 
SSA's indication that they are beginning the regulatory 
process, having already received input from the National 
Disability Forum, the National Institute of Medicine, as well 
as various aging and employment experts. These initial steps 
are well received, as Congress continues to work with the 
Administration to modernize the outdated vocational guidelines 
into a structure that reflects the 21st century labor market. 
However, SSA officials have indicated to GAO that the complete 
update of the occupational grid is not expected to be completed 
until 2024, and at a cost of $178,000,000. As this is the first 
significant overhaul of the grid in nearly 40 years, the 
Committee requests SSA to submit, no later than 60 days after 
the enactment of this act, a report on its ongoing efforts to 
update the grid, including the latest status of the 
Occupational Information System joint project with the 
Department of Labor. In addition, the report shall include a 
study assessing the feasibility of maintaining a continuous 
update of the medical vocational guidelines every 10 years. In 
conjunction with the agency's release of findings, the 
Committee directs SSA, in coordination with the U.S. Bureau of 
Labor Statistics, to brief the Committee on the status and 
progress of the ongoing update to the Medical Vocational 
Guidelines no later than 90 days after the enactment of this 
act.
    Reducing the Hearing Backlog.--The Committee is aware of 
the discord between SSA and the ALJ community regarding the 
implementation of part of SSA's Compassionate and Responsive 
Service [CARES] plan to reduce the significant hearing backlog 
at the agency. Specifically, there is concern regarding the 
Administration's hiring of Administrative Appeals Judges for 
non-disability and remanded cases. The Committee recognizes the 
need for further discussion regarding this matter and 
encourages SSA to engage with the ALJ community and appropriate 
stakeholders to find innovative solutions to address hearing 
wait times, keeping in mind the goal of reducing the backlog to 
serve the over 1,100,000 individuals and their families 
awaiting a hearing decision.
    Social Security Advisory Board.--The Committee 
recommendation includes not less than $2,300,000 for the Social 
Security Advisory 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 $119,000,000 for administrative 
activities funded from user fees. This includes $118,000,000 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.
    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 2017 levels, respectively. These programs provide 
valuable services to help Social Security disability 
beneficiaries return to work.

                      OFFICE OF INSPECTOR GENERAL

Appropriations, 2017....................................    $105,500,000
Budget estimate, 2018...................................     105,500,000
Committee recommendation................................     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.

                                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 1-year 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.
    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 security number if based on a conviction for a violation 
under section 208(a)(6) or (7) of the Social Security Act.
    Section 519. The bill continues a provision prohibiting SSA 
from establishing a totalization agreement with Mexico.
    Section 520. The bill continues a provision regarding 
funding for programs that carry out distribution of sterile 
needles or syringes.
    Section 521. The bill continues a provision requiring 
computer networks to block pornography.
    Section 522. 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 523. The bill continues a provision related to 
reporting requirements for conference spending.
    Section 524. The bill continues a provision related to 
advertisement costs.
    Section 525. The bill continues a provision on Performance 
Partnerships.
    Section 526. The bill continues a provision regarding 
reporting status of balances of appropriations.
    Section 527. The bill continues a provision rescinding 
funds from the Independent Payment Advisory Board.
    Section 528. The bill modifies a provision rescinding funds 
from the Children's Health Insurance Program Performance Bonus 
Fund.
    Section 529. The bill modifies a provision rescinding funds 
from the Children's Health Insurance Program regarding State 
allotments.
    Section 530. The bill continues 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; Combating Autism 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 7, 
2017, the Committee ordered favorably reported an original bill 
(S. 1771) making appropriations for the Departments of Labor, 
Health and Human Services, and Education, and related agencies 
for the fiscal year ending September 30, 2018, and for other 
purposes, provided, that the bill be subject to amendment and 
that the bill be consistent with its subcommittee funding 
guidance, 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 29-2, a quorum being present. The vote was as follows:
        Yeas                          Nays
Chairman Cochran                    Mr. Lankford
Mr. McConnell                       Mr. Daines
Mr. Shelby
Mr. Alexander
Ms. Collins
Ms. Murkowski
Mr. Graham
Mr. Blunt
Mr. Moran
Mr. Hoeven
Mr. Boozman
Mrs. Capito
Mr. Kennedy
Mr. Rubio
Mr. Leahy
Mrs. Murray
Mrs. Feinstein
Mr. Durbin
Mr. Reed
Mr. Tester
Mr. Udall
Mrs. Shaheen
Mr. Merkley
Mr. Coons
Mr. Schatz
Ms. Baldwin
Mr. Murphy
Mr. Manchin
Mr. Van Hollen

 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.''
    In compliance with this rule, changes in existing law 
proposed to be made by the bill are shown as follows: existing 
law to be omitted is enclosed in black brackets; new matter is 
printed in italic; and existing law in which no change is 
proposed is shown in roman.

                          TITLE 20--EDUCATION


     CHAPTER 28--HIGHER EDUCATION RESOURCES AND STUDENT ASSISTANCE


                    SUBCHAPTER I--GENERAL PROVISIONS


                 Part B--Additional General Provisions


Sec. 1011c. National Advisory Committee on Institutional Quality and 
                    Integrity

(a) Establishment

           *       *       *       *       *       *       *

(f) Termination

    The Committee shall terminate on September 30, [2017] 2018.

           *       *       *       *       *       *       *


                   SUBCHAPTER IV--STUDENT ASSISTANCE


  Part A--Grants to Students in Attendance at Institutions of Higher 
                               Education


                     SUBPART 1--FEDERAL PELL GRANTS

Sec. 1070a. Federal Pell Grants: amount and determinations; 
                    applications

(a) Program authority and method of distribution

           *       *       *       *       *       *       *

(b) Purpose and amount of grants

    (1) * * *

    (7) Additional funds.--

            (A) In general.--* * *

                    (i) * * *

           *       *       *       *       *       *       *

                    (iv) to carry out this section--

                            (I) * * *

           *       *       *       *       *       *       *

                            (VIII) [$1,382,000,000] 
                        $1,355,000,000 for fiscal year 2018;

           *       *       *       *       *       *       *

(c) Period of eligibility for grants

    [(5) The period]

    (5) Maximum period.--

            (A) In general.--Except as provided in subparagraph 
        (B), the period during which a student may receive 
        Federal Pell Grants shall not exceed 12 semesters, or 
        the equivalent of 12 semesters, as determined by the 
        Secretary by regulation. Such regulations shall 
        provide, with respect to a student who received a 
        Federal Pell Grant for a term but was enrolled at a 
        fraction of full-time, that only that same fraction of 
        such semester or equivalent shall count towards such 
        duration limits.

            (B) Exception.--

                    (i) In general.--Any Federal Pell Grant 
                that a student received during a period 
                described in subclause (I) or (II) of clause 
                (ii) shall not count towards the student's 
                duration limits under this paragraph.

                    (ii) Applicable periods.--Clause (i) shall 
                apply with respect to any Federal Pell Grant 
                awarded to a student to attend an institution--

                            (I) during a period--

                                    (aa) for which the student 
                                received a loan under this 
                                title; and

                                    (bb) for which the loan 
                                described in item (aa) is 
                                forgiven under--

                                            (AA) section 
                                        437(c)(1) or 464(g)(1) 
                                        due to the closing of 
                                        the institution or 
                                        false certification; or

                                            (BB) section 455(h) 
                                        due to the student's 
                                        successful assertion of 
                                        a defense to repayment 
                                        of the loan; or

                            (II) during a period for which the 
                        student did not receive a loan under 
                        this title but for which, if the 
                        student had received such a loan, the 
                        student would have qualified for loan 
                        forgiveness under subclause (I)(bb).

           *       *       *       *       *       *       *


          Part C--William D. Ford Federal Direct Loan Program


Sec. 1087h. Funds for administrative expenses

(a) Program authority and method of distribution

  (1) Mandatory funds for fiscal year 2006

           *       *       *       *       *       *       *

  (4) Continuing mandatory funds for account maintenance fees

    For each of the fiscal years 2007 through [2017] 2018, 
there shall be available to the Secretary, from funds not 
otherwise appropriated, funds to be obligated for account 
maintenance fees payable to guaranty agencies under part B and 
calculated in accordance with subsection (b).
                                ------                                


             TITLE 48--TERRITORIES AND INSULAR POSSESSIONS


          Chapter 18--Micronesia, Marshall Islands, and Palau


             SUBCHAPTER I--MICRONESIA AND MARSHALL ISLANDS


      Part B--Approval and Implementation of Compacts, As Amended


Sec. 1921d. Supplemental provisions

(a) Domestic program requirements

           *       *       *       *       *       *       *

(f) Continuing programs and laws

  (1) Federated States of Micronesia and Republic of the 
Marshall Islands

           *       *       *       *       *       *       *

          (A) Emergency and disaster assistance

           *       *       *       *       *       *       *

          (B) Treatment of additional programs

                  (i) Consultation

           *       *       *       *       *       *       *

                  (ix) Applicability

                    The government, institutions, and people of 
                Palau shall remain eligible for appropriations 
                and to receive grants under the provisions of 
                law specified in clauses (ii) and (iii) until 
                the end of fiscal year [2017] 2018, to the 
                extent the government, institutions, and people 
                of Palau were so eligible under such provisions 
                in fiscal year 2003.

                        BUDGETARY IMPACT OF BILL


  PREPARED IN CONSULTATION WITH THE CONGRESSIONAL BUDGET OFFICE PURSUANT TO SEC. 308(A), PUBLIC LAW 93-344, AS
                                                     AMENDED
                                            [In millions of dollars]
----------------------------------------------------------------------------------------------------------------
                                                                 Budget authority               Outlays
                                                           -----------------------------------------------------
                                                              Committee    Amount  in    Committee    Amount  in
                                                             guidance\1\      bill      guidance\1\      bill
----------------------------------------------------------------------------------------------------------------
Comparison of amounts in the bill with Committee guidance
 to its subcommittees of amounts for 2018: Subcommittee on
 Labor, HHS, Education, and Related Agencies:
    Mandatory.............................................       778,797      778,797       778,320   \2\778,320
    Discretionary.........................................       164,066      165,962       168,951   \2\170,527
        Security..........................................  ............  ...........            NA           NA
        Nonsecurity.......................................       164,066      165,962            NA           NA
Projections of outlays associated with the recommendation:
    2018..................................................  ............  ...........  ............   \3\849,560
    2019..................................................  ............  ...........  ............       75,282
    2020..................................................  ............  ...........  ............       19,834
    2021..................................................  ............  ...........  ............        3,138
    2022 and future years.................................  ............  ...........  ............          836
Financial assistance to State and local governments for               NA      475,555            NA   \3\440,448
 2018.....................................................
 
----------------------------------------------------------------------------------------------------------------
\1\There is no section 302(a) allocation to the Committee on Appropriations for fiscal year 2018.
\2\Includes outlays from prior-year budget authority.
\3\Excludes outlays from prior-year budget authority.
 
NA: Not applicable.
 
NOTE.--Consistent with the funding recommended in the bill for continuing disability reviews and
  redeterminations and for healthcare fraud and abuse control and in accordance with subparagraphs (B) and (C)
  of section 251(b)(2) of the BBEDCA of 1985, the Committee anticipates that the Budget Committee will provide,
  at the appropriate time, a 302(a) allocation for the Committee on Appropriations reflecting an upward
  adjustment of $1,896,000,000 in budget authority plus associated outlays. Also, pursuant to sections
  1001(b)(3)(B) and 1003(b)(3)(B) of the 21st Century Cures Act (Public Law 114-255), a total of $996,000,000 in
  budget authority and the resulting outlays do not count for the purposes of estimates under the Congressional
  Budget and Impoundment Control Act of 1974 or the Balanced Budget and Emergency Deficit Control Act of 1985.


  COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2017 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL FOR FISCAL
                                                                        YEAR 2018
                                                                [In thousands of dollars]
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                                        Senate Committee recommendation
                                                                                                                            compared with (+ or -)
                             Item                                     2017         Budget estimate      Committee    -----------------------------------
                                                                  appropriation                      recommendation         2017
                                                                                                                        appropriation    Budget estimate
--------------------------------------------------------------------------------------------------------------------------------------------------------
                 TITLE I--DEPARTMENT OF LABOR
 
            EMPLOYMENT AND TRAINING ADMINISTRATION
 
               Training and Employment Services
 
Grants to States:
    Adult Training, current year..............................          103,556           102,370           103,556   ................           +1,186
        Advance from prior year...............................         (712,000)         (712,000)         (712,000)  ................  ................
        Fiscal year 2019......................................          712,000           388,000           712,000   ................         +324,000
                                                               -----------------------------------------------------------------------------------------
          Subtotal............................................          815,556           490,370           815,556   ................         +325,186
 
    Youth Training............................................          873,416           523,667           873,416   ................         +349,749
    Dislocated Worker Assistance, current year................          160,860           160,485           160,860   ................             +375
        Advance from prior year...............................         (860,000)         (860,000)         (860,000)  ................  ................
        Fiscal year 2019......................................          860,000           455,000           860,000   ................         +405,000
                                                               -----------------------------------------------------------------------------------------
          Subtotal............................................        1,020,860           615,485         1,020,860   ................         +405,375
                                                               -----------------------------------------------------------------------------------------
          Subtotal, Grants to States..........................        2,709,832         1,629,522         2,709,832   ................       +1,080,310
 
            Current year......................................       (1,137,832)         (786,522)       (1,137,832)  ................        (+351,310)
            Fiscal year 2019..................................       (1,572,000)         (843,000)       (1,572,000)  ................        (+729,000)
 
National Programs:
    Dislocated Worker Assistance National Reserve:
        Current year..........................................           20,859            87,000            20,859   ................          -66,141
        Advance from prior year...............................         (200,000)         (200,000)         (200,000)  ................  ................
        Fiscal year 2019......................................          200,000            30,000           200,000   ................         +170,000
                                                               -----------------------------------------------------------------------------------------
          Subtotal............................................          220,859           117,000           220,859   ................         +103,859
                                                               -----------------------------------------------------------------------------------------
          Subtotal, Dislocated Worker Assistance..............        1,241,719           732,485         1,241,719   ................         +509,234
 
    Native American programs..................................           50,000            49,905            50,000   ................              +95
    Migrant and Seasonal Farmworker programs..................           81,896   ................           81,896   ................          +81,896
    YouthBuild activities.....................................           84,534            84,373            84,534   ................             +161
    Technical assistance......................................            2,500             5,226   ................           -2,500            -5,226
    Reintegration of Ex-Offenders.............................           88,078            77,911            88,078   ................          +10,167
    Workforce Data Quality Initiative.........................            6,000   ................            5,000            -1,000            +5,000
    Apprenticeship programs...................................           95,000            89,829            95,000   ................           +5,171
                                                               -----------------------------------------------------------------------------------------
      Total, National Programs................................          628,867           424,244           625,367            -3,500          +201,123
 
          Current year........................................         (428,867)         (394,244)         (425,367)          (-3,500)         (+31,123)
          Fiscal year 2019....................................         (200,000)          (30,000)         (200,000)  ................        (+170,000)
                                                               -----------------------------------------------------------------------------------------
      Total, Training and Employment Services [TES]...........        3,338,699         2,053,766         3,335,199            -3,500        +1,281,433
 
          Current year........................................       (1,566,699)       (1,180,766)       (1,563,199)          (-3,500)        (+382,433)
          Fiscal year 2019....................................       (1,772,000)         (873,000)       (1,772,000)  ................        (+899,000)
                                                               =========================================================================================
                           Job Corps
 
Operations....................................................        1,587,325         1,341,318         1,587,325   ................         +246,007
Construction, Rehabilitation and Acquisition..................           84,500            74,857            79,500            -5,000            +4,643
Administration................................................           32,330            32,269            32,330   ................              +61
                                                               -----------------------------------------------------------------------------------------
      Total, Job Corps........................................        1,704,155         1,448,444         1,699,155            -5,000          +250,711
          Current year........................................       (1,704,155)       (1,448,444)       (1,699,155)          (-5,000)        (+250,711)
Community Service Employment For Older Americans..............          400,000   ................          400,000   ................         +400,000
 
Federal Unemployment Benefits and Allowances (indefinite).....          849,000           790,000           790,000           -59,000   ................
 
          State Unemployment Insurance and Employment
 
                      Service Operations
 
Unemployment Compensation [UI]:
    State Operations..........................................        2,687,600         2,635,775         2,637,600           -50,000            +1,825
    National Activities.......................................           14,897            12,000            13,897            -1,000            +1,897
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Unemployment Compensation.....................        2,702,497         2,647,775         2,651,497           -51,000            +3,722
 
Employment Service [ES]:
    Grants to States:
        Federal Funds.........................................           21,413            21,372            21,413   ................              +41
        Trust Funds...........................................          650,000           394,516           645,000            -5,000          +250,484
                                                               -----------------------------------------------------------------------------------------
          Subtotal, Grants to States..........................          671,413           415,888           666,413            -5,000          +250,525
 
    ES National Activities....................................           19,818            19,780            19,818   ................              +38
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Employment Service............................          691,231           435,668           686,231            -5,000          +250,563
 
          Federal Funds.......................................          (21,413)          (21,372)          (21,413)  ................             (+41)
          Trust Funds.........................................         (669,818)         (414,296)         (664,818)          (-5,000)        (+250,522)
 
Foreign Labor Certifications and Related Activities:
    Federal Administration....................................           48,028            47,937            48,028   ................              +91
    Grants to States..........................................           14,282            14,255            14,282   ................              +27
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Foreign Labor Certification...................           62,310            62,192            62,310   ................             +118
 
One-Stop Career Centers/Labor Market Information..............           67,653            67,524            62,653            -5,000            -4,871
                                                               -----------------------------------------------------------------------------------------
      Total, State UI and ES..................................        3,523,691         3,213,159         3,462,691           -61,000          +249,532
          Federal Funds.......................................          (89,066)          (88,896)          (84,066)          (-5,000)          (-4,830)
          Trust Funds.........................................       (3,434,625)       (3,124,263)       (3,378,625)         (-56,000)        (+254,362)
                                                               =========================================================================================
                    Program Administration
 
Training and Employment.......................................           62,040            59,960            62,040   ................           +2,080
    Trust Funds...............................................            8,639             8,623             8,639   ................              +16
Employment Security...........................................            3,440             3,462             3,440   ................              -22
    Trust Funds...............................................           39,264            39,189            39,264   ................              +75
Apprenticeship Services.......................................           36,160            33,935            36,160   ................           +2,225
Executive Direction...........................................            7,034             7,021             7,034   ................              +13
    Trust Funds...............................................            2,079             2,075             2,079   ................               +4
                                                               -----------------------------------------------------------------------------------------
      Total, Program Administration...........................          158,656           154,265           158,656   ................           +4,391
 
          Federal Funds.......................................         (108,674)         (104,378)         (108,674)  ................          (+4,296)
          Trust Funds.........................................          (49,982)          (49,887)          (49,982)  ................             (+95)
                                                               =========================================================================================
      Total, Employment and Training Administration...........        9,974,201         7,659,634         9,845,701          -128,500        +2,186,067
          Federal Funds.......................................        6,489,594         4,485,484         6,417,094           -72,500        +1,931,610
              Current year....................................       (4,717,594)       (3,612,484)       (4,645,094)         (-72,500)      (+1,032,610)
              Fiscal year 2019................................       (1,772,000)         (873,000)       (1,772,000)  ................        (+899,000)
          Trust Funds.........................................        3,484,607         3,174,150         3,428,607           -56,000          +254,457
                                                               =========================================================================================
       EMPLOYEE BENEFITS SECURITY ADMINISTRATION [EBSA]
 
                     Salaries and Expenses
 
Enforcement and Participant Assistance........................          147,400   ................          147,400   ................         +147,400
Policy and Compliance Assistance..............................           26,901   ................           26,901   ................          +26,901
Executive Leadership, Program Oversight and Administration....            6,699   ................            6,699   ................           +6,699
Employee benefits security programs...........................  ................          183,926   ................  ................         -183,926
                                                               -----------------------------------------------------------------------------------------
      Total, EBSA.............................................          181,000           183,926           181,000   ................           -2,926
                                                               =========================================================================================
          PENSION BENEFIT GUARANTY CORPORATION (PBGC)
 
           Pension Benefit Guaranty Corporation Fund
 
Consolidated Administrative budget............................         (519,506)         (522,917)         (424,417)         (-95,089)         (-98,500)
WAGE AND HOUR DIVISION, Salaries and Expenses.................          227,500           230,068           227,500   ................           -2,568
OFFICE OF LABOR-MANAGEMENT STANDARDS, Salaries and Expenses...           38,187            46,634            40,187            +2,000            -6,447
OFFICE OF FEDERAL CONTRACT COMPLIANCE PROGRAMS, Salaries and            104,476            88,000           103,476            -1,000           +15,476
 Expenses.....................................................
 
           OFFICE OF WORKERS' COMPENSATION PROGRAMS
 
Salaries and Expenses.........................................          115,424           113,109           115,424   ................           +2,315
    Trust Funds...............................................            2,177             2,173             2,177   ................               +4
                                                               -----------------------------------------------------------------------------------------
      Total, Salaries and Expenses............................          117,601           115,282           117,601   ................           +2,319
 
          Federal Funds.......................................         (115,424)         (113,109)         (115,424)  ................          (+2,315)
          Trust Funds.........................................           (2,177)           (2,173)           (2,177)  ................              (+4)
                                                               =========================================================================================
                       Special Benefits
 
Federal Employees' Compensation Benefits......................          217,000           217,000           217,000   ................  ................
Longshore and Harbor Workers' Benefits........................            3,000             3,000             3,000   ................  ................
                                                               -----------------------------------------------------------------------------------------
      Total, Special Benefits.................................          220,000           220,000           220,000   ................  ................
                                                               =========================================================================================
           Special Benefits for Disabled Coal Miners
 
Benefit Payments..............................................           75,000            65,000            65,000           -10,000   ................
Administration................................................            5,319             5,319             5,319   ................  ................
                                                               -----------------------------------------------------------------------------------------
      Subtotal, fiscal year 2018 program level................           80,319            70,319            70,319           -10,000   ................
 
          Less funds advanced in prior year...................          -19,000           -16,000           -16,000            +3,000   ................
                                                               -----------------------------------------------------------------------------------------
      Total, Current Year.....................................           61,319            54,319            54,319            -7,000   ................
                                                               =========================================================================================
          New advances, 1st quarter, fiscal year 2019.........           16,000            15,000            15,000            -1,000   ................
                                                               -----------------------------------------------------------------------------------------
      Total, Special Benefits for Disabled Coal Miners........           77,319            69,319            69,319            -8,000   ................
                                                               =========================================================================================
             Energy Employees Occupational Illness
 
                       Compensation Fund
 
Administrative Expenses.......................................           59,846            59,846            59,846   ................  ................
 
               Black Lung Disability Trust Fund
 
Benefit Payments and Interest on Advances.....................          302,115           345,635           345,635           +43,520   ................
Workers' Compensation Programs, Salaries and Expenses.........           38,246            38,246            38,246   ................  ................
Departmental Management, Salaries and Expenses................           31,994            30,595            30,595            -1,399   ................
Departmental Management, Inspector General....................              330               330               330   ................  ................
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Black Lung Disability.........................          372,685           414,806           414,806           +42,121   ................
 
Treasury Department Administrative Costs......................              356               356               356   ................  ................
                                                               -----------------------------------------------------------------------------------------
      Total, Black Lung Disability Trust Fund.................          373,041           415,162           415,162           +42,121   ................
                                                               =========================================================================================
      Total, Workers' Compensation Programs...................          847,807           879,609           881,928           +34,121            +2,319
 
          Federal Funds.......................................          845,630           877,436           879,751           +34,121            +2,315
              Current year....................................         (829,630)         (862,436)         (864,751)         (+35,121)          (+2,315)
              Fiscal year 2019................................          (16,000)          (15,000)          (15,000)          (-1,000)  ................
          Trust Funds.........................................            2,177             2,173             2,177   ................               +4
                                                               =========================================================================================
     OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION (OSHA)
 
                     Salaries and Expenses
 
Safety and Health Standards...................................           18,000            18,176            18,000   ................             -176
Federal Enforcement...........................................          208,000           207,465           208,000   ................             +535
Whistleblower enforcement.....................................           17,500            17,383            17,500   ................             +117
State Programs................................................          100,850           100,658           100,850   ................             +192
Technical Support.............................................           24,469            24,281            24,469   ................             +188
 
Compliance Assistance:
    Federal Assistance........................................           70,981            72,351            70,981   ................           -1,370
    State Consultation Grants.................................           59,500            57,665            59,500   ................           +1,835
    Training Grants...........................................           10,537   ................           10,537   ................          +10,537
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Compliance Assistance.........................          141,018           130,016           141,018   ................          +11,002
 
Safety and Health Statistics..................................           32,900            34,326            32,900   ................           -1,426
Executive Direction and Administration........................           10,050            10,952            10,050   ................             -902
                                                               -----------------------------------------------------------------------------------------
      Total, OSHA.............................................          552,787           543,257           552,787   ................           +9,530
                                                               =========================================================================================
             MINE SAFETY AND HEALTH ADMINISTRATION
 
                     Salaries and Expenses
 
Coal Enforcement..............................................          160,000           157,026           160,000   ................           +2,974
Metal/Non-Metal Enforcement...................................           94,500            97,875            94,500   ................           -3,375
Standards Development.........................................            4,500             5,460             4,500   ................             -960
Assessments...................................................            6,627             7,457             6,627   ................             -830
Educational Policy and Development............................           39,320            37,365            39,320   ................           +1,955
Technical Support.............................................           35,041            34,330            35,041   ................             +711
Program Evaluation and Information Resources [PEIR]...........           17,990            19,169            17,990   ................           -1,179
Program Administration........................................           15,838            16,490            15,838   ................             -652
                                                               -----------------------------------------------------------------------------------------
      Total, Mine Safety and Health Administration............          373,816           375,172           373,816   ................           -1,356
                                                               =========================================================================================
      Total, Worker Protection Agencies.......................        1,595,367         1,582,339         1,596,367            +1,000           +14,028
          Federal Funds.......................................       (1,593,190)       (1,580,166)       (1,594,190)          (+1,000)         (+14,024)
          Trust Funds.........................................           (2,177)           (2,173)           (2,177)  ................              (+4)
                                                               =========================================================================================
                  BUREAU OF LABOR STATISTICS
 
