[House Report 117-403]
[From the U.S. Government Publishing Office]


117th Congress }                                                 {  Report
                          HOUSE OF REPRESENTATIVES  
2d Session     }                                                 {  117-403                    
                  
                                                       
_______________________________________________________________________

                                     




  DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND 
               RELATED AGENCIES APPROPRIATIONS BILL, 2023

                               ----------                              

                              R E P O R T

                                 of the

                      COMMITTEE ON APPROPRIATIONS
                        HOUSE OF REPRESENTATIVES

                             together with

                             MINORITY VIEWS

                        [to accompany h.r. 8295]




  July 5, 2022.--Committed to the Committee of the Whole House on the   
                 State of the Union and ordered to be printed
  
           


  DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND 
               RELATED AGENCIES APPROPRIATIONS BILL, 2023
               
               
               
117th Congress }                                               {   Report
                          HOUSE OF REPRESENTATIVES 
 2d Session    }                                               { 117-403
                                                                
_______________________________________________________________________

                                     



  DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND 
               RELATED AGENCIES APPROPRIATIONS BILL, 2023

                               __________

                              R E P O R T

                                 of the

                      COMMITTEE ON APPROPRIATIONS

                        HOUSE OF REPRESENTATIVES

                             together with

                             MINORITY VIEWS

                        [to accompany h.r. 8295]






  July 5, 2022.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed           
                           
              
              
              
                       ______                       


             U.S. GOVERNMENT PUBLISHING OFFICE 
 47-923              WASHINGTON : 2022 
             
              
              

117th Congress  }                                              {   Report
                        HOUSE OF REPRESENTATIVES
 2d Session     }                                              {  117-403

======================================================================



 
  DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND 
               RELATED AGENCIES APPROPRIATIONS BILL, 2023

                                _______
                                

  July 5, 2022.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

          Ms. DeLauro, from the Committee on Appropriations, 
                        submitted the following

                              R E P O R T

                             together with

                             MINORITY VIEWS

                        [To accompany H.R. 8295]

    The Committee on Appropriations submits the following 
report in explanation of the accompanying bill making 
appropriations for the Departments of Labor, Health and Human 
Services (except the Food and Drug Administration, the Agency 
for Toxic Substances and Disease Registry and the Indian Health 
Service), and Education, and the Committee for Purchase from 
People Who Are Blind or Severely Disabled, Corporation for 
National and Community Service, Corporation for Public 
Broadcasting, Federal Mediation and Conciliation Service, 
Federal Mine Safety and Health Review Commission, Institute of 
Museum and Library Services, Medicaid and CHIP Payment and 
Access Commission, Medicare Payment Advisory Commission, 
National Council on Disability, National Labor Relations Board, 
National Mediation Board, Occupational Safety and Health Review 
Commission, Railroad Retirement Board, and Social Security 
Administration for the fiscal year ending September 30, 2023, 
and for other purposes.

                        INDEX TO BILL AND REPORT

                                                            Page number

                                                            Bill Report
Summary of Estimates and Appropriation.....................     1
                                                                      3
General Summary of the Bill................................     1
                                                                      3
Title I--Department of Labor:                                   2
                                                                     11
        Employment and Training Administration.............     2
                                                                     11
        Employee Benefits Security Administration..........    22
                                                                     23
        Pension Benefit Guaranty Corporation...............    23
                                                                     24
        Wage and Hour Division.............................    24
                                                                     24
        Office of Labor-Management Standards...............    24
                                                                     26
        Office of Federal Contract Compliance Programs.....    25
                                                                     26
        Office of Workers' Compensation Programs...........    25
                                                                     27
        Occupational Safety and Health Administration......    29
                                                                     29
        Mine Safety and Health Administration..............    30
                                                                     32
        Bureau of Labor Statistics.........................    32
                                                                     33
        Office of Disability Employment Policy.............    32
                                                                     34
        Departmental Management............................    33
                                                                     35
        General Provisions.................................    38
                                                                     41
Title II--Department of Health and Human Services:             48
                                                                     42
        Health Resources and Services Administration.......    48
                                                                     42
        Centers for Disease Control and Prevention.........    58
                                                                     70
        National Institutes of Health......................    66
                                                                     95
        Substance Use And Mental Health Services 
            Administration.................................    74
                                                                    158
        Agency for Healthcare Research and Quality.........    81
                                                                    176
        Centers for Medicare & Medicaid Services...........    81
                                                                    178
        Administration for Children and Families...........    85
                                                                    196
        Administration for Community Living................    97
                                                                    212
        Office of the Secretary............................   100
                                                                    218
                Public Health and Social Services Emergency 
                    Fund...................................   104
                                                                    235
                Advanced Research Projects Agency for 
                    Health.................................   105
                                                                    242
        General Provisions.................................   106
                                                                    242
Title III--Department of Education:                           145
                                                                    246
        Education for the Disadvantaged....................   145
                                                                    246
        Impact Aid.........................................   147
                                                                    251
        School Improvement Programs........................   148
                                                                    252
        Indian Education...................................   150
                                                                    257
        Innovation and Improvement.........................   150
                                                                    258
        Safe Schools and Citizenship Education.............   151
                                                                    265
        English Language Acquisition.......................   152
                                                                    268
        Special Education..................................   152
                                                                    269
        Rehabilitation Services............................   158
                                                                    272
        Special Institutions for Persons with Disabilities.   159
                                                                    274
        Career, Technical and Adult Education..............   159
                                                                    275
        Student Financial Assistance.......................   160
                                                                    277
        Federal Direct Student Loan Program Account........         279
        Student Aid Administration.........................   161
                                                                    280
        Higher Education...................................   162
                                                                    283
        Howard University..................................   163
                                                                    295
        College Housing and Academic Facilities Loans......   163
                                                                    296
        Historically Black College and University Capital 
            Financing Program Account......................   164
                                                                    296
        Institute of Education Sciences....................   164
                                                                    296
        Departmental Management............................   165
                                                                    300
        General Provisions.................................   166
                                                                    303
Title IV--Related Agencies:                                   176
                                                                    305
        Committee for the Purchase from People Who Are 
            Blind or Severely Disabled.....................   176
                                                                    305
        Corporation for National and Community Service.....   177
                                                                    305
        Corporation for Public Broadcasting................   183
                                                                    309
        Federal Mediation and Conciliation Service.........   184
                                                                    310
        Federal Mine Safety and Health Review Commission...   185
                                                                    310
        Institute of Museum and Library Services...........   186
                                                                    311
        Medicare Payment Advisory Commission...............   186
                                                                    312
        Medicaid and CHIP Payment and Access Commission....   186
                                                                    313
        National Council on Disability.....................   186
                                                                    313
        National Labor Relations Board.....................   187
                                                                    313
        National Mediation Board...........................   187
                                                                    313
        Occupational Safety and Health Review Commission...   187
                                                                    314
        Railroad Retirement Board..........................   187
                                                                    314
        Social Security Administration.....................   189
                                                                    315
Title V--General Provisions:                                  195
                                                                    320
House of Representatives Report Requirements

                Summary of Estimates and Appropriations

    The following table compares on a summary basis the 
appropriations, including trust funds for fiscal year 2023, the 
budget request for fiscal year 2023, and the Committee 
recommendation for fiscal year 2023 in the accompanying bill.

                                         2023 LABOR, HHS, EDUCATION BILL
                                 [Discretionary funding in thousands of dollars]
----------------------------------------------------------------------------------------------------------------
                                                   Fiscal Year--                   2023 Committee compared to--
                                 -------------------------------------------------------------------------------
         Budget Activity                                               2023
                                   2022  Enacted   2023  Budget      Committee     2022  Enacted   2023  Budget
----------------------------------------------------------------------------------------------------------------
Department of Labor.............     $13,189,218     $14,900,363     $15,030,743     +$1,841,525       +$130,380
Department of Health and Human       108,625,224     123,894,211     124,218,951     +15,593,727        +324,740
 Services.......................
Department of Education.........      76,424,255      88,326,976      86,717,384     +10,293,129      -1,609,592
Related Agencies................      15,906,903      17,656,312      17,288,922      +1,382,019        -367,390
----------------------------------------------------------------------------------------------------------------

                      General Summary of the Bill

    For fiscal year 2023, the Committee recommends a total of 
$224,399,000,000 in current year discretionary funding--the 
302(b) allocation--and $242,105,000,000 in overall programmatic 
funding, including offsets and adjustments. The fiscal year 
2023 recommendation is an increase of $28,536,000,000 above the 
fiscal year 2022 enacted level.
    The Labor-HHS-Education bill supports some of the nation's 
most critical programs that touch individuals and families 
throughout their lifespan, from Early Head Start to Social 
Security.
    Through this bill, the Committee continues to build on 
progress from the fiscal year 2022 Consolidated Appropriations 
Act, such as significant investments in education, including 
strong funding increases for schools serving students in low-
income communities and students with disabilities, as well as 
programs to expand access to post-secondary education.
    The fiscal year 2023 Labor-HHS-Education bill continues to 
build on investments in public health, including flexible 
resources for State and local governments to strengthen core 
public health infrastructure and capacity. And the bill 
continues to build on progress in biomedical research--
following a 50 percent increase in funding for the National 
Institutes of Health over the past seven years--and expands the 
subcommittee's investment in the Advanced Research Projects 
Agency for Health (ARPA-H), which was established in fiscal 
year 2022, to accelerate the pace of scientific breakthroughs 
that have the potential to transform health care and address 
our most complex health challenges.
    The bill continues to address our nation's most urgent 
health crises, including maternal health, mental health, gun 
violence, and substance misuse, while making strides to reduce 
persistent and unacceptable health disparities.
    And the Committee invests in workforce training and worker 
protection agencies, including significant new investments to 
rebuild capacity to enforce federal labor laws to protect 
workers' paychecks, benefits, and ensure the health and safety 
of our workplaces. The Committee also makes a major commitment 
to retired workers by including an increase of $1,100,000,000 
for the Social Security Administration's operating expenses, 
which will restore federal capacity to provide earned benefits 
and services through Social Security, one of the cornerstones 
of the federal safety net.
    Some of the most notable initiatives in fiscal year 2023 
include:

                   Elementary and Secondary Education

    The Committee is committed to increasing investments in 
core Federal programs that support high-quality public 
education opportunities for all students. Our nation's public 
schools serve more than 50 million children, more than 50 
percent of whom come from low-income families. Research shows 
that low-income students are more likely to struggle 
academically and often attend high-need schools with fewer 
resources, less experienced teachers, and more limited access 
to advanced coursework. At the same time, there is overwhelming 
empirical evidence on education spending and student outcomes 
that finds more funding in schools yields statistically 
significant positive results for students.
    Overall, the Committee recommendation provides 
$50,918,030,000 for Federal K-12 education programs, including 
the Individuals with Disabilities Education Act (IDEA), an 
increase of $8,333,798,000 over the fiscal year 2022 enacted 
level. The recommendation is a 20 percent increase over last 
year.
    In particular, the Committee recommends an additional 
$3,000,000,000 over the fiscal year 2022 enacted level for 
Title I Grants to Local Educational Agencies for a total of 
$20,536,802,000. Title I serves an estimated 25 million 
students in nearly 90 percent of school districts and nearly 60 
percent of all public schools.
    The Committee recommends $1,000,000,000 for the English 
Language Acquisition program, which provides formula grants to 
States to serve English Leaners (EL), an increase of 
$168,600,000 over the fiscal year 2022 enacted level. Federal 
data shows that significant achievement gaps exist between ELs 
and their peers. At the same time, many States and school 
districts have experienced rapid growth in their EL 
populations. Providing increased resources to improve 
educational quality for EL students is a top priority for the 
Committee.
    The Committee recommends $16,259,193,000 for IDEA Part B 
Grants to States, which is $2,915,489,000 above the fiscal year 
2022 enacted level. The Committee is concerned that the Federal 
share of the excess cost of educating students with 
disabilities has declined and notes the critical role this 
increase will play in helping to reverse this trend and serve 
as a significant step toward fully funding IDEA.

                       Early Childhood Education

    The Committee includes nearly $20,000,000,000 for early 
childhood education programs through the Child Care and 
Development Block Grant (CCDBG), Head Start, and Preschool 
Development Grants--an increase of $2,420,000,000 over the 
fiscal year 2022 enacted level.
    The Committee recognizes that child care and early learning 
investments are essential for children and working families, 
and includes a $1,000,000,000 increase for the CCDBG program. 
This funding will provide critical support to families by 
providing affordable, high quality child care to more children, 
providing opportunities for more parents to remain in or return 
to the workforce, and supporting the child care workforce, 
which is primarily made up of women, and particularly women of 
color.
    The bill includes an increase of $1,360,000,000 for Head 
Start, including a $596,000,000 cost-of-living adjustment for 
the Head Start workforce, $262,000,000 in flexible, quality 
improvement funding for program-specific needs, and 
$500,000,000 to expand Head Start, Early Head Start, and Early 
Head Start-Child Care Partnerships to approximately 30,000 
additional infants and toddlers from low-income families.
    The Committee further recommends $350,000,000, an increase 
of $60,000,000, for Preschool Development Grants to build State 
and local capacity to provide early childhood care and 
education for children birth through five from low- and 
moderate-income families.

                            Higher Education

    In the aftermath of the COVID-19 pandemic, college 
affordability and access are vital to our nation's recovery 
efforts. Therefore, the Committee recommendation makes 
necessary investments in programs supporting student financial 
aid, student support services, and other programs supporting 
institutions of higher education and their students.
    The recommendation includes sufficient funding to support 
an increase in the maximum Pell Grant by $500 over the fiscal 
year 2022 enacted level, from $6,895 to $7,395. In addition, 
the Committee recommendation provides $1,243,882,000 for 
Federal Work Study, an increase of $33,882,000 over the fiscal 
year 2022 enacted level. The Committee recommendation also 
includes $920,000,000 for the Federal Supplemental Educational 
Opportunity Grants, an increase of $25,000,000 over the fiscal 
year 2022 enacted level.
    The Committee recommendation includes $1,297,761,000 for 
the TRIO programs, an increase of $160,761,000 over the fiscal 
year 2022 enacted level. The recommendation also includes 
$408,000,000 for the Gaining Early Awareness and Readiness for 
Undergraduate Programs, which is $30,000,000 more than the 
fiscal year 2022 enacted level.
    In an effort to assist postsecondary institutions in 
addressing barriers in completion and attainment, the Committee 
recommendation includes a total of $1,110,117,000 for programs 
that serve high proportions of students of color (Historically 
Black Colleges and Universities, Hispanic-Serving Institutions, 
Tribal Colleges and Universities, and other Minority Serving 
Institutions), an increase of $225,000,001 over the fiscal year 
2022 enacted level.
    The Committee also includes robust funding to support 
teacher preparation. The recommendation includes $30,000,000 in 
funding for the Augustus F. Hawkins Centers of Excellence 
program, an increase of $22,000,000 over the fiscal year 2022 
enacted level, and the recommendation includes $132,092,000 for 
the Teacher Quality Partnerships program, an increase of 
$73,000,000 over the fiscal year 2022 enacted level.

                             Public Health

    Public health can no longer only get attention during a 
crisis. The Committee recognizes that State, local, 
territorial, and Federal public health partners need a long-
term strategy and long-term investments, beginning at CDC. The 
bill includes approximately $10,500,000,000 for CDC, an 
increase of more than $2,000,000,000.
    Half of the increase included in the bill is directed to 
core capacities, as CDC's budget must be rebalanced between 
disease- or condition-specific activities and fundamental 
activities that support the nation's public health ecosystem. 
Building on funding initially provided in fiscal year 2022, the 
bill includes an increase of $550,000,000 for public health 
infrastructure to turn the tide on the nation's public health 
capacity by providing a stable source of disease-agnostic 
funding so the nation's State, local, territorial, and Federal 
public health agencies will be better equipped to coordinate 
together to save lives.
    This bill also includes core capacity increases of: 
$45,000,000 for Public Health Workforce and Career Development 
to invest in essential public health workers who protect our 
communities and are empowered by science; $150,000,000 for 
Public Health Data Modernization to advance the transformation 
of the collection and utilization of public health data from 
retrospective reporting to driving action in real time; 
$10,000,000 to advance laboratory science and safety so CDC is 
capable of meeting evolving health threats and maintaining the 
highest standards; $10,000,000 for the National Center for 
Health Statistics to initiate investments in the next 
generation of surveys; $100,000,000 for Global Public Health 
Protection to modernize and expand disease surveillance and 
response capabilities to strengthen global health security; and 
$50,000,000 for the Center for Forecasting and Outbreak 
Analytics to improve preparedness and response.

               Biomedical Research through NIH and ARPA-H

    The Committee has increased NIH funding by nearly 
$15,000,000,000, or 49 percent, over the past seven years, 
under both Democratic and Republican leadership. The Committee 
continues and accelerates this investment by providing 
$47,459,000,000, an increase of $2,500,000,000 above the fiscal 
year 2022 enacted level for NIH research and activities.
    The Committee continues its ongoing support for key NIH 
initiatives, such as the Cancer Moonshot, BRAIN Initiative, and 
the All of Us Precision Medicine Initiative. The bill also 
includes sufficient funding to provide an across-the-board 
increase of at least 3.2 percent for NIH Institutes and 
Centers. The Committee remains concerned that targeted funding 
for specific research initiatives in recent years has slowed 
the growth in other areas of basic research that may lead to 
unforeseeable scientific breakthroughs.
    The Committee also established the Advanced Projects 
Research Agency for Health (ARPA-H) in fiscal year 2022. 
Modeled after the Defense Advanced Research Project Agency 
(DARPA), ARPA-H will invest in large high-risk, high-reward 
research projects that have the potential to achieve 
breakthroughs in the treatment of diseases such as cancer, 
Alzheimer's disease, diabetes, amyotrophic lateral sclerosis 
(ALS), and others that impact the lives of millions of 
Americans and exacerbate existing health disparities. The 
Committee provides $2,750,000,000 for ARPA-H in fiscal year 
2023, an increase of $1,750,000,000 above the fiscal year 2022 
enacted level, to accelerate these critical research projects.

                      Mental and Behavioral Health

    The COVID-19 pandemic exacerbated existing mental health 
and substance use disorder crises, with more people reporting 
increased levels of anxiety, depression, suicidal ideation, and 
substance use. In particular, more than a third of high school 
students reported experiencing poor mental health during the 
COVID-19 pandemic. Suicide continues to be a leading cause of 
death, taking more than 45,000 lives in 2020, and is the second 
leading cause of death among youth between the ages of 10 and 
14. Drug overdose deaths have also continued to increase with 
CDC estimating more than 107,000 drug overdose deaths in the 
United States during 2021, an increase of nearly 15 percent 
from 2020, according to provisional data.
    The Committee recommendation includes $9,170,380,000 for 
the Substance Use And Mental Health Services Administration 
(SAMHSA), making a range of investments across the behavioral 
health continuum to support prevention, screening, treatment, 
and other services. The Committee includes a total increase of 
$1,726,062,000 for mental health activities. This includes an 
increase of $500,000,000 for the Mental Health Block Grant and 
an increase of $85,000,000 for Certified Community Behavioral 
Health Clinics. In addition, the Committee includes a 
significant increase of $640,280,000 for the new three-digit 
988 program, including the National Suicide Prevention Lifeline 
and behavioral health crisis response infrastructure, which is 
scheduled for rollout in July 2022. The bill also increases the 
mental health crisis set-aside to ten percent and creates a new 
set-aside for prevention and early intervention.
    The Committee includes $60,000,000, an increase of 
$50,000,000 over the fiscal year 2022 enacted level, for the 
second year of the Mental Health Crisis Response Grant program, 
to help communities continue to create mobile crisis response 
teams that divert the response for mental health crises from 
law enforcement to behavioral health teams.
    The bill supports children's mental health with a 
$68,113,000 increase to the National Child Traumatic Stress 
Initiative, a $20,000,000 increase for Infant and Early 
Childhood Mental Health, and an additional $100,000,000 for 
Children's Mental Health services, including a new pilot 
program to address the impact of violence in communities of 
color.
    The Committee includes a total increase of $871,452,000 for 
substance use treatment activities. This includes an increase 
of $500,000,000 for the Substance Use Prevention and Treatment 
Block Grant and an increase of $250,000,000 for State Opioid 
Response Grants. The bill creates a new set-aside within the 
block grant to support recovery services. The Committee 
recommendation also includes an increase of $30,215,000 for 
substance use prevention services and activities.
    The bill also includes a significant investment in 
recruiting and training mental and behavioral health 
professionals to expand access to quality mental health and 
substance use disorder treatment services to areas and 
populations most in need, including an increase of $62,000,000 
for HRSA's Behavioral Health Workforce Education and Training 
activities.

                            Maternal Health

    To help eliminate race-based disparities and drive down the 
rate of maternal mortality, the bill provides an increase of 
$60,000,000 for CDC's Safe Motherhood and Infant Health 
programs. This funding allows for the expansion of Maternal 
Mortality Review Committees and Perinatal Quality 
Collaboratives, and for increased support to current States and 
territories, as well as increased support for other programs 
including Sudden Unexplained Infant Death. The bill provides an 
increase of $120,000,000 for HRSA's Maternal and Child Health 
Services Block Grant, which includes investments in projects 
such as an increase of $10,000,000 for State Maternal Health 
Innovation Grants, an increase of $3,300,000 to expand the 
Alliance for Innovation in Maternal Health Safety Bundles to 
more States, and an increase of $3,000,000 to support and 
expand availability of the Maternal Mental Health Hotline. The 
bill also provides $30,000,000 to recruit and train midwives 
and doulas and an increase of $5,000,000 for Screening and 
Treatment for Maternal Depression and Related Disorders.

                             HIV Initiative

    Advances in medications for the prevention and treatment of 
HIV, improved diagnostic tests, and new outbreak detection 
technology provide a unique opportunity to alter the trajectory 
of HIV infection rates in the U.S. with a goal of eliminating 
new HIV infections. This bill provides a total of $738,000,000, 
which is an increase of $225,000,000 for the fourth year of the 
Ending the HIV Epidemic Initiative, which began a new era of 
moving the U.S. from HIV prevention to HIV epidemic control.

            Firearm Injury and Mortality Prevention Research

    Firearm injury and mortality is among the leading causes of 
death for people aged 1-64 in the U.S. In 2019, there were 
nearly 40,000 firearm-related deaths in the U.S. Addressing the 
gaps in knowledge around this issue and identifying effective 
prevention strategies are needed steps toward keeping people, 
families, schools, and communities safe from firearm injury. In 
fiscal year 2020, the Committee provided the first funding in 
more than two decades to address the public health emergency of 
firearm violence with a total of $25,000,000 to CDC and NIH. 
This bill more than doubles the total funding to $60,000,000 to 
support research to identify the most effective ways to prevent 
firearm related injuries and deaths, and to broaden firearm 
injury data collection. Building on these efforts to address 
firearm injury and death, this bill also includes $100,000,000 
for a new evidence-based community violence intervention 
initiative at CDC, which aims to prevent intentional violence, 
such as mass casualty violence or gang violence.

                        Employment and Training

    The economy and the labor market have seen significant 
gains since the economic recession resulting from the COVID-19 
pandemic. The U.S. economy has added 6.5 million jobs over the 
past year and the unemployment rate, which peaked at 14.7 
percent two years ago, is now down to 3.6 percent. Despite the 
strong labor market, however, economic opportunity remains hard 
to reach for millions in communities around the country. The 
unemployment rate for Black and Hispanic workers remains 
considerably higher than that of the overall population, and 
far too many women have been pushed out of the workforce or 
forced to consider new employment over the last two years. We 
must prioritize our workers and their wages as the nation 
emerges from the COVID-19 pandemic.
    As such, the Committee recommendation includes needed 
investments in workforce and training systems. Specifically, 
the recommendation includes $3,135,332,000 for Workforce 
Innovation and Opportunity Act Grants to States, an increase of 
$256,000,000 above the fiscal year 2022 enacted level and 
$116,230,000 above the fiscal year 2023 budget request. In 
addition, the recommendation includes $303,000,000 for 
registered apprenticeships, an increase of $68,000,000 above 
the fiscal year 2022 enacted level and the same as the fiscal 
year 2023 budget request.
    The recommendation also includes $100,000,000 for the 
Strengthening Community Colleges Training Grant program, an 
increase of $50,000,000 above the fiscal year 2022 enacted 
level and equal to the fiscal year 2023 budget request. This 
program helps community colleges build capacity for training 
workers. The recommendation includes $50,000,000 for a new 
grant program to support communities suffering dislocations 
related to changes in fossil fuel and other energy industries.
    The recommendation also includes $3,184,635,000 for 
Unemployment Compensation State Operations, an increase of 
$333,819,000 over the fiscal year 2022 enacted level and the 
same as the fiscal year 2023 budget request. This funding will 
help support States in overcoming challenges associated with 
administering unemployment insurance programs. Altogether, 
these investments will continue to support families with the 
economic consequences of COVID-19 and prepare workers for new 
employment opportunities.

                       Worker Protection Agencies

    The Committee recommends $2,179,524,000 for Department of 
Labor agencies responsible for worker protection and worker 
rights. This is an increase of $346,589,000 over the fiscal 
year 2022 enacted level.
    The Wage and Hour Division employs fewer investigators 
today than it did 75 years ago, despite the workforce having 
grown significantly in that time. To help make up for this lost 
ground, hold bad-acting employers accountable, and defend 
working people so they receive the pay they earned and are 
legally entitled to, the Committee recommendation includes 
$312,678,000, an increase of $61,678,000 over the fiscal year 
2022 enacted level and an increase of $5,000,000 over the 
fiscal year 2023 budget request.
    The Occupational Safety and Health Administration (OSHA) 
enforcement of safety and health laws is critical to preventing 
workplace tragedies from occurring, which is why it is 
concerning that, under current staffing levels, the agency 
would need more than 150 years to inspect each workplace under 
its jurisdiction. To restore OSHA's enforcement capacity, the 
Committee includes $712,015,000, an increase of $100,000,000 
over the fiscal year 2022 enacted level and $10,610,000 over 
the fiscal year 2023 budget request for this critical worker 
protection agency.
    The Committee also recommends $319,424,000 for the National 
Labor Relations Board, an increase of $45,200,000 over the 
fiscal year 2022 enacted level and the same as the fiscal year 
2022 budget request. This increase will restore the NLRB's 
capacity to protect workers' rights to union representation and 
collective bargaining.

                            POLICY HEARINGS

    The Committee continued to fulfill its responsibility to 
conduct oversight of programs under its jurisdiction by holding 
nine subcommittee hearings--including four budget hearings and 
three policy hearings, as well as subcommittee hearings to take 
testimony from Members of Congress and public witnesses.

Social and Emotional Learning and Whole Child Approaches in K-12 
        Education

    The Subcommittee held a hearing on ``Social and Emotional 
Learning (SEL) and Whole Child Approaches in K-12 Education,'' 
during which the Subcommittee heard from a panel of national 
experts on the robust evidence of effectiveness for whole child 
interventions, including SEL. The Subcommittee focused on how 
high-quality SEL programs that support students' social, 
emotional, and cognitive development result in lasting positive 
academic and life outcomes. In addition, the Subcommittee 
explored how dedicated Federal resources for these approaches 
are vital to expanding their reach nationwide.

Healthy Aging: Maximizing the Independence, Well-Being, and Health of 
        Older Adults

    The Subcommittee held a hearing to discuss some of the top 
health issues facing seniors, with a particular focus on the 
importance of senior nutrition, elder justice, mental health, 
and falls prevention programs. The Subcommittee recognizes that 
the country's senior population is growing, and that the Labor, 
Health and Human Services, Education, and Related Agencies bill 
funds several key agencies, including the Administration for 
Community Living (ACL), CDC, and SAMHSA, that provide direct 
services to support seniors' independence, health, and overall 
well-being. The Committee heard from four aging experts about 
some of the most significant challenges to healthy aging, and 
the need for specialized prevention, treatment, and support 
services to support seniors' physical and mental well-being.

Tackling Teacher Shortages

    The Subcommittee held a hearing on ``Tackling Teacher 
Shortages,'' during which the Subcommittee heard from a panel 
of national experts on the scope and severity of nationwide 
teacher shortages. The Subcommittee discussed root causes of 
teacher shortages and explored acute challenges with the 
retention and recruitment of educators of color and special 
educators. In addition, the Subcommittee identified strategies 
to help rebuild educator pipelines and address shortages and 
highlight needed investments in programs funded in this bill 
that support educator pipelines and address challenges related 
to recruitment and retention.

                      TITLE I--DEPARTMENT OF LABOR


                 Employment and Training Administration


 
 
 
Appropriation, fiscal year 2022.......................   $10,481,739,000
Budget request, fiscal year 2023......................    11,570,169,000
Committee Recommendation..............................    11,763,847,000
    Change from enacted level.........................    +1,282,108,000
    Change from budget request........................      +193,678,000
 

    The Employment and Training Administration (ETA) 
administers Federal job training grant programs and Trade 
Adjustment Assistance and provides funding for the 
administration and oversight of the State Unemployment 
Insurance and Employment Service system.

                    TRAINING AND EMPLOYMENT SERVICES

 
 
 
Appropriation, fiscal year 2022.......................    $3,912,338,000
Budget request, fiscal year 2023......................     4,410,999,000
Committee Recommendation..............................     4,597,632,000
    Change from enacted level.........................      +685,294,000
    Change from budget request........................      +186,633,000
 

    Training and Employment Services provides funding for 
Federal job training programs authorized primarily by the 
Workforce Innovation and Opportunity Act of 2014 (WIOA).
    Adult Employment and Training Activities.--For Adult 
Employment and Training Activities, the Committee recommends 
$940,649,000, which is $70,000,000 more than the fiscal year 
2022 enacted level and $40,662,000 more than the fiscal year 
2023 budget request.
    Youth Employment and Training Activities.--For Youth 
Employment and Training Activities, the Committee recommends 
$1,033,130,000, which is $100,000,000 more than the fiscal year 
2022 enacted level and $69,293,000 more than the fiscal year 
2023 budget request.
    Dislocated Worker Employment and Training Activities.--For 
Dislocated Worker Employment and Training Activities, the 
Committee recommends $1,161,553,000, which is $86,000,000 more 
than the fiscal year 2022 enacted level and $6,275,000 more 
than the fiscal year 2023 budget request.
    Dislocated Worker Assistance National Reserve.--The 
Committee recommends $457,386,000 for the Dislocated Workers 
National Reserve, an increase of $156,527,000 more than the 
fiscal year 2022 enacted level and $70,000,000 below the fiscal 
year 2023 budget request.
    The Committee recommendation includes $100,000,000, an 
increase of $50,000,000 over the fiscal year 2022 enacted level 
and is the same as the fiscal year 2023 budget request, for 
Strengthening Community College Training Grants to support a 
new grant competition. This funding will continue to help 
better align workforce development efforts with postsecondary 
education and build off lessons learned from the Trade 
Adjustment Assistance Community College and Career Training 
Grant program. The Committee continues to direct the Department 
to follow the program requirements as laid out in House Report 
116-62, except that the 120 day requirement for the 
solicitation shall not apply.
    The Committee recommendation also includes $50,000,000 for 
a new program designed to assist communities experiencing 
dislocations occurring in fossil fuel and other energy related 
industries. A part of the Interagency Working Group on Coal and 
Power Plant Communities and Economic Revitalization, this 
program builds upon the Obama Administration's POWER+ 
initiative and is intended to support the economic well-being 
of workers and communities impacted by changes in the coal, 
oil, gas, and other industries.
    The Committee strongly encourages continued investment in 
areas with high rates of unemployment and substance use 
disorder impacted by the loss of employment in the coal 
industry. This industry has experienced significant employment 
reduction in the past decade and sustained investment to 
transition workers to new industries is necessary to offset 
challenging economic conditions.
    The Committee is aware of the high, unmet demand for 
cybersecurity and software development skills in both the 
Department of Defense (DoD) and the private sector and 
appreciates the Secretary's attention to this priority. Given 
the high wages and job security associated with jobs in these 
areas, combined with the benefits for national security and the 
economy at large, the Committee directs the Secretary to 
utilize appropriate discretionary or mandatory funds available 
for the purpose of high skill job training to establish grants 
for qualified training and educational institutions to help 
increase training capacity to meet this demand. The Department 
is also strongly encouraged to coordinate with partners within 
the DoD to ensure the program is effectively targeted to meet 
existing needs.
    The Committee includes $5,000,000 for the Department of 
Labor to establish an Automation Impacted Industries Pilot 
Program to award competitive grants to industry or sector 
partnerships to support demonstration and pilot projects 
relating to the training needs of workers who are, or are 
likely to become, dislocated workers as a result of automation. 
Under this program, grantees may use the funds for one or more 
of the following: 1) Providing training services, which may 
include training services that prepare workers for in-demand 
industry sectors or occupations; 2) providing assistance for 
employers in developing a staff position for an individual who 
will be responsible for supporting training services provided 
under the grant; 3) purchasing equipment or technology 
necessary for training services; 4) providing job search and 
other transitional assistance to workers in industries with 
high rates of job loss; 5) providing a training stipend to 
workers for training services; 6) providing integrated 
education and training.
    The Committee provides $45,000,000 for the Workforce 
Opportunity for Rural Communities program, to provide enhanced 
worker training in the Appalachian, Delta, and Northern Border 
regions.
    The Committee encourages the Department to develop 
demonstration and pilot programs that facilitate education and 
training programs in the field of advanced manufacturing. 
Eligible entities include local educational entities (e.g., 
technical college, community college, a manufacturing extension 
center, or an entity that assists educationally underserved 
communities) partnering with manufacturers that employ 
individuals who have advanced manufacturing skills. These 
programs should (1) develop skills and competencies of workers 
in communities with expected growth in advanced manufacturing; 
(2) provide education and training for available and 
anticipated jobs in advanced manufacturing; (3) educate 
individuals about career advancement opportunities within 
advanced manufacturing; (4) strengthen community college 
partnerships with manufacturing extension centers and advanced 
manufacturing businesses in an effort to meet the needs of 
businesses for adaptability in training of workers; and (5) 
give priority to incumbent workers, dislocated workers, and 
unemployed individuals.
    The Committee recognizes that the environmental health 
workforce is vital to protecting the health and safety of the 
public. The Committee encourages the Secretary, in coordination 
with Federal, State, local, and tribal government agencies, and 
private-sector and nongovernmental entities, to develop model 
standards and guidelines for credentialing environmental health 
workers. The Committee further encourages the Secretary to 
develop a comprehensive and coordinated plan for developing the 
environmental health workforce to meet national needs. This 
plan should include performance measures to more clearly 
determine the extent to which these programs and activities are 
meeting the Department's strategic goal of strengthening the 
environmental health workforce; identify any gaps between 
existing programs and activities and future environmental 
health workforce needs; identify actions to address such 
identified gaps; and identify any additional statutory 
authority that is needed by the Department to implement such 
identified actions. The Committee requests this plan no later 
than 360 days after the date of enactment of this Act.
    The Committee recognizes that there is a significant number 
of immigrants that arrive in America, fluent in English and 
holding degrees and credentials in health care from their home 
countries. Because of the significant barriers of translating 
these foreign certifications into required American 
certifications, many immigrants are underemployed, resulting in 
a lower quality of life and contributing to the shortage of 
health care professionals. The Committee recommends that the 
Secretary of Labor release guidance that identifies ways to 
bridge the gap between unemployed immigrants and health care 
professions.
    The Committee supports efforts by organizations to advance 
worker training for individuals who are survivors of abuse, 
abandonment, or trauma. The Committee further supports worker 
training projects that provide wraparound services to these 
individuals and recognizes the value and need to support the 
``whole'' worker, including access to new clothing, shoes, home 
essentials, family hygiene items, relevant worker resources, 
and life skill classes to foster healing and create long-term 
goals.
    Native Americans.--For the Indian and Native American 
programs, the Committee recommends $63,800,000, which is 
$6,800,000 more than the fiscal year 2022 enacted level and the 
same as the fiscal year 2023 budget request.
    Migrant and Seasonal Farmworkers.--For the National 
Farmworker Jobs program, the Committee recommends $105,000,000, 
which is $9,604,000 more than the fiscal year 2022 enacted 
level and $8,289,000 more than the fiscal year 2023 budget 
request.
    The Committee directs the Secretary to ensure that 
additional funding made available in fiscal year 2023--above 
the fiscal year 2022 enacted level--is available to all 
eligible organizations.
    YouthBuild.--For the YouthBuild program, the Committee 
recommends $145,000,000, which is $45,966,000 more than the 
fiscal year 2022 enacted level and the same as the fiscal year 
2023 budget request.
    Reintegration of Ex-Offenders.--The Committee recommends 
$150,000,000 for training and reintegration activities for 
individuals with criminal legal histories or who have been 
justice system-involved, which is $47,921,000 more than the 
fiscal year 2022 enacted level and the same as the fiscal year 
2023 budget request. The Committee directs the Department to 
ensure grantees establish formal partnerships with employers 
and that program participants receive industry recognized 
credentials and training in fields that prepare them for 
successful reintegration, including ensuring participants 
receive training and credentials in fields where their criminal 
record is not a barrier to entry or continued employment. The 
Committee also directs the Department to consider the needs of 
communities that have recently experienced significant unrest.
    The Committee includes a set-aside of $50,000,000 for 
competitive grants to national and regional intermediaries. The 
Committee encourages the Department to prioritize grants to 
national intermediaries and community-based organizations with 
recognized expertise and nationwide employer partners that will 
address the inequities deepened by the pandemic by serving 
populations with multiple barriers to employment and providing 
wraparound services to the individuals served.
    The Committee is aware that recent re-entry programs are an 
excellent way to help address workforce challenges, including 
those in the advanced manufacturing sector. The Committee 
directs the Department to provide an update in the fiscal year 
2024 Congressional Budget Justification on information from the 
last three fiscal years on pathways and relationships built 
with employers, including data on formerly incarcerated 
individuals who have utilized the program, rates of increased 
credentials, and placement in higher paying positions.
    Workforce Data Quality Initiative.--The Committee 
recommends $6,000,000 for the Workforce Data Quality 
Initiative, which is the same as the fiscal year 2022 enacted 
level and the fiscal year 2023 budget request. The Committee 
supports the work of States in using these funds to create and 
utilize data to align preschool through workforce systems.
    Apprenticeship Grants.--The Committee recommends 
$303,000,000 for the apprenticeship grants program, which is 
$68,000,000 more than the fiscal year 2022 enacted level and 
the same as the fiscal year 2023 budget request. The Committee 
established this program in 2016 to expand work-based learning 
programs in in-demand industries through registered 
apprenticeships. Registered apprenticeships are a proven 
strategy for meeting the needs of our nation's workforce and 
industry simultaneously.
    The Committee continues to invest in expanding 
opportunities relating to Registered Apprenticeship programs 
registered only under the National Apprenticeship Act, to be 
available to the Secretary to carry out activities through 
grants, cooperative agreements, contracts and other 
arrangements with States and other appropriate entities. As 
part of these opportunities, the Committee directs the 
Secretary to continue funding for national and local 
apprenticeship intermediaries, business and labor industry 
partner intermediaries, and equity intermediaries. The 
Committee also directs the Department to ensure that these 
intermediaries are given opportunities to apply for competitive 
grants, cooperative agreements, contracts, and other funding 
opportunities. The Committee urges the Secretary to ensure that 
States engage both business and labor as part of any State 
funding opportunities associated with this program. In 
addition, the Committee continues to support the funding and 
development of industry or sector partnerships as a means to 
expand work-based learning programs and registered 
apprenticeships in in-demand industries.
    The Committee directs the Secretary to submit a report to 
the Committees on Appropriations providing details on entities 
awarded funding, selection criteria used, and the funding 
amount for each grant or contract awarded at the time such 
awards are made. Not later than 90 days after enactment of this 
Act, the Department shall provide the Committees on 
Appropriations a detailed spend plan of anticipated uses of 
funds made available, including administrative costs. The 
Committee also directs the Department to provide quarterly 
briefings on all spending activities under this program to the 
Committee. The Committee strongly supports efforts to expand 
Registered Apprenticeships to traditionally underrepresented 
communities.
    In addition, the Committee continues to note that 
apprenticeships are an important path to the middle-class, with 
those completing a program earning an average annual income of 
$70,000. However, women are largely underrepresented in 
apprenticeship programs, and women who do participate make far 
less than men. Therefore, the Committee directs the Department 
to accelerate efforts to recruit and retain women as part of 
these programs and to ensure equal compensation.
    The Committee recognizes that the creative economy was 
severely impacted by COVID-19 and encourages the Department to 
partner with the National Endowment for the Arts and the 
National Endowment for the Humanities to explore the 
feasibility and expansion of Registered Apprenticeship programs 
for creative workers who previously received income through 
creative, cultural, or artistic-based pursuits to produce 
ideas, content, goods, and services, without regard to whether 
such income is earned through employment as an independent 
contractor or as an employee for an employer.
    The Committee continues to be concerned about nationwide 
shortages of qualified drinking water and wastewater operation 
professionals, especially in rural areas, and urges the 
Secretary to address these challenges through apprenticeship 
opportunities consistent with the National Guideline Standards 
of Apprenticeship for Water and Wastewater System Operations 
Specialists.
    The Committee notes that apprenticeship programs contribute 
to higher wages and fewer injuries for workers in the energy 
industry. The Committee also notes that as the United States 
combats climate change, we need to expand the clean energy 
workforce. However, we currently lack sufficient apprenticeship 
programs in the clean energy sector. Therefore, the Committee 
continues to encourage prioritization of apprenticeships in 
clean energy and encourages the Department of Labor to 
accelerate efforts to support apprenticeship programs that 
increase the number of trained workers in the clean energy 
sector with an emphasis in regions anticipating a loss in 
fossil fuel industry jobs.
    The Committee appreciates the Administration's actions to 
ensure high-quality training opportunities by taking steps to 
rescind the industry registered apprenticeship program. The 
Committee strongly supports expansion of registered 
apprenticeships, youth apprenticeships, and pre-apprenticeship 
programs to create more job training opportunities--especially 
in the face of shifting workforce needs and in-demand career 
skills. In light of this need, the Committee encourages the 
Secretary to identify key sectors, including advanced 
manufacturing, with growing workforce demands that adapt well 
within apprenticeship models and develop streamlined plans with 
key stakeholders to execute apprenticeship programs.
    The Committee supports efforts by organizations to advance 
worker training for individuals who are survivors of abuse, 
abandonment, or trauma. The Committee further supports worker 
training projects that provide wraparound services to these 
individuals and recognizes the value and need to support the 
``whole'' worker, including access to new clothing, shoes, home 
essentials, family hygiene items, relevant worker resources, 
and life skill classes to foster healing and create long-term 
goals.
    National Youth Employment Program.--For the National Youth 
Employment Program, the Committee recommends $75,000,000, which 
is the same as the fiscal year 2023 budget request. This new 
competitive grant program will provide funding for youth 
employment programs, including summer and year-round 
opportunities.
    Veterans' Clean Energy Training Program.--For the Veterans' 
Clean Energy Training Program, the Committee recommends 
$10,000,000, which is the same as the fiscal year 2023 budget 
request. This new competitive grant program will prepare 
veterans and their spouses for careers in clean energy.
    Civilian Climate Corps.--For the Civilian Climate Corps, 
the Committee recommends $15,000,000, which is the same as the 
fiscal year 2023 budget request. This new grant pilot will rely 
on strong DOL partnerships with other Federal agencies to focus 
on job training and paid community service for underrepresented 
populations in clean energy and climate mitigation.
    Community Project Funding.--Within the funds included in 
this account, $132,114,000 shall be used for the projects, and 
in the amounts, specified in the table titled ``Labor, HHS, 
Education Incorporation of Community Project Funding Items'' at 
the end of this report.

                               JOB CORPS

 
 
 
Appropriation, fiscal year 2022.......................    $1,748,655,000
Budget request, fiscal year 2023......................     1,778,964,000
Committee Recommendation..............................     1,798,655,000
    Change from enacted level.........................       +50,000,000
    Change from budget request........................       +19,691,000
 

    Job Corps is the nation's largest residential employment 
and workforce development program for youth, helping prepare 
thousands of young people ages 16 through 24 for jobs in in-
demand occupations with good wages each year.
    Operations.--For Job Corps Operations, the Committee 
recommends $1,627,325,000, which is $24,000,000 more than the 
fiscal year 2022 enacted level and $24,314,000 more than the 
fiscal year 2023 budget request.
    Construction, Rehabilitation, and Acquisition.--The 
Committee recommends $133,000,000 for construction, 
rehabilitation, and acquisition activities of Job Corps 
centers, which is $20,000,000 more than the fiscal year 2022 
enacted level and the same as the fiscal year 2023 budget 
request.
    Administration.--The Committee recommends $38,330,000 for 
the administrative expenses of the Job Corps program, which is 
$6,000,000 more than the fiscal year 2022 enacted level and 
$4,623,000 below the fiscal year 2023 budget request.
    For over 50 years, Job Corps has successfully educated and 
trained millions of young adults for jobs in high demand 
industries and trades. Job Corps has campuses across all 50 
States and Puerto Rico and provides a safe living, learning and 
disciplined residential setting that allows disconnected and 
opportunity youth to gain the employment and skills that U.S. 
employers seek. The Committee recommendation includes funding 
for Job Corps to meet capacity and ensure a safe learning 
environment for all students and staff, including to train 
youth for employment in industry sectors facing critical 
shortages of skilled workers, such as construction, healthcare, 
manufacturing, transportation, and cyber technologies. Job 
Corps centers are capable of serving approximately 50,000 out-
of-work and out-of-school youth each year, and the Committee 
encourages the Department to use such funding accordingly.
    The Committee continues to be concerned with the 
administration of the Job Corps program, including the 
underutilization of centers relative to on-board strength, 
industry-standard training, and performance incentives.
    As millions of disconnected youth struggle with housing, 
food insecurity, and unemployment, the Committee supports the 
full resumption of Job Corps operations, including the 
reintegration of nonresidential students into normal classes, 
similar to other schools and institutes of higher education 
across the country.
    The Committee has previously expressed concern regarding 
the impact of the transition to fixed-price Job Corps contracts 
on staff compensation. Currently, the Department exempts Job 
Corps prime contracts from compliance with the McNamara-O'Hara 
Service Contract Act. The Committee directs the Department to 
provide a report within 90 days of enactment of this Act 
explaining the rationale for this exemption and an estimate of 
the costs of requiring all Job Corps contracts to comply with 
this statute. The Committee further directs the Department to 
estimate the costs of compliance if Job Corps academic and 
trade instructors were classified as nonexempt for the purposes 
of the Fair Standards Act.

            COMMUNITY SERVICE EMPLOYMENT FOR OLDER AMERICANS

 
 
 
Appropriation, fiscal year 2022.......................      $405,000,000
Budget request, fiscal year 2023......................       405,000,000
Committee Recommendation..............................       450,000,000
    Change from enacted level.........................       +45,000,000
    Change from budget request........................       +45,000,000
 

    The Community Service Employment for Older Americans 
program provides grants to public and private non-profit 
organizations that subsidize part-time work in community 
service activities for unemployed persons aged 55 and older 
whose family income is below 125 percent of the poverty level.
    The Committee recommends $450,000,000 for the Community 
Service Employment for Older Americans program, which is 
$45,000,000 more than the fiscal year 2022 enacted level and 
the fiscal year 2023 budget request.

              FEDERAL UNEMPLOYMENT BENEFITS AND ALLOWANCES

 
 
 
Appropriation, fiscal year 2022.......................      $540,000,000
Budget request, fiscal year 2023......................       494,400,000
Committee Recommendation..............................       494,400,000
    Change from enacted level.........................       -45,600,000
    Change from budget request........................             - - -
 

    The Trade Adjustment Assistance program (TAA) provides 
assistance to workers adversely affected by international 
trade. TAA provides training, income support, wage subsidies 
for older workers, job search and relocation allowances to 
groups of workers who file a petition and are certified as 
eligible to apply for such benefits due to job losses resulting 
from increases in imports or foreign trade.

     STATE UNEMPLOYMENT INSURANCE AND EMPLOYMENT SERVICE OPERATIONS

 
 
 
Appropriation, fiscal year 2022.......................    $3,711,331,000
Budget request, fiscal year 2023......................     4,258,173,000
Committee Recommendation..............................     4,213,960,000
    Change from enacted level.........................      +502,629,000
    Change from budget request........................       -44,213,000
 

    The total includes $4,124,894,000 from the Employment 
Security Administration Account from the Unemployment Trust 
Fund and $89,066,000 from the General Fund of the Treasury. 
These funds are used to support the administration of Federal 
and State unemployment compensation laws.
    Unemployment Insurance Compensation.--For Unemployment 
Insurance (UI) Compensation, the Committee recommends 
$3,184,635,000, which is $333,819,000 more than the fiscal year 
2022 enacted level and the same as the fiscal year 2023 budget 
request. The recommendation provides additional resources for 
States to increase staffing capacity and to accommodate 
sustained increases in workload.
    In addition, the recommendation provides contingency 
funding for increased workloads that States may face in the 
administration of UI. The Committee recommendation includes 
bill language so that, during fiscal year 2023, for every 
100,000 increase in the total average weekly insured 
unemployment (AWIU) above 1,778,000, an additional $28,600,000 
shall be made available to States from the Unemployment Trust 
Fund.
    In the event that additional funds are provided to States 
under the AWIU contingency authority, the Department is 
directed to provide notification to the Committees on 
Appropriations of the current projected AWIU level for the 
fiscal year, when funds were provided to States, and how much 
additional funding was provided in total and to each State 
within 15 days of funding being provided. In the event that 
additional funds are provided on a quarterly basis, the 
Department shall provide this information on a quarterly basis.
    The Committee includes $117,000,000 for the Reemployment 
Services and Eligibility Assessments program, and an additional 
$258,000,000 is made available pursuant to the Bipartisan 
Budget Act of 2018 (P.L. 115-123), which is $125,000,000 more 
than the fiscal year 2022 enacted level and equal to the fiscal 
year 2023 budget request.
    UI Integrity Center of Excellence (UIICE).--The 
recommendation provides $9,000,000 for the continued support of 
UIICE.
    Unemployment Compensation National Activities.--The 
Committee recommends $118,000,000 for National Activities, 
which is $100,000,000 more than the fiscal year 2022 enacted 
level and $50,174,000 below the fiscal year 2023 budget 
request. This increase in funding is intended to help modernize 
information technology systems and support States in 
administering the UI program.
    The Committee supports ongoing efforts by the Department's 
Employment and Training Administration to collaborate with 
state workforce agencies to modernize unemployment insurance 
management systems. The Committee continues to urge the 
department to develop a comprehensive long-term strategy for 
delivery of assistance to state workforce agencies, as outlined 
in House report 117-96.
    Employment Service.--The Committee recommends $723,862,000 
for the Employment Service allotment to States, which is 
$48,810,000 more than the fiscal year 2022 enacted level and 
$25,000,000 more than the fiscal year 2023 budget request.
    The Committee also recommends $25,000,000 for Employment 
Service National Activities, which is the same as the fiscal 
year 2022 enacted level and $2,682,000 more than the fiscal 
year 2023 budget request.
    The Employment Service offers vital services such as 
referrals for job openings, career counseling, and job searches 
for individuals seeking employment, including veterans and 
people with disabilities. Since 1933, this Federal-State 
partnership has facilitated the connection between employers in 
need of workers and individuals seeking employment. Given the 
nature of this exchange, the Department has historically 
required that the Employment Service system rely on State 
merit-staff employees to ensure that these services are 
rendered in the public interest and not solely to meet private 
interests. However, under the previous Administration, the 
Department's issued a final rule that marked a dangerous 
departure from this operation. As such, the recommendation 
includes new bill language preventing the implementation of the 
final rule, entitled ``Wagner-Peyser Act Staffing Flexibility'' 
(85 Fed. Reg. 592).
    Foreign Labor Certification.--The Committee recommends 
$94,810,000 for the Foreign Labor Certification (FLC) program, 
which is $15,000,000 more than the fiscal year 2022 enacted 
level and $3,721,000 below the fiscal year 2023 budget request. 
The recommendation includes $68,528,000 for Federal 
administration, an increase of $10,000,000 over the fiscal year 
2022 enacted level and $1,721,000 below the fiscal year 2023 
budget request, that is intended to be used to ensure effective 
oversight and enforcement of employer regulations, and 
$26,282,000 for grants to States, an increase of $5,000,000 
over the fiscal year 2022 enacted level and $2,000,000 below 
the fiscal year 2023 budget request.
    Heat-Related Deaths.--The Committee recognizes that farm 
workers ensure our nation's food supply at the risk of their 
own health and safety, toiling under extreme temperatures and 
other dangerous conditions. Agriculture had the highest average 
rate of heat-related deaths of all industry sectors. More 
specifically, agriculture had roughly three times the rate of 
heat-related death compared to construction, which is the 
industry with the second highest rate of heat-related death, 
and 35 times the risk of heat related death compared to other 
industry sectors. The Committee believes that no workers should 
die of heat. Heat death and illness can be prevented by very 
simple measures, such as access to drinking water, shade, and 
rest breaks. The Committee urges the DOL to consider what 
immediate steps they can take to prevent heat illness and death 
while the OSHA rulemaking is in progress. In particular, the 
Committee urges the DOL to consider what protections could be 
put into place to protect workers at H-2A employers from heat 
illness and death, such as requiring a heat illness prevention 
plan as part of the H-2A labor certification process.
    Workforce Information.--To better understand the growing 
threat heat-related illness poses to climate-vulnerable 
agricultural workers, the Committee encourages the Department 
to assess heat-related illness prevention and response through 
the National Agricultural Worker Survey. Specifically, the 
Committee encourages the Employment and Training Administration 
(ETA) to ensure workers' access to drinking vessels, potable 
water, restrooms, and shade are addressed by the National 
Agricultural Workers Survey. The Committee also directs ETA to 
incorporate questions about the incidence and prevalence of 
heat-related illness during agricultural employment and whether 
workers have been training on the job about heat-related 
illness. The Committee directs ETA to include a report to 
Congress on the findings from these questions of the survey as 
part of its annual report on the National Agricultural Worker 
Survey.
    Schedule A Occupational Classification.--The Committee is 
aware that the Schedule A occupational classification list 
currently includes only two broad occupational classifications 
and a narrow subset of other applicants. The Committee 
continues to encourage the Secretary to consider rulemaking to 
improve the experience of employers and to effectively allocate 
Department resources with the goal of protecting U.S. workers 
from undue foreign competition through the labor certification 
process.
    One-Stop Career Centers/Labor Market Information.--The 
Committee recommends $67,653,000 for One-Stop Career Centers 
and Labor Market Information, which is $5,000,000 more than the 
fiscal year 2022 enacted level and $18,000,000 below the fiscal 
year 2023 budget request. The recommendation also includes 
language authorizing the Secretary to transfer certain funding 
to the Office of Disability Employment Policy for research and 
demonstration projects.

        ADVANCES TO THE UNEMPLOYMENT TRUST FUND AND OTHER FUNDS

    The Committee recommends such sums as necessary for 
Advances to the Unemployment Trust Fund and Other Funds. The 
funds are made available to accounts authorized under Federal 
and State unemployment insurance laws and the Black Lung 
Disability Trust Fund when the balances in such accounts are 
insufficient.

                         PROGRAM ADMINISTRATION

 
 
 
Appropriation, fiscal year 2022.......................      $164,415,000
Budget request, fiscal year 2023......................       222,633,000
Committee Recommendation..............................       209,200,000
    Change from enacted level.........................       +44,785,000
    Change from budget request........................       -13,433,000
 

    The recommendation includes $144,465,000 from the General 
Fund of the Treasury and $64,735,000 from the Employment 
Security Administration Account in the Unemployment Trust Fund.
    The Committee includes new bill language ensuring Office of 
Apprenticeship resources support Registered Apprenticeships and 
adequate staffing in the Office of Apprenticeship and State 
offices.
    Prize Competition.--The Committee continues to encourage 
the Department, in coordination with the Office of Science and 
Technology Policy, to establish a prize competition consistent 
with the requirements of section 24 of the Stevenson-Wydler 
Technology Innovation Act of 1980, to support eligible programs 
designed to prepare high school students to enter and succeed 
in an in-demand industry sector or occupation.
    National Guard Job ChalleNGe.--The Committee appreciates 
the value and success of the National Guard's Youth ChalleNGe 
Program, and the benefits the Department of Labor's 
collaboration through Job ChalleNGe provides to the youth 
served through the experience. The occupational skills 
training, individualized career and academic counseling, work-
based learning opportunities, and leadership development 
activities provided through the Job ChalleNGe are even more 
vital in the aftermath of the economic fallout associated with 
the pandemic. The Committee encourages the Department to build 
upon its collaboration with Youth ChalleNGe programs and offer 
youth occupational skills training, individualized career and 
academic counseling, work-based learning opportunities, and 
leadership development activities.
    Gun Violence.--The Committee encourages the Department to 
prioritize Workforce Innovation and Opportunity funding 
opportunities, like the Young Adult Reentry Partnership and 
YouthBuild, to support reintegration, transitional employment, 
long-term impactful positions, union positions, and living 
wages for systems-involved youth and older adults in cities 
disproportionately impacted by daily gun violence.
    Higher Education Workforce Development Initiative.--The 
Committee encourages the Department of Labor to partner with 
the Department of Education to explore the feasibility of 
creating workforce development programs at 4-year higher 
education institutions to align workforce development efforts 
and post-secondary education and support expanded skills 
instruction, apprenticeships, and other work-based learning 
opportunities, including cooperative education and upskilling 
and reskilling efforts in industries like manufacturing, 
information technology, healthcare, and energy, among others. 
The Committee encourages the Department to model the Higher 
Education Workforce Development Innovation program similarly to 
the Strengthening Community College Training Grants Program.
    Electric Vehicle Mechanics.--The Committee recognizes the 
growing need of high skilled mechanics and workforce 
development in the automotive field to prepare for advances in 
the electric vehicle industry. The Committee encourages the 
Department of Labor and the Department of Education to explore 
the feasibility of working with industry partners, labor 
groups, and nonprofit experts to develop curriculum and 
training programs to further career pathways for electric 
vehicle mechanics. The collaboration should also develop 
recommendations of advanced training programs for established 
career mechanics to grow skilled labor outcomes and deepen 
their skills and knowledge to meet the needs of the future.
    Disaggregated Data by Race.--The Committee is aware that 
few federal or federally funded workforce training programs 
track outcomes by race. The Committee recommends careful 
evaluation of disaggregated racial data in order to advance 
racial equity and minimize racial disparities in workforce 
training. The Committee requests a report from ETA within 120 
days of enactment of this Act on efforts to evaluate 
disaggregated racial data in federally-funded workforce 
training programs.
    Reducing Homelessness.--The Committee recognizes that 
employment that pays a living wage and can support the cost of 
housing is a key to reducing homelessness. The Office of 
Workforce Investment (OWI) is responsible for a national 
workforce investment system that provides workers with the 
information, advice, job search assistance, supportive 
services, and training for in-demand industries and occupations 
needed to get and keep good jobs. The Committee urges OWI to 
provide workforce boards with incentives and guidance to 
promote coordination with local homelessness systems to ensure 
that employment services are accessible and useful to people 
who are homeless or have recently left homelessness.
    Justice Involved Workers.--The Committee supports the 
Department of Labor's intention to expand education, skills 
training, and work experience programs to connect justice-
involved individuals with employment opportunities to obtain 
and retain jobs. The Committee continues to recommend that 
Federal workforce development funding under covered education 
and training programs be available to eligible recipients with 
a demonstrated capacity to develop and improve the availability 
of employment and transitional job programs that support work-
based learning activities designed to increase reentry 
employment as an equitable workforce approach. To increase 
alignment of work experience opportunities across federal 
programs, the committee also directs the Department to enter 
into a cooperative agreement with national nonprofit 
organizations that have an established partnership with the 
SNAP Employment & Training program at the Department of 
Agriculture.
    Regional Councils and Councils of Governments.--The 
Committee encourages the Department to list regional councils 
and councils of governments as eligible entities in 
competitions for Federal funding whenever local governments or 
non-profit agencies are eligible entities. Furthermore, the 
Committee encourages the Department to seek opportunities for 
regional councils and councils of governments to serve as lead 
applicants and grantees to encourage and expand greater 
regional collaboration.

               Employee Benefits Security Administration


                         SALARIES AND EXPENSES

 
 
 
Appropriation, fiscal year 2022.......................      $185,000,000
Budget request, fiscal year 2023......................       233,867,000
Committee Recommendation..............................       233,867,000
    Change from enacted level.........................       +48,367,000
    Change from budget request........................             - - -
 

    The Employee Benefits Security Administration (EBSA) 
assures the security of retirement, health and other workplace-
related benefits of working Americans.
    The Committee recommends $233,867,000 for EBSA, which is 
$48,367,000 above the fiscal year 2022 enacted level and the 
same as the fiscal year 2023 budget request.
    Mental Health Parity and Addiction Equity Act (MHPAEA) 
Compliance.--The Committee has included resources for the 
Employee Benefits Security Administration (EBSA) to fully 
implement Section 203 of Division BB of the Consolidated 
Appropriations Act, 2021. Section 203 requires that all group 
health plans perform comparative analyses of the design and 
application of nonquantitative treatment limitations (NQTLs) to 
ensure those imposed on mental health and substance use 
disorder benefits are not more restrictive than limitations for 
medical and surgical benefits.
    The Committee is encouraged that EBSA formed a MHPAEA NQTL 
Task Force composed of experienced investigators, health policy 
experts, technical experts from EBSA's regional and national 
offices, and attorneys from the Office of the Solicitor of 
Labor to assist in the implementation of the new provisions. 
The Committee encourages EBSA to continue to enhance its MHPAEA 
NQTL enforcement program by increasing the investigative 
resources dedicated to NQTL review and analysis. To the extent 
resources allow, the Committee also encourages EBSA to create 
templates and tools for collecting and scoring the comparative 
analyses and rendering decisions on compliance; enhance 
coordination, standardization and MHPAEA-related decision-
making uniformity among regional offices; and conduct follow-up 
investigations into group health plans whose comparative 
analyses indicate likely noncompliance or areas in which 
further examination is needed to determine compliance.

                  Pension Benefit Guaranty Corporation


 
 
 
Appropriation, fiscal year 2022.......................      $472,955,000
Budget request, fiscal year 2023......................       493,314,000
Committee Recommendation..............................       493,314,000
    Change from enacted level.........................       +20,359,000
    Change from budget request........................             - - -
 

    Congress established the Pension Benefit Guaranty 
Corporation to insure the defined-benefit pension plans of 
working Americans.

                         Wage and Hour Division


                         SALARIES AND EXPENSES

 
 
 
Appropriation, fiscal year 2022.......................      $251,000,000
Budget request, fiscal year 2023......................       307,678,000
Committee Recommendation..............................       312,678,000
    Change from enacted level.........................       +61,678,000
    Change from budget request........................        +5,000,000
 

    The Wage and Hour Division (WHD) enforces Federal minimum 
wage, overtime pay, recordkeeping, and child labor requirements 
of the Fair Labor Standards Act (FLSA). WHD also has 
enforcement and other administrative responsibilities related 
to the Migrant and Seasonal Agricultural Worker Protection Act, 
the Employee Polygraph Protection Act, the Family and Medical 
Leave Act, the Davis Bacon Act, and the Service Contract Act.
    The Committee recommends $312,678,000 for WHD, which is 
$61,678,000 above the fiscal year 2022 enacted level and 
$5,000,000 above the fiscal year 2023 budget request. The 
increase will support additional investigators to combat wage 
theft and protect workers. The Committee urges WHD to explore 
and expand strategic enforcement approaches to the agency's 
work to make the most of this increase.
    Retaliation.--Because retaliation and the threat of 
retaliation remain a critical challenge to workers' ability to 
exercise their workplace rights, the Committee requests for WHD 
to provide information regarding its volume of retaliation 
complaints, the status of those complaints, and how WHD is 
working effectively to protect workers from retaliation in the 
fiscal year 2024 Congressional Budget Justification.
    Accessibility.--The Committee notes the importance of 
making sure all workers can access WHD's resources, including 
workers of color, immigrant workers, workers in rural 
communities or with limited access to transportation, and 
workers with disabilities. The Committee encourages WHD to 
undertake efforts to improve accessibility of WHD offices, 
translate WHD documentation and signage into languages spoken 
by 5 percent or more of the population in a given WHD region, 
and translate WHD's online webpages, complaint forms, and 
resources to match regional needs. In hiring investigators, the 
Committee encourages WHD to focus on employing and retaining a 
greater number of multilingual investigators. In addition, the 
Committee encourages WHD to establish protocols that permit 
workers to participate in investigations and hearings remotely 
where appropriate.
    Community-based Organizations and Partnerships.--The 
Committee believes that community-based organizations are 
critical in establishing necessary trust, connecting workers 
with agencies, facilitating communication between agencies and 
workers, and deploying enforcement resources strategically. 
Working with community-based organizations helps agencies 
cooperate with workers who might otherwise be difficult to 
reach, including workers employed by small businesses, workers 
with literacy challenges, workers with limited access to 
broadband, and workers in high-hazard industries most 
vulnerable to wage violations. Therefore, the Committee urges 
WHD to increase its capacity to conduct outreach and 
collaborate with community-based organizations.
    U and T Visa Certification.--The Committee notes the 
critical role WHD plays in completing U and T visa 
certifications on behalf of victims of crime and victims of 
trafficking in the workplace. Ensuring that all workers, 
regardless of immigration status, can participate in WHD 
investigations and exercise their workplace rights is critical 
to the full and effective enforcement of Federal labor laws. 
The Committee urges WHD to use resources provided in fiscal 
year 2023 to ensure the efficient and timely processing and 
certification of all certification requests.
    Domestic Workers.--The Committee is concerned that domestic 
workers are particularly vulnerable to workplace exploitation, 
including wage theft, verbal abuse, trafficking, and sexual 
assault. Domestic work commonly takes place in private homes, 
where workers are often isolated and alone. This workforce is 
predominantly female, and represents populations that are 
already vulnerable, including immigrant women and women of 
color. The Committee is concerned by the limited enforcement of 
workplace rights for this population and the severe power 
imbalance between domestic workers and their employers. In 
response to these concerns, the Committee includes new bill 
language directing the Secretary to use funds made available 
under WHD to establish a national hotline to support domestic 
workers. In addition, the Committee urges WHD to prioritize 
investigations in sectors where workers are more vulnerable to 
wage theft, including domestic work, long term care, and home 
health care.
    Misclassification.--The Committee is concerned that cases 
of workers being misclassified as independent contractors have 
been steadily rising in recent years, a development that 
transfers costs of doing business to workers, denies them the 
rights and protections of bedrock workplace protections, and 
depletes federal coffers by limiting payroll taxes. The 
Committee urges the WHD to use the full extent of its existing 
powers to enforce laws related to employee classification and 
to undertake such rulemaking action as may be necessary to 
execute Congress's direction under 29 USC 202.
    Warehouse Workers.--The Committee recognizes that temporary 
warehouse workers have been the backbone of efforts to address 
the supply chain issues that the United States experienced 
during the COVID-19 pandemic. The Committee strongly supports 
increased oversight to prevent wage theft from warehouse 
workers and is encouraged by the WHD's initiative on Warehouse 
and Logistics workers. The Committee requests a report within 
90 days of enactment of this Act detailing the steps the WHD is 
taking to address wage theft among warehouse workers, including 
non-union temporary warehouse workers. In addition, the 
Committee requests a progress report on the initiative on 
Warehouse and Logistics workers, including steps to provide 
education, outreach, enforcement to increase compliance and 
reduce industry violations.

                  Office of Labor Management Standards


                         SALARIES AND EXPENSES

 
 
 
Appropriation, fiscal year 2022.......................       $45,937,000
Budget request, fiscal year 2023......................        49,951,000
Committee Recommendation..............................        45,937,000
    Change from enacted level.........................             - - -
    Change from budget request........................        -4,014,000
 

    The Office of Labor Management Standards (OLMS) administers 
the Labor-Management Reporting and Disclosure Act (LMRDA), 
which establishes safeguards for union democracy and union 
financial integrity, and requires public disclosure reporting 
by unions, union officers, employees of unions, labor relations 
consultants, employers, and surety companies.
    The Committee recommends $44,937,000 for OLMS, which is the 
same as the fiscal year 2022 enacted level and $4,014,000 below 
the fiscal year 2023 budget request.
    Persuader Reporting.--The Committee is concerned about 
uneven compliance with rules regarding reporting of persuader 
activity and urges the Department to review its rules and 
policies on persuader reporting and take all appropriate 
actions to strengthen its rules and enforcement to ensure 
maximum compliance and reporting of persuader activity. 
Further, the Committee urges the Department to consider 
proposing a revision to its rules to require disclosure on the 
LM-10 form as to whether the filer is a federal contractor, 
whether the persuader activity relates to employees working on 
or in connection with the federal contract, and with which 
agency or agencies the employer contracts.

             Office of Federal Contract Compliance Programs


                         SALARIES AND EXPENSES

 
 
 
Appropriation, fiscal year 2022.......................      $108,476,000
Budget request, fiscal year 2023......................       147,051,000
Committee Recommendation..............................       147,051,000
    Change from enacted level.........................       +38,575,000
    Change from budget request........................             - - -
 

    The Office of Federal Contract Compliance Programs (OFCCP) 
ensures equal employment opportunity in the Federal contracting 
community through enforcement, regulatory work, outreach and 
education to workers and their advocates.
    OFCCP is responsible, per Executive Order 11246 (EO 11246), 
for ensuring Federal contractors and subcontractors take 
affirmative action to ensure that all individuals have an equal 
opportunity for employment, without regard to race, color, 
religion, sex, or national origin.
    The Committee recommends $147,051,000 for OFCCP, which is 
$38,575,000 above the fiscal year 2022 enacted level and the 
same as the fiscal year 2023 budget request. The Committee 
supports OFCCP's efforts to make sure contractors and 
subcontractors are adhering fully to EO 11246.

                Office of Workers' Compensation Programs


                         SALARIES AND EXPENSES

 
 
 
Appropriation, fiscal year 2022.......................      $120,129,000
Budget request, fiscal year 2023......................       145,977,000
Committee Recommendation..............................       145,977,000
    Change from enacted level.........................       +25,848,000
    Change from budget request........................             - - -
 

    The Office of Workers' Compensation Programs (OWCP) 
administers the Federal Employees' Compensation Act, the 
Longshore and Harbor Workers' Compensation Act, the Energy 
Employees Occupational Illness Compensation Program Act, and 
the Black Lung Benefits Act. These programs provide eligible 
injured and disabled workers and their survivors with 
compensation, medical benefits, and services including 
rehabilitation, supervision of medical care, and technical and 
advisory counseling.
    The Committee recommendation includes $143,772,000 in 
General Funds from the Treasury, which is $25,848,000 above the 
fiscal year 2022 enacted level and the same as the fiscal year 
2023 request, and $2,205,000 from the Special Fund established 
by the Longshore and Harbor Workers' Compensation Act.

                            SPECIAL BENEFITS

 
 
 
Appropriation, fiscal year 2022.......................      $244,000,000
Budget request, fiscal year 2023......................       250,000,000
Committee Recommendation..............................       250,000,000
    Change from enacted level.........................        +6,000,000
    Change from budget request........................             - - -
 

    These funds provide mandatory benefits under the Federal 
Employees' Compensation Act.

               SPECIAL BENEFITS FOR DISABLED COAL MINERS

 
 
 
Appropriation, fiscal year 2022.......................       $32,970,000
Budget request, fiscal year 2023......................        36,031,000
Committee Recommendation..............................        36,031,000
    Change from enacted level.........................        +3,061,000
    Change from budget request........................             - - -
 

    These funds provide mandatory benefits to coal miners 
disabled by black lung disease, to their survivors and eligible 
dependents, and for necessary administrative costs.
    The Committee recommends $36,031,000 for Special Benefits 
for Disabled Coal Miners. This amount is in addition to the 
$11,000,000 appropriated in fiscal year 2022 as an advance for 
the first quarter of fiscal year 2023. The total program level 
recommendation is $3,061,000 more than the fiscal year 2022 
enacted level and the same as the fiscal year 2023 budget 
request.
    The Committee recommendation also provides $10,250,000 as 
an advance appropriation for the first quarter of fiscal year 
2024. These funds ensure uninterrupted payments to 
beneficiaries.

    ADMINISTRATIVE EXPENSES, ENERGY EMPLOYEES OCCUPATIONAL ILLNESS 
                           COMPENSATION FUND

 
 
 
Appropriation, fiscal year 2022.......................       $63,428,000
Budget request, fiscal year 2023......................        64,564,000
Committee Recommendation..............................        64,564,000
    Change from enacted level.........................        +1,136,000
    Change from budget request........................             - - -
 

    These funds provide mandatory benefits to eligible 
employees or survivors of employees of the Department of Energy 
(DOE); its contractors and subcontractors; companies that 
provided beryllium to DOE; atomic weapons employees who suffer 
from a radiation-related cancer, beryllium-related disease, or 
chronic silicosis as a result of their work in producing or 
testing nuclear weapons; and uranium workers covered under the 
Radiation Exposure Compensation Act.
    Beryllium Vendor Eligibility.--The Committee is concerned 
that the Department of Labor's interpretation of what 
constitutes a ``covered employee'' under the terms of the 
Energy Employees Occupational Illness Compensation Program Act 
(EEOICPA) mistakenly excludes some employees of beryllium 
vendors and facilities and contravenes congressional intent 
under EEOICPA. As such, the Committee encourages the Department 
to examine making eligible all employees of beryllium vendors 
named in EEOICPA for benefits under the Act regardless of 
corporate structure, past reorganizations, or current ownership 
as a subsidiary provided those actions were compliant with 
applicable federal law. The Committee further directs the 
Department to submit a report to the Committee no later than 90 
days after the date of enactment of this Act that outlines the 
number of beneficiaries and eligible employers covered under 
the EEOICPA.

                    BLACK LUNG DISABILITY TRUST FUND

 
 
 
Appropriation, fiscal year 2022.......................      $331,505,000
Budget request, fiscal year 2023......................       394,896,000
Committee Recommendation..............................       394,896,000
    Change from enacted level.........................       +63,391,000
    Change from budget request........................             - - -
 

    The Black Lung Disability Trust Fund, supported with 
mandatory funding, pays black lung compensation, medical and 
survivor benefits, and administrative expenses when no mine 
operator can be assigned liability for such benefits, or when 
mine employment ceased prior to 1970. The Black Lung Disability 
Trust Fund is financed by an excise tax on coal, reimbursements 
from responsible mine operators, and short-term advances from 
the Treasury. The Emergency Economic Stabilization Act of 2008 
authorized a restructuring of the Black Lung Disability Trust 
Fund debt and required that annual operating surpluses be used 
to pay down the debt until all remaining obligations are 
retired.
    Black Lung Benefits Claims Processing.--The Committee is 
concerned with lengthy delays in the processing of Black Lung 
Benefits Act claims, particularly where the mine operator's 
ability to pay the claim is in question. Delays impede access 
to necessary medical care while claims are pending. The 
Committee supports efforts by the Secretary to resolve these 
claims expediently to ensure miners can receive the benefits 
and medical care they need. The Committee requests an update in 
the fiscal year 2024 Congressional Budget Justification on the 
Department's efforts to improve the speed and quality of its 
black lung claims processing.

             Occupational Safety and Health Administration


                         SALARIES AND EXPENSES

 
 
 
Appropriation, fiscal year 2022.......................      $612,015,000
Budget request, fiscal year 2023......................       701,405,000
Committee Recommendation..............................       712,015,000
    Change from enacted level.........................      +100,000,000
    Change from budget request........................       +10,610,000
 

    The Occupational Safety and Health Act of 1970 established 
the Occupational Safety and Health Administration (OSHA) to 
assure safe and healthy working conditions by setting and 
enforcing standards and by providing training, outreach, 
education and assistance.
    Within the total for OSHA, the Committee provides the 
following amounts:

------------------------------------------------------------------------
                   Budget Activity                     FY 2023 Committee
------------------------------------------------------------------------
Safety and Health Standards..........................        $29,080,000
Federal Enforcement..................................        285,508,000
Whistleblower Programs...............................         27,290,000
State Programs.......................................        121,075,000
Technical Support....................................         27,007,000
Federal Compliance Assistance........................         91,608,000
State Consultation Grants............................         63,500,000
Training Grants......................................         14,287,000
Safety and Health Statistics.........................         42,180,000
Executive Direction and Administration...............         10,480,000
------------------------------------------------------------------------

    Compliance Safety and Health Officers (CSHOs).--The 
Committee is concerned about the significant reduction in OSHA 
Compliance Safety and Health Officers (CSHOs) in recent decades 
relative to the number of workers they oversee. These CSHOs 
enforce federal workplace standards across the country, 
inspecting worksites and ensuring that employers comply with 
worker safety and health regulations. That is why the Committee 
is strongly supportive of OSHA's plans to use additional 
resources to support and rebuild OSHA's enforcement program by 
hiring additional CSHOs. The Committee encourages the agency to 
focus on employing and retaining multilingual officers crucial 
to thorough inspections of workplaces across the country.
    Elimination of the Limiting OSHA Coverage to Small Farms 
Rider.--The Committee continues to eliminate the existing 
appropriations rider that prevents OSHA from conducting any 
activities--including compliance assistance, investigations, 
and enforcement activities--on small farms. Agriculture is 
among the most dangerous industries in the United States. 
However, OSHA is currently prohibited from investigating even 
fatalities and serious injuries on small farms, as well as 
responding to worker complaints. Agricultural exemptions in New 
Deal worker protection laws, which set the precedent for the 
OSHA small farms rider, were included as compromises to secure 
the votes of Southern lawmakers who opposed expanding labor 
rights for black farmworkers and sharecroppers. This is an 
almost 40-year-old rider that continues to have a disparate 
impact on racial and ethnic minorities and should not be 
included in this Act. All farmworkers deserve to be protected 
by the OSHA law, regardless of the size of their employer.
    Penalties.--The Committee notes that OSHA penalties are 
among the lowest of any Federal agency and believes they are 
woefully inadequate in deterring workplace health and safety 
violations by employers. For instance, despite widespread 
reports that meatpacking facilities were becoming deadly COVID-
19 hotspots as early as March 2020, OSHA waited six months 
before issuing two small financial penalties totaling $29,000 
to a JBS plant and a Smithfield plant. For context, in 2019, 
JBS's annual revenue was $51.7 billion and Smithfield's was $14 
billion. To address these concerns, Committee urges OSHA to 
adopt policies that encourage the use of maximum penalties or a 
penalty multiplier for serious violations in large businesses.
    Whistleblower Protection Program.--The Committee is 
concerned about the increasing caseloads and unprecedented 
length of time taken by OSHA to complete whistleblower 
investigations. OSHA's whistleblower investigative staff 
enforces protections for employees who suffer retaliation for 
protected activity under more than 20 statutes, and the number 
of statutes continues to increase. OSHA's already-overburdened 
Whistleblower Protection Program staff has seen a consistent 
increase in new complaints filed, including a large increase in 
COVID-19 related complaints since the beginning of the 
pandemic, which has resulted in a significant backlog of 
pending investigations. The Office of Inspector General 
concluded in August 2020 that when OSHA fails to respond in a 
timely manner, it ``could leave workers to suffer emotionally 
and financially'' and may lead to the erosion of evidence 
needed for the case. To bolster the Whistleblower Protection 
Program's capacity to conduct critical investigations in a 
timely manner in industries across the country and bring the 
agency closer to compliance with statutory requirements of more 
than 20 statutes, the Committee increases resources for the 
Whistleblower Protection program by $5,790,000 above the fiscal 
year 2022 enacted level. This increase will support OSHA's 
efforts to update its decades-old Whistleblower data base to 
the current OSHA Information System for OSHA's main enforcement 
program or to develop a new system.
    Susan Harwood Training Grants.--The Susan Harwood Training 
Grants to non-profit organizations reach workers in dangerous 
industries with critical education and training on workplace 
hazards and statutory protections. The latest statistics from 
the Bureau of Labor Statistics show that workplace fatalities 
are increasing for Black workers and that fatality rates are 
higher among Hispanic and Black workers. The Committee supports 
OSHA's efforts to provide funding to non-profit, community-
based groups, and other non-profit organizations with the 
capability to reach workers in low-wage industries and workers 
in dangerous industries. In addition, the Committee urges OSHA 
to allow grantees to train on multiple hazards. Further, the 
Committee encourages OSHA to ensure grants are awarded to train 
workers employed in disaster recovery and rebuilding sectors.
    U and T Visas.--The Committee strongly supports efforts by 
OSHA to ensure all workers, regardless of immigration status, 
can participate in OSHA investigations and exercise their 
workplace rights. However, the Committee notes that OSHA does 
not outline a process for U and T visa certification. The 
Committee encourages OSHA to evaluate the merits of 
establishing a policy on U and T visa certification requests 
and consider assisting workers with U and T visa certification.
    OSHA Noise Standard.--The Committee is aware that the 
National Institute for Occupational Safety and Health (NIOSH) 
estimates that 22 million U.S. workers are exposed to 
potentially dangerous levels of noise in the workplace every 
year and that hearing loss is the most commonly recorded 
occupational illness in manufacturing, accounting for 1 in 9 
recordable illnesses. The Committee is also aware that the OSHA 
Noise Standard (20 CFR 1910.95) for employers was established 
in 1983, but has not been updated since that time even as the 
Department of Defense (DoD), NIOSH, and many other countries 
have recommended or adopted more protective noise exposure 
limits. Accordingly, to better protect the American workforce 
and reduce the risk of noise-induced hearing loss, the 
Committee urges OSHA to lower the current permissible exposure 
level to 85 dBA TWA using a 3 dB exchange rate. Such a change 
would substantially reduce the excess risk of developing 
occupational noise-induced hearing loss over a working lifetime 
and be consistent with current exposure limits specified by the 
DoD and voluntarily adopted by many private employers.
    OSHA Heat Standard.--The Committee recognizes that with 
climate change, risks of heat-related illnesses continue to 
grow, posing serious risks to workers and their families as 
well as the nation's food supply and supply chains. Workers 
exposed to extreme heat are disproportionately low-wage workers 
and workers of color. The Committee is encouraged by the notice 
of proposed rulemaking by the Department announced in October 
2021. While the rulemaking is underway, the Committee is 
pleased that OSHA's National Emphasis program will create, for 
the first time, a nationwide enforcement mechanism to 
proactively inspect workplaces for heat-related hazards and 
prevent worker injuries, illnesses, and fatalities.
    Children in Agriculture.--The Committee is concerned that 
children working in agriculture are at risk from work injuries 
that could result in death. The Committee requests a report 
within 180 days of the date of enactment of this Act which 
shall include an evaluation of data that reflects the status of 
child labor and related safety and health hazards, such as the 
health impact of pesticide use. The report shall include 
information on work-related serious injuries to children under 
18 employed in agriculture, as well as work-related deaths of 
children under 18 employed in agriculture. The report shall 
provide relevant details, including environmental hazards, such 
as chemical or pesticide exposure; use of machinery or tools at 
time of incident; work tasks performed at time of incident; and 
other details relating to the incident. OSHA is encouraged to 
collaborate with BLS and WHD.
    Technology.--The Committee recognizes that technology is 
increasingly incorporated into how we work. The Committee 
encourages OSHA, in collaboration with NIOSH and stakeholders, 
to examine the role of technology in improving safety. In 
particular, OSHA should review efforts to make technology 
innovation more accessible, to identify the most hazardous 
situations for the American workforce, and to eliminate 
barriers to the adoption of critical safety controls by 
employers. The Committee requests a briefing with 120 days of 
enactment of this Act on recommendations on these topics to 
specifically focus on reducing fatalities.
    Interagency Collaboration.--The Committee is concerned 
about the implementation and renegotiation of the 1994 
Memorandum of Understanding (MOU) between OSHA and the Food 
Safety and Inspection Service (FSIS) towards establishing a 
process for FSIS inspection personnel to be trained to 
recognize and report serious workplace hazards. The Committee 
requests a report within 90 days of enactment of this Act on 
the implementation status of this renegotiated MOU that 
includes the agencies' timeline and action plan for 
implementation.
    Asbestos.--The Committee is concerned that construction 
workers continue to be exposed to asbestos at renovation, 
rehabilitation, and restoration construction sites for both 
private developments and public housing. The Committee 
encourages OSHA, in collaboration with the Environmental 
Protection Agency, to prioritize activities that proactively 
prevent asbestos exposure, such as increased site visits. In 
addition, the Committee encourages OSHA to work with employers 
to ensure asbestos hazards, fact sheets, and safety protocols 
are publicly listed in English and Spanish and to provide 
trainings to employers and employees.
    Arc-flash Personal Protective Equipment.--The Committee is 
concerned with continued lack of compliance with OSHA's and 
industry's standards for arc-flash (AR) clothing and associated 
personal protective equipment (PPE) requirements that have been 
in place for over two decades. More than 600,000 American 
workers performing work on or near energized electrical 
equipment are exposed to deadly arc-flash related injuries and 
hazards on worksites across the country without the required 
lifesaving protection. This results in many catastrophic 
injuries and fatalities of American workers every year, 
virtually all of which are preventable. The Committee 
encourages OSHA to adopt an enforcement policy citing existing 
standards such as NFPA 70E, and for requiring appropriate arc 
flash protective clothing and PPE during all live electrical 
work performed in the United States.

                 Mine Safety and Health Administration


                         SALARIES AND EXPENSES

 
 
 
Appropriation, fiscal year 2022.......................      $383,816,000
Budget request, fiscal year 2023......................       423,449,000
Committee Recommendation..............................       403,816,000
    Change from enacted level.........................       +20,000,000
    Change from budget request........................       -19,633,000
 

    The Mine Safety and Health Administration (MSHA) enforces 
the Federal Mine Safety and Health Act in underground and 
surface coalmines and metal/non-metal mines.
    Within the total for MSHA, the Committee provides the 
following amounts:

------------------------------------------------------------------------
                   Budget Activity                     FY 2023 Committee
------------------------------------------------------------------------
Mine Safety and Health Enforcement...................       $279,509,000
Standards and Regulations Development................          6,229,000
Assessments..........................................          7,191,000
Educational Policy and Development...................         39,755,000
Technical Support....................................         36,209,000
Program Evaluation and Information Resources.........         18,655,000
Program Administration...............................         16,268,000
------------------------------------------------------------------------

    Coal, Metal, and Non-metal Mines.--MSHA is directed to 
include in the fiscal year 2024 Congressional Budget 
Justification and all future Congressional Budget 
Justifications historical and budget year information on 
enforcement activities and outcomes, distinguishing between 
coal and metal/non-metal mines. To promote transparency in 
agency spending on its enforcement activities, MSHA shall 
continue to separately present annual spending on coal and 
metal/non-metal mines as it has in past Congressional Budget 
Justifications.
    Resources and Activities.--The Committee notes significant 
worker dislocations and mine closures because of economic 
conditions throughout the mining industry, and in coal mining 
in particular. The Committee reiterates its support for the 
ongoing effort to bring MSHA enforcement into proportion by 
redistributing resources and activities to the areas where mine 
production is currently occurring and where MSHA identifies the 
most significant safety hazards.

                       Bureau of Labor Statistics


                         SALARIES AND EXPENSES

 
 
 
Appropriation, fiscal year 2022.......................      $687,952,000
Budget request, fiscal year 2023......................       741,744,000
Committee Recommendation..............................       726,334,000
    Change from enacted level.........................       +38,382,000
    Change from budget request........................       -15,410,000
 

    The Bureau of Labor Statistics (BLS) is an independent 
national statistical agency that collects, processes, analyzes, 
and disseminates essential economic data to the Congress, 
Federal agencies, State and local governments, businesses, and 
the public. Its principal surveys include the Consumer Price 
Index and the monthly unemployment series.
    The Committee recommendation includes $658,334,000 from the 
General Fund of the Treasury and $68,000,000 from the 
Employment Security Administration Account in the Unemployment 
Trust Fund. The recommendation does not include funds for the 
relocation of the BLS headquarters, which was fully funded in 
fiscal year 2022.
    Within the total for BLS, the Committee provides the 
following amounts:

------------------------------------------------------------------------
                   Budget Activity                     FY 2023 Committee
------------------------------------------------------------------------
Employment and Unemployment Statistics...............       $261,454,000
Labor Market Information.............................         68,000,000
Prices and Cost of Living............................        252,000,000
Compensation and Working Conditions..................         92,976,000
Productivity and Technology..........................         12,853,000
Executive Direction and Staff Services...............         39,051,000
------------------------------------------------------------------------

    National Longitudinal Survey of Youth (NLSY).--The 
Committee continues to recognize the importance of the National 
Longitudinal Survey of Youth (NLSY), which has provided 
valuable information about labor market trends for decades. The 
increase includes sufficient resources to continue development 
of a new NLSY cohort.
    Preserving Existing Statistical Work and Staff.--When 
implementing the NLSY and other new investments, the Committee 
directs BLS not to reduce or eliminate existing statistical 
work. Further, the Committee directs BLS not to reduce the 
number of full-time equivalent positions beyond the apportioned 
fiscal year 2022 full-time equivalent ceiling.
    Nonprofit Sector Workforce.--The Committee recognizes the 
importance of the nonprofit sector workforce as a critical 
partner to government and a frontline service provider in 
communities nationwide and encourages BLS to examine the value 
in including nonprofit organizations as a distinct category of 
employer in quarterly reports from its Quarterly Census of 
Employment and Wages (QCEW).
    Artificial Intelligence.--The Committee notes the continued 
development of artificial intelligence and encourages BLS to 
examine this trend's impact on the economy.
    Public Safety Telecommunicators.--The Committee recognizes 
that categorizations of a `public safety telecommunicator' as 
an `office and administrative support occupation' is outdated 
and does not reflect the nature of this life-saving work. The 
Committee encourages BLS to update data collection practices to 
be in line with modern changes to the public safety 
telecommunications profession, classifying them as a 
`protective service occupation' and collecting data 
accordingly.
    Military Spouses.--The Committee recognizes the need for 
comprehensive data measuring employment among military spouses 
over time. The Committee encourages BLS, in collaboration with 
the Department of Defense, to assess the potential for 
measuring labor market outcomes and characteristics of military 
spouses with existing survey data and explore options for 
modifying such surveys to capture this population.
    BLS Data Collection Sources.--The Committee recognizes the 
value and importance of real-time economic data for the purpose 
of identifying economic trends and consumer sentiment. Further, 
as the Department prepares future solicitations for economic 
data and research, the Committee encourages the Department to 
conduct robust market research to identify potential new market 
entrants.

                 Office of Disability Employment Policy


                         SALARIES AND EXPENSES

 
 
 
Appropriation, fiscal year 2022.......................       $40,500,000
Budget request, fiscal year 2023......................        58,566,000
Committee Recommendation..............................        58,566,000
    Change from enacted level.........................       +18,066,000
    Change from budget request........................             - - -
 

    The Office of Disability Employment Policy (ODEP) provides 
policy guidance and leadership to eliminate employment barriers 
to people with disabilities.
    The Committee recommendation for ODEP is $58,566,000, which 
is $18,066,000 above the fiscal year 2022 enacted level and the 
same as the fiscal year 2023 budget request. The Committee is 
supportive of the budget proposal for ODEP to support the 
planning and implementation of Equitable Transition Model (ETM) 
projects that will develop strategies to enable low-income 
youth with disabilities, including youth experiencing 
homelessness, leaving foster care, or involved in the justice 
system, to be more likely to transition to employment.

                        Departmental Management


                         SALARIES AND EXPENSES

 
 
 
Appropriation, fiscal year 2022.......................      $367,697,000
Budget request, fiscal year 2023......................       492,104,000
Committee Recommendation..............................       498,917,000
    Change from enacted level.........................      +131,220,000
    Change from budget request........................        +6,813,000
 

    The Departmental Management appropriation provides funds 
for the staff responsible for Departmental operations, 
management, and policy development.
    The Committee recommendation includes $498,609,000 from the 
General Fund of the Treasury, $131,220,000 above the fiscal 
year 2022 enacted level and $6,813,000 above the fiscal year 
2023 budget request, and $308,000 from the Employment Security 
Administration Account in the Unemployment Trust Fund.
    Within the total for Departmental Management, the Committee 
provides the following amounts:

------------------------------------------------------------------------
                   Budget Activity                     FY 2023 Committee
------------------------------------------------------------------------
Program Direction and Support........................        $38,958,000
Departmental Evaluation..............................         10,351,000
Legal Services.......................................        178,183,000
International Labor Affairs..........................        138,965,000
Administration and Management........................         36,630,000
Adjudication.........................................         42,836,000
Women's Bureau.......................................         35,361,000
Civil Rights Activities..............................         11,591,000
Chief Financial Officer..............................          6,042,000
------------------------------------------------------------------------

    Office of the Solicitor (SOL).--The recommendation includes 
$178,183,000 for SOL to bring enforcement actions on behalf of 
DOL's agencies. The SOL is encouraged to increase staffing 
levels to assist in the development of investigations, 
negotiations, and litigations to ensure workers get the relief 
they deserve.
    Bureau of International Labor Affairs (ILAB).--Of the 
$138,965,000 recommended for ILAB, the Committee directs the 
Secretary to allocate not less than $40,500,000 in grants to 
build the capacity of countries to enforce labor rights to 
promote a more level playing field for workers in the U. S. 
while maintaining critical funding for combatting child labor. 
The Committee directs ILAB to use its fiscal year 2023 funding 
increase to place additional labor attaches in strategic 
countries, including, but not limited to, Honduras.
    Flagship Reports on Child Labor and Forced Labor.--ILAB is 
directed to continue its work on three key reports, including: 
DOL's Findings on the Worst Forms of Child Labor; the List of 
Goods Produced by Child Labor or Forced Labor; and, the List of 
Products Produced by Forced or Indentured Child Labor. The 
Committee includes the resources requested in the fiscal year 
2023 budget request for staff and contract costs to fulfill a 
new statutory mandate requiring the List of Goods Produced by 
Child Labor or Forced Labor to include goods that are produced 
with inputs that are produced with forced labor or child labor.
    USMCA Implementation Act.--The Committee urges ILAB to use 
USMCA Implementation Act funding to directly support workers' 
rights and capacity to organize independent unions in Mexico. 
These activities must be central to ILAB's monitoring, 
enforcement, and capacity-building roles in USMCA 
implementation. ILAB can also advance this critical work 
through technical assistance that strengthens the capacity of 
independent unions in USMCA priority sectors. Further, ILAB can 
fund research and legal teams, including through academic 
institutions, to develop sustainable programs that train and 
support labor lawyers and researchers in priority sectors. 
Finally, ILAB can support key USMCA objectives by funding 
innovative supply chain monitoring and accountability 
mechanisms, focused on ensuring the effective recognition of 
workers' rights to organize and collective bargaining in USMCA 
priority sectors. Such efforts to develop necessary research, 
legal assistance and monitoring mechanisms will collectively 
supplement and strengthen core ILAB program to directly educate 
and train workers to build independent unions.
    In the fiscal year 2024 Congressional Budget Justification, 
ILAB is directed to include spending plans for resources 
provided in the USMCA Implementation Act for fiscal years 2020 
through 2024. Spending plans should include descriptions and 
amounts for projects and staffing.
    Child Labor in Cocoa.--The Committee is concerned about the 
continued prevalence of child labor in the harvesting and 
production of cocoa beans. Further, the Committee notes that 
while the Child Labor Cocoa Coordinating Group (GLCCG) has 
facilitated progress in the reduction of child labor in cocoa 
production, substantial levels of children remain engaged in 
child labor in the industry. The Committee is concerned about 
the progress of the GLCCG in accordance with goals established 
in the Harkin-Engel Protocol. The Committee encourages the 
Department to report on indicators of progress being made by 
high-risk countries to eliminate child labor and forced labor 
in the cocoa sector, including progress being made to map all 
cocoa farms. In addition, the Committee encourages the 
Department to report on government and industry use of 
available best practices for management, reporting, and 
verification, and on the active and meaningful participation of 
worker organizations in order to provide consumers with 
assurance that cocoa products are produced without the use of 
child labor and forced labor.
    Women's Bureau.--Of the $35,361,000 appropriated to the 
Women's Bureau, the Committee provides no less than $7,500,000 
for the Women in Apprenticeship and Nontraditional Occupations 
(WANTO) program, which is $5,000,000 above the fiscal year 2022 
enacted level and the fiscal year 2023 budget request. This 
program helps employers and labor unions recruit, train, and 
retain women for nontraditional employment opportunities. These 
resources are essential in helping women overcome traditional 
barriers to entry and supporting women's full participation in 
the labor force.
    Operating Plan.--The Committee directs the Department to 
submit its annual Operating Plan to the Committees on 
Appropriations within the 45-day statutory deadline.
    Advertising Spending.--The Committee understands that, as 
the largest advertiser in the U.S., the Federal Government 
should work to ensure fair access to its advertising contracts 
for small disadvantaged businesses and businesses owned by 
minorities and women. The Committee directs the Department to 
include the following information in its fiscal year 2024 
Congressional Budget Justification: Expenditures for fiscal 
year 2022 and expected expenditures for fiscal years 2023 and 
2024, respectively, for (1) all contracts for advertising 
services; and, (2) contracts for the advertising services 
of`(I) socially and economically disadvantaged small business 
concerns (as defined in section 8(a)(4) of the Small Business 
Act (15 U.S.C. 637(a)(4)); and (II) women- and minority-owned 
businesses.
    Nondisclosure Agreements.--The Committee recognizes that 
harassment, including sexual harassment and assault, continue 
to be pervasive in the workplace, and that the use of 
predispute nondisclosure and nondisparagement clauses as 
conditions of employment can perpetuate illegal conduct by 
silencing survivors and shielding perpetrators. The Committee 
directs the Department to include proposals in its fiscal year 
2024 Congressional Budget Justification to eliminate the use of 
grants and contracts to employers that use this practice.
    National Equal Pay Enforcement Task Force.--The Committee 
strongly urges the Secretary to establish a National Equal Pay 
Enforcement Task Force (Task Force), consisting of 
representatives from the Equal Employment Opportunity 
Commission, the Department of Justice, the Department of Labor, 
and the Office of Personnel Management. The mission of the Task 
Force should be to improve compliance, public education, and 
enforcement of equal pay laws. The agencies in the Task Force 
should coordinate activities and limit potential gaps in 
enforcement. The Committee further urges the Task Force to 
investigate challenges related to pay inequity, advance 
recommendations to address those challenges, and create action 
plans to implement the recommendations. The Committee requests 
an update in the fiscal year 2024 Congressional Budget 
Justification on steps to establish the Task Force.
    Employees.--The Committee directs the Department to provide 
a report not later than 30 days after the conclusion of each 
quarter detailing the number of full-time equivalent employees 
and attrition by principal office and appropriations account.
    Investments in Impoverished Areas.--The Committee supports 
targeted investments in impoverished areas, particularly in 
persistent poverty counties and in other high poverty census 
tracts. To understand how programs funded through the 
Department are serving these particular areas, the Committee 
directs the Department to submit a report to the Committees on 
Appropriations on the percentage of funds allocated by all 
competitive grant programs in fiscal years 2020, 2021 and 2022 
to serve individuals living in persistent poverty counties, as 
defined as a county that has had 20 percent or more of its 
population living in poverty over the past 30 years, as 
measured by the 1990 and 2000 decennial censuses and the most 
recent Small Area Income and Poverty estimates, or any 
territory or possession of the United States, and high-poverty 
areas, as defined as any census tract with a poverty rate of at 
least 20 percent as measured by the 2014-2018 5-year data 
series available from the American Community Survey of the 
Census Bureau. The Department shall report this information to 
the Committees within 90 days of such data being available and 
provide a briefing to the Committees not later than 180 days of 
enactment of this Act on how the Department is carrying out 
this directive. In the case of any competitive program for 
which at least 10 percent of the funds allocated were not 
allocated to persistent poverty counties or for which the 
percentage allocated to high-poverty areas in fiscal year 2021 
or 2022 was less than the average percentage of Federal 
assistance allocated to high-poverty areas awarded under the 
program in fiscal years 2017, 2018, and 2019, such report and 
briefing shall explain why such a benchmark is unable to be 
met.
    Study on the Health Impact of Pesticide Use on Children in 
Agriculture.--The Committee includes $1,000,000 for the 
Department to contract with the National Academies of Sciences, 
Engineering, and Medicine (NASEM) to study the impact of 
pesticide exposure on children working in agriculture. 
Pesticides have a detrimental effect on human health, with 
children among the particularly vulnerable, and low levels of 
pesticide exposure can affect children's neurological and 
behavioral development. The Committee encourages NASEM to 
review other environmental hazard-related exposures on children 
in agriculture as well.
    Evidence-based Policymaking Act.--The Committee is 
supportive of efforts by the Department to consider evidence of 
effectiveness in grant competitions and requests an update in 
the fiscal year 2024 Congressional Budget Justification on 
implementation of the Foundations for Evidence-based 
Policymaking Act (P.L. 115-435) and implementation plans for 
the coming year. The Committee encourages the Secretary to 
develop guidance to ensure relevant participants and grantees 
are involved in the Department-wide process of prioritizing 
evidence needs, including participating in Department led 
evaluations. Consistent with program statutes, the Committee 
encourages the Secretary to ensure that evidence of 
effectiveness is a consideration in grant opportunities.
    Organizational Priority Goals.--The Committee directs the 
Department to comply with title 31 of the United States Code, 
including the development of organizational priority goals and 
outcomes such as performance outcome measures, output measures, 
efficiency measures, and customer service measures. The 
Committee further directs the Department to include an update 
on the progress of these efforts in the fiscal year 2024 
Congressional Budget Justification.
    Streamlining Service Delivery and Improving Customer 
Service.--The Committee continues to support efforts to improve 
customer service in accordance with Executive Order 13571--
Streamlining Service Delivery and Improving Customer Service. 
The Committee directs the Secretary to develop standards to 
improve customer service and incorporate the standards into the 
performance plans required under 31 U.S.C. 1115. The Committee 
further directs the Department to include an update on the 
progress of these efforts in the fiscal year 2024 Congressional 
Budget Justification.
    Use of Force.--The Committee supports vigorous action to 
improve training for all Federal, State, and local law 
enforcement officers on racial profiling, implicit bias, 
procedural justice, the use of force, and the duty for officers 
to intervene when witnessing the use of excessive force against 
civilians. The Committee therefore directs the Secretary to 
work with the Attorney General and the Federal Law Enforcement 
Training Centers to implement improved, mandatory training on 
these topics for all federal law enforcement officers, along 
with the development of related standards that can be applied 
in hiring and performance assessments. These training 
requirements and standards should be based on the related 
provisions in H.R. 1280, as passed by the House of 
Representatives in March 2021.
    The Committee directs the Department's Division of 
Protective Operations, to the extent it has not already done 
so, to submit its use of force data to the Federal Bureau of 
Investigation's National Use of Force Data Collection database. 
The Committee requests a briefing within 90 days of enactment 
of this Act on current efforts to tabulate and submit use of 
force data to the FBI.
    Inter-agency Collaboration.--The Committee identifies a 
need for more inter-agency collaboration between the 
Department--including WHD and OSHA--, Equal Employment 
Opportunity Commission, and the National Labor Relations Board 
to enforce labor and civil rights laws fully and effectively. 
The Committee encourages the agencies to review and evaluate 
current enforcement efforts, rescind harmful regulations and 
sub-regulatory guidance, and ensure each agency is using all 
the tools and policies at their disposal to protect workers. 
This includes robust coordinated outreach and education to 
rebuild trust in government enforcement, especially in 
communities of color.
    Critical Minerals.--The Committee recognizes the importance 
of critical minerals for use in the United States. In response 
to this growing need, as part of the Consolidated 
Appropriations, Act of 2021 (P.L. 116-260), Congress authorized 
in section 7002 a workforce assessment and workforce 
development program in the Department of Labor to address 
mineral security. The Committee requests an update on these 
efforts in the fiscal year 2024 Congressional Budget 
Justification.
    Residential Contractor Certification Program.--The 
Committee encourages the Department to develop a system, 
similar to Energy Star, to help consumers make informed 
decisions when hiring a residential contractor to perform work. 
The Department should work with labor unions and other 
stakeholders in developing such a system. The Committee 
requests a briefing within 90 days of enactment of this Act on 
the Department's plans to develop this system.

                    VETERANS EMPLOYMENT AND TRAINING

 
 
 
Appropriation, fiscal year 2022.......................      $325,341,000
Budget request, fiscal year 2023......................       330,968,000
Committee Recommendation..............................       338,841,000
    Change from enacted level.........................       +13,500,000
    Change from budget request........................        +7,873,000
 

    The recommendation includes $70,500,000 from the General 
Fund of the Treasury and $268,341,000 from the Employment 
Security Administration Account in the Unemployment Trust Fund.
    The Veterans Employment and Training (VETS) program serves 
America's veterans and separating service members by preparing 
them for meaningful careers, providing employment resources and 
expertise, and protecting their employment rights.
    Within the total for VETS, the Committee provides the 
following amounts:

------------------------------------------------------------------------
                   Budget Activity                     FY 2023 Committee
------------------------------------------------------------------------
State Administration Grants..........................       $183,000,000
Transition Assistance Program........................         32,379,000
Federal Administration...............................         49,548,000
Veterans Employment and Training Institute...........          3,414,000
Homeless Veterans Reintegration Program..............         70,500,000
------------------------------------------------------------------------

    The Committee recommendation includes $32,379,000 for the 
Transition Assistance Program, which is the same as the fiscal 
year 2022 enacted level and $1,000,000 more than the fiscal 
year 2023 budget request. This funding will enhance the quality 
of employment support services for transitioning service 
members and allow VETS to develop and implement a course 
curriculum to help military spouses overcome the challenges 
they face related to employment and career development.
    The Committee includes $70,500,000 for the Homeless 
Veterans Reintegration Program, which is $10,000,000 more than 
the fiscal year 2022 enacted level and $8,000,000 more than the 
fiscal year 2023 budget request. Funds will be used to further 
support the needs of veterans experiencing homelessness.
    The Committee includes $500,000, which is the same as the 
fiscal year 2022 enacted level and the fiscal year 2023 budget 
request, to support the HIRE Vets Medallion Program authorized 
by the Honoring Investments in Recruiting and Employing 
American Military Veterans Act of 2017.
    The Committee recommendation includes $300,000 within 
Federal Administration, which is the same as the fiscal year 
2022 enacted level and the fiscal year 2023 budget request, to 
continue the operation of the Disabled Veteran Program (DVP), 
which was initiated by the Committee in fiscal year 2020. The 
DVP addresses the high unemployment and low labor force 
participation rate of veterans with service-connected and non-
service-connected disabilities. The DVP helps increase 
employment and advancement opportunities for veterans with 
disabilities by working with Federal, State, and private 
partners to promote the hiring of veterans with disabilities, 
improve coordination of available employment services and 
supports, and to identify and share employment best practices 
for hiring, retaining, and advancing veterans with disabilities 
in the workforce.
    Equity and Access for Homeless Veterans.--The Committee 
continues to direct the Department to include an update on 
racial equity and access to programs at the Department 
providing services to homeless veterans in its fiscal year 2024 
Congressional Budget Justification. The update shall also track 
departmental expenditures within the Homeless Veteran Programs, 
specifically with regard to minority, female, and LGBTQ 
populations. Where available, the Department shall disaggregate 
data by ethnicity, age, gender identity, and discharge status.

                  INFORMATION TECHNOLOGY MODERNIZATION

 
 
 
Appropriation, fiscal year 2022.......................       $28,269,000
Budget request, fiscal year 2023......................        47,969,000
Committee Recommendation..............................        38,269,000
    Change from enacted level.........................       +10,000,000
    Change from budget request........................        -9,700,000
 

    Information Technology (IT) Modernization provides a 
dedicated source of funding for Department-wide IT 
modernization projects together with funding through the 
Department's Working Capital Fund.

                      OFFICE OF INSPECTOR GENERAL

 
 
 
Appropriation, fiscal year 2022.......................       $90,847,000
Budget request, fiscal year 2023......................       107,865,000
Committee Recommendation..............................        99,028,000
    Change from enacted level.........................        +8,181,000
    Change from budget request........................        -8,837,000
 

    The Office of Inspector General (OIG) conducts audits of 
Department programs and operations in order to determine that 
they comply with the applicable laws and regulations, that they 
use resources effectively, and that they are achieving their 
intended results.
    The recommendation includes $93,187,000 from the General 
Fund of the Treasury, which is $8,000,000 more than the fiscal 
year 2022 enacted level, and $5,841,000 from the Employment 
Security Administration Account in the Unemployment Trust Fund.
    Pandemic Unemployment Assistance.--The PUA program was 
designed to ensure that critical emergency assistance was 
delivered immediately, so it would be available to unemployed 
workers when it was most needed. It is important to ensure that 
resources for such critical emergency assistance during 
simultaneous public health crisis and financial crisis should 
be targeted to individuals and families who are eligible for 
benefits. The Committee supports the Inspector General's 
oversight activities and efforts to investigate any illegal 
schemes to defraud the PUA program.

                           General Provisions

    Sec. 101. The Committee continues a provision to prohibit 
the use of Job Corps funds for the salary of an individual at a 
rate in excess of Executive Level II.

                          (TRANSFER OF FUNDS)

    Sec. 102. The Committee continues a provision regarding 
transfer authority.
    Sec. 103. The Committee continues a prohibition on use of 
funds to purchase goods that are in any part produced by 
indentured children.
    Sec. 104. The Committee continues a provision related to 
grants made from funds available to the Department under the 
American Competitiveness and Workforce Improvement Act.
    Sec. 105. The Committee continues a provision to prohibit 
recipients of funds provided to the Employment and Training 
Administration from using such funds for the compensation of 
any individual at a rate in excess of Executive Level II.

                          (TRANSFER OF FUNDS)

    Sec. 106. The Committee continues a provision providing the 
Secretary with the authority to transfer funds made available 
to the Employment and Training Administration to Program 
Administration for technical assistance and program integrity 
activities.

                          (TRANSFER OF FUNDS)

    Sec. 107. The Committee continues a provision allowing up 
to 0.75 percent of discretionary appropriations provided in 
this Act for specific Department of Labor agencies to be used 
by the Office of the Chief Evaluation Officer for evaluation 
purposes consistent with the terms and conditions in this Act 
applicable to such office.
    Sec. 108. The Committee continues a provision relating to 
surplus property and apprenticeship programs.
    Sec. 109. The Committee modifies a provision relating to 
the Secretary's security detail.
    Sec. 110. The Committee continues a provision relating to 
the Treasure Island Job Corps Center.
    Sec. 111. The Committee continues a provision relating to 
Job Corps.
    Sec. 112. The Committee includes a new provision relating 
to the Wagner-Peyser Act Staffing Flexibility regulation.
    Sec. 113. The Committee includes a new provision relating 
to regulations pertaining to industry recognized apprenticeship 
programs.

           TITLE II--DEPARTMENT OF HEALTH AND HUMAN SERVICES


              Health Resources and Services Administration


 
 
 
Appropriation, fiscal year 2022.......................    $8,891,772,000
Budget request, fiscal year 2023......................     8,782,614,000
Committee Recommendation..............................     9,574,521,000
    Change from enacted level.........................      +682,749,000
    Change from budget request........................      +791,907,000
 

    The Health Resources and Services Administration (HRSA) 
supports programs that provide health services to 
disadvantaged, medically underserved, and special populations; 
decrease infant mortality rates; assist in the education of 
health professionals; and provide technical assistance 
regarding the utilization of health resources and facilities.
    The Committee recommendation for HRSA includes 
$9,295,951,000 in discretionary budget authority, $256,370,000 
in mandatory funding and $15,200,000 in trust fund 
appropriations for the Vaccine Injury Compensation Program 
Trust Fund, and $7,000,000 for the Countermeasures Injury 
Compensation Program.

                          PRIMARY HEALTH CARE

 
 
 
Appropriation, fiscal year 2022.......................    $1,748,772,000
Budget request, fiscal year 2023......................     1,839,022,000
Committee Recommendation..............................     1,946,772,000
    Change from enacted level.........................      +198,000,000
    Change from budget request........................      +107,750,000
 

Health Centers

    The Committee recommends $1,945,772,000 for the Health 
Centers program, $198,000,000 above the fiscal year 2022 
enacted level and $107,750,000 above the fiscal year 2023 
budget request. Health Centers deliver affordable, accessible, 
quality, and cost-effective primary health care to millions of 
people across the country regardless of their ability to pay. 
Programs supported by this funding include community health 
centers, migrant health centers, health care for the homeless, 
and public housing health service grants.
    The Committee includes bill language providing up to 
$120,000,000 for the Federal Tort Claims Act program, the same 
as the fiscal year 2022 enacted level and the fiscal year 2023 
budget request.
    Alcee L. Hastings Program for Advanced Cancer Screening in 
Underserved Communities.--The Committee appreciates the work 
and leadership of HRSA to implement the Alcee L. Hastings 
Program for Advanced Cancer Screening in Underserved 
Communities and provides $15,000,000 for this activity, an 
increase of $10,000,000 above the fiscal year 2022 enacted 
level. This program is imperative to redressing disparities in 
cancer screening in medically underserved communities. In 
continuing to implement this program, the Committee encourages 
HRSA to support approaches that leverage the use of community 
health workers and navigators providing health services at the 
individual health center and, where appropriate, health center-
controlled network level with training, oversight, and clinical 
workflow support from NCI-designated comprehensive cancer 
centers. Also, given the immense data supporting the disparate 
impact of lung cancer on medically underserved populations and 
the effectiveness of screening for this condition, the 
Committee strongly encourages HRSA to prioritize programs 
targeting lung cancer, such as screening and smoking cessation 
counseling.
    Early Childhood Development.--The Committee provides 
$42,500,000 within the total for HRSA-funded Health Centers to 
hire or contract for early childhood development specialists to 
better integrate early developmental promotion services, as 
described in the fiscal year 2023 budget request. The Committee 
encourages HRSA to create a service expansion grant opportunity 
for health centers, with training and technical assistance to 
be provided by the Maternal and Child Health Bureau, which has 
a long-standing commitment to improving the health and 
wellbeing of young children and their families.
    Ending the HIV Epidemic (EHE) Initiative.--The Committee 
provides $172,000,000 within the Health Centers program for the 
EHE Initiative, $49,750,000 above the fiscal year 2022 enacted 
level and the same as the fiscal year 2023 budget request. This 
initiative provides funding to Health Centers in high-need 
jurisdictions to increase the use of pre-exposure prophylaxis 
(PrEP) among people at high risk for HIV transmission.
    Health Care for the Homeless.--The Committee supports the 
activities of the Health Care for the Homeless program, which 
provides funding to community-based health centers to provide 
low- or no-cost health care to underserved populations using a 
trauma-informed, harm reduction approach. Services provided by 
such health centers include primary care, mental health 
treatment, substance use treatment, medical respite care, case 
management, and enrollment/benefits assistance.
    Health Center Controlled Networks (HCCNs).--These networks 
are the foundation of health information technology (HIT) 
services for the nation's community health centers. Health 
centers function as the largest primary care network in the 
country, caring for 30 million patients. HCCNs are voluntary 
associations of community health centers that band together to 
invest in HIT tools, optimize the use of these technologies, 
digitally connect to health care and community partners, and 
more. The HIT infrastructure requires robust Federal investment 
to support the demand caused by the COVID-19 pandemic's 
resulting shift in how health care is provided. The Committee 
encourages HRSA to provide robust support for these networks 
and requests as part of the fiscal year 2024 Congressional 
Budget Justification an update on the status of the network HIT 
infrastructure.
    Integrating High-Quality Contraceptive Care.--The Committee 
is aware that while most primary care physicians provide 
women's health services, many are not able to provide patients 
with a broad range of contraceptive care options, including 
long-acting reversible contraceptive methods that require 
specialized training and skill development. The Committee 
includes $25,000,000 within the total for Health Centers to 
support grants for training and quality improvement efforts to 
make available patient-centered contraceptive care within 
health center primary care settings. Grantees may use funds to 
support training and quality improvement to implement best 
practices in contraceptive care, including reproductive health 
screening, patient-centered contraceptive counseling, and 
access to the full range of FDA-approved, cleared, or granted 
contraceptive products that are determined by an individual's 
medical provider to be medically appropriate. These activities 
would improve health equity, strengthen maternal health and 
prenatal care, and empower patients to decide if and when they 
want to become pregnant.
    School-Based Health Centers (SBHCs) and Health Center 
School-Based Service Sites.--Recognizing the critical role of 
Health Centers as part of our Nation's health care safety net, 
and that Health Centers providing services at sites located at 
schools within the communities they serve are currently one of 
the most effective sources of mental health care for children 
and adolescents, the Committee includes $50,000,000, an 
increase of $20,000,000 above the fiscal year 2022 enacted 
level, for awards to Health Centers operating school-based 
service sites to increase their capacity to meet the increasing 
demand for health services, including mental health services. 
The Committee also includes $50,000,000 to make grants to fund 
the School-Based Health Center Program and expand services at 
SBHCs pursuant to 42 USC 280h-5. SBHCs provide a convenient 
access point to high-quality, comprehensive primary health 
care, mental health services, preventive care, social services, 
and youth development to primarily children and adolescents 
from low-income families.
    HRSA Strategy to Address Intimate Partner Violence and 
Project Catalyst.--The Committee includes no less than 
$2,000,000 within the total for Health Centers for the HRSA 
Strategy to Address Intimate Partner Violence, the same as the 
fiscal year 2022 enacted level.
    Native Hawaiian Health Care Program.--The Committee 
provides $23,000,000 within the total for Health Centers for 
the Native Hawaiian Health Care Program, $1,000,000 above the 
fiscal year 2022 enacted level and the fiscal year 2023 budget 
request. The Native Hawaiian Health Care Systems help improve 
the health status of Native Hawaiians by making health 
education, health promotion, disease prevention, and Native 
Hawaiian traditional healing services available.
    Of the total amount appropriated for the Native Hawaiian 
Health Care Program, not less than $10,000,000 shall be 
provided to Papa Ola Lokahi for administrative purposes 
authorized under 42 U.S.C. 11706, including expanded research 
and surveillance related to the health status of Native 
Hawaiians and strengthening the capacity of the Native Hawaiian 
Health Care Systems to provide comprehensive health education 
and promotion, disease prevention services, traditional healing 
practices, and primary health services to Native Hawaiians.
    Vaccination and Screening for Hepatitis B.--The Committee 
encourages HRSA to urge health center grantees to adopt the 
necessary practices and policies to comply with the November 
2021 Advisory Committee on Immunization Practices (ACIP) 
recommendation that all adults between 19 and 59 be vaccinated 
for hepatitis B. To implement this policy, the Committee 
further encourages HRSA to ensure that Health Centers screen 
all individuals for hepatitis B, offer to immunize all non-
infected patients in the 19-59 age cohort, and navigate 
infected individuals into care. The Committee urges that this 
recommendation be implemented as early as possible in fiscal 
year 2023.

Free Clinics Medical Malpractice

    The Committee includes $1,000,000 for carrying out 
responsibilities under the Federal Tort Claims Act, the same as 
the fiscal year 2022 enacted level and the fiscal year 2023 
budget request. The program provides medical malpractice 
coverage to individuals involved in the operation of free 
clinics to expand access to health care services to low-income 
individuals in medically underserved areas.

                            HEALTH WORKFORCE

 
 
 
Appropriation, fiscal year 2022.......................    $1,295,742,000
Budget request, fiscal year 2023......................     1,619,884,000
Committee Recommendation..............................     1,543,566,000
    Change from enacted level.........................      +247,824,000
    Change from budget request........................       -76,318,000
 

    The Bureau of Health Workforce strengthens the health care 
workforce by providing grants, scholarships, and loan repayment 
programs to help communities recruit and retain health care 
providers where they are most needed.
    The Committee bill strikes language prohibiting HRSA funds 
from being used to support section 340G-1 of the Public Health 
Service Act (PHS Act), which authorizes demonstration projects 
to train or employ alternative dental health care providers, 
including dental therapists. Dental therapists are licensed 
providers who play a similar role in dentistry to that of 
physician assistants in medicine, and work under the 
supervision of a dentist to provide routine dental care like 
exams and fillings. Ending this prohibition on funding will 
give States flexibility to expand the oral health workforce and 
improve access to dental care, particularly in rural and 
underserved communities.
    Impact of the COVID-19 Pandemic on the Health Workforce.--
The Committee looks forward to receiving the report requested 
in House Report 117-96 on the impact of the COVID-19 public 
health emergency on the nursing workforce and encourages HRSA 
to continue to analyze and make information available about the 
impact of the pandemic on the broader health care workforce and 
strategies to mitigate and address these impacts.
    Registered Nursing Shortages.--The Committee is concerned 
about current and projected shortages of registered nurses in 
the U.S. as discussed in the HRSA publication Supply and Demand 
Projections of the Nursing Workforce 2014-2030. The Committee 
encourages HRSA to prioritize investments to increase the 
supply of registered nurses particularly in states with the 
greatest projected shortages.
    Report and Analysis of Technology's Role in the Health Care 
Workforce.--The Committee recognizes the important role that 
HHS and its operating divisions continue to provide to support 
and protect the public health workforce during the COVID-19 
pandemic. The Committee directs HRSA to submit a report to the 
Committee within 18 months of enactment of this Act on the 
challenges associated with hiring, recruiting, and retaining 
the Federal, State, local, Tribal and territorial public health 
workforce. This study should include a specific analysis of how 
technology, especially hands-free technology, could help to 
protect clinicians' physical safety and ease the burden of 
patient care, thereby increasing retention of the public health 
workforce.
    Grant-Based Program to Include Disability Clinical Care 
Competency Training.--The Committee strongly encourages HRSA to 
consider implementation of 42 U.S.C. 293, to develop a grant-
based program in collaboration with the National Council on 
Disability, professional societies, licensing and accreditation 
entities, health professions schools, experts in minority 
health and cultural competency, and public health and 
disability groups, and community-based organizations to expand 
upon the National Initiative In Developmental Medicine: Draft 
Curriculum, which targets a patient population of adults with 
intellectual and developmental disabilities, to include 
disability clinical care competency training inclusive of all 
disability patient subpopulations (e.g. deaf, blind, mobility 
disabilities, etc.).
    Addressing Workforce Shortages.--The Committee supports 
HRSA's efforts to develop the workforce needed to care for a 
rapidly aging U.S. population. The Committee encourages HRSA to 
address the skilled care workforce needs of seniors through 
existing workforce education and training programs.

National Health Service Corps (NHSC)

    The Committee includes $155,600,000, an increase of 
$34,000,000 above the fiscal year 2022 enacted level, for NHSC 
to support competitive awards to health care providers 
dedicated to working in underserved communities in urban, 
rural, and tribal areas. Within this total, the Committee 
includes an increase of $10,000,000 for loan repayment for 
mental and behavioral health providers, including peer support 
specialists, that serve in crisis centers, as described in the 
fiscal year 2023 budget request. The Committee also includes 
$15,600,000, the same as the fiscal year 2022 enacted level, 
within the total to support NHSC awards to participating 
individuals that provide health services in IHS facilities, 
Tribally-Operated Health Programs, and Urban Indian Health 
Programs.
    Behavioral Health Demonstration Program.--The Committee 
notes that racial and ethnic minority communities continue to 
face acute challenges accessing behavioral health services due 
to the lack of providers who speak their language or understand 
their culture. The Committee includes $10,000,000 within NHSC 
for a pilot program to evaluate the benefit to patient access 
and practitioner recruitment and retention of increasing loan 
repayment of upwards of $15,000 above the maximum amount for 
qualified behavioral health providers serving in Federally 
Qualified Health Centers (FQHCs), preferably at which at least 
20 percent of patients are best served in a language other than 
English. The Committee notes that if the qualified behavioral 
health provider is fluent in a language other than English or 
is determined by the health center to have achieved fluency in 
a language other than English during the provider's period of 
obligated service, the provider shall be paid $15,000 above the 
maximum amount. The Committee also directs HRSA to include an 
assessment of program utilization and impact in the annual NHSC 
report to Congress.
    Maternity Care Target Areas (MCTAs).--The Committee 
includes $5,000,000, $4,000,000 above the fiscal year 2022 
enacted level and the same as the fiscal year 2023 budget 
request, within NHSC to implement requirements contained in the 
Improving Access to Maternity Care Act, including establishing 
criteria for and identifying MCTAs and collecting and 
publishing data on the availability and need for maternity care 
health services in Health Professional Shortage Areas (HPSAs).
    NHSC Loan Repayment Application Process.--The Committee is 
concerned that HPSA designations may not arrive in time for 
provider to apply for loan forgiveness through the NHSC loan 
repayment program, and therefore must wait for the loan 
forgiveness application to reopen. Given the loan repayment 
program is a critical component to attract providers--
particularly those in critically needed fields like behavioral 
health--the Committee is concerned that the timeline for HPSA 
designation process and the timeline for NHSC loan repayment 
are inconsistent and could deter providers from participating 
in the NHSC. The Committee requests a report within 90 days of 
enactment of this Act assessing the coordination of the two 
processes, and any improvements that could be made to ensure 
all providers working in a HPSA are eligible for the NHSC 
student loan repayment program as soon as they are hired or the 
HPSA is designated during the calendar year.
    Rural Demonstration Program.--The Committee notes that 
rural communities continue to face acute workforce challenges, 
with approximately five percent of incoming medical students 
coming from rural areas and only one-third of NHSC placements 
in rural communities. The Committee includes $10,000,000 within 
NHSC to conduct a pilot program to evaluate the benefit to 
patient access and practitioner recruitment and retention of 
extending loan repayment for 5 years and $200,000 for providers 
serving in a rural HPSA. The Committee directs HRSA to submit a 
report to the Committee within a year of enactment of this Act 
on program utilization and impact.

Health Professions Training for Diversity

    The Committee supports programs that improve the diversity 
of the health care workforce. HRSA's diversity pipeline 
programs, including the Health Careers Opportunity Program, 
Centers for Excellence, Faculty Loan Repayment, Nursing 
Workforce Diversity, and Scholarships for Disadvantaged 
Students, help advance patient care and ensure opportunity for 
all health care providers.
    Centers of Excellence (COEs).--The Committee includes 
$30,422,000 for COEs, $6,000,000 above the fiscal year 2022 
enacted level. This program provides grants to health 
professions schools and other institutions to serve as resource 
and education centers for the recruitment, training, and 
retention of underrepresented minority students and faculty.
    Health Careers Opportunity Program (HCOP).--The Committee 
includes $18,500,000 for HCOP, $3,050,000 above the fiscal year 
2022 enacted level and the same as the fiscal year 2023 budget 
request. The Committee notes that HCOPs assist students from 
minority and economically disadvantaged backgrounds to navigate 
careers in the health professions. The Committee encourages 
HRSA to continue its improvement of the diversity and 
distribution of needed health care professionals through the 
National HCOP Academies.
    Faculty Loan Repayment.--The Committee includes $1,500,000 
for Faculty Loan Repayment, $274,000 above the fiscal year 2022 
enacted level. This program provides loan repayment to health 
profession graduates from disadvantaged backgrounds who serve 
as faculty at eligible health professions academic 
institutions.
    Scholarships for Disadvantaged Students (SDS).--The 
Committee includes $56,014,000 for SDS, $3,000,000 above the 
fiscal year 2022 enacted level and $4,044,000 above the fiscal 
year 2023 budget request. This program provides grants to 
health professions and nursing schools to provide scholarships 
to students from disadvantaged background who have financial 
need.
    Set-Aside for Midwifery Training.--Within the total for 
SDS, the Committee includes $5,000,000, $1,500,000 above the 
fiscal year 2022 enacted level, to increase the number of 
grants awarded for the purpose of educating midwives to address 
the national shortage of maternity care providers, and 
specifically the lack of adequate diversity in the maternity 
care workforce.

Primary Care Training and Enhancement

    The Committee includes $54,924,000, an increase of 
$6,000,000 above the fiscal year 2022 level and $1,000,000 
above the fiscal year 2023 budget request, for Primary Care 
Training and Enhancement programs, which support training and 
direct financial assistance for future primary care clinicians, 
teachers, and researchers. The Committee includes funding to 
support the proposal in the fiscal year 2023 budget request to 
make grants to support mental health training for primary care 
professionals.
    Eating Disorders Screening, Brief Intervention, Referral, 
and Treatment (SBIRT).--The COVID-19 pandemic worsened eating 
disorders across the Nation, with one study reporting a 
significant increase in eating disorder caseloads in children's 
hospitals. Despite the medical and psychiatric acuity 
associated with eating disorders, many patients remain 
undetected and untreated, as only 20 percent of surveyed 
medical residency programs offer elective training in eating 
disorders and only six percent require such training. Within 
the total for Primary Care Training and Enhancement, the 
Committee provides up to $1,000,000, in coordination with 
SAMHSA's Center of Excellence for Eating Disorders, to provide 
trainings for primary care health professionals to screen, 
briefly intervene, and refer patients to treatment for the 
severe mental illness of eating disorders, as authorized under 
section 13006 of the 21st Century Cures Act.

Oral Health Training

    The Committee includes $42,173,000 for Oral Health 
Training, $1,500,000 above the fiscal year 2022 enacted level 
and the fiscal year 2023 budget request. The Committee directs 
that this increased funding be allocated to General Dentistry 
Programs, Pediatric Dentistry Programs, and State Oral Health 
Workforce Improvement Grants. The Committee directs HRSA to 
provide continuation funding for section 748 post-doctoral 
training grants initially awarded in fiscal year 2020 and 
dental faculty loan repayment program (DFLRP) grants initially 
awarded in fiscal years 2021 and 2022. The Committee also 
directs HRSA to initiate a new DFLRP grant cycle with a 
preference for pediatric dentistry faculty supervising dental 
students or residents and providing clinical services in dental 
clinics located in dental schools, hospitals, and community-
based affiliated sites.
    Action for Dental Health.--With the enactment of the Action 
for Dental Health Act of 2018, the Committee encourages HRSA to 
expand oral health grants for innovative programs under PHS Act 
Section 340G to include Action for Dental Health activities. 
The Action for Dental Health program helps reduce barriers to 
dental care through oral health education, prevention, and the 
establishment of dental homes for underserved populations.

Interdisciplinary Community-Based Linkages

    Area Health Education Centers (AHEC).--The Committee 
includes $48,000,000 for the AHEC program, an increase of 
$3,000,000 above the fiscal year 2022 level and $4,750,000 
above the fiscal year 2023 budget request. This program links 
university health science centers with community health service 
delivery systems to provide education and training networks.
    Patient Safety Telesimulation Programs.--The Committee 
encourages HRSA to support the development and implementation 
of patient safety telesimulation programs. Allowable use of 
these funds may include increasing virtual content delivery 
capacity at modeling simulation centers, establishing 
partnerships with medical schools in providing telesimulation 
programs, developing telesimulation content and devices, 
developing appropriate governance on data and data management, 
and outfitting HPSA locations with necessary telesimulation 
hardware and software assets.
    Geriatrics Workforce Enhancement Program (GWEP).--The 
Committee includes $48,245,000 for the GWEP program, $3,000,000 
above the fiscal year 2022 level and $1,708,000 above the 
fiscal year 2023 budget request. This program supports training 
to integrate geriatrics into primary care delivery and develops 
academic-primary care-community based partnerships to address 
gaps in health care for older adults.
    Mental and Behavioral Health Programs.--The Committee 
includes $44,053,000 for Mental and Behavioral Health Programs, 
an increase of $5,000,000 above the fiscal year 2022 level.
    Adolescent Addiction Medicine and Addiction Psychiatry 
Workforce.--The Committee remains concerned by the lack of 
pediatric and adolescent addiction medicine and addiction 
psychiatry expertise. Currently, there are insufficient 
opportunities to effectively train a robust mental health and 
substance use disorder (SUD) workforce. Only 75 of the Nation's 
179 accredited medical schools offer addiction medicine 
fellowships, and only one program focuses on fellowship 
opportunities for pediatric and adolescent addiction medicine 
and addiction psychiatry. The Committee strongly encourages 
HRSA to include an adequate number of funding awards to 
fellowship programs focused on increasing the number of board 
certified pediatric and adolescent addiction medicine and 
addiction psychiatry subspecialists.
    Graduate Psychology Education (GPE).--Within the total for 
Mental and Behavioral Health Programs, the Committee 
recommendation includes $25,000,000, $5,000,000 above the 
fiscal year 2022 enacted level, for the interprofessional GPE 
program to increase the number of health service psychologists 
trained to provide integrated services to high-need, 
underserved populations in rural and urban communities. The 
Committee recognizes the severe impact of COVID-19 on 
Americans' mental and behavioral health and urges HRSA to 
strengthen investments in the training of health service 
psychologists to help meet these demands.
    Behavioral Health Workforce Education and Training 
(BHWET).--The Committee includes $185,000,000 for the BHWET 
Program, $62,000,000 above the fiscal year 2022 enacted level. 
This program establishes and expands internships or field 
placement programs in behavioral health, serving populations in 
rural and medically underserved areas.
    The Committee is concerned that increased gun violence and 
the pandemic's exacerbation of health disparities has unveiled 
an immediate and desperate need for behavioral health 
professionals, including social workers, psychologists, 
counselors, occupational therapists, and psychiatrists. 
Neuropsychiatrists and advanced practice behavioral nurses are 
specially trained to diagnose mood disorders or biochemical 
imbalances. A HRSA report, however, found that there will be a 
shortage of 250,000 mental health professionals by 2025. The 
Committee supports increased funding for BHWET to increase the 
quality and supply of behavioral health professionals and 
access to behavioral health services, in particular for 
children, adolescents, and transitional-aged youth at risk for 
behavioral health disorders. The Committee encourages HRSA to 
continue to collect data and analyze the scope of the shortage 
of behavioral health professionals and barriers to careers in 
behavioral health.
    Behavioral Health Integration Into Community-Based 
Settings.--The Committee includes $10,000,000, the same as the 
fiscal year 2023 budget request, to provide grants to 
community-based organizations and local health departments to 
integrate navigators and community health workers trained in 
Mental Health First Aid or similar trainings into non-
traditional community settings. This effort will be carried out 
in partnership with the Maternal and Child Health Bureau and 
will help to address the behavioral health needs of families in 
underserved communities.
    Community Improvement Program.--The Committee includes 
$10,000,000, the same as the fiscal year 2023 budget request, 
to develop and expand community-based experiential training 
through internships and field placements for behavioral health 
and behavioral health-related professionals to prepare them to 
work with and support individuals who are involved, or at risk 
of being involved, in the criminal justice system.
    Crisis Workforce Development.--The Committee includes 
$15,000,000 for grants to support crisis workforce development. 
Crisis service models present opportunities for cost savings 
and more effective use of the behavioral health workforce by 
stabilizing individuals experiencing behavioral health crises 
in less intensive settings.
    Mental and Substance Use Disorder Workforce Training 
Demonstration.--The Committee includes $34,700,000 for this 
activity, $3,000,000 above the fiscal year 2022 enacted level 
and $700,000 above the fiscal year 2023 budget request. This 
program makes grants to institutions, including but not limited 
to medical schools and FQHCs, to support training for medical 
residents and fellows in psychiatry and addiction medicine, as 
well as nurse practitioners, physician assistants, and others, 
to provide SUD treatment in underserved communities.
    Peer Support Specialists in the Opioid Use Disorder 
Workforce.--Within the total for BHWET, the Committee includes 
$14,000,000, the same as the fiscal year 2022 enacted level, to 
fund training, internships, and national certification for 
mental health and SUD peer support specialists to create an 
advanced peer workforce prepared to work in clinical settings.
    Social Workers.--While the Committee is aware that the 
behavioral health workforce is seeing shortages in all 
professions, the Committee encourages HRSA to ensure that 
social workers are receiving equitable treatment from the 
program given their multifaceted roles in health care settings. 
Additionally, the Committee encourages HRSA to ensure that 
program awardees are actively working to recruit a diverse 
field of behavioral health professionals.
    Substance Use Disorder Treatment and Recovery (STAR) Loan 
Repayment Program.--The Committee includes $28,000,000 for this 
program, $4,000,000 above the fiscal year 2022 enacted level 
and the same as fiscal year 2023 budget request. An estimated 
21 million Americans needed treatment for SUD in 2017, but only 
4 million received any form of treatment for SUD. The Bureau of 
Labor Statistics data has cited tremendous workforce shortages 
in the SUD treatment profession. Without strategic investments 
in the SUD workforce, this gap will not close and more lives 
will be lost. This program addresses shortages in the SUD 
workforce by providing for the repayment of education loans for 
individuals working in a full-time SUD treatment job that 
involves direct patient care in either a Mental Health 
Professional Shortage Area or a county where the overdose death 
rate exceeds the national average.

National Center for Health Workforce Analysis (NCHWA)

    The Committee includes $6,663,000, $1,000,000 above the 
fiscal year 2022 enacted level and the fiscal year 2023 budget 
request, for the NCHWA. This program collects and analyzes 
health workforce data to provide information on health 
workforce supply and demand.

Public Health and Preventive Medicine Training Programs

    The Committee includes $18,000,000 for Public Health and 
Preventive Medicine Training Grant Programs, $1,000,000 above 
the fiscal year 2022 enacted level and the same as the fiscal 
year 2023 budget request. Within this total, the Committee 
provides an increase of $500,000 for the Preventive Medicine 
Residency Training Program and an increase of $500,000 for 
Public Health Training Centers.

Nursing Workforce Development

    The Committee recommends $324,472,000 for Nursing Workforce 
Development programs authorized under title VIII of the PHS 
Act, $44,000,000 above the fiscal year 2022 enacted level and 
$29,500,000 above the fiscal year 2023 budget request.
    Expanding Access to Nursing Education.--The Committee 
remains concerned about workforce shortages among health care 
professionals, including the nursing workforce. According to 
the American Hospital Association, nursing vacancies increased 
by nearly 30 percent between 2019 and 2020, with an additional 
500,000 nurses expected to retire or leave the profession by 
the end of this year. Recent studies suggest that an additional 
1.2 million nurses will be required in the U.S. by 2030 to meet 
anticipated demand, with States like California, Texas, and 
Florida projected among those with the greatest need. The 
Committee also recognizes that nursing schools across the U.S. 
are struggling to expand capacity to meet this rising demand 
for care. Significant shortages of faculty, classroom space, 
and clinical training sites are commonly identified as factors 
in nursing schools turning away qualified applicants in many 
areas of the country. The Committee supports efforts to expand 
access to educational opportunities at accredited nursing 
schools to qualified applicants, including low-income and 
minority students, to meet this growing demand for nursing 
professionals.
    Experiential Learning Opportunities.--The Committee is 
aware that mental health is one of the most in-demand skills in 
nursing, but many nurse education training programs do not 
expose students to mental health care settings. The Committee 
encourages HRSA to give priority to experiential learning 
opportunities grantees that are partnering with behavioral and 
mental health hospitals to increase the pipeline of nurses into 
this field.
    Advanced Nursing Education.--The Committee includes 
$105,581,000 for Advanced Nursing Education, $26,000,000 above 
the fiscal year 2022 enacted level and the same as the fiscal 
year 2023 budget request. This program supports traineeships 
and faculty and curriculum development to increase the number 
of qualified nurses in the primary care workforce.
    Maternal and Perinatal Nursing Workforce Program.--Within 
the total for Advanced Nursing Education, the Committee 
includes $20,000,000 to increase and diversify the number of 
certified nurse midwives, with a focus on practitioners working 
in rural and underserved communities, as described in the 
fiscal year 2023 budget request. These funds will support 
grants to accredited nurse midwifery programs or other eligible 
entities to award scholarships to students and registered 
nurses to cover the total cost of tuition for the duration of 
the nurse midwifery program, as well as the planning/
development of new midwife training programs.
    Nursing Education, Practice, Quality, and Retention 
(NEPQR).--The Committee includes $56,413,000 for NEPQR, 
$2,000,000 above the fiscal year 2022 enacted level and 
$7,500,000 above the fiscal year 2023 budget request. This 
program supports academic, service, and continuing education 
projects to enhance nursing education, improve the quality of 
care, increase nurse retention, and strengthen the nursing 
workforce.
    Nurse Practitioner Optional Fellowship Program.--The 
Committee provides $6,000,000, the same as the fiscal year 2022 
enacted level, for grants to establish or expand community-
based nurse practitioner residency and fellowship training 
programs for practicing postgraduate nurse practitioners in 
primary care or behavioral health, as described in House Report 
117-96.
    Nursing Workforce Diversity.--The Committee includes 
$26,343,000 for Nursing Workforce Diversity, $3,000,000 above 
the fiscal year 2022 enacted level and the fiscal year 2023 
budget request. This program increases nursing education 
opportunities for individuals from disadvantaged backgrounds by 
providing student stipends, scholarships, and preparation and 
retention activities.
    Nurse Corps Scholarship and Loan Repayment.--The Committee 
includes $101,635,000 for Nurse Corps, $13,000,000 above the 
fiscal year 2022 enacted level and the fiscal year 2023 budget 
request. This program supports scholarships and loan repayment 
assistance for nurses and nursing students committed to working 
in communities with inadequate access to care.
    Nursing Faculty Loan Program.--The Committee includes 
$28,500,000 for the Nursing Faculty Loan Program, the same as 
the fiscal year 2022 enacted level and the fiscal year 2023 
budget request. This program supports schools of nursing to 
provide loans to students enrolled in advanced nursing 
education programs who are committed to becoming nurse faculty.

Children's Hospitals Graduate Medical Education (CHGME)

    The Committee includes $385,000,000 for the CHGME payment 
program, $10,000,000 above the fiscal year 2022 enacted level 
and $35,000,000 above the fiscal year 2023 budget request. This 
program helps eligible hospitals maintain graduate medical 
education programs, which support the training of residents to 
care for the pediatric population and enhance the supply of 
primary care and pediatric medical and surgical subspecialties.

Medical Student Education

    The Committee includes $60,000,000, $5,000,000 above the 
fiscal year 2022 enacted level, to support colleges of medicine 
at public universities located in the top quartile of States 
projected to have a primary care provider shortage. The 
Committee directs HRSA to give priority to applications from 
academic institutions located in States with the greatest 
number of Federally-recognized Tribes. The Committee also 
directs HRSA to give priority to applications from public 
universities with a demonstrated public-private partnership.

Pediatric Subspecialty Loan Repayment Program

    The Committee includes $15,000,000, an increase of 
$10,000,000 above the fiscal year 2022 enacted level, for the 
Pediatric Subspecialty Loan Repayment Program authorized in 
section 775 of the PHS Act. The Committee recognizes that there 
are significant shortages of pediatric subspecialists, child 
psychiatrists, and other child mental health providers in 
underserved areas. The Committee also understands that high 
graduate debt load is a significant barrier to providers 
choosing to complete additional training to enable them to 
provide specialized care for children with special medical and 
mental health care needs.

Public Health Loan Repayment Program

    The Committee includes $25,000,000 to establish the Public 
Health Loan Repayment Program. Funds will support loan 
repayment for public health professionals who agree to serve 
three years in a local, State, or tribal health department. 
This investment in the public health workforce will contribute 
to our Nation's preparedness to address current and future 
public health emergencies.

Preventing Burnout in the Health Workforce Program

    The Committee includes $25,000,000 for activities 
authorized in the Dr. Lorna Breen Health Care Provider 
Protection Act (P.L. 117-105) to provide comprehensive and 
evidence-based support to prevent suicide, burnout, and mental 
and behavioral health conditions among health care providers.

National Practitioner Data Bank (NPDB)

    The Committee includes $18,814,000 for the NPDB, the same 
as the fiscal year 2022 enacted level and the fiscal year 2023 
budget request. The NPDB is a workforce tool that collects and 
discloses information to authorized entities on past adverse 
actions of health care practitioners, providers, and suppliers 
to reduce fraud and abuse and improve health care quality.

                       MATERNAL AND CHILD HEALTH

 
 
 
Appropriation, fiscal year 2022.......................    $1,044,470,000
Budget request, fiscal year 2023......................     1,272,930,000
Committee Recommendation..............................     1,201,296,000
    Change from enacted level.........................      +156,826,000
    Change from budget request........................       -71,634,000
 

    The mission of the Maternal and Child Health Bureau (MCHB) 
is to improve the physical and mental health, safety, and well-
being of the Nation's women, infants, children, adolescents, 
and their families.

Maternal and Child Health (MCH) Block Grant

    The Committee recommends $872,700,000 for the MCH Block 
Grant, $125,000,000 above the fiscal year 2022 enacted level. 
States use the MCH Block Grant to improve access to care for 
mothers, children, and their families; reduce infant mortality; 
provide pre-and post-natal care; support screening and health 
assessments for children; and provide systems of care for 
children with special health care needs.

MCH Block Grant Special Projects of Regional and National Significance

    The Committee continues bill language identifying specific 
amounts for Special Projects of Regional and National 
Significance (SPRANS). The Committee provides the following 
within SPRANS:

------------------------------------------------------------------------
                                                            FY 2023
                   Budget Activity                         Committee
------------------------------------------------------------------------
Set-aside for Oral Health............................         $5,250,000
Set-aside for Epilepsy...............................          3,642,000
Set-aside for Sickle Cell Disease....................          7,000,000
Set-aside for Fetal Alcohol Syndrome.................          1,000,000
------------------------------------------------------------------------

    Addressing Emerging Issues and Social Determinants of 
Maternal Health.--The Committee includes $10,000,000 to create 
an innovation fund for community-based organizations to support 
reducing maternal mortality and adverse maternal outcomes, as 
described in the fiscal year 2023 budget request. Projects may 
include expanding access to maternal mental health and SUD 
services, providing resources to address social determinants of 
maternal health, developing digital tools to enhance maternal 
health care, and technology-enabled collaborative learning and 
capacity building models for pregnant and postpartum women.
    Alliance for Innovation in Maternal Health Safety 
Bundles.--The Committee includes $15,300,000, an increase of 
$3,300,000 above the fiscal year 2022 enacted level and the 
same as the fiscal year 2023 budget request, to support 
continued implementation of the Alliance for Innovation on 
Maternal Health program's maternal safety bundles to all U.S. 
States, the District of Columbia, and U.S. territories, as well 
as tribal entities. Maternal safety bundles are a set of 
targeted and evidence-based best practices that, when 
implemented, improve patient outcomes and reduce maternal 
mortality and severe maternal morbidity.
    Behavioral Health Integration Into Community-Based 
Settings.--The Committee includes $40,000,000, the same as the 
fiscal year 2023 budget request, to provide grants to engage 
and train community partners in underserved communities to link 
mothers and children with resources to address their mental and 
behavioral health needs, as well as children's social and 
emotional development. This effort will be carried out in 
partnership with the Behavioral Health Workforce Education and 
Training program.
    Bias Recognition in Clinical Skills Testing.--The Committee 
includes $1,000,000, the same as the fiscal year 2023 budget 
request, to support a National Academies of Sciences, 
Engineering, and Medicine (NASEM) study authorized under 
Subtitle D, Sec. 133 of the fiscal year 2022 Consolidated 
Appropriations Act (P.L. 117-103) to make recommendations for 
incorporating bias recognition in clinical skills testing for 
accredited schools of allopathic medicine and osteopathic 
medicine.
    Bias Training for Health Care Professionals.--The Committee 
includes $2,000,000 to make grant awards to train health care 
providers on identifying and avoiding implicit bias, as 
described in the fiscal year 2023 budget request.
    Congenital Syphilis (CS).--The Committee is concerned with 
the rise in CS. A recent report by CDC cited data showing a 300 
percent increase in CS over the past five years. Those born 
with CS can have skeletal and facial deformities, deafness, 
blindness, be still born, or die shortly after birth. These 
conditions and deaths are completely preventable with expanded 
prenatal screening and appropriate treatment. The Committee 
urges HRSA to expand efforts to increase multiple prenatal 
screening and testing for CS throughout pregnancies to detect 
and treat CS at the earlier possible stage. Assuring that 
providers are trained on the recommended treatment of syphilis 
in pregnant women is a critical component of eliminating CS.
    Early Childhood Development Expert Grants.--The Committee 
includes $10,000,000, $5,000,000 above the fiscal year 2022 
enacted level, to support the placement of early childhood 
development experts in pediatric settings with a high 
percentage of Medicaid and Children's Health Insurance Program 
patients. Funds will support additional State-level awards and 
related technical assistance with nationwide reach.
    Group Prenatal and Postpartum Care Programs.--The Committee 
recognizes the important role of group prenatal and postpartum 
care (GPC/PC) programs, such as Centering Pregnancy, can have 
on improving prenatal care and providing support for expecting 
mothers. GPC/PC programs provide the opportunity for expectant 
mothers to learn more about pregnancy, a network of social 
support, educational tools, and ultimately work towards 
lowering rates of infant and maternal mortality. The Committee 
includes $2,000,000 within SPRANS for grants to establish new 
or support existing GPC/PC programs.
    Growing and Diversifying the Doula Workforce Program.--The 
Committee includes $10,000,000 to provide grants to community-
based organizations to develop and/or expand programs to 
recruit doula candidates, support their training/certification, 
and then employ them as doulas to support improved birth 
outcomes in the community, as described in the fiscal year 2023 
budget request.
    Hereditary Hemorrhagic Telangiectasia (HHT) Centers of 
Excellence.--The Committee includes $2,000,000 for HHT Centers 
of Excellence. This funding supports coordination and expansion 
of care for HHT patients and participation in a prospective, 
longitudinal registry of HHT patients to better understand this 
rare disease and accelerate the development of new diagnostic 
and treatment options.
    Infant-Toddler Court Teams.--The Committee includes 
$18,000,000 for research-based Infant-Toddler Court Teams to 
change child welfare practices to improve well-being for 
infants, toddlers, and their families. The Committee directs 
HRSA to allocate the funding increase of $5,000,000 above the 
fiscal year 2022 enacted level to existing court team grantees.
    Maternal Mental Health Hotline.--The Committee includes 
$7,000,000, an increase of $3,000,000 above the fiscal year 
2022 level and the same as the fiscal year 2023 budget request, 
to support the maternal mental health hotline. The COVID-19 
pandemic has exacerbated maternal mental health conditions, 
with pregnant and new mothers experiencing anxiety and 
depression at a three to four times higher rate than prior to 
the pandemic. The hotline should provide 24 hours a day voice 
and text support that is culturally and linguistically 
appropriate. Funds provided should also be used to raise public 
awareness about maternal mental health issues and the hotline.
    Minority-Serving Institutions.--The Committee includes 
$5,000,000 to establish a research network to support minority-
serving institutions to study health disparities in maternal 
health outcomes, as described in the fiscal year 2022 budget 
request.
    Oral Health and Primary Care Integration.--The Committee 
includes $5,250,000 to continue demonstration projects to 
increase the implementation of integrating oral health and 
primary care practice. The projects should model the core 
clinical oral health competencies for non-dental providers that 
HRSA published and initially tested in its 2014 report 
Integration of Oral Health and Primary Care Practice. The 
Committee encourages the Chief Dental Officer to continue to 
provide leadership in the design, monitoring, oversight, and 
implementation of the demonstration projects.
    Pregnancy Medical Home Demonstration.--The Committee 
includes $10,000,000 to support a demonstration providing 
incentives to maternal health care providers to provide 
integral health care services to pregnant women and new 
mothers, with the goal of reducing adverse maternal health 
outcomes and maternal deaths, as described in the fiscal year 
2023 budget request. The Integrated Services for Pregnant and 
Postpartum Women Program will award grants to establish or 
operate programs to deliver integrated health care services to 
pregnant and postpartum women to optimize maternal and infant 
health outcomes.
    Regional Pediatric Pandemic Network.--The Committee 
provides $18,000,000, the same as the fiscal year 2022 enacted 
level, to continue support for coordination among the Nation's 
pediatric hospitals and their communities in preparing for and 
coordinating timely research-informed responses to future 
pandemics.
    State Maternal Health Innovation Grants.--The Committee 
includes $39,000,000, $10,000,000 above the fiscal year 2022 
enacted level, for State Maternal Health Innovation Grants to 
establish demonstrations to implement evidence-based 
interventions to address critical gaps in maternity care 
service delivery and reduce maternal mortality. The 
demonstrations should be representative of the demographic and 
geographic composition of communities most affected by maternal 
mortality.
    Fetal, Infant, and Child Death Review (FIDCR).--The 
Committee includes no less than $3,100,000, an increase of 
$1,000,000 above the fiscal year 2022 enacted level, for the 
FIDCR program to expand support and technical assistance to 
States and tribal communities and improve the availability of 
data on sudden unexpected infant deaths.
    Uterine Fibroids Public Health Information Dissemination.--
The Committee encourages HRSA to work with partners to advance 
awareness of uterine fibroids and promote evidence-based care 
for women with fibroids. These efforts may include specific 
information on minority women, who have an elevated risk to 
develop uterine fibroids, and the range of available options 
for the treatment of symptomatic uterine fibroids, including 
non-hysterectomy drugs and devices approved under the Federal 
Food, Drug, and Cosmetic Act in these awareness efforts. The 
Committee encourages HRSA to work with health care-related 
specialty societies and health systems, as appropriate, to 
promote awareness of evidence-based care for women with 
fibroids.

Maternal and Child Health Programs

Sickle Cell Anemia Demonstration Program

    The Committee includes $8,205,000 for this program, an 
increase of $1,000,000 above the fiscal year 2022 enacted level 
and the fiscal year 2023 budget request. The Committee 
recognizes the importance of the program in supporting the 
comprehensive sickle cell disease (SCD) centers in the 
provision of coordinated, comprehensive, culturally competent, 
and family-centered care to people with SCD. The Committee 
affirms the goals of the program to improve care delivery and 
access to high quality care for people with SCD, with a focus 
on increasing access to SCD specialists; increase the number of 
providers with SCD expertise and knowledge of SCD treatment 
methods; and enable access to the latest treatment options 
following evidence-based guidelines.
    With the start of new five-year grant awards in fiscal year 
2022, the Committee requests an update in the fiscal year 2024 
Congressional Justification on how the program is supporting 
the growth of comprehensive sickle cell disease centers that 
provide the latest treatment options following evidence-based 
guidelines and have mechanisms to identify and serve patients 
with SCD who are not currently being cared for by SCD 
specialists.

Autism and Other Developmental Disorders

    The Committee recommends $57,344,000 for Autism and Other 
Developmental Disorders, $3,000,000 above the fiscal year 2022 
enacted level. These programs seek to improve the health and 
well-being of children and adolescents with autism spectrum 
disorder and other developmental disabilities and to advance 
best practices for the early identification and treatment of 
autism and related developmental disabilities.
    Leadership Education in Neurodevelopmental and Related 
Disabilities (LEND).--The Committee provides $38,245,000, 
$1,000,000 above the fiscal year 2022 enacted level, for the 
LEND program to allow the existing 60 LEND sites to maintain 
their capacity to train interdisciplinary professionals to 
screen, diagnose, and provide evidence-based interventions to 
individuals with autism spectrum disorder and other 
developmental disabilities.

Heritable Disorders

    The Committee provides $21,883,000 for the Heritable 
Disorders program, $2,000,000 above the fiscal year 2022 
enacted level. This program assists States to improve and 
expand their newborn screening programs and to promote parent 
and provider education. HRSA also supports the work of the 
Advisory Committee on Heritable Disorders in Newborns and 
Children, which provides states with a Recommended Uniform 
Screening Panel (RUSP) to help ensure every infant is screened 
for conditions that have a recognized treatment. With new 
funding provided in fiscal year 2023, the Heritable Disorders 
program can continue to enhance, improve, expand and provide 
technical assistance to State public health newborn screening 
systems as four new disorders have been added to the RUSP in 
the last six years, and can continue developing and 
disseminating national, regional, and State education and 
training resources for parents, families, providers, and 
patient support groups.
    Severe Combined Immune Deficiency (SCID).--Within the total 
amount for Heritable Disorders, the Committee provides 
$4,000,000, the same as the fiscal year 2022 enacted level, to 
support wider implementation, education, and awareness of 
newborn screening and follow-up for SCID and other newborn 
screening disorders.

Healthy Start

    The Committee recommends $145,000,000 for the Healthy Start 
program, $13,160,000 above the fiscal year 2022 enacted level 
and the fiscal year 2023 budget request. The program provides 
grants to communities with high rates of infant mortality to 
support primary and preventive health care services for mothers 
and their infants.
    The primary purpose of Healthy Start is to reduce maternal 
and infant mortality and to generally improve maternal and 
infant health. Grants are awarded to nonprofits, State and 
local health departments, and community health centers in 
eligible communities with high rates of infant mortality and 
other adverse birth outcomes to develop a package of innovative 
health and social services for pregnant women and infants, and 
evaluate those services. Funding is provided to both increase 
funding to existing grantees so they can increase the number of 
individuals served and to support new, additional awards to 
community-based organizations for targeted initiatives to 
reduce disparities in maternal and infant health outcomes. The 
Committee requests an update in the fiscal year 2024 
Congressional Justification on existing evaluations of Healthy 
Start's effectiveness.
    Maternal Mortality.--The Committee continues to provide no 
less than $15,000,000, the same as the fiscal year 2022 enacted 
level and the fiscal year 2023 budget request, for Healthy 
Start grantees to support nurse practitioners, certified nurse 
midwives, physician assistants, and other maternal-child 
advance practice health professionals within all program sites 
nationwide.

Early Hearing Detection and Intervention (EHDI)

    The Committee includes $18,818,000 for the EHDI program, an 
increase of $1,000,000 above the fiscal year 2022 enacted level 
and the fiscal year 2023 budget request. This program awards 
grants to 53 States and territories to support Statewide 
systems of newborn hearing screening and early intervention 
programs.
    The Committee recognizes the requirement under the PHS Act 
for EHDI funds to support prompt evaluation and diagnosis of 
children referred from screening programs and appropriate 
educational, audiological, medical, and communication (or 
language acquisition) interventions (including family support), 
for children identified as deaf or hard-of-hearing. The 
Committee encourages HRSA to provide the most accurate, 
comprehensive, up-to-date, and evidence-based information to 
children identified as deaf or hard-of-hearing and their 
families. The Committee also encourages HRSA to work with 
partners to advance awareness about the wide range of 
modalities available for children who are deaf and hard of 
hearing, including but not limited to auditory-oral therapy, 
auditory-verbal therapy, Signed Exact English (SEE), American 
Sign Language (ASL), Total Communication (TC), and Cued Speech; 
as well as a full range of assistive hearing technologies, such 
as hearing aids and cochlear implants.

Emergency Medical Services for Children

    The Committee includes $25,000,000 for Emergency Medical 
Services for Children, an increase of $2,666,000 above the 
fiscal year 2022 enacted level. Funding is available to every 
State emergency medical services office to improve the quality 
of emergency care for children and to support research on and 
dissemination of best practices.

Screening and Treatment for Maternal Depression and Related Disorders 
        State Grants

    The Committee provides $11,500,000 for the Screening and 
Treatment of Maternal Depression and Related Behavioral 
Disorders Program (MDRBD), an increase of $5,000,000 above the 
fiscal year 2022 enacted level and $1,500,000 above the fiscal 
year 2023 budget request. Suicide and overdose, driven by 
maternal mental health conditions (MMH), are the leading cause 
of maternal mortality in the first year following pregnancy. 
MMH conditions impact one in five pregnant or postpartum 
individuals, including as many as one in three pregnant and 
postpartum Black individuals. However, 75 percent of those 
impacted by MMH conditions go untreated. The COVID-19 pandemic 
has exacerbated the number of individuals experiencing MMH 
conditions, with pregnant and new mothers experiencing anxiety 
and depression at a three to four times higher rate than prior 
to the pandemic. MDRBD trains health care providers to screen, 
assess, and treat for MMH conditions and provide specialized 
psychiatric consultation to assist the providers. The Committee 
directs HRSA to make grants to establish new State programs and 
improve or maintain existing State programs, prioritizing 
States with high rates of adverse maternal health outcomes. 
Grants shall include culturally and linguistically appropriate 
approaches to assist in the reduction of maternal health 
inequities. The Committee recognizes the high need amongst 
States and directs MDRBD to provide technical assistance to 
non-grantee States.

Pediatric Mental Health Access

    The Committee includes $14,000,000 for Pediatric Mental 
Health Access, an increase of $3,000,000 above the fiscal year 
2022 enacted level and $4,000,000 above the fiscal year 2023 
budget request. This program supports expanded access to 
behavioral health services in pediatric primary care by 
supporting the development of pediatric mental health care 
telehealth access programs.

Poison Control Centers

    The Committee includes $26,846,000 for Poison Control 
Centers, an increase of $1,000,000 above the fiscal year 2022 
enacted level and $2,000,000 above the fiscal year 2023 budget 
request. The Poison Control Centers program supports a national 
network of centers that prevent and treat poison exposures by 
providing cost effective, quality health care advice to the 
public and health care providers. The Committee encourages 
Poison Control Centers to partner with institutions of higher 
education in border communities to be better equipped to combat 
public health outbreaks exacerbated by the flow of people and 
goods across international borders.

                      RYAN WHITE HIV/AIDS PROGRAM

 
 
 
Appropriation, fiscal year 2022.......................    $2,494,776,000
Budget request, fiscal year 2023......................     2,654,781,000
Committee Recommendation..............................     2,694,776,000
    Change from enacted level.........................      +200,000,000
    Change from budget request........................       +39,995,000
 

    The Ryan White Human Immunodeficiency Virus/Acquired 
Immunodeficiency Syndrome (HIV/AIDS) program funds activities 
to address the care and treatment of persons living with HIV/
AIDS who are either uninsured or underinsured and need 
assistance to obtain treatment. The program provides grants to 
States and eligible metropolitan areas to improve the quality, 
availability, and coordination of health care and support 
services to include access to HIV-related medications; grants 
to service providers for early intervention outpatient 
services; grants to organizations to provide care to HIV 
infected women, infants, children, and youth; and grants to 
organizations to support the education and training of health 
care providers.
    Within the total for the Ryan White HIV/AIDS program, the 
Committee provides the following amounts:

------------------------------------------------------------------------
                   Budget Activity                     FY 2023 Committee
------------------------------------------------------------------------
Emergency Assistance.................................       $691,045,000
Comprehensive Care Programs..........................      1,385,517,000
    AIDS Drug Assistance Program.....................        900,313,000
Early Intervention Program...........................        211,861,000
Children, Youth, Women, and Families.................         79,114,000
AIDS Dental Services.................................         13,826,000
Education and Training Centers.......................         35,413,000
Special Projects of National Significance............         28,000,000
Ending the HIV Epidemic Initiative...................        250,000,000
------------------------------------------------------------------------

    Ending the HIV Epidemic (EHE) Initiative.--The Committee 
includes $250,000,000 within the Ryan White HIV/AIDS Program 
for the EHE Initiative, an increase of $125,000,000 above the 
fiscal year 2022 enacted level. Funds are distributed to high-
need jurisdictions to increase linkage, engagement, and 
retention in care with the goal of increasing viral suppression 
among people living with HIV.

                             HEALTH SYSTEMS

 
 
 
Appropriation, fiscal year 2022.......................       $96,009,000
Budget request, fiscal year 2023......................        94,009,000
Committee Recommendation..............................        99,009,000
    Change from enacted level.........................        +3,000,000
    Change from budget request........................        +5,000,000
 

    The Health Systems Bureau supports national activities that 
enhance health care delivery in the U.S., including maintaining 
a national system to allocate and distribute donor organs to 
individuals awaiting transplant; building an inventory of cord 
blood units; and maintaining a national system for the 
recruitment of bone marrow donors.

Organ Transplantation

    The Committee includes $31,049,000 for the Organ 
Transplantation program, $1,000,000 above the fiscal year 2022 
enacted level and $2,000,000 above the fiscal year 2023 budget 
request.
    Maximizing Deceased Donor Organ Recovery, Acceptance, and 
Utilization.--The Committee supports regulatory and enforcement 
efforts to minimize excessive and frivolous expenses reimbursed 
to Organ Procurement Organizations (OPOs) and the Organ 
Procurement Transplantation Network (OPTN) by Medicare, 
including as related to organ acquisition costs and the 
waitlisting of patients, and to ensure all potential conflicts 
of interest of OPO and OPTN executive and board leadership are 
publicly disclosed. The Committee encourages HHS to make all 
efforts to promote competition for the Organ Procurement 
Transplantation Network (OPTN) contract, including the NASEM 
recommendation that HRSA separate the information technology 
functions of the OPTN contract. The Committee supports this 
recommendation as it will both increase the likelihood of full 
and open competition for all components of the OPTN contract 
activities and likely lead to significant improvements in the 
OPTN's IT functionality, which is also a goal HRSA highlights 
in their request for information published on April 8, 2022.
    Living Organ Donation Reimbursement Program.--The Committee 
includes $8,000,000, an increase of $1,000,000 above the fiscal 
year 2022 enacted level, for the Living Organ Donation 
Reimbursement Program. The Committee supports significant 
expansion of income eligibility for the program to allow as 
many donors as possible to qualify and to ensure that financial 
reimbursement and monetary exchange take place outside of the 
organ donor-organ recipient relationship to the greatest extent 
possible.
    Reducing Organ Discards.--The Committee expresses its 
support for the procurement and transplantation of moderate-to-
high Kidney Donor Profile Index (KDPI) kidneys at risk of 
discard to alleviate the organ shortage. The Committee requests 
a report within 180 days of enactment of this Act regarding the 
OPTN proposal to remove donor service areas from allocation and 
the impact of this policy on organ discards.

National Cord Blood Inventory (NCBI)

    The Committee includes $19,266,000 for the NCBI, an 
increase of $1,000,000 above the fiscal year 2022 level. The 
NCBI program supports cord blood banks to build a genetically 
and ethnically diverse inventory of the highest quality cord 
blood units for transplantation. To further strengthen 
communication and collaboration between HRSA and cord blood 
banks, the Committee directs HRSA to host quarterly stakeholder 
calls open to all cord blood banks contracting with NCBI. These 
calls should serve as a forum for the agency to solicit 
feedback from the cord blood banks and ensure that the program 
is implemented in accordance with Congressional intent. Such 
feedback should be incorporated into contracts between the 
agency and the cord blood banks to increase the programs reach 
and achieve program goals.

C.W. Bill Young Cell Transplantation

    The Committee includes $33,009,000 for the C.W. Bill Young 
Cell Transplantation program, an increase of $1,000,000 above 
the fiscal year 2022 level. This program supports coordinating 
the procurement of bone marrow and umbilical cord blood units 
for transplantation.
    The Committee continues to support cell transplantation 
using bone marrow, peripheral blood stem cells, and cord blood. 
The Committee appreciates HRSA's efforts to increase the 
diversity of the volunteer registry and supports efforts to 
significantly reduce barriers to transplant for patients. This 
includes increasing targeted donor recruitment efforts, 
intervening with community referring physicians upon patient 
diagnosis to accelerate the path to transplant, and propelling 
innovation to improve outcomes and establish new treatment 
options to ensure a matched donor for all searching patients, 
regardless of their racial/ethnic background, socioeconomic 
status, age, ancestry, or any other individually defining 
characteristic. The highest priority should be given to 
providing immediate and free testing of patients' cellular 
markers to quickly determine if a there is an available matched 
a donor. Eliminating these barriers would allow therapies for 
patients to be delivered on time and to provide equal and 
successful outcomes for all.

Hansen's Disease Program

    The Committee includes $13,706,000 for the Hansen's Disease 
Program, $122,000 for Hansen's Disease Buildings and 
Facilities, and $1,857,000 for Payments to Hawaii for Treatment 
of Hansen's Disease. These funding levels are the same as the 
fiscal year 2022 enacted levels and the amounts requested in 
the fiscal year 2023 budget request. The programs support 
inpatient, outpatient, long-term care, as well as training and 
research in Baton Rouge, Louisiana; 11 outpatient clinic sites 
in the continental U.S. and Puerto Rico; facility-related 
expenses for the buildings of the Gillis W. Long Hansen's 
Disease Center; and medical care and treatment of persons with 
Hansen's disease in hospital and clinic facilities at 
Kalaupapa, Molokai, and Honolulu, Hawaii.

                              RURAL HEALTH

 
 
 
Appropriation, fiscal year 2022.......................      $331,062,000
Budget request, fiscal year 2023......................       373,709,000
Committee Recommendation..............................       375,675,000
    Change from enacted level.........................       +44,613,000
    Change from budget request........................        +1,966,000
 

    The Federal Office of Rural Health Policy's programs 
provide funding to improve access, quality, and coordination of 
care in rural communities; for research on rural health issues; 
for technical assistance and recruitment of health care 
providers; for screening activities for individuals affected by 
the mining, transport, and processing of uranium; and for the 
outreach and treatment of coal miners and others with 
occupation-related respiratory and pulmonary impairments.

Rural Health Outreach Programs

    The Committee includes $90,975,000 for Rural Health 
Outreach Programs, an increase of $5,000,000 above the fiscal 
year 2022 enacted level and $975,000 above the fiscal year 2023 
budget request. This program supports projects that demonstrate 
new and innovative modes of outreach in rural areas, such as 
integration and coordination of health services.
    Rural Maternity and Obstetrics Management Strategies 
(RMOMS).--The Committee recommendation includes no less than 
$8,000,000 for RMOMS, an increase of $2,000,000 above the 
fiscal year 2022 enacted level. RMOMS supports grants to 
improve access to and continuity of maternal and obstetrics 
care in rural communities by increasing the delivery of and 
access to preconception, pregnancy, labor and delivery, and 
postpartum services, as well as developing sustainable 
financing models for the provision of maternal and obstetrics 
care.

Rural Health Research and Policy Development

    The Committee includes $11,076,000 for Rural Health 
Research and Policy Development, the same as the fiscal year 
2022 enacted level and the fiscal year 2023 budget request. 
Funding supports the Federal Office of Rural Health Policy's 
activities to analyze, advise the Secretary, and provide 
information to the public regarding issues that affect the 
availability, access to, and quality of health care in rural 
areas.
    Rural Health Research Centers.--In the next competition for 
Rural Health Research Centers, the Committee strongly 
encourages the Federal Office of Rural Health Policy to 
prioritize States that have not previously hosted such a 
center. The Committee supports centers in areas that have a 
demonstrated collaborative partnership with research and 
education in the pharmacological and physician space. Further, 
the Committee strongly encourages the Office to explore 
establishing a center which encompasses research related to 
biomedical and cancer research, opioid abuse, delivery of rural 
healthcare, and training for rurally focused residency 
programs.

Rural Health Flexibility Grants

    The Committee includes $68,500,000 for Rural Health 
Flexibility Grants, $6,223,000 above the fiscal year 2022 
enacted level and $10,991,000 above the fiscal year 2023 budget 
request. These programs support States to assist small and 
critical access rural hospitals to remain economically viable 
and to provide high-quality care. Within this total, the 
Committee includes no less than $5,000,000 for the Rural 
Emergency Hospitals Technical Assistance Program and no less 
than $20,942,000 for the Small Rural Hospital Improvement 
Program.

State Offices of Rural Health

    The Committee includes $12,500,000 for State Offices of 
Rural Health, the same as the fiscal year 2022 enacted level 
and the fiscal year 2023 budget request. HRSA supports the 
establishment and operation of State offices of rural health to 
strengthen rural health care delivery system.

Black Lung Clinics

    The Committee includes $12,190,000 for Black Lung Clinics, 
an increase of $345,000 above the fiscal year 2022 enacted 
level and the same as the fiscal year 2023 budget request. 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.

Radiation Exposure Screening and Education Program (RESEP)

    The Committee includes $2,734,000 for the RESEP program, an 
increase of $845,000 above the fiscal year 2022 enacted level 
and the same as the fiscal year 2023 budget request. 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.

Rural Health Residency Program

    The Committee includes $12,700,000 for the Rural Health 
Residency Program, an increase of $2,200,000 above the fiscal 
year 2022 enacted level and the same as the fiscal year 2023 
budget request. This program funds physician residency training 
programs that support physician workforce expansion in rural 
areas.
    The Committee commends the Federal Office of Rural Health 
Policy for their efforts to expand the physician workforce in 
rural areas and supports continuation and expansion of the 
program to develop new rural residency programs, or Rural 
Training Programs.

Rural Communities Overdose Response Program (RCORP)

    The Committee includes $160,000,000, an increase of 
$25,000,000 above the fiscal year 2022 enacted level, for the 
RCORP program, and allows for the expanded focus on behavioral 
health care, including SUD, needs in rural communities. The 
Committee is particularly interested in programs that address 
health equity and reach rural populations that have 
historically suffered poorer behavioral health outcomes 
relative to their counterparts. Within the funding provided, 
the agreement includes $10,000,000 to continue the Rural 
Centers of Excellence (COE) program in order to collaboratively 
identify, implement, and evaluate innovative SUD and broader 
behavioral health approaches to build the evidence-base for 
effective prevention, treatment, and recovery programs in rural 
communities across the U.S.; and through the addition of a 
fourth coordinating COE, track, synthesize, and disseminate 
national and State-level SUD policies and research, including 
any effective interventions and outcomes identified.

Rural Health Clinic Behavioral Health Initiative

    The Committee includes $5,000,000 to support expanded 
access to behavioral health services at rural health clinics, 
as described in the fiscal year 2023 budget request.

