Senate Report 115-150 - DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND RELATED AGENCIES APPROPRIATION BILL, 2018

[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

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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:

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:

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:

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:

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:

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:

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:

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:

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:

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:

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:

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:

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:

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:

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:

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:

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:

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;

* * * * * * *

[(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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