                     Salaries and Expenses
 
Employment and Unemployment Statistics........................          208,000           203,878           208,000   ................           +4,122
Labor Market Information......................................           65,000            64,876            65,000   ................             +124
Prices and Cost of Living.....................................          207,000           209,863           207,000   ................           -2,863
Compensation and Working Conditions...........................           83,500            82,880            83,500   ................             +620
Productivity and Technology...................................           10,500            10,798            10,500   ................             -298
Executive Direction and Staff Services........................           35,000            35,547            35,000   ................             -547
                                                               -----------------------------------------------------------------------------------------
      Total, Bureau of Labor Statistics.......................          609,000           607,842           609,000   ................           +1,158
          Federal Funds.......................................          544,000           542,966           544,000   ................           +1,034
          Trust Funds.........................................           65,000            64,876            65,000   ................             +124
                                                               =========================================================================================
            OFFICE OF DISABILITY EMPLOYMENT POLICY
 
Salaries and Expenses.........................................           38,203            27,203            38,203   ................          +11,000
 
                    DEPARTMENTAL MANAGEMENT
 
                     Salaries and Expenses
 
Executive Direction...........................................           30,250            30,951            30,250   ................             -701
Departmental Program Evaluation...............................            8,040             8,025             8,040   ................              +15
Legal Services................................................          121,745           126,933           123,745            +2,000            -3,188
    Trust Funds...............................................              308               308               308   ................  ................
International Labor Affairs...................................           86,125            18,500            86,125   ................          +67,625
Administration and Management.................................           28,834            23,496            23,534            -5,300               +38
Adjudication..................................................           35,000            31,939            35,000   ................           +3,061
Women's Bureau................................................           12,530             2,925            12,530   ................           +9,605
Civil Rights Activities.......................................            6,880             6,867             6,880   ................              +13
Chief Financial Officer.......................................            5,132             9,914            10,432            +5,300              +518
                                                               -----------------------------------------------------------------------------------------
      Total, Departmental Management Salaries and expenses....          334,844           259,858           336,844            +2,000           +76,986
          Federal Funds.......................................         (334,536)         (259,550)         (336,536)          (+2,000)         (+76,986)
          Trust Funds.........................................             (308)             (308)             (308)  ................  ................
                                                               =========================================================================================
               Veterans Employment and Training
 
State Administration, Grants..................................          175,000           174,667           175,000   ................             +333
Transition Assistance Program.................................           14,600            16,073            18,500            +3,900            +2,427
Federal Administration........................................           41,027            40,410            42,127            +1,100            +1,717
National Veterans' Employment and Training Services Institute.            3,414             3,408             3,414   ................               +6
Homeless Veterans Programs....................................           45,000            45,037            45,000   ................              -37
                                                               -----------------------------------------------------------------------------------------
      Total, Veterans Employment and Training.................          279,041           279,595           284,041            +5,000            +4,446
          Federal Funds.......................................           45,000            45,037            45,000   ................              -37
          Trust Funds.........................................          234,041           234,558           239,041            +5,000            +4,483
                                                               =========================================================================================
                       IT Modernization
 
Departmental support systems..................................            4,898             4,889             4,898   ................               +9
Infrastructure technology modernization.......................           13,880            24,833            13,880   ................          -10,953
                                                               -----------------------------------------------------------------------------------------
      Total, IT Modernization.................................           18,778            29,722            18,778   ................          -10,944
                                                               =========================================================================================
                  Office of Inspector General
 
Program Activities............................................           82,061            80,487            82,061   ................           +1,574
    Trust Funds...............................................            5,660             5,649             5,660   ................              +11
                                                               -----------------------------------------------------------------------------------------
      Total, Office of Inspector General......................           87,721            86,136            87,721   ................           +1,585
                                                               =========================================================================================
      Total, Departmental Management..........................          720,384           655,311           727,384            +7,000           +72,073
          Federal Funds.......................................          480,375           414,796           482,375            +2,000           +67,579
              Current Year....................................         (480,375)         (414,796)         (482,375)          (+2,000)         (+67,579)
          Trust Funds.........................................          240,009           240,515           245,009            +5,000            +4,494
                                                               =========================================================================================
      Total, Workforce Investment Act Programs................        5,042,854         3,502,210         5,034,354            -8,500        +1,532,144
 
          Current year........................................       (3,270,854)       (2,629,210)       (3,262,354)          (-8,500)        (+633,144)
          Fiscal year 2019....................................       (1,772,000)         (873,000)       (1,772,000)  ................        (+899,000)
                                                               =========================================================================================
      Total, Title I, Department of Labor.....................       13,667,361        11,296,656        13,580,982           -86,379        +2,284,326
 
          Federal Funds.......................................        9,875,568         7,814,942         9,840,189           -35,379        +2,025,247
              Current year....................................       (8,087,568)       (6,926,942)       (8,053,189)         (-34,379)      (+1,126,247)
              Fiscal year 2019................................       (1,788,000)         (888,000)       (1,787,000)          (-1,000)        (+899,000)
          Trust Funds.........................................        3,791,793         3,481,714         3,740,793           -51,000          +259,079
                                                               =========================================================================================
       TITLE II--DEPARTMENT OF HEALTH AND HUMAN SERVICES
 
      HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA)
 
                      Primary Health Care
 
Community Health Centers......................................        1,490,522         1,488,587         1,490,522   ................           +1,935
Free Clinics Medical Malpractice..............................            1,000               100             1,000   ................             +900
                                                               -----------------------------------------------------------------------------------------
      Total, Primary Health Care..............................        1,491,522         1,488,687         1,491,522   ................           +2,835
                                                               =========================================================================================
                       Health Workforce
 
Training for Diversity:
    Centers of Excellence.....................................           21,711   ................           21,711   ................          +21,711
    Health Careers Opportunity Program........................           14,189   ................           14,189   ................          +14,189
    Faculty Loan Repayment....................................            1,190   ................            1,190   ................           +1,190
    Scholarships for Disadvantaged Students...................           45,970   ................           45,970   ................          +45,970
                                                               -----------------------------------------------------------------------------------------
      Total, Training for Diversity...........................           83,060   ................           83,060   ................          +83,060
                                                               =========================================================================================
Training in Primary Care Medicine.............................           38,924   ................           38,924   ................          +38,924
Oral Health Training..........................................           36,673   ................           36,673   ................          +36,673
 
Interdisciplinary Community-Based Linkages:
    Area Health Education Centers.............................           30,250   ................           32,750            +2,500           +32,750
    Geriatric Programs........................................           38,737   ................           38,737   ................          +38,737
    Mental and Behavorial Health..............................            9,916   ................            9,916   ................           +9,916
    Behavioral Health Workforce Education and Training........           50,000   ................           50,000   ................          +50,000
    Screening for treatment for material depression...........  ................  ................            5,000            +5,000            +5,000
                                                               -----------------------------------------------------------------------------------------
      Total, Interdisciplinary Community Linkages.............          128,903   ................          136,403            +7,500          +136,403
                                                               =========================================================================================
Workforce Information and Analysis............................            4,663             4,654             4,663   ................               +9
Public Health and Preventive Medicine programs................           17,000   ................           17,000   ................          +17,000
 
Nursing Programs:
    Advanced Education Nursing................................           64,581   ................           69,581            +5,000           +69,581
    Nurse Education, Practice, and Retention..................           39,913   ................           39,913   ................          +39,913
    Nursing Workforce Diversity...............................           15,343   ................           15,343   ................          +15,343
    Nursing Corps Scholarship and Loan Repayment Program......           83,135            82,977            83,135   ................             +158
    Nursing Workforce Development.............................  ................  ................  ................  ................  ................
    Nursing Faculty Loan Program..............................           26,500   ................           26,500   ................          +26,500
                                                               -----------------------------------------------------------------------------------------
      Total, Nursing programs.................................          229,472            82,977           234,472            +5,000          +151,495
                                                               =========================================================================================
Children's Hospitals Graduate Medical Education...............          300,000           295,000           305,000            +5,000           +10,000
National Practitioner Data Bank...............................           18,814            18,000            18,814   ................             +814
    User Fees.................................................          -18,814           -18,000           -18,814   ................             -814
                                                               -----------------------------------------------------------------------------------------
      Total, Health Workforce.................................          838,695           382,631           856,195           +17,500          +473,564
                                                               =========================================================================================
                   Maternal and Child Health
 
Maternal and Child Health Block Grant.........................          641,700           666,987           641,700   ................          -25,287
Sickle Cell Anemia Demonstration Program......................            4,455   ................            4,455   ................           +4,455
Autism and Other Developmental Disorders......................           47,099   ................           47,099   ................          +47,099
Heritable Disorders...........................................           13,883   ................           13,883   ................          +13,883
Healthy Start.................................................          103,500           128,303           103,500   ................          -24,803
    Healthy Start Initiative (PL 114-254).....................           15,000   ................  ................          -15,000   ................
Universal Newborn Hearing Screening...........................           17,818   ................           17,818   ................          +17,818
Emergency Medical Services for Children.......................           20,162   ................           20,162   ................          +20,162
                                                               -----------------------------------------------------------------------------------------
      Total, Maternal and Child Health........................          863,617           795,290           848,617           -15,000           +53,327
                                                               =========================================================================================
                  Ryan White HIV/AIDS Program
 
Emergency Assistance..........................................          655,876           654,629           655,876   ................           +1,247
Comprehensive Care Programs...................................        1,315,005         1,312,505         1,315,005   ................           +2,500
    AIDS Drug Assistance Program [ADAP] (NA)..................         (900,313)        (-898,602)         (900,313)  ................      (+1,798,915)
Early Intervention Program....................................          201,079           204,689           201,079   ................           -3,610
Children, Youth, Women, and Families..........................           75,088            75,088            75,088   ................  ................
AIDS Dental Services..........................................           13,122            13,097            13,122   ................              +25
Education and Training Centers................................           33,611   ................           33,611   ................          +33,611
Special Projects of National Significance.....................           25,000   ................           25,000   ................          +25,000
                                                               -----------------------------------------------------------------------------------------
      Total, Ryan White HIV/AIDS program......................        2,318,781         2,260,008         2,318,781   ................          +58,773
                                                               =========================================================================================
                      Health Care Systems
 
Organ Transplantation.........................................           23,549            23,504            23,549   ................              +45
National Cord Blood Inventory.................................           12,266            11,245            12,266   ................           +1,021
CW Bill Young Cell Transplantation program....................           22,109            22,067            22,109   ................              +42
340B Drug Pricing program/Office of Pharmacy Affairs..........           10,238            10,219            19,238            +9,000            +9,019
    User Fees.................................................  ................  ................           -9,000            -9,000            -9,000
Poison Control................................................           18,846            18,810            19,846            +1,000            +1,036
National Hansen's Disease Program.............................           15,206            11,653            11,653            -3,553   ................
Hansen's Disease Program Buildings and Facilities.............              122   ................              122   ................             +122
Payment to Hawaii, Treatment of Hansen's......................            1,857             1,853             1,857   ................               +4
                                                               -----------------------------------------------------------------------------------------
      Total, Health Care Systems..............................          104,193            99,351           101,640            -2,553            +2,289
                                                               =========================================================================================
                         Rural Health
 
Rural Outreach Grants.........................................           65,500            50,811            67,500            +2,000           +16,689
Rural Health Research/Policy Development......................            9,351             5,000             9,351   ................           +4,351
Rural Hospital Flexibility Grants.............................           43,609   ................           43,609   ................          +43,609
State Offices of Rural Health.................................           10,000   ................           10,000   ................          +10,000
Black Lung Clinics............................................            7,266             6,753             7,266   ................             +513
Radiation Exposure Screening and Education Program............            1,834             1,831             1,834   ................               +3
Telehealth....................................................           18,500            10,000            21,000            +2,500           +11,000
                                                               -----------------------------------------------------------------------------------------
      Total, Rural Health.....................................          156,060            74,395           160,560            +4,500           +86,165
                                                               =========================================================================================
Family Planning...............................................          286,479           286,479           286,479   ................  ................
Program Management............................................          154,000           151,993           154,000   ................           +2,007
 
        Vaccine Injury Compensation Program Trust Fund
 
Post-fiscal year 1988 Claims..................................          240,000           268,000           240,000   ................          -28,000
HRSA Administrative expenses..................................            7,750             9,200             7,750   ................           -1,450
                                                               -----------------------------------------------------------------------------------------
      Total, Vaccine Injury Compensation Trust Fund...........          247,750           277,200           247,750   ................          -29,450
                                                               =========================================================================================
      Total, Health Resources and Services Administration.....        6,461,097         5,816,034         6,465,544            +4,447          +649,510
                                                               =========================================================================================
          CENTERS FOR DISEASE CONTROL AND PREVENTION
 