                            FAMILY PLANNING

 
 
 
Appropriation, fiscal year 2022.......................      $286,479,000
Budget request, fiscal year 2023......................       400,000,000
Committee Recommendation..............................       500,000,000
    Change from enacted level.........................      +213,521,000
    Change from budget request........................      +100,000,000
 

    The Family Planning program administers Title X of the PHS 
Act. This program supports preventive and primary health care 
services at health centers nationwide by increasing access to 
affordable contraceptive education, services, and supplies; STD 
prevention, screening, and treatment; cervical and breast 
cancer screenings; first-line infertility services; and other 
community and health care services. The Title X program is a 
vital component of the health care safety net and is essential 
to addressing health inequities.
    The Committee directs the Secretary to ensure that grantees 
certify that they: (1) provide medically accurate and complete 
counseling, including referral as requested, on all matters; 
(2) shall not condition the receipt of Title X-supported 
services on patients remaining sexually abstinent until 
marriage; and (3) will not make any appointments or referrals 
for patients that are contrary to the patient's wishes. The 
bill requires that all recipients of funds under this heading 
offer services consistent with the best available evidence-
based standards, including the Quality Family Planning 
guidelines from the CDC and the Office of Population Affairs 
(OPA).
    Recommendations for Quality Family Planning Services.--The 
Committee directs the Secretary to continue the process of 
revising ``Providing Quality Family Planning Services,'' 
evidence-based recommendations that were last updated in 2017, 
and to ensure the robust participation of both the CDC's 
Division of Reproductive Health and OPA in this effort. 
Revisions should incorporate new evidence and support 
comprehensive reproductive and sexual health needs of all 
people. The Committee requests a briefing on the status of this 
process no later than 180 days of enactment of this Act.
    Estimated Need for Services.--The Committee requests the 
Secretary conduct a study, within 270 days of enactment of this 
Act, determining the current estimated need for Title X 
services, updating the 2016 study published in the American 
Journal of Public Health. The Committee requests that, as in 
the previous work, the CDC's Division of Reproductive Health 
and OPA collaborate on this effort.

                HRSA-Wide Activities and Program Support


 
 
 
Appropriation, fiscal year 2022.......................    $1,259,484,000
Budget request, fiscal year 2023......................       230,709,000
Committee Recommendation..............................       934,857,000
    Change from enacted level.........................      -324,627,000
    Change from budget request........................      +704,148,000
 

    This account supports telehealth programs, operation of the 
340B drug pricing program, community projects, and the cost of 
Federal staff and related activities to coordinate, direct, and 
manage the programs of HRSA.
    HRSA Chief Dental Officer.--The Committee is disturbed to 
learn that despite its directive to have HRSA ensure that the 
Chief Dental Officer (CDO) is functioning at an executive level 
with resources and staff to lead oral health programs and 
initiatives across HRSA, no such authority has been delegated. 
The Committee urges HRSA to hire a CDO and restore the position 
with executive level authority and resources to oversee and 
lead dental programs and initiatives across the agency. The CDO 
is also expected to serve as the agency representative on oral 
health issues to international, national, State, and/or local 
government agencies, universities, and oral health stakeholder 
organizations. The Committee requests an update as part of the 
fiscal year 2024 Congressional Justification on how the CDO is 
serving as the agency representative with executive level 
authority on oral health issues to international, national, 
State and/or local government agencies, universities, and oral 
health stakeholder organizations.
    Oral Health Literacy.--The Committee includes $300,000 to 
continue the development of an oral health awareness and 
education campaign across relevant HRSA divisions, including 
the Health Centers Program, Oral Health Workforce, Maternal and 
Child Health, Ryan White HIV/AIDS Program, and Rural Health. 
The Committee directs HRSA to identify oral health literacy 
strategies that are evidence-based and focused on oral health 
care prevention and education, including prevention of oral 
disease such as early childhood and other caries, periodontal 
disease, and oral cancer. The Committee encourages HRSA to 
ensure that the Chief Dental Officer plays a key role in the 
design, monitoring, oversight, and implementation of this 
project.
    Targeted Investments in Impoverished Areas.--The Committee 
supports targeted investments in impoverished areas, 
particularly in persistent poverty counties and in other high-
poverty census tracts. For purposes of this Act, the term 
``high-poverty area'' means any census tract with a poverty 
rate of at least 20 percent as measured by the 2016-2020 5-year 
data series available from the American Community Survey of the 
Census Bureau and the term ``persistent poverty counties'' 
means any county that has had 20 percent or more of its 
population living in poverty over the past 30 years, as 
measured by the 1993 Small Area Income and Poverty Estimates, 
the 2000 decennial census, and the most recent Small Area 
Income and Poverty Estimates, or any territory or possession of 
the U.S. The Committee directs HRSA to develop and implement 
measures to increase the share of investments in high-poverty 
census tracts with a poverty rate of at least 20 percent as 
measured by the 2016-2020 5-year data series available from the 
American Community Survey of the Census Bureau, and any other 
impoverished areas the Department determines to be appropriate 
areas to target. The Committee directs HRSA to submit a report 
to the Committee within 180 days of enactment of this Act that 
includes the amount of funds that were targeted to such areas; 
the percent change from fiscal year 2022 in the amount of funds 
that were targeted toward such areas; and, to the extent 
practicable, an assessment of the economic impact of the 
program on the areas, including data on the categories of 
individuals impacted by the targeting of funds to such areas 
under the program, disaggregated by household income, race, 
gender, age, national origin, disability status, and whether 
the individuals live in an urban area, suburban area, or rural 
area.

Office of Pharmacy Affairs (OPA)

    The Committee includes $13,238,000 for OPA, $2,000,000 
above the fiscal year 2022 enacted level. OPA administers the 
340B drug pricing program, which was designed to help safety 
net providers maintain, improve, and expand patient access to 
health care services. The 340B program has lowered the cost of 
outpatient drugs to health clinics and nonprofit and public 
hospitals that serve a disproportionate share of low-income and 
rural patients. These entities provide additional services and 
benefits to their communities with the savings realized.
    The Committee recognizes that the 340B program is a 
critical lifeline to safety net providers, including FQHCs, 
FQHC Look-Alikes, children's hospitals, Ryan White HIV/AIDS 
clinics, and other safety-net hospitals and providers. These 
covered entities are model stewards of the program and reinvest 
340B savings to reach more patients and provide more 
comprehensive services.
    The Committee is concerned by the fact that the number of 
pharmaceutical manufacturers that are violating the 340B 
statute has dramatically increased, threatening the ability of 
safety-net providers to care for patients in need. The 
Committee is pleased that HRSA has continued to take steps to 
enforce the statute and take action against companies that 
curtail the use of 340B drugs in contract pharmacies, refer 
violations of the statute by manufacturers to the HHS Office of 
Inspector General, and appeal litigation in these matters. The 
Committee encourages HRSA to continue to use its authority and 
any available measures, including the imposition of civil 
penalties, where appropriate, to hold those drug manufacturers 
in violation of the law directly accountable. The Committee 
urges HRSA to continue to take actions to safeguard covered 
entities' lawful access to discounted drugs.

Telehealth

    The Committee includes $37,050,000 for Telehealth, an 
increase of $2,000,000 above the fiscal year 2022 enacted 
level. Funds support the Office for the Advancement of 
Telehealth, which promotes the effective use of technologies to 
improve access to health services for people who are isolated 
from health care and to provide distance education for health 
professionals.
    Provider Bridge.--The Committee includes $500,000 within 
the total for Telehealth for the Provider Bridge program. With 
funds appropriated in the Coronavirus License Portability Grant 
Program, HRSA established the Provider Bridge Program to 
empower medical professionals to safely and efficiently deliver 
urgently-needed care to communities during public health 
emergencies. To date, over 400 entities and 85,000 healthcare 
professionals have leveraged this national tool connecting 
health care professionals with State agencies and health care 
entities to quickly verify credentials and professional 
background information. Specifically, the platform provides a 
directory of State and Federal COVID-19 resources, allows 
health care professionals to submit professional background 
information, produces official and verified digital documents 
of licensure and credentialing information, and provides access 
to a database of information for volunteer clinicians willing 
to provide care.
    Telehealth Centers of Excellence.--The Committee supports 
the continued development of Telehealth Centers of Excellence 
to continue to validate technologies and reimbursement 
mechanisms, establish training protocols, and develop 
comprehensive templates for States to integrate telehealth into 
their state health provider networks.
    Rural Telehealth Initiative.--The Committee supports the 
Memorandum of Understanding entered into on August 31, 2020, 
establishing a Rural Telehealth Initiative among HHS, the 
Federal Communications Commission, and the Department of 
Agriculture. Together, this important initiative can leverage 
expertise of each respective agency and improve collaboration 
amongst entities tasked with addressing rural telehealth 
access. This initiative recognizes the unique problems facing 
rural Americans that need access to critical care services 
through telehealth platforms. The Committee encourages agencies 
involved in this initiative to prioritize opportunities to 
continue the expansion of telehealth services, close the 
digital divide, and not leave rural communities behind.

Community Project Funding

    Within the funds included in this account, $726,569,000 
shall be used for the projects, and in the amounts, specified 
in the table titled ``Labor, HHS, Education Incorporation of 
Community Project Funding Items'' at the end of this report. 
The Committee includes $6,000,000 within this total for agency 
administrative expenses.

                  VACCINE INJURY COMPENSATION PROGRAM

 
 
 
Appropriation, fiscal year 2022.......................       $13,200,000
Budget request, fiscal year 2023......................        26,200,000
Committee Recommendation..............................        15,200,000
    Change from enacted level.........................        +2,000,000
    Change from budget request........................       -11,000,000
 

    The Committee includes $15,200,000 for administrative costs 
associated with the Vaccine Injury Compensation Program, an 
increase of $2,000,000 above the fiscal year 2022 enacted 
level. This program provides compensation for individuals with 
vaccine-associated injuries or deaths.
    COVID-19 Vaccine Liability.--The FDA has approved one 
COVID-19 vaccine for children 5 and older and granted emergency 
use authorization for a second COVID-19 vaccine for children 12 
and older. The ACIP recommends that every eligible person 
receive the COVID-19 vaccine, including children aged 5 and 
older. Under the National Childhood Vaccine Injury Act (NCVIA), 
this recommendation requires the Secretary to add the COVID-19 
vaccine to the VICP within two years. As the public anticipates 
the transition of COVID-19 vaccine injury compensation claims 
from the Countermeasure Injury Compensation Program (CICP) to 
the VICP, the Committee requests a report within 60 days of 
enactment of this Act regarding HHS's transition plan for 
COVID-19 vaccine injury compensation claims. This report should 
include a specific timeline for the rulemaking process to add 
COVID-19 vaccines to the Vaccine Injury Table, as well as a 
plan for how pending claims already filed with the 
Countermeasure Injury Compensation program will be handled. The 
plan should also include any anticipated resources needed to 
facilitate this transition and quickly process pending claims 
as well as how HHS will inform current and potential 
petitioners of their options.

                  COVERED COUNTERMEASURES PROCESS FUND

 
 
 
Appropriation, fiscal year 2022.......................        $5,000,000
Budget request, fiscal year 2023......................        15,000,000
Committee Recommendation..............................         7,000,000
    Change from enacted level.........................        +2,000,000
    Change from budget request........................        -8,000,000
 

    The Committee includes $7,000,000 for administrative costs 
associated with the Countermeasures Injury Compensation Program 
(CICP), an increase of $2,000,000 above the fiscal year 2022 
enacted level. The CICP provides benefits to individuals who 
are seriously injured as a result of a vaccination, medication, 
device, or other item recommended to diagnose, prevent or treat 
a declared pandemic, epidemic or security threat.

               Centers for Disease Control and Prevention


 
 
 
Appropriation, fiscal year 2022.......................    $8,457,204,000
Budget request, fiscal year 2023......................    10,730,159,000
Committee Recommendation..............................    10,499,354,000
    Change from enacted level.........................    +2,042,150,000
    Change from budget request........................      -230,805,000
 

    The Committee recommendation for the Centers for Disease 
Control and Prevention (CDC) program level includes 
$9,540,696,000 in discretionary budget authority, $55,358,000 
in mandatory funds under the terms of the Energy Employees 
Occupational Illness Compensation Program Act, and $903,300,000 
in transfers from the Prevention and Public Health (PPH) Fund.
    CDC's mission is to protect America from health, safety, 
and security threats, which it accomplishes by supporting core 
public health functions at State, local, and tribal health 
departments, detecting and responding to new and emerging 
health threats, promoting health and safety, and providing 
leadership in the public health workforce.

                 IMMUNIZATION AND RESPIRATORY DISEASES

 
 
 
Appropriation, fiscal year 2022.......................      $868,155,000
Budget request, fiscal year 2023......................     1,250,930,000
Committee Recommendation..............................     1,083,155,000
    Change from enacted level.........................      +215,000,000
    Change from budget request........................      -167,775,000
 

    The Committee recommendation includes $663,805,000 in 
discretionary budget authority and $419,350,000 in transfers 
from the PPH Fund.
    Immunization cooperative agreements are awarded to State 
and local public health departments for planning, developing, 
and conducting childhood, adolescent, and adult immunization 
programs, including enhancement of the vaccine delivery 
infrastructure. CDC directly maintains a stockpile of vaccines, 
supports consolidated purchase of vaccines for State and local 
health agencies, and conducts surveillance, investigations, and 
research into the safety and efficacy of new and presently used 
vaccines.
    Within the total for Immunization and Respiratory Diseases, 
the Committee recommends the following amounts:

------------------------------------------------------------------------
                                                            FY 2023
                   Budget Activity                         Committee
------------------------------------------------------------------------
Immunization Program.................................       $825,797,000
Acute Flaccid Myelitis...............................          6,000,000
Influenza Planning and Response......................        251,358,000
------------------------------------------------------------------------

    Cost Estimates.--The Committee urges that the report on 
estimated funding needs of the Section 317 Immunization Program 
be updated and submitted not later than February 1, 2023. The 
updated report should include an estimate of optimum State and 
local operations funding, as well as a discussion of the role 
of the 317 Program, as coverage for vaccination under public 
and private resources continues to evolve. It should also 
include specific information on the estimated cost to fully 
address evidence-based public health strategies that could be 
funded through CDC to improve coverage for human papillomavirus 
(HPV) and influenza.
    Immunization Program.--The Committee includes an increase 
of $175,000,000 to enhance immunization efforts, including 
increasing awardee base awards with a focus on expanding and 
sustaining critical immunization program infrastructure.
    Immunization Rates.--The Committee is concerned about the 
marked decline in routine vaccines as a result of the pandemic. 
The Committee encourages CDC to continue surveillance and 
laboratory efforts, and to promote HPV vaccination in support 
of the Administration's Cancer Moonshot Initiative. In 
addition, the Committee requests information in the fiscal year 
2024 Congressional Budget Justification on how the Advisory 
Committee on Immunization Practices (ACIP) can support both 
routine and emergency reviews in real time to ensure timely 
access to immunizations. Furthermore, the Committee recognizes 
that office-based physicians are trusted sources of health care 
information and delivery, and encourages CDC to consider their 
role in vaccination efforts.
    Improving Immunization Information System Infrastructure 
and Data.--The Committee encourages CDC to engage with States 
and local jurisdictions to assess gaps and greatest areas of 
need to work toward all Immunization Information Systems (IIS) 
adopting and adhering to national standards to support the 
capture of data for all vaccinations administered across the 
life course, and have secure bi-directional information sharing 
capabilities both inter- and intra-State and with other IIS, 
health information exchanges, health data systems and entities, 
including data repositories to achieve interoperability levels 
needed to capture reliable, complete, real-time vaccine 
administration data.
    Influenza Planning and Response.--The Committee includes an 
increase of $40,000,000 to enhance CDC's influenza activities, 
including expanding vaccine effectiveness monitoring and 
evaluation, and increasing influenza vaccine acceptance by 
removing barriers to vaccination and promoting vaccination 
coverage.
    Influenza Vaccine.--The Committee encourages CDC to 
consider including vaccines produced through recombinant DNA 
technology in addition to traditionally-produced vaccines in 
future solicitations to facilitate the competitive process for 
all vaccine manufacturers.

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

 
 
 
Appropriation, fiscal year 2022.......................    $1,345,056,000
Budget request, fiscal year 2023......................     1,470,556,000
Committee Recommendation..............................     1,463,556,000
    Change from enacted level.........................      +118,500,000
    Change from budget request........................        -7,000,000
 

    CDC provides national leadership and support for prevention 
research and the development, implementation, and evaluation of 
evidence-based HIV, viral hepatitis, sexually transmitted 
diseases (STD), and tuberculosis (TB) prevention programs 
serving persons affected by, or at risk for, these infections. 
Activities include surveillance, epidemiologic and laboratory 
studies, and prevention activities. CDC provides funds to 
State, local, and tribal health departments and community-based 
organizations to develop and implement integrated community 
prevention plans.
    Within the total for HIV/AIDS, Viral Hepatitis, STD, and TB 
Prevention, the Committee recommends the following amounts:

------------------------------------------------------------------------
                                                            FY 2023
                   Budget Activity                         Committee
------------------------------------------------------------------------
Domestic HIV/AIDS Prevention and Research............     $1,046,712,000
    HIV Initiative...................................        245,000,000
    School Health-HIV................................         46,081,000
Viral Hepatitis......................................         54,500,000
Sexually Transmitted Infections......................        179,310,000
Tuberculosis.........................................        140,034,000
Infectious Diseases and the Opioid Epidemic..........         43,000,000
------------------------------------------------------------------------

    Access to PrEP.--The Committee notes the importance of 
expanding HIV pre-exposure prophylaxis (PrEP) nationally to 
improve access to medications and essential support services, 
community and provider outreach, to make progress towards 
ending the HIV epidemic.
    Ending the HIV Epidemic Initiative.--The Committee includes 
an increase of $50,000,000 for the fourth year of the Ending 
the HIV Epidemic initiative. The Committee commends CDC for 
including dedicated funding within this initiative for sexually 
transmitted infection clinics. The Committee notes the 
important role that self-testing has played in the response to 
the COVID-19 pandemic and encourages CDC to explore 
opportunities to facilitate access to HIV self-testing.
    Hepatitis.--The Committee includes an increase of 
$13,500,000 to enhance efforts to eliminate the public health 
threat of viral hepatitis. The Committee is aware of the 
November 2021 ACIP recommendation that all adults between ages 
19 and 59 be vaccinated for hepatitis B, and urges CDC to take 
any associated action as early as possible. In addition, the 
Committee urges CDC to expand the viral hepatitis disease 
tracking and surveillance capabilities of States to permit an 
effective targeting of resources and evaluation of program 
effectiveness. Furthermore, the Committee encourages CDC to 
expand outreach and communications efforts and related 
initiatives to promote hepatitis C screening during pregnancy 
with the goal of ensuring that every pregnant individual gets 
tested for hepatitis C during each pregnancy.
    Infectious Diseases and the Opioid Epidemic.--The Committee 
includes an increase of $25,000,000 to expand activities to 
target the infectious disease consequences of the public health 
crisis involving injection drug use, including expanding the 
implementation of and access to high quality syringe services 
programs nationwide.
    School Health.--The Committee includes an increase of 
$10,000,000 to bolster school capacity for evidence-based 
sexual health education, and access to sexual health services 
and safe and supportive environments.
    Sexually Transmitted Infections.--The Committee includes an 
increase of $15,000,000 to address the high rates of sexually 
transmitted infections (STIs). The Committee directs CDC to 
utilize a portion of the increase to move the grant year 
forward by one month to provide for a more efficient 
expenditure of funds and improve grantee activities, with the 
intention that the grant year will be moved forward by one 
month each year for the next three years, contingent on the 
availability of funds. In addition, the Committee encourages 
CDC to maximize the impact of available resources, prevent the 
largest number of infections, and increase health equity by 
allocating funding to States and local jurisdictions using data 
driven methods incorporating burden of disease provided that a 
portion of these funds be used to ensure that no grantee 
receives less than the amount received in fiscal year 2022. 
Furthermore, the Committee encourages CDC to work with other 
agencies, as appropriate, to develop innovative approaches 
including the use of telehealth platforms and at home specimen 
collection to increase screening, treatment, and education to 
curb the spread of STIs in vulnerable populations.
    Tuberculosis.--The Committee includes an increase of 
$5,000,000 to enable CDC, along with State and local entities, 
to provide TB screening, identification, treatment and 
prevention services, and to support the TB Trials Consortium. 
The Committee is concerned that the COVID-19 pandemic caused 
significant impacts on individuals with TB and on State and 
local TB programs, including delays in care for people with TB 
and postponement of identification and treatment of individuals 
with latent TB infection, stalling efforts to eliminate TB in 
the U.S.

               EMERGING AND ZOONOTIC INFECTIOUS DISEASES

 
 
 
Appropriation, fiscal year 2022.......................      $693,272,000
Budget request, fiscal year 2023......................       703,272,000
Committee Recommendation..............................       799,272,000
    Change from enacted level.........................      +106,000,000
    Change from budget request........................       +96,000,000
 

    The Committee recommendation includes $747,272,000 in 
discretionary appropriations and $52,000,000 in transfers from 
the PPH Fund.
    Programs funded under Emerging and Zoonotic Infectious 
Diseases (EZID) support the prevention and control of 
infectious diseases through surveillance, outbreak 
investigation and response, research, and prevention.
    Within the total for EZID, the Committee recommends the 
following amounts:

------------------------------------------------------------------------
                   Budget Activity                     FY 2023 Committee
------------------------------------------------------------------------
Antibiotic Resistance Initiative.....................       $202,000,000
Vector-borne Diseases................................         87,103,000
Prion Disease........................................          7,500,000
Chronic Fatigue Syndrome.............................          5,400,000
Emerging Infectious Diseases.........................        214,997,000
Harmful Algal Blooms.................................          3,500,000
Food Safety..........................................         80,000,000
National Healthcare Safety Network...................         31,000,000
Quarantine...........................................         65,772,000
Advanced Molecular Detection.........................         50,000,000
Epidemiology and Laboratory Capacity.................         40,000,000
Healthcare-Associated Infections.....................         12,000,000
------------------------------------------------------------------------

    Advanced Molecular Detection.--The Committee includes an 
increase of $15,000,000 and recognizes the value of the 
Advanced Molecular Detection program through its crosscutting 
and collaborative work that introduces and helps establish 
biotechnology-focused innovation to public health programs 
across CDC and in State and local health departments.
    Antibiotic Resistance.--The Committee includes an increase 
of $20,000,000 to enhance capacity to combat the growing threat 
of antibiotic resistant bacteria. The Committee recognizes the 
importance of addressing the problem of antibiotic-resistant 
bacteria through a One Health approach and by tracking 
resistance through local, regional, national, and global 
surveillance. In addition, the Committee urges CDC to develop 
improved data collection and surveillance of Clostridioides 
Difficle (C diff.), including working with State and local 
partners as part of the Nationally Notifiable Diseases 
Surveillance System. The Committee urges CDC to assist State 
and local partners in increasing awareness of antibiotic 
stewardship as it relates to C diff. The Committee requests an 
update in the fiscal year 2024 Congressional Budget 
Justification on these activities.
    Emerging Infectious Diseases.--The Committee includes an 
increase of $20,000,000 for emerging infectious disease work, 
including laboratory capacity and wastewater surveillance. The 
Committee commends CDC for implementing the National Wastewater 
Surveillance System (NWSS) with partners at health laboratories 
and academic institutions to better track COVID-19. The 
Committee encourages CDC to support staff sharing arrangements 
among multiple local health departments implementing NWSS and 
efforts to stand up systems in rural settings that do not have 
access to centralized wastewater treatment services. The 
Committee requests information in the fiscal year 2024 
Congressional Budget Justification on best practices in 
developing wastewater surveillance programs in rural settings, 
and strategies to increase participation in the NWSS among 
State and local governments, institutions of higher education, 
and correctional facilities.
    Food Safety.--The Committee includes an increase of 
$12,000,000 to help address the critical unmet needs in the 
nation's food safety system, in part through programs that 
enhance State and local public health capacity to support vital 
national surveillance, improve foodborne outbreak detection and 
investigations, enhance food safety prevention efforts, and 
maintain vigilance for emerging threats to our nation's food 
supply.
    Harmful Algal Blooms.--The Committee includes an increase 
of $1,000,000 to support monitoring and health reporting 
concerns related to harmful algal blooms (HABs). The Committee 
urges CDC to continue work on affected waters, with a focus on 
freshwater and the related dangers to drinking water supplies. 
CDC has a unique role in better understanding the intersection 
of public health and environmental impacts of HABs using a One 
Health approach to: (1) increase outreach efforts to States and 
local public health officials to use these monitoring and 
reporting systems; and (2) work with a variety of agencies that 
currently collaborate on HABs. The scope of future research may 
expand to include improving laboratory methods for HAB-related 
toxins in biological specimens and clinical diagnostic methods 
to identify HAB-related symptoms and illnesses, optimizing 
emergency response capacities, and identifying and addressing 
the impacts of harmful algal toxins to humans. There is an 
important nexus between freshwater and health through drinking 
water and recreation, and CDC is urged to expand their work 
regionally to understand HABs impact on our nation's largest 
fresh bodies of water. In addition, CDC is urged to work with 
other agencies to integrate disparate sets of data to allow for 
a broader understanding of the spatial and temporal dynamics of 
the environmental and health impacts of harmful algal blooms.
    Live Animal Imports.--The Committee notes the importance 
that live cargo inspections maintain standards of animal 
welfare and occur in the shortest practicable period. In 
addition, the Committee recognizes CDC's efforts to eliminate 
canine rabies in the U.S. and encourages CDC to provide a clear 
framework for those seeking to bring canines into the U.S.
    Myalgic Encephalomyelitis/Chronic Fatigue Syndrome.--The 
Committee commends CDC for its recent progress in myalgic 
encephalomyelitis/chronic fatigue syndrome (ME/CFS) medical 
education and in its participation in the Interagency Working 
Group for ME/CFS.
    Mycotic Diseases.--The Committee provides an increase of 
$2,000,000 in Emerging Infectious Diseases for mycotic 
diseases, including, but not limited to, surveillance and 
prevention, building capacity in the State and local health 
departments, cooperative agreements, education of the public 
and healthcare providers, and laboratory support. The Committee 
requests an update in the fiscal year 2024 Congressional Budget 
Justification on how this funding is being utilized.
    National Healthcare Safety Network.--The Committee includes 
an increase of $10,000,000 and recognizes the value of this 
system for healthcare quality measurement and improvement. The 
Committee supports the modernization of the system's 
infrastructure resulting in increased timeliness and accuracy, 
reduced burden on healthcare facilities, and the ability to 
collect urgent data.
    Prion.--The Committee includes an increase of $1,000,000 to 
advance efforts on human prion diseases, rapidly progressive 
and fatal neurodegenerative diseases that occur in both humans 
and animals, and recognizes the critical work of the National 
Prion Disease Pathology Surveillance Center.
    Quarantine.--The Committee includes an increase of 
$15,000,000 to enhance programs to protect the U.S. from 
infectious diseases, including expanded coverage at the most 
heavily trafficked airports and land border crossings and 
increased capacity for health screenings.
    Vector-Borne Diseases.--The Committee includes an increase 
of $12,000,000 for enhanced vector-borne disease activities, 
including Lyme Disease and tickborne diseases. The Committee 
includes funding to support training and the development of 
communities of practice in vector-borne disease prevention and 
control for the regions of the U.S. that account for the 
largest burden of vector-borne disease. The Committee urges CDC 
to increase provider and public awareness of Lyme and known 
tickborne diseases (TBD) in differential diagnoses, to practice 
shared decision making, to be aware of the existence of two 
sets of differing Lyme Disease Clinical Guidelines, and to 
encourage the public to take preventive measures. The Committee 
requests an update in the fiscal year 2024 Congressional Budget 
Justification on the use of advanced and emerging technologies 
for the development of improved diagnostics, including a 
timeline on when improved diagnostics may become commercially 
available for Lyme disease. In addition, the Committee notes 
that the pandemic response necessitated the disruption of 
mosquito control and abatement efforts by many State and local 
health departments and notes the importance of continuing 
mosquito prevention efforts. The Committee is aware of the 
ongoing challenges faced by the U.S. territories in the 
Caribbean and the Pacific regarding control and management of 
vector-borne diseases. The Committee urges CDC to support the 
training and research needs of the U.S. territories and 
encourages the use of the Mosquito Abatement for Safety and 
Health Program to provide grants and technical assistance to 
States and political subdivisions to prevent and control 
mosquito-borne diseases. In addition, the Committee requests 
CDC, in consultation with other appropriate agencies, to 
provide information in the fiscal year 2024 Congressional 
Budget Justification on the ecological structure and 
epidemiological factors that must be known and monitored to 
estimate the mosquito-borne infectious disease outbreak risk.

            CHRONIC DISEASE PREVENTION AND HEALTH PROMOTION

 
 
 
Appropriation, fiscal year 2022.......................    $1,338,664,000
Budget request, fiscal year 2023......................     1,612,264,000
Committee Recommendation..............................     1,601,914,000
    Change from enacted level.........................      +263,250,000
    Change from budget request........................       -10,350,000
 

    The Committee recommendation includes $1,346,964,000 in 
discretionary appropriations and $254,950,000 in transfers from 
the PPH Fund.
    Programs supported within Chronic Disease Prevention and 
Health Promotion provide national leadership and support for 
State, tribal, and community efforts to promote health and 
well-being through the prevention and control of chronic 
diseases.
    Within the total provided, the Committee recommends the 
following amounts:

------------------------------------------------------------------------
                   Budget Activity                     FY 2023 Committee
------------------------------------------------------------------------
Tobacco..............................................       $251,500,000
Nutrition, Physical Activity, and Obesity............         58,420,000
    High Obesity Rate Counties.......................         16,500,000
School Health........................................         27,400,000
Glaucoma.............................................          4,000,000
Vision and Eye Health................................          2,500,000
Alzheimer's Disease..................................         35,500,000
Inflammatory Bowel Diseases..........................          1,000,000
Interstitial Cystitis................................          1,100,000
Excessive Alcohol Use................................          6,000,000
Chronic Kidney Disease...............................          8,500,000
Chronic Disease Education and Awareness..............          6,000,000
Prevention Research Centers..........................         29,961,000
Heart Disease and Stroke.............................        147,105,000
Diabetes.............................................        156,129,000
National Diabetes Prevention Program.................         38,300,000
Breast and Cervical Cancer...........................        244,500,000
    WISEWOMAN........................................         37,620,000
Breast Cancer Awareness for Young Women..............          8,960,000
Cancer Registries....................................         56,440,000
Colorectal Cancer....................................         45,294,000
Comprehensive Cancer.................................         26,425,000
Johanna's Law........................................         12,500,000
Ovarian Cancer.......................................         14,500,000
Prostate Cancer......................................         15,205,000
Skin Cancer..........................................          5,000,000
Cancer Survivorship Resource Center..................            725,000
Oral Health..........................................         20,750,000
Safe Motherhood/Infant Health........................        143,000,000
Arthritis............................................         11,000,000
Epilepsy.............................................         13,000,000
National Lupus Registry..............................         10,500,000
Racial and Ethnic Approaches to Community Health.....         75,950,000
    Good Health and Wellness in Indian Country.......         26,500,000
Social Determinants of Health........................        100,000,000
Million Hearts.......................................         10,000,000
National Early Child Care Collaboratives.............          5,000,000
Hospitals Promoting Breastfeeding....................          9,750,000
------------------------------------------------------------------------

    Alzheimer's Disease.--The Committee includes an increase of 
$5,000,000 to support provisions enacted in the Building Our 
Largest Dementia (BOLD) Infrastructure for Alzheimer's Act 
(P.L. 115-406), including the implementation of the Road Map 
Series, expanding the number of Centers of Excellence, and 
building a robust Alzheimer's and other dementias public health 
infrastructure across the country.
    Breast and Cervical Cancer.--The Committee includes an 
increase of $10,000,000 to increase the provision of critical, 
lifesaving breast cancer screening and diagnostic services to 
uninsured and underinsured women, supporting the Cancer 
Moonshot goal to increase the percentage of women served by the 
National Breast and Cervical Cancer Early Detection Program 
(NBCCEDP) who have rarely or never been screened. In addition, 
the Committee is concerned with the public health impact from 
triple-negative breast cancer, named as such because it tests 
negative for estrogen receptors, progesterone receptors, and 
excess HER2 protein and thus does not respond to treatments 
developed for these subtypes. The Committee supports efforts to 
increase awareness of triple negative breast cancer and 
incorporate diagnoses strategies in existing breast cancer 
screening, diagnosis and linkage to care health programs. 
Furthermore, the Committee encourages recipients to implement 
navigator programs to help patients overcome barriers and have 
the resources they need. The Committee requests information in 
the fiscal year 2024 Congressional Budget Justification 
outlining current activities to support navigation services.
    Cancer.--The Committee includes a total increase of 
$32,250,000 for cancer prevention and control activities in 
this account. The Committee supports the Administration's 
inclusion of CDC in the Cancer Moonshot initiative, recognizing 
the importance of public health efforts in cancer prevention, 
screening, early detection, and reducing disparities in quality 
of care. In addition to the programs discussed separately under 
this account, the Committee includes: an increase of $3,000,000 
to expand awareness and prevention efforts for Breast Cancer 
Awareness for Young Women; an increase of $5,000,000 to enhance 
the work of the National Program of Cancer Registries; an 
increase of $2,000,000 for colorectal cancer; an increase of 
$6,000,000 for the National Comprehensive Cancer Control 
Program; an increase of $2,000,000 for Johanna's Law that 
raises awareness of the five main types of gynecological 
cancer; an increase of $2,000,000 to advance ovarian cancer 
prevention, early detection, risk assessment, and access to the 
standard of care; an increase of $1,000,000 for skin cancer; 
and an increase of $250,000 for the Cancer Survivorship 
Resource Center.
    Chronic Disease Education and Awareness.--The Committee 
includes an increase of $3,000,000 to expand public health 
education and awareness activities that help to improve 
surveillance, diagnosis, and proper treatment for chronic 
diseases. This competitive grant program expands and advances 
CDC's work with stakeholders on education, outreach, and public 
awareness activities for a variety of chronic diseases for 
which there is a clear disparity in public and professional 
awareness that are not already specified under CDC in this 
report. As this program matures, CDC is urged to identify and 
facilitate opportunities for coordination and best practices 
among grantees to benefit from shared goals and if appropriate, 
with smaller partners and rare disease organizations that 
receive funding through other chronic disease programs.
    Chronic Kidney Disease.--The Committee includes an increase 
of $5,000,000 to accelerate activities to increase awareness, 
diagnosis, and treatment of chronic kidney disease (CKD) and to 
fund partnerships to support community-based activities that 
enhance health systems' capacity to identify, risk-stratify, 
and manage individuals with CKD. The Committee urges CDC to 
support activities addressing inherited kidney diseases, such 
as polycystic kidney disease (PKD) and encourages CDC to 
continue to discuss the availability and feasibility of any 
potential data sources for surveillance of PKD.
    Diabetes.--The Committee includes an increase of $5,000,000 
to prevent diabetes and its complications, and to reduce 
inequities through prevention strategies, translational 
research, and education. In addition, the Committee includes an 
increase of $5,000,000 for the Diabetes Prevention Program to 
expand efforts of this public-private partnership that provides 
diabetes prevention for people with prediabetes. The Committee 
supports the dissemination of community-based prevention and 
control programs and encourages flexibility to organizations 
serving low-income populations to address barriers these 
populations face in achieving weight loss outcomes.
    Early Child Care Collaboratives.--The Committee includes an 
increase of $1,000,000 to enable training of early care and 
education providers in the 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.
    Eating Disorders.--The Committee encourages CDC to assist 
States in collecting data by including standard questions on 
unhealthy weight control practices for eating disorders, 
including binge eating, through the Youth Risk Behavior 
Surveillance System and the Behavioral Risk Factor Surveillance 
System.
    Epilepsy.--The Committee includes an increase of $2,500,000 
for epilepsy. The Committee commends CDC for its ongoing 
leadership of this successful program and its effective 
community collaborations, and encourages further efforts to 
eliminate stigma, improve awareness and education, and better 
connect people with the epilepsies to health and community 
services.
    Excessive Alcohol Use Prevention.--The Committee includes 
an increase of $1,000,000 to expand alcohol epidemiology 
capacity through improved data collection on excessive drinking 
and related harms in more States, and monitoring identifying 
strategies to reduce youth exposure to alcohol and alcohol 
marketing.
    Farm-to-School.--The Committee includes $2,000,000 within 
Nutrition, Physical Activity, and Obesity to continue research 
and education activities related to farm to school programs 
that result in promoting healthy eating habits for students.
    Food Allergies.--The Committee includes $2,000,000 for a 
school-based effort to address food allergies and reduce 
potentially fatal anaphylactic reactions.
    Glaucoma.--The Committee requests information in the fiscal 
year 2024 Congressional Budget Justification on efforts to 
reach African American and Hispanic communities through the 
glaucoma program.
    Heart Disease and Stroke.--The Committee includes a total 
increase of $15,500,000 to address cardiovascular diseases. The 
Committee includes an increase of $2,000,000 to support, 
strengthen, and expand evidence-based initiatives at the State, 
local, tribal, and territorial level. The Committee recognizes 
the vital importance of addressing cardiovascular disease among 
women, particularly women of color, and further recognizes that 
the resulting costs to the health care system of unrecognized 
cardiovasular disease in women can be substantially reduced 
with appropriate public awareness and prevention efforts. The 
Committee includes an increase of $7,500,000 for the WISEWOMAN 
program to be expanded to additional States, growing the number 
of low-income, uninsured and underinsured women who are 
assessed and connected to resources. The Committee also 
includes an increase of $6,000,000 for the Million Hearts 
initiative to increase education and outreach about the 
importance of healthy behaviors, regular heart screenings, and 
prevention measures.
    High Obesity Rate Counties.--The Committee continues to 
support the rural extension and outreach service grants for 
rural counties with an obesity prevalence of over 40 percent. 
CDC is encouraged to give preference to projects in States 
where at least 10 percent of counties meet the requirements of 
the program.
    Inflammatory Bowel Diseases.--The Committee commends the 
ongoing work of CDC to better understand the incidence and 
prevalence of Crohn's disease and ulcerative colitis, as well 
as disparities in patterns of care and health outcomes for this 
patient population through the Incidence, Prevalence, and 
Treatment Patterns of IBD in the United States (INPUT) study. 
The Committee is concerned about new information from the INPUT 
Study indicating that social determinants of health contribute 
to disparities in diagnosis and patterns of care and encourages 
CDC to continue supporting the INPUT study to better understand 
these disparities in children and in adults related to race, 
socioeconomic status and other factors, and to identify 
potential interventions to reduce disparities in care and 
outcomes. The Committee also encourages CDC to develop a 
strategic framework for the next iteration of the INPUT study 
and to produce a concept plan for an education and awareness 
campaign focused on communicating these messages to healthcare 
providers, patients, and caregivers.
    Interstitial Cystitis.--The Committee requests an update in 
the fiscal year 2024 Congressional Budget Justification on 
education, outreach, and public awareness activities related to 
interstitial cystitis.
    Lupus.--The Committee includes an increase of $1,000,000 
for activities to advance public health knowledge about lupus, 
which will lead to improved care for those living with the 
disease.
    Multiple Myeloma.--The Committee is concerned about the 
burden of multiple myeloma on patients and their caregivers. 
The Committee encourages CDC to increase outreach and education 
of myeloma among high-risk individuals especially among African 
Americans, Hispanics, and other communities of color.
    Nutrition, Physical Activity and Obesity.--The Committee 
supports CDC's efforts to promote healthy behaviors at every 
stage of life by encouraging regular physical activity, good 
nutrition, and preventing adult and childhood obesity.
    Oral Health.--The Committee includes an increase of 
$1,000,000 to expand support to State and territorial health 
departments in their efforts to reduce oral disease and improve 
oral health through effective interventions.
    Prevention Research Centers.--The Committee includes an 
increase of $3,000,000 to expand the national network 
conducting prevention research and translating research results 
into policy and public health practice that address local 
health needs.
    Prostate Cancer.--The Committee includes an increase of 
$1,000,000 to bolster public awareness of prostate cancer 
risks, screening, and treatment, and improve surveillance of 
this disease. The Committee encourages CDC to increase outreach 
and education among high-risk men, especially African-American 
men. In addition, the Committee encourages CDC to consider an 
interactive simulation decision aid for men at risk of prostate 
cancer, and to establish a resource center with educational 
materials to assist in decision-making for men, their partners, 
and providers.
    Racial and Ethnic Approaches to Community Health (REACH).--
The Committee includes a total increase of $10,000,000 to 
continue scaling this program to all States and territories, 
and to support grantees in building capacity for collaboration 
and disseminating evidence-based strategies in communities. 
REACH is a vital initiative to help eliminate healthcare 
disparities in minority communities. The Committee's 
recommended level includes an increase of $4,000,000 for Good 
Health and Wellness in Indian Country.
    Safe Motherhood and Infant Health.--The Committee includes 
a total increase of $60,000,000 for this portfolio of programs 
to improve the health of pregnant and postpartum individuals 
and their babies, including to reduce disparities in maternal 
and infant health outcomes. The total funding allows for the 
expansion of Maternal Mortality Review Committees (MMRCs) and 
Perinatal Quality Collaboratives (PQCs) to additional States 
and territories and for increased support to current States and 
territories, as well as increased support for other programs 
including Sudden Unexplained Infant Death (SUID). The Committee 
supports CDC's efforts to provide technical assistance to 
existing State MMRCs to build stronger data systems, improve 
data collection to ensure the accuracy and completeness, and 
create consistency in data collection. The Committee encourages 
CDC to establish data collection guidelines and to provide 
technical assistance to State MMRCs regarding the unique 
concerns of rural and underserved communities. The Committee 
encourages CDC to work with States to include and report data 
from birth centers in the Maternity Practices in Infant 
Nutrition and Care Survey and the Levels of Care Assessment 
Tool. In addition, the Committee encourages CDC to collect and 
report PQC data by race and ethnicity to mitigate inequities in 
overuse of cesarean sections. The Committee also encourages 
PQCs, whenever feasible, to include all care settings 
(hospital, birth center, home) and midwives with all nationally 
recognized credentials (certified nurse-midwives, certified 
professional midwives, certified midwives) for shared learning 
and teaching in this quality improvement work. The Committee 
also encourages CDC to increase awareness through PQCs of newer 
options and technologies for postpartum hemorrhage management. 
In addition, the Committee urges CDC to facilitate improved 
data collection and analysis, including the expansion of the 
SUID and Sudden Death in the Young Case Registry, to improve 
SUID prevention strategies. Furthermore, the Committee supports 
the CDC's past efforts to promote the engagement of fathers and 
partners in addressing maternal mortality and severe morbidity. 
The Committee encourages CDC to continue these efforts and to 
consider opportunities to build on the PRAMS for Dads pilot 
projects by expanding such pilot projects into additional 
States.
    School Health.--The Committee includes an increase of 
$10,000,000 to expand the number of States in the Healthy 
Schools program.
    Social Determinants of Health.--The Committee includes an 
increase of $92,000,000 to award competitive grants to State, 
local, territorial, or tribal jurisdictions to support the 
development of Social Determinants of Health Accelerator Plans, 
the implementation of those plans, and to improve the health of 
Medicaid beneficiaries. Such plans should include a description 
of the health and social outcome objectives of the Social 
Determinants Accelerator Plan; identify target populations that 
would benefit from implementation of the plan including 
Medicaid-eligible individuals; and identify non-governmental, 
private, or public health organizations and community 
organizations that would participate in the development of the 
plan. Grantees may use a portion of grant funding to convene 
government entities, public and private stakeholders, and to 
engage qualified research experts in developing Accelerator 
Plans.
    Tobacco.--The Committee includes an increase of $10,000,000 
so that CDC, States and territories can continue efforts to 
more robustly respond to the public health threat caused by 
youth use of e-cigarettes and other tobacco products, to reduce 
tobacco use among disparate populations and in areas and 
regions with high tobacco prevalence and mortality, and to 
expand the highly successful and cost-effective Tips from 
Former Smokers media campaign.
    In addition, the Committee encourages CDC, in consultation 
with the Food and Drug Administration (FDA), Director of the 
Center for Tobacco Products, and any other relevant agency, to 
develop an additional question on National Youth Tobacco Survey 
to assess youth consumption of premium cigars. For purposes of 
this section, the term premium cigar shall be the definition 
agreed upon by DOJ, FDA and industry in the case of Cigar 
ssociation of America vs. FDA.
    Vision and Eye Health.--The Committee includes an increase 
of $1,000,000 to initiate efforts to reinstate national-level 
surveillance of vision impairment and eye disease.

   BIRTH DEFECTS, DEVELOPMENTAL DISABILITIES, DISABILITIES AND HEALTH

 
 
 
Appropriation, fiscal year 2022.......................      $177,060,000
Budget request, fiscal year 2023......................       195,310,000
Committee Recommendation..............................       225,060,000
    Change from enacted level.........................       +48,000,000
    Change from budget request........................       +29,750,000
 

    This account supports efforts to conduct research on and 
address the causes of birth defects and developmental 
disabilities, as well as reduce the complications of blood 
disorders and improve the health of people with disabilities.
    Within the total, the Committee recommends the following 
amounts:

------------------------------------------------------------------------
                   Budget Activity                     FY 2023 Committee
------------------------------------------------------------------------
Birth Defects........................................        $19,000,000
Fetal Death..........................................          1,900,000
Fetal Alcohol Syndrome...............................         12,000,000
Folic Acid...........................................          3,150,000
Infant Health........................................          8,650,000
Autism...............................................         33,100,000
Disability & Health..................................         49,000,000
Tourette Syndrome....................................          2,500,000
Early Hearing Detection and Intervention.............         10,760,000
Muscular Dystrophy...................................          7,500,000
Attention Deficit Hyperactivity Disorder.............          1,900,000
Fragile X............................................          2,000,000
Spina Bifida.........................................          7,500,000
Congenital Heart.....................................          8,250,000
Public Health Approach to Blood Disorders............         10,900,000
Hemophilia Activities................................          3,500,000
Hemophilia Treatment Centers.........................          5,100,000
Thalassemia..........................................          2,100,000
Neonatal Abstinence Syndrome.........................          3,250,000
Surveillance for Emerging Threats to Mothers and              33,000,000
 Babies..............................................
------------------------------------------------------------------------

    Autism.--The Committee includes an increase of $10,000,000 
to expand the Autism and Developmental Disabilities Monitoring 
(ADDM) Network and to re-establish surveillance of cerebral 
palsy at two ADDM sites.
    Blood Disorders.--The Committee includes an increase of 
$3,500,000 for sickle cell data collection and analysis. The 
Committee encourages CDC to provide technical assistance to 
additional States with a higher prevalence of sickle cell 
disease, so that they can successfully participate in this 
grant program to better identify affected individuals in their 
states and better meet their needs.
    Congenital Heart Defects.--The Committee includes an 
increase of $1,000,000 to advance congenital heart disease-
related public health research and surveillance initiatives.
    Early Hearing Detection and Intervention.--The Committee is 
aware of the significant racial and ethnic disparities in care 
facing children with hearing loss, and the effect unaddressed 
congenital hearing loss has on communication skills, 
psychosocial development, educational progress, and language 
development. The Committee encourages CDC to expand their work 
to improve surveillance of early hearing detection and 
intervention systems to ensure access to timely identification 
of congenital and acquired hearing loss and develop materials 
to enhance connection to follow up services among racial and 
ethnic minorities, and other medically underserved populations.
    Fetal Alcohol Spectrum Disorders.--The Committee includes 
an increase of $1,000,000 to expand efforts related to fetal 
alcohol spectrum disorders.
    Fetal Death.--The Committee includes an increase of 
$1,000,000 to expand research, surveillance and data collection 
activities related to stillbirth and stillbirth risk factors 
and to develop, make available, and evaluate evidence-based 
awareness and educational activities on stillbirth prevention.
    Fragile X and Fragile X-Associated Disorders.--The 
Committee commends CDC's efforts to identify and define the 
population impacted by fragile X (FX) and all conditions 
associated with the gene mutation with the goal of 
understanding the public health impact of these conditions. To 
help this effort, the Committee urges CDC to support additional 
strategies to promote earlier identification of children with 
FX. The Committee also urges CDC to work to ensure underserved 
populations at risk of FX conditions are being properly 
diagnosed and are aware of medical services available.
    Improving the Health of People with Intellectual 
Disabilities.--The Committee includes an increase of 
$10,000,000 for the expanded provision of year-round, 
grassroots activities in communities to create opportunities 
for health screenings and access to quality healthcare, and 
health and wellness programming for people with intellectual 
disabilities. These efforts enhance the lives of individuals 
while eliminating stigmas and stereotypes.
    Muscular Dystrophy.--The Committee includes an increase of 
$1,000,000 to enhance Muscular Dystrophy research and disease 
surveillance initiatives, including the Duchenne Muscular 
Dystrophy Care Considerations. The Committee looks forward to 
CDC's report describing how the Muscular Dystrophy Program 
funding is allocated, including evaluation of the impact of the 
Care Considerations as well as differences in care and outcomes 
between Certified Duchenne Care Centers and non-certified 
centers with the MD-STARnet network. Finally, the Committee 
encourages CDC to work with stakeholders to extract and 
evaluate the utility of common data elements in electronic 
health records to improve care, understand disease outcomes, 
and model disease progression.
    Spina Bifida.--The Committee requests an update in the 
fiscal year 2024 Congressional Budget Justification on efforts 
to address the transitional and adult care needs of the 
growing, aging spina bifida community.
    Surveillance for Emerging Threats to Mothers and Babies 
Network (SET-NET).--The Committee includes an increase of 
$20,000,000 to increase efforts and expand the reach of SET-NET 
to detect and respond to emerging threats to mothers and 
babies.
    Tourette Syndrome.--The Committee includes an increase of 
$500,000 to enhance efforts focused on Tourette Syndrome.

                   PUBLIC HEALTH SCIENTIFIC SERVICES

 
 
 
Appropriation, fiscal year 2022.......................      $651,997,000
Budget request, fiscal year 2023......................       798,537,000
Committee Recommendation..............................       867,497,000
    Change from enacted level.........................      +215,500,000
    Change from budget request........................       +68,960,000
 

    This account supports programs that provide leadership and 
training for the public health workforce, support 
infrastructure to modernize public health surveillance, promote 
and facilitate science standards and policies, and improve 
access to information on disease outbreaks and other threats.
    Within the total, the Committee recommends the following 
amounts:

------------------------------------------------------------------------
                   Budget Activity                     FY 2023 Committee
------------------------------------------------------------------------
Health Statistics....................................       $190,397,000
Surveillance, Epidemiology, and Informatics..........        298,100,000
Advancing Laboratory Science.........................         23,000,000
Public Health Data Modernization.....................        250,000,000
Public Health Workforce..............................        106,000,000
------------------------------------------------------------------------

    Advancing Laboratory Science.--The Committee includes an 
increase of $10,000,000 to strengthen CDC's laboratory science 
and safety, as CDC scientists and laboratories must be capable 
and prepared to meet evolving health threats, and maintain the 
highest standards of laboratory quality and safety oversight. 
The Committee is concerned about the suspension of parasitic 
lab services which clinicians and patients rely upon and urges 
prompt resumption of all services.
    Familial Hypercholesterolemia.--The Committee includes 
$100,000 to support public health efforts focused on this 
inherited genetic disorder to improve diagnosis and care 
delivery and prevent heart disease.
    National Center for Health Statistics (NCHS).--The 
Committee includes an increase of $10,000,000 for NCHS, a 
component of our nation's public health infrastructure, to 
monitor the health of our Nation and to make much-needed 
investments in the next generation of surveys and products.
    National Neurological Conditions Surveillance System.--The 
Committee includes $5,000,000 within Surveillance, 
Epidemiology, and Informatics to continue efforts on the two 
initial conditions.
    Primary Immunodeficiencies.--The Committee includes 
$3,500,000, an increase of $500,000, for education, awareness, 
and genetic sequencing surveillance related to primary 
immunodeficiencies. This program has proven effective in 
identifying undiagnosed patients and linking them to centers of 
care.
    Public Health Data Modernization Initiative.--The Committee 
includes an increase of $150,000,000 for the Data Modernization 
Initiative (DMI) to build upon current work to create modern, 
integrated, and real-time public health surveillance with CDC, 
State, territorial, local and tribal partners. The Committee 
acknowledges the need for sustained funding for this public 
health infrastructure to continue to move from siloed and 
brittle public health data systems to connected, resilient, 
adaptable, and sustainable systems to achieve real change. 
Essential to this significant effort are core data standards 
and support to recruit and retain the data science workforce. 
This is a massive undertaking by CDC, and it will only be 
successful with the commitment to improvement by the entire 
agency, and active engagement with partners. The Committee 
reiterates that the NCHS is to be fully integrated in the DMI.
    Public Health Workforce.--The Committee includes an 
increase of $45,000,000 to aid in the rebuilding of the public 
health workforce. The Committee recognizes that a robust and 
well-trained public health workforce is critical to maintaining 
a highly effective public health infrastructure.

                          ENVIRONMENTAL HEALTH

 
 
 
Appropriation, fiscal year 2022.......................      $228,350,000
Budget request, fiscal year 2023......................       401,850,000
Committee Recommendation..............................       328,850,000
    Change from enacted level.........................      +100,500,000
    Change from budget request........................       -73,000,000
 

    The Committee recommendation includes $311,850,000 in 
discretionary appropriations and $17,000,000 in transfers from 
the PPH Fund.
    Programs supported within Environmental Health conduct 
surveillance and data collection to detect and address emerging 
pathogens and environmental toxins that pose significant 
challenges to public health, as well as determine whether and 
at what level of exposure these substances are harmful to 
humans.
    Within the total, the Committee recommends the following 
amounts:

------------------------------------------------------------------------
                                                             FY 2023
                    Budget Activity                         Committee
------------------------------------------------------------------------
Environmental Health Laboratory.......................       $71,750,000
    Newborn Screening Quality Assurance Program.......        22,000,000
    Newborn Screening /Severe Combined                         1,250,000
     Immunodeficiency Diseases........................
Environmental Health Activities.......................        23,000,000
Safe Water............................................         8,600,000
Amyotrophic Lateral Sclerosis (ALS) Registry..........        10,000,000
Climate and Health....................................        75,000,000
Trevor's Law..........................................         2,000,000
Environmental and Health Outcome Tracking Network.....        34,000,000
Asthma................................................        33,500,000
Childhood Lead Poisoning..............................        66,000,000
Lead Exposure Registry................................         5,000,000
------------------------------------------------------------------------

    Amyotrophic Lateral Sclerosis (ALS) Registry.--The 
Committee recognizes that the National ALS Registry is a unique 
scientific resource in the fight to understand and prevent ALS. 
The Committee urges CDC to continue its investment in research 
that will lead to interventions to reduce the incidence of ALS 
and encourages CDC to further examine the potential risks of 
ALS through State and local environmental reports where there 
is an increased prevalence of ALS to further understand the 
disease's etiology.
    Asthma.--The Committee includes an increase of $3,000,000 
for the National Asthma Control Program to increase the number 
of States carrying out programmatic activities. In addition, 
the Committee recognizes that States receiving funding under 
CDC's National Asthma Control Program utilize the EXHALE 
strategy to better control asthma and reduce asthma-related 
hospitalizations, emergency department visits, and healthcare 
costs. The Committee requests a report within one year of the 
date of enactment of this Act on the activities that have been 
undertaken by each State grantee to address the outdoor 
environment component of their asthma control program.
    Childhood Lead Poisoning.--The Committee includes an 
increase of $25,000,000 to support the expansion of direct CDC 
assistance and funding to additional State and local public 
health departments. The Committee recognizes that CDC's 
expertise and technical assistance can be a valuable asset. 
Furthermore, the Committee encourages CDC to require that 
States receiving funding for lead prevention report all blood 
tests in a standardized format through the Nationally 
Notifiable Noninfectious Diseases and Conditions reporting 
system.
    Climate and Health.--The Committee includes an increase of 
$65,000,000 to expand to more States and territories to 
identify potential health effects associated with climate 
change and implement health adaptation plans. Climate-related 
events affect everyone, but not everyone is affected equally.
    Newborn Screening.--The Committee includes an increase of 
$3,000,000 to further support newborn screening efforts so that 
affected newborns can receive early and often life-saving 
treatment through the timely implementation for all Recommended 
Uniform Screening Panel conditions. The Committee is aware that 
State laboratories need specialized support to begin screening 
for additional newborn conditions and recognizes CDC's 
expertise in working with laboratories to implement accurate 
newborn screening tests. The Committee supports the Newborn 
Screening Quality Assurance Program to support State 
laboratories as they implement screening for new disorders. The 
increase in funding will enable States to establish testing for 
new conditions and improve testing of current conditions; build 
technical capacity in States by providing education, training 
and technical assistance to address testing challenges and 
determine appropriate testing methods for rapid screening; and 
ensure test results for new conditions are accurate by 
improving test result interpretation and expanding data 
analytic capacity.
    Vessel Sanitation Program.--The Committee includes 
$4,000,000 to support the critical public health functions of 
the vessel sanitation program. The Committee requests 
additional information in the fiscal year 2024 Congressional 
Budget Justification on the program budget, including user fee 
and no year funding balances, estimated user fee collections, 
and the anticipated workload.

                     INJURY PREVENTION AND CONTROL

 
 
 
Appropriation, fiscal year 2022.......................      $714,879,000
Budget request, fiscal year 2023......................     1,283,169,000
Committee Recommendation..............................       897,779,000
    Change from enacted level.........................      +182,900,000
    Change from budget request........................      -385,390,000
 

    Programs supported within Injury Prevention and Control 
provide national leadership on violence and injury prevention, 
conduct research and surveillance, and promote evidence-based 
strategies to inform real-world solutions to prevent premature 
death and disability and to reduce human suffering and medical 
costs caused by injury and violence.
    Within the total, the Committee recommends the following 
amounts:

------------------------------------------------------------------------
                                                             FY 2023
                    Budget Activity                         Committee
------------------------------------------------------------------------
Domestic Violence and Sexual Violence.................       $37,700,000
    Child Maltreatment................................         7,250,000
    Child Sexual Abuse Prevention.....................         3,000,000
Community and Youth Violence Prevention...............       100,000,000
Domestic Violence Community Projects..................         9,500,000
Rape Prevention.......................................        71,750,000
Suicide Prevention....................................        22,000,000
Adverse Childhood Experiences.........................        10,000,000
National Violent Death Reporting System...............        34,500,000
Traumatic Brain Injury................................        11,250,000
Elderly Falls.........................................         4,050,000
Drowning..............................................         2,000,000
Injury Prevention Activities..........................        31,950,000
Opioid Overdose Prevention and Surveillance...........       515,579,000
Injury Control Research Centers.......................        12,500,000
Firearm Injury and Mortality Prevention Research......        35,000,000
------------------------------------------------------------------------

    Adverse Childhood Experiences.--The Committee includes an 
increase of $3,000,000 to expand efforts including technical 
assistance to States to analyze data and burden.
    Child Sexual Abuse Prevention.--The Committee includes an 
increase of $1,000,000 and recognizes the severe and often 
life-long physical, cognitive and emotional impact of child 
sexual abuse. CDC's child sexual abuse prevention research 
includes opportunities to improve surveillance systems and data 
collection, increase the understanding of risk and protective 
factors, and develop and disseminate effective prevention 
efforts.
    Community and Youth Violence Prevention.--The Committee 
includes an increase of $84,900,000 for a new evidence-based 
community violence intervention, which aims to prevent 
intentional violence, such as mass casualty violence or gang 
violence. The Committee continues to recognize all forms of 
violence as a health crisis that is in desperate need of 
increased data collection and funding to support effective 
prevention and intervention efforts grounded in public health 
approaches. There is increasing evidence of the profound 
negative effects of violence and the exposure to violence on 
child development, the long-term mental and physical health of 
affected populations, and the economic development of 
communities, especially communities of color. The Committee 
encourages CDC to fund a broad range of interventions, 
including programs to provide de-escalation and conflict 
mitigation skills.
    Core State Injury Prevention Program (Core SIPP).--The 
Committee includes an increase of $3,000,000 for Core SIPP to 
enhance efforts to identify and respond to injury threats with 
data-driven public health actions.
    Domestic Violence and Sexual Violence.--The Committee 
includes an increase of $2,000,000 for intimate partner 
violence. The Committee notes the importance of the collection, 
reporting, and sharing of data on domestic violence and sexual 
violence across agencies. The Committee looks forward to 
receiving the National Domestic Violence Prevention Action Plan 
in 2023, as requested in House Report 117-96.
    Domestic Violence Community Projects.--The Committee 
includes an increase of $4,000,000 to expand the reach of the 
Domestic Violence Prevention Enhancement and Leadership Through 
Alliances (DELTA) program.
    Drowning.--The Committee includes an increase of $1,000,000 
to support proven drowning prevention programs with national 
organizations working with underserved and diverse youth, to 
support State drowning surveillance efforts, and to begin 
implementation of a national plan on water safety.
    Elderly Falls.--The Committee includes an increase of 
$2,000,000, doubling efforts related to fall prevention.
    Firearm Injury and Mortality Prevention Research.--The 
Committee includes an increase of $22,500,000 for research on 
firearm injury and mortality through a public health approach 
that focuses on data to understand its causes and to inform 
prevention strategies, including emergency room data on 
nonfatal gunshot injuries. The Committee continues to be 
concerned by the prevalence of firearm-related violence across 
the country, especially in our nation's schools, and urges CDC 
to conduct policy evaluation research to prevent violence in 
our schools. Furthermore, the Committee recognizes that 
community gun violence, such as gang violence, constitutes a 
significant portion of gun homicides in the U.S. There is a 
disproportionate impact of community gun violence on low-income 
communities of color, which is not often reflected in the 
national narrative surrounding gun violence. The Committee 
encourages CDC to support research on community gun violence, 
reflecting the diversity of the victims of gun violence. 
Furthermore, the Committee urges CDC to investigate the impact 
of access to teen and youth services in a community on rates of 
community violence.
    High School Sports Injuries.--The Committee encourages CDC 
to consider the feasibility of collecting and reporting data 
related to injuries in high school sports to improve the safety 
of student athletes.
    Injury Control Research Centers.--The Committee includes an 
increase of $3,500,000 to increase the number of awards for 
multidisciplinary research on the causes, outcomes, and 
prevention of injuries and violence.
    National Violent Death Reporting System.--The Committee 
includes an increase of $10,000,000 to increase efforts so that 
data can inform prevention efforts and save lives, including 
collecting data on gender identity and sexual orientation.
    Opioid Abuse and Overdose Prevention.--The Committee 
includes an increase of $25,000,000 to enhance activities, 
including outreach capacity and to help eliminate racial 
disparities in overdose deaths and improve access to prevention 
and treatment services. In addition, the Committee notes that 
CDC is currently conducting efforts focused on chronic pain as 
directed in House Report 117-96, and requests an update in the 
fiscal year 2024 Congressional Budget Justification on the 
status of these efforts. In addition, the Committee requests an 
update in the fiscal year 2024 Congressional Budget 
Justification on the percentage of funding provided to local 
communities for each entity receiving funds under this heading.
    Rape Prevention.--The Committee includes an increase of 
$15,000,000 to support rape prevention and education programs.
    Suicide.--The Committee includes an increase of $2,000,000 
to expand surveillance and comprehensive prevention efforts, as 
suicide is devastating communities across the U.S. In addition, 
the Committee requests report, in consultation with SAMHSA, 
within 180 days of the date of enactment of this Act on the 
impact of online forums promoting suicide on suicide rates, 
including the popularization of a specific method and 
disseminating information on its antidote. If the data for 
creating such a report is insufficient, CDC is directed to 
provide recommendations for how existing databases can be 
supplemented or the creation of new ones to capture this 
information.
    Traumatic Brain Injury.--The Committee provides an increase 
of $4,000,000 to initiate concussion surveillance, particularly 
among children and youth.

         NATIONAL INSTITUTE FOR OCCUPATIONAL SAFETY AND HEALTH

 
 
 
Appropriation, fiscal year 2022.......................      $351,800,000
Budget request, fiscal year 2023......................       345,300,000
Committee Recommendation..............................       363,300,000
    Change from enacted level.........................       +11,500,000
    Change from budget request........................       +18,000,000
 

    The National Institute for Occupational Safety and Health 
(NIOSH) conducts applied research, develops criteria for 
occupational safety and health standards, and provides 
technical services to government, labor, and industry, 
including training for the prevention of work-related diseases 
and injuries. This appropriation supports surveillance, health 
hazard evaluations, intramural and extramural research, 
instrument and methods development, dissemination, and training 
grants.
    Within the total for NIOSH, the Committee recommends the 
following amounts:

------------------------------------------------------------------------
                                                            FY 2023
                   Budget Activity                         Committee
------------------------------------------------------------------------
National Occupational Research Agenda................       $121,000,000
    Agriculture, Forestry, and Fishing...............         29,500,000
Education and Research Centers.......................         33,000,000
Personal Protective Technology.......................         24,000,000
Mining Research......................................         62,500,000
National Mesothelioma Registry and Tissue Bank.......          1,200,000
Firefighter Cancer Registry..........................          5,500,000
Other Occupational Safety and Health Research........        116,100,000
------------------------------------------------------------------------

    Agriculture, Forestry, and Fishing.--The Committee includes 
an increase of $2,000,000 to expand efforts to protect workers 
in this sector by providing leadership in applied research, 
disease and injury surveillance, education and prevention.
    Education and Research Centers.--The Committee includes an 
increase of $2,000,000 to support efforts to reduce work-
related injuries and illnesses through prevention research, 
education, and implementation of programs to improve 
occupational health and safety and minimize the dangers faced 
by workers across the country.
    Firefighter Cancer Registry.--The Committee includes an 
increase of $2,500,000, as the registry prepares to recruit and 
enroll participants.
    Occupational Injury and Illness.--The Committee requests a 
report within 180 days of the date of enactment of this Act on 
the estimate of the total incidence and economic burden of 
fatal and nonfatal occupational injury and illness in the U.S. 
The report shall adjust for known underreporting of 
occupational injury and illness, estimate the incidence or 
prevalence of occupational illnesses from public health data 
through attributable risk proportions or other standard 
methodologies, and estimate both medical and indirect costs, 
such as lost earnings, benefits, and home production. This 
report shall also estimate the proportion of the total economic 
burden not absorbed by worker's compensation insurance and 
shifted onto federal programs such as Medicare, Medicaid, and 
Social Security Disability Insurance.
    Personal Protective Technologies.--The Committee includes 
an increase of $2,000,000 to enhance efforts regarding personal 
protective technologies in response to the COVID-19 pandemic 
and to protect workers every day.
    PFAS Exposure.--The Committee urges CDC to include farming 
and agricultural sectors in its PFAS exposure research on 
health impacts.
    Radiation Exposure in Medical Procedures.--The Committee 
notes that many patients, doctors and health care workers are 
exposed to excessive radiation during medical procedures. The 
Committee requests a report within 90 days of the date of 
enactment of this Act on appropriate standards of practice 
recommendations for providers to follow to increase the use of 
radiation protection technologies such as non-lead/non-vinyl/
PVC shielding and reduce avoidable exposures.
    Total Worker Health.--The Committee includes an increase of 
$2,000,000 to expand the Total Worker Health program, which 
supports and conducts ground-breaking research to advance the 
overall safety, health, and well-being of U.S. workers.
    World Trade Center Health Program.--The Committee 
recognizes that thousands of eligible members of the World 
Trade Center Health Program (WTCHP) reside in States outside of 
New York today. In consideration of migration trends and with a 
greater need to provide clinical services, in particular, 
monitoring and treatment of WTCHP certified conditions, and 
improve access to research within the regions where eligible 
members live, the Committee encourages CDC to assess where 
eligible persons are located when planning future Clinical 
Centers of Excellence competitions.

       ENERGY EMPLOYEES OCCUPATIONAL ILLNESS COMPENSATION PROGRAM

 
 
 
Appropriation, fiscal year 2022.......................       $55,358,000
Budget request, fiscal year 2023......................        55,358,000
Committee Recommendation..............................        55,358,000
    Change from enacted level.........................             - - -
    Change from budget request........................             - - -
 

    The Energy Employees Occupational Illness Compensation 
Program provides compensation to employees and survivors of 
employees of Department of Energy facilities and private 
contractors who have been diagnosed with a radiation-related 
cancer, beryllium-related disease, or chronic silicosis as a 
result of their work. NIOSH estimates occupational radiation 
exposure for cancer cases, considers and issues determinations 
for adding classes of workers to the Special Exposure Cohort, 
and provides administrative support to the Advisory Board on 
Radiation and Worker Health.

                             GLOBAL HEALTH

 
 
 
Appropriation, fiscal year 2022.......................      $646,843,000
Budget request, fiscal year 2023......................       747,843,000
Committee Recommendation..............................       757,843,000
    Change from enacted level.........................      +111,000,000
    Change from budget request........................       +10,000,000
 

    Through its Global Health activities, CDC coordinates, 
cooperates, participates with, and provides consultation to 
other nations, Federal agencies, and international 
organizations to prevent and contain diseases and environmental 
health problems and to develop and apply health promotion 
activities. In cooperation with ministries of health and other 
appropriate organizations, CDC tracks and assesses evolving 
global health issues and identifies and develops activities to 
apply CDC's technical expertise.
    Within the total, the Committee recommends the following 
amounts:

------------------------------------------------------------------------
                                                            FY 2023
                   Budget Activity                         Committee
------------------------------------------------------------------------
Global AIDS Program..................................       $128,921,000
Global Tuberculosis..................................         14,722,000
Global Immunization Program..........................        230,000,000
    Polio Eradication................................        180,000,000
    Other Global/Measles.............................         50,000,000
Parasitic Diseases and Malaria.......................         31,000,000
Global Public Health Protection......................        353,200,000
------------------------------------------------------------------------

    Global Health Security.--The Committee supports CDC's work 
to protect global health security through programs that detect, 
prevent, and respond to infectious diseases and other health 
threats, including the development of new tools, especially 
diagnostics, the application of advanced molecular detection 
for the identification and tracking of diseases and disease 
variants at home and abroad, and core technical contributions 
to developing and validating tools for use by U.S. bilateral 
and multilateral global health programs and laboratory efforts 
to monitor and combat drug and insecticide resistance, 
functions essential to ensuring that global health programs are 
responsive, efficient, and tailored for maximum impact. The 
Committee urges CDC to ensure that the importance of research 
and development to global health security is appropriately 
reflected in their international engagements.
    Global Public Health Protection.--The Committee includes an 
increase of $100,000,000 to support CDC's mission to protect 
the health of our nation including by working across the globe. 
The Committee supports CDC's global efforts to detect epidemic 
threats earlier, respond more effectively, and prevent 
avoidable crises.
    Parasitic Disease and Malaria.--The Committee provides an 
increase of $4,000,000 recognizing the important role CDC plays 
in the fight against malaria and parasitic disease and 
encourages CDC to continue to research, monitor, and evaluate 
efforts for malaria and parasitic disease in collaboration 
across the agency and with other agencies.
    Polio Eradication.--The Committee includes an increase of 
$2,000,000 to advance polio eradication efforts.
    Population-based Surveillance Platforms.--The Committee 
provides $10,000,000 to support existing longitudinal 
population-based infectious disease surveillance platforms that 
enable comparative analysis between urban and rural populations 
in the developing world.
    Soil Transmitted Helminth and Related Diseases of 
Poverty.--The Committee includes $1,500,000 to extend the 
currently funded CDC projects aimed at surveillance, source 
remediation and clinical care to reduce soil transmitted 
helminth infection.
    Tuberculosis.--The Committee includes an increase of 
$5,000,000 to advance tuberculosis prevention, diagnosis, and 
treatment efforts.

                PUBLIC HEALTH PREPAREDNESS AND RESPONSE

 
 
 
Appropriation, fiscal year 2022.......................      $862,200,000
Budget request, fiscal year 2023......................       842,200,000
Committee Recommendation..............................       882,200,000
    Change from enacted level.........................       +20,000,000
    Change from budget request........................       +40,000,000
 

    The Public Health Preparedness and Response (PHPR) account 
supports programs that build and strengthen national 
preparedness for public health emergencies, both naturally-
occurring and intentional. PHPR supports needs assessments, 
response planning, training, epidemiology and surveillance, and 
upgrades for laboratory capacity and communications systems.
    Within the total, the Committee recommends the following 
amounts:

------------------------------------------------------------------------
                                                            FY 2023
                   Budget Activity                         Committee
------------------------------------------------------------------------
Public Health Emergency Preparedness Cooperative            $735,000,000
 Agreement...........................................
Academic Centers for Public Health Preparedness......          8,200,000
CDC Preparedness and Response........................        139,000,000
------------------------------------------------------------------------

    Public Health Preparedness Cooperative Agreements.--The 
Committee includes an increase of $20,000,000 to enhance 
investments in State, local, and territorial health departments 
to quickly detect, monitor, and respond to health threats. 
Public health system investments serve as the backbone for 
disaster and outbreak response in every State and the pandemic 
has shown that increased funding for preparedness is necessary 
for a baseline of consistent protection. The Committee directs 
that grant recipients incorporate Limited English Proficient 
(LEP) Individuals into their emergency response. Grant 
recipients must ensure that they are conducting tailored and 
robust outreach efforts to LEP communities. In addition, the 
Committee requests the fiscal year 2024 Congressional Budget 
Justification include a State distribution table, which should 
also include how funding is being allocated to local health 
departments and how States are determining these allocations.

                        BUILDINGS AND FACILITIES

 
 
 
Appropriation, fiscal year 2022.......................       $30,000,000
Budget request, fiscal year 2023......................        55,000,000
Committee Recommendation..............................        55,000,000
    Change from enacted level.........................       +25,000,000
    Change from budget request........................             - - -
 

    This account supports capital projects as well as repairs 
and improvements to restore, maintain, and improve CDC's assets 
at facilities in seven States and San Juan, Puerto Rico.
    The Committee continues language to allow CDC to retain 
unobligated funds in the Individual Learning Accounts from 
departed employees to support the replacement of the 
underground and surface coal mine safety and health research 
facility.
    Maintenance Backlog.--The Committee includes an increase of 
$25,000,000 to make significant progress on reducing CDC's 
backlog of maintenance and repairs.

                CDC-WIDE ACTIVITIES AND PROGRAM SUPPORT

 
 
 
Appropriation, fiscal year 2022.......................      $493,570,000
Budget request, fiscal year 2023......................       968,570,000
Committee Recommendation..............................     1,118,570,000
    Change from enacted level.........................      +625,000,000
    Change from budget request........................      +150,000,000
 

    This account supports public health leadership and support 
activities at CDC.
    The Committee recommendation includes $958,570,000 in 
discretionary funds and $160,000,000 in transfers from the PPH 
Fund.
    Within the total, the Committee recommends the following 
amounts:

------------------------------------------------------------------------
                   Budget Activity                     FY 2023 Committee
------------------------------------------------------------------------
Preventive Health and Health Services Block Grant....       $160,000,000
Public Health Leadership and Support.................        123,570,000
Infectious Disease Rapid Response Reserve Fund.......         35,000,000
Public Health Infrastructure and Capacity............        750,000,000
Center for Forecasting and Outbreak Analytics........         50,000,000
------------------------------------------------------------------------

    Center for Forecasting and Outbreak Analytics.--The 
Committee includes funding for the new Center for Forecasting 
and Outbreak Analytics to facilitate the use of data, modeling, 
and analytics to improve preparedness and response. The 
Committee urges CDC to continue to work with schools of public 
health and other academic institutions to engage the nation's 
expertise in disease modeling, public health data analysis, 
research, and training to build workforce capacity in this 
emerging field.
    Infectious Disease Rapid Response Reserve Fund.--The 
Committee includes an increase of $15,000,000. As utilized 
during the initial response to COVID-19, the Reserve Fund will 
provide an immediate source of funding to quickly respond to an 
imminent infectious disease crisis. Funds are available until 
expended.
    Local Health Departments.--The Committee notes that Federal 
funding intended for both State and local health departments 
does not consistently reach local health departments beyond 
those directly-funded and recognizes the important role of 
local health departments in our nation's governmental public 
health partnership to protect the public's health.
    Preventive Health and Health Services Block Grant.--The 
Committee continues to support the Preventive Health and Health 
Services Block grant, of which at least $7,000,000 is to 
support direct services to victims of sexual assault and to 
prevent rape.
    Public Health Infrastructure and Capacity.--The Committee 
includes an increase of $550,000,000 to provide consistent and 
reliable funding for State, local, territorial, Federal public 
health agencies. This disease-agnostic funding can be used to 
address cross-cutting needs, including bolstering the public 
health workforce, addressing local priorities, ensuring 
capacity to meet urgent needs during emergencies, and improving 
data collection and sharing processes. The Committee encourages 
CDC to provide States with clear guidance on the suballocation 
of this funding to local health departments that do not receive 
funding directly. The Committee further urges CDC to publicly 
track and report on the suballocation of funding through State 
health departments to local health departments. The Committee 
directs that no less than 70 percent of this funding be awarded 
to health departments.
    Public Health Leadership and Support.--The Committee 
includes an increase of $10,000,000 to support CDC's 
foundational public health activities and to facilitate 
partnerships.

                     National Institutes of Health


 
 
 
Appropriation, fiscal year 2022.......................   $44,959,000,000
Budget request, fiscal year 2023......................    45,233,218,000
Committee Recommendation..............................    47,459,000,000
    Change from enacted level.........................    +2,500,000,000
    Change from budget request........................    +2,225,782,000
 

    The Committee recommendation for the National Institutes of 
Health (NIH) program level includes $46,038,300,000 in 
discretionary appropriations and $1,420,700,000 in Public 
Health Service Act (PHS Act) section 241 evaluation set-aside 
transfers.
    The mission of NIH is to seek fundamental knowledge about 
the nature and behavior of living systems and the application 
of that knowledge to enhance health, lengthen life, and reduce 
illness and disability. NIH conducts and supports research to 
understand the basic biology of human health and disease; apply 
this understanding towards designing new approaches for 
preventing, diagnosing, and treating disease and disability; 
and ensure that these approaches are widely available.
    The recommendation includes funding for initiatives 
established in the 21st Century Cures Act (Cures Act), 
including a total of $216,000,000 for the Cancer Moonshot 
Initiative; $541,000,000 for the All of Us precision medicine 
initiative (including $419,000,000 from the Cures Act); and 
$620,000,000 for the Brain Research through Application of 
Innovative Neurotechnologies (BRAIN) Initiative (including 
$450,000,000 from the Cures Act).
    The Committee includes specific funding allocations for 
several initiatives and activities detailed in the Institute- 
and Center-specific sections below.

                    NATIONAL CANCER INSTITUTE (NCI)

 
 
 
Appropriation, fiscal year 2022.......................    $6,912,522,000
Budget request, fiscal year 2023......................     6,713,851,000
Committee Recommendation..............................     7,378,579,000
    Change from enacted level.........................      +466,057,000
    Change from budget request........................      +664,728,000
 

    The Committee recommendation includes $7,162,579,000 in 
discretionary appropriations and $216,000,000 made available in 
the Cures Act.
    Mission.--NCI leads, conducts, and supports cancer research 
across the Nation to advance scientific knowledge and help all 
people live longer, healthier lives.
    Brain Cancer.--The Committee recognizes that certain types 
of brain cancers are associated with high mortality and 
morbidity rates. Brain and other nervous system cancers have a 
five-year survival rate of 33 percent. Certain brain tumors 
that occur in humans also occur spontaneously and naturally in 
dogs. These brain cancers in dogs share many of the same 
molecular underpinnings of their human counterparts. There is 
great potential for developing treatments for brain cancers 
that will benefit dogs and humans and provide an intermediate 
step to evaluate human treatments in a more meaningful and 
related species. The Committee encourages NIH to continue to 
support research that brings together researchers and 
clinicians from pediatrics, adult oncology, veterinary 
medicine, and biomedical engineering to leverage the linkage 
between brain cancers in dogs and humans to evaluate and 
develop treatments and safe delivery systems to benefit both 
species.
    Cancer Immunotherapy and Correlative Research.--
Understanding the complex factors that determine whether a 
particular cancer immunotherapy will succeed for a given 
patient is a vital area of research. Central to this research 
is the analysis of blood, tumor, and other tissues in 
conjunction with the outcome of clinical trials (known as 
correlative studies), which can help explain why a treatment 
worked or not, and why it did or did not produce serious side 
effects, as well as providing critical insights to help 
optimize subsequent trials. For example, by evaluating 
peripheral blood and tumor biopsies obtained from patients 
prior to and during treatment, researchers can better 
understand the factors that influence successful anti-tumor 
immune response and the development of treatment resistance. In 
general, correlative studies are most useful when conducted in 
a timely manner as an integrated part of clinical trials. The 
Committee urges NCI to continue to explore approaches to 
support and streamline the incorporation of correlative studies 
in immunotherapy trials and commends NCI for the establishment 
of the Cancer Immune Monitoring and Analysis Centers (CIMACS) 
and the Cancer Immunologic Data Commons (CIDC) as part of the 
Cancer Moonshot. This network carries out comprehensive 
molecular analysis of clinical trial specimens for biomarkers 
and pathways associated with response to immunotherapy and 
conducts correlative studies and profiling of tumors and immune 
cells for NCI-funded early trials of immunotherapy. The 
Committee encourages NCI to continue funding for correlative 
studies through existing funded networks.
    Cancer Moonshot.--The Committee directs NIH to transfer 
$216,000,000 from the NIH Innovation Account to NCI to support 
the Cancer Moonshot initiative. These funds were authorized in 
the Cures Act.
    The Committee also encourages NCI to leverage Cancer 
Moonshot efforts to continue supporting research aimed at 
addressing health disparities and expanding the scientific 
understanding of the genetic and molecular drivers of cancer, 
including for diseases with significant differences in outcomes 
between White and non-White patients, such as acute myeloid 
leukemia (AML). According to research using data from NCI's 
Surveillance, Epidemiology, and End Results (SEER) Program, 
there is a wide disparity and higher mortality rate among 
African American patients compared to White patients with AML. 
The Committee encourages NCI to continue intramural and 
extramural research efforts to identify the underlying causes 
of health disparities associated with AML, including hereditary 
blood cancers.
    Cancer Survivorship.--As of January 2019, there were an 
estimated 16.9 million cancer survivors in the U.S. and the 
number of cancer survivors is projected to increase to 22.2 
million by 2030. The Committee encourages NCI to continue to 
address the unique needs of cancer survivors with resources to 
support cancer survivors whether through additional research on 
essential elements of survivorship care, leveraging Federal 
resources, or improving coordination among providers. An 
investment in quality of life after a diagnosis is a critical 
component of our Nation's fight against the disease.
    Cancer Vaccines.--The Committee recognizes that the success 
of the COVID 19 vaccines--which became available less than a 
year from the outset of the pandemic and now deliver up to 95 
percent protection rates--is because these vaccines were built 
on messenger RNA technology, or mRNA, an approach that had been 
initiated for cancer research. The Committee understands that 
with further research, mRNA cancer vaccines could potentially 
be among the most cost-effective methods of preventing 
recurrences and the high costs of cancer care. In addition, the 
fiscal year 2023 budget request explicitly acknowledged that a 
potential area of transformative research within NIH is the 
preparation of mRNA vaccines against common forms of cancer. 
The Committee encourages NIH to continue to support research 
efforts that move the field forward for mRNA vaccines in 
cancer. Areas of particular scientific opportunity include 
focus on enhancing immune recognition of solid tumors, 
overcoming suppression in the tumor microenvironment, and 
personalization of mRNA vaccines. Together, these strategies 
have high potential for increasing the effectiveness for cancer 
immunotherapy treatment and prevention.
    Childhood Cancer Data Initiative (CCDI).--The Committee 
includes no less than $50,000,000 for the CCDI, the same as the 
fiscal year 2022 level. Within this total, the Committee 
includes no less than $750,000 to continue to support 
enhancement of the CCDI Molecular Characterization Initiative 
and other efforts as applicable through continued expansion to 
focus on ultra-rare tumor types, such as atypical teratoid 
rhabdoid tumor (ATRT), and other ultra-rare pediatric tumor 
types with limited therapeutic options. The effort should 
include comprehensive clinical and molecular data for each 
patient to the extent possible. The dataset should include 
clinical, radiographic, histopathologic, and molecular 
information to the extent possible and be stored in a manner 
that allows for interrogation of patient level data. The data 
collected will be used to identify risk factors, aid in 
prognostication and treatment recommendations, and assist with 
the development of novel therapeutics for these diseases.
    Childhood Cancer STAR Act.--The Committee includes no less 
than $30,000,000, the same as the fiscal year 2022 enacted 
level, for continued implementation of sections of the 
Childhood Cancer Survivorship, Treatment, Access, and Research 
(STAR) Act to expand existing biorepositories for childhood 
cancer patients enrolled in NCI-sponsored clinical trials to 
collect and maintain relevant clinical, biological, and 
demographic information on children, adolescents, and young 
adults, with an emphasis on selected cancer subtypes (and their 
recurrences) for which current treatments are least effective, 
and to continue to conduct and support childhood and adolescent 
survivorship research. This amount also includes the $2,000,000 
provided for the CDC's ongoing efforts to enhance cancer 
registry case capture efforts for childhood and adolescent 
cancers.
    Clinical Trials Reporting of Data.--The Committee 
recognizes that children have often been historically 
underrepresented in clinical trials. However, children with 
cancer participate in clinical trials at a high rate, thanks in 
large part to NCI support for clinical trials through the 
Children's Oncology Group, the Pediatric Early Phase Clinical 
Trials Network, the Pediatric Brain Tumor Consortium, and NCI's 
Pediatric Oncology Branch at the NIH Clinical Center. The 
Committee encourages NCI to continue to make information 
available to the public regarding adult trials that allow 
enrollment of patients under age 18.
    Colorectal Cancer.--The Committee recognizes that 
colorectal cancer is the second leading cause of cancer death 
for men and women in the U.S. While colorectal cancer incidence 
rates in individuals over 50 have largely stabilized or 
declined due to significant advancements in preventive 
screening, incidence rates for early-onset colorectal cancer 
(individuals diagnosed at ages 20 to 49) have been consistently 
increasing. Three out of four early-onset colorectal cancer 
patients have no family history of the disease and over 60 
percent of early-onset colorectal cancer patients are diagnosed 
at a late stage. There are several racial/ethnic disparities in 
colorectal cancer screening and outcomes. Black individuals 
have the highest incidence and mortality and face lower 
survival than White individuals. American Indians/Alaskan 
Natives also have elevated rates and deaths compared to the 
general population and represent the only racial/ethnic group 
for whom colorectal cancer mortality rates are not declining. 
Racial and ethnic minorities are also more likely than White 
individuals to present with late-stage, incurable disease. 
Notably, the sharpest increase in metastatic, early-onset 
colorectal cancer is among people 20 to 39 years old, 
especially Black and Hispanic individuals. Mortality rates 
across all ages for late-stage colorectal cancer have remained 
stagnant due to minimal progress in treatments for colorectal 
cancer patients.
    Given these challenges, the Committee urges NCI to 
prioritize research on colorectal cancer. The Committee directs 
NCI to submit a plan to the Committee within 180 days of 
enactment of this Act guided by a multidisciplinary and multi-
agency advisory council to include diverse representatives from 
the colorectal cancer community, including colorectal cancer 
patients, patient organizations, industry, academic 
researchers, and community-based providers, to include all 
relevant health care agencies. Specifically, this plan should 
identify research priorities, gaps, and opportunities, and 
include detailed sections focused on the following non-
exhaustive list of topics: the lack of progress in the 
development of effective therapeutics for colorectal cancer, 
the rising rates of colorectal cancer in people under the age 
of 50, with a special focus on the rapidly increasing rates of 
early onset colorectal cancer in the 20 to 39 year old age 
range; and the persistent health disparities in colorectal 
cancer prevalence, screening, and outcomes. The plan should 
describe how NCI plans to play a role in addressing these 
challenges and what existing and future innovative grant 
mechanisms can be leveraged to advance progress.
    Deadliest Cancers.--The Recalcitrant Cancer Research Act 
(RCRA) of 2012 focuses on cancers with a five-year survival 
rate below 50 percent, which account for 44 percent of all U.S. 
cancer deaths. In House Report 117-96, the Committee directed 
NCI to develop a scientific framework using the process 
outlined in the RCRA for gastric and esophageal cancers. The 
Committee also notes that NCI has taken an important step by 
receiving approval for a Program in Origins of Gastroesophageal 
Cancers from the National Cancer Advisory Board and Board of 
Scientific Advisors. Given the toll all recalcitrant cancers 
exact on society and the lack of diagnostic and treatment 
resources currently available to help patients, the Committee 
encourages NCI to continue to invest in the most promising 
research opportunities to advance progress against each of the 
deadliest cancers (gastric, esophageal, and GE junction; liver, 
including cholangiocarcinoma; lung, including mesothelioma; 
ovary; pancreas; and brain, including adult and pediatric brain 
tumors), and to provide an update on research focused on each 
of these areas in the fiscal year 2024 Congressional 
Justification.
    Endometrial Cancer.--The Committee remains concerned about 
the significant racial and ethnic disparities in mortality 
rates for endometrial cancer that adversely impact Black women. 
The age-adjusted mortality rate for Black women with 
endometrial cancer is nearly twice the rate of White women, 
which is partly attributed to cancer stage at diagnosis. The 
Committee commends NCI's efforts to address these disparities 
through projects like the Discovery and Evaluation of Testing 
for Endometrial Cancer in Tampons (DETECT) Study, and 
encourages NCI to continue supporting research activities that 
will lead to the development of targeted interventions to 
improve early diagnosis among Black women with endometrial 
cancer. The Committee also encourages NCI to research 
innovative community-based outreach methods to improve access 
to high-quality care, with the goal of increasing enrollment 
and participation by Black women in clinical trials. The 
Committee requests an update on NCI's activities regarding 
endometrial cancer in the fiscal year 2024 Congressional 
Justification, including progress made in endometrial cancer 
early diagnosis, survival rates, and clinical trial enrollment 
by race and ethnicity.
    Environmental Exposures and Cancer in Firefighters.--The 
Committee is aware that firefighters have increased rates of 
cancer diagnoses and death relative to the general population. 
Firefighters are exposed to a complex mix of known and possible 
cancer-causing chemicals through breathing hazardous substances 
and absorbing them through their skin. Despite an understanding 
of the risks associated with firefighter environmental 
exposures, there has been no large-scale, systematic 
examination of the mechanisms by which the environmental 
exposures experienced by these frontline responders can cause 
cancer. The Committee recognizes the work NIH and CDC/NIOSH 
have performed to better understand the cancer risks 
firefighters may experience and encourages these agencies to 
continue conducting this research, including efforts measuring 
environmental exposures in firefighters and determining the 
mechanisms by which these exposures lead to increased cancer 
incidence, morbidity, and mortality. The Committee also 
encourages NIH to continue to support research to improve 
health equity among firefighters, including through inclusion 
of participants across race, ethnicity, gender, and workplace 
environment groups to evaluate potential differences in 
exposures and risk.
    Glioblastoma (GBM).--Glioblastoma is a cancer with less 
than a five percent five-year relative survival rate, and the 
average survival time from diagnosis has improved by only six 
months over the last 30 years. To date, there have only been 
five drugs and one medical device approved by the FDA for the 
treatment of GBM. With prior Congressional investment in NCI 
programs, glioblastomas have been molecularly characterized, 
resulting in a new and promising understanding of these tumors, 
including the identification of potential clinical strategies 
and agents, trial designs, and imaging and pathology 
technologies.
    The Committee commends NCI for its establishment and 
initial implementation of the GBM Therapeutics Network (GTN). 
The GTN's cross-cutting teams' capabilities to conduct pre-
clinical studies and early-phase clinical trials enables the 
careful evaluation of potential treatments, including small 
molecule drugs, immunotherapies, radiation, and devices. The 
overall goal of the GTN is advancing progress towards future 
cures and improved quality of life for GBM patients.
    Given this initial progress, the Committee urges NCI to 
continue to enhance and accelerate its implementation of the 
GTN and continue to fund to the full extent necessary so that 
this program can rapidly launch clinical trials that speed 
access to promising qualified treatments to patients consistent 
with NCI's Glioblastoma Working Group recommendations in 2019.
    Gynecologic Cancers.--The Committee continues to be 
concerned about the growing racial, socioeconomic, and 
geographic disparities in gynecologic cancers. In contrast to 
most other common cancers in the U.S., relative survival for 
women with newly diagnosed advanced cervical or endometrial 
cancer has not significantly improved since the 1970s. 
Furthermore, historical data demonstrates that Black and Latina 
women with gynecologic cancers are not as likely to receive 
standard therapy and/or die more frequently. The current COVID-
19 pandemic has only exacerbated the health care disparities 
that were already present in minority and underrepresented 
communities. For example, in early 2021, CDC published findings 
that cervical cancer screenings among women aged 21-29 in 
California decreased by as much as 78 percent during the 
pandemic. This is concerning because cervical cancer incidence 
and mortality rates are disproportionately higher in Hispanic 
women and non-Hispanic Black women.
    The Committee urges NCI to expand the number of clinical 
trials, research grants, and contract opportunities for 
investigators that focus on discoveries that will positively 
impact access to prevention, early detection, diagnosis, and 
treatment for gynecologic cancers and address these now well-
documented disparities. The Committee requests an update on 
NCI's research program for gynecologic cancers in the fiscal 
year 2024 Congressional Justification, including specific 
grants and strategies where the intent is to overcome these 
racial disparities in gynecologic cancers outcomes and 
opportunities to increase participation of minority women in 
gynecologic cancer clinical trials.
    Health Disparities Research.--The Committee commends NCI 
for supporting research related to cancer health disparities, 
including studies on the molecular basis for disparities that 
could lead to improved screening and treatment strategies, as 
well as best practices for increasing participation of 
underrepresented populations in NCI-supported clinical trials. 
The Committee includes an increase of $10,000,000 for NCI to 
support research related to identifying and reducing health 
disparities as described in the fiscal year 2023 budget 
request.
    HPV Associated Cancers.--The Committee encourages NCI to 
expand research related to human papillomavirus (HPV) and HPV-
associated cancers.
    Improve Native American Cancer Outcomes.--The Committee 
continues to be concerned that Native Americans experience 
overall cancer incidence and mortality rates that are 
strikingly higher than non-Native populations and encourages 
NCI to expand research efforts to reduce American Indian cancer 
disparities and improve outcomes. The Committee notes NCI's 
successful efforts through the Cancer Moonshot's Accelerating 
Colorectal Cancer Screening and Follow-Up through 
Implementation Science (ACCSIS) program, and parallel efforts 
by NCI Designated Cancer Centers collaborating with American 
Indian communities, that are improving colorectal cancer 
screening, follow-up, and referral for care among populations 
that have low colorectal cancer screening rates. The Committee 
encourages NCI to continue efforts such as the ACCSIS 
initiative to develop durable capacity for tribally-engaged 
cancer disparities research through an integrated program of 
research, education, outreach, and clinical access.
    Liver Cancer.--The Committee notes that liver cancer is the 
second most common cause of cancer worldwide, with cases in the 
U.S. increasing over 250 percent since 2000. The incidence of 
liver cancer is three times higher in men than women, and the 
burden is higher in African Americans, Hispanics, and Asians. 
The incidence of liver cancer geographically parallels the 
prevalence of viral hepatitis, with hepatis B estimated to 
cause up to 60 percent of the cases of liver cancer. For these 
reasons, the Committee applauds NCI for its collaboration in 
the effort to update the Strategic Plan for Trans-NIH Research 
to Cure Hepatitis B. The Committee also is supportive of the 
NCI intramural Liver Cancer Program, the Hepatobiliary and 
Hepatocellular Carcinoma (HCC) SPOREs, the new Diversity SPORE, 
the Translational Liver Cancer Network, the Hepatocellular 
Carcinoma Epidemiology Consortium, the large Genome-Wide 
Association Study (GWAS) of liver cancer and the need to expand 
the GWAS study to include a focus on Hispanic and African 
Descent populations. The Committee also urges NCI to continue 
its support of the Translational Liver Cancer Consortium, which 
supports research focused on early detection, and to support 
research to explore the usefulness of current and new 
interventions in reducing HBV associated HCC and whether early 
treatment with direct action antivirals or other strategies can 
reduce cancer risk.
    Lung Cancer.--The recent decline in cancer mortality fueled 
by progress in lung cancer is directly attributable to NIH-
funded research to inform development of new effective 
therapeutics and to continue progress in tobacco prevention and 
cessation. Ongoing understanding of the molecular underpinnings 
of lung cancer and identification of additional oncogene driver 
subsets has led to rapid development of new targeted therapies, 
which, together with efforts to broaden uptake of comprehensive 
biomarker testing, has the potential to deliver the promise of 
precision medicine to more patients than ever before. The 
Committee encourages NIH and its Office of Disease Prevention 
to continue to fund important research across each of these 
areas to broaden the base of lung cancer survivors across 
different disease types, including small cell lung cancer.
    Lung Cancer Disparities.--The Committee is concerned that 
lung cancer disproportionally impacts communities of color. The 
Committee commends NCI for its role in supporting research that 
established low-dose computed tomography as an effective lung 
cancer screening approach and for the Institute's continued 
research in this area, which has directly informed updates to 
the United States Preventive Services Task Force (USPSTF) lung 
cancer screening guidelines. In 2021, USPSTF expanded the 
recommended age range for screening to 50 to 80 years 
(previously 55 to 80 years) and reduced the pack-year history 
to 20 pack-years of smoking (previously 30 pack-years). By 
expanding who is eligible for screening, the changes to this 
recommendation are particularly relevant to Black people and to 
women. Data shows that both groups tend to smoke fewer 
cigarettes than White men. Data also shows that Black people 
have a higher risk of lung cancer than White people. These 
changes will mean that many more Black people and women who 
smoke will be eligible for this potentially life-saving 
screening. Unfortunately, lung cancer screening is currently 
underutilized. Therefore, the Committee encourages NCI to 
continue to support research focused on approaches to encourage 
broader uptake of lung cancer screening among the USPSTF 
recommended populations, including evaluating strategies with a 
focus on increasing screening uptake among communities with 
lung cancer death rates higher than the national average, with 
a goal of reducing lung cancer mortality disparities among 
people of color and women.
    Melanoma.--As UV radiation is established as the primary 
carcinogen for melanoma, the Committee urges NCI to continue to 
support research directed at genomic and mechanistic 
characteristics of mutagenesis; optimization of prevention 
strategies; and early detection and risk declassification 
strategies that leverage artificial intelligence, access to 
large databases, noninvasive technologies, and molecular 
markers that will support precision medicine.
    Although SEER data show a decline in mortality with the 
advent of new categories of treatment, some patients do not 
respond to initial treatment, and many of the responders have 
disease that will recur. The Committee encourages NCI to expand 
research on mechanisms of primary and secondary drug resistance 
and validation of predictive biomarkers that allow selection of 
optimal therapy and prediction of comprehensive longitudinal 
monitoring. Basic and translational goals should be facilitated 
through development and use of ever-improving models of human 
melanoma.
    Building on the success of adjuvant therapies, and the 
promising results of neoadjuvant therapies, the Committee 
encourages NCI to continue support of research addressing tumor 
cell dormancy and metastases. The Committee encourages NCI to 
explore opportunities for multicenter trials that will 
determine whether shorter courses of therapy will decrease 
toxicity while maintaining benefit, refine adjuvant therapies, 
and continue to develop neoadjuvant therapies.
    The Committee also encourages NCI to continue to support 
research on novel targets, especially for rare subtypes. The 
Committee requests an update on these requests and the status 
of NCI-funded melanoma research in the fiscal year 2024 
Congressional Justification.
    Metastatic Cancer Research.--While the early detection and 
treatment of early-stage disease for many cancers results in 
cures, for most tumors, metastatic cancer remains incurable. 
More than 90 percent of cancer deaths are due to metastatic 
disease. In addition to genetic alterations in the cancer 
itself, recent research has revealed that there is a genetic 
basis for susceptibility to metastatic cancer or resistance to 
metastasis. More research is required to develop a 
comprehensive understanding of this complex process involving 
tumor and host interactions. Clinical trials are an important 
aspect of that progress, and diverse representation of patients 
in clinical trials is integral to the development of 
medications and therapies that effectively treat metastatic 
disease. Ethnicity, gender, age, and genetics all play a role 
in the safety and efficacy of a treatment for an individual. 
The Committee commends NIH and the Department of Defense (DoD) 
for work already underway to support research needs and 
opportunities identified in the April 2018 Task Force Report to 
Congress on Metastatic Cancer. The Committee encourages NIH to 
maintain collaborative efforts with DoD and the Department of 
Veterans' Affairs (VA) to provide subject matter expertise, as 
appropriate, as DoD provides updates and continues to implement 
recommendations from the report aimed at achieving 
representation of the demographic of the U.S. population in 
clinical trials.
    NCI Paylines.--Grant applications to NCI have increased by 
approximately 50 percent since 2013, outpacing available 
funding, with requests for cancer research ten-fold greater 
than other Institutes and Centers. With such a high demand for 
NCI grants, only a fraction of highly meritorious research 
proposals can be funded. To support more awards and improve 
success rates, the Committee provides an increase of 
$200,000,000 for NCI to prioritize competing grants and to 
sustain commitments to continuing grants.
    Pediatric Cancer Research.--NCI has supported research to 
advance significant achievements in childhood cancer diagnosis, 
prevention, treatment, and quality of life improvements. 
Children that are diagnosed with cancer deserve a fighting 
chance and effective and less toxic therapies. Childhood 
cancers are rare, and they need specialized treatments, not 
just lower dose treatments that adults receive. The Committee 
urges NCI to continue this important work to examine novel 
systems to better understand rare cancers, and to support and 
accelerate the development of life-saving therapeutics for 
pediatric patients who often have no other options.
    Prostate Cancer.--The Committee remains concerned that 
prostate cancer lacks treatments for men with advanced disease 
as well as adequate diagnostic and imaging methodologies. To 
ensure Federal resources are leveraged to the greatest extent 
possible, the Committee encourages NCI to coordinate, when 
appropriate, its research efforts with other Federal agencies, 
including DoD, as well as private research foundations and 
advocacy groups.
    Radiopharmaceutical Development.--Recognizing the promise 
of radiotherapy treatments and other diagnostic uses, NCI has 
organized a Radiopharmaceutical Development Initiative (RDI), 
which is a specialized infrastructure for the clinical 
evaluation of novel theranostic radiopharmaceutical cancer 
therapies and which complements academic and industry 
development of these agents with early phase combination 
studies to test tolerability and early signs of efficacy. While 
clinical trials for radiopharmaceuticals are presently ongoing, 
domestic production of such drugs relies on a very small number 
of reactors, and the future loss of such reactors would not 
only deal a significant blow to domestic patients due to the 
short half-life of many of these drugs, but would also limit 
NCI's ability to continue to support and conduct this important 
research. The Committee is aware of alternative technologies to 
produce radionuclides by accelerators, such as the one located 
at Brookhaven National Laboratory; however, some radionuclides 
can be produced only in nuclear reactors. Therefore, the 
Committee requests NIH, in conjunction with the Department of 
Energy, to provide an update in the fiscal year 2024 
Congressional Justification regarding the impact shortages of 
medical isotopes and radiopharmaceuticals have on the ability 
to conduct cancer research.
    Rare Blood Cancers and Germline Mutations.--The Committee 
commends NCI for collaborating with NHGRI in running natural 
history studies of patients with germline mutations and their 
families, which frequently lead to blood cancers including 
acute myeloid leukemia (AML). More research on how genetic 
dispositions, such as RUNX1 familial platelet disorder (RUNX1-
FPD), lead to rare blood cancers will ultimately support the 
discovery of treatments that could prevent malignancy through 
advances in early detection and early treatment for all blood 
cancers. Interest in this field has grown significantly in 
recent years, and the Committee strongly urges NCI to initiate 
new and expanded funding opportunities related to germline 
predispositions to rare blood cancers. The Committee is pleased 
to hear that NCI will soon be launching a precision medicine 
clinical trial for AML and myelodysplastic syndromes and 
requests an update in the fiscal year 2024 Congressional 
Justification.
    Rare Cancer Equity.--Nearly half a million Americans are 
diagnosed with a rare form of cancer every year. Rare cancers 
could account for hundreds, if not thousands, of distinct forms 
of cancer. The Committee encourages NCI to continue research to 
better understand the molecular drivers of all cancers, 
including through molecular characterization and molecular 
diagnostics for patients. The Committee also encourages NCI to 
continue to support research on cancer subtypes, which could 
benefit rare cancers.

           NATIONAL HEART, LUNG, AND BLOOD INSTITUTE (NHLBI)

 
 
 
Appropriation, fiscal year 2022.......................    $3,808,494,000
Budget request, fiscal year 2023......................     3,822,961,000
Committee Recommendation..............................     3,943,702,000
    Change from enacted level.........................      +135,208,000
    Change from budget request........................      +120,741,000
 

    Mission.--NHLBI provides global leadership for a research, 
training, and education program to promote the prevention and 
treatment of heart, lung, and blood disorders and enhance the 
health of all individuals so that they can live longer and more 
fulfilling lives.
    Blood Donor Questionnaire Educational Materials.--The 
Committee is concerned that certain FDA guidance in the 
educational materials provided in the blood donor questionnaire 
are inappropriate and misguided. The recommendations for 
deferral should not hinge on a person's sexual orientation, and 
rather should focus on risk factors that might expose a 
potential donor to blood-borne illness. The Committee strongly 
recommends that NHLBI evaluate the need for additional research 
studies to inform the FDA on removing or replacing the 
recommended deferment of blood for men who have had sex with 
men in the last three months.
    Community Engagement Alliance (CEAL) Against COVID-19 
Disparities Initiative.--The Committee continues to support the 
CEAL initiative, which connects researchers with community 
organizations and leaders to conduct outreach and increase 
participation of people from underrepresented communities in 
clinical trials for COVID-19 treatments, vaccines, and ongoing 
COVID-19 related research needs.
    COVID-19-Associated Illnesses.--The Committee recognizes 
the growing burden of COVID-associated critical illnesses, 
including sepsis and pneumonia. The Committee encourages NIH to 
accelerate research into sepsis, pneumonia, and acute lung 
injury.
    Duchenne and Becker Muscular Dystrophy.--Now that life 
expectancy for Duchenne patients has increased, there is a need 
for more research related to clinical care and long-term 
cardiac impacts. Furthermore, there is a paucity of data on 
Becker patients to understand cardiac implications long term. 
The Committee urges NHLBI to work with NINDS to explore 
research collaborations to follow patients throughout the 
lifespan to fully clinically characterize cardiac muscle 
function and better establish the relationship between cardiac 
muscle function and the impact of its progressive deterioration 
on both lifespan and quality of life.
    Developing gene therapies to treat Duchenne muscular 
dystrophy is a complex and multifaceted process. The Committee 
encourages NIH to support research aimed at gene therapy safety 
utilizing viral vectors and support the development of less 
immunogenetic non-viral delivery systems. The Committee also 
supports further NIH investment in the development of more 
sensitive outcome measures and biomarkers for both Duchenne and 
Becker.
    Harmful Algal Blooms.--The Committee strongly encourages 
NHLBI to support research to address the human health concerns 
of cyanotoxin exposure from harmful algal blooms and emergent 
chemicals of concern, and particularly the need for research 
directed on health issues relating to aerosolized exposure to 
water contaminated with HABS and ECC toxins. This research 
could take advantage of unique laboratory facilities at the 
Nation's national laboratories and prioritize new preventative, 
diagnostic, and therapeutic strategies to combat the harmful 
health effects of airborne HAB and ECC toxin exposure, 
especially in vulnerable, at-risk populations.
    Health Disparities Research.--The COVID-19 pandemic has 
highlighted and exacerbated health disparities in the U.S. The 
Committee includes an increase of $15,000,000 for leveraging 
lessons learned by NHLBI to support research related to 
identifying and reducing health disparities.
    Kleine-Levin Syndrome (KLS).--The Committee commends NIH 
for its December 2021 publication of the Sleep Research Plan. 
The Committee recommends the inclusion of KLS, a complex 
neurological disorder characterized by long, recurring episodes 
of excessive sleep and derealization, as a sleep disorder 
requiring attention and study in the next publication of the 
Sleep Research Plan. The cause of KLS is still unknown, and 
there are no known treatments. Because KLS shares symptoms with 
other sleep disorders and mental health conditions, the 
Committee encourages NIH to expand its support for research 
about KLS, which could provide the KLS community and many 
others with critical information and answers.
    Long-Term Impact of COVID-19.--The Committee notes with 
concern that an estimated ten percent of individuals who have 
recovered from COVID-19 are experiencing longer term health 
consequences, including residual lung damage. More studies are 
needed to understand if such changes resolve or are permanent. 
The Committee urges NHLBI to prioritize research into the 
understanding, treatment, and prevention of post-COVID 
respiratory conditions, particularly among minority populations 
disproportionately impacted by COVID-19.
    Lung Health Research.--The Committee recognizes that, over 
the past year, lung failure was the number one cause of death 
in the U.S. More than one million Americans have died as a 
direct result from a respiratory pandemic. Even prior to 
emergence of SARS CoV-2, deaths from chronic obstructive 
pulmonary disease were already the third leading cause of death 
in the world, and pneumonia was the leading cause of death 
worldwide among children under the age of five. The risks to 
lung health are only increasing as global air quality 
deteriorates from dust and particle pollution among other 
factors. All of these exposures drive lung inflammation and 
ultimately made COVID-19 more devastating as well. Furthermore, 
the Nation's capability to address acute lung injury or acute 
respiratory distress syndrome (ARDS) has been demonstrated to 
be deeply inadequate.
    The Committee supports the activities of NHLBI's lung 
health research program, which supports mechanisms of lung 
injury and repair as well as clinical intervention trials 
addressing both acute and chronic lung diseases. These 
investments will help to identify the biological pathways of 
lung injury to find ways to help the lung recover from injury.
    Mitral Valve Prolapse (MVP) Research.--The Committee 
encourages NHLBI to advance technological imaging and precision 
medicine to generate data on individuals with valvular disease, 
identify individuals who are at high risk of sudden cardiac 
death as a result of valvular heart disease, develop prediction 
models for high-risk patients, and enable interventions and 
treatment plans to keep these patients healthy throughout their 
lives.
    National Chronic Obstructive Pulmonary Disease (COPD) 
Action Plan.--The Committee notes NHLBI's role in crafting the 
National COPD Action Plan and encourages NHLBI to continue this 
important work by supporting additional research activities and 
collaborating with other PHS agencies to facilitate 
implementation of the plan's recommendations.
    National Commission on Lymphatic Diseases.--The Committee 
requests an update on the establishment of a National 
Commission on Lymphatic Diseases and strongly encourages the 
Director to engage with relevant Institutes, Centers, and 
external stakeholders to demonstrate key progress within 90 
days of the enactment of this Act.
    NIH Sleep Research Plan.--The Committee commends the 
National Center on Sleep Disorders Research (NCSDR) for the 
release of the NIH Sleep Research Plan and supports the full 
implementation of the Plan. The Committee specifically 
encourages strong consideration of the Plan's proposal for 
multi-center studies and clinical trials.
    Pulmonary Fibrosis (PF).--Many PF patients wait more than a 
year for diagnosis after symptom onset, and patients with some 
types of PF have a life expectancy of only 3-5 years. The 
Committee urges NHLBI to support research into biomarkers that 
can aid in earlier, safer diagnosis of pulmonary fibrosis, as 
well as tools that can help predict which patients will 
experience disease progression. The Committee also encourages 
NHLBI to support the development of novel outcome measures for 
clinical trials in pulmonary fibrosis, such as imaging, and to 
continue to fund research involving early phase clinical 
assessment of novel drugs and personalized approaches to 
therapies. The Committee requests an update on PF research in 
the fiscal year 2024 Congressional Justification.
    Pulmonary Hypertension.--The Committee continues to note 
the relationship between the long-term effects of COVID-19 and 
pulmonary hypertension. The Committee encourages NHLBI to 
increase their collaboration with key stakeholders in advancing 
critical research priorities.
    Sickle Cell Disease.--Sickle cell disease (SCD) is the most 
common inherited blood disorder in the U.S. The Committee 
commends NIH, including NHLBI, for past research efforts aimed 
at developing more effective treatments and cures, but believes 
more can be done. As such, the Committee encourages NIH to 
renew its focus and continue to prioritize efforts by 
supporting extramural grants for research projects that will 
support the development of a treatment approach for SCD, 
research into potential cures, and provide better outreach and 
education for health care providers. The Committee encourages 
NIH to consider programs both domestically and globally to 
evaluate the effectiveness of screening technologies for 
infants and children with the sickle cell trait and disease and 
to develop different innovative technologies and medicines to 
treat and cure SCD. The Committee also encourages NHLBI to 
increase its focus on disease modifying therapies that could 
improve day-to-day care for the vast majority of patients and 
address issues such as organ damage and pain management. 
Lastly, the Committee encourages NHLBI to fund the training of 
more sickle cell disease clinicians and researchers to maintain 
this essential workforce pipeline and to make advances on the 
transition from childhood medical care to adult.
    Support for The Heart Truth Program.--For over a decade, 
``The Heart Truth'' program has worked to raise awareness about 
women's risk of heart disease. The program's goals are to 
increase awareness that heart disease is the leading cause of 
death among women and to increase the conversations between 
women and their health care providers. Accordingly, the 
Committee encourages NHLBI to robustly fund ``The Heart Truth'' 
program.
    Thalassemia.--Donated blood has a relatively short shelf 
life and is generally stored for only 42 days. However, stored 
blood begins to degrade before the end of that 42-day period, 
with possible stiffening of cell membranes as early as after 21 
days. For patients in need of emergency blood transfusions, 
that degradation may not be significant; however, studies are 
needed to determine the impact of older red blood cells on 
patients who require chronic transfusion, such as those with 
thalassemia, especially in terms of iron loading in the heart 
and internal organs. The Committee urges NHLBI to establish 
research initiatives focused on this issue.
    Valvular Heart Disease Research.--Many people in the U.S. 
have heart valve defects or disease but do not have symptoms. 
For some, the condition remains the same throughout their lives 
and does not cause significant or life-threatening problems. 
Unfortunately, over 25,000 people die each year in the U.S. 
from heart valve disease, primarily due to underdiagnosis and 
undertreatment of the condition. The Committee strongly 
supports more research into valvular heart disease. Such 
research should focus on advances in technological imaging and 
precision medicine to generate data on individuals with 
valvular heart disease, identify individuals who are at high 
risk of sudden cardiac death, and develop prediction models for 
high-risk patients, enabling interventions and treatment plans 
to help keep these patients healthy throughout their lives. The 
Committee thanks NHLBI for hosting a workshop on this issue.

     NATIONAL INSTITUTE OF DENTAL AND CRANIOFACIAL RESEARCH (NIDCR)

 
 
 
Appropriation, fiscal year 2022.......................      $501,231,000
Budget request, fiscal year 2023......................       513,191,000
Committee Recommendation..............................       526,051,000
    Change from enacted level.........................       +24,820,000
    Change from budget request........................       +12,860,000
 

    Mission.--The mission of NIDCR is to advance fundamental 
knowledge about dental, oral, and craniofacial (DOC) health and 
disease and translate these findings into prevention, early 
detection, and treatment strategies that improve overall health 
for all individuals and communities across the lifespan.
    Pain Management Research.--The Committee commends NIDCR for 
supporting research related to pain and pain management, 
including studies to develop safer, non-opioid pain medications 
and interventions. The Committee includes an increase of 
$9,000,000 for NIDCR to support additional research in this 
area as described in the fiscal year 2023 budget request.

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

 
 
 
Appropriation, fiscal year 2022.......................    $2,203,926,000
Budget request, fiscal year 2023......................     2,206,080,000
Committee Recommendation..............................     2,283,489,000
    Change from enacted level.........................       +79,563,000
    Change from budget request........................       +77,409,000
 

    Mission.--The NIDDK mission is to conduct and support 
medical research and research training and disseminate science-
based information on diabetes and other endocrine and metabolic 
diseases; digestive diseases, nutritional disorders, and 
obesity; and kidney, urologic, and hematologic diseases, to 
improve people's health and quality of life.
    Chronic Kidney Disease (CKD).--The Committee urges NIDDK to 
continue support for kidney research. The Committee applauds 
recent changes to clinical practice in the diagnosis of kidney 
disease and concurs with recommendations for new markers for 
estimating kidney function. NIDDK is encouraged to prioritize 
research into endogenous filtration markers, activities that 
spur the adoption of new equations for estimating GFR that do 
not include race as a modifier, and interventions to eliminate 
racial and ethnic disparities. Finally, the Committee 
encourages NIDDK to continue investment in research that 
bridges existing deficits in CKD management and treatments to 
reduce incidence and progression, increases the number of CKD 
clinical trials and diversity of participants, improves the 
delivery of evidenced-base care in underrepresented 
populations, and improves patients' quality of life. The 
Committee requests an update on these priorities in the fiscal 
year 2024 Congressional Justification.
    Dietary Supplements.--The Committee supports efforts by 
NIDDK to monitor drug-induced liver injury. Recently, more than 
20 percent of cases are reported to be caused by dietary 
supplements. These products need to be analyzed for their label 
claims; it is essential to identify the component that may 
cause liver injury. It has been reported that more than 70 
percent of products analyzed do not meet label claims, and many 
of them are laced with steroids and pharmaceuticals. The 
Committee continues to support NIDDK research into dietary 
supplements.
    Inflammatory Bowel Disease.--The CDC estimates that in 
2015, three million Americans were living with IBD, and the 
Global Burden of Disease Study 2017 reported that IBD 
prevalence in the U.S. increased by nearly 24 percent between 
1990 and 2017. Many patients may be undiagnosed until the 
disease has become severe, and despite the therapeutic options 
on the market, some patients remain without an effective 
treatment. The Committee continues to support NIH in funding 
basic, translational, and clinical studies on the diagnosis and 
treatment of IBD.
    Interstitial Cystitis.--The Committee notes the progress of 
interstitial cystitis research through the Multidisciplinary 
Approach to the Study of Chronic Pelvic Pain program and 
encourages NIDDK and stakeholders to continue collaboration on 
a scientific workshop to examine mechanisms for scientific 
opportunity. The Committee requests an update on the progress 
of the conference in the fiscal year 2024 Congressional 
Justification.
    Pain Management Research.--The Committee commends NIDDK for 
supporting research related to pain and pain management, 
including studies to develop interventions to reduce opioid use 
in people on hemodialysis. The Committee includes an increase 
of $10,000,000 for NIDDK to support additional research in this 
area as described in the fiscal year 2023 budget request.
    Polycystic Kidney Disease (PKD).--The Committee commends 
NIDDK for its continued commitment to PKD Research and 
Translation Centers and the Pediatric Centers of Excellence in 
Nephrology, which improve our understanding of the causes of 
autosomal dominant PKD and autosomal recessive PKD. The 
Committee continues to encourage NIDDK to fund innovative, 
high-impact PKD research and promote the development of new 
therapeutic strategies.

    NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKE (NINDS)

 
 
 
Appropriation, fiscal year 2022.......................    $2,611,370,000
Budget request, fiscal year 2023......................     2,768,043,000
Committee Recommendation..............................     2,833,590,000
    Change from enacted level.........................      +222,220,000
    Change from budget request........................       +65,547,000
 

    The Committee recommendation includes $2,608,590,000 in 
discretionary appropriations and $225,000,000 made available in 
the Cures Act.
    Mission.--The NINDS mission is to seek fundamental 
knowledge about the brain and nervous system and use that 
knowledge to reduce the burden of neurological disease.
    Amyotrophic Lateral Sclerosis (ALS).--The Committee 
recognizes the devastating toll that ALS takes on those 
affected by the disease and their loved ones. ALS causes 
progressive and cumulative physical disabilities in patients, 
and leads to death due to respiratory muscle failure. The 
Committee strongly urges NINDS to expand support for research 
on ALS, including but not limited to its causes, diagnosis, and 
treatment. The Committee directs NIH to provide an update on 
NIH-supported research related to ALS in the fiscal year 2024 
Congressional Justification.
    Brain Aneurysm Research.--The Committee remains concerned 
that an estimated one out of every 50 individuals in the U.S. 
has a brain aneurysm and an estimated 30,000 Americans suffer a 
brain aneurysm rupture each year, with little or no warning. 
Ruptured brain aneurysms are fatal in about 50 percent of 
cases. The Committee continues to be concerned about the lack 
of research focused on prevention and early detection of brain 
aneurysms and encourages NIH to expand its support for research 
in this area.
    BRAIN Initiative.--The Committee directs NIH to transfer 
$225,000,000 from the NIH Innovation Account to NINDS to 
support the BRAIN Initiative. These funds were authorized in 
the Cures Act. This collaborative effort is revolutionizing the 
understanding of how neural components and their dynamic 
interactions result in complex behaviors, cognition, and 
disease, while accelerating the development of transformative 
tools to explore the brain in unprecedented ways, making 
information previously beyond reach accessible.
    Cerebral Palsy.--The Committee encourages NIH to continue 
to prioritize and invest in research on cerebral palsy (CP) 
including the establishment of a cerebral palsy Notice of 
Special Interest (NOSI) to significantly strengthen and 
accelerate progress toward CP research priorities across the 
lifespan. Cerebral palsy research should focus on basic and 
translational discoveries, as well as implementation, 
observational, and clinical studies aimed at early detection 
and intervention, comparative effectiveness, and functional 
outcomes. While some progress has been made in the 
understanding of CP, the most common lifelong physical 
disability, large gaps remain that must be addressed to improve 
outcomes and treatment for the cerebral palsy population and 
their families, impacting quality of life and reducing medical 
costs. Similarly, to address the racial and socioeconomic 
health equity challenges experienced by the cerebral palsy 
population, it is imperative that greater investment is made to 
address disparities in access to interventions and stakeholder 
engagement. The Committee encourages NIH to support greater 
investment in research focused on the areas in need of growth, 
as outlined in the Strategic Plan on Cerebral Palsy Research 
directed by the Joint Explanatory Statement accompanying the 
fiscal year 2022 Appropriations Act, including research on 
lifespan issues to address the needs of transition-age youth 
and adults with cerebral palsy, and research to support the 
development and delivery of new and improved screening tools, 
treatments and interventions.
    The Committee also encourages NIH to consider a 
neuroplasticity workshop and research opportunities focusing on 
the motor and health benefits of physical activity specifically 
for individuals with CP across all gross motor functional 
classification levels, which is vital to help prevent chronic 
disease and premature aging.
    Dystonia.--The Committee requests an update in the fiscal 
year 2024 Congressional Justification on the status of the 
implementation of the recommendations from the NINDS workshop 
Defining Emergent Opportunities in Dystonia Research that was 
held in 2018.
    Lyme Disease.--The Committee recognizes that there have 
been only a small number of clinical trials involving Lyme 
disease, which lacks a gold standard test, and that those 
trials have involved a relatively small number of patients. For 
other diseases, high quality multi-site trials involving robust 
number of well-characterized patients have been considered 
essential to facilitate advancements in the development of more 
effective treatments and improved outcomes. Because of the 
clear neurological dysfunction of Lyme disease and the 
existence of the Network for Excellence in Neuroscience 
Clinical Trials, the Committee encourages NINDS to evaluate how 
it may contribute to improvements in tools to manage Lyme 
disease.
    Multiple Sclerosis (MS).--The Committee encourages NINDS to 
prioritize studies that develop the medical understanding of 
the progression of MS and advance research on prevention 
strategies, treatments, and cures for MS.
    Opioid, Stimulant, and Pain Management Research.--The 
Committee includes no less than the fiscal year 2022 enacted 
level within NINDS for the Helping to End Addiction Long-Term 
(HEAL) Initiative, which is a trans-NIH effort to accelerate 
scientific discovery related to prevention and treatment of 
opioid use disorder and improving pain management. The 
Committee also includes an additional $11,500,000 in NINDS to 
support related research on pain and pain management, as 
described in the fiscal year 2023 budget request.
    Parkinson's Disease (PD).--The Committee commends NINDS for 
taking critical steps in identifying priority research 
recommendations to advance research on PD, which impacts 
between 500,000 and 1,500,000 Americans and is the second most 
prevalent neurodegenerative disease in the U.S. The Committee 
recognizes that NINDS is prioritizing public health concerns 
with severe gaps in unmet medical needs and supports the 
research recommendations set forth by the NINDS planning 
strategy to bring us closer to better treatments and a cure for 
PD. The Committee also encourages NINDS to submit an update on 
its progress on implementing these recommendations in the 
fiscal year 2024 Congressional Justification.
    Parkinson's Disease and Dementia.--The Committee recognizes 
that although PD is often thought of only as a movement 
disorder, most PD patients also develop dementia. Common 
symptoms include difficulty with problem solving and speed of 
thinking, memory, and other cognitive skills. Because people 
with PD usually develop these symptoms several years after 
their diagnosis, PD represents an under-explored opportunity to 
study the onset and progression of dementia. Therefore, the 
Committee strongly urges NIA and NINDS to put a higher priority 
on PD, both before and after onset of dementia, within their 
overall dementia research portfolios. The Committee requests an 
update on these activities in the fiscal year 2024 
Congressional Justification.
    Prion Research and Brain Health.--The Committee supports 
the efforts of NINDS to support research across the spectrum of 
neurodegenerative disease, including through the BRAIN 
Initiative and the Alzheimer's disease research portfolio. The 
Committee encourages NINDS to support enhanced research on the 
processes whereby misfolded proteins (prions) are replicated in 
the brain. Such proteins are critically implicated in numerous 
neurodegenerative diseases, many of which are both lethal and 
incurable. The Committee also encourages NINDS to enhance its 
focus on the identification of genetic and other biomarkers for 
disorders that involve misfolded proteins, such as traumatic 
brain injury, ALS, Huntington's disease, Parkinson's disease, 
and Alzheimer's disease, and the development of related 
diagnostic tools and therapies.

     NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES (NIAID)

 
 
 
Appropriation, fiscal year 2022.......................    $6,322,728,000
Budget request, fiscal year 2023......................     6,268,313,000
Committee Recommendation..............................     6,642,608,000
    Change from enacted level.........................      +319,880,000
    Change from budget request........................      +374,295,000
 

    Mission.--The NIAID mission is to conduct and support basic 
and applied research to better understand, treat, and 
ultimately prevent infectious, immunologic, and allergic 
diseases.
    Antimicrobial Resistance.--The Committee includes 
$560,000,000 to support antimicrobial resistance research, 
$20,000,000 above the fiscal year 2022 enacted level. Increased 
funding would support the training of new investigators; 
strengthen clinical trial infrastructure to boost preparedness; 
enhance basic, translational, and clinical research on 
mechanisms of resistance, therapeutics, vaccines and 
diagnostics; and support the development of a clinical trials 
network to reduce barriers to research on difficult-to-treat 
infections.
    Celiac Disease.--The Committee supports research to improve 
the quality of life for patients with celiac disease, efforts 
to find the cause of the disease, and efforts to find a cure. 
The Committee commends NIH for issuing a Notice of Special 
Interest to spur additional research on the study of celiac 
disease. Today, the only known treatment for this disease is a 
gluten-free diet; however, recent public and private sector 
research confirms that such a ``treatment'' is insufficient for 
many who suffer from celiac disease. The Committee urges NIH to 
support focused research on the study of celiac disease; to 
better coordinate existing research; and, to focus new research 
efforts toward causation, diagnosis, management, treatment, 
and, ultimately, a cure of this disease. The Committee thanks 
NIH for establishing a Research Condition, Disease 
Categorization (RCDC) for celiac disease.
    Cellular Immunity.--To better understand diseases like 
COVID-19, the Committee is aware of the enormous value in 
assessing cellular immunity, in addition to antibodies, which 
may help us answer questions about the efficacy of vaccines, 
the need for boosters, and the degree to which they prime the 
body to protect against future variants, as well as the role of 
cellular immune response diagnostics. With more comprehensive 
immune response data, the Committee understands that it may be 
possible to identify features of immune responses to viruses 
like SARS-CoV-2 that make some people more susceptible to 
severe disease, long COVID, and reinfection. The Committee 
believes enhanced cellular immunity assessment will help to 
generate deeper insights into the immune response, and may help 
identify new strategies to improve countermeasures, including 
cellular immune response diagnostics, for SARS-CoV-2 and other 
potential pathogens in the future. The Committee encourages 
NIAID to incorporate cellular immunity assessment into the wide 
range of intramural and extramural COVID-19 and other disease 
studies conducted and supported by NIH, including but not 
limited to vaccine schedule studies and understanding post-
acute sequalae of SARS-CoV-2 infection (PASC/long COVID). The 
Committee requests that NIAID provide an update on these 
efforts in the fiscal year 2024 Congressional Justification.
    Centers for AIDS Research.--As part of the Ending the HIV 
Epidemic initiative, the Committee includes $71,000,000 for the 
longstanding HIV research efforts of the Centers for AIDS 
Research (CFARs) as well as CFAR activities and similar efforts 
to support the EHE, the same as the fiscal year 2022 enacted 
level and the fiscal year 2023 budget request. These Centers 
and related efforts offer evidence-based practices on 
prevention and treatment to initiative partners and support for 
evaluating the initiative. The Committee encourages CFAR to 
assess whether resources are targeting areas with the highest 
prevalence and to develop targeted interventions that address 
high-need communities.
    Centers for Research and Emerging Infectious Diseases.--The 
Committee recognizes the importance of the connection between 
animal health and its impacts on human health. The NIH Centers 
for Research on Emerging Infectious Diseases, a global network 
of researchers dedicated to investigating how and why viruses 
emerge from animals to cause disease in humans, has been 
established by NIAID to investigate how and where viruses and 
other pathogens can emerge from wildlife and spill over to 
cause disease in people. The Committee commends the work of 
this program and supports its continuation.
    Consortium of Food Allergy Research (CoFAR).--The Committee 
recognizes the serious issue of food allergies, which affect 
approximately eight percent of children and ten percent of 
adults in the U.S. The Committee commends the ongoing work of 
NIAID in supporting a total of 17 clinical sites for this 
critical research, including seven sites as part of the CoFAR. 
The Committee includes $12,100,000, an increase of $3,000,000, 
for CoFAR to expand its clinical research network to add new 
centers of excellence in food allergy clinical care and to 
select such centers from those with proven expertise in food 
allergy research.
    Health Disparities Research.--The Committee includes an 
increase of $10,000,000 for NIAID to support research related 
to identifying and reducing health disparities as described in 
the fiscal year 2023 budget request.
    Hereditary Angioedema (HAE).--The Committee recognizes 
NIAID for its ongoing stewardship of the HAE research 
portfolio, including advancements that have taken HAE from a 
debilitating and fatal condition to a manageable chronic 
disease. The Committee notes the potential of gene therapy and 
other cutting-edge research to further improve health outcomes 
for HAE patients and encourages NIAID to maintain its 
commitment to the HAE research.
    Late-Stage Antifungal Research and Development.--Fungal 
diseases, like Valley fever, pose a threat to public health, 
including life-threatening drug resistant infections. The 
Committee supports research to further the research and 
development of novel anti-fungal therapies for multi-drug 
resistant pathogens to minimize their impact on public health.
    Next-Generation Vaccine Platforms.--The Committee notes 
that many current vaccines protect from disease but do not 
always prevent the spreading of pathogens. When this occurs, 
protected people might not experience symptoms but are still 
infectious. Next-generation viral vectors, designed to target 
specific tissue like mucosal sites or specific immune cells, 
offer new abilities to induce the desired immune responses and 
protect the necessary tissues. This will open novel 
opportunities to prevent diseases and transmission. The 
Committee encourages NIAID to maintain a balanced portfolio of 
vaccine platform approaches to include next-generation viral 
vectors, particularly in vaccine centers that have experience 
in developing viral vectors covering multiple virus-based 
vaccine platforms and that have established collaborations with 
high containment laboratories (e.g., BSL-3 and BSL-4) for 
preclinical studies.
    Primary Immunodeficiencies (PI) Research.--The Committee 
applauds NIH for recognizing the need for research on primary 
immunodeficiencies and other related conditions by issuing a 
Notice of Special Interest for research on inborn errors of 
immunity/primary immunodeficiencies. The Committee encourages 
NIH to fund as many meritorious proposals as possible and to 
consider building upon the notice by issuing a targeted funding 
announcement focused on research topics of significance to the 
PI research and patient communities.
    Regional Biocontainment Laboratories (RBLs).--The Committee 
provides $52,000,000 to be evenly divided among the 12 RBLs to 
support efforts to prevent, prepare for, and respond to 
infectious disease outbreaks, including, but not limited to: 
(1) conducting research on developing new antiviral compounds, 
vaccines, and point of care tests; (2) conducting research on 
prophylactic methods to prevent infections; (3) supporting 
operations costs and purchase of equipment to speed drug 
discovery and testing; and (4) training new researchers in 
biosafety level 3 practices. The Committee recognizes the need 
for RBLs to be able to utilize funding for all four of the 
aforementioned areas. The Committee urges NIAID to identify 
appropriate grant mechanisms that will allow RBLs to access 
funding to support these four critical areas.
    Tick-Borne Disease Research.--The Committee is supportive 
of the NIH Strategic Plan for Tickborne Disease Research 
published in 2019. The Committee encourages NIAID to increase 
efforts to understand causes of the increase in tick-borne 
diseases, to support research on tick-borne tularemia 
(Francisella tularensis), and to determine whether information 
learned on ways that ticks respond to bacterial infections 
offer avenues to thwart tick infections in humans.
    Universal Influenza Vaccine.--The Committee includes no 
less than $260,000,000, an increase of $15,000,000 over the 
fiscal year 2022 level and the same as the fiscal year 2023 
budget request, to support basic, translational, and clinical 
research to develop a universal influenza vaccine that provides 
robust, long-lasting protection against multiple subtypes of 
flu, rather than a select few. Such a vaccine would eliminate 
the need to update and administer the seasonal flu vaccine each 
year and could provide protection against newly emerging flu 
strains, potentially including those that could cause a flu 
pandemic. The Committee requests an update on these efforts 
within 60 days of enactment of this Act.

         NATIONAL INSTITUTE OF GENERAL MEDICAL SCIENCES (NIGMS)

 
 
 
Appropriation, fiscal year 2022.......................    $3,092,373,000
Budget request, fiscal year 2023......................     3,097,557,000
Committee Recommendation..............................     3,200,157,000
    Change from enacted level.........................      +107,784,000
    Change from budget request........................      +102,600,000
 

    The Committee recommendation includes $1,779,457,000 in 
discretionary appropriations and $1,420,700,000 in PHS Act 
section 241 evaluation set-aside transfers.
    Mission.--NIGMS supports basic research that increases our 
understanding of biological processes and lays the foundation 
for advances in disease diagnosis, treatment, and prevention.
    Health Disparities Research.--The Committee includes an 
increase of $10,000,000 for NIGMS to support research and 
activities related to identifying and reducing health 
disparities as described in the fiscal year 2023 budget 
request.
    Institutional Development Awards (IDeA).--The Committee 
provides $423,076,000 for IDeA, $13,119,000 above the fiscal 
year 2022 enacted level. The program increases our Nation's 
biomedical research capability by improving research in States 
that have historically been less successful in obtaining 
biomedical research funding. IDeA funds only merit-based, peer-
reviewed research that meets NIH research objectives in the 23 
IDeA States and Puerto Rico. NIH IDeA is comprised of these key 
initiatives: Centers of Biomedical Research Excellence (COBRE) 
and IDeA Networks of Biomedical Research Excellence (INBRE). 
The program aims to strengthen an institution's ability to 
support biomedical research, enhance the competitiveness of 
investigators in securing research funding, and enable clinical 
and translational research that addresses the needs of 
medically underserved communities.
    COBRE is a proven successful method to increase the number 
of new scientists at institutions in States eligible for IDeA 
awards. The Committee recognizes the success of the COBRE 
program and encourages NIH to continue working to increase the 
number of new scientists at institutions in eligible IDeA 
States.

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

 
 
 
Appropriation, fiscal year 2022.......................    $1,683,009,000
Budget request, fiscal year 2023......................     1,674,941,000
Committee Recommendation..............................     1,756,630,000
    Change from enacted level.........................       +73,621,000
    Change from budget request........................       +81,689,000
 

    Mission.--NICHD's mission is to lead research and training 
to understand human development, improve reproductive health, 
enhance the lives of children and adolescents, and optimize 
abilities for all.
    Endometriosis Research.--The Committee urges NICHD to 
continue to expand basic, clinical, and translational research 
into the mechanics of endometriosis, identify early diagnostic 
markers, and develop new treatment methods.
    Health Impacts on Children of Technology and Social Media 
Use.--The Committee remains concerned about the impacts of 
technology use and media consumption on infant, children, and 
adolescent development. The Committee appreciates NIH's ongoing 
engagement on this important topic and encourages NIH to 
prioritize research into the cognitive, physical, and 
socioemotional impacts of young people's use of technologies as 
well as long-term developmental effects on children's social, 
communication, and creative skills. The Committee also 
encourages NIH to study the repercussions of increased use of 
digital media and technologies on suicidal thoughts and 
ideation among children. The Committee asks NIH to consider 
different forms of digital media and technologies, including 
mobile devices, smart phones, tablets, computers, and virtual 
reality tools, as well as social-media content, video games, 
and television programming. The Committee includes no less than 
$15,000,000 for this activity.
    Impact of COVID-19 on Children.--The Committee includes no 
less than $10,000,000, an increase of $2,500,000 above the 
fiscal year 2022 enacted level, for NICHD to support additional 
research into multisystem inflammatory syndrome in children 
(MIS-C) and other ways in which COVID-19 affects children, as 
described in the fiscal year 2023 budget request.
    Impact of COVID-19 on Pregnant and Lactating Women.--The 
Committee includes an increase of $3,000,000, the same as the 
fiscal year 2023 budget request, to support research on the 
effects of COVID-19 on pregnancy, lactation, and postpartum 
health with a focus on individuals from racial and ethnic 
minority groups.
    IMPROVE Maternal Health Initiative.--The Committee includes 
no less than $30,000,000 for the Implementing a Maternal Health 
and Pregnancy Outcomes Vision for Everyone (IMPROVE) 
Initiative, the same as the fiscal year 2022 enacted level and 
the fiscal year 2023 budget request. The IMPROVE Initiative 
advances research to reduce preventable causes of maternal 
deaths and improve health for pregnant and postpartum 
individuals before, during, and after delivery.
    Learning Disabilities Research.--The Committee is 
increasingly concerned with the decline in achievement for 
students with disabilities and recognizes the need for 
continued research and improved interventions, particularly in 
light of the COVID-19 crisis, which has led to significant loss 
of in-person instruction for many students. The Committee 
recognizes the importance of NICHD's funding of Learning 
Disabilities Research Centers and Learning Disabilities 
Innovation Hubs, which are a source of Federal funding 
available to researchers interested in exploring child 
development and learning disabilities to conduct randomized 
control trials and explore the relationships between different 
variables at work. While learning disabilities do impact an 
individual's education and academic achievement, these 
disorders are brain-based, and so clinical research using the 
latest technology and advances in neuroscience is essential. To 
continue robust research into language, reading development, 
learning disabilities, and disorders that adversely affect the 
development of listening, speaking, reading, writing, and 
mathematics abilities, the Committee urges NICHD to continue 
its investment in its Learning Disabilities Research Centers 
and Learning Disabilities Innovation Hubs.
    Male Reproductive Health.--The Committee urges NICHD to 
continue to support research on male mechanisms of infertility. 
There is a gap in the knowledge of how to diagnose and treat 
male infertility, often resulting in women undergoing 
unnecessary treatments due to undiagnosed or untreated male 
partner infertility. The Committee notes that NICHD has 
recently recognized the importance of male reproduction in its 
strategic plan and included andrology as a research priority. 
The Committee is concerned, however, that none of the NICHD 
branches focus on male fertility, leaving a gap in 
representation. The Committee encourages NICHD to consider 
forming a distinct Male Fertility Health branch to prioritize 
research in this area, including identifying new proteins and 
sperm structures necessary for normal sperm function and, 
consequently, for fertility and healthy embryo development.
    Maternal-Fetal Medicine Units Network.--The Committee 
supports the Maternal-Fetal Medicine Units Network of centers 
across the country that conduct clinical studies to improve 
maternal, fetal, and neonatal health that ultimately improves 
the clinical practice of obstetrics. Many Institutes at the NIH 
support at least one grant or project related to pregnancy, 
which further improves maternal and infant health outcomes and 
addresses maternal mortality.
    Pelvic Floor Disorders.--Pelvic floor disorders, including 
urinary incontinence, accidental bowel leakage, and pelvic 
organ prolapse, negatively impact the quality of life of more 
than 25 million U.S. women each year. There are socioeconomic 
disparities amongst women suffering from pelvic floor 
disorders, with differences in symptoms, knowledge, access to 
care, availability of treatments, and treatment outcomes noted 
in patients from different backgrounds. The Committee urges 
NICHD to prioritize research activities into underrepresented 
patient populations and pelvic floor disorders. Such activities 
may include the development of educational programs for general 
practitioners, the evaluation of effectiveness of screening 
protocols for pelvic floor disorders in the primary care 
setting, investigating medical literacy amongst minority women 
as it pertains to pelvic floor disorders, as well as assessing 
socioeconomic and socio-cultural disease perspectives by 
designing qualitative studies using focus groups of women with 
varying socio-economic, cultural, and ethnic backgrounds, 
evaluating current educational resources, determining gaps in 
patient knowledge, and designing culture-specific educational 
materials and resources. The Committee requests an update on 
this research in the fiscal year 2024 Congressional 
Justification.
    Population Research.--The Committee congratulates NICHD for 
leading efforts to promote research regarding the effects of 
COVID-19 on child development and health disparities. The 
Committee encourages NICHD to sustain these research priorities 
through its support of the Population Dynamics Research Centers 
Program and population-representative longitudinal datasets, 
such as the Fragile Families and Child Wellbeing Study, Baby's 
First Years, Panel Study of Income Dynamics Child Supplement 
Survey, and National Longitudinal Survey of Youth. The 
Committee urges NICHD to engage the population research field 
to develop informed frameworks for conceptualizing and 
measuring social determinants of health, including structural 
racism. The Committee also encourages NICHD to support research 
exploring the direct and indirect effects of COVID-19 on 
reproductive health, marriage, and divorce and to expand 
research and data collection on mortality, especially during 
adolescence and the transition to adulthood. Within 90 days of 
enactment of this Act, the Committee requests a report on the 
Institute's efforts to address these priority areas.
    Pregnancy Loss Research.--The Committee supports NIH 
research into pregnancy loss and encourages NIH to expand and 
coordinate research activities with respect to pregnancy loss.
    Research in Pregnant and Lactating Women.--The Committee is 
pleased with the progress being made by the Task Force on 
Research Specific to Pregnant Women and Lactating Women in 
identifying and developing strategies to address gaps in 
knowledge and research on safe and effective therapies for 
pregnant and lactating women. The Committee encourages NIH to 
continue implementing these recommendations to the extent 
appropriate and feasible under the legal authorities available 
to the Secretary.
    Sudden Infant Death Syndrome (SIDS).--The Committee urges 
NICHD to strengthen support for research into the causes and 
prevention of SIDS.
    Trans-NIH Pediatric Research Consortium (N-PeRC).--The 
Committee is aware of the N-PeRC that was established in 2018 
to better coordinate pediatric research activities across 
multiple Institutes and Centers. The Committee supports the 
goals and objectives of N-PeRC and requests that NIH update the 
Committee on its activities and focus of multi-Institute or -
Center pediatric research projects implemented as a result of 
N-PeRC. Additionally, the Committee requests a report in the 
fiscal year 2024 Congressional Justification on how N-PeRC 
plans to encourage longitudinal studies of the physical, 
mental, and behavioral health impacts of COVID-19 on children, 
including multisystem inflammatory syndrome in children (MIS-
C), as well as plans for N-PeRC's focus over the coming three 
years.
    Uterine Fibroids.--The Committee encourages NIH to support 
the activities outlined in the Stephanie Tubbs Jones Uterine 
Fibroid Research and Education Act of 2022 (H.R. 2007), as 
introduced in the House, to support research related to uterine 
fibroids etiology, prevention, diagnosis, disparities, and 
treatment.

                      NATIONAL EYE INSTITUTE (NEI)

 
 
 
Appropriation, fiscal year 2022.......................      $863,918,000
Budget request, fiscal year 2023......................       853,355,000
Committee Recommendation..............................       891,186,000
    Change from enacted level.........................       +27,268,000
    Change from budget request........................       +37,831,000
 

    Mission.-- The mission of the National Eye Institute is to 
eliminate vision loss and improve quality of life through 
vision research.
    Blepharospasm.--The Committee continues to encourage NEI to 
expand research into blepharospasm, a form of dystonia, and 
requests an update on collaborative efforts amongst 
stakeholders and other Institutes and Centers in the fiscal 
year 2024 Congressional Justification.

      NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES (NIEHS)

 
 
 
Appropriation, fiscal year 2022.......................      $842,169,000
Budget request, fiscal year 2023......................       932,056,000
Committee Recommendation..............................       878,750,000
    Change from enacted level.........................       +36,581,000
    Change from budget request........................       -53,306,000
 

    Mission.--NIEHS's mission is to discover how the 
environment affects people in order to promote healthier lives.
    The Committee includes an additional $10,000,000 for NIEHS 
to support and coordinate research on the rise in and 
exacerbation of a wide range of health conditions related to 
the environment, which may include infectious disease, injury 
and trauma, and chronic conditions such as asthma, mental 
health, and health disparities. Such research may include 
evaluation of both preventive and intervention strategies for 
such conditions.
    Harmful Algal Blooms (HABs) Human Health Effects 
Research.--Harmful algal blooms are occurring with increasing 
frequency and severity across the country. While we know of the 
temporary physical discomfort caused by the toxic bacteria, we 
do not know if exposure presents a long-term threat to human 
health. The Committee supports NIEHS research to determine the 
impact of red tide and other HABs on human health. The 
Committee commends NIEHS for its collaborations with other 
agencies, including NSF, NOAA, EPA, and CDC, to advance such 
research and translate key research findings for clinical and 
public health benefits.
    Indoor Amplified Microbial Growth Research.--The Committee 
believes that a more robust and focused NIH commitment to 
research relating to mold and amplified microbial growth in 
damp and water-damaged buildings would yield significant 
advancements of knowledge and insight regarding how fungi, 
mycotoxins, actinobacteria, and endotoxins within indoor 
environments affect public health. The Committee encourages NIH 
to expedite planned and ongoing studies already nominated and 
established through the National Toxicology Program (NTP). The 
Committee also urges the Director of NIEHS, in coordination 
with the Division of the National Toxicology Program (DNTP), as 
well as the NTP, to prioritize new research and explore the 
causal links to the potential neurotoxic, immunosuppressive, 
immunoreactive, nephrotoxic, carcinogenic, and inflammatory 
responses due to inhalation of indoor amplified microbial 
growth in damp and water-damaged indoor environments. The 
Committee encourages NIH to improve applied research, 
communication and education, and coordination with other 
Federal, State, and local health and environmental agencies 
regarding mold and microbial growth in damp and water-damaged 
indoor environments.
    Parkinson's Disease.--Research suggests that Parkinson's 
disease (PD) is caused by a combination of genetic and 
environmental factors. Agricultural exposure to pesticides, 
including herbicides, has been associated with an increased 
risk of developing the disease, yet other exposures common to 
soldiers, firefighters, first responders, and others, such as 
burn pits, insecticides, solvents and heavy metals, need to be 
explored or should be considered. The Committee urges NIEHS to 
expand its research and collaborate with appropriate partners 
to understand the effects of these chemicals on PD development 
and progression. Research should include fundamental approaches 
to identify other environmental triggers and to understand the 
expression of PD traits that result from the interplay of genes 
and environment to advance the development of individualized 
precision environmental health strategies to prevent and treat 
PD. The Committee requests an update on these activities in the 
fiscal year 2024 Congressional Justification.

                   NATIONAL INSTITUTE ON AGING (NIA)

 
 
 
Appropriation, fiscal year 2022.......................    $4,219,936,000
Budget request, fiscal year 2023......................     4,011,413,000
Committee Recommendation..............................     4,443,196,000
    Change from enacted level.........................      +223,260,000
    Change from budget request........................      +431,783,000
 

    Mission.--NIA's mission is to understand the nature of 
aging and the aging process, and diseases and conditions 
associated with growing older, in order to extend the healthy, 
active years of life.
    Alzheimer's Disease and Related Dementias (ADRD).--The 
Committee recommends an increase of $200,000,000 for ADRD 
research. The Committee encourages NIA to continue addressing 
the research targets outlined in the fiscal year 2023 
Professional Judgment Budget. The Committee encourages NIA to 
take the necessary steps to ensure that NIH-sponsored clinical 
trials take into account racial and ethnic diversity and the 
impact of Alzheimer's disease on underserved populations. In 
addition, with various treatments for Alzheimer's disease in 
the pipeline, the Committee encourages NIA to support a wide 
range of trials, including those with a patient-based national 
registry of regulatory grade, longitudinal evidence for 
patients receiving any FDA-approved disease modifying therapies 
for Alzheimer's disease in real-world clinical practice.
    Autism Spectrum Disorder (ASD) in Older Adults.--The 
Committee recognizes recent research which indicates that 
individuals with ASD are more likely to be diagnosed with 
neurodegenerative conditions, including dementia, compared to 
the general population. The Committee supports ongoing research 
at NIA to understand how ASD affects the aging process and to 
develop tools for identifying ASD and related mental health 
needs and evidence-based services, and commends the NIA for 
convening a workshop in 2022 to discuss possible linkages 
between ASD and Alzheimer's disease. The Committee requests an 
update on opportunities for research activities in this area 
within 180 days of enactment of this Act.
    Geroscience.--The Committee commends NIA for its support of 
geroscience, which seeks to understand the genetic, molecular, 
and cellular mechanisms that make aging a major risk factor and 
driver of numerous chronic conditions and diseases, including 
Alzheimer's disease, cancer, cardiovascular diseases, and many 
others. A growing body of research suggests it is possible to 
develop treatments that would address many late-life diseases, 
as opposed to solely tackling each disease individually, as 
under the current prevailing model. Significant advances in 
recent years highlight the need to develop a comprehensive 
strategy for addressing research gaps and opportunities. 
Therefore, the Committee urges NIA to convene a meeting of 
experts across NIH, other relevant Federal agencies, academic 
researchers, and the private sector to identify gaps and 
opportunities for this research field. The Committee also 
recognizes that there is a shortage of investigators who 
combine clinical, social, and behavioral research skills with a 
knowledge of aging biology and experience in the care of older 
adults and the processes of aging at the individual and 
societal level. The Committee encourages NIA to expand its 
translational geroscience training programs to support the 
pipeline of such investigators. The Committee requests an 
update on these topics in the fiscal year 2024 Congressional 
Justification.
    National Strategy for Recruitment and Participation in 
Alzheimer's Disease and Related Dementias Clinical Research.--
The Committee applauds NIA's efforts to initiate, identify, and 
develop the National Strategy for Recruitment and Participation 
in Alzheimer's and Related Dementias Clinical Research. An 
effective way of determining whether those recommended 
strategies are being well-implemented and having the desired 
impact is through data collection and reporting. The Committee 
urges NIA to provide an assessment of the data and metrics it 
collects related to the planning, recruitment, and retention of 
clinical trial participants from underrepresented communities 
and how those data have been or will be used in grantmaking 
decisions. The assessment should also address how NIA plans to 
provide more timely data to Congress and greater transparency 
to the public about the planning, engagement, and recruitment 
efforts of its extramural grantees, including a focus on 
addressing barriers to inclusive and representative enrollment 
such as eligibility criteria, language accessibility, and 
adequate planning for diverse enrollment among grantees. The 
Committee requests that NIA provide this assessment to the 
Committee within 180 days of the enactment of this Act.
    Parkinson's Disease and Dementia.--The Committee recognizes 
that although PD is often thought of only as a movement 
disorder, most PD patients also develop dementia. Common 
symptoms include difficulty with problem solving, speed of 
thinking, memory, and other cognitive skills. Because people 
with PD usually develop these symptoms several years after 
their diagnosis, PD represents an under-explored opportunity to 
study the onset and progression of dementia. The Committee 
strongly urges NIA and NINDS to put a higher priority on PD, 
both before and after onset of dementia, within their overall 
dementia research portfolios. The Committee requests an update 
on these activities in the fiscal year 2024 Congressional 
Justification.
    Population Research.--The Committee recognizes NIA for 
supporting a robust population aging research portfolio within 
its Division of Behavioral and Social Research (DBSR) and 
encouraging enhanced collaborations between DBSR and the 
Institute's other scientific research divisions. The Committee 
is pleased to learn these collaborations include, for example, 
integrating the population sciences into the Institute's 
geroscience research agenda and initiatives regarding 
Alzheimer's disease and the long-term social, behavioral, and 
economic consequences of COVID-19 on older people and their 
families. Continued support for large-scale, longitudinal, and 
representative studies, such as Health and Retirement Study and 
the National Health and Aging Trends Study, the Centers on the 
Demography and Economics of Aging, research networks, training 
grants, and early career opportunities are needed to sustain 
and enhance the field of population aging research. The 
Committee asks NIA to report on its plans for ensuring long-
term investment and support for population aging research 
activities within 90 days of enactment of this Act.
    Thalassemia.--Thalassemia patients and others dealing with 
chronic diseases are now living well into adulthood, some even 
into their 60s. While this is a tremendous victory for 
research, it has opened new questions. For example, even in 
well-managed cases, individuals with thalassemia are likely to 
be exposed to levels of iron loading that, while too low to 
create immediate damage, are significantly in excess of what 
occurs in the typical population. Such exposure may occur for 
decades in many patients. The long-term effect of this exposure 
on patient health and outcomes is unknown. In addition, many 
thalassemia patients develop low bone mass issues early in life 
and may be prescribed treatments which are in the general 
population typically prescribed much later in life; the long-
term efficacy and possible consequences of this extended 
exposure is unknown. In addition, there are female and male 
reproductive issues, the impact of other non-disease related 
medicines, the relationship to diseases of aging such as 
Alzheimer's disease, Parkinson's disease, arthritis, 
osteoporosis, and more. The Committee encourages NIA to develop 
a plan to research comorbidities in thalassemia and other rare 
disease patient populations as they continue to age. In 
addition, individuals with thalassemia trait are asymptomatic, 
aside from perhaps an occasional mild anemia, and do not 
require clinical care. However, research is lacking in the 
possible effects of thalassemia trait on an older adults. 
Research is warranted to determine if thalassemia trait 
carriers do experience adverse effects related to the trait as 
they age.

 NATIONAL INSTITUTE OF ARTHRITIS AND MUSCULOSKELETAL AND SKIN DISEASES 
                                (NIAMS)

 
 
 
Appropriation, fiscal year 2022.......................      $655,699,000
Budget request, fiscal year 2023......................       676,254,000
Committee Recommendation..............................       676,395,000
    Change from enacted level.........................       +20,696,000
    Change from budget request........................          +141,000
 

    Mission.--NIAMS's mission is to support research into the 
causes, treatment, and prevention of arthritis and 
musculoskeletal and skin diseases; the training of basic and 
clinical scientists to carry out this research; and the 
dissemination of information on research progress in these 
diseases.
    Alopecia Areata.--The Committee notes the importance of 
research into autoimmune skin conditions such as alopecia 
areata. The Committee requests an update in the fiscal year 
2024 Congressional Justification on research initiatives into 
this condition and opportunities to advance research.
    Thalassemia.--Individuals with thalassemia frequently 
develop low bone mass issues, often several decades earlier 
than is typical in the general population. Most currently 
recognized treatment options for low bone mass issues have been 
developed for populations that develop these issues at an older 
age than in thalassemia, and which may not have the same 
characteristics as those with thalassemia. More research in 
treatments for and prevention of low bone mass for this 
population, including the proper use of low intensity vibration 
therapy, may be warranted.

   NATIONAL INSTITUTE ON DEAFNESS AND OTHER COMMUNICATION DISORDERS 
                                (NIDCD)

 
 
 
Appropriation, fiscal year 2022.......................      $514,885,000
Budget request, fiscal year 2023......................       508,704,000
Committee Recommendation..............................       531,136,000
    Change from enacted level.........................       +16,251,000
    Change from budget request........................       +22,432,000
 

    Mission.--NIDCD conducts and supports biomedical and 
behavioral research and research training in the normal and 
disordered processes of hearing, balance, taste, smell, voice, 
speech, and language. NIDCD also conducts and supports research 
and research training related to disease prevention and health 
promotion; addresses special biomedical and behavioral problems 
associated with people who have communication impairments or 
disorders; and supports efforts to create devices which 
substitute for lost and impaired sensory and communication 
function.
    Hearing Loss.--The Committee is concerned about the rapidly 
escalating public health crisis of hearing loss, which now 
impacts one in five people in the U.S. alone. The Committee 
encourages NIDCD to convene a workshop involving key 
stakeholders including industry, academia, and patient 
advocates, to develop a roadmap for bringing these much-needed 
therapies to patients. The Committee also urges NIDCD, to the 
extent practicable, to involve other agencies who serve 
disproportionately impacted populations, including VA and DoD.
    Spasmodic Dysphonia.--The Committee notes the research 
NIDCD continues to facilitate on spasmodic dysphonia and 
collaborative efforts with relevant Institutes, Centers, and 
stakeholders. The Committee continues to encourage sustained 
collaboration with key stakeholders and agencies.

             NATIONAL INSTITUTE OF NURSING RESEARCH (NINR)

 
 
 
Appropriation, fiscal year 2022.......................      $180,862,000
Budget request, fiscal year 2023......................       198,670,000
Committee Recommendation..............................       208,571,000
    Change from enacted level.........................       +27,709,000
    Change from budget request........................        +9,901,000
 

    Mission.--The mission of NINR is to lead nursing research 
to solve pressing health challenges and inform practice and 
policy--optimizing health and advancing health equity into the 
future.
    Health Disparities Research.--The Committee includes an 
increase of $22,000,000 for NINR to support research related to 
identifying and reducing health disparities, the same as the 
fiscal year 2023 budget request.

NATIONAL INSTITUTE ON ALCOHOL EFFECTS AND ALCOHOL-ASSOCIATED DISORDERS 
                                (NIAAA)

 
 
 
Appropriation, fiscal year 2022.......................      $573,651,000
Budget request, fiscal year 2023......................       566,725,000
Committee Recommendation..............................       591,757,000
    Change from enacted level.........................       +18,106,000
    Change from budget request........................       +25,032,000
 

    Mission.--NIAAA's mission is to generate and disseminate 
fundamental knowledge about the adverse effects of alcohol on 
health and well-being, and apply that knowledge to improve 
diagnosis, prevention, and treatment of alcohol-related 
problems, including alcohol use disorder, across the lifespan.
    Alcohol-Associated Liver Disease.--The Committee is aware 
that alcohol use disorder and alcohol-associated liver disease 
are distinct diseases. However, it is rare for patients to have 
the latter without first having the former. Combining the 
research in this area in a holistic approach could lead to 
advancements for both, which are needed urgently given the 
increased rates of alcohol consumption during the pandemic. The 
Committee requests an update in the fiscal year 2024 
Congressional Justification on the viability of this approach, 
including NIAAA's capacity to award related grants and the 
field's capacity to develop scientifically valid research 
projects.

            NATIONAL INSTITUTE ON DRUGS AND ADDICTION (NIDA)

 
 
 
Appropriation, fiscal year 2022.......................    $1,595,474,000
Budget request, fiscal year 2023......................     1,843,326,000
Committee Recommendation..............................     1,712,832,000
    Change from enacted level.........................      +117,358,000
    Change from budget request........................      -130,494,000
 

    Mission.--NIDA's mission is to advance science on the 
causes and consequences of drug use and addiction and to apply 
that knowledge to improve individual and public health.
    Addiction Intervention.--The Committee is deeply concerned 
by alarming trends of drug use and addiction in the U.S. The 
number of alcohol-related deaths doubled in the U.S. from 1999 
to 2017. Staggeringly, the number of drug overdose deaths 
doubled from 2015-2021. Difficulty managing impulsivity, a key 
function of cognitive self-control, is associated with 
substance use disorders. The Committee recognizes that Episodic 
Future Thinking is a promising intervention that can help 
individuals with substance use disorders consider the positive 
outcomes of abstaining from use through a mental simulation of 
positive events that might occur in the future. The Committee 
encourages NIDA to support transdisciplinary research that 
incorporates neuroscience, behavioral research, neuroeconomics, 
brain imaging, engineering, and computer science to deploy 
Episodic Future Thinking intervention strategies across a range 
of substance use disorders.
    Barriers to Research.--The Committee is concerned that 
restrictions associated with Schedule I of the Controlled 
Substance Act effectively limit the amount and type of research 
that can be conducted on certain Schedule I drugs, especially 
opioids, marijuana or its component chemicals, and new 
synthetic drugs and analogs. At a time when as much information 
as possible about these drugs is needed, including research on 
their therapeutic potential and on overdose reversal agents, it 
would be helpful to lower regulatory and other barriers to 
conducting this research. The Committee appreciates NIDA's 
completion of a report on the barriers to research that result 
from the classification of drugs and compounds as Schedule I 
substances, including the challenges researchers face as a 
result of limited access to sources of marijuana including 
dispensary products.
    COVID-19 Pandemic and Impact on Substance Use Disorders.--
The Committee is acutely aware of the risks that the ongoing 
COVID-19 pandemic poses to individuals with substance use 
disorders (SUDs). According to CDC, drug overdose deaths 
accelerated during the pandemic. Moreover, NIDA-supported 
research found that individuals with substance use disorders 
are at increased risk for COVID-19 and its adverse outcomes. 
The Committee commends NIDA for conducting research on the 
adverse impact of the pandemic on people with SUDs and 
encourages NIDA to continue to support research on these 
issues.
    Development of Cocaine Overdose Treatment.--The Committee 
continues to recognize the ``fourth wave'' of the overdose 
public health crisis involves rising overdoses involving 
stimulants. The Committee is concerned about the increase in 
overdose deaths involving cocaine and the lack of FDA-approved 
cocaine overdose reversal medications to address the increase 
in fatalities. The Committee understands that NIH has 
previously supported research and development of treatments 
that can rapidly reverse cocaine toxicity and reduce mortality 
rates. The Committee encourages NIDA to fund additional 
research to advance a life-saving treatment for overdoses 
caused by cocaine and other stimulants.
    Electronic Cigarettes.--The Committee understands that 
electronic cigarettes (e-cigarettes) and other vaporizing 
equipment are increasingly popular among adolescents, and 
encourages NIDA to continue to fund research on the use and 
consequences of these devices.
    Headache Disorders and Migraines.--Migraine is the second 
leading cause of disability, and 60 million Americans have 
migraines. There is a critical need for more effective and 
safer treatments for headache disorders, especially because 
current treatment using opioids can worsen migraine frequency 
and severity. Ten percent of Americans with migraines are 
opioid users and 59 percent receive opioids in U.S. emergency 
departments. The HEAL Initiative calls for disease burden to be 
a crucial consideration when prioritizing research programs. 
The Committee supports efforts to address the need for more 
effective pain management for those suffering from headache 
disorders and migraines.
    Kratom.--The Committee recognizes that NIH- and NIDA-funded 
research has contributed to the continued understanding of the 
health impacts of kratom, including its constituent compounds, 
mitragynine and 7-hydroxymitragynine. The Committee is aware of 
the potential promising results of kratom for acute and chronic 
pain patients who seek safer alternatives to sometimes 
dangerously addictive and potentially deadly prescription 
opioids and of research investigating the use of kratom's 
constituent compounds for opioid use disorder. The Committee 
acknowledges NIDA's support of preclinical research on the 
toxicology of mitragynine, which will enable future studies of 
its safety, tolerability, and clinical pharmacokinetics in 
humans. The Committee also urges NIDA to consider a human 
clinical trial on its therapeutic effects to treat opioid use 
disorder, especially in light of the increases in overdose 
deaths reported during the COVID-19 pandemic.
    Marijuana Research.--The Committee supports the development 
of an objective standard to measure marijuana impairment to 
ensure highway safety. Essential to that development are high-
quality scientific studies using marijuana and products 
containing marijuana lawfully available to patients or 
consumers in a State on a retail basis. The Committee notes 
that a majority of Federal research on marijuana has been 
limited to a single strain of marijuana that is not fully 
representative. The Committee emphasizes the need for research 
that encompasses the diversity, quality, and potency of 
products commonly available to patients or consumers in a State 
on a retail basis. The Committee requests an update on efforts 
to expand researcher access to different marijuana strains in 
the fiscal year 2024 Congressional Justification.
    Medications for Opioid Use Disorder and Neonatal Opioid 
Withdrawal Syndrome.--The Committee recognizes the increasing 
incidence of neonatal opioid withdrawal syndrome (NOWS), with 
nearly 80 newborns diagnosed with NOWS in the U.S. daily. 
Currently, hospital stays for newborns with NOWS are six times 
as long and eight times as expensive as hospital stays for 
newborns without NOWS. The Committee also recognizes that 
medications for opioid use disorder (MOUD) are the gold 
standard for treatment for opioid use disorder, including in 
pregnant people. MOUD in pregnancy reduces the risk of adverse 
birth outcomes, including preterm birth, but may lead to NOWS. 
The Committee encourages NIDA to support research on types of 
MOUD that would not cause NOWS or would have fewer symptoms of 
NOWS compared to currently available medications.
    Opioid, Stimulant, and Pain Research.--The Committee 
continues to be concerned about the high mortality rate due to 
the opioid epidemic and appreciates the important role that 
research plays in the various Federal initiatives aimed at the 
overdose crisis. The Committee is also aware of the most recent 
provisional data from CDC that shows opioid overdose fatalities 
exceeded 100,000 in 2021, primarily driven by illicitly 
manufactured fentanyl and fentanyl analogs. More research is 
needed to find new and better agents to prevent or reverse the 
effects caused by this class of chemicals and to provide 
improved access to treatments for those addicted to these 
drugs. The Committee is also concerned that, according to 
provisional data released by CDC, over 45,000 overdose deaths 
involved drugs in the categories that include methamphetamine 
and cocaine in the 12-month period ending in June 2021, an 
increase of 25 percent in a single year. The sharp increase has 
led some to refer to stimulant overdoses as the ``fourth wave'' 
of the current overdose crisis in America following the rise of 
opioid-related deaths involving prescription opioids, heroin, 
and fentanyl-related substances. To combat this crisis, the 
Committee includes no less than the fiscal year 2022 enacted 
level for NIDA's share of the HEAL Initiative, and in response 
to rising rates of stimulant use and overdose, the Committee 
has maintained bill language expanding the allowable use of 
these funds to include research related to stimulant use and 
addiction. The Committee also includes an additional 
$67,000,000 in NIDA to support basic research on pain and pain 
management, as described in the fiscal year 2023 budget 
request.
    Overdose Prevention Centers.--The Committee recognizes that 
overdose prevention centers, or supervised consumption sites, 
are part of a larger effort of harm reduction interventions 
intended to reduce the risk of drug overdose death and reduce 
the spread of infectious disease. The Committee encourages NIH 
to discuss in the fiscal year 2024 Congressional Justification 
significant advances in research on the potential public health 
impact of overdose prevention centers in the U.S.
    Raising Awareness and Engaging the Medical Community in 
Drug Use and Addiction Prevention and Treatment.--Education is 
a critical component of any effort to curb drug use and 
addiction, and it must target every segment of society, 
including health care providers (doctors, nurses, dentists, and 
pharmacists), patients, and families. Medical professionals 
must be in the forefront of efforts to curb the opioid crisis. 
The Committee continues to be pleased with the NIDAMED 
initiative, targeting physicians-in-training, including medical 
students and resident physicians in primary care specialties 
(e.g., internal medicine, family practice, and pediatrics). The 
Committee encourages NIDA to continue its efforts in this area, 
providing physicians and other medical professionals with the 
tools and skills needed to incorporate substance use and misuse 
screening and treatment into their clinical practices. The 
Committee encourages NIDA to increase its support for the 
education of scientists and practitioners to find improved 
prevention and treatments for substance use disorders.
    Youth and Perinatal Marijuana Use.--The Committee includes 
$2,000,000 for NIDA to enter into a contract with NASEM to 
commission a study to determine the scope of the problem of 
underage youth and perinatal marijuana use and effective ways 
of reducing it. Topics explored should include but not be 
limited to the demographics of underage and perinatal marijuana 
use; its economic and social costs; adolescent and perinatal 
decision making and risk and protective factors; and the 
effectiveness of various prevention programs and approaches, 
including media campaigns, school-based education, pricing, and 
access. NASEM will develop a strategy for reducing and 
preventing underage and perinatal consumption of today's 
marijuana and THC products, specifically focused on the impacts 
of THC on the developing brain. To help develop an effective 
strategy, NASEM shall review existing Federal, State, and non-
governmental programs, including media-based programs, that 
have been shown to be effective with other substances that can 
be harmful to youth, including any done on marijuana, that are 
designed to change the attitudes and health behaviors of youth 
(those under the age of 21). In addition, NASEM shall review 
existing Federal, State, and non-governmental programs 
including media-based programs, that have been shown to be 
effective with other substances that can be harmful to babies 
of pregnant and breast-feeding women, including with any 
completed on marijuana, that are designed to change the 
attitudes and health behaviors of pregnant and breast-feeding 
women. Based on its reviews, NASEM shall produce a strategy 
designed to prevent and reduce underage consumption of today's 
marijuana and THC products in addition to a strategy designed 
to prevent and reduce consumption of today's marijuana and THC 
products by pregnant and breast-feeding women. This shall 
include, but not be limited to: an outline and implementation 
strategy; message points that will be effective in changing the 
attitudes and health behaviors of youth concerning underage 
marijuana consumption; and an outline and implementation 
strategy, and message points that will be effective in changing 
the attitudes and health behaviors of pregnant and breast-
feeding women, target audience identification, goals and 
objectives of both campaigns, and the estimated costs of 
development and implementation.

               NATIONAL INSTITUTE OF MENTAL HEALTH (NIMH)

 
 
 
Appropriation, fiscal year 2022.......................    $2,216,976,000
Budget request, fiscal year 2023......................     2,210,828,000
Committee Recommendation..............................     2,428,775,000
    Change from enacted level.........................      +211,799,000
    Change from budget request........................      +217,947,000
 

    The Committee recommendation includes $2,203,775,000 in 
discretionary appropriations and $225,000,000 made available in 
the Cures Act.
    Mission.--NIMH's mission is to transform the understanding 
and treatment of mental illnesses through basic and clinical 
research, paving the way for prevention, recovery, and cure.
    Autism.--The Committee strongly encourages NIH to support 
greater investment in research related to autism, particularly 
in priority areas outlined in the IACC Strategic Plan for ASD. 
While significant progress has been made in the understanding 
of autism, large gaps remain in the ability to improve outcomes 
and access to services for autistic individuals across their 
life span. Research has shown that autistic individuals have 
higher rates of some co-occurring physical and mental health 
conditions, impacting quality of life and increasing medical 
utilization and costs. Additionally, there are significant 
unaddressed racial, ethnic, and socioeconomic health equity 
challenges experienced by autistic individuals across their 
life span and by their families. As such, the Committee further 
encourages NIMH to work collaboratively with NIMHD to support 
research on the socioeconomic, racial, and ethnic health 
disparities associated with autism spectrum disorder, and to 
work collaboratively with other Institutes to support research 
on understanding the impact of social and environmental factors 
leading to co-occurring health conditions.
    BRAIN Initiative.--The Committee directs NIH to transfer 
$225,000,000 from the NIH Innovation Account to NIMH to support 
the BRAIN Initiative. These funds are authorized by the Cures 
Act. This collaborative effort is revolutionizing our 
understanding of how neural components and their dynamic 
interactions result in complex behaviors, cognition, and 
disease, while accelerating the development of transformative 
tools to explore the brain in unprecedented ways making 
information previously beyond reach accessible.
    Impact of COVID on Mental Health.--The Committee includes 
an increase of $5,000,000 for NIMH to expand research to 
understand and mitigate the impact of the COVID-19 pandemic on 
mental health, as described in the fiscal year 2023 budget 
request.
    Mental Health Impact of Alopecia.--The Committee notes 
recent events that have highlighted the effect on an 
individual's mental health because of alopecia. The Committee 
encourages NIMH to work with key stakeholders to advance 
research and resource development aimed at understanding this 
connection and opportunities for innovative discovery.
    Mental Health Research.--The Committee supports the high-
quality basic research on serious mental illnesses being 
conducted at NIMH. The Committee requests an update on the 
evaluation of funding allocations at NIMH detailing the 
percentage of funds spent on both basic and clinical research. 
The Committee also encourages NIMH to provide ARPA-H with a 
roadmap of clinical research gaps needed to conduct deeper 
clinical studies and invest in breakthrough technologies and 
treatments to continue improving the field of mental health 
research and improve the lives of those experiencing serious 
mental illnesses.
    Prioritizing Black Youth Suicide Prevention.--The Committee 
commends NIMH for consistently expanding resources for suicide 
screening and prevention research over the last four fiscal 
years and strongly encourages the Institute to provide 
additional increases for this purpose in fiscal year 2023, with 
special emphasis on producing models that are interpretable, 
scalable, and practical for clinical implementation, including 
utilization of healthcare, education and criminal justice 
systems that serve populations at risk. Specifically, this 
includes Black youth, whose suicide death rate is increasing 
faster than any other racial/ethnic group. In addition, the 
Committee encourages NIMH to prioritize research efforts 
related to primary care settings to evaluate suicide prevention 
interventions, strategies, and programs, including assessments 
of the effects of the COVID-19 epidemic. The Committee requests 
that NIMH provide an update on all of these efforts in the 
fiscal year 2024 Congressional Justification.
    Psychiatric Drug Prescription Research.--The Committee 
encourages NIH to conduct research to support the creation of 
best practices for follow-up and outreach following the 
prescription of psychiatric medication that could increase 
suicidal thoughts or behaviors in order to better allow for 
timely intervention in individuals experiencing increased 
suicidal ideation following such prescriptions.
    Suicide Prevention.--The Committee is encouraged that 2020 
was the second year in two decades in which the suicide rate 
decreased. However, suicide was the 12th leading cause of death 
overall in the U.S. in 2020, and third among youth and young 
adults ages 10-24. The Committee remains committed to providing 
the resources necessary to address the current youth mental 
health crisis. The Committee commends NIMH for consistently 
expanding resources for suicide screening and prevention 
research in recent years and strongly encourages the Institute 
to continue to prioritize suicide prevention research in fiscal 
year 2023, with special emphasis on producing models that are 
interpretable, scalable, and practical for implementation. In 
addition, the Committee encourages NIMH to prioritize research 
efforts related to school-based suicide prevention models to 
evaluate suicide prevention interventions, strategies, and 
programs, including assessments of the effects of the COVID-19 
epidemic on young adults and children. The Committee requests 
that NIMH provide an update on these efforts in the fiscal year 
2024 Congressional Justification.