Immunization and Respiratory Diseases.........................          455,000           497,228           470,000           +15,000           -27,228
    Pandemic Flu balances (Public Law 111-32).................          (15,000)  ................  ................         (-15,000)  ................
    Prevention and Public Health Fund\1\......................         (324,350)         (203,600)         (324,350)  ................        (+120,750)
                                                               -----------------------------------------------------------------------------------------
      Subtotal................................................         (794,350)         (700,828)         (794,350)  ................         (+93,522)
 
HIV/AIDS, Viral Hepatitis, Sexually Transmitted Diseases, and         1,117,278           934,000         1,117,278   ................         +183,278
 Tuberculosis Prevention......................................
Emerging and Zoonotic Infectious Diseases.....................          532,922           377,000           532,922   ................         +155,922
    Prevention and Public Health Fund\1\......................          (52,000)         (137,000)          (52,000)  ................         (-85,000)
                                                               -----------------------------------------------------------------------------------------
      Subtotal................................................          584,922           514,000           584,922   ................          +70,922
 
Chronic Disease Prevention and Health Promotion...............          777,646           452,250           817,596           +39,950          +365,346
    Prevention and Public Health Fund\1\......................         (337,950)         (500,000)         (247,550)         (-90,400)        (-252,450)
                                                               -----------------------------------------------------------------------------------------
      Subtotal................................................        1,115,596           952,250         1,065,146           -50,450          +112,896
 
Birth Defects, Developmental Disabilities, Disabilities and             137,560           100,000           139,560            +2,000           +39,560
 Health.......................................................
    Prevention and Public Health Fund\1\......................  ................  ................  ................  ................  ................
                                                               -----------------------------------------------------------------------------------------
      Subtotal................................................          137,560           100,000           139,560            +2,000           +39,560
 
Public Health Scientific Services.............................          489,397           317,032           489,397   ................         +172,365
    Evaluation Tap Funding....................................  ................         (142,968)  ................  ................        (-142,968)
                                                               -----------------------------------------------------------------------------------------
      Subtotal................................................         (489,397)         (460,000)         (489,397)  ................         (+29,397)
 
Environmental Health..........................................          163,750           157,000           163,750   ................           +6,750
    Childhood lead poisoning prevention (PL 114-254)..........           35,000   ................  ................          -35,000   ................
    Prevention and Public Health Fund\1\......................          (17,000)  ................          (17,000)  ................         (+17,000)
                                                               -----------------------------------------------------------------------------------------
      Subtotal................................................          215,750           157,000           180,750           -35,000           +23,750
 
Injury Prevention and Control.................................          286,059           216,165           291,059            +5,000           +74,894
National Institute for Occupational Safety and Health.........          335,200           200,000           335,200   ................         +135,200
Energy Employees Occupational Illness Compensation Program....           55,358            55,358            55,358   ................  ................
Global Health.................................................          435,121           350,000           433,621            -1,500           +83,621
Public Health Preparedness and Response.......................        1,405,000         1,266,000         1,405,000   ................         +139,000
Buildings and Facilities......................................           10,000            20,000            10,000   ................          -10,000
 
            CDC-Wide Activities and Program Support
 
Prevention and Public Health Fund\1\..........................         (160,000)  ................         (160,000)  ................        (+160,000)
Office of the Director........................................          113,570           105,000           113,570   ................           +8,570
                                                               -----------------------------------------------------------------------------------------
      Subtotal, CDC-Wide Activities...........................         (273,570)         (105,000)         (273,570)  ................        (+168,570)
                                                               =========================================================================================
      Total, Centers for Disease Control......................        6,348,861         5,047,033         6,374,311           +25,450        +1,327,278
          Discretionary.......................................        6,293,503         4,991,675         6,318,953           +25,450        +1,327,278
          Evaluation Tap Funding (NA).........................  ................         (142,968)  ................  ................        (-142,968)
          Pandemic Flu balances (Public Law 111-32)...........          (15,000)  ................  ................         (-15,000)  ................
          Prevention and Public Health Fund\1\................         (891,300)         (840,600)         (800,900)         (-90,400)         (-39,700)
      Total, Centers for Disease Control Program Level........       (7,255,161)       (6,030,601)       (7,175,211)         (-79,950)      (+1,144,610)
                                                               =========================================================================================
 
                 NATIONAL INSTITUTES OF HEALTH
 
National Cancer Institute.....................................        5,371,926         4,174,222         5,558,270          +186,344        +1,384,048
    Transfer from NIH Innovation, CURES Act\4\................          300,000           300,000           300,000   ................  ................
                                                               -----------------------------------------------------------------------------------------
      Subtotal, National Cancer Institute.....................        5,671,926         4,474,222         5,858,270          +186,344        +1,384,048
 
National Heart, Lung, and Blood Institute.....................        3,217,081         2,534,803         3,322,774          +105,693          +787,971
National Institute of Dental and Craniofacial Research........          425,751           320,749           439,738           +13,987          +118,989
National Institute of Diabetes and Digestive and Kidney               1,874,028         1,449,534         1,935,597           +61,569          +486,063
 Diseases [NIDDK].............................................
    Juvenile Diabetes (mandatory).............................         (150,000)         (150,000)         (150,000)  ................  ................
                                                               -----------------------------------------------------------------------------------------
      Subtotal, NIDDK program level...........................        2,024,028         1,599,534         2,085,597           +61,569          +486,063
 
National Institute of Neurological Disorders and Stroke.......        1,782,582         1,312,998         1,861,666           +79,084          +548,668
    Transfer from NIH Innovation, CURES Act\4\................  ................           43,000            43,000           +43,000   ................
                                                               -----------------------------------------------------------------------------------------
      Subtotal, National Institute of Neurological Disorders          1,782,582         1,355,998         1,904,666          +122,084          +548,668
       and Stroke.............................................
 
National Institute of Allergy and Infectious Diseases.........        4,916,346         3,782,670         5,127,866          +211,520        +1,345,196
National Institute of General Medical Sciences................        1,825,685         1,405,509         1,812,751           -12,934          +407,242
    Evaluation Tap Funding....................................         (824,443)         (780,000)       (1,074,443)        (+250,000)        (+294,443)
                                                               -----------------------------------------------------------------------------------------
      Subtotal, NGMS program level............................        2,650,128         2,185,509         2,887,194          +237,066          +701,685
 
Eunice Kennedy Shriver National Institute of Child Health and         1,379,684         1,032,029         1,426,092           +46,408          +394,063
 Human Development............................................
National Eye Institute........................................          732,855           549,847           758,552           +25,697          +208,705
National Institute of Environmental Health Sciences...........          714,261           533,537           737,727           +23,466          +204,190
National Institute on Aging...................................        2,052,487         1,303,541         2,535,539          +483,052        +1,231,998
National Institute of Arthritis and Musculoskeletal and Skin            557,851           417,898           576,178           +18,327          +158,280
 Diseases.....................................................
National Institute on Deafness and Other Communication                  436,875           325,846           451,768           +14,893          +125,922
 Disorders....................................................
National Institute of Nursing Research........................          150,273           113,688           155,210            +4,937           +41,522
National Institute on Alcohol Abuse and Alcoholism............          483,525           361,356           500,491           +16,966          +139,135
National Institute on Drug Abuse..............................        1,073,320           864,998         1,113,442           +40,122          +248,444
National Institute of Mental Health...........................        1,608,212         1,201,901         1,681,568           +73,356          +479,667
    Transfer from NIH Innovation, CURES Act\4\................  ................           43,000            43,000           +43,000   ................
                                                               -----------------------------------------------------------------------------------------
      Subtotal, National Institute of Mental Health...........        1,608,212         1,244,901         1,724,568          +116,356          +479,667
 
National Human Genome Research Institute......................          529,537           399,622           546,934           +17,397          +147,312
National Institute of Biomedical Imaging and Bioengineering...          357,777           282,614           371,151           +13,374           +88,537
National Center for Complementary and Integrative Health......          134,689           101,793           139,654            +4,965           +37,861
National Institute on Minority Health and Health Disparities..          288,312           214,723           297,784            +9,472           +83,061
John E. Fogarty International Center..........................           72,014   ................           74,380            +2,366           +74,380
National Center for Advancing Translational Sciences..........          705,903           557,373           729,094           +23,191          +171,721
National Library of Medicine (NLM)............................          407,510           373,258           420,898           +13,388           +47,640
National Institute for Research on Safety and Quality\3\......  ................          272,000   ................  ................         -272,000
Office of the Director........................................        1,667,610         1,329,833         1,796,970          +129,360          +467,137
    Common Fund (non-add).....................................         (682,856)         (441,823)         (575,290)        (-107,566)        (+133,467)
    Gabriella Miller Kids First Research Act (Common Fund add)           12,600            12,600            12,600   ................  ................
Buildings and Facilities......................................          128,863            98,615           128,863   ................          +30,248
NIH Innovation Account, CURES Act\4\..........................           52,000           496,000           496,000          +444,000   ................
NIH Innovation Account, CURES Act transfers...................  ................         -386,000          -386,000          -386,000   ................
                                                               =========================================================================================
      Total, National Institutes of Health (NIH)..............       33,259,557        25,823,557        35,009,557        +1,750,000        +9,186,000
          (Evaluation Tap Funding)............................         (824,443)         (780,000)       (1,074,443)        (+250,000)        (+294,443)
      Total, NIH Program Level................................      (34,084,000)      (26,603,557)      (36,084,000)      (+2,000,000)      (+9,480,443)
                                                               =========================================================================================
   SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION
                           (SAMHSA)
 
                         Mental Health
 
Programs of Regional and National Significance................          386,659           277,419           386,659   ................         +109,240
    Prevention and Public Health Fund\1\......................          (12,000)  ................          (12,000)  ................         (+12,000)
                                                               -----------------------------------------------------------------------------------------
      Subtotal................................................          398,659           277,419           398,659   ................         +121,240
 
Mental Health block grant.....................................          541,532           400,000           541,532   ................         +141,532
    Evaluation Tap Funding....................................          (21,039)          (15,539)          (21,039)  ................          (+5,500)
                                                               -----------------------------------------------------------------------------------------
      Subtotal................................................         (562,571)         (415,539)         (562,571)  ................        (+147,032)
 
Children's Mental Health......................................          119,026           118,800           119,026   ................             +226
Grants to States for the Homeless (PATH)......................           64,635            64,512            64,635   ................             +123
Protection and Advocacy.......................................           36,146            36,077            36,146   ................              +69
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Mental Health.................................        1,147,998           896,808         1,147,998   ................         +251,190
          (Evaluation Tap Funding)............................          (21,039)          (15,539)          (21,039)  ................          (+5,500)
                                                               -----------------------------------------------------------------------------------------
            Subtotal, Mental Health program level.............       (1,181,037)         (912,347)       (1,181,037)  ................        (+268,690)
 
                   Substance Abuse Treatment
 
Programs of Regional and National Significance................          352,427           339,738           352,427   ................          +12,689
    Evaluation Tap Funding....................................           (2,000)           (2,000)           (2,000)  ................  ................
                                                               -----------------------------------------------------------------------------------------
      Subtotal................................................         (354,427)         (341,738)         (354,427)  ................         (+12,689)
 
Substance Abuse block grant...................................        1,778,879         1,775,497         1,778,879   ................           +3,382
    Evaluation Tap Funding....................................          (79,200)          (79,200)          (79,200)  ................  ................
                                                               -----------------------------------------------------------------------------------------
      Subtotal, block grant...................................       (1,858,079)       (1,854,697)       (1,858,079)  ................          (+3,382)
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Substance Abuse Treatment.....................        2,131,306         2,115,235         2,131,306   ................          +16,071
          (Evaluation Tap Funding)............................          (81,200)          (81,200)          (81,200)  ................  ................
          Subtotal, Program level.............................       (2,212,506)       (2,196,435)       (2,212,506)  ................         (+16,071)
 
                  Substance Abuse Prevention
 
Programs of Regional and National Significance................          223,219           149,703           238,219           +15,000           +88,516
                                                               -----------------------------------------------------------------------------------------
      Total, Substance Abuse Prevention.......................          223,219           149,703           238,219           +15,000           +88,516
                                                               =========================================================================================
Health Surveillance and Program Support.......................          116,830           108,922           114,402            -2,428            +5,480
    Evaluation Tap Funding (NA)...............................          (31,428)          (23,426)          (31,428)  ................          (+8,002)
                                                               -----------------------------------------------------------------------------------------
      Subtotal................................................          148,258           132,348           145,830            -2,428           +13,482
                                                               =========================================================================================
      Total, SAMHSA...........................................        3,619,353         3,270,668         3,631,925           +12,572          +361,257
          (Evaluation Tap Funding)............................         (133,667)         (120,165)         (133,667)  ................         (+13,502)
          (Prevention and Public Health Fund\1\...............          (12,000)  ................          (12,000)  ................         (+12,000)
            Total, SAMHSA Program Level.......................       (3,765,020)       (3,390,833)       (3,777,592)         (+12,572)        (+386,759)
                                                               =========================================================================================
     AGENCY FOR HEALTHCARE RESEARCH AND QUALITY (AHRQ)\3\
 
                Healthcare Research and Quality
 
Research on Health Costs, Quality, and Outcomes:
    Federal Funds.............................................          187,156   ................          187,156   ................         +187,156
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Health Costs, Quality, and Outcomes...........         (187,156)  ................         (187,156)  ................        (+187,156)
 
Medical Expenditures Panel Surveys:
    Federal Funds.............................................           66,000   ................           66,000   ................          +66,000
 
Program Support:
    Federal Funds.............................................           70,844   ................           70,844   ................          +70,844
                                                               -----------------------------------------------------------------------------------------
      Total, AHRQ Program Level\3\............................         (324,000)  ................         (324,000)  ................        (+324,000)
 
          Federal funds\3\....................................         (324,000)  ................         (324,000)  ................        (+324,000)
      Total, Public Health Service (PHS) appropriation........       50,012,868        39,957,292        51,805,337        +1,792,469       +11,848,045
      Total, Public Health Service Program Level..............      (51,889,278)      (41,841,025)      (53,826,347)      (+1,937,069)     (+11,985,322)
                                                               =========================================================================================
          CENTERS FOR MEDICARE AND MEDICAID SERVICES
 
                 Grants to States for Medicaid
 
Medicaid Current Law Benefits.................................      354,223,901       384,608,394       384,608,394       +30,384,493   ................
State and Local Administration................................       18,975,984        20,811,084        20,811,084        +1,835,100   ................
Vaccines for Children.........................................        4,386,584         4,598,358         4,598,358          +211,774   ................
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Medicaid Program Level........................      377,586,469       410,017,836       410,017,836       +32,431,367   ................
          Less funds advanced in prior year...................     -115,582,502      -125,219,452      -125,219,452        -9,636,950   ................
                                                               -----------------------------------------------------------------------------------------
      Total, Grants to States for Medicaid....................      262,003,967       284,798,384       284,798,384       +22,794,417   ................
            New advance, 1st quarter, fiscal year 2019........      125,219,452       134,847,759       134,847,759        +9,628,307   ................
                                                               =========================================================================================
              Payments to Health Care Trust Funds
 
Supplemental Medical Insurance................................      214,944,000       245,396,000       245,396,000       +30,452,000   ................
Federal Uninsured Payment.....................................          147,000           132,000           132,000           -15,000   ................
Program Management............................................          877,500         1,104,000         1,104,000          +226,500   ................
General Revenue for Part D Benefit............................       82,512,000        76,133,000        76,133,000        -6,379,000   ................
General Revenue for Part D Administration.....................          405,000           422,000           422,000           +17,000   ................
HCFAC Reimbursement...........................................          299,000           307,000           307,000            +8,000   ................
State Low-Income Determination for Part D.....................            3,200             3,300             3,300              +100   ................
                                                               -----------------------------------------------------------------------------------------
      Total, Payments to Trust Funds, Program Level...........      299,187,700       323,497,300       323,497,300       +24,309,600   ................
                                                               =========================================================================================
                      Program Management
 
Research, Demonstration, Evaluation...........................           20,054            18,054            20,054   ................           +2,000
Program Operations............................................        2,519,823         2,441,274         2,519,823   ................          +78,549
State Survey and Certification................................          397,334           406,135           397,334   ................           -8,801
Federal Administration........................................          732,533           722,533           732,533   ................          +10,000
                                                               -----------------------------------------------------------------------------------------
      Total, Program management...............................        3,669,744         3,587,996         3,669,744   ................          +81,748
                                                               =========================================================================================
          Health Care Fraud and Abuse Control Account
 
Centers for Medicare and Medicaid Services....................          486,936           536,145           584,766           +97,830           +48,621
HHS Office of Inspector General...............................           82,132            74,246            84,398            +2,266           +10,152
Medicaid/CHIP.................................................           82,132            74,246   ................          -82,132           -74,246
Department of Justice.........................................           73,800            66,363            75,836            +2,036            +9,473
                                                               -----------------------------------------------------------------------------------------
      Total, Health Care Fraud and Abuse Control..............          725,000           751,000           745,000           +20,000            -6,000
                                                               =========================================================================================
      Total, Centers for Medicare and Medicaid Services.......      690,805,863       747,482,439       747,558,187       +56,752,324           +75,748
 
          Federal funds.......................................      686,411,119       743,143,443       743,143,443       +56,732,324   ................
              Current year....................................     (561,191,667)     (608,295,684)     (608,295,684)     (+47,104,017)  ................
          New advance, fiscal year 2019.......................     (125,219,452)     (134,847,759)     (134,847,759)      (+9,628,307)  ................
          Trust Funds.........................................        4,394,744         4,338,996         4,414,744           +20,000           +75,748
                                                               =========================================================================================
        ADMINISTRATION FOR CHILDREN AND FAMILIES (ACF)
 
     Payments to States for Child Support Enforcement and
 
                    Family Support Programs
 
Payments to Territories.......................................           33,000            33,000            33,000   ................  ................
Repatriation..................................................            1,000             1,000             1,000   ................  ................
                                                               -----------------------------------------------------------------------------------------
      Subtotal................................................           34,000            34,000            34,000   ................  ................
 
Child Support Enforcement:
    State and Local Administration............................        3,680,840         3,763,200         3,763,200           +82,360   ................
    Federal Incentive Payments................................          585,791           588,200           588,200            +2,409   ................
    Access and Visitation.....................................           10,000            10,000            10,000   ................  ................
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Child Support Enforcement.....................        4,276,631         4,361,400         4,361,400           +84,769   ................
                                                               -----------------------------------------------------------------------------------------
      Total, Family Support Payments Program Level............        4,310,631         4,395,400         4,395,400           +84,769   ................
          Less funds advanced in previous years...............       -1,300,000        -1,400,000        -1,400,000          -100,000   ................
                                                               =========================================================================================
      Total, Family Support Payments, current year............        3,010,631         2,995,400         2,995,400           -15,231   ................
          New advance, 1st quarter, fiscal year 2019..........        1,400,000         1,400,000         1,400,000   ................  ................
                                                               =========================================================================================
          Low Income Home Energy Assistance (LIHEAP)
 
Formula Grants................................................        3,390,304   ................        3,390,304   ................       +3,390,304
 
                Refugee and Entrant Assistance
 
Transitional and Medical Services.............................          490,000           320,000           320,000          -170,000   ................
Refugee Support Services......................................  ................          159,321           207,201          +207,201           +47,880
Victims of Trafficking........................................           18,755            18,719            20,755            +2,000            +2,036
Social Services...............................................          155,000   ................  ................         -155,000   ................
Preventive Health.............................................            4,600   ................  ................           -4,600   ................
Targeted Assistance...........................................           47,601   ................  ................          -47,601   ................
Unaccompanied Minors..........................................          948,000           948,000           948,000   ................  ................
Victims of Torture............................................           10,735            10,715            10,735   ................              +20
                                                               -----------------------------------------------------------------------------------------
      Total, Refugee and Entrant Assistance...................        1,674,691         1,456,755         1,506,691          -168,000           +49,936
                                                               =========================================================================================
Payments to States for the Child Care and Development Block           2,856,000         2,761,000         2,856,000   ................          +95,000
 Grant........................................................
Social Services Block Grant (Title XX)........................        1,700,000   ................        1,700,000   ................       +1,700,000
                                                               -----------------------------------------------------------------------------------------
      Total, Social Services Block Grant......................        1,700,000   ................        1,700,000   ................       +1,700,000
                                                               =========================================================================================
            Children and Families Services Programs
 
Programs for Children, Youth and Families:
    Head Start, current funded................................        9,253,095         9,168,095         9,253,095   ................          +85,000
    Preschool Development Grants..............................          250,000   ................          250,000   ................         +250,000
    Consolidated Runaway, Homeless Youth Program..............          101,980           101,786           101,980   ................             +194
    Prevention Grants to Reduce Abuse of Runaway Youth........           17,141            17,108            17,141   ................              +33
    Child Abuse State Grants..................................           25,310            25,262            25,310   ................              +48
    Child Abuse Discretionary Activities......................           33,000            32,937            33,000   ................              +63
    Community Based Child Abuse Prevention....................           39,764            39,688            39,764   ................              +76
    Child Welfare Services....................................          268,735           268,224           268,735   ................             +511
    Child Welfare Training, Research, or Demonstration                   17,984            17,950            17,984   ................              +34
     projects.................................................
    Adoption Opportunities....................................           39,100            30,072            39,100   ................           +9,028
    Adoption Incentive grants.................................           37,943            37,871            37,943   ................              +72
Social Services and Income Maintenance Research...............            6,512             6,500             6,512   ................              +12
Native American Programs......................................           52,050            49,905            52,050   ................           +2,145
 
Community Services:
    Community Services Block Grant Act programs:
        Grants to States for Community Services...............          715,000   ................          700,000           -15,000          +700,000
        Economic Development..................................           19,883   ................           19,883   ................          +19,883
        Rural Community Facilities............................            7,500   ................            7,500   ................           +7,500
                                                               -----------------------------------------------------------------------------------------
          Subtotal............................................          742,383   ................          727,383           -15,000          +727,383
                                                               -----------------------------------------------------------------------------------------
          Subtotal, Community Services........................          742,383   ................          727,383           -15,000          +727,383
 
Domestic Violence Hotline.....................................            8,250             8,250             8,250   ................  ................
Family Violence/Battered Women's Shelters.....................          151,000           151,000           156,000            +5,000            +5,000
Chafee Education and Training Vouchers........................           43,257            43,175            43,257   ................              +82
Disaster Human Services Case Management.......................            1,864             1,860             1,864   ................               +4
Program Direction.............................................          205,000           204,610           205,000   ................             +390
                                                               -----------------------------------------------------------------------------------------
      Total, Children and Families Services Programs..........       11,294,368        10,204,293        11,284,368           -10,000        +1,080,075
                                                               =========================================================================================
Promoting Safe and Stable Families............................          325,000           345,000           325,000   ................          -20,000
    Discretionary Funds.......................................           59,765            59,651            59,765   ................             +114
                                                               -----------------------------------------------------------------------------------------
      Total, Promoting Safe and Stable Families...............          384,765           404,651           384,765   ................          -19,886
                                                               =========================================================================================
            Payments for Foster Care and Permanency
 
Foster Care...................................................        4,992,000         5,537,000         5,537,000          +545,000   ................
Adoption Assistance...........................................        2,780,000         2,867,000         2,867,000           +87,000   ................
Guardianship..................................................          152,000           181,000           181,000           +29,000   ................
Independent Living............................................          140,000           140,000           140,000   ................  ................
                                                               -----------------------------------------------------------------------------------------
      Total, Payments to States...............................        8,064,000         8,725,000         8,725,000          +661,000   ................
          Less Advances from Prior Year.......................       -2,300,000        -2,500,000        -2,500,000          -200,000   ................
                                                               -----------------------------------------------------------------------------------------
      Total, payments, current year...........................        5,764,000         6,225,000         6,225,000          +461,000   ................
          New Advance, 1st quarter, fiscal year 2019..........        2,500,000         2,700,000         2,700,000          +200,000   ................
                                                               =========================================================================================
      Total, ACF..............................................       33,974,759        28,147,099        34,442,528          +467,769        +6,295,429
          Current year........................................      (30,074,759)      (24,047,099)      (30,342,528)        (+267,769)      (+6,295,429)
          Fiscal year 2019....................................       (3,900,000)       (4,100,000)       (4,100,000)        (+200,000)  ................
      Total, ACF Program Level................................       33,974,759        28,147,099        34,442,528          +467,769        +6,295,429
                                                               =========================================================================================
              ADMINISTRATION FOR COMMUNITY LIVING
 
            Aging and Disability Services Programs
 
Grants to States:
    Home and Community-based Supportive Services..............          350,224           347,063           350,224   ................           +3,161
    Preventive Health.........................................           19,848            19,810            19,848   ................              +38
    Protection of Vulnerable Older Americans-Title VII........           20,658            20,619            20,658   ................              +39
                                                               -----------------------------------------------------------------------------------------
      Subtotal................................................          390,730           387,492           390,730   ................           +3,238
 
    Family Caregivers.........................................          150,586           150,300           150,586   ................             +286
    Native American Caregivers Support........................            7,556             7,517             7,556   ................              +39
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Caregivers....................................          158,142           157,817           158,142   ................             +325
 
    Nutrition:
        Congregate Meals......................................          450,342           447,490           450,342   ................           +2,852
        Home Delivered Meals..................................          227,342           225,912           227,342   ................           +1,430
        Nutrition Services Incentive Program..................          160,069           159,765           160,069   ................             +304
                                                               -----------------------------------------------------------------------------------------
          Subtotal............................................          837,753           833,167           837,753   ................           +4,586
                                                               -----------------------------------------------------------------------------------------
          Subtotal, Grants to States..........................        1,386,625         1,378,476         1,386,625   ................           +8,149
 