            NATIONAL HUMAN GENOME RESEARCH INSTITUTE (NHGRI)

 
 
 
Appropriation, fiscal year 2022.......................      $639,062,000
Budget request, fiscal year 2023......................       629,154,000
Committee Recommendation..............................       659,233,000
    Change from enacted level.........................       +20,171,000
    Change from budget request........................       +30,079,000
 

    Mission.--NHGRI's mission is to accelerate scientific and 
medical breakthroughs that improve human health by driving 
cutting-edge research, developing new technologies, and 
studying the impact of genomics on society.
    Germline RUNX1 Mutations.--The Committee commends NHGRI for 
collaborating with NCI to launch and maintain the NIH RUNX1-FPD 
Clinical Research Study, the only longitudinal natural history 
study of patients with germline RUNX1 mutations and their 
families. This study has broad implications for the fields of 
hematology and oncology because it offers researchers the 
opportunity to monitor the genomic evolution of cancer within a 
precancerous population in real-time. Insights gained from such 
careful monitoring can result in the development of improved 
early detection methods and novel treatment interventions. 
Given the critical importance of such natural history studies, 
the Committee encourages NHGRI to leverage NIH resources and 
toolkits to advance participant recruitment and enrollment, 
timely data dissemination, and to ensure optimal execution and 
implementation of the NIH RUNX1-FPD Clinical Research Study.
    The Committee strongly urges NHGRI to collaborate with 
other NIH Institutes to identify additional resources that 
would leverage the expertise across NIH Institutes so that the 
study can include more patients each year. In addition, the 
Committee encourages NHGRI to continue to adhere to the NIH 
Genomic Data Sharing Policy for the benefit of the entire 
research community and the patients and their families 
searching for answers.
    Pharmacogenomics.--NHGRI supports pharmacogenomic research 
in a variety of ways, including by working to develop community 
research resources. For instance, the program funds the 
Clinical Pharmacogenetics Implementation Consortium, an 
international consortium of experts that create, curate, and 
make publicly accessible detailed gene-drug clinical practice 
guidelines that inform medical management decisions. The 
Committee encourages NIH to continue support for this research.
    Proteomics.--The Committee recognizes the promise of 
research into the proteome in the study of biological systems. 
The ability to effectively and efficiently analyze protein 
patterns and their changes over time has potential to provide 
valuable insights into a person's real-time state of health 
including identifying existing disease, understanding the 
biological drivers of that disease, predicting near-term health 
events, and guiding effective therapeutic interventions. The 
Committee encourages NHGRI to utilize existing resources to 
expand its research into this cutting-edge field.

  NATIONAL INSTITUTE OF BIOMEDICAL IMAGING AND BIOENGINEERING (NIBIB)

 
 
 
Appropriation, fiscal year 2022.......................      $424,590,000
Budget request, fiscal year 2023......................       419,493,000
Committee Recommendation..............................       437,991,000
  Change from enacted level...........................       +13,401,000
  Change from budget request..........................       +18,498,000
 

    Mission.--The NIBIB mission is to improve health by leading 
the development and accelerating the application of biomedical 
technologies.
    Medical Imaging and Data Resource Center (MIDRC).--The 
Committee supports NIBIB's work to develop the MIDRC, a growing 
repository of over 85,000 images and associated data to help 
accelerate strategies for COVID-19 diagnosis and therapeutic 
management. This resource is creating and enabling broader use 
of machine learning algorithms in medical image analysis for 
coronavirus patients and may serve as a model for understanding 
other diseases to improve patient outcomes across medical 
disciplines, including diagnosis, monitoring, and predictive 
prognoses. The Committee encourages NIBIB to continue its 
engagement with external stakeholders to advance this promising 
project.
    Neurotechnology.--The Committee recognizes that recent 
developments in wearable devices, remote monitoring, 
implantable medical devices, 3-D neural constructs, and 
bioprinting have accelerated the rate of discovery of methods 
to sense and modulate the activity of the nervous system. The 
rate of discovery now strains the ability of academic 
laboratories and medical centers to perform the necessary 
product development and early human clinical trial work, in a 
timely manner, to demonstrate the efficacy of these 
neurotechnology interventions. New neurotechnology diagnostics 
and therapies could enable injury prevention in both able-
bodied and at-risk populations and transform treatment of 
children and adults living with the chronic effects of 
neurological disease and injury, in particular, with 
impairments in mobility, cognition, pain, mood, perception, and 
systemic health. The Committee encourages NIBIB, in 
collaboration with NINDS, to prioritize additional funding to 
accelerate the pace of bench-to-bedside clinical development of 
environmental, 3-D printable, wearable, and implantable 
artificial and biological neurotechnology.

  NATIONAL INSTITUTE ON MINORITY HEALTH AND HEALTH DISPARITIES (NIMHD)

 
 
 
Appropriation, fiscal year 2022.......................      $459,056,000
Budget request, fiscal year 2023......................       659,817,000
Committee Recommendation..............................       505,292,000
    Change from enacted level.........................       +46,236,000
    Change from budget request........................      -154,525,000
 

    Mission.--NIMHD's mission is to lead scientific research to 
improve minority health and reduce health disparities.
    Health Disparities Research.--The Committee includes an 
increase of $23,000,000 for NIMHD to support additional 
research related to identifying and reducing health 
disparities.
    Long COVID Research.--The Committee urges NIMHD to support 
research on racial and ethnic health disparities prevalent in 
the diagnosis, treatment, recovery, and quality of life of long 
COVID-19 patients.
    Racial and Ethnic Disparities in Alopecia.--The Committee 
notes the disproportionate effect of alopecia on people of 
color, specifically women. The Committee encourages NIMHD to 
collaborate with relevant Institutes and Centers, such as 
NIAMS, and relevant stakeholders to identify key research areas 
of concern.
    Research Centers at Minority Institutions (RCMIs).--The 
Committee includes no less than $89,765,000, an increase of 
$5,000,000 above the fiscal year 2022 enacted level, for RCMIs 
to ensure critical infrastructure development in historically 
minority graduate and health professional schools.
    Research Grants on Cosmetic Safety, Health Disparities and 
Communities of Color and Professional Salon Workers.--The 
Committee is concerned about the prevalence of cosmetics 
containing dangerous levels of mercury made available through 
online sales and increased global travel. Evidence suggests 
that these harmful unregulated cosmetics, such as skin 
lightening creams and hair chemical relaxers, are 
disproportionately used by women of color. The Committee 
encourages NIH to support competitive research grants to fund 
epidemiological, social, and behavioral sciences research into 
the negative health impacts of chemicals in cosmetic products 
and to disseminate the results of these studies, including 
public health information strategies to reduce potentially 
unsafe exposure. The Committee urges NIH to support research 
grants investigating unsafe cosmetic chemical exposures 
impacting communities of color and as well as grants 
researching the same impacts on professional nail, hair, 
barbershop, and beauty salon workers. The Committee thanks 
NIMHD for their report submitted in September 2021 summarizing 
the state of science and describing NIMHD's collaboration with 
FDA.
    Research Endowment Program.--The Committee includes no less 
than $12,000,000 to support the Research Endowment Program, an 
increase of $8,000,000 above the estimated fiscal year 2022 
funding level. The Committee notes the recent passage of the 
John Lewis NIMHD Research Endowment Revitalization Act to 
reinvigorate the Research Endowment Program. The Committee has 
provided funds to implement the revitalized program and urges 
NIMHD to work swiftly on its implementation. The Committee 
further notes that the statutory goal of the program is to 
assist eligible institutions in achieving a research endowment 
that is comparable to the mean endowment of health professions 
schools in its health professions discipline. The Committee 
requests a report no later than 60 days after enactment of this 
Act on implementation plans and engagement with key 
stakeholders.
    Sleep Health and Health Disparities.--The Committee 
applauds ongoing and emerging efforts by NIMHD to advance 
health equity and address health disparities, including cross-
Institute initiatives and the initiatives identified by the 
recent Minority Health and Health Disparities Research 
Framework. The Committee notes the disproportionate impact of 
sleep deficiencies among populations that experience health 
disparities in the U.S., including American Indians/Alaska 
Natives, Asian Americans, African Americans, Hispanics/Latinos, 
Native Hawaiians and other Pacific Islanders, sexual and gender 
minorities, the socioeconomically disadvantaged, and those 
living in underserved rural areas. The Committee encourages 
further work in and collaboration with community stakeholders 
on the issue of sleep health disparities.

    NATIONAL CENTER FOR COMPLEMENTARY AND INTEGRATIVE HEALTH (NCCIH)

 
 
 
Appropriation, fiscal year 2022.......................      $159,365,000
Budget request, fiscal year 2023......................       183,368,000
Committee Recommendation..............................       164,395,000
    Change from enacted level.........................        +5,030,000
    Change from budget request........................       -18,973,000
 

    Mission.--The mission of NCCIH is to define, through 
rigorous scientific investigation, the usefulness and safety of 
complementary and integrative health interventions and their 
roles in improving health and health care.

      NATIONAL CENTER FOR ADVANCING TRANSLATIONAL SCIENCES (NCATS)

 
 
 
Appropriation, fiscal year 2022.......................      $882,265,000
Budget request, fiscal year 2023......................       873,654,000
Committee Recommendation..............................       901,678,000
    Change from enacted level.........................       +19,413,000
    Change from budget request........................       +28,024,000
 

    Mission.--NCATS was established to transform the 
translational process so that new treatments and cures for 
disease can be delivered to patients faster.
    Clinical and Translational Science Awards (CTSA) Program.--
The Committee includes no less than $626,059,000 for the CTSA 
Program, an increase of $19,413,000 above the fiscal year 2022 
enacted level. The Committee reiterates that CTSA funding, 
including these additional resources, are intended, to the 
greatest extent possible, to enhance support for CTSA hubs so 
that they can continue to effectively provide important 
collaborative national research infrastructure, train the next 
generation of physician-scientists, and provide important local 
services and partnerships. The Committee applauds the CTSA 
program for its contributions to the rapid response to COVID-
19, efforts to address health disparities and deliver 
innovative care in rural areas, and to provide critical support 
for other national priorities and translational research 
activities.
    Cures Acceleration Network.--The Committee includes up to 
$60,000,000 for the Cures Acceleration Network, the same as the 
fiscal year 2022 enacted level.
    Collaboration with Business Incubators.--The Committee 
urges NCATS to redouble its efforts to leverage its mission by 
exploring opportunities or potential collaborations with 
business incubators that host small to mid-size science, 
research, and pharmaceutical companies that use service-based 
approaches to nurture and guide their member companies to 
success.
    Full Spectrum of Medical Research.--The Committee 
recognizes the emerging role that the full spectrum of medical 
research is playing in across NIH Institutes and Centers to 
ensure that advancements in basic science are translated into 
innovative therapies and diagnostic tools, and improved care 
and public health information. The Committee notes the 
relevance of the CTSA program to a variety on ongoing and 
emerging NIH research activities, including the importance of 
training and career development to adequately enhance the 
translational science workforce.
    National COVID Cohort Collaborative (N3C).--The Committee 
continues to support NCATS N3C's open-science platform to 
accelerate biomedical research and discovery. N3C is the 
largest public clinical repository of COVID-19 data in the 
U.S., enabling collaborative research between more than 3,500 
researchers from over 300 institutions to answer research 
questions such as the cause of long COVID-19 and how COVID-19 
affects children. The Committee encourages NCATS to consider 
expanding the platform to accelerate research and cures for 
other high-priority diseases such as cancer and other rare 
diseases.
    Rare Disease Research.--The Committee encourages NCATS to 
increase support for rare disease funding opportunities, 
including for the Rare Disease Clinical Research Network, the 
Therapeutics for Rare and Neglected Diseases program, and other 
grant opportunities to help increase the speed of rare disease 
therapeutic and diagnostic development. Accelerating rare 
disease research will allow society to capitalize on the 
evolution of science in rare diseases, leading to new 
treatments for the 93-95 percent of rare diseases with no 
approved treatments and innovative diagnostics to help shorten 
the average 6.3 year-long diagnostic odyssey and lower the 
nearly $1 trillion annual economic burden of rare diseases.

               JOHN E. FOGARTY INTERNATIONAL CENTER (FIC)

 
 
 
Appropriation, fiscal year 2022.......................       $86,880,000
Budget request, fiscal year 2023......................        95,801,000
Committee Recommendation..............................        99,622,000
    Change from enacted level.........................       +12,742,000
    Change from budget request........................        +3,821,000
 

    Mission.--FIC's mission is to support and facilitate global 
health research conducted by U.S. and international 
investigators, building partnerships between health research 
institutions in the U.S. and abroad, and training the next 
generation of scientists to address global health needs.
    The Fogarty International Center supports cross-cutting 
research and research training programs that apply to a broad 
range of health threats, enabling grantees and trainees to 
anticipate and respond effectively to new global challenges. 
Fogarty programs also support training for researchers in the 
development and use of powerful tools such as data science, 
mobile health, and bioinformatics, which are applied to 
anticipating and controlling a wide range of global health 
threats that could impact the U.S. The Committee encourages FIC 
to continue to expand training and research partnerships with 
schools and programs of public health and related academic 
institutions in support of this core mission, including new 
investments to support health disparities and pandemic research 
preparedness and response.
    In light of the global impact of COVID-19, the Committee 
recognizes the need to continue steadily increasing the 
resources of FIC to support its work to strengthen health 
research systems, train health researchers and improve pandemic 
preparedness in low- and middle-income countries (LMICs). Over 
more than five decades, FIC has developed strong partnerships 
in LMICs to train researchers to respond to and prevent 
emerging and enduring infectious disease and other health 
threats. The COVID-19 pandemic underscores the value of FIC's 
efforts to strengthen research capacity in LMICs, increasing 
the likelihood that emerging diseases can be quickly addressed 
wherever they appear--ultimately protecting American health 
security. The Committee also recognizes that investing in 
health research capacity in LMICs leads to reciprocal 
innovation and produces tools that can drive down health care 
costs and increase impact and effectiveness in low-resource 
settings everywhere, including in the U.S. The Committee 
believes FIC's long-standing partnerships and unique 
capabilities position it to play an expanded role in pandemic 
preparedness and health research capacity building, including 
by strengthening international research coordination, building 
capacity for computational modeling and outbreak analytics, 
supporting research to reduce health disparities, and improving 
implementation of health interventions in low-resource 
settings.
    Health Disparities Research.--The Committee includes an 
increase of $10,000,000 for FIC to support additional research 
related to identifying and reducing health disparities, as 
described in the fiscal year 2023 budget request.
    Obstetric Fistula Research.--Worldwide, an estimated 
500,000 women and girls live with obstetric fistula, with 
thousands more occurring annually. It occurs disproportionately 
among impoverished, vulnerable, and marginalized girls and 
women. Skilled health personnel at birth and emergency 
obstetric and newborn care can ensure obstetric fistula is 
prevented. The Committee is concerned that fistula repairs were 
widely halted due to COVID-19, as they were deemed non-urgent 
and unsafe during the pandemic. This may result in an increased 
backlog of fistula cases. The Committee is concerned that not 
enough funding is provided to support existing academic 
curricula for the education and training for health care 
providers on obstetric fistula. The Committee requests a report 
regarding the annual support level for this training funding 
over the past five years, including the types of grants 
supported, in the fiscal year 2024 Congressional Justification.

                   NATIONAL LIBRARY OF MEDICINE (NLM)

 
 
 
Appropriation, fiscal year 2022.......................      $479,439,000
Budget request, fiscal year 2023......................       471,998,000
Committee Recommendation..............................       494,572,000
    Change from enacted level.........................       +15,133,000
    Change from budget request........................       +22,574,000
 

    Mission.--As a leader in computational health and the 
world's largest medical library, NLM collects, organizes, 
preserves, and disseminates data and information important to 
biomedicine and health; serves as a national information 
resource for medical education, research, and health service 
activities; enhances access to biomedical literature through 
electronic services; serves the public by providing electronic 
access to reliable health information for consumers; supports 
and directs the Network of the National Library of Medicine; 
provides grants for research in biomedical communications, 
medical library development, and training health information 
specialists; conducts and supports research and research 
training in biomedical informatics, computational health, 
computational biology, and data science; supports development, 
maintenance, and dissemination of health data standards that 
promote interoperability among clinical and research 
information systems; and manages and maintains information 
resources for genomics, molecular biology, clinical trials, 
medical images, environmental health, public health, and health 
services research.

                      OFFICE OF THE DIRECTOR (OD)

 
 
 
Appropriation, fiscal year 2022.......................    $2,629,120,000
Budget request, fiscal year 2023......................     2,314,665,000
Committee Recommendation..............................     2,549,813,000
    Change from enacted level.........................       -79,307,000
    Change from budget request........................      +235,148,000
 

    The Committee recommendation includes $2,537,213,000 in 
discretionary appropriations and an additional $12,600,000 made 
available in the Gabriella Miller Kids First Research Act.
    Mission.--The OD provides leadership to the NIH research 
enterprise and coordinates and directs initiatives that 
crosscut NIH. OD is responsible for the development and 
management of intramural and extramural research and research 
training policy, the review of program quality and 
effectiveness, the coordination of selected NIH-wide program 
activities, and the administration of centralized support 
activities essential to the operations of NIH.
    The items below include issues and programs specific to the 
Office of the Director as well as those that involve multiple 
Institutes and Centers.
    Adoption of Dogs, Cats, and Rabbits Used in Research.--The 
Committee encourages NIH to recommend that grantees receiving 
extramural funds from NIH for research using dogs, cats, or 
rabbits implement post-research adoption policies for those 
animals and to maintain records on the aggregate number of 
animals released for adoption. The post-research adoption 
policies and animal release numbers should be made publicly 
available.
    Advancing Cell-Based Therapies.--The Committee recognizes 
that cell-based therapies hold promise for a broad range of 
conditions, including neurological conditions, musculoskeletal 
conditions, cancer, radiation damage, cardiovascular disease, 
diabetes, wound healing, and immunological disease. The 
Committee encourages NIH to support research, development, and 
manufacturing of adult cell-based therapies for patients with 
serious or life-threatening conditions. The Committee 
encourages NIH to support clinical trials and pre-clinical 
research exploring the use of adult cell-based therapies for 
serious or life-threatening conditions; support development, 
characterization, optimization, and scaling of manufacturing of 
cell-based therapies; support sharing of best practices and 
lessons learned; workforce development activities; and 
collaborative evidence development, including continued NIH 
collaboration with FDA and HRSA to enhance transparency 
regarding outcomes from cellular therapies from adult (somatic) 
cells that are FDA-approved or being administered under FDA 
Investigational New Drug or Investigational Device Exemption 
protocols by ensuring that results are submitted to appropriate 
databases such as the Stem Cell Therapeutics Outcomes Database 
and ClinicalTrials.gov.
    All of Us Research Program.--The Committee provides a total 
of $541,000,000 for the All of Us Research Program Precision 
Medicine Initiative, the same as the fiscal year 2022 enacted 
level and the fiscal year 2023 budget request. The total 
includes $419,000,000 authorized in the Cures Act to be 
transferred from the NIH Innovation Account. All of Us' mission 
is to accelerate health research and medical breakthroughs to 
enable individualized prevention, treatment, and care for all 
of us. As of the beginning of June 2022, the All of Us Research 
Program enrolled 497,000 participants, more than 341,000 of 
whom have completed the initial steps of the program. About 80 
percent of these individuals are from populations that have 
largely been overlooked in past research, including rural 
communities, people with lower incomes, those who self-identify 
as belonging to racial or and ethnic minority groups, and 
others. In March 2022, the program released nearly 100,000 
whole genome sequences and data from 165,000 genotyping arrays 
in its Researcher Workbench for the research community to 
analyze. This data can be used in concert with the robust 
information the program's participants have previously donated, 
including responses to surveys and electronic health records. 
Nearly half of the genomic information comes from people who 
identify with a racial or ethnic minority group, making the 
dataset one of the most diverse in the world. To date, more 
than 90 percent of participants in genome-wide association 
studies worldwide have been of European descent. All of Us' 
efforts to recruit and retain participants that have been 
historically underrepresented in research is imperative to 
ensure that future discoveries benefit all.
    ALS Research, Treatments, and Expanded Access.--The 
Committee believes it is critically important that NIH 
continues to grow its investment in ALS research to capitalize 
on the momentum to find new treatments for ALS and a cure for 
the disease. The Committee recognizes that each year, only a 
small portion of research funds are spent on new research 
projects. The Committee strongly urges NIH to maintain the ALS 
drug ecosystem with additional grant funding for extramural 
research through NINDS. In addition, The Committee urges NIH to 
continue to increase support and momentum for ALS research that 
can lead to new treatments and better care as quickly as 
possible, as well as support expanded access research for ALS 
investigational drugs. In addition, the Committee urges NIH to 
handle funding of expanded access grants as authorized in the 
ACT for ALS (P.L. 117-79) as separate, and not competing with, 
funding for other research on ALS and includes $75,000,000 for 
this purpose, an increase of $50,000,000 above the fiscal year 
2022 enacted level.
    Amyloidosis.--The Committee strongly encourages NIH to 
expand its research efforts in amyloidosis, a group of rare 
diseases characterized by abnormally folded protein deposits in 
tissues. Although amyloidosis is often fatal, Federal and 
foundation support over the past years has given hope for 
successful new treatments. More efforts are needed to 
accelerate research and awareness of the disease and to help 
patients with amyloidosis related multi-organ dysfunction. The 
Committee also directs NIH to provide an update in the fiscal 
year 2024 Congressional Justification on the steps NIH has 
taken to expand research into the causes of amyloidosis and the 
measures taken to improve the diagnosis and treatment of this 
devastating group of diseases.
    Artificial Intelligence to Address Chronic Diseases.--The 
Committee supports NIH's efforts to use artificial intelligence 
(AI) to gain a deeper understanding of the underlying causes of 
chronic diseases, including health disparities, and to identify 
successful early treatments. The Committee provides sufficient 
resources to support NIH efforts to employ advanced 
technologies such as AI, machine learning, deep learning, and 
related approaches to enhance the collection, integration, 
analyses, and interpretation of data related to the onset, 
progression, and treatment of chronic diseases.
    Autoimmune Diseases.--The Committee recognizes that a 
recent report by NASEM recommends that NIH establish an office 
to support the coordination of all autoimmune diseases research 
across Institutes and Centers. The Committee encourages NIH to 
implement this recommendation, and additionally urges NIH to 
develop clear, consistent, and uniform guidance around 
autoimmunity, including a shared, working definition applicable 
to autoimmune disease research and how these efforts should be 
worked into the broader policies. The Committee also encourages 
NIH to establish long-term systems in determining numbers of 
autoimmune patients and mortality rates in the U.S. comparable 
to NCI's SEER database, support the development of population 
cohorts of the progression and coexisting morbidities, and 
provide funding and support for a national research agenda that 
addresses critical gaps. The Committee encourages NIH to work 
with health partners and relevant patient organizations to 
ensure a bidirectional relationship is developed between the 
agency and the autoimmune community that includes a more 
consistent approach to communicating new or updated guidance 
pertinent to the community, and that creates a foundation for 
improving the quality of lives for patients of autoimmune 
diseases.
    Autism Spectrum Disorder (ASD).--Recent reports indicate 
that an estimated one in 44 children in the U.S. is diagnosed 
with an ASD. While early intervention affords the best 
opportunity to support healthy development, many children with 
an autism diagnosis lack access to quality care and 
interventions. The Committee is encouraged by the growing 
evidence that caregiver-mediated early intervention can lead to 
improved child developmental outcomes, improved caregiver-
reported skills and knowledge, and reduced stress. The 
Committee encourages NIH to invest in implementation-focused 
research that targets caregiver-mediated interventions, 
including caregiver skills training and naturalistic 
developmental behavioral interventions. The Committee strongly 
encourages NIH to work collaboratively across Institutes and 
Centers in this effort to ensure culturally competent 
approaches. Furthermore, the Committee is supportive of the 
research recommendations included in the Interagency Autism 
Coordinating Committee's (IACC) Strategic Plan for ASD. The 
Committee urges the NIH to provide an update on its investment 
across the priority areas outlined in the IACC Strategic Plan 
in the fiscal year 2024 Congressional Justification.
    Biomedical Research Facilities.--The Committee includes 
$60,000,000, the same as the fiscal year 2022 enacted level, 
for grants to public and/or nonprofit 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 make awards to support 
a significant number of newly constructed or renovated 
facilities.
    Biomedical Research Workforce Diversity.--The Committee is 
concerned with the impact of COVID-19 on the diversity of the 
biomedical research workforce, particularly women and women of 
color across career stages. The Committee strongly encourages 
NIH to study the race/ethnicity and sex/gender breakdown of the 
impact of COVID on participation in the workforce by monitoring 
the sex/gender and race/ethnicity of principal investigators 
designated on applications from and awards to institutions for 
two years. If the data demonstrate that fewer women are 
designated on applications from institutions for grants, then 
it is imperative that NIH take steps to address this disparity. 
The Committee requests a status update in the fiscal year 2024 
Congressional Justification as well as a description of the 
steps being taken to maintain and strengthen the diversity of 
the biomedical research workforce.
    Black Men and Women Pursuing Medicine and Science.--The 
Committee supports the efforts of the National Academies 
Roundtable on Black Men and Black Women in Science, 
Engineering, and Medicine and its efforts to develop specific 
programs to increase numbers and effectiveness of Black men and 
women pursuing medicine and science and commends NIH for 
participating. The Committee directs the Immediate Office of 
the Director to allocate increased resources from the Common 
Fund of the diversity program consortium to the National 
Academies Roundtable on Black Men and Black Women in Science, 
Engineering, and Medicine to address the increasing 
underrepresentation of Black men in medical schools and in the 
biomedical research profession.
    Cannabis Research.--The Committee recognizes that although 
concrete steps have been taken towards ameliorating the 
regulatory and supply issues hampering cannabis research in the 
U.S., funding levels have not kept pace with widespread use of 
cannabis and substantial clinical interest in the field. 
Cannabis is fully legal in 18 States and the District of 
Columbia, effectively so in 20 others that permit some form of 
medical marijuana, and consumed by nearly half of American 
teens and adults at some time in their lives, yet there is 
surprisingly little information about its effects on body 
chemistry and cognition. The Committee is concerned that 
marijuana policies on the Federal level and in the States 
(medical marijuana, recreational use, etc.) are being changed 
without the benefit of scientific research to help guide those 
decisions. While there are FDA-approved prescription 
medications that contain cannabidiol or THC which are used to 
treat various conditions such as certain seizure disorders and 
nausea associated with chemotherapy, research is needed to 
determine if cannabis or cannabis products could effectively 
treat chronic pain, certain mental illnesses, opioid use 
disorder or other substance use disorders, among other 
conditions. Therefore, the Committee encourages NIH to fund 
cannabis research to study efficacy of cannabinoid therapies 
for patients. NIH is encouraged to continue supporting a full 
range of research on the health effects of marijuana and its 
components, including research to understand how marijuana 
policies affect public health.
    Childhood Post-Infectious Neuroimmune Disorders/PANS/
PANDAS.--The Committee strongly encourages NIH to advance 
research and education related to the devastating diseases of 
Pediatric Acute-Onset Neuropsychiatric Syndromes (PANS) and 
Pediatric Autoimmune Neuropsychiatric Disorders Associated with 
Streptococcus (PANDAS). Although NIH has undertaken some 
research in this area, more research is necessary to fully 
understand causes, diagnosis, and treatment. Training the 
medical community is essential to early identification and 
intervention, reducing the risk of chronic illness and 
associated costs to families, school systems, health care 
systems, and insurers. The association between neuropsychiatric 
illness and infections has become even more evident because of 
SARS-CoV-2 and provides increasing opportunities for 
breakthroughs in research and treatment. The Committee 
encourages NIH to prioritize research in this area, and report 
to the Committee in the fiscal year 2024 Congressional 
Justification on the progress being made on the understanding 
of the costs, causes, diagnostic criteria, and treatment of 
these conditions.
    Clinical Trial Diversity.--The Committee recognizes NIH's 
efforts to increase meaningful participation across the 
lifespan of ethnic and racial minority populations and 
underrepresented communities in clinical trials. The Committee 
encourages NIH to continue improving clinical research 
diversity, equity, inclusion, and accessibility by engaging in 
proactive outreach efforts to people including women and racial 
and ethnic minority groups, underrepresented communities, and 
health care organizations serving these populations, to improve 
awareness of clinical research, including trials, and 
understanding of how people can participate. The Committee 
requests an update on these activities in the fiscal year 2024 
Congressional Justification.
    Collection and Reporting of Animal Research Numbers and 
Agency Funding.--Congress has long expressed interest in 
reducing the use of animals in NIH-funded research and 
replacing them with valid, reliable alternatives. In the NIH 
Revitalization Act of 1993, Congress first requested the agency 
create a plan for doing so. The Committee also recognizes the 
scientific community's stated commitment to the three Rs of 
replacement, reduction, and refinement, which requires accurate 
counting of animals used in research and accurate reporting of 
NIH funding dedicated to projects involving animals. It has 
been NIH's policy since 1985 to collect an average daily 
inventory of vertebrate animals housed in recipient 
institutions that receive agency funding. Domestic facilities 
are required to file such documentation every four years as 
part of an Animal Welfare Assurance and copies of the documents 
are available to the public only through FOIA requests. The 
Committee directs that the report requested in the Joint 
Explanatory Statement for the Consolidated Appropriations Act, 
2022 outlining a plan to improve the accuracy and transparency 
of collected data, also include how the agency plans to 
annually collect from each NIH funded research facility the 
total number of animals bred, housed, and used in the previous 
year, sorted by species and pain and distress categories. The 
Committee directs NIH to include a draft form for collecting 
this information, and details on how the agency will create a 
publicly accessible online database for dissemination of this 
new information. NIH currently collects such information with 
every grant application using the Research & Related Other 
Project Information form. NIH's plan should ensure that the 
answers for each funded project are publicly searchable via the 
Expenditures and Results module of NIH's Research Portfolio 
Online Reporting Tools website.
    Common Data Elements.--The Committee recognizes the 
increasing importance of common data elements (CDEs) that 
enable standardized and consistent use of data in research, 
especially translational and clinical research, and that 
facilitate efforts to replicate and validate findings, 
including clinical trials, for a disease area. NIH encourages 
use of CDEs including use of the NIH's CDE repository. To 
encourage development and use of CDEs in disease areas where 
they currently do not exist, the Committee directs the Office 
of Data Science Strategy to work with Institutes and Centers to 
support efforts to develop CDEs, including through 
collaborations with research stakeholders. The Committee also 
directs NIH to develop a list of diseases and diseases areas 
that stand to benefit most from development of CDEs, including 
complex diseases with heterogeneous presentations, such as 
autoimmune and immune-mediated conditions, to inform further 
NIH efforts to support development of such elements.
    Common Fund.--The Committee recommends $678,151,000 for the 
Common Fund, and an additional $12,600,000 provided to support 
the Gabriella Miller Kids First Research Act for the ninth year 
of the ten-year Pediatric Research Initiative. This is 
$20,750,000 above the fiscal year 2022 enacted level and 
$32,212,000 above the fiscal year 2023 budget request.
    Communications with the Committee.--The Committee relies on 
its relationships with agency budget offices to do its work. 
The Committee expects the NIH Office of Budget to improve the 
quality and timeliness of the information that it provides to 
the Committee.
    Cybersecurity.--The Committee continues to support expanded 
cybersecurity efforts at NIH, including enhanced Security 
Operations Center functions, expanded threat mitigation and 
incident response capabilities, implementation of important 
architectural improvements to the NIH network, and 
implementation of tools and technologies to identify patterns 
of activities that may forecast security risks and allow real 
time monitoring of activity across a variety of sources as well 
as implementation of mitigation and remediation efforts.
    Diabetic Neuropathy.--Diabetic neuropathy is the most 
common complication of diabetes, affecting at least 50 percent 
of individuals with diabetes and resulting in numbness, 
unsteadiness, and chronic pain. Additionally, the annual cost 
of managing complications from diabetic neuropathy in the U.S. 
is estimated to be more than $10 billion. Despite its high 
incidence rate and major impact on quality of life for affected 
patients, there are limited treatment options available, and 
available options are not effective for all individuals with 
diabetic neuropathy. The Committee encourages NIH to fund 
collaborative research awards for diabetic neuropathy research 
and treatment. The Committee also encourages NIH to fund 
additional research on diabetic neuropathy-induced chronic pain 
through existing programs such as the HEAL Initiative.
    Diet and Chronic Diseases.--The Committee is aware of 
ongoing efforts to better understand the impact of diet on 
mucosal immunity and the microbiome and the relevance of this 
topic to multiple immune-related conditions including Crohn's 
disease, ulcerative colitis, allergies, celiac disease, 
rheumatoid arthritis, metabolic syndrome, and obesity. The 
Committee encourages NIH to identify gaps and research needs 
and to encourage research focused on this topic.
    Diversifying Research on Health and Wellbeing to include 
Asian Americans, Native Hawaiians, and Pacific Islanders.--The 
Committee notes that in the last decade, less than one percent 
of the NIH's total budget went to research centered on Asian 
American, Native Hawaiian, and Pacific Islander (AANHPI) health 
outcomes. The lack of data available on AANHPIs, or the failure 
to disaggregate from this group, has resulted in misleading 
narratives and conclusions made from the lack of available 
research. The Committee encourages NIH to support research on 
the health and wellbeing of AA and NHPI communities, including 
specific AA and NHPI subgroups. In addition to the expansion of 
research, the Committee encourages NIH to support in-language 
and culturally competent recruitment, outreach, education, and 
testing materials to ensure outcomes are representative of 
diverse AANHPI populations. The Committee directs NIH to 
provide a report to the Committee within one year of enactment 
of this Act describing research projects targeted to AA and 
NHPI communities, as well as participation barriers, including 
language access.
    Diversity in NIH Kidney Disease Research Populations.--The 
Committee recognizes NIH's commitment to understanding, 
evaluating, and resolving racial and ethnic disparities in 
health outcomes and adverse social determinants of health for 
individuals with chronic kidney disease (CKD) and end stage 
renal disease. The Committee directs NIH to submit to the 
Committee an update in the fiscal year 2024 Congressional 
Justification on NIH research related to kidney disease, 
including research focusing on health disparities in the 
prevention, diagnosis, and treatment of kidney disease among 
racial and ethnic minority populations.
    Early-Career Pediatric Researchers.--The Committee remains 
concerned about the ongoing challenges in developing the next 
generation of researchers--including physician scientists--
focusing their careers in pediatrics. Challenges to the 
pediatric research workforce include declining numbers of 
graduating medical students choosing to enter the field of 
pediatrics, declining numbers of pediatric residents choosing 
to enter most pediatric subspecialties, lower transition rates 
from early-career to full awards, increased clinical demands, 
and limited mentorship opportunities compared to other fields. 
If unaddressed, a contraction of the pediatric researcher 
pipeline will result in both limited breakthroughs in child 
health research and to diminished understanding of adult-onset 
conditions given the growing body of research that many such 
conditions have their roots in childhood. To begin addressing 
this problem, the Committee encourages NIH, through the Trans-
NIH Pediatric Research Consortium (N-PeRC), to explore programs 
for NIH-wide early career development focused on early-career 
researchers in the field of pediatrics and encourages NIH to 
include efforts to recruit researchers from diverse 
backgrounds, including those that are from groups 
underrepresented in the biomedical research workforce. The 
Committee requests an update on progress in the fiscal year 
2024 Congressional Justification.
    Early-Career Researchers.--The Committee notes that the 
mean age of a first R01 award has continued to increase over 
the past 25 years. Accordingly, the Committee directs NIH to 
examine existing efforts to expand early career research, 
including the Next Generation Researchers Initiative, and 
provide an update in the fiscal year 2024 Congressional 
Justification. The Committee requests that NIH consider 
additional actions, including larger payline differentials for 
new or early-stage investigator applications, to further 
prioritize early career research.
    Eating Disorders.--The Committee commends NIH for 
supporting multi-Institute research on the chronic, fatal, and 
serious mental illnesses encompassing eating disorders that 
impact nearly 30,000,000 Americans during their lifetimes, and 
their association with other conditions such as co-morbid 
mental illnesses, substance use disorder, and metabolic, 
cardiovascular, neurological, and reproductive disturbances. 
The Committee encourages NIH to increase resources for eating 
disorders research and directs NIMH, NIMHD, NICHD, and NIDA to 
provide the Committee with an update within 180 days of 
enactment of this Act on research gaps in the genetics, 
prevention, diagnosis, and treatment of eating disorders.
    Ehlers-Danlos Syndrome.--The Committee encourages NIH to 
support research activities with respect to Ehlers-Danlos 
Syndrome and related connective tissue disorders.
    Environmental Influences on Child Health Outcomes (ECHO).--
The Committee includes $180,000,000, the same as the fiscal 
year 2022 enacted level and the fiscal year 2023 budget 
request, for the ECHO Project, which has the potential to 
greatly increase understanding of critical determinants of 
health across the lifespan, through its observational cohorts 
and the IDeA States Pediatric Clinical Trials Network. The 
Committee encourages continued communication about to the 
program's progress toward goals, milestones, and projected 
funding estimates with both external stakeholders and Congress.
    Faculty Institutional Recruitment for Sustainable 
Transformation (FIRST) Program.--The Committee applauds NIH for 
its continuous efforts to diversify the biomedical workforce 
and is encouraged by the recent FIRST program that was 
established to create a more inclusive and diverse biomedical 
research workforce through cluster hiring and institutional 
culture shifts. To build on these investments, the Committee 
directs NIH to provide increased and robust funding to the NIH 
Common Fund for the continuation of the FIRST program.
    Federal Advisory Committees Transparency Initiative.--The 
Committee continues to focus on improving transparency for 
Federal advisory committees established pursuant to 42 U.S.C. 
282(b)(16). The Committee appreciates that NIH ensures all its 
Federal advisory committees operate in accordance with the 
provisions of the Federal Advisory Committee Act, as amended (5 
U.S.C., Appendix 2), including the Literature Selection 
Technical Review Committee (LSTRC). The Committee appreciates 
the steps NIH has taken to further enhance the transparency of 
MEDLINE processes through via its centralized MEDLINE website. 
The Committee encourages NIH to continue its commitment to 
ensure all its committees, including the LSTRC, operate in a 
transparent manner in accordance with the provisions of the 
Federal Advisory Committee Act.
    Firearm Injury and Mortality Prevention Research.--The 
Committee includes $25,000,000 to support research on the 
prevention of firearm violence, $12,500,000 above the fiscal 
year 2022 enacted level and the same as the fiscal year 2023 
budget request. The Committee also directs NIH to collaborate 
with the National Institute of Justice to compile, share, and 
improve firearm violence data. Such data must include the 
Uniform Crime Report (UCR) and include data from hospitals 
treating victims of nonfatal gunshot wounds.
    Foreign Threats to Research.--Foreign government actors 
continue to have an interest in engaging in the theft of 
intellectual property from NIH and its funding recipients, 
posing risks to the integrity of NIH-supported research, fair 
competition, and the public's trust in resulting outcomes. The 
Committee directs NIH to provide biannual briefings on the 
progress of investigations into these efforts, as well as the 
institutions, scientists, and research affected. The Committee 
continues to direct NIH to transfer $5,000,000 to the Inspector 
General to continue additional investigations into this issue.
    Foundations of Evidence-Based Policymaking Act and OPEN 
Government Data Act.--The Foundations of Evidence-Based 
Policymaking Act of 2018 (P.L. 115-435) and the OPEN Government 
Data Act, which was enacted as part of P.L. 115-435 can aid in 
the discovery and sharing of publicly-funded biomedical 
research and public health data. The Committee requests a 
report no later than 120 days after enactment of this Act on 
the implementation and progress being made across NIH to comply 
with this legislation by ensuring that all non-sensitive 
government data be made available in open and machine-readable 
formats by default.
    Fragile X.--The Committee notes the importance of expanding 
the base of researchers and clinicians who are familiar with 
and trained in the fragile X-associated disorders and promoting 
collaboration between basic scientists and clinicians to enable 
researchers to better understand phenotypes, document 
variations in how the disorder presents itself, identify 
potential biomarkers and outcome measures, and develop new 
interventions. The Committee also commends NIH for recognizing 
the ethical, legal, and social issues in premutation screening 
and testing and encourages NIH to consider at existing pilot 
studies that are looking at innovative ways to screen newborns, 
and to coordinate efforts with CDC as they consider at 
screening solutions for FMR1-related conditions.
    Gabriella Miller Kids First Pediatric Research Program.--
The Committee recognizes that pediatric cancer and birth 
defects are a leading cause of death among children and are 
still poorly understood. Childhood cancer also has lasting 
negative health effects on children who do survive due to the 
high levels of toxicity associated with treatment. The 
Committee acknowledges that the Gabriella Miller Kids First 
Research Program enables researchers to uncover new insights 
into the biology of childhood cancer and birth defects. Since 
its inception, Kids First has initiated the Gabriella Miller 
Kids First Data Resource Center, which is a comprehensive data 
resource for research and patient communities meant to advance 
discoveries. The Committee recognizes the progress that the 
Program has made towards understanding childhood cancer and 
birth defects and provides $12,600,000 to support pediatric 
research as authorized by the Gabriella Miller Kids First 
Research Act (P.L. 113-94). The funding provided helps lay the 
foundation for expanded research in future years.
    Gene-Environment Interactions in Neurodegenerative 
Disorders in the Diverse Populations of Black/African Americans 
and Hispanics/Latinos.--In the context of NIH's robust 
neurological disease research portfolio, the Committee commends 
the leadership of NIH in advancing the relevant objectives of 
the Cures Act and the BRAIN Initiative. The Committee is 
concerned and recognizes the need to better understand the 
interactions between genetics and environmental factors, in 
particular with older and diverse populations of Black/African 
Americans and Hispanics/Latinos. The Committee encourages NIH 
to accelerate collaborative research across relevant Institutes 
and Centers and the research community to better understand 
structural level and intermediary levels of the social 
determinants of health, namely those that may potentially 
identify the interaction between environmental exposures to 
toxic chemicals and genetics and their impact on 
neurodegenerative disorders in diverse populations of Black/
African Americans and Hispanics/Latinos, to allow for earlier 
and more accurate diagnosis and subsequent treatment to arrest 
the progression of these devastating neurodegenerative 
disorders.
    Geroscience.--The Committee applauds NIH for recognizing 
the importance of geroscience to a wide range of chronic 
conditions and diseases by creating the Cellular Senescence 
Network (SenNet), an effort to identify and characterize the 
differences in senescent cells across the body, within the 
Common Fund. While NIA serves as the lead Institute for 
geroscience, programs such as SenNet demonstrate how all 
Institutes and Centers benefit from a greater understanding of 
this field, given the wide range of chronic conditions and 
diseases that are influenced by the biology of aging. To date, 
however, NIH has not analyzed which topics in geroscience are 
currently being addressed across the Institutes and Centers or 
how much funding the Institutes and Centers are using to 
support this research. The lack of this information limits 
NIH's ability to address research gaps in a strategic way. 
Therefore, the Committee encourages NIH to submit a report 
within 180 days of enactment of this Act that describes current 
NIH research focused on geroscience and future plans in this 
area. The Committee would also welcome exploration of a trans-
NIH initiative. Such an initiative might include increased 
funding for basic, translational, and clinical research, 
research infrastructure, workforce development, the development 
of platform technologies for geroscience, and collaboration 
with the FDA, industry, and academia on the discovery and 
validation of biomarkers.
    HEALthy Brain and Child Development (HBCD) Study.--The 
Committee recognizes and supports the NIH HEALthy Brain and 
Child Development Study, which will establish a large cohort of 
pregnant individuals and follow them and their children up to 
age 10 to characterize the influence of a variety of factors on 
neurodevelopment and long-term outcomes. The study aims to 
enroll approximately 7,500 pregnant individuals through 25 
research sites across the U.S., including regions of the 
country significantly affected by the opioid crisis. The study 
cohort will comprise participants that reflect the U.S. 
population but will oversample for individuals that have used 
substances sometime during their pregnancy and a matching 
cohort with similar characteristics, but no substance exposure 
during the pregnancy. Multimodal data collection will include 
neuroimaging, behavioral and cognitive assessments as well as 
collection of biospecimens and brain activity measurements. 
Knowledge gained will be critical to help predict and prevent 
some of the known impacts of pre- and postnatal exposure to 
drugs and environmental influences, including risk for future 
illicit substance use, mental disorders, and other behavioral 
and developmental problems as well as identify factors that 
contribute to resilience and opportunities for intervention. 
The Committee recognizes that the HBCD Study is supported in 
part by the NIH HEAL Initiative, and NIH Institutes, Centers, 
and Offices, including OBSSR, ORWH, NEI, NIMHD, NIBIB, NIMH, 
NIEHS, NICHD, NINDS, NIAAA, NIMH, and NIDA, and encourages 
additional NIH support for this important study.
    Hearing Health Screening for Older Adults.--The Committee 
recognizes the associated comorbidities and costs of untreated 
hearing loss and, with the growing aging population, the 
importance of hearing screening for older Americans. The 
Committee urges NIH to provide an update in the fiscal year 
2024 Congressional Justification on hearing screening research 
for older adults across NIH. The Committee encourages NIDCD and 
NIA to support studies that address the research needs and gaps 
identified by the USPSTF in their review of hearing screening 
recommendations for older Americans.
    Hepatitis B (HBV).--The Committee applauds NIH for its work 
to update the Strategic Plan for Trans-NIH Research to Cure 
Hepatitis B and urges that the update identify what has been 
learned since the plan was first released and what additional 
research is needed to find a cure. The Committee is aware of 
strong interest in more research to understand and manage HBV 
reactivation and research to understand and develop biomarkers 
of disease and therefore recommends these research ideas be 
evaluated and supported. The Committee is also aware of the 
view within the scientific community that finding a cure for 
HBV is a winnable goal and is within reach in the near-term and 
therefore remains concerned that the slow growth in NIH-funded 
HBV research could compromise the goal of finding a cure. For 
these reasons, the Committee applauds efforts to create common 
resource services and materials for the research community and 
further urges that targeted calls for research, based on the 
needs as identified in the updated Plan, be issued and funded 
in fiscal year 2023 and beyond.
    Herpes Simplex Virus, Types 1 and 2.--The Committee 
recognizes the serious nature of herpes simplex virus, a 
neuropathic infectious disease which impacts nearly one in two 
Americans, and the critical need for Federal investment in 
treatment and prevention. The Committee is concerned with 
potential health, quality of life, and economic impacts for 
herpes simplex virus seropositive individuals, as well as the 
risk for severe, persistent disease in a significant portion of 
Americans. The Committee directs NIH to prioritize research and 
development of curative approaches to herpes simplex virus, 
with a specific focus on research projects with commercial 
viability and intention of bringing new HSV treatments to 
market.
    The Committee understands that herpes simplex virus is a 
pathogen with considerations beyond a single NIH Institute or 
Center and directs NIH to assemble a multi-council working 
group to ensure a coordinated and focused effort across NIH. 
Institutes and Centers may include, but are not limited to: 
NIAID, NIMH, NCI, NIA, NIMHD and NINDS. This working group will 
assemble a review of NIH efforts in herpes simplex virus 
treatment and prevention with commercial viability, outline 
gaps and/or misconceptions in currently available research, and 
outline future priority areas for new clinical research, with a 
focus on addressing Americans holistic health and well-being. 
The multi-council working group will also provide a funding 
analysis to illustrate NIH priorities, gaps, and opportunities 
in clinical research of HSV treatment to date.
    HIV/AIDS Research.--The Committee includes no less than 
$3,394,283,000 for HIV/AIDS research, an increase of 
$200,000,000 above the estimated fiscal year 2022 level. While 
great advancements have been made in HIV prevention, care, and 
treatment over the last 30 years, more must be done to improve 
the lives of the more than one million Americans with HIV, 
especially with over 36,000 new diagnoses in the U.S. in 2019 
alone. The targeted HIV/AIDS research funding at NIH is needed 
to improve diagnosis, linkage to, and retention in care for 
persons with HIV; prevent at-risk populations from HIV 
acquisition and transmission; develop more effective treatments 
and evidence-based interventions; and ultimately discover a 
cure for HIV.
    HIV and Aging.--The Committee encourages the NIH Office of 
AIDS Research to fund interdisciplinary research and training 
programs in HIV and aging to increase understanding of HIV 
across the lifespan and to expand the diverse HIV workforce 
that addresses the unique health needs of this population.
    Humane Research Alternatives.--Recognizing that humane, 
cost-effective, and scientifically suitable non-animal methods 
are available for certain research models but underutilized, 
the Committee directs NIH to establish incentives to encourage 
investigators to utilize non-animal methods whenever 
appropriate for the research question and establish 
standardized guidelines for peer review evaluation of the 
justification for research with animals.
    Hypermobile Ehlers-Danlos Syndrome.--Hypermobile Ehlers-
Danlos Syndrome (hEDS) is an autosomal dominant connective 
tissue disorder that attacks connective tissues in nearly every 
organ System. Data from the NIH All of Us research program 
shows hEDS has a disease prevalence of approximately one in 
300. This chronic condition initiates during adolescence or 
earlier and disproportionately affects females (90 percent 
versus 10 percent male). Patients with hEDS progress from a 
normal, active lifestyle to one filled with surgeries and, in 
severe cases, to becoming wheelchair bound. hEDS takes an 
average of 14 years to diagnose, partially due to the lack of a 
clear genetic marker and very little clinical and research 
attention to date. Patients suffering from hEDS are typically 
young girls, who undergo an average of six surgeries before 
reaching the age of 25.
    The Committee is aware that researchers recently identified 
the first disease gene for hEDS and have developed the first 
hEDS animal model. In order to continue strides forward and 
expedite translational discoveries of cures, treatments and 
diagnosis, the Committee encourages NIH to increase support for 
hEDS related research at academic medical centers where hEDS 
patients are being treated. This investment could help lead to 
diagnostic markers of disease and provide the basis for long-
term sustainable research programs. In addition, the Committee 
encourages NIH to evaluate the best approach to establishing 
multi-institution centers that can serve as regional institutes 
to spur earlier diagnosis and improved treatment, care, 
education and mechanistic understanding of hEDS.
    INCLUDE Down Syndrome Research Initiative.--The Committee 
includes no less than $90,000,000, an increase of $15,000,000 
above the fiscal year 2022 enacted level, within OD for the 
INCLUDE Initiative. The Committee is pleased that this multi-
year, trans-NIH research initiative continues to drive 
important advances in understanding immune system 
dysregulation, Alzheimer's disease, and leukemia that is 
contributing to improvements in the health outcomes and quality 
of life of individuals with Down syndrome as well as millions 
of typical individuals. The Committee continues to encourage 
NIH to make further investments in health equity-focused 
research and care including for African Americans with Down 
syndrome, mosaic Down syndrome, those with the dual diagnosis 
of Down syndrome and autism or regression, with additional 
attention to neurodevelopment, metabolism, large cohort studies 
across the lifespan, and novel clinical trials. The Committee 
requests that NIH provide an updated plan within 60 days of 
enactment of this Act that includes a timeline and description 
of potential grant opportunities and deadlines for all expected 
funding opportunities so that young investigators and new 
research institutions may be further encouraged to explore 
research in this space. This plan should also incorporate and 
increase pipeline research initiatives specific to Down 
syndrome.
    Infection-Associated Illnesses.--The Committee recognizes 
the scientific and clinical opportunities in infection-
associated illnesses research and strongly encourages NIH to 
continue and expand its efforts to understand the underlying 
causes and risk factors for individuals with long COVID and ME/
CFS, with a focus on diagnosis, treatment, and prevention. The 
Committee encourages NIH to support multidisciplinary efforts 
related to expanding existing long COVID research efforts to 
include study participants with ME/CFS and other overlapping 
infection-associated illnesses.
    Interagency Coordinating Committee on the Validation of 
Alternative Methods (ICCVAM).--The Committee is aware that the 
Government Accountability Office recommended that NIEHS (1) 
facilitate the establishment of a workgroup of ICCVAM member 
agencies to develop metrics that member agencies could use to 
assess the progress made toward reducing, refining, or 
replacing animal use in testing and (2) incorporate those 
metrics into the committee's biennial progress reports. The 
Committee urges ICCVAM to provide an update on progress made, 
including publication of the Biennial Report with information 
individual agency metrics.
    Long COVID.--The Committee is concerned about the 
prevalence of long COVID in patients who have previously been 
diagnosed with COVID-19. Many people suffering with symptoms 
consistent with long COVID have been reduced to part-time work 
or are unable to work at all. While there are no therapeutics 
currently on the market for this condition, there are current 
FDA-approved services being used to treat long-term vascular 
disease which may also show promise in reducing long COVID 
symptoms. The Committee urges NIH to conduct clinical trials 
which seek to improve long COVID-related clinical markers and 
outcomes, with a specific focus on improvement of symptoms that 
can lead to full resumption of daily activities and return to 
work. The Committee also strongly encourages the Secretary to 
increase access to treatments of vascular disease that could 
also treat symptoms associated with long COVID. The agency is 
directed to prioritize access to such treatments in areas with 
higher prevalence of patients with heart disease.
    Lyme and Other Tick-Borne Diseases.--The Committee 
encourages NIH to hold a public workshop on the molecular 
mechanisms that Borrelia burgdorferi (Bb) employs to evade the 
human immune system, the human immune responses and 
consequences of Bb infection, and how these mechanisms and 
responses may influence the effectiveness of antibiotics.
    The Committee recognizes that there have been only a small 
number of clinical trials involving Lyme disease, which lacks a 
gold standard test, and that those trials have involved a 
relatively small number of patients. Because of the clear 
neurological dysfunction of Lyme disease and the existence of 
the Network for Excellence in Neuroscience Clinical Trials 
(NeuroNEXT), the Committee encourages NINDS to evaluate how it 
may contribute to improvements in tools to manage Lyme disease.
    The Committee asks NIH to consider the value of 
establishing a work group on long-term, not well understood 
outcomes for different diseases with similar long-term 
sequelae, particularly SARS-CoV-2 infection and Lyme disease, 
taking into account the input of patients not fully recovered 
from these infections and who offer experiences and insights, 
such as called for in RECOVER.
    Finally, the Committee encourages NIH to intensify research 
on adverse outcomes related to Lyme disease during pregnancy 
and to continue to participate with Lyme advocacy organizations 
on these issues.
    Maintenance of Chimpanzees on US Air Force Bases.--When 
Congress passed the CHIMP Act, it intended for all chimpanzees 
owned by NIH to be retired to a sanctuary. Despite this, in 
2019 NIH announced 44 chimpanzees housed at the Alamogordo 
Primate Facility (APF) and in 2021 announced that another 51 
chimpanzees from the Keeling Center for Comparative Medicine 
and Research (KCCMR) would not be transferred to Chimp Haven, 
the national sanctuary. The Committee has previously noted in 
its fiscal year 2022 report that the chimpanzees must be 
provided an opportunity to live the remainder of their lives in 
the national sanctuary. As such, the Committee strongly urges 
NIH to reevaluate the remaining animals at APF, KCCMR and the 
Southwest National Primate Research Center (SNPRC) and assess 
options for their transport to the national sanctuary. The 
Committee also directs NIH to provide a written report to the 
Committee each quarter, beginning no later than January 31, 
2023 that shall include: (1) the number of chimpanzees 
transported to the national sanctuary over the last quarter; 
(2) a census of all government-owned and supported chimpanzees 
remaining, if any, at APF, KCCMR or SNPRC and results of any 
reevaluations of their health; and (3) a list of any chimpanzee 
deaths that have occurred at any time after January 1, 2022 at 
APF, KCCMR or SNPRC.
    Maternal Health Research.--Research is critically important 
to optimizing the health of women and their families in the 
U.S. and identifying the causes behind pregnancy-related deaths 
and complications. The vast majority of research in pregnancy 
in the U.S. is supported by NIH. Each Institute and Center 
supports at least one grant or project related to pregnancy-
related research, with NICHD consistently providing the 
greatest support of perinatal research in the U.S. NICHD's work 
includes the Maternal-Fetal Medicine Units Network (MFMU), a 
network of centers across the country that conduct clinical 
studies to improve maternal, fetal, and neonatal health. NICHD 
is also working to advance safe and effective therapies for 
pregnant and lactating women as recommended in the report 
released in 2018 by the Federal Task Force on Research Specific 
to Pregnant Women and Lactating Women (authorized under P.L. 
114-255) and the implementation plan released in 2020. NICHD 
funding also supports research to address gaps in our 
understanding of the best way to support pregnant and 
postpartum women with a substance use disorder. Strengthened, 
prioritized support for maternal health research at the NIH is 
crucial to fully understanding the health inequities and 
disparities in outcomes that the U.S. is facing.
    Menopause.--The Committee is concerned about the lack of an 
RCDC category for menopause, which limits the ability to 
analyze current and future biomedical research being done on 
menopause and its short- and long-term effects on the health of 
women. As menopause is a female-specific condition and an 
important component of understanding women's health across the 
lifespan, it is critical that NIH report on and be able to 
track the intramural and extramural research supported by NIH. 
The Committee requests that NIH create a RCDC category for the 
menopausal transition and its related health conditions.
    Microbicides.--The Committee recognizes that with NIH and 
USAID leadership, research has shown the potential for 
antiretroviral (ARV) drugs to prevent HIV infection in women. 
The Committee encourages NIH to continue coordination with 
USAID, the State Department, and others to advance ARV-based 
microbicide development efforts with the goal of enabling 
regulatory approvals and product access of safe and effective 
microbicides for women.
    Mitochondrial Disease Research.--The Committee urges NIH to 
increase its support for primary mitochondrial disease research 
and to prioritize the development of potentially life-saving 
therapeutics. The Committee strongly encourages NIH to consider 
funding at least one mitochondrial disease center of excellence 
to centralize a critical mass of research, clinical care, and 
provider education. The Committee encourages NIH to consider 
supporting research on the role of mitochondrial function in 
long COVID.
    Mucopolysaccharidoses and Mucolipidosis (MPS/ML).--The 
Committee recognizes the severity of MPS/ML diseases and 
encourages NIH to support additional research in order to 
improve life expectancy and quality of life for patients.
    National Laboratories.--NIH funding supports investments 
which are collaborative with the ongoing work of the Department 
of Energy (DOE). The Committee directs NIH to update the 
Committee on the work to coordinate its efforts with DOE and 
the National Laboratories, and in more strategic ways to 
leverage NIH's research needs in the next generation of cancer 
research, brain mapping, drug development, or other emerging 
ideas in biomedical research that requires DOE's 
instrumentation, materials, modeling simulation, and data 
science. In 2015, the Secretary of Energy established the 
Energy Advisory Board (SEAB) to evaluate the prospects for 
increased collaboration between DOE researchers and biomedical 
scientists supported by other agencies, especially NIH. 
Increased and more effective coordination could be instrumental 
to assist in the development of the Nation's health, security, 
novel biomedical technologies, and in the development of more 
strategic enabling technologies. The Committee supports NIH's 
collaboration with DOE and the National Laboratories in an 
effort to maximize utilization of DOE's capabilities, 
particularly for NIH's rapidly growing data and computational 
challenges, and encourages NCI to build off the success of 
previous initiatives and consider additional pilots to address 
key computation and imaging bottlenecks in cancer research. The 
Committee requests an update within 120 days of enactment of 
this Act on its ongoing collaborations with DOE and 
opportunities for continued partnership growth.
    Native Hawaiian/Pacific Islander Health Research.--The 
Committee encourages NIH to place a high priority on addressing 
Native Hawaiian and Pacific Islander (NHPI) health disparities 
as well as supporting the career pathways and research of NHPI 
investigators. NIMHD, working with other Institutes and 
Centers, is encouraged to develop partnerships with academic 
institutions with a proven track record of working closely with 
NHPI communities and NHPI-serving organizations and located in 
States with significant NHPI populations to support the 
development of future researchers from these same communities. 
The Committee directs NIMHD to provide an update in the fiscal 
year 2023 Congressional Justification on NIH research to 
advance NHPI health and faculty researcher development.
    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 
elevated risk for the development of many forms of cancer, 
deafness, blindness, developmental delays, and autism. The 
Committee encourages NCI to increase its NF research portfolio 
in fundamental laboratory science, patient-directed research, 
and clinical trials focused on NF-associated benign and 
malignant cancers. The Committee also encourages NCI to 
continue to support preclinical research and clinical trials. 
Because NF can cause blindness, pain, and hearing loss, the 
Committee urges NINDS and NIDCD to continue to support 
fundamental basic science research on NF relevant to restoring 
normal nerve function. Based on emerging findings from numerous 
researchers worldwide demonstrating that children with NF have 
a higher chance of developing autism, learning disabilities, 
motor delays, and attention deficits, the Committee encourages 
NINDS, NIMH, and NICHD to increase their support of clinical 
research investigations in these areas. Since NF2 accounts for 
some genetic forms of deafness, the Committee encourages NIDCD 
to expand its investment in NF2-related research. NF1 can cause 
vision loss due to optic gliomas. The Committee encourages NEI 
to expand its investment in NF1-focused research on optic 
gliomas and vision restoration.
    NIH Division of Police.--The Committee notes that the 
explanatory statement accompanying the Commerce, Justice, 
Science, and Related Agencies Appropriations Act, 2022 directs 
the Attorney General to ensure implementation of evidence-based 
training programs on de-escalation and the use-of-force, as 
well as on police community relations, and the protection of 
civil rights, that are broadly applicable and scalable to all 
Federal law enforcement agencies. The Committee further notes 
that several agencies funded by this Act employ Federal law 
enforcement officers and are Federal Law Enforcement Training 
Centers partner organizations. The Committee directs NIH to 
consult with the Attorney General regarding the implementation 
of these programs for their law enforcement officers. The 
Committee further directs NIH to submit a report to the 
Committee no later than 180 days after consultation with the 
Attorney General on their efforts relating to such 
implementation. In addition, the Committee directs NIH, to the 
extent that they are not already participating, to consult with 
the Attorney General and the Director of the FBI regarding 
participation in the National Use-of-Force Data Collection. The 
Committee further directs NIH to submit a report to the 
Committees on Appropriations, no later than 180 days after 
enactment of this Act, on their efforts to so participate.
    Office of Behavioral and Social Sciences Research 
(OBSSR).--The Committee includes no less than the fiscal year 
2022 enacted level for OBSSR. The Committee commends OBSSR for 
effectively coordinating and supporting essential basic, 
clinical, and translational research in the behavioral, social, 
and population sciences to advance the NIH mission and 
recognizes the critical role of OBSSR to integrate these 
sciences throughout the NIH research enterprise via OBSSR's 
leadership and coordination. The Committee urges NIH to provide 
an update on OBSSR's activities and progress in the fiscal year 
2024 Congressional Justification.
    The Committee notes that multiple Surgeon General and NASEM 
reports have concluded that most diseases and health problems 
facing the Nation have significant behavioral components. 
Meanwhile, behavioral science issues surrounding the current 
pandemic, including vaccine hesitancy and health 
misinformation, have made clear that it is important to better 
understand healthy behavior and how to improve health 
communications. The Committee notes the OBSSR's mission to 
enhance NIH's behavioral sciences research enterprise across 
all Institutes and Centers, but that its direct authorities to 
meet its mission are limited. The Committee is pleased that an 
NIH working group was established to review how better to 
integrate and realize the benefits of overall health from 
behavioral research at NIH, and encourages NIH to consider 
appropriate OBSSR funding levels, resources, and organizational 
structure to support full implementation of the working group 
recommendations.
    Office of Nutrition Research.--The Committee includes 
$40,000,000 for the Office of Nutrition Research (ONR). With 
nutrition research occurring across NIH Institutes and Centers, 
ONR's work is essential for coordinating and advancing 
nutrition research across NIH and with other Federal agencies. 
This investment will accelerate discoveries across numerous 
critical areas and positively impact public health, societal 
equity, the economy, national security, as well as bolster the 
Nation's resilience to current and future threats like COVID-
19.
    Office of Research on Women's Health.--The Committee 
recommends $64,480,000 for the Office of Research on Women's 
Health, an increase of $5,000,000 above the fiscal year 2022 
enacted level. This office ensures women's health research and 
research on the biological and sociocultural influence of sex 
and gender are included within the NIH scientific framework. 
The Committee recognizes ORWH's critical leadership in 
promoting women's health research and spearheading research 
programs like the Specialized Centers of Research Excellence 
(SCORE). SCORE is a disease-agnostic research program designed 
to expedite the development and translation of basic and 
preclinical knowledge to human diseases that affect women, to 
learn more about the etiology of these diseases, and to foster 
improved approaches to treatment and/or prevention. The SCORE 
program also supports pilot research projects to train the next 
generation of scientists in the study of sex differences.
    Building Interdisciplinary Research Careers in Women's 
Health.--Within the total for ORWH, the Committee includes 
$5,000,000, an increase of $1,000,000 above the fiscal year 
2022 enacted level, for the ORWH's Building Interdisciplinary 
Research Careers in Women's Health (BIRCWH) program to fund 
additional BIRCWH fellows at all existing sites with a goal of 
increasing the diversity of the scholars, sites, and research 
areas supported by the program. These funds support additional 
researchers focused on women's health and sex differences, 
which are priority research areas, as well as expand the 
program's work in the reproductive sciences. The Committee 
recognizes the effectiveness of the BIRCWH program, which is a 
mentored career-development program designed to connect junior 
faculty and senior faculty with shared interests.
    Office of the Chief Officer for Scientific Workforce 
Diversity.--The Committee includes $22,400,000 for the Office 
of the Chief Officer for Scientific Workforce Diversity, 
$6,210,000 above the fiscal year 2022 enacted level and the 
same as the fiscal year 2023 budget request.
    Osteopathic Medical Schools.--The Committee recognizes that 
increased access to research funding for the osteopathic 
profession will bolster NIH's capacity to support recovery from 
the COVID-19 pandemic, address health disparities in rural and 
medically-underserved populations, and advance research in 
primary care, prevention, and treatment. The Committee requests 
an update on the current status of NIH funding to colleges of 
osteopathic medicine and representation of doctors of 
osteopathic medicine on NIH National Advisory Councils and 
standing study sections in the fiscal year 2024 Congressional 
Justification.
    Overactive Bladder Treatment.--The Committee remains 
concerned about the safety of medications used to treat 
overactive bladder, which may be increasing risk of ADRD. 
Overactive bladder affects 38 million Americans, and one in 
three older adults in this country. Overactive bladder has a 
significant impact on quality of life and the health care 
system. The anticholinergic medications typically used first-
line to treat overactive bladder have been shown to increase 
the risk of developing dementia. Dementia continues to grow as 
a prevalent and serious public health issue. The Committee 
urges NIA to study anticholinergic medications and alternative 
treatments to determine the safety and effectiveness of 
medications for overactive bladder, and their potential risks 
related to ADRD. The Committee requests an update on the status 
of research activities focused on this issue in the fiscal year 
2024 Congressional Justification.
    Polycystic Ovary Syndrome (PCOS).--PCOS affects up to 15 
percent of women and is a significant risk factor for multiple 
cardio-metabolic conditions, such as type 2 diabetes, lipid 
disorders, high blood pressure, obesity, sleep disorders, and 
others which may significantly increase risk for adverse COVID-
19 outcomes. The Committee encourages NIH to increase 
investments into research on the metabolic, cardiovascular, 
psychosocial, maternal-fetal, oncologic, pediatric, 
dermatologic, and reproductive aspects of PCOS. Fifty percent 
of PCOS patients become diabetic or prediabetic before age 40, 
and are at higher risk for hypertension, stroke, nonalcoholic 
fatty liver disease, and non-alcoholic steatohepatitis, 
independent of, but exacerbated by obesity. There is also 
evidence of racial and ethnic differences that 
disproportionately increase the risk for cardiovascular and 
metabolic disease in PCOS. The Committee urges NIH to continue 
to support fundamental laboratory science, patient-directed 
research, clinical trials, and large longitudinal studies 
focused on the cardiometabolic features and endocrinopathy of 
PCOS throughout the lifespan. The Committee also encourages NIH 
to provide an update on research that has been conducted on 
PCOS and its impact on cardio-metabolic health to date in the 
fiscal year 2024 Congressional Justification. Additionally, the 
Committee requests that PCOS--one of the most common human 
disorders--be added to the NIH Research, Condition, and Disease 
Categories reporting.
    Prion Disease.--The Committee encourages NIH to recognize 
prion disease as an ADRD. The disease mechanism and clinical 
presentation of prion diseases closely resemble AD/ADRDs. 
Advances in prion disease science have been valuable to the 
study of other ADRDs and vice versa, and further integration of 
the fields will benefit scientific pursuits in both fields.
    Psychedelic Research.--The Committee encourages NIH to 
assess opportunities for further private-public partnerships on 
researching the use of psychedelic drugs to treat posttraumatic 
stress disorder and major depressive disorders and provide a 
report within six months of enactment of this Act on the 
feasibility of providing potential dedicated researching 
funding for such partnerships.
    Psychedelic Treatments.--Despite the recent Department of 
Veterans Affairs' 2020 National Veteran Suicide Prevention 
Annual Report that showed there were no significant increases 
in the veteran suicide rate from 2017 and 2018, the Committee 
is concerned that over 17 veterans on average continue to 
commit suicide each day, which is a number that has remained 
persistent over the past decade. There have been many recent 
studies and clinical trials demonstrating the positive impact 
of alternative therapies, including psychedelics, for 
treatmentresistant PTSD and major depressive disorder, 
particularly for veteran participants. Further, U.S. academic 
research institutions are involved in investigating psychedelic 
treatments, including Johns Hopkins University, Harvard 
University, Yale University, New York University and Baylor 
University. In light of growing interest in this area, the 
Committee encourages NIH and other relevant Federal agencies to 
undertake, and where appropriate expand, research to evaluate 
the effectiveness of psychedelic therapies in treating PTSD, 
major depressive disorder, and other serious mental health 
conditions.
    Repeat Expansion Diseases.--The Committee recognizes the 
rapidly emerging science on DNA repeat expansions, which causes 
over 50 distinct diseases. Myotonic dystrophy (DM1 and DM2) is 
one of these repeat expansion diseases and has served as 
paradigm for a class of diseases caused by repeat instability 
and toxic RNA, which includes C9ORF72/amyotrophic lateral 
sclerosis/frontotemporal dementia, Huntington's disease, and 
many common forms of dominantly inherited ataxias. Due to 
recently developed molecular and cell biological tools, a 
common thread has recently emerged, that repeat expansions may 
underlie multiple neurodegenerative conditions. The Committee 
encourages NIH to explore the most effective approaches to 
support trans-NIH research on repeat expansions and consider 
new funding mechanisms across multiple Institutes and Centers 
to support scientific discoveries that will lead to treatments 
and cures for these genetic disorders and related conditions. 
The Committee requests an update on these activities in the 
fiscal year 2024 Congressional Justification.
    Sexual Orientation and Gender Identity (SOGI) Research 
Center.--The Committee includes $2,000,000 to establish the 
SOGI Research Center, which will build upon the success of the 
NASEM consensus study and the Sexual and Gender Minority 
Research Office to disseminate best practices in data 
collection on sexual orientation, gender identity, and sex 
characteristics on a government-wide basis.
    Spina Bifida Research.--The Committee encourages NIA, 
NIDDK, NICHD, and NINDS to study the causes and care of the 
neurogenic bladder and kidney disease in order to improve the 
quality of life of children and adults with spina bifida; to 
support research to address issues related to the treatment and 
management of spina bifida and associated secondary conditions, 
such as hydrocephalus and sudden death in the adult spina 
bifida population; and to invest in understanding the myriad 
co-morbid conditions experienced by individuals with spina 
bifida, including those associated with both paralysis and 
developmental delay. The Committee requests and update in the 
fiscal year 2024 Congressional Justification on research 
findings on spina bifida and issues related to it. The 
Committee supports the specific efforts of NICHD to understand 
early human development; set the foundation for healthy 
pregnancy, and lifelong wellness of women and children; and 
promote the gynecological, andrological, and reproductive 
health for people with spina bifida. Additionally, NIH is 
encouraged to identify sensitive time periods to optimize 
health interventions; improve health during transition from 
adolescence to adulthood; and ensure safe and effective 
therapeutics and devices for adults as well as children.
    Spinal Muscular Atrophy.--The Committee commends NIH for 
its past research into spinal muscular atrophy (SMA) that has 
led to new therapies to treat SMA and also contributed toward 
greater knowledge and research capacity into nervous system 
disorders. While current SMA treatments can slow or stop future 
degenerative nerve damage, they are not cures, and there 
remains significant unmet need across all ages and disease 
stages of SMA. Individuals with SMA, particularly adults, the 
largest segment of the SMA population, face significant 
challenges in muscle weakness and fatigue due to degeneration 
that occurred prior to treatment. Individuals treated prior to 
clinical symptoms onset may also display unmet needs, such as 
bulbar impairment and gait abnormalities. The Committee urges 
NIH to address these unmet needs, which are common across other 
neurological and neuro-muscular diseases, by supporting new 
research into the role and function of survival motor neuron 
(SMN) protein, investigation into non-SMN pathways and targets 
capable of modifying disease, and research into how to best 
combine SMN-enhancing and non-SMN approaches for optimal 
therapeutic outcomes.
    Thalassemia.--Nutrition can be an important tool in the 
management of rare diseases. Currently, there is no evidence-
based guidance on nutrition approaches for the management of 
thalassemia, which occurs most often in African Americans and 
in people of Mediterranean and Southeast Asian descent. In 
addition to the possibility that thalassemia itself creates 
nutritional deficits, there is concern that necessary iron 
chelation therapy may create additional deficits. Research is 
needed to provide practitioners with evidence-based advice for 
patients, both on diets that would help improve and manage 
their condition, and those that may be harmful. The Committee 
encourages the Office of Nutrition Research to coordinate 
across NIH on the impact of nutrition on thalassemia management 
and current gaps in clinical understanding in this area.
    Transformative Research Award for ALS.--The Committee 
strongly supports the Transformative Research Award program for 
ALS and directs NIH to continue to fund this critical 
initiative in fiscal year 2023.
    Undiagnosed Diseases.--NIH is helping construct and 
implement the Undiagnosed Disease Network, a research study to 
improve the diagnosis of undiagnosed, rare disorders so that no 
family has to endure the anxiety associated with undiagnosed 
diseases. The Committee recognizes that while the research is 
challenging, the great effort spent on this endeavor is 
beneficial for every American, especially those that are 
fighting unknown diseases. The Committee encourages robust 
support for the Undiagnosed Disease Network.
    Wastewater Surveillance Research.--The Committee recognizes 
the potential and importance of wastewater surveillance in 
public health surveillance, including during the ongoing 
pandemic to inform COVID-19 surveillance. The Committee 
encourages NIH to continue efforts on Rapid Acceleration of 
Diagnostics (RADx) to continue innovation through developing 
and improving wastewater surveillance capabilities, including 
for innovations that can apply to non-centralized wastewater 
treatment services that would serve rural communities. NIH is 
directed to report back to the Committee within 180 days of 
enactment of this Act on such efforts.
    Women's Health Research Study.--The Committee recognizes 
persistent gaps remain in the knowledge of women's health. To 
address these gaps and improve women's health, the Committee 
includes $2,000,000 to contract with NASEM to conduct a study 
on the gaps present in women's health research across all NIH 
Institutes and Centers. Specifically, the study should be 
designed to explore the proportion of research on conditions 
that are more common or unique to women, establish how these 
conditions are defined and ensure that it captures conditions 
across the lifespan, evaluate sex and gender differences and 
racial health disparities, and determine the appropriate level 
of funding that is needed to address gaps in women's health 
research at NIH. The Committee requests that NASEM, not later 
than 18 months after enactment of this Act, submit to the 
Committee a report containing the findings of the study and the 
recommendations to address research gaps in women's health 
research, including measurable metrics to ensure that this 
research is accurately tracked to meet the continuing health 
needs of women.
    Wound Care and Pressure Injuries.--The Committee commends 
NIH for updating RCDC with a wound care category, as it is 
estimated that pressure ulcers impact over 2.5 million 
Americans annually. Unfortunately, an estimated 60,000 patient 
deaths occur each year due to complications directly attributed 
to this painful condition. NIH is encouraged to support 
research projects in this area. Further, the Committee urges 
NIH to work with the U.S. National Pressure Injury Advisory 
Panel.

                        BUILDINGS AND FACILITIES

 
 
 
Appropriation, fiscal year 2022.......................      $250,000,000
Budget request, fiscal year 2023......................       300,000,000
Committee Recommendation..............................       300,000,000
    Change from enacted level.........................       +50,000,000
    Change from budget request........................             - - -
 

    Mission.--This account provides for the design, 
construction, improvement, major repair, and demolition of 
clinical, laboratory, and office buildings and supporting 
facilities essential to the mission of NIH. The funds in this 
appropriation support the buildings on the main NIH campus in 
Bethesda, Maryland; the Animal Center in Poolesville, Maryland; 
the National Institute of Environmental Health Sciences 
facility in Research Triangle Park, North Carolina; the 
National Institute of Allergy and Infectious Diseases in 
Hamilton, Montana; and other smaller facilities throughout the 
U.S.

                         NIH INNOVATION ACCOUNT

 
 
 
Appropriation, fiscal year 2022.......................      $150,000,000
Budget request, fiscal year 2023......................       419,000,000
Committee Recommendation..............................       419,000,000
    Change from enacted level.........................      +269,000,000
    Change from budget request........................             - - -
 

    This account supports NIH programs authorized in the Cures 
Act.

        SUBSTANCE USE AND MENTAL HEALTH SERVICES ADMINISTRATION

 
 
 
Appropriation, fiscal year 2022.......................    $6,545,602,000
Budget request, fiscal year 2023......................    10,283,154,000
Committee Recommendation..............................     9,170,380,000
    Change from enacted level.........................    +2,624,778,000
    Change from budget request........................    -1,112,774,000
 

    The Committee recommendation for the Substance Use And 
Mental Health Services Administration (SAMHSA) program level 
includes $9,024,713,000 in discretionary budget authority, 
$133,667,000 in Public Health Service (PHS) Act section 241 
evaluation set-aside transfers, and $12,000,000 in transfers 
from the Prevention and Public Health Fund (PPHF).
    SAMHSA is the agency within the U.S. Department of Health 
and Human Services (HHS) that leads public health efforts to 
advance the behavioral health of the nation. SAMHSA's mission 
is to reduce the impact of substance misuse and mental illness 
on America's communities.
    The Committee continues to include bill language that 
exempts the Mental Health Block Grant and the Substance Use 
Prevention and Treatment Block Grant as a source for the PHS 
Act section 241 evaluation set-aside in fiscal year 2023.

                             MENTAL HEALTH

 
 
 
Appropriation, fiscal year 2022.......................    $2,081,129,000
Budget request, fiscal year 2023......................     4,215,726,000
Committee Recommendation..............................     3,807,191,000
    Change from enacted level.........................    +1,726,062,000
    Change from budget request........................      -408,535,000
 

    Within the total provided for Mental Health Programs of 
Regional and National Significance, the Committee includes the 
following amounts:

------------------------------------------------------------------------
                                                             FY 2023
                    Budget Activity                         Committee
------------------------------------------------------------------------
Capacity:
    Seclusion and Restraint...........................        $1,147,000
    Project AWARE.....................................       229,000,000
    Mental Health Awareness Training..................        44,963,000
    Healthy Transitions...............................        49,451,000
    Infant and Early Childhood Mental Health..........        30,000,000
    Children and Family Programs......................         7,229,000
    Consumer and Family Network Grants................         4,954,000
    Project LAUNCH....................................        25,605,000
    Mental Health System Transformation...............         3,779,000
    Primary and Behavioral Health Care Integration....       102,877,000
    Mental Health Crisis Response Grants..............        60,000,000
    988 Program.......................................       746,901,000
        Behavioral Health Crisis and 988 Coordinating         10,000,000
         Office.......................................
    National Strategy for Suicide Prevention..........        28,200,000
        Zero Suicide..................................        26,200,000
            American Indian and Alaska Native Set-             3,400,000
             Aside....................................
    Garrett Lee Smith-Youth Suicide Prevention
        State Grants..................................        33,806,000
        Campus Grants.................................        11,488,000
    American Indian and Alaska Native Suicide                  3,931,000
     Prevention.......................................
    Tribal Behavioral Health Grants...................        25,000,000
    Homeless Prevention Programs......................        35,696,000
    Minority AIDS.....................................         9,224,000
    Criminal and Juvenile Justice Programs............        16,269,000
    Assisted Outpatient Treatment.....................        21,420,000
    Assertive Community Treatment for Individuals with         9,000,000
     Serious Mental Illness...........................
    Interagency Task Force on Trauma-Informed Care....         3,000,000
Science and Service:
    Garrett Lee Smith-Suicide Prevention Resource             10,000,000
     Center...........................................
    Practice Improvement and Training.................         7,828,000
    Consumer and Consumer Support Technical Assistance         1,918,000
     Centers..........................................
    Primary and Behavioral Health Care Integration             1,991,000
     Technical Assistance.............................
    Minority Fellowship Program.......................        14,059,000
    Disaster Response.................................         1,953,000
    Homelessness......................................         2,296,000
------------------------------------------------------------------------

    Assisted Outpatient Treatment.--The Committee includes 
$21,420,000 to expand access to evidence-based mental health 
services for individuals with serious mental illness.

Behavioral Health Crisis Services and 988 Program

    The Committee recognizes that suicide is a leading cause of 
death, taking more than 45,000 lives every year. According to 
the CDC, mental health and suicidal ideation have worsened 
significantly since the onset of the COVID-19 pandemic; 
approximately twice as many individuals have reported serious 
thoughts of suicide and 40 percent of adults reported 
struggling with mental health or substance use. The Committee 
includes a total of $746,901,000, an increase of $640,280,000, 
to support the entirety of the 988 Program, which includes 
continuing to enhance the National Suicide Prevention Lifeline 
(NSPL) and crisis response infrastructure for the new 988 
number which is launching in July 2022. SAMHSA estimates that 
the 988 call centers will respond to approximately 7.6 million 
individuals in fiscal year 2023, compared to approximately 3.3 
million estimated in fiscal year 2022. The 988 Program has the 
potential to make it simpler for people experiencing a mental 
health crisis to connect with lifesaving crisis intervention 
services. This funding will support the NSPL infrastructure 
including national back-up services; expand local call center 
and crisis capacity across the continuum of care; promote 
ongoing Federal direction and leadership through coordination, 
standards setting, technical assistance and evaluation; and 
facilitate partner engagement, audience research, content and 
strategy development to ensure that there is public awareness 
of the health benefits of the 988 Program, particularly for 
populations at high risk of suicide. The Committee requests a 
briefing within 90 days of the date of enactment of this Act on 
implementation of the 988 Program, including an operating plan 
outlining how SAMHSA intends to allocate funding across 988 
Program activities. The Committee also directs that as SAMHSA 
continues to enhance the NSPL and crisis response 
infrastructure, it should expand existing capabilities for 
response in a manner that, to the extent possible, utilizes 
existing phone, chat, and text capabilities.
    Behavioral Health Crisis and 988 Coordinating Office.--Of 
the funds provided for the 988 Program, the Committee includes 
an increase of $5,000,000 for SAMHSA to continue to staff an 
office within the Center for Mental Health Services to 
coordinate work relating to behavioral health crisis care 
across HHS operating divisions, including CMS and HRSA, as well 
as with external stakeholders. The office will continue to 
support technical assistance, data analysis, and evaluation 
functions in order to develop a crisis care system encompassing 
nationwide standards with the objective of expanding the 
capacity of and access to local crisis call centers, mobile 
crisis care, crisis stabilization, psychiatric emergency 
services, and rapid post-crisis follow up, provided by the 
National Suicide Prevention and Mental Health Crisis Response 
System, Community Mental Health Centers, Certified Community 
Behavioral Health Clinics and other community mental health and 
substance use disorder (SUD) providers.
    NSPL-Specialized Services for LGBTQI+ Youth.--Of the funds 
provided for the 988 Program, the Committee includes 
$30,000,000 for SAMHSA to continue to provide specialized 
services for LGBTQI+ youth within the NSPL, including training 
for existing counselors in LGBTQI+ youth cultural competency 
and the establishment and operation of an Interactive Voice 
Response (IVR) and other technical solutions to transfer 
LGBTQI+ youth to a specialty organization. SAMHSA shall make 
this funding competitively available to an organization with 
experience working with LGBTQI+ youth and possessing the 
capacity and infrastructure to handle LGBTQI+ youth callers 
through an IVR.
    Criminal Justice Activities.--The Committee includes an 
increase of $10,000,000 for Criminal and Juvenile Justice 
Programs to address some of the unmet need for effective 
behavioral health services and supports that are accessible 
before, during, and after incarceration and continue in the 
community for those with a mental disorder. The Committee 
recognizes the importance of providing comprehensive services 
to those who suffer from severe mental health issues. The 
Committee is aware that lack of coordinated and accessible 
treatment for individuals with mental health and co-occurring 
disorders often results in avoidable arrest and incarceration, 
and that these individuals often recidivate in part due to gaps 
in addressing their needs. Communities of color are often 
disproportionately impacted by these service gaps. The 
Committee encourages SAMHSA to prioritize funding for centers 
that provide assistance to those with severe mental health 
needs who are at risk of recidivism. These mental health 
centers can provide, but are not limited to, the following 
services: crisis care, residential treatment, outpatient mental 
health and primary care services, and community re-entry 
supports. The Committee also encourages SAMHSA to prioritize 
applications from areas with high rates of uninsured 
individuals, poverty, and SUDs.
    Garrett Lee Smith Youth Suicide Prevention.--The Committee 
includes a total increase of $13,000,000 for Garrett Lee Smith 
Youth Suicide Prevention, to develop and implement youth 
suicide prevention and early intervention strategies.
    Healthy Transitions.--The Committee includes an increase of 
$20,000,000 for the Healthy Transitions program, which provides 
grants to States and Tribes to improve access to mental 
disorder treatment and related support services for young 
people aged 16 to 25 who either have, or are at risk of 
developing a serious mental health condition.
    Homelessness Prevention Programs.--The Committee includes 
an increase of $5,000,000 for Homeless Prevention Programs to 
help prevent or reduce chronic homelessness by funding services 
for individuals and families experiencing homelessness while 
living with severe mental illness or co-occurring mental and 
substance disorders. The program addresses the need for 
treatment and support service provision to individuals and 
families.
    Infant and Early Childhood Mental Health.--The Committee 
recognizes the importance of building mental health services 
for children under the age of six and includes an increase of 
$20,000,000 for Infant and Early Childhood Mental Health. The 
Committee continues to urge SAMHSA to expand grants to entities 
such as State agencies, tribal communities, and university or 
medical centers that are in different stages of developing 
infant and early childhood mental health services. These 
entities should have the capacity to lead partners in systems-
level change as well as building or enhancing the basic 
components of such early childhood services, including an 
appropriately trained workforce. The Committee is pleased with 
SAMHSA's use of a portion of funding to provide technical 
assistance to existing grantees to better integrate infant and 
early childhood mental health into State systems and encourages 
that work to continue. The Committee encourages SAMHSA to 
increase technical assistance allocations as the number of 
grantees increases.
    Interagency Task Force on Trauma-Informed Care.--The 
Committee includes $3,000,000 for the Interagency Task Force on 
Trauma-Informed Care, as authorized by section 7132 of the 
SUPPORT Act (P.L. 115-271). The Task Force recommends best 
practices to identify, prevent, and mitigate the effects of 
trauma on infants, children, youth, and their families.
    Mental Health Crisis Response Grants.--The Committee notes 
that funding crisis care services can help divert people 
experiencing a mental health crisis from the criminal justice 
system into mental health treatment. However, the availability 
of mental health crisis care remains inconsistent across the 
U.S., and first responders are not always trained and equipped 
to diffuse a mental health crisis, which can lead to tragic 
outcomes. Many communities are implementing model programs 
where mental health providers respond to mental health 
emergencies, sometimes in partnership with law enforcement. To 
make these model programs more widely available, the Committee 
includes an increase of $50,000,000 to expand the grant program 
for communities to create, or enhance existing, mobile crisis 
response teams that divert the response for mental health 
crises from law enforcement to behavioral health teams. These 
teams may be composed of licensed counselors, clinical social 
workers, physicians, EMTs, crisis workers, and/or peers 
available to respond to people in crisis and provide immediate 
stabilization and referral to community-based mental health 
services and supports. The Committee encourages grantees to 
partner or co-respond with law enforcement to ensure community 
policing meets the needs of everyone in the community. The 
Committee looks forward to receiving the report on existing 
steps being taken to strengthen partnerships between mental 
health providers, behavioral health teams, and first responders 
requested in House Report 117-96. The Committee requests a 
report not later than one year following the obligation of 
awards in fiscal year 2023 for this program, including best 
practices and recommendations for subsequent grant cycles.
    Minority Fellowship Program.--The Committee provides a 
total of $25,169,000, an increase of $9,000,000, across SAMHSA 
for the Minority Fellowship Program in order to improve 
prevention, wellness, and treatment across the lifespan. As 
Congress seeks to better address substance misuse and mental 
health disorders across all populations, the Committee 
recognizes the critical importance of supporting a diverse 
behavioral health workforce and its effectiveness in addressing 
SUDs and mental health issues impacting minority and 
underserved populations.
    National Strategy for Suicide Prevention.--The Committee 
includes an increase of $5,000,000 for the implementation of 
the National Strategy for Suicide Prevention, including raising 
suicide awareness, establishing emergency room referral 
processes, and improving clinical care practice standards. In 
addition, funding will further support the Zero Suicide model, 
a comprehensive, multi-setting approach to suicide prevention 
in health care systems. The Committee also includes an increase 
of $1,000,000 for the American Indian/Alaska Native (AI/AN) 
Suicide Prevention Initiative.
    Primary and Behavioral Health Care Integration.--The 
Committee includes an increase of $50,000,000 to improve the 
coordination and integration of primary care services and 
publicly funded behavioral health services.
    Project AWARE.--The Committee includes a total increase of 
$108,999,000 for Project AWARE, which is designed to identify 
children and youth in need of mental health services, to 
increase access to mental health treatment, and to promote 
mental health literacy among teachers and school personnel, as 
set out by the 2013 ``Now is the Time'' plan. This includes an 
increase of $102,749,000 for Project AWARE State grants, and an 
increase of $6,250,000 for Resilience in Communities after 
Stress and Trauma (ReCAST) grants. In addition, the Committee 
includes an increase of $20,000,000 for Mental Health Awareness 
Training. The Committee encourages SAMHSA to sustain and 
strengthen its grant and other programs that support school-
based and campus-based services aimed at preventing and 
treating mental health challenges experienced by younger 
Americans.
    Tribal Behavioral Grants.--The Committee includes an 
increase of $4,250,000 to expand efforts to address the high 
incidence of substance misuse and suicide among AI/AN 
populations.

Certified Community Behavioral Health Clinics

    The Committee includes $400,000,000, an increase of 
$85,000,000 for the Certified Community Behavioral Health 
Clinics (CCHBC) program. The Committee is pleased that the 
CCBHC program is expanding access to mental health and SUD 
treatment services and significantly reducing hospital 
emergency room utilization. CCBHCs are required to partner with 
local agencies, and this often includes partnering with law 
enforcement to develop safe and effective crisis response. The 
Committee directs SAMHSA to continue to make funds available 
nationwide and to prioritize resources to entities within 
States that are part of section 223(a) of the Protecting Access 
to Medicare Act of 2014 (P.L. 113-93) demonstration and to 
entities within States that were awarded planning grants.

Children's Mental Health Services

    The Committee includes $225,000,000, an increase of 
$100,000,000 for Children's Mental Health Services (CMHS), 
which support grants and technical assistance for community-
based services for children and adolescents with serious 
emotional, behavioral, or mental disorders, and assists States 
and local jurisdictions in developing integrated systems of 
community care.
    Community Violence Pilot.--The Committee recognizes the 
crisis of community violence that is devastating families and 
claiming the lives of youth--particularly youth in communities 
of color--all across this country. Of the funds provided for 
CMHS, the Committee includes $50,000,000 for SAMHSA to 
establish a pilot program to provide and expand mental health 
services for families affected by community violence. The 
severe lack of resources for emotional support and wellbeing is 
of paramount need in Black and brown communities and this 
funding would be a crucial support for the pervasive trauma 
that so many families, especially families of color, face in 
the aftermath of fatal community violence.

Mental Health Block Grant

    The Committee includes $1,357,571,000, an increase of 
$500,000,000, for the Mental Health Block Grant (MHBG). The 
MHBG provides funds to States to support mental illness 
prevention, treatment, and rehabilitation services. Funds are 
allocated according to a statutory formula among the States 
that have submitted approved annual plans. The Committee 
continues the 10 percent set-aside within the MHBG for 
evidence-based programs that address the needs of individuals 
with early serious mental illness, including psychotic 
disorders.
    MHBG Crisis Care Set-Aside.--The Committee increases the 
set-aside in the MHBG for evidence-based crisis care programs 
to 10 percent to address the needs of individuals with serious 
mental illnesses and children with serious mental and emotional 
disturbances. The Committee directs SAMHSA to use the set-aside 
to fund, at the discretion of eligible States and Territories, 
some or all of a set of core crisis care elements including: 
local, regional or statewide call centers that have capacity to 
address distressed and suicidal callers and deploy mobile teams 
or direct persons to accessible crisis receiving centers or 
clinics with same day appointments, mobile crisis response 
teams and crisis receiving units.
    MHBG Prevention and Early Intervention Set-Aside.--The 
Committee understands that early intervention is critical if we 
are to prevent or mitigate the effects of mental illness and 
enable individuals to live fulfilling, productive lives. To 
increase access to early intervention and prevention services, 
the Committee includes a new 10 percent set-aside within the 
MHBG total to support evidence-based programs that address 
early intervention and prevention of mental disorders among at-
risk children, including young children and toddlers, and 
adolescents. The Committee directs SAMHSA to use the set-aside 
to fund, at the discretion of eligible States and Territories, 
activities targeted to children and youth such as, but not 
limited to, training school-based personnel to identify 
children and youth at risk of mental disorders; programs to 
promote positive social-emotional development in children from 
birth to age five; mental health consultation for child care 
programs; collaborating with primary care associations to field 
depression and anxiety screening tools in front line primary 
care practices; or partnering with local non-profit entities in 
low-income and minority communities to implement trauma-
informed early intervention and prevention initiatives. 
Statutory State plan and reporting requirements will apply to 
early intervention and prevention set-aside programming.
    MHBG and Children Ages Zero-Five.--The Committee recognizes 
that by investing in early mental health prevention, 
identification, and treatment, the need for treatment later in 
life when it becomes much more difficult, time intensive, and 
expensive can be reduced. The Committee is concerned that there 
has not been a sufficient focus on this population. The 
Committee urges States to dedicate a portion of their MHBG 
funding through the new Prevention and Early Intervention Set-
Aside for services and activities related to infants and 
toddlers, such as expanding the infant and early childhood 
mental health workforce; improving the quality of services 
available to children and families; increasing knowledge of 
infant and early childhood mental health among professionals 
who see children most; and strengthening systems and networks 
for identification and referral to reach more young children in 
need. The Committee looks forward to receiving the report on 
the portion of MHBG funding that States are allocating to 
services and activities for infants and toddlers requested in 
House Report 117-96.
    MHBG and AANHPIs.--The Committee urges States to ensure a 
portion of MHBG funding is allocated to focus on Asian 
Americans, Native Hawaiians, and Pacific Islanders (AANHPI). 
This focus should include the training of professionals on 
effective outreach and engagement with AANHPIs to raise 
awareness of these culturally inclusive services, including 
those with lived experiences.
    Workplace Mental Health Wellness.--The Committee notes that 
workforce mental health is an important part of ensuring the 
overall mental health of our larger communities. To address 
workforce mental health in the community context, the Committee 
urges SAMHSA to encourage States to use a portion of their MHBG 
funds to work with public and nonprofit organizations to 
implement evidence-based programs designed to educate and aid 
employers in providing mental health assistance to their 
employees to reduce the stigma and encourage the treatment of 
mental health illness in the workplace.

National Child Traumatic Stress Initiative

    The Committee includes $150,000,000, an increase of 
$68,113,000 for the National Child Traumatic Stress Initiative. 
The Committee strongly supports the National Child Traumatic 
Stress Network (NCTSN), which carries out essential work in 
building, evaluating, disseminating, and delivering evidence-
based services and best practices, including through 
universities, hospitals, and front-line providers, to prevent 
and mitigate the impact of exposure to trauma among children 
and families. The Committee directs SAMHSA to ensure that the 
NCTSN maintains its focus on collaboration, data collection, 
and the provision of direct services and that new grants should 
not be awarded as training only. The agreement also provides no 
less than $10,000,000 for activities authorized under section 
582(d) and (e) of the PHS Act for the National Center for Child 
Traumatic Stress.

Projects for Assistance in Transition from Homelessness

    The Committee includes $79,635,000, an increase of 
$15,000,000 for the Projects for Assistance in Transition from 
Homelessness (PATH) program, which supports grants to States 
and territories for assistance to individuals suffering from 
severe mental illness and/or SUDs and who are experiencing 
homelessness or at imminent risk of becoming homeless. Grants 
may be used for outreach, screening and diagnostic treatment 
services, rehabilitation services, community mental health 
services, alcohol or drug treatment services, training, case 
management services, supportive and supervisory services in 
residential settings, and a limited set of housing services.
    HUD/HHS Collaboration Supportive Housing for People with 
Mental Illness Pilot.--The Committee is concerned that 
inadequate housing and support opportunities exist for people 
with serious mental health illness, which often results in 
people with serious mental illness cycling through hospitals 
and public institutions like jails, prisons, and homeless 
shelters. The Committee recognizes that housing support paired 
with wraparound services is a successful model. In fiscal year 
2021, the Committee requested a report from the Department of 
Housing and Urban Development (HUD) and SAMHSA on the 
feasibility of such a program and received agency feedback for 
its creation. The Committee directs SAMHSA to work with HUD to 
establish a pilot program for PATH grantees to partner with 
public housing agencies to provide mental health, SUD, and 
other supportive services for people experiencing homelessness, 
at imminent risk of becoming homeless, or in HUD-assisted 
housing. The Committee directs SAMHSA to use no less than 
$5,000,000 of the funds made available for the PATH program for 
this pilot.

Protection and Advocacy for Individuals with Mental Illness

    The Committee includes $40,000,000, an increase of 
$2,000,000, for the Protection and Advocacy for Individuals 
with Mental Illness program, which ensures that the rights of 
individuals with mental illness are protected while they are 
patients in all public and private facilities or while they are 
living in the community. Funds are allocated to States 
according to a formula based on population and relative per 
capita incomes.

    Addressing Access to Firearms and Suicide Prevention 
Programs.--The Committee continues to encourage SAMHSA to focus 
on suicide prevention policies that limit access to firearms 
and other lethal means when an individual is in crisis. The 
Committee urges SAMHSA to develop, adapt, and disseminate 
training on lethal means safety counseling for health care 
providers; to collaborate with the Department of Veterans 
Affairs (VA) and NSPL to promote gun storage maps, accessible 
by both VA health care providers and Crisis Center counselors, 
to facilitate temporary out-of-home firearm storage; and to 
encourage the incorporation of tools such as extreme risk laws 
into risk mitigation and response plans.
    Behavioral Health Intervention Training.--The Committee 
continues to encourage SAMHSA to develop school-based and 
evidence-based best practices addressing behavioral health 
intervention training to support practices that assist children 
and youth with behavioral health needs. One potential best 
practice is behavioral intervention teams--a team of qualified 
mental health professionals who are responsible for 
identifying, screening, and assessing behaviors of concern and 
facilitating the implementation of evidence-based 
interventions. SAMHSA shall also provide technical assistance 
to institutions of higher education, elementary schools, and 
secondary schools to assist such institutions and schools in 
implementing the best practices.
    COVID-19 Impact on Communities of Color.--The Committee is 
concerned by the enduring impact of the COVID-19 pandemic on 
the mental health of communities of color. The pandemic 
exacerbated high rates of mental illness in these communities 
and highlighted the need for culturally and linguistically 
appropriate services. The Committee requests a report not later 
than 180 days after the date of enactment of this Act on 
SAMHSA's outreach, education, and public engagement strategies, 
designed to meet the cultural and language needs of diverse 
populations; increase awareness of symptoms of SUD and mental 
illness common among the aforementioned populations, taking 
into account differences within subgroups such as gender, 
gender identity, age, sexual orientation, or disability; 
disseminate evidence-based, culturally and linguistically 
appropriate and adapted interventions and treatments; ensure 
meaningful engagement of people with lived experiences, their 
families, and community members in the materials development 
and implementation; broaden the perspective among both 
individuals in these communities and stakeholders serving these 
communities, to use a comprehensive public health approach to 
promoting behavioral health that addresses a holistic view of 
health by focusing on the intersection between behavioral and 
physical health; and address the impact of the COVID-19 
pandemic on the behavioral health of such populations.
    Impact of COVID-19 on the Mental Health of Older Adults.--
The Committee recognizes the exacerbated impact of the COVID-19 
pandemic on older adults, who, being more susceptible to the 
virus, have experienced heightened isolation since the onset of 
the pandemic, which is linked to higher rates of loneliness, 
depression, suicidal ideation, and other mental health issues. 
The Committee encourages SAMHSA to work with States to address 
the impact of increased isolation of seniors. The Committee 
requests a report within 180 days of the date of enactment of 
this Act, outlining specific efforts to address seniors' mental 
health challenges.
    Mental Health Centers of Excellence.--The Committee 
continues to be concerned about the growing need for more 
effective health care programs and a need to better provide 
treatment recommendations to meet the needs of those 
experiencing mental illness. The Committee urges SAMHSA to 
establish a center of excellence program focused on 
comprehensive mental health treatments. The Centers will focus 
on the development, evaluation, and distribution of evidence-
based resources regarding comprehensive treatment 
recommendations for mental health patients that include 
supportive services, wraparound services, and social 
determinants of health where applicable. The Centers will also 
work to disseminate treatment recommendations to the broader 
network of mental health clinicians. Preference should be given 
to entities that can demonstrate existing behavioral health 
medical home model services, CCBHC implementation, work with 
HUD's Housing for Persons with Disabilities (section 811) 
program, collaborative care agreements with primary care 
practices, and/or programs for supported living and supported 
employment. One grantee should be designated as the National 
Coordinating Center across the selected centers and provide 
technical expertise across all recipients. The Centers should 
collaborate with SAMHSA's Mental Health Technology Transfer 
Center Network and the Serious Mental Illness advisor in 
developing the new program.
    Perinatal Suicide Prevention.--The Committee continues to 
urge SAMHSA to develop and implement perinatal suicide 
prevention programs, including culturally appropriate resources 
and programs for Black and other at-risk pregnant and 
postpartum individuals.
    Reducing Barriers to Transportation.--The Committee notes 
that mental health, SUD, and opioid use disorder (OUD) are a 
pervasive crisis across the country and have been exacerbated 
by the effects of the COVID-19 pandemic. The Committee is also 
aware that many seeking treatment lack reliable transportation 
which becomes a major barrier for individuals seeking out 
treatment or other mental health services. The Committee 
encourages SAMHSA to acknowledge funds for State and local 
governments can be used to provide reliable, equitable, and 
convenient access to transportation for those seeking 
treatment. The Committee requests SAMHSA conduct a review 
within 180 days of the date of enactment of this Act to measure 
the impact of recovery transportation on individuals' ability 
to access treatment and provide a summary report.
    Rural Mental Health.--The Committee recognizes the unique 
challenges faced by those who live in rural and frontier areas 
to access regular mental health and substance use services. 
These challenges are further complicated when individuals need 
timely behavioral health crisis services led by behavioral 
health professionals in these areas. Providers in rural areas 
also face unique obstacles. They may lack the full staff or 
resources to implement evidence-based practices or meet 
requirements for grant funding. Given these challenges, the 
Committee requests a report not later than one year after the 
date of enactment of this Act providing details on strategies 
to address the unique concerns of those in rural communities. 
The report should address what resources are needed to improve 
and sustain access to prevention, treatment, and recovery-
oriented services, including crisis response services, and to 
recruit, train, and sustain sufficient workforce in rural and 
frontier settings.
    Youth Mental Health and Mentoring Initiatives.--The 
Committee notes that since the pandemic began, rates of 
psychological distress among young people, including symptoms 
of anxiety, depression, and other mental health disorders, have 
increased. Professional mentoring programs provide evidence-
based mental health and trauma mitigation services to children 
and families who experience barriers to accessing mental health 
supports, while reducing the burdens on existing systems of 
care. The Committee urges SAMHSA to prioritize funds to these 
programs to improve access to mental health services for at-
risk youth and their families and to ensure applicable grant 
opportunities include these types of professionals as parties 
grantees can work with when implementing SAMHSA grants. In 
addition, the Committee urges SAMHSA to study underlying causes 
of psychological distress in young people.

                         SUBSTANCE USE SERVICES

 
 
 
Appropriation, fiscal year 2022.......................    $3,954,596,000
Budget request, fiscal year 2023......................     5,574,443,000
Committee Recommendation..............................     4,826,048,000
    Change from enacted level.........................      +871,452,000
    Change from budget request........................      -748,395,000
 

    Within the total provided for Programs of Regional and 
National Significance, the Committee recommends the following 
amounts:

------------------------------------------------------------------------
                   Budget Activity                     FY 2023 Committee
------------------------------------------------------------------------
Capacity:
    Opioid Treatment Programs and Regulatory                  $9,724,000
     Activities......................................
    Screening, Brief Intervention, Referral to                32,840,000
     Treatment.......................................
        PHS Evaluation Funds ........................          2,000,000
    Targeted Capacity Expansion-General..............        147,916,000
        Medication-Assisted Treatment................        136,500,000
            Tribal Set-aside.........................         16,500,000
    Grants to Prevent Prescription Drug/Opioid                18,000,000
     Overdose........................................
    First Responder Training.........................         61,000,000
        Rural Focus..................................         36,000,000
    Pregnant and Postpartum Women....................         49,931,000
    Recovery Community Services Program..............          5,151,000
    Children and Families............................         30,197,000
    Treatment Systems for Homeless...................         37,114,000
    Minority AIDS....................................         66,881,000
    Criminal Justice Activities......................         99,380,000
        Drug Courts..................................         80,000,000
    Improving Access to Overdose Treatment...........          1,500,000
    Building Communities of Recovery.................         28,000,000
    Peer Support Technical Assistance Center.........          2,000,000
    Comprehensive Opioid Recovery Centers............          7,500,000
    Emergency Department Alternatives to Opioids.....         10,000,000
    Treatment, Recovery, and Workforce Support.......         12,000,000
    Youth Prevention and Recovery Initiative.........          4,000,000
Science and Service:
    Addiction Technology Transfer Centers............          9,046,000
    Minority Fellowship Program......................          8,789,000
------------------------------------------------------------------------

    Building Communities of Recovery.--The Committee includes 
an increase of $15,000,000 to support the development, 
enhancement, expansion, and delivery of recovery support 
services.
    Children and Families.--The Committee includes an increase 
of $592,000 for the Children and Families program, which makes 
appropriate treatment available to youth and their families or 
caregivers to reduce the impact of SUD and/or co-occurring 
mental and substance use disorders on communities in the U.S.
    Comprehensive Opioid Recovery Centers.--The Committee 
includes an increase of $2,500,000 for Comprehensive Opioid 
Recovery Centers, as authorized by section 7121 of the SUPPORT 
Act (P.L. 115-271), to help ensure that people with SUD can 
access proper treatment.
    Emergency Department Alternatives to Opioids.--The 
Committee includes an increase of $4,000,000 for Emergency 
Department Alternatives to Opioids, as authorized by section 
7091 of the SUPPORT Act (P.L. 115-271). This program provides 
funding to hospitals and emergency departments to develop and 
implement alternative pain management protocols and treatments 
that limit the prescribing of opioids in emergency departments.
    Grants to Prevent Prescription Drug/Opioid Overdose and 
First Responder Training.--The Committee includes an increase 
of $4,000,000 for Grants to Prevent Prescription Drug/Opioid 
Overdose Deaths, and an increase of $15,000,000 for First 
Responder Training for Opioid Overdose Reversal Drugs, which 
includes an increase of $10,000,000 for a rural set-aside. Of 
the funds provided for First Responder Training, the Committee 
directs at least $10,000,000 to Rural Emergency Medical 
Services Training Grants. The Committee notes strong concerns 
about the increasing number of unintentional overdose deaths 
attributable to prescription and nonprescription opioids. The 
Committee urges SAMHSA to take steps to encourage and support 
the use of funds for opioid safety education and training, 
including initiatives that improve access for licensed health 
care professionals, including paramedics, to emergency devices 
used to rapidly reverse the effects of opioid overdoses. Such 
initiatives should incorporate robust evidence-based 
intervention training and facilitate linkage to treatment and 
recovery services.
    Improving Access to Overdose Treatment.--The Committee 
includes an increase of $500,000 to train and support health 
care providers and pharmacists on the prescribing of FDA 
approved drugs or devices for the emergency treatment of opioid 
overdose.
    Minority AIDS Initiative.--The Committee includes a total 
of $119,275,000, an increase of $3,276,000, across SAMHSA to 
expand access to effective, culturally competent, HIV/AIDS-
related mental health services in racial and ethnic minority 
communities, for people living with an SMI and who are living 
with or are at high risk for HIV/AIDS.
    Peer Support Technical Assistance Center.--The Committee 
includes an increase of $1,000,000 to provide technical 
assistance to recovery community organizations and peer support 
networks.
    Pregnant and Postpartum Women program.--The Committee 
includes an increase of $15,000,000 for the Pregnant and 
Postpartum Women program and recognizes SAMSHA for its work 
managing this program, which utilizes a family-centered 
approach to provide comprehensive residential SUD treatment 
services for pregnant and postpartum women, their minor 
children and other family members.
    Recovery Community Services Program.--The Committee 
includes an increase of $2,717,000 for the Recovery Community 
Services Program (RCSP) to help recovery communities strengthen 
their infrastructure and provide peer recovery support services 
to those in or seeking recovery from SUD. These funds will also 
support the Recovery Community Services Program Statewide 
Network (RSCP-SN) program to strengthen the relationships 
between recovery community organizations and their statewide 
networks of recovery stakeholders as key partners in the 
delivery of State and local treatment and recovery support 
services (RSS), as well as allied health systems through 
collaboration, systems improvement, public health messaging, 
and training conducted for (or with) key recovery stakeholder 
organizations. RCSP-SN grantees collaborate with traditional 
SUD treatment providers and other purchasers of PRSS to 
strengthen and embed these critical service elements as 
fixtures on the Recovery Oriented Systems of Care landscape.
    Screening, Brief Intervention, and Referral to Treatment.--
The Committee includes an increase of $3,000,000 for Screening, 
Brief Intervention, and Referral to Treatment (SBIRT). The 
Committee urges SAMHSA to continue working to ensure SBIRT 
screening is more widely adopted by health providers, and 
directs this increase be used for implementing grants to 
pediatric health care providers in accordance with the 
specifications outlined in section 9016 of P.L. 114-255, Sober 
Truth in Preventing Underage Drinking Reauthorization. Training 
grants should focus on screening for underage drinking, opioid 
use, and other drug use, and be managed by the Center for 
Substance Use Services within the existing SBIRT program. 
Grantees would train providers in screening children and 
adolescents for and offering brief interventions to discourage 
alcohol and other substance use; educating parents; diagnosing 
and treating alcohol use and other SUDs; and referring patients 
to other appropriate care, when necessary.
    Targeted Capacity Expansion-Medication Assisted 
Treatment.--The Committee includes an increase of $35,500,000 
for Medication Assisted Treatment (MAT) for Prescription Drug 
and Opioid Addiction; an increase of $4,500,000, for grants to 
Indian Tribes, tribal organizations, or consortia; and an 
increase of $224,000 for general Targeted Capacity Expansion 
activities. The Committee urges SAMHSA to require opioid 
treatment program applicants submit with their certification 
application, a description of outreach displaying that the 
applicant has properly notified the community of the treatment 
center location. The Committee recommends that outreach shall 
include community stakeholders including community board(s), 
tenant associations, residential and outpatient treatment SUD 
providers, health care providers, community-based organizations 
who provide opioid prevention services.
    Treatment Systems for Homeless.--The Committee includes an 
increase of $728,000 to support services for people with 
alcohol or another SUD and who are experiencing homelessness, 
including youth, veterans, and families.
    Treatment, Recovery, and Workforce Support.--The Committee 
includes an increase of $2,000,000 for Treatment, Recovery, and 
Workforce Support, as authorized by section 7183 of the SUPPORT 
Act (P.L. 115-271). This program will help implement evidence-
based programs to support individuals in SUD treatment and 
recover to live independently and participate in the workforce.
    Youth Prevention and Recovery Initiative.--The Committee 
includes $4,000,000 for the Youth Prevention and Recovery 
Initiative, as authorized by section 7102 of the SUPPORT Act 
(P.L. 115-271), to create a competitive grant program for 
health care providers and other entities to create SUD 
treatment and prevention programs that include the appropriate 
use of medications for opioid use disorder (MOUD) for 
adolescents and young adults. The Committee notes access to 
treatment for individuals experiencing SUD is critical. The use 
of MOUD has been shown to be a safe and effective treatment for 
SUD. However, access to MOUD for adolescents and young adults 
remains low. In order to provide MOUD to those who need it, 
adolescent health care providers must have the ability to 
prescribe these drugs and must also have access to the latest 
resources and training to be able to dispense MOUD safely and 
effectively.

State Opioid Response Grants

    The Committee includes $1,775,000,000 for State Opioid 
Response (SOR) grants, an increase of $250,000,000. The 
Committee further directs SAMHSA to ensure that these resources 
continue to be managed by State alcohol and drug agencies 
defined as the agency that manages the Substance Use Prevention 
and Treatment Block Grant under part B of title X of the PHS 
Act. This approach will ensure continuity of funding, effective 
coordination of efforts, and decrease fragmentation within each 
State system. The Committee supports efforts from SAMHSA 
through SOR grants to expand access to SUD treatments in rural 
and underserved communities, including through funding and 
technical assistance. The Committee encourages SAMHSA to 
continue to focus on expanding access to evidence-based MOUD in 
counties that lack providers who are actively dispensing or 
prescribing MOUD.
    SOR Funding Cliff.--The Committee remains concerned that 
longstanding guidance to the Department to avoid a significant 
cliff between States with similar mortality rates was 
overlooked in the award for fiscal year 2020 funds. When the 
determination of new award amounts is made in fiscal year 2023, 
the Committee urges the SAMHSA to award funds to avoid funding 
cliffs between States with similar mortality rates.

Substance Use Prevention and Treatment Block Grant

    The Committee includes a program level of $2,408,079,000 
for the Substance Use Prevention and Treatment Block Grant 
(SUBG), an increase of $500,000,000. SUBG provides funding to 
States to support alcohol and drug use prevention, treatment, 
and rehabilitation services. The Committee recognizes the 
critical role the block grant plays in State systems across the 
country, giving States the flexibility to direct resources to 
address the most pressing needs of localities across the State. 
The Committee also recognizes that the 20 percent prevention 
set-aside within the SUBG is a vital source of funding for 
primary prevention. The prevention set-aside represents an 
average of 62 percent of all State alcohol and drug agency's 
budget for primary prevention and is essential to ending the 
substance misuse crisis. In addition, the Committee includes 
new language to use HIV cases, as opposed to AIDS cases, to 
calculate the HIV set-aside in the SUBG.
    SUBG Recovery Set-Aside.--The Committee establishes a 10 
percent set-aside within total SUBG funding for the provision 
of evidence-informed SUD non-clinical recovery supports and 
services. The Committee directs SAMHSA to ensure that this set-
aside shall support programs that: 1) develop local recovery 
community support institutions including but not limited to 
recovery community centers, recovery homes, and recovery 
schools or programs to mobilize resources within and outside of 
the recovery community, to increase the prevalence and quality 
of long-term recovery from SUD; 2) provide peer-based recovery 
coaching, individual or group supports, to individuals and 
families led by those with lived experience with SUD, delivered 
in person or using technology; 3) provide ancillary community-
based supports necessary to sustain recovery, including access 
to transportation, job training, and educational services; 4) 
provide activities to reduce SUD recovery-related stigma and 
discrimination at the local level; and 5) provide technical 
assistance to organizations principally governed by people in 
recovery from SUD through facilitating financing, business 
functions and cross-training on evidence informed practices 
within the recovery community. The Committee directs SAMHSA to 
prioritize programs for underserved populations, to promote 
health equity, and to support community-based strategies to 
increase recovery capital and support individuals to sustain 
long-term recovery, as identified at the local, regional and/or 
State level by the recovery community. Funds from the recovery 
set-aside will help support operating costs for organizations 
that provide the above services, prioritizing those with 
leadership, staffing, and governance structures that include 
representation from those identified as in long-term recovery 
and impacted family members who reflect the community served.
    Block Grant Reporting Requirements.--The Committee 
acknowledges the important role of the Mental Health and 
Substance Use Prevention and Treatment Block Grants in 
supporting States' efforts to provide resources for expanded 
mental health and SUD treatment and prevention services. The 
Committee is concerned with the lack of transparency and 
information that is provided to Congress and the public about 
how States are distributing those funds and what programs or 
services they are going toward. The Committee continues to 
encourage SAMHSA to implement public reporting on their 
existing block grants. The Committee looks forward to receiving 
the report on data collection and reporting barriers requested 
in House Report 117-96.
    Fentanyl Awareness Education.--The Committee notes that the 
SUBG may be used to develop educational materials related to 
the dangers of fentanyl, including the lethalness of small 
quantities.
    Contingency Management.--The Committee is aware that 
contingency management, also known as motivational incentives, 
is an evidence-based treatment method for individuals with SUD, 
particularly for substances such as stimulants that currently 
have no FDA-approved pharmacological intervention. Current 
interpretation of Federal laws and regulations constrain the 
ability of individuals and entities to use Federal funding for 
appropriate contingency management program incentives. The 
Committee urges SAMHSA, in coordination with the Office of 
Inspector General, to reevaluate the limitations on the use of 
cash and cash-equivalent payments offered as part of 
contingency management in the treatment of SUD to better align 
them with current research.
    Data Collection for SUD Grants to States.--The Committee is 
aware that in November 2020, the GAO issued a report (GAO-21-
96) recommending that school-based drug prevention programs 
under SUBG and SOR better report how their activities 
contribute to the National Drug Control Strategy's prevention 
education goals. A GAO report issued in December 2021 (GAO-22-
104520) recommends further analysis and clarification of data 
collected through the SOR program. The Committee encourages 
SAMHSA to fully adopt the recommendations in these reports and 
requests an update in the fiscal year 2024 Congressional Budget 
Justification on the implementation of these recommendations.
    Evidence-Based Practices To Combat the Opioid Crisis.--The 
Committee directs SAMSHA to encourage States to use grant funds 
provided to combat the SUD crisis to prioritize evidence-based 
best practices exemplified by the States, including but not 
limited to: MAT, Overdose Education and Naloxone Distribution, 
Warm Handoff Protocols for Overdose Survivors Discharged from 
Emergency Rooms, and peer recovery support groups. The 
Committee directs that SAMHSA-funded SUD treatment and recovery 
activities shall include evidence-based, self-empowering, 
mutual aid recovery support programs that expressly support 
MAT.
    Evidence-Based Programs for People Experiencing 
Homelessness.--The Committee recognizes the importance of 
access to SUD treatment for individuals experiencing 
homelessness. The Committee encourages SAMHSA to prioritize 
disseminating evidence-based programs and treatments 
specifically tailored for those with SUD(s) and who are at a 
high risk of becoming homeless, and to consider grant 
applications that include targeting resources to address SUD 
within the homeless population.
    Medications for Opioid Use Disorder.--The Center for 
Substance Use Services is urged to include as an allowable use 
of funds (all FDA approved) medications for opioid use disorder 
(MOUD) and other clinically appropriate services to treat 
opioid use disorder.
    Opioid Use Disorder Relapse.--The Committee recognizes that 
return to use (or recurrence of symptoms) might occur after OUD 
treatment. The Committee appreciates SAMHSA's efforts to 
address this by emphasizing the importance of adherence to 
evidence-based practices that have been demonstrated to reduce 
the risk of return to use (or recurrence of symptoms) and 
encourages SAMHSA to disseminate and emphasize implementation 
of these practices in all settings where treatment is offered, 
including rehabilitation and criminal justice settings.
    Recovery Housing.--The Committee recognizes the importance 
of recovery housing, in which individuals abstain from use of 
non-prescribed substances in a supportive environment. In order 
to increase the availability of high-quality recovery housing, 
the Committee encourages SAMHSA to collaborate with other 
Federal agencies, including HUD, the Department of Labor, the 
Department of Justice, and the Bureau of Indian Affairs, to 
coordinate activities across the Federal government and develop 
recommendations to improve policies on recovery housing and 
support services spanning the continuum of care.
    SUD Response in Rural America.--The Committee encourages 
SAMHSA to support initiatives to advance SUD objectives in 
rural areas, specifically focusing on addressing the needs of 
individuals with SUD in rural and medically-underserved areas, 
and programs that stress a comprehensive community-based 
approach involving academic institutions, health care 
providers, and local criminal justice systems.

                   SUBSTANCE USE PREVENTION SERVICES

 
 
 
Appropriation, fiscal year 2022.......................      $218,219,000
Budget request, fiscal year 2023......................       311,912,000
Committee Recommendation..............................       248,434,000
    Change from enacted level.........................       +30,215,000
    Change from budget request........................       -63,478,000
 

    Within the total provided for Programs of Regional and 
National Significance, the Committee provides the following 
amounts:

------------------------------------------------------------------------
                                                            FY 2023
                   Budget Activity                         Committee
------------------------------------------------------------------------
Capacity:
    Strategic Prevention Framework...................       $137,484,000
        Strategic Prevention Framework Rx............         15,000,000
    Federal Drug-Free Workplace......................          4,894,000
    Minority AIDS Initiative.........................         43,170,000
    Sober Truth on Preventing Underage Drinking......         14,500,000
        National Adult-Oriented Media Public Service           2,000,000
         Campaign....................................
        Community Based Coalition Enhancement Grants.         11,500,000
        Interagency Coordinating Committee to Prevent          1,000,000
         Underage Drinking...........................
    Tribal Behavioral Health Grants..................         25,000,000
    At-Home Prescription Drug Disposal Demonstration.          5,000,000
Science and Service:
    Center for the Application of Prevention                  11,993,000
     Technologies....................................
    Science and Service Program Coordination.........          4,072,000
    Minority Fellowship Program......................          2,321,000
------------------------------------------------------------------------

    At-Home Prescription Drug Disposal Demonstration and 
Evaluation.--The Committee is aware that many unused and 
unwanted prescription opioids and other powerful medications 
remain in homes and are subject to diversion. The Committee 
includes $5,000,000 for an at-home drug deactivation and 
disposal demonstration and evaluation initiative and urges 
SAMHSA to make a diverse selection of grantees including urban, 
rural, and tribal government partners. The initiative will 
assess the effectiveness of drug disposal technologies that 
meet the standard in section 3032 of the SUPPORT for Patients 
and Communities Act (21 U.S.C. 355-1(e)(4)(B)).
    Center for the Application of Prevention Technologies.--The 
Committee includes an increase of $4,500,000 for the Center for 
the Application of Prevention Technologies. The Committee 
encourages SAMHSA to ensure eligibility for private, non-
profit, and regional organizations, including faith-based 
organizations for the Center for the Application of Prevention 
Technologies. The broad coalitions orchestrated by these 
regional organizations are uniquely positioned to supplement 
the work already being done by the State, tribal, and community 
organizations currently authorized for such grants.
    Eliminating Racial Disparities in Overdose Deaths.--The 
Committee is concerned with the rising rates of overdose deaths 
in communities of color, specifically among Black people. These 
racial disparities are made worse by the fact that access to 
treatment is often dependent on race, income, geography, and 
insurance status, rather than individual preferences, or 
medical or psychiatric indicators and needs. The Committee 
urges SAMHSA to scale programs in communities of color, 
including increased outreach capacity, to help eliminate racial 
disparities in overdose deaths and improve access to prevention 
and treatment services.
    PTSD in First Responders.--The Committee looks forward to 
receiving the report requested in House Report 117-96 that 
examines post-traumatic stress disorder (PTSD) in individuals 
working in civilian first responder disciplines of law 
enforcement, fire services, and emergency medical services.
    Sober Truth on Preventing Underage Drinking Act.--The 
Committee includes an increase of $2,500,000 for the Sober 
Truth on Preventing Underage Drinking (STOP) Act. Of this 
amount, the Committee includes an increase of $2,500,000 for 
the Community Based Enhancement Grant Program to help community 
coalitions address underage drinking.
    Strategic Prevention Framework.--The Committee provides an 
increase of $10,000,000 for the Strategic Prevention Framework 
(SPF). Of this amount, the Committee includes an increase of 
$5,000,000 for SPF for Prescription Drugs (SPF Rx).
    Tribal Behavioral Grants.--The Committee includes an 
increase of $4,250,000 to expand efforts to address the high 
incidence of substance misuse and suicide among AI/AN 
populations.

                HEALTH SURVEILLANCE AND PROGRAM SUPPORT

 
 
 
Appropriation, fiscal year 2022.......................      $291,658,000
Budget request, fiscal year 2023......................       181,073,000
Committee Recommendation..............................       288,707,000
    Change from enacted level.........................        -2,951,000
    Change from budget request........................      +107,634,000
 

    The Committee provides the following amounts for Health 
Surveillance and Program Support:

------------------------------------------------------------------------
                                                            FY 2023
                    Budget Activity                        Committee
------------------------------------------------------------------------
Health Surveillance..................................        $53,295,000
    PHS Evaluation Funds.............................         30,428,000
Program Support......................................         85,000,000
Public Awareness and Support.........................         13,260,000
Performance and Quality Information Systems..........         10,200,000
Drug Abuse Warning Network...........................         15,000,000
Behavioral Health Workforce..........................          1,000,000
    PHS Evaluation Funds.............................          1,000,000
------------------------------------------------------------------------

    Community Project Funding.--Within the funds included in 
this account, $110,952,000 shall be used for the projects, and 
in the amounts, specified in the table titled ``Labor, HHS, 
Education Incorporation of Community Project Funding Items'' at 
the end of this report.
    State Opioid Response Network-Technical Assistance.--The 
Committee directs SAMHSA to continue funding the State Opioid 
Response Network-Technical Assistance grant that funds the 
Opioid Response Network to provide locally based technically 
assistance teams within the administrative portion of the 
appropriated amounts for SOR grants. The Committee recognizes 
the essential work currently being done by the Opioid Response 
Network in delivering technical assistance to SOR grantees, 
sub-recipients and others addressing opioid use disorder and 
stimulant use disorder in their communities.

               Agency for Healthcare Research and Quality


                    HEALTHCARE RESEARCH AND QUALITY

 
 
 
Appropriation, fiscal year 2022.......................      $350,400,000
Budget request, fiscal year 2023......................       415,891,000
Committee Recommendation..............................       385,000,000
    Change from enacted level.........................       +34,600,000
    Change from budget request........................       -30,891,000
 

    The Committee includes $385,000,000 for the Agency for 
Healthcare Research and Quality (AHRQ), $34,600,000 above the 
fiscal year 2022 enacted level.
    AHRQ's mission is to produce evidence to make health care 
safer, higher quality, more accessible, equitable, and 
affordable, and to work within HHS and with other partners to 
make sure that the evidence is understood and used. AHRQ 
conducts, supports, and disseminates scientific and policy-
relevant research on topics such as promoting high-quality 
care, eliminating health care disparities, using information 
technology, and evaluating the effectiveness of clinical 
services.
    Within the total for AHRQ, the House includes the following 
amounts:

------------------------------------------------------------------------
                   Budget Activity                     FY 2023 Committee
------------------------------------------------------------------------
Scientific Support for the US Preventive Services             11,542,000
 Task Force..........................................
Digital Health Care Research.........................         16,349,000
Patient Safety Research..............................         99,615,000
Health Services Research, Data, and Dissemination....        110,312,000
Medical Expenditure Panel Survey.....................         71,791,000
Program Management...................................         75,391,000
------------------------------------------------------------------------

    Antimicrobial Resistance.--The Committee continues to 
provide no less than $10,000,000 for activities related to 
combating antibiotic-resistant bacteria.
    Center for Primary Care Research.--The Committee includes 
no less than $5,000,000 for the Center for Primary Care 
Research authorized at 42 USC 299b-4(b).
    Improving Maternal Morbidity and Mortality State and Local 
Data.--The Committee supports efforts described in the fiscal 
year 2023 budget request to improve the provision of timely and 
accurate data about maternal health and the health care system 
to policymakers, health care providers, and the public.
    Long COVID.--The Committee supports efforts described in 
the fiscal year 2023 budget request regarding health systems 
research on how to organize and deliver patient-centered care 
for people living with long COVID, including the use of digital 
and telehealth, providing needed mentoring and support to 
smaller communities to establish multidisciplinary clinics to 
care for people with complex cases of long COVID, and enhancing 
the ability of primary care practices to use emerging evidence 
to care for millions of Americans with long COVID.
    Diagnostic Safety.--The Committee includes no less than 
$20,000,000, a $10,000,000 increase above the fiscal year 2022 
enacted level and the fiscal year 2023 budget request, to fund 
AHRQ research, testing, and solutions to avoid diagnostic error 
and to support Diagnostic Safety Centers of Excellence to 
disseminate related findings. Funding provided will support 
eight centers, with each center focusing on specific 
conditions, populations, or settings of diagnostic safety as 
noted in the fiscal year 2023 budget request.
    Person-Reported Experience of Care Quality Maternal Health 
Measures.--The Committee is concerned that the U.S. spends 
significantly more per capita on childbirth than any other 
high-income nation, with costs estimated to be well over $50 
billion annually, and yet despite this expenditure ranks far 
behind almost all other high-income countries in birth outcomes 
for both mothers and babies, including high and deeply 
inequitable rates of preterm birth, low birth weight, and 
maternal and infant mortality. Quality measures are important 
drivers of quality improvement in health care, and their 
significance is growing in the context of increasing 
alternative payment model mechanisms for accountability. The 
portfolio of nationally-endorsed maternity care quality 
measures is small and includes no person-reported measures of 
the experience of receiving maternal-newborn care. Given 
widespread reports, especially among of people of color, of 
experiencing disrespectful maternity care, and of persistent 
inequitable health outcomes, the need for nationally-endorsed 
person-reported measures of maternity care to discern, track 
and improve maternal-newborn care experiences is crucial. The 
Committee strongly encourages AHRQ to develop maternity 
adaptations of the generic Consumer Assessment of Healthcare 
Providers and Systems surveys and other evidence-based 
assessment tools as necessary for facilities, health plans, and 
individual/group clinicians to fill these crucial gaps in 
maternal and newborn health measures. The Committee requests 
that the measures be designed to capture and reduce inequities 
and measure care across the continuum of maternity care 
providers and care settings, as well at the health plan level. 
Such measures will elevate birthing people's voices in 
standardized ways that foster accountability and quality 
improvement.
    Statewide Surgical Quality Initiatives.--The Committee is 
aware that several States have moved aggressively to combine 
the knowledge, skills, and resources of diverse hospitals 
across the State with the expertise of foundations, hospital 
associations, and other outside stakeholders to identify and 
disseminate best practices in surgical care. The goals of the 
collaborative are to improve surgical outcomes, improve the 
value (quality/cost) of surgical care, and decrease disparities 
in care. The Committee urges AHRQ to prioritize grants to 
States that have developed such collaborations and intend to 
expand by adding more hospitals and incorporate telehealth and 
mobile solutions into higher-value care.
    Trafficking Awareness Training for Health Care.--The 
Committee strongly encourages AHRQ to support activities 
authorized under the Trafficking Awareness Training for Health 
Care Act to award, on a competitive basis, grants or contracts 
to eligible entities to train health care professionals to 
recognize and respond to victims of a severe form of 
trafficking for purposes authorized under the Trafficking 
Awareness Training for Health Care Act. Medical professionals 
are in a unique position to identify abuse and help victims of 
trafficking, and this program will support training to enable 
them to do so.
    United States Preventive Services Task Force (USPSTF).--In 
fiscal year 2022, the Committee expressed its initial concerns 
about significant deficiencies in the process and structure of 
the USPSTF, as illustrated by its recommendations concerning 
screening mammography and cervical cancer screening. The 
Committee addressed the need for comprehensive USPSTF reform to 
ensure that its recommendations further public health for all 
Americans and address health inequities by outlining several 
recommendations. Within 120 days of enactment of this Act, the 
Committee requests an update from USPSTF on its implementation 
of the recommendations identified to reform its process for 
developing recommendations.
    The Committee also is concerned about the ability of the 
USPSTF to keep pace with medical innovation. Emerging and 
innovative screening modalities can further public health for 
all Americans and address health inequities by increasing 
access to and compliance with USPSTF recommended screenings. 
The Committee encourages USPSTF to utilize the Early Topic 
Update process described in the USPSTF procedure manual to 
review a recommendation on an enhanced timeframe upon a showing 
of new evidence. The Committee also encourages USPSTF to 
prioritize review of any new screening test or preventive 
medication approved or cleared by the FDA that is a preventive 
strategy or modality pertaining to but not included in a 
previous Task Force recommendation. In addition to 
prioritization, the Committee encourages the Task Force to act 
on such prioritization in a timely manner. Within 120 days of 
enactment of this Act, the Committee requests an update from 
USPSTF on its use of the Early Topic Update process.

                Centers for Medicare & Medicaid Services


                     GRANTS TO STATES FOR MEDICAID

 
 
 
Appropriation, fiscal year 2022...................      $368,666,106,000
Budget request, fiscal year 2023..................       367,357,090,000
Committee Recommendation..........................       367,357,090,000
    Change from enacted level.....................        -1,309,016,000
    Change from budget request....................                 - - -
 

    Medicaid provides health coverage to eligible populations, 
including eligible low-income adults, children, pregnant women, 
elderly adults, and people with disabilities. Medicaid is 
administered by States, according to Federal requirements. The 
program is funded jointly by States and the Federal government.
    This amount does not include $165,722,018,000, which was 
provided as advance funding for the first quarter of fiscal 
year 2023. In addition, the Committee recommends an advance 
appropriation of $197,580,474,000 for program costs in the 
first quarter of fiscal year 2024, to remain available until 
expended.
    The Committee continues bill language providing indefinite 
budget authority for unanticipated costs in fiscal year 2023. 
Federal Medicaid grants reimburse States for a portion of their 
expenditures in providing health care for individuals whose 
income and resources fall below specified levels. Subject to 
certain minimum requirements, States are provided certain 
limited authority within the law to set eligibility, coverage, 
and payment levels.

                PAYMENTS TO THE HEALTH CARE TRUST FUNDS

 
 
 
Appropriation, fiscal year 2022................         $487,862,000,000
Budget request, fiscal year 2023...............          548,130,000,000
Committee Recommendation.......................          548,130,000,000
    Change from enacted level..................          +60,268,000,000
    Change from budget request.................                    - - -
 

    This account includes the general fund subsidy to the 
Federal Supplementary Medical Insurance Trust Fund for Medicare 
Part B benefits, and Medicare drug benefits and administration, 
as well as other reimbursements to the Federal Hospital 
Insurance Trust Fund for benefits and related to administrative 
costs, which have not been financed by payroll taxes or premium 
contributions. The Committee continues bill language providing 
indefinite authority to pay the general revenue portion of the 
Medicare Part B premium match and providing resources for the 
Medicare Part D drug benefit program in the event that the 
annual appropriation is insufficient.

                           PROGRAM MANAGEMENT

 
 
 
Appropriation, fiscal year 2022.......................    $4,024,744,000
Budget request, fiscal year 2023......................     4,346,985,000
Committee Recommendation..............................     4,346,985,000
    Change from enacted level.........................      +322,241,000
    Change from budget request........................             - - -
 

    Note: The fiscal year 2022 appropriation includes funding 
provided in section 227 of P.L. 117-103.

Program Operations

    The Committee includes $2,957,300,000 for Program 
Operations, an increase of $122,477,000. This appropriation 
includes funding for Research, Demonstration, and Evaluation, 
which was previously funded on its own line. This office 
administers the programs under the Centers for Medicare & 
Medicaid Services (CMS), funds beneficiary outreach and 
education, maintains information technology infrastructure 
needed to support various claims processing systems, and 
supports other programmatic improvements.
    Access to Buprenorphine.--The Committee is concerned by 
reports of patients not being able to fill buprenorphine 
prescriptions at pharmacies. The Committee requests a briefing 
from CMS and OIG within 180 days of the date of enactment of 
this Act on the results of the current audits examining access 
to and use of medications for opioid use disorder (MOUD) and 
CMS's intended response.
    Advancements in Breast Reconstruction.--The Committee notes 
that reconstruction after mastectomy can have a significant, 
positive impact on the quality of life for breast cancer 
survivors. For this reason, the Women's Health and Cancer 
Rights Act (WHCRA) was enacted in 1998 to provide insurance 
protections to women choosing breast reconstruction after a 
mastectomy. The number of breast reconstructions performed in 
the U.S. has steadily increased over the past two decades. Over 
the same timeframe, significant technological procedure 
advancements have shifted the focus beyond cosmetic-only 
results to include the restoration of typical breast functions, 
such as sensation. Sensory restoration as a part of breast 
reconstruction can ultimately improve the overall physical and 
emotional health, safety, and quality of life for breast cancer 
survivors. The Committee directs CMS, in collaboration with 
other HHS agencies with necessary expertise, to study the 
landscape of surgical techniques and other procedures for 
breast reconstruction, and whether gaps exist in the insurance 
coverage provided by the WHCRA. The Committee requests an 
update in the fiscal year 2024 Congressional Budget 
Justification on this study.
    Adverse Childhood Experiences.--The Committee is aware that 
childhood trauma and toxic stress have been linked to negative 
health outcomes through adulthood, including higher rates of 
diabetes, stroke, depression, lapses in cognitive abilities, 
and developmental delays, suicide, and substance misuse, among 
other negative outcomes. Low-income children are particularly 
vulnerable to the impacts of adverse childhood experiences 
(ACEs). The Committee directs CMS to comply with the language 
included in House Report 116-450 which requires the agency to 
work with the National Child Traumatic Stress Network and the 
CDC to provide a report, no later than 180 days after the date 
of enactment of this Act, that evaluates how Medicaid could be 
further leveraged to screen, diagnose, and provide evidence-
based interventions to children ages 0-21 suffering from ACEs.
    Biosimilars.--The Committee is concerned about the lack of 
access to lower cost biosimilars to beneficiaries within the 
Medicare Part D program. The Committee encourages CMS to 
examine existing barriers to biosimilar adoption and to explore 
the development of policies that incentivize and facilitate the 
adoption of biosimilar to reduce prescription drug costs to 
patients and Medicare. The Committee urges CMS to provide 
beneficiary focused education on the availability, safety, and 
efficacy of biosimilars and the potential for lower out-of-
pocket costs. CMS should include this information in Medicare 
Plan Finder and in Real Time Benefit tools. CMS should also 
prioritize policies to accelerate the adoption of all 
biosimilars on Medicare Advantage and Part D formularies.
    Cardiac Computed Tomography.--The Committee notes that 
unstable and low Medicare payment for cardiac computed 
tomography (CT) services is contributing to significant 
disparity in access to this vital service among minority 
populations. The Committee requests a report within 90 days of 
the date of enactment of this Act on actions being taken by the 
agency to address this inequity.
    Certified Registered Nurse Anesthetists.--The Committee is 
aware that during the COVID-19 pandemic, Certified Registered 
Nurse Anesthetists (CRNAs) have been working under a waiver 
that expanded access to care for CRNA services. With the 
current workforce shortages in the healthcare industry, the 
Committee urges HHS to consider options to permanently extend 
waivers that will help best utilize the current workforce to 
improve access to care before the end of the COVID-19 public 
health emergency.
    Children's Mental Health.--The Committee is aware of 
reporting in recent years on trends in behavioral health 
services for children insured by Medicaid, including increased 
reliance on psychotropic medications without accompanying 
behavioral health services, a lack of home- and community-based 
services options, and children in Medicaid from racially/
ethnically diverse backgrounds being less likely than white 
children to use behavioral health services. The Committee 
requests a report within 180 days of the date of enactment of 
this Act on Medicaid spending for children, youth, and young 
adolescents on behavioral health, disaggregated by race and 
ethnicity. This report should include data on the settings in 
which children and youth receive services, the use of 
psychotropic medications in this population, a breakdown of 
mental health services and substance use services, and whether 
children who received outpatient treatment received care in 
their state of residence.
    Colorectal Cancer Screenings.--The Committee commends CMS 
for removing cost sharing requirements for patients for the 
removal of potential precancerous or cancerous polyps during a 
screening colonoscopy. However, the Committee urges CMS to 
explore options to fully remove any barrier to access to 
colonoscopies by also waiving cost-sharing requirements for 
beneficiaries that select a covered non-invasive colorectal 
screening test who receive a positive test result and require a 
colonoscopy. At home colorectal cancer screening tests are an 
important tool to encourage increased adoption of colorectal 
cancer screenings and should be treated equal to a screening 
colonoscopy under CMS's reimbursement policy.
    Compounded Medications.--The Committee continues to request 
a report, within 120 days of the date of enactment of this Act, 
assessing Medicare's current policy for Part D coverage of 
medications compounded using bulk drug ingredients.
    Consensus on Assessing Mobility.--The Committee encourages 
CMS and other stakeholders to promote development of consensus 
around a mobility assessment that is validated and clinically 
meaningful to providers and patients. In addition, CMS should 
evaluate feasibility of a mobility quality measure to 
incentivize providers to actively intervene to prevent mobility 
loss among hospitalized older adults.
    Contraceptive Access under the Affordable Care Act.--The 
Committee is concerned about access to care for patients 
seeking preventive services, including contraceptive services. 
The Committee directs CMS to engage in patient education to 
ensure patients understand their rights under the Affordable 
Care Act (ACA) to access (without cost sharing) the 
contraceptive product that is determined best for the patient, 
in consultation with their health care provider. In addition, 
the Committee directs CMS to engage with health care providers 
to disseminate the latest guidance on contraceptive access for 
patients, as well as how to help patients seek access to 
contraceptive services (without cost sharing) through a health 
insurance plan's exceptions process.
    Consumer Assistance Program.--The Committee encourages the 
Secretary to allocate up to $400,000,000 derived from ACA user 
fees to restore Consumer Assistance Program grants under 
section 1002 of the ACA.
    Cost-Sharing for Vaccines.--The Committee notes that 
minimizing cost sharing with Medicare Part D is critical to 
ensuring that Medicare beneficiaries have access to vaccines 
that can prevent serious disease. Studies have shown a direct 
correlation between cost sharing and increased abandonment 
rates of vaccines. To help reduce these barriers, the Committee 
encourages CMS to update the Medicare plan finder to clearly 
designate to consumers the plans that cover vaccines at no 
cost.
    Dementia Care Management Model.--The Committee urges the 
Center for Medicare & Medicaid Innovation (CMMI) consider how 
best to test a Medicare dementia care management model. The 
Committee encourages CMMI to continue working with stakeholders 
to find a way to test a value-based dementia care management 
model that could reach dementia patients across the stages and 
include coordinated care management and caregivers. The 
Committee requests an update not later than one year after the 
date of enactment of this Act on the progress for this model.
    Diabetes Self-Management Training Benefit.--The Committee 
is concerned that barriers to accessing the Medicare diabetes 
self-management training benefit, particularly among 
communities of color, have resulted in utilization by only five 
percent of newly diagnosed Medicare beneficiaries. The 
Committee looks forward to receiving the report addressing the 
barriers to accessing the diabetes self-management training 
benefit, as requested in House Report 117-96.
    Disability Clinical Care.--The Committee is aware of a 
recent National Council on Disability (NCD) report entitled 
``Enforceable Accessible Medical Equipment Standards--A 
Necessary Means to Address the Health Care Needs of People with 
Mobility Disabilities,'' which identified inaccessible medical 
equipment among the reasons for the susceptibility of people 
with disabilities to experience substandard health care, citing 
numerous studies documenting access barriers involving medical 
equipment and the health disparities experienced by millions of 
people with disabilities. NCD raised concerns that people with 
physical disabilities often postpone or delay care due to the 
inability to get onto exam tables and other diagnostic 
equipment and have to search for facilities that have such 
equipment. Relatedly, NCD has recently advised Congress and the 
Administration regarding the nexus between the lack of 
disability clinical care training for health care professionals 
and the well-documented health disparities experienced by 
people with disabilities. The Committee encourages CMS to 
examine including disability clinical care training and the 
availability of accessible medical and diagnostic equipment in 
its conditions of participation for Part A and Part B 
providers.
    Disproportionate Share Hospitals.--The Committee again 
encourages CMS to compile publicly available information on 
hospitals that receive payments under Medicaid as 
disproportionate share hospitals. Such information shall 
include the Medicaid inpatient utilization rate and low-income 
utilization rate. Within each category, CMS should further 
identify such hospitals by rural or urban status, number of 
beds, and status as a major teaching hospital.
    Domestic Manufacturing.--The Committee recognizes the 
importance of ensuring a robust U.S. manufacturing base and 
domestic supply chain to support Federal health programs. 
Therefore, the Committee urges CMS to develop and implement a 
pilot or demonstration program to identify innovative payment 
and reimbursement policies within Federal health care programs, 
including Medicare, Medicaid, and CHIP, to support the 
utilization of U.S. manufactured generic and biosimilar 
medications to ensure increased access and utilization of life-
saving and life-changing drugs.
    Drug Quality.--The Committee continues to be concerned 
about the discovery of dangerous levels of carcinogens in 
frequently prescribed medications, including angiotensin II 
receptor blockers (ARBs) like losartan and valsartan, 
ranitidine, and metformin. As two of the country's largest 
payers for prescription medication, Medicare and Medicaid have 
a responsibility to help ensure the safety and quality of 
prescribed therapies. The Committee reiterates its request for 
a report on the amount that the Medicare and Medicaid programs 
spent on medication in the previous three fiscal years that was 
subsequently recalled by manufacturers, as requested in House 
Report 117-96. The Committee also requests that CMS consider 
the potential value of increased chemical testing of medication 
in the U.S. supply chain and quality rating systems for drug 
manufacturers.
    Enhancing Access to Recommended Vaccines.--The Committee is 
concerned that current regulations implementing the Public 
Health Service Act's (PHSA) provisions regarding vaccine 
coverage and cost-sharing have caused uneven access to CDC-
recommended vaccines. The Committee encourages HHS, Department 
of Labor (DOL), and Department of the Treasury (Treasury) to 
act to ensure that its regulations fully implement section 2713 
of the PHSA, which ensures broad-based coverage of all CDC-
recommended vaccines without cost-sharing, including 
occupational and travel vaccines, regardless of whether the 
vaccine is recommended for routine use or placed on the CDC's 
Immunization Schedules.
    Ensuring Access to Lifesaving COVID-19 Oral Medications 
from Pharmacists.--The Committee is concerned with CMS's 
guidance ``Permissible Flexibilities Related to Oral Antiviral 
Drugs for Treatment of COVID-19 that May Receive U.S. Food and 
Drug Administration Emergency Use Authorization and are 
Procured by the U.S. Government,'' which only encourages, but 
does not require, Part D ``sponsors to consider paying a 
dispensing fee for these drugs that may be higher than a 
sponsor's usual negotiated dispensing fees given the unique 
circumstances during the public health emergency.'' The 
Committee is concerned about patients' access to these 
lifesaving medications and encourages CMS to review policy 
options for Part D sponsors to cover all the necessary services 
to ensure the safe pharmacy dispensing of COVID-19 oral 
medications.
    GAO Report on Health Care Consolidation.--The Committee 
recognizes the need for more research on consolidation in 
health care markets. As such, the Committee directs GAO to 
study the extent health care consolidation is taking place 
across Medicare and Medicaid, and how the involvement of 
private equity in healthcare could be contributing to 
consolidation. The Committee requests a briefing, including GAO 
and CMS, within 90 days of the date of enactment of this Act to 
discuss the scope and requirements of the study, and expects to 
receive regular updates from GAO about the status of the report 
and any initial critical findings.
    Geographic Practice Cost Index.--The Committee encourages 
CMS to publish its work on a rationale for current methodology 
for the Geographic Practice Cost Index so that the various 
inputs can be better understood. In addition, the Committee 
requests a briefing from the GAO within 90 days of the date of 
enactment of this Act on the results from the recent GAO report 
on geographic adjustments to Medicare physician payments (GAO-
22-103876).
    Graduate Medical Education.--The Committee notes that in 
section 126 of P.L. 116-260, Congress provided an additional 
1,000 new graduate medical education (GME) slots eligible for 
Medicare payment. In section 126, Congress specified four 
categories of hospitals eligible for additional GME slots: 
hospitals located in rural areas; hospitals currently training 
over their caps; hospitals located in States with new medical 
schools; and hospitals serving Health Professional Shortage 
Areas; however, when CMS released their final plan for the 
distribution of the 1,000 new slots, a ``super prioritization'' 
based on location of resident training was created that is not 
found in the statute. The Committee urges CMS to prioritize 
applications in fiscal year 2023 from any hospitals seeking to 
establish or expand residency training in certain needed 
specialties, such as primary care, geriatrics, and general 
surgery, as had been the priority with previous GME slot 
distribution programs.
    Hospitals in the U.S. Virgin Islands.--The Committee 
remains concerned that Medicare payments for hospitals in the 
U.S. Virgin Islands are calculated using out-of-date payment 
data and formulas under the Tax Equity and Fiscal 
Responsibility Act of 1982 (TEFRA). The two hospitals in the 
U.S. Virgin Islands are reimbursed based on 1982 and 1996 
costs. As a result, patients are forced to travel outside the 
territory for necessary services, including total joint 
replacements and chemotherapy, often at great expense and 
personal hardship. The Committee encourages CMS to update the 
TEFRA base period for these hospitals to more accurately 
reflect current conditions and costs.
    IMD Exclusion Pilot Program.--The Committee is aware that 
although HHS allows waivers to States allowing short-term stays 
in Institutions for Mental Disease (IMD) for mental health 
treatment, there are IMDs that provide care to thousands of 
individuals in acute psychiatric distress located in States 
without waivers. The Committee continues to urge CMS to pursue 
a pilot program, as outlined in House Report 117-96.
    IMD Exclusion Report.--The Committee continues to request a 
report, as included in House Report 117-96, examining how 
repealing Medicaid's IMD exclusion could affect access to and 
quality of mental health services, including mental health 
services for nonelderly, Medicaid-eligible adults. The report 
should include a cost estimate for repealing the exclusion.
    Infectious Disease Outbreaks.--The Committee requests a 
briefing within 90 days of the date of enactment of this Act on 
policy and administrative options, including a modifier to 
current evaluation and management (E/M) codes for infectious 
disease physicians and other types of clinicians, that CMS 
could take to reimburse clinicians for critical activities 
associated with managing infectious disease outbreaks that 
would automatically initiate payment to clinicians under the 
Physician Fee Schedule for services associated with these 
unanticipated events.
    Language Access.--The Committee recognizes the need to 
ensure that translated materials are culturally competent and 
written in a manner that can be adequately understood by 
limited English proficient populations (LEP). The Committee 
urges CMS to improve the quality and quantity of such 
materials, and consult community based organizations to help 
vet translated consumer-facing materials produced by CMS in at 
least the top 15 languages spoken by LEP people living in the 
United States. The Committee also encourages CMS to develop 
translation glossaries of common terms used within CMS programs 
in at least the top 15 languages spoken by LEP people.
    Limited Wraparound Coverage.--The Committee continues to 
remain concerned that the previous Administration allowed the 
limited wraparound coverage pilot program to expire. This 
failure has caused significant uncertainty for patients who 
depended on this program for several years. The Committee looks 
forward to receiving the report outlining a plan to ensure that 
participants impacted by the expiration of the pilot program 
will receive benefits equivalent to those of the limited 
wraparound coverage program as requested in House Report 117-
96. This report should include an analysis of the outcomes of 
the pilot program and an explanation for the decision by HHS, 
DOL, and Treasury not to extend it. The Committee continues to 
recommend this pilot program be made permanent and encourages 
the HHS, DOL, and Treasury to restore the program.
    Lowering the Cost of Care.--The agreement continues to 
encourage CMMI to consider creative pilot projects that lower 
the cost of care among older Americans and enable individuals 
who retire overseas to retain and utilize their Medicare 
primary healthcare benefits. The pilot should consider 
potential cost savings involving international collaborations 
where the quality of care is comparable and less expensive. The 
Committee requests an update on this effort in the fiscal year 
2024 Congressional Budget Justification.
    Maximizing Deceased Donor Organ Recovery, Acceptance, and 
Utilization.--The Committee supports full implementation of the 
CMS final rule for Organ Procurement Organizations (OPOs) 
Conditions for Coverage (CMS-3380-F), including efforts to 
decertify underperforming OPOs in advance of 2026 given the 
lives, Medicare costs, and urgent equity issues at stake. OPO 
failures are disproportionately borne by patients of color, 
which means OPO reform is an urgent health equity issue. This 
fact further emphasizes the need for effective implementation 
of the Final Rule, and to ensure effective and equitable OPO 
performance, the Committee encourages CMS to require OPO 
process data to be publicly available, in line with 
international best practice.
    Medicaid Dental Audits.--The Committee has previously 
raised concerns that failure to use professional guidelines or 
established State Medicaid manual parameters in the auditing 
process can result in inaccurate Medicaid dental audits, 
negatively impacting dentist participation in the program and 
impeding patient access to care. While State Medicaid agencies 
(SMA) have significant responsibility in managing provider 
audits, the Committee believes that as part of CMS oversight of 
the Medicaid program, it is appropriate to issue guidance to 
SMAs concerning best practices in dental audits and offer 
training in such practices. The Committee again urges CMS to 
develop such guidance for SMAs and looks forward to receiving 
the report on steps taken to develop such guidance as requested 
in House Report 117-96.
    Medicaid Parity in Territories.--The Committee supports the 
Administration's proposal to eliminate the Medicaid allotment 
caps for U.S. Territories and to align the territories' Federal 
matching rate to that of the States.
    Medicare Advantage and Long-Term Acute Care Hospitals 
(LTCHs).--The Committee is aware there is concern there are 
more barriers to LTCHs and Inpatient Rehabilitation Facilities 
(IRFs) in Medicare Advantage (MA) plans as compared to 
traditional Medicare. The Committee requests CMS review whether 
MA plan pre-authorization requirements and their use of 
proprietary or home-grown algorithms or admission criteria are 
consistent with current Medicare Part A coverage policy to 
protect MA enrollees' statutory right to comparable benefits. 
The review should also determine the validity of Medicare 
Advantage Plans denials of admissions to LTCH and IRF based on 
not offering the benefit of a Medicare approved level of care; 
verify that personnel being utilized by MA plans for pre-
authorizations and denials have the necessary specialized 
rehabilitation education and training when requests from LTCHs 
and IRFs are being reviewed; review MA plans' process to 
provide pre-authorization review and appeals for denials within 
reasonable amount of time of planned discharge, including 
weekends, to allow for accelerated transfer to LTCHs and IRFs 
when necessary; review transparency of MA plans on how they 
determine medical necessity, as well as the specific standards 
and guidelines that lead to a denial; review transparency of MA 
Plans with regard to medical necessity, the number of initial 
pre-authorization denials, the number of initial denials 
overturned, and the number of second level appeals for pre-
authorization for LTCHs and IRFs.
    Medicare Advantage Coverage of Substance Use Services.--The 
Committee is aware that enrollees of Medicare Advantage (MA) 
plans may face barriers to accessing timely and appropriate 
care for substance use disorder (SUD) compared to enrollees of 
other insurers. The Committee urges CMS to review how MA plans 
can improve access to care for SUD, including by measuring 
provider availability as part of network adequacy standards, 
such as by maintaining sufficient networks of providers for SUD 
and mental health care. The Committee also urges CMS to review 
how MA plans can improve access to care for SUD, including 
through reviewing level of care assessment tools that reflect 
generally accepted standards of care and informing 
beneficiaries of the plan's responsibility to arrange for 
medically necessary care outside of the network, but at in-
network cost sharing, if the covered service is not provided in 
network. The Committee requests a report in the fiscal year 
2024 Congressional Budget Justification on updates since the 
October 2020 report required by P.L. 115-271 on SUD treatment 
services that are provided by MA plans as supplemental 
benefits.
    Medicare Advantage Overpayments.--The Committee is 
concerned about the accuracy of CMS's payments to Medicare 
Advantage (MA) plans. The Committee urges CMS to consider 
making the following adjustments to MA plan payments: use the 
Demographic Estimate of Coding Intensity (DECI) model to 
evaluate the relationship of fee-for-service and MA risk scores 
for the overall system and plan sponsors; develop a Coding 
Intensity Adjustment (CIA) factors applied to MA payments using 
the DECI model; calculate the CIA factor to be used in MA 
Payments; set limits on the use of select factors and data for 
risk adjustment systems and risk score calculations; and use 
social determinants of health data in a potential new risk 
adjustment model. The Committee requests a report within 180 
days of the date of enactment of this Act analyzing the impact 
of these potential adjustments on the accuracy of payments to 
MA plans.
    Medicare Coverage of Behavioral Health Services.--The 
Committee is concerned there is insufficient Medicare coverage 
of community-based behavioral health services for individuals 
in crisis. The Committee requests a report in the fiscal year 
2024 Congressional Budget Justification on addressing the scope 
of Medicare coverage of behavioral health services for 
outpatient behavioral and mental health services. This report 
should include information on the total amount of Medicare 
spending on behavioral and mental health services in calendar 
years 2019 through 2021 by site of service, the amount spent on 
each code for services that could be furnished to individuals 
in behavioral or mental health crisis, and the provider types 
that billed for these services.
    Medicare Coverage of Home-based Extended Care Services.--
The Committee encourages CMS to consider options to improve 
extended care services for Medicare beneficiaries, such as 
through home-based extended care by home health agencies.
    Medicare Coverage of Medicines to Treat Obesity.--The 
Committee notes that access to obesity treatment, including 
anti-obesity medication is an important part of the 
Administration's effort to combat chronic disease, reduce 
health care costs and improve care. Obesity is associated with 
over 200 comorbid conditions and is a driver of health care 
costs and poor health outcomes for patients with heart disease, 
Alzheimer's, diabetes, cancer, among many others, and is a top 
modifiable risk factor for serious COVID-19 outcomes. 
Furthermore, consistent with the President's Executive Order on 
Advancing Racial Equity, the Committee acknowledges that 
obesity is a chronic disease that disproportionately impacts 
communities of color. Therefore, consistent with the 
Administration's priorities, the Committee believes and that it 
is a matter of health equity and key to reducing modifiable 
risk factors for cancer and Alzheimer's disease, to ensure that 
seniors have access to obesity treatments under Medicare Part D 
to complement coverage of intensive behavioral therapy and 
bariatric surgery under Medicare Part B. The Committee 
encourages CMS to ensure access to treatments for obesity in 
Part D by clarifying that an agent for ``weight loss'' does not 
include an FDA-approved anti-obesity agent as classified by the 
United States Pharmacopeia Drug Classification system.
    Mental Health Parity.--The Committee was pleased to see the 
2022 Mental Health Parity and Addiction Equity Act (MHPAEA) 
Report to Congress from HHS, DOL, and Treasury implementing 
section 203 of Division BB of P.L. 116-260. The report points 
out, however, that several health insurance plans and issuers 
failed to accurately and timely submit comparative analyses on 
nonquantitative treatment limits (NQTLs). This has resulted in 
HHS, DOL, and Treasury being unable to issue final 
determinations of non-compliance, thus limiting enforcement of 
MHPAEA. The Committee urges the Secretary of HHS, jointly with 
DOL and Treasury, to complete its determinations of non-
compliance and make public the findings related to NQTLs found 
to be in violation of MHPAEA. While it is encouraging that 
plans and issuers chose to remove problematic provisions 
voluntarily, the report suggests there has been sufficient 
denial of mental health services through the use of NQTLs.
    Navigators.--The Committee strongly supports the Navigators 
program, which helps consumers understand their health coverage 
options and sign up for health insurance coverage during 
enrollment periods. The Committee urges CMS to return to 
providing robust funding for Navigator activities.
    Neonatal Opioid Withdrawal Syndrome.--The Committee 
recognizes the increasing incidence of neonatal opioid 
withdrawal syndrome (NOWS) in the United States, including 
increasing hospital stays and rates of NOWS among Medicaid-
covered births. The Committee is concerned there are currently 
no quality measures for NOWS and prenatal opioid exposure, and 
requests a report within 180 days of the date of enactment of 
this Act on recommendations for quality measures to be 
implemented for improving the quality, safety, value, and 
consistency of care for newborns with opioid-exposure, 
including NOWS. In developing these recommendations, CMS should 
consider how they can be used to advance health equity and 
promote person-centered care. The Committee encourages CMS to 
consider these recommendations in the next Child Core Set 
annual update.
    Nuclear Medicine Quality Improvement.--The Committee is 
aware of evidence demonstrating the occurrence and consequence 
of extravasations in nuclear medicine procedures. These events 
can harm patients through compromised imaging that negatively 
affects care, repeated or additional procedures, increased 
costs, and unintended irradiation to patient tissue. The 
Committee supports CMS engagement with outside stakeholders on 
the issue.
    Obesity and Comorbidities.--The Committee notes obesity is 
a disease, and it leads to serious and costly health issues, 
including diabetes, heart disease, stroke, certain chronic 
liver diseases like nonalcoholic steatohepatitis, and some 
types of cancer. Comprehensive management of obesity requires 
both lifestyle changes and physician-guided support including 
access to innovative pharmacological treatments. The Committee 
requests additional information in the fiscal year 2024 
Congressional Budget Justification on how policies in Medicare 
could be improved to help reduce obesity and its comorbidities 
for those Americans who require clinical interventions and 
reduce the racial and ethnic disparities in health care 
outcomes for beneficiaries suffering from obesity.
    Ovarian Cancer Testing.--The Committee recognizes that 
ovarian cancer is the only gender-specific cancer with greater 
than 50 percent mortality rate, and accounts for more deaths 
than any other cancer of the female reproductive system, 
especially among women of color. African American women have a 
62 percent five-year mortality rate compared to 54 percent for 
Caucasian women. The most commonly used detection method may 
miss ovarian cancer 37 to 67 percent of the time in African 
American women. Asian Pacific Islanders have a higher risk of 
developing ovarian clear cell cancer, Hispanic women are 
diagnosed with ovarian cancer at an earlier age than non-
Hispanic groups, and there are significant regional differences 
in the incidence and mortality of ovarian cancer among Native 
American women in the United States. FDA-cleared medical 
innovations that use multi-marker testing for ovarian cancer 
can improve early detection in women, and especially women of 
color, but are not universally reimbursed. The Committee 
recommends CMS cover and pay for multi-marker testing related 
to ovarian cancer for Medicare beneficiaries. In addition, the 
Committee requests a report not later than 180 days after the 
date of enactment of this Act with the status and timeline for 
a national coverage determination for multi-marker tests for 
ovarian cancer.
    Patient Access to Home Health Care.--The Committee supports 
the intent of the network adequacy rules of CMS for Medicare 
Advantage organizations and for Medicaid managed care 
organizations under 42 C.F.R. 438 and 457 to maintain a network 
of qualified providers sufficient to provide adequate access 
for covered services to meet the health care needs of the 
patient population served. The Committee requests a report 
within 180 days of the date of enactment of this Act on 
regulatory actions related to network adequacy.
    Patient Advocate Program.--The Committee is concerned about 
barriers hospitalized patients face during time of discharge 
and the subsequent coordination of care at discharge. Patients 
from historically underserved racial and cultural groups suffer 
the greatest challenges in terms of care coordination. While 
some patients are able to contribute to the decision making 
process regarding healthcare, there are other patients who are 
unable to fully comprehend the coordination of care at 
discharge, including: access to nurse case managers, social 
workers, and/or mental health care providers. The number of 
patients assigned to a nurse case manager or social worker is 
high. Therefore, an additional level of patient advocacy and 
support is critical to the ongoing coordination of safe patient 
care at discharge from acute care and/or acute rehabilitation 
facilities. The Committee recommends $10,000,000 for the 
development of a patient advocacy program to support improved 
coordination of care and improve patient care outcomes for all 
patients discharged from acute care or acute rehabilitation 
settings. The Committee also requests a report within 180 days 
of the date of enactment of this Act to assess barriers to 
coordination of care for hospitalized patients, address 
disparities by race, ethnicity, and culturally responsive care. 
In addition, the Committee makes these recommendations to 
improve patient access to care within a hospital and/or acute 
rehabilitation setting.
    Pediatric ESRD Services.--The Committee recognizes that 
children with end stage renal disease (ESRD) have unique care 
needs and require services that are not typically required by 
adult ESRD patients, including specialized nursing care, 
nutritional support, social workers, and child life 
specialists. The Committee commends CMS for focusing on 
pediatric case-mix adjustment in its December 2020 technical 
expert panel and requesting information on the adequacy of 
reimbursement for pediatric services in the request for 
information included in the calendar year 2022 End Stage Renal 
Disease Prospective Payment System Proposed Rule. The Committee 
requests an update in the fiscal year 2024 Congressional Budget 
Justification on progress towards establishing adequate bundled 
payments for pediatric ESRD services.
    Peripheral Artery Disease.--The Committee is aware that an 
estimated 20 million Americans have peripheral artery disease 
and about 200,000 of them, disproportionately people of color, 
suffer avoidable amputations every year as a result. The 
Committee urges CMS to raise public awareness in Medicare 
beneficiaries and providers of racial disparities in 
amputations due to peripheral artery disease, diabetes, and 
related comorbidities through a nationwide awareness and 
education campaign. Further, the Committee encourages the 
Secretary to establish an interagency working group in 
coordination with CMS, the Indian Health Service (IHS), and the 
Department of Veterans Affairs (VA) and to study the 
implementation of a comprehensive amputation reduction program 
within CMS and IHS based on the VA Preventing Amputations in 
Veterans Everywhere Program. The Committee directs the 
Secretary to provide recommendations not later than one year 
after the date of enactment of this Act on how to reduce 
amputations.
    Pharmacists and Patient Care Services.--The Committee is 
aware that certain Medicare Part B services and care frameworks 
have provisions to include pharmacists and their patient care 
services. However, CMS has few mechanisms to identify and 
evaluate the contributions of pharmacists to patient care and 
outcomes or to identify barriers within current service 
requirements that prevent scalable involvement of pharmacists. 
The Committee encourages CMS to create a mechanism to provide 
greater visibility into the scope and outcomes of the Medicare 
services currently provided by pharmacists.
    Pharmacist-Provided Incident to Physician Services.--The 
Committee is pleased with CMS's recognition in the calendar 
year 2021 physician fee schedule (PFS) final rule (FR 84583) 
that ``pharmacists could be considered QHPs [qualified health 
care professionals] or clinical staff, depending on their role 
in a given service,'' and that ``new coding might be useful to 
specifically identify these particular models of care.'' 
However, the Committee remains concerned with current CMS PFS 
requirements restricting physicians' and nonphysician 
practitioners' (NPPs) utilizing pharmacists under incident to 
models to bill at the lowest E/M code (99211), with an 
estimated time commitment of 7 minutes. The Committee 
understands this restriction has diminished providers' 
engagement with pharmacists in team-based care models across 
the country. CMS should consider how to ensure physicians and 
NPPs can optimize the use of pharmacists. The Committee 
encourages CMS identify mechanisms to attribute, report, and 
sustain pharmacists' patient care contributions to 
beneficiaries in the Medicare Part B program.
    Programs of All-Inclusive Care for the Elderly.--The 
Committee notes during the COVID-19 pandemic, Programs of All-
Inclusive Care for the Elderly (PACE) have been effective in 
keeping their medically complex, nursing home eligible 
population safe at home. PACE organizations furnish all 
Medicare and Medicaid covered services, long term care and 
supports, meals and other services as needed by participants, 
principally in participants homes. PACE participants have had 
one-third the COVID-19 cases and deaths as compared to the 
rates of nursing home residents. The Committee urges CMS to 
consider moving forward on PACE-specific pilots in fiscal year 
2023, so this community-based model of care may be evaluated as 
to whether it increases access and affordability for Medicare 
or Medicaid beneficiaries.
    Psychosocial Rehabilitation Model.--The Committee is 
concerned about the high prevalence of loneliness and social 
isolation among Americans with severe mental illness (SMI), 
especially given the body of research indicating that these 
factors, along with other social determinants of health, can 
strongly affect mental and physical health outcomes for this 
population. The Committee encourages CMS to explore alternative 
payment models that better reflect the significant health, 
economic, and overall societal benefits associated with 
alleviating social isolation among people with SMI. The 
Committee encourages CMS to consider how CMMI could integrate 
the value associated with reducing social isolation for people 
with SMI in current and future value-based models; how the 
Center for Clinical Standards of Quality could identify 
patient-reported outcome measures related to social isolation 
and loneliness that could be included in current and future 
value-based models; and how the Center for Medicaid and CHIP 
Services (CMCS) could encourage State Medicaid agencies to 
contract with payers that offer comprehensive psychosocial 
rehabilitation services that reduce social isolation and 
improve quality of life for people with SMI.
    Radiation Oncology Model.--Despite the delay in 
implementation, the Committee is concerned that the radiation 
oncology (RO) model as currently proposed could potentially 
reduce access to certain types of radiation therapy and 
negatively affect patient outcomes. The Committee looks forward 
to the report on the RO model requested in House Report 116-
450. In addition, the Committee encourages CMS to work with 
stakeholders to develop a RO model that supports patients 
access to care, patient quality, and the Medicare trust funds.
    Rare Diseases.--The Committee recognizes patients with rare 
and ultra-rare diseases experience significant challenges, and 
such challenges are likely to impact marginalized communities 
and communities of color disproportionately. The Committee 
requests a report within 180 days of the date of enactment of 
this Act on barriers to accessing treatments, diagnostics, 
clinicians, especially specialists, in both conditions 
affecting fewer than 20,000 patients, and in communities of 
color affected by diseases with fewer than 200,000 patients. 
The report should include an assessment of any legal, improper 
payment, and fraud implications of any denials of care for 
these patients, as well as recommendations for addressing any 
barriers to accessing treatments for such patients.
    Robotic Stereotactic Radiosurgery.--The Committee continues 
to support robotic stereotactic radiosurgery (SRS) and robotic 
stereotactic body radiation therapy (SBRT). The Committee urges 
CMS to maintain sufficient payment for SRS and SBRT to ensure 
viability in both the freestanding and hospital outpatient 
setting, including in both traditional fee-for-service Medicare 
as well as in the context of any alternative payment models 
developed by CMS.
    Rural Pharmacies.--The Committee recognizes the importance 
of rural pharmacies in dispensing medications, providing care, 
educating patients, ensuring patient safety, and responding to 
the COVID-19 pandemic. The Committee is concerned that 
insufficient reimbursement and payments, increasing costs of 
operation, and narrowing profit margins threatens the viability 
of pharmacies in rural areas. The Committee requests a report 
within 180 days of the date of enactment of this Act that 
includes a review and assessment of the reimbursement and 
payment options for rural pharmacies.
    Saline Shortage.--The Committee notes the FDA has 
recognized a shortage of saline solution since at least 2013, 
when it was included on the FDA drug shortage list. Saline 
solution is delivered to patients through intravenous (IV) 
pumps. The shortage of saline highlights a potential risk for 
routine health care delivery and critical care during trauma 
events. The Committee encourages CMS to coordinate with the FDA 
and complete its coverage and payment reviews of products 
related to new classes of resuscitation fluids as expeditiously 
as possible.
    Site Neutral Reimbursement.--The Committee remains 
concerned with the financial impact of the Site Neutral Payment 
Rule on access to care, health disparities, and hospital 
finances for Sole Community Hospitals and other hospitals in 
underserved areas. The Committee encourages CMS to consider 
restoring payment rates for Sole Community Hospitals with 
excepted off-campus provider-departments.
    Social Determinants of Health.--The Committee is aware that 
social determinants of health are critical drivers of health 
outcomes and health care costs and that early childhood 
development is affected by social factors. The Committee 
commends CMS for the guidance on social determinants issued to 
States in January 2021 and encourages CMS to continue to 
clarify and disseminate strategies that States can implement 
under current Medicaid and Children's Health Insurance Program 
(CHIP) authority, or through waivers, to address social 
determinants of health (SDOH) in the provision of health care, 
including strategies specifically targeting the pediatric 
population. This should include guidance on how States can 
encourage and incentivize managed care organizations to address 
SDOH through contracts.
    Social Determinants of Health Analytics.--The Committee is 
encouraged that Medicare Advantage (MA) and Medicaid Managed 
Care Organizations (MCOs) have stated an intent to employ 
strategies to address SDOH, and the Committee supports work on 
SDOH given historic inequities that have existed among at-risk 
populations like communities of color and rural communities. 
However, in constructing SDOH-based recommendations for 
beneficiaries, many health plans are regularly using what is 
described as ``consumer data,'' which includes clinical, 
social, economic, behavioral, and environmental data that is 
individually identified, sometimes combining or allowing other 
entities to combine it with protected medical information 
governed by Health Insurance Portability and Accountability Act 
of 1996. The Committee requests a report within 180 days of the 
date of enactment of this Act on efforts by CMS to ensure the 
transparency by MA and MCO plans in the use of data of 
beneficiaries in addressing SDOH, how CMS ensures that MA and 
MCO plans notify beneficiaries of the use of protected or 
consumer data, and how ongoing CMS work with MA and MCOs around 
SDOH and the use of consumer data and protected medical 
information aligns with and improves health equity as per the 
goals of Executive Order 13985 and the HHS's Equity Action 
Plan.
    Sole Community Hospitals.--The Committee appreciates that 
CMS, during the COVID-19 public health emergency (PHE), waived 
distance requirements to ensure Sole Community Hospitals were 
able to focus on maintaining access to needed health care 
services for Medicare beneficiaries. The Committee encourages 
CMS to consider utilizing its regulatory flexibilities to 
provide a transition period for hospitals that may have fallen 
out of compliance with Sole Community Hospital requirements 
during the PHE.
    State All Payer Claims Databases.--The Committee includes 
sufficient funding to support grants of $1,000,000 to up to 25 
eligible States under section 320B of the PHS Act for the first 
year of activities to establish a State All Payer Claims 
Database (APCD) or improve an existing State APCD. These grants 
will support the work the Agency for Healthcare Research and 
Quality and the Assistant Secretary for Planning and Evaluation 
are currently conducting on APCD infrastructure.
    STI Screening and Treatment Initiative.--The Committee 
continues to be concerned with the high rates of sexually 
transmitted infections (STIs) among young adults and pregnant 
women. As STIs continue to rise, reaching this vulnerable 
population is critical to curb the spread of these diseases. 
The Committee urges CMS to collaborate with the CDC's Division 
of STD Prevention to develop a screening, treatment, and 
education initiative under the Medicaid program.
    Supplemental Liquid Oxygen.--The Committee notes reports of 
ongoing supplemental oxygen shortage exacerbated by the 
increase in patients with COVID-19 and long COVID. The 
Committee is concerned about reports of Medicare beneficiary 
barriers to liquid oxygen for home and community use. The 
Committee encourages HHS to evaluate options to ensure the 
long-term availability of supplemental liquid oxygen.
    Supportive Services through Medicaid.--The Committee 
recognizes the importance of supportive services for 
individuals with a substance use or mental health disorder. 
Supportive services, like peer support workers, help people 
stay in treatment or recovery and avoid recurrence of substance 
use. The Committee urges CMS to continue working with States to 
incorporate support services, including peer support services, 
supportive employment services, and tenancy support services, 
into State Medicaid plans or waivers of such plans in a way 
that promotes sustainability of services and aligns with the 
best available evidence and contributes to supporting the full 
spectrum of treatment and recovery support services for 
behavioral health conditions.
    Telehealth and Health Care Access.--The Committee requests 
a report in the fiscal year 2024 Congressional Budget 
Justification on the impact of telehealth on health care 
access, utilization, cost, and outcomes, broken down by race, 
ethnicity, sex, age, disability status, and zip code under the 
Medicaid program and CHIP.
    Transportation for Dialysis.--The Committee continues to 
strongly urge CMS to delay further implementation of the Prior 
Authorization of Repetitive, Scheduled Non-Emergent Ambulance 
Transport model until it ensures appropriate alternative 
transportation to dialysis services and diabetes-related wound 
care for low-income beneficiaries who have no other means of 
transportation. The Committee further requests a plan within 90 
days of the date of enactment of this Act to provide 
alternative transportation to the low-income Medicare-Medicaid 
full and partial dual eligibles who have no alternative 
transportation to dialysis and diabetes wound care services.
    Utilization Management for MOUD.--The Committee recognizes 
that frontline medical provider experience and research 
increasingly indicate that individuals who take oral 
buprenorphine for opioid use disorder (OUD) may benefit from 
doses higher than 24mg. The population of individuals who may 
need higher doses of buprenorphine to prevent cravings is 
expected to increase as fentanyl continues to proliferate the 
illicit opioid market. The Committee is aware that State 
Medicaid programs may have in place utilization management 
practices, including those that require a prior authorization 
before prescribing oral buprenorphine above 16mg or 24mg daily. 
The Committee requests that CMS examine State utilization 
management requirements related to oral buprenorphine, and 
whether such requirements unnecessarily delay access to 
treatment.
    Utilization of Z Codes for Social Determinants of Health.--
The Committee commends CMS for publishing a report on the 
Utilization of Z codes for SDOH among Medicare FFS 
beneficiaries. As the report notes, the COVID-19 pandemic has 
disproportionately affected underserved communities. The 
Committee is concerned about whether the current Z codes 
definitions are expansive and specific enough to track the SDOH 
impacting underserved communities. To help reduce these 
barriers, the Committee encourages HHS to update the current Z 
code definitions and establish a national standard to review 
SDOH to ensure physicians nationwide use the same tools to 
analyze SDOH. The Committee requests a briefing within 180 days 
of the date of enactment of this Act on the current utilization 
of Z codes, how HHS suggests the Z codes definitions could be 
updated to better track SDOH impacting underserved communities 
and recommendations on how to increase the utilization of Z 
codes.
    Whole Child Health.--The Committee recognizes that SDOH 
influence health outcomes, particularly for children. The 
Committee further recognizes that the COVID-19 pandemic has 
placed additional social stressors on children and their 
families and has negatively impacted pediatric mental health. 
The Committee commends CMS for testing the Integrated Care for 
Kids Model and for its guidance on social determinants issued 
to States in January 2021. The Committee urges the CMCS to 
establish a whole child health demonstration program to address 
the health and social factors impacting children served by 
Medicaid and CHIP and to improve health equity. This 
demonstration program should include pediatric value-based care 
models and locally driven strategies to align financial 
incentives and resources across Medicaid and other public and 
private programs and resources. The Committee requests a report 
within 180 days of the date of enactment of this Act on the 
plan to establish the demonstration program, including cost 
estimates for implementation.
    Whole Genome Sequencing Guidance for Medicaid and CHIP 
Programs.--The Committee understands there is a growing body of 
evidence that whole genome sequencing (WGS), whole exome 
sequencing, and gene panel testing can save lives and save 
money when used to diagnose infants and children who are 
suspected of having a rare genetic disease. Under ``Project 
Baby Bear,'' a pilot program in California's Medicaid program, 
the use of rapid WGS helped physicians more accurately identify 
the exact cause of rare genetic diseases. The Committee also 
understands that other States are pursuing or considering 
similar initiatives. The Committee encourages CMS to develop 
guidance for State health officials on best practices for 
incorporating WGS, whole exome sequencing, and gene panel 
testing into their Medicaid and CHIP programs as a first-line 
diagnostic for infants and children who are suspected of having 
rare genetic diseases in the inpatient setting. This guidance 
should also include advice for States on how to encourage 
managed care organizations to cover WGS, whole exome 
sequencing, and gene panel testing for this population. The 
Committee requests a report within 180 days of the date of 
enactment of this Act on steps taken to develop such guidance. 
In addition, the Committee understands there are undiagnosed 
diseases that do not require hospital inpatient care. 
Therefore, the Committee encourages CMS to issue guidance on 
the Early and Periodic Screening, Diagnostic and Treatment 
(EPSDT) Benefit on the usage of WGS, whole exome sequencing, 
and gene panel testing.