Grants for Native Americans...................................           31,208            31,099            31,208   ................             +109
Aging Network Support Activities..............................            9,961             9,942             9,961   ................              +19
Alzheimer's Disease Demonstrations............................            4,800            19,490             4,800   ................          -14,690
    Prevention and Public Health Fund\1\......................          (14,700)  ................          (14,700)  ................         (+14,700)
Lifespan Respite Care.........................................            3,360             3,354             3,360   ................               +6
Chronic Disease Self-Management Program.......................  ................            5,000   ................  ................           -5,000
    Prevention and Public Health Fund\1\......................           (8,000)  ................           (8,000)  ................          (+8,000)
Elder Falls Prevention........................................  ................            5,000   ................  ................           -5,000
    Prevention and Public Health Fund\1\......................           (5,000)  ................           (5,000)  ................          (+5,000)
Elder Rights Support Activities...............................           13,874            11,851            13,874   ................           +2,023
Aging and Disability Resources................................            6,119             6,107             6,119   ................              +12
Senior Community Service Employment Program...................  ................  ................  ................  ................  ................
State Health Insurance Program................................           47,115   ................           47,115   ................          +47,115
Paralysis Resource Center.....................................            6,700   ................            6,700   ................           +6,700
Limb loss.....................................................            2,500   ................            2,500   ................           +2,500
Traumatic Brain Injury........................................            9,321             3,162             9,321   ................           +6,159
 
Developmental Disabilities Programs:
    Partnerships for Innovation, Inclusion, and Independence..  ................           45,000   ................  ................          -45,000
    State Councils............................................           73,000   ................           73,000   ................          +73,000
    Protection and Advocacy...................................           38,734            38,660            38,734   ................              +74
    Voting Access for Individuals with Disabilities...........            4,963             4,954             4,963   ................               +9
    Developmental Disabilities Projects of National                      10,000             7,600            10,000   ................           +2,400
     Significance.............................................
    University Centers for Excellence in Developmental                   38,619            38,546            38,619   ................              +73
     Disabilities.............................................
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Developmental Disabilities Programs...........          165,316           134,760           165,316   ................          +30,556
 
Workforce Innovation and Opportunity Act Independent Living...          101,183            78,156           101,183   ................          +23,027
    National Institute on Disability, Independent Living, and           103,970            95,127           103,970   ................           +8,843
     Rehabilitation Research..................................
    Assistive Technology......................................           34,000            31,939            34,000   ................           +2,061
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Workforce Innovation and Opportunity Act......          239,153           205,222           239,153   ................          +33,931
 
Program Administration........................................           40,063            37,987            40,063   ................           +2,076
                                                               =========================================================================================
      Total, Administration for Community Living (ACL)........        1,966,115         1,851,450         1,966,115   ................         +114,665
          Federal funds.......................................       (1,919,000)       (1,851,450)       (1,919,000)  ................         (+67,550)
          Trust Funds.........................................          (47,115)  ................          (47,115)  ................         (+47,115)
          (Prevention and Public Health Fund\1\...............          (27,700)  ................          (27,700)  ................         (+27,700)
      Total, ACL program level................................        1,993,815         1,851,450         1,993,815   ................         +142,365
                                                               =========================================================================================
                    OFFICE OF THE SECRETARY
 
                General Departmental Management
 
General Departmental Management, Federal Funds................          199,620           203,500           199,620   ................           -3,880
    Teen Pregnancy Prevention Community Grants................          101,000   ................          101,000   ................         +101,000
    Evaluation Tap Funding....................................           (6,800)  ................           (6,800)  ................          (+6,800)
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Grants........................................         (107,800)  ................         (107,800)  ................        (+107,800)
 
Faith-Based Center............................................            1,299             1,299             1,299   ................  ................
Sexual Risk Avoidance.........................................           15,000            10,000            25,000           +10,000           +15,000
Minority Health...............................................           56,670            56,562            56,670   ................             +108
Office of Women's Health......................................           32,140            32,140            32,140   ................  ................
Minority HIV/AIDS prevention and treatment....................           53,900   ................           53,900   ................          +53,900
Embryo Adoption Awareness Campaign............................            1,000             1,000             1,000   ................  ................
Planning and Evaluation, Evaluation Tap Funding...............          (58,028)          (57,465)          (58,028)  ................            (+563)
                                                               -----------------------------------------------------------------------------------------
      Subtotal, General Departmental Management...............          460,629           304,501           470,629           +10,000          +166,128
                                                               -----------------------------------------------------------------------------------------
      Total, General Departmental Management..................          460,629           304,501           470,629           +10,000          +166,128
 
          Federal Funds.......................................         (460,629)         (304,501)         (470,629)         (+10,000)        (+166,128)
          (Evaluation Tap Funding)............................          (64,828)          (57,465)          (64,828)  ................          (+7,363)
      Total, General Departmental Management Program..........          525,457           361,966           535,457           +10,000          +173,491
                                                               =========================================================================================
Office of Medicare Hearings and Appeals.......................          107,381           117,177           107,381   ................           -9,796
Office of the National Coordinator for Health Information                60,367            38,381            60,367   ................          +21,986
 Technology...................................................
 
                  Office of Inspector General
 
Inspector General Federal Funds...............................           80,000            68,085            80,000   ................          +11,915
    HCFAC funding (NA)........................................         (334,097)  ................         (334,097)  ................        (+334,097)
                                                               -----------------------------------------------------------------------------------------
      Total, Inspector General Program Level..................         (414,097)          (68,085)         (414,097)  ................        (+346,012)
                                                               =========================================================================================
                    Office for Civil Rights
 
Federal Funds.................................................           38,798            32,530            38,798   ................           +6,268
 
 Retirement Pay and Medical Benefits for Commissioned Officers
 
Retirement Payments...........................................          457,459           456,266           456,266            -1,193   ................
Survivors Benefits............................................           31,559            31,583            31,583               +24   ................
Dependents' Medical Care......................................          141,390           130,840           130,840           -10,550   ................
                                                               -----------------------------------------------------------------------------------------
      Total, Medical Benefits for Commissioned Officers.......          630,408           618,689           618,689           -11,719   ................
                                                               =========================================================================================
   Public Health and Social Services Emergency Fund (PHSSEF)
 
       Assistant Secretary for Preparedness and Response
 
Operations....................................................           30,938            30,879            30,938   ................              +59
Preparedness and Emergency Operations.........................           24,654            24,607            24,654   ................              +47
National Disaster Medical System..............................           49,904            49,809            49,904   ................              +95
 
Hospital Preparedness Cooperative Agreement Grants:
    Formula Grants............................................          254,555           227,201           254,555   ................          +27,354
Biomedical Advanced Research and Development Authority (BARDA)          511,700           511,700           511,700   ................  ................
Policy and Planning...........................................           14,877            14,849            14,877   ................              +28
Project BioShield.............................................          510,000           510,000           510,000   ................  ................
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Preparedness and Response.....................        1,396,628         1,369,045         1,396,628   ................          +27,583
 
            Assistant Secretary for Administration
 
Assistant Secretary for Administration, Cybersecurity.........           50,860            73,263            50,860   ................          -22,403
Office of Security and Strategic Information..................            7,470             7,456             7,470   ................              +14
 
                   Public Health and Science
 
Medical Reserve Corps.........................................            6,000             5,989             6,000   ................              +11
Pandemic Influenza Preparedness...............................           57,000           206,863            92,000           +35,000          -114,863
    Pandemic Flu balances (Public Law 111-32).................          (15,000)  ................  ................         (-15,000)  ................
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Pandemic Influenza Preparedness...............           72,000           206,863            92,000           +20,000          -114,863
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Non-pandemic flu/BioShield/Parklawn/Other               950,958           945,753           950,958   ................           +5,205
       construction...........................................
                                                               -----------------------------------------------------------------------------------------
      Total, PHSSEF...........................................        1,517,958         1,662,616         1,552,958           +35,000          -109,658
      Total, PHSSEF Program level.............................        1,532,958         1,662,616         1,552,958           +20,000          -109,658
                                                               =========================================================================================
Account for the State Response to the Opioid Abuse Crisis,              500,000           500,000           500,000   ................  ................
 CURES Act\2\.................................................
                                                               =========================================================================================
      Total, Office of the Secretary..........................        3,395,541         3,341,979         3,428,822           +33,281           +86,843
          Federal Funds.......................................        3,288,160         3,224,802         3,321,441           +33,281           +96,639
          Trust Funds.........................................          107,381           117,177           107,381   ................           -9,796
          (Evaluation Tap Funding)............................          (64,828)          (57,465)          (64,828)  ................          (+7,363)
      Total, Office of the Secretary Program Level............        3,475,369         3,399,444         3,493,650           +18,281           +94,206
                                                               =========================================================================================
      Total, Title II, Health and Human Services..............      780,155,146       820,780,259       839,200,989       +59,045,843       +18,420,730
          Federal Funds.......................................      775,598,156       816,314,886       834,623,999       +59,025,843       +18,309,113
              Current year....................................     (646,478,704)     (677,367,127)     (695,676,240)     (+49,197,536)     (+18,309,113)
              Fiscal year 2019................................     (129,119,452)     (138,947,759)     (138,947,759)      (+9,828,307)  ................
          Trust Funds.........................................        4,556,990         4,465,373         4,576,990           +20,000          +111,617
      Total, Pandemic Flu balances (Public Law 111-32)........          (30,000)  ................  ................         (-30,000)  ................
      Total, Prevention and Public Health Fund\1\.............         (931,000)         (840,600)         (840,600)         (-90,400)  ................
                                                               =========================================================================================
              TITLE III--DEPARTMENT OF EDUCATION
 
                EDUCATION FOR THE DISADVANTAGED
 
Grants to Local Educational Agencies (LEAs) Basic Grants:
    Advance from prior year...................................       (2,390,776)       (1,840,776)       (1,840,776)        (-550,000)  ................
    Forward funded............................................        4,613,625         2,733,460         4,639,033           +25,408        +1,905,573
    Current funded............................................            5,000           466,100             5,000   ................         -461,100
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Basic grants current year approp..............        4,618,625         3,199,560         4,644,033           +25,408        +1,444,473
      Subtotal, Basic grants total funds available............       (7,009,401)       (5,040,336)       (6,484,809)        (-524,592)      (+1,444,473)
 
    Basic Grants fiscal year 2019 Advance.....................        1,840,776         3,231,497         1,815,368           -25,408        -1,416,129
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Basic grants, program level...................        6,459,401         6,431,057         6,459,401   ................          +28,344
 
    Concentration Grants:
        Advance from prior year...............................       (1,362,301)       (1,362,301)       (1,362,301)  ................  ................
        Fiscal year 2019 Advance..............................        1,362,301         1,362,301         1,362,301   ................  ................
                                                               -----------------------------------------------------------------------------------------
          Subtotal............................................        1,362,301         1,362,301         1,362,301   ................  ................
 
    Targeted Grants:
        Advance from prior year...............................       (3,544,050)       (3,819,050)       (3,819,050)        (+275,000)  ................
        Fiscal year 2019 Advance..............................        3,819,050         3,544,050         3,831,754           +12,704          +287,704
                                                               -----------------------------------------------------------------------------------------
          Subtotal............................................        3,819,050         3,544,050         3,831,754           +12,704          +287,704
 
    Education Finance Incentive Grants:
        Advance from prior year...............................       (3,544,050)       (3,819,050)       (3,819,050)        (+275,000)  ................
        Fiscal year 2019 Advance..............................        3,819,050         3,544,050         3,831,754           +12,704          +287,704
                                                               -----------------------------------------------------------------------------------------
          Subtotal............................................        3,819,050         3,544,050         3,831,754           +12,704          +287,704
                                                               =========================================================================================
      Subtotal, Grants to LEAs, program level.................       15,459,802        15,881,458        15,485,210           +25,408          -396,248
 
    FOCUS Grants (ESIA-I-E)...................................  ................        1,000,000   ................  ................       -1,000,000
Innovative Approaches to Literacy.............................           27,000   ................           27,000   ................          +27,000
Comprehensive literacy development grants.....................          190,000   ................          190,000   ................         +190,000
State Agency Programs:
    Migrant...................................................          374,751           374,039           374,751   ................             +712
    Neglected and Delinquent/High Risk Youth..................           47,614            47,523            47,614   ................              +91
                                                               -----------------------------------------------------------------------------------------
      Subtotal, State Agency programs.........................          422,365           421,562           422,365   ................             +803
 
Migrant Education:
     High School Equivalency Program..........................           44,623            44,538            44,623   ................              +85
                                                               =========================================================================================
      Total, Education for the disadvantaged..................       16,143,790        16,347,558        16,169,198           +25,408          -178,360
          Current year........................................       (5,302,613)       (4,665,660)       (5,328,021)         (+25,408)        (+662,361)
          Fiscal year 2019....................................      (10,841,177)      (11,681,898)      (10,841,177)  ................        (-840,721)
      Total, Forward Funded...................................       (5,225,990)       (3,155,022)       (5,251,398)         (+25,408)      (+2,096,376)
                                                               =========================================================================================
                          IMPACT AID
 
Basic Support Payments........................................        1,189,233         1,166,012         1,200,242           +11,009           +34,230
Payments for Children with Disabilities.......................           48,316            48,224            48,316   ................              +92
Facilities Maintenance (Sec. 8008)............................            4,835             4,826             4,835   ................               +9
Construction (Sec. 8007)......................................           17,406            17,373            17,406   ................              +33
Payments for Federal Property (Sec. 8002).....................           68,813   ................           69,313              +500           +69,313
                                                               =========================================================================================
      Total, Impact aid.......................................        1,328,603         1,236,435         1,340,112           +11,509          +103,677
                                                               =========================================================================================
                  SCHOOL IMPROVEMENT PROGRAMS
 
Supporting Effective Instruction State Grants.................          374,389   ................          374,389   ................         +374,389
    Advance from prior year...................................       (1,681,441)       (1,681,441)       (1,681,441)  ................  ................
    Fiscal year 2019..........................................        1,681,441   ................        1,681,441   ................       +1,681,441
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Supporting Effective Instruction State Grants,        2,055,830   ................        2,055,830   ................       +2,055,830
       program level..........................................
 
Supplemental Education Grants.................................           16,699            16,667            16,699   ................              +32
21st Century Community Learning Centers.......................        1,191,673   ................        1,191,673   ................       +1,191,673
State Assessments.............................................          369,100           377,281           369,100   ................           -8,181
Education for Homeless Children and Youth.....................           77,000            69,867            77,000   ................           +7,133
Training and Advisory Services (Civil Rights).................            6,575             6,563             6,575   ................              +12
Education for Native Hawaiians................................           33,397   ................           33,397   ................          +33,397
Alaska Native Education Equity................................           32,453   ................           32,453   ................          +32,453
Rural Education...............................................          175,840           175,506           175,840   ................             +334
Comprehensive Centers.........................................           50,000            51,347            50,000   ................           -1,347
Student Support and Academic Enrichment grants................          400,000   ................          450,000           +50,000          +450,000
                                                               =========================================================================================
      Total, School Improvement Programs......................        4,408,567           697,231         4,458,567           +50,000        +3,761,336
 
          Current year........................................       (2,727,126)         (697,231)       (2,777,126)         (+50,000)      (+2,079,895)
          Fiscal year 2019....................................       (1,681,441)  ................       (1,681,441)  ................      (+1,681,441)
      Total, Forward Funded...................................       (2,588,002)         (622,654)       (2,638,002)         (+50,000)      (+2,015,348)
                                                               =========================================================================================
                       INDIAN EDUCATION
 
Grants to Local Educational Agencies..........................          100,381           100,190           100,381   ................             +191
 
Federal Programs:
    Special Programs for Indian Children......................           57,993            37,921            57,993   ................          +20,072
    National Activities.......................................            6,565             5,554             6,865              +300            +1,311
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Federal Programs..............................           64,558            43,475            64,858              +300           +21,383
                                                               =========================================================================================
      Total, Indian Education.................................          164,939           143,665           165,239              +300           +21,574
                                                               =========================================================================================
                  INNOVATION AND IMPROVEMENT
 
Education Innovation and Research.............................          100,000           370,000            95,000            -5,000          -275,000
American History and Civics Academies.........................            1,815   ................            1,815   ................           +1,815
American History and Civics National Activities...............            1,700   ................  ................           -1,700   ................
School Leader Recruitment and Support.........................           14,500   ................  ................          -14,500   ................
Charter Schools Grants........................................          342,172           500,000           367,172           +25,000          -132,828
Magnet Schools Assistance.....................................           97,647            96,463            97,647   ................           +1,184
Teacher and School Leader Incentive Grants....................          200,000           199,563           187,000           -13,000           -12,563
Ready-to-Learn Television.....................................           25,741   ................           27,741            +2,000           +27,741
Supporting Effective Educator Development (SEED)..............           65,000            42,000            65,000   ................          +23,000
Arts in Education.............................................           27,000   ................           27,000   ................          +27,000
Javits Gifted and Talented Students...........................           12,000   ................           12,000   ................          +12,000
                                                               -----------------------------------------------------------------------------------------
      Total, Innovation and Improvement.......................          887,575         1,208,026           880,375            -7,200          -327,651
          Current year........................................         (887,575)       (1,208,026)         (880,375)          (-7,200)        (-327,651)
                                                               =========================================================================================
            SAFE SCHOOLS AND CITIZENSHIP EDUCATION
 
Promise Neighborhoods.........................................           73,254            60,000            73,254   ................          +13,254
School Safety National Activities.............................           68,000            74,857            58,000           -10,000           -16,857
Full-Service Community Schools................................           10,000   ................  ................          -10,000   ................
                                                               -----------------------------------------------------------------------------------------
      Total, Safe Schools and Citizenship Education...........          151,254           134,857           131,254           -20,000            -3,603
                                                               =========================================================================================
                 ENGLISH LANGUAGE ACQUISITION
 
Current funded................................................           47,931            47,840            47,931   ................              +91
Forward funded................................................          689,469           688,158           689,469   ................           +1,311
                                                               -----------------------------------------------------------------------------------------
      Total, English Language Acquisition.....................          737,400           735,998           737,400   ................           +1,402
                                                               =========================================================================================
                       SPECIAL EDUCATION
 
State Grants:
    Grants to States Part B current year......................        2,719,465         1,766,099         2,719,465   ................         +953,366
        Part B advance from prior year........................       (9,283,383)       (9,283,383)       (9,283,383)  ................  ................
    Grants to States Part B (fiscal year 2019)................        9,283,383        10,124,103         9,283,383   ................         -840,720
                                                               -----------------------------------------------------------------------------------------
      Subtotal, program level.................................       12,002,848        11,890,202        12,002,848   ................         +112,646
 
    Preschool Grants..........................................          368,238           367,538           368,238   ................             +700
    Grants for Infants and Families...........................          458,556           457,684           458,556   ................             +872
                                                               -----------------------------------------------------------------------------------------
      Subtotal, program level.................................       12,829,642        12,715,424        12,829,642   ................         +114,218
 
IDEA National Activities (current funded):
    State Personnel Development...............................           38,630            41,551            38,630   ................           -2,921
    Technical Assistance and Dissemination (including Special            56,928            44,261            59,428            +2,500           +15,167
     Olympics Education)......................................
    Personnel Preparation.....................................           83,700            83,541            83,700   ................             +159
    Parent Information Centers................................           27,411            27,359            27,411   ................              +52
EducationalTechnology, Media, and Materials...................           28,047            29,990            28,047   ................           -1,943
                                                               -----------------------------------------------------------------------------------------
      Subtotal, IDEA National Activities......................          234,716           226,702           237,216            +2,500           +10,514
                                                               =========================================================================================
      Total, Special education................................       13,064,358        12,942,126        13,066,858            +2,500          +124,732
          Current year........................................       (3,780,975)       (2,818,023)       (3,783,475)          (+2,500)        (+965,452)
          Fiscal year 2019....................................       (9,283,383)      (10,124,103)       (9,283,383)  ................        (-840,720)
      Subtotal, Forward Funded................................       (3,546,259)       (2,591,321)       (3,546,259)  ................        (+954,938)
                                                               =========================================================================================
                    REHABILITATION SERVICES
 
Vocational Rehabilitation State Grants........................        3,398,554         3,452,931         3,452,931           +54,377   ................
Client Assistance State grants................................           13,000            12,975            13,000   ................              +25
Training......................................................           29,388            30,131            29,388   ................             -743
Demonstration and Training programs...........................            5,796             5,785             5,796   ................              +11
Protection and Advocacy of Individual Rights [PAIR]...........           17,650            17,616            17,650   ................              +34
Supported Employment State grants.............................           27,548   ................  ................          -27,548   ................
 
Independent Living:
    Services for Older Blind Individuals......................           33,317            33,254            33,317   ................              +63
Helen Keller National Center for Deaf/Blind Youth and Adults..           10,336            10,316            10,336   ................              +20
                                                               -----------------------------------------------------------------------------------------
      Total, Rehabilitation services..........................        3,535,589         3,563,008         3,562,418           +26,829              -590
                                                               =========================================================================================
      SPECIAL INSTITUTIONS FOR PERSONS WITH DISABILITIES
 
American Printing House for the Blind.........................           25,431            25,383            25,431   ................              +48
 
National Technical Institute for the Deaf [NTID]:
    Operations................................................           70,016            69,883            70,016   ................             +133
 
Gallaudet University:
    Operations................................................          121,275           121,044           121,275   ................             +231
                                                               -----------------------------------------------------------------------------------------
      Total, Gallaudet University.............................          121,275           121,044           121,275   ................             +231
                                                               =========================================================================================
      Total, Special Institutions for Persons with                      216,722           216,310           216,722   ................             +412
       Disabilities...........................................
                                                               =========================================================================================
            CAREER, TECHNICAL, AND ADULT EDUCATION
 
Career Education:
    Basic State Grants/Secondary & Technical Education State            326,598           158,499           326,598   ................         +168,099
     Grants, current funded...................................
        Advance from prior year...............................         (791,000)         (791,000)         (791,000)  ................  ................
        Fiscal year 2019......................................          791,000           791,000           791,000   ................  ................
                                                               -----------------------------------------------------------------------------------------
          Subtotal, Basic State Grants, program level.........        1,117,598           949,499         1,117,598   ................         +168,099
 
    National Programs.........................................            7,421            27,407             7,421   ................          -19,986
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Career Education..............................        1,125,019           976,906         1,125,019   ................         +148,113
 
Adult Education:
    State Grants/Adult Basic and Literacy Education:
        State Grants, current funded..........................          581,955           485,849           581,955   ................          +96,106
National Leadership Activities................................           13,712            13,686            13,712   ................              +26
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Adult education...............................          595,667           499,535           595,667   ................          +96,132
                                                               =========================================================================================
      Total, Career, Technical, and Adult Education...........        1,720,686         1,476,441         1,720,686   ................         +244,245
 
          Current year........................................         (929,686)         (685,441)         (929,686)  ................        (+244,245)
          Fiscal year 2019....................................         (791,000)         (791,000)         (791,000)  ................  ................
          Total, Forward Funded...............................         (929,686)         (685,441)         (929,686)  ................        (+244,245)
                                                               =========================================================================================
                 STUDENT FINANCIAL ASSISTANCE
 
Pell Grants--maximum grant (NA)...............................           (4,860)           (4,860)           (4,960)            (+100)            (+100)
Pell Grants...................................................       22,475,352        22,432,626        22,475,352   ................          +42,726
Federal Supplemental Educational Opportunity Grants...........          733,130   ................          733,130   ................         +733,130
Federal Work Study............................................          989,728           500,000           989,728   ................         +489,728
                                                               -----------------------------------------------------------------------------------------
      Total, Student Financial Assistance [SFA]...............       24,198,210        22,932,626        24,198,210   ................       +1,265,584
                                                               =========================================================================================
                  STUDENT AID ADMINISTRATION
 
Salaries and Expenses.........................................          696,643           680,711           696,643   ................          +15,932
Servicing Activities..........................................          880,211         1,017,000           880,211   ................         -136,789
                                                               -----------------------------------------------------------------------------------------
      Total, Student Aid Administration.......................        1,576,854         1,697,711         1,576,854   ................         -120,857
                                                               =========================================================================================
                       HIGHER EDUCATION
 
Aid for Institutional Development:
    Strengthening Institutions................................           86,534   ................           86,534   ................          +86,534
    Hispanic Serving Institutions.............................          107,795           107,590           107,795   ................             +205
    Promoting Post-Baccalaureate Opportunities for Hispanic               9,671             9,653             9,671   ................              +18
     Americans................................................
    Strengthening Historically Black Colleges (HBCUs).........          244,694           244,229           244,694   ................             +465
    Strengthening Historically Black Graduate Institutions....           63,281            63,161            63,281   ................             +120
    Strengthening Predominantly Black Institutions............            9,942             9,923             9,942   ................              +19
    Asian American Pacific Islander...........................            3,348             3,342             3,348   ................               +6
    Strengthening Alaska Native and Native Hawaiian-Serving              13,802            13,776            13,802   ................              +26
     Institutions.............................................
    Strengthening Native American-Serving Nontribal                       3,348             3,342             3,348   ................               +6
     Institutions.............................................
    Strengthening Tribal Colleges.............................           27,599            27,547            27,599   ................              +52
    Strengthening HBCU Masters programs.......................            7,500   ................            7,500   ................           +7,500
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Aid for Institutional development.............          577,514           482,563           577,514   ................          +94,951
 
International Education and Foreign Language:
    Domestic Programs.........................................           65,103   ................           65,103   ................          +65,103
    Overseas Programs.........................................            7,061   ................            7,061   ................           +7,061
                                                               -----------------------------------------------------------------------------------------
      Subtotal, International Education & Foreign Lang........           72,164   ................           72,164   ................          +72,164
 
Postsecondary Program for Students with Intellectual                     11,800            11,778            11,800   ................              +22
 Disabilities.................................................
Minority Science and Engineering Improvement..................            9,648             9,630             9,648   ................              +18
Tribally Controlled Postsec Voc/Tech Institutions.............            8,286             8,270             8,286   ................              +16
Federal TRIO Programs.........................................          950,000           808,289           953,000            +3,000          +144,711
GEAR UP.......................................................          339,754           219,000           339,754   ................         +120,754
Graduate Assistance in Areas of National Need.................           28,047             5,775            23,047            -5,000           +17,272
Teacher Quality Partnerships..................................           43,092   ................           38,092            -5,000           +38,092
Child Care Access Means Parents in School.....................           15,134   ................           15,134   ................          +15,134
                                                               -----------------------------------------------------------------------------------------
      Total, Higher Education.................................        2,055,439         1,545,305         2,048,439            -7,000          +503,134
                                                               =========================================================================================
                       HOWARD UNIVERSITY
 