State Survey and Certification

    The Committee provides $494,261,000 for State Survey and 
Certification activities, an increase of $96,927,000. State 
Survey and Certification supports certifications of Medicare 
and Medicaid certified health care facilities to ensure that 
beneficiaries receive care at facilities that meet health, 
safety, and quality standards required by CMS.

Federal Administration

    The Committee provides $895,424,000 for Federal 
Administration activities related to the Medicare and Medicaid 
programs, an increase of $122,891,000. Federal Administration 
funding supports CMS staff, along with operating and 
administrative expenses for information technology, 
communication, utilities, rent and space requirements, as well 
as administrative contracts.
    Quality Improvement Organizations.--The Committee does not 
support the Administration's proposal to shift personnel costs 
to the Federal Administration account that have previously been 
funded by a mandatory appropriation.

              Health Care Fraud and Abuse Control Account


 
 
 
Appropriation, fiscal year 2022.......................      $873,000,000
Budget request, fiscal year 2023......................       899,000,000
Committee Recommendation..............................       899,000,000
    Change from enacted level.........................       +26,000,000
    Change from budget request........................             - - -
 

    The Health Care Fraud and Abuse Control Account (HCFAC) 
funds support activities conducted by CMS, the HHS Office of 
Inspector General, and the Department of Justice (DOJ). This 
appropriation includes a base amount of $323,000,000 and an 
additional $576,000,000 through a discretionary budget cap 
adjustment provided to meet the terms of H. Res. 1151. This is 
$26,000,000 above the fiscal year 2022 enacted level.
    This funding is in addition to other mandatory funding 
provided through authorizing legislation. The funding will 
provide resources to continue efforts for Medicaid program 
integrity activities, for safeguarding the Medicare 
prescription drug benefit and the Medicare Advantage program, 
and for program integrity efforts related to these programs 
carried out by the DOJ.
    Care Denials.--The Committee strongly encourages CMS to 
increase investigations of inappropriate care denials by 
private insurance companies.
    Senior Medicare Patrol.--The Committee includes $35,000,000 
for the Senior Medicare Patrol program. The Committee continues 
to include modified bill language to enable the Secretary to 
fund the Senior Medicare Patrol program, which is administered 
by the Administration for Community Living, from either 
discretionary or mandatory funds provided to this account.

                Administration for Children and Families


  PAYMENTS TO STATES FOR CHILD SUPPORT ENFORCEMENT AND FAMILY SUPPORT 
                                PROGRAMS

 
 
 
Appropriation, fiscal year 2022.......................    $2,795,000,000
Budget request, fiscal year 2023......................     2,883,000,000
Committee Recommendation..............................     2,883,000,000
    Change from enacted level.........................       +88,000,000
    Change from budget request........................             - - -
 

    The Committee also recommends $1,300,000,000 in advance 
funding, as requested, for the first quarter of fiscal year 
2024 to ensure timely payments for Child Support Enforcement 
programs. These programs support State-administered programs of 
financial assistance and services for low-income families to 
promote their economic security and self-sufficiency.

                   LOW INCOME HOME ENERGY ASSISTANCE

 
 
 
Appropriation, fiscal year 2022.......................    $3,800,304,000
Budget request, fiscal year 2023......................     3,975,304,000
Committee Recommendation..............................     4,000,000,000
    Change from enacted level.........................      +199,696,000
    Change from budget request........................       +24,696,000
 

    The Committee recommends $4,000,000,000 for the Low Income 
Home Energy Assistance program, which is $199,696,000 above the 
fiscal year 2022 enacted level and $24,696,000 above the fiscal 
year 2023 budget request. The Low Income Home Energy Assistance 
Program (LIHEAP) supports eligible families and households 
through programs providing assistance with energy costs.
    In addition to funding made available in this bill, the 
Committee notes that the Infrastructure Investment and Jobs Act 
(P.L. 117-58) provided $500,000,000 in LIHEAP funding over five 
fiscal years, with $100,000,000 made available each fiscal year 
through September 30, 2026, to support eligible families with 
home energy costs.
    Hold Harmless.--While the Committee recognizes that 
progress has been made in recent years to limit annual 
decreases in State allocations to no more than three percent of 
what a State received in the previous year, the Committee 
continues to believe that all States have unmet needs and that 
all States benefit from the consistency of annual 
appropriations when the overall account is unchanged or 
increased. To correct this volatility and hold States, 
territories, and Tribes (funded through the States) harmless 
from annual reductions, the bill includes language directing 
the Administration for Children and Families (ACF) to 
distribute, at a minimum, no less than the amount of funding to 
each State, territory, and Tribe as was appropriated in the 
Consolidated Appropriations Act, 2022.
    Technical Assistance.--The Committee recommends a 
$1,700,000 increase for HHS to establish a system to automate 
the formulation process to enable ACF staff to provide 
estimates more readily when requested by the Committee.

                     REFUGEE AND ENTRANT ASSISTANCE

 
 
 
Appropriation, fiscal year 2022.......................    $6,425,214,000
Budget request, fiscal year 2023......................     6,327,843,000
Committee Recommendation..............................     7,979,346,000
    Change from enacted level.........................    +1,554,132,000
    Change from budget request........................    +1,651,503,000
 

    The Office of Refugee Resettlement (ORR) programs are 
designed to help refugees, asylees, Cuban and Haitian entrants, 
and trafficking victims become employed and self-sufficient. 
These programs also provide for care of unaccompanied children 
in Federal custody and survivors of torture.
    Funding for several of the programs within this account is 
highly dependent on estimates and as such, it is critical that 
ORR communicate changes to estimated numbers of arrivals and 
costs as they become available. The Committee directs ORR to 
provide monthly updates of arrivals each month by category, 
including refugees, asylees, Cuban and Haitian entrants, 
Special Immigrant Visas, and unaccompanied children, to include 
any updates in estimated funding needs as a result of changes 
in trends in those categories.
    Within the total, the Committee includes the following:

------------------------------------------------------------------------
                   Budget Activity                     FY 2023 Committee
------------------------------------------------------------------------
 Transitional and Medical Services...................       $760,000,000
Victims of Trafficking...............................         35,000,000
Refugee Support Services.............................        450,000,000
Unaccompanied Children...............................      6,714,346,000
Survivors of Torture.................................         20,000,000
------------------------------------------------------------------------

Transitional and Medical Services

    The Committee includes $760,000,000, which is $196,000,000 
above the fiscal year 2022 enacted level. The Transitional and 
Medical Services (TAMS) program provides grants to States and 
nonprofit organizations to provide refugees and other eligible 
populations with up to eight months of cash and medical 
assistance.

Victims of Trafficking

    The Committee includes $35,000,000 for the Victims of 
Trafficking program, which is $5,245,000 above the fiscal year 
2022 enacted level. The recommendation includes $5,500,000 for 
the National Human Trafficking Hotline.
    The Committee appreciates that the Office on Trafficking in 
Persons (OTIP) has integrated legal services into its 
comprehensive case management grant programs and encourages ACF 
to continue to increase access to legal services for both 
foreign national victims and U.S. citizen and legal permanent 
resident victims, consistent with demonstrated need.

Refugee Support Services

    The recommendation includes $450,000,000, which is 
$142,799,000 above the fiscal year 2022 enacted level. The 
Refugee Support Services (RSS) program provides formula and 
competitive grants to States and nonprofit organizations to 
address barriers to employment and help refugees become self-
sufficient.
    The Committee urges ORR to engage with the Department of 
Housing and Urban Development and Department of State on ways 
to align Federal efforts and reduce administrative costs across 
refugee support programs to maximize the efficient provision of 
safe housing and other services for eligible populations.

Unaccompanied Children

    The Committee includes $6,714,346,000 for the Unaccompanied 
Children (UC) Program, which is equal to the amount requested 
in the fiscal year 2023 budget request (including both 
discretionary and contingency funding). The Committee notes 
that the request is approximately $1,300,000,000 below the 
amount that was provided for the program in fiscal year 2022, 
despite the continued impacts of COVID-19 and the high numbers 
of children seeking refuge at the Southern border. The 
Committee provides the funding requested for fiscal year 2023 
with the understanding that the reduction of funding (compared 
to fiscal year 2022) is the result of strategic improvements 
ORR is making to plan for additional capacity when there are 
surges in arrivals, and the sustained focus on efforts to 
discharge children safely and expeditiously to vetted sponsors. 
The Committee recommends this funding level with the 
understanding that ORR will continue its commitment to invest 
in a network of licensed beds to the greatest extent possible, 
increase oversight and monitoring of all shelters, expand 
services for children while they are in care and post-release, 
and importantly, to maintain the closure of emergency intake 
sites.
    The Committee continues to stress the critical importance 
of increased services to children, and provides not less than 
$650,000,000, an increase of $92,000,000 over the fiscal year 
2022 enacted level, for legal services, post-release services, 
and child advocates. The Committee directs ORR to report 
regularly the number of referrals from CBP, and to continue to 
provide quarterly reports on the number of children receiving 
services from legal service providers, the number receiving 
post-release legal and social services, and the number who are 
appointed child advocates, including the number of children on 
the waitlist for any of these services, in accordance with the 
directive in House Report 116-450. The Committee expects ORR to 
set targets for the number and percentage of children that will 
be provided such services so that the Committee can ensure that 
the number of children with access to such services 
significantly increases over fiscal year 2022.
    Age-Outs.--The Committee continues to direct ORR to develop 
tangible post-18 plans for every 17-year-old unaccompanied 
child in ORR care at least two weeks in advance of their 18th 
birthday to ensure that an appropriate non-secure placement, 
along with any necessary social support services, has been 
identified for the child prior to discharge from ORR.
    Case Management and Community Support Services.--The 
Committee expects HHS to coordinate with DHS to provide an 
analysis of existing case management programs, including the 
Alternatives to Detention Case Management pilot program being 
administered by the DHS Office of Civil Rights and Civil 
Liberties, and to promptly brief the Committee within 180 days 
of enactment of P.L. 117-103. The Committee remains concerned 
that case management programs accountable only to U.S. 
Immigration and Customs Enforcement may negatively impact the 
ability and willingness of community-based organizations to 
directly contract for community-based support services, and 
encourages HHS to evaluate which agencies or offices within HHS 
may be well-positioned to ensure that individuals and families 
receiving short term assistance upon entry can receive 
referrals for longer term community-based case management 
services through HHS when requested.
    Child Advocates.--The recommendation includes $12,000,000 
for ORR to expand Child Advocate services and to ensure that 
child advocates are appointed to particularly vulnerable 
children, including victims of abuse or trafficking, children 
12 years old and younger, children in residential treatment 
centers, children seeking review of their release or placement, 
pregnant and parenting children, children with disabilities or 
complex medical conditions, and children who are expected to 
remain in ORR custody for prolonged periods of time. The 
Committee encourages ORR to ensure that child advocates are 
able to communicate and share information essential to 
protecting a child's best interests with the child and the 
child's attorney. The recommendation continues language waiving 
matching requirements, and provides an increase in funding for 
the program to more than offset previous matching requirements.
    To ensure that child advocates have the visibility and 
capacity to be appointed to the most pressing cases in ORR 
custody, the Committee strongly urges ORR to proactively share 
census data from each facility with child advocates on a 
consistent basis. Such census should list the names, ages, 
countries of origins, languages, and lengths of stay of each 
child in the program, which will help child advocates identify 
the children in greatest need.
    Children with Prolonged Stays.--The Committee continues to 
direct ORR to submit a report every six months on the number of 
children who have been in ORR custody longer than a year. Such 
report should include how long each child has been in ORR 
custody and a status update on their case, including whether 
the child has any family or other potential sponsor(s) in the 
United States and a summary of ORR's efforts to place the child 
with a sponsor or in a long-term foster care setting. The 
Committee directs ORR to ensure that a care provider is taking 
all steps necessary to place every child in a home as 
expeditiously as possible and that no child is unaccounted for, 
resulting in prolonged detention.
    Communicating With Congress.--The Committee expects HHS to 
notify the Committee prior to making any administrative or 
policy changes expected to impact the number of children in ORR 
custody; shelter operations; the placement of children with 
sponsors; or any post-release services.
    Community-Based Facilities.--The Committee directs ORR to 
prioritize new grant or contract funding to small-scale, 
community-based residential care placements. As ORR adds State-
licensed capacity to its network, the Committee expects that no 
less than 50 percent of beds added to the network be in small-
scale shelters, transitional foster care, small group homes, or 
long-term foster care. The Committee further directs ORR to 
ensure there is an adequate supply of long-term foster care 
beds in the network to minimize the time it takes for a child 
to be moved to this least restrictive placement.
    In addition, ORR is directed to notify the Committee prior 
to all new funding opportunity announcements, grant or contract 
awards, or plans to release or acquire property. Further, the 
Committee strongly encourages ORR to post funding opportunity 
announcements more consistently and predictably, and to provide 
training and technical assistance to potential new providers.
    Legal Services.--The Committee supports the continued 
expansion of independent legal services for unaccompanied 
children and notes that services provided by independent and 
qualified legal counsel to unaccompanied children increase the 
efficiency, effectiveness, and fairness of immigration 
proceedings, significantly reduce the failure-to-appear rate of 
children who are released from HHS custody, and help relieve 
the immigration court backlog. The recommendation includes 
funding and direction for ORR to ensure in-person ``Know Your 
Rights'' and legal screenings for every child in custody, and 
for the continued expansion of direct representation for 
released unaccompanied children. The Committee emphasizes the 
vital importance of legal services for unaccompanied children 
both during ORR custody and following release and expects post-
release direct representation to be made available to children 
up to funded capacity, without restrictions related to age 
while in ORR care; release date; estimated time to conclude a 
case; or other characteristics, provided the representation is 
initiated while the individual is still a minor.
    The Committee expects legal services to be in person absent 
exigent circumstances, such as for a public health emergency, 
and expects ORR to ensure that there is sufficient confidential 
space available for legal services at all facilities, including 
emergency or influx facilities. When services must be provided 
remotely, ORR shall make sufficient technology and confidential 
space available for communication via video whenever possible, 
or via telephone if necessary.
    In addition, the Committee strongly encourages ORR to work 
with legal service providers to develop a strategy to minimize 
the risks of any child having to go to immigration court 
without independent legal counsel. Within the amount for 
services for children, the recommendation includes up to 
$8,300,000 for legal service providers to recruit and train 
additional attorneys for the purposes of building the capacity 
necessary to provide independent representation to 
unaccompanied children with pending immigration cases.
    Mental Health Services.--The Committee appreciates the 
steps that ORR has taken to improve mental health services for 
children in its custody and urges ORR to further expand mental 
health services and the use of other interventions, and to 
provide in-person and continuous training to ORR-contracted 
staff on the specialized needs of children in ORR's care. The 
Committee directs ORR to work with residential care service 
providers, child welfare experts, and other stakeholders with 
relevant expertise to ensure compliance with Federal, State and 
local codes related to the standards of care or the well-being 
of young children and children with disabilities, and to 
develop policy guidelines regarding residential care and 
specialized, trauma-informed practices for the aforementioned 
groups of children, including regarding appropriateness of 
residential treatment centers as a form of residential care. 
The Committee directs ORR to include in its fiscal year 2024 
Congressional Budget Justification information on these 
efforts, including details and metrics on the types of training 
offered to staff to ensure appropriate care is available for 
young children, children with disabilities, and children with 
mental health needs.
    Non-Parental Relatives.--The Committee strongly supports 
efforts to reduce the amount of time a child may be separated 
from a family member when referred from CBP as unaccompanied 
even though the child arrived at the border with a non-parental 
relative. The Committee further supports ORR's efforts to 
improve efficiency, including by deploying HHS staff to DHS 
facilities for the purposes of verifying relationships and 
initiating the sponsor suitability process for adult family 
members claiming a Category 2a or 2b relationship with the 
child (or children) with whom they arrived.
    Office of the Ombudsperson.--The Committee continues to 
support efforts to increase and improve independent oversight 
of the UC program through the establishment of an Office of the 
Ombudsperson. The Committee expects the briefing required in 
accordance with the Joint Explanatory Statement that 
accompanied P.L. 117-103 to include a strategy for 
establishment of the Office, including estimates of the 
resources necessary to do so. The Committee includes up to 
$10,000,000 for establishment of the Office.
    Post-Release Services.--The Committee includes an increase 
in funding for post-release services to enhance and extend case 
management services to more children to assist them with school 
enrollment; access to legal services, health care, mental 
health and community services; and to provide counseling to the 
child and families in the initial period after release. The 
Committee urges ORR to engage with current family reunification 
service providers, post-release service providers, and recently 
released children and sponsors to discuss needed services, the 
length of services, and how to improve coordination between 
shelters, providers and other community services providers, to 
help evaluate the current program, to identify new risks and 
opportunities for improvement.
    In addition to children already designated under law or 
policy to receive such services, the Committee encourages ORR 
to ensure that all pregnant or parenting teens, children whose 
primary language is neither English nor Spanish, as well as 
children who faced separation from a parent or legal guardian 
at the U.S.-Mexico border, are referred for post-release 
services. ORR should arrange for such services to be provided 
by non-governmental organizations with experience and expertise 
in working with these children. The Committee urges ORR to 
develop and make public on its website the criteria for how 
children are prioritized for post-release services, and the 
number of children receiving services in each fiscal year.
    Protection of Genetic Information.--The Committee continues 
to prohibit any governmental agency or private entity from 
accessing, using, or storing any genetic material, data, or 
information collected in this reunification effort, including 
for the purpose of criminal or immigration enforcement. Any 
genetic material, data, or information obtained by a government 
agency or private entity should be destroyed after testing and 
the probability of a genetic relationship is calculated. The 
entities conducting DNA testing shall obtain the consent of any 
individual over age 18 prior to testing, and shall make every 
effort to obtain the consent of a guardian prior to testing 
anyone under age 18. The Committee requests ORR continue to 
include in its annual Congressional Budget Justification the 
steps it is taking to protect the privacy and genetic material 
and data of individuals who are being tested as part of 
reunification efforts.
    Spend Plan.--The bill includes a general provision 
requiring the Secretary of HHS to continue to submit a 
comprehensive spend plan to the Committee every 60 days. The 
plan should continue to include a report on facilities, by 
facility type, including facility-specific data including 
number of licensed beds; operating status (open or not yet 
open); whether a facility is operated by a for-profit or non-
profit company; and the availability of such facilities to 
legal, medical and social service resources.
    Tender Age Children.--The Committee directs ORR to include 
in the fiscal year 2024 Congressional Budget Justification 
information on efforts to ensure developmentally appropriate 
care is available for tender age children. The justification 
should detail how placement options, services, and staff 
training are tailored for tender age children, as well as an 
assessment of the circumstances under which very young children 
are referred to ORR.
    Unlicensed Facilities.--The Committee understands the 
challenges facing HHS in ensuring sufficient State-licensed 
shelter capacity amid the ongoing COVID-19 pandemic and high 
numbers of children seeking protection at the Southern border. 
The Committee recognizes and shares HHS's commitment to 
ensuring that unaccompanied children are not subject to 
prolonged detention in U.S. Customs and Border Protection (CBP) 
facilities--however, the Committee strongly supports the 
medical, psychological, and child welfare advocacy communities 
in their compelling arguments against, and well-founded reasons 
to limit, the use of any unlicensed facilities, especially 
large-capacity temporary shelters where large numbers of 
children reside in the same space and where access to services 
may be limited. The Committee acknowledges that ORR has 
discontinued the use of emergency intake sites--including by 
expanding services at some of those sites to meet influx 
standards--but continues to have concerns about how ORR will 
ensure that influx facilities maintain standards that are 
robust and comprehensive. The Committee directs ORR to submit, 
within 120 days of enactment of this Act, a report detailing 
plans to ensure independent, third-party monitoring of all 
unlicensed facilities to verify their compliance with required 
standards, as well as a plan for licensure for all unlicensed 
facilities, or a comparable plan for how ORR can independently 
verify that each such facility has satisfied requirements 
equivalent to applicable State licensing standards while such 
facilities are in use.
    In addition, the Committee is aware of actions recently 
taken by certain States that remove, exempt, or threaten to 
strip ORR facilities of State licenses and important safety and 
monitoring mechanisms. The Committee urges HHS to ensure State 
actions do not undermine the safety and well-being of 
unaccompanied children, and the Committee expects ORR to take 
steps to ensure third-party oversight and monitoring of 
affected ORR facilities, commensurate with State-licensed 
monitoring and oversight requirements and timelines. As part of 
the report requested above, the Committee directs ORR to 
include a section on the actions it is taking to appropriately 
monitor and oversee operations of any facilities affected by 
such State actions.

Survivors of Torture

    The Committee includes $20,000,000 for the Survivors of 
Torture program, which is $2,000,000 above the fiscal year 2022 
enacted level. The program funds non-profit organizations 
providing healing and support services to refugees, asylees and 
asylum seekers, who need help overcoming the effects of 
torture.

   PAYMENTS TO STATES FOR THE CHILD CARE AND DEVELOPMENT BLOCK GRANT

 
 
 
Appropriation, fiscal year 2022.......................    $6,165,330,000
Budget request, fiscal year 2023......................     7,562,000,000
Committee Recommendation..............................     7,165,330,000
    Change from enacted level.........................    +1,000,000,000
    Change from budget request........................      -396,670,000
 

    The Committee recommends $7,165,330,000 for the Child Care 
and Development Block Grant (CCDBG) program, which is 
$1,000,000,000 above the fiscal year 2022 enacted level. The 
Committee strongly supports the commitment in the budget to 
allot three percent for Indian Tribes, in addition to the set-
aside of $184,960,000 included in this Act. The CCDBG provides 
funds according to a formula to States, territories, and Tribes 
to provide financial assistance to help low-income working 
families and families engaged in training or education 
activities access child care and to improve the quality of 
child care for all children.
    Child Care Facilities Needs Assessment.--The Committee 
appreciates that ACF has been conducting a feasibility study to 
determine how States could conduct needs assessments of their 
child care and early education facilities and requests a 
briefing within 30 days of enactment of this Act on the results 
of that analysis, including an estimate of the resources 
necessary to fund such Statewide needs assessments.
    Early Childhood Educator Workforce Pipeline.--The Committee 
encourages the Department of Health and Human Services to work 
with the Department of Education and the Department of Labor to 
develop and implement a strategy for strengthening the early 
educator workforce pipeline, including in the child care 
sector.
    Home-Based Providers.--The Committee recognizes the value 
of home-based providers to the field of child care, and directs 
ACF to develop and disseminate guidance clarifying authorities 
under existing law for use of CCDBG funds to support home-based 
child care providers, including relative providers, and offer 
examples of initiatives currently underway in States to do so.
    Homelessness Data.--The Committee encourages OCC to provide 
technical assistance to and conduct monitoring of States to 
improve the quality and completeness of the data States are 
required to collect on the homelessness status of children 
receiving childcare subsidies. The Committee expects OCC to 
annually publish on its website data gathered regarding 
homelessness status and related demographic data.

                      SOCIAL SERVICES BLOCK GRANT

 
 
 
Appropriation, fiscal year 2022.......................    $1,700,000,000
Budget request, fiscal year 2023......................     1,700,000,000
Committee Recommendation..............................     1,700,000,000
    Change from enacted level.........................             - - -
    Change from budget request........................             - - -
 

    The Social Services Block Grant provides grants to States 
by formula. States have the flexibility to determine what 
services and activities are supported, provided they are 
targeted at a broad set of goals, including reducing or 
eliminating poverty, achieving or maintaining self-sufficiency, 
and preventing neglect, abuse, or exploitation of children and 
adults.

                CHILDREN AND FAMILIES SERVICES PROGRAMS

 
 
 
Appropriation, fiscal year 2022.......................   $13,438,343,000
Budget request, fiscal year 2023......................    15,311,822,000
Committee Recommendation..............................    15,167,344,000
    Change from enacted level.........................    +1,729,001,000
    Change from budget request........................      -144,478,000
 

    The Children and Families Services programs fund activities 
serving children, youth, families, the developmentally 
disabled, Native Americans, victims of child abuse and neglect 
and domestic violence, and other vulnerable populations.
    The Committee recommends the following amounts:

------------------------------------------------------------------------
                                                            FY 2023
                   Budget Activity                         Committee
------------------------------------------------------------------------
Programs for Children, Youth, and Families
    Head Start.......................................    $12,396,820,000
    Preschool Development Grants.....................        350,000,000
    Runaway/Homeless Youth...........................        133,000,000
    Abuse of Runaway Youth Prevention................         22,000,000
    State Child Abuse Prevention.....................        110,000,000
    Discretionary Child Abuse Prevention.............         41,000,000
    Community-based Child Abuse Prevention...........         75,000,000
    Child Welfare Services...........................        273,735,000
    Child Welfare Training...........................         38,984,000
    Adoption Opportunities...........................         50,000,000
    Adoption Incentives..............................         75,000,000
    Social Services Research and Demonstration.......        101,679,000
    Native American Programs.........................         63,762,000
Community Services
    Community Services Block Grant...................        800,000,000
    Community Economic Development...................         22,383,000
    Rural Community Facilities.......................         12,000,000
Domestic Violence Hotline............................         27,360,000
Family Violence/Battered Women's Shelters............        300,000,000
Chafee Education and Training Vouchers...............         45,257,000
Disaster Human Services Case Management..............          2,364,000
Program Direction....................................        227,000,000
------------------------------------------------------------------------

Head Start

    The Committee recommends $12,396,820,000 for the Head Start 
program, which is $1,360,000,000 above the fiscal year 2022 
enacted level and $193,366,000 above the fiscal year 2023 
budget request. Head Start and Early Head Start promote school 
readiness of children under 5 from low-income families through 
education, health, social and other services.
    Cost-of-Living Adjustment.--The Committee recommends 
$596,000,000 for a cost-of-living adjustment.
    Early Head Start (EHS) Expansion and Early Head Start-Child 
Care (EHS-CC) Partnerships.--The Committee includes 
$500,000,000 to expand Head Start and Early Head Start programs 
for eligible children and families. The Committee understands 
that the EHS-CC Partnership grant program was designed to 
enhance the quality of child care to better meet the needs of 
working families, and supports the program's appreciation for 
how Head Start can be critically helpful to meeting those 
needs. However, the Committee is aware of certain communities 
for which there are significant barriers to establishing the 
EHS-CCP model and expects grants for EHS expansion or EHS-CC 
partnerships to be awarded based on the unique needs of each 
community with due consideration of local feasibility. The 
Committee requests a briefing within 30 days of enactment of 
this Act, on how the Office of Head Start (OHS) can promote the 
EHS-CCP model without awarding funding based on a predetermined 
spending level, and in a way that does not disadvantage 
communities where EHS-CCP is infeasible. The Committee urges 
OHS to ensure that the program is not expanded in a way that 
excludes children and babies whose parents do not qualify for 
child care, or pregnant women.
    The Committee continues to direct ACF to include in the 
fiscal year 2024 Congressional Budget Justification and each 
Congressional Budget Justification thereafter, the actual and 
estimated number of funded slots for each of the following: 
Head Start, EHS, and EHS-CC Partnerships.
    Migrant and Seasonal Head Start.--The Committee is 
concerned by reports that an increasing number of farmworker 
families with young children are finding it difficult to 
qualify for Migrant and Seasonal Head Start (MSHS) services 
despite regulatory flexibilities available to the program in 
the Head Start Act. The Committee is concerned that 2019 
enrollment data indicates that MSHS programs may not be 
utilizing these flexibilities to the maximum extent allowable 
and urges the Secretary to continue to work with individual 
MSHS programs to maximize flexibilities related to income 
eligibility where under-enrollment is an issue. Within 120 days 
of enactment of this Act, the Committee directs OHS to provide 
a comprehensive list of the MSHS programs reporting under-
enrollment in fiscal years 2021 and 2022 and to include program 
specific data on the percent of enrollees determined eligible 
by the allowable flexibilities (as outlined in the Report to 
Congress on Head Act Eligibility, April 2022), so that the 
Committee can better understand the eligibility issues facing 
MSHS programs and can continue to discuss any further actions 
that may be necessary.
    Quality Improvement Funding.--The Committee includes 
$262,000,000 in quality improvement funding. The Committee 
strongly believes the flexibility provided by this funding is 
necessary for Head Start programs to meet the local needs of 
programs, and expects funding to be prioritized for recruiting 
and retaining quality staff and improving facilities and 
classroom environments to support high quality program 
services, and address the rise of adverse childhood 
experiences.
    Tribal Colleges and Universities-Head Start Partnership 
Program.--The Committee includes $8,000,000 for the Tribal 
Colleges and Universities (TCU)-Head Start Partnership Program.

Preschool Development Grants

    The Committee recommends $350,000,000 for Preschool 
Development Grants, which is $60,000,000 above the fiscal year 
2022 enacted level. This program provides grants to States to 
build State and local capacity to provide preschool for 4-year-
olds from low-and moderate-income families.
    The Committee encourages ACF to continue to support States 
that choose to use a portion of their renewal grant funding to 
award sub-grants to programs in a mixed delivery system across 
the State, particularly for low-income and disadvantaged 
children prior to entering kindergarten, or to improve the 
quality of local programs through the enhancement of early 
childhood systems.

Runaway and Homeless Youth

    The Committee recommends $155,000,000 for the Runaway and 
Homeless Youth (RHY) program, which is $14,717,000 above the 
fiscal year 2022 enacted level and $4,951,000 above the fiscal 
year 2023 budget request.
    The Committee supports the ability of grantees to provide 
prevention services regardless of enrollment in residential 
services, and urges the program to remind grantees that they 
are not required to enroll a young person in shelter or 
residential services, nor require the young person to 
physically travel to the grantee's location, in order for the 
young person who is deemed at risk of running away or becoming 
homeless to be eligible to receive prevention and supportive 
services, including counseling and case management.
    The program is encouraged to notify applicants if grant 
applications were successful at least 30 days before the grant 
is to begin, or no less than 30 days before an existing grant 
is set to end.
    The Committee strongly urges the program to ensure that 
service delivery and staff training comprehensively address the 
individual strengths and needs of youth, as well as be language 
appropriate, gender appropriate (interventions that are 
sensitive to the diverse experiences of male, female, and 
transgender youth and consistent with the gender identity of 
participating youth), and culturally sensitive and respectful 
of the complex social identities of youth (e.g., race, 
ethnicity, nationality, age, religion/spirituality, gender 
identity/expression, sexual orientation, socioeconomic status, 
physical or cognitive ability, language, beliefs, values, 
behavior patterns, or customs). The Committee strongly believes 
that no runaway youth or homeless youth should be excluded from 
participation in, be denied the benefits of, or be subject to 
discrimination under, any program or activity funded in whole 
or in part under the Runaway and Homeless Youth Act, based on 
any of the conditions outlined in this paragraph.

State Child Abuse Prevention

    The Committee recommends $110,000,000 for Child Abuse 
Prevention and Treatment Act (CAPTA) State Grants, which is 
$14,909,000 above the fiscal year 2022 enacted level.

Child Abuse Discretionary Activities

    The Committee recommends $41,000,000 for Child Abuse 
Discretionary Activities, which is $5,000,000 above the fiscal 
year 2022 enacted level.
    Child Abuse Hotline.--The recommendation includes 
$2,000,000 for ongoing support for a national child abuse 
hotline to provide resources and intervention in all 
modalities, including chat, text, and call, to provide 
comprehensive capabilities to serve both youth and concerned 
adults facing child abuse and neglect.
    The Committee encourages ACF to continue evaluating and 
sharing text and chat best practices in appropriate 
communication, identity verification, privacy protection, and 
resource sharing with other national hotlines.
    National Child Abuse and Neglect Data System (NCANDS).--The 
Committee continues to encourage HHS to explore the feasibility 
of adding--to the caregiver characteristics and environmental 
factors fields in NCANDS--a category of animal abuse as an 
additional factor that could place a child at risk for 
maltreatment.
    Preventing Maltreatment in Youth Residential Facilities.--
The Committee is concerned by reports of youth being maltreated 
by staff employed at residential facilities and urges HHS, in 
consultation with the Department of Education, to share 
information with States on promising practices for preventing 
and addressing maltreatment in residential facilities for 
youth.
    Trauma-Informed Interventions.--The Committee includes 
$5,000,000 for a demonstration project related to the 
implementation of a new and innovative approach to serving 
children in foster care by providing trauma-informed 
interventional programming, including evidence-based clinical 
services, foster parent training and curriculum, volunteer 
support services for foster parents, positive biological and 
birth family engagement to enhance family reunification, 
enrichment activities for the children and trauma-informed 
systems work. Eligible applicants should be nonprofit 
organizations with a demonstrated experience working with 
children in foster care who have experienced severe trauma. 
Applicants shall include Institutional Review Board-approved 
research supported by content area and epidemiological experts. 
The project should report regularly to ACF on findings, 
outcomes, and recommendations regarding sustainable funding and 
replicable programmatic models.

Community-Based Child Abuse Prevention

    The Committee recommends $75,000,000 for Community-Based 
Child Abuse Prevention, which is $9,340,000 above the fiscal 
year 2022 enacted level. These formula grants support 
community-based approaches to child abuse and neglect 
prevention.
    The Committee believes that communities can help build 
strong families and improve their capacity to nurture the 
healthy development of their children by providing ready access 
to online information about the full range of public and 
private resources available to them. The Committee encourages 
ACF to continue providing technical assistance to State lead 
agencies on how they may use funds provided under this account 
to help local governments and communities to develop (or 
maintain) websites that provide current and regularly updated 
information on family, youth, and community resources, 
including programs and services provided through nonprofits; 
community organizations; the Federal Government; and State and 
local governments.

Child Welfare Research, Training and Demonstration

    The Committee recommends $38,984,000 for the Child Welfare 
Research, Training and Demonstration program, which is 
$20,000,000 above the fiscal year 2022 enacted level. This 
program awards competitive grants to entities that prepare 
personnel for work in the child welfare field and those engaged 
in research around child welfare issues.
    The Committee recognizes the need for reforms in the child 
welfare system and includes $20,000,000 for a new competitive 
grant program to address racial inequity in the child welfare 
field and reorient systems towards a prevention-first model.

Adoption Opportunities

    The Committee recommends $50,000,000 for the Adoption 
Opportunities program, which is $2,000,000 above the fiscal 
year 2022 enacted level and $3,900,000 above the fiscal year 
2023 budget request. This program funds competitive grants and 
contracts to public and private organizations to remove 
barriers to adoption and to provide permanent homes for 
children who would benefit from adoption, particularly children 
with special needs.
    The Committee includes $2,000,000 for the National Adoption 
Competency Mental Health Training Initiative to provide States, 
Tribes and territories technical assistance to ensure that 
training curriculums are available and appropriately used by 
State child welfare and mental health professionals, and to 
initiate the development of derivative trainings for courts and 
continuing medical education for medical professionals to 
ensure consistency across disciplines. The Committee continues 
to encourage the program to institutionalize its curriculums as 
the standard for consistent training in all State child welfare 
agencies.

Social Services Research and Demonstration

    The Committee recommends $101,679,000 for the Social 
Services Research and Demonstration program.
    Community Project Funding.--Within the funds included in 
this account, $69,167,000 shall be used for the projects, and 
in the amounts, specified in the table titled ``Labor, HHS, 
Education Incorporation of Community Project Funding Items'' at 
the end of this report.
    Diaper Distribution Grant Demonstration.--The Committee 
includes $20,000,000, a $10,000,000 increase above the fiscal 
year 2022 enacted level, for the diaper distribution grant 
program first funded in P.L. 117-103, for grants to social 
service agencies or other non-profit organizations for diaper 
and diapering supply needs.
    Medical-Legal Partnerships.--The Committee recognizes the 
value that medical-legal partnerships (MLPs) provide to 
underserved communities by combining health and legal services 
at a single site of care. The recommendation includes 
$2,000,000 for an MLP grant program to assist individuals with 
health-harming legal needs, including in the areas of housing 
stability, income supports, family stability, civil rights, 
immigration, and environmental health. The Committee directs 
ACF to award grants to multidisciplinary teams that will work 
together to address medical and social/legal problems that have 
an impact on overall health and expects the program to award 
grants with preference to Minority-Serving Institutions and 
university-affiliated safety-net non-profit hospitals that have 
long-standing Medical-Legal Partnerships that primarily serve 
Native and underserved populations.
    Support Services at Affordable Housing.--The Committee 
includes $3,000,000 for a demonstration program to provide 
funding to owners of affordable housing properties to offer 
supportive services for their residents, including after-school 
programs for children and teenagers; education opportunities 
for youth and adult residents; mental health, alcohol and 
addiction treatment; self-sufficiency resources; resources on 
future home ownership; financial literacy training; elderly 
care; assistance to residents with disabilities; and other 
community services. The Committee requests a report one year 
after award of such grants on the findings of this 
demonstration program.

Native American Programs

    The Committee recommends $63,762,000 for Native American 
Programs, which is $5,000,000 above the fiscal year 2022 
enacted level and $1,263,000 above the fiscal year 2023 budget 
request. These programs assist tribal and village governments 
and Native American institutions and organizations in their 
efforts to support and develop stable, diversified local 
economies. Tribes and non-profit organizations use funds to 
develop and implement sustainable community-based social and 
economic programs and services to improve the well-being of 
Native people.
    Within the total, the recommendation includes no less than 
$18,000,000 for Native American language preservation 
activities, including no less than $8,000,000 for language 
immersion programs as authorized by section 803C(b)(7)(A)-(C) 
of the Native American Programs Act, as amended by the Esther 
Martinez Native American Language Preservation Act of 2006.

Community Services Programs

    Community Services Block Grant.--The Committee recommends 
$800,000,000 for the Community Services Block Grant (CSBG), 
which is $45,000,000 above the fiscal year 2022 enacted level 
and $45,781,000 above the fiscal year 2023 budget request. The 
CSBG provides funds to alleviate the causes and conditions of 
poverty in communities.
    The Committee is concerned about a lack of supportive 
services in low-income housing areas, and urges the Office of 
Community Services (OCS) to coordinate with the Department of 
Housing and Urban Development (HUD), and State and local 
housing authorities to expand supportive services at low-income 
housing communities to leverage Federal funding sources to 
increase self-sufficiency and improve low-income individuals' 
living conditions.
    Community Economic Development.--The Committee recommends 
$22,383,000 for Community Economic Development, which is 
$1,000,000 above the fiscal year 2022 enacted level. Community 
Economic Development is a grant program which funds Community 
Development Corporations seeking to address the economic needs 
of low-income individuals and families through the creation of 
sustainable business development and employment opportunities.
    Rural Community Facilities Development.--The Committee 
recommends $12,000,000 for the Rural Community Facilities 
Development program, which is $1,000,000 above the fiscal year 
2022 enacted level and equal to the fiscal year 2023 budget 
request. Rural Community Development is a grant program that 
works with regional and Tribal organizations to manage safe 
water systems in rural communities.

Domestic Violence Hotline

    The Committee recommends $27,360,000 for the Domestic 
Violence Hotline, which is $11,860,000 above the fiscal year 
2022 enacted level and equal to the fiscal year 2023 budget 
request. The Hotline provides 24-hour, toll-free and 
confidential services immediately connecting callers to local 
service providers.
    Within the recommendation, the Committee includes 
$1,000,000 for a pilot project to explore best practices, 
intervention, and prevention methods, including establishment 
of a hotline for those who choose to cause harm, to reduce 
incidents of domestic violence.
    In addition, the Committee recognizes the unique challenges 
experienced by individuals in religious communities, especially 
populations underserved because of religion, in accessing 
appropriate domestic violence services and support, and 
includes $250,000 for the Domestic Violence Hotline to evaluate 
and expand its list of resources for contacts from religious 
communities.

Family Violence Prevention and Battered Women's Shelters

    The Committee recommends $300,000,000 for the Family 
Violence Prevention and Battered Women's Shelters programs, 
which is $100,000,000 above the fiscal year 2022 enacted level. 
The Family Violence Prevention and Services Act (FVPSA) 
programs provide funding to support the prevention of incidents 
of family violence, domestic violence, and dating violence, and 
provide the immediate shelter and supportive services for adult 
and youth victims (and their dependents).
    Addressing Domestic Violence in Religious Communities.--The 
Committee recognizes the unique challenges experienced by 
individuals in religious communities, especially populations 
underserved because of religion, in accessing appropriate 
domestic violence services and supports. The Committee supports 
the work that FVPSA Resource Centers are doing to improve 
outreach to faith-based communities. The Committee encourages 
the Resource Centers to continue to provide training and 
technical assistance to faith-based communities, especially 
populations underserved because of religion and requests a 
report within 180 days of enactment of this Act on the ways 
Resource Centers provide training and technical assistance to 
religious communities.
    Culturally Specific Services for Domestic Violence and 
Sexual Assault.--The Committee recognizes that current public 
health and social pandemics have disproportionally impacted 
communities of color, leaving women and girls of color more 
vulnerable to incidents of domestic violence and sexual 
assault, and recommends no less than $20,000,000 for culturally 
specific organizations to develop or enhance appropriate 
services that are specific to their community.
    Native Hawaiian Resource Center on Domestic Violence.--
Within the recommendation, the Committee includes $2,000,000 
for the Native Hawaiian Resource Center on Domestic Violence to 
support the prevention of incidents of family violence, 
domestic violence, and dating violence, and provide the 
immediate shelter and supportive services for adult and youth 
victims in Native Hawaiian communities.
    Sexual Assault Technical Assistance Initiative.--The 
Committee provides $5,000,000 for the program to support the 
Federal administrative costs to monitor grants for survivors of 
sexual assault and grants to support culturally specific 
populations, and to provide grants for technical assistance 
providers with extensive knowledge of and demonstrated 
expertise in the problem and solutions to sexual assault, as 
well as experience in the anti-sexual assault field.

Chaffee Education and Training Vouchers

    The Committee recommends $45,257,000 for the Chafee 
Education and Training Voucher (CETV) program, which is 
$2,000,000 above the fiscal year 2022 enacted level. The CETV 
provides vouchers to youth who are, or were formerly, in foster 
care for expenses related to post-secondary education 
assistance and vocational training.

Program Direction

    The Committee recommends $227,000,000 for Program 
Direction, which is $14,500,000 above the fiscal year 2022 
enacted level.

                   PROMOTING SAFE AND STABLE FAMILIES

 
 
 
Appropriation, fiscal year 2022.......................      $427,515,000
Budget request, fiscal year 2023......................       451,000,000
Committee Recommendation..............................       427,515,000
    Change from enacted level.........................             - - -
    Change from budget request........................       -23,485,000
 

    The Committee recommends $345,000,000 in mandatory funds 
and $82,515,000 in discretionary funds for the Promoting Safe 
and Stable Families program. This program enables each State to 
operate a coordinated program of family preservation services, 
community-based family support services, time-limited 
reunification services, and adoption promotion and support 
services. States receive funds based on their share of children 
in all States receiving food stamp benefits.

                PAYMENTS FOR FOSTER CARE AND PERMANENCY

 
 
 
Appropriation, fiscal year 2022.......................    $6,963,000,000
Budget request, fiscal year 2023......................     7,606,000,000
Committee Recommendation..............................     7,606,000,000
    Change from enacted level.........................      +643,000,000
    Change from budget request........................             - - -
 

    The Committee also recommends an advance appropriation of 
$3,200,000,000 for the first quarter of fiscal year 2024 to 
ensure timely completion of first quarter grant awards.
    Mental Health Services for Foster Youth.--The Committee 
appreciates that the Children's Bureau complies with the 
statutory requirement to conduct periodic Child and Family 
Services Reviews (CFSR) to ensure that State child welfare 
systems' practices are in compliance with State plan 
requirements in title IV-B and IV-E of the Social Security Act 
in order to direct corrective action if outcomes do not meet 
Federal benchmarks. The Committee urges the Department to use 
the CFSR case file reviews and stakeholder interviews to verify 
that States are ensuring that foster children receive mental 
health screenings, follow-up mental health assessments, and are 
referred for mental health services, as required by title IV-B, 
and looks forward to receiving data on the number of children 
in out-of-home care who received a diagnosis of a behavioral or 
mental health condition when the AFCARS 2020 data is available 
for analysis.

                  Administration for Community Living


                 AGING AND DISABILITY SERVICES PROGRAMS

 
 
 
Appropriation, fiscal year 2022.......................    $2,264,927,000
Budget request, fiscal year 2023......................     2,930,491,000
Committee Recommendation..............................     2,860,008,000
    Change from enacted level.........................      +595,081,000
    Change from budget request........................       -70,483,000
 

    Created in 2012, the Administration for Community Living 
(ACL) brings together the efforts and achievements of the 
Administration on Aging, the Administration on Intellectual and 
Developmental Disabilities, and the HHS Office on Disability to 
serve as the Federal agency responsible for increasing access 
to community supports, while focusing attention and resources 
on the unique needs of older Americans and people with 
disabilities across the lifespan.
    The Committee continues to fund the Senior Medicare Patrol 
Program through the Health Care Fraud and Abuse Control 
Account.

Home and Community-Based Supportive Services

    The Committee recommends $450,000,000 for Home and 
Community-Based Supportive Services, which is $51,426,000 above 
the fiscal year 2022 enacted level. This program provides 
formula grants to States and territories to fund a wide range 
of social services that enable seniors to remain independent in 
their homes for as long as possible.

Preventive Health Services

    The Committee recommends $27,500,000 for Preventive Health 
Services, which is $2,652,000 above the fiscal year 2022 
enacted level and $1,161,000 above the fiscal year 2023 budget 
request. This program funds activities that help seniors remain 
healthy and avoid chronic diseases. Funding supports a variety 
of healthy aging programs aimed to reduce disease and prevent 
injuries, including evidence-based programs to address the risk 
of falls, chronic diseases, mental health, and medication 
management.

Protection of Vulnerable Older Americans

    The Committee recommends $41,944,000 for activities to 
protect vulnerable older Americans, which is $17,286,000 above 
the fiscal year 2022 enacted level and equal to the fiscal year 
2023 budget request. These programs provide grants to States 
for protection of vulnerable older Americans through the Long-
Term Care Ombudsman and Prevention of Elder Abuse and Neglect 
programs. Within the recommendation, the Committee provides a 
$17,000,000 increase to the Long-Term Care Ombudsman program.

Family Caregiver Support Services

    The Committee recommends $230,000,000 for the National 
Caregiver Support program, which is $36,064,000 above the 
fiscal year 2022 enacted level. This program offers a range of 
support services to family caregivers, including assistance in 
accessing services such as respite care, counseling, support 
groups, and caregiver training.
    GAO Study on Caregiving Youth.--The Committee is concerned 
with reports that there may be 3 to 5 million youths serving as 
a primary or secondary caretaker for a family member and 
believes there is insufficient data on this population. The 
Committee directs GAO to complete a study examining what is 
known about the number and characteristics of caregiving youth; 
to what extent the substance abuse crisis and COVID-19 pandemic 
has increased this population; what challenges caregiving youth 
face; what additional resources are needed to address these 
challenges; what Federal programs could be expanded to serve 
this population; and how HHS coordinates with other programs to 
support caregiving youth.

Native American Caregiver Support Services

    The Committee recommends $13,806,000 for the Native 
American Caregiver Support program, which is $2,500,000 above 
the fiscal year 2022 enacted level. This program provides 
grants to Tribes for the support of American Indian, Alaskan 
Native, and Native Hawaiian families caring for older relatives 
with chronic illness or disabilities.

Congregate and Home-Delivered Nutrition Services

    The Committee recommends a total of $1,260,069,000 for 
senior nutrition. The recommendation includes: $700,000,000 for 
Congregate Nutrition Services; $400,000,000 for Home-Delivered 
Meal Services; and $160,069,000 for the Nutrition Services 
Incentives program. These programs help older Americans remain 
healthy and independent in their communities by providing meals 
and related services in a variety of settings (including 
congregate facilities such as senior centers) and via home-
delivery to older adults who are homebound due to illness, 
disability, or geographic isolation.

Native American Nutrition and Supportive Services

    The Committee recommends $41,264,000 for Native American 
Nutrition and Supportive Services, which is $5,000,000 above 
the fiscal year 2022 enacted level. This program provides 
grants to Tribes to promote the delivery of nutrition and home 
and community-based supportive services to Native American, 
Alaskan Native, and Native Hawaiian elders.

Aging Network Support Activities

    The Committee recommends $36,961,000 for Aging Network 
Support Activities, which is $18,500,000 above the fiscal year 
2022 enacted level and $14,015,000 above the fiscal year 2023 
budget request. This program supports activities that expand 
public understanding of aging and the aging process.
    Care Corps.--The recommendation includes $5,500,000 for the 
Care Corps program. The Committee recognizes the success of 
local programs that are increasing seniors' access to non-
emergency medical services by offering transportation with 
trained volunteers to serve as aides and advocates for those 
with accessibility challenges, and includes a $1,500,000 
increase for ACL to award grants to programs capable of 
building a network of screened and trained volunteer chaperones 
to accompany older adults and adults with disabilities in need 
to and from non-emergency medical appointments and outpatient 
procedures.
    Direct Care Workforce Demonstration.--The Committee 
provides $3,000,000 for a Direct Care Workforce Demonstration 
project, to reduce barriers to entry for a diverse and high-
quality direct care workforce, including providing wages, 
benefits, and advancement opportunities needed to attract or 
retain direct care workers.
    Holocaust Survivor's Assistance and Person-Centered, 
Trauma-Informed Care (PCTI).--The Committee provides 
$10,000,000 for the Holocaust Survivor's Assistance program, 
which provides supportive services for aging Holocaust 
survivors and their families, and to other older adult 
populations that have been exposed to and impacted by traumatic 
events, including aging military veterans, first responders, 
victims of childhood and domestic violence, and survivors of 
man-made or natural disasters.
    Interagency Coordinating Committee on Healthy Aging and 
Age-Friendly Communities.--While numerous Federal agencies and 
programs support older Americans and aim to reduce falls and 
provide safe and accessible living environments, interagency 
coordination is critical to ensure these programs are effective 
and cohesive. The Committee provides $1,000,000 for the 
coordination of healthy aging programs across HHS, the 
Department of Housing and Urban Development, the Department of 
Transportation, and other agencies as appropriate, with a focus 
on falls prevention programs and safe living environments, and 
with a goal of informing the 2025 White House Conference on 
Aging.
    Research, Demonstration, and Evaluation Center for the 
Aging Network.--The Committee includes $10,000,000 to create a 
Research, Demonstration, and Evaluation Center for the Aging 
Network, as authorized in the 2020 OAA Reauthorization. Funding 
should be used to hire staff, and invest in research, 
demonstration, and evaluation of falls prevention programs. The 
Committee expects the Center to research best practices on 
falls prevention and distribute the most promising practices in 
the field of falls prevention to the aging network. Within 
funding provided, the Committee expects the Center to offer 
demonstration and evaluation programs through competitive 
grants to be innovative and respond to evolving evidence about 
what works to prevent and reduce risk of falls, and equip the 
Network with funding to implement those models.

Alzheimer's Disease Program

    The Committee recommends $30,060,000 for the Alzheimer's 
disease program, which is $560,000 above the fiscal year 2022 
enacted level and equal to the fiscal year 2023 budget request. 
This program provides competitive matching grants to a limited 
number of States to encourage program innovation and 
coordination of public and private services for people with 
Alzheimer's disease and their families.
    The recommendation includes $2,000,000 for the National 
Alzheimer's Call Center.

Respite Care

    The Committee recommends $14,220,000 for Respite Care, 
which is $6,110,000 above the fiscal year 2022 enacted level 
and equal to the fiscal year 2023 budget request. The program 
focuses on easing the burdens of caregiving by providing grants 
to eligible State organizations to improve the quality of, and 
access to, respite care for family caregivers.

Falls Prevention

    The Committee recommends $10,000,000 for the Falls 
Prevention program, which is $5,000,000 above the fiscal year 
2022 enacted level and $5,000,000 above the fiscal year 2023 
budget request. Falls prevention grants support the promotion 
and dissemination of prevention tools delivered in community 
settings.

Chronic Disease Self-Management Program

    The Committee recommends $8,000,000 to be transferred from 
the PPH Fund to ACL for the Chronic Disease Self-Management 
program, which is equal to the fiscal year 2022 enacted level 
and the fiscal year 2023 budget request. This program supports 
grants to States for low-cost, evidence-based prevention models 
that use state-of-the-art techniques to help those with chronic 
conditions address issues related to the management of their 
disease.

Elder Rights Support Activities

    The Committee recommends $100,000,000 for Elder Rights 
Support Activities, which is $81,126,000 above the fiscal year 
2022 enacted level and $22,600,000 above the fiscal year 2023 
budget request. This program supports efforts that provide 
information, training, and technical assistance to legal and 
aging services organizations working to prevent and detect 
elder abuse and neglect.
    The recommendation includes $80,000,000 to continue the 
nationwide Adult Protective Services formula grant program 
authorized in 2012 by the Elder Justice Act.

Aging and Disability Resource Centers

    The Committee recommends $9,119,000 for Aging and 
Disability Resource Centers (ADRCs), which is $1,000,000 above 
the fiscal year 2022 enacted level. These centers provide 
information, counseling, and access for individuals to learn 
about the services and support options available to seniors and 
the disabled so they may retain their independence.

State Health Insurance Assistance Program

    The Committee recommends $58,115,000 for the State Health 
Insurance Assistance Program, which is $5,000,000 above the 
fiscal year 2022 enacted level and $2,873,000 above the fiscal 
year 2023 budget request. The State Health Insurance Assistance 
Program provides Medicare beneficiaries with information, 
counseling, and enrollment assistance.

Paralysis Resource Center

    The Committee recommends $10,185,000 for the Paralysis 
Resource Center (PRC), and directs not less than $9,400,000 to 
the National PRC. The Paralysis Resource Center offers 
activities and services aimed at increasing independent living 
for people with paralysis and related mobility impairments, and 
supporting integration into the physical and cultural 
communities in which they live.

Limb Loss Resource Center

    The Committee recommends $4,200,000 for the Limb Loss 
Resource Center, which is $200,000 above the fiscal year 2022 
enacted level and equal to the fiscal year 2023 budget request. 
The Limb Loss Resource Center supports a variety of programs 
and services for those living with limb loss, including a 
national peer support program, educational events, training for 
consumers and healthcare professionals, and information and 
referral services.

Traumatic Brain Injury

    The Committee recommends $13,118,000 for the Traumatic 
Brain Injury program, which is $1,297,000 above the fiscal year 
2022 enacted level and equal to the fiscal year 2023 budget 
request. The program provides grants to States for the 
development of a comprehensive, coordinated family and person-
centered service system at the State and community level for 
individuals who sustain a traumatic brain injury.

Developmental Disabilities State Councils

    The Committee recommends $85,000,000 for State Councils on 
Developmental Disabilities, which is $5,000,000 above the 
fiscal year 2022 enacted level. The Developmental Disabilities 
State Councils work to develop, improve, and expand the system 
of services and supports for people with developmental 
disabilities. The Committee recommends not less than $700,000 
for technical assistance and training for the State Councils on 
Developmental Disabilities.
    In addition, the Committee encourages ACL to consult with 
the appropriate Developmental Disabilities Act stakeholders 
prior to announcing opportunities for new technical assistance 
projects and to notify the Committee prior to releasing new 
funding opportunity announcements, grants, or contract awards 
with technical assistance funding.

Developmental Disabilities Protection and Advocacy

    The Committee recommends $50,000,000 for Developmental 
Disabilities Protection and Advocacy, which is $7,216,000 above 
the fiscal year 2022 enacted level. This formula grant program 
provides funding to States to establish and maintain protection 
and advocacy systems to protect the legal rights of persons 
with developmental disabilities.
    The Committee notes that the Supreme Court decision in 
Olmstead v. L.C. (1999) held that the Americans with 
Disabilities Act (ADA) does not require removing individuals 
from institutional settings when they are unable to handle or 
benefit from a community-based setting and that the ADA does 
not require the imposition of community-based treatment on 
patients who do not desire it. The Committee notes that actions 
to close intermediate care facilities for individuals with 
intellectual disabilities may impact some individuals who do 
not meet the criteria for transfer to a community-based 
setting. The Committee urges HHS to ensure that programs 
properly account for the needs and desires of patients, their 
families, and caregivers and the importance of affording 
patients the proper setting for their care.

Voting Access for Individuals With Disabilities

    The Committee recommends $12,414,000 for the Voting Access 
for Individuals with Disabilities program, which is $3,951,000 
above the fiscal year 2022 enacted level and equal to the 
fiscal year 2023 budget request. The Voting Access for 
Individuals with Disabilities program authorized by the Help 
America Vote Act provides formula grants to ensure full 
participation in the electoral process for individuals with 
disabilities, including registering to vote, accessing polling 
places, and casting a vote.

Developmental Disabilities Projects of National Significance

    The Committee recommends $13,750,000 for Developmental 
Disabilities Projects of National Significance, which is 
$1,500,000 above the fiscal year 2022 enacted level. This 
program funds grants and contracts that develop new 
technologies and demonstrate innovative methods to support the 
independence, productivity, and integration of those living 
with a disability into the community.

University Centers for Excellence in Developmental Disabilities

    The Committee recommends $42,119,000 for University Centers 
for Excellence in Developmental Disabilities, which is equal to 
the fiscal year 2022 enacted level. The University Centers for 
Excellence in Developmental Disabilities Education, Research, 
and Service are a nationwide network of independent but 
interlinked centers, representing a national resource for 
addressing issues, finding solutions, and advancing research 
related to the needs of individuals with developmental 
disabilities and their families.

Independent Living

    The Committee recommends $140,000,000 for the Independent 
Living program, of which $27,195,000 is for the Independent 
Living State Grants program and $112,805,000 is for the Centers 
for Independent Living program. This funding level is 
$21,817,000 above the fiscal year 2022 enacted level. 
Independent Living programs maximize the leadership, 
empowerment, independence, and productivity of individuals with 
disabilities.

National Institute on Disability, Independent Living, and 
        Rehabilitation Research

    The Committee recommends $117,470,000 for the National 
Institute on Disability, Independent Living, and Rehabilitation 
Research (NIDILRR), which is $1,000,000 above the fiscal year 
2022 enacted level. NIDILRR generates knowledge and promotes 
its effective use to enhance the abilities of people with 
disabilities to perform activities of their choice in the 
community and to expand society's capacity to provide full 
opportunities for its citizens with disabilities.
    The Committee notes the potential of emerging technologies, 
like distributed ledger technologies or blockchain, to expand 
voting access for individuals with disabilities. The Committee 
encourages NIDILRR to consider a feasibility analysis into the 
use of emerging technologies to assist with voting access for 
individuals with disabilities, that includes but is not limited 
to, the particular voting challenges faced by individuals with 
disabilities, and how emerging technologies could be utilized.

Assistive Technology

    The Committee recommends $44,000,000 for Assistive 
Technology, which is $5,500,000 above the fiscal year 2022 
enacted level and equal to the fiscal year 2023 budget request. 
Assistive Technology (AT) supports programs providing grants to 
States for addressing assistive technology needs of individuals 
with disabilities. The goal is to increase awareness of and 
access to assistive technology devices and services that may 
help with education, employment, daily activities, and 
inclusion of people with disabilities in their communities.
    The Committee continues to provide $2,000,000 for 
competitive grants to support existing and new alternative 
financing programs that provide for the purchase of AT devices.

Program Administration

    The Committee recommends $52,063,000 for Program 
Administration, which is $10,000,000 above the fiscal year 2022 
enacted level. This funding supports Federal administrative 
costs associated with administering ACL's programs.

Community Project Funding

    Within the funds included in this account, $30,446,000 
shall be used for the projects, and in the amounts, specified 
in the table titled ``Labor, HHS, Education Incorporation of 
Community Project Funding Items'' at the end of this report.

                        Office of the Secretary


                    GENERAL DEPARTMENTAL MANAGEMENT

 
 
 
Appropriation, fiscal year 2022.......................      $571,122,000
Budget request, fiscal year 2023......................       665,067,000
Committee Recommendation..............................       639,622,000
    Change from enacted level.........................       +68,500,000
    Change from budget request........................       -25,445,000
 

    Of the funds provided, $75,728,000 shall be derived from 
evaluation set-aside transfers available under section 241 of 
the Public Health Service (PHS) Act, which is $10,900,000 above 
the fiscal year 2022 enacted level.
    This appropriation supports activities that are associated 
with the Secretary's roles as policy officer and general 
manager of the Department of Health and Human Services (HHS). 
The Office of the Secretary also implements administration and 
Congressional directives, and provides assistance, direction 
and coordination to the headquarters, regions, and field 
organizations of the department. In addition, this funding 
supports the Office of the Surgeon General and several other 
health promotion and disease prevention activities that are 
centrally administered.
    Advertising Contracts for Small Business Owners.--The 
Committee understands that, as the largest advertiser in the 
United States, the Federal government should work to ensure 
fair access to its advertising contracts, including outdoor 
advertising, for small disadvantaged businesses and businesses 
owned by minorities and women. The Committee directs each 
department and agency to include the following information in 
its fiscal year 2024 Congressional Budget Justification: 
expenditures for fiscal year 2022 and expected expenditures for 
fiscal year 2024 for (1) all contracts for advertising 
services; and (2) contracts for the advertising services of (I) 
socially and economically disadvantaged small businesses 
concerns (as defined in section 8(a)(4) of the Small Business 
Act (15 U.S.C. 637(a)(4)); and (II) women- and minority-owned 
businesses.
    Bereaved Children.--The Committee is concerned with the 
impact of the COVID-19 pandemic on bereaved children. The 
consequences of losing a caregiver include higher risk of 
experiencing substance abuse and mental health problems, 
including anxiety, depression, and post-traumatic stress 
disorder, as well as higher risk of reduced employment and 
housing instability. Bereaved children also experience lower 
rates of academic attainment and higher dropout rates. The 
COVID-19 pandemic created the additional stressor on bereaved 
children by reducing or limiting their access to critical 
social support systems commonly provided through consistent 
school or community. The Committee acknowledges the President's 
efforts to identify these children and families and make 
resources available to them and encourages HHS to coordinate 
with Congress and relevant agencies to establish a taskforce to 
ensure the social and emotional development of bereaved 
children.
    Blood Donation Education.--The Committee includes 
$1,000,000 for outreach and education to individuals who become 
newly eligible to donate blood due to evidence-based updates to 
FDA's deferral guidelines. The Committee directs HHS to conduct 
such community outreach in consultation with community 
stakeholders.
    Brain Aneurysms.--The Committee recognizes that although 
one in 50 Americans has a brain aneurysm, there are typically 
no warning signs or symptoms unless the aneurysm ruptures. Up 
to 50 percent of patients will not survive such a hemorrhage. 
Even when an aneurysm has ruptured, the symptoms are not widely 
known among health care professionals. The Committee reiterates 
the language included in House Report 115-862 directing the 
Secretary, in consultation with appropriate stakeholders--
including health care providers, brain aneurysm patient 
advocacy foundations, brain aneurysm survivors, and 
caregivers--to facilitate the development of best practices on 
brain aneurysm detection and rupture for first responders, 
emergency room physicians, primary care physicians, nurses, and 
advanced practice providers. The Committee encourages the 
Secretary to consider incorporating topics including, but not 
limited to, the symptoms of brain aneurysms, evidence-based 
risk factors for brain aneurysms, appropriate utilization of 
medical testing and diagnostic equipment, and screening 
recommendations. The Secretary shall continue to consult with 
appropriate stakeholders to develop a strategy for 
disseminating information about the best practices and begin 
implementing this strategy within one year after the date of 
enactment of this Act. The Secretary shall review research on 
brain aneurysm detection and diagnosis and update the best 
practices every three years, as appropriate. In addition, the 
Committee requests an update in the fiscal year 2024 
Congressional Budget Justification outlining the Department's 
expenditures over the last five fiscal years on research and 
other activities related to brain aneurysms.
    Breastfeeding Services and Supplies.--The Committee 
acknowledges that HRSA updated its Women's Preventive Services 
Initiative (WPSI) Breastfeeding Services and Supplies 
recommendation which serves as the basis for insurer decisions 
around coverage of related services and supplies especially for 
Medicaid beneficiaries in expansion States. Concerns have been 
raised that the WPSI recommendation's lack of consideration for 
quality in its coverage recommendations will lead insurers to 
cover only the most inexpensive supplies without regard to the 
needs of individual infants and mothers. HHS is directed to 
provide, within 120 days of the date of enactment of this Act, 
the information first requested by the Committee in House 
Report 115-862 detailing how health insurers have implemented 
comprehensive lactation services, the standards insurers use to 
set reimbursement rates for breastfeeding supplies and 
services, and the current best practices used to provide 
coverage to help women breastfeed. HHS also is directed to 
respond to the request in House Report 115-244 to examine the 
impact of clinically recommended breastfeeding rates on 
associated Medicaid expenditures, urgent care costs, and direct 
and indirect medical costs, including workplace productivity 
and employee retention.
    Cardiovascular Disease Patients.--The Committee notes the 
growing prevalence of cardiovascular disease (CVD) and the 
economic burden this deadly disease has on the health care 
system. The Committee further notes that lipid-panel 
(cholesterol) screenings, diagnosis and appropriate treatment 
and management of CVD is vital to prevent major cardiac events 
and hospitalizations. Various disease prevention and 
progression therapies are widely available, including statins 
and modern biologic treatments that have demonstrated efficacy 
against certain types of CVD. However, such therapies often 
face barriers including prohibitive utilization management 
practices by health plans, which limit adoption. The Committee 
requests a report within 180 days of the date of enactment of 
this Act on challenges facing healthcare providers and patients 
with a specific focus on healthcare costs incurred related to 
postponed, delayed, or suboptimal treatments associated with 
CVD.
    Children's Interagency Coordinating Council.--The Committee 
notes that the COVID-19 pandemic has contributed to a further 
decline in the economic standing, education, and physical and 
mental health status of low-income children, particularly among 
children in Hispanic, African American, Asian American, Native 
Hawaiian, Pacific Islander, and American Indian/Alaska Native 
families. Data shows that the COVID-19 pandemic is causing more 
children to experience poverty and resulting in additional 
hardships including educational gaps and negative mental health 
impacts. The Committee supports collaboration amongst HHS, the 
Department of Energy, the Department of Justice, the Department 
of Agriculture (USDA), United States Agency for International 
Development, and other Federal agencies to address these 
pressing problems. To foster greater coordination, 
collaboration, and transparency on child policy across agency 
lines, the Committee again directs the Secretary to establish a 
Children's Interagency Coordinating Council. Among other tasks, 
the Council shall enter into an agreement with the National 
Academy of Sciences to provide an annual report to Congress 
analyzing and monitoring how existing and emerging Federal 
policies have affected child poverty using the U.S. Census 
Bureau Supplemental Poverty Measure. In addition, the Council 
will examine and periodically report on a broad array of 
comprehensive and cross-cutting issues affecting child well-
being.
    Combating Opioid Overdoses.--The Committee commends NIDA 
for funding studies on kratom based on promising results that 
unadulterated kratom may provide help for some Americans 
struggling with addictions, given its analgesic and less 
addictive properties as compared to opioids.
    Contraceptive Deserts.--The Committee notes that an 
estimated 19 million women in need of publicly funded 
contraception live in contraceptive deserts, counties in which 
there is no reasonable access to the full range of 
contraceptive options. A recent study found that contraceptive 
deserts vary across States, with between 17 and 53 percent of 
the State population living in a desert. Furthermore, it found 
that low-income people and people of color are more likely to 
live in contraceptive deserts. The Committee requests the 
Secretary undertake a study of contraceptive deserts and 
examine the extent to which Federal policy changes and 
resources can improve access to the full range of contraceptive 
options. The Committee requests this report within 180 days of 
the date of enactment of this Act, along with the Department's 
policy recommendations.
    Contraceptive Access Under the Affordable Care Act.--The 
Committee is concerned about access to care for patients 
seeking preventive services, including contraceptive services. 
The Committee directs the Secretary, in collaboration with the 
Departments of Labor (DOL) and Treasury, to engage in patient 
education to ensure patients understand their rights under the 
Affordable Care Act to access (without cost sharing) the 
contraceptive product that is determined best for the patient, 
in consultation with their health care provider. In addition, 
the Committee directs the Secretary to engage with health care 
providers to disseminate the latest guidance on contraceptive 
access for patients, as well as how to help patients seek 
access to contraceptive services (without cost sharing) through 
a health insurance plan's exceptions process. The Committee 
urges the Secretary to take action against health insurance 
plans that are not meeting their obligations to patients under 
the law.
    Cosmetic Safety.--The Committee encourages the Secretary of 
HHS to establish and maintain an interagency council for the 
purpose of sharing data, promoting collaboration on cosmetic 
safety, and generating solutions to address negative impacts on 
the health of women and girls of color, professional nail, 
hair, beauty, and salon workers, and other vulnerable 
populations caused by exposure to unsafe chemicals in cosmetic 
products. The interagency should include, but not be limited 
to, representatives from the Office of the Secretary FDA, NIH, 
CDC, the Assistant Secretary of Labor for Occupational Safety 
and Health (or the Administrator's designee), the Administrator 
of the Environmental Protection Agency (or the Administrator's 
designee), the Administrator of the Small Business 
Administration (or the Administrator's designee), and the 
Secretary of Labor (or the Secretary's designee).
    Chronic Fatigue Syndrome Advisory Committee.--The Committee 
looks forward to reviewing the HHS plan regarding myalgic 
encephalomyelitis/chronic fatigue syndrome (ME/CFS) which was 
requested in House Report 116-62 and was required within 180 
days of the date of enactment of that Act. In the interim, the 
Committee encourages HHS to foster interagency and stakeholder 
collaboration in addressing the related crisis in post-acute 
COVID-19 syndrome (PACS) and ME/CFS by forming an Infection-
Associated Chronic Illnesses Advisory Committee that includes, 
but is not limited to relevant agency representatives, patient 
representatives from long COVID, ME/CFS, and other infection-
associated chronic illnesses communities, medical care 
providers, and disease experts.
    Decentralized Trials.--The Committee notes the COVID-19 
pandemic has shown the possibility of conducting remote and 
decentralized clinical trials. In parallel, decentralized 
trials can foster greater participation, including by promoting 
increased diversity in clinical trial participants. The 
Committee directs the Secretary, in collaboration with NIH, 
FDA, ONC, CMS, and HRSA to evaluate policy options across the 
department to ensure health care providers and patients have 
tools to identify and participate in decentralized and remote 
clinical trials. This assessment should include steps to foster 
greater data sharing, including related to electronic health 
records, genomics, and imaging. The Committee requests a report 
not later than two years after the date of enactment of this 
Act, with findings from the assessment and proposals to 
accelerate decentralized clinical trials and foster trial 
diversity.
    Embryo Adoption Awareness Campaign.--The Committee includes 
$1,000,000 for the Embryo Adoption Awareness Campaign to 
educate Americans about the existence of frozen human embryos 
(resulting from in-vitro fertilization), which may be available 
for donation/adoption to help other couples build their 
families. The Committee includes bill language permitting these 
funds also to be used to provide medical and administrative 
services to individuals adopting embryos, deemed necessary for 
such adoptions, consistent with the Code of Federal 
Regulations.
    Food as Medicine.--The Committee directs the Secretary, in 
consultation with other Federal agencies, to develop and 
implement a Federal strategy to reduce nutrition-related 
chronic diseases and food insecurity and improve health and 
racial equity in the U.S., including diet-related research and 
programmatic efforts that increase Americans' access to food as 
medicine, and healthy, nutritious, organic, and affordable 
foods, especially in at-risk communities. The Committee 
includes $2,000,000 in the Office of the Secretary to establish 
a Food As Medicine pilot program, an integrative model for 
healthcare, that addresses food insecurity, social isolation, 
and chronic disease to advance health and racial equity. The 
model shall include the following as defined by the Secretary: 
a produce prescription of pesticide-free regenerative or 
regenerative organic produce; clinical nutrition training for 
healthcare providers; and nutritional and behavioral support 
for patients to integrate food interventions into daily habits. 
The Secretary may enter into competitively awarded contracts or 
cooperative agreements with, or provide grants to, public or 
private organizations or agencies within varying States. 
Additionally, the Committee requests a report within two years 
of the date of enactment of this Act on the implementation of 
the Federal strategy and an examination of the status of each 
pilot project; the results of the evaluation completed during 
the previous fiscal year; and to the maximum extent practicable 
the impact of the pilot project on appropriate health, 
nutrition, and associated behavioral outcomes among patients 
participating in the pilot project baseline information 
relevant to the stated goals and desired outcomes of the pilot 
project; and equivalent information about similar or identical 
measures among control or comparison groups that did not 
participate in the pilot project.
    Genetic Counseling Inequity.--The Committee recognizes that 
genetic counseling and testing provide individuals the 
opportunity to learn if they have an inherited genetic 
mutation, enabling them--and their families--to better 
understand their risk of developing breast (and other) cancers, 
help tailor future screening plans, and guide decision making 
about ways to reduce the risk of breast cancer. However, access 
and utilization of genetic counseling and testing are not the 
same for all communities; Black people in the U.S. do not 
participate in genetic testing at the same rate as Americans of 
European ancestry. The Committee encourages the Secretary to 
examine opportunities to increase utilization of genetic 
counseling and testing associated with breast cancer for Black 
women and requests an update in the fiscal year 2024 
Congressional Budget Justification addressing barriers to 
increasing access to and utilization of genetic counseling and 
testing for all populations, including how to increase health 
equity in this area.
    Global Health Research.--The Committee requests an update 
in the fiscal year 2024 Congressional Budget Justification on 
how the Office of Global Affairs (OGA), CDC, FDA, BARDA, and 
NIH--including the Fogarty International Center--jointly 
coordinate global health research activities with specific 
measurable metrics used to track progress and collaboration 
toward agreed upon health goals.
    Health Attaches.--The Committee includes $3,000,000 to 
expand OGA's Health Diplomacy program to fund health attache 
offices in Africa, Asia, and Europe.
    Health Benefits of Proper Nutrition.--The Committee 
continues to recognize the value of proper nutrition and 
understands that many chronic medical conditions can be managed 
cost effectively by improved nutrition. The Committee again 
encourages the Secretary to establish an interagency 
collaboration with the Department of Education and the USDA to 
enhance nutritional education in K-12 schools and urges the 
Secretary to be proactive in promoting disease prevention by 
providing a plan to expand nutritional education and to 
increase access to nutritional foods for students. The 
Committee also requests a strategic plan, led by HHS in 
partnership with the USDA, on how culturally appropriate, food-
based solutions can improve health outcomes and save money.
    Health Care Providers, Including Pregnancy Help Centers, 
Safety.--The Committee includes $5,000,000 for the Secretary to 
award grants to health care providers, including Pregnancy Help 
Centers, to pay for security services or otherwise to enhance 
the security of their facilities, personnel, and patients to 
ensure safe access. A health care provider, including a 
pregnancy help center, receiving a grant may use the grant to 
pay the costs of necessary security services or enhancements to 
physical access and cyber security, including video 
surveillance camera systems, data privacy enhancements, and 
structural improvements.
    Home Health Aides.--The Committee recognizes that home 
health aides (HHAs) are the foundation of professional home-
based caregiving, and that the growing population of disabled, 
chronically ill, and elderly Americans receiving home-based 
care requires a skilled and highly trained HHA workforce 
prepared to manage complex care needs. The Committee encourages 
HHS to explore how HHAs are meeting clinical competencies 
necessary to provide high-quality home-based care.
    KidneyX.--The Committee continues to include a total of 
$5,000,000 for KidneyX to support a public private partnership 
to accelerate innovation in the prevention, diagnosis, and 
treatment of kidney diseases. An estimated 850 million people 
worldwide are living with kidney disease. KidneyX exit 
disclaimer icon seeks to improve their lives by accelerating 
the development of drugs, devices, biologics, and other 
therapies across the spectrum of kidney care.
    Local News Media.--The Committee encourages the Department 
to utilize local broadcasters and local newspapers, including 
those in small communities, in their public affairs Federal 
advertising campaigns. The Committee requests an update in the 
fiscal year 2024 Congressional Budget Justification on the 
Department's public affairs advertising campaigns by percentage 
of Federal funding spent on social media, national media, local 
news media, and outdoor advertising during fiscal years 2021 
and 2022. In addition, the Committee encourages the 
Department's Office of the Assistant Secretary for Public 
Affairs, in consultation with other relevant offices, to 
consider a pilot project focusing on Federal advertising 
effectiveness in rural communities--with populations under 
40,000 individuals or fewer than 20,000 households--utilizing 
local news media, including broadcast, radio, and non-daily 
newspapers, whose involvement in advertising campaigns and 
message delivery can assist in reaching under-served rural 
areas.
    LymeX Innovation Accelerator.--The Committee commends the 
Office of the Secretary and its Chief Technology Officer for 
the Lyme Innovation Initiative, launched November 2018, and the 
LymeX Innovation Accelerator announced in October 2020. LymeX 
is a $25,000,000 public-private partnership between HHS and the 
Steven & Alexandra Cohen Foundation to accelerate innovation in 
prevention, diagnostics, and treatments for Lyme and other 
tick-borne diseases.
    Medication Abortion.--The Committee urges the Department of 
Health and Human Services to use every tool at its disposal to 
ensure that medication abortion care is accessible, affordable, 
covered, and convenient for patients including through access 
to telehealth.
    Mental Health Parity.--The Committee continues to be 
concerned that after 12 years since enactment of the Mental 
Health Parity and Addiction Equity Act (MHPAEA), there is still 
a lack of oversight and compliance among insurance companies 
and health plans not adequately covering mental and behavioral 
health services and providers. In December 2019, the GAO 
reported that this lack of compliance extends beyond plans 
investigated by the DOL and includes plans over which HHS has 
oversight authority. The Committee urges the HHS Secretary, 
jointly with the Secretary of Labor and the Secretary of the 
Treasury, to comply with language included in House Report 117-
96 to establish a process through which employer-sponsored 
health plans and health insurance issuers subject to MHPAEA may 
submit a public report regarding nonquantitative treatment 
limitations while ensuring that any personal or confidential 
consumer information is protected. The Committee looks forward 
to receiving the report requested in House Report 117-96 on any 
auditing and enforcement of all plans and issuers within the 
jurisdiction of the respective Department.
    National Center on Antiracism and Health Equity.--The 
Committee continues to strongly support the Secretary's efforts 
to advance health equity and reduce disparities for communities 
of color. The Committee looks forward to reviewing the 
Secretary's plan to establish a National Center on Antiracism 
and Health Equity within the Department to lead efforts to 
identify and understand the policies and practices that have a 
disparate impact on the health and well-being of communities of 
color as requested in House Report 117-96. The Committee 
includes $10,000,000 for the Office of the Secretary to 
establish a grant program to support public and nonprofit 
entities, including community-based organizations, to build and 
strengthen coalitions focused on addressing structural racism 
in public health and activities that counter the disparate 
impact on the health and well-being of communities of color. 
The Committee requests a report not later than 180 days after 
the date of enactment of this Act on the progress of this pilot 
program.
    Newborn Screening.--The Committee includes $1,000,000 for 
HHS to commission a study with the National Academy of Medicine 
to examine the current status of Newborn Screening systems, 
processes, and research and make recommendations for future 
improvements that would include: the recommended uniform 
screening panel review and recommendation process; the barriers 
and support to add new Recommended Uniform Screening Panel 
conditions to State screening panels; assessments of State 
capacity to strengthen current screening processes and 
implement screening for new conditions; recommendations for 
optimizing federally and privately funded newborn screening 
research; new and emerging technologies that would permit 
screening for new categories of disorders and how technology 
impacts States; technological and other infrastructure needs to 
improve diagnosis, follow-up and public health surveillance; 
communication and educational needs for stakeholders; data 
collection on disease prevalence and improved long term 
outcomes; and the impacts of newborn screening efforts on 
newborn morbidity and mortality.
    Pharmacists and COVID-19 Authorities.--The Committee 
appreciates HHS's recognition under the Public Readiness and 
Emergency Preparedness (PREP) Act declaration authorities for 
pharmacists to order, treat, immunize, and provide other 
patient care services, including the ordering and 
administration of time-sensitive COVID-19 therapeutics. The 
Committee requests a report within 180 days of the date of 
enactment of this Act on the impact of these authorities on 
public health and proposed actions and recommendations on 
whether to make these authorities permanent.
    Population Health Task Force.--The Committee notes that the 
world's most advanced and innovative hospitals, clinics, 
pharmacies, research institutions, healthcare professional 
schools, managed care organization, and medical therapies are 
addressing social determinants of health by implementing 
population health management strategies and value-based care 
approaches to improve health outcomes, lower cost of care and 
optimize experience of care. The Committee includes $1,000,000 
for the Secretary to establish and maintain a report on best 
practices of population health management through the creation 
of a population health task force. The task force should be 
comprised of representatives from, but not limited to, the 
Office of the Secretary, CMS, CDC, population health providers, 
experts on health equity, health technology, and value-based 
care. The Committee requests a report within a year of the date 
of enactment of this Act from the task force on population 
health, including the task force's initial recommendations.
    Prohibition on Contractors with Nondisclosure Agreements.--
The Committee recognizes that harassment, including sexual 
harassment and assault, continue to be pervasive in the 
workplace, and that the use of predispute nondisclosure and 
nondisparagement clauses as conditions of employment can 
perpetuate illegal conduct by silencing survivors and shielding 
perpetrators. The Committee directs the Department to include 
proposals in its fiscal year 2024 Congressional Budget 
Justification to eliminate the use of grants and contracts to 
employers that use this practice.
    Rare Kidney Diseases in Health Equity Initiatives.--The 
Committee recognizes the work across HHS to implement practices 
and policies to eliminate healthcare disparities in America, 
particularly for communities of color. Rare kidney diseases are 
underreported and understudied, especially among Black 
Americans. The Committee requests an update in the fiscal year 
2024 Congressional Budget Justification on disparities in 
kidney care and the inclusion of rare kidney diseases in 
policies and programs aimed at eliminating health disparities 
in communities of color.
    Regional Councils and Councils of Governments.--The 
Committee encourages the Department to list regional councils 
and councils of governments as eligible entities in 
competitions for Federal funding whenever local governments or 
non-profit agencies are eligible entities. Furthermore, the 
Committee encourages the Department to seek opportunities for 
regional councils and councils of governments to serve as lead 
applicants and grantees to encourage and expand greater 
regional collaboration.
    Sickle Cell Interagency Working Group.--The Committee notes 
approximately 100,000 Americans are living with sickle cell 
disease, an inherited blood disorder that causes pain, 
infection, and stroke. This disease disproportionately affects 
Black Americans. The National Academies of Sciences, 
Engineering, and Medicine (NASEM) report ``Addressing Sickle 
Cell Disease: A Strategic Plan and Blueprint for Action'' 
provides important recommendations for improving the health and 
quality of life for sickle cell disease patients, including a 
hub and spoke ``Centers of Excellence'' care model. The 
Committee urges HHS to encourage the Sickle Cell Interagency 
Working Group to utilize the NASEM report to develop a plan for 
treatment centers address the unmet care needs for patients 
with sickle cell disease, sickle cell trait and other heritable 
hemoglobinopathies. The Committee requests a report within 180 
days of the date of enactment of this Act on the working 
group's progress.
    Social Determinants of Health.--The Committee directs the 
Social Determinants Council created by House Report 116-450 to 
continue to provide technical assistance to jurisdictions in 
this program. The Committee requests a report within 90 days of 
the date of enactment of this Act on the status of the 
selection of all Council members.
    Stillbirth Task Force.--The Committee provides an 
additional $1,000,000 for the Secretary to bolster the work for 
the Stillbirth Task Force. The task force should continue to 
include the CDC, NIH, outside specialty organizations, and 
maternal and fetal medicine specialists. The task force should 
work through the Office of the Secretary to identify current 
knowledge on stillbirth and prevention, areas of improvement 
for data collection, current resources for families impacted by 
stillbirth, and next steps to gather data and lower the rate of 
stillbirth in the United States. The Committee directs the 
Secretary to provide a report within 120 days of the date of 
enactment of this Act on the progress of the task force.
    Strategy to Reduce Nutrition Related Chronic Diseases.--The 
Committee encourages the Secretary, in consultation with other 
Federal agencies, to work through the Office of Disease 
Prevention and Health Promotion to develop and implement a 
Federal strategy to reduce nutrition-related chronic diseases 
in the U.S., including diet-related research and programmatic 
efforts that increase Americans' access to food as medicine, 
and healthy, nutritious, organic, and affordable foods, 
especially in at-risk communities. The Committee requests a 
report within one year of the enactment of this Act on the 
implementation of the Federal strategy and its effectiveness in 
reducing nutrition related chronic diseases in the U.S. In 
developing the strategy, HHS shall reference the recommendation 
of the Government Accountability Office in its September 2021 
report entitled ``Chronic Health Conditions: Federal Strategy 
Needed to Coordinate Diet-Related Efforts.''
    Supporting Community Violence Intervention Programs.--The 
Committee notes HHS and its agencies, including CDC and SAMHSA, 
have a critical role to play in supporting community violence 
intervention, including by providing grant funding to eligible 
programs and technical assistance to grant recipients, and 
through evaluating the implementation of community violence 
intervention programs. The Committee urges the Department to 
evaluate its existing grant programs to determine which 
programs can be used to support community-based violence 
intervention activities and ensure that relevant funding 
opportunity announcements clearly articulate that they can fund 
community violence interventions. The Committee also urges the 
Department to conduct outreach to raise awareness about the 
funding available for community violence intervention programs, 
provide technical assistance to grant recipients and conduct 
research into program efficacy and implementation.
    Technology's Role in Healthcare Workforce.--The Committee 
recognizes the important role that HHS continues to provide to 
support and protect the public health workforce during the 
COVID-19 pandemic. The Committee requests an update in the 
fiscal year 2024 Congressional Budget Justification on the 
challenges associated with hiring, recruiting, and retaining 
the Federal, State, local, tribal and territorial public health 
workforce. This update should include a specific analysis of 
how technology, especially hands-free technology, could help to 
protect clinicians' physical safety and ease the burden of 
patient care, thereby increasing retention of the public health 
workforce.
    Telehealth Data.--The Committee recognizes that demand for 
telemedicine increased in 2020 in response to the COVID-19 
pandemic. In addition, the Committee notes disparities in 
telehealth exist between and within racial and ethnic groups, 
rural and urban locations, and geographic regions as detailed 
in a December 2021 report by the Assistant Secretary for 
Planning and Evaluation. The Committee urges the Secretary, 
working with CMS and HRSA, to categorize telehealth usage data, 
including for audio-only services, by Health Professional 
Shortage Areas. The Committee further urges the Secretary to 
work across agencies to ensure that improvements to broadband 
availability are prioritized in those areas with lowest 
telehealth usage, highest audio-only usage, and a known health 
professional shortage. The Committee requests an update within 
120 days of the date of enactment of this Act on this 
categorization and broadband availability.
    U.S.-Mexico Border Health Commission.--The Committee 
recognizes the important role the U.S.-Mexico Border Health 
Commission plays in promoting solutions to health issues unique 
to the Southern border. The Committee includes $2,500,000 for 
the Commission, an increase of $500,000.
    U.S.-Mexico Border Health Commission Vaccine Deployment 
Strategy.--The Committee notes the U.S. must work with Mexico 
to implement a binational COVID-19 strategy to ensure a full 
economic recovery both in border communities and nationally. 
The Committee encourages the U.S. section of the U.S.-Mexico 
Border Health Commission to engage with their Mexican 
counterparts to develop a COVID-19 vaccine deployment strategy 
for communities on both sides of the border. The Committee 
requests a report within 180 days of the date of enactment of 
this Act on these efforts.
    White House Initiative on Asian Americans, Native 
Hawaiians, and Pacific Islanders (AANHPI).--The Committee 
includes funding to support the White House Initiative on Asian 
Americans, Native Hawaiians, and Pacific Islanders, led by the 
Secretary of HHS, to advance health equity and economic justice 
for AANHPI communities that continue to face racism, nativism, 
and xenophobia.

Minority HIV/AIDS Fund

    The Committee includes $60,000,000 for the Minority HIV/
AIDS Fund (MHAF), which is $3,100,000 above the fiscal year 
2022 enacted level, and encourages the Secretary to prioritize 
MHAF grants to HIV-based agencies that are minority led with 
preference given to organizations led by women, men, and 
transgender persons who identify as African American/Black, 
Latino, American Indian/Alaskan Native, Asian American, and/or 
Native Hawaiian/Pacific Islander.
    Tribal Set-Aside.--The Committee notes that according to 
the CDC, HIV-positive status among Native Americans is 
increasing and nearly one-in-five HIV-positive Native Americans 
is unaware of their status. In addition, only three-in-five 
receive care and less than half are virally suppressed. To 
increase access to HIV/AIDS testing, prevention, and treatment, 
the Committee includes $5,000,000 as a tribal set-aside within 
the MHAF.

Office of the Assistant Secretary for Health

    Commissioned Corps of the United States Public Health 
Service.--The Committee is aware that as of October 1, 2021, 
the Commissioned Corps of the U.S. Public Health Service (USPHS 
Commissioned Corps) is issuing a ``Certificate of Release or 
Discharge from Active Duty'' (DD Form 214) to USPHS 
Commissioned Corps officers who are released from active duty. 
The Committee requests a report within 90 days of the date of 
enactment of this Act on the feasibility of issuing a DD Form 
214 to each USPHS Commissioned Corps Officer who retired or 
separated from USPHS Commissioned Corps service prior to 
October 1, 2021 and received a different statement of service.
    Hepatitis B Adult Vaccination.--The Committee encourages 
the Office of the Assistant Secretary for Health (OASH) to host 
an interagency summit to discuss dissemination and 
implementation of the Advisory Committee Immunization Practices 
(ACIP) recommendation that all adults between 19 and 59 be 
vaccinated for hepatitis B. The Committee is also aware that 
CDC is actively considering a complimentary universal hepatitis 
B vaccine screening policy and encourages OASH to support this 
process, as appropriate.
    Office of Climate Change and Health Equity.--The Committee 
includes $3,000,000 in funding for the Office of Climate Change 
and Health Equity (OCCHE) within OASH. HHS established OCCHE to 
enhance overall population health by serving at the 
intersection of social determinants of health and climate 
resiliency.
    Teen Pregnancy Prevention.--The Committee strongly supports 
the Teen Pregnancy Prevention (TPP) Program and provides 
$130,000,000, an increase of $29,000,000 above the enacted 
level. The TPP Program has been widely cited as a high-quality 
evidence-based program, including by the bipartisan Commission 
on Evidence-Based Policymaking.
    Teen Pregnancy Prevention Program Evidence Review.--The 
Committee includes $900,000 for the TPP Evidence Review, for a 
total of $7,700,000 in PHS Act section 241 evaluation set-aside 
transfers. The Evidence Review is an independent, systematic, 
rigorous review of evaluation studies that inform grantmaking 
and provide a clearinghouse of evidence-based programs for 
other Federal, State, and community initiatives.

Office of Minority Health

    The Committee includes $80,835,000 for the Office of 
Minority Health (OMH), which is $16,000,000 above the fiscal 
year 2022 enacted level. The OMH works with U.S. Public Health 
Service agencies and other agencies of the Department to 
address the health status and quality of life for racial and 
ethnic minority populations in the United States. OMH develops 
and implements new policies; partners with States, Tribes, and 
communities through cooperative agreements; supports research, 
demonstration, and evaluation projects; and disseminates 
information.
    Center for Indigenous Innovation and Health Equity.--The 
Committee continues to recognize the importance of advancing 
Indigenous solutions to achieve health equity. The Committee 
includes $4,000,000, an increase of $2,000,000 to support the 
work of the Center for Indigenous Innovation and Health Equity. 
The Committee continues to urge HHS to consider partnering with 
universities with a focus on Indigenous health research and 
policy among Native Americans and Alaska Natives, as well as 
universities with a focus on Indigenous health policy and 
innovation among Native Hawaiians/Pacific Islanders.
    Community Health Worker Workgroup.--The Committee provides 
an additional $1,000,000 for the Community Health Worker 
Workgroup within OMH specifically to focus on increasing 
cultural competency in educational campaigns on public health 
vaccines and prevention, including but not limited to influenza 
and COVID-19.
    Healthcare Delivery and Faith-Based Organizations.--The 
Committee notes the emerging partnerships with faith-based 
organizations to deliver healthcare in underserved communities, 
including recent successful efforts to address the COVID-19 
pandemic. The Committee understands that community partners and 
faith-based organizations can take on an expanded role and 
support efforts to address health disparities and promote 
health equity. HHS and OMH are encouraged to continue to pursue 
new and expanded opportunities.
    Language Access Services.--The Committee includes 
$3,000,000 to research, develop, and test methods of informing 
limited English proficient (LEP) individuals about their right 
to and the availability of language access services, including 
considerations related to literacy levels of LEP populations, 
the needs of older adults and speakers of indigenous languages, 
readability, and the usage of symbols, taglines, translated 
materials and other methodologies. OMH shall consult external 
experts and organizations with knowledge on or connections to 
LEP communities and partner with nonprofit community-based 
organizations to test solutions and solicit feedback from LEP 
populations. The goal of this research would preferably be to 
develop a universal symbol that, accompanied by a phone number 
or similar information, could be prominently placed on 
consumer-facing documents, websites and notices, about the 
availability of language access services. In addition, the 
Committee notes that the HHS language access plan has not been 
updated since 2013. The Committee requests a report not later 
than 180 days after the date of enactment of this Act, on HHS's 
plan to update its language access plan, including a timeline 
for publication on lep.gov.
    Minority Leaders Development Program.--The Committee 
provides a $1,000,000 increase for the Minority Leaders 
Development Program which aims to enhance skills and 
competencies necessary for Federal leadership service among 
participants through a curriculum focused on health care 
policy, leadership skill-building, and cultural competence. The 
initiative will fill a gap in Federal fellowship opportunities 
for individuals interested in working at HHS to advance health 
equity and address the social determinants of health through 
health policies, programs, and practices.
    National Lupus Training, Outreach, and Clinical Trial 
Education Program.--The Committee continues to support the 
National Lupus Training, Outreach, and Clinical Trial Education 
Program at $2,000,000. The Committee commends efforts by OMH to 
increase outreach, education, and awareness of opportunities to 
participate in lupus clinical trials among minority populations 
nationally.
    Shortage of Healthcare Providers.--The Committee is 
concerned about the growing shortage of providers including 
both primary and specialty healthcare providers that threatens 
the foundation of the health care system and health equity. A 
coordinated national strategy is needed to diversify the health 
care workforce and address shortages in rural and urban 
communities. The findings of The Roundtable on Black Men and 
Black Women in Science, Engineering, and Medicine outline 
racism and bias as significant reasons for this disparity in 
science, engineering, and medicine, with detrimental 
implications on individuals, health care organizations, and the 
nation as a whole. The Committee directs the Secretary to 
include a multi-year plan in the fiscal year 2024 Congressional 
Budget Justification to address the national primary care and 
specialty provider shortages to improve access to care. The 
plan shall include strategies to improve health outcomes by 
diversifying the field of primary care through the 
establishment of a pathway program for community college 
students to pursue premedical training and enter medical 
school.
    In addition, the Committee looks forward to receiving the 
report from the Advisory Committee on Minority Health advising 
HHS on the best efforts to create pipeline programs that start 
with pre-med students in underserved areas and end in more 
graduate medical education training programs in those 
underserved areas requested in House Report 117-96. The 
Committee recognizes the need to build and strengthen the 
pipeline for physicians who practice in medically underserved 
areas. The COVID-19 pandemic has exposed how fragile the 
frontline provider workforce is because of the physician 
shortage crisis, and it is most pronounced in medically 
underserved areas.

Office on Women's Health

    The Committee includes $48,140,000 for the Office on 
Women's Health (OWH), which is $10,000,000 above the fiscal 
year 2022 enacted level.
    Breastfeeding Analysis.--The Committee includes $1,250,000 
for the Office on Women's Health to enter into an agreement 
with the National Academy of Sciences (NAS) to provide an 
evidence-based, non-partisan analysis of the macroeconomic, 
health, and social costs of U.S. breastfeeding rates and 
national breastfeeding goals. This analysis should include a 
differential analysis of the current policies, programs, and 
investments aimed at increasing breastfeeding initiation, 
improving 3- and 6-month exclusive breastfeeding rates, 
reducing racial, geographic, and income-related breastfeeding 
disparities, and reducing U.S. reliance on formula. NAS should 
propose recommendations for achieving the Healthy People 2020 
and 2030 breastfeeding goals by 2030. The Committee requests a 
briefing on this analysis within 90 days of the date of 
enactment of this Act.
    Combatting Violence Against Women.--The Committee includes 
$10,000,000 to combat violence against women through the State 
partnership initiative and directs the OWH to work in 
conjunction with the Family Violence Prevention and Services 
Program office. This program provides funding to State-level 
public and private health programs to partner with domestic and 
sexual violence organizations to improve health care providers 
ability to help victims of violence and improve prevention 
programs.
    Interagency Coordinating Committee on the Promotion of 
Optimal Birth Outcomes.--The Committee includes $2,000,000 for 
the OWH to convene an Interagency Coordinating Committee on the 
Promotion of Optimal Birth Outcomes (Coordinating Committee) to 
oversee and coordinate the HHS Action Plan to Improve Maternal 
Health in America. The Coordinating Committee shall meet 
biannually and shall include, but not be limited to, the 
Administrators of HRSA, CDC, CMS, ACF, ACL, SAMHSA, the Indian 
Health Service, and the Secretaries of the VA and DOD. The 
Coordinating Committee shall produce an annual progress report 
that reports on activities and outcomes of the HHS programs 
directed toward improving maternity outcomes.
    Pregnant Women and Lactating Women Advisory Committee.--The 
Committee includes $200,000 for the creation of an Advisory 
Committee to monitor and report on the implementation of the 
recommendations from the Task Force on Research Specific to 
Pregnant Women and Lactating Women (PRGLAC). PRGLAC's 2020 
Implementation Plan called for the creation of an Advisory 
Committee to monitor and report on implementing 
recommendations, updating regulations, and guidance, as 
applicable, regarding the inclusion of pregnant women and 
lactating women in clinical trials. Additionally, the Committee 
directs the Secretary to submit a report to Congress within 180 
days of the date of enactment of this Act outlining the 
Department's progress on implementing each of PRGLAC's 15 
recommendations from the Implementation Plan it submitted to 
the Secretary in August 2020.

                     MEDICARE HEARINGS AND APPEALS

 
 
 
Appropriation, fiscal year 2022.......................      $196,000,000
Budget request, fiscal year 2023......................       196,000,000
Committee Recommendation..............................       196,000,000
    Change from enacted level.........................             - - -
    Change from budget request........................             - - -
 

    This appropriation supports activities carried out by two 
Office of the Secretary Staff Divisions. The Office of Medicare 
Hearings and Appeals supports Medicare appeals at the 
administrative law judge level, the third level of Medicare 
claims appeals. The Departmental Appeals Board represents the 
fourth level of the Medicare appeals process and provides 
impartial, independent hearings and appellate reviews.

  OFFICE OF THE NATIONAL COORDINATOR FOR HEALTH INFORMATION TECHNOLOGY

 
 
 
Appropriation, fiscal year 2022.......................       $64,238,000
Budget request, fiscal year 2023......................       103,614,000
Committee Recommendation..............................        86,614,000
    Change from enacted level.........................       +22,376,000
    Change from budget request........................       -17,000,000
 

    The Office of the National Coordinator (ONC) is the 
principal Federal entity charged with coordinating efforts to 
implement and use health information technology and exchange 
electronically health information.
    Electronic Health Information Security.--The Committee 
notes that as patients electronically access and share their 
electronic health information (EHI) in new ways, it is 
important that both patients and their healthcare providers 
have confidence in the privacy and security of that information 
regardless of which entities hold that data, including those 
that may not be subject to the HIPAA Rules. To better 
understand and protect against potential security 
vulnerabilities and cyberattacks to those entities not subject 
to the HIPAA Rules, the Committee urges the Secretary to 
examine and brief the Federal Trade Commission on the 
vulnerabilities to patients' EHI associated with increased use 
of application programming interfaces (APIs) by consumer-
oriented app companies and consumer data aggregation services, 
the extent to which potential vulnerabilities may result 
because of a lack of consistent security safeguards for 
entities operating outside the bounds of Federal health 
information privacy and security rules, and potential Federal 
policy options to better protect the security of patients' 
health information.
    Information Blocking Guidance.--The Committee recognizes 
that the ONC's rule to implement the interoperability and 
information blocking provisions of the 21st Century Cures Act 
took significant steps forward to give patients greater access 
to and improve the electronic flow of electronic health 
information across care settings. Given the significant 
penalties and other consequences for information blocking, the 
Committee urges ONC to provide regulated entities and other 
affected stakeholders with clear, practical guidance regarding 
foundational concepts in the rule. Guidance should clearly 
outline how regulated entities can evaluate their particular 
circumstances and scenarios against the rule's provisions, 
including how to identify and apply relevant exceptions to the 
information blocking definition.
    Interoperability of Maternity Care Records.--The Committee 
recognizes that Personal Health Records for pregnant people are 
needed to improve patient health and safety as they move from 
one level of care to another during pregnancy, and that efforts 
must continue to improve the interoperability of electronic 
health records in order to optimize the care of pregnant 
persons. The Committee requests that within one year of 
enactment of this Act, HHS create and publish guidelines that 
address Perinatal Care and that leverage the skills of all 
providers, including physicians and midwives, and all sites of 
care, including hospitals and freestanding birth centers. The 
guidelines should also outline best practices for creating and 
maintaining accessible, longitudinal peri- and post-natal 
health records for patients.
    Patient Matching.--The Committee is concerned there is no 
consistent and accurate way to link patients to their health 
information as they seek care across the continuum, and 
believes health information must be accurate, timely, and 
robust to inform clinical care decisions for every patient. The 
recommendation includes $5,000,00 for ONC to work with industry 
to develop matching standards that prioritize interoperability, 
patient safety, and patient privacy.
    Standards for Interoperability.--The recommendation 
includes not less than $5,000,000 to support Fast Healthcare 
Interoperability Resource standards-related activities needed 
to successfully achieve interoperability and information 
sharing for better health and health care.

                      OFFICE OF INSPECTOR GENERAL

 
 
 
Appropriation, fiscal year 2022.......................       $82,400,000
Budget request, fiscal year 2023......................       106,329,000
Committee Recommendation..............................        94,400,000
    Change from enacted level.........................       +12,000,000
    Change from budget request........................       -11,929,000
 

    The Committee recommends $94,400,000 for the Office of 
Inspector General (OIG), which is $12,000,000 above the fiscal 
year 2022 enacted level.
    In addition, within the Health Care Fraud and Abuse Control 
(HCFAC) program discretionary appropriations for fiscal year 
2023, the Committee provides the OIG with $109,612,000. 
Mandatory appropriations for this office also are contained in 
the HCFAC program and the Health Insurance Portability and 
Accountability Act of 1996.

                        OFFICE FOR CIVIL RIGHTS

 
 
 
Appropriation, fiscal year 2022.......................       $39,798,000
Budget request, fiscal year 2023......................        60,250,000
Committee Recommendation..............................        49,798,000
    Change from enacted level.........................       +10,000,000
    Change from budget request........................       -10,452,000
 

    The Office for Civil Rights (OCR) is responsible for 
enforcing civil rights statutes that prohibit discrimination in 
health and human services programs. OCR implements the civil 
rights laws through a compliance program designed to generate 
voluntary compliance among all HHS recipients.
    National Council on Disability.--The Committee strongly 
encourages the HHS Office of Civil Rights (OCR) to clarify that 
all HHS suicide prevention grants and services must comply with 
existing disability rights laws, including the ADA, and 
Sections 504 and 508 of the Rehabilitation Act, including the 
provisions requiring accessible communications, so that all 
videos, documents, and other products ensure access to persons 
with disabilities. In addition, the Committee encourages OCR to 
recommend that hospitals create a disability ombudsperson 
position who is authorized to facilitate communication between 
healthcare providers and patients with disabilities or their 
proxies and advocate on the patient's behalf, when required, to 
ensure that all clinical and LTSS options and choices are made 
available.

     RETIREMENT PAY AND MEDICAL BENEFITS FOR COMMISSIONED OFFICERS

 
 
 
Appropriation, fiscal year 2022.......................      $673,278,000
Budget request, fiscal year 2023......................       710,327,000
Committee Recommendation..............................       710,327,000
    Change from enacted level.........................       +37,049,000
    Change from budget request........................             - - -
 

    The Committee provides for retirement pay and medical 
benefits of Public Health Service Commissioned Officers, for 
payments under the Retired Serviceman's Family Protection Plan, 
and for medical care of dependents and retired personnel.

            PUBLIC HEALTH AND SOCIAL SERVICES EMERGENCY FUND

 
 
 
Appropriation, fiscal year 2022.......................    $3,199,678,000
Budget request, fiscal year 2023......................     3,814,610,000
Committee Recommendation..............................     3,699,356,000
    Change from enacted level.........................      +499,678,000
    Change from budget request........................      -115,254,000
 

    This account supports the activities of the Assistant 
Secretary for Preparedness and Response (ASPR) and other 
components within the Office of the Secretary to prevent, 
prepare for, and respond to the health consequences of 
bioterrorism and other public health emergencies, including 
pandemic influenza. It also includes funding for the 
Department's cybersecurity efforts.

Office of the Assistant Secretary for Preparedness and Response (ASPR)

    The Committee provides $3,144,558,000 for activities 
administered by ASPR. ASPR is responsible for coordinating 
national policies and plans for medical and public health 
preparedness and for administering a variety of public health 
preparedness programs.
    Chemical, Biological, Radiological, and Nuclear (CBRN) 
Threats.--The Committee urges ASPR to prioritize the 
development and stockpiling of critical CBRN vaccines, 
treatments, and personal protective equipment. The Committee 
encourages ASPR to engage more frequently with private sector 
partners in the Broad Agency Announcement process to speed the 
development of new medical countermeasures (MCMs) and the 
stockpiling of existing MCMs against CBRN threats.
    Cold Chain Technologies.--The Committee recognizes the 
limitations that are presented by cold chain requirements for 
vaccine distribution and storage, and supports efforts to 
address these challenges in the coming years. The Committee 
directs ASPR to explore opportunities for new technologies such 
as dry power approaches or thin-film freeze drying that allow 
for vaccines to be physiochemically stable for an extended 
period without causing degradation or reduction in 
immunogenicity. The Committee requests an update in the fiscal 
year 2024 Congressional Budget Justification on such efforts.
     Commercialization of COVID Vaccines and Therapeutics.--The 
Committee directs ASPR to provide a briefing within 60 days of 
enactment of this Act on the Department's planning for the 
transition of COVID-19 medical countermeasures procurements to 
the commercial market, including estimated timelines for 
vaccines, therapeutics, and other products with FDA approval or 
an emergency use authorization.
    Far-Forward Patient Care.--The Committee recognizes that 
conducting traditional medical care closer to the point of 
injury can have many positive effects. ASPR is encouraged to 
consider establishing a Federally Funded Research and 
Development Center in partnership with an academic medical 
center to improve far-forward care, transportation and 
coordination, and advanced technology that can provide 
additional solutions to future patient care.
    Freeze-Dried Hemostatic Products.--The Committee urges the 
further development of freeze-dried hemostatic products, 
especially platelet-derived products, to include a wide range 
of indications. Further, the Committee encourages the 
consideration of additional efforts to expand the manufacturing 
base for these products.
    Medical Distribution Supply Chain.--The Committee 
encourages ASPR to engage government partners and 
pharmaceutical and medical distribution experts to proactively 
prepare for the next public health emergency through tabletop 
exercises and planning.
    Performance Improvement.--The Committee encourages ASPR to 
explore the Department of Veterans Affairs, Health 
Administration Office of Emergency Preparedness Performance 
Improvement Management System to determine if such a system 
could benefit the ASPR ecosystem of programs.
    Public Health Emergency Medical Countermeasures 
Enterprise.--The Committee is aware that the National Academies 
of Sciences, Engineering, and Medicine released a report in 
November 2021, Ensuring an Effective Public Health Emergency 
Medical Countermeasures Enterprise, that provides 
recommendations for a re-envisioned Public Health Emergency 
Medical Countermeasures Enterprise (PHEMCE). Four priority 
areas of improvement emerged including collaborating more 
effectively with external public and private partners. The 
Committee encourages efforts by the PHEMCE to create an 
advisory committee incorporating private sector and non-federal 
partners and stakeholders to enhance transparency and 
communication, identify and close gaps, and build collaborative 
solutions.
    Reporting.--The Committee directs ASPR to provide monthly 
briefings regarding activities funded by this Act and other 
available appropriations. The agency shall provide notification 
24 hours in advance of any obligation greater than $25,000,000 
from any appropriation. Such notification shall include the 
source of funding, including section number where applicable or 
program name, and a description of the obligation. In addition, 
ASPR shall submit a monthly obligation report in electronic 
format. Such report shall include information for each 
obligation greater than $25,000,000, and each obligation shall 
include the source of the appropriation and the program under 
which the obligation occurred. Such report is due not later 
than 30 days after the end of the month and shall be cumulative 
for the fiscal year with the most recent obligations listed at 
the top. Furthermore, the Secretary shall report to the 
Committees on the current inventory of COVID-19 vaccines and 
therapeutics, as well as the deployment of these vaccines and 
therapeutics during the previous month, reported by State and 
other jurisdiction not later than 30 days after the enactment 
of this Act, and monthly thereafter until the inventory is 
expended.

Operations

    The Committee includes $34,376,000, an increase of 
$3,438,000, for activities within the Assistant Secretary's 
Immediate Office; the Office of the Chief Operating Officer; 
the Office of Acquisitions Management, Contracts, and Grants; 
and the Office of Financial Planning and Analysis.
    Working Capital Fund.--The Committee provides funding for 
the establishment of a working capital fund to increase fiscal 
transparency and accountability of the use of funds. The 
Committee supports ASPR's efforts to document cost allocation 
methodologies and processes, and to clearly define the approval 
process, including requirements for administrative adjustments, 
and to update cost allocation practices to include current and 
dynamic methodologies. While there was no finding of the misuse 
of BARDA funds from the external audit requested by HHS, the 
Committee urges ASPR to promptly implement such formal 
processes to reduce occurrences of ``Administrative 
Discretion.'' The Committee requests a briefing within 90 days 
of the date of enactment of this Act on the status of the 
working capital fund, including plans for the estimated 
reduction in future year operations budget requests due to its 
implementation.

HHS Coordination Operations and Response Element (H-CORE)

    The Committee includes $132,801,000 to establish annual 
funding to ensure the synchronization of the medical 
countermeasure efforts for the COVID-19 response and other 
threats, as they arise.

Preparedness and Emergency Operations

    The Committee includes $28,300,000, an increase of 
$3,646,000, for Preparedness and Emergency Operations. The 
Preparedness and Emergency Operations account funds the Office 
of Emergency Management, which supports a full spectrum of 
emergency management responsibilities, including planning, 
coordination, logistics, training, and responding to planned 
events and unplanned incidents.

National Disaster Medical System

    The Committee includes $93,904,000, an increase of 
$18,500,000, for the National Disaster Medical System (NDMS). 
NDMS deploys trained medical teams to communities impacted by 
public health and medical emergencies due to natural and man-
made incidents.
    Mission Zero.--The Committee includes $10,000,000, an 
increase of $8,000,000, for civilian trauma centers to train 
and incorporate military trauma care providers and teams into 
care centers.
    Pediatric Disaster Care.--The Committee includes 
$8,000,000, an increase of $2,000,000, for the pediatric 
disaster care program.

Hospital Preparedness Program

    The Committee includes $327,055,000, an increase of 
$31,500,000, for the Hospital Preparedness Program (HPP). HPP 
supports a variety of programs to strengthen the preparedness 
and response of the health care sector.
    Hospital Preparedness Program Cooperative Agreements.--The 
Committee includes $261,500,000, an increase of $30,000,000, 
for critical support to State, local and regional partners to 
advance health care system preparedness and response.
    National Special Pathogen System.--The Committee includes 
$8,000,000, an increase of $1,500,000, for the National 
Emerging Special Pathogens Training and Education Center 
(NETEC), and $21,000,000 for Regional Ebola and Other Special 
Pathogen Treatment Centers (RESPTCs).
    Regional Disaster Health Response System.--The Committee 
includes $7,000,000 for these cooperative agreements.

Biomedical Advanced Research and Development Authority (BARDA)

    The Committee includes $845,005,000, an increase of 
$100,000,000, for BARDA. BARDA supports the advanced 
development of vaccines, drugs, and therapeutics for potential 
serious public health threats, including chemical, biological, 
radiological, and nuclear threats, pandemic influenza, and 
emerging and re-emerging infectious diseases. BARDA continues 
to have an essential role in the response to COVID-19.
    Active Pharmaceutical Ingredients and Manufacturing of 
Essential Drugs.--The Committee continues to be concerned with 
the risk of increased reliance on foreign-based sources of 
active pharmaceutical ingredients (APIs), their chemical 
components, and off-shore drug production. The Committee 
recognizes the importance of domestic drug manufacturing and 
onshore production of medicine and medical countermeasures, and 
the successful work of BARDA in addressing these public health 
vulnerabilities, including APIs, such as those included in 
Heparin, and to collaborate within ASPR to support domestic 
manufacturing surge capacity. The Committee requests an updated 
report within 180 days of the date of enactment of this Act, 
including efforts to ensure robust domestic drug manufacturing 
and stockpiling and mitigation of supply chain vulnerabilities 
to enable continuous manufacturing capabilities of APIs from 
procurement to finished drug formulations.
    Advanced Pharmaceutical Manufacturing Technologies.--The 
Committee encourages BARDA to support the research, development 
and facilitation of novel pharmaceutical manufacturing 
technologies that provide flexible systems for the production 
of medical countermeasures at a lower cost than traditional 
manufacturing processes, including technologies that utilize 
agricultural cell line development. The Committee urges BARDA 
to partner with domestic manufacturers to bolster U.S. supply 
chains to enhance our domestic capacity to respond to a variety 
of new threats more effectively in the future.
    Antifungal Research.--The Committee provides an increase to 
support the research and development of novel antifungal 
therapies, particularly for multi-drug resistant fungal 
pathogens, to bolster national health security and minimize 
their impact on public health. Antifungal development faces 
similar challenges to antibacterial development and BARDA's 
Advanced Research and Development program support will be 
critical to generate additional antifungal products, including 
for endemic fungal diseases, like Valley Fever. In addition, 
the Committee urges the Secretary to update the scope of 
support for the CARB-X program to include pathogens listed in 
the 2019 CDC Antibiotic Resistant Threats report, which 
includes products that target fungal pathogens. The Committee 
requests a report within the 180 days of the date of enactment 
of this Act on actions taken.
    Antimicrobial Resistance.--The Committee provides an 
increase for efforts to combat antimicrobial resistance, 
recognizing the importance and challenges of this threat. 
BARDA's Advanced Research and Development program support will 
be critical to support new products. The Committee requests 
within 180 days of the date of enactment of this Act a 
professional judgement budget estimate to support a 
comprehensive, long-term program for the development and 
procurement of novel antibiotics.
    At-Home Diagnostics.--The Committee encourages BARDA to 
advance at-home infectious disease diagnostic technologies, 
including those that are designed to diagnose more than one 
viral agent, and to work collaboratively across HHS to advance 
such tests and technological solutions that can facilitate at-
home test result reporting to relevant public health 
authorities and providers. The Committee directs BARDA to 
provide a briefing within 180 days of the date of enactment of 
this Act on this topic.
    Development of Immunomodulators as Therapeutics.--The 
Committee encourages BARDA to consider the immunomodulators 
category of therapeutics to treat Acute Respiratory Distress 
Syndrome.
    Long-COVID.--The Committee is concerned about the 
prevalence of ``long-COVID'' in patients who have previously 
been diagnosed with COVID-19. While there are no therapeutics 
currently on the market for this condition, there are current 
FDA-approved services being used to treat long-term vascular 
disease which may also show promise in reducing long-COVID 
symptoms. The Committee encourages BARDA to consider 
investments to address this issue, with a specific focus on 
therapies with demonstrated evidence of improvement of 
symptoms.
    Nanovaccines.--The Committee encourages BARDA to support 
nanovaccine research to improve upon existing COVID-19 
vaccines, as room temperature stable nanovaccines can be 
rapidly designed, tested, and deployed.
    Next Generation Blood Products.--The Committee urges BARDA 
to continue investments in blood technologies, including the 
completion of the ongoing clinical trials for nucleic acid 
targeted pathogen reduction technology to improve red blood 
cell transfusion safety.
    Next Generation Vaccines.--The Committee encourages BARDA 
to support a variety of vaccine platforms and the development 
of novel technologies to improve vaccine immunogenicity, 
durability, and tolerability, as well as thermostability, 
storage, and transport.
    Portfolio Updates.--The Committee encourages BARDA to 
provide and regularly update portfolio webpages to mimic the 
information posted on COVID-19 investments.
    Strengthening Domestic Medical Manufacturing and 
Production.--The Committee is concerned about the nation's 
limited infrastructure to produce essential products such as 
medical devices, medical equipment, pharmaceuticals, and 
personal protective equipment. Weaknesses in the supply chain 
and the dependence of the U.S. healthcare system on other 
countries continues to impact the availability of products and 
in some cases, limits care. The Committee recognizes the 
importance of domestic manufacturing and raw materials and 
urges HHS to undertake efforts to ensure a long-term 
sustainable domestic supply chain for medical products.
    Zika Vaccine.--The Committee is concerned about the risk of 
Zika mutations and new variants. The Committee encourages BARDA 
to continue to include Zika vaccine efforts in its portfolio.

Policy and Planning

    The Committee includes $17,877,000, an increase of 
$3,000,000, for Policy and Planning. The Office of Policy and 
Planning leads the Department's emergency preparedness and 
response strategic direction and policy coordination.

Project BioShield Special Reserve Fund

    The Committee includes $800,000,000, an increase of 
$20,000,000, for Project BioShield. These funds support the 
acquisition of promising medical countermeasures developed 
through BARDA contracts for the most serious public health 
threats.

Strategic National Stockpile

    The Committee includes $855,000,000, an increase of 
$10,000,000, for the Strategic National Stockpile (SNS).
    CDC Engagement.--The Committee directs ASPR to support the 
significant role of the Centers for Disease Control and 
Prevention in the SNS by providing scientific expertise in 
decision-making related to procurement of countermeasures, and 
maintaining strong relationships with State and local public 
health departments to facilitate efficient deployment of 
countermeasures in public health emergencies.
    Domestic Diagnostic Manufacturing.--The Committee remains 
concerned the COVID-19 pandemic demonstrated the need for warm-
base manufacturing for U.S. diagnostic companies. Therefore, 
the Committee encourages ASPR to pursue public-private 
partnerships with U.S. diagnostic manufacturers to invest in 
warm-base manufacturing of over-the-counter tests for the SNS 
and public health surveillance.
    Influenza Antivirals.--The Committee remains concerned 
about the stockpile of influenza antivirals. The Committee 
supports the initiative to diversify and replenish its 
stockpile of emergency influenza antivirals to ensure that the 
U.S. has multiple treatment options.
    Re-Envisioning the Strategic National Stockpile.--The 
Committee recognizes that efforts are underway to review and 
propose a path forward for the SNS, as directed by P.L. 117-
103, and awaits the release of these plans.
    Strategic National Stockpile Supplies.--Not later than 30 
days after the date of enactment of this Act, and monthly 
thereafter until the public health emergency related to COVID-
19 is no longer in effect, the Secretary shall report to the 
Committee on the current inventory of ventilators and personal 
protective equipment in the SNS, including the numbers of face 
shields, gloves, goggles and glasses, gowns, head covers, 
masks, and respirators, as well as deployment of ventilators 
and personal protective equipment during the previous month, 
reported by State and other jurisdiction. Further, the 
Committee directs the Assistant Secretary to ensure that the 
working group under section 319F(a) of the Public Health 
Service Act and the Public Health Emergency Medical 
Countermeasures Enterprise (PHEMCE) established under section 
2811-1 of such Act includes expenditures necessary to maintain 
the minimum level of relevant supplies in the SNS, including in 
case of a significant pandemic, in the yearly submission of the 
PHEMCE multi-year budget.

Medical Reserve Corps

    The Committee includes $6,240,000 for the Medical Reserve 
Corps program, which is a network of local volunteers made up 
of doctors, dentists, nurses, pharmacists, and other community 
members who work to strengthen the public health infrastructure 
and preparedness capabilities of their communities.

Preparedness and Response Innovation

    The Committee provides $4,000,000, an increase of 
$1,920,000, for a bilateral cooperative program with the 
Government of Israel for the development of health 
technologies.

Cybersecurity

    The Committee provides $131,915,000, an increase of 
$60,500,000, for information technology cybersecurity in the 
Office of the Chief Information Officer and HHS-wide to 
strengthen the Department's cybersecurity posture.
    In addition, the Committee provides $21,900,000 for HHS 
Protect and directs this effort to be transferred to CDC, as 
proposed. The Committee directs CDC to lead HHS Protect and to 
immediately reassess its scope and capabilities, considering 
data quantity and quality as the COVID-19 pandemic evolves, and 
to make appropriate modifications. The Committee directs HHS 
Protect to be integrated into other programs and initiatives, 
as appropriate but not be prioritized above other efforts. The 
Committee requests a briefing not later than 60 days after the 
date of enactment of this Act on the path forward for HHS 
Protect, including current and future year budget estimates.

Office of National Security

    The Committee provides $8,983,000, an increase of $473,000, 
for the Office of National Security to maintain the security of 
the Department's personnel, systems, and critical 
infrastructure.

Office of the Assistant Secretary for Health

    The Committee provides $10,000,000 for preparedness and 
readiness activities.

Pandemic Influenza Preparedness

    The Committee includes $382,000,000, an increase of 
$82,000,000, for the pandemic influenza preparedness program. 
This funding supports efforts to modernize influenza research 
and development of vaccines and the next-generation influenza 
medical countermeasures, preparedness testing and evaluation, 
and stockpiling, as well as critical domestic vaccine 
manufacturing infrastructure.

              ADVANCED RESEARCH PROJECTS AGENCY FOR HEALTH

 
 
 
Appropriation, fiscal year 2022.......................    $1,000,000,000
Budget request, fiscal year 2023......................     5,000,000,000
Committee Recommendation..............................     2,750,000,000
    Change from enacted level.........................    +1,750,000,000
    Change from budget request........................    -2,250,000,000
 

    The Committee includes $2,750,000,000 for the Advanced 
Research Projects Agency for Health (ARPA-H), $1,750,000,000 
above the fiscal year 2022 enacted level and $2,250,000,000 
below the fiscal year 2023 budget request.
    The Committee strongly supports the mission of ARPA-H to 
drive transformational innovation in health research. The 
Committee believes that given its focus on supporting high-
risk, high-reward projects and distinct approach to selecting 
and managing research projects, establishing ARPA-H as a 
separate entity within HHS will maximize the likelihood of the 
agency's success. The Committee strongly encourages HHS to 
collaborate with DARPA to develop the foundational policies, 
procedures, and staff training for ARPA-H employees.
    ALS Research and Treatments.--The Committee urges ARPA-H to 
consider funding ALS research that prioritizes time to 
beneficial impacts on people living with ALS and their 
families.
    Mental Health Research.--The Committee urges ARPA-H to 
consider mental health research, including diagnosis and 
treatment of SMI to address widespread behavioral health issues 
to spur industry developments and new academic partnerships.
    Nanovaccine Research.--The Committee recognizes the need to 
invest in nanovaccine research at U.S. universities to improve 
upon existing COVID-19 vaccines such as room temperature stable 
nanovaccines that can be rapidly designed, tested, and 
deployed. The Committee directs NIH to consider funding a 
consortium of academic researchers working on nanovaccines.

                           General Provisions

    Sec. 201. The Committee continues a provision to limit the 
amount available for official reception and representation 
expenses.
    Sec. 202. The Committee continues a provision to limit the 
salary of an individual through an HHS grant or other 
extramural mechanism to not more than the rate of Executive 
Level II.
    Sec. 203. The Committee continues a provision to prohibit 
the Secretary from using evaluation set-aside funds until the 
Committees on Appropriations receive a report detailing the 
planned use of such funds.
    Sec. 204. The Committee continues a provision regarding the 
PHS evaluation set-aside.

                          (TRANSFER OF FUNDS)

    Sec. 205. The Committee continues a provision permitting 
the Secretary of HHS to transfer up to one percent of any 
discretionary funds between appropriations, provided that no 
appropriation is increased by more than three percent by any 
such transfer to meet emergency needs. Notification must be 
provided to the Committees on Appropriations at the program, 
project, and activity level in advance of any such transfer.
    Sec. 206. The Committee continues the 60-day flexibility 
for National Health Service Corps contract terminations.
    Sec. 207. The Committee continues a provision to prohibit 
the use of Title X funds unless the applicant for the award 
certifies to the Secretary that it encourages family 
participation in the decision of minors to seek family planning 
services and that it provides counseling to minors on how to 
resist attempts to coerce minors into engaging in sexual 
activities.
    Sec. 208. The Committee continues a provision stating that 
no provider of services under Title X shall be exempt from any 
law requiring notification or the reporting of child abuse, 
child molestation, sexual abuse, rape, or incest.
    Sec. 209. The Committee continues a provision related to 
the Medicare Advantage program.
    Sec. 210. The Committee continues a provision prohibiting 
funds from being used to advocate or promote gun control.
    Sec. 211. The Committee continues a provision to allow 
funding for HHS international HIV/AIDS and other infectious 
disease, chronic and environmental disease, and other health 
activities abroad to be spent under the State Department Basic 
Authorities Act of 1956.
    Sec. 212. The Committee continues a provision authorizing 
certain international health activities.

                          (TRANSFER OF FUNDS)

    Sec. 213. The Committee continues a provision to provide 
the Director of NIH, jointly with the Director of the Office of 
AIDS Research, the authority to transfer up to three percent of 
human immunodeficiency virus funds.

                          (TRANSFER OF FUNDS)

    Sec. 214. The Committee continues a provision that makes 
NIH funds for human immunodeficiency virus research available 
to the Office of AIDS Research.
    Sec. 215. The Committee continues a provision granting 
authority to the Office of the Director of the NIH to enter 
directly into transactions in order to implement the NIH Common 
Fund for medical research and permitting the Director to 
utilize peer review procedures, as appropriate, to obtain 
assessments of scientific and technical merit.
    Sec. 216. The Committee continues a provision clarifying 
that funds appropriated to NIH Institutes and Centers may be 
used for minor repairs or improvements to their buildings, up 
to $5,000,000 per project with a total limit for NIH of 
$100,000,000.

                          (TRANSFER OF FUNDS)

    Sec. 217. The Committee continues a provision transferring 
one percent of the funding made available for National 
Institutes of Health National Research Service Awards to the 
Health Resources and Services Administration.
    Sec. 218. The Committee continues the Biomedical Advanced 
Research and Development Authority ten year contract authority.
    Sec. 219. The Committee continues specific report 
requirements for CMS's Health Insurance Exchange activities in 
the fiscal year 2024 budget request.
    Sec. 220. The Committee continues a provision prohibiting 
the CMS Program Management account from being used to support 
risk corridor payments.

                          (TRANSFER OF FUNDS)

    Sec. 221. The Committee continues language directing the 
spending of the Prevention and Public Health fund.

                   PREVENTION AND PUBLIC HEALTH FUND

    The Committee continues a provision that directs the 
transfer of the Prevention and Public Health Fund. In fiscal 
year 2023, the level appropriated for the fund is $943,000,000 
after accounting for sequestration. The Committee includes bill 
language in section 221 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:

------------------------------------------------------------------------
             Agency                 Budget Activity    FY 2023 Committee
------------------------------------------------------------------------
ACL.............................  Alzheimer's Disease        $14,700,000
                                   Program.
ACL.............................  Chronic Disease              8,000,000
                                   Self-Management.
ACL.............................  Falls Prevention...          5,000,000
CDC.............................  Breastfeeding                9,750,000
                                   Grants (Hospitals
                                   Promoting
                                   Breastfeeding).
CDC.............................  Diabetes...........         52,275,000
CDC.............................  Epidemiology and            40,000,000
                                   Laboratory
                                   Capacity Grants.
CDC.............................  Healthcare                  12,000,000
                                   Associated
                                   Infections.
CDC.............................  Heart Disease and           57,075,000
                                   Stroke Prevention
                                   Program.
CDC.............................  Million Hearts              10,000,000
                                   Program.
CDC.............................  Preventive Health          160,000,000
                                   and Health
                                   Services Block
                                   Grant.
CDC.............................  Tobacco............        120,850,000
CDC.............................  Section 317                419,350,000
                                   Immunization
                                   Grants.
CDC.............................  Lead Poisoning              17,000,000
                                   Prevention.
CDC.............................  Early Care                   5,000,000
                                   Collaboratives.
SAMHSA..........................  Garrett Lee Smith--         12,000,000
                                   Youth Suicide
                                   Prevention.
------------------------------------------------------------------------

    Sec. 222. The Committee modifies a provision related to 
breast cancer screening.
    Sec. 223. The Committee continues a provision related to 
indirect cost negotiated rates.

                          (TRANSFER OF FUNDS)

    Sec. 224. The Committee continues a provision permitting 
transfer of funds within NIH, if such funds are related to 
opioid, stimulant, and pain management research.
    Sec. 225. The Committee continues certain Congressional 
notification requirements.
    Sec. 226. The Committee continues a provision related to a 
report on staffing.
    Sec. 227. The Committee continues a provision allowing HHS 
to cover travel expenses when necessary for employees to obtain 
medical care when they are assigned to duty in a location with 
a public health emergency.
    Sec. 228. The Committee modifies a provision related to 
donations for unaccompanied children.
    Sec. 229. The Committee modifies a provision related to the 
use of funds to house unaccompanied children in facilities that 
are not State-licensed for the care of unaccompanied children.
    Sec. 230. The Committee continues a provision related to 
the notification requirements regarding the use of facilities 
that are not State-licensed for the care of unaccompanied 
children.
    Sec. 231. The Committee modifies a provision related to 
Members of Congress and oversight of facilities responsible for 
the care of unaccompanied children.
    Sec. 232. The Committee continues a provision requiring 
monthly reporting on unaccompanied children who were separated 
from their parents or legal guardians and transferred to the 
care of the Office of Refugee Resettlement.
    Sec. 233. The Committee includes a new provision 
prohibiting the use of funds for sharing any information 
pertaining to unaccompanied children for use or reference in 
removal proceedings or immigration enforcement.
    Sec. 234. The Committee includes a new provision ensuring 
that efforts are taken to place unaccompanied children who are 
siblings together.
    Sec. 235. The Committee includes a new provision requiring 
the Secretary to submit a detailed spend plan outlining 
anticipated uses of funds in the Refugee and Entrant Assistance 
account.
    Sec. 236. The Committee includes a new provision 
authorizing the use of funds in the Refugee and Entrant 
Assistance account for services to children, parents, and legal 
guardians who were separated at the United States-Mexico border 
in connection with the Zero-Tolerance Policy.
    Sec. 237. The Committee continues a provision related to 
primary and secondary school costs for eligible dependents of 
HHS personnel stationed in the Commonwealth of Puerto Rico, the 
Commonwealth of the Northern Mariana Islands, and the 
possessions of the United States.

                              (RESCISSION)

    Sec. 238. The Committee modifies a provision related to the 
Nonrecurring Expenses Fund.
    Sec. 239. The Committee continues a provision related to 
flexibility for grantees of the Ryan White HIV/AIDS program.
    Sec. 240. The Committee includes a new provision 
prohibiting funds for foster care programs from being awarded 
to an organization that excludes an individual based on non-
merit factors such as age, disability, sex, race, color, 
national origin, religion, gender identity, or sexual 
orientation.
    Sec. 241. The Committee includes a new provision related to 
premium pay authority.
    Sec. 242. The Committee includes a new provision to amend 
the PHS Act and related statutes to revise references to the 
National Institute on Drug Abuse.
    Sec. 243. The Committee includes a new provision to amend 
the PHS Act and related statutes to revise references to the 
National Institute on Alcohol Abuse and Alcoholism.
    Sec. 244. The Committee includes a new provision to amend 
the PHS Act and related statutes to revise references to the 
Substance Abuse and Mental Health Services Administration.
    Sec. 245. The Committee includes a new provision related to 
notification requirements in the Social Security Act.
    Sec. 246. The Committee continues a provision related to 
multi-year grant funding for research projects that were 
delayed due to COVID-19.
    Sec. 247. The Committee includes a new provision related to 
CDC fellowship and training participants.

                   TITLE III--DEPARTMENT OF EDUCATION


                    EDUCATION FOR THE DISADVANTAGED

 
 
 
Appropriation, fiscal year 2022.......................   $18,229,790,000
Budget request, fiscal year 2023......................    21,280,551,000
Committee Recommendation..............................    21,260,551,000
    Change from enacted level.........................    +3,030,761,000
    Change from budget request........................       -20,000,000
 

    This account provides foundational funding to help ensure 
all children receive a fair, equitable and high-quality 
education.
    Of the total amount available, $10,306,490,000 is 
appropriated for fiscal year 2023 for obligation on or after 
July 1, 2024 and $10,841,177,000 is appropriated for fiscal 
year 2023 for obligation on or after October 1, 2024.

Grants to Local Educational Agencies

    For fiscal year 2023, the Committee recommends 
$20,536,802,000 for Title I grants to Local Educational 
Agencies (LEAs or school districts), an increase of 
$3,000,000,000 over the fiscal year 2022 enacted level. Title I 
is the cornerstone of Federal K-12 education programs and 
critical to the nation's collective efforts to ensure that 
every child has the opportunity to obtain a high-quality 
education. The program serves an estimated 25 million students 
in nearly 90 percent of school districts and nearly 60 percent 
of all public schools. Providing additional resources so that 
children can succeed in school and in life is one of the 
Committee's highest priorities in the bill.
    Of the amounts provided for Title I programs, 
$6,459,401,000 is available for Basic Grants to LEAs, which is 
the same as the fiscal year 2022 enacted level. Basic grants 
are awarded to school districts with at least 10 low-income 
children who make up more than two percent of the school-age 
population.
    Within the amount for Title I Basic Grants, up to 
$5,000,000 is made available to the Secretary of Education 
(Secretary) on October 1, 2022, to obtain annually-updated LEA-
level poverty data from the Bureau of the Census.
    The Committee recommends $1,362,301,000 for Title I 
Concentration Grants, which is the same as the fiscal year 2022 
enacted level. Concentration Grants target funds to school 
districts in which the number of low-income children exceeds 
6,500 or 15 percent of the total school-age population.
    The Committee recommends $6,357,550,000 for Title I 
Targeted Grants, which is $1,500,000,000 above the fiscal year 
2022 enacted level. Targeted Grants provide higher payments to 
school districts with high numbers or percentages of low-income 
students.
    The Committee recommends $6,357,550,000 for Title I 
Education Finance Incentive Grants (EFIGs) which is 
$1,500,000,000 above the fiscal year 2022 enacted level. EFIGs 
provide payments to States and school districts that 
incorporate equity and effort factors to improve the equity of 
State funding systems.
    Fiscal Equity.--The Committee is concerned that school 
districts serving majority students of color and students from 
low-income backgrounds are more likely to be funded 
inadequately. Data shows school districts with the highest 
percentage enrollments of students of color receive nearly 
$1,800 per student less in State and local funding than school 
districts serving the fewest students of color, while districts 
serving the most students in poverty receive $1,000 less than 
districts serving the fewest students in poverty.
    Against the backdrop of these unacceptable inequities, 
Title I provides vital additional resources to support low-
income students in school. Since fiscal year 2002, the 
Committee has directed increases to Title I through the 
Targeted and EFIG formulas. Under the Targeted and within-State 
EFIG formulas, a school district receives higher grants per 
child counted in the Title I formula the higher its poverty 
rate or number. A 2019 study of the Title I formulas by the 
National Center for Education Statistics illustrates their 
progressive structure--under Targeted, districts in the highest 
poverty quarter received $118 more per formula-eligible child 
than the lowest poverty quarter. Under EFIG, districts in the 
highest poverty quarter received $143 more per formula-eligible 
child than the lowest poverty quarter.
    The Committee regards the Targeted and EFIG formulas as 
essential tools for promoting funding equity nationwide; 
however, the Committee recognizes that State and local funding 
represents more than 90 percent of public K-12 funding 
nationwide. Accordingly, the Committee believes States can do 
far more to improve school district funding equity through 
improvements to school finance formulas. While some will argue 
that Federal legislative attention should exclusively focus on 
improvements to Title I formulas, the Committee believes such 
efforts represent work avoidance. Instead, the Committee 
believes States have an opportunity to combat urgent funding 
inequities through more progressive funding allocations to 
districts. For instance, if State-level funding to school 
districts were distributed via methods similar to the Federal 
Targeted and within-State EFIG formulas, the impact would be 
transformative for students attending the nation's highest-need 
schools.
    To begin this work, the Committee recommendation includes a 
new provision, which allows the Secretary to use up to 
$50,000,000 to award competitive grants to States for voluntary 
activities designed to identify and close funding gaps between 
high-poverty and low-poverty school districts. The Committee is 
supportive of efforts to provide financial assistance to States 
that request aid to identify disparities in State or local 
funding for high-need LEAs; engage with local communities in 
developing plans, goals and timelines for reducing identified 
disparities; and report on interim goals, progress and 
corrective actions.
    The Committee also acknowledges that the Elementary and 
Secondary Education Act (ESEA) contains several provisions 
intended to reduce resource inequities between high-poverty and 
low-poverty school districts, particularly regarding school 
improvement activities. The Committee encourages the Department 
to continue its efforts to assist States in evaluating resource 
allocation in districts that serve a significant number of 
schools identified for improvement and districts in identifying 
resource inequities for schools identified for improvement as 
part of a comprehensive school support and improvement plan.
    Transportation and School Improvement.--The Committee 
recognized a longstanding barrier to the implementation of 
strategies to increase student diversity as a means of school 
improvement in the Department of Education Appropriations Act, 
2019 when it removed two decades-old prohibitions on the use of 
Federal funds for transportation costs to carry out school 
desegregation efforts. Subsequently, in the Department of 
Education Appropriations Act, 2021, the Committee removed the 
last of these long-standing prohibitions in the Federal code in 
the General Education Provisions Act. With the recent removal 
of these prohibitions, the Committee remains concerned many 
States and districts may be unaware of their ability to use 
ESEA funding to support voluntary school integration efforts. 
In response, the Committee included a directive in House Report 
117-96 requiring the Department to provide technical assistance 
to school districts regarding the use of school improvement 
funds under Title I, Part A for transportation to support 
voluntary school integration efforts. The Committee looks 
forward to receiving an update on the Department's progress in 
carrying out this work by September 30, 2022.
    Reservation for Homeless Students.--The Committee continues 
to urge that the Department support LEAs' development of plans 
under section 1112(b)(6) of the ESEA that describe the amount 
of funds for homeless students reserved under section 
1113(c)(3)(A) of the ESEA, how such amount was determined, and 
the amount of the prior year's reservation that was spent on 
homeless students. The Committee further urges that the 
Department support State educational agencies' (SEAs) 
development of plans under section 1111(g)(1)(F) of the ESEA 
that describe how the SEA will monitor the amount and use of 
funds reserved for homeless students under section 
1113(c)(3)(A) and provide technical assistance to assist LEAs 
in effectively using such funds to support homeless students.
    Diverse Texts in School Libraries.--The Committee believes 
that all students should be able to access texts that reflect 
their interests and diverse cultures. Unfortunately, too many 
Black, Latino, Asian-American, and Native students are unable 
to access such books and printed materials in their classrooms 
and school libraries. To address this challenge, the Committee 
supports classroom and school libraries that seek to include 
content that reflects the history and diversity of their 
student populations.
    School Names.--The Committee supports efforts by school 
districts that are home to populations of Latino, Black, Asian-
American, and Native students to ensure public schools reflect 
the diversity of their districts, which may extend to the 
naming of schools to highlight the achievements of members from 
Latino, Black, Asian-American, and Native communities.
    History and Cultural Contributions of Racial and Ethnic 
Minorities.--The Committee recognizes the increasing diversity 
of student populations attending K-12 public schools in the 
United States, and the value in developing curricula that fully 
capture the history and cultural contributions of racial and 
ethnic minorities in the U.S. The Committee supports efforts by 
the Department to provide technical assistance to K-12 public 
schools and educators interested in developing such courses and 
curricula for their students. The Committee also supports 
efforts by the Department to provide technical assistance 
around professional development for K-12 educators to develop, 
implement, and teach these emerging curricula using research-
based, culturally responsive teaching methods and best 
practices. The Committee recognizes that well-taught and well-
designed courses highlighting the history and cultural 
contributions of diverse populations provide academic benefits 
to all students and contribute to students' sense of self and 
belonging in school.
    Increasing Equity in Advanced Coursework.--Research shows 
that Black, Latino, and Native American students, students with 
disabilities, and students from low-income families are 
underrepresented in advanced programs and courses (gifted and 
talented, advanced placement, international baccalaureate, 
honors courses, dual enrollment). A major barrier for these 
students is the over-reliance on subjective criteria not proven 
to predict course success. The Committee is encouraged by 
recent State and district actions to lessen these disparities, 
including the implementation of open enrollment, automatic 
enrollment for students who have demonstrated readiness, and/or 
universal screening for gifted and talented programs. The 
Committee notes that funds under ESEA may be used to implement 
open enrollment, automatic enrollment, and/or universal 
screening practices; as well as use these funds to increase 
course access and success, provide coaching and training for 
educators, purchase materials, and/or cover exam fees for 
underrepresented students. To ensure these resources advance 
student outcomes for historically underserved students, the 
Committee continues to encourage the Department to resume 
collecting data on passing rates for all Advanced Placement 
subject areas.
    Military Student Identifier.--The Committee notes that the 
ESEA recognizes military-connected students as a distinct 
subgroup of students. More than 80 percent of military-
connected children attend public schools. Students with 
parents/guardians who serve full-time in the military move and 
change schools frequently. In addition, they may experience 
trauma resulting from separations from a parent/guardian due to 
their parents' service to the U.S. Military. The Military 
Student Identifier provides educators, school leaders, and 
policymakers with critical information to personalize attention 
and direct resources to better support military dependent 
children. Current law directs the Military Student Identifier 
toward the children of active duty families, leaving out the 
nearly one-half million children of the reserve component, both 
National Guard and Reserves. The Committee supports efforts to 
address the unique needs of children whose parents/guardians 
serve in the National Guard and reserve components.

Comprehensive Literacy Development Grants

    The Committee recommends $192,000,000 for Comprehensive 
Literacy Development Grants, which is the same as the fiscal 
year 2022 enacted level. Funds are awarded to States to 
subgrant to school districts and/or early education programs to 
improve literacy instruction for disadvantaged students.

Innovative Approaches to Literacy

    The Committee recommends $31,000,000 for Innovative 
Approaches to Literacy (IAL), which is $2,000,000 above the 
fiscal year 2022 enacted level. IAL funds support competitive 
grants to school libraries and national not-for-profit 
organizations to provide books and literacy activities to 
children and families in high-need communities.
    Underserved Urban School Districts.--The Committee directs 
the Department in any new fiscal year 2023 competition to 
continue prioritizing underserved communities in urban school 
districts in which students from low-income families make up at 
least 50 percent of enrollment.

State Agency Programs: Migrant

    The Committee recommends $375,626,000 for the State Agency 
Program for Migrant Education, which is the same as the fiscal 
year 2022 enacted level. This program supports special 
educational and related services for children of migrant 
agricultural workers and fishermen, including: (1) 
supplementary academic education; (2) remedial or compensatory 
instruction; (3) English for limited English proficient 
students; (4) testing; (5) guidance counseling; and (6) other 
activities to promote coordination of services across States 
for migrant children whose education is interrupted by frequent 
moves.

State Agency Programs: Neglected and Delinquent

    For the State Agency Program for Neglected and Delinquent 
Children, the Committee recommends $48,239,000, the same as the 
fiscal year 2022 enacted level. This formula grant program 
supports educational services for children and youth under age 
21 in State-run institutions, attending community day programs, 
and in correctional facilities. A portion of these funds is 
provided for projects that support the successful re-entry of 
youth from the criminal justice system into postsecondary and 
vocational programs.
    Support for At-risk Youth.--The Committee is concerned with 
findings from the Department's report to Congress on Neglected 
and Delinquent Programs, which found that State-level data on 
re-entry activities required under ESEA is insufficient to 
provide an accurate sense of the success of such efforts 
nationally. Given the disproportionate impact of the COVID-19 
pandemic on the youth justice system, the Committee believes it 
is essential that the Department monitor and ensure compliance 
with re-entry activities required under ESEA. In the fiscal 
year 2024 Congressional Budget Justification, the Committee 
requests information regarding how the Department will support 
each State in meeting the data reporting and re-entry 
requirements for youth included in ESEA.

Children and Youth in Foster Care

    The Committee includes $18,761,000 for a new program, 
Improving Outcomes for Children and Youth in Foster Care.
    The Committee notes the importance of mentoring in helping 
children and youth in foster care thrive and strongly 
encourages the Department to prioritize partnership grants that 
match students in foster care with mentors and tutors.

Special Programs for Migrant Students

    The Committee recommends $58,123,000 for the Special 
Programs for Migrant Students, which is $10,000,000 above the 
fiscal year 2022 enacted level. These programs make grants to 
colleges, universities, and nonprofit organizations to support 
educational programs designed for students who are engaged in 
migrant and other seasonal farm work. The High School 
Equivalency Program (HEP) recruits migrant students age 16 and 
over and provides academic and support services to help those 
students obtain a high school equivalency certificate and 
subsequently to gain employment or admission to a postsecondary 
institution or training program. The College Assistance Migrant 
Program (CAMP) provides tutoring and counseling services to 
first-year, undergraduate migrant students and assists those 
students in obtaining student financial aid for their remaining 
undergraduate years.

                               IMPACT AID

 
 
 
Appropriation, fiscal year 2022.......................    $1,557,112,000
Budget request, fiscal year 2023......................     1,541,112,000
Committee Recommendation..............................     1,614,112,000
    Change from enacted level.........................       +57,000,000
    Change from budget request........................       +73,000,000
 

    This account supports payments to school districts affected 
by Federal activities, such as those that educate children 
whose families are connected with the military or who live on 
Indian land.

Basic Support Payments

    The Committee recommends $1,464,242,000 for Basic Support 
Payments to LEAs, which is $55,000,000 above the fiscal year 
2022 enacted level. Basic Support Payments compensate school 
districts for lost tax revenue and are made on behalf of 
Federally-connected children, such as children of members of 
the uniformed services who live on Federal property.

Payments for Children With Disabilities

    The Committee recommends $48,316,000 for Payments for 
Children with Disabilities, which is the same as the fiscal 
year 2022 enacted level. These payments compensate school 
districts for the increased costs of serving Federally-
connected children with disabilities.

Facilities Maintenance

    The Committee recommends $4,835,000 for Facilities 
Maintenance, which is the same as the fiscal year 2022 enacted 
level. These capital payments are authorized for maintenance of 
certain facilities owned by the Department.

Construction

    The Committee recommends $17,406,000 for the Construction 
program, which is the same as the fiscal year 2022 enacted 
level. Funding is allocated by formula to eligible LEAs for 
school construction activities under section 7007(b) of ESEA.

Payments for Federal Property

    The Committee recommends $79,313,000 for Payments for 
Federal Property, which is $2,000,000 above the fiscal year 
2022 enacted level. Funds are awarded to school districts to 
compensate for lost tax revenue as the result of Federal 
acquisition of real property since 1938.
    Data for Eligible Communities.--The reporting method used 
to calculate the amount of Impact Aid a school receives is 
critical to ensuring accurate data for eligible communities. 
Correct student counts ensure adequate resources are provided 
for students. The Committee repeats its request that the 
Department assess the merits of such flexibilities in future 
years, along with other potential process modifications, in the 
fiscal year 2024 Congressional Budget Justification. In 
addition, the Committee requests recommendations for helping 
LEAs plan for discrepancies between estimated and actual award 
levels.

                      SCHOOL IMPROVEMENT PROGRAMS

 
 
 
Appropriation, fiscal year 2022.......................    $5,595,835,000
Budget request, fiscal year 2023......................     5,525,982,000
Committee Recommendation..............................     5,905,642,000
    Change from enacted level.........................      +309,807,000
    Change from budget request........................      +379,660,000
 

    The Committee recommendation includes $5,905,642,000 for 
the School Improvement Programs account.

Supporting Effective Instruction State Grants

    The Committee recommends $2,270,080,000 for Supporting 
Effective Instruction State Grants (Title II-A), which is 
$100,000,000 above the fiscal year 2022 enacted level. Title 
II-A grants provide States and school districts with a flexible 
source of funding to strengthen the skills and knowledge of 
teachers, principals, and administrators to enable them to 
improve student achievement.
    Educator Diversity.--Research shows that all students, and 
in particular students of color, benefit from a racially 
diverse workforce. Research shows that students benefit both 
academically and through the positive relationships they build 
with educators. However, barriers such as unfavorable working 
conditions or antagonistic work cultures mean that teachers of 
color leave the profession at higher rates than their peers. 
The Committee recognizes that the need for a more diverse 
educator workforce is always pressing, but is especially urgent 
right now, as nearly half of U.S. schools are facing COVID-
related staff shortages. The Committee is encouraged by efforts 
to address factors undergirding teacher shortages and lack of 
teacher diversity in States and districts, including using 
evidence-based models such as Grow Your Own programs. The 
Committee's increase to Title II-A for fiscal year 2023 is 
intended to address concerns about staffing shortages, increase 
educator diversity, and implement evidence-based programs. The 
Committee encourages the Department to ensure funds support 
States and districts with the greatest need and programs that 
specifically aim to increase the diversity of the teaching 
workforce.
    Materials from Teacher Professional Development.--Given the 
importance of funds under Title II-A in helping teachers 
advance their own professional development and meet the needs 
of their students, the Committee encourages the Department to 
issue guidance clarifying allowable uses of funds. Teachers 
often take professional development training that, in turn, 
requires access to additional funding for instructional 
materials to be able to utilize their training in the 
classroom. The Committee continues to support efforts by the 
Secretary to offer guidance on how an LEA may use Title II-A 
funds on instructional materials that are directly connected to 
teacher professional development training. In addition, the 
Committee continues to note the benefits of posting guidance 
online and communicating about guidance with outside 
stakeholders, particularly district superintendents.

Supplemental Education Grants

    The Committee recommends $24,464,000 for Supplemental 
Education Grants to the Federated States of Micronesia and the 
Republic of the Marshall Islands, which is $4,807,000 more than 
the fiscal year 2022 enacted level. The Compact of Free 
Association Amendments Act of 2003 (P.L. 108-188) authorizes 
these entities to receive funding for general education 
assistance.

Nita M. Lowey 21st Century Community Learning Centers

    The Committee recommends $1,409,673,000 for Nita M. Lowey 
21st Century Community Learning Centers, $120,000,000 more than 
the fiscal year 2022 enacted level and $100,000,000 above the 
fiscal year 2022 budget request. Funds are awarded by formula 
to States, which in turn distribute funds on a competitive 
basis to local school districts, nonprofit organizations, and 
other public entities.
    The Committee notes that only one in three 21st Century 
Community Learning Centers grant applications is awarded, 
reflecting substantial unmet demand for these opportunities. 
The $120,000,000 increase over fiscal year 2022 will help 
communities providing afterschool programs serve 144,000 more 
students than in fiscal year 2022.

State Assessments

    The Committee recommends $390,000,000 for State 
Assessments, which is the same as the fiscal year 2022 enacted 
level. Funds are available to develop and implement academic 
standards and assessments. The program includes a set-aside for 
audits to identify and eliminate low-quality or duplicative 
assessments.

Education for Homeless Children and Youth

    The Committee recommends $122,000,000 for the Education for 
Homeless Children and Youth program, which is $8,000,000 more 
than the fiscal year 2022 enacted level. Grants are allocated 
to States in proportion to the total each State receives under 
the Title I program.

Training and Advisory Services

    The Committee recommends $6,575,000 for Training and 
Advisory Services authorized by Title IV-A of the Civil Rights 
Act, which is the same as the fiscal year 2022 enacted level. 
Title IV-A authorizes technical assistance and training 
services for school districts to address problems associated 
with desegregation on the basis of race, sex, or national 
origin. The Department awards three-year grants to regional 
Equity Assistance Centers (EACs) located in each of the 10 
Department of Education regions. The EACs provide services to 
school districts upon request. Typical activities include 
disseminating information on successful education practices and 
legal requirements related to nondiscrimination on the basis of 
race, sex, and national origin in educational programs.

Education for Native Hawaiians

    The Committee recommends $40,897,000 for the Education for 
Native Hawaiian program, which is $2,000,000 more than the 
fiscal year 2022 enacted level. Funds are used to provide 
competitive awards for supplemental education services to the 
Native Hawaiian population.
    Construction.--The Committee's $2,000,000 increase to this 
program will specifically focus on construction needs for 
schools that serve Native Hawaiian students. The Committee is 
supportive of resources to public elementary and secondary 
schools that serve Native Hawaiian students, including 
activities for construction, renovation, and modernization of 
any public elementary school, secondary school, or structure 
related to a public elementary school or secondary school, as 
authorized under part B of Title VI. The Committee encourages 
the Department to prioritize funding to organizations with 
construction needs that have experience providing supplemental 
education services to Native Hawaiian children and youth.
    Applicant Support.--For the fiscal year 2023 Education for 
Native Hawaiians competition, the Committee encourages the 
Department to offer technical assistance to quality applicants 
who have not received awards in previous competitions in order 
to promote grantee diversity among schools and programs that 
have experience providing education services to Native Hawaiian 
children and youth.

Alaska Native Education Equity

    The Committee recommends $37,953,000 for the Alaska Native 
Education Equity program, which is the same as the fiscal year 
2022 level. Funds are used to provide competitive awards for 
supplemental education services to the Alaska Native 
population.

Rural Education

    The Committee recommends $195,000,000 for Rural Education 
programs, which is the same as the fiscal year 2022 enacted 
level. There are two dedicated programs to assist rural school 
districts with improving teaching and learning in their 
schools: the Small, Rural Schools Achievement program, which 
provides funds to rural districts that serve a small number of 
students; and the Rural and Low-Income Schools program, which 
provides funds to rural districts that serve concentrations of 
poor students, regardless of the number of students served by 
the district. Funds appropriated for Rural Education shall be 
divided equally between these two programs.

Comprehensive Centers

    The Committee recommends $54,000,000 for Comprehensive 
Centers, which is the same as the fiscal year 2022 enacted 
level. The Comprehensive Centers program includes support for 
regional centers that provide training, technical assistance, 
and professional development to build State capacity to provide 
high-quality education to all students.

Student Support and Academic Enrichment State Grants

    The Committee recommends $1,355,000,000 for Student Support 
and Academic Enrichment (SSAE) State Grants, which is 
$75,000,000 above the fiscal year 2022 enacted level. SSAE 
grants provide SEAs and LEAs with flexible resources that 
provide students with access to a well-rounded education, 
including rigorous coursework, and improve school conditions 
and the use of technology.
    Arts and Entertainment Pipeline Programs.--The Committee 
continues to encourage the Department to work with States and 
school districts that serve diverse youth to explore using SSAE 
funding to support and create youth pipeline programs in the 
arts and entertainment industries. The Committee is aware of 
programs that focus on closing student opportunity gaps by 
bringing filmmakers into Title I schools to partner with 
teachers to expand access to the arts, implement social and 
emotional learning strategies, and support rigorous academic 
curricula. A 2019 evaluation by the Stanford Center for 
Assessment, Learning, and Equity found that such programs 
create a positive environment and learning community, promote 
active and social learning, provide in-depth instruction of 
vocabulary practices, and cultivate social and emotional 
learning competencies.
    Accelerated Learning Programs.--The Committee continues to 
support efforts by States and LEAs to increase diversity in 
accelerated student learning programs, such as advanced 
placement courses, gifted and talented classes and honors 
programs. The Committee supports the use of ESEA funding to 
create State or local equity offices. Equity offices could 
evaluate current data on the students enrolled in accelerated 
student learning programs and use such data to inform 
recommendations to LEAs on how to improve the diversity of 
those programs. The Committee recognizes that Black, Latino, 
and Native students, students living in poverty, and English 
learners are historically underrepresented in accelerated 
learning programs. Research shows that developing targeted 
recruitment and outreach plans, as well as universal screening 
for talented and gifted programs help address inequitable 
access that lock students out of opportunities that engage them 
more meaningfully in school and expand their postsecondary 
success.
    Menstrual Health.--The Committee is concerned about the 
disruptions to educational opportunities that children living 
in period poverty experience. Industry reports found that one 
in five school age children have missed school due to lack of 
access to safe and affordable menstrual products. In the fiscal 
year 2024 Congressional Budget Justification, Committee directs 
the Department to provide an update on the Department's 
implementation of the directive provided under this heading in 
House Report 117-96. In addition, the Committee requests 
information around the feasibility of supporting free menstrual 
product programs through the Nita M. Lowey 21st Century 
Community Learning Centers program.
    School Diversity.--The Committee strongly encourages the 
Department to use the two percent set-aside for technical 
assistance and capacity building under SSAE to award capacity-
building grants to LEAs and SEAs to reduce racial and 
socioeconomic segregation across and within school districts.
    Eye-care Services--The Committee is supportive of efforts 
by SEAs and LEAs to provide on-campus eye-care services free of 
charge to students in public elementary or secondary schools.
    Youth Mental Health and Social and Emotional Learning.--In 
the face of a youth mental health crisis, the Committee 
believes it is critical to invest in key social and emotional 
learning programs that build essential life skills as an 
effective component of promoting student mental wellness and 
preventing the development of substance use, child sexual 
abuse, bullying, and youth suicide. Investments in evidence-
based social and emotional learning programs return $11 for 
every dollar invested and the Committee encourages the 
Department to work with the Department of Health and Human 
Services on youth mental health to prioritize access to primary 
prevention programs and ensure such programs across the 
government are coordinated and leveraged for the maximum 
impact.
    Mentoring to Address Chronic Absence.--The Committee is 
concerned about the high rates of student chronic absenteeism 
across the country since the onset of the COVID-19 pandemic and 
encourages the Department to inform SEAs on how Title IV-A and 
other Federal funding sources can be used to support early 
warning data systems that identify populations of students who 
are chronically absent and successful interventions to address 
chronic absence and school engagement, such as mentoring.
    Technical Assistance on Inclusive Practices.--The Committee 
notes that SSAE provides flexible funding to support activities 
that promote a safe and healthy learning environment. With 
respect to these authorized activities, the Committee believes 
there is no more urgent charge than to support students through 
inclusive practices that are evidence-based and address the 
needs of the whole child. Further, the Committee is concerned 
by efforts that would promote SSAE for unintended purposes, 
including purposes that generate disproportionate negative 
impacts on specific student subgroups. Accordingly, the 
Committee directs the Department to describe the technical 
assistance it provides on inclusive, evidence-based practices 
that address the needs of the whole child in the fiscal year 
2024 Congressional Budget Justification.
    Trafficking Prevention Activities.--The Committee supports 
the Department's current technical assistance support to SEAs 
and LEAs in implementing human trafficking prevention 
activities and encourages the Department to offer additional 
support for these efforts.

                            Indian Education


 
 
 
Appropriation, fiscal year 2022.......................      $189,246,000
Budget request, fiscal year 2023......................       186,239,000
Committee Recommendation..............................       195,246,000
    Change from enacted level.........................        +6,000,000
    Change from budget request........................        +9,007,000
 

    This account supports programs authorized by part A of 
title VI of the ESEA.

Grants to Local Educational Agencies

    The Committee recommends $110,381,000 for Grants to Local 
Educational Agencies, which is $500,000 above the fiscal year 
2022 enacted level. This program provides assistance through 
formula grants to school districts and schools supported or 
operated by the Bureau of Indian Education. The purpose of this 
program is to improve elementary and secondary school programs 
that serve American Indian students, including preschool 
children. Grantees must develop a comprehensive plan and ensure 
that the programs they carry out will help Indian students 
reach the same challenging standards that apply to all 
students. This program supplements the regular school program 
to help American Indian children sharpen their academic skills, 
bolster their self-confidence, and participate in enrichment 
activities that would otherwise be unavailable.

Special Programs for Indian Children

    The Committee recommends $72,000,000 for Special Programs 
for Indian Children, which is $2,000,000 more than the fiscal 
year 2022 enacted level. These programs make competitive awards 
to improve the quality of education for American Indian 
students. The program also funds the American Indian Teacher 
Corps and the American Indian Administrator Corps to recruit 
and support American Indians as teachers and school 
administrators.
    The Committee's investment for Special Programs for Indian 
Children is intended to help address the shortage of Native 
American educators nationwide.

National Activities

    The Committee recommends $12,865,000 for National 
Activities, which is $3,500,000 above the fiscal year 2022 
enacted level. Within this account, funding is provided for 
grants to Tribes for education administrative planning, 
development, and coordination, grants to support Native 
language immersion schools and programs. Funds under this 
authority also support research, evaluation and data collection 
to provide information about the educational status of Indian 
students and the effectiveness of Indian education programs.
    Native American Language Immersion and the State-Tribal 
Education Partnership Program.--The Committee provides a 
$3,000,000 increase to the Native American Language Immersion 
and the State-Tribal Education Partnership (STEP) programs 
above the fiscal year 2022 enacted levels for these programs. 
The Committee looks forward to a new fiscal year 2023 STEP 
competition and directs a portion of this increase to support 
new STEP awards.
    Native American Language Resource Centers.--Within this 
account, the Committee provides no less than $1,500,000 to 
support American Indian, Alaska Native and Native Hawaiian 
language activities for the Native American Language Resource 
Center program established in the explanatory statement 
accompanying the Department of Education Appropriations Act, 
2022.

                       INNOVATION AND IMPROVEMENT

 
 
 
Appropriation, fiscal year 2022.......................    $1,300,730,000
Budget request, fiscal year 2023......................     1,572,000,000
Committee Recommendation..............................     1,484,608,000
    Change from enacted level.........................      +183,878,000
    Change from budget request........................       -87,392,000
 

    The Committee recommends $1,484,608,000 for programs within 
the Innovation and Improvement account.

Education Innovation and Research

    The Committee recommends $384,000,000 for the Education 
Innovation and Research (EIR) program, which is $150,000,000 
above the fiscal year 2022 enacted level. This program makes 
competitive grants to support the replication and scaling-up of 
evidence-based education innovations.
    Social and Emotional Learning Grants.--On April 6, 2022, 
the Subcommittee on Labor-HHS Education-Related Agencies held a 
hearing entitled ``Social and Emotional Learning (SEL) and 
Whole Child Approaches in K-12 Education,'' during which the 
Subcommittee heard from a panel of national experts on the 
robust evidence of effectiveness for whole child interventions, 
including SEL. The Subcommittee discussed how high-quality SEL 
programs that support students' social, emotional, and 
cognitive development result in lasting positive academic and 
life outcomes. In addition, the Subcommittee explored how 
dedicated Federal resources for these approaches are vital to 
expanding their reach nationwide.
    To address these critical needs, within the total for EIR, 
the agreement includes $132,000,000, $50,000,000 above the 
fiscal year 2022 enacted level, to provide high-quality, 
evidence-based SEL grants. To fulfill the SEL set-aside, the 
Committee urges prioritization of SEL for both the early- and 
mid-phase evidence tiers.
    The Committee requests a briefing within 90 days of 
enactment of this Act on plans for carrying out the SEL 
competition. In addition, the Department shall provide notice 
and a briefing to the Committees at least seven days before 
grantees are announced.
    SEL Interventions for Educational Staff.--The Committee 
notes that the EIR SEL competition can also support evidence-
based interventions for educational staff, including but not 
limited to teachers, school counselors, school psychologists, 
and school social workers. In light of the significant 
challenges educators have faced during the COVID-19 pandemic, 
the Committee recognizes that educational staff may experience 
fatigue or stress related to their work in supporting students 
and their families, as well as burnout due to a combination of 
factors related to their work. While teacher retention and 
teacher shortage challenges remain multifaceted, the Committee 
recognizes the value of mental health resources and SEL 
interventions in order to support the emotional and mental 
health and wellbeing of educational staff.
    STEAM and Computer Science Grants.--In addition, within the 
total for EIR, the Committee recommendation includes 
$87,000,000 for STEAM education, including computer science, 
$5,000,000 above the fiscal year 2022 enacted level. Within the 
STEAM and computer science set-aside, awards should expand 
opportunities for underrepresented students such as minorities, 
girls, and youth from families living at or below the poverty 
line to help reduce the enrollment and achievement gap.
    Teacher Education Programs in Computer Science.--The 
Committee notes that the EIR STEAM and computer science 
competition can also support grants to institutions of higher 
education for teacher education programs in computer science. 
Such grants can prepare aspiring teachers with the training, 
experience, and resources needed to become successful computer 
science educators; hire and retain faculty to carry out robust 
computer science education research; train doctoral students in 
the computer science field; educate graduate and undergraduate 
students preparing to become teachers in computer science; 
develop resources for computer science teachers or teachers in-
training, informed by credible computer science education 
research or best practices from the computer science education 
field; and provide scholarships to students, particularly for 
students from traditionally underrepresented groups in computer 
science and based on financial need.
    Technology Access and Engagement.--The Committee notes that 
the EIR STEAM and computer science competition can also support 
grants that facilitate the implementation or expansion of 
technology-focused experiences that strengthen STEAM education. 
The Committee recognizes providing learning experiences to 
students that incorporate innovative technologies, such as 
digital learning platforms, improves STEM learning outcomes and 
equips students with vital skills high-demand fields like 
computer science and engineering. The Committee encourages the 
Department to provide priority to Historically Black Colleges 
and Universities (HBCUs) and Minority-Serving Institutions 
(MSIs) and applicants seeking to implement or scale technology-
enabled learning experiences in K-12 schools, including via the 
creation or acquisition of technological resources.
    Publicizing Research Findings.--The Committee continues to 
be supportive of efforts by the Department to publicize 
research findings from the EIR program as described in House 
Report 117-96.
    Diverse Geographic Areas.--The Committee encourages the 
Department to take steps necessary to ensure the statutory set-
aside for rural areas is met and that EIR funds are awarded to 
diverse geographic areas.

Teacher and School Leader Incentive Grants

    The Committee recommends $88,500,000 for the Teacher and 
School Leader Incentive Grants program, which is $84,500,000 
less than the fiscal year 2022 enacted level. This program 
provides grants to States, school districts, and partnerships 
to develop, implement, improve, or expand human capital 
management systems or performance-based compensation systems in 
schools.

American History and Civics Academies

    The Committee recommends $3,000,000 for American History 
and Civics Academies, which is the same as the fiscal year 2022 
enacted.

American History and Civics National Activities

    The Committee recommends $12,500,000 for American History 
and Civics National Activities, which is $7,750,000 more than 
the fiscal year 2022 enacted level.
    Civics Secures Democracy.--The Committee acknowledges the 
need for broad investment in civics education. In addition, the 
Committee recognizes that students who receive quality civics 
education are more likely to vote and to discuss politics at 
home, complete college and develop skills that lead to 
employment, and give back to their communities through 
volunteering and working on community issues. The Committee 
believes that Civics education in the United States is crucial 
to preserving democracy and the future safety of our nation.
    Therefore, the Committee directs the Department to run a 
new competition in fiscal year 2023 for grants supporting 
evidence-based practices proven to contribute to the 
effectiveness of educational programs in civics, including 
innovative and engaging classroom instruction in civics, 
government, and history; community service linked to classroom 
learning; learning through participation in models and 
simulations of democratic processes; meaningful participation 
in school governance; and instruction in media literacy through 
the study of common informal fallacies in logic. The Department 
is directed to prioritize grants that support traditionally 
underserved communities, including students from low-income 
urban and rural school districts, English learners, and 
students with disabilities. Eligible entities shall include 
LEAs, SEAs, and consortia of LEAs.
    Improving Civics Education Engagement.--The Committee 
recognizes that additional efforts are needed to ensure that 
our elementary, secondary, and postsecondary schools and 
institutions are coherently supporting civic education and 
experiences, rather than reinforcing siloed approaches. 
Accordingly, the Committee encourages partnerships that connect 
elementary and secondary civic education efforts with similar 
efforts at institutions of higher education. The Committee 
encourages such efforts to prioritize LEA partnerships with 
HBCUs and MSIs.

Supporting Effective Educator Development

    The Committee recommends $90,000,000 for the Supporting 
Effective Educator Development (SEED) grant program, which is 
$5,000,000 more than the fiscal year 2022 level. SEED provides 
competitive grants to support alternative certification and 
other professional development and enrichment activities for 
teachers, principals, and other school leaders. Funds are 
included to fully support continuation costs for grants made in 
prior years.
    SEL and Whole Child Education.--The Committee continues to 
support the SEL competitive preference priority within the SEED 
competition. The priority supports professional development 
that helps educators incorporate SEL practices into teaching 
and supports pathways into teaching that provide a strong 
foundation in child development and learning, including skills 
for implementing SEL strategies in the classroom. The Committee 
directs the Department to include the competitive preference 
priority in any new SEED competition in fiscal year 2023.
    If the Department issues a new notice inviting application 
for fiscal year 2023, the Committee requests a briefing within 
90 days of enactment of this Act on plans for carrying out the 
SEL competitive preference priority in SEED. In addition, the 
Department shall provide notice and a briefing to the 
Committees at least seven days before grantees for a new 
competition are announced.
    Computer Science and Native Students.--The Committee 
continues to encourage the Department, through the SEED 
program, to support projects that increase the number of 
teachers with computer science certifications with a priority 
to increase the number of such teachers in rural public schools 
and public schools serving high percentages of Native students.

Charter Schools Grants

    The Committee recommends $400,000,000 for Charter School 
Program (CSP) Grants, which is $40,000,000 below the fiscal 
year 2022 enacted level and the fiscal year 2022 budget 
request.
    CSP awards grants to SEAs or, if a State's SEA chooses not 
to participate, to charter school developers to support the 
development and initial implementation of public charter 
schools. State Facilities Incentive Grants and Credit 
Enhancement for Charter School Facilities awards help charter 
schools obtain adequate school facilities. These programs work 
in tandem to support the development and operation of charter 
schools.
    For-profit Entities.--The Department has long recognized 
the particular risks posed by for-profit education management 
organizations (EMOs). In response to a 2016 audit, the 
Department conceded to the Inspector General, ``ED is well 
aware of the challenges and risks posed by CMOs and, in 
particular, EMOs, that enter into contracts to manage the day-
to-day operations of charter schools that receive Federal 
funds. We recognize that the proliferation of charter schools 
with these relationships has introduced potential risks with 
respect to conflicts of interest, related-party transactions, 
and fiscal accountability, particularly in regard to the use of 
federal funds.'' Since that initial acknowledgement by the 
Department regarding for-profit EMOs, the Committee has been 
made aware of concerning instances of criminal fraud, conflicts 
of interest, and inadequate transparency.
    In addition, the Committee is deeply concerned that for-
profit charter schools, including those run by for-profit EMOs, 
deliver concerning outcomes for students. A 2017 report from 
Stanford University's Center for Research on Education Outcomes 
compared student performance at non-profit charters, for-profit 
charters, and traditional public schools and found that for-
profit charters perform worse in reading, and significantly 
worse in math, than non-profit charters. In addition, the 
report found that for-profit charters perform worse in math 
than traditional public schools.
    That is why the Committee is strongly supportive of the 
Department's proposal to prohibit Federal CSP funding from 
supporting for-profit EMOs through its notice published in the 
Federal Register on March 14, 2022 (87 Fed. Reg. 14197). The 
Committee includes bill language codifying the prohibition to 
establish this precedent for fiscal year 2023 and for future 
years. Moving forward, the Committee urges the Secretary to 
work with Congress on efforts to fully phase out the concerning 
for-profit EMO sector. Such efforts could include reasonable 
transition periods that allow schools run by for-profit EMOs to 
shift to independent or nonprofit management. In the interim, 
the Committee is committed to continuing its oversight of the 
for-profit EMO sector and ensuring fewer taxpayer dollars 
enrich for-profit EMO shareholders.
    Defunct CSP Grantees.--The Committee is deeply concerned by 
the Department's analysis that fifteen percent of the charter 
schools receiving CSP funding since 2001 have never opened or 
closed before their three-year grant period is complete, 
representing an unacceptable waste of at least $174,000,000 in 
taxpayer funds. Accordingly, the Committee is strongly 
supportive of the Department's fiscal year 2022 CSP notice (87 
Fed. Reg. 14197) that requires applicants to demonstrate local 
demand for new schools. The Committee rejects the premise that 
grant failure and school closure is the cost of doing business 
in CSP and welcomes reforms that will improve its performance.
    GAO Mandate from House Report 116-450.--The Committee 
continues to be supportive of GAO's work on the mandate 
included in House Report 116-450 regarding the Department's 
oversight over CSP and whether the program is being implemented 
effectively among grantees and subgrantees. The Committee is 
particularly interested in the issue of CSP-funded schools that 
eventually closed or received funds but never opened; the 
relationships between charter schools supported by CSP grants 
and charter management organizations; and enrollment patterns 
at these schools, especially for students with disabilities. In 
addition, the Committee is interested in recommendations on 
potential legislative changes to the program that would reduce 
the potential for mismanagement and ineffective operations.
    Oversight from the Office of Inspector General.--The 
Committee continues to support efforts by the Department's 
Office of Inspector General (OIG) to examine grantee 
administration of Replication and Expansion Grants, including 
charter management organization grantees. The Committee also 
supports the OIG's efforts to evaluate whether the Department 
adequately monitored grantees' performance and uses of funds 
for CSP competitions.
    Students with Disabilities and English Learners.--The 
Committee encourages the Department to continue including in 
their evaluation of State CSP grants the extent to which State 
entities are utilizing the seven percent of funding received 
under the program to ensure that charter schools receiving CSP 
grants are equipped to appropriately serve students with 
disabilities and, by extension, prepared to become high-quality 
charter schools. In addition, the Committee urges the 
Department to ensure subgrantees are equipped to meet the needs 
of English learners. The Committee directs the Department to 
provide an update on these efforts in the fiscal year 2024 
Congressional Budget Justification.
    Charter School Effects on School Segregation.--The 
Committee is concerned by findings from a 2019 Urban Institute 
report which concluded that growth in charter school enrollment 
increases the segregation of Black, Latino, and white students. 
To address this concern, the Committee urges the Department to 
give priority to applicants that plan to use CSP funds to 
operate or manage charter schools intentionally designed to be 
racially and socioeconomically diverse.
    The Committee is strongly supportive of proposed 
requirements in the Department's fiscal year 2022 CSP notice 
(87 Fed. Reg. 14197) that grantees show that they will not 
exacerbate school segregation. Accordingly, the Committee urges 
the Department to examine the merits of diversity reporting 
that compares demographic data of grantees to that of local 
districts. The Committee directs the Department to share its 
assessment of CSP diversity reporting, along with any 
prospective plans for implementation, in the fiscal year 2024 
Congressional Budget Justification.

Magnet Schools Assistance

    The Committee recommends $149,000,000 for the Magnet 
Schools Assistance program (MSAP), which is $25,000,000 more 
than the fiscal year 2022 enacted level. This program makes 
competitive grants to support the establishment and operation 
of magnet schools that are a part of a court-ordered or 
Federally-approved voluntary desegregation plan.
    Inter-district Magnet Schools.--A 2019 report by Urban 
Institute finds that two-thirds of total school segregation in 
metropolitan areas is due to segregation between, rather than 
within, school districts. Consortia of LEAs and regional 
education services agencies are eligible to receive MSAP grants 
to establish magnet schools that address inter-district school 
segregation; however, the Committee is concerned that these 
critical projects are infrequently funded. To address the 
urgent issue of inter-district segregation, the Committee 
continues to direct the Department to include a priority for 
applicants seeking to establish new inter-district magnet 
schools for any new competition in fiscal year 2023.
    Whole School Magnet Programs.--A recent Learning Policy 
Institute report finds that whole school magnet programs are 
more effective at fostering diversity than in-school magnet 
programs, which can create separate tracks and programs for 
different student populations. The Committee urges the 
Department to prioritize applicants seeking to establish and 
operate whole school magnet programs.

Ready to Learn Programming

    The Committee recommends $32,500,000 for Ready to Learn 
Programming, which is $2,000,000 more than the fiscal year 2022 
enacted level. This program supports the development and 
distribution of educational video programming for preschool and 
elementary school children and their parents, caregivers, and 
teachers.

Arts in Education

    The Committee recommends $38,500,000 for Arts in Education, 
which is $2,000,000 more than the fiscal year 2022 level. This 
program provides competitive grants to support professional 
development and the development of instructional materials and 
programming that integrate the arts into the curricula.

Javits Gifted and Talented Education

    The Committee recommends $16,500,000 for the Javits Gifted 
and Talented Education Program, which is $2,000,000 more than 
the fiscal year 2022 enacted level. Funds are awarded through 
grants and contracts to States, schools districts, and other 
organizations to support a coordinated program of research, 
demonstration projects, innovative strategies, and other 
activities to help schools identify gifted and talented 
students and address their unique educational needs.
    Underrepresented Populations.--The Committee encourages the 
Department to use funds to increase the number of grants that 
assist schools in the identification of, and provision of 
services to, gifted and talented students who may not be 
identified and served through traditional assessment methods, 
such as children with disabilities, English learners, children 
of color, and economically disadvantaged students.

Statewide Family Engagement Centers

    The Committee recommends $16,000,000 for the Statewide 
Family Engagement Centers program, which is $1,000,000 more 
than the fiscal year 2022 enacted level. Funds are awarded 
through grants to organizations to provide technical assistance 
and training to State and local educational agencies in the 
implementation and enhancement of systemic and effective family 
engagement policies, programs, and activities that lead to 
improvements in student development and academic achievement.

Fostering Diverse Schools

    The Committee includes $100,000,000 for a new competitive 
grant program, Fostering Diverse Schools. The program 
establishes competitive grants to local educational agencies 
and State educational agencies to reduce racial and 
socioeconomic segregation across and within school districts. A 
2019 report by Urban Institute finds that two-thirds of total 
school segregation in metropolitan areas is due to segregation 
between, rather than within, school districts. In response to 
this concerning dynamic, the Committee directs the Department 
to prioritize resources to address segregation across 
districts. The Committee notes the promise of strategies and 
models such as inter-district magnet schools, voluntary two-way 
transfer programs between segregated districts, district 
regionalization, and regional education service agency 
governance structures.
    The State of School District Secessions.--The Committee is 
concerned by research indicating that more than 128 school 
districts have attempted to break off, or ``secede'', from 
their school districts since the year 2000, and the likelihood 
of this trend increasing school segregation throughout the 
United States. The Committee continues to encourages the 
Department, in consultation with the Department of Justice, to 
issue a report describing the scope of the issue of school 
district ``secession'' and its impact on school segregation. 
Such a report could note which districts are party to Federal 
desegregation orders and explain whether these secessions are 
in violation of those orders. The report could also note what 
oversight exists on the part of State agencies regarding school 
district secession in the States where they have occurred.

Community Project Funding

    Within the funds included in this account, $154,108,000 
shall be used for the projects, and in the amounts, specified 
in the table titled ``Labor, HHS, Education Incorporation of 
Community Project Funding Items'' at the end of this report.

                 SAFE SCHOOLS AND CITIZENSHIP EDUCATION

 
 
 
Appropriation, fiscal year 2022.......................      $361,000,000
Budget request, fiscal year 2023......................     1,693,000,000
Committee Recommendation..............................     1,708,000,000
    Change from enacted level.........................    +1,347,000,000
    Change from budget request........................       +15,000,000
 

    The Committee recommends a total of $1,708,000,000 for 
activities to promote safe schools, healthy students, and 
citizenship education, which is $1,347,000,000 more than the 
fiscal year 2022 enacted level.

Promise Neighborhoods

    The Committee recommends $96,000,000 for Promise 
Neighborhoods, which is $11,000,000 above the fiscal year 2022 
enacted level. Promise Neighborhoods supports grants to 
nonprofit, community-based organizations for the development of 
comprehensive neighborhood programs designed to combat the 
effects of poverty and improve educational outcomes for 
children and youth, from birth through college.
    Planning Grants.--The Committee is supportive of planning 
grants within Promise intended to strengthen communities' 
abilities to scale city and regional reinvestment strategies 
and allow for direct services. These planning grants can 
support the alignment of resources and efforts across multiple 
sectors and focus on measurable shared goals.

School Safety National Activities

    The Committee recommends $1,134,000,000 for School Safety 
National Activities, which is $933,000,000 more than the fiscal 
year 2022 enacted level. The Committee's recommendation 
provides up to $5,000,000 for the Project School Emergency 
Response to Violence (Project SERV) program.
    School-based Mental Health Professionals.--The Committee 
applies the $1,000,000,000 fiscal year 2023 budget request for 
school-based mental health professionals to provide 
$500,000,000 for the Mental Health Services Professional 
Demonstration Grants program established in the Department of 
Education Appropriations Act, 2019 and $500,000,000 for the 
School-Based Mental Health Services Grants program established 
in the Department of Education Appropriations Act, 2020.
    The Committee does not expand the scope of these grants to 
include school nurses; however, the Committee helps address 
these urgent needs through increased support for School-based 
Health Centers administered by the Health Resources & Services 
Administration.
    The Committee notes that the School-Based Mental Health 
Services Grants program was created to award grants to SEAs, 
LEAs, or consortia of LEAs to increase the number of qualified, 
well-trained mental health professionals in schools. To achieve 
this critical goal, the Committee urges the Department to focus 
any new fiscal year 2023 competition on directly increasing the 
number of these vital mental health professionals, including 
school counselors, social workers, psychologists, or other 
mental health professionals qualified to provide school-based 
mental health services. In recognition of the role LEAs play in 
mental-health personnel decision making, the Committee directs 
the Department to guarantee no less than 75 percent of grants 
support LEA recipients. The Committee notes that the 
explanatory statement accompanying the Department of Education 
Appropriations Act, 2020 seeks to promote the sustainability of 
these services, by requiring that awards include a 25 percent 
match from grantees and by requiring that the awards do not 
supplant existing mental health funding.
    The Committee notes that other mandatory appropriations 
provided in fiscal year 2022 for School-Based Mental Health 
Services Grants are intended to supplement resources provided 
by the Committee through the Department of Education 
Appropriations Act, 2022 under a single competition that makes 
awards to school districts prior to December 31, 2022. The 
Committee looks forward to a briefing in the coming months on 
these transformative investments, which will assist school 
districts in their efforts to increase the number of qualified 
mental health professionals supporting students.
    The Committee requests a briefing within 90 days of 
enactment of this Act on plans for carrying out any new fiscal 
year 2023 Mental Health Services Professional Demonstration 
Grants and the School-Based Mental Health Services Grants 
competitions. In addition, the Department shall provide notice 
and a briefing to the Committees at least seven days before 
grantees for any new competitions are announced.
    Active Shooter Drills.--The Committee is concerned about 
the possible mental, emotional, and behavioral health effects 
on students and staff resulting from lockdown drills and active 
shooter drills conducted in elementary and secondary schools. 
In response, the Committee provides $1,000,000 for the 
Department to enter into an agreement with the National 
Academies of Sciences, Engineering, and Medicine (National 
Academies) under which the National Academies will conduct a 
study to assess the science on the potential mental, emotional, 
and behavioral health effects of firearm violence prevention 
activities on students and staff in elementary and secondary 
school settings. The study and subsequent report should include 
an analysis of the effects of active shooter simulations, full-
scale lockdowns, secured-perimeter lockouts, and other school 
security measures (e.g. metal detectors, visibility of police/
policing on campus) and their mental, emotional and behavioral 
consequences. The assessment should review the potential 
effects on children and youth of different ages and on students 
with disabilities. The National Academies report should 
identify practices and procedures that can minimize any adverse 
mental, emotional, and behavioral health effects on children, 
youth, and staff in elementary and secondary schools resulting 
from the drills and make recommendations where appropriate.
    School Climate and Safety Pilot.--Within School Safety 
National Activities, the Committee recommends $5,000,000 to 
establish a pilot program that would provide competitive grants 
to States to develop comprehensive school climate and safety 
plans that include effective, culturally competent, and 
evidence-based initiatives to strengthen, promote, and enhance 
school climates, affirm identities, and ensure school safety. 
Grant applications should be designed and submitted in 
consultation with a State multidisciplinary team of education 
and mental health professionals and should maintain the rights 
and dignity of all students. In addition, the plans must 
include diversity in placement, hiring, and retention of 
specialized instructional support personnel, including 
restorative practice practitioners, counselors, school social 
workers, school psychologists, and other supportive school 
staff. Once awarded, States should provide competitive grants 
to LEAs to implement the plan developed by the State and 
preference LEAs that utilize alternatives to exclusionary 
discipline, culturally sustaining education programs, 
community-based programs, and alternatives to law enforcement 
involvement.
    Digital Citizenship Education.--Technology has become an 
integral part of classroom learning, and students of all ages 
have access to digital media and devices at school. This 
dynamic highlights a significant need for students to partake 
in educational opportunities within the school setting focused 
on digital citizenship education, such as screen time balance, 
privacy and security, digital footprint, online relationships 
and communication, cyberbullying, civic engagement and news and 
media literacy, among other topics. The Committee continues to 
recognize the increased need to provide students with the tools 
and skills necessary to participate safely and responsibly in 
the digital world. To ensure the digital safety and well-being 
of K-12 students, the Committee continues to strongly urge the 
Department to raise awareness of digital citizenship education 
and identify opportunities to improve and expand digital 
citizenship education in K-12 schools.
    Mental Health Services.--The Committee recognizes that even 
prior to COVID-19, significant need existed among students for 
mental health services, while schools faced critical shortages 
of open positions and qualified practitioners, which includes 
school counselors, school psychologists, and school social 
workers. As schools reopen and efforts are underway to meet the 
academic needs of students, capacity to address their mental 
and emotional well-being is imperative. Adequate access to 
school-employed mental health professionals improves delivery 
and integration of school-wide programming to foster positive 
school climate, prevent violence, and balance physical and 
psychological safety. Without a highly qualified workforce of 
school-employed mental health professionals, schools lack the 
capacity to provide comprehensive social and emotional learning 
and mental, behavioral, and academic interventions and 
supports. The Committee's robust investments in initiatives to 
increase the amount of school-based mental health professionals 
and related programs that recruit, train, and retain well-
trained, high-qualified school-based mental health 
professionals are a high priority in this bill. The Committee 
believes this bill's investments will lay the foundation for a 
future where all students nationwide can benefit from a mental 
health professional working in their school.
    School Infrastructure.--The Committee strongly supports the 
Department's plans to fund a National Clearinghouse on School 
Infrastructure and Sustainability and to establish an Office of 
School Infrastructure and Sustainability, as described in the 
fiscal year 2023 Congressional Budget Justification, and 
provides sufficient funding under this account, and under 
Program Administration, for those purposes.
    Trauma-informed Practices.--The Committee encourages the 
Department to prioritize trauma-informed practices in grant 
activities.
    Secure Firearm Storage.--The Committee is concerned by 
studies showing that between 73 and 80 percent of school 
shooters under the age of 18 obtained their firearm(s) from 
their home or the home of a close relative or friend. In 
addition, the Committee is aware that researchers estimate 
roughly 4,600,000 children in the United States live in a home 
with an unsecured and loaded firearm. Accordingly, the 
Committee encourages the Department to offer support to Federal 
agencies that are leading efforts to promote secure household 
firearm storage.

Full-Service Community Schools

    The Committee recommends $468,000,000 for Full-Service 
Community Schools, which is $393,000,000 more than the fiscal 
year 2022 level. This program makes competitive grants to 
support school-based comprehensive services for students, 
families, and communities.

Integrated Student Supports

    The Committee recommends $10,000,000 for a new competitive 
grant program that would help school districts design and 
implement integrated student supports focused on addressing a 
range of student and family needs.
    Mentorship.--The Committee recognizes the importance of the 
coordination of mentorship programs with student participants' 
schools in order to support the goals of whole child learning 
and social and emotional learning. The Committee encourages the 
funding of activities that advance student success in the 
classroom in a manner that is informed by the coordination, 
insight, and partnership of mentorship programs.

                      ENGLISH LANGUAGE ACQUISITION

 
 
 
Appropriation, fiscal year 2022.......................      $831,400,000
Budget request, fiscal year 2023......................     1,075,000,000
Committee Recommendation..............................     1,000,000,000
    Change from enacted level.........................      +168,600,000
    Change from budget request........................       -75,000,000
 

    This program provides formula grants to States to serve 
Limited English Proficient (LEP) students. Grants are based on 
each State's share of the National LEP students and recent 
immigrant student population. Funds under this account also 
support professional development to increase the pool of 
teachers prepared to serve LEP students as well as evaluation 
activities. The bill continues language to calculate all State 
awards based on a three-year average of data from the American 
Community Survey.
    The Committee recommends $1,000,000,000 for English 
Language Acquisition (ELA) in fiscal year 2022, which is 
$168,600,000 above the fiscal year 2022 enacted level. Federal 
data shows that significant achievement gaps exist between 
English learners (ELs) and their peers. Since fiscal year 2020, 
the Committee has increased support for EL students by 
$94,000,000; however, at a time when many States and school 
districts have experienced rapid growth in their EL 
populations, the Committee remains concerned that services and 
supports for EL students are not adequately funded. Providing 
increased resources to improve educational quality for EL 
students is a top priority for the Committee in fiscal year 
2023.
    Translation and Interpretation Services.--The Committee 
continues to recognize that parents of ELs often need 
translation and interpretation services to stay abreast of 
school activities, help with homework, and support their 
children's college and career readiness goals. Many schools 
lack dedicated funding for translation and interpretation 
services, despite a growing EL population. In response to these 
concerns, the Committee encourages the Office of English 
Language Acquisition (OELA) to support LEAs and SEAs in 
providing robust translation and interpretation services for 
parents and guardians of ELs.
    Asian American, Native Hawaiian, and Pacific Islander 
(AANHPI) Data Disaggregation.--The Committee is concerned that 
aggregated AANHPI racial and ethnic subgroup data continues to 
obscure the experiences of AANHPI students. The Committee 
encourages OELA to prioritize funding for AANHPI data 
disaggregation within ELA national activities to support 
additional racial and ethnic subgroup data collection and 
reporting.
    Resources for EL Students.--The Committee recognizes that 
EL students have been the fastest growing student population in 
U.S. schools and that many schools and do not receive 
sufficient funding to meet the needs of these students. To 
promote EL student success, the Committee encourages the 
Department to prioritize technical assistance to SEAs and LEAs 
on how Title I and Title III funding in ESEA can improve 
academic achievement. In the fiscal year 2024 Congressional 
Budget Justification, the Committee requests information on how 
the Department assists SEAs and LEAs to ensure Title I and 
Title III funds support complementary activities for maximizing 
impact on EL student outcomes.

                           SPECIAL EDUCATION

 
 
 
Appropriation, fiscal year 2022.......................   $14,519,119,000
Budget request, fiscal year 2023......................    18,130,170,000
Committee Recommendation..............................    17,760,679,000
    Change from enacted level.........................    +3,241,560,000
    Change from budget request........................      -369,491,000
 

    Of the total amount available, $8,036,736,000 is available 
for obligation on July1, 2023, and $9,283,383,000 is available 
for obligation on October 1, 2023. These grants help States and 
localities pay for a free, appropriate education for students 
with disabilities aged 3 through 21.

Grants to States

    This program provides formula grants to assist States in 
meeting the costs of providing special education and related 
services to children with disabilities. States generally 
transfer most of the funds to LEAs; however, they can reserve 
some funds for program monitoring, technical assistance, and 
other related activities. In order to be eligible for funds, 
States must make free appropriate public education available to 
all children with disabilities.
    The Committee recommends $16,259,193,000 for Part B Grants 
to States, which is $2,915,489,000 above the fiscal year 2022 
enacted level.

Preschool Grants

    The Committee recommends $439,620,000 for Preschool Grants, 
which is $30,071,000 above the fiscal year 2022 enacted level. 
These funds provide additional assistance to States to help 
them make free, appropriate public education available to 
children with disabilities ages 3 through 5.

Grants for Infants and Families

    The Committee recommends $621,306,000 for Grants for 
Infants and Families, which is $125,000,000 above the fiscal 
year 2022 enacted level. These funds provide additional 
assistance to States to help them make free, appropriate public 
education available to children with disabilities from birth 
through age 2.
    The Committee continues bill language to promote the 
continuity of services for eligible infants and their families. 
In addition, the Committee recommendation includes new bill 
language to increase access for infants and families who have 
been traditionally underrepresented in the program, eliminate 
out-of-pocket costs for participating families, and conduct 
certain activities with individuals expecting to become parents 
of infants or toddlers with disabilities.

IDEA National Activities

    The Committee recommends $440,560,000 for IDEA National 
Activities, which is $171,000,000 above the fiscal year 2022 
enacted level. The IDEA National Activities programs support 
State efforts to improve early intervention and education 
results for children with disabilities.
    Educational Technology, Media, and Materials.--The 
Committee recommends $32,433,000 for Educational Technology, 
Media, and Materials, which is $2,000,000 above the fiscal year 
2022 enacted level. This program makes competitive awards to 
support the development, demonstration, and use of technology 
and educational media activities of educational value to 
children with disabilities.
    Within these amounts, the Committee provides no less than 
$11,000,000 for Educational Materials in Accessible Formats for 
Children and Students with Visual Impairments and Print 
Disabilities grants. The Department is encouraged to continue 
to expand this program's reach to K-12 students in underserved 
areas, further support eligible students enrolled in 
postsecondary schools, and expand or enhance models for 
postsecondary schools to produce and disseminate accessible 
educational materials and textbooks that align with the key 
recommendations from the Advisory Commission on Accessible 
Instructional Materials in Postsecondary Education for Students 
with Disabilities.
    Parent Information Centers.--The Committee recommends 
$40,152,000 for Parent Information Centers, which is 
$10,000,000 above the 2022 enacted level. This program makes 
awards to parent organizations to support Parent Training and 
Information Centers, including community parent resource 
centers. These centers provide training and information to meet 
the needs of parents of children with disabilities living in 
the areas served by the centers, particularly underserved 
parents and parents of children who may be inappropriately 
identified. Technical assistance is also provided under this 
program for developing, assisting, and coordinating centers 
receiving assistance under this program.
    Personnel Preparation.--The Committee recommends 
$250,000,000 for Personnel Preparation, which is $155,000,000 
above the fiscal year 2022 enacted level. This program supports 
competitive awards to help address State-identified needs for 
qualified personnel to work with children with disabilities, 
and to ensure that those personnel have the necessary skills 
and knowledge to serve children with special needs. Awards 
focus on addressing the need for leadership and personnel to 
serve low-incidence populations. Funds are included to fully 
support continuation costs for grants made in prior years. The 
Committee notes the critical role the Personnel Preparation 
program plays in helping to address the nation's shortage of 
teachers for students with disabilities.
    On May 25, 2022, the Subcommittee on Labor-HHS Education-
Related Agencies held a hearing entitled ``Tackling Teacher 
Shortages,'' during which the Subcommittee heard from a panel 
of national experts on the scope and severity of nationwide 
teacher shortages. The Subcommittee discussed root causes of 
teacher shortages and explored acute challenges with the 
retention and recruitment of educators of color and special 
educators. In addition, the Subcommittee identified strategies 
to help rebuild educator pipelines and address shortages and 
highlight needed investments in programs funded in this bill 
that support educator pipelines and address challenges related 
to recruitment and retention.
    The Committee is strongly supportive of the proposed 
increase in the fiscal year 2023 Congressional Budget 
Justification within Personnel Preparation for doctoral-level 
personnel preparation in special education. The Committee 
agrees that this investment would expand the teacher 
preparation pipeline and ensure that more well-prepared special 
education teachers enter the classroom per year than ever 
before.
    State Personnel Development.--The Committee recommends 
$38,630,000 for State Personnel Development, which is the same 
as the fiscal year 2022 enacted level. This program supports 
grants to States to assist with improving personnel preparation 
and professional development related to early intervention and 
educational and transition services that improve outcomes for 
students with disabilities. Funds are included to fully support 
continuation costs for grants made in prior years.
    Technical Assistance and Dissemination.--The Committee 
recommends $44,345,000 for Technical Assistance and 
Dissemination, which is the same as the fiscal year 2022 
enacted level. Funding supports technical assistance, 
demonstration projects, and information dissemination. These 
funds support efforts by State and local educational agencies, 
IHEs, and other entities to build State and local capacity to 
make systemic changes and improve results for children with 
disabilities.
    Special Olympics Education Programs.--The Committee 
recommends $35,000,000 for Special Olympics Education Programs, 
which is $4,000,000 above the fiscal year 2022 enacted 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.
    Prohibition on Use of Federal Funds for Electric Shock 
Devices.--The Committee is deeply concerned that Federal funds 
support services for children at private schools that use 
electric shock devices and equipment for student discipline and 
conditioning. The Committee includes new bill language to 
prohibit Federal funds from supporting institutions that carry 
out this horrific practice.
    Parent Supports.--The Committee encourages the Department 
to support SEAs and LEAs to counsel parents of children with 
504 plans, prior to them turning 18, on options for support 
once the child leaves the K-12 education system, including but 
not limited to the guardianship process.
    Students with Speech-Language Disorders.--The Committee 
encourages the Department to offer technical assistance to 
support students with speech-language disorders within school 
settings. The Committee notes the importance of providing 
guidance and sharing best practices to ensure the delivery of 
effective services for all children and youth with disabilities 
and speech-language disorders.

                        REHABILITATION SERVICES

 
 
 
Appropriation, fiscal year 2022.......................    $3,862,645,000
Budget request, fiscal year 2023......................     4,125,906,000
Committee Recommendation..............................     4,104,906,000
    Change from enacted level.........................      +242,261,000
    Change from budget request........................       -21,000,000
 

    The programs in this account are authorized by the 
Rehabilitation Act of 1973, the Helen Keller National Center 
Act, and the Randolph-Sheppard Act.

Vocational Rehabilitation State Grants

    The Committee recommends $3,949,707,000 in mandatory 
funding for Vocational Rehabilitation (VR) State Grants, which 
is $230,586,000 above the fiscal year 2022 enacted level.
    This program supports vocational rehabilitation services 
through formula grants to States. These grants support a wide 
range of services designed to help persons with physical and 
mental disabilities prepare for and engage in gainful 
employment to the extent of their capabilities. Emphasis is 
placed on providing vocational rehabilitation services to 
persons with the most significant disabilities. The Committee's 
recommendation provides the cost-of-living adjustment for 
Vocational Rehabilitation Grants to States, as authorized.

Client Assistance State Grants

    The Committee recommends $13,000,000 for Client Assistance 
State Grants, which is the same as the fiscal year 2022 enacted 
level. Client Assistance State Grants support services for 
eligible individuals and applicants of the VR State Grants 
program, and other programs, projects, and services funded 
under the Rehabilitation Act. These formula grants are used to 
help persons with disabilities overcome problems with the 
service delivery system and improve their understanding of 
services available to them under the Rehabilitation Act.

Training

    The Committee recommends $29,388,000 for the Training 
program, which is the same as the fiscal year 2022 enacted 
level. The program supports long-term and short-term training, 
in-service personnel training, and training of interpreters for 
deaf persons. Projects in a broad array of disciplines are 
funded to ensure that skilled personnel are available to serve 
the vocational needs of persons with disabilities. Funds are 
included to fully support continuation costs for grants made in 
prior years.

Demonstration and Training Programs

    The Committee recommends $15,796,000 for Demonstration and 
Training Programs, which is $10,000,000 above the fiscal year 
2022 enacted level. These programs support activities designed 
to increase employment opportunities for individuals with 
disabilities by expanding and improving the availability and 
provision of rehabilitation and other services. The Committee 
recommendation includes no less than the fiscal year 2022 
enacted level for parent information and training programs.
    National Consortium of Interpreter Education Centers 
(NCIEC) and Regional Interpreter Education Centers (RIEC).--The 
Committee commends the work by the Rehabilitation Services 
Administration to create resources for deaf, hard of hearing, 
and deaf-blind individuals and commends their support of 
special needs and sensory disabled persons. In addition, the 
Committee recognizes the positive impact the NCIEC and RIEC 
have had on the deaf, hard of hearing, and deaf-blind community 
through a variety of educational resources, interpreter 
development programs, and specialized services.

Protection and Advocacy of Individual Rights

    The Committee recommends $21,150,000 for Protection and 
Advocacy of Individual Rights, which is $2,000,000 more than 
the fiscal year 2022 enacted level. Grants are awarded to 
entities that have the authority to pursue legal, 
administrative, and other appropriate remedies to protect and 
advocate for the rights of persons with disabilities.

Supported Employment State Grants

    The Committee recommends $22,548,000 for Supported 
Employment State Grants, which is the same as the fiscal year 
2022 enacted level. These formula grants assist States in 
developing collaborative programs with public agencies and 
nonprofit agencies for training and post-employment services 
leading to supported employment. In supported employment 
programs, persons with the most significant disabilities are 
given special supervision and assistance to enable them to work 
in integrated settings.

Independent Living Services for Older Individuals Who Are Blind

    The Committee recommends $33,317,000 for Independent Living 
Services for Older Individuals Who Are Blind, which is the same 
as the fiscal year 2022 enacted level. Funds are distributed to 
States according to a formula based on the population of 
individuals who are 55 or older and provide support for 
services to persons 55 years old or over whose severe visual 
impairment makes gainful employment extremely difficult to 
obtain, but for whom independent living goals are feasible.

Helen Keller National Center

    The Committee recommends $20,000,000 for the Helen Keller 
National Center for Deaf-Blind Youth and Adults, which is 
$2,000,000 more than the fiscal year 2022 enacted level. These 
funds are used for the operation of a national center that 
provides intensive services for deaf-blind individuals and 
their families at Sands Point, New York, and a network of ten 
regional offices that provide referral, counseling, transition 
services, and technical assistance to service providers.

           SPECIAL INSTITUTIONS FOR PERSONS WITH DISABILITIES

 
 
 
Appropriation, fiscal year 2022.......................      $275,292,000
Budget request, fiscal year 2023......................       265,292,000
Committee Recommendation..............................       291,292,000
    Change from enacted level.........................       +16,000,000
    Change from budget request........................       +26,000,000
 

    The Committee recommends $291,292,000 for Special 
Institutions for Persons with Disabilities, which is 
$16,000,000 above the fiscal year 2022 enacted level.

                 AMERICAN PRINTING HOUSE FOR THE BLIND

 
 
 
Appropriation, fiscal year 2022.......................       $40,431,000
Budget request, fiscal year 2023......................        37,431,000
Committee Recommendation..............................        43,431,000
    Change from enacted level.........................        +3,000,000
    Change from budget request........................        +6,000,000
 

    This funding subsidizes the production of educational 
materials for legally blind persons enrolled in pre-college 
programs. The American Printing House for the Blind (Printing 
House), which is chartered by the Commonwealth of Kentucky, 
manufactures and maintains an inventory of educational 
materials in accessible formats that are distributed free of 
charge to schools and States based on the number of blind 
students in each State. The Printing House also conducts 
research and field activities to inform educators about the 
availability of materials and how to use them.
    Innovative Braille and Tactile Display Products.--Within 
amounts for the Printing House, the Committee provides 
$1,500,000 to support field testing of an innovative braille 
and tactile display product developed by the Printing House and 
its partners.

               NATIONAL TECHNICAL INSTITUTE FOR THE DEAF

 
 
 
Appropriation, fiscal year 2022.......................       $88,500,000
Budget request, fiscal year 2023......................        84,500,000
Committee Recommendation..............................        91,500,000
    Change from enacted level.........................        +3,000,000
    Change from budget request........................        +7,000,000
 

    Congress established the National Technical Institute for 
the Deaf (Institute) in 1965 to provide a residential facility 
for postsecondary technical training and education for deaf 
persons with the purpose of promoting the employment of these 
individuals. The Institute also conducts applied research and 
provides training related to various aspects of deafness. The 
Secretary of Education administers these activities through a 
contract with the Rochester Institute of Technology in 
Rochester, New York.

                          GALLAUDET UNIVERSITY

 
 
 
Appropriation, fiscal year 2022.......................      $146,361,000
Budget request, fiscal year 2023......................       143,361,000
Committee Recommendation..............................       156,361,000
    Change from enacted level.........................       +10,000,000
    Change from budget request........................       +13,000,000
 

    Gallaudet is a private, non-profit educational institution 
Federally chartered in 1864 providing elementary, secondary, 
undergraduate, and continuing education for deaf persons. In 
addition, the University offers graduate programs in fields 
related to deafness for deaf and hearing students, conducts 
research on deafness, and provides public service programs for 
deaf persons.

                 CAREER, TECHNICAL, AND ADULT EDUCATION

 
 
 
Appropriation, fiscal year 2022.......................    $2,091,436,000
Budget request, fiscal year 2023......................     2,308,981,000
Committee Recommendation..............................     2,214,981,000
    Change from enacted level.........................      +123,545,000
    Change from budget request........................       -94,000,000
 

    This account includes vocational education programs 
authorized by the Carl D. Perkins Career and Technical 
Education Act of 2006, as recently reauthorized by the 
Strengthening Career and Technical Education for the 21st 
Century Act, and the Adult Education and Family Literacy Act 
(AEFLA).

Career and Technical Education: State Grants

    The Committee recommends $1,424,848,000 for Career and 
Technical Education (CTE) State Grants, which is $45,000,000 
above the fiscal year 2022 enacted level. Of these funds, 
$633,848,000 will become available on July 1, 2023, and 
$791,000,000 will become available for obligation on October 1, 
2023.
    State Grants support a variety of career and technical 
education programs developed in accordance with the State plan. 
This program focuses Federal resources on institutions with 
high concentrations of low-income students. The populations 
assisted by State Grants range from secondary students in 
prevocational courses to adults who need retraining to adapt to 
changing technological and labor markets. Funding for State 
Grants will continue support for state-of-the art career and 
technical training to students in secondary schools and 
community and technical colleges.
    CTE Teacher Shortages.--The Committee is concerned about 
the growing shortage of qualified public school teachers at all 
levels of education and the lack of Federal data on CTE teacher 
shortages. Specifically, the Department's Teacher Shortage Area 
database does not account for schools which have ceased to 
offer a CTE course due to a staffing shortage. Further, the 
Department does not currently collect data on the 
characteristics of the CTE teacher workforce including 
demographic information, salary, years of industry experience, 
and highest level of educational attainment. In the fiscal year 
2024 Congressional Budget Justification, the Committee requests 
for the Department to identify Federal data that can help 
Congress and stakeholders better understand CTE teacher 
shortages. If such data are unavailable, the Committee requests 
the Department suggest methods for obtaining necessary data 
prospectively.

National Programs

    The Committee recommends $57,421,000 for National Programs, 
which is $50,000,000 more than the fiscal year 2022 enacted 
level.
    Career-Connected High Schools.--Within amounts for CTE 
National Programs, the Committee includes $50,000,000 and new 
bill language supporting the Department's proposal for Career-
Connected High Schools. The Committee encourages the Department 
to prioritize applications that establish plans with State 
agencies to improve policy and program alignment between K-12, 
higher education, and workforce systems, including through 
statewide credit transfer agreements and alignment of high 
school graduation requirements with college entrance 
requirements. In addition, the Committee encourages the 
Department to establish a competitive preference priority for 
LEAs serving students historically underrepresented in higher 
education and to require applicants to set goals for Career-
Connected High School enrollment to be representative of the 
LEAs' overall population. Finally, the Committee encourages the 
Department to require Career-Connected High School applicants 
to offer articulated course pathways that terminate in at least 
a two-year credential and to require Career-Connected High 
School applicants to offer at least 12 credits of dual 
enrollment, including both academic and CTE coursework.
    Cybersecurity Skills.--The Committee recognizes the 
cybersecurity threats facing our nation's critical 
infrastructure sectors and the need for workers in these 
industries, including those who operate cyber physical systems, 
to be equipped with skills to keep systems secure. The 
Committee acknowledges that many of these operators are 
educated through CTE programs that do not incorporate 
cybersecurity skills. Therefore, the Committee encourages the 
Secretary to support CTE programs that integrate cybersecurity 
into curricula used by students preparing for careers in 
critical infrastructure sectors.
    Youth Entrepreneurship and Financial Literacy.--The 
Committee recognizes the importance of preparing our students 
for the 21st century workforce through CTE programs, including 
entrepreneurship and financial literacy. The Committee is 
supportive of efforts to provide technical assistance and make 
resources available to help LEAs and IHEs prepare students for 
successful employment and attain high-skilled jobs through the 
implementation of entrepreneurship and financial literacy 
programs during and after school.

Adult Basic and Literacy Education State Grants

    The Committee recommends $714,000,000 for Adult Basic and 
Literacy Education State Grants, which is $23,545,000 more than 
the fiscal year 2022 enacted level. State formula grants, 
authorized under the AEFLA, support programs to enable adults 
to acquire basic literacy skills, to enable those who so desire 
to complete secondary education, and to make available to 
adults the means to become more employable, productive, and 
responsible citizens.

Adult Education National Leadership Activities

    The Committee recommends $18,712,000 for National 
Leadership Activities, which is $5,000,000 more than the fiscal 
year 2022 enacted level. This program supports applied 
research, development, dissemination, evaluation, and program 
improvement efforts to strengthen the quality of adult 
education services.
    Improved Coordination between Career and Technical 
Education and Adult Education.--To ensure that individuals can 
succeed in today's economy, the Committee encourages the 
Department to identify and pursue opportunities to better align 
the postsecondary CTE system with the adult education system. 
Adult education can be an effective on-ramp to postsecondary 
CTE and a valuable partner in designing and implementing 
integrated education and training (IET) models that blend basic 
skills instruction and occupational training to expand 
equitable access to skills training, high-quality credentials 
and family-supporting careers.

                      STUDENT FINANCIAL ASSISTANCE

 
 
 
Appropriation, fiscal year 2022.......................   $24,580,352,000
Budget request, fiscal year 2023......................    26,345,352,000
Committee Recommendation..............................    24,639,234,000
    Change from enacted level.........................       +58,882,000
    Change from budget request........................    -1,706,118,000
 

Pell Grants

    The Committee recommends $22,475,352,000 in discretionary 
funding for the Pell Grant program, which is the same as the 
fiscal year 2022 enacted level. These funds will support Pell 
grants to students for the 2023-2024 academic year.
    Combined with mandatory funding streams, the Committee 
recommendation supports a maximum Pell Grant in academic year 
2023-2024 of $7,395, a $500 increase over fiscal year 2022.
    Pell Grants help to ensure access to educational and 
economic opportunities for low- and middle-income students by 
providing need-based financial assistance. Grants are 
determined according to a statutory formula, which considers 
income, assets, household size, and the number of family 
members in college, among other factors. Pell Grants are the 
foundation of Federal postsecondary student aid programs. The 
Committee recognizes that Pell Grants help to ensure access to 
education and economic opportunities for low-and-middle-income 
students by providing need-based financial assistance. The 
recommendation includes new language extending eligibility for 
DACA-eligible students for all Title IV Student Assistance 
programs in the Higher Education Act (HEA), including Pell 
Grants.

Federal Supplemental Educational Opportunity Grants

    The Committee recommends $920,000,000 for the Federal 
Supplemental Educational Opportunity Grants (SEOG) program, 
which is $25,000,000 more than the fiscal year 2022 enacted 
level.
    SEOG provides funds to postsecondary institutions for need-
based grants of up to $4,000 to undergraduate students, with 
priority given to students who are Pell-eligible. Approximately 
67 percent of dependent recipients have annual family incomes 
under $30,000 and 70 percent of independent SEOG recipients 
have annual family incomes under $20,000. Institutions must 
contribute a 25 percent match toward their SEOG allocation. The 
recommendation includes new language extending eligibility for 
DACA-eligible students for all Title IV Student Assistance 
programs in the Higher Education Act (HEA), including SEOG.

Federal Work-Study

    The Committee recommends $1,243,882,000 for the Federal 
Work-Study program, which is $33,882,000 more than the fiscal 
year 2022 enacted level.
    Federal Work-Study funds are provided through institutions 
to students who work part-time. The funds assist with paying 
for the cost of education. Approximately 3,200 colleges and 
universities receive funding, according to a statutory formula, 
and may allocate it for job location and development centers. 
Work-study jobs must pay at least the Federal minimum wage and 
institutions must provide 25percent of student earnings.
    The Committee recommendation continues funding for the Work 
Colleges program, which supports institutions that require all 
resident students to participate in a work-learning program. 
The recommendation includes new language extending eligibility 
for DACA-eligible students for all Title IV Student Assistance 
programs in the Higher Education Act (HEA), including Work 
Study.
    Social Work Students.--The Committee notes that social work 
students at the undergraduate and graduate levels are required 
to complete hundreds of hours of field experience; however, the 
Committee is concerned that many times these experiences are 
unpaid. In the fiscal year 2024 Congressional Budget 
Justification, the Committee directs the Department to share 
information around the feasibility of using its Experimental 
Sites authority for a pilot to use Federal Work Study and other 
financial aid funding to support social work students involved 
in internships and field experiences.
    For-profit College Accountability.--The 85/15 Rule was 
first implemented in 1992 as a bipartisan amendment to the 
Higher Education Act (HEA). It is based on the rationale that 
if an institution provides a quality education, individuals 
without access to Federal funding sources should be willing to 
pay for it. The rule prevented for-profit postsecondary 
institutions from deriving more than 85 percent of revenues 
from Title IV of the HEA. It was based on a longstanding 
principle first enacted in 1952 to protect veterans from for-
profit college abuses dating back to the original GI Bill (the 
Servicemen's Readjustment Act) in 1944, and was in response to 
widespread reports that many for-profit colleges were using 
aggressive, sometimes fraudulent recruiting tactics in order to 
profit off of students with access to Federal student aid 
funding. In 1992, the rule was amended to allow for-profits to 
derive an extra five percent of their revenue from Title IV and 
became known as the 90/10 Rule. Since that time, thousands of 
students have been defrauded by schools that have since gone 
out of business. Students who graduate from these schools can 
obtain degrees that often offer little value. A 2016 National 
Bureau of Economic Research study using data from the 
Department and the Internal Revenue Service found that the 
earnings of students who attend for-profit colleges or 
universities are lower than if they had never enrolled at all. 
And while the for-profit college sector enrolls only nine 
percent of all students, 33 percent of all borrower who 
defaulted on student loans attend for-profit colleges.
    Given these deeply disappointing outcomes, the Committee 
believes that reverting back to the 85/15 ratio is a critical 
step in holding for-profit colleges accountable and protecting 
students from predatory practices and taxpayer dollars from 
being wasted. Therefore, the Committee includes new bill 
language requiring that for-profit institutions of higher 
education receive not more than 85 percent of their revenue 
from Federal sources.

              Federal Direct Student Loan Program Account


 
 
 
Appropriation, fiscal year 2022.......................       $25,000,000
Budget request, fiscal year 2022......................             - - -
Committee Recommendation..............................             - - -
    Change from enacted level.........................       -25,000,000
    Change from budget request........................             - - -
 

    Since fiscal year 2018, the Committee has provided 
$825,000,0000 for the Federal Direct Student Loan Program 
Account program (also known as Temporary Extended Public 
Service Loan Forgiveness or TEPSLF). Congress created the 
Public Service Loan Forgiveness (PSLF) program in 2007 to 
provide loan relief to borrowers pursuing careers in public 
service. After making 120 qualifying payments, the equivalent 
of 10 years, borrowers first became eligible for forgiveness 
under the program in 2017. TEPSLF was established to address 
the administrative challenges associated with the PSLF program. 
This account provides funding for loan forgiveness for 
borrowers who were led to believe they qualified for PSLF by 
their loan servicers but were denied forgiveness. However, many 
of the constraints and program features of TEPSLF have made the 
program similarly difficult to access. As of May 2022, the 
Department estimates that unused, previously appropriated 
TEPSLF resources provided in this account could forgive 
approximately $821,000,000 in loan volume for affected 
borrowers.
    The Committee is strongly supportive of the Department's 
Limited PSLF Waiver, established in October 2021, which has 
offered a more streamlined pathway to loan forgiveness for 
borrowers who dedicated a decade of their lives to public 
service. To date, the waiver has provided over $7,300,000,000 
in relief to over 127,000 student borrowers. To build on the 
success of the Department's administrative action, the 
Committee includes new bill language applying the streamlined 
terms and features of the Department's PSLF waiver to unused 
TEPSLF resources. The Committee hopes an enhanced TEPSLF, with 
similar terms to the Department's PSLF waiver, will allow for a 
seamless transition for affected borrowers after the PSLF 
waiver expires.
    The Committee requested an update in the fiscal year 2023 
Congressional Budget Justification identifying areas where the 
Department can further improve the administration of the PSLF 
and TEPSLF programs and directs the Department to provide a 
clear, comprehensive update on this topic in the fiscal year 
2024 Congressional Budget Justification.

                       Student Aid Administration


 
 
 
Appropriation, fiscal year 2022.......................    $2,033,943,000
Budget request, fiscal year 2023......................     2,654,034,000
Committee Recommendation..............................     2,579,034,000
    Change from enacted level.........................      +545,091,000
    Change from budget request........................       -75,000,000
 

    Programs administered under the Student Aid Administration 
(SAA) include Pell Grants, campus-based programs, Teacher 
Education Assistance for College and Higher Education (TEACH) 
grants, and Federal student loan programs.
    Salaries and Expenses.--Within the total provided for SAA, 
the Committee recommends $1,187,788,000 for salaries and 
expenses, which is $128,845,000 more than the fiscal year 2022 
enacted level.
    Loan Servicing Activities.--Within the total provided for 
SAA, the Committee recommends $1,391,246,000 for Loan Servicing 
Activities, which is $416,246,000 more than the fiscal year 
2022 enacted level.
    Quarterly Briefings.--The Department is directed to provide 
quarterly briefings to the Committee on general progress 
related to solicitations for Federal student loan servicing 
contracts.
    Spend Plans.--Not later than 60 days after enactment, the 
Committee directs the Department to provide a detailed spend 
plan of anticipated uses of funds made available in this 
account for fiscal year 2023 and provide quarterly updates on 
this plan (including contracts awarded, change orders, bonuses 
paid to staff, reorganization costs, and any other activity 
carried out using amounts provided under this heading for 
fiscal year 2023).
    State and Nonprofit Subcontracting.--The Committee 
encourages the Department to evaluate opportunities for 
qualified State and nonprofit organizations to contribute in 
the new servicing environment.
    Transparency in College Costs.--The Committee looks forward 
to the briefing it requested in House Report 117-96 on the 
Department's efforts to work with institutions of higher 
education to improve college cost transparency.
    Online Program Management (OPM) Companies.--The Committee 
is deeply concerned by the proliferation of for-profit OPMs in 
higher education. Specifically, the Committee is troubled by 
how tuition-sharing agreements between universities and for-
profit OPM companies can create perverse incentives that drive 
up costs, waste taxpayer dollars, and rip off students. In 
addition, the Committee is concerned by the role OPMs play in 
saddling graduate students with unsustainable student debt by 
taking advantage of the Grad Plus program, which lets students 
borrow as much as colleges charge. Though the practice has 
proven to be a valuable revenue stream for OPMs and 
universities, the Committee is not persuaded that these 
relationships are in the best interests of students.
    A November 2021 Wall Street Journal investigation revealed 
how for-profit OPM 2U and the University of Southern California 
(USC) recruited thousands of students to an expensive online 
graduate program which left student borrowers with median debt 
of $112,000 and median earnings of $52,000 two years later. 2U, 
which received 60 percent of the program's total revenue, 
helped USC use demographic profiles to target low-income and 
minority students to maximize profits. The Committee believes 
this behavior is straight from the playbook of the predatory 
for-profit colleges. Further, the Committee believes a status 
quo that allows for the continuation and proliferation of 
wasteful, abusive relationships between OPMs and universities 
is untenable. The Committee is disappointed by the 
inappropriately loose regulatory environment and sparse 
enforcement that has allowed OPMs to gain their foothold across 
the higher education landscape.
    The Committee is aware of GAO's recent report (GAO-22-
104463) and agrees with recommendations for the Department to 
improve its audit and review process regarding OPM 
arrangements, including via revisions to the Compliance 
Supplement; however, given the severity of OPM-driven waste and 
abuse, the Committee supports stronger, more urgent measures. 
Specifically, the Committee supports the complete rescission of 
March 2011 sub-regulatory guidance that established a loophole 
to the statutory incentive compensation ban. Under the HEA, 
individuals and entities cannot provide commissions, bonuses, 
or incentive payments based on securing enrollments or the 
awarding of Federal student aid. However, the misguided 2011 
guidance establishes a loophole if recruiting is part of a 
``bundle of services'' provided by an ``unaffiliated third 
party'' contractor, such as an OPM. The Committee strongly 
urges the Department to immediately rescind the 2011 bundled 
services guidance and to establish a process to wind down 
institutions' inappropriate reliance on wasteful, abusive OPM 
tactics.
    In the interim, the Committee strongly urges the Department 
to immediately enforce commonsense aspects of the otherwise 
flawed guidance. Specifically, the Committee urges the 
Department to ensure any contractors are independent entities, 
unaffiliated with the institution, and uninvolved in decision 
making. The Committee believes several common practices by OPMs 
clearly overstep the existing guidance, including, the 
establishment of steering committees or other governing bodies 
that give the OPM an official and regular role in decision 
making; higher shares of revenue paid to the OPM as enrollment 
increases; and OPM control over marketing and recruiting, in 
the name of school. The Committee urges the Department to 
employ meaningful consequences and penalties to deter predatory 
behavior.
    Finally, the Committee urges the Department to develop 
adequate guidance to institutions that indicates when marketing 
could be considered a covered activity under the ban on 
incentive compensation payments. In addition, the Committee 
urges the Department to revise audit and program review guides 
to meet oversight goals of the incentive compensation ban.
    Moving forward, the Committee is committed to vigorous 
oversight of relationships between universities and for-profit 
OPMs and urges the Department to crack down on OPM waste and 
abuse to protect students and the overall integrity of 
taxpayer-funded Federal student aid programs.
    Graduate Student Debt.--According to the fiscal year 2023 
budget request, excluding consolidations, graduate student 
loans are expected to make up over 47 percent of new Federal 
student loan originations in fiscal year 2023. This proportion 
is significantly up from the 34 percent of new loan 
originations graduate student debt represented in fiscal year 
2014. While OPMs play a concerning role in this trend, the 
Committee is also concerned about the broader landscape of 
graduate student debt. In response, the Committee urges the 
Department to analyze the disproportionate share of new student 
loan originations represented by graduate student programs and 
to determine whether graduate student programs leave students 
with reasonable debt levels. In addition, the Committee 
strongly urges the Department to take actions to ensure that 
graduate program outcomes are commensurate with the debt levels 
of their students.
    Borrower Defense Recoupment and OPMs.--The Committee is 
strongly supportive of the Department's most recent proposal 
for an automatic, formalized process for recouping funds from 
institutions that commit wrongdoings against student borrowers. 
Under the proposal, schools that commit wrongdoings are fully 
liable for any amounts discharged through the Borrower Defense 
process except under certain reasonable circumstances. The 
Committee notes that institutions in partnerships with 
predatory for-profit OPMs will incur liabilities for discharges 
resulting from predatory behavior. To build on these strong 
protections, the Committee urges the Department to clarify that 
OPMs function as third party servicers. Further, the Committee 
urges the Department to develop methods for determining when 
Borrower Defense liabilities should be shared jointly between 
the institution and OPM. Under such circumstances, the 
Committee urges the Department to recoup funds from both 
entities.
    The Committee notes that investors and shareholders have 
contributed to the growth of the OPM industry under an 
expectation of loose regulation or non-existent oversight. 
Accordingly, the Committee's recommendations regarding OPMs are 
intended to indicate that such assumptions are outdated, and 
that unscrupulous behavior will yield straightforward, 
substantial financial consequences.
    Appropriate Conditions for High-risk Schools.--The 
Committee recognizes that use of Federal student aid by 
institutions of higher education is contingent on their 
eligibility to be certified to do so under the Title IV of the 
HEA. To ensure that institutions are responsible stewards of 
Federal student aid, the Committee encourages the Department to 
place appropriate conditions on high-risk schools and to 
clarify procedures for when a high-risk institution may be 
eligible for a provisional program participation agreement.
    Spousal Consolidation Loans.--The Committee is aware that 
hundreds of borrowers remain in the spousal consolidation loan 
program which stopped originating new loans in 2006. The 
Committee is concerned that these loans cannot be separated and 
leave both borrowers liable for the entire debt, even after a 
divorce. The Committee believes it is deeply unwise for a 
Federal program to link the financial fates of two borrowers 
when their personal relationships may have deteriorated or 
perhaps become abusive. In response, the Committee urges the 
Department to assist struggling spousal consolidation loan 
borrowers and directs the Department to describe such efforts 
in the fiscal year 2024 Congressional Budget Justification.
    Postsecondary Research and Analysis.--The Committee is 
supportive of the Office of the Chief Economist's mission to 
conduct rigorous research in postsecondary education and notes 
that the Department maintains robust data sets that provide 
vital information on student outcomes, including those for 
student borrowers. The Committee supports the Department's 
continuous efforts to provide user-friendly, accessible 
postsecondary data through enhanced fields on the College 
Scorecard; however, the Committee believes the Department has 
fallen short in its efforts to interpret these data for 
policymakers and stakeholders. Accordingly, the Committee 
encourages the Office of the Chief Economist to produce regular 
working papers that present meaningful original research on the 
Department's postsecondary data, including outcomes for student 
borrowers. Specifically, the Committee is interested in 
analysis around the rapid growth of graduate student borrowing 
and whether this expansion in borrowing is beneficial to 
student borrowers and the overall economy.

                            HIGHER EDUCATION

 
 
 
Appropriation, fiscal year 2022.......................    $2,994,111,000
Budget request, fiscal year 2023......................     3,792,802,000
Committee Recommendation..............................     3,959,485,000
    Change from enacted level.........................      +965,374,000
    Change from budget request........................      -166,683,000
 

Strengthening Institutions

    The Committee recommends $175,070,000 for the Part A, 
Strengthening Institutions program, which is $65,000,000 more 
than the fiscal year 2022 enacted level. Funding supports 
competitive grants for general operating subsidies to 
institutions with below average educational and general 
expenditures per student and significant percentages of low-
income students. Funds may be used for faculty and academic 
program development, management, joint use of libraries and 
laboratories, acquisition of equipment, and student services.

Developing Hispanic-Serving Institutions

    The Committee recommends $246,732,000 for the Developing 
Hispanic-Serving Institutions (HSI) program, which is 
$63,878,000 more than the fiscal year 2022 enacted level.
    The Developing HSIs program provides operating subsidies to 
schools that serve at least 25 percent Hispanic students. Funds 
may be used for faculty and academic program development, 
management, joint use of libraries and laboratories, 
acquisition of equipment, and student services.
    Departmental Support for HSIs.--The Committee is interested 
in learning more about actions the Department has taken to 
support and improve HSIs, in addition to future actions the 
Department plans to take. Accordingly, the Committee directs 
the Department to include information on such efforts in the 
fiscal year 2024 Congressional Budget Justification.
    HSI Facilities.--The Committee is appreciative to GAO for 
their initial engagement and work on a requested report 
regarding HSI facilities and looks forward to reviewing its 
findings upon completion.

Promoting Postbaccalaureate Opportunities for Hispanic Americans

    The Committee recommends $28,845,000 for the Promoting 
Postbaccalaureate Opportunities for Hispanic Americans program, 
which is $9,184,000 more than the fiscal year 2022 enacted 
level. This program provides expanded postbaccalaureate 
educational opportunities for the academic attainment of 
Hispanic and low-income students. In addition, it expands 
academic offerings and enhances program quality at IHEs 
educating the majority of Hispanic college students.

Strengthening Historically Black Colleges and Universities

    The Committee recommends $402,619,000 for Strengthening 
Historically Black Colleges and Universities (HBCUs), which is 
$39,796,000 more than the fiscal year 2022 enacted level. This 
program provides operating subsidies to accredited HBCUs that 
were established prior to 1964, with the principal mission of 
educating Black Americans. Funds are distributed through a 
formula grant based on the enrollment of Pell Grant recipients, 
number of graduates, and the number of graduates entering 
graduate or professional schools in which Black students are 
underrepresented.
    Maximum Higher Education Emergency Relief Funding (HEERF) 
Flexibility.--The Committee urges the Department to use the 
broadest possible interpretation of allowable uses of funds 
when evaluating applications for grants awarded under the HEERF 
program as allocated in the Coronavirus Aid, Relief, and 
Economic Security Act (HEERF I), Coronavirus Response and 
Relief Supplemental Appropriations Act (HEERF II) and American 
Rescue Plan Act (HEERF III). These flexibilities are critical 
as institutions of higher education, such as HBCUs and MSIs, 
navigate ongoing and emerging challenges. HEERF fund 
flexibilities for HBCUs and MSIs could be used by these 
institutions to make critical investments in campus 
infrastructure, deferred maintenance projects, technological 
updates, and more robust building construction.

Strengthening Historically Black Graduate Institutions

    The Committee recommends $102,313,000 for the Strengthening 
Historically Black Graduate Institutions (HBGIs) program, which 
is $9,184,000 more than the fiscal year 2022 enacted level. The 
program provides five-year grants to postsecondary institutions 
that are specified in section 326(e)(1) of the HEA. 
Institutions may use funds to build endowments, provide 
scholarships and fellowships, and to assist students with the 
enrollment and completion of postbaccalaureate and professional 
degrees.

Strengthening Predominantly Black Institutions

    The Committee recommends $23,218,000 for the Strengthening 
Predominantly Black Institutions (PBIs) program, which is 
$5,100,000 more than the fiscal year 2022 enacted level and the 
same as the fiscal year 2022 budget request. This program 
provides grants to PBIs to increase their capacity to serve the 
academic needs of students.
    The bill continues bill language allowing certain PBIs to 
be eligible for additional grants.

Strengthening Asian American and Native American Pacific-Islander-
        Serving Institutions

    The Committee recommends $20,120,000 for the Strengthening 
Asian American and Native American Pacific-Islander-Serving 
Institutions (AANAPISIs) program, which is $9,184,000 more than 
the fiscal year 2022 enacted level. This program provides 
grants to undergraduate institutions that have an undergraduate 
student enrollment of at least 10 percent Asian American or 
Native American Pacific Islander.

Strengthening Alaska Native and Native Hawaiian-Serving Institutions

    The Committee recommends $25,044,000 for the Strengthening 
Alaska Native and Native Hawaiian-Serving Institutions program, 
which is $3,673,000 more than the fiscal year 2022 enacted 
level. Through the Strengthening Alaska Native and Native 
Hawaiian-Serving Institutions program, the Department provides 
grants to assist institutions of higher education in serving 
Alaska Native and Native Hawaiian students.

Strengthening Native American Serving Non-Tribal Institutions

    The Committee recommends $12,120,000 for the Native 
American Serving Non-Tribal Institutions program, which is 
$4,286,000 more than the fiscal year 2022 enacted level. This 
program makes grants to IHEs at which enrollment is at least 10 
percent Native American students and that are not Tribally 
Controlled Colleges or Universities.

Strengthening Tribally Controlled Colleges and Universities

    The Committee recommends $53,080,000 for the Strengthening 
Tribally Controlled Colleges and Universities (TCCUs) program, 
which is $9,184,000 more than the fiscal year 2022 enacted 
level. This program makes grants to TCCUs to increase their 
capacity to serve the academic needs of students.

Strengthening HBCU Masters Program

    The Committee recommends $20,956,000 for the Strengthening 
HBCU Masters Programs, which is $6,122,000 more than the fiscal 
year 2022 enacted level. This program provides grants to 
specified colleges and universities making a substantial 
contribution to graduate education opportunities at the 
Master's level in mathematics, engineering, the physical or 
natural sciences, computer science, information technology, 
nursing, allied health, or other scientific disciplines.

International Education and Foreign Language Studies

    Domestic Programs.--The Committee recommends $76,853,000 
for the Domestic Programs of the International Education and 
Foreign Languages Studies program, which is $5,000,000 more 
than the fiscal year 2022 enacted level. Authorized by Title VI 
of the HEA, these programs include National resource centers, 
foreign language and area studies fellowships, undergraduate 
international studies and foreign language programs, 
international research and studies projects, business and 
international education projects, international business 
education centers, language resource centers, American overseas 
research centers, and technological innovation and cooperation 
for foreign information access.
    Overseas Programs.--The Committee recommends $11,811,000 
for the Overseas Programs, which is $2,000,000 more than the 
fiscal year 2022 enacted level. Funding for these programs 
support group projects, faculty research, special bilateral 
research, and doctoral dissertation research conducted abroad.

Model Comprehensive Transition and Postsecondary Programs for Students 
        With Intellectual Disabilities

    The Committee recommends $15,180,000 for the Model 
Comprehensive Transition and Postsecondary Programs for 
Students with Intellectual Disabilities (TPSID) program, which 
is $1,380,000 more than the fiscal year 2022 enacted level. 
TPSID supports grants to create model transition programs into 
postsecondary education for students with intellectual 
disabilities.

Minority Science and Engineering Improvement

    The Committee recommends $18,370,000 for the Minority 
Science and Engineering Improvement Program, which is 
$3,831,000 more than the fiscal year 2022 enacted level. This 
program awards grants to improve mathematics, science, and 
engineering programs at institutions serving primarily minority 
students and to increase the number of minority students who 
pursue advanced degrees and careers in those fields.

Tribally Controlled Postsecondary Career and Technical Institutions

    The Committee recommends $10,953,000 for this program, 
which is the same as the fiscal year 2022 enacted level. The 
Tribally Controlled Postsecondary Career and Technical 
Institutions program awards competitive grants to Tribally 
controlled postsecondary career and technical institutions to 
provide career and technical education to Native American 
students.

Federal TRIO Programs

    The Committee recommends $1,297,761,000 for TRIO programs, 
which is $160,761,000 more than the fiscal year 2022 enacted 
level. The TRIO programs provide a variety of outreach and 
support services to encourage low-income, first-generation 
college students and individuals with disabilities to enter and 
complete college. Discretionary grants of up to four or five 
years are awarded competitively to IHEs and other nonprofit 
organizations. At least two thirds of the eligible participants 
in TRIO must be low-income, first-generation college students. 
The recommendation includes new language extending eligibility 
for DACA-eligible students for all Title IV Student Assistance 
programs in the HEA, including TRIO.
    The Committee directs the Department to allocate increases 
to each TRIO program. In addition, the Committee directs the 
Department to fund down the slate of unfunded high-quality 
applications from the Student Support Services competition held 
in fiscal year 2020; the Talent Search and Educational 
Opportunity Centers competitions in fiscal year 2021; and the 
Upward Bound, Upward Bound Math-Science, Veterans Upward Bound, 
and McNair Postbaccalaureate Achievement competitions in fiscal 
year 2022. Further, the Committee directs that such grantees 
are eligible for prior experience points for demonstrated 
performance outcomes in subsequent competitions.

Gaining Early Awareness and Readiness for Undergraduate Programs

    The Committee recommends $408,000,000 for Gaining Early 
Awareness and Readiness for Undergraduate Programs (GEAR UP), 
which is $30,000,000 more than the fiscal year 2022 enacted 
level. GEAR UP provides grants to States and partnerships of 
low-income middle and high schools, IHEs, and community 
organizations to target entire grades of students and give them 
the skills, encouragement, and scholarships to pursue 
successfully postsecondary education.
    The Committee continues bill language allowing the 
Department to maintain the GEAR UP evaluation set-aside at 1.5 
percent to work with the GEAR UP community and grantees to 
standardize data collection, including through the use of 
third-party data systems. The recommendation includes new 
language extending eligibility for DACA-eligible students for 
all Title IV Student Assistance programs in the HEA, including 
GEAR UP.
    Furthermore, the Committee directs the Department to 
announce Notices Inviting Applications for New Awards for State 
Grants and Partnership Grants in the Federal Register. In 
making new awards, the Committee directs the Department to 
ensure that not less than 33 percent of the new award dollars 
are allocated to State awards, and that not less than 33 
percent of the new award dollars are allocated to Partnerships 
awards, as described in section 404B of the HEA. In such notice 
for State grants, the Committee directs the Department to 
uphold the long-standing guidance that States may only 
administer one active State GEAR UP grant at a time. The 
Secretary is directed to provide written guidance in the 
Federal Register notifying applicants that only States without 
an active State GEAR UP grant, or States that have an active 
State GEAR UP grant that is scheduled to end prior to October 
1, 2023, will be eligible to receive a new State GEAR UP award 
funded in whole or in part by this appropriation. The Secretary 
is further directed to ensure that no request from a State 
Grant applicant to receive an exception to the GEAR UP 
scholarship (as described in section 404E(b)(2) of the HEA) 
shall be denied on the basis of 34 CFR 694.14(c)(3).

Graduate Assistance in Areas of National Need

    The Committee recommends $24,047,000 for the Graduate 
Assistance in Areas of National Need (GAANN) program, which is 
$500,000 more than the fiscal year 2022 enacted level. GAANN 
provides fellowships through grants to degree granting 
postsecondary institutions, for students of high financial need 
studying in areas of national need. The Department consults 
with appropriate agencies and organizations to designate the 
fields of study ``in areas of national need.'' GAANN offers 
innovative graduate education programs, with associated 
fellowship opportunities, at the intersection of humanities, 
arts, STEM, and health associated fields in order to prepare 
our national graduate students for increasingly 
interdisciplinary global challenges. Recent examples include 
engineering, nursing, and physics.

Teacher Quality Partnership Grants

    The Committee recommends $132,092,000 for the Teacher 
Quality Partnerships (TQP) program, which is $73,000,000 more 
than the fiscal year 2022 enacted level. 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.
    State Teaching Fellowship Programs.--The Committee 
recognizes the importance of State teaching fellowship programs 
and encourages the Department to continue to work with eligible 
State teaching fellowship programs that wish to apply for the 
TQP program.
    Teacher Preparation to Support EL Students.--The Committee 
recognizes the needs of the nation's growing EL student 
population, including a robust teacher workforce equipped with 
the skills to teach them. The Committee is concerned by the 
shortage of EL teachers in the majority of States, as well the 
academic achievement gap between ELs and their native English-
speaking peers. Therefore, the Committee encourages the 
Secretary to support the development and strengthening of high-
quality teacher preparation programs that enable graduates to 
meet licensure or certification requirements to teach ELs.
    Teacher Residency Programs.--The Committee notes that high-
quality teacher residency programs prepare diverse cohorts of 
teachers to serve high-need schools, improve teacher efficacy 
in the classroom, and are a high-retention teacher preparation 
pathway. In fact, 49 percent of residents are teachers of 
color, while only 20 percent of all teachers nationally are 
teachers of color. Further, a review of teacher residency 
programs shows that residents tend to have higher retention 
rates over time than nonresident teachers. As such, the 
Committee encourages the Department to prioritize grants under 
TQP for applicants that apply to fund high-quality teacher 
residency programs as authorized under Section 202(e) of the 
HEA. The Department is further encouraged to include a priority 
for teacher residency program applicants that include explicit 
admissions goals and priorities, as permitted under Section 
202(e)(2)(A)(vi)(II), for the consideration of teacher 
residency applicants from underrepresented populations in the 
teaching profession.

Child Care Access Means Parents in School

    The Committee recommends $95,000,000 for the Child Care 
Access Means Parents in School program, which is $30,000,000 
more than the fiscal year 2022 enacted level. This program 
makes competitive grants to colleges and universities to 
support or establish a campus-based childcare program primarily 
serving the needs of low-income students enrolled at the 
institution.
    The Committee continues bill language that lifts the 
statutory cap on grant awards to institutions of higher 
education, to more accurately reflect the costs of providing 
high-quality, convenient child care options for students. 
Consistent with this bill language, the Committee urges the 
Department to establish a maximum grant cap based on a 
reasonable estimation of the costs of providing child care 
rather than a fixed percentage of Pell Grant funding received 
by an institution. Additionally, the Committee urges the 
Department to prioritize applications from programs that 
connect parenting students with public benefits, case 
management, or sources of additional financial support, and to 
provide an application period of no less than 60 days.

Fund for the Improvement of Postsecondary Education

    The Committee recommendation includes $520,000,000 for the 
Fund for the Improvement of Postsecondary Education, which is 
$452,000,000 more than the fiscal year 2022 enacted level.

------------------------------------------------------------------------
                                                            FY 2023
                   Budget Activity                         Committee
------------------------------------------------------------------------
Basic Needs Grants...................................        $15,000,000
Centers of Excellence for Veteran Student Success             15,000,000
 Program.............................................
Distributed Digital Learning Infrastructure Pilot....         10,000,000
Emergency Aid Grants.................................          5,000,000
Increasing MSI PhDs Pilot............................          5,000,000
Matched Savings Program Grants.......................         10,000,000
Menstrual Products Programs..........................          5,000,000
Modeling and Simulation Programs.....................         10,000,000
Open Textbook Pilot..................................         10,000,000
Postsecondary Student Success Grants.................        200,000,000
Research and Development Infrastructure Grants.......        225,000,000
Transitioning Gang-Involved Youth to Higher Education         10,000,000
------------------------------------------------------------------------

    Basic Needs Grants.--The Committee recognizes that many 
college and graduate students are unable to achieve academic 
success because they cannot afford to meet their basic needs, 
such as housing, food, transportation, and access to physical 
and mental health services. The Committee includes $15,000,000 
for competitive grants to institutions of higher education, as 
defined by section 101 of the HEA, or consortia or systems of 
such institutions, to advance systemic solutions to student 
basic needs insecurity. Such grants shall include one or more 
of the following activities: establishing processes to 
automatically identify and conduct outreach students who may be 
eligible for public benefit programs in accordance with recent 
Federal guidance; conducting surveys and assessments of student 
basic needs security, including surveys of student needs 
conducted upon enrollment; or providing referrals and case 
management to students to enroll in local, State, and Federal 
public benefit programs. Activities may also include 
coordinating and collaborating with government and community-
based organizations and providing direct services such as 
temporary housing, secure sleeping arrangements, free or 
subsidized food, access to on-campus childcare. At least 25 
percent of grants must go to community colleges and at least 25 
percent must go to four-year HBCUs, HSIs, and other MSIs. Grant 
priority will go to institutions serving a significant number 
of students with low incomes using multiple indicators of 
student financial need.
    Centers of Excellence for Veteran Student Success 
Program.--The Committee includes $15,000,000 to support 
existing and new grantees for the Centers of Excellence for 
Veterans Student Success Program, as authorized by section 873 
of the HEA.
    Over one million veterans attend college every year and 
often need assistance receiving their benefits or transitioning 
to student life. Veteran Student Centers provide a one-stop-
shop for academic support, networking opportunities, peer 
mentorship, financial assistance, counseling, and career 
services.
    The Department should ensure that this program continues to 
support comprehensive services including veteran benefits 
assistance, tutoring, counseling, and housing. The Committee 
directs the Department to brief the Committees on 
Appropriations no later than 90 days after enactment of this 
Act on its plan to continue to carry out this program, as well 
as a plan for evaluation and accountability, and to notify the 
Committees no later than 15 days in advance of making any new 
grant award or changes to the programs.
    Distributed Digital Learning Infrastructure Pilot.--The 
Committee includes $10,000,000 to establish pilot programs for 
an institution of higher education with established remote 
learning infrastructure to work with MSIs in the grantee's 
region to provide support and technical assistance to expand 
MSI digital learning infrastructure.
    Emergency Aid Grants.--The Committee is aware of the large 
number of postsecondary students dropping out of school or 
failing to graduate due to not having the financial resources 
to cover emergency situations such as paying for a car repair, 
paying a late utility bill, or covering unforeseen or increased 
living costs. The COVID-19 pandemic raised the awareness of the 
public of these often small, but insurmountable financial 
challenges delaying or halting a student's education. The 
Committee includes $5,000,000 in competitive grants to 
institutions of higher education to provide direct financial 
support to their students to cover these emergency costs. To 
apply, institutions are required to submit a plan to the 
Secretary that defines how the institution would establish 
criteria to determine a student's eligibility for a direct 
emergency financial aid grant that would enable a student to 
enroll, stay enrolled or complete their program of study. 
Institutions that receive such grants must provide direct 
payments to such students and conduct outreach and awareness 
activities as to the existence of this program at the 
institution.
    Increasing MSI PhDs Pilot.--The Committee includes 
$5,000,000 to create the Increasing MSI PhDs Pilot program. 
This funding should support awards to a consortium of MSIs, 
including HSIs, that award PhDs to underrepresented student 
populations. Funding should be used to develop and test new 
models of cross-institutional intellectual, research, and 
resource-sharing communities, create mentorship programs for 
PhD students, support graduate research experiences, and other 
uses associated with the pursuit of PhDs by underrepresented 
postsecondary students.
    Matched Savings Grants.--The Committee includes $10,000,000 
for to establish matched savings programs for Pell-eligible 
postsecondary students. Grants will be awarded as partnerships 
between States and non-profits to establish and expand matched 
savings programs for eligible students that provide 
postsecondary cost assistance and financial literacy training. 
The grantees will establish savings accounts for each 
participating student, support financial literacy education, 
and support matching funds for amounts deposited by students 
and their families.
    A December 2020 report on matched savings programs by the 
Urban Institute found that safe, affordable matched savings 
account programs that offer strong match rates and provide 
financial education can help low-income families save and 
increase their financial well-being. The Committee is 
encouraged by the evidence base behind this innovative approach 
to improving the affordability of postsecondary education.
    Menstrual Products Programs.--Congress recognizes that the 
lack of access to menstrual products impedes the academic 
success of many college and graduate students as well as 
impacts their physical and mental well-being. Congress includes 
$5,000,000 for competitive grants to at least ten institutions 
of higher education, as defined by section 101 of the HEA, to 
support institutional programs that provide free menstrual 
products to students, as well as report on best practices. In 
order to qualify, grantees must agree to use funds to carry out 
or expand activities that fund programs that support direct 
provision of menstrual products in appropriate campus locations 
including, but not limited to, campus restroom facilities, 
wellness centers, on campus residential buildings; conduct 
outreach to students to encourage participation in menstrual 
equity programs and services; help eligible students apply for 
and enroll in local, State, and Federal public assistance 
programs; or coordinate and collaborate with government and/or 
community-based organizations. At least 50 percent of grants 
must go to community colleges. Grant priority will go to 
institutions with 25 percent or higher Pell enrollment, HBCUs, 
HSIs, AANAPISIs, and other MSIs.
    Modeling and Simulation Programs.--The Committee includes 
$10,000,000 for Modeling and Simulation Programs as authorized 
under section 891 of the HEA. Modeling and simulation 
technology has numerous applications for Federal and State 
governments and their partners in the defense, education, 
gaming, shipbuilding, and workforce training sectors, allowing 
them to generate data to help make decisions or predictions 
about their systems.
    Open Textbook Pilot.--The Committee includes $10,000,000 to 
continue the Open Textbook Pilot and fund a new grant 
competition in fiscal year 2023. The Department shall issue a 
notice inviting applications consistent with notice and comment 
procedures and allow for a 60-day application period. This 
funding should support a significant number of grant awards to 
IHEs as defined by 20 U.S.C. 1001, a group of IHEs, or State 
higher education agencies that lead the activities of (and 
serve as fiscal agent for) a consortium. Funding should be used 
to create new open textbooks and expand the use of open 
textbooks in courses that are part of a degree granting 
program, and particularly those with high enrollments. 
Allowable uses of funds should include professional development 
for faculty and staff, including relating to the search for and 
review of open textbooks; the creation or adaptation of open 
textbooks; development or improvement of tools and 
informational resources that support the use of open textbooks, 
including accessible instructional materials for students with 
disabilities; and research evaluating the efficacy of the use 
of open textbooks for achieving savings for students and the 
impact on instruction and student learning outcomes. The 
Secretary shall require that any open textbooks created with 
these funds shall be released to the public under a non-
exclusive, royalty-free, perpetual, and irrevocable license to 
exercise any of the rights under copyright conditioned only on 
the requirement that attribution be given as directed by the 
copyright owner. Further, any tools, technologies, or other 
resources that are created, developed, or improved wholly or in 
part with these funds for use with any open textbook must be 
similarly licensed. Any eligible entity receiving a grant 
through the Open Textbooks Pilot, upon completion of the 
supported project, shall report to the Secretary regarding the 
effectiveness of the project in expanding the use of open 
textbooks and in achieving savings for students; the impact of 
the project on expanding the use of open textbooks at IHEs 
outside of the institution receiving the grant; open textbooks 
created or adapted under the grant, including instructions on 
where the public can access each open textbook; the impact of 
the project on instruction and student learning outcomes; and 
all project costs, including the value of any volunteer labor 
and institutional capital used for the project. The Secretary 
shall make such reports publicly available.
    Postsecondary Student Success Grants (PSSG).--The Committee 
provides $200,000,000 for grants to support evidence-based 
activities to improve postsecondary retention and completion 
rates, including critical persistence benchmarks. Eligible 
applicants may include institutions of higher education, a 
consortium of institutions of higher education, statewide 
systems of higher education, a non-profit organization, or any 
of the preceding entities in partnership with a non-profit or 
business.
    The Committee directs the Secretary to execute this program 
as a tiered-evidence competition through the same structure as 
the EIR program authorized under ESEA. Under PSSG, the 
Secretary may award early-phase, mid-phase, or expansion grants 
that differ in terms of the level of prior evidence of 
effectiveness required for consideration for funding, the 
expectations regarding the kind of evidence and information 
funded projects should produce, the level of scale funded 
projects should reach, and, consequently, the amount of funding 
available to support each type of project. Early-phase grants 
will be supported by promising evidence, mid-phase grants will 
be supported by moderate evidence, and expansion grants will be 
supported by strong evidence as defined in the Department's 
fiscal year 2022 EIR notices. Under PSGG, all grantees must 
carry out rigorous, independent evaluations of the 
effectiveness of their projects. In carrying out PSGG, the 
Committee strongly encourages the Department to leverage the 
expertise of staff within the Office of Elementary and 
Secondary Education and the Institute of Education Sciences who 
have made EIR a highly successful program.
    The Committee is strongly encouraged by the evidence base 
behind comprehensive approaches to student success programs 
such as the What Works Clearinghouse-recognized CUNY ASAP 
program, which has been found to nearly double participant 
graduation rates. In addition, the Committee recognizes that 
other rigorously evaluated, effective comprehensive support 
programs such as One Million Degrees and Bottom Line have not 
yet been included in the Clearinghouse. In advance of the 
fiscal year 2023 competition, the Committee encourages the 
Department to review additional studies and strive to increase 
the number of postsecondary interventions included in the 
Clearinghouse.
    The Committee believes that the evidence of effectiveness 
for high-quality comprehensive support programs is 
transformative and that it is vital to expand their reach to 
more postsecondary students. Accordingly, for the fiscal year 
2023 PSSG competition, the Committee directs the Department to 
provide no less than $100,000,000 for grants at the mid-phase 
or expansion levels. By ensuring at least half of resources 
fund proven strategies, PSGG will strike a balance between 
testing innovative interventions and funding what works to help 
students succeed.
    The Committee directs the Department to brief the 
Committees on Appropriations no later than 90 days after 
enactment of this Act on its plan to continue to carry out this 
program, as well as a plan for evaluation and accountability, 
and to notify the Committees no later than 15 days in advance 
of making any new grant award or changes to the programs.
    Research and Development Infrastructure Grants.--The 
Committee provides $225,000,000 for planning and implementation 
grants designed to promote transformational investments in 
research infrastructure, including physical infrastructure and 
human capital development. Eligible entities include four-year 
HBCUs, TCUs, or other MSIs, either alone or as the lead entity 
in consortia including other academic partners such as 
community colleges, industry, and philanthropic partners.
    Transitioning Gang-Involved Youth to Higher Education.--The 
Committee directs the Department to work in conjunction with 
the Department of Labor to allocate no less than $10,000,000 to 
provide a funding opportunity for organizations that work 
directly with gang-involved youth to help such youth pursue 
higher education opportunities.
    National Center for College Students with Disabilities.--
The Committee encourages the National Center for College 
Students with Disabilities to continue providing technical 
assistance and best practice information about disability as 
students transition to institutions of higher education, 
collect information and research on disability services on 
college campuses, and report to the Department about the status 
of college students with disabilities in the United States.
    Reasonable Modifications at Institutions of Higher 
Education.--The Committee is interested in information 
pertaining to reasonable modifications and the provision of 
auxiliary aids and services, including those to access 
educational media, required by the Americans with Disabilities 
Act of 1990 and Section 504 of the Rehabilitation Act of 1973 
for college students with disabilities at institutions of 
higher education. The Committee directs the Department to 
include information on how it monitors institutional support 
for college students with disabilities, and information on 
technical assistance it provides to colleges regarding students 
with disabilities, in the fiscal year 2024 Congressional Budget 
Justification.
    Workforce Development Funding for University Consortia 
Focused on High-skill Fields.--The Committee is supportive of 
funding to consortia of institutions of higher education for 
innovative approaches to improve rates of baccalaureate 
exposure to artificial intelligence, data science, cyber 
security, additive manufacturing, clean energy and other high-
skill, high-wage, and in-demand industry sectors and 
occupations within a State region. Specifically, the Committee 
is supportive of funding that supports the development of 
career pathways in these sectors that support and subsidize 
wages for students in work-based learning settings.
    Reserve Officers' Training Corps (ROTC) Programs.--The 
Committee applauds all universities and colleges that host ROTC 
programs as they assist in the creation of each of the 
Services' officer corps. However, the Committee is concerned 
that some hosting ROTC activities may face challenges in 
maintaining the infrastructure needs to meet the ROTC mission 
goals. To ensure that ROTC candidates have the structures they 
need to become successful officers in their respective 
Services, the Committee encourages the Department to facilitate 
Service Secretaries' efforts to analyze the functionality and 
utilization of all ROTC facilities on university and college 
campuses.
    Foreign Gift Disclosures.--The Committee notes that, under 
section 117 of the HEA, colleges and universities receiving 
Federal funds must disclose certain gifts from or contracts 
with foreign entities and that the Department makes such 
information publicly available on its website. The Committee 
supports efforts by the Department to work with institutions to 
improve the reporting process in order to increase 
transparency, protect our national security, and preserve 
academic integrity.

Community Project Funding

    Within the funds included in this account, $209,301,000 
shall be used for the projects, and in the amounts, specified 
in the table titled ``Labor, HHS, Education Incorporation of 
Community Project Funding Items'' at the end of this report.

Augustus F. Hawkins Centers of Excellence

    The Committee recommends $30,000,000 for the Hawkins 
Centers of Excellence program, which is $22,000,000 more than 
the fiscal year 2022 enacted level. This program provides five-
year competitive grants to eligible institutions (HBCUs, HSIs, 
TCUs, and other MSIs) to establish centers of excellence. These 
centers will help strengthen and improve teacher preparation 
programs, increase the availability of educators from diverse 
backgrounds, and aid in the retention of teachers and 
principals of color.
    Comprehensive Educator Preparation.--The Committee notes 
that greater diversity in the teaching profession can have 
positive impacts on students' educational experiences and 
outcomes, especially for students of color. For example, one 
reanalysis of test score data from the Tennessee STAR class 
size study found that Black elementary students with Black 
teachers had reading and math test scores 3 to 6 percentile 
points higher than students without Black teachers and that 
gains in test scores accumulated with each year that Black 
students were in a class with a Black teacher. The Committee 
also notes that our current educator workforce does not reflect 
the increasing diversity of our nation or its students. The 
Committee also recognizes that HBCUs, TCUs, and other MSIs play 
a disproportionate and important role in preparing teachers of 
color, for example, preparing nearly 40 percent of Black 
teachers with bachelor's degrees in the United States. The 
Committee recognizes the importance of comprehensive educator 
preparation on student learning and educator retention, and 
therefore encourages the Department to create an absolute grant 
priority for eligible institutions that propose to establish or 
scale up comprehensive educator preparation programs as 
outlined in sections 202 (d),(e), and (f), of the HEA. The 
Committee also encourages the Secretary to prioritize grants to 
eligible institutions that will provide scholarships or grants 
to students based on financial need, for use in students 
accessing comprehensive educator preparation pathways that 
offer extensive preservice clinical training and mentoring by 
exemplary teachers.
    Preservice Clinical Training and Mentoring.--The Committee 
recognizes the importance of high-quality teacher preparation 
on student learning and teacher retention, and therefore 
encourages the Secretary to prioritize grants to eligible 
institutions that propose to establish or scale up high-quality 
teacher preparation pathways that offer extensive preservice 
clinical training and mentoring by exemplary teachers in grade 
and subject areas deemed high need by their State. The 
Committee also recognizes the value of a racially diverse 
teacher workforce and directs the Secretary to prioritize 
grants to eligible institutions that commit to increasing the 
number and proportion of students of color they serve by 
providing scholarships or grants, based on financial need, as 
well as academic supports to help teacher candidates 
successfully complete the preparation program and State 
licensure requirements, and to publicly report on these efforts 
and outcomes. The Committee also encourages the Department to 
include the establishment of formal partnerships between 
eligible institutions of higher education and local school 
districts as an allowable use of grant funding as well as 
programming that includes tutoring and support to prepare for 
licensure exams and funding to compensate mentors during the 
preservice clinical experience.
    Shortages of Black Male Teachers.--The Committee is 
concerned that Black men make up just two percent of teachers 
nationwide. The Committee's support for Hawkins is intended to 
address such shortages. In addition, the Committee encourages 
the Department to leverage the expertise and institutional 
capacity of HBCUs in mitigating this problem.

                           HOWARD UNIVERSITY

 
 
 
Appropriation, fiscal year 2022.......................      $344,018,000
Budget request, fiscal year 2023......................       311,018,000
Committee Recommendation..............................       394,018,000
    Change from enacted level.........................       +50,000,000
    Change from budget request........................       +83,000,000
 

    Howard University is a leading research university located 
in the District of Columbia and provides undergraduate liberal 
arts, graduate and professional instruction to students.
    The Committee recommends $394,018,000 for Howard University 
Hospital, an increase of $50,000,000 above the fiscal year 2022 
enacted level. Within the total, the agreement includes 
$150,000,000 to support construction of a new hospital. These 
amounts are in addition to the $107,000,000 provided for 
hospital construction in fiscal year 2021 and fiscal year 2022. 
The hospital serves as a major acute and ambulatory care center 
for the District of Columbia, and functions as a teaching 
facility. To continue this vital function, the Committee notes 
the need to modernize the hospital's facilities.

         COLLEGE HOUSING AND ACADEMIC FACILITIES LOANS PROGRAM

 
 
 
Appropriation, fiscal year 2022.......................          $435,000
Budget request, fiscal year 2023......................           298,000
Committee Recommendation..............................           298,000
    Change from enacted level.........................          -137,000
    Change from budget request........................             - - -
 

    Previously, these programs helped to ensure that 
postsecondary institutions were able to make necessary capital 
improvements to maintain and increase their ability to provide 
a high-quality education. Since 1994, no new loans have been 
made, and the Department's role has been to manage the 
outstanding loans.

  HISTORICALLY BLACK COLLEGE AND UNIVERSITY CAPITAL FINANCING PROGRAM 
                                ACCOUNT

 
 
 
Appropriation, fiscal year 2022.......................       $20,484,000
Budget request, fiscal year 2023......................        20,678,000
Committee Recommendation..............................        20,678,000
    Change from enacted level.........................          +194,000
    Change from budget request........................             - - -
 

    The Committee recommends $20,678,000 for the HBCU Capital 
Financing program, which is $194,000 more than the fiscal year 
2022 enacted level. This program is authorized under part D of 
Title III of the HEA and makes capital available for repair and 
renovation of facilities at HBCUs. In exceptional 
circumstances, capital provided under the program can be used 
for construction or acquisition of facilities.
    Within the total provided for this program, the Committee 
recommendation includes $528,000 for the administrative 
expenses to carry out the program and $20,150,000 for loan 
subsidy costs. In addition, the Committee raises the limit to 
the amount of bonds that may be insured under the HBCU Capital 
Financing program to $752,000,000, an increase of $477,916,725 
over the fiscal year 2022 enacted level.

                    INSTITUTE OF EDUCATION SCIENCES

 
 
 
Appropriation, fiscal year 2022.......................      $737,021,000
Budget request, fiscal year 2023......................       662,516,000
Committee Recommendation..............................       844,075,000
    Change from enacted level.........................      +107,054,000
    Change from budget request........................      +181,559,000
 

    The Committee recommends $844,075,000 for the Institute of 
Education Sciences (IES), $107,054,000 more than the fiscal 
year 2022 enacted level.

Research, Development, and Dissemination

    The Committee recommends $289,877,000 for Research, 
Development, and Dissemination, which is $85,000,000 more that 
the fiscal year 2022 enacted level. This account supports 
research, development, and national dissemination activities 
that are aimed at expanding fundamental knowledge of education 
and promoting the use of research and development findings in 
the design of efforts to improve education.
    National Center for Advanced Development in Education.--
Within amounts for Research, Development, and Dissemination, 
the Committee provides $75,000,000 for a new National Center 
for Advanced Development in Education (NCADE). Modeled on the 
Defense Advanced Research Projects Agency, the Department of 
Defense's renowned research and development center, NCADE will 
invest in high-reward, scalable solutions to address 
longstanding deficits and inequities in the education system. 
NCADE will be housed at IES and have a management structure 
that prioritizes solutions aligned with the science of learning 
and development that have the potential to dramatically improve 
student achievement and address gaps between advantaged and 
disadvantaged students. Specifically, NCADE programs will 
invest in breakthrough technologies; new pedagogical 
approaches; innovative learning models; and more efficient, 
reliable, and valid forms of measurement of student learning, 
experiences, and opportunities. Amounts for NCADE provided 
under Research, Development, and Dissemination will 
specifically support the Center's high-reward project funding. 
Personnel costs to support the Center's nimble program 
management structure will be supported through funding provided 
under IES Program Administration.
    Building State and Local Research and Development 
Capacity.--The Committee encourages IES to build State and 
local research and development capacity by creating a matching 
competitive grant program for American Rescue Plan Elementary 
and Secondary School Emergency Relief funds. These funds would 
allow States or districts to develop or implement diverse 
approaches specifically tailored to their contexts, including 
building research-practice partnerships, recruiting research 
and data talent into their agencies, and investing in their own 
research and development priorities to develop or implement 
more evidence-based solutions.

Statistics

    The Committee recommends $111,500,000 for the activities of 
the National Center for Education Statistics (NCES), which is 
the same as the the fiscal year 2022 enacted level. Statistics 
activities are authorized under Title I of the Education 
Sciences Reform Act of 2002. NCES collects, analyzes, and 
reports statistics on all levels of education in the U.S. 
Activities are carried out directly and through grants and 
contracts and include projections of enrollments, teacher 
supply and demand, and educational expenditures. NCES also 
provides technical assistance to State and local educational 
agencies and postsecondary institutions.
    Governing Boards of Institutions of Higher Education.--The 
Committee is interested in the disclosure of the gender, 
racial, and ethnic composition of governing boards of 
institutions of higher education in an ongoing effort to 
increase transparency and promote inclusive and equitable 
educational institutions. The Committee encourages the 
Department to ensure governing body composition, including the 
gender, racial, and ethnic composition of members, is included 
as a data component in surveys administered by the Integrated 
Postsecondary Education Data System (IPEDS) or other Federal 
postsecondary institution data collection effort. The Committee 
directs the Department to assess the feasibility of including 
such data in the fiscal year 2024 Congressional Budget 
Justification.
    Non-Academic Considerations in Postsecondary Data.--The 
Committee is aware of a 2019 report from NCES detailing 
recommendations to include non-academic considerations to 
improve and expand the IPEDS Admissions survey component (ADM) 
for prospective students, their families, and researchers 
interested in the college admissions process. The Committee is 
also aware of the lack of data available demonstrating how 
legacy status, or relationship to alumni of the institutions, 
factors in first-time, first-year degree-seeking admissions 
decisions. The Committee encourages the NCES to include non-
academic items, including alumni relationship, as factors for 
admissions in the next IPEDS ADM.

Regional Educational Laboratories

    The Committee recommends $63,733,000 for Regional 
Educational Laboratories (RELs), which is $5,000,000 more than 
the fiscal year 2022 enacted level. This program supports a 
network of 10 laboratories that promote the use and development 
of knowledge and evidence to increase student learning and 
further school improvement efforts.
    The Committee notes the critical role RELs play in helping 
to translate education research to policymakers and 
practitioners, which assists SEAs and LEAs in implementing the 
ESEA and providing a high-quality education for more children.

Research in Special Education

    The Committee recommends $64,255,000 for Research in 
Special Education, which is $4,000,000 more than the fiscal 
year 2022 enacted level. This program supports competitive 
awards to produce and advance the use of knowledge to improve 
services and results for children with disabilities. The 
program focuses on producing new knowledge, integrating 
research and practice, and improving the use of knowledge.

Special Education Studies and Evaluations

    The Committee recommends $13,318,000 for Special Education 
Studies and Evaluations, which is the same as the fiscal year 
2022 enacted level. This program awards competitive grants, 
contracts and cooperative agreements to assess the 
implementation of the IDEA and the effectiveness of State and 
local efforts to provide special education and early 
intervention programs and services to infants, toddlers, and 
children with disabilities.

Statewide Data Systems

    The Committee recommends $35,500,000 for Statewide Data 
Systems, which is $2,000,000 more than the fiscal year 2022 
enacted level. Competitive grants under this authority are made 
to SEAs to help them manage, analyze, disaggregate and use 
student data consistent with the ESEA.
    Growing Statewide Longitudinal Data Systems (SLDS).--The 
Committee supports the growth of the SLDS program to so that 
every State and locale has a robust data infrastructure capable 
of supporting effective education and talent development 
practices. The Committee believes these investments provide for 
the data backbone of education transparency, monitoring, and 
evidence building.

Assessment

    The Committee recommends $192,799,000 for Assessment, which 
is $5,054,000 more than the fiscal year 2022 enacted level. 
This amount includes $7,779,000 for the National Assessment 
Governing Board (NAGB), which is $54,000 more than the fiscal 
year 2022 enacted level.
    The National Assessment of Educational Progress (NAEP) is 
the only nationally representative and continuing survey of 
educational ability and achievement of students in the U.S. The 
primary goal of the assessment is to determine and report the 
status and trends of the knowledge and skills of students, 
subject by subject. Subject areas assessed in the past have 
included reading, writing, mathematics, science, history, 
citizenship, literature, art, and music. The NAEP is operated 
by contractors through competitive awards made by the NCES. The 
NAGB formulates the policy guidelines for the program.
    Civics and U.S. History Assessment.--Assessment.--The 
Committee's recommendation will support the current assessment 
schedule for the National Assessment of Educational Progress, 
including administration in 2022 of the Civics and U.S. History 
assessment in 8th grade at the national level; necessary 
research and development needed to maintain assessment quality, 
integrity and continuity, and achieve efficiencies; and 
maintain plans for the administration of a State-level Civics 
assessment in future years. The Committee directs NAGB and IES 
to consult with the Committee as it considers strategies in 
achieving cost efficiencies in and upgrades of its assessment 
program. Further, the Committee directs the Department to 
describe implemented and planned strategies for cost 
efficiencies and necessary research and development projects in 
the fiscal year 2024 Congressional Budget Justification.

Program Administration

    The Committee recommends $73,093,000 for Program 
Administration, which is $6,000,000 more than the fiscal year 
2022 enacted level.
    Operating Plan.--The agreement directs the Director to 
submit an operating plan within 90 days of enactment of this 
Act to the Committees detailing how IES plans to allocate 
funding available to the Institute for research, evaluation, 
statistics, administration and other activities.
    School Pulse Panel.--The Committee is supportive of IES' 
School Pulse Panel, which tracks the effects of COVID on 
schools through a national sample of elementary, middle, and 
high schools. This program has provided invaluable information 
as one of the nation's few sources of reliable data focused on 
school reopening efforts, as reported by school district staff 
and principals in U.S. public schools.
    Unique Needs of Military-Connected Youth in Mentorship 
Programs.--The Committee recognizes the unique circumstances of 
highly mobile students, including youth growing up in military-
connected families. The Committee supports IES' uplifting of 
mentorship programming tailored to military families' needs.

                        DEPARTMENTAL MANAGEMENT

 
 
 
Appropriation, fiscal year 2022.......................     $ 594,407,000
Budget request, fiscal year 2023......................       785,752,000
Committee Recommendation..............................       690,252,000
    Change from enacted level.........................      + 95,845,000
    Change from budget request........................       -95,500,000
 

Program Administration

    The Committee recommends $462,500,000 for Program 
Administration, which is $67,593,000 more than the fiscal year 
2022 enacted. These funds support the staff and other costs of 
administering programs and activities at the Department. Items 
include personnel compensation, health, retirement, and other 
benefits as well as travel, rent, telephones, utilities, 
postage fees, data processing, printing, equipment, supplies, 
technology training, consultants, and other contractual 
services.
    Advertising Contracts.--The Committee understands that, as 
the largest advertiser in the U.S., the Federal Government 
should work to ensure fair access to its advertising contracts 
for small disadvantaged businesses and businesses owned by 
minorities and women. The Committee directs the Department to 
include the following information in its fiscal year 2024 
Congressional Budget Justification: Expenditures for fiscal 
years 2022, 2023, and expected expenditures for fiscal year 
2024 respectively, for (1) all contracts for advertising 
services; and (2) contracts for the advertising services of (I) 
socially and economically disadvantaged small business concerns 
(as defined in section 8(a)(4) of the Small Business Act (15 
U.S.C. 637(a)(4)); and (II) women- and minority-owned 
businesses.
    Investments in Impoverished Areas.--The Committee is deeply 
appreciative to the Department for its thorough work on a 
report on educational investments in impoverished areas, 
particularly in persistent poverty counties and in other high 
poverty census tracts as described in House Report 117-81. The 
Committee directs the Department to update the report to 
include persistent poverty percentages for competitions in 
fiscal year 2022 once those data are available.
    Lead Testing and Remediation.--The Committee strongly 
agrees with recommendations from a 2018 GAO report, Lead 
Testing of School Drinking Water Would Benefit from Improved 
Federal Guidance, that the Assistant Secretary for Elementary 
and Secondary Education should collaborate with the 
Environmental Protection Agency (EPA) to disseminate guidance 
related to lead testing and remediation in schools. The 
Committee is aware that EPA has made available updated guidance 
and web-based toolkits for lead testing and remediation in 
schools. The Committee is also aware that EPA is soliciting 
applications from education officials to provide grant funds to 
assist States and local education agencies with testing and 
remediation efforts. The Committee appreciates the technical 
assistance provided by the Department to school districts in 
response to language included in House Report 116-62. The 
Committee directs the Department to continue coordinating with 
EPA in disseminating this new guidance and resources, assisting 
school systems seeking to remediate lead contamination in 
working with EPA, and sharing best practices among States and 
local school systems. The Committee directs the Department to 
report on ongoing efforts on these issues in the fiscal year 
2024 Congressional Budget Justification.
    FTE and Attrition Report.--The Committee directs the 
Department to provide the Committees on Appropriations a 
report, not later than 30 days after the conclusion of each 
quarter, detailing the number of full-time equivalent employees 
and attrition by principal office and appropriations account.
    Protecting Scientific Research on Marihuana.--Through 
scientific research, institutions of higher education advance 
our understanding and knowledge of various aspects of our 
world. Moreover, when in the public interest, such institutions 
should be able to conduct such research without fear of 
reprisal or loss of Federal funding. This includes research on 
cannabis, a Schedule I controlled substance under the 
Controlled Substances Act. As more States and localities move 
to legalize cannabis, many institutions of higher education are 
expanding the knowledge-base on this controlled substance. As a 
result, the Committee notes that such research is in the public 
interest, and the recommendation includes new bill language 
prohibiting the Department from penalizing institutions of 
higher education that conduct scientific research on marihuana.
    Evidence-based Grants and Policy.--The Committee requests 
an update in the fiscal year 2024 Congressional Budget 
Justification on implementation of the Foundations for 
Evidence-based Policymaking Act (P.L. 115-435) and 
implementation plans for the coming year. The Committee 
encourages the Secretary to develop guidance to ensure relevant 
participants and grantees are involved in the Department-wide 
process of prioritizing evidence needs, including participating 
in Department led evaluations. Consistent with program 
statutes, the Committee encourages the Secretary to ensure that 
evidence of effectiveness is a consideration in grant 
opportunities.
    Film Programs at Institutions of Higher Education.--The 
Committee recognizes the importance of ensuring diversity in 
student populations enrolled in film programs at institutions 
of higher education that receive any Federal funds and grants 
administrated by the Department of Education. The Committee 
encourages institutions of higher education to continue 
building on best practices in recruitment and retention to 
ensure student enrollment is reflective of the American 
population's diverse demographics.
    Customer Service.--The Committee continues to support 
efforts to improve customer service in accordance with 
Executive Order 13571--Streamlining Service Delivery and 
Improving Customer Service. The Committee directs the Secretary 
to develop standards to improve customer service and 
incorporate the standards into the performance plans required 
under 31 U.S.C. 1115. The Committee further directs the 
Department to include an update on the progress of these 
efforts in the fiscal year 2024 Congressional Budget 
Justification.
    Performance Measures.--The Committee directs the Department 
to comply with title 31 of the United States Code, including 
the development of organizational priority goals and outcomes 
such as performance outcome measures, output measures, 
efficiency measures, and customer service measures. The 
Committee further directs the Department to include an update 
on the progress of these efforts in the fiscal year 2024 
Congressional Budget Justification.
    Regional Councils and Councils of Governments.--The 
Committee encourages the Department to list regional councils 
and councils of governments as eligible entities in 
competitions for Federal funding whenever local governments or 
non-profit agencies are eligible entities. Furthermore, the 
Committee encourages the Department to seek opportunities for 
regional councils and councils of governments to serve as lead 
applicants and grantees to encourage and expand greater 
regional collaboration.
    Predispute Nondisclosure and Nondisparagement Clauses.--The 
Committee recognizes that harassment, including sexual 
harassment and assault, continue to be pervasive in the 
workplace, and that the use of predispute nondisclosure and 
nondisparagement clauses as conditions of employment can 
perpetuate illegal conduct by silencing survivors and shielding 
perpetrators. The Committee directs the Department to include 
proposals in its fiscal year 2024 Congressional Budget 
Justification to eliminate the use of grants and contracts to 
employers that use this practice.
    Geographical Distribution of Grants and Poverty.--The 
Committee acknowledges the value of ensuring K-12 grant 
competitions support entities across geographically diverse 
areas, including urban, suburban, and rural areas; however, the 
Committee is concerned that, without careful consideration and 
planning, efforts to prioritize specific geographical areas may 
have unintended negative consequences. The Department's 2021 
Condition on Education finds that 41 percent of students 
attending public schools in cities attend high-poverty schools, 
compared with 20 percent of students who attend schools in 
towns, 17 percent of students who attend suburban schools, and 
15 percent of students who attend rural schools. Given the 
significant differences in the share of students attending 
high-poverty schools across areas, the Committee urges the 
Department to consider the socioeconomic and racial equity 
implications of prioritizing specific geographic areas over 
cities in competitive grants.
    Out of School Time Organizations Supporting Mental Health 
for Youth.--The Committee notes that thousands of out of school 
time organizations are working with State governments, 
districts, schools, and youth to supplement the critical work 
of school-based mental health organizations without significant 
support from Federal funding streams. In order to better 
understand the Federal resources available, the Committee 
encourages the Department, in partnership with other relevant 
Federal agencies, to provide information on the ways community-
based organizations, specifically out of school time 
organizations, can utilize existing Federal funding streams to 
provide mental health and student support services that 
supplement school-based mental health services.

                        OFFICE FOR CIVIL RIGHTS

 
 
 
Appropriation, fiscal year 2022.......................      $135,500,000
Budget request, fiscal year 2023......................       161,300,000
Committee Recommendation..............................       151,300,000
    Change from enacted level.........................       +15,800,000
    Change from budget request........................       -10,000,000
 

    The Office for Civil Rights (OCR) is responsible for 
enforcing laws that prohibit discrimination on the basis of 
race, color, national origin, sex, disability, and age in all 
programs and institutions that receive funds from the 
Department. These laws extend to SEAs, LEAs, and IHEs, 
including proprietary schools. They also extend to State 
rehabilitation agencies, libraries, museums, and other 
institutions receiving Federal funds.
    The Committee recommendation includes $151,300,000, which 
is $15,800,000 more than the fiscal year 2022 enacted level.
    The School to Prison Pipeline.--The Committee directs GAO 
to study the role and oversight of policing in schools, 
including the impact of school policing on Black and Latino 
students. The study should also explore the extent to which 
school resource officers and evidence-based interventions, such 
as restorative justice practices, can enhance school safety, 
student well-being, and--to the extent practical--student 
outcomes. GAO should begin this work no later than September 
2022 and issue a final report on a date thereafter as agreed 
between GAO and the Committee.
    The State of Desegregation Orders.--The Committee is 
concerned by research from the UCLA Civil Rights Project 
indicating that schools and school districts are becoming 
increasingly racially and socioeconomically segregated across 
the country. At the same time, there is no clear or accurate 
reporting or transparency on the number of Federal 
desegregation orders, the status of these orders, or the impact 
they have had on segregation in districts. The Committee, 
therefore, continues to urge OCR to make a report publicly 
available on the Department's website, detailing a 
comprehensive list of all existing Federal desegregation orders 
in the United States, their principle requirements, and the 
status of the affected districts' compliance with these orders.
    Racial and Economic Segregation in Schools.--The Committee 
looks forward to receiving the report the Department was 
directed to complete in House Report 117-96.

                      OFFICE OF INSPECTOR GENERAL

 
 
 
Appropriation, fiscal year 2022.......................       $64,000,000
Budget request, fiscal year 2023......................        76,452,000
Committee Recommendation..............................        76,452,000
    Change from enacted level.........................       +12,452,000
    Change from budget request........................             - - -
 

    OIG has authority to inquire into all program and 
administrative activities of the Department as well as into 
related activities of grant and contract recipients. It 
conducts audits and investigations to determine compliance with 
applicable laws and regulations, to check alleged fraud and 
abuse, efficiency of operations, and effectiveness of results.
    The Committee recommendation continues bill language 
allowing the OIG to better respond to unexpected oversight 
needs by modifying the availability of funds.

                           General Provisions

    Sec. 301. The Committee continues a provision related to 
the implementation of programs of voluntary prayer and 
meditation in public schools.

                          (TRANSFER OF FUNDS)

    Sec. 302. The Committee continues a provision regarding 
transfer authority.
    Sec. 303. The Committee continues a provision allowing ESEA 
funds consolidated for evaluation purposes to be available from 
July 1, 2023 through September 30, 2024.
    Sec. 304. The Committee continues a provision allowing 
certain institutions to continue to use endowment income for 
student scholarships.
    Sec. 305. The Committee continues a provision extending the 
authorization of the National Advisory Committee on 
Institutional Quality and Integrity.
    Sec. 306. The Committee continues a provision extending the 
authority to provide account maintenance fees to guaranty 
agencies for Federal student loans.
    Sec. 307. The Committee continues a provision allowing 
administrative funds to cover outstanding Perkins loans 
servicing costs.

                              (RESCISSION)

    Sec. 308. The Committee modifies a provision rescinding 
fiscal year 2023 mandatory funding to offset the mandatory 
costs of increasing the discretionary Pell award and expanding 
Title IV eligibility.
    Sec. 309. The Committee continues a provision regarding 
outreach to borrowers and the Public Service Loan Forgiveness 
program.
    Sec. 310. The Committee modifies a provision regarding 
Public Service Loan Forgiveness.
    Sec. 311. The Committee continues a provision allowing up 
to 0.5 percent of funds appropriated in this Act for programs 
authorized under the HEA, except for the Pell Grant program, to 
be used for evaluation of any HEA program.
    Sec. 312. The Committee continues a provision providing an 
additional amount for the projects, and in the amounts, as 
specified in the table titled ``Labor, HHS, Education 
Incorporation of Community Project Funding Items'' in the 
report accompanying this title.
    Sec. 313. The Committee includes a new provision regarding 
charter schools that contract with a for-profit entity to 
operate, oversee or manage the activities of the school.
    Sec. 314. The Committee includes a new provision regarding 
research on marihuana.
    Sec. 315. The Committee includes a new provision related to 
the use of electric shock devices and equipment.
    Sec. 316. The Committee includes a new provision related to 
the 85-15 rule.
    Sec. 317. The Committee includes a new provision regarding 
Title IV eligibility under HEA.
    Sec. 318. The Committee includes a new provision regarding 
section 344 of the HEA.

                       TITLE IV--RELATED AGENCIES


 Committee for Purchase From People Who Are Blind or Severely Disabled


                         SALARIES AND EXPENSES

 
 
 
Appropriation, fiscal year 2022.......................       $11,000,000
Budget request, fiscal year 2023......................        13,124,000
Committee Recommendation..............................        13,124,000
    Change from enacted level.........................        +2,124,000
    Change from budget request........................             - - -
 

    The Committee believes oversight is necessary to ensure the 
program is operating in accordance with statutory requirements 
that blind or other severely disabled individuals provide at 
least 75 percent of hours of direct labor required for the 
production or provision of the products or services to Federal 
government agencies. To ensure the Committee for Purchase from 
People Who Are Blind or Severely Disabled (AbilityOne 
Commission) maintains its oversight capacity, the Committee 
continues bill language requiring the AbilityOne Commission to 
establish written agreements with central nonprofit agencies. 
The written agreements ensure the AbilityOne Commission can 
conduct appropriate audit, oversight, and reporting functions 
in accordance with standard Federal procurement policies.
    Committee for Purchase From People Who Are Blind or 
Severely Disabled--Requested Reports.--The Committee requests 
the reports as described in the explanatory statement 
accompanying P.L. 117-103.
    Office of Inspector General.--The Committee recommends not 
less than $3,124,000 for the Office of Inspector General.

             Corporation for National and Community Service


                           OPERATING EXPENSES

 
 
 
Appropriation, fiscal year 2022.......................      $865,409,000
Budget request, fiscal year 2023......................       982,126,000
Committee Recommendation..............................       947,829,000
    Change from enacted level.........................       +82,420,000
    Change from budget request........................       -34,297,000
 

    The Committee recommends $947,829,000 for operating 
expenses for the Corporation for National and Community Service 
(CNCS), an increase of $82,420,000 over the fiscal year 2022 
enacted level and $34,297,000 below the fiscal year 2023 budget 
request.
    Service Learning.--Within the total for Operating Expenses, 
the Committee directs $20,000,000 for CNCS to support service-
learning activities, such as the Summer of Service and Semester 
of Service, within existing programs. The Committee further 
recommends that CNCS prioritize grants directed to public 
schools and institutions of higher education in economically 
disadvantaged communities.
    Civic Bridgebuilding.--The Committee supports CNCS' goal of 
uniting Americans through national service and recognizes that 
national service is a proven model of civic bridgebuilding. To 
advance these shared goals, the Committee directs $15,000,000 
to CNCS for bridgebuilding activities, such as those modeled in 
the bipartisan Building Civic Bridges Act (H.R. 6843), within 
existing programs. These initiatives may include administering 
a grant program to support civic bridgebuilding programs and 
establish standardized criteria to track the effectiveness of 
funded projects and activities; providing training in civic 
bridgebuilding skills and techniques to AmeriCorps members and 
host sites; the establishment of a committee to advise on civic 
bridgebuilding initiatives at CNCS; the creation of a public 
research base focused on civic engagement, civic 
bridgebuilding, and civic renewal; and providing resources that 
can be publicly disseminated to support local civic 
bridgebuilding efforts, among other activities.

Volunteers in Service to America

    The Committee recommends $106,264,000 for Volunteers in 
Service to America (VISTA), an increase of $5,979,000 over the 
fiscal year 2022 enacted level and the same as the fiscal year 
2023 budget request. This program provides capacity building 
for small, community-based organizations with a mission of 
combating poverty. VISTA members raise resources, recruit, and 
organize volunteers, and establish and expand programs in 
housing, employment, health, and economic development.

National Senior Volunteer Corps

    The Committee recommends $245,145,000 for the National 
Senior Volunteer Corps programs, an increase of $14,377,000 
over the fiscal year 2022 enacted level and the same as the 
fiscal year 2023 budget request. Senior Corps is a collection 
of programs that connect individuals older than the age of 55 
with opportunities to contribute their job skills and expertise 
to community projects and organizations.
    The Committee intends for all funding to be used to support 
programs and volunteers.
    The funding breakout by program is as follows:

------------------------------------------------------------------------
           National Senior Volunteer Corps:            FY 2023 Committee
------------------------------------------------------------------------
Foster Grandparents Program..........................       $131,335,000
Senior Companion Program.............................         58,705,000
Retired Senior Volunteer Program.....................         55,105,000
------------------------------------------------------------------------

AmeriCorps State and National Grants

    The Committee recommends $522,797,000 for AmeriCorps State 
and National Grants, an increase of $56,048,000 over the fiscal 
year 2022 enacted level. This program provides funds to local 
and national organizations and agencies to address community 
needs in education, public safety, health, and the environment.
    The increase supports enhanced opportunities for more 
individuals to serve as AmeriCorps State and National members 
by increasing disability accommodation and eligibility for 
Segal Education awards for individuals with DACA status. 
AmeriCorps State and National members support children to 
achieve academic success, respond to natural disasters, build 
and renovate homes for families in under-resourced communities, 
give back to veterans and their families, preserve and restore 
the environment, and address other needs identified by 
communities.
    Digital Equity.--The Committee recognizes that digital 
equity needs persist in underserved or marginalized communities 
at a time when more Americans than ever before depend on, or 
could significantly benefit from, access to digital services. 
The Committee recognizes the role that national service 
organization volunteers through CNCS could play in helping to 
meet the IT needs of these communities across the country while 
also supporting IT skills and career development among 
participating volunteers. The Committee encourages CNCS to 
support existing programs that would focus on digital equity 
and digital literacy projects for underserved communities.
    Randomized Control Trials.--The Committee encourages 
AmeriCorps to continue its use of randomized control trials to 
build causal evidence for effective interventions.

Innovation, Assistance, and Other Activities

    The Committee recommends $10,100,000 for Innovation, 
Assistance, and Other Activities, an increase of $212,000 over 
the fiscal year 2022 enacted level and the same as the fiscal 
year 2023 budget request.
    National Days of Service.--The Committee continues to 
support the September 11 National Day of Service and 
Remembrance and the Martin Luther King, Jr. National Day of 
Service--two important national events. The Committee 
encourages CNCS to prioritize eligible organizations with 
expertise in representing families of victims of the September 
11, 2001 terrorist attacks and other impacted constituencies 
when planning for the September 11 National Day of Service and 
Remembrance.

Evaluation

    The Committee recommends $6,250,000 for evaluation, an 
increase of $2,130,000 over the fiscal year 2022 enacted level 
and the same as the fiscal year 2023 budget request. These 
funds support research on program effectiveness.

National Civilian Community Corps

    The Committee recommends $37,735,000 for National Civilian 
Community Corps, an increase of $3,230,000 over the fiscal year 
2022 enacted level and the same as the fiscal year 2023 budget 
request. This program supports residential, team-based service 
opportunities for individuals aged 18-24.

State Commission Administrative Grants

    The Committee recommends $19,538,000 for State Commission 
Support Grants, an increase of $444,000 over the fiscal year 
2022 enacted level and the same as the fiscal year 2023 budget 
request. Funds are used for formula grants to support State 
oversight of service programs.

                 Payment to the National Service Trust


 
 
 
Appropriation, fiscal year 2022.......................      $190,550,000
Budget request, fiscal year 2023......................       235,000,000
Committee Recommendation..............................       235,000,000
    Change from enacted level.........................       +44,450,000
    Change from budget request........................             - - -
 

    The National Service Trust makes payments for Segal 
education awards, pays interest that accrues on qualified 
student loans for AmeriCorps participants during terms of 
service in approved national service positions, and makes other 
payments entitled to members who serve in the programs of the 
Corporation for National and Community Service.

                         SALARIES AND EXPENSES

 
 
 
Appropriation, fiscal year 2022.......................       $88,082,000
Budget request, fiscal year 2023......................       114,686,000
Committee Recommendation..............................       109,686,000
    Change from enacted level.........................       +21,604,000
    Change from budget request........................        -5,000,000
 

    Evidence-based Grant Making.--The Committee is supportive 
of efforts by the Corporation to consider evidence of 
effectiveness in grant competitions. The Committee encourages 
CNCS to develop guidance to ensure relevant participants and 
grantees are involved in the Corporation-wide process of 
prioritizing evidence needs, including participating in CNCS 
led evaluations. Consistent with program statutes, the 
Committee encourages CNCS to ensure that evidence of 
effectiveness is a consideration in grant opportunities.
    Civilian Climate Corps (CCC).--Within the total, the 
Committee includes $15,000,000 to hire new staff, develop new 
capacity, and enhance core business functions to successfully 
stand up the Civilian Climate Corps program in partnership with 
other Federal agencies. These investments in staff and 
administrative capacity will support grantees' work related to 
climate resilience, environmental stewardship, and climate 
mitigation, as well as AmeriCorps' collaboration with other 
agencies implementing the CCC.

                      OFFICE OF INSPECTOR GENERAL

 
 
 
Appropriation, fiscal year 2022.......................        $6,595,000
Budget request, fiscal year 2023......................         8,121,000
Committee Recommendation..............................         8,121,000
    Change from enacted level.........................        +1,526,000
    Change from budget request........................             - - -
 

    The Committee recommends $8,121,000 for the Office of the 
Inspector General (OIG), an increase of $1,526,000 over the 
fiscal year 2022 enacted level and the same as the fiscal year 
2023 budget request.

                       ADMINISTRATIVE PROVISIONS

    Sec. 401. The Committee continues a provision requiring 
CNCS to make any significant changes to program requirements or 
policy through rulemaking.
    Sec. 402. The Committee continues a provision related to 
National Service Trust minimum share requirements.
    Sec. 403. The Committee continues a provision related to 
donations.
    Sec. 404. The Committee continues a provision related to 
veterans.
    Sec. 405. The Committee continues a provision related to 
criminal history background checks.
    Sec. 406. The Committee continues a provision related to 
1,200 hour service positions.
    Sec. 407. The Committee continues a provision related to 
VISTA members and Segal Education Awards.
    Sec. 408. The Committee includes a new provision related to 
allowing individuals with Deferred Action of Childhood Arrivals 
(DACA) status who successfully serve a term in AmeriCorps State 
and National, NCCC, or VISTA, to be eligible for a Segal 
AmeriCorps Education Award.
    Sec. 409. The Committee includes a new provision related to 
allowing AmeriCorps NCCC to keep teams in place over the 12-
month statutory restriction for work on disaster response or 
recovery, enabling overlap in NCCC service and coverage over 
the summer months.
    Sec. 410. The Committee includes a new provision related to 
allowing AmeriCorps NCCC members ages 18-26 to participate for 
a period of 3 to 6 months, as opposed to the usual term of 11 
to 12 months.

                  Corporation for Public Broadcasting


 
 
 
Appropriation, fiscal year 2024.......................      $525,000,000
Budget request, fiscal year 2025......................       565,000,000
Committee Recommendation..............................       565,000,000
    Change from enacted level.........................       +40,000,000
    Change from budget request........................             - - -
 

    The Committee recommends $565,000,000 as an advance 
appropriation for fiscal year 2025, an increase of $40,000,000 
over the fiscal year 2024 advance and the same as the fiscal 
year 2023 budget request. In addition, the Committee 
recommendation includes $60,000,000 in fiscal year 2023 for 
continued support of CPB in replacing and upgrading the public 
broadcasting interconnection system and further investing in 
system-wide infrastructure and services.
    National Multicultural Alliance.-- According to the Public 
Broadcasting Act, one of the greatest priorities of public 
broadcasting is to address the ``needs of unserved and 
underserved audiences, particularly children and minorities.'' 
Programming that reflects the histories and perspectives of 
diverse racial and ethnic communities is a core value and 
responsibility of public broadcasting. Therefore, the Committee 
supports continued investment in the National Multicultural 
Alliance to help accomplish this goal. The Corporation is 
directed to provide a briefing to the Committee within 90 days 
of enactment of this Act on this investment.
    Continued Access to Public Broadcasting.--The Committee 
recognizes the importance of continued access to public 
broadcasting in local communities. The Committee directs 
Federally funded public radio stations to engage in public-
private partnerships with State and local entities, including 
nonprofits, in this effort. The Committee looks forward to 
information in the fiscal year 2024 Congressional Budget 
Justification on how public private partnerships may be used to 
ensure continued access to public broadcasting in underserved 
areas.
    Diversity in CPB Funded Programming.--The Committee 
recognizes the importance of diversity and inclusion in 
federally funded public media in television and radio 
programming. The Committee requests CPB include in its fiscal 
years 2024/2026 Congressional Budget Justification information 
on its diversity and inclusion efforts, including programming 
supported by funding from the Corporation, as well as 
professional development opportunities and services provided by 
CPB for individuals from underrepresented communities.
    Diverse Content and Content Creators.--In recognizing the 
importance of public media and the inclusion of diverse and 
independent voices, Congress encourages CPB to continue to 
support the Independent Television Service (ITVS) and the 
National Multicultural Alliance (NMCA) and encourages CPB to 
expand its support through other established and emerging 
intermediaries that fund and support diverse filmmakers and 
production of diverse content. The Committee further encourages 
CPB to continue fulfilling its Congressional mandate to enrich 
the public media landscape with diverse content on broadcast 
and digital platforms by funding more content creators and 
producers from underrepresented backgrounds. As the federal 
funding provided for CPB also supports the work of ITVS, the 
Committee urges CPB to ensure that the increases in funding for 
future fiscal years are also used to provide additional 
financial support for ITVS, the National Multicultural 
Alliance, and content creators and producers from 
underrepresented backgrounds.

               Federal Mediation and Conciliation Service


                         SALARIES AND EXPENSES

 
 
 
Appropriation, fiscal year 2022.......................       $50,058,000
Budget request, fiscal year 2023......................        53,705,000
Committee Recommendation..............................        53,705,000
    Change from enacted level.........................        +3,647,000
    Change from budget request........................             - - -
 

    The Federal Mediation and Conciliation Service promotes 
labor-management cooperation through mediation and conflict 
resolution services to industry, government agencies, and 
communities.

            Federal Mine Safety and Health Review Commission


                         SALARIES AND EXPENSES

 
 
 
Appropriation, fiscal year 2022.......................       $17,539,000
Budget request, fiscal year 2023......................        18,012,000
Committee Recommendation..............................        18,012,000
    Change from enacted level.........................          +473,000
    Change from budget request........................             - - -
 

    The Federal Mine Safety and Health Review Commission is an 
independent adjudicative agency that provides administrative 
trial and appellate review of legal disputes arising under the 
Federal Mine Safety and Health Act of 1977.

                Institute of Museum and Library Services


    OFFICE OF MUSEUM AND LIBRARY SERVICES: GRANTS AND ADMINISTRATION

 
 
 
Appropriation, fiscal year 2022.......................      $268,000,000
Budget request, fiscal year 2023......................       276,800,000
Committee Recommendation..............................       280,000,000
    Change from enacted level.........................       +12,000,000
    Change from budget request........................        +3,200,000
 

    Within the total for the Institute of Museum and Library 
Services (IMLS), the Committee recommends the following 
amounts:

------------------------------------------------------------------------
                   Budget Activity                     FY 2023 Committee
------------------------------------------------------------------------
Library Services Technology Act:
    Grants to States.................................       $170,000,000
    Native American Library Services.................          5,763,000
    National Leadership: Libraries...................         15,787,000
    Laura Bush 21st Century Librarian................         10,000,000
Museum Services Act:
    Museums for America..............................         29,180,000
    Native American/Hawaiian Museum Service..........          3,272,000
    National Leadership: Museums.....................          9,848,000
African American History and Culture Act:
    Museum Grants for African American History and             6,000,000
     Culture.........................................
National Museum of the American Latino Act
    Museum Grants for American Latino History and              6,000,000
     Culture.........................................
Museum and Library Services Act General Provisions:
    Research, Analysis and Data Collection...........          5,650,000
Program Administration...............................         18,500,000
------------------------------------------------------------------------

Library Services and Technology

    The Grants to State Library Agencies program provides funds 
to State Library Administrative Agencies using a population-
based formula.
    Online Education Programs.--Bringing quality, online career 
high school education to adults is essential for entering the 
skilled workforce and/or matriculating into the community 
college system. Local libraries play a vital, central role in 
providing adult online high school education to patrons in 
their local communities. The Committee encourages IMLS to 
prioritize state grants to local libraries to further develop 
ways for libraries to adopt and utilize adult online career 
high school education programs.

Program Administration

    The Committee recommends $18,500,000 for Program 
Administration, which is the same as the fiscal year 2022 
enacted level. These funds provide administrative and 
management support for all programs administered by IMLS. The 
Committee also includes $5,650,000 for IMLS' activities in 
policy, research, and data collection, including functions 
formerly conducted by the National Commission on Libraries and 
Information Science.
    Holocaust Education and Survivor Stories.--The Committee is 
aware that the number of Holocaust survivors in the U.S. is 
diminishing due to the advanced age of the survivors. The 
Committee continues to commend the work that museums, 
libraries, and archives are doing to preserve their memories 
and to educate the public of the Holocaust. The Committee 
encourages IMLS to support the work organizations are doing 
across the country to preserve and present the living memories 
of Holocaust survivors in an interactive format, which can help 
educate future generations about the atrocities of the 
Holocaust.
    Information Literacy Taskforce.--The Committee encourages 
IMLS to support the Information Literacy Taskforce funded in 
fiscal year 2023 and to continue to follow the guidelines and 
priorities described in the explanatory statement accompanying 
P.L. 117-103.
    Public Library Assessment.--The Committee notes growing 
concern regarding the physical condition of public libraries. 
The Committee supports efforts to assess the availability and 
condition of public library facilities, the availability and 
condition of public library facilities located in economically 
disadvantaged or underserved communities, the accessibility of 
public library facilities for individuals with disabilities, 
the condition of public library facilities affected by natural 
disasters and extreme weather, and potential costs associated 
with bringing public library facilities to a state of good 
repair.

                  Medicare Payment Advisory Commission


                         SALARIES AND EXPENSES

 
 
 
Appropriation, fiscal year 2022.......................       $13,292,000
Budget request, fiscal year 2023......................        13,440,000
Committee Recommendation..............................        13,824,000
    Change from enacted level.........................          +532,000
    Change from budget request........................          +384,000
 

    The Medicare Payment Advisory Commission (MedPAC) is an 
independent agency tasked with advising the Congress on issues 
affecting the Medicare program. In addition to advising on 
payments to private health plans participating in Medicare and 
providers in Medicare's traditional fee-for-service program, 
MedPAC is also responsible for providing analysis on access to 
care, quality of care, and other issues affecting Medicare.
    Report on Spending.--The Committee requests a report no 
later than the March 15th following the enactment of this Act 
comparing per enrollee spending on behalf of Medicare 
beneficiaries enrolled in the Medicare Advantage (MA) program 
and beneficiaries enrolled in traditional fee-for-service (FFS) 
Medicare. In conducting such analysis, MedPAC shall evaluate at 
least the previous five plan years for which data is available. 
The analysis shall rely on data, as determined necessary, from 
the Centers for Medicare and Medicaid Services (CMS) Office of 
the Actuary, MA bids, the Medicare Trustees, and any other 
sources to assess spending on the MA and FFS Medicare programs. 
MedPAC shall conduct this analysis using the method used by CMS 
in calculating spending on FFS for use in the calculation of MA 
benchmarks, as well as spending on FFS beneficiaries only 
enrolled in both Part A and Part B. MedPAC shall also provide a 
detailed description of their methodology for any spending 
comparison between FFS and MA, including, but not be limited 
to, a description of data sources used, inclusions or 
exclusions of populations or services, and any adjustments made 
to prices, utilization, or payments.

            Medicaid and Chip Payment and Access Commission


                         SALARIES AND EXPENSES

 
 
 
Appropriation, fiscal year 2022.......................        $9,043,000
Budget request, fiscal year 2023......................         9,727,000
Committee Recommendation..............................         9,405,000
    Change from enacted level.........................          +362,000
    Change from budget request........................          -322,000
 

    The Medicaid and CHIP Payment and Access Commission 
(MACPAC) is an independent agency tasked with advising the 
Congress on issues affecting Medicaid and the State Children's 
Health Insurance Program (CHIP). MACPAC conducts policy and 
data analysis on Medicaid and CHIP to support policymakers and 
support program accountability.

                     National Council on Disability


                         SALARIES AND EXPENSES

 
 
 
Appropriation, fiscal year 2022.......................        $3,500,000
Budget request, fiscal year 2022......................         3,850,000
Committee Recommendation..............................         3,850,000
    Change from enacted level.........................          +350,000
    Change from budget request........................             - - -
 

    The National Council Disability (NCD) is an independent 
Federal agency charged with advising the President, Congress, 
and other Federal agencies regarding policies, programs, 
practices, and procedures that affect people with disabilities. 
NCD is comprised of a team of Presidential and Congressional 
appointees, an Executive Director appointed by the Chair, and a 
full-time professional staff.

                     National Labor Relations Board


                         SALARIES AND EXPENSES

 
 
 
Appropriation, fiscal year 2022.......................      $274,224,000
Budget request, fiscal year 2023......................       319,424,000
Committee Recommendation..............................       319,424,000
    Change from enacted level.........................       +45,200,000
    Change from budget request........................             - - -
 

    The National Labor Relations Board (NLRB) is an independent 
agency responsible for enforcing U.S. labor law related to 
collective bargaining and unfair labor practices, including the 
National Labor Relations Act (NLRA) of 1935.
    The Committee includes $319,424,000 for the NLRB, which is 
$45,200,000 above the fiscal year 2022 enacted level and the 
same as the fiscal year 2023 budget request. Within this 
amount, at least $1,000,000 is provided, along with new bill 
language, for the Board to develop and implement an electronic 
voting system.

                        National Mediation Board


                         SALARIES AND EXPENSES

 
 
 
Appropriation, fiscal year 2022.......................       $14,729,000
Budget request, fiscal year 2023......................        15,113,000
Committee Recommendation..............................        15,113,000
    Change from enacted level.........................          +384,000
    Change from budget request........................             - - -
 

    The National Mediation Board (NMB) is an independent agency 
that coordinates labor-management relations within the U.S. 
railroads and airlines industries.
    The Committee includes $15,113,000 for the NMB, which is 
$384,000 above the fiscal year 2022 enacted level and the same 
as the fiscal year 2023 budget request. The Committee urges NMB 
to use this increase to supplement, not supplant, existing 
resources devoted to Section 3 arbitrator salaries and expenses 
and to address the backlog of Section 3 arbitration cases at 
the NMB. The Committee has prioritized these additional funds 
to allow the Board to better accomplish its statutory mission 
in a timelier manner.

            Occupational Safety and Health Review Commission


                         SALARIES AND EXPENSES

 
 
 
Appropriation, fiscal year 2022.......................       $13,622,000
Budget request, fiscal year 2023......................        15,449,000
Committee Recommendation..............................        15,449,000
    Change from enacted level.........................        +1,827,000
    Change from budget request........................             - - -
 

    The Occupational Safety and Health Review Commission is an 
independent Federal agency, providing administrative trial and 
appellate review, created to decide contests of citations or 
penalties resulting from OSHA inspections of American 
workplaces.

                       Railroad Retirement Board


                     DUAL BENEFITS PAYMENTS ACCOUNT

 
 
 
Appropriation, fiscal year 2022.......................       $11,000,000
Budget request, fiscal year 2023......................         9,000,000
Committee Recommendation..............................         9,000,000
    Change from enacted level.........................        -2,000,000
    Change from budget request........................             - - -
 

    This appropriation is authorized by the Railroad Retirement 
Act of 1974 to fund vested dual benefits received by railroad 
retirees who, under prior law, would have become covered by 
both the railroad retirement system and the Social Security 
system because railroad retirement was not fully coordinated 
with Social Security from 1937 to 1974. The Committee includes 
a provision permitting a portion of these funds to be derived 
from income tax receipts on dual benefits as authorized by law. 
The Railroad Retirement Board (``RRB'') estimates that 
approximately $1,000,000 may be derived in this manner.

          FEDERAL PAYMENT TO THE RAILROAD RETIREMENT ACCOUNTS

 
 
 
Appropriation, fiscal year 2022.......................          $150,000
Budget request, fiscal year 2023......................           150,000
Committee Recommendation..............................           150,000
    Change from enacted level.........................             - - -
    Change from budget request........................             - - -
 

                      LIMITATION ON ADMINISTRATION

 
 
 
Appropriation, fiscal year 2022.......................      $124,000,000
Budget request, fiscal year 2023......................       131,666,000
Committee Recommendation..............................       131,666,000
    Change from enacted level.........................        +7,666,000
    Change from budget request........................             - - -
 

    The Committee recommends $131,666,000 for Limitation on 
Administration, an increase of $7,666,000 above the fiscal year 
2022 enacted level and the same as the fiscal year 2023 budget 
request.

             LIMITATION ON THE OFFICE OF INSPECTOR GENERAL

 
 
 
Appropriation, fiscal year 2022.......................       $12,650,000
Budget request, fiscal year 2023......................        13,269,000
Committee Recommendation..............................        13,269,000
    Change from enacted level.........................          +619,000
    Change from budget request........................             - - -
 

                     Social Security Administration


                PAYMENTS TO SOCIAL SECURITY TRUST FUNDS

 
 
 
Appropriation, fiscal year 2022.......................       $11,000,000
Budget request, fiscal year 2023......................        11,000,000
Committee Recommendation..............................        11,000,000
    Change from enacted level.........................             - - -
    Change from budget request........................             - - -
 

    This appropriation provides reimbursement to the Social 
Security trust funds for non-trust fund activities.

                  SUPPLEMENTAL SECURITY INCOME PROGRAM

 
 
 
Appropriation, fiscal year 2022.......................   $45,913,823,000
Budget request, fiscal year 2023......................    48,828,722,000
Committee Recommendation..............................    48,713,576,000
    Change from enacted level.........................    +2,799,753,000
    Change from budget request........................      -115,146,000
 

    The Committee recommends $15,800,000,000 in advance funding 
for the first quarter of fiscal year 2024, as requested.

Research and Demonstration

    Section 1110 of the Social Security Act provides authority 
to the Social Security Administration (SSA) for conducting 
research and demonstration projects related to SSA's programs.
    Within the appropriation for Supplemental Security Income 
(SSI), the Committee recommends $86,000,000 for research and 
demonstration activities, which is equal to the fiscal year 
2022 enacted level and the fiscal year 2023 budget request.

Administration

    Within the appropriation for SSI, the Committee recommends 
$4,878,576,000, which is $346,895,000 above the fiscal year 
2022 enacted level. This funding is for payment to the Social 
Security trust funds for SSI's share of the administrative 
expenses of SSA.

                 LIMITATION ON ADMINISTRATIVE EXPENSES

 
 
 
Appropriation, fiscal year 2022.......................   $11,494,945,000
Budget request, fiscal year 2023......................    12,833,300,000
Committee Recommendation..............................    12,501,945,000
    Change from enacted level.........................    +1,007,000,000
    Change from budget request........................      -331,355,000
 

    The Limitation on Administrative Expenses (LAE) funds the 
administrative and operational costs for administering the Old 
Age and Survivors Insurance, Disability Insurance, and 
Supplemental Security Income programs, and associated costs for 
support to the Centers for Medicare and Medicaid Services in 
administering their programs.
    The Committee recognizes that Social Security is an 
essential component of the nation's economic security, and that 
SSA faces unprecedented challenges as it recovers from years of 
underfunding and a pandemic that severely disrupted its 
operations, closing offices to most in-person visitors and 
generating delays in services and decisions on disability 
claims. The Committee believes that the critical need to 
rebuild the Social Security Administration's ability to serve 
the American people starts with adequately funding fixed cost 
increases. The recommendation includes funding to cover Federal 
employee salaries and benefits, fixed cost increases for State 
DDS partners, facilities, and other contracted expenses that 
will be necessary to fund regardless of investments that can be 
made to improve SSA operations in fiscal year 2023. In 
addition, the Committee includes increased funding necessary to 
help correct long-standing deficiencies, improve operations, 
and better serve the public. Within the total recommended 
increase, the Committee expects SSA to direct not less than 
$630,000,000 for field offices, teleservice centers, and 
program service centers, and $190,000,000 to replace losses and 
build capacity at the State Disability Determination Services 
(DDS) agencies that make disability determinations for SSA.
    In addition, within the recommended funding level, the 
Committee provides $89,500,000 for SSA to mail paper statements 
to all contributors aged 25 and older not yet receiving 
benefits, in accordance with Section 1143 of the Social 
Security Act (42 U.S.C. 1320b-13).
    Administrative Appeals Hearings.--The Committee continues 
to consider the Final Rule ``Hearings Held by Administrative 
Appeals Judges of the Appeals Council'' (85 Fed. Reg. 73138, 
December 16, 2020) to be an unjustified erosion of due process 
for individuals who are appealing a denial of Social Security 
or SSI benefits. As part of a beneficiary's right to an 
impartial appeal process, an on-the-record hearing, conducted 
by an impartial judge with decisional independence, must be 
conducted in accordance with the Administrative Procedure Act 
to ensure due process, without agency interference, or 
political bias. Replacing this appeals step and the role of 
independent administrative law judges (ALJs) with SSA employees 
jeopardizes the independence of the process. In light of the 
harm that would be caused by this policy change, the Committee 
strongly urges SSA not to exercise this authority.
    Authorization of Disability Evidence Collection.--The 
Committee appreciates that SSA is working to increase its 
ability to directly obtain electronic medical records and other 
evidence necessary for disability claims determination. The 
Committee expects that the Commissioner will continue to ensure 
that evidence is only accessed under a voluntary, time-limited, 
and revokable authorization by the claimant to permit medical 
providers and other sources to disclose information directly to 
SSA, consistent with Federal, State, and local laws.
    Disability Backlogs.--The Committee recognizes that the 
pandemic disrupted SSA operations, generating significant new 
delays in initial disability claims and reconsideration 
appeals, and temporarily halting in-person hearings before 
ALJs. The Committee requests SSA submit to the Committee within 
90 days of enactment of this Act a plan for reducing the 
initial and reconsideration claims backlogs, and continue to 
submit to the Committee quarterly reports on disability 
hearings backlogs until SSA has eliminated the hearings backlog 
and achieved its monthly average processing time goal. The 
Committee urges the Commissioner to prioritize the hiring of 
additional staff at the DDS agencies to determine initial 
claims and reconsideration appeals, as well as ALJs and 
requisite staff to adjudicate backlogged hearings claims.
    Disability Determinations.--The Committee remains concerned 
about the time it takes SSA to effectuate favorable SSI and/or 
SSDI disability determinations and requests a briefing on the 
issue withing 30 days of receiving the report on Disability 
Determinations as requested in House Report 117-96.
    Employee Incentives.--The Committee directs SSA to submit a 
report to the Committee within 180 days of enactment of this 
Act exploring the feasibility of using employee incentives, 
including an agency student loan repayment program, to improve 
recruitment and retention for qualified candidates across the 
agency.
    Field Office Closures.--The Committee recognizes the 
essential role that field offices play in the public's ability 
to access SSA benefits and services and strongly encourages the 
Commissioner to take every action possible to maintain 
operations at existing field offices. The Committee urges SSA 
to ensure its policies and procedures for closing field offices 
include at least 120 days advance notice to the public, SSA 
employees, Congress, and other stakeholders. Such notice should 
include a rationale for the proposed closure, and an evaluation 
of the effects on the public and SSA operations.
    Improving Ticket to Work Administration and Reducing 
Overpayments.--The Committee recognizes that overpayments due 
to delays in SSA processing are an issue for beneficiaries who 
are attempting to return to work, including through the Ticket 
to Work program. The Committee recommends SSA work to identify 
the root causes of overpayments and requests a briefing within 
90 days of enactment of this Act on agency efforts to improve 
administrative processes to reduce overpayments.
    Information Technology.--The Committee is concerned that 
SSA's antiquated Information Technology (IT) service management 
system is adversely impacting agency staff's ability to deliver 
the value, service, and efficiency that the public expects and 
deserves. The Committee recognizes that SSA began modernizing 
its IT Service Management tools in fiscal year 2021, and 
expects SSA to continue working on IT solutions to improve 
customer service, ensure high availability and service 
continuity, optimize operational efficiency, and maximize 
enterprise productivity.
    The Committee continues to monitor the IT Modernization 
Plan and encourages SSA to focus on improvements to customer 
service and efficiency as it makes updates to the plan. In 
addition, SSA should take steps to automate manual processes 
performed by staff, to reduce human error and improve 
processing time. The Committee continues to request an update 
of the plan referenced under this heading in House Report 114-
699.
    Legal Assistants.--The Committee understands that the 
Office of Hearings Operations (OHO) relies on legal assistants 
to conduct a broad range of work supporting hearings and 
reviewing work of its administrative law judges, and urges SSA 
to examine the position descriptions of legal assistants, pay 
and actual work conducted, to ensure that job classifications 
and compensation are commensurate with current duties.
    Pilot Program Metrics.--The Committee expects SSA to 
continue to follow the guidance and directives under this 
heading in House Report 116-450 for fiscal year 2023, and to 
include descriptions of pilots and associated pilot program 
metrics in its fiscal year 2024 Congressional Budget 
Justification.
    Professional Representatives.--The Committee believes that 
quality representation in matters with SSA assists claimants 
and beneficiaries, and can also help SSA work more accurately 
and efficiently. The Committee appreciates that the 
Commissioner is raising the cap on fees payable via fee 
agreement, and encourages the Commissioner to index the cap to 
account for inflation in future years.
    Program Integrity.--The Committee notes that the FY 2023 
President's Budget again proposes language for this account to 
expressly prohibit program integrity funding from being 
reprogrammed or transferred for non-program integrity 
activities.
    With respect to the reprogramming restriction portion of 
the proposal, the Committee does not accept this proposal again 
because the Congress need not expressly prohibit actions that 
it has not authorized. Under the statutory terms of the 
appropriation, amounts provided for program integrity 
activities may not be reprogrammed to base activities (or to 
any other non-program integrity activity). That is because this 
appropriation account statutorily establishes a required 
appropriation amount for program integrity activities--in this 
bill, at $1,799,000,000--which is provided by the sum of the 
amounts specified in the first and second provisos of the 
account's second paragraph. The bill also continues to 
emphasize that ``no more than'' that required sum for program 
integrity activities may be used for program integrity 
purposes. The Committee reminds SSA that this emphasis has been 
included since FY 2017 in response to SSA's view that other 
funds in the account, in addition to the sum statutorily 
required for program integrity activities, were otherwise 
available for program integrity activities. The Committee 
continues to agree with the explanatory statement accompanying 
the Consolidated Appropriations Act, 2017 that this emphasis 
``is for SSA to support program integrity activities solely 
from funds available for that purpose.''
    Finally, with respect to the transfer prohibition portion 
of the proposal, the Committee has not been apprised of any 
applicable transfer authority available to SSA that the 
President's Budget proposal seeks to prevent and therefore does 
not accept the proposal again.
    Report on LAE Expenditures.--The Committee continues to 
request that the data referenced under this heading in House 
Report 114-699 be included in future budget justifications. In 
addition, the Committee requests the fiscal year 2024 
Congressional Budget Justification include a historical table 
of costs and fiscal year 2024 requests for personnel and 
benefits, by major SSA component to include Operations (field 
offices, teleservice centers, processing centers, and regional 
offices); Office of Hearings Operations; Systems; Office of 
Analytics, Review, and Oversight; and Headquarters.
    Service to the Public.--SSA uses Public Service Indicators 
to measure the agency's progress in meeting the needs of the 
public in local field offices and teleservice centers. The 
Committee directs SSA to submit to the Committee within 90 days 
of enactment of this Act an updated report on Public Service 
Indicators for field offices and teleservice centers, providing 
the indicators and performance for Fiscal Years 2016 to 2022. 
Such report shall also detail any staffing needs and resources 
necessary in its field offices and teleservice centers to 
restore previous levels of public service.
    Telework.--The Committee reiterates its support for well-
managed telework programs in the Federal workplace and 
understands that SSA is in the process of evaluating how 
telework affects service delivery during the reentry evaluation 
period of March 30 through September 30, 2022. Within 90 days 
of enactment of this Act, the Committee requests a briefing on 
how the results of that evaluation will be used to measure and 
monitor the impact of telework on customer satisfaction, 
service availability including continuity of operations, 
workloads management, employee experience, stewardship, and 
environmental considerations. In addition, the Committee 
directs SSA to submit an update of the report that was 
requested under this heading in House Report 117-96, with 
updated data on the number of employees eligible and ineligible 
to telework, and any limitations or restrictions on the 
frequency of telework as a result of the evaluation.
    Video Hearings.--The Committee appreciates that SSA has 
resumed in-person hearings, and reiterates its support for SSA 
allowing a claimant to choose to use video and telephone 
hearings on a voluntary basis or to have an in-person hearing 
or proceeding if the party chooses to do so.
    Work Incentives Planning and Assistance (WIPA) and 
Protection and Advocacy for Beneficiaries of Social Security 
(PABSS).--The recommendation includes $23,000,000 for WIPA 
grants and $10,000,000 for PABSS.

Social Security Advisory Board

    The Committee recommends $2,700,000 for the Social Security 
Advisory Board (SSAB), $100,000 above the fiscal year 2022 
enacted level and $50,000 below the fiscal year 2023 budget 
request.

User Fees

    In addition to the other amounts provided, the Committee 
recommends $140,000,000 for administrative activities funded 
from user fees. Of this amount, $139,000,000 is derived from 
fees collected from States that request SSA to administer State 
SSI supplementary payments. The remaining $1,000,000 is derived 
from fees charged to non-attorneys who apply for certification 
to represent claimants under titles II and XVI of the Social 
Security Act.

Continuing Disability Reviews and Redeterminations

    The Committee recommends $1,799,000,000 for program 
integrity activities. This includes the maximum cap adjustment 
authorized in the terms of section 1(i) of H. Res. 1151 of the 
117th Congress as engrossed in the House of Representatives on 
June 8, 2022. The bill includes language allowing for the 
transfer of up to $15,100,000 to the Office of the Inspector 
General for the cost of jointly operating co-operative 
disability investigation units.

                    OFFICE OF THE INSPECTOR GENERAL

 
 
 
Appropriation, fiscal year 2022.......................      $108,665,000
Budget request, fiscal year 2023......................       117,500,000
Committee Recommendation..............................       117,500,000
    Change from enacted level.........................        +8,835,000
    Change from budget request........................             - - -
 

    The Office of the Inspector General (OIG) is responsible 
for meeting the statutory mission of promoting economy, 
efficiency, and effectiveness in the administration of SSA 
programs and operations and to prevent and detect fraud, waste, 
abuse, and mismanagement in such programs and operations. To 
accomplish this mission, the OIG directs, conducts, and 
supervises audits, evaluations, and investigations relating to 
SSA's programs and operations. In addition, the OIG searches 
for and reports on systemic weaknesses in SSA programs and 
operations, and makes recommendations for needed improvements 
and corrective actions.
    The bill includes $2,000,000, as requested, for information 
technology modernization.

                      TITLE V--GENERAL PROVISIONS


                          (TRANSFER OF FUNDS)

    Sec. 501. The Committee continues a provision allowing the 
Secretaries of Labor, Health and Human Services, and Education 
to transfer unexpended balances of prior appropriations to 
accounts corresponding to current appropriations to be used for 
the same purposes and for the same periods of time for which 
they were originally appropriated.
    Sec. 502. The Committee continues a provision prohibiting 
the obligation of funds beyond the current fiscal year unless 
expressly so provided.
    Sec. 503. The Committee continues a provision prohibiting 
funds from being used to support or defeat legislation.
    Sec. 504. The Committee continues a provision limiting the 
amount available for official reception and representation 
expenses for the Secretaries of Labor and Education, the 
Director of the Federal Mediation and Conciliation Service, and 
the Chairman of the National Mediation Board.
    Sec. 505. The Committee continues a provision requiring 
grantees receiving Federal funds to clearly state the 
percentage of the total cost of the program or project that 
will be financed with Federal money.
    Sec. 506. The Committee continues a provision prohibiting 
use of funds for certain research involving human embryos.
    Sec. 507. The Committee continues a provision prohibiting 
use of funds for any activity that promotes the legalization of 
any drug or substance included in schedule I of the schedules 
of controlled substances.
    Sec. 508. The Committee continues a provision related to 
annual reports to the Secretary of Labor.
    Sec. 509. The Committee continues a provision prohibiting 
transfer of funds made available in this Act except by 
authority provided in this Act or another appropriations Act.
    Sec. 510. The Committee continues a provision to limit 
funds in the bill for public libraries to those that comply 
with the requirements of the Children's Internet Protection 
Act.
    Sec. 511. The Committee continues a provision regarding 
procedures for reprogramming of funds.
    Sec. 512. The Committee continues a provision pertaining to 
appointments to scientific advisory committees.
    Sec. 513. The Committee continues a provision requiring 
each department and related agency funded through this Act to 
submit an operating plan within 45 days of enactment, detailing 
any funding allocations that are different than those specified 
in this Act, the accompanying detailed table, or budget 
request.
    Sec. 514. The Committee continues a provision requiring the 
Secretaries of Labor, Health and Human Services, and Education 
to submit a quarterly report to the Committees on 
Appropriations containing certain information on noncompetitive 
contracts, grants, and cooperative agreements exceeding 
$500,000 in value.
    Sec. 515. The Committee continues a provision prohibiting 
the use of funds to process claims for credit for quarters of 
coverage based on work performed under a Social Security number 
that was not the claimant's number, where the performance of 
such work under such number has formed the basis for a 
conviction of the claimant of a violation of section 208(a)(6) 
or (7) of the Social Security Act.
    Sec. 516. The Committee continues a provision prohibiting 
the use of funds to implement a Social Security totalization 
agreement with Mexico.
    Sec. 517. The Committee continues a provision prohibiting 
the use of funds for the downloading or exchanging of 
pornography.
    Sec. 518. The Committee continues a provision related to 
reporting requirements for conference expenditures.
    Sec. 519. The Committee continues a provision related to 
disclosure of U.S. taxpayer funding for programs used in 
advertising.
    Sec. 520. The Committee continues a provision related to 
performance partnership pilots.
    Sec. 521. The Committee continues provision requesting 
quarterly reports on the status of balances of appropriations 
from the Departments of Labor, Health and Human Services and 
Education.
    Sec. 522. The Committee continues a provision related to 
grant notifications.
    Sec. 523. The Committee continues a provision related to 
questions for the record.
    Sec. 524. The Committee modifies a provision to make funds 
from the Children's Health Insurance Program Performance Bonus 
Fund unavailable for obligation in fiscal year 2023.
    Sec. 525. The Committee continues a provision related to 
research and evaluation funding flexibility.