Academic Program..............................................          191,091           190,721           191,091   ................             +370
Endowment Program.............................................            3,405             3,405             3,405   ................  ................
Howard University Hospital....................................           27,325            27,273            27,325   ................              +52
                                                               -----------------------------------------------------------------------------------------
      Total, Howard University................................          221,821           221,399           221,821   ................             +422
                                                               =========================================================================================
COLLEGE HOUSING AND ACADEMIC FACILITIES LOANS PROGRAM.........              435               434               435   ................               +1
 
       HISTORICALLY BLACK COLLEGE AND UNIVERSITY (HBCU)
               CAPITAL FINANCING PROGRAM ACCOUNT
 
HBCU Federal Administration...................................              334               333               334   ................               +1
HBCU Loan Subsidies...........................................           20,150            20,112            20,150   ................              +38
                                                               -----------------------------------------------------------------------------------------
      Total, HBCU Capital Financing Program...................           20,484            20,445            20,484   ................              +39
                                                               =========================================================================================
             INSTITUTE OF EDUCATION SCIENCES (IES)
 
Research, Development and Dissemination.......................          187,500           194,629           185,000            -2,500            -9,629
Statistics....................................................          109,500           111,787           107,000            -2,500            -4,787
Regional Educational Laboratories.............................           54,423            54,320            54,423   ................             +103
Research in Special Education.................................           54,000            53,897            54,000   ................             +103
Special Education Studies and Evaluations.....................           10,818            10,797            10,818   ................              +21
Statewide Data Systems........................................           32,281            34,473            32,281   ................           -2,192
 
Assessment:
    National Assessment.......................................          149,000           148,717           149,000   ................             +283
    National Assessment Governing Board.......................            7,745             8,219             7,745   ................             -474
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Assessment....................................          156,745           156,936           156,745   ................             -191
                                                               =========================================================================================
      Total, IES..............................................          605,267           616,839           600,267            -5,000           -16,572
                                                               =========================================================================================
 
                    DEPARTMENTAL MANAGEMENT
 
Program Administration:
    Salaries and Expenses.....................................          431,000           438,000           430,000            -1,000            -8,000
    Building Modernization....................................            1,000   ................  ................           -1,000   ................
                                                               -----------------------------------------------------------------------------------------
      Total, Program administration...........................          432,000           438,000           430,000            -2,000            -8,000
 
Office for Civil Rights.......................................          108,500           106,797           117,000            +8,500           +10,203
Office of Inspector General...................................           59,256            61,143            59,256   ................           -1,887
                                                               -----------------------------------------------------------------------------------------
      Total, Departmental management..........................          599,756           605,940           606,256            +6,500              +316
                                                               =========================================================================================
      Total, Title III, Department of Education...............       71,637,749        66,342,354        71,721,595           +83,846        +5,379,241
          Current year........................................      (49,040,748)      (43,745,353)      (49,124,594)         (+83,846)      (+5,379,241)
          Fiscal year 2019....................................      (22,597,001)      (22,597,001)      (22,597,001)  ................  ................
                                                               =========================================================================================
                  TITLE IV--RELATED AGENCIES
 
Committee For Purchase From People Who Are Blind Or Severely              8,000             6,117             8,000   ................           +1,883
 Disabled.....................................................
 
        CORPORATION FOR NATIONAL AND COMMUNITY SERVICE
 
                      Operating Expenses
 
Domestic Volunteer Service Programs:
    Volunteers in Service to America [VISTA]..................           92,364             4,910            92,364   ................          +87,454
    National Senior Volunteer Corps:
        Foster Grandparents Program...........................          107,702               117           107,702   ................         +107,585
        Senior Companion Program..............................           45,512               117            45,512   ................          +45,395
        Retired Senior Volunteer Program......................           48,903               117            48,903   ................          +48,786
                                                               -----------------------------------------------------------------------------------------
          Subtotal, Senior Volunteers.........................          202,117               351           202,117   ................         +201,766
                                                               -----------------------------------------------------------------------------------------
          Subtotal, Domestic Volunteer Service................          294,481             5,261           294,481   ................         +289,220
 
National and Community Service Programs:
    AmeriCorps State and National Grants......................          386,010             2,341           386,010   ................         +383,669
    Innovation, Assistance, and Other Activities..............            5,000   ................            5,400              +400            +5,400
    Evaluation................................................            4,000   ................            4,000   ................           +4,000
    National Civilian Community Corps (NCCC)(subtitle E)......           30,000            24,087            30,000   ................           +5,913
    State Commission Support Grants...........................           16,538   ................           16,538   ................          +16,538
                                                               -----------------------------------------------------------------------------------------
      Subtotal, National and Community Service................          441,548            26,428           441,948              +400          +415,520
                                                               -----------------------------------------------------------------------------------------
      Total, Operating expenses...............................          736,029            31,689           736,429              +400          +704,740
                                                               =========================================================================================
National Service Trust........................................          206,842   ................          195,000           -11,842          +195,000
Salaries and Expenses.........................................           81,737            99,735            81,737   ................          -17,998
Office of Inspector General...................................            5,750             3,568             5,750   ................           +2,182
                                                               -----------------------------------------------------------------------------------------
      Total, Corp. for National and Community Service.........        1,030,358           134,992         1,018,916           -11,442          +883,924
                                                               =========================================================================================
 
CORPORATION FOR PUBLIC BROADCASTING:
    Fiscal year 2020 (current) with fiscal year 2018                    445,000   ................          445,000   ................         +445,000
     comparable...............................................
    Fiscal year 2019 advance with fiscal year 2017 comparable          (445,000)         (445,000)         (445,000)  ................  ................
     (NA).....................................................
        Rescission of fiscal year 2019 funds (NA).............  ................        (-445,000)  ................  ................        (+445,000)
                                                               -----------------------------------------------------------------------------------------
          Subtotal, fiscal year 2019 program level............          445,000   ................          445,000   ................         +445,000
 
    Fiscal year 2018 advance with fiscal year 2016 comparable          (445,000)         (445,000)         (445,000)  ................  ................
     (NA).....................................................
        Rescission of fiscal year 2018 funds (NA).............  ................        (-441,500)  ................  ................        (+441,500)
                                                               -----------------------------------------------------------------------------------------
          Subtotal, fiscal year 2018 program level............          445,000             3,500           445,000   ................         +441,500
 
    Public television interconnection system (current)........           50,000   ................           20,000           -30,000           +20,000
Federal Mediation and Conciliation Service....................           46,650            48,655            46,650   ................           -2,005
Federal Mine Safety and Health Review Commission..............           17,184            17,053            17,184   ................             +131
Institute of Museum and Library Services......................          231,000            23,000           235,000            +4,000          +212,000
Medicaid and Chip Payment and Access Commission...............            7,765             8,700             7,765   ................             -935
Medicare Payment Advisory Commission..........................           11,925            12,295            11,925   ................             -370
National Council on Disability................................            3,250             3,211             3,250   ................              +39
National Labor Relations Board................................          274,224           258,000           274,224   ................          +16,224
National Mediation Board......................................           13,800            13,205            13,800   ................             +595
Occupational Safety and Health Review Commission..............           13,225            12,615            13,225   ................             +610
 
                   RAILROAD RETIREMENT BOARD
 
Dual Benefits Payments Account................................           25,000            22,000            22,000            -3,000   ................
Less Income Tax Receipts on Dual Benefits.....................           -2,000            -1,000            -1,000            +1,000   ................
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Dual Benefits.................................           23,000            21,000            21,000            -2,000   ................
 
Federal Payments to the Railroad Retirement Accounts..........              150               150               150   ................  ................
Limitation on Administration..................................          113,500           111,225           114,500            +1,000            +3,275
Limitation on the Office of Inspector General.................           10,000             8,437            11,000            +1,000            +2,563
 
                SOCIAL SECURITY ADMINISTRATION
 
Payments to Social Security Trust Funds.......................           11,400            11,400            11,400   ................  ................
 
             Supplemental Security Income Program
 
Federal Benefit Payments......................................       52,941,736        48,236,000        48,236,000        -4,705,736   ................
Beneficiary Services..........................................           89,000           159,000           159,000           +70,000   ................
Research and Demonstration....................................           58,000           101,000           101,000           +43,000   ................
Afghanistan Special Immigrant Visa............................  ................  ................  ................  ................  ................
Administration................................................        5,029,427         5,060,526         4,954,927           -74,500          -105,599
                                                               -----------------------------------------------------------------------------------------
      Subtotal, SSI program level.............................       58,118,163        53,556,526        53,450,927        -4,667,236          -105,599
 
          Less funds advanced in prior year...................      -14,500,000       -15,000,000       -15,000,000          -500,000   ................
                                                               -----------------------------------------------------------------------------------------
      Subtotal, regular SSI current year......................       43,618,163        38,556,526        38,450,927        -5,167,236          -105,599
 
          New advance, 1st quarter, fiscal year 2019..........       15,000,000        19,500,000        19,500,000        +4,500,000   ................
                                                               -----------------------------------------------------------------------------------------
      Total, SSI program......................................       58,618,163        58,056,526        57,950,927          -667,236          -105,599
                                                               =========================================================================================
             Limitation on Administrative Expenses
 
OASI/DI Trust Funds...........................................        5,145,407         4,916,768         4,950,073          -195,334           +33,305
HI/SMI Trust Funds............................................        1,684,753         2,012,556         1,620,795           -63,958          -391,761
Social Security Advisory Board................................            2,300             2,300             2,300   ................  ................
SSI...........................................................        3,706,485         3,671,376         3,565,777          -140,708          -105,599
                                                               -----------------------------------------------------------------------------------------
      Subtotal, regular LAE...................................       10,538,945        10,603,000        10,138,945          -400,000          -464,055
 
User Fees:
    SSI User Fee activities...................................          126,000           118,000           118,000            -8,000   ................
        CBO adjustment........................................           -3,000            -3,000            -3,000   ................  ................
    SSPA User Fee Activities..................................            1,000             1,000             1,000   ................  ................
        CBO adjustment........................................           -1,000            -1,000            -1,000   ................  ................
                                                               -----------------------------------------------------------------------------------------
          Subtotal, User fees.................................          123,000           115,000           115,000            -8,000   ................
                                                               -----------------------------------------------------------------------------------------
          Subtotal, Limitation on administrative expenses.....       10,661,945        10,718,000        10,253,945          -408,000          -464,055
 
Program Integrity:
    OASDI Trust Funds.........................................          496,058           345,850           345,850          -150,208   ................
    SSI.......................................................        1,322,942         1,389,150         1,389,150           +66,208   ................
                                                               -----------------------------------------------------------------------------------------
      Subtotal, Program integrity funding.....................        1,819,000         1,735,000         1,735,000           -84,000   ................
                                                               =========================================================================================
      Total, Limitation on Administrative Expenses............       12,480,945        12,453,000        11,988,945          -492,000          -464,055
                                                               =========================================================================================
 
                  Office of Inspector General
 
Federal Funds.................................................           29,787            30,000            30,000              +213   ................
Trust Funds...................................................           75,713            75,500            75,500              -213   ................
                                                               -----------------------------------------------------------------------------------------
      Total, Office of Inspector General......................          105,500           105,500           105,500   ................  ................
                                                               =========================================================================================
Adjustment: Trust fund transfers from general revenues........       -5,029,427        -5,060,526        -4,954,927           +74,500          +105,599
                                                               -----------------------------------------------------------------------------------------
      Total, Social Security Administration...................       66,186,581        65,565,900        65,101,845        -1,084,736          -464,055
          Federal funds.......................................       58,782,350        58,212,926        58,107,327          -675,023          -105,599
              Current year....................................      (43,782,350)      (38,712,926)      (38,607,327)      (-5,175,023)        (-105,599)
              New advances, 1st quarter, fiscal year 2019.....      (15,000,000)      (19,500,000)      (19,500,000)      (+4,500,000)  ................
          Trust funds.........................................        7,404,231         7,352,974         6,994,518          -409,713          -358,456
                                                               =========================================================================================
      Total, Title IV, Related Agencies.......................       68,485,612        66,244,555        67,363,434        -1,122,178        +1,118,879
          Federal Funds.......................................       60,945,956        58,759,624        60,231,491          -714,465        +1,471,867
              Current Year....................................      (45,500,956)      (39,259,624)      (40,286,491)      (-5,214,465)      (+1,026,867)
              Fiscal Year 2019 Advance........................      (15,000,000)      (19,500,000)      (19,500,000)      (+4,500,000)  ................
              Fiscal Year 2020 Advance........................         (445,000)  ................         (445,000)  ................        (+445,000)
          Trust Funds.........................................        7,539,656         7,484,931         7,131,943          -407,713          -352,988
                                                               =========================================================================================
Grand Total...................................................      933,945,868       964,663,824       991,867,000       +57,921,132       +27,203,176
--------------------------------------------------------------------------------------------------------------------------------------------------------
\1\Sec.4002 of Public Law 111-148.
\2\21st Century CURES Act (Public Law 114-255); fiscal year 2017 funds provided in Public Law 114-254.
\3\Fiscal year 2018 budget request proposes consolidating the Agency for Healthcare Research and Quality within the National Institutes of Health as the
  National Institute for Research on Safety and Quality.
\4\Reflects transfer from NIH Innovation Account to NCI, NINDS and NIMH.

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