                     LABOR, HHS, EDUCATION INCORPORATION OF COMMUNITY PROJECT FUNDING ITEMS
----------------------------------------------------------------------------------------------------------------
             Agency                           Account                          Project              House Amount
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Agape Child & Family Services,     $1,000,000
                                   Administration.                  Memphis, TN for job training,
                                                                    career placement, and
                                                                    supportive services.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Apprentice Training for the         1,994,875
                                   Administration.                  Electrical Industry,
                                                                    Collegeville, PA for green job
                                                                    workforce development and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Apprenticeship and                    675,000
                                   Administration.                  Nontraditional Employment for
                                                                    Women, Renton, WA to expand
                                                                    construction pre-
                                                                    apprenticeship programming and
                                                                    CDL training.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Artpreneurs, Inc. dba Arts on         100,000
                                   Administration.                  the Block, Silver Spring, MD
                                                                    for a creative workforce
                                                                    apprenticeship program.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Association House of Chicago,         500,000
                                   Administration.                  Chicago, IL for workforce
                                                                    development training programs.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Augusta University, Augusta, GA     2,000,000
                                   Administration.                  for workforce training and job
                                                                    placement in the healthcare
                                                                    industry.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Baltimore Alliance for Careers        827,905
                                   Administration.                  in Healthcare, Baltimore, MD
                                                                    for healthcare workforce
                                                                    development.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Baycare Health Systems Inc,           963,620
                                   Administration.                  Clearwater, FL for a workforce
                                                                    development program focused on
                                                                    nurses and nursing support
                                                                    professionals.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Bidwell Training Center,              400,000
                                   Administration.                  Pittsburgh, PA for the
                                                                    development of a controlled
                                                                    environment agriculture
                                                                    workforce.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Black Veterans for Social           1,000,000
                                   Administration.                  Justice, Inc., Brooklyn, NY
                                                                    for stipends, supportive
                                                                    services, and job placement
                                                                    for formerly incarcerated
                                                                    veterans.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Boys & Girls Club of Greater        2,200,000
                                   Administration.                  Lowell, Inc., Lowell, MA for
                                                                    workforce development
                                                                    activities.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Boys & Girls Club San Fernando        500,000
                                   Administration.                  Valley, Pacoima, CA for a
                                                                    youth workforce development
                                                                    initiative and supportive
                                                                    services.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Bright Star Community Outreach,       175,000
                                   Administration.                  Chicago, IL for workforce
                                                                    development activities.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Bronx Community College of the        150,000
                                   Administration.                  City University of New York,
                                                                    Bronx, NY for health care job
                                                                    training.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Building and Construction           1,000,000
                                   Administration.                  Trades Council of Alameda
                                                                    County, Oakland, CA for the
                                                                    Retention Apprenticeship
                                                                    Mentoring Program.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          CAMBA, Inc., Brooklyn, NY for         590,000
                                   Administration.                  career navigation, job
                                                                    placement services, and
                                                                    supportive services for youth.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          CASA, Baltimore, MD for job           573,045
                                   Administration.                  skills training, job placement
                                                                    services, stipends, and
                                                                    supportive services.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Center for the Women of New         1,000,000
                                   Administration.                  York, Kew Gardens, NY for
                                                                    career skills and job
                                                                    counseling.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Center for Urban Families,            750,000
                                   Administration.                  Baltimore, MD for job
                                                                    readiness programs and job
                                                                    placement.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Chemeketa Community College,          340,000
                                   Administration.                  Salem, OR for a commercial
                                                                    truck driving program and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          City of Dearborn, MI for a          1,000,000
                                   Administration.                  training program for women who
                                                                    have been underrepresented in
                                                                    the workforce.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          City of Houston, TX for job         1,000,000
                                   Administration.                  training in the home recovery
                                                                    and construction industries.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          City of Jersey City, NJ for an        750,000
                                   Administration.                  apprenticeship program.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          City of Los Angeles Youth             640,108
                                   Administration.                  Development Department, Los
                                                                    Angeles, CA for workforce
                                                                    development activities and
                                                                    stipends.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          City of Stockton, CA for the        1,000,000
                                   Administration.                  Youth Workforce Development
                                                                    Program.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Colorado Building and                 500,000
                                   Administration.                  Construction Trades Council,
                                                                    Denver, CO for workforce
                                                                    training and supportive
                                                                    services.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Community College of Baltimore        721,130
                                   Administration.                  County, Baltimore, MD to
                                                                    expand their CDL training
                                                                    program and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Community Learning Partnership,       351,000
                                   Administration.                  Cupertino, CA for job skills
                                                                    training and stipends.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Consortium for Early Learning       1,000,000
                                   Administration.                  Services, Moreno Valley, CA
                                                                    for early care and education
                                                                    workforce development.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Construction Trade Workforce        1,000,000
                                   Administration.                  Initiative, Oakland, CA for an
                                                                    apprenticeship program and
                                                                    curriculum.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Construction Trades Workforce       1,000,000
                                   Administration.                  Initiative, Fremont, CA for
                                                                    construction trades
                                                                    apprenticeship programs and
                                                                    curriculum.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Construction Trades Workforce       1,000,000
                                   Administration.                  Initiative, Oakland, CA for a
                                                                    construction apprenticeship
                                                                    program.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Construction Trades Workforce       1,000,000
                                   Administration.                  Initiative, Oakland, CA for an
                                                                    apprenticeship readiness
                                                                    program focused on
                                                                    construction trades.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Construction Trades Workforce       1,000,000
                                   Administration.                  Initiative, Oakland, CA for
                                                                    apprenticeship readiness
                                                                    programs.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Corporation to Develop              1,862,625
                                   Administration.                  Communities of Tampa, Inc.,
                                                                    Tampa, FL for a pre-
                                                                    apprenticeship program,
                                                                    apprenticeship program, and
                                                                    job training services.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          County of Delaware, Media, PA       1,988,635
                                   Administration.                  for the Prison-to-Community
                                                                    Workforce Development
                                                                    Initiative.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          County of Los Angeles               2,000,000
                                   Administration.                  Alternatives to Incarceration
                                                                    Office (CEO), Los Angeles, CA
                                                                    for a youth job training
                                                                    program and supportive
                                                                    services.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Covenant House Washington,            329,750
                                   Administration.                  Washington, DC for workforce
                                                                    development activities.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Cuyahoga Community College          1,220,000
                                   Administration.                  District, Cleveland, OH for
                                                                    smart manufacturing workforce
                                                                    training, equipment, and
                                                                    supportive services.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Dallas College, Dallas, TX for        500,000
                                   Administration.                  a teaching residency
                                                                    apprenticeship program.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Delta Veterans Group, Antioch,        100,000
                                   Administration.                  CA for job readiness
                                                                    activities supporting veterans.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Des Moines Area Community             339,000
                                   Administration.                  College, Ankeny, IA for a
                                                                    workforce development
                                                                    initiative and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Downriver Community Conference,       703,700
                                   Administration.                  Southgate, MI for skills
                                                                    training, job placement, and
                                                                    supportive services.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Easter Seals North Georgia,           200,000
                                   Administration.                  Inc., Clarkston, GA for early
                                                                    childhood workforce
                                                                    development.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Economic Development and            1,000,000
                                   Administration.                  Industrial Corporation of
                                                                    Boston, Boston, MA for
                                                                    workforce development programs
                                                                    and supportive services.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Energy Coordinating Agency of         925,000
                                   Administration.                  Philadelphia, Inc.,
                                                                    Philadelphia, PA for skill
                                                                    training in high demand
                                                                    occupations.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          EntreNous Youth Empowerment           575,000
                                   Administration.                  Services, Compton, CA for
                                                                    vocational training and
                                                                    services.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Fairfax County Government,          2,000,000
                                   Administration.                  Fairfax, VA for medical
                                                                    professional workforce
                                                                    development.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Fairfax County, Fairfax, VA for     2,100,000
                                   Administration.                  career readiness and job
                                                                    training for youth.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Fresno County Economic                500,000
                                   Administration.                  Opportunities Commission,
                                                                    Fresno, CA for vocational
                                                                    training and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Future Plans Inc., Chagrin          1,000,000
                                   Administration.                  Falls, OH for the Great Lakes
                                                                    Career Corridor Project.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Future Plans, Inc., Chagrin         1,995,000
                                   Administration.                  Falls, OH for a career
                                                                    planning and community
                                                                    engagement initiative,
                                                                    including the purchase of
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Golden Triangle Resource            1,000,000
                                   Administration.                  Conservation and Development
                                                                    Council, Dawson, GA for heavy
                                                                    equipment training, including
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Green City Force, Brooklyn, NY        750,000
                                   Administration.                  to expand their workforce
                                                                    development program and
                                                                    stipends.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Guilford Child Development,           300,000
                                   Administration.                  Greensboro, NC for a child
                                                                    development associate
                                                                    apprenticeship program.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Hampton Roads Workforce               850,000
                                   Administration.                  Council, Norfolk, VA for
                                                                    maritime workforce development
                                                                    activities.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Hartford Communities That Care,     1,322,539
                                   Administration.                  Hartford, CT for a job
                                                                    training program to address
                                                                    the need for violence
                                                                    prevention professionals.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Hatzalah Chicago, Lincolnwood,        525,000
                                   Administration.                  IL for workforce training
                                                                    activities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Homeboy Industries, Los             1,959,451
                                   Administration.                  Angeles, CA for job training
                                                                    for culinary and hospitality
                                                                    careers and supportive
                                                                    services.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Howard County Autism Society,         440,000
                                   Administration.                  Columbia, MD for the Autism
                                                                    Hiring Program.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Jewish Community Centers of         1,504,329
                                   Administration.                  South Broward, Inc., Davie, FL
                                                                    for employment training for
                                                                    individuals with IDD.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Jewish Family Service of              550,000
                                   Administration.                  Atlantic County, Inc.,
                                                                    Margate, NJ for job skills
                                                                    program.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Jobs for America's Graduates of       350,000
                                   Administration.                  Pennslyvania, Inc.,
                                                                    Philadelphia, PA to expand
                                                                    career readiness programs and
                                                                    skill training.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Kean University, Union, NJ for      1,000,000
                                   Administration.                  workforce development
                                                                    activities and supportive
                                                                    services.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          LaGuardia Community College,          404,774
                                   Administration.                  Long Island City, NY to expand
                                                                    vocational training for the
                                                                    underemployed.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Latin American Association,           300,000
                                   Administration.                  Inc, Atlanta, GA for
                                                                    employment training, support
                                                                    services, and a workforce
                                                                    development initiative.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Latina Coalition of Silicon           376,000
                                   Administration.                  Vally, San Jose, CA for
                                                                    workforce development programs
                                                                    and supportive services.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Laurel Highlands Workforce and        445,000
                                   Administration.                  Opportunity Center,
                                                                    Greensburg, PA for a workforce
                                                                    support program, including
                                                                    supplies and wraparound
                                                                    services.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Los Angeles Brotherhood             1,000,000
                                   Administration.                  Crusade--Black United Fund
                                                                    Inc., CA for youth workforce
                                                                    development and job placement.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Los Angeles Conservation Corps,       272,000
                                   Administration.                  Los Angeles, CA, for job
                                                                    training and stipends.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Los Angeles World Airports, Los     1,000,000
                                   Administration.                  Angeles, CA for an aviation
                                                                    workforce development program.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Mahoning County Career and            285,000
                                   Administration.                  Technical Center, Canfield, OH
                                                                    for an energy and technology
                                                                    workforce training center
                                                                    project, including the
                                                                    purchase of equipment.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Maricopa County Community           1,000,000
                                   Administration.                  College District, Tempe, AZ
                                                                    for workforce development
                                                                    activities and curriculum.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          McAllen Independent School            200,000
                                   Administration.                  District, McAllen, TX for
                                                                    private pilot and remote drone
                                                                    license training.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Mercy Hospital dba Northern         1,000,000
                                   Administration.                  Light Mercy Hospital,
                                                                    Portland, ME for workforce
                                                                    training and supportive
                                                                    services.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Michigan Early Childhood            2,000,000
                                   Administration.                  Investment Corporation,
                                                                    Lansing, MI for the
                                                                    development of a child care
                                                                    workforce.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          MorseLife Health System, West         500,000
                                   Administration.                  Palm Beach, FL for job
                                                                    training of underserved
                                                                    populations and supportive
                                                                    services.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          New Immigrant Community               500,000
                                   Administration.                  Empowerment, Jackson Heights,
                                                                    NY to expand a construction
                                                                    industry workforce development
                                                                    program.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          New Mexico Highlands                  750,000
                                   Administration.                  University, Las Vegas, NM for
                                                                    the development of
                                                                    professional social workers.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          New York State Energy Research      3,000,000
                                   Administration.                  and Development Authority,
                                                                    Albany, NY for clean energy
                                                                    workforce development and
                                                                    supportive services.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Northeast Community College,        1,000,000
                                   Administration.                  Norfolk, NE for a commercial
                                                                    driver's license program,
                                                                    including the purchase of
                                                                    equipment and stipends.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Northwest Arkansas Community          355,000
                                   Administration.                  College, Bentonville, AR for a
                                                                    commercial driver's license
                                                                    program, including the
                                                                    purchase of equipment.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Northwest New Mexico Council of       750,000
                                   Administration.                  Governments, Gallup, NM to
                                                                    transition and re-skill
                                                                    workers into the industrial
                                                                    industry.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          OCHIN, Inc., Portland, OR for       2,001,642
                                   Administration.                  health information technology
                                                                    training and professional
                                                                    development.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Opportunity Junction, Antioch,        470,000
                                   Administration.                  CA for a job training program
                                                                    and supportive services.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Pasadena Independent School         2,200,000
                                   Administration.                  District, Pasadena, TX for job
                                                                    skill training and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Pee Dee Healthy Start Inc.,         1,000,000
                                   Administration.                  Florence, SC for workforce
                                                                    training and supportive
                                                                    services.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Plattsburgh-North County              500,000
                                   Administration.                  Chamber of Commerce,
                                                                    Plattsburgh, NY for a job
                                                                    training and assistance
                                                                    program, including support
                                                                    services and stipends.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Portland Community College,           910,000
                                   Administration.                  Portland, OR for semiconductor
                                                                    and advanced manufacturing
                                                                    workforce development
                                                                    initiative.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Primary Care Coalition of           1,300,000
                                   Administration.                  Montgomery County, Inc.,
                                                                    Silver Spring, MD for health
                                                                    care professionals' workforce
                                                                    development and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Prince George's County Memorial     2,200,000
                                   Administration.                  Library System, Largo, MD for
                                                                    a mobile job readiness unit.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Prince George's County, Largo,      3,000,000
                                   Administration.                  MD for the Youth@Work program.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Promise Neighborhoods of Lehigh     1,549,360
                                   Administration.                  Valley, Allentown, PA to
                                                                    expand their workforce
                                                                    development skills program.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Reading and Beyond, Fresno, CA        484,047
                                   Administration.                  for employment and training
                                                                    services and supportive
                                                                    services.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Rockdale County Georgia,              300,000
                                   Administration.                  Conyers, GA for a workforce
                                                                    development initiative.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          San Bernadino Valley College        1,500,000
                                   Administration.                  Foundation, San Bernadino, CA
                                                                    for clean energy workforce
                                                                    development and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          San Diego Community College         1,000,000
                                   Administration.                  District, San Diego, CA for
                                                                    the Gateway to College and
                                                                    Career program.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          San Diego Workforce                   800,000
                                   Administration.                  Partnership, San Diego, CA for
                                                                    the TechHire Program..
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          San Gabriel Valley Council of       2,000,000
                                   Administration.                  Governments, Alhambra, CA for
                                                                    a workforce development
                                                                    program.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Santa Clara County, San Jose,       3,000,000
                                   Administration.                  CA for workforce development,
                                                                    stipends, and supportive
                                                                    services.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Seattle Jobs Initiative,            1,000,000
                                   Administration.                  Seattle, WA for green
                                                                    stormwater infrastructure
                                                                    workforce development,
                                                                    stipends, and supportive
                                                                    services.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Service! Relief Effort for            475,000
                                   Administration.                  Hospitality Workers, Columbus,
                                                                    OH for job skills training and
                                                                    supportive services.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Society for the Advancement of        212,000
                                   Administration.                  Chicanos/Hispanics and Native
                                                                    Americans in Science, San
                                                                    Jose, CA to create a pipeline
                                                                    from community colleges into
                                                                    the STEM workforce.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          South Bay Workforce Investment        500,000
                                   Administration.                  Board Inc., Hawthorne, CA for
                                                                    occupation training and
                                                                    supportive services.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          South Texas College, McAllen,       1,000,000
                                   Administration.                  TX for healthcare workforce
                                                                    development.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          St. Clair County                      950,000
                                   Administration.                  Intergovernmental Grants
                                                                    Department, Belleville, IL for
                                                                    an advanced manufacturing
                                                                    program, including support
                                                                    services.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          St. Joseph Center, Venice, CA         898,053
                                   Administration.                  for job skills training and
                                                                    supportive services to those
                                                                    experiencing homelessness.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Stanislaus Business Alliance          410,000
                                   Administration.                  dba Opportunity Stanislaus,
                                                                    Modesto, CA for a logistics
                                                                    industry focused training
                                                                    program.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          State of Maine, Governor's          2,750,000
                                   Administration.                  Energy Office, Augusta, ME for
                                                                    job training, job placement
                                                                    services, stipends, equipment,
                                                                    and curriculum.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Suburban Emergency Medical            247,949
                                   Administration.                  Services, Palmer, PA for
                                                                    healthcare workforce
                                                                    development.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Suffolk County Community            1,435,000
                                   Administration.                  College, Selden, NY for a
                                                                    cybersecurity program,
                                                                    including the purchase of
                                                                    equipment and related
                                                                    information technology.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Taller San Jose Hope Builders,        500,000
                                   Administration.                  Santa Ana, CA for skills
                                                                    training and employment
                                                                    placement services for low-
                                                                    income young adults facing
                                                                    significant barriers.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Texas Trees Foundation, Dallas,       400,000
                                   Administration.                  TX for supportive services and
                                                                    job placement of at-risk young
                                                                    adults into the green jobs
                                                                    industry.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          The Indianapolis Private            1,000,000
                                   Administration.                  Industry Council, Inc.,
                                                                    Indianapolis, IN for youth job
                                                                    training and a work-based
                                                                    learning program.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          The Sanneh Foundation, Saint        1,000,000
                                   Administration.                  Paul, MN for a youth workforce
                                                                    development program.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          The Torres-Martinez Desert            250,000
                                   Administration.                  Cahuilla Indian Tribe,
                                                                    Thermal, CA for a workforce
                                                                    development program and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          The TransLatin@ Coalition, Los        750,000
                                   Administration.                  Angeles, CA for workforce
                                                                    development programs and
                                                                    supportive services.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          The WorkPlace, Inc.,                1,000,000
                                   Administration.                  Bridgeport, CT for skills
                                                                    training, workforce readiness,
                                                                    and supportive services.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          UAW Labor Employment and            1,000,000
                                   Administration.                  Training Corporation, St.
                                                                    Louis, MO for job training in
                                                                    the automotive services
                                                                    industry.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          United Way of Greater               1,000,000
                                   Administration.                  Greensboro, Inc., Greensboro,
                                                                    NC for job counseling, career
                                                                    training, and supportive
                                                                    services.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          United We Heal Training Trust         892,000
                                   Administration.                  dba Oregon AFSCME Training
                                                                    Trust, Portland, OR for pre-
                                                                    apprenticeship education and
                                                                    training.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          United We Heal, Portland, OR          892,000
                                   Administration.                  for pre-apprenticeship and
                                                                    apprenticeship programs.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          University of California, San       1,600,000
                                   Administration.                  Diego, La Jolla, CA for job
                                                                    skills development and
                                                                    supportive services for a
                                                                    child care worker and
                                                                    providers pipeline.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          University of Georgia, Athens,      3,000,000
                                   Administration.                  GA for the Archway Partnership.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Unloop, Seattle, WA for job           486,781
                                   Administration.                  training in the tech industry
                                                                    and supportive services for
                                                                    those with conviction
                                                                    histories.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Urban League of Long Island,        1,145,820
                                   Administration.                  Inc, Plainview, NY for
                                                                    workforce development
                                                                    activities.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Urban League of Louisiana, New      1,200,000
                                   Administration.                  Orleans, LA for the Career
                                                                    Pathways Program.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          US HART CARES A NJ NONPROFIT        1,000,000
                                   Administration.                  CORPORATION, Atlantic City, NJ
                                                                    for cyber job training
                                                                    program, including the
                                                                    purchase of equipment.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Valley of the Sun Young Men's       1,000,000
                                   Administration.                  Christian Association,
                                                                    Phoenix, AZ for expanding a
                                                                    current youth workforce
                                                                    development program.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Variety Boys and Girls Club of        250,000
                                   Administration.                  Queens, Inc., Long Island
                                                                    City, NY for job readiness and
                                                                    supportive services for teens.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Virginia Commonwealth               1,000,000
                                   Administration.                  University Health System
                                                                    Authority, Richmond, VA for
                                                                    healthcare workforce
                                                                    development.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Watts Labor Community Action          783,067
                                   Administration.                  Committee, Los Angeles, CA for
                                                                    job training, workforce
                                                                    development activities, and
                                                                    job placement services.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Wayne Community College,              651,000
                                   Administration.                  Goldsboro, NC to expand its
                                                                    apprenticeship training
                                                                    programs.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Workforce Connections, Las            800,000
                                   Administration.                  Vegas, NV for workforce
                                                                    development programs.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Workforce Inc. dba                  1,000,203
                                   Administration.                  Recycleforce, Indianapolis, IN
                                                                    to expand job training and job
                                                                    placement programs.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Young Men's and Young Women's       1,000,000
                                   Administration.                  Hebrew Association of
                                                                    Washington Heights and Inwood,
                                                                    New York, NY for vocational
                                                                    training, workforce
                                                                    development, and supportive
                                                                    services.
----------------------------------------------------------------------------------------------------------------
Department of Labor               Employment and Training          Young Women's Christian               690,449
                                   Administration.                  Association of Yonkers, Inc.,
                                                                    Yonkers, NY for a workforce
                                                                    development initiative and
                                                                    support services.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  100 Suits for 100 Men,                750,000
 Services                          Families.                        Laurelton, NY for a youth
                                                                    employment training program,
                                                                    including for the purchase of
                                                                    food and equipment, to serve
                                                                    vulnerable families and
                                                                    seniors and improve economic
                                                                    outcomes.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  A New Way of Life Reentry           1,000,000
 Services                          Families.                        Project, Los Angeles, CA for
                                                                    housing, legal clinics,
                                                                    educational opportunities and
                                                                    supportive services to improve
                                                                    outcomes and economic
                                                                    opportunities.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  Action for a Better Community,        517,000
 Services                          Families.                        Inc., Rochester, NY for
                                                                    employment advancement,
                                                                    benefit and eligibility
                                                                    mapping, and other services to
                                                                    help individuals and families
                                                                    move towards financial
                                                                    sustainability.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  Adoptions Together, Calverton,        750,639
 Services                          Families.                        MD for trauma-informed care
                                                                    training.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  Alfond Youth and Community            500,000
 Services                          Families.                        Center, Waterville, ME for
                                                                    targeted support services to
                                                                    children and families in need.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  All Star Children's Foundation,     1,500,000
 Services                          Families.                        Sarasota, FL for a foster care
                                                                    program, including behavioral
                                                                    health services.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  Big Brothers Big Sisters Lone         300,000
 Services                          Families.                        Star, Irving, TX for a youth
                                                                    mentoring program.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  Bivona Child Advocacy Center,         306,000
 Services                          Families.                        Rochester, NY for child abuse
                                                                    prevention training and
                                                                    programs.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  Boys & Girls Clubs of America,      2,000,000
 Services                          Families.                        Atlanta, GA for increasing
                                                                    support services and abuse
                                                                    prevention resources to
                                                                    recognize and reduce abuse.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  Bucks County Opportunity            1,000,000
 Services                          Families.                        Council, Doylestown, PA for a
                                                                    self-sufficiency program,
                                                                    including supportive services.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  Center for Pan Asian Community        300,000
 Services                          Families.                        Services, Inc., Atlanta, GA
                                                                    for survivor-centered, trauma-
                                                                    informed services for women
                                                                    and families to work towards
                                                                    self-reliance.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  Childhelp Inc., Scottsdale, AZ      1,000,000
 Services                          Families.                        for outreach, education
                                                                    materials and programming to
                                                                    reduce and prevent child abuse.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  Children's Home of Stockton,          973,552
 Services                          Families.                        Stockton, CA for supportive
                                                                    housing, services, supplies,
                                                                    transportation expenses, and
                                                                    goods, including the purchase
                                                                    of food, to help establish
                                                                    self-sufficiency.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  Christus Santa Rosa Health Care       472,699
 Services                          Families.                        Corporation, San Antonio, TX
                                                                    for training and education to
                                                                    reduce and prevent child abuse.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  Circle of Brotherhood, Miami,       2,000,000
 Services                          Families.                        FL for a social services hub
                                                                    focused on assistance to low
                                                                    income families to improve
                                                                    life and economic outcomes.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  City of Boston, MA for housing,     1,000,000
 Services                          Families.                        educational and support
                                                                    services for children and
                                                                    families, and to provide
                                                                    parents with opportunities to
                                                                    reduce poverty.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  City of Jersey City, NJ for           500,000
 Services                          Families.                        expanding domestic violence
                                                                    intervention services.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  City of Leander, TX for a child       500,000
 Services                          Families.                        abuse prevention and treatment
                                                                    program, including the
                                                                    purchase of information
                                                                    technology and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  City of Los Angeles, CA for           982,045
 Services                          Families.                        operating costs and community
                                                                    services, including motel
                                                                    vouchers and the purchase of
                                                                    food, to reduce poverty.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  City of Mount Vernon, NY for          999,000
 Services                          Families.                        services to support at-risk
                                                                    girls and to improve
                                                                    employment opportunities and
                                                                    economic outcomes.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  City of Richmond, VA for social       797,329
 Services                          Families.                        services and a one-stop shop
                                                                    to help families and
                                                                    individuals working to
                                                                    establish financial self-
                                                                    sufficiency and for social
                                                                    service providers working to
                                                                    reduce poverty.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  City of Rochester, NY for youth       500,000
 Services                          Families.                        employment services and young
                                                                    adult workforce development to
                                                                    increase self-sufficiency.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  Columbus Metropolitan Housing       1,000,000
 Services                          Families.                        Authority, Columbus, OH for
                                                                    informational and financial
                                                                    resources to assist residents
                                                                    and achieve economic self-
                                                                    sufficiency.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  Community Action Network, Ann         500,000
 Services                          Families.                        Arbor, MI for educational and
                                                                    social-emotional services to
                                                                    achieve self-sufficiency.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  Community Help Center DBA             333,000
 Services                          Families.                        Muslim Women Resource Center,
                                                                    Chicago, IL for the purchase
                                                                    of equipment to help achieve
                                                                    self-sufficiency.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  County of San Diego, CA for           220,000
 Services                          Families.                        training and materials for
                                                                    child welfare programs.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  Court Appointed Special               175,000
 Services                          Families.                        Advocates (CASA) of Ocean
                                                                    County, Toms River, NJ for
                                                                    increasing volunteers to
                                                                    advocate for foster care
                                                                    children.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  Court Appointed Special                40,000
 Services                          Families.                        Advocates of Mercer County,
                                                                    Ewing, NJ for expanding
                                                                    services for, and increasing
                                                                    the number of volunteers
                                                                    available to work with,
                                                                    children aging out of foster
                                                                    care.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  Eastern Shore Coalition Against       250,000
 Services                          Families.                        Domestic Violence, Onancock,
                                                                    VA for staffing, children's
                                                                    programming, and supplies to
                                                                    support survivors of abuse.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  Eastmont Community Center, Los        100,000
 Services                          Families.                        Angeles, CA for equipment and
                                                                    services for low income
                                                                    families to reduce poverty.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  Elite Learners, Brooklyn, NY          750,000
 Services                          Families.                        for promoting financial
                                                                    literacy and management
                                                                    services to increase self-
                                                                    sufficiency.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  Father Flanagan's Boys' Home,       1,000,000
 Services                          Families.                        Boys Town, NE for an at-risk
                                                                    youth program, including the
                                                                    purchase of equipment and
                                                                    information technology.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  First 5 Contra Costa Children         150,000
 Services                          Families.                        and Families Commission,
                                                                    Concord, CA for a workforce
                                                                    compensation assessment to
                                                                    build a pipeline for more to
                                                                    attain economic stability.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  Food Bank of Eastern Michigan,      2,000,000
 Services                          Families.                        Flint, MI for the purchase of
                                                                    equipment and food to support
                                                                    mobile food distributions.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  Foodbank of Southeastern              447,600
 Services                          Families.                        Virginia and the Eastern
                                                                    Shore, Norfolk, VA for
                                                                    staffing costs and the
                                                                    purchase of food and
                                                                    equipment, for mobile food
                                                                    distribution.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  FoodCycle Food Recovery               652,500
 Services                          Families.                        Network, Los Angeles, CA for
                                                                    services and the purchase of
                                                                    equipment for a hub to improve
                                                                    access to food resources to
                                                                    combat hunger and reduce
                                                                    poverty.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  Georgia Center for Child              200,000
 Services                          Families.                        Advocacy, Atlanta, GA for
                                                                    services, education and
                                                                    outreach to support families
                                                                    affected by abuse or trauma.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  Georgia State University,             700,000
 Services                          Families.                        Atlanta, GA for services and
                                                                    the purchase of equipment to
                                                                    improve emotional and economic
                                                                    outcomes.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  Goodness Village, Livermore, CA     1,000,000
 Services                          Families.                        for housing support and
                                                                    services to improve self-
                                                                    sufficiency.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  Guardian House, San Antonio, TX       483,963
 Services                          Families.                        for a parenting education
                                                                    program to reduce and prevent
                                                                    child abuse.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  Hellenic American Neighborhood        500,000
 Services                          Families.                        Action Committee INC, New
                                                                    York, NY for education and
                                                                    language services to improve
                                                                    employment and economic
                                                                    outcomes and reduce poverty.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  Helping Mamas, Inc., Norcross,        195,475
 Services                          Families.                        GA for products and services,
                                                                    including the purchase of
                                                                    equipment and goods, for a
                                                                    mobile distribution project to
                                                                    support long-term financial
                                                                    security.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  Higher Ground A Resource            1,088,768
 Services                          Families.                        Center, Tucson, AZ for
                                                                    coordinating resources and
                                                                    services to reduce poverty.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  Houston Area Women's Center         1,000,000
 Services                          Families.                        (HAWC), Houston, TX for
                                                                    services to support children
                                                                    and families affected by
                                                                    violence.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  Individuals Aiding in                  50,000
 Services                          Families.                        Emergencies Foundation, Aston,
                                                                    PA for products and services
                                                                    for low-income individuals to
                                                                    reduce poverty.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  IU Health Foundation,                 600,000
 Services                          Families.                        Indianapolis, IN for services
                                                                    to improve health and
                                                                    nutrition of vulnerable
                                                                    individuals and provide job
                                                                    training and new employment to
                                                                    improve outcomes.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  Kids' Voice of Indiana,               185,000
 Services                          Families.                        Indianapolis, IN for services
                                                                    to children and families who
                                                                    are survivors of violence,
                                                                    abuse, or neglect.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  Knoxville-Knox County Community       575,000
 Services                          Families.                        Action Committee, Knoxville,
                                                                    TN for a Head Start program,
                                                                    including the purchase of
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  La Jornada LTD, Flushing, NY          250,000
 Services                          Families.                        for expanding educational
                                                                    supports and workshops for
                                                                    families in poverty to promote
                                                                    healthy living and improve
                                                                    economic outcomes.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  Labor Community Services of Los       600,000
 Services                          Families.                        Angeles (LCS) , Los Angeles,
                                                                    CA for services, and transport
                                                                    and purchase of goods,
                                                                    including food, to reduce
                                                                    poverty.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  Larkin Street Youth Services,       1,550,000
 Services                          Families.                        San Francisco, CA for safe,
                                                                    stable housing with wraparound
                                                                    case management, education and
                                                                    employment support to reduce
                                                                    poverty and improve economic
                                                                    outcomes.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  Long Island Cares, Hauppauge,         360,100
 Services                          Families.                        NY for the purchase of food
                                                                    and social services, to
                                                                    connect individuals to
                                                                    referral and benefits programs
                                                                    and reduce poverty.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  Long Island Cares, Inc.,              400,000
 Services                          Families.                        Hauppauge, NY for the purchase
                                                                    of equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  Make the Road New York,               800,000
 Services                          Families.                        Brooklyn, NY for adult
                                                                    literacy programs and
                                                                    services, including the
                                                                    purchase of equipment, to
                                                                    improve economic outcomes.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  Make the Road New York,               400,000
 Services                          Families.                        Brooklyn, NY for education and
                                                                    services, including for the
                                                                    purchase of equipment and
                                                                    technology.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  Make the Road New York,               400,000
 Services                          Families.                        Brooklyn, NY for equipment and
                                                                    services, including the
                                                                    purchase of technology, to
                                                                    reduce poverty and create
                                                                    opportunities for economic
                                                                    advancement.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  Maternal and Family Health          2,150,000
 Services                          Families.                        Service, Inc., Wilkes-Barre,
                                                                    PA for improving access to
                                                                    social services for at-risk
                                                                    and low-income women, children
                                                                    and families.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  McMahon Ryan Child Advocacy           125,000
 Services                          Families.                        Center, Syracuse, NY for a
                                                                    child abuse prevention and
                                                                    education program, including
                                                                    information technology.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  Metropolitan Council on Jewish      1,000,000
 Services                          Families.                        Poverty, New York, NY for anti-
                                                                    poverty services and
                                                                    assistance, including for the
                                                                    purchase of food, to create
                                                                    pathways to self-sufficiency.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  Metropolitan Council on Jewish      2,000,000
 Services                          Families.                        Poverty, New York, NY for
                                                                    supplying pantries with
                                                                    essential products, including
                                                                    food, formula, diapers and
                                                                    diapering supplies, menstrual
                                                                    and hygiene products, to meet
                                                                    the essential needs of women
                                                                    and infants to reduce poverty.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  Michigan State University Child     2,187,500
 Services                          Families.                        Development Laboratories, East
                                                                    Lansing, MI for staffing and
                                                                    training, including equipment,
                                                                    to serve at-risk children and
                                                                    improve economic outcomes.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  Mitzvah Circle Foundation,            300,000
 Services                          Families.                        Norristown, PA for products
                                                                    and services to reduce poverty.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  Mott Community College, Flint,      2,064,000
 Services                          Families.                        MI for increasing access to
                                                                    high quality language
                                                                    education materials for
                                                                    families and young children to
                                                                    improve economic outcomes.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  Muslim Community Center (MCC) --      250,000
 Services                          Families.                         East Bay, Pleasanton, CA for
                                                                    services including rental
                                                                    assistance, to assist refugees
                                                                    as they work towards self-
                                                                    sufficiency.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  Neighborhood Legal Services of        817,006
 Services                          Families.                        Los Angeles County, Glendale,
                                                                    CA for advocates to partner
                                                                    with justice-involved
                                                                    individuals to identify and
                                                                    address barriers to self-
                                                                    sufficiency and family well-
                                                                    being.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  Newark Emergency Services for       1,107,500
 Services                          Families.                        Families, Inc., Newark, NJ for
                                                                    services and the purchase of
                                                                    equipment and goods, including
                                                                    food, for fresh food
                                                                    distribution, healthy cooking
                                                                    workshops, and art therapy
                                                                    classes for children and
                                                                    families.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  Next Door Solutions to Domestic       125,000
 Services                          Families.                        Violence, San Jose, CA for
                                                                    violence prevention and
                                                                    intervention services.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  Office of the Mayor, New York       2,000,000
 Services                          Families.                        City, NY for improving
                                                                    coordination between social
                                                                    agencies to support children
                                                                    and families.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  One Nation Dream Makers,            2,000,000
 Services                          Families.                        Livermore, CA for services
                                                                    including the purchase of food
                                                                    and equipment to distribute
                                                                    food to reduce poverty.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  Oregon Community Programs,          1,000,000
 Services                          Families.                        Eugene, OR for supporting
                                                                    foster youth and families and
                                                                    improving the administration
                                                                    of the foster care program.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  Plaza Comunitaria Sinaloa,            800,000
 Services                          Families.                        Mission Hills, CA for
                                                                    expanding educational programs
                                                                    and implementing workforce
                                                                    development programs to
                                                                    provide low-income individuals
                                                                    with access to better job
                                                                    opportunities to improve
                                                                    economic outcomes.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  Safe Space, Inc., Louisburg, NC       197,800
 Services                          Families.                        for culturally-specific child
                                                                    abuse prevention services for
                                                                    at-risk families.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  Samuel Field YM-YWHA dba            1,000,000
 Services                          Families.                        Commonpoint Queens, Little
                                                                    Neck, NY for workforce and
                                                                    wraparound services to improve
                                                                    economic outcomes.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  San Diego County, CA for              500,000
 Services                          Families.                        outreach and recruitment of
                                                                    foster care families to
                                                                    support children.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  Sanctuary of Hope, Los Angeles,       749,920
 Services                          Families.                        CA for expanded navigation and
                                                                    support services to improve
                                                                    employment, education, and
                                                                    economic opportunities.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  Save the Children Federation,       1,080,764
 Services                          Families.                        Inc., Fairfield, CT for
                                                                    programs, workshops, services
                                                                    and goods, including the
                                                                    purchase of food and
                                                                    equipment, to reduce poverty
                                                                    and improve outcomes for
                                                                    children and families.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  South Central LAMP, Los               100,000
 Services                          Families.                        Angeles, CA for support
                                                                    services for children and
                                                                    families.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  Southwest Georgia Children's          367,362
 Services                          Families.                        Alliance, Inc., Americus, GA
                                                                    for child abuse treatment and
                                                                    prevention programs.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  Spectrum Youth and Family             225,000
 Services                          Families.                        Services, Burlington, VT for
                                                                    services and direct assistance
                                                                    to improve self-sufficiency.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  The Center for Hope and               505,813
 Services                          Families.                        Healing, Inc., Lowell, MA for
                                                                    services and supplies to
                                                                    establish financial stability
                                                                    and security through job
                                                                    training and soft skills
                                                                    development.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  The Children's Home Society of        631,500
 Services                          Families.                        New Jersey, Trenton, NJ for
                                                                    employment training and
                                                                    related expenses for low
                                                                    income women to improve health
                                                                    and economic outcomes.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  The Early Excellence Project,         600,000
 Services                          Families.                        Pittsburgh, PA for expanding
                                                                    educational opportunities and
                                                                    improving economic outcomes.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  Today is a Good Day, Flourtown,       332,275
 Services                          Families.                        PA for personal and financial
                                                                    supports for families.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  UCAN, Chicago, IL for expanding     1,000,000
 Services                          Families.                        programs and social services
                                                                    supporting foster youth to
                                                                    improve economic outcomes and
                                                                    community well-being.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  United Jewish Organizations of      1,200,000
 Services                          Families.                        Williamsburg Inc., Brooklyn,
                                                                    NY for a social services
                                                                    initiative connecting families
                                                                    to assistance to reduce
                                                                    poverty and improve economic
                                                                    independence.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  United Way of Central and             150,000
 Services                          Families.                        Northeastern Connecticut,
                                                                    Hartford, CT for training and
                                                                    outreach programs, services,
                                                                    and literacy supports for
                                                                    under-resourced communities.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  United Way of Greater                 255,000
 Services                          Families.                        Cleveland, Cleveland, OH for
                                                                    the 2-1-1 system, including
                                                                    the purchase of information
                                                                    technology and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  United Way of Greater Union           100,000
 Services                          Families.                        County, Elizabeth, NJ for
                                                                    addressing food insecurity,
                                                                    access to transportation and
                                                                    healthcare, and financial
                                                                    stability.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  United Way of Southern Nevada,      1,000,000
 Services                          Families.                        Las Vegas, NV for programs
                                                                    that improve self-sufficiency
                                                                    and reduce poverty for the non-
                                                                    English proficient community.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  UnLocal, Inc., New York, NY for     1,000,000
 Services                          Families.                        services, education and
                                                                    outreach to help financial
                                                                    self-sufficiency.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  Volunteers of America Delaware        479,100
 Services                          Families.                        Valley, Camden, NJ for
                                                                    partnerships to promote human
                                                                    trafficking victimization
                                                                    education and awareness and
                                                                    prevent abuse.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  Wellroot Family Services,             286,500
 Services                          Families.                        Tucker, GA for housing and
                                                                    services and supplies,
                                                                    including the purchase of
                                                                    food, to improve economic
                                                                    outcomes of young adults
                                                                    transitioning out of foster
                                                                    care or experiencing
                                                                    homelessness.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  Wellspring Living, Inc,               245,560
 Services                          Families.                        Atlanta, GA for workforce
                                                                    services for victims of sexual
                                                                    exploitation and violence to
                                                                    increase employment
                                                                    opportunities and improve
                                                                    economic outcomes.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  WestCare Ohio, Inc., Dayton, OH     1,000,000
 Services                          Families.                        for community services
                                                                    programming, including
                                                                    wraparound services.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  White Pony Express, Pleasant          105,000
 Services                          Families.                        Hill, CA for services, and the
                                                                    purchase of food and equipment
                                                                    to support low income children.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  Willow Domestic Violence Center       325,000
 Services                          Families.                        of Greater Rochester, Inc.,
                                                                    Rochester, NY for services and
                                                                    training to support survivors
                                                                    of abuse.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Children and  YMCA of Greater Louisville,           200,000
 Services                          Families.                        Louisville, KY, for model
                                                                    service improvement,
                                                                    information dissemination, and
                                                                    technical assistance to
                                                                    address and prevent child
                                                                    abuse and neglect.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Community     A Kid Again, Columbus, OH for         510,000
 Services                          Living.                          increasing access to
                                                                    therapeutic events for
                                                                    children, including the
                                                                    purchase of equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Community     AIDS Foundation of Chicago,           250,000
 Services                          Living.                          Chicago, IL for training and
                                                                    services to better support
                                                                    seniors living with HIV.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Community     Alpha Phi Alpha Senior Citizens       154,000
 Services                          Living.                          Center, Inc., Cambria Heights,
                                                                    NY for assisted transportation
                                                                    services, including for the
                                                                    purchase of equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Community     Alzheimer's Foundation of             250,000
 Services                          Living.                          America, Amityville, NY for an
                                                                    Alzheimer's education,
                                                                    training, and supportive
                                                                    services center, including the
                                                                    purchase of equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Community     APNA Brooklyn Community Center,       670,902
 Services                          Living.                          Inc., Brooklyn, NY for
                                                                    expanding senior services,
                                                                    including for the purchase of
                                                                    food and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Community     Arc of Prince George's County         819,500
 Services                          Living.                          Inc., Largo, MD for expanding
                                                                    services for individuals with
                                                                    disabilities to prepare them
                                                                    for employment and independent
                                                                    living.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Community     BakerRipley, Houston, TX for        1,000,000
 Services                          Living.                          increasing access to food and
                                                                    other services for seniors.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Community     Bancroft, Cherry Hill, NJ for         500,000
 Services                          Living.                          increasing independent living,
                                                                    including for the purchase of
                                                                    equipment, including
                                                                    technology and devices.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Community     Central Massachusetts Agency on     1,200,000
 Services                          Living.                          Aging, Inc., Worcester, MA for
                                                                    increasing services and
                                                                    resources for grandparents
                                                                    raising grandchildren.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Community     Charter Township of Commerce,         235,050
 Services                          Living.                          Commerce Township, MI for
                                                                    increasing senior reading and
                                                                    independence including for the
                                                                    purchase of equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Community     Choice in Aging, Pleasant Hill,       500,000
 Services                          Living.                          CA for increasing access to
                                                                    and awareness of community-
                                                                    based alternatives to nursing
                                                                    homes.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Community     City of Ontario, CA for               439,094
 Services                          Living.                          expanding wellness programs,
                                                                    meal services, and
                                                                    transportation services for
                                                                    seniors.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Community     Clausen House, Oakland, CA for      1,058,408
 Services                          Living.                          an adult transition services
                                                                    program to improve employment,
                                                                    educational, life skills and
                                                                    supports for individuals with
                                                                    disabilities.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Community     Community Action of Greater           100,000
 Services                          Living.                          Indianapolis, Indianapolis, IN
                                                                    for services, outreach,
                                                                    events, transportation
                                                                    expenses, and supplies to
                                                                    increase the number of senior
                                                                    volunteers in their
                                                                    communities.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Community     Community Services Inc. of            270,475
 Services                          Living.                          Ocean County, Manahawkin, NJ
                                                                    for increasing food delivery
                                                                    to seniors, including the
                                                                    purchase of equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Community     Creative Enterprises, Inc,            612,320
 Services                          Living.                          Lawrenceville, GA for
                                                                    expanding access and
                                                                    increasing opportunities for
                                                                    employment and community
                                                                    inclusion, including the
                                                                    purchase of equipment and
                                                                    technology.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Community     Designated Exceptional Services        85,000
 Services                          Living.                          for Independence (DESI), Los
                                                                    Angeles, CA for expanding
                                                                    access to and delivery of food
                                                                    for seniors, including for the
                                                                    purchase of equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Community     DOROT, Inc., New York, NY for         551,210
 Services                          Living.                          expanding intergenerational
                                                                    programming to increase social
                                                                    enrichment services for older
                                                                    adults.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Community     Endeavor Forward, Inc,                300,000
 Services                          Living.                          Marianna, FL for a transition
                                                                    program for adults with autism.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Community     Fairfax County, VA for services     1,000,000
 Services                          Living.                          and purchase of equipment,
                                                                    including technology, to
                                                                    increase access to technology
                                                                    and community engagement.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Community     Friendship Circle, West               364,009
 Services                          Living.                          Bloomfield Township, MI for
                                                                    expanding developmental
                                                                    learning opportunities to
                                                                    promote independence of
                                                                    students with disabilities.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Community     Hawaii Public Health Institute,     1,800,000
 Services                          Living.                          Honolulu, HI for support
                                                                    navigator services for seniors
                                                                    and caregivers.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Community     Health Care District of Palm        1,000,000
 Services                          Living.                          Beach County, West Palm Beach,
                                                                    FL for falls and injury
                                                                    prevention programs, outreach,
                                                                    and education.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Community     India Home, Inc., Jamaica, NY         500,000
 Services                          Living.                          for an outreach program to
                                                                    promote and incentivize senior
                                                                    health.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Community     Island Harvest, Brentwood, NY       1,100,000
 Services                          Living.                          for a nutrition program,
                                                                    including the purchase of
                                                                    food, supplies and equipment,
                                                                    and information technology.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Community     Jewish Service for the                760,000
 Services                          Living.                          Developmentally Disabled
                                                                    (JSDD), Livingston, NJ for
                                                                    equipment and support to
                                                                    expand access to technology
                                                                    for individuals with
                                                                    disabilities.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Community     Lighthouse for the Visually           600,000
 Services                          Living.                          Impaired and Blind of Pasco,
                                                                    Hernando and Citrus Counties,
                                                                    New Port Richey, FL for an
                                                                    education, training, and
                                                                    support services program for
                                                                    seniors with visual impairment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Community     Metropolitan Council on Jewish      1,000,000
 Services                          Living.                          Poverty, New York, NY for food
                                                                    and services for seniors.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Community     Metropolitan Council on Jewish      1,000,000
 Services                          Living.                          Poverty, New York, NY for food
                                                                    and services for seniors.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Community     Metropolitan Council on Jewish      1,000,000
 Services                          Living.                          Poverty, New York, NY for
                                                                    increasing senior access to
                                                                    and delivery of food.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Community     Minute Man Arc for Human              331,110
 Services                          Living.                          Services, Concord, MA for
                                                                    increasing community
                                                                    integration, access to social
                                                                    services, and benefits
                                                                    assistance resources.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Community     Ocean Community Economic Action        55,000
 Services                          Living.                          Now, Inc., Toms River, NJ for
                                                                    transportation and outreach
                                                                    activities to expand seniors'
                                                                    access to community living and
                                                                    supports.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Community     Pathlights Human Services,            100,000
 Services                          Living.                          Palos Heights, IL for
                                                                    expanding access to and
                                                                    delivery of meals for seniors.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Community     People Inc., Williamsville, NY      2,035,139
 Services                          Living.                          for improving access to health
                                                                    services, including for health
                                                                    staffing, purchase of
                                                                    equipment and technology
                                                                    expenses.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Community     Regional Aid for Interim Needs,       800,000
 Services                          Living.                          Incorporated, Bronx, NY for
                                                                    wraparound and case management
                                                                    support services to support
                                                                    older adults.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Community     Scranton Neighborhood Housing       1,000,000
 Services                          Living.                          Services, Inc., Scranton, PA
                                                                    for services including home
                                                                    repairs and modifications to
                                                                    support aging in place.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Community     Senior Services of Snohomish          250,400
 Services                          Living.                          County DBA Homage, Lynnwood,
                                                                    WA for a rural transportation
                                                                    project, including the
                                                                    purchase of equipment, to
                                                                    increase access to services.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Community     Shepherd Center Inc., Atlanta,        800,000
 Services                          Living.                          GA for the purchase of
                                                                    equipment, including
                                                                    information technology, and
                                                                    training expenses to increase
                                                                    the independence of people
                                                                    with disabilities.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Community     Tennessee State University,           500,000
 Services                          Living.                          Nashville, TN for a new
                                                                    program to expand
                                                                    opportunities for students to
                                                                    attend college and prepare for
                                                                    independent living and
                                                                    employment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Community     The City of Dover, DE for             500,000
 Services                          Living.                          improving opportunities for
                                                                    children, youth and adults who
                                                                    have physical and intellectual
                                                                    disabilities, including the
                                                                    purchase of equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Community     The Monmouth Ocean Foundation         400,000
 Services                          Living.                          for Children (MOFFC), Tinton
                                                                    Falls, NJ for an autism
                                                                    education, training, and
                                                                    support services program,
                                                                    including the purchase of
                                                                    information technology and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Community     The Rosalynn Carter Institute       1,020,047
 Services                          Living.                          for Caregivers, Americus, GA
                                                                    for expanding and increasing
                                                                    awareness of programs for
                                                                    caregivers.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Community     The University of Texas at San        492,370
 Services                          Living.                          Antonio, San Antonio, TX for
                                                                    an evaluation and research
                                                                    center to improve access to
                                                                    care and quality of life
                                                                    outcomes for individuals
                                                                    living with disabilities.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Community     Wesley Community Services,          1,322,415
 Services                          Living.                          Inc., Johnston, IA for
                                                                    expanding access to and
                                                                    delivery of senior services,
                                                                    including the purchase of
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Community     West Bloomfield Parks and              85,000
 Services                          Living.                          Recreation Commission, West
                                                                    Bloomfield, MI for social
                                                                    workers and expansion of
                                                                    social services for seniors.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Community     Westchester Residential               500,000
 Services                          Living.                          Opportunities, Inc., White
                                                                    Plains, NY for home repairs
                                                                    and modifications to support
                                                                    aging in place and enable
                                                                    healthy living.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Community     Yellow House Community                250,000
 Services                          Living.                          Services, Inc., Middlebury, VT
                                                                    for housing and services for
                                                                    individuals with disabilities.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Administration for Community     YWCA Greater Los Angeles, Los         375,000
 Services                          Living.                          Angeles, CA for expanding
                                                                    senior empowerment services.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Abide Women's Health Services,        290,261
 Services                          Administration.                  Dallas, TX for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    About Sojourners with Healing         167,500
 Services                          Administration.                  Hearts, West Palm Beach, FL
                                                                    for a cancer screening
                                                                    initiative.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Adapt, Inc., Roseburg, OR for       1,000,000
 Services                          Administration.                  facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Adult & Teen Challenge USA,           750,000
 Services                          Administration.                  Ozark, MO for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    AdventHealth Durand, West             916,000
 Services                          Administration.                  Durand, WI for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    AdventHealth for Children,          1,000,000
 Services                          Administration.                  Orlando, FL for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Adventist Health/Central Valley     1,250,000
 Services                          Administration.                  Network, Hanford, CA for
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Adventist HealthCare Fort           1,000,000
 Services                          Administration.                  Washington Medical Center,
                                                                    Inc., Fort Washington, MD for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Adventist Healthcare Inc.,            500,000
 Services                          Administration.                  Gaithersburg, MD for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Advocate Health and Hospitals       2,940,000
 Services                          Administration.                  Corporation, Downers Grove, IL
                                                                    for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Advocates for a Health              2,000,000
 Services                          Administration.                  Community DBA Jordan Valley
                                                                    Community Health Center,
                                                                    Springfield, MO for facilities.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Advocates Inc., Framingham, MA        500,000
 Services                          Administration.                  for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Alivio Medical Center, Chicago,     3,000,000
 Services                          Administration.                  IL for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Allegheny Health Network,           1,400,000
 Services                          Administration.                  Pittsburgh, PA for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    AltaMed Health Services, Los          255,000
 Services                          Administration.                  Angeles, CA for equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    AltaMed Health Services, Los        2,346,186
 Services                          Administration.                  Angeles, CA for equipment and
                                                                    operational costs.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    AMAAD Institute, Los Angeles,         935,000
 Services                          Administration.                  CA for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    American Indian Health & Family     1,500,000
 Services                          Administration.                  Services of Southeastern
                                                                    Michigan, Inc., Detroit, MI
                                                                    for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Americana Community Center          2,000,000
 Services                          Administration.                  Inc., Louisville, KY for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Anna Maria College, Paxton, MA      1,000,000
 Services                          Administration.                  for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    APLA Able Arts, Long Beach, CA        500,000
 Services                          Administration.                  for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Arts and Services for the             980,000
 Services                          Administration.                  Disabled, Inc. dba Able ARTS
                                                                    Work, Long Beach, CA for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    ARUP Laboratories, Inc., Salt       3,000,000
 Services                          Administration.                  Lake City, UT for facilities.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Ashtabula County Medical            3,000,000
 Services                          Administration.                  Center, Ashtabula, OH for
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Asian American Drug Abuse           2,230,000
 Services                          Administration.                  Prevention, Inc., Los Angeles,
                                                                    CA for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Asian American Health Coalition-    1,300,000
 Services                          Administration.                  HOPE Clinic, Houston, TX for
                                                                    equipment and operational
                                                                    costs for an oral health
                                                                    program.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Aspire Health Partners,               310,000
 Services                          Administration.                  Orlando, FL for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Association for Individual          3,000,000
 Services                          Administration.                  Development, Aurora, IL for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Atlantic Health System,             1,000,000
 Services                          Administration.                  Morristown, NJ for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Auburn Community Hospital,          2,000,000
 Services                          Administration.                  Auburn, NY for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Aunt Martha's Health and              450,000
 Services                          Administration.                  Wellness, Olympia Fields, IL
                                                                    for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Aurora Community Mental Health      2,000,000
 Services                          Administration.                  Center, Aurora, CO for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Ballad Health, Johnson City, TN       605,000
 Services                          Administration.                  for facilities.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Ballad Health, Johnson City, TN       500,000
 Services                          Administration.                  for facilities.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Banyan Community Health Center,     2,500,000
 Services                          Administration.                  Miami, FL for facilities.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Baptist Health Deaconess              515,000
 Services                          Administration.                  Madisonville, Inc.,
                                                                    Madisonville, KY for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Barton Hose Company No 1. Inc.,     1,875,000
 Services                          Administration.                  Barton, MD for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Bay Area Community Health,            700,000
 Services                          Administration.                  Fremont, CA for equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Bay Area Community Health, San      1,000,000
 Services                          Administration.                  Jose, CA for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Bay County Health Department,       2,000,000
 Services                          Administration.                  Bay City, MI for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Baylor Scott & White Medical        3,000,000
 Services                          Administration.                  Center--Round Rock, Round
                                                                    Rock, TX for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Beloved Community Family            2,000,000
 Services                          Administration.                  Wellness Center, Chicago, IL
                                                                    for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Beth Israel Deaconess Hospital--    2,000,000
 Services                          Administration.                  Plymouth, Inc., Plymouth, MA
                                                                    for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Block Island Health Services,       2,000,000
 Services                          Administration.                  New Shoreham, RI for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Bobby Benson Center, Kahuku, HI     1,200,000
 Services                          Administration.                  for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Bon Secours Charity Health          1,000,000
 Services                          Administration.                  System, Suffern, NY for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Boone Memorial Hospital, Inc.,      3,000,000
 Services                          Administration.                  Madison, WV for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Bread for the City, Washington,     3,000,000
 Services                          Administration.                  DC for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Brockton Neighborhood Health        1,000,000
 Services                          Administration.                  Center, Brockton, MA for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Bronx Community Health Network,     2,001,503
 Services                          Administration.                  Bronx, NY for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Brooks County Independent           1,500,000
 Services                          Administration.                  School District, Falfurrias,
                                                                    TX for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Brownsville Community               2,200,000
 Services                          Administration.                  Development Corporation,
                                                                    Brooklyn, NY for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Cabell Huntington Hospital,         3,000,000
 Services                          Administration.                  Inc., Huntington, WV for
                                                                    facilities.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    California State University,        2,000,000
 Services                          Administration.                  San Bernardino, CA for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    CalvertHealth Medical Center,         950,000
 Services                          Administration.                  Prince Frederick, MD for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Cambridge Public Health             1,000,000
 Services                          Administration.                  Commission (dba Cambridge
                                                                    Health Alliance), Cambridge,
                                                                    MA for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Campbell City School District,      2,000,000
 Services                          Administration.                  Campbell, OH for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Caridad Center, Inc., Boynton       1,000,000
 Services                          Administration.                  Beach, FL for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Cedar Riverside People's            1,000,000
 Services                          Administration.                  Center, Minneapolis, MN for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Center for Addiction Treatment,       500,000
 Services                          Administration.                  Cincinnati, OH for facilities.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Centerstone, Bradenton, FL for      1,200,000
 Services                          Administration.                  facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Central Pennsylvania Institute      2,000,000
 Services                          Administration.                  of Science and Technology,
                                                                    Bellefonte, PA for facilities.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Central Piedmont Community            575,000
 Services                          Administration.                  College, Charlotte, NC for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Central Vermont Medical Center,       735,560
 Services                          Administration.                  Berlin, VT for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Central Washington University,      1,000,000
 Services                          Administration.                  Ellensburg, WA for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    CentraState Medical Center,           615,000
 Services                          Administration.                  Inc. , Freehold, NJ for
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Centro del Barrio, Inc., San        1,000,000
 Services                          Administration.                  Antonio, TX for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Centro Hispano Daniel Torres          635,713
 Services                          Administration.                  Inc., Reading, PA for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Charles River Community Health        247,000
 Services                          Administration.                  Center, Waltham, MA for an
                                                                    electronic health records
                                                                    initiative.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Charlotte Community Health            600,000
 Services                          Administration.                  Clinic, Inc., Charlotte, NC
                                                                    for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Chattanooga-Hamilton County         2,000,000
 Services                          Administration.                  Hospital Authority d/b/a
                                                                    Erlanger Health System,
                                                                    Chattanooga, TN for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Cherry Creek School District,       1,500,000
 Services                          Administration.                  Greenwood Village, CO for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Cherry Hill Free Clinic, Cherry       440,905
 Services                          Administration.                  Hill, NJ for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Children's Health Clinical          1,000,000
 Services                          Administration.                  Operations, Dallas, TX for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Children's Hospital Los             1,500,000
 Services                          Administration.                  Angeles, Los Angeles, CA for
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Children's Clinic dba TCC             575,000
 Services                          Administration.                  Family Health, Long Beach, CA
                                                                    for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Children's Health Clinical          1,000,000
 Services                          Administration.                  Operations, Dallas, TX for
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Children's Health of Orange         1,000,000
 Services                          Administration.                  County, Orange, CA for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Children's Hospital Medical         2,000,000
 Services                          Administration.                  Center of Akron, OH for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Chinatown Service Center,             215,000
 Services                          Administration.                  Monterey Park, CA for
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Chinese Culture and Community       1,000,000
 Services                          Administration.                  Service Center, Inc.,
                                                                    Gaithersburg, MD for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Chiricahua Community Health           983,265
 Services                          Administration.                  Centers, Inc., Douglas, AZ for
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    ChristianaCare Health System,         900,000
 Services                          Administration.                  Wilmington, DE for a nutrition
                                                                    program for pregnant women.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    CHRISTUS Ochsner Health             1,000,000
 Services                          Administration.                  Southwestern Louisiana -- St.
                                                                    Patrick Hospital, Lake
                                                                    Charles, LA for facilities.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    CHRISTUS St. Frances Cabrini          775,000
 Services                          Administration.                  Hospital, Alexandria, LA for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Cincinnati Children's Hospital        630,000
 Services                          Administration.                  Medical Center, Cincinnati, OH
                                                                    for equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    City of Albuquerque, NM for         2,200,000
 Services                          Administration.                  facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    City of Berea, KY for equipment       350,000
 Services                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    City of Greenville, MS for          2,000,000
 Services                          Administration.                  facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    City of Guin, AL for facilities       150,000
 Services                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    City of Hope National Medical         150,000
 Services                          Administration.                  Center, Duarte, CA for
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    City of Houston--Houston Health     1,000,000
 Services                          Administration.                  Department, Houston, TX for a
                                                                    vision health program.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    City of West Hollywood, CA for        300,000
 Services                          Administration.                  facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Clay County Healthcare              1,500,000
 Services                          Administration.                  Authority, Ashland, AL for
                                                                    facilities.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Cleveland Clinic, Cleveland, OH       905,000
 Services                          Administration.                  for equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Cleveland Clinic, Cleveland, OH       615,000
 Services                          Administration.                  for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Clinica Msr. Oscar A. Romero,       1,000,000
 Services                          Administration.                  Los Angeles, CA for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Cold Spring Harbor Laboratory,      1,000,000
 Services                          Administration.                  Cold Spring Harbor, NY for
                                                                    equipment and operational
                                                                    costs.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    College of Southern Nevada,           750,000
 Services                          Administration.                  North Las Vegas Campus, North
                                                                    Las Vegas, NV for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    CommuniCare Health Centers,         1,500,000
 Services                          Administration.                  West Sacramento, CA for an
                                                                    electronic health records
                                                                    initiative.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Community Bridges, Inc., Mesa,      1,000,000
 Services                          Administration.                  AZ for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Community Care Clinic of              575,000
 Services                          Administration.                  Franklin, Inc., Franklin, NC
                                                                    for facilities.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Community Consolidated School       1,000,000
 Services                          Administration.                  District 21, Wheeling, IL for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Community Foundation of Greater     3,000,000
 Services                          Administration.                  Muscatine, Muscatine, IA for
                                                                    facilities.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Community Health Partnership,         175,000
 Services                          Administration.                  San Jose, CA for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Community Medical Centers,            500,000
 Services                          Administration.                  Stockton, CA for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Community Medical Centers,            950,000
 Services                          Administration.                  Stockton, CA for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Community Regional Medical          1,500,000
 Services                          Administration.                  Center, Fresno, CA for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Compass Health, Inc., St.           1,000,000
 Services                          Administration.                  Peters, MO for facilities.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Comprehensive Community Action,     1,000,000
 Services                          Administration.                  Inc., Cranston, RI for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Connecticut Hospice, Inc.,          1,940,000
 Services                          Administration.                  Branford, CT for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Connecticut Institute For           2,000,000
 Services                          Administration.                  Communities, Inc., Danbury, CT
                                                                    for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Cook County Health, Chicago, IL     1,000,000
 Services                          Administration.                  for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Cooperman Barnabas Medical          1,000,000
 Services                          Administration.                  Center, Livingston, NJ for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Cornerstone Family Healthcare,      2,800,000
 Services                          Administration.                  Cornwall, NY for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Cortland County, NY for             2,995,000
 Services                          Administration.                  facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    County of Bernalillo,                 422,031
 Services                          Administration.                  Albuquerque, NM for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    County of Clark, Las Vegas, NV      1,330,000
 Services                          Administration.                  for equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    County of Clark, Las Vegas, NV      1,600,000
 Services                          Administration.                  for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    County of Culpeper, VA for            324,494
 Services                          Administration.                  facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    County of Delaware, Media, PA       1,750,000
 Services                          Administration.                  for an electronic health
                                                                    records initiative.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    County of Fairfax, VA for           1,700,000
 Services                          Administration.                  facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    County of Lane, Eugene, OR for      1,500,000
 Services                          Administration.                  facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    County of Montgomery,               3,000,000
 Services                          Administration.                  Rockville, MD for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    County of Northampton, Easton,      1,000,000
 Services                          Administration.                  PA for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    County of Oakland, Pontiac, MI      1,200,000
 Services                          Administration.                  for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    County of Orange, Santa Ana, CA     3,000,000
 Services                          Administration.                  for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    County of Riverside--Riverside      1,000,000
 Services                          Administration.                  University Health System,
                                                                    Moreno Valley, CA for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    County of Riverside--Riverside      1,000,000
 Services                          Administration.                  University Health System,
                                                                    Riverside, CA for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    County of San Mateo, CA for an      1,000,000
 Services                          Administration.                  electronic health records
                                                                    initiative.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    County of Taos, NM for              2,200,000
 Services                          Administration.                  facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    County of Wake, Raleigh, NC for     2,000,000
 Services                          Administration.                  facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Covenant Community Care, Inc.,        500,000
 Services                          Administration.                  Detroit, MI for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Cowlitz Indian Tribe, Longview,       765,000
 Services                          Administration.                  WA for facilities.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Cowlitz Indian Tribe, Longview,     1,000,000
 Services                          Administration.                  WA for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Crouse Health, Syracuse, NY for     1,010,000
 Services                          Administration.                  facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Cullman Regional Medical            1,585,000
 Services                          Administration.                  Center, Inc., Cullman, AL for
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Cumberland University, Lebanon,       750,000
 Services                          Administration.                  TN for equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Denver Health and Hospital          2,200,000
 Services                          Administration.                  Authority, Denver, CO for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Desert AIDS Project, Palm           2,000,000
 Services                          Administration.                  Springs, CA for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Division of Infectious                500,000
 Services                          Administration.                  Diseases, University of Miami
                                                                    Miller School of Medicine,
                                                                    Miami, FL for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Downtown Emergency Service            985,000
 Services                          Administration.                  Center, Seattle, WA for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Doylestown Health Foundation        1,000,000
 Services                          Administration.                  D.B.A. Doylestown Health,
                                                                    Doylestown, PA for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Duncan Regional Hospital, Inc.,       750,000
 Services                          Administration.                  Duncan, OK for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Duquesne University,                2,200,000
 Services                          Administration.                  Pittsburgh, PA for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    East Bay Community Action             513,600
 Services                          Administration.                  Program, Newport, RI for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    East Tennessee Children's           2,500,000
 Services                          Administration.                  Hospital, Knoxville, TN for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Easterseals of Oak Hill,            1,874,000
 Services                          Administration.                  Hartford, CT for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Edward M. Kennedy Community         1,000,000
 Services                          Administration.                  Health Center, Inc.,
                                                                    Worcester, MA for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Edward M. Kennedy Health            3,000,000
 Services                          Administration.                  Center, Inc., Boston, MA for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Eisner Health, Los Angeles, CA        610,000
 Services                          Administration.                  for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    El Centro de Corazon, Houston,      3,000,000
 Services                          Administration.                  TX for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    El Paso Children's Hospital, El       595,000
 Services                          Administration.                  Paso, TX for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    El Proyecto del Barrio Inc.,        1,000,000
 Services                          Administration.                  Winnetka, CA for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Ellis County Coalition for          3,000,000
 Services                          Administration.                  Health Options, Inc., dba Hope
                                                                    Clinic, Waxahachie, TX for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Erie Family Health Centers,         1,173,900
 Services                          Administration.                  Chicago, IL for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Escambia County Health Care           655,000
 Services                          Administration.                  Authority dba Atmore Community
                                                                    Hospital, Atmore, AL for
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Fair Haven Community Health         3,000,000
 Services                          Administration.                  Clinic, Inc., New Haven, CT
                                                                    for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Family Centers Inc., Stamford,      1,000,000
 Services                          Administration.                  CT for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Family Christian Health Center,       353,441
 Services                          Administration.                  Harvey, IL for equipment and
                                                                    operational costs.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Family Health Services              1,550,000
 Services                          Administration.                  Corporation, Twin Falls, ID
                                                                    for facilities.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Ferd & Gladys Alpert Jewish           700,000
 Services                          Administration.                  Family & Children's Service of
                                                                    Palm Beach County, Inc., West
                                                                    Palm Beach, FL for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Figgers Foundation, Lauderhill,     2,200,000
 Services                          Administration.                  FL for a telehealth initiative.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Finkelstein Memorial Library,       2,000,000
 Services                          Administration.                  Spring Valley, NY for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    First Nations Community             1,000,000
 Services                          Administration.                  HealthSource, Albuquerque, NM
                                                                    for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Flaget Memorial Hospital              635,000
 Services                          Administration.                  Foundation, Bardstown, KY for
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Florida International               3,000,000
 Services                          Administration.                  University, Miami, FL for
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Florida State University,           2,490,000
 Services                          Administration.                  Tallahassee, FL for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Franciscan Missionaries of Our      1,935,000
 Services                          Administration.                  Lady University, Baton Rouge,
                                                                    LA for facilities.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Frederick County Government,          698,083
 Services                          Administration.                  Frederick, MD for equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Freedom Rain Incorporated dba       2,000,000
 Services                          Administration.                  The Lovelady Center,
                                                                    Birmingham, AL for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Fresno Center, Fresno, CA for       1,500,000
 Services                          Administration.                  facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Friends of Youth, Kirkland, WA      1,000,000
 Services                          Administration.                  for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Friendship House, Scranton, PA      1,500,000
 Services                          Administration.                  for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Gardner Family Health Network,        500,000
 Services                          Administration.                  Incorporated, Alviso, CA for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Gardner Family Health Network,      1,000,000
 Services                          Administration.                  Incorporated, San Jose, CA for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Garfield Health Center,               480,000
 Services                          Administration.                  Monterey Park, CA for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Garrett Regional Medical              650,000
 Services                          Administration.                  Center, Oakland, MD, for an
                                                                    electronic health records
                                                                    initiative.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Gateway Community Health            1,997,000
 Services                          Administration.                  Center, Inc., Laredo, TX for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    George Corley Wallace State         1,143,018
 Services                          Administration.                  Community College, Demopolis,
                                                                    AL for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    George Mason University,              820,000
 Services                          Administration.                  Fairfax, VA for equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    George Washington University,       1,190,000
 Services                          Administration.                  Washington, DC for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Germanna Community College            251,000
 Services                          Administration.                  Educational Foundation Inc.,
                                                                    Locust Grove, VA for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Gillette Children's Specialty       1,500,000
 Services                          Administration.                  Healthcare, St. Paul, MN for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Grace Health, Battle Creek, MI        525,000
 Services                          Administration.                  for facilities.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Grand View Hospital d/b/a Grand     1,000,000
 Services                          Administration.                  View Health, Sellersville, PA
                                                                    for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Grant County Public Hospital        2,500,000
 Services                          Administration.                  District No 1, dba Samaritan
                                                                    Healthcare, Moses Lake, WA for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Great Basin College, Elko, NV         940,000
 Services                          Administration.                  for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Great Salt Plains Health            2,180,000
 Services                          Administration.                  Center, Inc., Cherokee, OK for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Greater Baden Medical Services,     3,000,000
 Services                          Administration.                  Inc., Brandywine, MD for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Greene County Hospital and            521,100
 Services                          Administration.                  Nursing Home, Eutaw, AL for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Grover C. Dils Medical Center,      3,000,000
 Services                          Administration.                  Caliente, NV for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Gundersen Tri-County Hospital,      1,000,000
 Services                          Administration.                  Whitehall, WI for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    H. Lee Moffitt Cancer Center        3,000,000
 Services                          Administration.                  and Research Institute, Inc.,
                                                                    Tampa, FL for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    H. Lee Moffitt Cancer Center        1,000,000
 Services                          Administration.                  and Research Institute, Inc.,
                                                                    Tampa, FL for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Hackensack Meridian Health,         1,000,000
 Services                          Administration.                  Edison, NJ for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Hamakua-Kohala Health Center,       2,000,000
 Services                          Administration.                  Honokaa, HI for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Hamilton Community Health           1,000,000
 Services                          Administration.                  Network, Flint, MI for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Harris County Precinct 2,           3,000,000
 Services                          Administration.                  Houston, TX for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Havana Community Development        1,967,328
 Services                          Administration.                  Corp., Inc., Havana, FL for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Health and Hospital Corporation     1,385,487
 Services                          Administration.                  of Marion County,
                                                                    Indianapolis, IN for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Health Care Authority               1,000,000
 Services                          Administration.                  Corporation of the City of
                                                                    Thomasville, AL for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Health Service Alliance-              300,000
 Services                          Administration.                  Montclair Community Health
                                                                    Center, Montclair, CA for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Health Unit on Davidson Avenue        281,200
 Services                          Administration.                  (The HUDA Clinic), Detroit, MI
                                                                    for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    HealthFirst Family Center,            450,000
 Services                          Administration.                  Franklin, NH for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    HealthPoint, Renton, WA for         2,000,000
 Services                          Administration.                  facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    HealthRIGHT 360, San Francisco,     2,500,000
 Services                          Administration.                  CA for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Healthy Mothers, Healthy Babies       305,313
 Services                          Administration.                  Coalition of Palm Beach
                                                                    County, Inc., Greenacres, FL
                                                                    for a doula training program.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Henderson County Rural Health         517,783
 Services                          Administration.                  Center, Inc., dba Eagle View
                                                                    Community Health System,
                                                                    Oquawka, IL for health clinic
                                                                    operational costs.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Hendry County, LaBelle, FL for        700,000
 Services                          Administration.                  facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Henry J. Austin Health Center,        813,600
 Services                          Administration.                  Trenton, NJ for a mobile
                                                                    health unit and staffing.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Henry Mayo Newhall Hospital         1,115,000
 Services                          Administration.                  Foundation, Valencia, CA for
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Heritage Heights at Lake              800,000
 Services                          Administration.                  Chelan, WA for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Highlands Hospital dba Penn         1,000,000
 Services                          Administration.                  Highlands Connellsville
                                                                    (PHCV), a subsidiary of Penn
                                                                    Highlands Healthcare (PHH),
                                                                    Connellsville, PA for
                                                                    facilities.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Hillsdale Community Health            345,000
 Services                          Administration.                  Center, Hillsdale, MI for
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    His Branches, Inc., Rochester,        819,312
 Services                          Administration.                  NY for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Howard Brown Health, Chicago,       1,110,400
 Services                          Administration.                  IL for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Hyndman Area Health Center,           425,000
 Services                          Administration.                  Inc, Bedford, PA for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    I. M. Sulzbacher Center for the     2,000,000
 Services                          Administration.                  Homeless, Inc., Jacksonville,
                                                                    FL for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Illinois College of Optometry,        445,000
 Services                          Administration.                  Chicago, IL for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Illinois Community College            300,000
 Services                          Administration.                  District #519 (Highland
                                                                    Community College), Freeport,
                                                                    IL for equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Illinois State University,          2,000,000
 Services                          Administration.                  Mennonite College of Nursing,
                                                                    Normal, IL for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Inner City Health Center,             183,486
 Services                          Administration.                  Denver, CO for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Interfaith Medical Center           3,000,000
 Services                          Administration.                  Campus, Brooklyn, NY for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    J. Paul Jones Hospital, Camden,       595,041
 Services                          Administration.                  AL for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Jackson Parish Hospital,            2,000,000
 Services                          Administration.                  Jonesboro, LA for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Jamaica Hospital Medical            1,905,000
 Services                          Administration.                  Center, Jamaica, NY for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Jamaica Hospital Medical            2,400,000
 Services                          Administration.                  Center, Jamaica, NY for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Jawonio Inc., New City, NY for      1,300,000
 Services                          Administration.                  facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Jersey Community Hospital           2,000,000
 Services                          Administration.                  District, Jerseyville, IL for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Jessie Trice Community Health       3,000,000
 Services                          Administration.                  System, Inc., Miami, FL for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Jewish Community Free Clinic,         200,000
 Services                          Administration.                  Santa Rosa, CA for an
                                                                    electronic health records
                                                                    initiative.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Jewish Foundation for Group           750,000
 Services                          Administration.                  Homes, Rockville, MD for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Joseph P. Addabbo Family Health       325,000
 Services                          Administration.                  Center, Inc., New York, NY for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Josselyn Center, Northfield, IL     1,000,000
 Services                          Administration.                  for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Jurupa Unified, Jurupa Valley,      1,623,000
 Services                          Administration.                  CA for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Kern County Hospital Authority,     3,000,000
 Services                          Administration.                  Bakersfield, CA for equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Kern County Hospital Authority,     3,000,000
 Services                          Administration.                  Bakersfield, CA for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Keryx Ministries, Inc., Macon,        400,000
 Services                          Administration.                  GA for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Keystone Valley Fire                   29,385
 Services                          Administration.                  Department, Parkesburg, PA for
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Kids' Community Clinic of           1,200,000
 Services                          Administration.                  Burbank, CA for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    KidsPeace, Orefield, PA for         1,000,000
 Services                          Administration.                  facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    King Lunalilo Trust and Home,       1,740,550
 Services                          Administration.                  Honolulu, HI for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Kings County Hospital Center,       2,200,000
 Services                          Administration.                  Brooklyn, NY for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Klingberg Family Centers,           1,000,000
 Services                          Administration.                  Incorporated, New Britain, CT
                                                                    for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    La Maestra Family Clinic Inc.,        751,681
 Services                          Administration.                  San Diego, CA for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Lake County Free Clinic,              100,000
 Services                          Administration.                  Painesville, OH for equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Lakewood Community Services         1,000,000
 Services                          Administration.                  Corporation, Lakewood, NJ for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Lana'i Community Health Center,     1,538,000
 Services                          Administration.                  Lana'i City, HI for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Lansing Fire Department,            1,000,000
 Services                          Administration.                  Lansing, MI for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    LaSalle General Hospital, Jena,     1,065,000
 Services                          Administration.                  LA for facilities.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Lawrence General Hospital,          1,000,000
 Services                          Administration.                  Lawrence, MA for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Le Bonheur Children's Hospital,       970,000
 Services                          Administration.                  Memphis, TN for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Legacy Community Health,            1,000,000
 Services                          Administration.                  Houston, TX for an electronic
                                                                    health records initiative.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Legacy Community Health,              300,000
 Services                          Administration.                  Houston, TX for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Leyden Family Service & Mental        266,059
 Services                          Administration.                  Health Center, Hoffman
                                                                    Estates, IL for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    LifeCare Alliance, Columbus, OH       975,000
 Services                          Administration.                  for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Lighthouse Youth Services,          1,850,000
 Services                          Administration.                  Inc., Cincinnati, OH for
                                                                    facilities.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Lions Eye Institute for             1,000,000
 Services                          Administration.                  Transplant and Research
                                                                    Foundation, Tampa, FL for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Livingston County Emergency         1,169,950
 Services                          Administration.                  Management Services, Howell,
                                                                    MI for equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Loma Linda University Medical       2,000,000
 Services                          Administration.                  Center- Murrieta, Murrieta, CA
                                                                    for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Long Island Jewish Forest           1,000,000
 Services                          Administration.                  Hills, NY for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Los Angeles County Fire               201,834
 Services                          Administration.                  Department, Los Angeles, CA
                                                                    for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Louisiana Children's Medical        2,000,000
 Services                          Administration.                  Center, New Orleans, LA for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Louisiana State University          2,350,000
 Services                          Administration.                  Health Sciences Center--New
                                                                    Orleans, LA for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Loveland Fire Rescue Authority,       500,000
 Services                          Administration.                  Loveland, CO for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Lower Bucks Hospital, Bristol,      1,200,000
 Services                          Administration.                  PA for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Lower Elwha Tribal Community,       1,911,875
 Services                          Administration.                  Port Angeles, WA for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    LTSC Community Development          1,000,000
 Services                          Administration.                  Corporation, Los Angeles, CA
                                                                    for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Lynn Community Health Center,       1,000,000
 Services                          Administration.                  Lynn, MA for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Madison County Fiscal Court,          390,000
 Services                          Administration.                  Richmond, KY for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Main Line Hospitals, Inc.,          1,000,000
 Services                          Administration.                  Radnor, PA for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Maine Department of Defense,        3,000,000
 Services                          Administration.                  Veterans and Emergency
                                                                    Management, Augusta, ME for
                                                                    facilities and equipment, and
                                                                    operational costs for a rural
                                                                    health project.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    MaineHealth dba Western Maine       1,642,000
 Services                          Administration.                  Health/Stephens Memorial
                                                                    Hospital, Norway, ME for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Makah Indian Tribe, Neah Bay,       3,000,000
 Services                          Administration.                  WA for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Marian Regional Medical Center,     1,000,000
 Services                          Administration.                  Santa Maria, CA for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Marshall University Research        3,000,000
 Services                          Administration.                  Corporation, Huntington, WV
                                                                    for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Mary Free Bed Rehabilitation        3,000,000
 Services                          Administration.                  Hospital, Grand Rapids, MI for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Matthew Walker Comprehensive          480,000
 Services                          Administration.                  Health Center Inc., Nashville,
                                                                    TN for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    McLaren Central Michigan, Grand       850,000
 Services                          Administration.                  Blanc, MI for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    MedStar Curtis National Hand        1,500,000
 Services                          Administration.                  Center, Baltimore, MD for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    MedStar St. Mary's Hospital,          975,000
 Services                          Administration.                  Leonardtown, MD for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Melvin & Claire Levine Jewish         825,000
 Services                          Administration.                  Residential and Family
                                                                    Service, West Palm Beach, FL
                                                                    for facilities.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Metropolitan Government of          2,200,000
 Services                          Administration.                  Nashville and Davidson County,
                                                                    Nashville, TN for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Mid-Coast Health Net Inc. dba       2,105,000
 Services                          Administration.                  Knox Clinic, Rockland, ME for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Mid-State Health Center,              750,000
 Services                          Administration.                  Plymouth, NH for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Mid-Valley Healthcare, Inc.,        1,000,000
 Services                          Administration.                  Lebanon, OR for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Milwaukee Health Services,          2,983,000
 Services                          Administration.                  Inc., Milwaukee, WI for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Molokai Community Health            1,664,000
 Services                          Administration.                  Center, Kaunakakai, HI for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Morehead State University,          3,000,000
 Services                          Administration.                  Morehead, KY for equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Morehouse School of Medicine,         950,000
 Services                          Administration.                  Atlanta, GA for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    MossRehab-Albert Einstein             210,000
 Services                          Administration.                  Healthcare Network, Elkins
                                                                    Park, PA for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Mount Sinai Hospital, Chicago,      2,000,000
 Services                          Administration.                  IL for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Mountain Park Health Center,        3,000,000
 Services                          Administration.                  Phoenix, AZ for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    MRIGlobal, Kansas City, MO for      1,000,000
 Services                          Administration.                  facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    MyMichigan Medical Center           2,000,000
 Services                          Administration.                  Midland, Midland, MI for
                                                                    facilities.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Native American Community           1,000,000
 Services                          Administration.                  Clinic, Minneapolis, MN for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Native American Health Center,      1,000,000
 Services                          Administration.                  Inc., Oakland, CA for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    NATIVE HEALTH, Inc., Phoenix,         650,000
 Services                          Administration.                  AZ for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Natrona County, Casper, WY for      1,500,000
 Services                          Administration.                  facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Navajo Nation Division of           3,000,000
 Services                          Administration.                  Social Services, Window Rock,
                                                                    AZ for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Navajo Nation Division of           2,000,000
 Services                          Administration.                  Social Services, Window Rock,
                                                                    AZ for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Near North Health Service           2,000,000
 Services                          Administration.                  Corporation, Chicago, IL for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Nehalem Bay Health District,        1,000,000
 Services                          Administration.                  Wheeler, OR for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Neighborhood Health Association     1,000,000
 Services                          Administration.                  of Toledo, Inc., Toledo, OH
                                                                    for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Neighborhood Healthcare Inc,          575,000
 Services                          Administration.                  Menifee, CA for equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Neighborhood Medical Center,        1,650,000
 Services                          Administration.                  Incorporated, Tallahassee, FL
                                                                    for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    New Destiny Treatment Center,       1,500,000
 Services                          Administration.                  Clinton, OH for facilities.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    New Directions for Youth, Inc.,     1,000,000
 Services                          Administration.                  North Hollywood, CA for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    New England College, Henniker,      2,000,000
 Services                          Administration.                  NH for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    New Paths, Inc., Flint, MI for      1,000,000
 Services                          Administration.                  facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    New York City Health and            3,000,000
 Services                          Administration.                  Hospitals--Lincoln Medical and
                                                                    Mental Health Center, Bronx,
                                                                    NY for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    New York City Health and            2,000,000
 Services                          Administration.                  Hospitals Corporation, New
                                                                    York, NY for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    New York City Health and            1,000,000
 Services                          Administration.                  Hospitals/Elmhurst, Queens, NY
                                                                    for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    New York Community Hospital,        2,200,000
 Services                          Administration.                  Brooklyn, NY for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    New York Medical College,           1,900,000
 Services                          Administration.                  Valhalla, NY for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Newark Community Health             1,000,000
 Services                          Administration.                  Centers, Inc. , Newark, NJ for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Newport County Community Mental     1,000,000
 Services                          Administration.                  Health Center Inc.,
                                                                    Middletown, RI for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Next Steps of O'Connor                645,695
 Services                          Administration.                  Foundation dba Next Steps
                                                                    Chicago, Chicago, IL for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    NextStep Orlando, Inc.,               533,499
 Services                          Administration.                  Altamonte Springs, FL for
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Nicholas H. Noyes Memorial          1,500,000
 Services                          Administration.                  Hospital, Dansville, NY for
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Niscasa, Round Lake, IL for         2,100,000
 Services                          Administration.                  facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    North Broward Hospital District     3,000,000
 Services                          Administration.                  dba Broward Health, Fort
                                                                    Lauderdale, FL for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    North Carolina Central                643,750
 Services                          Administration.                  University, Durham, NC for
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    North Central Michigan College,     2,000,000
 Services                          Administration.                  Petoskey, MI for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    North Memorial Health Care,         1,000,000
 Services                          Administration.                  Robbinsdale, MN for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Northeast Iowa Community              375,000
 Services                          Administration.                  College, Peosta, IA for
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Northeast Valley Health             1,655,000
 Services                          Administration.                  Corporation, San Fernando, CA
                                                                    for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Northern Marianas College,          1,000,000
 Services                          Administration.                  Saipan, NP for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Northern Nevada HOPES, Reno, NV     2,000,000
 Services                          Administration.                  for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Northwest Indian College,           2,000,000
 Services                          Administration.                  Bellingham, WA for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Northwest Medical Foundation        1,000,000
 Services                          Administration.                  Tillamook, OR for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Northwest Technical Institute,      2,000,000
 Services                          Administration.                  Springdale, AR for facilities.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    NYU Langone Health, New York,       2,000,000
 Services                          Administration.                  NY for equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Odyssey House Louisiana Inc.,       1,000,000
 Services                          Administration.                  New Orleans, LA for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Oklahoma Blood Institute,           1,250,000
 Services                          Administration.                  Oklahoma City, OK for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Oklahoma Medical Research           1,755,000
 Services                          Administration.                  Foundation, Oklahoma City, OK
                                                                    for equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Oklahoma Medical Research           2,000,000
 Services                          Administration.                  Foundation, Oklahoma City, OK
                                                                    for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Olathe Fire Department                660,000
 Services                          Administration.                  Administration, Olathe, KS for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    OLE Health, Napa, CA for            1,796,139
 Services                          Administration.                  equipment, for an electronic
                                                                    health records initiative.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Oneida Health Systems Inc.,         1,000,000
 Services                          Administration.                  Oneida, NY for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Orange County Board of County         239,059
 Services                          Administration.                  Commissioners, Orlando, FL for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Orange County Health Authority      2,000,000
 Services                          Administration.                  (dba CalOptima), Orange, CA
                                                                    for equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Orange County Health Authority,     1,000,000
 Services                          Administration.                  Orange, CA for a health
                                                                    information technology
                                                                    initiative.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Oregon Association of Relief        5,055,844
 Services                          Administration.                  Nurseries, Newberg, OR for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Oregon Health & Science               800,000
 Services                          Administration.                  University, Portland, OR for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Ozark Tri-County Healthcare         1,500,000
 Services                          Administration.                  Consortium, DBA ACCESS Family
                                                                    Care, Neosho, MO for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Park West Health System,            1,000,000
 Services                          Administration.                  Baltimore, MD for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Parkland College, Champaign, IL       320,000
 Services                          Administration.                  for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    People Coordinated Services of      1,162,000
 Services                          Administration.                  Southern California, Los
                                                                    Angeles, CA for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    People's Community Clinic,            850,000
 Services                          Administration.                  Austin, TX for an electronic
                                                                    health records initiative.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Personal Enrichment through         2,000,000
 Services                          Administration.                  Mental Health Services, Inc.,
                                                                    Pinellas Park, FL for
                                                                    facilities.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Perspectives Inc., St. Louis        3,000,000
 Services                          Administration.                  Park, MN for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Pikeville Medical Center, Inc.,     3,000,000
 Services                          Administration.                  Pikeville, KY for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Plymouth Housing, Seattle, WA       1,000,000
 Services                          Administration.                  for equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Portsmouth Community Health           807,137
 Services                          Administration.                  Center, Inc., dba Hampton
                                                                    Roads Community Health Center,
                                                                    Portsmouth, VA for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Potomac Valley Hospital,            1,100,000
 Services                          Administration.                  Keyser, WV for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Power4STL, St. Louis, MO for        3,000,000
 Services                          Administration.                  facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Presbyterian Hospital DBA             216,200
 Services                          Administration.                  Novant Health Presbyterian
                                                                    Medical Center, Charlotte, NC
                                                                    for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Presbyterian Villages of              140,000
 Services                          Administration.                  Michigan, Southfield, MI for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Presbyterian Villages of              115,000
 Services                          Administration.                  Michigan, Southfield, MI for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Primary Care Health Services,       2,200,000
 Services                          Administration.                  Inc., Pittsburgh, PA for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Prince William County               2,000,000
 Services                          Administration.                  Government, Prince William, VA
                                                                    for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Project Angel Food, Los               913,500
 Services                          Administration.                  Angeles, CA for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Promise Fund of Florida, Inc.,        900,100
 Services                          Administration.                  Palm Beach, FL for equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Promise Fund of Florida, Inc.,        894,100
 Services                          Administration.                  Palm Beach, FL for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Promise Fund of Florida, Inc.,        951,500
 Services                          Administration.                  Palm Beach, FL for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Providence Holy Cross Medical         750,000
 Services                          Administration.                  Center, Mission Hills, CA for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Rappahannock Area Health              400,000
 Services                          Administration.                  District, Fredericksburg, VA
                                                                    for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Rappahannock-Rapidan Community      1,000,000
 Services                          Administration.                  Services, Culpeper, VA for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Red Oak Behavioral Health,          2,000,000
 Services                          Administration.                  Akron, OH for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Redwoods Rural Health Center,         775,000
 Services                          Administration.                  Redway, CA for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Regional One Health, Memphis,       2,000,000
 Services                          Administration.                  TN for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Research Institute at               1,000,000
 Services                          Administration.                  Nationwide Children's
                                                                    Hospital, Columbus, OH for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Resources for Human                 1,000,000
 Services                          Administration.                  Development, Philadelphia, PA
                                                                    for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Riverside Community Health          2,000,000
 Services                          Administration.                  Foundation, Riverside, CA for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Riverside Medical Center,           1,000,000
 Services                          Administration.                  Kankakee, IL for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Roanoke Chowan Community Health     1,300,000
 Services                          Administration.                  Center, Ahoskie, NC for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Roanoke College, Salem, VA for        505,000
 Services                          Administration.                  equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Rockland Community College,         3,000,000
 Services                          Administration.                  Suffern, NY for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Roxbury Volunteer Emergency           257,000
 Services                          Administration.                  Services, Inc., New York, NY
                                                                    for equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Rutgers Biomedical and Health         950,650
 Services                          Administration.                  Sciences, Newark, NJ for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Sacramento Native American          1,000,000
 Services                          Administration.                  Health Center, Sacramento, CA
                                                                    for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Saint Anselm College,               2,200,000
 Services                          Administration.                  Manchester, NH for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Saint Anthony Hospital,             1,000,000
 Services                          Administration.                  Chicago, IL for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Saint Francis University,             500,000
 Services                          Administration.                  Loretto, PA for equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Saint Xavier University,              106,885
 Services                          Administration.                  Chicago, IL for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    San Francisco Community Clinic      2,200,000
 Services                          Administration.                  Consortium, San Francisco, CA
                                                                    for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    San Gorgonio Memorial Hospital,       452,000
 Services                          Administration.                  Banning, CA for equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    San Joaquin Health Centers,         1,810,929
 Services                          Administration.                  Stockton, CA for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    San Juan County, Monticello, UT       515,000
 Services                          Administration.                  for cancer screening.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Sea Mar Community Health            2,200,000
 Services                          Administration.                  Centers, Seattle, WA for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Seattle Indian Health Board,        3,000,000
 Services                          Administration.                  Seattle, WA for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Self Help Movement, Inc.,           1,500,000
 Services                          Administration.                  Philadelphia, PA for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Seton Hall University, South        1,140,000
 Services                          Administration.                  Orange, NJ for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Shands Jacksonville Medical         2,000,000
 Services                          Administration.                  Center, Inc., Jacksonville, FL
                                                                    for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Shepherd's Hope, Winter Park,         395,500
 Services                          Administration.                  FL for facilities and
                                                                    equipment, including equipment
                                                                    related to telehealth.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Siena College, Loudonville, NY        496,541
 Services                          Administration.                  for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Sight For All United,                 550,000
 Services                          Administration.                  Struthers, OH for equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Sinclair Community College,         2,000,000
 Services                          Administration.                  Dayton, OH for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Singing River Health System,        2,800,000
 Services                          Administration.                  Ocean Springs, MS for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Siskin Hospital for Physical        2,500,000
 Services                          Administration.                  Rehabilitation, Inc.,
                                                                    Chattanooga, TN for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Sisters of Charity Hospital of      2,377,172
 Services                          Administration.                  Buffalo, New York,
                                                                    Cheektowaga, NY for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Solano County Public Health         1,000,000
 Services                          Administration.                  Department's Family Health
                                                                    Services, Fairfield, CA for an
                                                                    electronic health records
                                                                    initiative.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    South Boston Community Health       2,000,000
 Services                          Administration.                  Center, Inc., South Boston, MA
                                                                    for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    South Central Family Health           707,414
 Services                          Administration.                  Center, Cudahy, CA for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    South Shore Hospital                2,000,000
 Services                          Administration.                  Corporation, Chicago, IL for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    South Ward Alliance dba South       2,000,000
 Services                          Administration.                  Ward Promise Neighborhood,
                                                                    Newark, NJ for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Southeast Council on Alcoholism       915,000
 Services                          Administration.                  and Drug Dependence, Inc.,
                                                                    Lebanon, CT for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Southwest Community Health          2,000,000
 Services                          Administration.                  Center, Inc., Bridgeport, CT
                                                                    for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Southwestern Vermont Medical          250,000
 Services                          Administration.                  Center, Bennington, VT for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    SSM Health--St. Mary's              1,000,000
 Services                          Administration.                  Hospital--St. Louis, MO for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    St. Catherine Hospital, Inc.,       1,500,000
 Services                          Administration.                  East Chicago, IN for equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    St. Francis Medical Center,         2,000,000
 Services                          Administration.                  Monroe, LA for equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    St. John's Episcopal Hospital,      3,000,000
 Services                          Administration.                  Episcopal Health Services
                                                                    Inc., Far Rockaway, NY for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    St. John's Riverside Hospital,      1,000,000
 Services                          Administration.                  Yonkers, NY for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    St. Joseph Regional Health          1,000,000
 Services                          Administration.                  Network, Reading, PA for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    St. Joseph's Medical Center,        4,000,000
 Services                          Administration.                  Stockton, CA for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    State University of New York          900,000
 Services                          Administration.                  Upstate Medical University,
                                                                    Syracuse, NY for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Stockbridge Community Schools,      2,500,000
 Services                          Administration.                  Stockbridge, MI for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Sun River Health, Inc. dba          2,000,000
 Services                          Administration.                  Hudson River HealthCare,
                                                                    Peekskill, NY for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Sun River Health, Peekskill, NY     1,800,000
 Services                          Administration.                  for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Susannah's House, Inc.,               500,000
 Services                          Administration.                  Knoxville, TN for facilities.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    TCC Family Health, Long Beach,        375,000
 Services                          Administration.                  CA for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Tennyson Center for Children,       1,000,000
 Services                          Administration.                  Denver, CO for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Texas A&M University College of       940,000
 Services                          Administration.                  Dentistry, Dallas, TX for an
                                                                    oral health care initiative.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Texas A&M University- San           1,945,000
 Services                          Administration.                  Antonio, San Antonio, TX for
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Texas Children's Hospital,          2,000,000
 Services                          Administration.                  Houston, TX for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Texas Tech University Health        2,600,000
 Services                          Administration.                  Science Center (TTUHSC)
                                                                    Odessa, Odessa, TX for
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Texas Tech University Health        3,000,000
 Services                          Administration.                  Sciences Center El Paso, TX
                                                                    for an initiative related to
                                                                    health information technology
                                                                    and telehealth.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Texas Tech University Health        2,000,000
 Services                          Administration.                  Sciences Center, Dallas, TX
                                                                    for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    The Floating Hospital, Inc.,        1,040,489
 Services                          Administration.                  Long Island City, NY for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    The Foodbank, Inc., Dayton, OH      2,000,000
 Services                          Administration.                  for facilities.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    The Good Samaritan Hospital of        590,000
 Services                          Administration.                  Cincinnati, OH for equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    TidalHealth Nanticoke, Seaford,     1,000,000
 Services                          Administration.                  DE for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Town of Geraldine, AL for             375,000
 Services                          Administration.                  facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Township of Brick, NJ for             250,000
 Services                          Administration.                  facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Township of Edison, NJ for          3,000,000
 Services                          Administration.                  facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Township of Mount Olive, Budd       1,982,500
 Services                          Administration.                  Lake, NJ for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Tri-Area Community Health,            600,000
 Services                          Administration.                  Laurel Fork, VA for facilities.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Trinity Health System,              2,000,000
 Services                          Administration.                  Steubenville, OH for equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Tri-State Memorial Hospital,        2,500,000
 Services                          Administration.                  Clarkston, WA for equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Tucson Indian Center, Tucson,         588,059
 Services                          Administration.                  AZ for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    UMass Memorial Health--               450,000
 Services                          Administration.                  HealthAlliance--Clinton
                                                                    Hospital, Leominster, MA for
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    UMass Memorial Medical Center,      1,000,000
 Services                          Administration.                  Worcester, MA for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Union Community Health Center,        675,000
 Services                          Administration.                  Inc., Bronx, NY for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    United Neighborhood Health            750,000
 Services                          Administration.                  Services dba Neighborhood
                                                                    Health, Nashville, TN for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    University at Buffalo, NY for         933,800
 Services                          Administration.                  facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    University Community Health         2,000,000
 Services                          Administration.                  Services, Inc., Nashville, TN
                                                                    for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    University Health System (UHS)      1,250,000
 Services                          Administration.                  d/b/a University of Tennessee
                                                                    Medical Center, Knoxville, TN
                                                                    for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    University Health System (UHS)        750,000
 Services                          Administration.                  d/b/a University of Tennessee
                                                                    Medical Center, Knoxville, TN
                                                                    for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    University Health System (UHS),     1,000,000
 Services                          Administration.                  d/b/a/ University of Tennessee
                                                                    Medical Center, Knoxville, TN
                                                                    for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    University Hospital, Newark, NJ     3,000,000
 Services                          Administration.                  for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    University Hospitals Cleveland        855,000
 Services                          Administration.                  Medical Center, Cleveland, OH
                                                                    for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    University Hospitals,               1,145,520
 Services                          Administration.                  Cleveland, OH for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    University Hospitals,               1,500,000
 Services                          Administration.                  Cleveland, OH for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    University Muslim Medical             158,000
 Services                          Administration.                  Association Inc. (UMMA
                                                                    Community Clinic), Huntington
                                                                    Park, CA for equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    University of California, San       1,095,000
 Services                          Administration.                  Diego, La Jolla, CA for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    University of Hawaii--Office of     1,000,000
 Services                          Administration.                  Strategic Health Initiatives,
                                                                    Honolulu, HI for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    University of Kansas Medical        2,594,226
 Services                          Administration.                  Center, Kansas City, KS for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    University of Kansas Medical        2,956,507
 Services                          Administration.                  Center, Kansas City, KS for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    University of Kansas Medical        1,000,000
 Services                          Administration.                  Center, Kansas City, KS for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    University of Louisville, KY        2,000,000
 Services                          Administration.                  for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    University of Massachusetts         3,000,000
 Services                          Administration.                  Boston, MA for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    University of Miami Leonard M.        500,000
 Services                          Administration.                  Miller School of Medicine,
                                                                    Miami, FL for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    University of Miami, Miami, FL        800,000
 Services                          Administration.                  for equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    University of Mississippi           2,000,000
 Services                          Administration.                  Medical Center, Jackson, MS
                                                                    for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    University of Nevada Las Vegas,     1,000,000
 Services                          Administration.                  NV for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    University of Rochester, NY for     1,000,000
 Services                          Administration.                  facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    University of South Alabama,        1,500,000
 Services                          Administration.                  Mobile, AL for equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    University of South Florida,        2,000,000
 Services                          Administration.                  Sarasota, FL for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    University of South Florida,        1,000,000
 Services                          Administration.                  Tampa, FL for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    University of Texas at Dallas,      1,500,000
 Services                          Administration.                  Richardson, TX for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    University of Texas Health          1,000,000
 Services                          Administration.                  Science Center at Houston, TX
                                                                    for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    University of Texas Health          1,000,000
 Services                          Administration.                  Science Center at San Antonio,
                                                                    TX for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    University of Texas Rio Grande      1,000,000
 Services                          Administration.                  Valley, Edinburg, TX for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    University of Texas School of       1,000,000
 Services                          Administration.                  Public Health San Antonio, TX
                                                                    for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    University of Texas                 1,500,000
 Services                          Administration.                  Southwestern Medical Center,
                                                                    Dallas, TX for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    University of Toledo, OH for        1,000,000
 Services                          Administration.                  equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    University of Utah, Salt Lake       3,000,000
 Services                          Administration.                  City, UT for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    University of Wisconsin-            1,000,000
 Services                          Administration.                  Madison, WI for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    UPMC Altoona, Altoona, PA for         250,000
 Services                          Administration.                  facilities.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Urban Health Plan, Inc., Bronx,     2,106,950
 Services                          Administration.                  NY for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Urban Health Plan, Inc.,            3,000,000
 Services                          Administration.                  Corona, NY for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Valley Health Services, Inc.,       2,000,000
 Services                          Administration.                  Herkimer, NY for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Valley Health System,               1,500,000
 Services                          Administration.                  Winchester, VA for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Valley Hospital, Ridgewood, NJ        608,860
 Services                          Administration.                  for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Valparaiso University,              1,000,000
 Services                          Administration.                  Valparaiso, IN for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Van Buren County Hospital,          1,845,000
 Services                          Administration.                  Keosauqua, IA for equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Variety Care, Inc., Oklahoma        3,000,000
 Services                          Administration.                  City, OK for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Variety Children's Hospital DBA       450,000
 Services                          Administration.                  Nicklaus Children's Hospital,
                                                                    Miami, FL for equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Variety Children's Hospital DBA     1,000,000
 Services                          Administration.                  Nicklaus Children's Hospital,
                                                                    Miami, FL for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Venice Family Clinic, Venice,         500,000
 Services                          Administration.                  CA for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Vera French Community Mental        1,885,000
 Services                          Administration.                  Health Center, Davenport, IA
                                                                    for facilities.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Via Care Community Health             389,000
 Services                          Administration.                  Center, East Los Angeles, CA
                                                                    for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    View Point Health,                    900,000
 Services                          Administration.                  Lawrenceville, GA for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Virgin Islands Diabetes Center        995,000
 Services                          Administration.                  of Excellence, St. Croix, VI
                                                                    for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Virgin Islands Fire Services,       1,897,000
 Services                          Administration.                  St. Thomas, VI for equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Virtua Health, Camden, NJ for       2,000,000
 Services                          Administration.                  facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Virtua Health, Inc., Marlton,       1,000,000
 Services                          Administration.                  NJ for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Vision Urbana, Inc., New York,      1,000,000
 Services                          Administration.                  NY for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    VNA Health Care, Aurora, IL for       500,000
 Services                          Administration.                  facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    W.A. Foote Memorial Hospital,         310,000
 Services                          Administration.                  Inc., Jackson, MI for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Waimanalo Health Center,            2,000,000
 Services                          Administration.                  Waimanalo, HI for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    WakeMed Health & Hospitals,         6,000,000
 Services                          Administration.                  Raleigh, NC for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Washington County Healthcare        1,845,000
 Services                          Administration.                  Authority, INC dba Washington
                                                                    County Hospital and Nursing
                                                                    Home, Chatom, AL for
                                                                    facilities.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Watts Healthcare Corporation,       2,000,000
 Services                          Administration.                  Los Angeles, CA for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Wayside House, Inc., Delray         1,000,000
 Services                          Administration.                  Beach, FL for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Weber State University, Ogden,      1,500,000
 Services                          Administration.                  UT for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    West County Health Centers,           901,575
 Services                          Administration.                  Inc., Guerneville, CA for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    West Virginia School of               325,000
 Services                          Administration.                  Osteopathic Medicine,
                                                                    Lewisburg, WV for facilities.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Westchester Sickle Cell               500,000
 Services                          Administration.                  Outreach, Inc., White Plains,
                                                                    NY for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Western Nevada College, Carson      2,000,000
 Services                          Administration.                  City, NV for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    White Memorial Community Health     1,000,000
 Services                          Administration.                  Center, Los Angeles, CA for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Whitman County Public Hospital      3,000,000
 Services                          Administration.                  District Number 1-A, Pullman,
                                                                    WA for an electronic health
                                                                    records initiative.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Whitman-Walker Health,                250,000
 Services                          Administration.                  Washington, DC for equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Wilmington Community Clinic,          200,000
 Services                          Administration.                  Wilmington, CA for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Wilson Community College,           3,000,000
 Services                          Administration.                  Wilson, NC for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    WINGS Program, Inc., Rolling          200,000
 Services                          Administration.                  Meadows, IL for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Winston-Salem State University,     1,342,840
 Services                          Administration.                  Winston-Salem, NC for
                                                                    facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Wintersville Volunteer Fire           110,000
 Services                          Administration.                  Department, Wintersville, OH
                                                                    for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Worry Free Community, Glendale        144,800
 Services                          Administration.                  Heights, IL for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Worry Free Community, Glendale      1,000,000
 Services                          Administration.                  Heights, IL for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    Wyckoff Heights Medical Center,     2,000,000
 Services                          Administration.                  Brooklyn, NY for facilities
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Health Resources and Services    YMCA of Central Florida,            1,000,000
 Services                          Administration.                  Orlando, FL for facilities and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  A Safe Haven Foundation,            2,000,000
 Services                          Services Administration.         Chicago, IL for behavioral
                                                                    health, substance use
                                                                    disorder, and peer support
                                                                    services, including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  AABR, Inc., College Point, NY         382,174
 Services                          Services Administration.         for behavioral health services
                                                                    and training, including
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  AboutFace-USA, Inc., Cumming,       1,280,000
 Services                          Services Administration.         GA for mental health treatment
                                                                    and services for veterans,
                                                                    including equipment and
                                                                    wraparound services.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Alliance for Healthy                  800,000
 Services                          Services Administration.         Communities, Inc., New Port
                                                                    Richey, FL for a substance use
                                                                    prevention, treatment, and
                                                                    recovery services, and
                                                                    resources center, including
                                                                    the purchase of equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Amistad, Inc., Portland, ME for       535,000
 Services                          Services Administration.         behavioral health services and
                                                                    recovery housing.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Anaheim Community Foundation,       1,000,000
 Services                          Services Administration.         Anaheim, CA for mental health
                                                                    and related support services.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Apna Ghar, Chicago, IL for a          300,000
 Services                          Services Administration.         mobile mental health advocacy
                                                                    unit, including training.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Arab-American Family Support        1,800,453
 Services                          Services Administration.         Center, Brooklyn, NY for
                                                                    mental health services,
                                                                    including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Ashley Addiction Treatment            420,000
 Services                          Services Administration.         Center, Havre de Grace, MD for
                                                                    behavioral health services and
                                                                    youth education programs.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Asian Health Services, Oakland,     1,000,000
 Services                          Services Administration.         CA for mental health and
                                                                    wraparound services.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Bay Area Community Health, San      1,000,000
 Services                          Services Administration.         Jose, CA for behavioral health
                                                                    services.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Baylor College of Medicine,         1,000,000
 Services                          Services Administration.         Houston, TX for substance use
                                                                    disorder services and
                                                                    treatment for people
                                                                    experiencing homelessness.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Baylor College of Medicine,         1,200,000
 Services                          Services Administration.         Houston, TX to provide
                                                                    substance use disorder
                                                                    services and treatment,
                                                                    including minor facility
                                                                    repairs, improvements, and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Beit T'Shuvah, Los Angeles, CA        301,649
 Services                          Services Administration.         for behavioral health,
                                                                    recovery, and other supportive
                                                                    services.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Boys & Girls Clubs of Delaware,       250,000
 Services                          Services Administration.         Wilmington, DE for mental
                                                                    health and supportive services.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Boys & Girls Clubs of the           1,000,000
 Services                          Services Administration.         Valley, Phoenix, AZ for the
                                                                    Whole Child Approach Program
                                                                    to provide mental health and
                                                                    other supportive services for
                                                                    children.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  BPSOS Center for Community            300,000
 Services                          Services Administration.         Advancement, Westminster, CA
                                                                    for behavioral health services
                                                                    and training.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Cenikor Foundation, Waco, TX          640,000
 Services                          Services Administration.         for a substance use treatment
                                                                    and recovery program,
                                                                    including behavioral health
                                                                    services and support services.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Champions In Service, Pacoima,        722,223
 Services                          Services Administration.         CA for mental health and
                                                                    supportive services.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Child and Family Agency of            693,437
 Services                          Services Administration.         Southeastern CT, Inc., New
                                                                    London, CT for mental health
                                                                    and related services for
                                                                    youth, including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Children's Health Clinical            915,000
 Services                          Services Administration.         Operations, Dallas, TX for
                                                                    training, education, and
                                                                    pediatric mental health
                                                                    services.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Children's Health Clinical            500,000
 Services                          Services Administration.         Operations, Dallas, TX for
                                                                    youth behavioral health
                                                                    services and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Children's Hospital Colorado,         668,313
 Services                          Services Administration.         Aurora, CO to enhance access
                                                                    to mental health care
                                                                    services, including training.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Children's Hospital of The          1,000,000
 Services                          Services Administration.         King's Daughters, Norfolk, VA
                                                                    for mental health services and
                                                                    treatment, including outreach
                                                                    and programming.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Chinese-American Planning             500,000
 Services                          Services Administration.         Council, Inc., New York, NY
                                                                    for mental health services and
                                                                    treatment, outreach,
                                                                    education, and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  City of Austin, TX for              2,000,420
 Services                          Services Administration.         substance use prevention,
                                                                    awareness, and education
                                                                    activities.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  City of Hermosa Beach, CA for       1,000,000
 Services                          Services Administration.         mobile mental health crisis
                                                                    response teams.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  City of Monroe, WA for mental         480,804
 Services                          Services Administration.         health crisis support
                                                                    services, including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  City of Moreno Valley, CA for       1,000,000
 Services                          Services Administration.         the Homeless to Work program
                                                                    to provide behavioral health
                                                                    services, including equipment
                                                                    and outreach.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  City of Norco, CA for a               800,000
 Services                          Services Administration.         homelessness services program.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  City of North Las Vegas, NV for       875,000
 Services                          Services Administration.         a mental health crisis
                                                                    response unit.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  City of Pasadena, CA for the          900,000
 Services                          Services Administration.         Pasadena Outreach Response
                                                                    Team to provide behavioral
                                                                    health and related services to
                                                                    people experiencing
                                                                    homelessness.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  City of Pittsburg, PA for the       1,000,000
 Services                          Services Administration.         Reaching Out On The Streets
                                                                    (ROOTS) Overdose and Support
                                                                    Teams to provide behavioral
                                                                    health services, including
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  City of San Fernando, CA for          800,000
 Services                          Services Administration.         mental health crisis response
                                                                    services.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  City of Santa Monica, CA for        1,500,000
 Services                          Services Administration.         behavioral health and other
                                                                    supportive services.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Clark County, Nevada, Las           1,709,594
 Services                          Services Administration.         Vegas, NV for behavioral
                                                                    health and other support
                                                                    services.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Community Health Connections,       2,500,000
 Services                          Services Administration.         Inc., Fitchburg, MA for youth
                                                                    mental health services and
                                                                    treatment, including training
                                                                    and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Community Hero Action Group,          450,000
 Services                          Services Administration.         King of Prussia, PA for the
                                                                    Black Health Matters
                                                                    initiative to provide mental
                                                                    health services, and other
                                                                    supportive services.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Community Medical Wellness          2,000,000
 Services                          Services Administration.         Centers, USA, Long Beach, CA
                                                                    for behavioral health and
                                                                    substance use disorder
                                                                    services, including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Compass LGBTQ Youth and Family        523,345
 Services                          Services Administration.         Services, Lake Worth Beach, FL
                                                                    for behavioral health and
                                                                    wraparound services.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Contact Community Services,           135,000
 Services                          Services Administration.         Inc., Syracuse, NY for a
                                                                    crisis call center upgrade,
                                                                    including the purchase of
                                                                    equipment and information
                                                                    technology.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  County of San Diego, CA for         4,480,000
 Services                          Services Administration.         mobile behavioral health
                                                                    crisis response teams.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Court Appointed Special               600,000
 Services                          Services Administration.         Advocates Program, Inc. of
                                                                    Contra Costa, Concord, CA for
                                                                    mental health services for
                                                                    youth and education
                                                                    programming.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Douglas County, Castle Rock, CO       629,970
 Services                          Services Administration.         for mental and behavioral
                                                                    health services and treatment,
                                                                    including technology.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  DuPage County Health                1,000,000
 Services                          Services Administration.         Department, Wheaton, IL for
                                                                    mental health and substance
                                                                    use disorder services.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  East Bay Agency for Children,         477,000
 Services                          Services Administration.         Oakland, CA for student and
                                                                    teacher mental health services
                                                                    and supportive services.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  El Futuro, Inc., Durham, NC for       192,371
 Services                          Services Administration.         mental health training and
                                                                    curriculum development.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  EmblemHealth, Inc., New York,         450,000
 Services                          Services Administration.         NY for mental health services,
                                                                    education, and other related
                                                                    activities.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Emory University, Atlanta, GA         500,000
 Services                          Services Administration.         for a hospital-based violence
                                                                    intervention program to
                                                                    provide behavioral health
                                                                    services and wraparound
                                                                    services.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Family and Children's                 790,817
 Services                          Services Administration.         Association, Garden City, NY
                                                                    for the Senior Safety Net
                                                                    Program to provide behavioral
                                                                    health and wraparound
                                                                    services, including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Family and Children's Center          450,000
 Services                          Services Administration.         Wisconsin, La Crosse, WI to
                                                                    expand behavioral health
                                                                    services, including outreach,
                                                                    education, equipment, and
                                                                    technology.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  FosterHope Sacramento,                600,000
 Services                          Services Administration.         Sacramento, CA for mental
                                                                    health and associated support
                                                                    services.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Friends of the Children-              150,000
 Services                          Services Administration.         Detroit, Detroit, MI for
                                                                    mental health and other
                                                                    supportive services, including
                                                                    training.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  GAAMHA Inc., Gardner, MA for          200,000
 Services                          Services Administration.         behavioral health and
                                                                    supportive services.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  George Mason University,            1,037,519
 Services                          Services Administration.         Fairfax, VA for substance use
                                                                    services, treatment, and
                                                                    associated support services.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  George Mason University,              943,983
 Services                          Services Administration.         Fairfax, VA for youth mental
                                                                    health services, including
                                                                    training and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Grafton City Hospital, Grafton,       995,000
 Services                          Services Administration.         WV for a substance use
                                                                    treatment and recovery
                                                                    program, including the
                                                                    purchase of supplies,
                                                                    equipment, and information
                                                                    technology, and wraparound
                                                                    services.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Harris County Public Health,        1,000,000
 Services                          Services Administration.         Houston, TX for ACCESS Harris
                                                                    to provide behavioral health
                                                                    and wraparound services.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Harris County Public Health,        1,431,174
 Services                          Services Administration.         Houston, TX for behavioral
                                                                    health and supportive services
                                                                    for parents and infants.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Healthier Kids Foundation, San        644,000
 Services                          Services Administration.         Jose, CA for mental and
                                                                    behavioral health services for
                                                                    youth.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Hope for Heroes Horsemanship           70,000
 Services                          Services Administration.         Center, Yelm, WA for suicide
                                                                    prevention and mental health
                                                                    awareness training and
                                                                    treatment programming,
                                                                    including postvention services.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Hope of the Valley Rescue           2,000,000
 Services                          Services Administration.         Mission, North Hills, CA for
                                                                    mental health and substance
                                                                    use disorder services.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Ibn Sina Foundation, Inc.,          1,600,000
 Services                          Services Administration.         Houston, TX for mental health
                                                                    and substance use disorder
                                                                    services and treatment,
                                                                    including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Identity, Inc., Rockville, MD         121,000
 Services                          Services Administration.         for the Encuentros program to
                                                                    provide mental health and
                                                                    supportive services, including
                                                                    curriculum and training.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Indian Health Center of Santa         914,000
 Services                          Services Administration.         Clara Valley, San Jose, CA for
                                                                    behavioral health and
                                                                    wraparound services.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Jewish Adoption and Family Care       250,000
 Services                          Services Administration.         Options, Sunrise, FL for
                                                                    mental health and trauma
                                                                    prevention services.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Julia Dyckman Andrus Memorial,        802,583
 Services                          Services Administration.         Incorporated, Yonkers, NY to
                                                                    expand mental health services,
                                                                    including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  LCH Health and Community              605,000
 Services                          Services Administration.         Services, Oxford, PA for
                                                                    behavioral health services and
                                                                    treatment, including minor
                                                                    facility repairs and
                                                                    improvements.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  LIFE Camp, Inc., Jamaica, NY          800,000
 Services                          Services Administration.         for mental health, grief
                                                                    counseling, and other
                                                                    supportive services.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Loma Linda University Medical         542,597
 Services                          Services Administration.         Center, Loma Linda, CA for a
                                                                    mental health outreach
                                                                    demonstration program.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Long Island Council on                150,000
 Services                          Services Administration.         Alcoholism and Drug
                                                                    Dependence, Inc., Westbury, NY
                                                                    for the Student Assistance
                                                                    Program 2.0 to provide mental
                                                                    health and substance use
                                                                    disorder services.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Long Island Gay and Lesbian           500,000
 Services                          Services Administration.         Youth, Inc., Hauppauge, NY for
                                                                    substance use prevention and
                                                                    mental health services for
                                                                    youth.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Maimonides Medical Center,          1,650,000
 Services                          Services Administration.         Brooklyn, NY for behavioral
                                                                    health services, workforce
                                                                    training, and care
                                                                    coordination.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Massachusetts General Hospital      1,150,000
 Services                          Services Administration.         Center for Immigrant Health,
                                                                    Boston, MA for mental health
                                                                    and supportive services.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Massachusetts General Hospital,     1,000,000
 Services                          Services Administration.         Boston, MA for behavioral
                                                                    health and supportive services
                                                                    for adults and youth.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Mental Health Association,            513,000
 Services                          Services Administration.         Inc., Springfield, MA for
                                                                    mental health services,
                                                                    including technology and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Minnesota Psychiatric                 500,000
 Services                          Services Administration.         Information and Outreach, St.
                                                                    Paul, MN for behavioral health
                                                                    educational materials,
                                                                    training, and peer support
                                                                    services.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Mosaic Georgia, Inc., Duluth,       1,027,200
 Services                          Services Administration.         GA for behavioral health
                                                                    workforce and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Muslim Community and Health           290,000
 Services                          Services Administration.         Center, Milwaukee, WI to
                                                                    expand mental health services,
                                                                    including outreach and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  National Runaway Switchboard,         375,000
 Services                          Services Administration.         Chicago, IL for the Teen
                                                                    Suicide Prevention Line to
                                                                    provide mental health
                                                                    services, including
                                                                    technology, public awareness,
                                                                    training, and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Nevada State College,               1,337,000
 Services                          Services Administration.         Henderson, NV for behavioral
                                                                    health and support services,
                                                                    including technology and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  New Age Services Corporation,         600,000
 Services                          Services Administration.         Chicago, IL to expand
                                                                    substance use disorder and
                                                                    mental health services.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  New Mexico Human Services           2,800,000
 Services                          Services Administration.         Department, Behavioral Health
                                                                    Services Division, Santa Fe,
                                                                    NM for mobile mental health
                                                                    crisis response teams.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Northville Township Police            135,359
 Services                          Services Administration.         Department, Northville, MI to
                                                                    expand mobile crisis response
                                                                    and related services.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  NYC Health + Hospitals/ Jacobi,       845,026
 Services                          Services Administration.         Bronx, NY for the Stand Up to
                                                                    Violence program to provide
                                                                    youth mental health and
                                                                    substance use treatment
                                                                    services, and other support
                                                                    services.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Ohio Fire and Emergency               200,000
 Services                          Services Administration.         Services Foundation,
                                                                    Worthington, OH for a mental
                                                                    health training program.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Oklahoma Children's Hospital,       2,115,000
 Services                          Services Administration.         Oklahoma City, OK for a
                                                                    behavioral health program,
                                                                    including the purchase of
                                                                    equipment and information
                                                                    technology.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Operation New Hope,                   100,000
 Services                          Services Administration.         Jacksonville, FL for mental
                                                                    health services and trainings.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Orange County Asian and Pacific       805,000
 Services                          Services Administration.         Islander Community Alliance,
                                                                    Inc., Garden Grove, CA for
                                                                    mental health and supportive
                                                                    services.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Overdose Lifeline, Inc.,               87,000
 Services                          Services Administration.         Indianapolis, IN for Camp
                                                                    Mariposa-Aaron's Place Youth
                                                                    Prevention Program to provide
                                                                    behavioral health and related
                                                                    services to youth.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Partnership to End Addiction,         293,000
 Services                          Services Administration.         New York, NY for telehealth
                                                                    and mobile behavioral health
                                                                    services, outreach, and
                                                                    awareness activities.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Philadelphia Mural Arts               500,000
 Services                          Services Administration.         Advocates, Philadelphia, PA
                                                                    for behavioral health and
                                                                    other support services.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Pinebrook Family Answers,             197,477
 Services                          Services Administration.         Allentown, PA for suicide
                                                                    prevention and mental health
                                                                    services, including training,
                                                                    technology, and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Polk County, FL for behavioral      1,000,000
 Services                          Services Administration.         health and mobile crisis
                                                                    services.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Primo Center for Women and            800,000
 Services                          Services Administration.         Children, Chicago, IL for
                                                                    trauma-informed behavioral
                                                                    health and other supportive
                                                                    services.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Public Defender Association,        1,500,000
 Services                          Services Administration.         Seattle, WA for behavioral
                                                                    health and wraparound services.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  RefugeeOne, Chicago, IL for           546,859
 Services                          Services Administration.         mental health and recovery
                                                                    support services for refugee
                                                                    communities, including
                                                                    training.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Reimagining Justice Inc.,           1,000,000
 Services                          Services Administration.         Paterson, NJ for mental health
                                                                    and wraparound services.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  San Francisco General Hospital      1,000,000
 Services                          Services Administration.         Foundation, San Francisco, CA
                                                                    for behavioral health programs
                                                                    and services.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  San Gabriel Valley Council of       1,500,000
 Services                          Services Administration.         Governments, Alhambra, CA for
                                                                    mental health crisis response
                                                                    services and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Santa Cruz County Office of         1,000,000
 Services                          Services Administration.         Education, Santa Cruz, CA for
                                                                    behavioral health services and
                                                                    treatment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Sheppard Pratt Health System,       1,500,000
 Services                          Services Administration.         Inc., Baltimore, MD for mental
                                                                    health services and treatment,
                                                                    including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Sheppard Pratt Health System,       1,000,000
 Services                          Services Administration.         Inc., Baltimore, MD for the
                                                                    Zero Suicide Initiative to
                                                                    provide mental health services
                                                                    and treatment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Sheppard Pratt Health System,       1,000,000
 Services                          Services Administration.         Inc., Hagerstown, MD to expand
                                                                    mental health services,
                                                                    including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Stanislaus County Behavioral          711,690
 Services                          Services Administration.         Health and Recovery Services,
                                                                    Modesto, CA to expand mobile
                                                                    behavioral health crisis
                                                                    services.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Temple University--Of The             750,000
 Services                          Services Administration.         Commonwealth System of Higher
                                                                    Education, Philadelphia, PA
                                                                    for mental and behavioral
                                                                    health services to communities
                                                                    in crisis, including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Texas A&M Engineering Extension       500,000
 Services                          Services Administration.         Service, College Station, TX
                                                                    for a mental health program
                                                                    for first responders.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Texas State University, San         1,000,000
 Services                          Services Administration.         Marcos, TX for mental health
                                                                    training, including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  The Beebe Medical Foundation,         381,406
 Services                          Services Administration.         Lewes, DE for a community harm
                                                                    reduction program to provide
                                                                    mental health and substance
                                                                    use disorder services.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  The Center for Great                  500,000
 Services                          Services Administration.         Expectations, Somerset, NJ for
                                                                    mental health services and
                                                                    treatment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  The Centre for Women, Inc.,         1,205,394
 Services                          Services Administration.         Tampa, FL for mental health
                                                                    and related services,
                                                                    including minor facility
                                                                    repairs and improvements.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  The Institute for Family Health       411,381
 Services                          Services Administration.         at 17th Street, New York, NY
                                                                    for substance use disorder
                                                                    services and treatment,
                                                                    including a mobile harm
                                                                    reduction unit.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  The Marion and Aaron Gural JCC,       300,000
 Services                          Services Administration.         Cedarhurst, NY for the
                                                                    Resilient Impactful Sustaining
                                                                    Empowerment Project to provide
                                                                    mental health and supportive
                                                                    services.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  The Nemours Foundation,             1,500,000
 Services                          Services Administration.         Jacksonville, FL for pediatric
                                                                    mental health therapists,
                                                                    trainings, and other support
                                                                    services.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  The Welcome Project PA,               226,500
 Services                          Services Administration.         Hatboro, PA for mental health
                                                                    services, case management,
                                                                    training, and wraparound
                                                                    services.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Turning Point Behavioral Health       650,000
 Services                          Services Administration.         Care Center, Skokie, IL for
                                                                    the Living Room program to
                                                                    provide behavioral health
                                                                    crisis and supportive services.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  UCAN, Chicago, IL for                  95,000
 Services                          Services Administration.         behavioral health and
                                                                    supportive services for youth,
                                                                    including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  United Way of Greater LaPorte         100,000
 Services                          Services Administration.         County, Michigan City, IN for
                                                                    mental health and substance
                                                                    use disorder services,
                                                                    including community outreach
                                                                    and education.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  United Way of Will County,            883,395
 Services                          Services Administration.         Joliet, IL for the Resilient
                                                                    Youth program to provide
                                                                    behavioral health services,
                                                                    including training.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  University of California,           1,509,543
 Services                          Services Administration.         Davis, Sacramento, CA for
                                                                    behavioral health services and
                                                                    treatment, including
                                                                    technology.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  University of North Carolina          230,000
 Services                          Services Administration.         System, Chapel Hill, NC for
                                                                    mental health training and
                                                                    services.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Unlawful Narcotics                  1,400,000
 Services                          Services Administration.         Investigations, Treatment, and
                                                                    Education, Inc., London, KY
                                                                    for a substance use
                                                                    prevention, treatment, and
                                                                    recovery program, including
                                                                    the purchase of equipment and
                                                                    housing assistance, and
                                                                    education programming.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  UTOPIA Washington, Kent, WA for       500,000
 Services                          Services Administration.         mental health and substance
                                                                    use disorder services,
                                                                    including training and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Valley Health System,                 500,000
 Services                          Services Administration.         Winchester, VA for behavioral
                                                                    health training.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Variety Boys and Girls Club of        502,250
 Services                          Services Administration.         Queens, Inc., Astoria, NY for
                                                                    mental health and supportive
                                                                    services, including outreach.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Washington State University,          500,000
 Services                          Services Administration.         Spokane, WA for a mental and
                                                                    behavioral health services
                                                                    program for rural and
                                                                    underserved communities,
                                                                    including student stipends.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Wendt Center for Loss and              94,444
 Services                          Services Administration.         Healing, Washington, DC for
                                                                    behavioral health crisis
                                                                    response services.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Western Michigan University,        1,820,000
 Services                          Services Administration.         Kalamazoo, MI for a mental and
                                                                    behavioral health initiative,
                                                                    including teacher and student
                                                                    stipends.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Wyandotte County Public Health        750,000
 Services                          Services Administration.         Department, Kansas City, KS
                                                                    for mental and behavioral
                                                                    health services, including
                                                                    wraparound services.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  YMCA of Honolulu, HI for the          270,000
 Services                          Services Administration.         Youth Wellness Program for
                                                                    Mental Health to provide
                                                                    mental health services,
                                                                    including equipment and
                                                                    technology.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Youth Shelter Program of            1,600,000
 Services                          Services Administration.         Westchester, Mount Vernon, NY
                                                                    for the YouthHEAL Integrated
                                                                    Network project to provide
                                                                    behavioral health services,
                                                                    including equipment and
                                                                    training.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  Youth Visionaries Youth               733,533
 Services                          Services Administration.         Leadership Academy, San
                                                                    Bernardino, CA for the
                                                                    Empowering Youth Resilience
                                                                    and Promoting Social Emotional
                                                                    Healing project to provide
                                                                    mental health and other
                                                                    wraparound services.
----------------------------------------------------------------------------------------------------------------
Department of Health and Human    Substance Use And Mental Health  YWCA Pierce County, Tacoma, WA        151,000
 Services                          Services Administration.         for behavioral health and
                                                                    supportive services, including
                                                                    training.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Abyssinian Development              1,000,000
                                   Education.                       Corporation, New York, NY for
                                                                    SEL programming and
                                                                    professional development.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Admiral Peary Area Vocational       1,005,000
                                   Education.                       Technical School, Ebensburg,
                                                                    PA for an instructional
                                                                    program, including the
                                                                    purchase of equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Adrienne Arsht Center Trust,          500,000
                                   Education.                       Miami, FL for arts education
                                                                    through theater production and
                                                                    performance.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         American Association of               491,000
                                   Education.                       Caregiving Youth, Boca Raton,
                                                                    FL for supportive services for
                                                                    caregiving youth.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         An Achievable Dream, Newport        1,594,355
                                   Education.                       News, VA for student
                                                                    enrichment and academic
                                                                    support.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Anaheim Union High School           2,000,000
                                   Education.                       District, Anaheim, CA for a
                                                                    theater and performing arts
                                                                    program, including equipment
                                                                    and technology installation.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Austin Independent School           2,015,750
                                   Education.                       District, Austin, TX for
                                                                    outdoor learning experiences,
                                                                    including equipment and
                                                                    furniture for outdoor
                                                                    classrooms and exhibits.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Baldwin Union Free School           3,000,000
                                   Education.                       District, Baldwin, NY for SEL
                                                                    programs.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Beasley-Brown Community             2,280,000
                                   Education.                       Development Corporation, San
                                                                    Antonio, TX for community-
                                                                    based learning centers.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Best Buddies International,           100,000
                                   Education.                       Baltimore, MD for school-based
                                                                    programs that promote
                                                                    inclusion.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Best Buddies International,           100,000
                                   Education.                       Baltimore, MD for school-based
                                                                    programs that promote
                                                                    inclusion.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Best Buddies International,           100,000
                                   Education.                       Houston, TX for inclusion
                                                                    support for students with
                                                                    disabilities.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Big Brothers Big Sisters Lone         250,000
                                   Education.                       Star, Irving, TX for a youth
                                                                    mentoring program.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Big Brothers Big Sisters of         1,000,000
                                   Education.                       Essex, Hudson & Union
                                                                    Counties, Newark, NJ for
                                                                    mentoring and student support.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Big Sister Association of             250,000
                                   Education.                       Greater Boston, MA for student
                                                                    mentoring and enrichment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Big Thought, Dallas, TX for out-    1,000,000
                                   Education.                       of-school learning, digital
                                                                    credentialing, and learning
                                                                    systems.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Birch Family Services, New            201,096
                                   Education.                       York, NY for communication
                                                                    systems for nonverbal children
                                                                    and families.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Black Hawk College, Kewanee, IL     1,000,000
                                   Education.                       for a manufacturing training
                                                                    program, including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Black Spectrum Theatre Co.,         1,275,750
                                   Education.                       Jamaica, NY for an African
                                                                    American history program.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Boys & Girls Club of Monmouth         500,000
                                   Education.                       County, Asbury Park, NJ for
                                                                    trauma-informed interventions
                                                                    to address adverse childhood
                                                                    experiences.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Boys & Girls Clubs of Southern        750,000
                                   Education.                       Nevada, Las Vegas, NV for STEM
                                                                    and SEL programs.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Boys & Girls Clubs of the Los       1,000,000
                                   Education.                       Angeles Harbor, San Pedro, CA
                                                                    for developing a digital
                                                                    program for student support.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Boys and Girls Club of Metro          400,861
                                   Education.                       Atlanta, Chamblee, GA for
                                                                    academic enrichment and
                                                                    tutoring.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Boys and Girls Club of Metro          549,374
                                   Education.                       Denver, CO for afterschool and
                                                                    summer programming.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Boys and Girls Club of Metro        1,212,062
                                   Education.                       Denver, CO for afterschool
                                                                    programs.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Boys and Girls Club of Pharr,       1,753,812
                                   Education.                       TX for equipment and supplies
                                                                    for youth development services.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Boys and Girls Clubs of Benton      1,500,000
                                   Education.                       Harbor, Benton Harbor, MI for
                                                                    educational, mentoring, and
                                                                    tutoring program.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Breakthrough of Greater               500,000
                                   Education.                       Philadelphia, PA for a
                                                                    teaching fellows program.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Bridgewater State University,       1,358,000
                                   Education.                       Bridgewater, MA for an
                                                                    aviation education program.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Bristol Community College, Fall     1,000,000
                                   Education.                       River, MA for workforce
                                                                    education access and credit
                                                                    programs.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Brooklyn Bridge Park                1,025,000
                                   Education.                       Conservancy, Brooklyn, NY for
                                                                    academic enrichment programs.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Broward County Public Schools,        525,000
                                   Education.                       Fort Lauderdale, FL for visual
                                                                    arts and computer science
                                                                    education, including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Cambodia Town, Long Beach, CA          56,950
                                   Education.                       for language access programs.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Cameron Community Ministries,         200,000
                                   Education.                       Rochester, NY for afterschool
                                                                    and summer enrichment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Cape Cod Community College,         1,000,000
                                   Education.                       Barnstable, MA for a dental
                                                                    hygiene program.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Capitol Hill Arts Workshop,           250,000
                                   Education.                       Washington, DC for youth
                                                                    engagement through arts
                                                                    education, including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Career Technical Education            200,000
                                   Education.                       Foundation Sonoma County,
                                                                    Santa Rosa, CA for whole-
                                                                    school transformation efforts.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Catholic Big Brothers and Big         500,000
                                   Education.                       Sisters of Los Angeles, CA for
                                                                    a postsecondary student
                                                                    support program.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Centro Cultural Aztlan, San            95,000
                                   Education.                       Antonio, TX for arts education.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Chapman University, Orange, CA      2,200,000
                                   Education.                       for computational clusters,
                                                                    lab infrastructure, and
                                                                    postsecondary research
                                                                    activities.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Chicago Public Schools,               500,000
                                   Education.                       Chicago, IL for arts
                                                                    education, including equipment
                                                                    and supplies.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Chicago Public Schools,               500,000
                                   Education.                       Chicago, IL for arts
                                                                    education, including equipment
                                                                    and supplies.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Chicago Public Schools,               500,000
                                   Education.                       Chicago, IL for arts
                                                                    education, including equipment
                                                                    and supplies.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Chinese American Social               105,000
                                   Education.                       Services Center, Brooklyn, NY
                                                                    for academic and arts
                                                                    programs, including support
                                                                    for English learners.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         City of Greenacres, FL for          1,000,000
                                   Education.                       youth programs, services, and
                                                                    curricula, including
                                                                    technology.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         City of Indianapolis Department     1,000,000
                                   Education.                       of Parks and Recreation,
                                                                    Indianapolis, IN for an
                                                                    afterschool physical education
                                                                    enrichment program.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         City of Indianapolis Department     1,000,000
                                   Education.                       of Parks and Recreation,
                                                                    Indianapolis, IN for arts and
                                                                    environmental education access
                                                                    in afterschool and summer
                                                                    learning settings.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         City School District of New         2,000,000
                                   Education.                       Rochelle, NY for afterschool
                                                                    programs and summer learning.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Clayton State University,             750,000
                                   Education.                       Morrow, GA for environmental
                                                                    studies research, including
                                                                    equipment and technology.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Clearwater Marine Aquarium,           976,000
                                   Education.                       Clearwater, FL for science
                                                                    education and a mobile
                                                                    classroom, including a vehicle.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Commonwealth of the Northern          311,939
                                   Education.                       Mariana Islands Public School
                                                                    System, Saipan, MP for
                                                                    language immersion curriculum
                                                                    and programming.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Connecticut Historical Society      1,000,000
                                   Education.                       Museum and Library, Hartford,
                                                                    CT for civics education.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         CUNY Dominican Studies                809,092
                                   Education.                       Institute, New York, NY for
                                                                    historical curricula and
                                                                    enrichment programs.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Dance Institute of Washington,      1,000,000
                                   Education.                       DC for arts education and
                                                                    dance training, including
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Dearborn Heights Libraries,           206,000
                                   Education.                       Dearborn Heights, MI for
                                                                    student mobile library
                                                                    services, including a vehicle.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Dr. Carter G. Woodson African       3,000,000
                                   Education.                       American History Museum, St.
                                                                    Petersburg, FL for an African
                                                                    American history program,
                                                                    including technology.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Drew Child Development                143,000
                                   Education.                       Corporation, Lynwood, CA for
                                                                    an early childhood education
                                                                    program, including
                                                                    installation of an outdoor
                                                                    science lab and learning space.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         El Paso Independent School          2,000,000
                                   Education.                       District, El Paso, TX for
                                                                    afterschool enrichment and
                                                                    STEAM education.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Empowering Success Now,               532,500
                                   Education.                       Fontana, CA for afterschool
                                                                    and tutoring programs.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Encompass: Resources for              700,000
                                   Education.                       Learning, Rochester, NY for
                                                                    student academic and
                                                                    wraparound services, including
                                                                    transportation.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         End Hunger Calvert County,            300,000
                                   Education.                       Huntingtown, MD for a pre-
                                                                    apprentice skills program.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Fairfax County, VA for early        1,500,000
                                   Education.                       childhood development and
                                                                    learning.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Fine Arts Work Center in              400,000
                                   Education.                       Provincetown, MA for arts
                                                                    education and cultural
                                                                    programming for community
                                                                    development.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Flint Institute of Science and      1,905,421
                                   Education.                       History, Flint, MI for
                                                                    afterschool programs.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Food Literacy Center,               1,050,000
                                   Education.                       Sacramento, CA for science and
                                                                    nutrition education, including
                                                                    the development of a student
                                                                    garden.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Foundation Communities, Austin,     1,107,925
                                   Education.                       TX for learning center
                                                                    programs, including enrichment
                                                                    and literacy support.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Foundation for the Advancement        750,000
                                   Education.                       of Music & Education, Bowie,
                                                                    MD for music education
                                                                    programs.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Freeport Union Free School            173,923
                                   Education.                       District, Freeport, NY for a
                                                                    college and career center,
                                                                    including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Friendship Foundation, Redondo      1,000,000
                                   Education.                       Beach, CA for inclusive
                                                                    programs for students with
                                                                    disabilities.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Georgia Institute of                  215,000
                                   Education.                       Technology, Atlanta, GA for
                                                                    educational services for
                                                                    children of military families,
                                                                    including the purchase of
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Girl Scouts of Eastern                 70,000
                                   Education.                       Missouri, St. Louis, MO for
                                                                    student mental health and anti-
                                                                    violence programs.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Girl Scouts of Northeast Texas,       920,000
                                   Education.                       Dallas, TX for programming to
                                                                    develop skills and
                                                                    competencies in STEM,
                                                                    leadership development, and
                                                                    financial empowerment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Glen Ellyn School District 41,        250,000
                                   Education.                       Glen Ellyn, IL for school-
                                                                    based mental health services
                                                                    for students and families.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Grand Valley State University,      1,000,000
                                   Education.                       Allendale, MI for a student
                                                                    development program, including
                                                                    the purchase of supplies and
                                                                    student stipends.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Greater New York Councils, Boy         50,000
                                   Education.                       Scouts of America, New York,
                                                                    NY for a youth scouting
                                                                    program.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Guadalupe Cultural Arts Center,       102,250
                                   Education.                       San Antonio, TX for student
                                                                    literacy programs and access
                                                                    to culturally relevant texts.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Guilford County Schools,            2,200,000
                                   Education.                       Greensboro, NC for wraparound
                                                                    services, academic supports,
                                                                    and learning hubs.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Haitian Americans United for          364,558
                                   Education.                       Progress, Hollis, NY for youth
                                                                    leadership and youth workforce
                                                                    programming.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Harris County Public Library,         139,212
                                   Education.                       Houston, TX for student access
                                                                    to texts, including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Hawaii Agriculture Foundation,        372,000
                                   Education.                       Honolulu, HI for STEM programs
                                                                    that incorporate innovative
                                                                    agriculture technologies.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Henry County Board of                  40,000
                                   Education.                       Education, McDonough, GA for
                                                                    afterschool enrichment and
                                                                    STEM education.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Hillsborough County Public          1,986,353
                                   Education.                       Schools, Tampa, FL for arts
                                                                    education.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Hillsborough County Public          1,000,000
                                   Education.                       Schools, Tampa, FL for career
                                                                    and technical education in
                                                                    construction and medical
                                                                    training, including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Hispanic Counseling Center,           128,468
                                   Education.                       Hempstead, NY for afterschool
                                                                    programming.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Holocaust Memorial Center,            605,000
                                   Education.                       Farmington Hills, MI for a
                                                                    Holocaust education program.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Holocaust Memorial Center,            550,000
                                   Education.                       Farmington Hills, MI for a
                                                                    Holocaust education program,
                                                                    including support for English
                                                                    learners and students with
                                                                    disabilities.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Houston Independent School          1,975,000
                                   Education.                       District, Houston, TX for
                                                                    family and community
                                                                    engagement programs for
                                                                    students.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Houston Public Library,             2,000,347
                                   Education.                       Houston, TX for digital
                                                                    literacy resources.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Iowa Jobs for America's               250,000
                                   Education.                       Graduates, Des Moines, IA for
                                                                    career pathways and counseling
                                                                    supports.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Ivy Tech Community College,           500,000
                                   Education.                       Indianapolis, IN for early
                                                                    childhood education programs,
                                                                    including furniture, minor
                                                                    repairs, and classroom
                                                                    upgrades.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Jobs for Arizona's Graduates,         167,700
                                   Education.                       Phoenix, AZ for targeted
                                                                    student support programs.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Kennedy King Memorial                 100,000
                                   Education.                       Initiative, Indianapolis, IN
                                                                    for human rights education.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Kennedy Krieger Institute,          2,000,000
                                   Education.                       Baltimore, MD for services to
                                                                    students with disabilities.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Kula No Na Poe Hawaii,              1,800,000
                                   Education.                       Honolulu, HI for academic
                                                                    supports and wraparound
                                                                    services.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Lenape Regional High School           593,663
                                   Education.                       District, Shamong, NJ for post-
                                                                    graduation student success
                                                                    programs.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Leo High School, Chicago, IL          250,000
                                   Education.                       for a parent engagement
                                                                    center, including equipment
                                                                    and technology.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         LGBT Center of Greater Reading,       113,520
                                   Education.                       PA for wraparound services and
                                                                    support for at-risk youth.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         LIFT, Detroit, MI for a             1,250,000
                                   Education.                       manufacturing technician
                                                                    education program.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Long Beach Day Nursery, Long          250,000
                                   Education.                       Beach, CA for early childhood
                                                                    learning.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Long Beach Latino Civic                50,000
                                   Education.                       Association, Long Beach, NY
                                                                    for student support,
                                                                    mentoring, and enrichment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Massachusetts Women of Color          416,275
                                   Education.                       Coalition, Worcester, MA for a
                                                                    summer learning program.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Michigan's Own, Inc. dba--            215,000
                                   Education.                       Michigan Heroes Museum,
                                                                    Frankenmuth, MI for
                                                                    curriculum, exhibit, website
                                                                    development, and educational
                                                                    programming, including
                                                                    information technology.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Milwaukee Public Library,             241,250
                                   Education.                       Milwaukee, WI for child
                                                                    literacy programs.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Monmouth College, Monmouth, IL        750,000
                                   Education.                       for rural teacher preparation
                                                                    and development.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Museum of Science and Industry,     1,022,000
                                   Education.                       Chicago, IL for STEM
                                                                    education, including teacher
                                                                    stipends.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Museums at Mitchel Doing               75,000
                                   Education.                       Business As Cradle of Aviation
                                                                    Museum, Garden City, NY for
                                                                    STEM education.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         NAACP--Hayward/South Alameda          285,000
                                   Education.                       County, Hayward, CA for a
                                                                    parent engagement and student
                                                                    success program.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         National Aquarium, Baltimore,         401,615
                                   Education.                       MD for STEM education and
                                                                    professional development.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         National Center for Families          500,000
                                   Education.                       Learning, Louisville, KY for a
                                                                    family engagement and
                                                                    immersive technology program.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         National Children's Museum,         1,000,000
                                   Education.                       Washington, DC for student
                                                                    educational exhibits and
                                                                    programming.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         National World War II Museum,       2,000,000
                                   Education.                       New Orleans, LA, for a
                                                                    historical education project,
                                                                    including technology and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         New York Hall of Science,             750,000
                                   Education.                       Corona, NY for science
                                                                    programming for preschool
                                                                    students, including exhibits.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         New York Sun Works, New York,         800,000
                                   Education.                       NY for a hydroponic farm STEM
                                                                    program, including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         New York Sun Works, New York,         800,000
                                   Education.                       NY for hydroponic STEM
                                                                    classrooms, including
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         New York Sun Works, New York,         500,000
                                   Education.                       NY for hydroponic STEM
                                                                    education, including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         NH Jobs for America's                 300,000
                                   Education.                       Graduates, Manchester, NH for
                                                                    programs to develop student
                                                                    academic skills, including
                                                                    supplies and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Norwalk La-Mirada Unified           2,200,000
                                   Education.                       School District, Norwalk, CA
                                                                    for career and technical
                                                                    education pathways, dual
                                                                    enrollment programs, and
                                                                    technology.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Norwalk Public Schools,             1,323,660
                                   Education.                       Norwalk, CT for marine science
                                                                    pathways.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Ontario-Montclair School              272,077
                                   Education.                       District, Ontario, CA for
                                                                    STEAM programs, including
                                                                    equipment and technology.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Open Door Preschools, Austin,         824,900
                                   Education.                       TX for preschool programs,
                                                                    including outdoor learning
                                                                    spaces, and wraparound
                                                                    supports for at-risk families.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Optimist Boys' Home & Ranch,          270,000
                                   Education.                       Inc. dba Optimist Youth Homes
                                                                    & Family Services, Los
                                                                    Angeles, CA for a tutoring
                                                                    program.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Oregon Institute of Technology,       700,000
                                   Education.                       Wilsonville, OR for a
                                                                    healthcare career pathways
                                                                    program.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Orlando Community & Youth             100,000
                                   Education.                       Trust, Orlando, FL for student
                                                                    enrichment through dragon
                                                                    boating.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Pace Center for Girls, Inc.,          500,000
                                   Education.                       Jacksonville, FL for an
                                                                    educational services,
                                                                    counseling, and training
                                                                    program, including the
                                                                    purchase of equipment and
                                                                    information technology.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Pace Center for Girls, Inc.,          500,000
                                   Education.                       Jacksonville, FL for
                                                                    curriculum, technology, and
                                                                    training program, including
                                                                    the purchase of information
                                                                    technology and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Pace Center for Girls,                500,000
                                   Education.                       Jacksonville, FL for
                                                                    curriculum development and
                                                                    support services.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Pace Center for Girls,                500,000
                                   Education.                       Jacksonville, FL for student
                                                                    support programs, including
                                                                    SEL resources and technology.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Pascua Yaqui Tribe, Tucson, AZ        862,813
                                   Education.                       for academic programs,
                                                                    curricula, and teacher
                                                                    development.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Penumbra Theatre, Saint Paul,       1,000,000
                                   Education.                       MN for the development,
                                                                    testing, and implementation of
                                                                    curriculum.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Pima County School                    252,000
                                   Education.                       Superintendent's Office,
                                                                    Tucson, AZ for curricula,
                                                                    resources, and professional
                                                                    development.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Pinellas County Education           1,225,000
                                   Education.                       Foundation, Inc., Largo, FL
                                                                    for an early learning
                                                                    initiative, including teacher
                                                                    stipends.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Providence After School               350,000
                                   Education.                       Alliance, Providence, RI for a
                                                                    summer learning STEAM program.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Research Foundation of the City       191,160
                                   Education.                       University of New York,
                                                                    Brooklyn, NY for a literacy
                                                                    program.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Riverside County Office of          1,000,000
                                   Education.                       Education, Riverside, CA for
                                                                    early childhood education.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Rock and Roll Hall of Fame and      1,000,000
                                   Education.                       Museum, Cleveland, OH for arts
                                                                    education programs.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Roosevelt Union Free School           525,000
                                   Education.                       District, Roosevelt, NY for
                                                                    homework and tutoring support.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         San Diego State University, San       524,972
                                   Education.                       Diego, CA for school-based
                                                                    behavioral health training and
                                                                    supports.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Santa Ana College, Santa Ana,       2,000,000
                                   Education.                       CA for CTE pathways to
                                                                    certificate and degree
                                                                    programs.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Santa Clara County Office of        1,000,000
                                   Education.                       Education, San Jose, CA for
                                                                    student broadband access,
                                                                    including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         School District of Borough of         850,000
                                   Education.                       Morrisville, PA for a
                                                                    curriculum, instruction, and
                                                                    technology program, including
                                                                    the purchase of information
                                                                    technology and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         School District of Osceola            953,000
                                   Education.                       County, FL for a youth
                                                                    entrepreneurship program,
                                                                    including support for student
                                                                    internships, a vehicle, and
                                                                    capital for student businesses.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Seed St. Louis, MO for STEM           380,000
                                   Education.                       education programs.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Seminole County Public Schools,       526,692
                                   Education.                       Sanford, FL for high school
                                                                    health careers programs,
                                                                    including medical equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Shedd Aquarium, Chicago, IL for       595,025
                                   Education.                       STEAM education.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Soulsville Foundation, Memphis,     1,150,000
                                   Education.                       TN for an afterschool music
                                                                    education program.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Soundscapes, Newport News, VA         677,000
                                   Education.                       for expanding access to arts
                                                                    education, including a
                                                                    feasibility study for growth.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         South City Foundation,              2,000,000
                                   Education.                       Tallahassee, FL for an early
                                                                    childhood education program,
                                                                    including technology upgrades.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Southland Career and Technical      1,740,000
                                   Education.                       Education Center, Matteson, IL
                                                                    for classroom design and
                                                                    curricula for career and
                                                                    technical education programs.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Springfield Public Schools,           385,000
                                   Education.                       Springfield, OR for a career
                                                                    and technical cosmetology
                                                                    program, including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         St. Louis Public Schools, St.         252,713
                                   Education.                       Louis, MO for CTE programs in
                                                                    construction trades, including
                                                                    scholarships for technical
                                                                    college programs.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Stars of New York Dance,              500,000
                                   Education.                       Brooklyn, NY for arts
                                                                    education enrichment programs,
                                                                    including student scholarships.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Start Lighthouse, New York, NY        205,500
                                   Education.                       for literacy and learning
                                                                    spaces in schools.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Strategic Human Services,             832,140
                                   Education.                       Chicago, IL for communication
                                                                    and journalism education,
                                                                    including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Tacoma Public School District,        555,000
                                   Education.                       Tacoma, WA for career
                                                                    preparation and internship
                                                                    programs.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         TECH CORPS, Columbus, OH for          300,000
                                   Education.                       computer science education,
                                                                    including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Tennessee Technological               400,000
                                   Education.                       University, Cookeville, TN for
                                                                    lending library programs,
                                                                    including purchase of
                                                                    supplies, information
                                                                    technology, and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Texas A&M University San              300,000
                                   Education.                       Antonio, TX for a mobile unit
                                                                    offering school-based autism
                                                                    services and educational
                                                                    supports.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Texas State University -- Round     1,000,000
                                   Education.                       Rock, Round Rock, TX for a
                                                                    STEM educational and
                                                                    professional development
                                                                    program.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         The Bridge Teen Center, Orland        500,000
                                   Education.                       Park, IL for afterschool
                                                                    programs.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         The Brotherhood Sister Sol, New     1,000,000
                                   Education.                       York, NY for afterschool
                                                                    programs.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         The Center for the Innovative       2,000,000
                                   Education.                       Training of Youth STEM NOLA,
                                                                    New Orleans, LA for STEM
                                                                    learning and career readiness
                                                                    programs, including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         The Garage Community and Youth        100,000
                                   Education.                       Center, Avondale, PA for
                                                                    afterschool youth development
                                                                    programs, including a vehicle.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         The Noel Pointer Foundation,          414,500
                                   Education.                       Brooklyn, NY for music
                                                                    instruction programs,
                                                                    including student scholarships.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         The Regents of the University       1,125,360
                                   Education.                       of California; University of
                                                                    California San Diego, La
                                                                    Jolla, CA for summer math
                                                                    academies.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         The West Virginia Chamber             200,000
                                   Education.                       Foundation Corporation,
                                                                    Charleston, WV for a drop-out
                                                                    prevention and school-to-work
                                                                    transition program.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Toledo Tomorrow, Toledo, OH for     1,050,000
                                   Education.                       an early childhood reading
                                                                    program.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Town of Randolph, MA for mobile       524,000
                                   Education.                       library and STEM programming,
                                                                    including vehicle and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Trumbull County Educational           650,000
                                   Education.                       Service Center, Niles, OH for
                                                                    STEM education, including
                                                                    equipment and technology.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         United Way of Wyoming Valley,       2,200,000
                                   Education.                       Wilkes-Barre, PA for
                                                                    wraparound services and
                                                                    academic supports, including
                                                                    pre-K tuition stipends.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         University of California            1,000,000
                                   Education.                       Berkeley, CA for a social
                                                                    science research and
                                                                    postdoctoral pipeline program.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         University of Connecticut           1,000,000
                                   Education.                       Health Center, Farmington, CT
                                                                    for K-12 STEM education
                                                                    programs.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         University of Mississippi,          1,000,000
                                   Education.                       University, MS for a
                                                                    professional development
                                                                    program and writing initiative.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         University of Nebraska System,      2,000,000
                                   Education.                       Lincoln, NE for a science,
                                                                    technology, engineering, and
                                                                    mathematics program.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         University of Washington              811,061
                                   Education.                       Bothell, WA for pathways
                                                                    toward environment and
                                                                    sustainability degree
                                                                    programs, including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Upper Darby Arts & Education          115,000
                                   Education.                       Foundation, Drexel Hill, PA
                                                                    for creative arts programs for
                                                                    students with disabilities.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Virgin Islands Department of        2,200,000
                                   Education.                       Education, St. Thomas, VI for
                                                                    electric vehicle classes,
                                                                    career and technical college
                                                                    programs, and STEM education.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Washtenaw Community College,        1,000,000
                                   Education.                       Ann Arbor, MI for an electric
                                                                    battery and charging station
                                                                    program, including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Waterbury Public Schools,           2,265,000
                                   Education.                       Waterbury, CT for education
                                                                    technology equipment,
                                                                    including computers.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Watts Labor Community Action          922,000
                                   Education.                       Committee, Los Angeles, CA for
                                                                    afterschool programming and
                                                                    arts education.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Waukegan to College, Waukegan,        315,000
                                   Education.                       IL for mentoring, tutoring,
                                                                    and academic advising programs.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         West Chester University, West         715,770
                                   Education.                       Chester, PA for STEM education
                                                                    programs.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         Winston-Salem/Forsyth County          301,548
                                   Education.                       Schools, Winston-Salem, NC for
                                                                    teacher academy programs.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         YMCA of Greater New York, NY        1,000,000
                                   Education.                       for youth support and
                                                                    enrichment programs.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         YMCA of Memphis and the Mid-        1,000,000
                                   Education.                       South, Cordova, TN for
                                                                    educational programs before
                                                                    and after school.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         YMCA of Metropolitan Chicago,         666,366
                                   Education.                       IL for afterschool programs.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         YMCA of Metropolitan Los            1,500,000
                                   Education.                       Angeles, CA for empowerment
                                                                    learning pods.
----------------------------------------------------------------------------------------------------------------
Department of Education           Elementary and Secondary         YMCA of Metropolitan Los            2,000,000
                                   Education.                       Angeles, Van Nuys, CA for
                                                                    STEAM and civics education.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Adoption Rhode Island,                201,639
                                                                    Providence, RI for an adoption
                                                                    and foster care certificate
                                                                    program, including
                                                                    scholarships and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Agnes Scott College, Decatur,       1,024,940
                                                                    GA for digital skill building
                                                                    programs, including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Albany Technical College,           1,000,000
                                                                    Albany, GA for allied health
                                                                    programs, including equipment,
                                                                    a vehicle, and scholarships.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Aliento Education Fund,               300,000
                                                                    Phoenix, AZ for first-
                                                                    generation college student
                                                                    access and success programs,
                                                                    including scholarships.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  AltaSea at the Port of Los          1,000,000
                                                                    Angeles, San Pedro, CA for
                                                                    postsecondary ocean-based
                                                                    research, including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Alvernia University Reading         2,000,000
                                                                    Collegetowne, Reading, PA for
                                                                    a health science program,
                                                                    including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Alvernia University, Reading,       1,000,000
                                                                    PA for the purchase of
                                                                    information technology and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Angelo State University, San        2,000,000
                                                                    Angelo, TX for equipment,
                                                                    scholarships, and stipends for
                                                                    an aviation degree program.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Aquinas College, Grand Rapids,        185,000
                                                                    MI for a professional
                                                                    development and curriculum
                                                                    development for a teaching
                                                                    center.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Arkansas Tech University,             730,000
                                                                    Russellville, AR for purchase
                                                                    of lab equipment and
                                                                    technology for agricultural
                                                                    education program.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  AUC Consortium, Atlanta, GA for     2,000,000
                                                                    programs promoting career
                                                                    pathways into government
                                                                    service, including
                                                                    scholarships.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Augusta University, Augusta, GA     1,000,000
                                                                    for a telemedicine education
                                                                    initiative, including the
                                                                    purchase of equipment and
                                                                    information technology.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Aurora University, Aurora, IL         955,000
                                                                    for an emerging technologies
                                                                    learning lab, including
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Austin Community College            2,830,000
                                                                    District, Austin, TX for the
                                                                    purchase of equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Austin Community College,           1,467,542
                                                                    Austin, TX for cybersecurity
                                                                    training, including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Austin Independent School           1,862,600
                                                                    District for college and
                                                                    career preparation, including
                                                                    transportation.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Bay Path University,                1,000,000
                                                                    Longmeadow, MA for wraparound
                                                                    academic and student support
                                                                    services.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Baylor University, Waco, TX for     1,500,000
                                                                    a cybersecurity program,
                                                                    including the purchase of
                                                                    equipment and information
                                                                    technology.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Birmingham-Southern College,          500,000
                                                                    Birmingham, AL for
                                                                    experimental learning and
                                                                    civic engagement.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Bluegrass Community and             1,570,000
                                                                    Technical College, Lexington,
                                                                    KY for a health professions
                                                                    program, including the
                                                                    purchase of equipment and
                                                                    supplies.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Boys & Girls Club of the West         450,000
                                                                    Valley, Canoga Park, CA for
                                                                    afterschool programs.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Cabrillo College, Aptos, CA for       163,539
                                                                    science learning, including
                                                                    learning lab furniture and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  California State University--       1,681,720
                                                                    Stanislaus, Turlock, CA for a
                                                                    mental health workforce
                                                                    program, including
                                                                    scholarships.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  California State University           550,800
                                                                    Channel Islands, Camarillo, CA
                                                                    for a cybersecurity degree
                                                                    program, including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  California State University,        1,000,000
                                                                    Northridge, CA for arts,
                                                                    media, and communications
                                                                    programs, including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Campbellsville University,            950,000
                                                                    Campbellsville, KY for
                                                                    information technology and
                                                                    equipment upgrades.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Chabot--Las Positas Community       1,000,000
                                                                    College District, Dublin, CA
                                                                    for student support programs.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Chicago State University,           1,600,000
                                                                    Chicago, IL for communication
                                                                    and media career development
                                                                    programs, including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  City College of New York, NY        2,200,000
                                                                    for an infrastructure
                                                                    workforce training program and
                                                                    center.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  City Colleges of Chicago Malcom     1,000,000
                                                                    X College, Chicago, IL for an
                                                                    emergency medical technician
                                                                    student success program,
                                                                    including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Coahoma Community College,          1,664,100
                                                                    Clarksdale, MS for campus
                                                                    safety, including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Collaborative for Higher            2,000,000
                                                                    Education Shared Services,
                                                                    Santa Fe, NM for a
                                                                    cybersecurity shared services
                                                                    program.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Connecticut Historical Society      1,000,000
                                                                    Museum and Library, Hartford,
                                                                    CT for the use of community
                                                                    history in postsecondary
                                                                    education, including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Contra Costa Community College      1,000,000
                                                                    District, Martinez, CA for an
                                                                    open educational resources
                                                                    project.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  CUNY Mexican Studies Institute,     1,246,080
                                                                    Bronx, NY for a literacy and
                                                                    language skills program.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  CUNY York College, Queens, NY       1,267,500
                                                                    for geology and environmental
                                                                    science programs, including
                                                                    student stipends and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  CUNY York College, Queens, NY         850,000
                                                                    for pharmaceutical science
                                                                    workforce training, including
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Cyber Security Range at Union       3,000,000
                                                                    Station, Springfield, MA for a
                                                                    cybersecurity program,
                                                                    including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Cypress College, Cypress, CA          500,000
                                                                    for veteran and military-
                                                                    connected student pathways,
                                                                    including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Dallas College, Dallas, TX for        500,000
                                                                    a teaching residency
                                                                    apprenticeship program,
                                                                    including stipends.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Davenport University, Grand         1,325,000
                                                                    Rapids, MI for a dual language
                                                                    education program.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Davenport University, Grand           760,000
                                                                    Rapids, MI for a teacher
                                                                    training program, including
                                                                    scholarships.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Desert Research Institute, Las      1,000,000
                                                                    Vegas, NV for partnerships
                                                                    between STEM and education
                                                                    majors, including scholarships.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Dominican Women's Development       1,000,000
                                                                    Center, New York, NY for
                                                                    afterschool, STEM education,
                                                                    and postsecondary access
                                                                    programs.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  East Central College, Union, MO     1,000,000
                                                                    for the purchase of distance
                                                                    learning equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Eastern Gateway Community             914,000
                                                                    College, Steubenville, OH for
                                                                    electric vehicle technology
                                                                    training, including
                                                                    installation of equipment and
                                                                    technology.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Eckerd College, St. Petersburg,     1,000,000
                                                                    FL for a marine science
                                                                    laboratory space, including
                                                                    the installation of equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Edmonds College, Lynnwood, WA       1,300,000
                                                                    for marine and AI robotics
                                                                    pathways programs, including
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Elgin Community College, Elgin,       936,000
                                                                    IL for a mechatronics
                                                                    certificate program, including
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Elms College, Chicopee, MA for      1,000,000
                                                                    social sciences and education
                                                                    curriculum and programming,
                                                                    including scholarships and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Emory University, Atlanta, GA         500,000
                                                                    for a nursing apprenticeship
                                                                    program, including stipends.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Folsom Lake College, Folsom, CA       950,000
                                                                    for a prison and reentry
                                                                    program.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  FoodTEC, Newburgh, NY for a         1,125,000
                                                                    workforce development program,
                                                                    including scholarships for
                                                                    daycare facilities.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Franklin Pierce University,           825,000
                                                                    Rindge, NH for rural health
                                                                    care education and training,
                                                                    including technology and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  George Mason University,            1,000,000
                                                                    Fairfax, VA for a
                                                                    cybersecurity and IT
                                                                    modernization program.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Georgia State University,             400,000
                                                                    Atlanta, GA for programs to
                                                                    expand access to postsecondary
                                                                    education, including English
                                                                    language proficiency support.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Glendale College Foundation,        1,250,000
                                                                    Glendale, CA for student basic
                                                                    needs support, including
                                                                    rental assistance.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Goodwin University, East            2,200,000
                                                                    Hartford, CT for a mobile
                                                                    manufacturing and nursing
                                                                    program, including equipment
                                                                    and scholarships.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Goucher College, Towson, MD for     1,255,800
                                                                    life and health sciences
                                                                    teaching labs, including
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Grambling State University,         2,500,000
                                                                    Grambling, LA for a
                                                                    cybersecurity initiative,
                                                                    including scholarships,
                                                                    stipends and purchase of
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Hamline University, Saint Paul,     1,000,000
                                                                    MN for academic internship
                                                                    programs, including student
                                                                    stipends.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Hampton University, Hampton, VA     2,200,000
                                                                    for an allied health services
                                                                    and workforce development
                                                                    program.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Harper College Aviation               500,000
                                                                    Maintenance Program, Palatine,
                                                                    IL for an aviation technical
                                                                    training program, including
                                                                    scholarships and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Harris County Public Library,         578,000
                                                                    Houston, TX for college and
                                                                    career guidance programs.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Hispanic Federation, Orlando,         200,000
                                                                    FL for college preparatory
                                                                    support for middle and high
                                                                    school students, including
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Hostos Community College of the     1,000,000
                                                                    City University of New York,
                                                                    The Bronx, NY, for community
                                                                    college articulation agreement
                                                                    support.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Hudson County Community             2,200,000
                                                                    College, Jersey City, NJ for
                                                                    technological enhancements to
                                                                    student learning, including
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Hudson Valley Community             2,065,000
                                                                    College, Troy, NY for STEM and
                                                                    healthcare workforce
                                                                    development.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Husson University, Bangor, ME         725,491
                                                                    for science laboratory
                                                                    programming, including
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Joan B Kroc School of Peace           580,000
                                                                    Studies at the University of
                                                                    San Diego, CA for a research
                                                                    lab program to combat
                                                                    violence, including
                                                                    scholarships.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Johnson & Wales University,         1,012,000
                                                                    Providence, RI for
                                                                    cybersecurity training for
                                                                    teachers, including stipends.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Kirkwood Community College,           360,000
                                                                    Cedar Rapids, IA for the
                                                                    purchase of aviation
                                                                    information technology and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Lehman College of the City            500,000
                                                                    University of New York, Bronx,
                                                                    NY for a digital equity
                                                                    initiative, including
                                                                    technology.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Local 212 MATC Believe in             250,000
                                                                    Students FAST Fund, Milwaukee,
                                                                    WI for financial assistance to
                                                                    low-income students.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Loisaida, New York, NY for an         300,000
                                                                    environmental and community
                                                                    science program.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Los Angeles Community College       1,000,000
                                                                    District, Los Angeles, CA for
                                                                    mobile work-based workforce
                                                                    programs, including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Los Angeles Mission College,        2,000,000
                                                                    Sylmar, CA for allied health
                                                                    programs and STEM services,
                                                                    including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Louisiana Delta Community           1,555,000
                                                                    College, Monroe, LA for a
                                                                    health science and education
                                                                    program, including
                                                                    scholarships, purchase of
                                                                    equipment, and support
                                                                    services.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Louisiana State University of         990,000
                                                                    Alexandria, Alexandria, LA for
                                                                    a teacher education program,
                                                                    including scholarships and
                                                                    tuition reimbursement.
----------------------------------------------------------------------------------------------------------------
 
Department of Education           Higher Education...............  Manor College, Jenkintown, PA       1,275,667
                                                                    for wraparound services,
                                                                    advising, and basic needs
                                                                    supports for at-risk student
                                                                    populations, including
                                                                    scholarships.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Maria College, Albany, NY for         770,088
                                                                    nursing programs, including
                                                                    technology and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Marquette University,                 799,500
                                                                    Milwaukee, WI for college
                                                                    readiness and STEM pipeline
                                                                    services.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Maryville College, Maryville,         645,000
                                                                    TN for a STEM project,
                                                                    including scholarships,
                                                                    stipends, and purchase of
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Marywood University, Scranton,      2,607,464
                                                                    PA for healthcare workforce
                                                                    expansion programs, including
                                                                    equipment and scholarships.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Mass. Bay Community College,          400,000
                                                                    Wellesley, MA for a center for
                                                                    health sciences, early
                                                                    education, and human services,
                                                                    including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Massachusetts College of              620,000
                                                                    Liberal Arts, North Adams, MA
                                                                    for a nursing program,
                                                                    including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  McLennan Community College,         1,100,000
                                                                    Waco, TX for the purchase of
                                                                    information technology and
                                                                    equipment for healthcare
                                                                    training programs.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Mid-America Christian                 555,000
                                                                    University, Oklahoma City, OK
                                                                    for the purchase of STEM lab
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Middlesex College, Edison, NJ       1,000,000
                                                                    for adult and justice-impacted
                                                                    learner support, including
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Midlands Technical College,         1,000,000
                                                                    Columbia, SC for a skilled
                                                                    trades training program,
                                                                    including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  MiraCosta Community College         1,000,000
                                                                    District, Oceanside, CA for
                                                                    accelerated skills-based
                                                                    training, including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Modesto Junior College,             2,000,000
                                                                    Modesto, CA for regional fire
                                                                    science training programs,
                                                                    including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Montgomery County Community           100,000
                                                                    College, Blue Bell, PA for
                                                                    early college programs,
                                                                    including equipment and
                                                                    tuition support.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Moorpark College, Moorpark, CA        300,000
                                                                    for a work-based learning
                                                                    cybersecurity program.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Moraine Valley Community              500,000
                                                                    College, Palos Hills, IL for
                                                                    non-destructive testing
                                                                    training, including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Nevada State College,               1,624,294
                                                                    Henderson, NV for a career
                                                                    advancement and training
                                                                    center, including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Nevada State College,                 611,968
                                                                    Henderson, NV for a nursing
                                                                    program, including equipment
                                                                    and scholarships.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  New Hampshire Technical               767,000
                                                                    Institute, Concord, NH for
                                                                    dental training program
                                                                    modernization, including
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Niagara University, NY for            750,000
                                                                    study and research in
                                                                    scientific disciplines,
                                                                    including equipment and
                                                                    materials.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Nichols College, Dudley, MA for       680,000
                                                                    an intelligent business
                                                                    automation program, including
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Normandale Community College,         188,875
                                                                    Bloomington, MN for health
                                                                    sciences education.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Northampton County Community        2,729,288
                                                                    College, Bethlehem, PA for
                                                                    healthcare and workforce
                                                                    development programs,
                                                                    including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Northeastern University,            1,000,000
                                                                    Boston, MA for an associate's
                                                                    to master's degree accelerator
                                                                    program.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Northern Illinois University,       1,500,000
                                                                    DeKalb, IL for microchip
                                                                    research and training,
                                                                    including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Northern Virginia Community           685,000
                                                                    College, Annandale, VA for a
                                                                    diesel technology certificate
                                                                    program, including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Northern Virginia Community         2,200,000
                                                                    College, Annandale, VA for a
                                                                    nursing program, including
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Nova Southeastern University,       2,000,000
                                                                    Fort Lauderdale, FL for a
                                                                    spatial computing and robotics
                                                                    program, including equipment
                                                                    and technology.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Nova Southeastern University,       2,500,000
                                                                    Fort Lauderdale, FL for
                                                                    cybersecurity research,
                                                                    including equipment and
                                                                    technology.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Oklahoma State University--         3,000,000
                                                                    Oklahoma City, Oklahoma City,
                                                                    OK for an education program,
                                                                    including the purchase of
                                                                    equipment and information
                                                                    technology.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Oxnard College, Oxnard, CA for        628,600
                                                                    faculty professional
                                                                    development.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Palm Beach State College, Lake      1,000,000
                                                                    Worth, FL for an artificial
                                                                    intelligence workforce
                                                                    development program, including
                                                                    equipment and technology.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Pasadena Community College            500,000
                                                                    District, Pasadena, CA for a
                                                                    family resource center,
                                                                    including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Pierce College, Woodland Hills,     2,000,000
                                                                    CA for biotech baccalaureate
                                                                    programs.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Pima Community College              1,000,000
                                                                    District, Tucson, AZ for a
                                                                    building and construction
                                                                    technology program, including
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Pima County Community College       1,000,000
                                                                    District, Tucson, AZ for a
                                                                    building and construction
                                                                    technology program, including
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Prairie State College, Chicago      1,000,000
                                                                    Heights, IL for a dental
                                                                    hygiene program, including
                                                                    enhancements and the
                                                                    installation of equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Prairie View A&M University,        2,400,000
                                                                    Prairie View, TX for the
                                                                    purchase of science and
                                                                    engineering lab equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Ready to Succeed, Santa Monica,     1,000,000
                                                                    CA for support for college-
                                                                    going foster youth, including
                                                                    scholarships.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Research Foundation of the City       534,982
                                                                    University of New York,
                                                                    Brooklyn, NY for a pre-law
                                                                    program.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Research Foundation of the City       792,000
                                                                    University of New York, NY for
                                                                    a learning hub for the study
                                                                    of history and culture,
                                                                    including equipment and space
                                                                    furnishings.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Riverside Community College         3,000,000
                                                                    District, Riverside, CA for a
                                                                    military articulation platform
                                                                    expansion, including the
                                                                    purchase of equipment and
                                                                    information technology.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Riverside Community College         3,000,000
                                                                    District, Riverside, CA for
                                                                    career training programs.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Rust College, Holly Springs, MS       500,000
                                                                    for a leadership development
                                                                    program, including
                                                                    scholarships.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Rutgers University-Camden, NJ       1,404,800
                                                                    for community partnership
                                                                    centers.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Saint Augustine's University,         490,000
                                                                    Raleigh, NC for public health
                                                                    education, including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Salt Lake Community College,          390,000
                                                                    Salt Lake City, UT for an
                                                                    educational program, including
                                                                    student scholarships.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  San Diego Community College         1,200,000
                                                                    District, San Diego, CA for
                                                                    centers to support LGBT
                                                                    students.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  San Diego Community College         1,200,000
                                                                    District, San Diego, CA for
                                                                    student support services for
                                                                    DACA recipients.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  San Joaquin Delta College,          3,800,000
                                                                    Stockton, CA for nursing
                                                                    programs, including equipment
                                                                    and technology for simulation
                                                                    labs.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Santa Clarita Community College     1,000,000
                                                                    District -- College of the
                                                                    Canyons, Santa Clarita, CA for
                                                                    the purchase of robotics
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Seminole State College of             404,114
                                                                    Florida, Sanford, FL for a
                                                                    fire science program,
                                                                    including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Siena Heights University,           1,000,000
                                                                    Adrian, MI for student
                                                                    scholarships and the purchase
                                                                    of lab equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Simmons College of Kentucky,          602,500
                                                                    Louisville, KY for academic
                                                                    support programs, including
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Snead State Community College,      1,000,000
                                                                    Boaz, AL for the purchase of
                                                                    information technology and
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Social Enterprise Center,           1,500,000
                                                                    Albuquerque, NM for computing
                                                                    infrastructure and workforce
                                                                    development, including
                                                                    scholarships.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  St. Francis College, Brooklyn,      1,500,000
                                                                    NY for nursing programs,
                                                                    including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  St. Joseph's College New York,        754,000
                                                                    Brooklyn, NY for a
                                                                    cybersecurity lab program,
                                                                    including equipment
                                                                    installation, furnishings, and
                                                                    refurbishments.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Stevens Institute of                  960,000
                                                                    Technology, Hoboken, NJ for
                                                                    computer science programs,
                                                                    including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Sustainable Cities Institute,       1,156,695
                                                                    Eugene, OR for a
                                                                    sustainability and student
                                                                    support program.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Tennessee Technological             3,000,000
                                                                    University, Cookeville, TN for
                                                                    the purchase of equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Texas A&M International             1,000,000
                                                                    University, Laredo, TX for a
                                                                    center to combat human
                                                                    trafficking, including
                                                                    equipment and technology.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Texas A&M Transportation            1,600,000
                                                                    Institute, Bryan, TX for an
                                                                    electric vehicle program,
                                                                    including the purchase of
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Texas A&M University, College       1,500,000
                                                                    Station, TX for a forensic
                                                                    science education program,
                                                                    including student support for
                                                                    fellowships and internships
                                                                    and the purchase of equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Texas A&M University-Commerce,        516,614
                                                                    Dallas, TX for a teacher
                                                                    certification program,
                                                                    including scholarships.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Texas Wesleyan University, Fort     1,439,695
                                                                    Worth, TX for STEM education
                                                                    programs, including lab
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  The National Veteran Memorial         204,800
                                                                    and Museum Operating
                                                                    Corporation, Columbus, OH for
                                                                    graduate-level instruction to
                                                                    veterans, including
                                                                    scholarships.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  The Ohio State University,          1,045,000
                                                                    Columbus, OH for a quantum
                                                                    network research program,
                                                                    including the purchase of
                                                                    equipment and information
                                                                    technology.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  The University of North               399,952
                                                                    Georgia, Dahlonega, GA for a
                                                                    teacher candidate residency
                                                                    program, including equipment
                                                                    and stipends.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  The University of Texas at          3,000,000
                                                                    Dallas, Richardson, TX for
                                                                    semiconductor workforce
                                                                    development programs,
                                                                    including equipment
                                                                    infrastructure and
                                                                    scholarships.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Towson University, Towson, MD         950,000
                                                                    for a teacher workforce
                                                                    pipeline program.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  University of California            1,000,000
                                                                    Riverside, CA for agricultural
                                                                    innovation programs.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  University of California,           1,205,967
                                                                    Davis, CA for wildfire smoke
                                                                    research, including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  University of California-San        2,160,000
                                                                    Diego, La Jolla, CA for
                                                                    pipelines into STEM careers.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  University of Central Florida,        500,000
                                                                    Orlando, FL for academic
                                                                    research on Puerto Rico.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  University of Colorado Anschutz       783,580
                                                                    Medical Center, Aurora, CO for
                                                                    a rural public health
                                                                    certificate program, including
                                                                    student project support.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  University of Colorado Anschutz       460,584
                                                                    Medical Center, Aurora, CO for
                                                                    an injury and violence
                                                                    prevention center, including
                                                                    scholarships.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  University of Georgia College       1,000,000
                                                                    of Agricultural and
                                                                    Environmental Sciences,
                                                                    Athens, GA for a poultry
                                                                    science program, including
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  University of Hawaii--Office of     1,000,000
                                                                    Strategic Health Initiatives,
                                                                    Honolulu, HI for an indigenous
                                                                    data science hub.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  University of La Verne, CA for      2,200,000
                                                                    a mental health practitioner
                                                                    program, including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  University of Maryland Global         246,000
                                                                    Campus, Adelphi, MD for a peer
                                                                    tutoring program, including
                                                                    technology.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  University of Nevada Las Vegas,     3,000,000
                                                                    NV for advanced sports
                                                                    research, including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  University of New Hampshire,        1,000,000
                                                                    Durham, NH for child study and
                                                                    development education.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  University of North Alabama,          500,000
                                                                    Florence, AL for new program
                                                                    development, including the
                                                                    purchase of equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  University of North Florida,          750,000
                                                                    Jacksonville, FL for
                                                                    information technology
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  University of North Florida,          375,000
                                                                    Jacksonville, FL for the
                                                                    purchase of information
                                                                    technology and equipment,
                                                                    including associated software.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  University of South Florida,        2,000,000
                                                                    Sarasota, FL for a
                                                                    cybersecurity program,
                                                                    including the purchase of
                                                                    information technology.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  University of the District of       1,000,000
                                                                    Columbia, Washington, DC for a
                                                                    math teacher training
                                                                    institute, including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  University of Wisconsin --          1,000,000
                                                                    Madison, WI for STEM education
                                                                    programs.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Utah System of Higher               1,250,000
                                                                    Education, Salt Lake City, UT
                                                                    for the purchase of equipment
                                                                    and supplies to expand
                                                                    healthcare training programs.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Utah Tech University, St.             790,000
                                                                    George, UT for a science
                                                                    training program, including
                                                                    purchase of equipment and
                                                                    teacher stipends.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Valdosta State University,            750,000
                                                                    Valdosta, GA for an online
                                                                    educational degree program,
                                                                    including purchase of
                                                                    information technology.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Vida Mobile Clinic, Granada         1,350,000
                                                                    Hills, CA for programs to
                                                                    support pre-health
                                                                    postsecondary students,
                                                                    including student stipends.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Virginia Commonwealth               1,073,550
                                                                    University, Richmond, VA for
                                                                    pipelines into STEM
                                                                    professions, including
                                                                    scholarships.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Virginia Foundation for               254,910
                                                                    Community College Education,
                                                                    Richmond, VA for early
                                                                    childhood educator development
                                                                    programs, including
                                                                    scholarships.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Virginia State University,          2,200,000
                                                                    Petersburg, VA for broadband
                                                                    improvement, including
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Virginia Union University,          2,000,000
                                                                    Richmond, VA for cybersecurity
                                                                    programming, including
                                                                    installation and
                                                                    reconfiguration of equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Wake Technical Community              939,041
                                                                    College, Raleigh, NC for
                                                                    electric vehicle technical
                                                                    training, including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Wayne County Community College        212,400
                                                                    District, Detroit, MI for an
                                                                    automotive electrification and
                                                                    testing program.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Western Kentucky University,          460,000
                                                                    Bowling Green, KY for the
                                                                    purchase of applied research
                                                                    and technology equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Western University of Health          100,000
                                                                    Sciences, Ontario, CA for
                                                                    health career student support
                                                                    programs.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Western Washington University,        450,000
                                                                    Bellingham, WA for a food
                                                                    security program, including
                                                                    furnishing a longhouse with
                                                                    equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  Westfield State University,         1,000,000
                                                                    Westfield, MA for a nursing
                                                                    and health sciences program,
                                                                    including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education           Higher Education...............  William Paterson University,        1,000,000
                                                                    Wayne, NJ for student support,
                                                                    including scholarships.
----------------------------------------------------------------------------------------------------------------

            House of Representatives Reporting Requirements

    The following materials are submitted in accordance with 
various requirements of the Rules of the House of 
Representatives:

         Statement of General Performance Goals and Objectives

    Pursuant to clause 3(c)(4) of rule XIII of the Rules of the 
House of Representatives, the following is a statement of 
general performance goals and objectives for which this measure 
authorizes funding: The Committee on Appropriations considers 
program performance, including a program's success in 
developing and attaining outcome-related goals and objectives, 
in developing funding recommendations.

                          RESCISSION OF FUNDS

    Pursuant to clause 3(f)(2) of rule XIII of the Rules of the 
House of Representatives, the following lists the rescissions 
of unexpended balances included in the accompanying bill:

                  RESCISSIONS RECOMMENDED IN THE BILL

------------------------------------------------------------------------
                        Account                              Amount
------------------------------------------------------------------------
Department of Health and Human Services Nonrecurring        $500,000,000
 Expenses Fund........................................
Department of Education Pell Grants...................       221,000,000
------------------------------------------------------------------------

   Disclosure of Earmarks and Congressionally Directed Spending Items

    The following table is submitted in compliance with clause 
9 of rule XXI, and lists the congressional earmarks (as defined 
in paragraph (e) of clause 9) contained in the bill or in this 
report. Neither the bill nor the report contain any limited tax 
benefits or limited tariff benefits as defined in paragraphs 
(f) or (g) of clause 9 of rule XXI.

              DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND RELATED AGENCIES
                                           [Community Project Funding]
----------------------------------------------------------------------------------------------------------------
                                                                                                       House
         Agency                  Account                       Project               House Amount    Requestors
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Agape Child & Family Services,       $1,000,000  Cohen
                          Administration.          Memphis, TN for job training,
                                                   career placement, and supportive
                                                   services.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Apprentice Training for the           1,994,875  Dean
                          Administration.          Electrical Industry,
                                                   Collegeville, PA for green job
                                                   workforce development and
                                                   equipment.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Apprenticeship and Nontraditional       675,000  Smith (WA)
                          Administration.          Employment for Women, Renton, WA
                                                   to expand construction pre-
                                                   apprenticeship programming and
                                                   CDL training.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Artpreneurs, Inc. dba Arts on the       100,000  Raskin
                          Administration.          Block, Silver Spring, MD for a
                                                   creative workforce
                                                   apprenticeship program.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Association House of Chicago,           500,000  Garcia (IL)
                          Administration.          Chicago, IL for workforce
                                                   development training programs.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Augusta University, Augusta, GA       2,000,000  Bishop (GA)
                          Administration.          for workforce training and job
                                                   placement in the healthcare
                                                   industry.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Baltimore Alliance for Careers in       827,905  Sarbanes
                          Administration.          Healthcare, Baltimore, MD for
                                                   healthcare workforce development.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Baycare Health Systems Inc,             963,620  Crist
                          Administration.          Clearwater, FL for a workforce
                                                   development program focused on
                                                   nurses and nursing support
                                                   professionals.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Bidwell Training Center,                400,000  Lamb
                          Administration.          Pittsburgh, PA for the
                                                   development of a controlled
                                                   environment agriculture
                                                   workforce.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Black Veterans for Social             1,000,000  Jeffries
                          Administration.          Justice, Inc., Brooklyn, NY for
                                                   stipends, supportive services,
                                                   and job placement for formerly
                                                   incarcerated veterans.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Boys & Girls Club of Greater          2,200,000  Trahan
                          Administration.          Lowell, Inc., Lowell, MA for
                                                   workforce development activities.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Boys & Girls Club San Fernando          500,000  Cardenas
                          Administration.          Valley, Pacoima, CA for a youth
                                                   workforce development initiative
                                                   and supportive services.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Bright Star Community Outreach,         175,000  Rush
                          Administration.          Chicago, IL for workforce
                                                   development activities.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Bronx Community College of the          150,000  Torres (NY)
                          Administration.          City University of New York,
                                                   Bronx, NY for health care job
                                                   training.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Building and Construction Trades      1,000,000  Lee (CA)
                          Administration.          Council of Alameda County,
                                                   Oakland, CA for the Retention
                                                   Apprenticeship Mentoring Program.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  CAMBA, Inc., Brooklyn, NY for           590,000  Jeffries
                          Administration.          career navigation, job placement
                                                   services, and supportive
                                                   services for youth.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  CASA, Baltimore, MD for job             573,045  Mfume
                          Administration.          skills training, job placement
                                                   services, stipends, and
                                                   supportive services.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Center for the Women of New York,     1,000,000  Suozzi
                          Administration.          Kew Gardens, NY for career
                                                   skills and job counseling.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Center for Urban Families,              750,000  Mfume
                          Administration.          Baltimore, MD for job readiness
                                                   programs and job placement.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Chemeketa Community College,            340,000  Schrader
                          Administration.          Salem, OR for a commercial truck
                                                   driving program and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  City of Dearborn, MI for a            1,000,000  Dingell
                          Administration.          training program for women who
                                                   have been underrepresented in
                                                   the workforce.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  City of Houston, TX for job           1,000,000  Jackson Lee
                          Administration.          training in the home recovery
                                                   and construction industries.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  City of Jersey City, NJ for an          750,000  Sires
                          Administration.          apprenticeship program.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  City of Los Angeles Youth               640,108  Schiff
                          Administration.          Development Department, Los
                                                   Angeles, CA for workforce
                                                   development activities and
                                                   stipends.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  City of Stockton, CA for the          1,000,000  McNerney
                          Administration.          Youth Workforce Development
                                                   Program.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Colorado Building and                   500,000  Perlmutter
                          Administration.          Construction Trades Council,
                                                   Denver, CO for workforce
                                                   training and supportive services.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Community College of Baltimore          721,130  Ruppersberger
                          Administration.          County, Baltimore, MD to expand
                                                   their CDL training program and
                                                   equipment.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Community Learning Partnership,         351,000  Khanna
                          Administration.          Cupertino, CA for job skills
                                                   training and stipends.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Consortium for Early Learning         1,000,000  Takano
                          Administration.          Services, Moreno Valley, CA for
                                                   early care and education
                                                   workforce development.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Construction Trade Workforce          1,000,000  Swalwell
                          Administration.          Initiative, Oakland, CA for an
                                                   apprenticeship program and
                                                   curriculum.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Construction Trades Workforce         1,000,000  Khanna
                          Administration.          Initiative, Fremont, CA for
                                                   construction trades
                                                   apprenticeship programs and
                                                   curriculum.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Construction Trades Workforce         1,000,000  DeSaulnier
                          Administration.          Initiative, Oakland, CA for a
                                                   construction apprenticeship
                                                   program.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Construction Trades Workforce         1,000,000  Garamendi
                          Administration.          Initiative, Oakland, CA for an
                                                   apprenticeship readiness program
                                                   focused on construction trades.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Construction Trades Workforce         1,000,000  Lee (CA)
                          Administration.          Initiative, Oakland, CA for
                                                   apprenticeship readiness
                                                   programs.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Corporation to Develop                1,862,625  Castor (FL)
                          Administration.          Communities of Tampa, Inc.,
                                                   Tampa, FL for a pre-
                                                   apprenticeship program,
                                                   apprenticeship program, and job
                                                   training services.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  County of Delaware, Media, PA for     1,988,635  Scanlon
                          Administration.          the Prison-to-Community
                                                   Workforce Development Initiative.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  County of Los Angeles                 2,000,000  Lieu
                          Administration.          Alternatives to Incarceration
                                                   Office (CEO), Los Angeles, CA
                                                   for a youth job training program
                                                   and supportive services.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Covenant House Washington,              329,750  Norton
                          Administration.          Washington, DC for workforce
                                                   development activities.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Cuyahoga Community College            1,220,000  Brown (OH)
                          Administration.          District, Cleveland, OH for
                                                   smart manufacturing workforce
                                                   training, equipment, and
                                                   supportive services.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Dallas College, Dallas, TX for a        500,000  Veasey
                          Administration.          teaching residency
                                                   apprenticeship program.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Delta Veterans Group, Antioch, CA       100,000  McNerney
                          Administration.          for job readiness activities
                                                   supporting veterans.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Des Moines Area Community               339,000  Axne
                          Administration.          College, Ankeny, IA for a
                                                   workforce development initiative
                                                   and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Downriver Community Conference,         703,700  Dingell
                          Administration.          Southgate, MI for skills
                                                   training, job placement, and
                                                   supportive services.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Easter Seals North Georgia, Inc.,       200,000  Johnson (GA)
                          Administration.          Clarkston, GA for early
                                                   childhood workforce development.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Economic Development and              1,000,000  Pressley
                          Administration.          Industrial Corporation of
                                                   Boston, Boston, MA for workforce
                                                   development programs and
                                                   supportive services.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Energy Coordinating Agency of           925,000  Evans
                          Administration.          Philadelphia, Inc.,
                                                   Philadelphia, PA for skill
                                                   training in high demand
                                                   occupations.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  EntreNous Youth Empowerment             575,000  Barragan
                          Administration.          Services, Compton, CA for
                                                   vocational training and services.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Fairfax County Government,            2,000,000  Connolly
                          Administration.          Fairfax, VA for medical
                                                   professional workforce
                                                   development.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Fairfax County, Fairfax, VA for       2,100,000  Connolly,
                          Administration.          career readiness and job                         Wexton
                                                   training for youth.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Fresno County Economic                  500,000  Costa
                          Administration.          Opportunities Commission,
                                                   Fresno, CA for vocational
                                                   training and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Future Plans Inc., Chagrin Falls,     1,000,000  Kaptur
                          Administration.          OH for the Great Lakes Career
                                                   Corridor Project.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Future Plans, Inc., Chagrin           1,995,000  Johnson (OH)
                          Administration.          Falls, OH for a career planning
                                                   and community engagement
                                                   initiative, including the
                                                   purchase of equipment.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Golden Triangle Resource              1,000,000  Bishop (GA)
                          Administration.          Conservation and Development
                                                   Council, Dawson, GA for heavy
                                                   equipment training, including
                                                   equipment.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Green City Force, Brooklyn, NY to       750,000  Jeffries
                          Administration.          expand their workforce
                                                   development program and stipends.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Guilford Child Development,             300,000  Manning
                          Administration.          Greensboro, NC for a child
                                                   development associate
                                                   apprenticeship program.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Hampton Roads Workforce Council,        850,000  Scott (VA)
                          Administration.          Norfolk, VA for maritime
                                                   workforce development activities.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Hartford Communities That Care,       1,322,539  Larson (CT)
                          Administration.          Hartford, CT for a job training
                                                   program to address the need for
                                                   violence prevention
                                                   professionals.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Hatzalah Chicago, Lincolnwood, IL       525,000  Schakowsky
                          Administration.          for workforce training
                                                   activities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Homeboy Industries, Los Angeles,      1,959,451  Gomez
                          Administration.          CA for job training for culinary
                                                   and hospitality careers and
                                                   supportive services.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Howard County Autism Society,           440,000  Sarbanes
                          Administration.          Columbia, MD for the Autism
                                                   Hiring Program.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Jewish Community Centers of South     1,504,329  Wasserman
                          Administration.          Broward, Inc., Davie, FL for                     Schultz
                                                   employment training for
                                                   individuals with IDD.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Jewish Family Service of Atlantic       550,000  Van Drew
                          Administration.          County, Inc., Margate, NJ for
                                                   job skills program.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Jobs for America's Graduates of         350,000  Boyle,
                          Administration.          Pennslyvania, Inc.,                              Brendan F.
                                                   Philadelphia, PA to expand
                                                   career readiness programs and
                                                   skill training.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Kean University, Union, NJ for        1,000,000  Payne
                          Administration.          workforce development activities
                                                   and supportive services.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  LaGuardia Community College, Long       404,774  Maloney,
                          Administration.          Island City, NY to expand                        Carolyn B.
                                                   vocational training for the
                                                   underemployed.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Latin American Association, Inc,        300,000  Bourdeaux
                          Administration.          Atlanta, GA for employment
                                                   training, support services, and
                                                   a workforce development
                                                   initiative.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Latina Coalition of Silicon             376,000  Lofgren
                          Administration.          Vally, San Jose, CA for
                                                   workforce development programs
                                                   and supportive services.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Laurel Highlands Workforce and          445,000  Reschenthaler
                          Administration.          Opportunity Center, Greensburg,
                                                   PA for a workforce support
                                                   program, including supplies and
                                                   wraparound services.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Los Angeles Brotherhood Crusade--     1,000,000  Bass
                          Administration.          Black United Fund Inc., CA for
                                                   youth workforce development and
                                                   job placement.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Los Angeles Conservation Corps,         272,000  Barragan
                          Administration.          Los Angeles, CA, for job
                                                   training and stipends.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Los Angeles World Airports, Los       1,000,000  Waters
                          Administration.          Angeles, CA for an aviation
                                                   workforce development program.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Mahoning County Career and              285,000  Johnson (OH)
                          Administration.          Technical Center, Canfield, OH
                                                   for an energy and technology
                                                   workforce training center
                                                   project, including the purchase
                                                   of equipment.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Maricopa County Community College     1,000,000  Stanton
                          Administration.          District, Tempe, AZ for
                                                   workforce development activities
                                                   and curriculum.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  McAllen Independent School              200,000  Gonzalez,
                          Administration.          District, McAllen, TX for                        Vicente
                                                   private pilot and remote drone
                                                   license training.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Mercy Hospital dba Northern Light     1,000,000  Pingree
                          Administration.          Mercy Hospital, Portland, ME for
                                                   workforce training and
                                                   supportive services.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Michigan Early Childhood              2,000,000  Lawrence
                          Administration.          Investment Corporation, Lansing,
                                                   MI for the development of a
                                                   child care workforce.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  MorseLife Health System, West           500,000  Cherfilus-
                          Administration.          Palm Beach, FL for job training                  McCormick
                                                   of underserved populations and
                                                   supportive services.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  New Immigrant Community                 500,000  Ocasio-Cortez
                          Administration.          Empowerment, Jackson Heights, NY
                                                   to expand a construction
                                                   industry workforce development
                                                   program.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  New Mexico Highlands University,        750,000  Leger
                          Administration.          Las Vegas, NM for the                            Fernandez
                                                   development of professional
                                                   social workers.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  New York State Energy Research        3,000,000  Ocasio-Cortez
                          Administration.          and Development Authority,
                                                   Albany, NY for clean energy
                                                   workforce development and
                                                   supportive services.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Northeast Community College,          1,000,000  Smith (NE)
                          Administration.          Norfolk, NE for a commercial
                                                   driver's license program,
                                                   including the purchase of
                                                   equipment and stipends.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Northwest Arkansas Community            355,000  Womack
                          Administration.          College, Bentonville, AR for a
                                                   commercial driver's license
                                                   program, including the purchase
                                                   of equipment.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Northwest New Mexico Council of         750,000  Leger
                          Administration.          Governments, Gallup, NM to                       Fernandez
                                                   transition and re-skill workers
                                                   into the industrial industry.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  OCHIN, Inc., Portland, OR for         2,001,642  Bonamici
                          Administration.          health information technology
                                                   training and professional
                                                   development.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Opportunity Junction, Antioch, CA       470,000  DeSaulnier
                          Administration.          for a job training program and
                                                   supportive services.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Pasadena Independent School           2,200,000  Garcia (TX)
                          Administration.          District, Pasadena, TX for job
                                                   skill training and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Pee Dee Healthy Start Inc.,           1,000,000  Clyburn
                          Administration.          Florence, SC for workforce
                                                   training and supportive services.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Plattsburgh-North County Chamber        500,000  Stefanik
                          Administration.          of Commerce, Plattsburgh, NY for
                                                   a job training and assistance
                                                   program, including support
                                                   services and stipends.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Portland Community College,             910,000  Bonamici
                          Administration.          Portland, OR for semiconductor
                                                   and advanced manufacturing
                                                   workforce development initiative.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Primary Care Coalition of             1,300,000  Raskin
                          Administration.          Montgomery County, Inc., Silver
                                                   Spring, MD for health care
                                                   professionals' workforce
                                                   development and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Prince George's County Memorial       2,200,000  Brown (MD)
                          Administration.          Library System, Largo, MD for a
                                                   mobile job readiness unit.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Prince George's County, Largo, MD     3,000,000  Brown (MD)
                          Administration.          for the Youth@Work program.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Promise Neighborhoods of Lehigh       1,549,360  Wild
                          Administration.          Valley, Allentown, PA to expand
                                                   their workforce development
                                                   skills program.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Reading and Beyond, Fresno, CA          484,047  Costa
                          Administration.          for employment and training
                                                   services and supportive services.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Rockdale County Georgia, Conyers,       300,000  Johnson (GA)
                          Administration.          GA for a workforce development
                                                   initiative.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  San Bernadino Valley College          1,500,000  Aguilar
                          Administration.          Foundation, San Bernadino, CA
                                                   for clean energy workforce
                                                   development and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  San Diego Community College           1,000,000  Peters
                          Administration.          District, San Diego, CA for the
                                                   Gateway to College and Career
                                                   program.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  San Diego Workforce Partnership,        800,000  Peters
                          Administration.          San Diego, CA for the TechHire
                                                   Program..
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  San Gabriel Valley Council of         2,000,000  Napolitano,
                          Administration.          Governments, Alhambra, CA for a                  Sanchez
                                                   workforce development program.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Santa Clara County, San Jose, CA      3,000,000  Khanna
                          Administration.          for workforce development,
                                                   stipends, and supportive
                                                   services.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Seattle Jobs Initiative, Seattle,     1,000,000  Jayapal
                          Administration.          WA for green stormwater
                                                   infrastructure workforce
                                                   development, stipends, and
                                                   supportive services.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Service! Relief Effort for              475,000  Beatty
                          Administration.          Hospitality Workers, Columbus,
                                                   OH for job skills training and
                                                   supportive services.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Society for the Advancement of          212,000  Lofgren
                          Administration.          Chicanos/Hispanics and Native
                                                   Americans in Science, San Jose,
                                                   CA to create a pipeline from
                                                   community colleges into the STEM
                                                   workforce.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  South Bay Workforce Investment          500,000  Waters
                          Administration.          Board Inc., Hawthorne, CA for
                                                   occupation training and
                                                   supportive services.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  South Texas College, McAllen, TX      1,000,000  Gonzalez,
                          Administration.          for healthcare workforce                         Vicente
                                                   development.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  St. Clair County                        950,000  Bost
                          Administration.          Intergovernmental Grants
                                                   Department, Belleville, IL for
                                                   an advanced manufacturing
                                                   program, including support
                                                   services.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  St. Joseph Center, Venice, CA for       898,053  Lieu
                          Administration.          job skills training and
                                                   supportive services to those
                                                   experiencing homelessness.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Stanislaus Business Alliance dba        410,000  Harder (CA)
                          Administration.          Opportunity Stanislaus, Modesto,
                                                   CA for a logistics industry
                                                   focused training program.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  State of Maine, Governor's Energy     2,750,000  Pingree
                          Administration.          Office, Augusta, ME for job
                                                   training, job placement
                                                   services, stipends, equipment,
                                                   and curriculum.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Suburban Emergency Medical              247,949  Wild
                          Administration.          Services, Palmer, PA for
                                                   healthcare workforce development.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Suffolk County Community College,     1,435,000  Zeldin
                          Administration.          Selden, NY for a cybersecurity
                                                   program, including the purchase
                                                   of equipment and related
                                                   information technology.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Taller San Jose Hope Builders,          500,000  Correa
                          Administration.          Santa Ana, CA for skills
                                                   training and employment
                                                   placement services for low-
                                                   income young adults facing
                                                   significant barriers.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Texas Trees Foundation, Dallas,         400,000  Johnson (TX)
                          Administration.          TX for supportive services and
                                                   job placement of at-risk young
                                                   adults into the green jobs
                                                   industry.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  The Indianapolis Private Industry     1,000,000  Carson
                          Administration.          Council, Inc., Indianapolis, IN
                                                   for youth job training and a
                                                   work-based learning program.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  The Sanneh Foundation, Saint          1,000,000  McCollum
                          Administration.          Paul, MN for a youth workforce
                                                   development program.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  The Torres-Martinez Desert              250,000  Ruiz
                          Administration.          Cahuilla Indian Tribe, Thermal,
                                                   CA for a workforce development
                                                   program and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  The TransLatin@ Coalition, Los          750,000  Gomez
                          Administration.          Angeles, CA for workforce
                                                   development programs and
                                                   supportive services.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  The WorkPlace, Inc., Bridgeport,      1,000,000  Himes
                          Administration.          CT for skills training,
                                                   workforce readiness, and
                                                   supportive services.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  UAW Labor Employment and Training     1,000,000  Bush
                          Administration.          Corporation, St. Louis, MO for
                                                   job training in the automotive
                                                   services industry.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  United Way of Greater Greensboro,     1,000,000  Manning
                          Administration.          Inc., Greensboro, NC for job
                                                   counseling, career training, and
                                                   supportive services.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  United We Heal Training Trust dba       892,000  Bonamici
                          Administration.          Oregon AFSCME Training Trust,
                                                   Portland, OR for pre-
                                                   apprenticeship education and
                                                   training.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  United We Heal, Portland, OR for        892,000  Schrader
                          Administration.          pre-apprenticeship and
                                                   apprenticeship programs.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  University of California, San         1,600,000  Jacobs (CA)
                          Administration.          Diego, La Jolla, CA for job
                                                   skills development and
                                                   supportive services for a child
                                                   care worker and providers
                                                   pipeline.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  University of Georgia, Athens, GA     3,000,000  McBath
                          Administration.          for the Archway Partnership.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Unloop, Seattle, WA for job             486,781  Jayapal
                          Administration.          training in the tech industry
                                                   and supportive services for
                                                   those with conviction histories.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Urban League of Long Island, Inc,     1,145,820  Rice (NY)
                          Administration.          Plainview, NY for workforce
                                                   development activities.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Urban League of Louisiana, New        1,200,000  Carter (LA)
                          Administration.          Orleans, LA for the Career
                                                   Pathways Program.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  US HART CARES A NJ NONPROFIT          1,000,000  Van Drew
                          Administration.          CORPORATION, Atlantic City, NJ
                                                   for cyber job training program,
                                                   including the purchase of
                                                   equipment.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Valley of the Sun Young Men's         1,000,000  Gallego
                          Administration.          Christian Association, Phoenix,
                                                   AZ for expanding a current youth
                                                   workforce development program.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Variety Boys and Girls Club of          250,000  Maloney,
                          Administration.          Queens, Inc., Long Island City,                  Carolyn B.
                                                   NY for job readiness and
                                                   supportive services for teens.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Virginia Commonwealth University      1,000,000  McEachin
                          Administration.          Health System Authority,
                                                   Richmond, VA for healthcare
                                                   workforce development.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Watts Labor Community Action            783,067  Waters
                          Administration.          Committee, Los Angeles, CA for
                                                   job training, workforce
                                                   development activities, and job
                                                   placement services.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Wayne Community College,                651,000  Butterfield
                          Administration.          Goldsboro, NC to expand its
                                                   apprenticeship training programs.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Workforce Connections, Las Vegas,       800,000  Lee (NV)
                          Administration.          NV for workforce development
                                                   programs.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Workforce Inc. dba Recycleforce,      1,000,203  Carson
                          Administration.          Indianapolis, IN to expand job
                                                   training and job placement
                                                   programs.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Young Men's and Young Women's         1,000,000  Espaillat
                          Administration.          Hebrew Association of Washington
                                                   Heights and Inwood, New York, NY
                                                   for vocational training,
                                                   workforce development, and
                                                   supportive services.
----------------------------------------------------------------------------------------------------------------
Department of Labor      Employment and Training  Young Women's Christian                 690,449  Bowman
                          Administration.          Association of Yonkers, Inc.,
                                                   Yonkers, NY for a workforce
                                                   development initiative and
                                                   support services.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       100 Suits for 100 Men, Laurelton,       750,000  Meng
 and Human Services       Children and Families.   NY for a youth employment
                                                   training program, including for
                                                   the purchase of food and
                                                   equipment, to serve vulnerable
                                                   families and seniors and improve
                                                   economic outcomes.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       A New Way of Life Reentry             1,000,000  Bass
 and Human Services       Children and Families.   Project, Los Angeles, CA for
                                                   housing, legal clinics,
                                                   educational opportunities and
                                                   supportive services to improve
                                                   outcomes and economic
                                                   opportunities.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Action for a Better Community,          517,000  Morelle
 and Human Services       Children and Families.   Inc., Rochester, NY for
                                                   employment advancement, benefit
                                                   and eligibility mapping, and
                                                   other services to help
                                                   individuals and families move
                                                   towards financial sustainability.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Adoptions Together, Calverton, MD       750,639  Brown (MD)
 and Human Services       Children and Families.   for trauma-informed care
                                                   training.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Alfond Youth and Community              500,000  Pingree
 and Human Services       Children and Families.   Center, Waterville, ME for
                                                   targeted support services to
                                                   children and families in need.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       All Star Children's Foundation,       1,500,000  Buchanan
 and Human Services       Children and Families.   Sarasota, FL for a foster care
                                                   program, including behavioral
                                                   health services.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Big Brothers Big Sisters Lone           300,000  Van Duyne
 and Human Services       Children and Families.   Star, Irving, TX for a youth
                                                   mentoring program.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Bivona Child Advocacy Center,           306,000  Morelle
 and Human Services       Children and Families.   Rochester, NY for child abuse
                                                   prevention training and programs.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Boys & Girls Clubs of America,        2,000,000  Williams (GA)
 and Human Services       Children and Families.   Atlanta, GA for increasing
                                                   support services and abuse
                                                   prevention resources to
                                                   recognize and reduce abuse.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Bucks County Opportunity Council,     1,000,000  Fitzpatrick
 and Human Services       Children and Families.   Doylestown, PA for a self-
                                                   sufficiency program, including
                                                   supportive services.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Center for Pan Asian Community          300,000  Bourdeaux
 and Human Services       Children and Families.   Services, Inc., Atlanta, GA for
                                                   survivor-centered, trauma-
                                                   informed services for women and
                                                   families to work towards self-
                                                   reliance.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Childhelp Inc., Scottsdale, AZ        1,000,000  Kirkpatrick
 and Human Services       Children and Families.   for outreach, education
                                                   materials and programming to
                                                   reduce and prevent child abuse.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Children's Home of Stockton,            973,552  McNerney
 and Human Services       Children and Families.   Stockton, CA for supportive
                                                   housing, services, supplies,
                                                   transportation expenses, and
                                                   goods, including the purchase of
                                                   food, to help establish self-
                                                   sufficiency.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Christus Santa Rosa Health Care         472,699  Castro (TX)
 and Human Services       Children and Families.   Corporation, San Antonio, TX for
                                                   training and education to reduce
                                                   and prevent child abuse.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Circle of Brotherhood, Miami, FL      2,000,000  Wilson (FL)
 and Human Services       Children and Families.   for a social services hub
                                                   focused on assistance to low
                                                   income families to improve life
                                                   and economic outcomes.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       City of Boston, MA for housing,       1,000,000  Pressley
 and Human Services       Children and Families.   educational and support services
                                                   for children and families, and
                                                   to provide parents with
                                                   opportunities to reduce poverty.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       City of Jersey City, NJ for             500,000  Payne
 and Human Services       Children and Families.   expanding domestic violence
                                                   intervention services.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       City of Leander, TX for a child         500,000  Carter (TX)
 and Human Services       Children and Families.   abuse prevention and treatment
                                                   program, including the purchase
                                                   of information technology and
                                                   equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       City of Los Angeles, CA for             982,045  Schiff
 and Human Services       Children and Families.   operating costs and community
                                                   services, including motel
                                                   vouchers and the purchase of
                                                   food, to reduce poverty.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       City of Mount Vernon, NY for            999,000  Bowman
 and Human Services       Children and Families.   services to support at-risk
                                                   girls and to improve employment
                                                   opportunities and economic
                                                   outcomes.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       City of Richmond, VA for social         797,329  McEachin
 and Human Services       Children and Families.   services and a one-stop shop to
                                                   help families and individuals
                                                   working to establish financial
                                                   self-sufficiency and for social
                                                   service providers working to
                                                   reduce poverty.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       City of Rochester, NY for youth         500,000  Morelle
 and Human Services       Children and Families.   employment services and young
                                                   adult workforce development to
                                                   increase self-sufficiency.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Columbus Metropolitan Housing         1,000,000  Beatty
 and Human Services       Children and Families.   Authority, Columbus, OH for
                                                   informational and financial
                                                   resources to assist residents
                                                   and achieve economic self-
                                                   sufficiency.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Community Action Network, Ann           500,000  Dingell
 and Human Services       Children and Families.   Arbor, MI for educational and
                                                   social-emotional services to
                                                   achieve self-sufficiency.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Community Help Center DBA Muslim        333,000  Schakowsky
 and Human Services       Children and Families.   Women Resource Center, Chicago,
                                                   IL for the purchase of equipment
                                                   to help achieve self-sufficiency.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       County of San Diego, CA for             220,000  Jacobs (CA)
 and Human Services       Children and Families.   training and materials for child
                                                   welfare programs.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Court Appointed Special Advocates       175,000  Kim (NJ)
 and Human Services       Children and Families.   (CASA) of Ocean County, Toms
                                                   River, NJ for increasing
                                                   volunteers to advocate for
                                                   foster care children.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Court Appointed Special Advocates        40,000  Kim (NJ)
 and Human Services       Children and Families.   of Mercer County, Ewing, NJ for
                                                   expanding services for, and
                                                   increasing the number of
                                                   volunteers available to work
                                                   with, children aging out of
                                                   foster care.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Eastern Shore Coalition Against         250,000  Luria
 and Human Services       Children and Families.   Domestic Violence, Onancock, VA
                                                   for staffing, children's
                                                   programming, and supplies to
                                                   support survivors of abuse.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Eastmont Community Center, Los          100,000  Roybal-Allard
 and Human Services       Children and Families.   Angeles, CA for equipment and
                                                   services for low income families
                                                   to reduce poverty.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Elite Learners, Brooklyn, NY for        750,000  Jeffries
 and Human Services       Children and Families.   promoting financial literacy and
                                                   management services to increase
                                                   self-sufficiency.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Father Flanagan's Boys' Home,         1,000,000  Bacon
 and Human Services       Children and Families.   Boys Town, NE for an at-risk
                                                   youth program, including the
                                                   purchase of equipment and
                                                   information technology.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       First 5 Contra Costa Children and       150,000  DeSaulnier
 and Human Services       Children and Families.   Families Commission, Concord, CA
                                                   for a workforce compensation
                                                   assessment to build a pipeline
                                                   for more to attain economic
                                                   stability.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Food Bank of Eastern Michigan,        2,000,000  Kildee
 and Human Services       Children and Families.   Flint, MI for the purchase of
                                                   equipment and food to support
                                                   mobile food distributions.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Foodbank of Southeastern Virginia       447,600  Luria
 and Human Services       Children and Families.   and the Eastern Shore, Norfolk,
                                                   VA for staffing costs and the
                                                   purchase of food and equipment,
                                                   for mobile food distribution.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       FoodCycle Food Recovery Network,        652,500  Schiff
 and Human Services       Children and Families.   Los Angeles, CA for services and
                                                   the purchase of equipment for a
                                                   hub to improve access to food
                                                   resources to combat hunger and
                                                   reduce poverty.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Georgia Center for Child                200,000  McBath
 and Human Services       Children and Families.   Advocacy, Atlanta, GA for
                                                   services, education and outreach
                                                   to support families affected by
                                                   abuse or trauma.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Georgia State University,               700,000  Williams (GA)
 and Human Services       Children and Families.   Atlanta, GA for services and the
                                                   purchase of equipment to improve
                                                   emotional and economic outcomes.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Goodness Village, Livermore, CA       1,000,000  Swalwell
 and Human Services       Children and Families.   for housing support and services
                                                   to improve self-sufficiency.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Guardian House, San Antonio, TX         483,963  Castro (TX)
 and Human Services       Children and Families.   for a parenting education
                                                   program to reduce and prevent
                                                   child abuse.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Hellenic American Neighborhood          500,000  Maloney,
 and Human Services       Children and Families.   Action Committee INC, New York,                  Carolyn B.
                                                   NY for education and language
                                                   services to improve employment
                                                   and economic outcomes and reduce
                                                   poverty.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Helping Mamas, Inc., Norcross, GA       195,475  Bourdeaux
 and Human Services       Children and Families.   for products and services,
                                                   including the purchase of
                                                   equipment and goods, for a
                                                   mobile distribution project to
                                                   support long-term financial
                                                   security.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Higher Ground A Resource Center,      1,088,768  Grijalva
 and Human Services       Children and Families.   Tucson, AZ for coordinating
                                                   resources and services to reduce
                                                   poverty.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Houston Area Women's Center           1,000,000  Garcia (TX)
 and Human Services       Children and Families.   (HAWC), Houston, TX for services
                                                   to support children and families
                                                   affected by violence.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Individuals Aiding in Emergencies        50,000  Scanlon
 and Human Services       Children and Families.   Foundation, Aston, PA for
                                                   products and services for low-
                                                   income individuals to reduce
                                                   poverty.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       IU Health Foundation,                   600,000  Carson
 and Human Services       Children and Families.   Indianapolis, IN for services to
                                                   improve health and nutrition of
                                                   vulnerable individuals and
                                                   provide job training and new
                                                   employment to improve outcomes.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Kids' Voice of Indiana,                 185,000  Carson
 and Human Services       Children and Families.   Indianapolis, IN for services to
                                                   children and families who are
                                                   survivors of violence, abuse, or
                                                   neglect.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Knoxville-Knox County Community         575,000  Burchett
 and Human Services       Children and Families.   Action Committee, Knoxville, TN
                                                   for a Head Start program,
                                                   including the purchase of
                                                   equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       La Jornada LTD, Flushing, NY for        250,000  Meng
 and Human Services       Children and Families.   expanding educational supports
                                                   and workshops for families in
                                                   poverty to promote healthy
                                                   living and improve economic
                                                   outcomes.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Labor Community Services of Los         600,000  Schiff
 and Human Services       Children and Families.   Angeles (LCS) , Los Angeles, CA
                                                   for services, and transport and
                                                   purchase of goods, including
                                                   food, to reduce poverty.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Larkin Street Youth Services, San     1,550,000  Pelosi
 and Human Services       Children and Families.   Francisco, CA for safe, stable
                                                   housing with wraparound case
                                                   management, education and
                                                   employment support to reduce
                                                   poverty and improve economic
                                                   outcomes.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Long Island Cares, Hauppauge, NY        360,100  Meeks
 and Human Services       Children and Families.   for the purchase of food and
                                                   social services, to connect
                                                   individuals to referral and
                                                   benefits programs and reduce
                                                   poverty.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Long Island Cares, Inc.,                400,000  Garbarino
 and Human Services       Children and Families.   Hauppauge, NY for the purchase
                                                   of equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Make the Road New York, Brooklyn,       800,000  Velazquez
 and Human Services       Children and Families.   NY for adult literacy programs
                                                   and services, including the
                                                   purchase of equipment, to
                                                   improve economic outcomes.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Make the Road New York, Brooklyn,       400,000  Ocasio-Cortez
 and Human Services       Children and Families.   NY for education and services,
                                                   including for the purchase of
                                                   equipment and technology.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Make the Road New York, Brooklyn,       400,000  Jones
 and Human Services       Children and Families.   NY for equipment and services,
                                                   including the purchase of
                                                   technology, to reduce poverty
                                                   and create opportunities for
                                                   economic advancement.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Maternal and Family Health            2,150,000  Cartwright
 and Human Services       Children and Families.   Service, Inc., Wilkes-Barre, PA
                                                   for improving access to social
                                                   services for at-risk and low-
                                                   income women, children and
                                                   families.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       McMahon Ryan Child Advocacy             125,000  Katko
 and Human Services       Children and Families.   Center, Syracuse, NY for a child
                                                   abuse prevention and education
                                                   program, including information
                                                   technology.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Metropolitan Council on Jewish        1,000,000  Maloney,
 and Human Services       Children and Families.   Poverty, New York, NY for anti-                  Carolyn B.
                                                   poverty services and assistance,
                                                   including for the purchase of
                                                   food, to create pathways to self-
                                                   sufficiency.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Metropolitan Council on Jewish        2,000,000  Meng
 and Human Services       Children and Families.   Poverty, New York, NY for
                                                   supplying pantries with
                                                   essential products, including
                                                   food, formula, diapers and
                                                   diapering supplies, menstrual
                                                   and hygiene products, to meet
                                                   the essential needs of women and
                                                   infants to reduce poverty.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Michigan State University Child       2,187,500  Slotkin
 and Human Services       Children and Families.   Development Laboratories, East
                                                   Lansing, MI for staffing and
                                                   training, including equipment,
                                                   to serve at-risk children and
                                                   improve economic outcomes.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Mitzvah Circle Foundation,              300,000  Dean
 and Human Services       Children and Families.   Norristown, PA for products and
                                                   services to reduce poverty.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Mott Community College, Flint, MI     2,064,000  Kildee
 and Human Services       Children and Families.   for increasing access to high
                                                   quality language education
                                                   materials for families and young
                                                   children to improve economic
                                                   outcomes.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Muslim Community Center (MCC) --        250,000  Swalwell
 and Human Services       Children and Families.   East Bay, Pleasanton, CA for
                                                   services including rental
                                                   assistance, to assist refugees
                                                   as they work towards self-
                                                   sufficiency.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Neighborhood Legal Services of          817,006  Cardenas
 and Human Services       Children and Families.   Los Angeles County, Glendale, CA
                                                   for advocates to partner with
                                                   justice-involved individuals to
                                                   identify and address barriers to
                                                   self-sufficiency and family well-
                                                   being.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Newark Emergency Services for         1,107,500  Payne
 and Human Services       Children and Families.   Families, Inc., Newark, NJ for
                                                   services and the purchase of
                                                   equipment and goods, including
                                                   food, for fresh food
                                                   distribution, healthy cooking
                                                   workshops, and art therapy
                                                   classes for children and
                                                   families.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Next Door Solutions to Domestic         125,000  Lofgren
 and Human Services       Children and Families.   Violence, San Jose, CA for
                                                   violence prevention and
                                                   intervention services.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Office of the Mayor, New York         2,000,000  Bowman
 and Human Services       Children and Families.   City, NY for improving
                                                   coordination between social
                                                   agencies to support children and
                                                   families.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       One Nation Dream Makers,              2,000,000  Swalwell
 and Human Services       Children and Families.   Livermore, CA for services
                                                   including the purchase of food
                                                   and equipment to distribute food
                                                   to reduce poverty.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Oregon Community Programs,            1,000,000  Bonamici
 and Human Services       Children and Families.   Eugene, OR for supporting foster
                                                   youth and families and improving
                                                   the administration of the foster
                                                   care program.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Plaza Comunitaria Sinaloa,              800,000  Cardenas
 and Human Services       Children and Families.   Mission Hills, CA for expanding
                                                   educational programs and
                                                   implementing workforce
                                                   development programs to provide
                                                   low-income individuals with
                                                   access to better job
                                                   opportunities to improve
                                                   economic outcomes.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Safe Space, Inc., Louisburg, NC         197,800  Price (NC)
 and Human Services       Children and Families.   for culturally-specific child
                                                   abuse prevention services for at-
                                                   risk families.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Samuel Field YM-YWHA dba              1,000,000  Meng
 and Human Services       Children and Families.   Commonpoint Queens, Little Neck,
                                                   NY for workforce and wraparound
                                                   services to improve economic
                                                   outcomes.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       San Diego County, CA for outreach       500,000  Vargas
 and Human Services       Children and Families.   and recruitment of foster care
                                                   families to support children.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Sanctuary of Hope, Los Angeles,         749,920  Bass
 and Human Services       Children and Families.   CA for expanded navigation and
                                                   support services to improve
                                                   employment, education, and
                                                   economic opportunities.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Save the Children Federation,         1,080,764  Kilmer
 and Human Services       Children and Families.   Inc., Fairfield, CT for
                                                   programs, workshops, services
                                                   and goods, including the
                                                   purchase of food and equipment,
                                                   to reduce poverty and improve
                                                   outcomes for children and
                                                   families.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       South Central LAMP, Los Angeles,        100,000  Roybal-Allard
 and Human Services       Children and Families.   CA for support services for
                                                   children and families.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Southwest Georgia Children's            367,362  Bishop (GA)
 and Human Services       Children and Families.   Alliance, Inc., Americus, GA for
                                                   child abuse treatment and
                                                   prevention programs.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Spectrum Youth and Family               225,000  Welch
 and Human Services       Children and Families.   Services, Burlington, VT for
                                                   services and direct assistance
                                                   to improve self-sufficiency.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       The Center for Hope and Healing,        505,813  Trahan
 and Human Services       Children and Families.   Inc., Lowell, MA for services
                                                   and supplies to establish
                                                   financial stability and security
                                                   through job training and soft
                                                   skills development.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       The Children's Home Society of          631,500  Watson
 and Human Services       Children and Families.   New Jersey, Trenton, NJ for                      Coleman
                                                   employment training and related
                                                   expenses for low income women to
                                                   improve health and economic
                                                   outcomes.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       The Early Excellence Project,           600,000  Lamb
 and Human Services       Children and Families.   Pittsburgh, PA for expanding
                                                   educational opportunities and
                                                   improving economic outcomes.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Today is a Good Day, Flourtown,         332,275  Dean
 and Human Services       Children and Families.   PA for personal and financial
                                                   supports for families.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       UCAN, Chicago, IL for expanding       1,000,000  Davis, Danny
 and Human Services       Children and Families.   programs and social services                     K.
                                                   supporting foster youth to
                                                   improve economic outcomes and
                                                   community well-being.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       United Jewish Organizations of        1,200,000  Velazquez
 and Human Services       Children and Families.   Williamsburg Inc., Brooklyn, NY
                                                   for a social services initiative
                                                   connecting families to
                                                   assistance to reduce poverty and
                                                   improve economic independence.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       United Way of Central and               150,000  Hayes
 and Human Services       Children and Families.   Northeastern Connecticut,
                                                   Hartford, CT for training and
                                                   outreach programs, services, and
                                                   literacy supports for under-
                                                   resourced communities.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       United Way of Greater Cleveland,        255,000  Gonzalez (OH)
 and Human Services       Children and Families.   Cleveland, OH for the 2-1-1
                                                   system, including the purchase
                                                   of information technology and
                                                   equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       United Way of Greater Union             100,000  Watson
 and Human Services       Children and Families.   County, Elizabeth, NJ for                        Coleman
                                                   addressing food insecurity,
                                                   access to transportation and
                                                   healthcare, and financial
                                                   stability.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       United Way of Southern Nevada,        1,000,000  Titus
 and Human Services       Children and Families.   Las Vegas, NV for programs that
                                                   improve self-sufficiency and
                                                   reduce poverty for the non-
                                                   English proficient community.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       UnLocal, Inc., New York, NY for       1,000,000  Torres (NY)
 and Human Services       Children and Families.   services, education and outreach
                                                   to help financial self-
                                                   sufficiency.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Volunteers of America Delaware          479,100  Norcross
 and Human Services       Children and Families.   Valley, Camden, NJ for
                                                   partnerships to promote human
                                                   trafficking victimization
                                                   education and awareness and
                                                   prevent abuse.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Wellroot Family Services, Tucker,       286,500  Johnson (GA)
 and Human Services       Children and Families.   GA for housing and services and
                                                   supplies, including the purchase
                                                   of food, to improve economic
                                                   outcomes of young adults
                                                   transitioning out of foster care
                                                   or experiencing homelessness.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Wellspring Living, Inc, Atlanta,        245,560  McBath
 and Human Services       Children and Families.   GA for workforce services for
                                                   victims of sexual exploitation
                                                   and violence to increase
                                                   employment opportunities and
                                                   improve economic outcomes.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       WestCare Ohio, Inc., Dayton, OH       1,000,000  Turner
 and Human Services       Children and Families.   for community services
                                                   programming, including
                                                   wraparound services.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       White Pony Express, Pleasant            105,000  DeSaulnier
 and Human Services       Children and Families.   Hill, CA for services, and the
                                                   purchase of food and equipment
                                                   to support low income children.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Willow Domestic Violence Center         325,000  Morelle
 and Human Services       Children and Families.   of Greater Rochester, Inc.,
                                                   Rochester, NY for services and
                                                   training to support survivors of
                                                   abuse.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       YMCA of Greater Louisville,             200,000  Yarmuth
 and Human Services       Children and Families.   Louisville, KY, for model
                                                   service improvement, information
                                                   dissemination, and technical
                                                   assistance to address and
                                                   prevent child abuse and neglect.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       A Kid Again, Columbus, OH for           510,000  Beatty
 and Human Services       Community Living.        increasing access to therapeutic
                                                   events for children, including
                                                   the purchase of equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       AIDS Foundation of Chicago,             250,000  Quigley
 and Human Services       Community Living.        Chicago, IL for training and
                                                   services to better support
                                                   seniors living with HIV.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Alpha Phi Alpha Senior Citizens         154,000  Meeks
 and Human Services       Community Living.        Center, Inc., Cambria Heights,
                                                   NY for assisted transportation
                                                   services, including for the
                                                   purchase of equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Alzheimer's Foundation of               250,000  Garbarino
 and Human Services       Community Living.        America, Amityville, NY for an
                                                   Alzheimer's education, training,
                                                   and supportive services center,
                                                   including the purchase of
                                                   equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       APNA Brooklyn Community Center,         670,902  Jeffries
 and Human Services       Community Living.        Inc., Brooklyn, NY for expanding
                                                   senior services, including for
                                                   the purchase of food and
                                                   equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Arc of Prince George's County           819,500  Brown (MD)
 and Human Services       Community Living.        Inc., Largo, MD for expanding
                                                   services for individuals with
                                                   disabilities to prepare them for
                                                   employment and independent
                                                   living.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       BakerRipley, Houston, TX for          1,000,000  Garcia (TX)
 and Human Services       Community Living.        increasing access to food and
                                                   other services for seniors.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Bancroft, Cherry Hill, NJ for           500,000  Norcross
 and Human Services       Community Living.        increasing independent living,
                                                   including for the purchase of
                                                   equipment, including technology
                                                   and devices.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Central Massachusetts Agency on       1,200,000  McGovern
 and Human Services       Community Living.        Aging, Inc., Worcester, MA for
                                                   increasing services and
                                                   resources for grandparents
                                                   raising grandchildren.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Charter Township of Commerce,           235,050  Stevens
 and Human Services       Community Living.        Commerce Township, MI for
                                                   increasing senior reading and
                                                   independence including for the
                                                   purchase of equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Choice in Aging, Pleasant Hill,         500,000  DeSaulnier
 and Human Services       Community Living.        CA for increasing access to and
                                                   awareness of community-based
                                                   alternatives to nursing homes.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       City of Ontario, CA for expanding       439,094  Torres (CA)
 and Human Services       Community Living.        wellness programs, meal
                                                   services, and transportation
                                                   services for seniors.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Clausen House, Oakland, CA for an     1,058,408  Lee (CA)
 and Human Services       Community Living.        adult transition services
                                                   program to improve employment,
                                                   educational, life skills and
                                                   supports for individuals with
                                                   disabilities.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Community Action of Greater             100,000  Carson
 and Human Services       Community Living.        Indianapolis, Indianapolis, IN
                                                   for services, outreach, events,
                                                   transportation expenses, and
                                                   supplies to increase the number
                                                   of senior volunteers in their
                                                   communities.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Community Services Inc. of Ocean        270,475  Kim (NJ)
 and Human Services       Community Living.        County, Manahawkin, NJ for
                                                   increasing food delivery to
                                                   seniors, including the purchase
                                                   of equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Creative Enterprises, Inc,              612,320  Bourdeaux
 and Human Services       Community Living.        Lawrenceville, GA for expanding
                                                   access and increasing
                                                   opportunities for employment and
                                                   community inclusion, including
                                                   the purchase of equipment and
                                                   technology.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Designated Exceptional Services          85,000  Roybal-Allard
 and Human Services       Community Living.        for Independence (DESI), Los
                                                   Angeles, CA for expanding access
                                                   to and delivery of food for
                                                   seniors, including for the
                                                   purchase of equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       DOROT, Inc., New York, NY for           551,210  Meng
 and Human Services       Community Living.        expanding intergenerational
                                                   programming to increase social
                                                   enrichment services for older
                                                   adults.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Endeavor Forward, Inc, Marianna,        300,000  Dunn
 and Human Services       Community Living.        FL for a transition program for
                                                   adults with autism.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Fairfax County, VA for services       1,000,000  Beyer
 and Human Services       Community Living.        and purchase of equipment,
                                                   including technology, to
                                                   increase access to technology
                                                   and community engagement.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Friendship Circle, West                 364,009  Lawrence
 and Human Services       Community Living.        Bloomfield Township, MI for
                                                   expanding developmental learning
                                                   opportunities to promote
                                                   independence of students with
                                                   disabilities.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Hawaii Public Health Institute,       1,800,000  Case
 and Human Services       Community Living.        Honolulu, HI for support
                                                   navigator services for seniors
                                                   and caregivers.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Health Care District of Palm          1,000,000  Frankel, Lois
 and Human Services       Community Living.        Beach County, West Palm Beach,
                                                   FL for falls and injury
                                                   prevention programs, outreach,
                                                   and education.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       India Home, Inc., Jamaica, NY for       500,000  Suozzi
 and Human Services       Community Living.        an outreach program to promote
                                                   and incentivize senior health.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Island Harvest, Brentwood, NY for     1,100,000  Garbarino
 and Human Services       Community Living.        a nutrition program, including
                                                   the purchase of food, supplies
                                                   and equipment, and information
                                                   technology.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Jewish Service for the                  760,000  Sherrill
 and Human Services       Community Living.        Developmentally Disabled (JSDD),
                                                   Livingston, NJ for equipment and
                                                   support to expand access to
                                                   technology for individuals with
                                                   disabilities.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Lighthouse for the Visually             600,000  Bilirakis
 and Human Services       Community Living.        Impaired and Blind of Pasco,
                                                   Hernando and Citrus Counties,
                                                   New Port Richey, FL for an
                                                   education, training, and support
                                                   services program for seniors
                                                   with visual impairment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Metropolitan Council on Jewish        1,000,000  Jeffries
 and Human Services       Community Living.        Poverty, New York, NY for food
                                                   and services for seniors.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Metropolitan Council on Jewish        1,000,000  Meeks
 and Human Services       Community Living.        Poverty, New York, NY for food
                                                   and services for seniors.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Metropolitan Council on Jewish        1,000,000  Meng
 and Human Services       Community Living.        Poverty, New York, NY for
                                                   increasing senior access to and
                                                   delivery of food.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Minute Man Arc for Human                331,110  Trahan
 and Human Services       Community Living.        Services, Concord, MA for
                                                   increasing community
                                                   integration, access to social
                                                   services, and benefits
                                                   assistance resources.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Ocean Community Economic Action          55,000  Kim (NJ)
 and Human Services       Community Living.        Now, Inc., Toms River, NJ for
                                                   transportation and outreach
                                                   activities to expand seniors'
                                                   access to community living and
                                                   supports.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Pathlights Human Services, Palos        100,000  Newman
 and Human Services       Community Living.        Heights, IL for expanding access
                                                   to and delivery of meals for
                                                   seniors.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       People Inc., Williamsville, NY        2,035,139  Higgins (NY)
 and Human Services       Community Living.        for improving access to health
                                                   services, including for health
                                                   staffing, purchase of equipment
                                                   and technology expenses.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Regional Aid for Interim Needs,         800,000  Bowman
 and Human Services       Community Living.        Incorporated, Bronx, NY for
                                                   wraparound and case management
                                                   support services to support
                                                   older adults.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Scranton Neighborhood Housing         1,000,000  Cartwright
 and Human Services       Community Living.        Services, Inc., Scranton, PA for
                                                   services including home repairs
                                                   and modifications to support
                                                   aging in place.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Senior Services of Snohomish            250,400  DelBene
 and Human Services       Community Living.        County DBA Homage, Lynnwood, WA
                                                   for a rural transportation
                                                   project, including the purchase
                                                   of equipment, to increase access
                                                   to services.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Shepherd Center Inc., Atlanta, GA       800,000  Williams (GA)
 and Human Services       Community Living.        for the purchase of equipment,
                                                   including information
                                                   technology, and training
                                                   expenses to increase the
                                                   independence of people with
                                                   disabilities.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Tennessee State University,             500,000  Cooper
 and Human Services       Community Living.        Nashville, TN for a new program
                                                   to expand opportunities for
                                                   students to attend college and
                                                   prepare for independent living
                                                   and employment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       The City of Dover, DE for               500,000  Blunt
 and Human Services       Community Living.        improving opportunities for                      Rochester
                                                   children, youth and adults who
                                                   have physical and intellectual
                                                   disabilities, including the
                                                   purchase of equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       The Monmouth Ocean Foundation for       400,000  Smith (NJ)
 and Human Services       Community Living.        Children (MOFFC), Tinton Falls,
                                                   NJ for an autism education,
                                                   training, and support services
                                                   program, including the purchase
                                                   of information technology and
                                                   equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       The Rosalynn Carter Institute for     1,020,047  Bishop (GA)
 and Human Services       Community Living.        Caregivers, Americus, GA for
                                                   expanding and increasing
                                                   awareness of programs for
                                                   caregivers.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       The University of Texas at San          492,370  Castro (TX)
 and Human Services       Community Living.        Antonio, San Antonio, TX for an
                                                   evaluation and research center
                                                   to improve access to care and
                                                   quality of life outcomes for
                                                   individuals living with
                                                   disabilities.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Wesley Community Services, Inc.,      1,322,415  Axne
 and Human Services       Community Living.        Johnston, IA for expanding
                                                   access to and delivery of senior
                                                   services, including the purchase
                                                   of equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       West Bloomfield Parks and                85,000  Stevens
 and Human Services       Community Living.        Recreation Commission, West
                                                   Bloomfield, MI for social
                                                   workers and expansion of social
                                                   services for seniors.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Westchester Residential                 500,000  Jones
 and Human Services       Community Living.        Opportunities, Inc., White
                                                   Plains, NY for home repairs and
                                                   modifications to support aging
                                                   in place and enable healthy
                                                   living.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       Yellow House Community Services,        250,000  Welch
 and Human Services       Community Living.        Inc., Middlebury, VT for housing
                                                   and services for individuals
                                                   with disabilities.
----------------------------------------------------------------------------------------------------------------
Department of Health     Administration for       YWCA Greater Los Angeles, Los           375,000  Roybal-Allard
 and Human Services       Community Living.        Angeles, CA for expanding senior
                                                   empowerment services.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Abide Women's Health Services,          290,261  Johnson (TX)
 and Human Services       Services                 Dallas, TX for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     About Sojourners with Healing           167,500  Cherfilus-
 and Human Services       Services                 Hearts, West Palm Beach, FL for                  McCormick
                          Administration.          a cancer screening initiative.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Adapt, Inc., Roseburg, OR for         1,000,000  DeFazio
 and Human Services       Services                 facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Adult & Teen Challenge USA,             750,000  Long
 and Human Services       Services                 Ozark, MO for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     AdventHealth Durand, West Durand,       916,000  Kind
 and Human Services       Services                 WI for facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     AdventHealth for Children,            1,000,000  Murphy (FL)
 and Human Services       Services                 Orlando, FL for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Adventist Health/Central Valley       1,250,000  Valadao
 and Human Services       Services                 Network, Hanford, CA for
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Adventist HealthCare Fort             1,000,000  Hoyer
 and Human Services       Services                 Washington Medical Center, Inc.,
                          Administration.          Fort Washington, MD for
                                                   facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Adventist Healthcare Inc.,              500,000  Raskin
 and Human Services       Services                 Gaithersburg, MD for facilities
                          Administration.          and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Advocate Health and Hospitals         2,940,000  Newman
 and Human Services       Services                 Corporation, Downers Grove, IL
                          Administration.          for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Advocates for a Health Community      2,000,000  Long
 and Human Services       Services                 DBA Jordan Valley Community
                          Administration.          Health Center, Springfield, MO
                                                   for facilities.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Advocates Inc., Framingham, MA          500,000  Clark (MA)
 and Human Services       Services                 for facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Alivio Medical Center, Chicago,       3,000,000  Garcia (IL)
 and Human Services       Services                 IL for facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Allegheny Health Network,             1,400,000  Lamb
 and Human Services       Services                 Pittsburgh, PA for facilities
                          Administration.          and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     AltaMed Health Services, Los            255,000  Gomez
 and Human Services       Services                 Angeles, CA for equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     AltaMed Health Services, Los          2,346,186  Barragan
 and Human Services       Services                 Angeles, CA for equipment and
                          Administration.          operational costs.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     AMAAD Institute, Los Angeles, CA        935,000  Waters
 and Human Services       Services                 for facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     American Indian Health & Family       1,500,000  Tlaib
 and Human Services       Services                 Services of Southeastern
                          Administration.          Michigan, Inc., Detroit, MI for
                                                   facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Americana Community Center Inc.,      2,000,000  Yarmuth
 and Human Services       Services                 Louisville, KY for facilities
                          Administration.          and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Anna Maria College, Paxton, MA        1,000,000  McGovern
 and Human Services       Services                 for facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     APLA Able Arts, Long Beach, CA          500,000  Lowenthal
 and Human Services       Services                 for facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Arts and Services for the               980,000  Lowenthal
 and Human Services       Services                 Disabled, Inc. dba Able ARTS
                          Administration.          Work, Long Beach, CA for
                                                   facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     ARUP Laboratories, Inc., Salt         3,000,000  Stewart
 and Human Services       Services                 Lake City, UT for facilities.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Ashtabula County Medical Center,      3,000,000  Joyce (OH)
 and Human Services       Services                 Ashtabula, OH for equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Asian American Drug Abuse             2,230,000  Bass
 and Human Services       Services                 Prevention, Inc., Los Angeles,
                          Administration.          CA for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Asian American Health Coalition-      1,300,000  Garcia (TX)
 and Human Services       Services                 HOPE Clinic, Houston, TX for
                          Administration.          equipment and operational costs
                                                   for an oral health program.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Aspire Health Partners, Orlando,        310,000  Murphy (FL)
 and Human Services       Services                 FL for facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Association for Individual            3,000,000  Krishnamoorth
 and Human Services       Services                 Development, Aurora, IL for                      i
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Atlantic Health System,               1,000,000  Sherrill
 and Human Services       Services                 Morristown, NJ for facilities
                          Administration.          and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Auburn Community Hospital,            2,000,000  Katko
 and Human Services       Services                 Auburn, NY for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Aunt Martha's Health and                450,000  Underwood
 and Human Services       Services                 Wellness, Olympia Fields, IL for
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Aurora Community Mental Health        2,000,000  Crow
 and Human Services       Services                 Center, Aurora, CO for
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Ballad Health, Johnson City, TN         605,000  Griffith
 and Human Services       Services                 for facilities.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Ballad Health, Johnson City, TN         500,000  Harshbarger
 and Human Services       Services                 for facilities.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Banyan Community Health Center,       2,500,000  Salazar
 and Human Services       Services                 Miami, FL for facilities.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Baptist Health Deaconess                515,000  Comer
 and Human Services       Services                 Madisonville, Inc.,
                          Administration.          Madisonville, KY for facilities
                                                   and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Barton Hose Company No 1. Inc.,       1,875,000  Trone
 and Human Services       Services                 Barton, MD for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Bay Area Community Health,              700,000  Swalwell
 and Human Services       Services                 Fremont, CA for equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Bay Area Community Health, San        1,000,000  Lofgren
 and Human Services       Services                 Jose, CA for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Bay County Health Department, Bay     2,000,000  Kildee
 and Human Services       Services                 City, MI for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Baylor Scott & White Medical          3,000,000  Carter (TX)
 and Human Services       Services                 Center--Round Rock, Round Rock,
                          Administration.          TX for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Beloved Community Family Wellness     2,000,000  Rush
 and Human Services       Services                 Center, Chicago, IL for
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Beth Israel Deaconess Hospital--      2,000,000  Keating
 and Human Services       Services                 Plymouth, Inc., Plymouth, MA for
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Block Island Health Services, New     2,000,000  Langevin
 and Human Services       Services                 Shoreham, RI for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Bobby Benson Center, Kahuku, HI       1,200,000  Kahele
 and Human Services       Services                 for facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Bon Secours Charity Health            1,000,000  Jones
 and Human Services       Services                 System, Suffern, NY for
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Boone Memorial Hospital, Inc.,        3,000,000  Miller (WV)
 and Human Services       Services                 Madison, WV for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Bread for the City, Washington,       3,000,000  Norton
 and Human Services       Services                 DC for facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Brockton Neighborhood Health          1,000,000  Lynch
 and Human Services       Services                 Center, Brockton, MA for
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Bronx Community Health Network,       2,001,503  Bowman
 and Human Services       Services                 Bronx, NY for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Brooks County Independent School      1,500,000  Gonzalez,
 and Human Services       Services                 District, Falfurrias, TX for                     Vicente
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Brownsville Community Development     2,200,000  Clarke (NY)
 and Human Services       Services                 Corporation, Brooklyn, NY for
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Cabell Huntington Hospital, Inc.,     3,000,000  Miller (WV)
 and Human Services       Services                 Huntington, WV for facilities.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     California State University, San      2,000,000  Aguilar
 and Human Services       Services                 Bernardino, CA for facilities
                          Administration.          and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     CalvertHealth Medical Center,           950,000  Hoyer
 and Human Services       Services                 Prince Frederick, MD for
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Cambridge Public Health               1,000,000  Clark (MA)
 and Human Services       Services                 Commission (dba Cambridge Health
                          Administration.          Alliance), Cambridge, MA for
                                                   facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Campbell City School District,        2,000,000  Ryan
 and Human Services       Services                 Campbell, OH for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Caridad Center, Inc., Boynton         1,000,000  Frankel, Lois
 and Human Services       Services                 Beach, FL for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Cedar Riverside People's Center,      1,000,000  Omar
 and Human Services       Services                 Minneapolis, MN for facilities
                          Administration.          and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Center for Addiction Treatment,         500,000  Chabot
 and Human Services       Services                 Cincinnati, OH for facilities.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Centerstone, Bradenton, FL for        1,200,000  Buchanan
 and Human Services       Services                 facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Central Pennsylvania Institute of     2,000,000  Thompson (PA)
 and Human Services       Services                 Science and Technology,
                          Administration.          Bellefonte, PA for facilities.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Central Piedmont Community              575,000  Adams
 and Human Services       Services                 College, Charlotte, NC for
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Central Vermont Medical Center,         735,560  Welch
 and Human Services       Services                 Berlin, VT for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Central Washington University,        1,000,000  Schrier
 and Human Services       Services                 Ellensburg, WA for facilities
                          Administration.          and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     CentraState Medical Center, Inc.        615,000  Smith (NJ)
 and Human Services       Services                 , Freehold, NJ for equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Centro del Barrio, Inc., San          1,000,000  Castro (TX)
 and Human Services       Services                 Antonio, TX for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Centro Hispano Daniel Torres            635,713  Houlahan
 and Human Services       Services                 Inc., Reading, PA for facilities
                          Administration.          and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Charles River Community Health          247,000  Clark (MA)
 and Human Services       Services                 Center, Waltham, MA for an
                          Administration.          electronic health records
                                                   initiative.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Charlotte Community Health              600,000  Adams
 and Human Services       Services                 Clinic, Inc., Charlotte, NC for
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Chattanooga-Hamilton County           2,000,000  Fleischmann
 and Human Services       Services                 Hospital Authority d/b/a
                          Administration.          Erlanger Health System,
                                                   Chattanooga, TN for facilities
                                                   and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Cherry Creek School District,         1,500,000  Crow
 and Human Services       Services                 Greenwood Village, CO for
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Cherry Hill Free Clinic, Cherry         440,905  Norcross
 and Human Services       Services                 Hill, NJ for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Children's Health Clinical            1,000,000  Allred,
 and Human Services       Services                 Operations, Dallas, TX for                       Veasey
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Children's Hospital Los Angeles,      1,500,000  Garcia (CA)
 and Human Services       Services                 Los Angeles, CA for equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Children's Clinic dba TCC Family        575,000  Lowenthal
 and Human Services       Services                 Health, Long Beach, CA for
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Children's Health Clinical            1,000,000  Van Duyne
 and Human Services       Services                 Operations, Dallas, TX for
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Children's Health of Orange           1,000,000  Correa
 and Human Services       Services                 County, Orange, CA for
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Children's Hospital Medical           2,000,000  Ryan
 and Human Services       Services                 Center of Akron, OH for
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Chinatown Service Center,               215,000  Chu
 and Human Services       Services                 Monterey Park, CA for equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Chinese Culture and Community         1,000,000  Trone
 and Human Services       Services                 Service Center, Inc.,
                          Administration.          Gaithersburg, MD for facilities
                                                   and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Chiricahua Community Health             983,265  Kirkpatrick
 and Human Services       Services                 Centers, Inc., Douglas, AZ for
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     ChristianaCare Health System,           900,000  Blunt
 and Human Services       Services                 Wilmington, DE for a nutrition                   Rochester
                          Administration.          program for pregnant women.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     CHRISTUS Ochsner Health               1,000,000  Higgins (LA)
 and Human Services       Services                 Southwestern Louisiana -- St.
                          Administration.          Patrick Hospital, Lake Charles,
                                                   LA for facilities.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     CHRISTUS St. Frances Cabrini            775,000  Letlow
 and Human Services       Services                 Hospital, Alexandria, LA for
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Cincinnati Children's Hospital          630,000  Chabot
 and Human Services       Services                 Medical Center, Cincinnati, OH
                          Administration.          for equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     City of Albuquerque, NM for           2,200,000  Stansbury
 and Human Services       Services                 facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     City of Berea, KY for equipment..       350,000  Barr
 and Human Services       Services
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     City of Greenville, MS for            2,000,000  Thompson (MS)
 and Human Services       Services                 facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     City of Guin, AL for facilities..       150,000  Aderholt
 and Human Services       Services
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     City of Hope National Medical           150,000  Garcia (CA)
 and Human Services       Services                 Center, Duarte, CA for equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     City of Houston--Houston Health       1,000,000  Jackson Lee
 and Human Services       Services                 Department, Houston, TX for a
                          Administration.          vision health program.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     City of West Hollywood, CA for          300,000  Schiff
 and Human Services       Services                 facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Clay County Healthcare Authority,     1,500,000  Rogers (AL)
 and Human Services       Services                 Ashland, AL for facilities.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Cleveland Clinic, Cleveland, OH         905,000  Gonzalez (OH)
 and Human Services       Services                 for equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Cleveland Clinic, Cleveland, OH         615,000  Joyce (OH)
 and Human Services       Services                 for facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Clinica Msr. Oscar A. Romero, Los     1,000,000  Gomez
 and Human Services       Services                 Angeles, CA for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Cold Spring Harbor Laboratory,        1,000,000  Suozzi
 and Human Services       Services                 Cold Spring Harbor, NY for
                          Administration.          equipment and operational costs.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     College of Southern Nevada, North       750,000  Horsford
 and Human Services       Services                 Las Vegas Campus, North Las
                          Administration.          Vegas, NV for facilities and
                                                   equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     CommuniCare Health Centers, West      1,500,000  Matsui
 and Human Services       Services                 Sacramento, CA for an electronic
                          Administration.          health records initiative.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Community Bridges, Inc., Mesa, AZ     1,000,000  Gallego
 and Human Services       Services                 for facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Community Care Clinic of                575,000  Cawthorn
 and Human Services       Services                 Franklin, Inc., Franklin, NC for
                          Administration.          facilities.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Community Consolidated School         1,000,000  Schneider
 and Human Services       Services                 District 21, Wheeling, IL for
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Community Foundation of Greater       3,000,000  Miller-Meeks
 and Human Services       Services                 Muscatine, Muscatine, IA for
                          Administration.          facilities.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Community Health Partnership, San       175,000  Lofgren
 and Human Services       Services                 Jose, CA for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Community Medical Centers,              500,000  Harder (CA),
 and Human Services       Services                 Stockton, CA for facilities and                  McNerney
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Community Medical Centers,              950,000  Harder (CA)
 and Human Services       Services                 Stockton, CA for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Community Regional Medical            1,500,000  Costa
 and Human Services       Services                 Center, Fresno, CA for
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Compass Health, Inc., St. Peters,     1,000,000  Luetkemeyer
 and Human Services       Services                 MO for facilities.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Comprehensive Community Action,       1,000,000  Langevin
 and Human Services       Services                 Inc., Cranston, RI for
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Connecticut Hospice, Inc.,            1,940,000  DeLauro
 and Human Services       Services                 Branford, CT for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Connecticut Institute For             2,000,000  Hayes
 and Human Services       Services                 Communities, Inc., Danbury, CT
                          Administration.          for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Cook County Health, Chicago, IL       1,000,000  Krishnamoorth
 and Human Services       Services                 for facilities and equipment.                    i
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Cooperman Barnabas Medical            1,000,000  Sherrill
 and Human Services       Services                 Center, Livingston, NJ for
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Cornerstone Family Healthcare,        2,800,000  Maloney, Sean
 and Human Services       Services                 Cornwall, NY for facilities and                  Patrick
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Cortland County, NY for               2,995,000  Tenney
 and Human Services       Services                 facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     County of Bernalillo,                   422,031  Stansbury
 and Human Services       Services                 Albuquerque, NM for facilities
                          Administration.          and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     County of Clark, Las Vegas, NV        1,330,000  Lee (NV)
 and Human Services       Services                 for equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     County of Clark, Las Vegas, NV        1,600,000  Titus
 and Human Services       Services                 for facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     County of Culpeper, VA for              324,494  Spanberger
 and Human Services       Services                 facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     County of Delaware, Media, PA for     1,750,000  Scanlon
 and Human Services       Services                 an electronic health records
                          Administration.          initiative.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     County of Fairfax, VA for             1,700,000  Beyer
 and Human Services       Services                 facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     County of Lane, Eugene, OR for        1,500,000  DeFazio
 and Human Services       Services                 facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     County of Montgomery, Rockville,      3,000,000  Raskin
 and Human Services       Services                 MD for facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     County of Northampton, Easton, PA     1,000,000  Wild
 and Human Services       Services                 for facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     County of Oakland, Pontiac, MI        1,200,000  Stevens
 and Human Services       Services                 for facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     County of Orange, Santa Ana, CA       3,000,000  Correa
 and Human Services       Services                 for facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     County of Riverside--Riverside        1,000,000  Takano
 and Human Services       Services                 University Health System, Moreno
                          Administration.          Valley, CA for facilities and
                                                   equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     County of Riverside--Riverside        1,000,000  Ruiz
 and Human Services       Services                 University Health System,
                          Administration.          Riverside, CA for facilities and
                                                   equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     County of San Mateo, CA for an        1,000,000  Speier
 and Human Services       Services                 electronic health records
                          Administration.          initiative.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     County of Taos, NM for facilities     2,200,000  Leger
 and Human Services       Services                 and equipment.                                   Fernandez
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     County of Wake, Raleigh, NC for       2,000,000  Ross
 and Human Services       Services                 facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Covenant Community Care, Inc.,          500,000  Tlaib
 and Human Services       Services                 Detroit, MI for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Cowlitz Indian Tribe, Longview,         765,000  Herrera
 and Human Services       Services                 WA for facilities.                               Beutler
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Cowlitz Indian Tribe, Longview,       1,000,000  Smith (WA)
 and Human Services       Services                 WA for facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Crouse Health, Syracuse, NY for       1,010,000  Katko
 and Human Services       Services                 facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Cullman Regional Medical Center,      1,585,000  Aderholt
 and Human Services       Services                 Inc., Cullman, AL for equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Cumberland University, Lebanon,         750,000  Rose
 and Human Services       Services                 TN for equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Denver Health and Hospital            2,200,000  DeGette
 and Human Services       Services                 Authority, Denver, CO for
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Desert AIDS Project, Palm             2,000,000  Ruiz
 and Human Services       Services                 Springs, CA for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Division of Infectious Diseases,        500,000  Deutch
 and Human Services       Services                 University of Miami Miller
                          Administration.          School of Medicine, Miami, FL
                                                   for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Downtown Emergency Service              985,000  Jayapal
 and Human Services       Services                 Center, Seattle, WA for
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Doylestown Health Foundation          1,000,000  Fitzpatrick
 and Human Services       Services                 D.B.A. Doylestown Health,
                          Administration.          Doylestown, PA for facilities
                                                   and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Duncan Regional Hospital, Inc.,         750,000  Cole
 and Human Services       Services                 Duncan, OK for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Duquesne University, Pittsburgh,      2,200,000  Doyle,
 and Human Services       Services                 PA for facilities and equipment.                 Michael F.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     East Bay Community Action               513,600  Cicilline
 and Human Services       Services                 Program, Newport, RI for
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     East Tennessee Children's             2,500,000  Burchett
 and Human Services       Services                 Hospital, Knoxville, TN for
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Easterseals of Oak Hill,              1,874,000  Courtney
 and Human Services       Services                 Hartford, CT for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Edward M. Kennedy Community           1,000,000  Auchincloss
 and Human Services       Services                 Health Center, Inc., Worcester,
                          Administration.          MA for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Edward M. Kennedy Health Center,      3,000,000  McGovern
 and Human Services       Services                 Inc., Boston, MA for facilities
                          Administration.          and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Eisner Health, Los Angeles, CA          610,000  Barragan
 and Human Services       Services                 for facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     El Centro de Corazon, Houston, TX     3,000,000  Garcia (TX)
 and Human Services       Services                 for facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     El Paso Children's Hospital, El         595,000  Escobar
 and Human Services       Services                 Paso, TX for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     El Proyecto del Barrio Inc.,          1,000,000  Sherman
 and Human Services       Services                 Winnetka, CA for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Ellis County Coalition for Health     3,000,000  Ellzey
 and Human Services       Services                 Options, Inc., dba Hope Clinic,
                          Administration.          Waxahachie, TX for facilities
                                                   and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Erie Family Health Centers,           1,173,900  Garcia (IL)
 and Human Services       Services                 Chicago, IL for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Escambia County Health Care             655,000  Carl
 and Human Services       Services                 Authority dba Atmore Community
                          Administration.          Hospital, Atmore, AL for
                                                   equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Fair Haven Community Health           3,000,000  DeLauro
 and Human Services       Services                 Clinic, Inc., New Haven, CT for
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Family Centers Inc., Stamford, CT     1,000,000  Himes
 and Human Services       Services                 for facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Family Christian Health Center,         353,441  Kelly (IL)
 and Human Services       Services                 Harvey, IL for equipment and
                          Administration.          operational costs.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Family Health Services                1,550,000  Simpson
 and Human Services       Services                 Corporation, Twin Falls, ID for
                          Administration.          facilities.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Ferd & Gladys Alpert Jewish             700,000  Frankel, Lois
 and Human Services       Services                 Family & Children's Service of
                          Administration.          Palm Beach County, Inc., West
                                                   Palm Beach, FL for facilities
                                                   and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Figgers Foundation, Lauderhill,       2,200,000  Cherfilus-
 and Human Services       Services                 FL for a telehealth initiative.                  McCormick
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Finkelstein Memorial Library,         2,000,000  Jones
 and Human Services       Services                 Spring Valley, NY for facilities
                          Administration.          and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     First Nations Community               1,000,000  Stansbury
 and Human Services       Services                 HealthSource, Albuquerque, NM
                          Administration.          for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Flaget Memorial Hospital                635,000  Guthrie
 and Human Services       Services                 Foundation, Bardstown, KY for
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Florida International University,     3,000,000  Gimenez
 and Human Services       Services                 Miami, FL for equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Florida State University,             2,490,000  Dunn
 and Human Services       Services                 Tallahassee, FL for facilities
                          Administration.          and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Franciscan Missionaries of Our        1,935,000  Graves (LA)
 and Human Services       Services                 Lady University, Baton Rouge, LA
                          Administration.          for facilities.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Frederick County Government,            698,083  Trone
 and Human Services       Services                 Frederick, MD for equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Freedom Rain Incorporated dba The     2,000,000  Sewell
 and Human Services       Services                 Lovelady Center, Birmingham, AL
                          Administration.          for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Fresno Center, Fresno, CA for         1,500,000  Costa
 and Human Services       Services                 facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Friends of Youth, Kirkland, WA        1,000,000  DelBene
 and Human Services       Services                 for facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Friendship House, Scranton, PA        1,500,000  Cartwright
 and Human Services       Services                 for facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Gardner Family Health Network,          500,000  Khanna
 and Human Services       Services                 Incorporated, Alviso, CA for
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Gardner Family Health Network,        1,000,000  Lofgren
 and Human Services       Services                 Incorporated, San Jose, CA for
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Garfield Health Center, Monterey        480,000  Chu
 and Human Services       Services                 Park, CA for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Garrett Regional Medical Center,        650,000  Trone
 and Human Services       Services                 Oakland, MD, for an electronic
                          Administration.          health records initiative.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Gateway Community Health Center,      1,997,000  Cuellar
 and Human Services       Services                 Inc., Laredo, TX for facilities
                          Administration.          and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     George Corley Wallace State           1,143,018  Sewell
 and Human Services       Services                 Community College, Demopolis, AL
                          Administration.          for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     George Mason University, Fairfax,       820,000  Wexton
 and Human Services       Services                 VA for equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     George Washington University,         1,190,000  Norton
 and Human Services       Services                 Washington, DC for facilities
                          Administration.          and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Germanna Community College              251,000  Spanberger
 and Human Services       Services                 Educational Foundation Inc.,
                          Administration.          Locust Grove, VA for facilities
                                                   and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Gillette Children's Specialty         1,500,000  McCollum
 and Human Services       Services                 Healthcare, St. Paul, MN for
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Grace Health, Battle Creek, MI          525,000  Meijer
 and Human Services       Services                 for facilities.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Grand View Hospital d/b/a Grand       1,000,000  Fitzpatrick
 and Human Services       Services                 View Health, Sellersville, PA
                          Administration.          for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Grant County Public Hospital          2,500,000  Newhouse
 and Human Services       Services                 District No 1, dba Samaritan
                          Administration.          Healthcare, Moses Lake, WA for
                                                   facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Great Basin College, Elko, NV for       940,000  Amodei
 and Human Services       Services                 facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Great Salt Plains Health Center,      2,180,000  Lucas
 and Human Services       Services                 Inc., Cherokee, OK for
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Greater Baden Medical Services,       3,000,000  Brown (MD)
 and Human Services       Services                 Inc., Brandywine, MD for
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Greene County Hospital and              521,100  Sewell
 and Human Services       Services                 Nursing Home, Eutaw, AL for
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Grover C. Dils Medical Center,        3,000,000  Horsford
 and Human Services       Services                 Caliente, NV for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Gundersen Tri-County Hospital,        1,000,000  Kind
 and Human Services       Services                 Whitehall, WI for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     H. Lee Moffitt Cancer Center and      3,000,000  Bilirakis
 and Human Services       Services                 Research Institute, Inc., Tampa,
                          Administration.          FL for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     H. Lee Moffitt Cancer Center and      1,000,000  Castor (FL)
 and Human Services       Services                 Research Institute, Inc., Tampa,
                          Administration.          FL for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Hackensack Meridian Health,           1,000,000  Pascrell
 and Human Services       Services                 Edison, NJ for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Hamakua-Kohala Health Center,         2,000,000  Kahele
 and Human Services       Services                 Honokaa, HI for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Hamilton Community Health             1,000,000  Kildee
 and Human Services       Services                 Network, Flint, MI for
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Harris County Precinct 2,             3,000,000  Garcia (TX)
 and Human Services       Services                 Houston, TX for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Havana Community Development          1,967,328  Lawson (FL)
 and Human Services       Services                 Corp., Inc., Havana, FL for
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Health and Hospital Corporation       1,385,487  Carson
 and Human Services       Services                 of Marion County, Indianapolis,
                          Administration.          IN for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Health Care Authority Corporation     1,000,000  Sewell
 and Human Services       Services                 of the City of Thomasville, AL
                          Administration.          for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Health Service Alliance-Montclair       300,000  Torres (CA)
 and Human Services       Services                 Community Health Center,
                          Administration.          Montclair, CA for facilities and
                                                   equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Health Unit on Davidson Avenue          281,200  Tlaib
 and Human Services       Services                 (The HUDA Clinic), Detroit, MI
                          Administration.          for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     HealthFirst Family Center,              450,000  Kuster
 and Human Services       Services                 Franklin, NH for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     HealthPoint, Renton, WA for           2,000,000  DelBene
 and Human Services       Services                 facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     HealthRIGHT 360, San Francisco,       2,500,000  Pelosi
 and Human Services       Services                 CA for facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Healthy Mothers, Healthy Babies         305,313  Cherfilus-
 and Human Services       Services                 Coalition of Palm Beach County,                  McCormick
                          Administration.          Inc., Greenacres, FL for a doula
                                                   training program.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Henderson County Rural Health           517,783  Bustos
 and Human Services       Services                 Center, Inc., dba Eagle View
                          Administration.          Community Health System,
                                                   Oquawka, IL for health clinic
                                                   operational costs.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Hendry County, LaBelle, FL for          700,000  Diaz-Balart
 and Human Services       Services                 facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Henry J. Austin Health Center,          813,600  Watson
 and Human Services       Services                 Trenton, NJ for a mobile health                  Coleman
                          Administration.          unit and staffing.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Henry Mayo Newhall Hospital           1,115,000  Garcia (CA)
 and Human Services       Services                 Foundation, Valencia, CA for
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Heritage Heights at Lake Chelan,        800,000  Schrier
 and Human Services       Services                 WA for facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Highlands Hospital dba Penn           1,000,000  Reschenthaler
 and Human Services       Services                 Highlands Connellsville (PHCV),
                          Administration.          a subsidiary of Penn Highlands
                                                   Healthcare (PHH), Connellsville,
                                                   PA for facilities.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Hillsdale Community Health              345,000  Walberg
 and Human Services       Services                 Center, Hillsdale, MI for
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     His Branches, Inc., Rochester, NY       819,312  Morelle
 and Human Services       Services                 for facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Howard Brown Health, Chicago, IL      1,110,400  Quigley
 and Human Services       Services                 for facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Hyndman Area Health Center, Inc,        425,000  Joyce (PA)
 and Human Services       Services                 Bedford, PA for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     I. M. Sulzbacher Center for the       2,000,000  Rutherford
 and Human Services       Services                 Homeless, Inc., Jacksonville, FL
                          Administration.          for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Illinois College of Optometry,          445,000  Rush
 and Human Services       Services                 Chicago, IL for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Illinois Community College              300,000  Bustos
 and Human Services       Services                 District #519 (Highland
                          Administration.          Community College), Freeport, IL
                                                   for equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Illinois State University,            2,000,000  LaHood
 and Human Services       Services                 Mennonite College of Nursing,
                          Administration.          Normal, IL for facilities and
                                                   equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Inner City Health Center, Denver,       183,486  DeGette
 and Human Services       Services                 CO for facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Interfaith Medical Center Campus,     3,000,000  Jeffries
 and Human Services       Services                 Brooklyn, NY for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     J. Paul Jones Hospital, Camden,         595,041  Sewell
 and Human Services       Services                 AL for facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Jackson Parish Hospital,              2,000,000  Letlow
 and Human Services       Services                 Jonesboro, LA for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Jamaica Hospital Medical Center,      1,905,000  Meeks
 and Human Services       Services                 Jamaica, NY for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Jamaica Hospital Medical Center,      2,400,000  Meeks
 and Human Services       Services                 Jamaica, NY for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Jawonio Inc., New City, NY for        1,300,000  Jones
 and Human Services       Services                 facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Jersey Community Hospital             2,000,000  Davis, Rodney
 and Human Services       Services                 District, Jerseyville, IL for
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Jessie Trice Community Health         3,000,000  Wilson (FL)
 and Human Services       Services                 System, Inc., Miami, FL for
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Jewish Community Free Clinic,           200,000  Huffman
 and Human Services       Services                 Santa Rosa, CA for an electronic
                          Administration.          health records initiative.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Jewish Foundation for Group             750,000  Raskin
 and Human Services       Services                 Homes, Rockville, MD for
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Joseph P. Addabbo Family Health         325,000  Meeks
 and Human Services       Services                 Center, Inc., New York, NY for
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Josselyn Center, Northfield, IL       1,000,000  Schneider
 and Human Services       Services                 for facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Jurupa Unified, Jurupa Valley, CA     1,623,000  Takano
 and Human Services       Services                 for facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Kern County Hospital Authority,       3,000,000  Valadao
 and Human Services       Services                 Bakersfield, CA for equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Kern County Hospital Authority,       3,000,000  Valadao
 and Human Services       Services                 Bakersfield, CA for facilities
                          Administration.          and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Keryx Ministries, Inc., Macon, GA       400,000  Bishop (GA)
 and Human Services       Services                 for facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Keystone Valley Fire Department,         29,385  Houlahan
 and Human Services       Services                 Parkesburg, PA for equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Kids' Community Clinic of             1,200,000  Schiff
 and Human Services       Services                 Burbank, CA for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     KidsPeace, Orefield, PA for           1,000,000  Wild
 and Human Services       Services                 facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     King Lunalilo Trust and Home,         1,740,550  Case
 and Human Services       Services                 Honolulu, HI for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Kings County Hospital Center,         2,200,000  Clarke (NY)
 and Human Services       Services                 Brooklyn, NY for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Klingberg Family Centers,             1,000,000  Hayes
 and Human Services       Services                 Incorporated, New Britain, CT
                          Administration.          for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     La Maestra Family Clinic Inc.,          751,681  Jacobs (CA)
 and Human Services       Services                 San Diego, CA for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Lake County Free Clinic,                100,000  Joyce (OH)
 and Human Services       Services                 Painesville, OH for equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Lakewood Community Services           1,000,000  Smith (NJ)
 and Human Services       Services                 Corporation, Lakewood, NJ for
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Lana'i Community Health Center,       1,538,000  Kahele
 and Human Services       Services                 Lana'i City, HI for facilities
                          Administration.          and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Lansing Fire Department, Lansing,     1,000,000  Slotkin
 and Human Services       Services                 MI for facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     LaSalle General Hospital, Jena,       1,065,000  Letlow
 and Human Services       Services                 LA for facilities.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Lawrence General Hospital,            1,000,000  Trahan
 and Human Services       Services                 Lawrence, MA for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Le Bonheur Children's Hospital,         970,000  Cohen
 and Human Services       Services                 Memphis, TN for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Legacy Community Health, Houston,     1,000,000  Green (TX)
 and Human Services       Services                 TX for an electronic health
                          Administration.          records initiative.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Legacy Community Health, Houston,       300,000  Garcia (TX)
 and Human Services       Services                 TX for facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Leyden Family Service & Mental          266,059  Krishnamoorth
 and Human Services       Services                 Health Center, Hoffman Estates,                  i
                          Administration.          IL for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     LifeCare Alliance, Columbus, OH         975,000  Beatty
 and Human Services       Services                 for facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Lighthouse Youth Services, Inc.,      1,850,000  Wenstrup
 and Human Services       Services                 Cincinnati, OH for facilities.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Lions Eye Institute for               1,000,000  Castor (FL)
 and Human Services       Services                 Transplant and Research
                          Administration.          Foundation, Tampa, FL for
                                                   facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Livingston County Emergency           1,169,950  Slotkin
 and Human Services       Services                 Management Services, Howell, MI
                          Administration.          for equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Loma Linda University Medical         2,000,000  Calvert
 and Human Services       Services                 Center- Murrieta, Murrieta, CA
                          Administration.          for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Long Island Jewish Forest Hills,      1,000,000  Meng
 and Human Services       Services                 NY for facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Los Angeles County Fire                 201,834  Torres (CA)
 and Human Services       Services                 Department, Los Angeles, CA for
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Louisiana Children's Medical          2,000,000  Carter (LA)
 and Human Services       Services                 Center, New Orleans, LA for
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Louisiana State University Health     2,350,000  Carter (LA)
 and Human Services       Services                 Sciences Center--New Orleans, LA
                          Administration.          for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Loveland Fire Rescue Authority,         500,000  Neguse
 and Human Services       Services                 Loveland, CO for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Lower Bucks Hospital, Bristol, PA     1,200,000  Fitzpatrick
 and Human Services       Services                 for facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Lower Elwha Tribal Community,         1,911,875  Kilmer
 and Human Services       Services                 Port Angeles, WA for facilities
                          Administration.          and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     LTSC Community Development            1,000,000  Schiff
 and Human Services       Services                 Corporation, Los Angeles, CA for
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Lynn Community Health Center,         1,000,000  Moulton
 and Human Services       Services                 Lynn, MA for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Madison County Fiscal Court,            390,000  Barr
 and Human Services       Services                 Richmond, KY for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Main Line Hospitals, Inc.,            1,000,000  Scanlon
 and Human Services       Services                 Radnor, PA for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Maine Department of Defense,          3,000,000  Golden
 and Human Services       Services                 Veterans and Emergency
                          Administration.          Management, Augusta, ME for
                                                   facilities and equipment, and
                                                   operational costs for a rural
                                                   health project.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     MaineHealth dba Western Maine         1,642,000  Golden
 and Human Services       Services                 Health/Stephens Memorial
                          Administration.          Hospital, Norway, ME for
                                                   facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Makah Indian Tribe, Neah Bay, WA      3,000,000  Kilmer
 and Human Services       Services                 for facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Marian Regional Medical Center,       1,000,000  Carbajal
 and Human Services       Services                 Santa Maria, CA for facilities
                          Administration.          and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Marshall University Research          3,000,000  Miller (WV)
 and Human Services       Services                 Corporation, Huntington, WV for
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Mary Free Bed Rehabilitation          3,000,000  Meijer
 and Human Services       Services                 Hospital, Grand Rapids, MI for
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Matthew Walker Comprehensive            480,000  Cooper
 and Human Services       Services                 Health Center Inc., Nashville,
                          Administration.          TN for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     McLaren Central Michigan, Grand         850,000  Moolenaar
 and Human Services       Services                 Blanc, MI for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     MedStar Curtis National Hand          1,500,000  Ruppersberger
 and Human Services       Services                 Center, Baltimore, MD for
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     MedStar St. Mary's Hospital,            975,000  Hoyer
 and Human Services       Services                 Leonardtown, MD for facilities
                          Administration.          and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Melvin & Claire Levine Jewish           825,000  Mast
 and Human Services       Services                 Residential and Family Service,
                          Administration.          West Palm Beach, FL for
                                                   facilities.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Metropolitan Government of            2,200,000  Cooper
 and Human Services       Services                 Nashville and Davidson County,
                          Administration.          Nashville, TN for facilities and
                                                   equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Mid-Coast Health Net Inc. dba         2,105,000  Pingree
 and Human Services       Services                 Knox Clinic, Rockland, ME for
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Mid-State Health Center,                750,000  Kuster
 and Human Services       Services                 Plymouth, NH for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Mid-Valley Healthcare, Inc.,          1,000,000  DeFazio
 and Human Services       Services                 Lebanon, OR for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Milwaukee Health Services, Inc.,      2,983,000  Moore (WI)
 and Human Services       Services                 Milwaukee, WI for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Molokai Community Health Center,      1,664,000  Kahele
 and Human Services       Services                 Kaunakakai, HI for facilities
                          Administration.          and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Morehead State University,            3,000,000  Rogers (KY)
 and Human Services       Services                 Morehead, KY for equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Morehouse School of Medicine,           950,000  Williams (GA)
 and Human Services       Services                 Atlanta, GA for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     MossRehab-Albert Einstein               210,000  Dean
 and Human Services       Services                 Healthcare Network, Elkins Park,
                          Administration.          PA for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Mount Sinai Hospital, Chicago, IL     2,000,000  Davis, Danny
 and Human Services       Services                 for facilities and equipment.                    K.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Mountain Park Health Center,          3,000,000  Gallego
 and Human Services       Services                 Phoenix, AZ for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     MRIGlobal, Kansas City, MO for        1,000,000  Cleaver
 and Human Services       Services                 facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     MyMichigan Medical Center             2,000,000  Moolenaar
 and Human Services       Services                 Midland, Midland, MI for
                          Administration.          facilities.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Native American Community Clinic,     1,000,000  Omar
 and Human Services       Services                 Minneapolis, MN for facilities
                          Administration.          and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Native American Health Center,        1,000,000  Lee (CA)
 and Human Services       Services                 Inc., Oakland, CA for facilities
                          Administration.          and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     NATIVE HEALTH, Inc., Phoenix, AZ        650,000  Stanton
 and Human Services       Services                 for facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Natrona County, Casper, WY for        1,500,000  Cheney
 and Human Services       Services                 facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Navajo Nation Division of Social      3,000,000  Leger
 and Human Services       Services                 Services, Window Rock, AZ for                    Fernandez
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Navajo Nation Division of Social      2,000,000  O'Halleran
 and Human Services       Services                 Services, Window Rock, AZ for
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Near North Health Service             2,000,000  Davis, Danny
 and Human Services       Services                 Corporation, Chicago, IL for                     K.
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Nehalem Bay Health District,          1,000,000  Schrader
 and Human Services       Services                 Wheeler, OR for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Neighborhood Health Association       1,000,000  Kaptur
 and Human Services       Services                 of Toledo, Inc., Toledo, OH for
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Neighborhood Healthcare Inc,            575,000  Calvert
 and Human Services       Services                 Menifee, CA for equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Neighborhood Medical Center,          1,650,000  Lawson (FL)
 and Human Services       Services                 Incorporated, Tallahassee, FL
                          Administration.          for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     New Destiny Treatment Center,         1,500,000  Gonzalez (OH)
 and Human Services       Services                 Clinton, OH for facilities.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     New Directions for Youth, Inc.,       1,000,000  Cardenas
 and Human Services       Services                 North Hollywood, CA for
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     New England College, Henniker, NH     2,000,000  Kuster
 and Human Services       Services                 for facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     New Paths, Inc., Flint, MI for        1,000,000  Kildee
 and Human Services       Services                 facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     New York City Health and              3,000,000  Torres (NY)
 and Human Services       Services                 Hospitals--Lincoln Medical and
                          Administration.          Mental Health Center, Bronx, NY
                                                   for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     New York City Health and              2,000,000  Velazquez
 and Human Services       Services                 Hospitals Corporation, New York,
                          Administration.          NY for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     New York City Health and              1,000,000  Meng
 and Human Services       Services                 Hospitals/Elmhurst, Queens, NY
                          Administration.          for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     New York Community Hospital,          2,200,000  Clarke (NY)
 and Human Services       Services                 Brooklyn, NY for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     New York Medical College,             1,900,000  Jones
 and Human Services       Services                 Valhalla, NY for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Newark Community Health Centers,      1,000,000  Payne
 and Human Services       Services                 Inc. , Newark, NJ for facilities
                          Administration.          and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Newport County Community Mental       1,000,000  Cicilline
 and Human Services       Services                 Health Center Inc., Middletown,
                          Administration.          RI for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Next Steps of O'Connor Foundation       645,695  Newman
 and Human Services       Services                 dba Next Steps Chicago, Chicago,
                          Administration.          IL for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     NextStep Orlando, Inc., Altamonte       533,499  Murphy (FL)
 and Human Services       Services                 Springs, FL for equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Nicholas H. Noyes Memorial            1,500,000  Jacobs (NY)
 and Human Services       Services                 Hospital, Dansville, NY for
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Niscasa, Round Lake, IL for           2,100,000  Schneider
 and Human Services       Services                 facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     North Broward Hospital District       3,000,000  Cherfilus-
 and Human Services       Services                 dba Broward Health, Fort                         McCormick
                          Administration.          Lauderdale, FL for facilities
                                                   and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     North Carolina Central                  643,750  Price (NC)
 and Human Services       Services                 University, Durham, NC for
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     North Central Michigan College,       2,000,000  Bergman
 and Human Services       Services                 Petoskey, MI for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     North Memorial Health Care,           1,000,000  Phillips
 and Human Services       Services                 Robbinsdale, MN for facilities
                          Administration.          and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Northeast Iowa Community College,       375,000  Hinson
 and Human Services       Services                 Peosta, IA for equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Northeast Valley Health               1,655,000  Cardenas
 and Human Services       Services                 Corporation, San Fernando, CA
                          Administration.          for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Northern Marianas College,            1,000,000  Sablan
 and Human Services       Services                 Saipan, NP for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Northern Nevada HOPES, Reno, NV       2,000,000  Amodei
 and Human Services       Services                 for facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Northwest Indian College,             2,000,000  DelBene
 and Human Services       Services                 Bellingham, WA for facilities
                          Administration.          and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Northwest Medical Foundation          1,000,000  Schrader
 and Human Services       Services                 Tillamook, OR for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Northwest Technical Institute,        2,000,000  Womack
 and Human Services       Services                 Springdale, AR for facilities.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     NYU Langone Health, New York, NY      2,000,000  Malliotakis
 and Human Services       Services                 for equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Odyssey House Louisiana Inc., New     1,000,000  Carter (LA)
 and Human Services       Services                 Orleans, LA for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Oklahoma Blood Institute,             1,250,000  Bice (OK)
 and Human Services       Services                 Oklahoma City, OK for facilities
                          Administration.          and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Oklahoma Medical Research             1,755,000  Bice (OK)
 and Human Services       Services                 Foundation, Oklahoma City, OK
                          Administration.          for equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Oklahoma Medical Research             2,000,000  Cole
 and Human Services       Services                 Foundation, Oklahoma City, OK
                          Administration.          for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Olathe Fire Department                  660,000  Davids (KS)
 and Human Services       Services                 Administration, Olathe, KS for
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     OLE Health, Napa, CA for              1,796,139  Thompson (CA)
 and Human Services       Services                 equipment, for an electronic
                          Administration.          health records initiative.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Oneida Health Systems Inc.,           1,000,000  Tenney
 and Human Services       Services                 Oneida, NY for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Orange County Board of County           239,059  Murphy (FL)
 and Human Services       Services                 Commissioners, Orlando, FL for
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Orange County Health Authority        2,000,000  Kim (CA)
 and Human Services       Services                 (dba CalOptima), Orange, CA for
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Orange County Health Authority,       1,000,000  Correa
 and Human Services       Services                 Orange, CA for a health
                          Administration.          information technology
                                                   initiative.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Oregon Association of Relief          5,055,844  Bonamici,
 and Human Services       Services                 Nurseries, Newberg, OR for                       Schrader
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Oregon Health & Science                 800,000  Blumenauer
 and Human Services       Services                 University, Portland, OR for
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Ozark Tri-County Healthcare           1,500,000  Long
 and Human Services       Services                 Consortium, DBA ACCESS Family
                          Administration.          Care, Neosho, MO for facilities
                                                   and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Park West Health System,              1,000,000  Mfume
 and Human Services       Services                 Baltimore, MD for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Parkland College, Champaign, IL         320,000  Davis, Rodney
 and Human Services       Services                 for facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     People Coordinated Services of        1,162,000  Bass
 and Human Services       Services                 Southern California, Los
                          Administration.          Angeles, CA for facilities and
                                                   equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     People's Community Clinic,              850,000  Doggett
 and Human Services       Services                 Austin, TX for an electronic
                          Administration.          health records initiative.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Personal Enrichment through           2,000,000  Bilirakis
 and Human Services       Services                 Mental Health Services, Inc.,
                          Administration.          Pinellas Park, FL for facilities.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Perspectives Inc., St. Louis          3,000,000  Omar
 and Human Services       Services                 Park, MN for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Pikeville Medical Center, Inc.,       3,000,000  Rogers (KY)
 and Human Services       Services                 Pikeville, KY for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Plymouth Housing, Seattle, WA for     1,000,000  Smith (WA)
 and Human Services       Services                 equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Portsmouth Community Health             807,137  Scott (VA)
 and Human Services       Services                 Center, Inc., dba Hampton Roads
                          Administration.          Community Health Center,
                                                   Portsmouth, VA for facilities
                                                   and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Potomac Valley Hospital, Keyser,      1,100,000  McKinley
 and Human Services       Services                 WV for facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Power4STL, St. Louis, MO for          3,000,000  Bush
 and Human Services       Services                 facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Presbyterian Hospital DBA Novant        216,200  Adams
 and Human Services       Services                 Health Presbyterian Medical
                          Administration.          Center, Charlotte, NC for
                                                   facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Presbyterian Villages of                140,000  Bergman
 and Human Services       Services                 Michigan, Southfield, MI for
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Presbyterian Villages of                115,000  Moolenaar
 and Human Services       Services                 Michigan, Southfield, MI for
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Primary Care Health Services,         2,200,000  Doyle,
 and Human Services       Services                 Inc., Pittsburgh, PA for                         Michael F.
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Prince William County Government,     2,000,000  Connolly
 and Human Services       Services                 Prince William, VA for
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Project Angel Food, Los Angeles,        913,500  Schiff
 and Human Services       Services                 CA for facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Promise Fund of Florida, Inc.,          900,100  Wasserman
 and Human Services       Services                 Palm Beach, FL for equipment.                    Schultz
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Promise Fund of Florida, Inc.,          894,100  Cherfilus-
 and Human Services       Services                 Palm Beach, FL for facilities                    McCormick
                          Administration.          and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Promise Fund of Florida, Inc.,          951,500  Frankel, Lois
 and Human Services       Services                 Palm Beach, FL for facilities
                          Administration.          and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Providence Holy Cross Medical           750,000  Cardenas
 and Human Services       Services                 Center, Mission Hills, CA for
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Rappahannock Area Health                400,000  Spanberger
 and Human Services       Services                 District, Fredericksburg, VA for
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Rappahannock-Rapidan Community        1,000,000  Spanberger
 and Human Services       Services                 Services, Culpeper, VA for
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Red Oak Behavioral Health, Akron,     2,000,000  Ryan
 and Human Services       Services                 OH for facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Redwoods Rural Health Center,           775,000  Huffman
 and Human Services       Services                 Redway, CA for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Regional One Health, Memphis, TN      2,000,000  Cohen
 and Human Services       Services                 for facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Research Institute at Nationwide      1,000,000  Balderson
 and Human Services       Services                 Children's Hospital, Columbus,
                          Administration.          OH for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Resources for Human Development,      1,000,000  Scanlon
 and Human Services       Services                 Philadelphia, PA for facilities
                          Administration.          and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Riverside Community Health            2,000,000  Takano
 and Human Services       Services                 Foundation, Riverside, CA for
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Riverside Medical Center,             1,000,000  Kelly (IL)
 and Human Services       Services                 Kankakee, IL for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Roanoke Chowan Community Health       1,300,000  Butterfield
 and Human Services       Services                 Center, Ahoskie, NC for
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Roanoke College, Salem, VA for          505,000  Griffith
 and Human Services       Services                 equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Rockland Community College,           3,000,000  Jones
 and Human Services       Services                 Suffern, NY for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Roxbury Volunteer Emergency             257,000  Meeks
 and Human Services       Services                 Services, Inc., New York, NY for
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Rutgers Biomedical and Health           950,650  Payne
 and Human Services       Services                 Sciences, Newark, NJ for
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Sacramento Native American Health     1,000,000  Matsui
 and Human Services       Services                 Center, Sacramento, CA for
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Saint Anselm College, Manchester,     2,200,000  Pappas
 and Human Services       Services                 NH for facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Saint Anthony Hospital, Chicago,      1,000,000  Garcia (IL)
 and Human Services       Services                 IL for facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Saint Francis University,               500,000  Joyce (PA)
 and Human Services       Services                 Loretto, PA for equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Saint Xavier University, Chicago,       106,885  Newman
 and Human Services       Services                 IL for facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     San Francisco Community Clinic        2,200,000  Pelosi
 and Human Services       Services                 Consortium, San Francisco, CA
                          Administration.          for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     San Gorgonio Memorial Hospital,         452,000  Ruiz
 and Human Services       Services                 Banning, CA for equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     San Joaquin Health Centers,           1,810,929  McNerney
 and Human Services       Services                 Stockton, CA for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     San Juan County, Monticello, UT         515,000  Curtis
 and Human Services       Services                 for cancer screening.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Sea Mar Community Health Centers,     2,200,000  Smith (WA)
 and Human Services       Services                 Seattle, WA for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Seattle Indian Health Board,          3,000,000  Jayapal
 and Human Services       Services                 Seattle, WA for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Self Help Movement, Inc.,             1,500,000  Boyle,
 and Human Services       Services                 Philadelphia, PA for facilities                  Brendan F.
                          Administration.          and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Seton Hall University, South          1,140,000  Pascrell
 and Human Services       Services                 Orange, NJ for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Shands Jacksonville Medical           2,000,000  Rutherford
 and Human Services       Services                 Center, Inc., Jacksonville, FL
                          Administration.          for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Shepherd's Hope, Winter Park, FL        395,500  Demings
 and Human Services       Services                 for facilities and equipment,
                          Administration.          including equipment related to
                                                   telehealth.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Siena College, Loudonville, NY          496,541  Tonko
 and Human Services       Services                 for facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Sight For All United, Struthers,        550,000  Ryan
 and Human Services       Services                 OH for equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Sinclair Community College,           2,000,000  Turner
 and Human Services       Services                 Dayton, OH for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Singing River Health System,          2,800,000  Palazzo
 and Human Services       Services                 Ocean Springs, MS for facilities
                          Administration.          and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Siskin Hospital for Physical          2,500,000  Fleischmann
 and Human Services       Services                 Rehabilitation, Inc.,
                          Administration.          Chattanooga, TN for facilities
                                                   and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Sisters of Charity Hospital of        2,377,172  Higgins (NY)
 and Human Services       Services                 Buffalo, New York, Cheektowaga,
                          Administration.          NY for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Solano County Public Health           1,000,000  Garamendi
 and Human Services       Services                 Department's Family Health
                          Administration.          Services, Fairfield, CA for an
                                                   electronic health records
                                                   initiative.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     South Boston Community Health         2,000,000  Lynch
 and Human Services       Services                 Center, Inc., South Boston, MA
                          Administration.          for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     South Central Family Health             707,414  Roybal-Allard
 and Human Services       Services                 Center, Cudahy, CA for
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     South Shore Hospital Corporation,     2,000,000  Kelly (IL)
 and Human Services       Services                 Chicago, IL for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     South Ward Alliance dba South         2,000,000  Payne
 and Human Services       Services                 Ward Promise Neighborhood,
                          Administration.          Newark, NJ for facilities and
                                                   equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Southeast Council on Alcoholism         915,000  Courtney
 and Human Services       Services                 and Drug Dependence, Inc.,
                          Administration.          Lebanon, CT for facilities and
                                                   equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Southwest Community Health            2,000,000  Himes
 and Human Services       Services                 Center, Inc., Bridgeport, CT for
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Southwestern Vermont Medical            250,000  Welch
 and Human Services       Services                 Center, Bennington, VT for
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     SSM Health--St. Mary's Hospital--     1,000,000  Bush
 and Human Services       Services                 St. Louis, MO for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     St. Catherine Hospital, Inc.,         1,500,000  Mrvan
 and Human Services       Services                 East Chicago, IN for equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     St. Francis Medical Center,           2,000,000  Letlow
 and Human Services       Services                 Monroe, LA for equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     St. John's Episcopal Hospital,        3,000,000  Meeks
 and Human Services       Services                 Episcopal Health Services Inc.,
                          Administration.          Far Rockaway, NY for facilities
                                                   and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     St. John's Riverside Hospital,        1,000,000  Bowman
 and Human Services       Services                 Yonkers, NY for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     St. Joseph Regional Health            1,000,000  Meuser
 and Human Services       Services                 Network, Reading, PA for
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     St. Joseph's Medical Center,          4,000,000  Harder (CA),
 and Human Services       Services                 Stockton, CA for facilities and                  McNerney
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     State University of New York            900,000  Katko
 and Human Services       Services                 Upstate Medical University,
                          Administration.          Syracuse, NY for facilities and
                                                   equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Stockbridge Community Schools,        2,500,000  Slotkin
 and Human Services       Services                 Stockbridge, MI for facilities
                          Administration.          and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Sun River Health, Inc. dba Hudson     2,000,000  Maloney, Sean
 and Human Services       Services                 River HealthCare, Peekskill, NY                  Patrick
                          Administration.          for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Sun River Health, Peekskill, NY       1,800,000  Jeffries
 and Human Services       Services                 for facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Susannah's House, Inc.,                 500,000  Burchett
 and Human Services       Services                 Knoxville, TN for facilities.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     TCC Family Health, Long Beach, CA       375,000  Barragan
 and Human Services       Services                 for facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Tennyson Center for Children,         1,000,000  DeGette
 and Human Services       Services                 Denver, CO for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Texas A&M University College of         940,000  Johnson (TX)
 and Human Services       Services                 Dentistry, Dallas, TX for an
                          Administration.          oral health care initiative.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Texas A&M University- San             1,945,000  Gonzales,
 and Human Services       Services                 Antonio, San Antonio, TX for                     Tony
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Texas Children's Hospital,            2,000,000  Green (TX)
 and Human Services       Services                 Houston, TX for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Texas Tech University Health          2,600,000  Pfluger
 and Human Services       Services                 Science Center (TTUHSC) Odessa,
                          Administration.          Odessa, TX for equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Texas Tech University Health          3,000,000  Escobar
 and Human Services       Services                 Sciences Center El Paso, TX for
                          Administration.          an initiative related to health
                                                   information technology and
                                                   telehealth.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Texas Tech University Health          2,000,000  Johnson (TX)
 and Human Services       Services                 Sciences Center, Dallas, TX for
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     The Floating Hospital, Inc., Long     1,040,489  Maloney,
 and Human Services       Services                 Island City, NY for facilities                   Carolyn B.
                          Administration.          and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     The Foodbank, Inc., Dayton, OH        2,000,000  Turner
 and Human Services       Services                 for facilities.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     The Good Samaritan Hospital of          590,000  Chabot
 and Human Services       Services                 Cincinnati, OH for equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     TidalHealth Nanticoke, Seaford,       1,000,000  Blunt
 and Human Services       Services                 DE for facilities and equipment.                 Rochester
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Town of Geraldine, AL for               375,000  Aderholt
 and Human Services       Services                 facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Township of Brick, NJ for               250,000  Kim (NJ)
 and Human Services       Services                 facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Township of Edison, NJ for            3,000,000  Pallone
 and Human Services       Services                 facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Township of Mount Olive, Budd         1,982,500  Malinowski
 and Human Services       Services                 Lake, NJ for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Tri-Area Community Health, Laurel       600,000  Griffith
 and Human Services       Services                 Fork, VA for facilities.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Trinity Health System,                2,000,000  Johnson (OH)
 and Human Services       Services                 Steubenville, OH for equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Tri-State Memorial Hospital,          2,500,000  Rodgers (WA)
 and Human Services       Services                 Clarkston, WA for equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Tucson Indian Center, Tucson, AZ        588,059  Grijalva
 and Human Services       Services                 for facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     UMass Memorial Health--                 450,000  Trahan
 and Human Services       Services                 HealthAlliance--Clinton
                          Administration.          Hospital, Leominster, MA for
                                                   equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     UMass Memorial Medical Center,        1,000,000  McGovern
 and Human Services       Services                 Worcester, MA for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Union Community Health Center,          675,000  Torres (NY)
 and Human Services       Services                 Inc., Bronx, NY for facilities
                          Administration.          and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     United Neighborhood Health              750,000  Cooper
 and Human Services       Services                 Services dba Neighborhood
                          Administration.          Health, Nashville, TN for
                                                   facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     University at Buffalo, NY for           933,800  Higgins (NY)
 and Human Services       Services                 facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     University Community Health           2,000,000  Cooper
 and Human Services       Services                 Services, Inc., Nashville, TN
                          Administration.          for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     University Health System (UHS) d/     1,250,000  Fleischmann
 and Human Services       Services                 b/a University of Tennessee
                          Administration.          Medical Center, Knoxville, TN
                                                   for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     University Health System (UHS) d/       750,000  Fleischmann
 and Human Services       Services                 b/a University of Tennessee
                          Administration.          Medical Center, Knoxville, TN
                                                   for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     University Health System (UHS), d/    1,000,000  Burchett
 and Human Services       Services                 b/a/ University of Tennessee
                          Administration.          Medical Center, Knoxville, TN
                                                   for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     University Hospital, Newark, NJ       3,000,000  Payne
 and Human Services       Services                 for facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     University Hospitals Cleveland          855,000  Gonzalez (OH)
 and Human Services       Services                 Medical Center, Cleveland, OH
                          Administration.          for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     University Hospitals, Cleveland,      1,145,520  Brown (OH)
 and Human Services       Services                 OH for facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     University Hospitals, Cleveland,      1,500,000  Joyce (OH)
 and Human Services       Services                 OH for facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     University Muslim Medical               158,000  Roybal-Allard
 and Human Services       Services                 Association Inc. (UMMA Community
                          Administration.          Clinic), Huntington Park, CA for
                                                   equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     University of California, San         1,095,000  Jacobs (CA),
 and Human Services       Services                 Diego, La Jolla, CA for                          Vargas
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     University of Hawaii--Office of       1,000,000  Case
 and Human Services       Services                 Strategic Health Initiatives,
                          Administration.          Honolulu, HI for facilities and
                                                   equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     University of Kansas Medical          2,594,226  Davids (KS)
 and Human Services       Services                 Center, Kansas City, KS for
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     University of Kansas Medical          2,956,507  Davids (KS)
 and Human Services       Services                 Center, Kansas City, KS for
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     University of Kansas Medical          1,000,000  Davids (KS)
 and Human Services       Services                 Center, Kansas City, KS for
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     University of Louisville, KY for      2,000,000  Yarmuth
 and Human Services       Services                 facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     University of Massachusetts           3,000,000  Lynch
 and Human Services       Services                 Boston, MA for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     University of Miami Leonard M.          500,000  Wasserman
 and Human Services       Services                 Miller School of Medicine,                       Schultz
                          Administration.          Miami, FL for facilities and
                                                   equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     University of Miami, Miami, FL          800,000  Gimenez
 and Human Services       Services                 for equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     University of Mississippi Medical     2,000,000  Guest
 and Human Services       Services                 Center, Jackson, MS for
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     University of Nevada Las Vegas,       1,000,000  Lee (NV)
 and Human Services       Services                 NV for facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     University of Rochester, NY for       1,000,000  Morelle
 and Human Services       Services                 facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     University of South Alabama,          1,500,000  Carl
 and Human Services       Services                 Mobile, AL for equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     University of South Florida,          2,000,000  Buchanan
 and Human Services       Services                 Sarasota, FL for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     University of South Florida,          1,000,000  Castor (FL)
 and Human Services       Services                 Tampa, FL for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     University of Texas at Dallas,        1,500,000  Allred
 and Human Services       Services                 Richardson, TX for facilities
                          Administration.          and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     University of Texas Health            1,000,000  Jackson Lee
 and Human Services       Services                 Science Center at Houston, TX
                          Administration.          for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     University of Texas Health            1,000,000  Castro (TX)
 and Human Services       Services                 Science Center at San Antonio,
                          Administration.          TX for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     University of Texas Rio Grande        1,000,000  Gonzalez,
 and Human Services       Services                 Valley, Edinburg, TX for                         Vicente
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     University of Texas School of         1,000,000  Castro (TX)
 and Human Services       Services                 Public Health San Antonio, TX
                          Administration.          for facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     University of Texas Southwestern      1,500,000  Allred
 and Human Services       Services                 Medical Center, Dallas, TX for
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     University of Toledo, OH for          1,000,000  Kaptur
 and Human Services       Services                 equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     University of Utah, Salt Lake         3,000,000  Stewart
 and Human Services       Services                 City, UT for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     University of Wisconsin-Madison,      1,000,000  Pocan
 and Human Services       Services                 WI for facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     UPMC Altoona, Altoona, PA for           250,000  Joyce (PA)
 and Human Services       Services                 facilities.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Urban Health Plan, Inc., Bronx,       2,106,950  Torres (NY)
 and Human Services       Services                 NY for facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Urban Health Plan, Inc., Corona,      3,000,000  Ocasio-Cortez
 and Human Services       Services                 NY for facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Valley Health Services, Inc.,         2,000,000  Tenney
 and Human Services       Services                 Herkimer, NY for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Valley Health System, Winchester,     1,500,000  Wexton
 and Human Services       Services                 VA for facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Valley Hospital, Ridgewood, NJ          608,860  Gottheimer
 and Human Services       Services                 for facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Valparaiso University,                1,000,000  Mrvan
 and Human Services       Services                 Valparaiso, IN for facilities
                          Administration.          and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Van Buren County Hospital,            1,845,000  Miller-Meeks
 and Human Services       Services                 Keosauqua, IA for equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Variety Care, Inc., Oklahoma          3,000,000  Cole
 and Human Services       Services                 City, OK for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Variety Children's Hospital DBA         450,000  Salazar
 and Human Services       Services                 Nicklaus Children's Hospital,
                          Administration.          Miami, FL for equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Variety Children's Hospital DBA       1,000,000  Salazar
 and Human Services       Services                 Nicklaus Children's Hospital,
                          Administration.          Miami, FL for facilities and
                                                   equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Venice Family Clinic, Venice, CA        500,000  Lieu
 and Human Services       Services                 for facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Vera French Community Mental          1,885,000  Miller-Meeks
 and Human Services       Services                 Health Center, Davenport, IA for
                          Administration.          facilities.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Via Care Community Health Center,       389,000  Roybal-Allard
 and Human Services       Services                 East Los Angeles, CA for
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     View Point Health, Lawrenceville,       900,000  Bourdeaux
 and Human Services       Services                 GA for facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Virgin Islands Diabetes Center of       995,000  Plaskett
 and Human Services       Services                 Excellence, St. Croix, VI for
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Virgin Islands Fire Services, St.     1,897,000  Plaskett
 and Human Services       Services                 Thomas, VI for equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Virtua Health, Camden, NJ for         2,000,000  Norcross
 and Human Services       Services                 facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Virtua Health, Inc., Marlton, NJ      1,000,000  Kim (NJ)
 and Human Services       Services                 for facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Vision Urbana, Inc., New York, NY     1,000,000  Nadler
 and Human Services       Services                 for facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     VNA Health Care, Aurora, IL for         500,000  Foster,
 and Human Services       Services                 facilities and equipment.                        Underwood
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     W.A. Foote Memorial Hospital,           310,000  Walberg
 and Human Services       Services                 Inc., Jackson, MI for facilities
                          Administration.          and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Waimanalo Health Center,              2,000,000  Kahele
 and Human Services       Services                 Waimanalo, HI for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     WakeMed Health & Hospitals,           6,000,000  Price (NC),
 and Human Services       Services                 Raleigh, NC for facilities and                   Ross
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Washington County Healthcare          1,845,000  Carl
 and Human Services       Services                 Authority, INC dba Washington
                          Administration.          County Hospital and Nursing
                                                   Home, Chatom, AL for facilities.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Watts Healthcare Corporation, Los     2,000,000  Waters
 and Human Services       Services                 Angeles, CA for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Wayside House, Inc., Delray           1,000,000  Frankel, Lois
 and Human Services       Services                 Beach, FL for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Weber State University, Ogden, UT     1,500,000  Moore (UT)
 and Human Services       Services                 for facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     West County Health Centers, Inc.,       901,575  Huffman
 and Human Services       Services                 Guerneville, CA for facilities
                          Administration.          and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     West Virginia School of                 325,000  Miller (WV)
 and Human Services       Services                 Osteopathic Medicine, Lewisburg,
                          Administration.          WV for facilities.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Westchester Sickle Cell Outreach,       500,000  Jones
 and Human Services       Services                 Inc., White Plains, NY for
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Western Nevada College, Carson        2,000,000  Amodei
 and Human Services       Services                 City, NV for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     White Memorial Community Health       1,000,000  Gomez
 and Human Services       Services                 Center, Los Angeles, CA for
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Whitman County Public Hospital        3,000,000  Rodgers (WA)
 and Human Services       Services                 District Number 1-A, Pullman, WA
                          Administration.          for an electronic health records
                                                   initiative.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Whitman-Walker Health,                  250,000  Norton
 and Human Services       Services                 Washington, DC for equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Wilmington Community Clinic,            200,000  Barragan
 and Human Services       Services                 Wilmington, CA for facilities
                          Administration.          and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Wilson Community College, Wilson,     3,000,000  Butterfield
 and Human Services       Services                 NC for facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     WINGS Program, Inc., Rolling            200,000  Casten
 and Human Services       Services                 Meadows, IL for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Winston-Salem State University,       1,342,840  Manning
 and Human Services       Services                 Winston-Salem, NC for facilities
                          Administration.          and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Wintersville Volunteer Fire             110,000  Johnson (OH)
 and Human Services       Services                 Department, Wintersville, OH for
                          Administration.          facilities and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Worry Free Community, Glendale          144,800  Casten
 and Human Services       Services                 Heights, IL for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Worry Free Community, Glendale        1,000,000  Newman
 and Human Services       Services                 Heights, IL for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     Wyckoff Heights Medical Center,       2,000,000  Velazquez
 and Human Services       Services                 Brooklyn, NY for facilities and
                          Administration.          equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Health Resources and     YMCA of Central Florida, Orlando,     1,000,000  Demings
 and Human Services       Services                 FL for facilities and equipment.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        A Safe Haven Foundation, Chicago,     2,000,000  Davis, Danny
 and Human Services       Mental Health Services   IL for behavioral health,                        K.
                          Administration.          substance use disorder, and peer
                                                   support services, including
                                                   equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        AABR, Inc., College Point, NY for       382,174  Ocasio-Cortez
 and Human Services       Mental Health Services   behavioral health services and
                          Administration.          training, including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        AboutFace-USA, Inc., Cumming, GA      1,280,000  Bourdeaux
 and Human Services       Mental Health Services   for mental health treatment and
                          Administration.          services for veterans, including
                                                   equipment and wraparound
                                                   services.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Alliance for Healthy Communities,       800,000  Bilirakis
 and Human Services       Mental Health Services   Inc., New Port Richey, FL for a
                          Administration.          substance use prevention,
                                                   treatment, and recovery
                                                   services, and resources center,
                                                   including the purchase of
                                                   equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Amistad, Inc., Portland, ME for         535,000  Pingree
 and Human Services       Mental Health Services   behavioral health services and
                          Administration.          recovery housing.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Anaheim Community Foundation,         1,000,000  Correa
 and Human Services       Mental Health Services   Anaheim, CA for mental health
                          Administration.          and related support services.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Apna Ghar, Chicago, IL for a            300,000  Schakowsky
 and Human Services       Mental Health Services   mobile mental health advocacy
                          Administration.          unit, including training.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Arab-American Family Support          1,800,453  Velazquez
 and Human Services       Mental Health Services   Center, Brooklyn, NY for mental
                          Administration.          health services, including
                                                   equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Ashley Addiction Treatment              420,000  Ruppersberger
 and Human Services       Mental Health Services   Center, Havre de Grace, MD for
                          Administration.          behavioral health services and
                                                   youth education programs.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Asian Health Services, Oakland,       1,000,000  Lee (CA)
 and Human Services       Mental Health Services   CA for mental health and
                          Administration.          wraparound services.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Bay Area Community Health, San        1,000,000  Lofgren
 and Human Services       Mental Health Services   Jose, CA for behavioral health
                          Administration.          services.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Baylor College of Medicine,           1,000,000  Jackson Lee
 and Human Services       Mental Health Services   Houston, TX for substance use
                          Administration.          disorder services and treatment
                                                   for people experiencing
                                                   homelessness.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Baylor College of Medicine,           1,200,000  Garcia (TX)
 and Human Services       Mental Health Services   Houston, TX to provide substance
                          Administration.          use disorder services and
                                                   treatment, including minor
                                                   facility repairs, improvements,
                                                   and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Beit T'Shuvah, Los Angeles, CA          301,649  Sherman
 and Human Services       Mental Health Services   for behavioral health, recovery,
                          Administration.          and other supportive services.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Boys & Girls Clubs of Delaware,         250,000  Blunt
 and Human Services       Mental Health Services   Wilmington, DE for mental health                 Rochester
                          Administration.          and supportive services.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Boys & Girls Clubs of the Valley,     1,000,000  Gallego
 and Human Services       Mental Health Services   Phoenix, AZ for the Whole Child
                          Administration.          Approach Program to provide
                                                   mental health and other
                                                   supportive services for children.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        BPSOS Center for Community              300,000  Lowenthal
 and Human Services       Mental Health Services   Advancement, Westminster, CA for
                          Administration.          behavioral health services and
                                                   training.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Cenikor Foundation, Waco, TX for        640,000  Sessions
 and Human Services       Mental Health Services   a substance use treatment and
                          Administration.          recovery program, including
                                                   behavioral health services and
                                                   support services.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Champions In Service, Pacoima, CA       722,223  Cardenas
 and Human Services       Mental Health Services   for mental health and supportive
                          Administration.          services.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Child and Family Agency of              693,437  Courtney
 and Human Services       Mental Health Services   Southeastern CT, Inc., New
                          Administration.          London, CT for mental health and
                                                   related services for youth,
                                                   including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Children's Health Clinical              915,000  Allred,
 and Human Services       Mental Health Services   Operations, Dallas, TX for                       Johnson
                          Administration.          training, education, and                         (TX), Van
                                                   pediatric mental health services.                Duyne
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Children's Health Clinical              500,000  Allred, Van
 and Human Services       Mental Health Services   Operations, Dallas, TX for youth                 Duyne
                          Administration.          behavioral health services and
                                                   equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Children's Hospital Colorado,           668,313  Crow
 and Human Services       Mental Health Services   Aurora, CO to enhance access to
                          Administration.          mental health care services,
                                                   including training.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Children's Hospital of The King's     1,000,000  Scott (VA)
 and Human Services       Mental Health Services   Daughters, Norfolk, VA for
                          Administration.          mental health services and
                                                   treatment, including outreach
                                                   and programming.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Chinese-American Planning               500,000  Nadler
 and Human Services       Mental Health Services   Council, Inc., New York, NY for
                          Administration.          mental health services and
                                                   treatment, outreach, education,
                                                   and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        City of Austin, TX for substance      2,000,420  Doggett
 and Human Services       Mental Health Services   use prevention, awareness, and
                          Administration.          education activities.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        City of Hermosa Beach, CA for         1,000,000  Lieu
 and Human Services       Mental Health Services   mobile mental health crisis
                          Administration.          response teams.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        City of Monroe, WA for mental           480,804  DelBene
 and Human Services       Mental Health Services   health crisis support services,
                          Administration.          including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        City of Moreno Valley, CA for the     1,000,000  Takano
 and Human Services       Mental Health Services   Homeless to Work program to
                          Administration.          provide behavioral health
                                                   services, including equipment
                                                   and outreach.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        City of Norco, CA for a                 800,000  Calvert
 and Human Services       Mental Health Services   homelessness services program.
                          Administration.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        City of North Las Vegas, NV for a       875,000  Horsford
 and Human Services       Mental Health Services   mental health crisis response
                          Administration.          unit.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        City of Pasadena, CA for the            900,000  Chu
 and Human Services       Mental Health Services   Pasadena Outreach Response Team
                          Administration.          to provide behavioral health and
                                                   related services to people
                                                   experiencing homelessness.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        City of Pittsburg, PA for the         1,000,000  Doyle,
 and Human Services       Mental Health Services   Reaching Out On The Streets                      Michael F.
                          Administration.          (ROOTS) Overdose and Support
                                                   Teams to provide behavioral
                                                   health services, including
                                                   equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        City of San Fernando, CA for            800,000  Cardenas
 and Human Services       Mental Health Services   mental health crisis response
                          Administration.          services.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        City of Santa Monica, CA for          1,500,000  Lieu
 and Human Services       Mental Health Services   behavioral health and other
                          Administration.          supportive services.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Clark County, Nevada, Las Vegas,      1,709,594  Lee (NV)
 and Human Services       Mental Health Services   NV for behavioral health and
                          Administration.          other support services.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Community Health Connections,         2,500,000  Trahan
 and Human Services       Mental Health Services   Inc., Fitchburg, MA for youth
                          Administration.          mental health services and
                                                   treatment, including training
                                                   and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Community Hero Action Group, King       450,000  Dean
 and Human Services       Mental Health Services   of Prussia, PA for the Black
                          Administration.          Health Matters initiative to
                                                   provide mental health services,
                                                   and other supportive services.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Community Medical Wellness            2,000,000  Lowenthal
 and Human Services       Mental Health Services   Centers, USA, Long Beach, CA for
                          Administration.          behavioral health and substance
                                                   use disorder services, including
                                                   equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Compass LGBTQ Youth and Family          523,345  Cherfilus-
 and Human Services       Mental Health Services   Services, Lake Worth Beach, FL                   McCormick
                          Administration.          for behavioral health and
                                                   wraparound services.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Contact Community Services, Inc.,       135,000  Katko
 and Human Services       Mental Health Services   Syracuse, NY for a crisis call
                          Administration.          center upgrade, including the
                                                   purchase of equipment and
                                                   information technology.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        County of San Diego, CA for           4,480,000  Levin (CA),
 and Human Services       Mental Health Services   mobile behavioral health crisis                  Peters
                          Administration.          response teams.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Court Appointed Special Advocates       600,000  DeSaulnier
 and Human Services       Mental Health Services   Program, Inc. of Contra Costa,
                          Administration.          Concord, CA for mental health
                                                   services for youth and education
                                                   programming.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Douglas County, Castle Rock, CO         629,970  Crow
 and Human Services       Mental Health Services   for mental and behavioral health
                          Administration.          services and treatment,
                                                   including technology.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        DuPage County Health Department,      1,000,000  Casten
 and Human Services       Mental Health Services   Wheaton, IL for mental health
                          Administration.          and substance use disorder
                                                   services.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        East Bay Agency for Children,           477,000  Swalwell
 and Human Services       Mental Health Services   Oakland, CA for student and
                          Administration.          teacher mental health services
                                                   and supportive services.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        El Futuro, Inc., Durham, NC for         192,371  Price (NC)
 and Human Services       Mental Health Services   mental health training and
                          Administration.          curriculum development.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        EmblemHealth, Inc., New York, NY        450,000  Clarke (NY)
 and Human Services       Mental Health Services   for mental health services,
                          Administration.          education, and other related
                                                   activities.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Emory University, Atlanta, GA for       500,000  Williams (GA)
 and Human Services       Mental Health Services   a hospital-based violence
                          Administration.          intervention program to provide
                                                   behavioral health services and
                                                   wraparound services.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Family and Children's                   790,817  Rice (NY)
 and Human Services       Mental Health Services   Association, Garden City, NY for
                          Administration.          the Senior Safety Net Program to
                                                   provide behavioral health and
                                                   wraparound services, including
                                                   equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Family and Children's Center            450,000  Kind
 and Human Services       Mental Health Services   Wisconsin, La Crosse, WI to
                          Administration.          expand behavioral health
                                                   services, including outreach,
                                                   education, equipment, and
                                                   technology.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        FosterHope Sacramento,                  600,000  Bera
 and Human Services       Mental Health Services   Sacramento, CA for mental health
                          Administration.          and associated support services.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Friends of the Children- Detroit,       150,000  Lawrence
 and Human Services       Mental Health Services   Detroit, MI for mental health
                          Administration.          and other supportive services,
                                                   including training.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        GAAMHA Inc., Gardner, MA for            200,000  Trahan
 and Human Services       Mental Health Services   behavioral health and supportive
                          Administration.          services.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        George Mason University, Fairfax,     1,037,519  Wexton
 and Human Services       Mental Health Services   VA for substance use services,
                          Administration.          treatment, and associated
                                                   support services.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        George Mason University, Fairfax,       943,983  Connolly
 and Human Services       Mental Health Services   VA for youth mental health
                          Administration.          services, including training and
                                                   equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Grafton City Hospital, Grafton,         995,000  McKinley
 and Human Services       Mental Health Services   WV for a substance use treatment
                          Administration.          and recovery program, including
                                                   the purchase of supplies,
                                                   equipment, and information
                                                   technology, and wraparound
                                                   services.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Harris County Public Health,          1,000,000  Fletcher
 and Human Services       Mental Health Services   Houston, TX for ACCESS Harris to
                          Administration.          provide behavioral health and
                                                   wraparound services.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Harris County Public Health,          1,431,174  Fletcher
 and Human Services       Mental Health Services   Houston, TX for behavioral
                          Administration.          health and supportive services
                                                   for parents and infants.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Healthier Kids Foundation, San          644,000  Eshoo
 and Human Services       Mental Health Services   Jose, CA for mental and
                          Administration.          behavioral health services for
                                                   youth.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Hope for Heroes Horsemanship             70,000  Strickland
 and Human Services       Mental Health Services   Center, Yelm, WA for suicide
                          Administration.          prevention and mental health
                                                   awareness training and treatment
                                                   programming, including
                                                   postvention services.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Hope of the Valley Rescue             2,000,000  Sherman
 and Human Services       Mental Health Services   Mission, North Hills, CA for
                          Administration.          mental health and substance use
                                                   disorder services.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Ibn Sina Foundation, Inc.,            1,600,000  Green (TX)
 and Human Services       Mental Health Services   Houston, TX for mental health
                          Administration.          and substance use disorder
                                                   services and treatment,
                                                   including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Identity, Inc., Rockville, MD for       121,000  Raskin
 and Human Services       Mental Health Services   the Encuentros program to
                          Administration.          provide mental health and
                                                   supportive services, including
                                                   curriculum and training.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Indian Health Center of Santa           914,000  Lofgren
 and Human Services       Mental Health Services   Clara Valley, San Jose, CA for
                          Administration.          behavioral health and wraparound
                                                   services.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Jewish Adoption and Family Care         250,000  Deutch
 and Human Services       Mental Health Services   Options, Sunrise, FL for mental
                          Administration.          health and trauma prevention
                                                   services.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Julia Dyckman Andrus Memorial,          802,583  Bowman
 and Human Services       Mental Health Services   Incorporated, Yonkers, NY to
                          Administration.          expand mental health services,
                                                   including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        LCH Health and Community                605,000  Houlahan
 and Human Services       Mental Health Services   Services, Oxford, PA for
                          Administration.          behavioral health services and
                                                   treatment, including minor
                                                   facility repairs and
                                                   improvements.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        LIFE Camp, Inc., Jamaica, NY for        800,000  Meng
 and Human Services       Mental Health Services   mental health, grief counseling,
                          Administration.          and other supportive services.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Loma Linda University Medical           542,597  Aguilar
 and Human Services       Mental Health Services   Center, Loma Linda, CA for a
                          Administration.          mental health outreach
                                                   demonstration program.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Long Island Council on Alcoholism       150,000  Rice (NY)
 and Human Services       Mental Health Services   and Drug Dependence, Inc.,
                          Administration.          Westbury, NY for the Student
                                                   Assistance Program 2.0 to
                                                   provide mental health and
                                                   substance use disorder services.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Long Island Gay and Lesbian             500,000  Suozzi
 and Human Services       Mental Health Services   Youth, Inc., Hauppauge, NY for
                          Administration.          substance use prevention and
                                                   mental health services for youth.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Maimonides Medical Center,            1,650,000  Malliotakis,
 and Human Services       Mental Health Services   Brooklyn, NY for behavioral                      Nadler
                          Administration.          health services, workforce
                                                   training, and care coordination.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Massachusetts General Hospital        1,150,000  Pressley
 and Human Services       Mental Health Services   Center for Immigrant Health,
                          Administration.          Boston, MA for mental health and
                                                   supportive services.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Massachusetts General Hospital,       1,000,000  Lynch
 and Human Services       Mental Health Services   Boston, MA for behavioral health
                          Administration.          and supportive services for
                                                   adults and youth.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Mental Health Association, Inc.,        513,000  Neal
 and Human Services       Mental Health Services   Springfield, MA for mental
                          Administration.          health services, including
                                                   technology and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Minnesota Psychiatric Information       500,000  Phillips
 and Human Services       Mental Health Services   and Outreach, St. Paul, MN for
                          Administration.          behavioral health educational
                                                   materials, training, and peer
                                                   support services.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Mosaic Georgia, Inc., Duluth, GA      1,027,200  Bourdeaux
 and Human Services       Mental Health Services   for behavioral health workforce
                          Administration.          and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Muslim Community and Health             290,000  Moore (WI)
 and Human Services       Mental Health Services   Center, Milwaukee, WI to expand
                          Administration.          mental health services,
                                                   including outreach and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        National Runaway Switchboard,           375,000  Quigley
 and Human Services       Mental Health Services   Chicago, IL for the Teen Suicide
                          Administration.          Prevention Line to provide
                                                   mental health services,
                                                   including technology, public
                                                   awareness, training, and
                                                   equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Nevada State College, Henderson,      1,337,000  Lee (NV)
 and Human Services       Mental Health Services   NV for behavioral health and
                          Administration.          support services, including
                                                   technology and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        New Age Services Corporation,           600,000  Davis, Danny
 and Human Services       Mental Health Services   Chicago, IL to expand substance                  K.
                          Administration.          use disorder and mental health
                                                   services.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        New Mexico Human Services             2,800,000  Stansbury
 and Human Services       Mental Health Services   Department, Behavioral Health
                          Administration.          Services Division, Santa Fe, NM
                                                   for mobile mental health crisis
                                                   response teams.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Northville Township Police              135,359  Stevens
 and Human Services       Mental Health Services   Department, Northville, MI to
                          Administration.          expand mobile crisis response
                                                   and related services.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        NYC Health + Hospitals/ Jacobi,         845,026  Ocasio-Cortez
 and Human Services       Mental Health Services   Bronx, NY for the Stand Up to
                          Administration.          Violence program to provide
                                                   youth mental health and
                                                   substance use treatment
                                                   services, and other support
                                                   services.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Ohio Fire and Emergency Services        200,000  Joyce (OH)
 and Human Services       Mental Health Services   Foundation, Worthington, OH for
                          Administration.          a mental health training program.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Oklahoma Children's Hospital,         2,115,000  Cole
 and Human Services       Mental Health Services   Oklahoma City, OK for a
                          Administration.          behavioral health program,
                                                   including the purchase of
                                                   equipment and information
                                                   technology.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Operation New Hope, Jacksonville,       100,000  Lawson (FL)
 and Human Services       Mental Health Services   FL for mental health services
                          Administration.          and trainings.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Orange County Asian and Pacific         805,000  Lowenthal
 and Human Services       Mental Health Services   Islander Community Alliance,
                          Administration.          Inc., Garden Grove, CA for
                                                   mental health and supportive
                                                   services.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Overdose Lifeline, Inc.,                 87,000  Carson
 and Human Services       Mental Health Services   Indianapolis, IN for Camp
                          Administration.          Mariposa-Aaron's Place Youth
                                                   Prevention Program to provide
                                                   behavioral health and related
                                                   services to youth.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Partnership to End Addiction, New       293,000  Maloney,
 and Human Services       Mental Health Services   York, NY for telehealth and                      Carolyn B.
                          Administration.          mobile behavioral health
                                                   services, outreach, and
                                                   awareness activities.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Philadelphia Mural Arts                 500,000  Boyle,
 and Human Services       Mental Health Services   Advocates, Philadelphia, PA for                  Brendan F.
                          Administration.          behavioral health and other
                                                   support services.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Pinebrook Family Answers,               197,477  Wild
 and Human Services       Mental Health Services   Allentown, PA for suicide
                          Administration.          prevention and mental health
                                                   services, including training,
                                                   technology, and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Polk County, FL for behavioral        1,000,000  Soto
 and Human Services       Mental Health Services   health and mobile crisis
                          Administration.          services.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Primo Center for Women and              800,000  Davis, Danny
 and Human Services       Mental Health Services   Children, Chicago, IL for trauma-                K.
                          Administration.          informed behavioral health and
                                                   other supportive services.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Public Defender Association,          1,500,000  Smith (WA)
 and Human Services       Mental Health Services   Seattle, WA for behavioral
                          Administration.          health and wraparound services.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        RefugeeOne, Chicago, IL for             546,859  Schakowsky
 and Human Services       Mental Health Services   mental health and recovery
                          Administration.          support services for refugee
                                                   communities, including training.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Reimagining Justice Inc.,             1,000,000  Pascrell
 and Human Services       Mental Health Services   Paterson, NJ for mental health
                          Administration.          and wraparound services.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        San Francisco General Hospital        1,000,000  Pelosi
 and Human Services       Mental Health Services   Foundation, San Francisco, CA
                          Administration.          for behavioral health programs
                                                   and services.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        San Gabriel Valley Council of         1,500,000  Chu
 and Human Services       Mental Health Services   Governments, Alhambra, CA for
                          Administration.          mental health crisis response
                                                   services and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Santa Cruz County Office of           1,000,000  Panetta
 and Human Services       Mental Health Services   Education, Santa Cruz, CA for
                          Administration.          behavioral health services and
                                                   treatment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Sheppard Pratt Health System,         1,500,000  Brown (MD)
 and Human Services       Mental Health Services   Inc., Baltimore, MD for mental
                          Administration.          health services and treatment,
                                                   including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Sheppard Pratt Health System,         1,000,000  Raskin
 and Human Services       Mental Health Services   Inc., Baltimore, MD for the Zero
                          Administration.          Suicide Initiative to provide
                                                   mental health services and
                                                   treatment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Sheppard Pratt Health System,         1,000,000  Trone
 and Human Services       Mental Health Services   Inc., Hagerstown, MD to expand
                          Administration.          mental health services,
                                                   including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Stanislaus County Behavioral            711,690  Harder (CA)
 and Human Services       Mental Health Services   Health and Recovery Services,
                          Administration.          Modesto, CA to expand mobile
                                                   behavioral health crisis
                                                   services.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Temple University--Of The               750,000  Evans
 and Human Services       Mental Health Services   Commonwealth System of Higher
                          Administration.          Education, Philadelphia, PA for
                                                   mental and behavioral health
                                                   services to communities in
                                                   crisis, including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Texas A&M Engineering Extension         500,000  Nehls
 and Human Services       Mental Health Services   Service, College Station, TX for
                          Administration.          a mental health program for
                                                   first responders.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Texas State University, San           1,000,000  Doggett
 and Human Services       Mental Health Services   Marcos, TX for mental health
                          Administration.          training, including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        The Beebe Medical Foundation,           381,406  Blunt
 and Human Services       Mental Health Services   Lewes, DE for a community harm                   Rochester
                          Administration.          reduction program to provide
                                                   mental health and substance use
                                                   disorder services.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        The Center for Great                    500,000  Watson
 and Human Services       Mental Health Services   Expectations, Somerset, NJ for                   Coleman
                          Administration.          mental health services and
                                                   treatment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        The Centre for Women, Inc.,           1,205,394  Castor (FL)
 and Human Services       Mental Health Services   Tampa, FL for mental health and
                          Administration.          related services, including
                                                   minor facility repairs and
                                                   improvements.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        The Institute for Family Health         411,381  Maloney,
 and Human Services       Mental Health Services   at 17th Street, New York, NY for                 Carolyn B.
                          Administration.          substance use disorder services
                                                   and treatment, including a
                                                   mobile harm reduction unit.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        The Marion and Aaron Gural JCC,         300,000  Rice (NY)
 and Human Services       Mental Health Services   Cedarhurst, NY for the Resilient
                          Administration.          Impactful Sustaining Empowerment
                                                   Project to provide mental health
                                                   and supportive services.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        The Nemours Foundation,               1,500,000  Blunt
 and Human Services       Mental Health Services   Jacksonville, FL for pediatric                   Rochester
                          Administration.          mental health therapists,
                                                   trainings, and other support
                                                   services.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        The Welcome Project PA, Hatboro,        226,500  Dean
 and Human Services       Mental Health Services   PA for mental health services,
                          Administration.          case management, training, and
                                                   wraparound services.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Turning Point Behavioral Health         650,000  Schakowsky
 and Human Services       Mental Health Services   Care Center, Skokie, IL for the
                          Administration.          Living Room program to provide
                                                   behavioral health crisis and
                                                   supportive services.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        UCAN, Chicago, IL for behavioral         95,000  Newman
 and Human Services       Mental Health Services   health and supportive services
                          Administration.          for youth, including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        United Way of Greater LaPorte           100,000  Mrvan
 and Human Services       Mental Health Services   County, Michigan City, IN for
                          Administration.          mental health and substance use
                                                   disorder services, including
                                                   community outreach and education.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        United Way of Will County,              883,395  Foster
 and Human Services       Mental Health Services   Joliet, IL for the Resilient
                          Administration.          Youth program to provide
                                                   behavioral health services,
                                                   including training.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        University of California, Davis,      1,509,543  Matsui
 and Human Services       Mental Health Services   Sacramento, CA for behavioral
                          Administration.          health services and treatment,
                                                   including technology.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        University of North Carolina            230,000  Adams
 and Human Services       Mental Health Services   System, Chapel Hill, NC for
                          Administration.          mental health training and
                                                   services.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Unlawful Narcotics                    1,400,000  Rogers (KY)
 and Human Services       Mental Health Services   Investigations, Treatment, and
                          Administration.          Education, Inc., London, KY for
                                                   a substance use prevention,
                                                   treatment, and recovery program,
                                                   including the purchase of
                                                   equipment and housing
                                                   assistance, and education
                                                   programming.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        UTOPIA Washington, Kent, WA for         500,000  Smith (WA)
 and Human Services       Mental Health Services   mental health and substance use
                          Administration.          disorder services, including
                                                   training and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Valley Health System, Winchester,       500,000  Wexton
 and Human Services       Mental Health Services   VA for behavioral health
                          Administration.          training.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Variety Boys and Girls Club of          502,250  Ocasio-Cortez
 and Human Services       Mental Health Services   Queens, Inc., Astoria, NY for
                          Administration.          mental health and supportive
                                                   services, including outreach.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Washington State University,            500,000  Rodgers (WA)
 and Human Services       Mental Health Services   Spokane, WA for a mental and
                          Administration.          behavioral health services
                                                   program for rural and
                                                   underserved communities,
                                                   including student stipends.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Wendt Center for Loss and                94,444  Norton
 and Human Services       Mental Health Services   Healing, Washington, DC for
                          Administration.          behavioral health crisis
                                                   response services.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Western Michigan University,          1,820,000  Upton
 and Human Services       Mental Health Services   Kalamazoo, MI for a mental and
                          Administration.          behavioral health initiative,
                                                   including teacher and student
                                                   stipends.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Wyandotte County Public Health          750,000  Davids (KS)
 and Human Services       Mental Health Services   Department, Kansas City, KS for
                          Administration.          mental and behavioral health
                                                   services, including wraparound
                                                   services.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        YMCA of Honolulu, HI for the            270,000  Case
 and Human Services       Mental Health Services   Youth Wellness Program for
                          Administration.          Mental Health to provide mental
                                                   health services, including
                                                   equipment and technology.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Youth Shelter Program of              1,600,000  Bowman
 and Human Services       Mental Health Services   Westchester, Mount Vernon, NY
                          Administration.          for the YouthHEAL Integrated
                                                   Network project to provide
                                                   behavioral health services,
                                                   including equipment and training.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        Youth Visionaries Youth                 733,533  Aguilar
 and Human Services       Mental Health Services   Leadership Academy, San
                          Administration.          Bernardino, CA for the
                                                   Empowering Youth Resilience and
                                                   Promoting Social Emotional
                                                   Healing project to provide
                                                   mental health and other
                                                   wraparound services.
----------------------------------------------------------------------------------------------------------------
Department of Health     Substance Use And        YWCA Pierce County, Tacoma, WA          151,000  Kilmer
 and Human Services       Mental Health Services   for behavioral health and
                          Administration.          supportive services, including
                                                   training.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Abyssinian Development                1,000,000  Espaillat
                          Secondary Education.     Corporation, New York, NY for
                                                   SEL programming and professional
                                                   development.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Admiral Peary Area Vocational         1,005,000  Thompson (PA)
                          Secondary Education.     Technical School, Ebensburg, PA
                                                   for an instructional program,
                                                   including the purchase of
                                                   equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Adrienne Arsht Center Trust,            500,000  Wilson (FL)
                          Secondary Education.     Miami, FL for arts education
                                                   through theater production and
                                                   performance.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           American Association of                 491,000  Frankel, Lois
                          Secondary Education.     Caregiving Youth, Boca Raton, FL
                                                   for supportive services for
                                                   caregiving youth.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           An Achievable Dream, Newport          1,594,355  Scott (VA)
                          Secondary Education.     News, VA for student enrichment
                                                   and academic support.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Anaheim Union High School             2,000,000  Correa
                          Secondary Education.     District, Anaheim, CA for a
                                                   theater and performing arts
                                                   program, including equipment and
                                                   technology installation.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Austin Independent School             2,015,750  Doggett
                          Secondary Education.     District, Austin, TX for outdoor
                                                   learning experiences, including
                                                   equipment and furniture for
                                                   outdoor classrooms and exhibits.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Baldwin Union Free School             3,000,000  Rice (NY)
                          Secondary Education.     District, Baldwin, NY for SEL
                                                   programs.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Beasley-Brown Community               2,280,000  Cuellar
                          Secondary Education.     Development Corporation, San
                                                   Antonio, TX for community-based
                                                   learning centers.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Best Buddies International,             100,000  Hoyer
                          Secondary Education.     Baltimore, MD for school-based
                                                   programs that promote inclusion.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Best Buddies International,             100,000  Sarbanes
                          Secondary Education.     Baltimore, MD for school-based
                                                   programs that promote inclusion.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Best Buddies International,             100,000  Jackson Lee
                          Secondary Education.     Houston, TX for inclusion
                                                   support for students with
                                                   disabilities.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Big Brothers Big Sisters Lone           250,000  Nehls
                          Secondary Education.     Star, Irving, TX for a youth
                                                   mentoring program.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Big Brothers Big Sisters of           1,000,000  Watson
                          Secondary Education.     Essex, Hudson & Union Counties,                  Coleman
                                                   Newark, NJ for mentoring and
                                                   student support.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Big Sister Association of Greater       250,000  Pressley
                          Secondary Education.     Boston, MA for student mentoring
                                                   and enrichment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Big Thought, Dallas, TX for out-      1,000,000  Allred
                          Secondary Education.     of-school learning, digital
                                                   credentialing, and learning
                                                   systems.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Birch Family Services, New York,        201,096  Ocasio-Cortez
                          Secondary Education.     NY for communication systems for
                                                   nonverbal children and families.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Black Hawk College, Kewanee, IL       1,000,000  Bustos
                          Secondary Education.     for a manufacturing training
                                                   program, including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Black Spectrum Theatre Co.,           1,275,750  Meeks
                          Secondary Education.     Jamaica, NY for an African
                                                   American history program.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Boys & Girls Club of Monmouth           500,000  Pallone
                          Secondary Education.     County, Asbury Park, NJ for
                                                   trauma-informed interventions to
                                                   address adverse childhood
                                                   experiences.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Boys & Girls Clubs of Southern          750,000  Horsford
                          Secondary Education.     Nevada, Las Vegas, NV for STEM
                                                   and SEL programs.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Boys & Girls Clubs of the Los         1,000,000  Lieu
                          Secondary Education.     Angeles Harbor, San Pedro, CA
                                                   for developing a digital program
                                                   for student support.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Boys and Girls Club of Metro            400,861  Bourdeaux
                          Secondary Education.     Atlanta, Chamblee, GA for
                                                   academic enrichment and tutoring.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Boys and Girls Club of Metro            549,374  Perlmutter
                          Secondary Education.     Denver, CO for afterschool and
                                                   summer programming.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Boys and Girls Club of Metro          1,212,062  Crow
                          Secondary Education.     Denver, CO for afterschool
                                                   programs.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Boys and Girls Club of Pharr, TX      1,753,812  Gonzalez,
                          Secondary Education.     for equipment and supplies for                   Vicente
                                                   youth development services.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Boys and Girls Clubs of Benton        1,500,000  Upton
                          Secondary Education.     Harbor, Benton Harbor, MI for
                                                   educational, mentoring, and
                                                   tutoring program.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Breakthrough of Greater                 500,000  Evans
                          Secondary Education.     Philadelphia, PA for a teaching
                                                   fellows program.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Bridgewater State University,         1,358,000  Keating
                          Secondary Education.     Bridgewater, MA for an aviation
                                                   education program.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Bristol Community College, Fall       1,000,000  Keating
                          Secondary Education.     River, MA for workforce
                                                   education access and credit
                                                   programs.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Brooklyn Bridge Park Conservancy,     1,025,000  Velazquez
                          Secondary Education.     Brooklyn, NY for academic
                                                   enrichment programs.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Broward County Public Schools,          525,000  Wasserman
                          Secondary Education.     Fort Lauderdale, FL for visual                   Schultz
                                                   arts and computer science
                                                   education, including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Cambodia Town, Long Beach, CA for        56,950  Lowenthal
                          Secondary Education.     language access programs.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Cameron Community Ministries,           200,000  Morelle
                          Secondary Education.     Rochester, NY for afterschool
                                                   and summer enrichment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Cape Cod Community College,           1,000,000  Keating
                          Secondary Education.     Barnstable, MA for a dental
                                                   hygiene program.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Capitol Hill Arts Workshop,             250,000  Norton
                          Secondary Education.     Washington, DC for youth
                                                   engagement through arts
                                                   education, including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Career Technical Education              200,000  Huffman
                          Secondary Education.     Foundation Sonoma County, Santa
                                                   Rosa, CA for whole-school
                                                   transformation efforts.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Catholic Big Brothers and Big           500,000  Schiff
                          Secondary Education.     Sisters of Los Angeles, CA for a
                                                   postsecondary student support
                                                   program.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Centro Cultural Aztlan, San              95,000  Castro (TX)
                          Secondary Education.     Antonio, TX for arts education.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Chapman University, Orange, CA        2,200,000  Correa
                          Secondary Education.     for computational clusters, lab
                                                   infrastructure, and
                                                   postsecondary research
                                                   activities.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Chicago Public Schools, Chicago,        500,000  Newman
                          Secondary Education.     IL for arts education, including
                                                   equipment and supplies.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Chicago Public Schools, Chicago,        500,000  Quigley
                          Secondary Education.     IL for arts education, including
                                                   equipment and supplies.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Chicago Public Schools, Chicago,        500,000  Rush
                          Secondary Education.     IL for arts education, including
                                                   equipment and supplies.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Chinese American Social Services        105,000  Nadler
                          Secondary Education.     Center, Brooklyn, NY for
                                                   academic and arts programs,
                                                   including support for English
                                                   learners.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           City of Greenacres, FL for youth      1,000,000  Frankel, Lois
                          Secondary Education.     programs, services, and
                                                   curricula, including technology.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           City of Indianapolis Department       1,000,000  Carson
                          Secondary Education.     of Parks and Recreation,
                                                   Indianapolis, IN for an
                                                   afterschool physical education
                                                   enrichment program.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           City of Indianapolis Department       1,000,000  Carson
                          Secondary Education.     of Parks and Recreation,
                                                   Indianapolis, IN for arts and
                                                   environmental education access
                                                   in afterschool and summer
                                                   learning settings.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           City School District of New           2,000,000  Bowman
                          Secondary Education.     Rochelle, NY for afterschool
                                                   programs and summer learning.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Clayton State University, Morrow,       750,000  Scott, David
                          Secondary Education.     GA for environmental studies
                                                   research, including equipment
                                                   and technology.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Clearwater Marine Aquarium,             976,000  Crist
                          Secondary Education.     Clearwater, FL for science
                                                   education and a mobile
                                                   classroom, including a vehicle.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Commonwealth of the Northern            311,939  Sablan
                          Secondary Education.     Mariana Islands Public School
                                                   System, Saipan, MP for language
                                                   immersion curriculum and
                                                   programming.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Connecticut Historical Society        1,000,000  Larson (CT)
                          Secondary Education.     Museum and Library, Hartford, CT
                                                   for civics education.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           CUNY Dominican Studies Institute,       809,092  Espaillat
                          Secondary Education.     New York, NY for historical
                                                   curricula and enrichment
                                                   programs.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Dance Institute of Washington, DC     1,000,000  Norton
                          Secondary Education.     for arts education and dance
                                                   training, including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Dearborn Heights Libraries,             206,000  Tlaib
                          Secondary Education.     Dearborn Heights, MI for student
                                                   mobile library services,
                                                   including a vehicle.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Dr. Carter G. Woodson African         3,000,000  Crist
                          Secondary Education.     American History Museum, St.
                                                   Petersburg, FL for an African
                                                   American history program,
                                                   including technology.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Drew Child Development                  143,000  Barragan
                          Secondary Education.     Corporation, Lynwood, CA for an
                                                   early childhood education
                                                   program, including installation
                                                   of an outdoor science lab and
                                                   learning space.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           El Paso Independent School            2,000,000  Escobar
                          Secondary Education.     District, El Paso, TX for
                                                   afterschool enrichment and STEAM
                                                   education.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Empowering Success Now, Fontana,        532,500  Torres (CA)
                          Secondary Education.     CA for afterschool and tutoring
                                                   programs.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Encompass: Resources for                700,000  Morelle
                          Secondary Education.     Learning, Rochester, NY for
                                                   student academic and wraparound
                                                   services, including
                                                   transportation.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           End Hunger Calvert County,              300,000  Hoyer
                          Secondary Education.     Huntingtown, MD for a pre-
                                                   apprentice skills program.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Fairfax County, VA for early          1,500,000  Connolly,
                          Secondary Education.     childhood development and                        Wexton
                                                   learning.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Fine Arts Work Center in                400,000  Keating
                          Secondary Education.     Provincetown, MA for arts
                                                   education and cultural
                                                   programming for community
                                                   development.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Flint Institute of Science and        1,905,421  Kildee
                          Secondary Education.     History, Flint, MI for
                                                   afterschool programs.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Food Literacy Center, Sacramento,     1,050,000  Matsui
                          Secondary Education.     CA for science and nutrition
                                                   education, including the
                                                   development of a student garden.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Foundation Communities, Austin,       1,107,925  Doggett
                          Secondary Education.     TX for learning center programs,
                                                   including enrichment and
                                                   literacy support.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Foundation for the Advancement of       750,000  Brown (MD)
                          Secondary Education.     Music & Education, Bowie, MD for
                                                   music education programs.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Freeport Union Free School              173,923  Rice (NY)
                          Secondary Education.     District, Freeport, NY for a
                                                   college and career center,
                                                   including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Friendship Foundation, Redondo        1,000,000  Lieu
                          Secondary Education.     Beach, CA for inclusive programs
                                                   for students with disabilities.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Georgia Institute of Technology,        215,000  Carter (GA)
                          Secondary Education.     Atlanta, GA for educational
                                                   services for children of
                                                   military families, including the
                                                   purchase of equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Girl Scouts of Eastern Missouri,         70,000  Bush
                          Secondary Education.     St. Louis, MO for student mental
                                                   health and anti-violence
                                                   programs.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Girl Scouts of Northeast Texas,         920,000  Johnson (TX)
                          Secondary Education.     Dallas, TX for programming to
                                                   develop skills and competencies
                                                   in STEM, leadership development,
                                                   and financial empowerment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Glen Ellyn School District 41,          250,000  Casten
                          Secondary Education.     Glen Ellyn, IL for school-based
                                                   mental health services for
                                                   students and families.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Grand Valley State University,        1,000,000  Meijer
                          Secondary Education.     Allendale, MI for a student
                                                   development program, including
                                                   the purchase of supplies and
                                                   student stipends.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Greater New York Councils, Boy           50,000  Malliotakis
                          Secondary Education.     Scouts of America, New York, NY
                                                   for a youth scouting program.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Guadalupe Cultural Arts Center,         102,250  Castro (TX)
                          Secondary Education.     San Antonio, TX for student
                                                   literacy programs and access to
                                                   culturally relevant texts.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Guilford County Schools,              2,200,000  Manning
                          Secondary Education.     Greensboro, NC for wraparound
                                                   services, academic supports, and
                                                   learning hubs.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Haitian Americans United for            364,558  Meeks
                          Secondary Education.     Progress, Hollis, NY for youth
                                                   leadership and youth workforce
                                                   programming.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Harris County Public Library,           139,212  Fletcher
                          Secondary Education.     Houston, TX for student access
                                                   to texts, including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Hawaii Agriculture Foundation,          372,000  Kahele
                          Secondary Education.     Honolulu, HI for STEM programs
                                                   that incorporate innovative
                                                   agriculture technologies.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Henry County Board of Education,         40,000  Scott, David
                          Secondary Education.     McDonough, GA for afterschool
                                                   enrichment and STEM education.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Hillsborough County Public            1,986,353  Castor (FL)
                          Secondary Education.     Schools, Tampa, FL for arts
                                                   education.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Hillsborough County Public            1,000,000  Castor (FL)
                          Secondary Education.     Schools, Tampa, FL for career
                                                   and technical education in
                                                   construction and medical
                                                   training, including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Hispanic Counseling Center,             128,468  Rice (NY)
                          Secondary Education.     Hempstead, NY for afterschool
                                                   programming.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Holocaust Memorial Center,              605,000  Levin (MI)
                          Secondary Education.     Farmington Hills, MI for a
                                                   Holocaust education program.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Holocaust Memorial Center,              550,000  Stevens
                          Secondary Education.     Farmington Hills, MI for a
                                                   Holocaust education program,
                                                   including support for English
                                                   learners and students with
                                                   disabilities.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Houston Independent School            1,975,000  Green (TX)
                          Secondary Education.     District, Houston, TX for family
                                                   and community engagement
                                                   programs for students.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Houston Public Library, Houston,      2,000,347  Fletcher
                          Secondary Education.     TX for digital literacy
                                                   resources.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Iowa Jobs for America's                 250,000  Krishnamoorth
                          Secondary Education.     Graduates, Des Moines, IA for                    i
                                                   career pathways and counseling
                                                   supports.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Ivy Tech Community College,             500,000  Carson
                          Secondary Education.     Indianapolis, IN for early
                                                   childhood education programs,
                                                   including furniture, minor
                                                   repairs, and classroom upgrades.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Jobs for Arizona's Graduates,           167,700  Grijalva
                          Secondary Education.     Phoenix, AZ for targeted student
                                                   support programs.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Kennedy King Memorial Initiative,       100,000  Carson
                          Secondary Education.     Indianapolis, IN for human
                                                   rights education.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Kennedy Krieger Institute,            2,000,000  Hoyer
                          Secondary Education.     Baltimore, MD for services to
                                                   students with disabilities.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Kula No Na Poe Hawaii, Honolulu,      1,800,000  Case
                          Secondary Education.     HI for academic supports and
                                                   wraparound services.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Lenape Regional High School             593,663  Kim (NJ)
                          Secondary Education.     District, Shamong, NJ for post-
                                                   graduation student success
                                                   programs.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Leo High School, Chicago, IL for        250,000  Rush
                          Secondary Education.     a parent engagement center,
                                                   including equipment and
                                                   technology.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           LGBT Center of Greater Reading,         113,520  Houlahan
                          Secondary Education.     PA for wraparound services and
                                                   support for at-risk youth.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           LIFT, Detroit, MI for a               1,250,000  Lawrence
                          Secondary Education.     manufacturing technician
                                                   education program.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Long Beach Day Nursery, Long            250,000  Lowenthal
                          Secondary Education.     Beach, CA for early childhood
                                                   learning.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Long Beach Latino Civic                  50,000  Rice (NY)
                          Secondary Education.     Association, Long Beach, NY for
                                                   student support, mentoring, and
                                                   enrichment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Massachusetts Women of Color            416,275  McGovern
                          Secondary Education.     Coalition, Worcester, MA for a
                                                   summer learning program.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Michigan's Own, Inc. dba--              215,000  Moolenaar
                          Secondary Education.     Michigan Heroes Museum,
                                                   Frankenmuth, MI for curriculum,
                                                   exhibit, website development,
                                                   and educational programming,
                                                   including information technology.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Milwaukee Public Library,               241,250  Moore (WI)
                          Secondary Education.     Milwaukee, WI for child literacy
                                                   programs.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Monmouth College, Monmouth, IL          750,000  Bustos
                          Secondary Education.     for rural teacher preparation
                                                   and development.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Museum of Science and Industry,       1,022,000  Quigley
                          Secondary Education.     Chicago, IL for STEM education,
                                                   including teacher stipends.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Museums at Mitchel Doing Business        75,000  Rice (NY)
                          Secondary Education.     As Cradle of Aviation Museum,
                                                   Garden City, NY for STEM
                                                   education.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           NAACP--Hayward/South Alameda            285,000  Swalwell
                          Secondary Education.     County, Hayward, CA for a parent
                                                   engagement and student success
                                                   program.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           National Aquarium, Baltimore, MD        401,615  Ruppersberger
                          Secondary Education.     for STEM education and
                                                   professional development.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           National Center for Families            500,000  Yarmuth
                          Secondary Education.     Learning, Louisville, KY for a
                                                   family engagement and immersive
                                                   technology program.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           National Children's Museum,           1,000,000  Norton
                          Secondary Education.     Washington, DC for student
                                                   educational exhibits and
                                                   programming.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           National World War II Museum, New     2,000,000  Carter (LA)
                          Secondary Education.     Orleans, LA, for a historical
                                                   education project, including
                                                   technology and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           New York Hall of Science, Corona,       750,000  Ocasio-Cortez
                          Secondary Education.     NY for science programming for
                                                   preschool students, including
                                                   exhibits.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           New York Sun Works, New York, NY        800,000  Torres (NY)
                          Secondary Education.     for a hydroponic farm STEM
                                                   program, including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           New York Sun Works, New York, NY        800,000  Clarke (NY)
                          Secondary Education.     for hydroponic STEM classrooms,
                                                   including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           New York Sun Works, New York, NY        500,000  Jeffries
                          Secondary Education.     for hydroponic STEM education,
                                                   including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           NH Jobs for America's Graduates,        300,000  Pappas
                          Secondary Education.     Manchester, NH for programs to
                                                   develop student academic skills,
                                                   including supplies and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Norwalk La-Mirada Unified School      2,200,000  Sanchez
                          Secondary Education.     District, Norwalk, CA for career
                                                   and technical education
                                                   pathways, dual enrollment
                                                   programs, and technology.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Norwalk Public Schools, Norwalk,      1,323,660  Himes
                          Secondary Education.     CT for marine science pathways.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Ontario-Montclair School                272,077  Torres (CA)
                          Secondary Education.     District, Ontario, CA for STEAM
                                                   programs, including equipment
                                                   and technology.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Open Door Preschools, Austin, TX        824,900  Doggett
                          Secondary Education.     for preschool programs,
                                                   including outdoor learning
                                                   spaces, and wraparound supports
                                                   for at-risk families.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Optimist Boys' Home & Ranch, Inc.       270,000  Garcia (CA)
                          Secondary Education.     dba Optimist Youth Homes &
                                                   Family Services, Los Angeles, CA
                                                   for a tutoring program.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Oregon Institute of Technology,         700,000  Schrader
                          Secondary Education.     Wilsonville, OR for a healthcare
                                                   career pathways program.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Orlando Community & Youth Trust,        100,000  Demings
                          Secondary Education.     Orlando, FL for student
                                                   enrichment through dragon
                                                   boating.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Pace Center for Girls, Inc.,            500,000  Bilirakis
                          Secondary Education.     Jacksonville, FL for an
                                                   educational services,
                                                   counseling, and training
                                                   program, including the purchase
                                                   of equipment and information
                                                   technology.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Pace Center for Girls, Inc.,            500,000  Rutherford
                          Secondary Education.     Jacksonville, FL for curriculum,
                                                   technology, and training
                                                   program, including the purchase
                                                   of information technology and
                                                   equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Pace Center for Girls,                  500,000  Crist
                          Secondary Education.     Jacksonville, FL for curriculum
                                                   development and support services.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Pace Center for Girls,                  500,000  Lawson (FL)
                          Secondary Education.     Jacksonville, FL for student
                                                   support programs, including SEL
                                                   resources and technology.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Pascua Yaqui Tribe, Tucson, AZ          862,813  Grijalva
                          Secondary Education.     for academic programs,
                                                   curricula, and teacher
                                                   development.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Penumbra Theatre, Saint Paul, MN      1,000,000  McCollum
                          Secondary Education.     for the development, testing,
                                                   and implementation of curriculum.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Pima County School                      252,000  Grijalva
                          Secondary Education.     Superintendent's Office, Tucson,
                                                   AZ for curricula, resources, and
                                                   professional development.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Pinellas County Education             1,225,000  Bilirakis
                          Secondary Education.     Foundation, Inc., Largo, FL for
                                                   an early learning initiative,
                                                   including teacher stipends.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Providence After School Alliance,       350,000  Cicilline
                          Secondary Education.     Providence, RI for a summer
                                                   learning STEAM program.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Research Foundation of the City         191,160  Clarke (NY)
                          Secondary Education.     University of New York,
                                                   Brooklyn, NY for a literacy
                                                   program.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Riverside County Office of            1,000,000  Ruiz
                          Secondary Education.     Education, Riverside, CA for
                                                   early childhood education.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Rock and Roll Hall of Fame and        1,000,000  Brown (OH)
                          Secondary Education.     Museum, Cleveland, OH for arts
                                                   education programs.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Roosevelt Union Free School             525,000  Rice (NY)
                          Secondary Education.     District, Roosevelt, NY for
                                                   homework and tutoring support.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           San Diego State University, San         524,972  Jacobs (CA)
                          Secondary Education.     Diego, CA for school-based
                                                   behavioral health training and
                                                   supports.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Santa Ana College, Santa Ana, CA      2,000,000  Correa
                          Secondary Education.     for CTE pathways to certificate
                                                   and degree programs.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Santa Clara County Office of          1,000,000  Eshoo
                          Secondary Education.     Education, San Jose, CA for
                                                   student broadband access,
                                                   including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           School District of Borough of           850,000  Fitzpatrick
                          Secondary Education.     Morrisville, PA for a
                                                   curriculum, instruction, and
                                                   technology program, including
                                                   the purchase of information
                                                   technology and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           School District of Osceola              953,000  Soto
                          Secondary Education.     County, FL for a youth
                                                   entrepreneurship program,
                                                   including support for student
                                                   internships, a vehicle, and
                                                   capital for student businesses.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Seed St. Louis, MO for STEM             380,000  Bush
                          Secondary Education.     education programs.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Seminole County Public Schools,         526,692  Murphy (FL)
                          Secondary Education.     Sanford, FL for high school
                                                   health careers programs,
                                                   including medical equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Shedd Aquarium, Chicago, IL for         595,025  Quigley
                          Secondary Education.     STEAM education.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Soulsville Foundation, Memphis,       1,150,000  Cohen
                          Secondary Education.     TN for an afterschool music
                                                   education program.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Soundscapes, Newport News, VA for       677,000  Scott (VA)
                          Secondary Education.     expanding access to arts
                                                   education, including a
                                                   feasibility study for growth.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           South City Foundation,                2,000,000  Lawson (FL)
                          Secondary Education.     Tallahassee, FL for an early
                                                   childhood education program,
                                                   including technology upgrades.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Southland Career and Technical        1,740,000  Kelly (IL)
                          Secondary Education.     Education Center, Matteson, IL
                                                   for classroom design and
                                                   curricula for career and
                                                   technical education programs.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Springfield Public Schools,             385,000  DeFazio
                          Secondary Education.     Springfield, OR for a career and
                                                   technical cosmetology program,
                                                   including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           St. Louis Public Schools, St.           252,713  Bush
                          Secondary Education.     Louis, MO for CTE programs in
                                                   construction trades, including
                                                   scholarships for technical
                                                   college programs.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Stars of New York Dance,                500,000  Jeffries
                          Secondary Education.     Brooklyn, NY for arts education
                                                   enrichment programs, including
                                                   student scholarships.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Start Lighthouse, New York, NY          205,500  Ocasio-Cortez
                          Secondary Education.     for literacy and learning spaces
                                                   in schools.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Strategic Human Services,               832,140  Davis, Danny
                          Secondary Education.     Chicago, IL for communication                    K.
                                                   and journalism education,
                                                   including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Tacoma Public School District,          555,000  Strickland
                          Secondary Education.     Tacoma, WA for career
                                                   preparation and internship
                                                   programs.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           TECH CORPS, Columbus, OH for            300,000  Ryan
                          Secondary Education.     computer science education,
                                                   including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Tennessee Technological                 400,000  Rose
                          Secondary Education.     University, Cookeville, TN for
                                                   lending library programs,
                                                   including purchase of supplies,
                                                   information technology, and
                                                   equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Texas A&M University San Antonio,       300,000  Castro (TX)
                          Secondary Education.     TX for a mobile unit offering
                                                   school-based autism services and
                                                   educational supports.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Texas State University -- Round       1,000,000  Carter (TX)
                          Secondary Education.     Rock, Round Rock, TX for a STEM
                                                   educational and professional
                                                   development program.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           The Bridge Teen Center, Orland          500,000  Newman
                          Secondary Education.     Park, IL for afterschool
                                                   programs.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           The Brotherhood Sister Sol, New       1,000,000  Espaillat
                          Secondary Education.     York, NY for afterschool
                                                   programs.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           The Center for the Innovative         2,000,000  Carter (LA)
                          Secondary Education.     Training of Youth STEM NOLA, New
                                                   Orleans, LA for STEM learning
                                                   and career readiness programs,
                                                   including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           The Garage Community and Youth          100,000  Houlahan
                          Secondary Education.     Center, Avondale, PA for
                                                   afterschool youth development
                                                   programs, including a vehicle.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           The Noel Pointer Foundation,            414,500  Jeffries
                          Secondary Education.     Brooklyn, NY for music
                                                   instruction programs, including
                                                   student scholarships.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           The Regents of the University of      1,125,360  Vargas
                          Secondary Education.     California; University of
                                                   California San Diego, La Jolla,
                                                   CA for summer math academies.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           The West Virginia Chamber               200,000  Miller (WV)
                          Secondary Education.     Foundation Corporation,
                                                   Charleston, WV for a drop-out
                                                   prevention and school-to-work
                                                   transition program.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Toledo Tomorrow, Toledo, OH for       1,050,000  Kaptur
                          Secondary Education.     an early childhood reading
                                                   program.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Town of Randolph, MA for mobile         524,000  Pressley
                          Secondary Education.     library and STEM programming,
                                                   including vehicle and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Trumbull County Educational             650,000  Ryan
                          Secondary Education.     Service Center, Niles, OH for
                                                   STEM education, including
                                                   equipment and technology.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           United Way of Wyoming Valley,         2,200,000  Cartwright
                          Secondary Education.     Wilkes-Barre, PA for wraparound
                                                   services and academic supports,
                                                   including pre-K tuition stipends.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           University of California              1,000,000  Lee (CA)
                          Secondary Education.     Berkeley, CA for a social
                                                   science research and
                                                   postdoctoral pipeline program.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           University of Connecticut Health      1,000,000  Hayes
                          Secondary Education.     Center, Farmington, CT for K-12
                                                   STEM education programs.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           University of Mississippi,            1,000,000  Kelly (MS)
                          Secondary Education.     University, MS for a
                                                   professional development program
                                                   and writing initiative.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           University of Nebraska System,        2,000,000  Bacon
                          Secondary Education.     Lincoln, NE for a science,
                                                   technology, engineering, and
                                                   mathematics program.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           University of Washington Bothell,       811,061  DelBene
                          Secondary Education.     WA for pathways toward
                                                   environment and sustainability
                                                   degree programs, including
                                                   equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Upper Darby Arts & Education            115,000  Scanlon
                          Secondary Education.     Foundation, Drexel Hill, PA for
                                                   creative arts programs for
                                                   students with disabilities.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Virgin Islands Department of          2,200,000  Plaskett
                          Secondary Education.     Education, St. Thomas, VI for
                                                   electric vehicle classes, career
                                                   and technical college programs,
                                                   and STEM education.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Washtenaw Community College, Ann      1,000,000  Dingell
                          Secondary Education.     Arbor, MI for an electric
                                                   battery and charging station
                                                   program, including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Waterbury Public Schools,             2,265,000  Hayes
                          Secondary Education.     Waterbury, CT for education
                                                   technology equipment, including
                                                   computers.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Watts Labor Community Action            922,000  Barragan
                          Secondary Education.     Committee, Los Angeles, CA for
                                                   afterschool programming and arts
                                                   education.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Waukegan to College, Waukegan, IL       315,000  Schneider
                          Secondary Education.     for mentoring, tutoring, and
                                                   academic advising programs.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           West Chester University, West           715,770  Houlahan
                          Secondary Education.     Chester, PA for STEM education
                                                   programs.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           Winston-Salem/Forsyth County            301,548  Manning
                          Secondary Education.     Schools, Winston-Salem, NC for
                                                   teacher academy programs.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           YMCA of Greater New York, NY for      1,000,000  Meeks
                          Secondary Education.     youth support and enrichment
                                                   programs.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           YMCA of Memphis and the Mid-          1,000,000  Cohen
                          Secondary Education.     South, Cordova, TN for
                                                   educational programs before and
                                                   after school.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           YMCA of Metropolitan Chicago, IL        666,366  Underwood
                          Secondary Education.     for afterschool programs.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           YMCA of Metropolitan Los Angeles,     1,500,000  Gomez
                          Secondary Education.     CA for empowerment learning pods.
----------------------------------------------------------------------------------------------------------------
Department of Education  Elementary and           YMCA of Metropolitan Los Angeles,     2,000,000  Cardenas
                          Secondary Education.     Van Nuys, CA for STEAM and
                                                   civics education.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Adoption Rhode Island,                  201,639  Langevin
                                                   Providence, RI for an adoption
                                                   and foster care certificate
                                                   program, including scholarships
                                                   and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Agnes Scott College, Decatur, GA      1,024,940  Williams (GA)
                                                   for digital skill building
                                                   programs, including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Albany Technical College, Albany,     1,000,000  Bishop (GA)
                                                   GA for allied health programs,
                                                   including equipment, a vehicle,
                                                   and scholarships.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Aliento Education Fund, Phoenix,        300,000  Kirkpatrick
                                                   AZ for first-generation college
                                                   student access and success
                                                   programs, including scholarships.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  AltaSea at the Port of Los            1,000,000  Barragan
                                                   Angeles, San Pedro, CA for
                                                   postsecondary ocean-based
                                                   research, including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Alvernia University Reading           2,000,000  Houlahan
                                                   Collegetowne, Reading, PA for a
                                                   health science program,
                                                   including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Alvernia University, Reading, PA      1,000,000  Meuser
                                                   for the purchase of information
                                                   technology and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Angelo State University, San          2,000,000  Pfluger
                                                   Angelo, TX for equipment,
                                                   scholarships, and stipends for
                                                   an aviation degree program.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Aquinas College, Grand Rapids, MI       185,000  Meijer
                                                   for a professional development
                                                   and curriculum development for a
                                                   teaching center.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Arkansas Tech University,               730,000  Womack
                                                   Russellville, AR for purchase of
                                                   lab equipment and technology for
                                                   agricultural education program.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  AUC Consortium, Atlanta, GA for       2,000,000  Williams (GA)
                                                   programs promoting career
                                                   pathways into government
                                                   service, including scholarships.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Augusta University, Augusta, GA       1,000,000  Carter (GA)
                                                   for a telemedicine education
                                                   initiative, including the
                                                   purchase of equipment and
                                                   information technology.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Aurora University, Aurora, IL for       955,000  Foster
                                                   an emerging technologies
                                                   learning lab, including
                                                   equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Austin Community College              2,830,000  McCaul
                                                   District, Austin, TX for the
                                                   purchase of equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Austin Community College, Austin,     1,467,542  Doggett
                                                   TX for cybersecurity training,
                                                   including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Austin Independent School             1,862,600  Doggett
                                                   District for college and career
                                                   preparation, including
                                                   transportation.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Bay Path University, Longmeadow,      1,000,000  Neal
                                                   MA for wraparound academic and
                                                   student support services.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Baylor University, Waco, TX for a     1,500,000  Sessions
                                                   cybersecurity program, including
                                                   the purchase of equipment and
                                                   information technology.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Birmingham-Southern College,            500,000  Sewell
                                                   Birmingham, AL for experimental
                                                   learning and civic engagement.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Bluegrass Community and Technical     1,570,000  Barr
                                                   College, Lexington, KY for a
                                                   health professions program,
                                                   including the purchase of
                                                   equipment and supplies.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Boys & Girls Club of the West           450,000  Sherman
                                                   Valley, Canoga Park, CA for
                                                   afterschool programs.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Cabrillo College, Aptos, CA for         163,539  Panetta
                                                   science learning, including
                                                   learning lab furniture and
                                                   equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  California State University--         1,681,720  Harder (CA)
                                                   Stanislaus, Turlock, CA for a
                                                   mental health workforce program,
                                                   including scholarships.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  California State University             550,800  Brownley
                                                   Channel Islands, Camarillo, CA
                                                   for a cybersecurity degree
                                                   program, including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  California State University,          1,000,000  Sherman
                                                   Northridge, CA for arts, media,
                                                   and communications programs,
                                                   including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Campbellsville University,              950,000  Comer
                                                   Campbellsville, KY for
                                                   information technology and
                                                   equipment upgrades.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Chabot--Las Positas Community         1,000,000  Swalwell
                                                   College District, Dublin, CA for
                                                   student support programs.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Chicago State University,             1,600,000  Rush
                                                   Chicago, IL for communication
                                                   and media career development
                                                   programs, including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  City College of New York, NY for      2,200,000  Espaillat
                                                   an infrastructure workforce
                                                   training program and center.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  City Colleges of Chicago Malcom X     1,000,000  Davis, Danny
                                                   College, Chicago, IL for an                      K.
                                                   emergency medical technician
                                                   student success program,
                                                   including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Coahoma Community College,            1,664,100  Thompson (MS)
                                                   Clarksdale, MS for campus
                                                   safety, including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Collaborative for Higher              2,000,000  Leger
                                                   Education Shared Services, Santa                 Fernandez
                                                   Fe, NM for a cybersecurity
                                                   shared services program.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Connecticut Historical Society        1,000,000  Larson (CT)
                                                   Museum and Library, Hartford, CT
                                                   for the use of community history
                                                   in postsecondary education,
                                                   including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Contra Costa Community College        1,000,000  DeSaulnier
                                                   District, Martinez, CA for an
                                                   open educational resources
                                                   project.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  CUNY Mexican Studies Institute,       1,246,080  Espaillat
                                                   Bronx, NY for a literacy and
                                                   language skills program.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  CUNY York College, Queens, NY for     1,267,500  Meeks
                                                   geology and environmental
                                                   science programs, including
                                                   student stipends and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  CUNY York College, Queens, NY for       850,000  Meeks
                                                   pharmaceutical science workforce
                                                   training, including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Cyber Security Range at Union         3,000,000  Neal
                                                   Station, Springfield, MA for a
                                                   cybersecurity program, including
                                                   equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Cypress College, Cypress, CA for        500,000  Lowenthal
                                                   veteran and military-connected
                                                   student pathways, including
                                                   equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Dallas College, Dallas, TX for a        500,000  Allred,
                                                   teaching residency                               Johnson (TX)
                                                   apprenticeship program,
                                                   including stipends.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Davenport University, Grand           1,325,000  Meijer
                                                   Rapids, MI for a dual language
                                                   education program.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Davenport University, Grand             760,000  Meijer
                                                   Rapids, MI for a teacher
                                                   training program, including
                                                   scholarships.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Desert Research Institute, Las        1,000,000  Lee (NV)
                                                   Vegas, NV for partnerships
                                                   between STEM and education
                                                   majors, including scholarships.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Dominican Women's Development         1,000,000  Espaillat
                                                   Center, New York, NY for
                                                   afterschool, STEM education, and
                                                   postsecondary access programs.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  East Central College, Union, MO       1,000,000  Luetkemeyer
                                                   for the purchase of distance
                                                   learning equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Eastern Gateway Community               914,000  Ryan
                                                   College, Steubenville, OH for
                                                   electric vehicle technology
                                                   training, including installation
                                                   of equipment and technology.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Eckerd College, St. Petersburg,       1,000,000  Crist
                                                   FL for a marine science
                                                   laboratory space, including the
                                                   installation of equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Edmonds College, Lynnwood, WA for     1,300,000  Larsen (WA)
                                                   marine and AI robotics pathways
                                                   programs, including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Elgin Community College, Elgin,         936,000  Krishnamoorth
                                                   IL for a mechatronics                            i
                                                   certificate program, including
                                                   equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Elms College, Chicopee, MA for        1,000,000  Neal
                                                   social sciences and education
                                                   curriculum and programming,
                                                   including scholarships and
                                                   equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Emory University, Atlanta, GA for       500,000  McBath
                                                   a nursing apprenticeship
                                                   program, including stipends.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Folsom Lake College, Folsom, CA         950,000  Bera
                                                   for a prison and reentry program.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  FoodTEC, Newburgh, NY for a           1,125,000  Maloney, Sean
                                                   workforce development program,                   Patrick
                                                   including scholarships for
                                                   daycare facilities.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Franklin Pierce University,             825,000  Kuster
                                                   Rindge, NH for rural health care
                                                   education and training,
                                                   including technology and
                                                   equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  George Mason University, Fairfax,     1,000,000  Connolly
                                                   VA for a cybersecurity and IT
                                                   modernization program.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Georgia State University,               400,000  Johnson (GA)
                                                   Atlanta, GA for programs to
                                                   expand access to postsecondary
                                                   education, including English
                                                   language proficiency support.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Glendale College Foundation,          1,250,000  Schiff
                                                   Glendale, CA for student basic
                                                   needs support, including rental
                                                   assistance.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Goodwin University, East              2,200,000  Larson (CT)
                                                   Hartford, CT for a mobile
                                                   manufacturing and nursing
                                                   program, including equipment and
                                                   scholarships.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Goucher College, Towson, MD for       1,255,800  Ruppersberger
                                                   life and health sciences
                                                   teaching labs, including
                                                   equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Grambling State University,           2,500,000  Letlow
                                                   Grambling, LA for a
                                                   cybersecurity initiative,
                                                   including scholarships, stipends
                                                   and purchase of equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Hamline University, Saint Paul,       1,000,000  McCollum
                                                   MN for academic internship
                                                   programs, including student
                                                   stipends.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Hampton University, Hampton, VA       2,200,000  Scott (VA)
                                                   for an allied health services
                                                   and workforce development
                                                   program.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Harper College Aviation                 500,000  Krishnamoorth
                                                   Maintenance Program, Palatine,                   i
                                                   IL for an aviation technical
                                                   training program, including
                                                   scholarships and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Harris County Public Library,           578,000  Fletcher
                                                   Houston, TX for college and
                                                   career guidance programs.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Hispanic Federation, Orlando, FL        200,000  Demings
                                                   for college preparatory support
                                                   for middle and high school
                                                   students, including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Hostos Community College of the       1,000,000  Torres (NY)
                                                   City University of New York, The
                                                   Bronx, NY, for community college
                                                   articulation agreement support.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Hudson County Community College,      2,200,000  Sires
                                                   Jersey City, NJ for
                                                   technological enhancements to
                                                   student learning, including
                                                   equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Hudson Valley Community College,      2,065,000  Tonko
                                                   Troy, NY for STEM and healthcare
                                                   workforce development.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Husson University, Bangor, ME for       725,491  Golden
                                                   science laboratory programming,
                                                   including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Joan B Kroc School of Peace             580,000  Jacobs (CA)
                                                   Studies at the University of San
                                                   Diego, CA for a research lab
                                                   program to combat violence,
                                                   including scholarships.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Johnson & Wales University,           1,012,000  Langevin
                                                   Providence, RI for cybersecurity
                                                   training for teachers, including
                                                   stipends.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Kirkwood Community College, Cedar       360,000  Hinson
                                                   Rapids, IA for the purchase of
                                                   aviation information technology
                                                   and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Lehman College of the City              500,000  Torres (NY)
                                                   University of New York, Bronx,
                                                   NY for a digital equity
                                                   initiative, including technology.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Local 212 MATC Believe in               250,000  Moore (WI)
                                                   Students FAST Fund, Milwaukee,
                                                   WI for financial assistance to
                                                   low-income students.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Loisaida, New York, NY for an           300,000  Velazquez
                                                   environmental and community
                                                   science program.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Los Angeles Community College         1,000,000  Bass
                                                   District, Los Angeles, CA for
                                                   mobile work-based workforce
                                                   programs, including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Los Angeles Mission College,          2,000,000  Cardenas
                                                   Sylmar, CA for allied health
                                                   programs and STEM services,
                                                   including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Louisiana Delta Community             1,555,000  Letlow
                                                   College, Monroe, LA for a health
                                                   science and education program,
                                                   including scholarships, purchase
                                                   of equipment, and support
                                                   services.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Louisiana State University of           990,000  Letlow
                                                   Alexandria, Alexandria, LA for a
                                                   teacher education program,
                                                   including scholarships and
                                                   tuition reimbursement.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Manor College, Jenkintown, PA for     1,275,667  Dean
                                                   wraparound services, advising,
                                                   and basic needs supports for at-
                                                   risk student populations,
                                                   including scholarships.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Maria College, Albany, NY for           770,088  Tonko
                                                   nursing programs, including
                                                   technology and equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Marquette University, Milwaukee,        799,500  Moore (WI)
                                                   WI for college readiness and
                                                   STEM pipeline services.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Maryville College, Maryville, TN        645,000  Burchett
                                                   for a STEM project, including
                                                   scholarships, stipends, and
                                                   purchase of equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Marywood University, Scranton, PA     2,607,464  Cartwright
                                                   for healthcare workforce
                                                   expansion programs, including
                                                   equipment and scholarships.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Mass. Bay Community College,            400,000  Clark (MA)
                                                   Wellesley, MA for a center for
                                                   health sciences, early
                                                   education, and human services,
                                                   including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Massachusetts College of Liberal        620,000  Neal
                                                   Arts, North Adams, MA for a
                                                   nursing program, including
                                                   equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  McLennan Community College, Waco,     1,100,000  Sessions
                                                   TX for the purchase of
                                                   information technology and
                                                   equipment for healthcare
                                                   training programs.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Mid-America Christian University,       555,000  Cole
                                                   Oklahoma City, OK for the
                                                   purchase of STEM lab equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Middlesex College, Edison, NJ for     1,000,000  Pallone
                                                   adult and justice-impacted
                                                   learner support, including
                                                   equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Midlands Technical College,           1,000,000  Clyburn
                                                   Columbia, SC for a skilled
                                                   trades training program,
                                                   including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  MiraCosta Community College           1,000,000  Levin (CA)
                                                   District, Oceanside, CA for
                                                   accelerated skills-based
                                                   training, including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Modesto Junior College, Modesto,      2,000,000  Harder (CA)
                                                   CA for regional fire science
                                                   training programs, including
                                                   equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Montgomery County Community             100,000  Dean
                                                   College, Blue Bell, PA for early
                                                   college programs, including
                                                   equipment and tuition support.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Moorpark College, Moorpark, CA          300,000  Brownley
                                                   for a work-based learning
                                                   cybersecurity program.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Moraine Valley Community College,       500,000  Newman
                                                   Palos Hills, IL for non-
                                                   destructive testing training,
                                                   including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Nevada State College, Henderson,      1,624,294  Lee (NV)
                                                   NV for a career advancement and
                                                   training center, including
                                                   equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Nevada State College, Henderson,        611,968  Lee (NV)
                                                   NV for a nursing program,
                                                   including equipment and
                                                   scholarships.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  New Hampshire Technical                 767,000  Kuster
                                                   Institute, Concord, NH for
                                                   dental training program
                                                   modernization, including
                                                   equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Niagara University, NY for study        750,000  Higgins (NY)
                                                   and research in scientific
                                                   disciplines, including equipment
                                                   and materials.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Nichols College, Dudley, MA for         680,000  Neal
                                                   an intelligent business
                                                   automation program, including
                                                   equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Normandale Community College,           188,875  Phillips
                                                   Bloomington, MN for health
                                                   sciences education.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Northampton County Community          2,729,288  Wild
                                                   College, Bethlehem, PA for
                                                   healthcare and workforce
                                                   development programs, including
                                                   equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Northeastern University, Boston,      1,000,000  Pressley
                                                   MA for an associate's to
                                                   master's degree accelerator
                                                   program.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Northern Illinois University,         1,500,000  Underwood
                                                   DeKalb, IL for microchip
                                                   research and training, including
                                                   equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Northern Virginia Community             685,000  Wexton
                                                   College, Annandale, VA for a
                                                   diesel technology certificate
                                                   program, including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Northern Virginia Community           2,200,000  Connolly
                                                   College, Annandale, VA for a
                                                   nursing program, including
                                                   equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Nova Southeastern University,         2,000,000  Deutch
                                                   Fort Lauderdale, FL for a
                                                   spatial computing and robotics
                                                   program, including equipment and
                                                   technology.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Nova Southeastern University,         2,500,000  Wasserman
                                                   Fort Lauderdale, FL for                          Schultz
                                                   cybersecurity research,
                                                   including equipment and
                                                   technology.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Oklahoma State University--           3,000,000  Bice (OK)
                                                   Oklahoma City, Oklahoma City, OK
                                                   for an education program,
                                                   including the purchase of
                                                   equipment and information
                                                   technology.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Oxnard College, Oxnard, CA for          628,600  Brownley
                                                   faculty professional development.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Palm Beach State College, Lake        1,000,000  Frankel, Lois
                                                   Worth, FL for an artificial
                                                   intelligence workforce
                                                   development program, including
                                                   equipment and technology.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Pasadena Community College              500,000  Chu
                                                   District, Pasadena, CA for a
                                                   family resource center,
                                                   including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Pierce College, Woodland Hills,       2,000,000  Sherman
                                                   CA for biotech baccalaureate
                                                   programs.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Pima Community College District,      1,000,000  Kirkpatrick
                                                   Tucson, AZ for a building and
                                                   construction technology program,
                                                   including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Pima County Community College         1,000,000  Grijalva
                                                   District, Tucson, AZ for a
                                                   building and construction
                                                   technology program, including
                                                   equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Prairie State College, Chicago        1,000,000  Kelly (IL)
                                                   Heights, IL for a dental hygiene
                                                   program, including enhancements
                                                   and the installation of
                                                   equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Prairie View A&M University,          2,400,000  McCaul
                                                   Prairie View, TX for the
                                                   purchase of science and
                                                   engineering lab equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Ready to Succeed, Santa Monica,       1,000,000  Lieu
                                                   CA for support for college-going
                                                   foster youth, including
                                                   scholarships.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Research Foundation of the City         534,982  Clarke (NY)
                                                   University of New York,
                                                   Brooklyn, NY for a pre-law
                                                   program.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Research Foundation of the City         792,000  Espaillat
                                                   University of New York, NY for a
                                                   learning hub for the study of
                                                   history and culture, including
                                                   equipment and space furnishings.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Riverside Community College           3,000,000  Calvert
                                                   District, Riverside, CA for a
                                                   military articulation platform
                                                   expansion, including the
                                                   purchase of equipment and
                                                   information technology.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Riverside Community College           3,000,000  Takano
                                                   District, Riverside, CA for
                                                   career training programs.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Rust College, Holly Springs, MS         500,000  Kelly (MS)
                                                   for a leadership development
                                                   program, including scholarships.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Rutgers University-Camden, NJ for     1,404,800  Norcross
                                                   community partnership centers.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Saint Augustine's University,           490,000  Ross
                                                   Raleigh, NC for public health
                                                   education, including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Salt Lake Community College, Salt       390,000  Owens
                                                   Lake City, UT for an educational
                                                   program, including student
                                                   scholarships.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  San Diego Community College           1,200,000  Jacobs (CA)
                                                   District, San Diego, CA for
                                                   centers to support LGBT students.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  San Diego Community College           1,200,000  Vargas
                                                   District, San Diego, CA for
                                                   student support services for
                                                   DACA recipients.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  San Joaquin Delta College,            3,800,000  Harder (CA),
                                                   Stockton, CA for nursing                         McNerney
                                                   programs, including equipment
                                                   and technology for simulation
                                                   labs.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Santa Clarita Community College       1,000,000  Garcia (CA)
                                                   District -- College of the
                                                   Canyons, Santa Clarita, CA for
                                                   the purchase of robotics
                                                   equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Seminole State College of               404,114  Murphy (FL)
                                                   Florida, Sanford, FL for a fire
                                                   science program, including
                                                   equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Siena Heights University, Adrian,     1,000,000  Walberg
                                                   MI for student scholarships and
                                                   the purchase of lab equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Simmons College of Kentucky,            602,500  Yarmuth
                                                   Louisville, KY for academic
                                                   support programs, including
                                                   equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Snead State Community College,        1,000,000  Aderholt
                                                   Boaz, AL for the purchase of
                                                   information technology and
                                                   equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Social Enterprise Center,             1,500,000  Stansbury
                                                   Albuquerque, NM for computing
                                                   infrastructure and workforce
                                                   development, including
                                                   scholarships.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  St. Francis College, Brooklyn, NY     1,500,000  Velazquez
                                                   for nursing programs, including
                                                   equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  St. Joseph's College New York,          754,000  Jeffries
                                                   Brooklyn, NY for a cybersecurity
                                                   lab program, including equipment
                                                   installation, furnishings, and
                                                   refurbishments.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Stevens Institute of Technology,        960,000  Sires
                                                   Hoboken, NJ for computer science
                                                   programs, including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Sustainable Cities Institute,         1,156,695  DeFazio
                                                   Eugene, OR for a sustainability
                                                   and student support program.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Tennessee Technological               3,000,000  Rose
                                                   University, Cookeville, TN for
                                                   the purchase of equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Texas A&M International               1,000,000  Cuellar
                                                   University, Laredo, TX for a
                                                   center to combat human
                                                   trafficking, including equipment
                                                   and technology.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Texas A&M Transportation              1,600,000  Sessions
                                                   Institute, Bryan, TX for an
                                                   electric vehicle program,
                                                   including the purchase of
                                                   equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Texas A&M University, College         1,500,000  McCaul
                                                   Station, TX for a forensic
                                                   science education program,
                                                   including student support for
                                                   fellowships and internships and
                                                   the purchase of equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Texas A&M University-Commerce,          516,614  Allred
                                                   Dallas, TX for a teacher
                                                   certification program, including
                                                   scholarships.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Texas Wesleyan University, Fort       1,439,695  Veasey
                                                   Worth, TX for STEM education
                                                   programs, including lab
                                                   equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  The National Veteran Memorial and       204,800  Beatty
                                                   Museum Operating Corporation,
                                                   Columbus, OH for graduate-level
                                                   instruction to veterans,
                                                   including scholarships.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  The Ohio State University,            1,045,000  Carey
                                                   Columbus, OH for a quantum
                                                   network research program,
                                                   including the purchase of
                                                   equipment and information
                                                   technology.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  The University of North Georgia,        399,952  Bourdeaux
                                                   Dahlonega, GA for a teacher
                                                   candidate residency program,
                                                   including equipment and stipends.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  The University of Texas at            3,000,000  Allred
                                                   Dallas, Richardson, TX for
                                                   semiconductor workforce
                                                   development programs, including
                                                   equipment infrastructure and
                                                   scholarships.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Towson University, Towson, MD for       950,000  Ruppersberger
                                                   a teacher workforce pipeline                     , Sarbanes
                                                   program.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  University of California              1,000,000  Takano
                                                   Riverside, CA for agricultural
                                                   innovation programs.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  University of California, Davis,      1,205,967  Thompson (CA)
                                                   CA for wildfire smoke research,
                                                   including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  University of California-San          2,160,000  Peters
                                                   Diego, La Jolla, CA for
                                                   pipelines into STEM careers.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  University of Central Florida,          500,000  Soto
                                                   Orlando, FL for academic
                                                   research on Puerto Rico.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  University of Colorado Anschutz         783,580  Crow
                                                   Medical Center, Aurora, CO for a
                                                   rural public health certificate
                                                   program, including student
                                                   project support.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  University of Colorado Anschutz         460,584  Crow
                                                   Medical Center, Aurora, CO for
                                                   an injury and violence
                                                   prevention center, including
                                                   scholarships.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  University of Georgia College of      1,000,000  Scott, David
                                                   Agricultural and Environmental
                                                   Sciences, Athens, GA for a
                                                   poultry science program,
                                                   including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  University of Hawaii--Office of       1,000,000  Case
                                                   Strategic Health Initiatives,
                                                   Honolulu, HI for an indigenous
                                                   data science hub.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  University of La Verne, CA for a      2,200,000  Napolitano
                                                   mental health practitioner
                                                   program, including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  University of Maryland Global           246,000  Hoyer
                                                   Campus, Adelphi, MD for a peer
                                                   tutoring program, including
                                                   technology.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  University of Nevada Las Vegas,       3,000,000  Lee (NV)
                                                   NV for advanced sports research,
                                                   including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  University of New Hampshire,          1,000,000  Pappas
                                                   Durham, NH for child study and
                                                   development education.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  University of North Alabama,            500,000  Aderholt
                                                   Florence, AL for new program
                                                   development, including the
                                                   purchase of equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  University of North Florida,            750,000  Rutherford
                                                   Jacksonville, FL for information
                                                   technology equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  University of North Florida,            375,000  Rutherford
                                                   Jacksonville, FL for the
                                                   purchase of information
                                                   technology and equipment,
                                                   including associated software.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  University of South Florida,          2,000,000  Steube
                                                   Sarasota, FL for a cybersecurity
                                                   program, including the purchase
                                                   of information technology.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  University of the District of         1,000,000  Norton
                                                   Columbia, Washington, DC for a
                                                   math teacher training institute,
                                                   including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  University of Wisconsin --            1,000,000  Pocan
                                                   Madison, WI for STEM education
                                                   programs.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Utah System of Higher Education,      1,250,000  Owens
                                                   Salt Lake City, UT for the
                                                   purchase of equipment and
                                                   supplies to expand healthcare
                                                   training programs.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Utah Tech University, St. George,       790,000  Stewart
                                                   UT for a science training
                                                   program, including purchase of
                                                   equipment and teacher stipends.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Valdosta State University,              750,000  Carter (GA)
                                                   Valdosta, GA for an online
                                                   educational degree program,
                                                   including purchase of
                                                   information technology.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Vida Mobile Clinic, Granada           1,350,000  Cardenas
                                                   Hills, CA for programs to
                                                   support pre-health postsecondary
                                                   students, including student
                                                   stipends.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Virginia Commonwealth University,     1,073,550  McEachin
                                                   Richmond, VA for pipelines into
                                                   STEM professions, including
                                                   scholarships.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Virginia Foundation for Community       254,910  Wexton
                                                   College Education, Richmond, VA
                                                   for early childhood educator
                                                   development programs, including
                                                   scholarships.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Virginia State University,            2,200,000  McEachin
                                                   Petersburg, VA for broadband
                                                   improvement, including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Virginia Union University,            2,000,000  McEachin
                                                   Richmond, VA for cybersecurity
                                                   programming, including
                                                   installation and reconfiguration
                                                   of equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Wake Technical Community College,       939,041  Ross
                                                   Raleigh, NC for electric vehicle
                                                   technical training, including
                                                   equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Wayne County Community College          212,400  Lawrence
                                                   District, Detroit, MI for an
                                                   automotive electrification and
                                                   testing program.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Western Kentucky University,            460,000  Guthrie
                                                   Bowling Green, KY for the
                                                   purchase of applied research and
                                                   technology equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Western University of Health            100,000  Torres (CA)
                                                   Sciences, Ontario, CA for health
                                                   career student support programs.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Western Washington University,          450,000  Larsen (WA)
                                                   Bellingham, WA for a food
                                                   security program, including
                                                   furnishing a longhouse with
                                                   equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  Westfield State University,           1,000,000  Neal
                                                   Westfield, MA for a nursing and
                                                   health sciences program,
                                                   including equipment.
----------------------------------------------------------------------------------------------------------------
Department of Education  Higher Education.......  William Paterson University,          1,000,000  Sherrill
                                                   Wayne, NJ for student support,
                                                   including scholarships.
----------------------------------------------------------------------------------------------------------------

                           Transfer of Funds

    Pursuant to clause 3(f)(2) of rule XIII of the Rules of the 
House of Representatives, the following lists the transfers [of 
unexpended balances] included in the accompanying bill:

                                TITLE I

    Language is included under ``Job Corps'' permitting the 
transfer of funds for Job Corps Center construction, 
rehabilitation, and acquisition to meet the operational needs 
of Job Corps Centers or to achieve administrative efficiencies.
    Language is included under ``State Unemployment Insurance 
and Employment Services Operations'' which provides for the 
transfer of funds to ``Office of Disability Employment 
Policy.''
    Language is included under ``Special Benefits'' which 
provides for the transfer of such sums as necessary from the 
``Postal Service'' account.
    Language is included under ``Black Lung Disability Trust 
Fund'' which provides for the transfer of funds to the 
``Department of Labor, Office of Workers'' Compensation 
Program, Salaries and Expenses.''
    Language is included under ``Black Lung Disability Trust 
Fund'' which provides for the transfer of funds to the 
``Department of Labor, Departmental Management, Salaries and 
Expenses.''
    Language is included under ``Black Lung Disability Trust 
Fund'' which provides for the transfer of funds to the 
``Department of Labor, Departmental Management, Office of 
Inspector General.''
    Language is included under ``Black Lung Disability Trust 
Fund'' which provides for the transfer of funds to the 
``Department of the Treasury.''
    Language is included under ``Departmental Management, 
Salaries and Expenses'' authorizing the transfer of funds 
available for program evaluation to any other account within 
the Department to carry out evaluation activities.
    A general provision is included permitting up to one 
percent of any discretionary appropriation to be transferred 
between a program, project, or activity of the Department of 
Labor, provided that no such program, project, or activity is 
increased by more than three percent by any such transfer.
    A general provision is included that provides for the 
transfer of funds from the ``Employment and Training 
Administration'' for technical assistance services to grantees 
to ``Program Administration''. The provision does not apply to 
section 171 of the WIOA. The general provision also authorizes 
the transfer of up 0.5 percent of each discretionary 
appropriation for ``Employment and Training Administration'' to 
carry out program integrity activities subject to certain 
limitations related to ``Job Corps.''
    A general provision is included that provides for the 
transfer of up to 0.75 percent of appropriated funds to carry 
out program evaluations of ``Training and Employment 
Services'', ``Job Corps'', ``Community Service Employment for 
Older Americans,'' ``State Unemployment Insurance and 
Employment Service Operations'', ``Employee Benefits Security 
Administration'', ``Office of Workers' Compensation Programs'', 
``Wage and Hour Division'', ``Office of Federal Contract 
Compliance Programs'', ``Office of Labor-Management 
Standards'', ``Occupational Safety and Health Administration'', 
``Mine Safety and Health Administration'', ``Office of 
Disability Employment Policy'', funding made available to the 
``Bureau of International Labor Affairs'' and ``Women's 
Bureau'' within the Departmental Management, Salaries and 
Expenses'' account, and ``Veterans Employment and Training'' 
for use by the Office of the Chief Evaluation Officer.

                                TITLE II

    Language is included under ``Centers for Disease Control 
and Prevention, Buildings and Facilities'' to allow the 
transfer of prior year unobligated Individual Learning Account 
funds to be transferred to this account to carry out the 
purpose of this account.
    Language is included under ``Centers for Disease Control 
and Prevention, CDC-Wide Activities and Program Support'' for 
funds to be transferred to and merged with the Infectious 
Disease Rapid Response Reserve Fund.
    Language is included under ``National Institutes of Health, 
Office of the Director'' to transfer $5,000,000 to the ``Office 
of Inspector General'' for oversight of grant programs and 
operations of NIH.
    Language is included under ``National Institutes of Health, 
Innovation Account'' to allow the transfer of funds to other 
Institutes and Centers to support activities authorized in the 
21st Century Cures Act (PL 114-255).
    Language is included under ``Administration for Community 
Living, Aging and Disability Services Programs'' for transfer 
to the Secretary of Agriculture to carryout section 311 of the 
Older Americans Act of 1965.
    A general provision is included that allows not to exceed 
one percent of any discretionary funds to be transferred 
between appropriation accounts of the ``Department of Health 
and Human Services'', provided that no appropriation account is 
increased by more than three percent by such transfer.
    A general provision is included that allows the transfer of 
up to three percent among the institutes and centers of the 
``National Institutes of Health'' from amounts identified as 
pertaining to the human immunodeficiency virus.
    A general provision is included that allows the transfer of 
funding determined to be related to the human immunodeficiency 
virus to the ``Office of AIDS Research''.
    A general provision is included that transfers one percent 
of the amount made available for ``National Research Service 
Awards'' at the ``National Institutes of Health'' to the 
``Health Resources and Services Administration''.
    A general provision is included to direct the transfer of 
the ``Prevention and Public Health Fund'' as specified in the 
committee report accompanying this Act.
    A general provision is included that allows the transfer of 
funding related to research on opioid misuse, opioid 
alternatives, pain management, and substance use disorder 
treatment between the institutes and centers of the ``National 
Institute of Health''.

                               TITLE III

    A general provision is included that allows not to exceed 
one percent of any discretionary funds to be transferred 
between appropriation accounts of the Department of Education, 
provided that no appropriation account is increased by more 
than three percent by such transfer.

                                TITLE IV

    Language is included under Payment to the National Service 
Trust authorizing the transfer of funds from the ``Corporation 
for National and Community Service, Operating Expenses'' to 
support the activities of national service participants.
    Language is included under ``Social Security 
Administration'' authorizing the transfer funds from the Social 
Security Administration's ``Limitation on Administration 
Expenses'' account to be available for purposes of the Office 
of Inspector General.

                                TITLE V

    A general provision is included that allows the Secretaries 
of Labor, Health and Human Services, and Education to transfer 
balances of prior appropriation to accounts corresponding to 
current appropriations.

          Compliance With Rule XIII, Cl. 3(e) (Ramseyer Rule)

  In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (existing law 
proposed to be omitted is enclosed in black brackets, new 
matter is printed in italics, existing law in which no change 
is proposed is shown in roman):

                       PUBLIC HEALTH SERVICE ACT




           *       *       *       *       *       *       *
         TITLE II--ADMINISTRATION AND MISCELLANEOUS PROVISIONS


Part A--Administration

           *       *       *       *       *       *       *



                           pay and allowances

  Sec. 208. (a)(1) Commissioned officers of the Regular Corps 
and Ready Reserve Corps shall be entitled to receive such pay 
and allowances as are now or may hereafter be authorized by 
law.
  (2) For provisions relating to the receipt of special pay by 
commissioned officers of the Regular Corps and Ready Reserve 
Corps while on active duty, see section 303a(b) or 373 of title 
37, United States Code.
  (b) Commissioned officers on active duty, and retired 
officers entitled to retired pay pursuant to section 210(g)(3), 
section 211 or section 221(a), shall be permitted to purchase 
supplies from the Army, Navy, Air Force, and Marine Corps at 
the same price as is charged officers thereof.
  (c) Members of the National Advisory Health Council and 
members of other national advisory or review councils or 
committees established under this Act, including members of the 
Technical Electronic Product Radiation Safety Standards 
Committee and the Board of Regents of the National Library of 
Medicine, but excluding ex officio members, while attending 
conferences or meetings of their respective councils or 
committees or while otherwise serving at the request of the 
Secretary shall be entitled to receive compensation at rates to 
be fixed by the Secretary, but at rates not exceeding the daily 
equivalent of the rate specified at the time of such service 
for grade GS-18 of the General Schedule, including traveltime; 
and while away from their homes or regular places of business 
they may be allowed travel expenses, including per diem in lieu 
of subsistence, as authorized by section 5703 of title 5 of the 
United States Code for persons in the Government service 
employed intermittently.
  (d) Field employees of the Service, except those employed on 
a per diem or fee basis, who render part-time duty and are also 
subject to call at any time for services not contemplated in 
their regular part-time employment, may be paid annual 
compensation for such part-time duty and, in addition, such 
fees for such other services as the Surgeon General may 
determine; but in no case shall the total paid to any such 
employee for any fiscal year exceed the amount of the minimum 
annual salary rate of the classification grade of the employee.
  (e) Any civilian employee of the Service who is employed at 
the Gillis W. Long Hansen's Disease Center on the date of the 
enactment of the Consolidated Omnibus Budget Reconciliation Act 
of 1985 shall be entitled to receive, in addition to any 
compensation to which the employee may otherwise be entitled 
and for so long as the employee remains employed at the Center, 
an amount equal to one-fourth of such compensation.
  (f) Individuals appointed under subsection (g) shall have 
included in their fellowships such stipends or allowances, 
including travel and subsistence expenses, as the Surgeon 
General may deem necessary to procure qualified fellows.
  (g) The Secretary is authorized to establish and fix the 
compensation for, within the Public Health Service, not more 
than one hundred and seventy-nine positions, of which not less 
than one hundred and fifteen shall be for the National 
Institutes of Health, not less than five shall be for the 
[National Institute on Alcohol Abuse and Alcoholism] National 
Institute on Alcohol Effects and Alcohol-Associated Disorders 
for individuals engaged in research on alcohol and alcoholism, 
not less than ten shall be for the National Center for Health 
Services Research, not less than twelve shall be for the 
National Center for Health Statistics, and not less than seven 
shall be for the National Center for Health Care Technology, in 
the professional, scientific, and executive service, each such 
position being established to effectuate those research and 
development activities of the Public Health Service which 
require the services of specially qualified scientific, 
professional, and administrative personnel: Provided, That the 
rates of compensation for positions established pursuant to the 
provisions of this subsection shall not be less than the 
minimum rate of grade 16 of the General Schedule of the 
Classification Act of 1949, as amended, nor more than (1) the 
highest rate of grade 18 of the General Schedule of such Act, 
or (2) in the case of two such positions, the rate specified, 
at the time the service in the position is performed, for level 
II of the Executive Schedule (5 U.S.C. 5313); and such rates of 
compensation for all positions included in this proviso shall 
be subject to the approval of the Civil Service Commission. 
Positions created pursuant to this subsection shall be included 
in the classified civil service of the United States, but 
appointments to such positions shall be made without 
competitive examination upon approval of the proposed 
appointee's qualifications by the Civil Service Commission or 
such officers or agents as it may designate for this purpose.

           *       *       *       *       *       *       *


TITLE III--GENERAL POWERS AND DUTIES OF PUBLIC HEALTH SERVICE

           *       *       *       *       *       *       *



Part B--Federal-State Cooperation

           *       *       *       *       *       *       *



SEC. 317G. FELLOWSHIP AND TRAINING PROGRAMS.

  The Secretary, acting through the Director of the Centers for 
Disease Control and Prevention, shall establish fellowship and 
training programs to be conducted by such Centers to train 
individuals to develop skills in epidemiology, surveillance, 
laboratory analysis, and other disease detection and prevention 
methods. Such programs shall be designed to enable health 
professionals and health personnel trained under such programs 
to work, after receiving such training, in local, State, 
national, and international efforts toward the prevention and 
control of diseases, injuries, and disabilities. Such 
fellowships and training may be administered through the use of 
either appointment or nonappointment procedures. The Secretary 
may, no later than 120 days after the end of an individual's 
participation in such a fellowship or training program, and 
without regard to those provisions of title 5, United States 
Code, governing appointments in the competitive service, 
appoint a participant in such a fellowship or training program 
to a term or permanent position in the Centers for Disease 
Control and Prevention.

           *       *       *       *       *       *       *


                 TITLE IV--NATIONAL RESEARCH INSTITUTES


                 Part A--National Institutes of Health


SEC. 401. ORGANIZATION OF NATIONAL INSTITUTES OF HEALTH.

  (a) Relation to Public Health Service.--The National 
Institutes of Health is an agency of the Service.
  (b) National Research Institutes and National Centers.--The 
following agencies of the National Institutes of Health are 
national research institutes or national centers:
          (1) The National Cancer Institute.
          (2) The National Heart, Lung, and Blood Institute.
          (3) The National Institute of Diabetes and Digestive 
        and Kidney Diseases.
          (4) The National Institute of Arthritis and 
        Musculoskeletal and Skin Diseases.
          (5) The National Institute on Aging.
          (6) The National Institute of Allergy and Infectious 
        Diseases.
          (7) The Eunice Kennedy Shriver National Institute of 
        Child Health and Human Development.
          (8) The National Institute of Dental and Craniofacial 
        Research.
          (9) The National Eye Institute.
          (10) The National Institute of Neurological Disorders 
        and Stroke.
          (11) The National Institute on Deafness and Other 
        Communication Disorders.
          (12) The [National Institute on Alcohol Abuse and 
        Alcoholism] National Institute on Alcohol Effects and 
        Alcohol-Associated Disorders.
          (13) The [National Institute on Drug Abuse] National 
        Institute on Drugs and Addiction.
          (14) The National Institute of Mental Health.
          (15) The National Institute of General Medical 
        Sciences.
          (16) The National Institute of Environmental Health 
        Sciences.
          (17) The National Institute of Nursing Research.
          (18) The National Institute of Biomedical Imaging and 
        Bioengineering.
          (19) The National Human Genome Research Institute.
          (20) The National Library of Medicine.
          (21) The National Center for Advancing Translational 
        Sciences.
          (22) The John E. Fogarty International Center for 
        Advanced Study in the Health Sciences.
          (23) The National Center for Complementary and 
        IntegrativeHealth.
          (24) The National Institute on Minority Health and 
        Health Disparities.
          (25) Any other national center that, as an agency 
        separate from any national research institute, was 
        established within the National Institutes of Health as 
        of the day before the date of the enactment of the 
        National Institutes of Health Reform Act of 2006.
  (c) Division of Program Coordination, Planning, and Strategic 
Initiatives.--
          (1) In general.--Within the Office of the Director of 
        the National Institutes of Health, there shall be a 
        Division of Program Coordination, Planning, and 
        Strategic Initiatives (referred to in this subsection 
        as the ``Division'').
          (2) Offices within division.--
                  (A) Offices.--The following offices are 
                within the Division: The Office of AIDS 
                Research, the Office of Research on Women's 
                Health, the Office of Behavioral and Social 
                Sciences Research, the Office of Disease 
                Prevention, the Office of Dietary Supplements, 
                and any other office located within the Office 
                of the Director of NIH as of the day before the 
                date of the enactment of the National 
                Institutes of Health Reform Act of 2006. In 
                addition to such offices, the Director of NIH 
                may establish within the Division such 
                additional offices or other administrative 
                units as the Director determines to be 
                appropriate.
                  (B) Authorities.--Each office in the 
                Division--
                          (i) shall continue to carry out the 
                        authorities that were in effect for the 
                        office before the date of enactment 
                        referred to in subparagraph (A); and
                          (ii) shall, as determined appropriate 
                        by the Director of NIH, support the 
                        Division with respect to the 
                        authorities described in section 
                        402(b)(7).
  (d) Organization.--
          (1) Number of institutes and centers.--In the 
        National Institutes of Health, the number of national 
        research institutes and national centers may not exceed 
        a total of 27, including any such institutes or centers 
        established under authority of paragraph (2) or under 
        authority of this title as in effect on the day before 
        the date of the enactment of the National Institutes of 
        Health Reform Act of 2006.
          (2) Reorganization of institutes.--
                  (A) In general.--The Secretary may establish 
                in the National Institutes of Health one or 
                more additional national research institutes to 
                conduct and support research, training, health 
                information, and other programs with respect to 
                any particular disease or groups of diseases or 
                any other aspect of human health if--
                          (i) the Secretary determines that an 
                        additional institute is necessary to 
                        carry out such activities; and
                          (ii) the additional institute is not 
                        established before the expiration of 
                        180 days after the Secretary has 
                        provided the Committee on Energy and 
                        Commerce of the House of 
                        Representatives and the Committee on 
                        Health, Education, Labor, and Pensions 
                        of the Senate written notice of the 
                        determination made under clause (i) 
                        with respect to the institute.
                  (B) Additional authority.--The Secretary may 
                reorganize the functions of any national 
                research institute and may abolish any national 
                research institute if the Secretary determines 
                that the institute is no longer required. A 
                reorganization or abolition may not take effect 
                under this paragraph before the expiration of 
                180 days after the Secretary has provided the 
                Committee on Energy and Commerce of the House 
                of Representatives and the Committee on Health, 
                Education, Labor, and Pensions of the Senate 
                written notice of the reorganization or 
                abolition.
          (3) Reorganization of office of director.--
        Notwithstanding subsection (c), the Director of NIH 
        may, after a series of public hearings, and with the 
        approval of the Secretary, reorganize the offices 
        within the Office of the Director, including the 
        addition, removal, or transfer of functions of such 
        offices, and the establishment or termination of such 
        offices, if the Director determines that the overall 
        management and operation of programs and activities 
        conducted or supported by such offices would be more 
        efficiently carried out under such a reorganization.
          (4) Internal reorganization of institutes and 
        centers.--Notwithstanding any conflicting provisions of 
        this title, the director of a national research 
        institute or a national center may, after a series of 
        public hearings and with the approval of the Director 
        of NIH, reorganize the divisions, centers, or other 
        administrative units within such institute or center, 
        including the addition, removal, or transfer of 
        functions of such units, and the establishment or 
        termination of such units, if the director of such 
        institute or center determines that the overall 
        management and operation of programs and activities 
        conducted or supported by such divisions, centers, or 
        other units would be more efficiently carried out under 
        such a reorganization.
  (e) Scientific Management Review Board for Periodic 
Organizational Reviews.--
          (1) In general.--Not later than 60 days after the 
        date of the enactment of the National Institutes of 
        Health Reform Act of 2006, the Secretary shall 
        establish an advisory council within the National 
        Institutes of Health to be known as the Scientific 
        Management Review Board (referred to in this subsection 
        as the ``Board'').
          (2) Duties.--
                  (A) Reports on organizational issues.--The 
                Board shall provide advice to the appropriate 
                officials under subsection (d) regarding the 
                use of the authorities established in 
                paragraphs (2), (3), and (4) of such subsection 
                to reorganize the National Institutes of Health 
                (referred to in this subsection as 
                ``organizational authorities''). Not less 
                frequently than once each 7 years, the Board 
                shall--
                          (i) determine whether and to what 
                        extent the organizational authorities 
                        should be used; and
                          (ii) issue a report providing the 
                        recommendations of the Board regarding 
                        the use of the authorities and the 
                        reasons underlying the recommendations.
                  (B) Certain responsibilities regarding 
                reports.--The activities of the Board with 
                respect to a report under subparagraph (A) 
                shall include the following:
                          (i) Reviewing the research portfolio 
                        of the National Institutes of Health 
                        (referred to in this subsection as 
                        ``NIH'') in order to determine the 
                        progress and effectiveness and value of 
                        the portfolio and the allocation among 
                        the portfolio activities of the 
                        resources of NIH.
                          (ii) Determining pending scientific 
                        opportunities, and public health needs, 
                        with respect to research within the 
                        jurisdiction of NIH.
                          (iii) For any proposal for 
                        organizational changes to which the 
                        Board gives significant consideration 
                        as a possible recommendation in such 
                        report--
                                  (I) analyzing the budgetary 
                                and operational consequences of 
                                the proposed changes;
                                  (II) taking into account 
                                historical funding and support 
                                for research activities at 
                                national research institutes 
                                and centers that have been 
                                established recently relative 
                                to national research institutes 
                                and centers that have been in 
                                existence for more than two 
                                decades;
                                  (III) estimating the level of 
                                resources needed to implement 
                                the proposed changes;
                                  (IV) assuming the proposed 
                                changes will be made and making 
                                a recommendation for the 
                                allocation of the resources of 
                                NIH among the national research 
                                institutes and national 
                                centers; and
                                  (V) analyzing the 
                                consequences for the progress 
                                of research in the areas 
                                affected by the proposed 
                                changes.
                  (C) Consultation.--In carrying out 
                subparagraph (A), the Board shall consult 
                with--
                          (i) the heads of national research 
                        institutes and national centers whose 
                        directors are not members of the Board;
                          (ii) other scientific leaders who are 
                        officers or employees of NIH and are 
                        not members of the Board;
                          (iii) advisory councils of the 
                        national research institutes and 
                        national centers;
                          (iv) organizations representing the 
                        scientific community; and
                          (v) organizations representing 
                        patients.
          (3) Composition of board.--The Board shall consist of 
        the Director of NIH, who shall be a permanent nonvoting 
        member on an ex officio basis, and an odd number of 
        additional members, not to exceed 21, all of whom shall 
        be voting members. The voting members of the Board 
        shall be the following:
                  (A) Not fewer than 9 officials who are 
                directors of national research institutes or 
                national centers. The Secretary shall designate 
                such officials for membership and shall ensure 
                that the group of officials so designated 
                includes directors of--
                          (i) national research institutes 
                        whose budgets are substantial relative 
                        to a majority of the other institutes;
                          (ii) national research institutes 
                        whose budgets are small relative to a 
                        majority of the other institutes;
                          (iii) national research institutes 
                        that have been in existence for a 
                        substantial period of time without 
                        significant organizational change under 
                        subsection (d);
                          (iv) as applicable, national research 
                        institutes that have undergone 
                        significant organization changes under 
                        such subsection, or that have been 
                        established under such subsection, 
                        other than national research institutes 
                        for which such changes have been in 
                        place for a substantial period of time; 
                        and
                          (v) national centers.
                  (B) Members appointed by the Secretary from 
                among individuals who are not officers or 
                employees of the United States. Such members 
                shall include--
                          (i) individuals representing the 
                        interests of public or private 
                        institutions of higher education that 
                        have historically received funds from 
                        NIH to conduct research; and
                          (ii) individuals representing the 
                        interests of private entities that have 
                        received funds from NIH to conduct 
                        research or that have broad expertise 
                        regarding how the National Institutes 
                        of Health functions, exclusive of 
                        private entities to which clause (i) 
                        applies.
          (4) Chair.--The Chair of the Board shall be selected 
        by the Secretary from among the members of the Board 
        appointed under paragraph (3)(B). The term of office of 
        the Chair shall be 2 years.
          (5) Meetings.--
                  (A) In general.--The Board shall meet at the 
                call of the Chair or upon the request of the 
                Director of NIH, but not fewer than 5 times 
                with respect to issuing any particular report 
                under paragraph (2)(A). The location of the 
                meetings of the Board is subject to the 
                approval of the Director of NIH.
                  (B) Particular forums.--Of the meetings held 
                under subparagraph (A) with respect to a report 
                under paragraph (2)(A)--
                          (i) one or more shall be directed 
                        toward the scientific community to 
                        address scientific needs and 
                        opportunities related to proposals for 
                        organizational changes under subsection 
                        (d), or as the case may be, related to 
                        a proposal that no such changes be 
                        made; and
                          (ii) one or more shall be directed 
                        toward consumer organizations to 
                        address the needs and opportunities of 
                        patients and their families with 
                        respect to proposals referred to in 
                        clause (i).
                  (C) Availability of information from 
                forums.--For each meeting under subparagraph 
                (B), the Director of NIH shall post on the 
                Internet site of the National Institutes of 
                Health a summary of the proceedings.
          (6) Compensation; term of office.--The provisions of 
        subsections (b)(4) and (c) of section 406 apply with 
        respect to the Board to the same extent and in the same 
        manner as such provisions apply with respect to an 
        advisory council referred to in such subsections, 
        except that the reference in such subsection (c) to 4 
        years regarding the term of an appointed member is 
        deemed to be a reference to 5 years.
          (7) Reports.--
                  (A) Recommendations for changes.--Each report 
                under paragraph (2)(A) shall be submitted to--
                          (i) the Committee on Energy and 
                        Commerce and the Committee on 
                        Appropriations of the House of 
                        Representatives;
                          (ii) the Committee on Health, 
                        Education, Labor, and Pensions and the 
                        Committee on Appropriations of the 
                        Senate;
                          (iii) the Secretary; and
                          (iv) officials with organizational 
                        authorities, other than any such 
                        official who served as a member of the 
                        Board with respect to the report 
                        involved.
                  (B) Availability to public.--The Director of 
                NIH shall post each report under paragraph (2) 
                on the Internet site of the National Institutes 
                of Health.
                  (C) Report on board activities.--Not later 
                than 18 months after the date of the enactment 
                of the National Institutes of Health Reform Act 
                of 2006, the Board shall submit to the 
                committees specified in subparagraph (A) a 
                report describing the activities of the Board.
  (f) Organizational Changes per Recommendation of Scientific 
Management Review Board.--
          (1) In general.--With respect to an official who has 
        organizational authorities within the meaning of 
        subsection (e)(2)(A), if a recommendation to the 
        official for an organizational change is made in a 
        report under such subsection, the official shall, 
        except as provided in paragraphs (2), (3), and (4) of 
        this subsection, make the change in accordance with the 
        following:
                  (A) Not later than 100 days after the report 
                is submitted under subsection (e)(7)(A), the 
                official shall initiate the applicable public 
                process required in subsection (d) toward 
                making the change.
                  (B) The change shall be fully implemented not 
                later than the expiration of the 3-year period 
                beginning on the date on which such process is 
                initiated.
          (2) Inapplicability to certain reorganizations.--
        Paragraph (1) does not apply to a recommendation made 
        in a report under subsection (e)(2)(A) if the 
        recommendation is for--
                  (A) an organizational change under subsection 
                (d)(2) that constitutes the establishment, 
                termination, or consolidation of one or more 
                national research institutes or national 
                centers; or
                  (B) an organizational change under subsection 
                (d)(3).
          (3) Objection by director of nih.--
                  (A) In general.--Paragraph (1) does not apply 
                to a recommendation for an organizational 
                change made in a report under subsection 
                (e)(2)(A) if, not later than 90 days after the 
                report is submitted under subsection (e)(7)(A), 
                the Director of NIH submits to the committees 
                specified in such subsection a report providing 
                that the Director objects to the change, which 
                report includes the reasons underlying the 
                objection.
                  (B) Scope of objection.--For purposes of 
                subparagraph (A), an objection by the Director 
                of NIH may be made to the entirety of a 
                recommended organizational change or to 1 or 
                more aspects of the change. Any aspect of a 
                change not objected to by the Director in a 
                report under subparagraph (A) shall be 
                implemented in accordance with paragraph (1).
          (4) Congressional review.--An organizational change 
        under subsection (d)(2) that is initiated pursuant to 
        paragraph (1) shall be carried out by regulation in 
        accordance with the procedures for substantive rules 
        under section 553 of title 5, United States Code. A 
        rule under the preceding sentence shall be considered a 
        major rule for purposes of chapter 8 of such title 
        (relating to congressional review of agency 
        rulemaking).
  (g) Definitions.--For purposes of this title:
          (1) The term ``Director of NIH'' means the Director 
        of the National Institutes of Health.
          (2) The terms ``national research institute'' and 
        ``national center'' mean an agency of the National 
        Institutes of Health that is--
                  (A) listed in subsection (b) and not 
                terminated under subsection (d)(2)(A); or
                  (B) established by the Director of NIH under 
                such subsection.
  (h) References to NIH.--For purposes of this title, a 
reference to the National Institutes of Health includes its 
agencies.

           *       *       *       *       *       *       *


Part C--Specific Provisions Respecting National Research Institutes

           *       *       *       *       *       *       *



   Subpart 14--[National Institute on Alcohol Abuse and Alcoholism] 
 National Institute on Alcohol Effects and Alcohol-Associated Disorders


                          purpose of institute

  Sec. 464H. (a) In General.--The general purpose of the 
[National Institute on Alcohol Abuse and Alcoholism] National 
Institute on Alcohol Effects and Alcohol-Associated Disorders 
(hereafter in this subpart referred to as the ``Institute'') is 
the conduct and support of biomedical and behavioral research, 
health services research, research training, and health 
information dissemination with respect to the [prevention of 
alcohol abuse] prevention of alcohol misuse and the [treatment 
of alcoholism] treatment of alcohol-associated disorders.
  (b) Research Program.--The research program established under 
this subpart shall encompass the social, behavioral, and 
biomedical etiology, mental and physical health consequences, 
and social and economic consequences of [alcohol abuse and 
alcoholism] alcohol misuse, alcohol use disorder, and other 
alcohol-associated disorders. In carrying out the program, the 
Director of the Institute is authorized to--
          (1) collect and disseminate through publications and 
        other appropriate means (including the development of 
        curriculum materials), information as to, and the 
        practical application of, the research and other 
        activities under the program;
          (2) make available research facilities of the Public 
        Health Service to appropriate public authorities, and 
        to health officials and scientists engaged in special 
        study;
          (3) make grants to universities, hospitals, 
        laboratories, and other public or nonprofit 
        institutions, and to individuals for such research 
        projects as are recommended by the [National Advisory 
        Council on Alcohol Abuse and Alcoholism] National 
        Advisory Council on Alcohol Effects and Alcohol-
        Associated Disorders, giving special consideration to 
        projects relating to--
                  (A) the relationship between [alcohol abuse 
                and domestic violence] alcohol misuse and 
                domestic violence,
                  (B) the effects of alcohol use during 
                pregnancy,
                  (C) the impact of [alcoholism and alcohol 
                abuse] alcohol misuse, alcohol use disorder, 
                and other alcohol-associated disorders on the 
                family, the workplace, and systems for the 
                delivery of health services,
                  (D) the relationship between the [abuse of 
                alcohol] misuse of alcohol and other drugs,
                  [(E) the effect on the incidence of alcohol 
                abuse and alcoholism of social pressures, legal 
                requirements respecting the use of alcoholic 
                beverages, the cost of such beverages, and the 
                economic status and education of users of such 
                beverages,]**ERR02
                  (E) the effect of social pressures, legal 
                requirements regarding the use of alcoholic 
                beverages, the cost of such beverages, and the 
                economic status and education of users of such 
                beverages on the incidence of alcohol misuse, 
                alcohol use disorder, and other alcohol-
                associated disorders,**ERR02
                  (F) the interrelationship between alcohol use 
                and other health problems,
                  (G) the comparison of the cost and 
                effectiveness of various treatment methods for 
                [alcoholism and alcohol abuse] alcohol misuse, 
                alcohol use disorder, and other alcohol-
                associated disorders and the effectiveness of 
                prevention and intervention programs for 
                [alcoholism and alcohol abuse] alcohol misuse, 
                alcohol use disorder, and other alcohol-
                associated disorders, and
                  (H) [alcoholism and alcohol abuse] alcohol 
                misuse, alcohol use disorder, and other 
                alcohol-associated disorders among women;
          (4) secure from time to time and for such periods as 
        he deems advisable, the assistance and advice of 
        experts, scholars, and consultants from the United 
        States or abroad;
          (5) promote the coordination of research programs 
        conducted by the Institute, and similar programs 
        conducted by the [National Institute of Drug Abuse] 
        National Institute on Drugs and Addiction and by other 
        departments, agencies, organizations, and individuals, 
        including all National Institutes of Health research 
        activities which are or may be related to the problems 
        of individuals suffering from alcoholism or alcohol 
        abuse or those of their families or the [impact of 
        alcohol abuse] impact of alcohol misuse on other health 
        problems;
          (6) conduct an intramural program of biomedical, 
        behavioral, epidemiological, and social research, 
        including research into the most effective means of 
        treatment and service delivery, and including research 
        involving human subjects, which is--
                  (A) located in an institution capable of 
                providing all necessary medical care for such 
                human subjects, including complete 24-hour 
                medical diagnostic services by or under the 
                supervision of physicians, acute and intensive 
                medical care, including 24-hour emergency care, 
                psychiatric care, and such other care as is 
                determined to be necessary for individuals 
                suffering from [alcoholism and alcohol abuse] 
                alcohol misuse, alcohol use disorder, and other 
                alcohol-associated disorders; and
                  (B) associated with an accredited medical or 
                research training institution;
          (7) for purposes of study, admit and treat at 
        institutions, hospitals, and stations of the Public 
        Health Service, persons not otherwise eligible for such 
        treatment;
          (8) provide to health officials, scientists, and 
        appropriate public and other nonprofit institutions and 
        organizations, technical advice and assistance on the 
        application of statistical and other scientific 
        research methods to experiments, studies, and surveys 
        in health and medical fields;
          (9) enter into contracts under this title without 
        regard to sections 3648 and 3709 of the Revised 
        Statutes (31 U.S.C. 529; 41 U.S.C. 5); and
          (10) adopt, upon recommendation of the [National 
        Advisory Council on Alcohol Abuse and Alcoholism] 
        National Advisory Council on Alcohol Effects and 
        Alcohol-Associated Disorders, such additional means as 
        he deems necessary or appropriate to carry out the 
        purposes of this section.
  (c) Collaboration.--The Director of the Institute shall 
collaborate with the Administrator of the [Substance Abuse and 
Mental Health Services Administration] Substance Use And Mental 
Health Services Administration in focusing the services 
research activities of the Institute and in disseminating the 
results of such research to health professionals and the 
general public.

                   associate director for prevention

  Sec. 464I. (a) In General.--There shall be in the Institute 
an Associate Director for Prevention who shall be responsible 
for the full-time coordination and promotion of the programs in 
the Institute concerning the prevention of [alcohol abuse and 
alcoholism] alcohol misuse, alcohol use disorder, and other 
alcohol-associated disorders. The Associate Director shall be 
appointed by the Director of the Institute from individuals who 
because of their professional training or expertise are experts 
in alcohol abuse and alcoholism or the prevention of such.
  (b) Biennial Report.--The Associate Director for Prevention 
shall prepare for inclusion in the biennial report made under 
section 407 a description of the prevention activities of the 
Institute, including a description of the staff and resources 
allocated to those activities.

                    national alcohol research center

  Sec. 464J. (a) The Secretary acting through the Institute may 
designate National Alcohol Research Centers for the purpose of 
interdisciplinary research relating to alcoholism and other 
biomedical, behavioral, and social issues related to alcoholism 
and alcohol abuse. No entity may be designated as a Center 
unless an application therefor has been submitted to, and 
approved by, the Secretary. Such an application shall be 
submitted in such manner and contain such information as the 
Secretary may reasonably require. The Secretary may not approve 
such an application unless--
          (1) the application contains or is supported by 
        reasonable assurances that--
                  (A) the applicant has the experience, or 
                capability, to conduct, through biomedical, 
                behavioral, social, and related disciplines, 
                long-term research on [alcoholism and other 
                alcohol problems] alcohol misuse, alcohol use 
                disorder, and other alcohol-associated 
                disorders and to provide coordination of such 
                research among such disciplines;
                  (B) the applicant has available to it 
                sufficient facilities (including laboratory, 
                reference, and data analysis facilities) to 
                carry out the research plan contained in the 
                application,
                  (C) the applicant has facilities and 
                personnel to provide training in the prevention 
                and treatment of [alcoholism and other alcohol 
                problems] alcohol misuse, alcohol use disorder, 
                and other alcohol-associated disorders;
                  (D) the applicant has the capacity to train 
                predoctoral and postdoctoral students for 
                careers in research on [alcoholism and other 
                alcohol problems] alcohol misuse, alcohol use 
                disorder, and other alcohol-associated 
                disorders;
                  (E) the applicant has the capacity to conduct 
                courses on [alcohol problems] alcohol misuse, 
                alcohol use disorder, and other alcohol-
                associated disorders and research on [alcohol 
                problems] alcohol misuse, alcohol use disorder, 
                and other alcohol-associated disorders for 
                undergraduate and graduate students, and 
                medical and osteopathic, nursing, social work, 
                and other specialized graduate students; and
                  (F) the applicant has the capacity to conduct 
                programs of continuing education in such 
                medical, legal, and social service fields as 
                the Secretary may require.
          (2) the application contains a detailed five-year 
        plan for research relating to [alcoholism and other 
        alcohol problems] alcohol misuse, alcohol use disorder, 
        and other alcohol-associated disorders.
  (b) The Secretary shall, under such conditions as the 
Secretary may reasonably require, make annual grants to Centers 
which have been designated under this section. No funds 
provided under a grant under this subsection may be used for 
the purchase of any land or the purchase, construction, 
preservation, or repair of any building. For the purposes of 
the preceding sentence, the term ``construction'' has the 
meaning given that term by section 701(1). The Secretary shall 
include in the grants made under this section for fiscal year 
beginning after September 30, 1981, a grant to a designated 
Center for research on the effects of alcohol on the elderly.

              Subpart 15--National Institute on Drug Abuse


                          purpose of institute

  Sec. 464L. (a) In General.--The general purpose of the 
[National Institute on Drug Abuse] National Institute on Drugs 
and Addiction (hereafter in this subpart referred to as the 
``Institute'') is the conduct and support of biomedical and 
behavioral research, health services research, research 
training, and health information dissemination with respect to 
the prevention of [drug abuse] drug use and the [treatment of 
drug abusers] treatment of drug addiction.
  (b) Research Program.--The research program established under 
this subpart shall encompass the social, behavioral, and 
biomedical etiology, mental and physical health consequences, 
and social and economic consequences of [drug abuse] drug use. 
In carrying out the program, the Director of the Institute 
shall give special consideration to projects relating to [drug 
abuse] drug use among women (particularly with respect to 
pregnant women).
  (c) Collaboration.--The Director of the Institute shall 
collaborate with the [Substance Abuse and Mental Health 
Services Administration] Substance Use And Mental Health 
Services Administration in focusing the services research 
activities of the Institute and in disseminating the results of 
such research to health professionals and the general public.

                   associate director for prevention

  Sec. 464M. (a) In General.--There shall be in the Institute 
an Associate Director for Prevention who shall be responsible 
for the full-time coordination and promotion of the programs in 
the Institute concerning the prevention of [drug abuse] drug 
use. The Associate Director shall be appointed by the Director 
of the Institute from individuals who because of their 
professional training or expertise are experts in [drug abuse] 
drug use and the [prevention of such abuse] prevention of such 
use.
  (b) Report.--The Associate Director for Prevention shall 
prepare for inclusion in the biennial report made under section 
407 a description of the prevention activities of the 
Institute, including a description of the staff and resources 
allocated to those activities.

   [drug abuse research centers]  drugs and addiction research centers

  Sec. 464N. (a) Authority.--The Director of the Institute may 
designate [National Drug Abuse Research Centers] National Drugs 
and Addiction Research Centers for the purpose of 
interdisciplinary research relating to [drug abuse] drug use 
and other biomedical, behavioral, and social issues related to 
[drug abuse] drug use. No entity may be designated as a Center 
unless an application therefore has been submitted to, and 
approved by, the Secretary. Such an application shall be 
submitted in such manner and contain such information as the 
Secretary may reasonably require. The Secretary may not approve 
such an application unless--
          (1) the application contains or is supported by 
        reasonable assurances that--
                  (A) the applicant has the experience, or 
                capability, to conduct, through biomedical, 
                behavioral, social, and related disciplines, 
                long-term research on [drug abuse] drug use and 
                to provide coordination of such research among 
                such disciplines;
                  (B) the applicant has available to it 
                sufficient facilities (including laboratory, 
                reference, and data analysis facilities) to 
                carry out the research plan contained in the 
                application;
                  (C) the applicant has facilities and 
                personnel to provide training in the prevention 
                and [treatment of drug abuse] treatment of drug 
                addiction;
                  (D) the applicant has the capacity to train 
                predoctoral and postdoctoral students for 
                careers in research on [drug abuse] drug use;
                  (E) the applicant has the capacity to conduct 
                courses on [drug abuse] drug use problems and 
                research on [drug abuse] drug use for 
                undergraduate and graduate students, and 
                medical and osteopathic, nursing, social work, 
                and other specialized graduate students; and
                  (F) the applicant has the capacity to conduct 
                programs of continuing education in such 
                medical, legal, and social service fields as 
                the Secretary may require.
          (2) the application contains a detailed five-year 
        plan for research relating to [drug abuse] drug use.
  (b) Grants.--The Director of the Institute shall, under such 
conditions as the Secretary may reasonably require, make annual 
grants to Centers which have been designated under this 
section. No funds provided under a grant under this subsection 
may be used for the purchase of any land or the purchase, 
construction, preservation, or repair of any building. For the 
purposes of the preceding sentence, the term ``construction'' 
has the meaning given that term by section 701(1).
  (c)  [Drug Abuse and Addition Research] Drugs and Addiction 
Research Centers.--
          (1) Grants or cooperative agreements.--The Director 
        of the Institute may make grants or enter into 
        cooperative agreements to expand the current and 
        ongoing interdisciplinary research and clinical trials 
        with treatment centers of the [National Drug Abuse 
        Treatment Clinical Trials Network] National Drug 
        Addiction Treatment Clinical Trials Network relating to 
        [drug abuse] drug use and addiction, including related 
        biomedical, behavioral, and social issues.
          (2) Use of funds.--Amounts made available under a 
        grant or cooperative agreement under paragraph (1) for 
        [drug abuse] drug use and addiction may be used for 
        research and clinical trials relating to--
                  (A) the effects of [drug abuse] drug use on 
                the human body, including the brain;
                  (B) the addictive nature of drugs and how 
                such effects differ with respect to different 
                individuals;
                  (C) the connection between [drug abuse] drug 
                use and mental health;
                  (D) the identification and evaluation of the 
                most effective methods of prevention of [drug 
                abuse] drug use and addiction;
                  (E) the identification and development of the 
                most effective methods of treatment of drug 
                addiction, including pharmacological 
                treatments;
                  (F) risk factors for [drug abuse] drug use;
                  (G) effects of [drug abuse] drug use and 
                addiction on pregnant women and their fetuses; 
                and
                  (H) cultural, social, behavioral, 
                neurological, and psychological [reasons that 
                individuals abuse drugs, or refrain from 
                abusing drugs] reasons that individuals use 
                drugs or refrain from using drugs.
          (3) Research results.--The Director shall promptly 
        disseminate research results under this subsection to 
        Federal, State, and local entities involved in 
        combating [drug abuse] drug use and addiction.

                             office on aids

  Sec. 464O. The Director of the Institute shall establish 
within the Institute an Office on AIDS. The Office shall be 
responsible for the coordination of research and determining 
the direction of the Institute with respect to AIDS research 
related to--
          (1) primary prevention of the spread of HIV, 
        including transmission via [drug abuse] drug use;
          (2) [drug abuse] drug use services research; and
          (3) other matters determined appropriate by the 
        Director.

                     medication development program

  Sec. 464P. (a) Establishment.--There is established in the 
Institute a Medication Development Program through which the 
Director of such Institute shall--
          (1) conduct periodic meetings with the Commissioner 
        of Food and Drugs to discuss measures that may 
        facilitate the approval process of [drug abuse 
        treatments] drug addiction treatments;
          (2) encourage and promote (through grants, contracts, 
        international collaboration, or otherwise) expanded 
        research programs, investigations, experiments, 
        community trials, and studies, into the development and 
        use of medications to treat drug addiction;
          (3) establish or provide for the establishment of 
        research facilities;
          (4) report on the activities of other relevant 
        agencies relating to the development and use of 
        pharmacotherapeutic treatments for drug addiction;
          (5) collect, analyze, and disseminate data useful in 
        the development and use of pharmacotherapeutic 
        treatments for drug addiction and collect, catalog, 
        analyze, and disseminate through international 
        channels, the results of such research;
          (6) directly or through grants, contracts, or 
        cooperative agreements, support training in the 
        fundamental sciences and clinical disciplines related 
        to the pharmacotherapeutic [treatment of drug abuse] 
        treatment of drug addiction, including the use of 
        training stipends, fellowships, and awards where 
        appropriate; and
          (7) coordinate the activities conducted under this 
        section with related activities conducted within the 
        [National Institute on Alcohol Abuse and Alcoholism] 
        National Institute on Alcohol Effects and Alcohol-
        Associated Disorders, the National Institute of Mental 
        Health, and other appropriate institutes and shall 
        consult with the Directors of such Institutes.
  (b) Duties.--In carrying out the activities described in 
subsection (a), the Director of the Institute--
          (1) shall collect and disseminate through 
        publications and other appropriate means, information 
        pertaining to the research and other activities under 
        this section;
          (2) shall make grants to or enter into contracts and 
        cooperative agreements with individuals and public and 
        private entities to further the goals of the program;
          (3) may, in accordance with section 496, and in 
        consultation with the [National Advisory Council on 
        Drug Abuse] National Advisory Council on Drugs and 
        Addiction, acquire, construct, improve, repair, 
        operate, and maintain pharmacotherapeutic research 
        centers, laboratories, and other necessary facilities 
        and equipment, and such other real or personal property 
        as the Director determines necessary, and may, in 
        consultation with such Advisory Council, make grants 
        for the construction or renovation of facilities to 
        carry out the purposes of this section;
          (4) may accept voluntary and uncompensated services;
          (5) may accept gifts, or donations of services, 
        money, or property, real, personal, or mixed, tangible 
        or intangible; and
          (6) shall take necessary action to ensure that all 
        channels for the dissemination and exchange of 
        scientific knowledge and information are maintained 
        between the Institute and the other scientific, 
        medical, and biomedical disciplines and organizations 
        nationally and internationally.
  (c) Report.--
          (1) In general.--Not later than December 31, 1992, 
        and each December 31 thereafter, the Director of the 
        Institute shall submit to the Office of National Drug 
        Control Policy established under section 1002 of the 
        Anti-Drug Abuse Act of 1988 (21 U.S.C. 1501) a report, 
        in accordance with paragraph (3), that describes the 
        objectives and activities of the program assisted under 
        this section.
          (2) National drug control strategy.--The Director of 
        National Drug Control Policy shall incorporate, by 
        reference or otherwise, each report submitted under 
        this subsection in the National Drug Control Strategy 
        submitted the following February 1 under section 1005 
        of the Anti-Drug Abuse Act of 1988 (21 U.S.C. 1504).
  (d) Definition.--For purposes of this section, the term 
``pharmacotherapeutics'' means medications used to treat the 
symptoms and [disease of drug abuse] disease of drug addiction, 
including medications to--
          (1) block the effects of [abused drugs] addictive 
        drugs;
          (2) reduce the craving for [abused drugs] addictive 
        drugs;
          (3) moderate or eliminate withdrawal symptoms;
          (4) block or reverse the toxic effect of [abused 
        drugs] addictive drugs; or
          (5) prevent relapse in persons who have been 
        detoxified from [drugs of abuse] drugs of addiction.

            Subpart 16--National Institute of Mental Health


                          purpose of institute

  Sec. 464R. (a) In General.--The general purpose of the 
National Institute of Mental Health (hereafter in this subpart 
referred to as the ``Institute'') is the conduct and support of 
biomedical and behavioral research, health services research, 
research training, and health information dissemination with 
respect to the cause, diagnosis, treatment, control and 
prevention of mental illness.
  (b) Research Program.--The research program established under 
this subpart shall include support for biomedical and 
behavioral neuroscience and shall be designed to further the 
treatment and prevention of mental illness, the promotion of 
mental health, and the study of the psychological, social and 
legal factors that influence behavior.
  (c) Collaboration.--The Director of the Institute shall 
collaborate with the Administrator of the [Substance Abuse and 
Mental Health Services Administration] Substance Use And Mental 
Health Services Administration in focusing the services 
research activities of the Institute and in disseminating the 
results of such research to health professionals and the 
general public.
  (d) Information With Respect to Suicide.--
          (1) In general.--The Director of the Institute 
        shall--
                  (A) develop and publish information with 
                respect to the causes of suicide and the means 
                of preventing suicide; and
                  (B) make such information generally available 
                to the public and to health professionals.
          (2) Youth suicide.--Information described in 
        paragraph (1) shall especially relate to suicide among 
        individuals under 24 years of age.
  (e) Associate Director for Special Populations.--
          (1) In general.--The Director of the Institute shall 
        designate an Associate Director for Special 
        Populations.
          (2) Duties.--The Associate Director for Special 
        Populations shall--
                  (A) develop and coordinate research policies 
                and programs to assure increased emphasis on 
                the mental health needs of women and minority 
                populations;
                  (B) support programs of basic and applied 
                social and behavioral research on the mental 
                health problems of women and minority 
                populations;
                  (C) study the effects of discrimination on 
                institutions and individuals, including 
                majority institutions and individuals;
                  (D) support and develop research designed to 
                eliminate institutional discrimination; and
                  (E) provide increased emphasis on the 
                concerns of women and minority populations in 
                training programs, service delivery programs, 
                and research endeavors of the Institute.

           *       *       *       *       *       *       *


Part H--General Provisions

           *       *       *       *       *       *       *



      collaborative use of certain health services research funds

  Sec. 494A. The Secretary shall ensure that amounts made 
available under subparts 14, 15 and 16 of part C for health 
services research relating to [alcohol abuse and alcoholism] 
alcohol misuse, alcohol use disorder, and other alcohol-
associated disorders, [drug abuse] drug use and mental health 
be used collaboratively, as appropriate, and in consultation 
with the Agency for Health Care Policy Research.

           *       *       *       *       *       *       *


 TITLE V-- [SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION] 
        SUBSTANCE USE AND MENTAL HEALTH SERVICES ADMINISTRATION


              Part A--Organization and General Authorities


SEC. 501. [SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION]  
                    SUBSTANCE USE AND MENTAL HEALTH SERVICES 
                    ADMINISTRATION.

  (a) Establishment.--The [Substance Abuse and Mental Health 
Services Administration] Substance Use And Mental Health 
Services Administration [(hereafter referred to in this title 
as the ``Administration'')] (hereafter referred to in this 
title as ``SAMHSA'' or the ``Administration'') is an agency of 
the Service.
  (b) Centers.--The following Centers are agencies of the 
Administration:
          (1) The [Center for Substance Abuse Treatment] Center 
        for Substance Use Services.
          (2) The [Center for Substance Abuse Prevention] 
        Center for Substance Use Prevention Services.
          (3) The Center for Mental Health Services.
  (c) Assistant Secretary and Deputy Assistant Secretary.--
          (1) Assistant secretary.--The Administration shall be 
        headed by an official to be known as the Assistant 
        Secretary for Mental Health and Substance Use 
        (hereinafter in this title referred to as the 
        ``Assistant Secretary'') who shall be appointed by the 
        President, by and with the advice and consent of the 
        Senate.
          (2) Deputy assistant secretary.--The Assistant 
        Secretary, with the approval of the Secretary, may 
        appoint a Deputy Assistant Secretary and may employ and 
        prescribe the functions of such officers and employees, 
        including attorneys, as are necessary to administer the 
        activities to be carried out through the 
        Administration.
  (d) Authorities.--The Secretary, acting through the Assistant 
Secretary, shall--
          (1) supervise the functions of the Centers of the 
        Administration in order to assure that the programs 
        carried out through each such Center receive 
        appropriate and equitable support and that there is 
        cooperation among the Centers in the implementation of 
        such programs;
          (2) establish and implement, through the respective 
        Centers, a comprehensive program to improve the 
        provision of treatment and related services to 
        individuals with respect to substance use disorders and 
        mental illness and to improve prevention services, 
        promote mental health and protect the legal rights of 
        individuals with mental illnesses and individuals with 
        substance use disorders;
          (3) carry out the administrative and financial 
        management, policy development and planning, 
        evaluation, knowledge dissemination, and public 
        information functions that are required for the 
        implementation of this title;
          (4) assure that the Administration conduct and 
        coordinate demonstration projects, evaluations, and 
        service system assessments and other activities 
        necessary to improve the availability and quality of 
        treatment, prevention and related services;
          (5) support activities that will improve the 
        provision of treatment, prevention and related 
        services, including the development of national mental 
        health and substance use disorder goals and model 
        programs;
          (6) in cooperation with the National Institutes of 
        Health, the Centers for Disease Control and Prevention, 
        and the Health Resources and Services Administration, 
        develop educational materials and intervention 
        strategies to reduce the risks of HIV, hepatitis, 
        tuberculosis, and other communicable diseases among 
        individuals with mental or substance use disorders, and 
        to develop appropriate mental health services for 
        individuals with such diseases or disorders;
          (7) coordinate Federal policy with respect to the 
        provision of treatment services for substance use 
        disorders, including services that utilize drugs or 
        devices approved or cleared by the Food and Drug 
        Administration for the treatment of substance use 
        disorders;
          (8) conduct programs, and assure the coordination of 
        such programs with activities of the National 
        Institutes of Health and the Agency for Healthcare 
        Research and Quality, as appropriate, to evaluate the 
        process, outcomes and community impact of prevention 
        and treatment services and systems of care in order to 
        identify the manner in which such services can most 
        effectively be provided;
          (9) collaborate with the Director of the National 
        Institutes of Health in the development and maintenance 
        of a system by which the relevant research findings of 
        the [National Institute on Drug Abuse] National 
        Institute on Drugs and Addiction, the [National 
        Institute on Alcohol Abuse and Alcoholism] National 
        Institute on Alcohol Effects and Alcohol-Associated 
        Disorders, the National Institute of Mental Health, 
        and, as appropriate, the Agency for Healthcare Research 
        and Quality are disseminated to service providers in a 
        manner designed to improve the delivery and 
        effectiveness of prevention, treatment, and recovery 
        support services and are appropriately incorporated 
        into programs carried out by the Administration;
          (10) encourage public and private entities that 
        provide health insurance to provide benefits for 
        substance use disorder and mental health services;
          (11) work with relevant agencies of the Department of 
        Health and Human Services on integrating mental health 
        promotion and substance use disorder prevention with 
        general health promotion and disease prevention and 
        integrating mental and substance use disorders 
        treatment services with physical health treatment 
        services;
          (12) monitor compliance by hospitals and other 
        facilities with the requirements of sections 542 and 
        543;
          (13) with respect to grant programs authorized under 
        this title or part B of title XIX, or grant programs 
        otherwise funded by the Administration--
                  (A) require that all grants that are awarded 
                for the provision of services are subject to 
                performance and outcome evaluations;
                  (B) ensure that the director of each Center 
                of the Administration consistently documents 
                the application of criteria when awarding 
                grants and the ongoing oversight of grantees 
                after such grants are awarded;
                  (C) require that all grants that are awarded 
                to entities other than States are awarded only 
                after the State in which the entity intends to 
                provide services--
                          (i) is notified of the pendency of 
                        the grant application; and
                          (ii) is afforded an opportunity to 
                        comment on the merits of the 
                        application; and
                  (D) inform a State when any funds are awarded 
                through such a grant to any entity within such 
                State;
          (14) assure that services provided with amounts 
        appropriated under this title are provided bilingually, 
        if appropriate;
          (15) improve coordination among prevention programs, 
        treatment facilities and nonhealth care systems such as 
        employers, labor unions, and schools, and encourage the 
        adoption of employee assistance programs and student 
        assistance programs;
          (16) maintain a clearinghouse for substance use 
        disorder information, including evidence-based and 
        promising best practices for prevention, treatment, and 
        recovery support services for individuals with mental 
        and substance use disorders, to assure the widespread 
        dissemination of such information to States, political 
        subdivisions, educational agencies and institutions, 
        treatment providers, and the general public;
          (17) in collaboration with the National Institute on 
        Aging, and in consultation with the [National Institute 
        on Drug Abuse] National Institute on Drugs and 
        Addiction, the [National Institute on Alcohol Abuse and 
        Alcoholism] National Institute on Alcohol Effects and 
        Alcohol-Associated Disorders and the National Institute 
        of Mental Health, as appropriate, promote and evaluate 
        substance use disorder services for older Americans in 
        need of such services, and mental health services for 
        older Americans who are seriously mentally ill;
          (18) promote the coordination of service programs 
        conducted by other departments, agencies, organizations 
        and individuals that are or may be related to the 
        problems of individuals suffering from mental illness 
        or substance abuse, including liaisons with the Social 
        Security Administration, Centers for Medicare & 
        Medicaid Services, and other programs of the 
        Department, as well as liaisons with the Department of 
        Education, Department of Justice, and other Federal 
        Departments and offices, as appropriate;
          (19) consult with State, local, and tribal 
        governments, nongovernmental entities, and individuals 
        with mental illness, particularly adults with a serious 
        mental illness, children with a serious emotional 
        disturbance, and the family members of such adults and 
        children, with respect to improving community-based and 
        other mental health services;
          (20) collaborate with the Secretary of Defense and 
        the Secretary of Veterans Affairs to improve the 
        provision of mental and substance use disorder services 
        provided by the Department of Defense and the 
        Department of Veterans Affairs to members of the Armed 
        Forces, veterans, and the family members of such 
        members and veterans, including through the provision 
        of services using the telehealth capabilities of the 
        Department of Defense and the Department of Veterans 
        Affairs;
          (21) collaborate with the heads of relevant Federal 
        agencies and departments, States, communities, and 
        nongovernmental experts to improve mental and substance 
        use disorders services for chronically homeless 
        individuals, including by designing strategies to 
        provide such services in supportive housing;
          (22) work with States and other stakeholders to 
        develop and support activities to recruit and retain a 
        workforce addressing mental and substance use 
        disorders;
          (23) collaborate with the Attorney General and 
        representatives of the criminal justice system to 
        improve mental and substance use disorders services for 
        individuals who have been arrested or incarcerated;
          (24) after providing an opportunity for public input, 
        set standards for grant programs under this title for 
        mental and substance use disorders services and 
        prevention programs, which standards may address--
                  (A) the capacity of the grantee to implement 
                the award;
                  (B) requirements for the description of the 
                program implementation approach;
                  (C) the extent to which the grant plan 
                submitted by the grantee as part of its 
                application must explain how the grantee will 
                reach the population of focus and provide a 
                statement of need, which may include 
                information on how the grantee will increase 
                access to services and a description of 
                measurable objectives for improving outcomes;
                  (D) the extent to which the grantee must 
                collect and report on required performance 
                measures; and
                  (E) the extent to which the grantee is 
                proposing to use evidence-based practices; and
          (25) advance, through existing programs, the use of 
        performance metrics, including those based on the 
        recommendations on performance metrics from the 
        Assistant Secretary for Planning and Evaluation under 
        section 6021(d) of the Helping Families in Mental 
        Health Crisis Reform Act of 2016.
  (e) Associate Administrator for Alcohol Prevention and 
Treatment Policy.--
          (1) In general.--There may be in the Administration 
        an Associate Administrator for Alcohol Prevention and 
        Treatment Policy to whom the Assistant Secretary may 
        delegate the functions of promoting, monitoring, and 
        evaluating service programs for the prevention and 
        treatment of alcoholism and alcohol abuse within the 
        [Center for Substance Abuse Prevention] Center for 
        Substance Use Prevention Services, the [Center for 
        Substance Abuse Treatment] Center for Substance Use 
        Services and the Center for Mental Health Services, and 
        coordinating such programs among the Centers, and among 
        the Centers and other public and private entities. The 
        Associate Administrator also may ensure that alcohol 
        prevention, education, and policy strategies are 
        integrated into all programs of the Centers that 
        address substance abuse prevention, education, and 
        policy, and that the [Center for Substance Abuse 
        Prevention] Center for Substance Use Prevention 
        Services addresses the Healthy People 2010 goals and 
        the National Dietary Guidelines of the Department of 
        Health and Human Services and the Department of 
        Agriculture related to alcohol consumption.
          (2) Plan.--
                  (A) The Assistant Secretary, acting through 
                the Associate Administrator for Alcohol 
                Prevention and Treatment Policy, shall develop, 
                and periodically review and as appropriate 
                revise, a plan for programs and policies to 
                treat and prevent alcoholism and alcohol abuse. 
                The plan shall be developed (and reviewed and 
                revised) in collaboration with the Directors of 
                the Centers of the Administration and in 
                consultation with members of other Federal 
                agencies and public and private entities.
                  (B) Not later than 1 year after the date of 
                the enactment of the ADAMHA Reorganization Act, 
                the Assistant Secretary shall submit to the 
                Congress the first plan developed under 
                subparagraph (A).
          (3) Report.--
                  (A) Not less than once during each 2 years, 
                the Assistant Secretary, acting through the 
                Associate Administrator for Alcohol Prevention 
                and Treatment Policy, shall prepare a report 
                describing the alcoholism and alcohol abuse 
                prevention and treatment programs undertaken by 
                the Administration and its agencies, and the 
                report shall include a detailed statement of 
                the expenditures made for the activities 
                reported on and the personnel used in 
                connection with such activities.
                  (B) Each report under subparagraph (A) shall 
                include a description of any revisions in the 
                plan under paragraph (2) made during the 
                preceding 2 years.
                  (C) Each report under subparagraph (A) shall 
                be submitted to the Assistant Secretary for 
                inclusion in the biennial report under 
                subsection (m).
  (f) Associate Administrator for Women's Services.--
          (1) Appointment.--The Assistant Secretary, with the 
        approval of the Secretary, shall appoint an Associate 
        Administrator for Women's Services who shall report 
        directly to the Assistant Secretary.
          (2) Duties.--The Associate Administrator appointed 
        under paragraph (1) shall--
                  (A) establish a committee to be known as the 
                Coordinating Committee for Women's Services 
                (hereafter in this subparagraph referred to as 
                the ``Coordinating Committee''), which shall be 
                composed of the Directors of the agencies of 
                the Administration (or the designees of the 
                Directors);
                  (B) acting through the Coordinating 
                Committee, with respect to women's substance 
                abuse and mental health services--
                          (i) identify the need for such 
                        services, and make an estimate each 
                        fiscal year of the funds needed to 
                        adequately support the services;
                          (ii) identify needs regarding the 
                        coordination of services;
                          (iii) encourage the agencies of the 
                        Administration to support such 
                        services; and
                          (iv) assure that the unique needs of 
                        minority women, including Native 
                        American, Hispanic, African-American 
                        and Asian women, are recognized and 
                        addressed within the activities of the 
                        Administration; and
                  (C) establish an advisory committee to be 
                known as the Advisory Committee for Women's 
                Services, which shall be composed of not more 
                than 10 individuals, a majority of whom shall 
                be women, who are not officers or employees of 
                the Federal Government, to be appointed by the 
                Assistant Secretary from among physicians, 
                practitioners, treatment providers, and other 
                health professionals, whose clinical practice, 
                specialization, or professional expertise 
                includes a significant focus on women's 
                substance abuse and mental health conditions, 
                that shall--
                          (i) advise the Associate 
                        Administrator on appropriate activities 
                        to be undertaken by the agencies of the 
                        Administration with respect to women's 
                        substance abuse and mental health 
                        services, including services which 
                        require a multidisciplinary approach;
                          (ii) collect and review data, 
                        including information provided by the 
                        Secretary (including the material 
                        referred to in paragraph (3)), and 
                        report biannually to the Assistant 
                        Secretary regarding the extent to which 
                        women are represented among senior 
                        personnel, and make recommendations 
                        regarding improvement in the 
                        participation of women in the workforce 
                        of the Administration; and
                          (iii) prepare, for inclusion in the 
                        biennial report required pursuant to 
                        subsection (m), a description of 
                        activities of the Committee, including 
                        findings made by the Committee 
                        regarding--
                                  (I) the extent of 
                                expenditures made for women's 
                                substance abuse and mental 
                                health services by the agencies 
                                of the Administration; and
                                  (II) the estimated level of 
                                funding needed for substance 
                                abuse and mental health 
                                services to meet the needs of 
                                women;
                  (D) improve the collection of data on women's 
                health by--
                          (i) reviewing the current data at the 
                        Administration to determine its 
                        uniformity and applicability;
                          (ii) developing standards for all 
                        programs funded by the Administration 
                        so that data are, to the extent 
                        practicable, collected and reported 
                        using common reporting formats, 
                        linkages and definitions; and
                          (iii) reporting to the Assistant 
                        Secretary a plan for incorporating the 
                        standards developed under clause (ii) 
                        in all Administration programs and a 
                        plan to assure that the data so 
                        collected are accessible to health 
                        professionals, providers, researchers, 
                        and members of the public; and
                  (E) shall establish, maintain, and operate a 
                program to provide information on women's 
                substance abuse and mental health services.
          (3) Study.--
                  (A) The Secretary, acting through the 
                Assistant Secretary for Personnel, shall 
                conduct a study to evaluate the extent to which 
                women are represented among senior personnel at 
                the Administration.
                  (B) Not later than 90 days after the date of 
                the enactment of the ADAMHA Reorganization Act, 
                the Assistant Secretary for Personnel shall 
                provide the Advisory Committee for Women's 
                Services with a study plan, including the 
                methodology of the study and any sampling 
                frames. Not later than 180 days after such date 
                of enactment, the Assistant Secretary shall 
                prepare and submit directly to the Advisory 
                Committee a report concerning the results of 
                the study conducted under subparagraph (A).
                  (C) The Secretary shall prepare and provide 
                to the Advisory Committee for Women's Services 
                any additional data as requested.
          (4) Office.--Nothing in this subsection shall be 
        construed to preclude the Secretary from establishing 
        within the Substance Abuse and Mental Health 
        Administration an Office of Women's Health.
          (5) Definition.--For purposes of this subsection, the 
        term ``women's substance abuse and mental health 
        conditions'', with respect to women of all age, ethnic, 
        and racial groups, means all aspects of substance abuse 
        and mental illness--
                  (A) unique to or more prevalent among women; 
                or
                  (B) with respect to which there have been 
                insufficient services involving women or 
                insufficient data.
  (g) Chief Medical Officer.--
          (1) In general.--The Assistant Secretary, with the 
        approval of the Secretary, shall appoint a Chief 
        Medical Officer to serve within the Administration.
          (2) Eligible candidates.--The Assistant Secretary 
        shall select the Chief Medical Officer from among 
        individuals who--
                  (A) have a doctoral degree in medicine or 
                osteopathic medicine;
                  (B) have experience in the provision of 
                mental or substance use disorder services;
                  (C) have experience working with mental or 
                substance use disorder programs;
                  (D) have an understanding of biological, 
                psychosocial, and pharmaceutical treatments of 
                mental or substance use disorders; and
                  (E) are licensed to practice medicine in one 
                or more States.
          (3) Duties.--The Chief Medical Officer shall--
                  (A) serve as a liaison between the 
                Administration and providers of mental and 
                substance use disorders prevention, treatment, 
                and recovery services;
                  (B) assist the Assistant Secretary in the 
                evaluation, organization, integration, and 
                coordination of programs operated by the 
                Administration;
                  (C) promote evidence-based and promising best 
                practices, including culturally and 
                linguistically appropriate practices, as 
                appropriate, for the prevention and treatment 
                of, and recovery from, mental and substance use 
                disorders, including serious mental illness and 
                serious emotional disturbances;
                  (D) participate in regular strategic planning 
                with the Administration;
                  (E) coordinate with the Assistant Secretary 
                for Planning and Evaluation to assess the use 
                of performance metrics to evaluate activities 
                within the Administration related to mental and 
                substance use disorders; and
                  (F) coordinate with the Assistant Secretary 
                to ensure mental and substance use disorders 
                grant programs within the Administration 
                consistently utilize appropriate performance 
                metrics and evaluation designs.
  (h) Services of Experts.--
          (1) In general.--The Assistant Secretary may obtain 
        (in accordance with section 3109 of title 5, United 
        States Code, but without regard to the limitation in 
        such section on the number of days or the period of 
        service) the services of not more than 20 experts or 
        consultants who have professional qualifications. Such 
        experts and consultants shall be obtained for the 
        Administration and for each of its agencies.
          (2) Compensation and expenses.--
                  (A) Experts and consultants whose services 
                are obtained under paragraph (1) shall be paid 
                or reimbursed for their expenses associated 
                with traveling to and from their assignment 
                location in accordance with sections 5724, 
                5724a(a), 5724a(c), and 5726(c) of title 5, 
                United States Code.
                  (B) Expenses specified in subparagraph (A) 
                may not be allowed in connection with the 
                assignment of an expert or consultant whose 
                services are obtained under paragraph (1), 
                unless and until the expert or consultant 
                agrees in writing to complete the entire period 
                of assignment or one year, whichever is 
                shorter, unless separated or reassigned for 
                reasons beyond the control of the expert or 
                consultant that are acceptable to the 
                Secretary. If the expert or consultant violates 
                the agreement, the money spent by the United 
                States for the expenses specified in 
                subparagraph (A) is recoverable from the expert 
                or consultant as a debt of the United States. 
                The Secretary may waive in whole or in part a 
                right of recovery under this subparagraph.
  (i) Peer Review Groups.--The Assistant Secretary shall, 
without regard to the provisions of title 5, United States 
Code, governing appointments in the competitive service, and 
without regard to the provisions of chapter 51 and subchapter 
III of chapter 53 of such title, relating to classification and 
General Schedule pay rates, establish such peer review groups 
and program advisory committees as are needed to carry out the 
requirements of this title and appoint and pay members of such 
groups, except that officers and employees of the United States 
shall not receive additional compensation for services as 
members of such groups. The Federal Advisory Committee Act 
shall not apply to the duration of a peer review group 
appointed under this subsection.
  (j) Voluntary Services.--The Assistant Secretary may accept 
voluntary and uncompensated services.
  (k) Administration.--The Assistant Secretary shall ensure 
that programs and activities assigned under this title to the 
Administration are fully administered by the respective Centers 
to which such programs and activities are assigned.
  (l) Strategic Plan.--
          (1) In general.--Not later than September 30, 2018, 
        and every 4 years thereafter, the Assistant Secretary 
        shall develop and carry out a strategic plan in 
        accordance with this subsection for the planning and 
        operation of activities carried out by the 
        Administration, including evidence-based programs.
          (2) Coordination.--In developing and carrying out the 
        strategic plan under this subsection, the Assistant 
        Secretary shall take into consideration the findings 
        and recommendations of the Assistant Secretary for 
        Planning and Evaluation under section 6021(d) of the 
        Helping Families in Mental Health Crisis Reform Act of 
        2016 and the report of the Interdepartmental Serious 
        Mental Illness Coordinating Committee under section 
        6031 of such Act.
          (3) Publication of plan.--Not later than September 
        30, 2018, and every 4 years thereafter, the Assistant 
        Secretary shall--
                  (A) submit the strategic plan developed under 
                paragraph (1) to the Committee on Energy and 
                Commerce and the Committee on Appropriations of 
                the House of Representatives and the Committee 
                on Health, Education, Labor, and Pensions and 
                the Committee on Appropriations of the Senate; 
                and
                  (B) post such plan on the Internet website of 
                the Administration.
          (4) Contents.--The strategic plan developed under 
        paragraph (1) shall--
                  (A) identify strategic priorities, goals, and 
                measurable objectives for mental and substance 
                use disorders activities and programs operated 
                and supported by the Administration, including 
                priorities to prevent or eliminate the burden 
                of mental and substance use disorders;
                  (B) identify ways to improve the quality of 
                services for individuals with mental and 
                substance use disorders, and to reduce 
                homelessness, arrest, incarceration, violence, 
                including self-directed violence, and 
                unnecessary hospitalization of individuals with 
                a mental or substance use disorder, including 
                adults with a serious mental illness or 
                children with a serious emotional disturbance;
                  (C) ensure that programs provide, as 
                appropriate, access to effective and evidence-
                based prevention, diagnosis, intervention, 
                treatment, and recovery services, including 
                culturally and linguistically appropriate 
                services, as appropriate, for individuals with 
                a mental or substance use disorder;
                  (D) identify opportunities to collaborate 
                with the Health Resources and Services 
                Administration to develop or improve--
                          (i) initiatives to encourage 
                        individuals to pursue careers 
                        (especially in rural and underserved 
                        areas and with rural and underserved 
                        populations) as psychiatrists, 
                        including child and adolescent 
                        psychiatrists, psychologists, 
                        psychiatric nurse practitioners, 
                        physician assistants, clinical social 
                        workers, certified peer support 
                        specialists, licensed professional 
                        counselors, or other licensed or 
                        certified mental health or substance 
                        use disorder professionals, including 
                        such professionals specializing in the 
                        diagnosis, evaluation, or treatment of 
                        adults with a serious mental illness or 
                        children with a serious emotional 
                        disturbance; and
                          (ii) a strategy to improve the 
                        recruitment, training, and retention of 
                        a workforce for the treatment of 
                        individuals with mental or substance 
                        use disorders, or co-occurring 
                        disorders;
                  (E) identify opportunities to improve 
                collaboration with States, local governments, 
                communities, and Indian tribes and tribal 
                organizations (as such terms are defined in 
                section 4 of the Indian Self-Determination and 
                Education Assistance Act); and
                  (F) specify a strategy to disseminate 
                evidence-based and promising best practices 
                related to prevention, diagnosis, early 
                intervention, treatment, and recovery services 
                related to mental illness, particularly for 
                adults with a serious mental illness and 
                children with a serious emotional disturbance, 
                and for individuals with a substance use 
                disorder.
  (m) Biennial Report Concerning Activities and Progress.--Not 
later than September 30, 2020, and every 2 years thereafter, 
the Assistant Secretary shall prepare and submit to the 
Committee on Energy and Commerce and the Committee on 
Appropriations of the House of Representatives and the 
Committee on Health, Education, Labor, and Pensions and the 
Committee on Appropriations of the Senate, and post on the 
Internet website of the Administration, a report containing at 
a minimum--
          (1) a review of activities conducted or supported by 
        the Administration, including progress toward strategic 
        priorities, goals, and objectives identified in the 
        strategic plan developed under subsection (l);
          (2) an assessment of programs and activities carried 
        out by the Assistant Secretary, including the extent to 
        which programs and activities under this title and part 
        B of title XIX meet identified goals and performance 
        measures developed for the respective programs and 
        activities;
          (3) a description of the progress made in addressing 
        gaps in mental and substance use disorders prevention, 
        treatment, and recovery services and improving outcomes 
        by the Administration, including with respect to 
        serious mental illnesses, serious emotional 
        disturbances, and co-occurring disorders;
          (4) a description of the manner in which the 
        Administration coordinates and partners with other 
        Federal agencies and departments related to mental and 
        substance use disorders, including activities related 
        to--
                  (A) the implementation and dissemination of 
                research findings into improved programs, 
                including with respect to how advances in 
                serious mental illness and serious emotional 
                disturbance research have been incorporated 
                into programs;
                  (B) the recruitment, training, and retention 
                of a mental and substance use disorders 
                workforce;
                  (C) the integration of mental disorder 
                services, substance use disorder services, and 
                physical health services;
                  (D) homelessness; and
                  (E) veterans;
          (5) a description of the manner in which the 
        Administration promotes coordination by grantees under 
        this title, and part B of title XIX, with State or 
        local agencies; and
          (6) a description of the activities carried out under 
        section 501A(e), with respect to mental and substance 
        use disorders, including--
                  (A) the number and a description of grants 
                awarded;
                  (B) the total amount of funding for grants 
                awarded;
                  (C) a description of the activities supported 
                through such grants, including outcomes of 
                programs supported; and
                  (D) information on how the National Mental 
                Health and Substance Use Policy Laboratory is 
                consulting with the Assistant Secretary for 
                Planning and Evaluation and collaborating with 
                the [Center for Substance Abuse Treatment] 
                Center for Substance Use Services, the [Center 
                for Substance Abuse Prevention] Center for 
                Substance Use Prevention Services, the Center 
                for Behavioral Health Statistics and Quality, 
                and the Center for Mental Health Services to 
                carry out such activities; and
          (7) recommendations made by the Assistant Secretary 
        for Planning and Evaluation under section 6021 of the 
        Helping Families in Mental Health Crisis Reform Act of 
        2016 to improve programs within the Administration, and 
        actions taken in response to such recommendations to 
        improve programs within the Administration.
The Assistant Secretary may meet reporting requirements 
established under this title by providing the contents of such 
reports as an addendum to the biennial report established under 
this subsection, notwithstanding the timeline of other 
reporting requirements in this title. Nothing in this 
subsection shall be construed to alter the content requirements 
of such reports or authorize the Assistant Secretary to alter 
the timeline of any such reports to be less frequent than 
biennially, unless as specified in this title.
  (n) Applications for Grants and Contracts.--With respect to 
awards of grants, cooperative agreements, and contracts under 
this title, the Assistant Secretary, or the Director of the 
Center involved, as the case may be, may not make such an award 
unless--
          (1) an application for the award is submitted to the 
        official involved;
          (2) with respect to carrying out the purpose for 
        which the award is to be provided, the application 
        provides assurances of compliance satisfactory to such 
        official; and
          (3) the application is otherwise in such form, is 
        made in such manner, and contains such agreements, 
        assurances, and information as the official determines 
        to be necessary to carry out the purpose for which the 
        award is to be provided.
  (o) Emergency Response.--
          (1) In general.--Notwithstanding section 504 and 
        except as provided in paragraph (2), the Secretary may 
        use not to exceed 2.5 percent of all amounts 
        appropriated under this title for a fiscal year to make 
        noncompetitive grants, contracts or cooperative 
        agreements to public entities to enable such entities 
        to address emergency substance abuse or mental health 
        needs in local communities.
          (2) Exceptions.--Amounts appropriated under part C 
        shall not be subject to paragraph (1).
          (3) Emergencies.--The Secretary shall establish 
        criteria for determining that a substance abuse or 
        mental health emergency exists and publish such 
        criteria in the Federal Register prior to providing 
        funds under this subsection.
          (4) Emergency response.--Amounts made available for 
        carrying out this subsection shall remain available 
        through the end of the fiscal year following the fiscal 
        year for which such amounts are appropriated.
  (p) Limitation on the Use of Certain Information.--No 
information, if an establishment or person supplying the 
information or described in it is identifiable, obtained in the 
course of activities undertaken or supported under section 505 
may be used for any purpose other than the purpose for which it 
was supplied unless such establishment or person has consented 
(as determined under regulations of the Secretary) to its use 
for such other purpose. Such information may not be published 
or released in other form if the person who supplied the 
information or who is described in it is identifiable unless 
such person has consented (as determined under regulations of 
the Secretary) to its publication or release in other form.
  (q) Authorization of Appropriations.--For the purpose of 
providing grants, cooperative agreements, and contracts under 
this section, there are authorized to be appropriated 
$25,000,000 for fiscal year 2001, and such sums as may be 
necessary for each of the fiscal years 2002 and 2003.

SEC. 501A. NATIONAL MENTAL HEALTH AND SUBSTANCE USE POLICY LABORATORY.

  (a) In General.--There shall be established within the 
Administration a National Mental Health and Substance Use 
Policy Laboratory (referred to in this section as the 
``Laboratory'').
  (b) Responsibilities.--The Laboratory shall--
          (1) continue to carry out the authorities and 
        activities that were in effect for the Office of 
        Policy, Planning, and Innovation as such Office existed 
        prior to the date of enactment of the Helping Families 
        in Mental Health Crisis Reform Act of 2016;
          (2) identify, coordinate, and facilitate the 
        implementation of policy changes likely to have a 
        significant effect on mental health, mental illness, 
        recovery supports, and the prevention and treatment of 
        substance use disorder services;
          (3) work with the Center for Behavioral Health 
        Statistics and Quality to collect, as appropriate, 
        information from grantees under programs operated by 
        the Administration in order to evaluate and disseminate 
        information on evidence-based practices, including 
        culturally and linguistically appropriate services, as 
        appropriate, and service delivery models;
          (4) provide leadership in identifying and 
        coordinating policies and programs, including evidence-
        based programs, related to mental and substance use 
        disorders;
          (5) periodically review programs and activities 
        operated by the Administration relating to the 
        diagnosis or prevention of, treatment for, and recovery 
        from, mental and substance use disorders to--
                  (A) identify any such programs or activities 
                that are duplicative;
                  (B) identify any such programs or activities 
                that are not evidence-based, effective, or 
                efficient; and
                  (C) formulate recommendations for 
                coordinating, eliminating, or improving 
                programs or activities identified under 
                subparagraph (A) or (B) and merging such 
                programs or activities into other successful 
                programs or activities;
          (6) issue and periodically update information for 
        entities applying for grants or cooperative agreements 
        from the [Substance Abuse and Mental Health Services 
        Administration] Substance Use And Mental Health 
        Services Administration in order to--
                  (A) encourage the implementation and 
                replication of evidence-based practices; and
                  (B) provide technical assistance to 
                applicants for funding, including with respect 
                to justifications for such programs and 
                activities; and
          (7) carry out other activities as deemed necessary to 
        continue to encourage innovation and disseminate 
        evidence-based programs and practices.
  (c) Evidence-based Practices and Service Delivery Models.--
          (1) In general.--In carrying out subsection (b)(3), 
        the Laboratory--
                  (A) may give preference to models that 
                improve--
                          (i) the coordination between mental 
                        health and physical health providers;
                          (ii) the coordination among such 
                        providers and the justice and 
                        corrections system; and
                          (iii) the cost effectiveness, 
                        quality, effectiveness, and efficiency 
                        of health care services furnished to 
                        adults with a serious mental illness, 
                        children with a serious emotional 
                        disturbance, or individuals in a mental 
                        health crisis; and
                  (B) may include clinical protocols and 
                practices that address the needs of individuals 
                with early serious mental illness.
          (2) Consultation.--In carrying out this section, the 
        Laboratory shall consult with--
                  (A) the Chief Medical Officer appointed under 
                section 501(g);
                  (B) representatives of the National Institute 
                of Mental Health, the [National Institute on 
                Drug Abuse] National Institute on Drugs and 
                Addiction, and the [National Institute on 
                Alcohol Abuse and Alcoholism] National 
                Institute on Alcohol Effects and Alcohol-
                Associated Disorders, on an ongoing basis;
                  (C) other appropriate Federal agencies;
                  (D) clinical and analytical experts with 
                expertise in psychiatric medical care and 
                clinical psychological care, health care 
                management, education, corrections health care, 
                and mental health court systems, as 
                appropriate; and
                  (E) other individuals and agencies as 
                determined appropriate by the Assistant 
                Secretary.
  (d) Deadline for Beginning Implementation.--The Laboratory 
shall begin implementation of this section not later than 
January 1, 2018.
  (e) Promoting Innovation.--
          (1) In general.--The Assistant Secretary, in 
        coordination with the Laboratory, may award grants to 
        States, local governments, Indian tribes or tribal 
        organizations (as such terms are defined in section 4 
        of the Indian Self-Determination and Education 
        Assistance Act), educational institutions, and 
        nonprofit organizations to develop evidence-based 
        interventions, including culturally and linguistically 
        appropriate services, as appropriate, for--
                  (A) evaluating a model that has been 
                scientifically demonstrated to show promise, 
                but would benefit from further applied 
                development, for--
                          (i) enhancing the prevention, 
                        diagnosis, intervention, and treatment 
                        of, and recovery from, mental illness, 
                        serious emotional disturbances, 
                        substance use disorders, and co-
                        occurring illness or disorders; or
                          (ii) integrating or coordinating 
                        physical health services and mental and 
                        substance use disorders services; and
                  (B) expanding, replicating, or scaling 
                evidence-based programs across a wider area to 
                enhance effective screening, early diagnosis, 
                intervention, and treatment with respect to 
                mental illness, serious mental illness, serious 
                emotional disturbances, and substance use 
                disorders, primarily by--
                          (i) applying such evidence-based 
                        programs to the delivery of care, 
                        including by training staff in 
                        effective evidence-based treatments; or
                          (ii) integrating such evidence-based 
                        programs into models of care across 
                        specialties and jurisdictions.
          (2) Consultation.--In awarding grants under this 
        subsection, the Assistant Secretary shall, as 
        appropriate, consult with the Chief Medical Officer, 
        appointed under section 501(g), the advisory councils 
        described in section 502, the National Institute of 
        Mental Health, the [National Institute on Drug Abuse] 
        National Institute on Drugs and Addiction, and the 
        [National Institute on Alcohol Abuse and Alcoholism] 
        National Institute on Alcohol Effects and Alcohol-
        Associated Disorders, as appropriate.
          (3) Authorization of appropriations.--There are 
        authorized to be appropriated--
                  (A) to carry out paragraph (1)(A), $7,000,000 
                for the period of fiscal years 2018 through 
                2020; and
                  (B) to carry out paragraph (1)(B), $7,000,000 
                for the period of fiscal years 2018 through 
                2020.

                           advisory councils

  Sec. 502. (a) Appointment.--
          (1) In general.--The Secretary shall appoint an 
        advisory council for--
                  (A) the [Substance Abuse and Mental Health 
                Services Administration] Substance Use And 
                Mental Health Services Administration;
                  (B) the [Center for Substance Abuse 
                Treatment] Center for Substance Use Services;
                  (C) the [Center for Substance Abuse 
                Prevention] Center for Substance Use Prevention 
                Services; and
                  (D) the Center for Mental Health Services.
        Each such advisory council shall advise, consult with, 
        and make recommendations to the Secretary and the 
        Assistant Secretary or Director of the Administration 
        or Center for which the advisory council is established 
        concerning matters relating to the activities carried 
        out by and through the Administration or Center and the 
        policies respecting such activities.
          (2) Function and activities.--An advisory council--
                  (A)(i) may on the basis of the materials 
                provided by the organization respecting 
                activities conducted at the organization, make 
                recommendations to the Assistant Secretary or 
                Director of the Administration or Center for 
                which it was established respecting such 
                activities;
                  (ii) shall review applications submitted for 
                grants and cooperative agreements for 
                activities for which advisory council approval 
                is required under section 504(d)(2) and 
                recommend for approval applications for 
                projects that show promise of making valuable 
                contributions to the Administration's mission; 
                and
                  (iii) may review any grant, contract, or 
                cooperative agreement proposed to be made or 
                entered into by the organization;
                  (B) may collect, by correspondence or by 
                personal investigation, information as to 
                studies and services that are being carried on 
                in the United States or any other country as to 
                the diseases, disorders, or other aspects of 
                human health with respect to which the 
                organization was established and with the 
                approval of the Assistant Secretary or 
                Director, whichever is appropriate, make such 
                information available through appropriate 
                publications for the benefit of public and 
                private health entities and health professions 
                personnel and for the information of the 
                general public; and
                  (C) may appoint subcommittees and convene 
                workshops and conferences.
  (b) Membership.--
          (1) In general.--Each advisory council shall consist 
        of nonvoting ex officio members and not more than 12 
        members to be appointed by the Secretary under 
        paragraph (3).
          (2) Ex officio members.--The ex officio members of an 
        advisory council shall consist of--
                  (A) the Secretary;
                  (B) the Assistant Secretary;
                  (C) the Director of the Center for which the 
                council is established;
                  (D) the Under Secretary for Health of the 
                Department of Veterans Affairs;
                  (E) the Assistant Secretary for Defense for 
                Health Affairs (or the designates of such 
                officers);
                  (F) the Chief Medical Officer, appointed 
                under section 501(g);
                  (G) the Director of the National Institute of 
                Mental Health for the advisory councils 
                appointed under subsections (a)(1)(A) and 
                (a)(1)(D);
                  (H) the Director of the [National Institute 
                on Drug Abuse] National Institute on Drugs and 
                Addiction for the advisory councils appointed 
                under subsections (a)(1)(A), (a)(1)(B), and 
                (a)(1)(C);
                  (I) the Director of the [National Institute 
                on Alcohol Abuse and Alcoholism] National 
                Institute on Alcohol Effects and Alcohol-
                Associated Disorders for the advisory councils 
                appointed under subsections (a)(1)(A), 
                (a)(1)(B), and (a)(1)(C); and
                  (J) such additional officers or employees of 
                the United States as the Secretary determines 
                necessary for the advisory council to 
                effectively carry out its functions.
          (3) Appointed members.--Individuals shall be 
        appointed to an advisory council under paragraph (1) as 
        follows:
                  (A) Nine of the members shall be appointed by 
                the Secretary from among the leading 
                representatives of the health disciplines 
                (including public health and behavioral and 
                social sciences) relevant to the activities of 
                the Administration or Center for which the 
                advisory council is established.
                  (B) Three of the members shall be appointed 
                by the Secretary from the general public and 
                shall include leaders in fields of public 
                policy, public relations, law, health policy 
                economics, or management.
                  (C) Not less than half of the members of the 
                advisory council appointed under subsection 
                (a)(1)(D)--
                          (i) shall--
                                  (I) have a medical degree;
                                  (II) have a doctoral degree 
                                in psychology; or
                                  (III) have an advanced degree 
                                in nursing or social work from 
                                an accredited graduate school 
                                or be a certified physician 
                                assistant; and
                          (ii) shall specialize in the mental 
                        health field.
                  (D) Not less than half of the members of the 
                advisory councils appointed under subsections 
                (a)(1)(B) and (a)(1)(C)--
                          (i) shall--
                                  (I) have a medical degree;
                                  (II) have a doctoral degree; 
                                or
                                  (III) have an advanced degree 
                                in nursing, public health, 
                                behavioral or social sciences, 
                                or social work from an 
                                accredited graduate school or 
                                be a certified physician 
                                assistant; and
                          (ii) shall have experience in the 
                        provision of substance use disorder 
                        services or the development and 
                        implementation of programs to prevent 
                        substance misuse.
          (4) Compensation.--Members of an advisory council who 
        are officers or employees of the United States shall 
        not receive any compensation for service on the 
        advisory council. The remaining members of an advisory 
        council shall receive, for each day (including travel 
        time) they are engaged in the performance of the 
        functions of the advisory council, compensation at 
        rates not to exceed the daily equivalent to the annual 
        rate in effect for grade GS-18 of the General Schedule.
  (c) Terms of Office.--
          (1) In general.--The term of office of a member of an 
        advisory council appointed under subsection (b) shall 
        be 4 years, except that any member appointed to fill a 
        vacancy for an unexpired term shall serve for the 
        remainder of such term. The Secretary shall make 
        appointments to an advisory council in such a manner as 
        to ensure that the terms of the members not all expire 
        in the same year. A member of an advisory council may 
        serve after the expiration of such member's term until 
        a successor has been appointed and taken office.
          (2) Reappointments.--A member who has been appointed 
        to an advisory council for a term of 4 years may not be 
        reappointed to an advisory council during the 2-year 
        period beginning on the date on which such 4-year term 
        expired.
          (3) Time for appointment.--If a vacancy occurs in an 
        advisory council among the members under subsection 
        (b), the Secretary shall make an appointment to fill 
        such vacancy within 90 days from the date the vacancy 
        occurs.
  (d) Chair.--The Secretary shall select a member of an 
advisory council to serve as the chair of the council. The 
Secretary may so select an individual from among the appointed 
members, or may select the Assistant Secretary or the Director 
of the Center involved. The term of office of the chair shall 
be 2 years.
  (e) Meetings.--An advisory council shall meet at the call of 
the chairperson or upon the request of the Assistant Secretary 
or Director of the Administration or Center for which the 
advisory council is established, but in no event less than 2 
times during each fiscal year. The location of the meetings of 
each advisory council shall be subject to the approval of the 
Assistant Secretary or Director of Administration or Center for 
which the council was established.
  (f) Executive Secretary and Staff.--The Assistant Secretary 
or Director of the Administration or Center for which the 
advisory council is established shall designate a member of the 
staff of the Administration or Center for which the advisory 
council is established to serve as the Executive Secretary of 
the advisory council. The Assistant Secretary or Director shall 
make available to the advisory council such staff, information, 
and other assistance as it may require to carry out its 
functions. The Assistant Secretary or Director shall provide 
orientation and training for new members of the advisory 
council to provide for their effective participation in the 
functions of the advisory council.

           *       *       *       *       *       *       *


                      Part B--Centers and Programs


            Subpart 1--Center for Substance Abuse Treatment


    [center for substance abuse treatment]  center for substance use 
                                services

  Sec. 507. (a) Establishment.--There is established in the 
Administration a [Center for Substance Abuse Treatment] Center 
for Substance Use Services (hereafter in this section referred 
to as the ``Center''). The Center shall be headed by a Director 
(hereafter in this section referred to as the ``Director'') 
appointed by the Secretary from among individuals with 
extensive experience or academic qualifications in the 
treatment of substance use disorders or in the evaluation of 
substance use disorder treatment systems.
  (b) Duties.--The Director of the Center shall--
          (1) administer the substance use disorder treatment 
        block grant program authorized in section 1921;
          (2) ensure that emphasis is placed on children and 
        adolescents in the development of treatment programs;
          (3) collaborate with the Attorney General to develop 
        programs to provide substance use disorder treatment 
        services to individuals who have had contact with the 
        Justice system, especially adolescents;
          (4) collaborate with the Director of the [Center for 
        Substance Abuse Prevention] Center for Substance Use 
        Prevention Services in order to provide outreach 
        services to identify individuals in need of treatment 
        services, with emphasis on the provision of such 
        services to pregnant and postpartum women and their 
        infants and to individuals who illicitly use drugs 
        intravenously;
          (5) collaborate with the Director of the [National 
        Institute on Drug Abuse] National Institute on Drugs 
        and Addiction, with the Director of the [National 
        Institute on Alcohol Abuse and Alcoholism] National 
        Institute on Alcohol Effects and Alcohol-Associated 
        Disorders, and with the States to promote the study, 
        dissemination, and implementation of research findings 
        that will improve the delivery and effectiveness of 
        treatment services;
          (6) collaborate with the Administrator of the Health 
        Resources and Services Administration and the 
        Administrator of the Centers for Medicare & Medicaid 
        Services to promote the increased integration into the 
        mainstream of the health care system of the United 
        States of programs for providing treatment services;
          (7) evaluate plans submitted by the States pursuant 
        to section 1932(a)(6) in order to determine whether the 
        plans adequately provide for the availability, 
        allocation, and effectiveness of treatment services;
          (8) sponsor regional workshops on improving the 
        quality and availability of treatment services;
          (9) provide technical assistance to public and 
        nonprofit private entities that provide treatment 
        services, including technical assistance with respect 
        to the process of submitting to the Director 
        applications for any program of grants or contracts;
          (10) carry out activities to educate individuals on 
        the need for establishing treatment facilities within 
        their communities;
          (11) encourage public and private entities that 
        provide health insurance to provide benefits for 
        outpatient treatment services and other nonhospital-
        based treatment services;
          (12) evaluate treatment programs to determine the 
        quality and appropriateness of various forms of 
        treatment, which shall be carried out through grants, 
        contracts, or cooperative agreements provided to public 
        or nonprofit private entities;
          (13) ensure the consistent documentation of the 
        application of criteria when awarding grants and the 
        ongoing oversight of grantees after such grants are 
        awarded;
          (14) work with States, providers, and individuals in 
        recovery, and their families, to promote the expansion 
        of recovery support services and systems of care 
        oriented toward recovery;
          (15) in cooperation with the Secretary, implement and 
        disseminate, as appropriate, the recommendations in the 
        report entitled ``Protecting Our Infants Act: Final 
        Strategy'' issued by the Department of Health and Human 
        Services in 2017; and
          (16) in cooperation with relevant stakeholders, and 
        through public-private partnerships, encourage 
        education about substance use disorders for pregnant 
        women and health care providers who treat pregnant 
        women and babies.
  (c) Grants and Contracts.--In carrying out the duties 
established in subsection (b), the Director may make grants to 
and enter into contracts and cooperative agreements with public 
and nonprofit private entities.

    residential treatment programs for pregnant and postpartum women

  Sec. 508. (a) In General.--The Director of the [Center for 
Substance Abuse Treatment] Center for Substance Use Services 
(referred to in this section as the ``Director'') shall provide 
awards of grants, including the grants under subsection (r), 
cooperative agreements or contracts to public and nonprofit 
private entities for the purpose of providing to pregnant and 
postpartum women treatment for substance use disorders through 
programs in which, during the course of receiving treatment--
          (1) the women reside in or receive outpatient 
        treatment services from facilities provided by the 
        programs;
          (2) the minor children of the women reside with the 
        women in such facilities, if the women so request; and
          (3) the services described in subsection (d) are 
        available to or on behalf of the women.
  (b) Availability of Services for Each Participant.--A funding 
agreement for an award under subsection (a) for an applicant is 
that, in the program operated pursuant to such subsection--
          (1) treatment services and each supplemental service 
        will be available through the applicant, either 
        directly or through agreements with other public or 
        nonprofit private entities; and
          (2) the services will be made available to each woman 
        admitted to the program and her children.
  (c) Individualized Plan of Services.--A funding agreement for 
an award under subsection (a) for an applicant is that--
          (1) in providing authorized services for an eligible 
        woman pursuant to such subsection, the applicant will, 
        in consultation with the women, prepare an 
        individualized plan for the provision of services for 
        the woman and her children; and
          (2) treatment services under the plan will include--
                  (A) individual, group, and family counseling, 
                as appropriate, regarding substance use 
                disorders; and
                  (B) follow-up services to assist the woman in 
                preventing a relapse into such a disorder.
  (d) Required Supplemental Services.--In the case of an 
eligible woman, the services referred to in subsection (a)(3) 
are as follows:
          (1) Prenatal and postpartum health care.
          (2) Referrals for necessary hospital services.
          (3) For the infants and children of the woman--
                  (A) pediatric health care, including 
                treatment for any perinatal effects of a 
                maternal substance use disorder and including 
                screenings regarding the physical and mental 
                development of the infants and children;
                  (B) counseling and other mental health 
                services, in the case of children; and
                  (C) comprehensive social services.
          (4) Providing therapeutic, comprehensive child care 
        for children during the periods in which the woman is 
        engaged in therapy or in other necessary health and 
        rehabilitative activities.
          (5) Training in parenting.
          (6) Counseling on the human immunodeficiency virus 
        and on acquired immune deficiency syndrome.
          (7) Counseling on domestic violence and sexual abuse.
          (8) Counseling on obtaining employment, including the 
        importance of graduating from a secondary school.
          (9) Reasonable efforts to preserve and support the 
        family unit of the woman, including promoting the 
        appropriate involvement of parents and others, and 
        counseling the children of the woman.
          (10) Planning for and counseling to assist reentry 
        into society, both before and after discharge, 
        including referrals to any public or nonprofit private 
        entities in the community involved that provide 
        services appropriate for the woman and the children of 
        the woman.
          (11) Case management services, including--
                  (A) assessing the extent to which authorized 
                services are appropriate for the woman and any 
                child of such woman;
                  (B) in the case of the services that are 
                appropriate, ensuring that the services are 
                provided in a coordinated manner;
                  (C) assistance in establishing eligibility 
                for assistance under Federal, State, and local 
                programs providing health services, mental 
                health services, housing services, employment 
                services, educational services, or social 
                services; and
                  (D) family reunification with children in 
                kinship or foster care arrangements, where safe 
                and appropriate.
  (e) Minimum Qualifications For Receipt of Award.--
          (1) Certification by relevant state agency.--With 
        respect to the principal agency of the State involved 
        that administers programs relating to substance use 
        disorders, the Director may make an award under 
        subsection (a) to an applicant only if the agency has 
        certified to the Director that--
                  (A) the applicant has the capacity to carry 
                out a program described in subsection (a);
                  (B) the plans of the applicant for such a 
                program are consistent with the policies of 
                such agency regarding the treatment of 
                substance use disorders; and
                  (C) the applicant, or any entity through 
                which the applicant will provide authorized 
                services, meets all applicable State licensure 
                or certification requirements regarding the 
                provision of the services involved.
          (2) Status as medicaid provider.--
                  (A) In general.--Subject to subparagraphs (B) 
                and (C), the Director may make an award under 
                subsection (a) only if, in the case of any 
                authorized service that is available pursuant 
                to the State plan approved under title XIX of 
                the Social Security Act for the State 
                involved--
                          (i) the applicant for the award will 
                        provide the service directly, and the 
                        applicant has entered into a 
                        participation agreement under the State 
                        plan and is qualified to receive 
                        payments under such plan; or
                          (ii) the applicant will enter into an 
                        agreement with a public or nonprofit 
                        private entity under which the entity 
                        will provide the service, and the 
                        entity has entered into such a 
                        participation agreement plan and is 
                        qualified to receive such payments.
                  (B) Waiver of participation agreements.--
                          (i) In general.--In the case of an 
                        entity making an agreement pursuant to 
                        subparagraph (A)(ii) regarding the 
                        provision of services, the requirement 
                        established in such subparagraph 
                        regarding a participation agreement 
                        shall be waived by the Director if the 
                        entity does not, in providing health 
                        care services, impose a charge or 
                        accept reimbursement available from any 
                        third-party payor, including 
                        reimbursement under any insurance 
                        policy or under any Federal or State 
                        health benefits plan.
                          (ii) Donations.--A determination by 
                        the Director of whether an entity 
                        referred to in clause (i) meets the 
                        criteria for a waiver under such clause 
                        shall be made without regard to whether 
                        the entity accepts voluntary donations 
                        regarding the provision of services to 
                        the public.
                  (C) Nonapplication of certain requirements.--
                With respect to any authorized service that is 
                available pursuant to the State plan described 
                in subparagraph (A), the requirements 
                established in such subparagraph shall not 
                apply to the provision of any such service by 
                an institution for mental diseases to an 
                individual who has attained 21 years of age and 
                who has not attained 65 years of age. For 
                purposes of the preceding sentence, the term 
                ``institution for mental diseases'' has the 
                meaning given such term in section 1905(i) of 
                the Social Security Act.
  (f) Requirement of Matching Funds.--
          (1) In general.--With respect to the costs of the 
        program to be carried out by an applicant pursuant to 
        subsection (a), a funding agreement for an award under 
        such subsection is that the applicant will make 
        available (directly or through donations from public or 
        private entities) non-Federal contributions toward such 
        costs in an amount that--
                  (A) for the first fiscal year for which the 
                applicant receives payments under an award 
                under such subsection, is not less than $1 for 
                each $9 of Federal funds provided in the award;
                  (B) for any second such fiscal year, is not 
                less than $1 for each $9 of Federal funds 
                provided in the award; and
                  (C) for any subsequent such fiscal year, is 
                not less than $1 for each $3 of Federal funds 
                provided in the award.
          (2) Determination of amount contributed.--Non-Federal 
        contributions required in paragraph (1) may be in cash 
        or in kind, fairly evaluated, including plant, 
        equipment, or services. Amounts provided by the Federal 
        Government, or services assisted or subsidized to any 
        significant extent by the Federal Government, may not 
        be included in determining the amount of such non-
        Federal contributions.
  (g) Outreach.--A funding agreement for an award under 
subsection (a) for an applicant is that the applicant will 
provide outreach services in the community involved to identify 
women who have a substance use disorder and to encourage the 
women to undergo treatment for such disorder.
  (h) Accessibility of Program; Cultural Context of Services.--
A funding agreement for an award under subsection (a) for an 
applicant is that--
          (1) the program operated pursuant to such subsection 
        will be operated at a location that is accessible to 
        low-income pregnant and postpartum women; and
          (2) authorized services will be provided in the 
        language and the cultural context that is most 
        appropriate.
  (i) Continuing Education.--A funding agreement for an award 
under subsection (a) is that the applicant involved will 
provide for continuing education in treatment services for the 
individuals who will provide treatment in the program to be 
operated by the applicant pursuant to such subsection.
  (j) Imposition of Charges.--A funding agreement for an award 
under subsection (a) for an applicant is that, if a charge is 
imposed for the provision of authorized services to or on 
behalf of an eligible woman, such charge--
          (1) will be made according to a schedule of charges 
        that is made available to the public;
          (2) will be adjusted to reflect the income of the 
        woman involved; and
          (3) will not be imposed on any such woman with an 
        income of less than 185 percent of the official poverty 
        line, as established by the Director of the Office of 
        Management and Budget and revised by the Secretary in 
        accordance with section 673(2) of the Omnibus Budget 
        Reconciliation Act of 1981.
  (k) Reports to Director.--A funding agreement for an award 
under subsection (a) is that the applicant involved will submit 
to the Director a report--
          (1) describing the utilization and costs of services 
        provided under the award;
          (2) specifying the number of women served, the number 
        of infants served, and the type and costs of services 
        provided; and
          (3) providing such other information as the Director 
        determines to be appropriate.
  (l) Requirement of Application.--The Director may make an 
award under subsection (a) only if an application for the award 
is submitted to the Director containing such agreements, and 
the application is in such form, is made in such manner, and 
contains such other agreements and such assurances and 
information as the Director determines to be necessary to carry 
out this section.
  (m) Allocation of Awards.--In making awards under subsection 
(a), the Director shall give priority to an applicant that 
agrees to use the award for a program serving an area that is a 
rural area, an area designated under section 332 by the 
Secretary as a health professional shortage area, or an area 
determined by the Director to have a shortage of family-based 
substance use disorder treatment options.
  (n) Duration of Award.--The period during which payments are 
made to an entity from an award under subsection (a) may not 
exceed 5 years. The provision of such payments shall be subject 
to annual approval by the Director of the payments and subject 
to the availability of appropriations for the fiscal year 
involved to make the payments. This subsection may not be 
construed to establish a limitation on the number of awards 
under such subsection that may be made to an entity.
  (o) Evaluations; Dissemination of Findings.--The Director 
shall, directly or through contract, provide for the conduct of 
evaluations of programs carried out pursuant to subsection (a). 
The Director shall disseminate to the States the findings made 
as a result of the evaluations.
  (p) Reports to Congress.--Not later than October 1, 1994, the 
Director shall submit to the Committee on Energy and Commerce 
of the House of Representatives, and to the Committee on Labor 
and Human Resources of the Senate, a report describing programs 
carried out pursuant to this section (other than subsection 
(r)). Every 2 years thereafter, the Director shall prepare a 
report describing such programs carried out during the 
preceding 2 years, and shall submit the report to the Assistant 
Secretary for inclusion in the biennial report under section 
501(m). Each report under this subsection shall include a 
summary of any evaluations conducted under subsection (m) 
during the period with respect to which the report is prepared.
  (q) Definitions.--For purposes of this section:
          (1) The term ``authorized services'' means treatment 
        services and supplemental services.
          (2) The term ``eligible woman'' means a woman who has 
        been admitted to a program operated pursuant to 
        subsection (a).
          (3) The term ``funding agreement'', with respect to 
        an award under subsection (a), means that the Director 
        may make the award only if the applicant makes the 
        agreement involved.
          (4) The term ``treatment services'' means treatment 
        for a substance use disorder, including the counseling 
        and services described in subsection (c)(2).
          (5) The term ``supplemental services'' means the 
        services described in subsection (d).
  (r) Pilot Program for State Substance Abuse Agencies.--
          (1) In general.--From amounts made available under 
        subsection (s), the Director of the [Center for 
        Substance Abuse Treatment] Center for Substance Use 
        Services shall carry out a pilot program under which 
        competitive grants are made by the Director to State 
        substance abuse agencies--
                  (A) to enhance flexibility in the use of 
                funds designed to support family-based services 
                for pregnant and postpartum women with a 
                primary diagnosis of a substance use disorder, 
                including opioid use disorders;
                  (B) to help State substance abuse agencies 
                address identified gaps in services furnished 
                to such women along the continuum of care, 
                including services provided to women in 
                nonresidential-based settings; and
                  (C) to promote a coordinated, effective, and 
                efficient State system managed by State 
                substance abuse agencies by encouraging new 
                approaches and models of service delivery.
          (2) Requirements.--In carrying out the pilot program 
        under this subsection, the Director shall--
                  (A) require State substance abuse agencies to 
                submit to the Director applications, in such 
                form and manner and containing such information 
                as specified by the Director, to be eligible to 
                receive a grant under the program;
                  (B) identify, based on such submitted 
                applications, State substance abuse agencies 
                that are eligible for such grants;
                  (C) require services proposed to be furnished 
                through such a grant to support family-based 
                treatment and other services for pregnant and 
                postpartum women with a primary diagnosis of a 
                substance use disorder, including opioid use 
                disorders;
                  (D) not require that services furnished 
                through such a grant be provided solely to 
                women that reside in facilities;
                  (E) not require that grant recipients under 
                the program make available through use of the 
                grant all the services described in subsection 
                (d); and
                  (F) consider not applying the requirements 
                described in paragraphs (1) and (2) of 
                subsection (f) to an applicant, depending on 
                the circumstances of the applicant.
          (3) Required services.--
                  (A) In general.--The Director shall specify a 
                minimum set of services required to be made 
                available to eligible women through a grant 
                awarded under the pilot program under this 
                subsection. Such minimum set of services--
                          (i) shall include the services 
                        requirements described in subsection 
                        (c) and be based on the recommendations 
                        submitted under subparagraph (B); and
                          (ii) may be selected from among the 
                        services described in subsection (d) 
                        and include other services as 
                        appropriate.
                  (B) Stakeholder input.--The Director shall 
                convene and solicit recommendations from 
                stakeholders, including State substance abuse 
                agencies, health care providers, persons in 
                recovery from substance abuse, and other 
                appropriate individuals, for the minimum set of 
                services described in subparagraph (A).
          (4) Duration.--The pilot program under this 
        subsection shall not exceed 5 years.
          (5) Evaluation and report to congress.--
                  (A) In general.--The Director of the Center 
                for Behavioral Health Statistics and Quality 
                shall evaluate the pilot program at the 
                conclusion of the first grant cycle funded by 
                the pilot program.
                  (B) Report.--The Director of the Center for 
                Behavioral Health Statistics and Quality, in 
                coordination with the Director of the [Center 
                for Substance Abuse Treatment] Center for 
                Substance Use Services shall submit to the 
                relevant committees of jurisdiction of the 
                House of Representatives and the Senate a 
                report on the evaluation under subparagraph 
                (A). The report shall include, at a minimum--
                          (i) outcomes information from the 
                        pilot program, including any resulting 
                        reductions in the use of alcohol and 
                        other drugs;
                          (ii) engagement in treatment 
                        services;
                          (iii) retention in the appropriate 
                        level and duration of services;
                          (iv) increased access to the use of 
                        medications approved by the Food and 
                        Drug Administration for the treatment 
                        of substance use disorders in 
                        combination with counseling; and
                          (v) other appropriate measures.
                  (C) Recommendation.--The report under 
                subparagraph (B) shall include a recommendation 
                by the Director of the [Center for Substance 
                Abuse Treatment] Center for Substance Use 
                Services as to whether the pilot program under 
                this subsection should be extended.
          (6) State substance abuse agencies defined.--For 
        purposes of this subsection, the term ``State substance 
        abuse agency'' means, with respect to a State, the 
        agency in such State that manages the Substance Abuse 
        Prevention and Treatment Block Grant under part B of 
        title XIX.
  (s) Authorization of Appropriations.--For the purpose of 
carrying out this section, there are authorized to be 
appropriated $29,931,000 for each of fiscal years 2019 through 
2023. Of the amounts made available for a year pursuant to the 
previous sentence to carry out this section, not more than 25 
percent of such amounts shall be made available for such year 
to carry out subsection (r), other than paragraph (5) of such 
subsection. Notwithstanding the preceding sentence, no funds 
shall be made available to carry out subsection (r) for a 
fiscal year unless the amount made available to carry out this 
section for such fiscal year is more than the amount made 
available to carry out this section for fiscal year 2016.

           *       *       *       *       *       *       *


   action by national institute on drug abuse and states concerning 
                          military facilities

  Sec. 513. (a)  [Center for Substance Abuse Treatment] Center 
for Substance Use Services.--The Director of the [Center for 
Substance Abuse Treatment] Center for Substance Use Services 
shall--
          (1) coordinate with the agencies represented on the 
        Commission on Alternative Utilization of Military 
        Facilities the utilization of military facilities or 
        parts thereof, as identified by such Commission, 
        established under the National Defense Authorization 
        Act of 1989, that could be utilized or renovated to 
        house nonviolent persons for drug treatment purposes;
          (2) notify State agencies responsible for the 
        oversight of drug abuse treatment entities and programs 
        of the availability of space at the installations 
        identified in paragraph (1); and
          (3) assist State agencies responsible for the 
        oversight of drug abuse treatment entities and programs 
        in developing methods for adapting the installations 
        described in paragraph (1) into residential treatment 
        centers.
  (b) States.--With regard to military facilities or parts 
thereof, as identified by the Commission on Alternative 
Utilization of Military Facilities established under section 
3042 of the Comprehensive Alcohol Abuse, Drug Abuse, and Mental 
Health Amendments Act of 1988, that could be utilized or 
renovated to house nonviolent persons for drug treatment 
purposes, State agencies responsible for the oversight of drug 
abuse treatment entities and programs shall--
          (1) establish eligibility criteria for the treatment 
        of individuals at such facilities;
          (2) select treatment providers to provide drug abuse 
        treatment at such facilities;
          (3) provide assistance to treatment providers 
        selected under paragraph (2) to assist such providers 
        in securing financing to fund the cost of the programs 
        at such facilities; and
          (4) establish, regulate, and coordinate with the 
        military official in charge of the facility, work 
        programs for individuals receiving treatment at such 
        facilities.
  (c) Reservation of Space.--Prior to notifying States of the 
availability of space at military facilities under subsection 
(a)(2), the Director may reserve space at such facilities to 
conduct research or demonstration projects.

           *       *       *       *       *       *       *


            Subpart 2--Center for Substance Abuse Prevention


   [center for substance abuse prevention]  center for substance use 
                          prevention services

  Sec. 515. (a) There is established in the Administration a 
[Center for Substance Abuse Prevention] Center for Substance 
Use Prevention Services (hereafter referred to in this part as 
the ``Prevention Center''). The Prevention Center shall be 
headed by a Director appointed by the Secretary from 
individuals with extensive experience or academic 
qualifications in the prevention of drug or alcohol abuse.
  (b) The Director of the Prevention Center shall--
          (1) sponsor regional workshops on the prevention of 
        drug and alcohol abuse through the reduction of risk 
        and the promotion of resiliency;
          (2) coordinate the findings of research sponsored by 
        agencies of the Service on the prevention of drug and 
        alcohol abuse;
          (3) collaborate with the Director of the [National 
        Institute on Drug Abuse] National Institute on Drugs 
        and Addiction, the Director of the [National Institute 
        on Alcohol Abuse and Alcoholism] National Institute on 
        Alcohol Effects and Alcohol-Associated Disorders, and 
        States to promote the study of substance abuse 
        prevention and the dissemination and implementation of 
        research findings that will improve the delivery and 
        effectiveness of substance abuse prevention activities;
          (4) develop effective drug and alcohol abuse 
        prevention literature (including educational 
        information on the effects of drugs abused by 
        individuals, including drugs that are emerging as 
        abused drugs);
          (5) in cooperation with the Secretary of Education, 
        assure the widespread dissemination of prevention 
        materials among States, political subdivisions, and 
        school systems;
          (6) support clinical training programs for health 
        professionals who provide substance use and misuse 
        prevention and treatment services and other health 
        professionals involved in illicit drug use education 
        and prevention;
          (7) in cooperation with the Director of the Centers 
        for Disease Control and Prevention, develop and 
        disseminate educational materials to increase awareness 
        for individuals at greatest risk for substance use 
        disorders to prevent the transmission of communicable 
        diseases, such as HIV, hepatitis, tuberculosis, and 
        other communicable diseases;
          (8) conduct training, technical assistance, data 
        collection, and evaluation activities of programs 
        supported under the Drug Free Schools and Communities 
        Act of 1986;
          (9) support the development of model, innovative, 
        community-based programs that reduce the risk of 
        alcohol and drug abuse among young people and promote 
        resiliency;
          (10) collaborate with the Attorney General of the 
        Department of Justice to develop programs to prevent 
        drug abuse among high risk youth;
          (11) prepare for distribution documentary films and 
        public service announcements for television and radio 
        to educate the public, especially adolescent audiences, 
        concerning the dangers to health resulting from the 
        consumption of alcohol and drugs and, to the extent 
        feasible, use appropriate private organizations and 
        business concerns in the preparation of such 
        announcements;
          (12) develop and support innovative demonstration 
        programs designed to identify and deter the improper 
        use or abuse of anabolic steroids by students, 
        especially students in secondary schools;
          (13) ensure the consistent documentation of the 
        application of criteria when awarding grants and the 
        ongoing oversight of grantees after such grants are 
        awarded;
          (14) assist and support States in preventing illicit 
        drug use, including emerging illicit drug use issues; 
        and
          (15) in consultation with relevant stakeholders and 
        in collaboration with the Director of the Centers for 
        Disease Control and Prevention, develop educational 
        materials for clinicians to use with pregnant women for 
        shared decision making regarding pain management and 
        the prevention of substance use disorders during 
        pregnancy.
  (c) The Director may make grants and enter into contracts and 
cooperative agreements in carrying out subsection (b).
  (d) The Director of the Prevention Center shall establish a 
national data base providing information on programs for the 
prevention of substance abuse. The data base shall contain 
information appropriate for use by public entities and 
information appropriate for use by nonprofit private entities.

           *       *       *       *       *       *       *


SEC. 519B. PROGRAMS TO REDUCE UNDERAGE DRINKING.

  (a) Definitions.--For purposes of this section:
          (1) The term ``alcohol beverage industry'' means the 
        brewers, vintners, distillers, importers, distributors, 
        and retail or online outlets that sell or serve beer, 
        wine, and distilled spirits.
          (2) The term ``school-based prevention'' means 
        programs, which are institutionalized, and run by staff 
        members or school-designated persons or organizations 
        in any grade of school, kindergarten through 12th 
        grade.
          (3) The term ``youth'' means persons under the age of 
        21.
          (4) The term ``IOM report'' means the report released 
        in September 2003 by the National Research Council, 
        Institute of Medicine, and entitled ``Reducing Underage 
        Drinking: A Collective Responsibility''.
  (b) Sense of Congress.--It is the sense of the Congress that:
          (1) A multi-faceted effort is needed to more 
        successfully address the problem of underage drinking 
        in the United States. A coordinated approach to 
        prevention, intervention, treatment, enforcement, and 
        research is key to making progress. This Act recognizes 
        the need for a focused national effort, and addresses 
        particulars of the Federal portion of that effort, as 
        well as Federal support for State activities.
          (2) The Secretary of Health and Human Services shall 
        continue to conduct research and collect data on the 
        short and long-range impact of alcohol use and abuse 
        upon adolescent brain development and other organ 
        systems.
          (3) States and communities, including colleges and 
        universities, are encouraged to adopt comprehensive 
        prevention approaches, including--
                  (A) evidence-based screening, programs and 
                curricula;
                  (B) brief intervention strategies;
                  (C) consistent policy enforcement; and
                  (D) environmental changes that limit underage 
                access to alcohol.
          (4) Public health groups, consumer groups, and the 
        alcohol beverage industry should continue and expand 
        evidence-based efforts to prevent and reduce underage 
        drinking.
          (5) The entertainment industries have a powerful 
        impact on youth, and they should use rating systems and 
        marketing codes to reduce the likelihood that underage 
        audiences will be exposed to movies, recordings, or 
        television programs with unsuitable alcohol content.
          (6) The National Collegiate Athletic Association, its 
        member colleges and universities, and athletic 
        conferences should affirm a commitment to a policy of 
        discouraging alcohol use among underage students and 
        other young fans.
          (7) Alcohol is a unique product and should be 
        regulated differently than other products by the States 
        and Federal Government. States have primary authority 
        to regulate alcohol distribution and sale, and the 
        Federal Government should support and supplement these 
        State efforts. States also have a responsibility to 
        fight youth access to alcohol and reduce underage 
        drinking. Continued State regulation and licensing of 
        the manufacture, importation, sale, distribution, 
        transportation and storage of alcoholic beverages are 
        clearly in the public interest and are critical to 
        promoting responsible consumption, preventing illegal 
        access to alcohol by persons under 21 years of age from 
        commercial and non-commercial sources, maintaining 
        industry integrity and an orderly marketplace, and 
        furthering effective State tax collection.
  (c) Interagency Coordinating Committee; Annual Report on 
State Underage Drinking Prevention and Enforcement 
Activities.--
          (1) Interagency coordinating committee on the 
        prevention of underage drinking.--
                  (A) In general.--The Secretary, in 
                collaboration with the Federal officials 
                specified in subparagraph (B), shall formally 
                establish and enhance the efforts of the 
                interagency coordinating committee, that began 
                operating in 2004, focusing on underage 
                drinking (referred to in this subsection as the 
                ``Committee'').
                  (B) Other agencies.--The officials referred 
                to in paragraph (1) are the Secretary of 
                Education, the Attorney General, the Secretary 
                of Transportation, the Secretary of the 
                Treasury, the Secretary of Defense, the Surgeon 
                General, the Director of the Centers for 
                Disease Control and Prevention, the Director of 
                the [National Institute on Alcohol Abuse and 
                Alcoholism] National Institute on Alcohol 
                Effects and Alcohol-Associated Disorders, the 
                Assistant Secretary for Mental Health and 
                Substance Use, the Director of the [National 
                Institute on Drug Abuse] National Institute on 
                Drugs and Addiction, the Assistant Secretary 
                for Children and Families, the Director of the 
                Office of National Drug Control Policy, the 
                Administrator of the National Highway Traffic 
                Safety Administration, the Administrator of the 
                Office of Juvenile Justice and Delinquency 
                Prevention, the Chairman of the Federal Trade 
                Commission, and such other Federal officials as 
                the Secretary of Health and Human Services 
                determines to be appropriate.
                  (C) Chair.--The Secretary of Health and Human 
                Services shall serve as the chair of the 
                Committee.
                  (D) Duties.--The Committee shall guide policy 
                and program development across the Federal 
                Government with respect to underage drinking, 
                provided, however, that nothing in this section 
                shall be construed as transferring regulatory 
                or program authority from an Agency to the 
                Coordinating Committee.
                  (E) Consultations.--The Committee shall 
                actively seek the input of and shall consult 
                with all appropriate and interested parties, 
                including States, public health research and 
                interest groups, foundations, and alcohol 
                beverage industry trade associations and 
                companies.
                  (F) Annual report.--
                          (i) In general.--The Secretary, on 
                        behalf of the Committee, shall annually 
                        submit to the Congress a report that 
                        summarizes--
                                  (I) all programs and policies 
                                of Federal agencies designed to 
                                prevent and reduce underage 
                                drinking;
                                  (II) the extent of progress 
                                in preventing and reducing 
                                underage drinking nationally;
                                  (III) data that the Secretary 
                                shall collect with respect to 
                                the information specified in 
                                clause (ii); and
                                  (IV) such other information 
                                regarding underage drinking as 
                                the Secretary determines to be 
                                appropriate.
                          (ii) Certain information.--The report 
                        under clause (i) shall include 
                        information on the following:
                                  (I) Patterns and consequences 
                                of underage drinking as 
                                reported in research and 
                                surveys such as, but not 
                                limited to Monitoring the 
                                Future, Youth Risk Behavior 
                                Surveillance System, the 
                                National Survey on Drug Use and 
                                Health, and the Fatality 
                                Analysis Reporting System.
                                  (II) Measures of the 
                                availability of alcohol from 
                                commercial and non-commercial 
                                sources to underage 
                                populations.
                                  (III) Measures of the 
                                exposure of underage 
                                populations to messages 
                                regarding alcohol in 
                                advertising and the 
                                entertainment media as reported 
                                by the Federal Trade 
                                Commission.
                                  (IV) Surveillance data, 
                                including information on the 
                                onset and prevalence of 
                                underage drinking, consumption 
                                patterns and the means of 
                                underage access. The Secretary 
                                shall develop a plan to improve 
                                the collection, measurement and 
                                consistency of reporting 
                                Federal underage alcohol data.
                                  (V) Any additional findings 
                                resulting from research 
                                conducted or supported under 
                                subsection (f).
                                  (VI) Evidence-based best 
                                practices to prevent and reduce 
                                underage drinking and provide 
                                treatment services to those 
                                youth who need them.
          (2) Annual report on state underage drinking 
        prevention and enforcement activities.--
                  (A) In general.--The Secretary shall, with 
                input and collaboration from other appropriate 
                Federal agencies, States, Indian tribes, 
                territories, and public health, consumer, and 
                alcohol beverage industry groups, annually 
                issue a report on each State's performance in 
                enacting, enforcing, and creating laws, 
                regulations, and programs to prevent or reduce 
                underage drinking.
                  (B) State performance measures.--
                          (i) In general.--The Secretary shall 
                        develop, in consultation with the 
                        Committee, a set of measures to be used 
                        in preparing the report on best 
                        practices.
                          (ii) Categories.--In developing these 
                        measures, the Secretary shall consider 
                        categories including, but not limited 
                        to:
                                  (I) Whether or not the State 
                                has comprehensive anti-underage 
                                drinking laws such as for the 
                                illegal sale, purchase, attempt 
                                to purchase, consumption, or 
                                possession of alcohol; illegal 
                                use of fraudulent ID; illegal 
                                furnishing or obtaining of 
                                alcohol for an individual under 
                                21 years; the degree of 
                                strictness of the penalties for 
                                such offenses; and the 
                                prevalence of the enforcement 
                                of each of these infractions.
                                  (II) Whether or not the State 
                                has comprehensive liability 
                                statutes pertaining to underage 
                                access to alcohol such as dram 
                                shop, social host, and house 
                                party laws, and the prevalence 
                                of enforcement of each of these 
                                laws.
                                  (III) Whether or not the 
                                State encourages and conducts 
                                comprehensive enforcement 
                                efforts to prevent underage 
                                access to alcohol at retail 
                                outlets, such as random 
                                compliance checks and shoulder 
                                tap programs, and the number of 
                                compliance checks within 
                                alcohol retail outlets measured 
                                against the number of total 
                                alcohol retail outlets in each 
                                State, and the result of such 
                                checks.
                                  (IV) Whether or not the State 
                                encourages training on the 
                                proper selling and serving of 
                                alcohol for all sellers and 
                                servers of alcohol as a 
                                condition of employment.
                                  (V) Whether or not the State 
                                has policies and regulations 
                                with regard to direct sales to 
                                consumers and home delivery of 
                                alcoholic beverages.
                                  (VI) Whether or not the State 
                                has programs or laws to deter 
                                adults from purchasing alcohol 
                                for minors; and the number of 
                                adults targeted by these 
                                programs.
                                  (VII) Whether or not the 
                                State has programs targeted to 
                                youths, parents, and caregivers 
                                to deter underage drinking; and 
                                the number of individuals 
                                served by these programs.
                                  (VIII) Whether or not the 
                                State has enacted graduated 
                                drivers licenses and the extent 
                                of those provisions.
                                  (IX) The amount that the 
                                State invests, per youth 
                                capita, on the prevention of 
                                underage drinking, further 
                                broken down by the amount spent 
                                on--
                                          (aa) compliance check 
                                        programs in retail 
                                        outlets, including 
                                        providing technology to 
                                        prevent and detect the 
                                        use of false 
                                        identification by 
                                        minors to make alcohol 
                                        purchases;
                                          (bb) checkpoints and 
                                        saturation patrols that 
                                        include the goal of 
                                        reducing and deterring 
                                        underage drinking;
                                          (cc) community-based, 
                                        school-based, and 
                                        higher-education-based 
                                        programs to prevent 
                                        underage drinking;
                                          (dd) underage 
                                        drinking prevention 
                                        programs that target 
                                        youth within the 
                                        juvenile justice and 
                                        child welfare systems; 
                                        and
                                          (ee) other State 
                                        efforts or programs as 
                                        deemed appropriate.
          (3) Authorization of appropriations.--There are 
        authorized to be appropriated to carry out this 
        subsection $1,000,000 for each of the fiscal years 2018 
        through 2022.
  (d) National Media Campaign To Prevent Underage Drinking.--
          (1) Scope of the campaign.--The Secretary shall 
        continue to fund and oversee the production, 
        broadcasting, and evaluation of the national adult-
        oriented media public service campaign if the Secretary 
        determines that such campaign is effective in achieving 
        the media campaign's measurable objectives.
          (2) Report.--The Secretary shall provide a report to 
        the Congress annually detailing the production, 
        broadcasting, and evaluation of the campaign referred 
        to in paragraph (1), and to detail in the report the 
        effectiveness of the campaign in reducing underage 
        drinking, the need for and likely effectiveness of an 
        expanded adult-oriented media campaign, and the 
        feasibility and the likely effectiveness of a national 
        youth-focused media campaign to combat underage 
        drinking.
          (3) Consultation requirement.--In carrying out the 
        media campaign, the Secretary shall direct the entity 
        carrying out the national adult-oriented media public 
        service campaign to consult with interested parties 
        including both the alcohol beverage industry and public 
        health and consumer groups. The progress of this 
        consultative process is to be covered in the report 
        under paragraph (2).
          (4) Authorization of appropriations.--There are 
        authorized to be appropriated to carry out this 
        subsection, $1,000,000 for each of the fiscal years 
        2018 through 2022.
  (e) Interventions.--
          (1) Community-based coalition enhancement grants to 
        prevent underage drinking.--
                  (A) Authorization of program.--The Assistant 
                Secretary for Mental Health and Substance Use, 
                in consultation with the Director of the Office 
                of National Drug Control Policy, shall award, 
                if the Assistant Secretary determines that the 
                Department of Health and Human Services is not 
                currently conducting activities that duplicate 
                activities of the type described in this 
                subsection, ``enhancement grants'' to eligible 
                entities to design, test, evaluate and 
                disseminate effective strategies to maximize 
                the effectiveness of community-wide approaches 
                to preventing and reducing underage drinking. 
                This subsection is subject to the availability 
                of appropriations.
                  (B) Purposes.--The purposes of this paragraph 
                are to--
                          (i) prevent and reduce alcohol use 
                        among youth in communities throughout 
                        the United States;
                          (ii) strengthen collaboration among 
                        communities, the Federal Government, 
                        and State, local, and tribal 
                        governments;
                          (iii) enhance intergovernmental 
                        cooperation and coordination on the 
                        issue of alcohol use among youth;
                          (iv) serve as a catalyst for 
                        increased citizen participation and 
                        greater collaboration among all sectors 
                        and organizations of a community that 
                        first demonstrates a long-term 
                        commitment to reducing alcohol use 
                        among youth;
                          (v) disseminate to communities timely 
                        information regarding state-of-the-art 
                        practices and initiatives that have 
                        proven to be effective in preventing 
                        and reducing alcohol use among youth; 
                        and
                          (vi) enhance, not supplant, effective 
                        local community initiatives for 
                        preventing and reducing alcohol use 
                        among youth.
                  (C) Application.--An eligible entity desiring 
                an enhancement grant under this paragraph shall 
                submit an application to the Assistant 
                Secretary at such time, and in such manner, and 
                accompanied by such information as the 
                Assistant Secretary may require. Each 
                application shall include--
                          (i) a complete description of the 
                        entity's current underage alcohol use 
                        prevention initiatives and how the 
                        grant will appropriately enhance the 
                        focus on underage drinking issues; or
                          (ii) a complete description of the 
                        entity's current initiatives, and how 
                        it will use this grant to enhance those 
                        initiatives by adding a focus on 
                        underage drinking prevention.
                  (D) Uses of funds.--Each eligible entity that 
                receives a grant under this paragraph shall use 
                the grant funds to carry out the activities 
                described in such entity's application 
                submitted pursuant to subparagraph (C). Grants 
                under this paragraph shall not exceed $50,000 
                per year and may not exceed four years.
                  (E) Supplement not supplant.--Grant funds 
                provided under this paragraph shall be used to 
                supplement, not supplant, Federal and non-
                Federal funds available for carrying out the 
                activities described in this paragraph.
                  (F) Evaluation.--Grants under this paragraph 
                shall be subject to the same evaluation 
                requirements and procedures as the evaluation 
                requirements and procedures imposed on 
                recipients of drug free community grants.
                  (G) Definitions.--For purposes of this 
                paragraph, the term ``eligible entity'' means 
                an organization that is currently receiving or 
                has received grant funds under the Drug-Free 
                Communities Act of 1997 (21 U.S.C. 1521 et 
                seq.).
                  (H) Administrative expenses.--Not more than 6 
                percent of a grant under this paragraph may be 
                expended for administrative expenses.
                  (I) Authorization of appropriations.--There 
                are authorized to be appropriated to carry out 
                this paragraph $5,000,000 for each of the 
                fiscal years 2018 through 2022.
          (2) Grants directed at preventing and reducing 
        alcohol abuse at institutions of higher education.--
                  (A) Authorization of program.--The Secretary 
                shall award grants to eligible entities to 
                enable the entities to prevent and reduce the 
                rate of underage alcohol consumption including 
                binge drinking among students at institutions 
                of higher education.
                  (B) Applications.--An eligible entity that 
                desires to receive a grant under this paragraph 
                shall submit an application to the Secretary at 
                such time, in such manner, and accompanied by 
                such information as the Secretary may require. 
                Each application shall include--
                          (i) a description of how the eligible 
                        entity will work to enhance an 
                        existing, or where none exists to build 
                        a, statewide coalition;
                          (ii) a description of how the 
                        eligible entity will target underage 
                        students in the State;
                          (iii) a description of how the 
                        eligible entity intends to ensure that 
                        the statewide coalition is actually 
                        implementing the purpose of this 
                        section and moving toward indicators 
                        described in subparagraph (D);
                          (iv) a list of the members of the 
                        statewide coalition or interested 
                        parties involved in the work of the 
                        eligible entity;
                          (v) a description of how the eligible 
                        entity intends to work with State 
                        agencies on substance abuse prevention 
                        and education;
                          (vi) the anticipated impact of funds 
                        provided under this paragraph in 
                        preventing and reducing the rates of 
                        underage alcohol use;
                          (vii) outreach strategies, including 
                        ways in which the eligible entity 
                        proposes to--
                                  (I) reach out to students and 
                                community stakeholders;
                                  (II) promote the purpose of 
                                this paragraph;
                                  (III) address the range of 
                                needs of the students and the 
                                surrounding communities; and
                                  (IV) address community norms 
                                for underage students regarding 
                                alcohol use; and
                          (viii) such additional information as 
                        required by the Secretary.
                  (C) Uses of funds.--Each eligible entity that 
                receives a grant under this paragraph shall use 
                the grant funds to carry out the activities 
                described in such entity's application 
                submitted pursuant to subparagraph (B).
                  (D) Accountability.--On the date on which the 
                Secretary first publishes a notice in the 
                Federal Register soliciting applications for 
                grants under this paragraph, the Secretary 
                shall include in the notice achievement 
                indicators for the program authorized under 
                this paragraph. The achievement indicators 
                shall be designed--
                          (i) to measure the impact that the 
                        statewide coalitions assisted under 
                        this paragraph are having on the 
                        institutions of higher education and 
                        the surrounding communities, including 
                        changes in the number of incidents of 
                        any kind in which students have abused 
                        alcohol or consumed alcohol while under 
                        the age of 21 (including violations, 
                        physical assaults, sexual assaults, 
                        reports of intimidation, disruptions of 
                        school functions, disruptions of 
                        student studies, mental health 
                        referrals, illnesses, or deaths);
                          (ii) to measure the quality and 
                        accessibility of the programs or 
                        information offered by the eligible 
                        entity; and
                          (iii) to provide such other measures 
                        of program impact as the Secretary 
                        determines appropriate.
                  (E) Supplement not supplant.--Grant funds 
                provided under this paragraph shall be used to 
                supplement, and not supplant, Federal and non-
                Federal funds available for carrying out the 
                activities described in this paragraph.
                  (F) Definitions.--For purposes of this 
                paragraph:
                          (i) Eligible entity.--The term 
                        ``eligible entity'' means a State, 
                        institution of higher education, or 
                        nonprofit entity.
                          (ii) Institution of higher 
                        education.--The term ``institution of 
                        higher education'' has the meaning 
                        given the term in section 101(a) of the 
                        Higher Education Act of 1965 (20 U.S.C. 
                        1001(a)).
                          (iii) Secretary.--The term 
                        ``Secretary'' means the Secretary of 
                        Education.
                          (iv) State.--The term ``State'' means 
                        each of the 50 States, the District of 
                        Columbia, and the Commonwealth of 
                        Puerto Rico.
                          (v) Statewide coalition.--The term 
                        ``statewide coalition'' means a 
                        coalition that--
                                  (I) includes, but is not 
                                limited to--
                                          (aa) institutions of 
                                        higher education within 
                                        a State; and
                                          (bb) a nonprofit 
                                        group, a community 
                                        underage drinking 
                                        prevention coalition, 
                                        or another substance 
                                        abuse prevention group 
                                        within a State; and
                                  (II) works toward lowering 
                                the alcohol abuse rate by 
                                targeting underage students at 
                                institutions of higher 
                                education throughout the State 
                                and in the surrounding 
                                communities.
                          (vi) Surrounding community.--The term 
                        ``surrounding community'' means the 
                        community--
                                  (I) that surrounds an 
                                institution of higher education 
                                participating in a statewide 
                                coalition;
                                  (II) where the students from 
                                the institution of higher 
                                education take part in the 
                                community; and
                                  (III) where students from the 
                                institution of higher education 
                                live in off-campus housing.
                  (G) Administrative expenses.--Not more than 5 
                percent of a grant under this paragraph may be 
                expended for administrative expenses.
                  (H) Authorization of appropriations.--There 
                are authorized to be appropriated to carry out 
                this paragraph $5,000,000 for fiscal year 2007, 
                and $5,000,000 for each of the fiscal years 
                2008 through 2010.
  (f) Additional Research.--
          (1) Additional research on underage drinking.--
                  (A) In general.--The Secretary shall, subject 
                to the availability of appropriations, collect 
                data, and conduct or support research that is 
                not duplicative of research currently being 
                conducted or supported by the Department of 
                Health and Human Services, on underage 
                drinking, with respect to the following:
                          (i) Comprehensive community-based 
                        programs or strategies and statewide 
                        systems to prevent and reduce underage 
                        drinking, across the underage years 
                        from early childhood to age 21, 
                        including programs funded and 
                        implemented by government entities, 
                        public health interest groups and 
                        foundations, and alcohol beverage 
                        companies and trade associations.
                          (ii) Annually obtain and report more 
                        precise information than is currently 
                        collected on the scope of the underage 
                        drinking problem and patterns of 
                        underage alcohol consumption, including 
                        improved knowledge about the problem 
                        and progress in preventing, reducing 
                        and treating underage drinking; as well 
                        as information on the rate of exposure 
                        of youth to advertising and other media 
                        messages encouraging and discouraging 
                        alcohol consumption.
                          (iii) Compiling information on the 
                        involvement of alcohol in unnatural 
                        deaths of persons ages 12 to 20 in the 
                        United States, including suicides, 
                        homicides, and unintentional injuries 
                        such as falls, drownings, burns, 
                        poisonings, and motor vehicle crash 
                        deaths.
                  (B) Certain matters.--The Secretary shall 
                carry out activities toward the following 
                objectives with respect to underage drinking:
                          (i) Obtaining new epidemiological 
                        data within the national or targeted 
                        surveys that identify alcohol use and 
                        attitudes about alcohol use during pre- 
                        and early adolescence, including harm 
                        caused to self or others as a result of 
                        adolescent alcohol use such as 
                        violence, date rape, risky sexual 
                        behavior, and prenatal alcohol 
                        exposure.
                          (ii) Developing or identifying 
                        successful clinical treatments for 
                        youth with alcohol problems.
                  (C) Peer review.--Research under subparagraph 
                (A) shall meet current Federal standards for 
                scientific peer review.
          (2) Authorization of appropriations.--There are 
        authorized to be appropriated to carry out this 
        subsection $3,000,000 for each of the fiscal years 2018 
        through 2022
  (g) Reducing Underage Drinking Through Screening and Brief 
Intervention.--
          (1) Grants to pediatric health care providers to 
        reduce underage drinking.--The Assistant Secretary may 
        make grants to eligible entities to increase 
        implementation of practices for reducing the prevalence 
        of alcohol use among individuals under the age of 21, 
        including college students.
          (2) Purposes.--Grants under this subsection shall be 
        made to improve--
                  (A) screening children and adolescents for 
                alcohol use;
                  (B) offering brief interventions to children 
                and adolescents to discourage such use;
                  (C) educating parents about the dangers of, 
                and methods of discouraging, such use;
                  (D) diagnosing and treating alcohol use 
                disorders; and
                  (E) referring patients, when necessary, to 
                other appropriate care.
          (3) Use of funds.--An entity receiving a grant under 
        this subsection may use such funding for the purposes 
        identified in paragraph (2) by--
                  (A) providing training to health care 
                providers;
                  (B) disseminating best practices, including 
                culturally and linguistically appropriate best 
                practices, as appropriate, and developing and 
                distributing materials; and
                  (C) supporting other activities, as 
                determined appropriate by the Assistant 
                Secretary.
          (4) Application.--To be eligible to receive a grant 
        under this subsection, an entity shall submit an 
        application to the Assistant Secretary at such time, 
        and in such manner, and accompanied by such information 
        as the Assistant Secretary may require. Each 
        application shall include--
                  (A) a description of the entity;
                  (B) a description of activities to be 
                completed;
                  (C) a description of how the services 
                specified in paragraphs (2) and (3) will be 
                carried out and the qualifications for 
                providing such services; and
                  (D) a timeline for the completion of such 
                activities.
          (5) Definitions.--For the purpose of this subsection:
                  (A) Brief intervention.--The term ``brief 
                intervention'' means, after screening a 
                patient, providing the patient with brief 
                advice and other brief motivational enhancement 
                techniques designed to increase the insight of 
                the patient regarding the patient's alcohol 
                use, and any realized or potential consequences 
                of such use, to effect the desired related 
                behavioral change.
                  (B) Children and adolescents.--The term 
                ``children and adolescents'' means any person 
                under 21 years of age.
                  (C) Eligible entity.--The term ``eligible 
                entity'' means an entity consisting of 
                pediatric health care providers and that is 
                qualified to support or provide the activities 
                identified in paragraph (2).
                  (D) Pediatric health care provider.--The term 
                ``pediatric health care provider'' means a 
                provider of primary health care to individuals 
                under the age of 21 years.
                  (E) Screening.--The term ``screening'' means 
                using validated patient interview techniques to 
                identify and assess the existence and extent of 
                alcohol use in a patient.

           *       *       *       *       *       *       *


       Part G--Services Provided Through Religious Organizations


SEC. 581. APPLICABILITY TO DESIGNATED PROGRAMS.

  (a) Designated Programs.--Subject to subsection (b), this 
part applies to discretionary and formula grant programs 
administered by the [Substance Abuse and Mental Health Services 
Administration] Substance Use And Mental Health Services 
Administration that make awards of financial assistance to 
public or private entities for the purpose of carrying out 
activities to prevent or treat substance abuse (in this part 
referred to as a ``designated program''). Designated programs 
include the program under subpart II of part B of title XIX 
(relating to formula grants to the States).
  (b) Limitation.--This part does not apply to any award of 
financial assistance under a designated program for a purpose 
other than the purpose specified in subsection (a).
  (c) Definitions.--For purposes of this part (and subject to 
subsection (b)):
          (1) The term ``designated program'' has the meaning 
        given such term in subsection (a).
          (2) The term ``financial assistance'' means a grant, 
        cooperative agreement, or contract.
          (3) The term ``program beneficiary'' means an 
        individual who receives program services.
          (4) The term ``program participant'' means a public 
        or private entity that has received financial 
        assistance under a designated program.
          (5) The term ``program services'' means treatment for 
        substance abuse, or preventive services regarding such 
        abuse, provided pursuant to an award of financial 
        assistance under a designated program.
          (6) The term ``religious organization'' means a 
        nonprofit religious organization.

           *       *       *       *       *       *       *


TITLE XIX--BLOCK GRANTS

           *       *       *       *       *       *       *



    Part B--Block Grants Regarding Mental Health and Substance Abuse


Subpart I--Block Grants for Community Mental Health Services

           *       *       *       *       *       *       *


SEC. 1918. DETERMINATION OF AMOUNT OF ALLOTMENT.

  (a) States.--
          (1) Determination under formula.--Subject to 
        subsection (b), the Secretary shall determine the 
        amount of the allotment required in section 1911 for a 
        State for a fiscal year in accordance with the 
        following formula:


 
                                                                   X
                              A                                ( ----  )
                                                                   U
------------------------------------------------------------------------
 

          (2) Determination of term ``a''.--For purposes of 
        paragraph (1), the term ``A'' means the difference 
        between--
                  (A) the amount appropriated under section 
                1920(a) for allotments under section 1911 for 
                the fiscal year involved; and
                  (B) an amount equal to 1.5 percent of the 
                amount referred to in subparagraph (A).
          (3) Determination of term ``u''.--For purposes of 
        paragraph (1), the term ``U'' means the sum of the 
        respective terms ``X'' determined for the States under 
        paragraph (4).
          (4) Determination of term ``x''.--For purposes of 
        paragraph (1), the term ``X'' means the product of--
                  (A) an amount equal to the product of--
                          (i) the term ``P'', as determined for 
                        the State involved under paragraph (5); 
                        and
                          (ii) the factor determined under 
                        paragraph (8) for the State; and
                  (B) the greater of--
                          (i) 0.4; and
                          (ii) an amount equal to an amount 
                        determined for the State in accordance 
                        with the following formula:


 
                                                                  R%
                            1-.35                              ( ----  )
                                                                  P%
------------------------------------------------------------------------
 

          (5) Determination of term ``p''.--
                  (A) For purposes of paragraph (4), the term 
                ``P'' means the sum of--
                          (i) an amount equal to the product of 
                        0.107 and the number of individuals in 
                        the State who are between 18 and 24 
                        years of age (inclusive);
                          (ii) an amount equal to the product 
                        of 0.166 and the number of individuals 
                        in the State who are between 25 and 44 
                        years of age (inclusive);
                          (iii) an amount equal to the product 
                        of 0.099 and the number of individuals 
                        in the State who are between 45 and 64 
                        years of age (inclusive); and
                          (iv) an amount equal to the product 
                        of 0.082 and the number of individuals 
                        in the State who are 65 years of age or 
                        older.
                  (B) With respect to data on population that 
                is necessary for purposes of making a 
                determination under subparagraph (A), the 
                Secretary shall use the most recent data that 
                is available from the Secretary of Commerce 
                pursuant to the decennial census and pursuant 
                to reasonable estimates by such Secretary of 
                changes occurring in the data in the ensuing 
                period.
          (6) Determination of term ``r%''.--
                  (A) For purposes of paragraph (4), the term 
                ``R%'', except as provided in subparagraph (D), 
                means the percentage constituted by the ratio 
                of the amount determined under subparagraph (B) 
                for the State involved to the amount determined 
                under subparagraph (C).
                  (B) The amount determined under this 
                subparagraph for the State involved is the 
                quotient of--
                          (i) the most recent 3-year arithmetic 
                        mean of the total taxable resources of 
                        the State, as determined by the 
                        Secretary of the Treasury; divided by
                          (ii) the factor determined under 
                        paragraph (8) for the State.
                  (C) The amount determined under this 
                subparagraph is the sum of the respective 
                amounts determined for the States under 
                subparagraph (B) (including the District of 
                Columbia).
                  (D)(i) In the case of the District of 
                Columbia, for purposes of paragraph (4), the 
                term ``R%'' means the percentage constituted by 
                the ratio of the amount determined under clause 
                (ii) for such District to the amount determined 
                under clause (iii).
                  (ii) The amount determined under this clause 
                for the District of Columbia is the quotient 
                of--
                          (I) the most recent 3-year arithmetic 
                        mean of total personal income in such 
                        District, as determined by the 
                        Secretary of Commerce; divided by
                          (II) the factor determined under 
                        paragraph (8) for the District.
                  (iii) The amount determined under this clause 
                is the sum of the respective amounts determined 
                for the States (including the District of 
                Columbia) by making, for each State, the same 
                determination as is described in clause (ii) 
                for the District of Columbia.
          (7) Determination of term ``p%''.--For purposes of 
        paragraph (4), the term ``P%'' means the percentage 
        constituted by the ratio of the term ``P'' determined 
        under paragraph (5) for the State involved to the sum 
        of the respective terms ``P'' determined for the 
        States.
          (8) Determination of certain factor.--
                  (A) The factor determined under this 
                paragraph for the State involved is a factor 
                whose purpose is to adjust the amount 
                determined under clause (i) of paragraph 
                (4)(A), and the amounts determined under each 
                of subparagraphs (B)(i) and (D)(ii)(I) of 
                paragraph (6), to reflect the differences that 
                exist between the State and other States in the 
                costs of providing comprehensive community 
                mental health services to adults with a serious 
                mental illness and to children with a serious 
                emotional disturbance.
                  (B) Subject to subparagraph (C), the factor 
                determined under this paragraph and in effect 
                for the fiscal year involved shall be 
                determined according to the methodology 
                described in the report entitled ``Adjusting 
                the Alcohol, Drug Abuse and Mental Health 
                Services Block Grant Allocations for Poverty 
                Populations and Cost of Service'', dated March 
                30, 1990, and prepared by Health Economics 
                Research, a corporation, pursuant to a contract 
                with the [National Institute on Drug Abuse] 
                National Institute on Drugs and Addiction.
                  (C) The factor determined under this 
                paragraph for the State involved may not for 
                any fiscal year be greater than 1.1 or less 
                than 0.9.
                  (D)(i) Not later than October 1, 1992, the 
                Secretary, after consultation with the 
                Comptroller General, shall in accordance with 
                this section make a determination for each 
                State of the factor that is to be in effect for 
                the State under this paragraph. The factor so 
                determined shall remain in effect through 
                fiscal year 1994, and shall be recalculated 
                every third fiscal year thereafter.
                  (ii) After consultation with the Comptroller 
                General, the Secretary shall, through 
                publication in the Federal Register, 
                periodically make such refinements in the 
                methodology referred to in subparagraph (B) as 
                are consistent with the purpose described in 
                subparagraph (A).
  (b) Minimum Allotments for States.--With respect to fiscal 
year 2000, and subsequent fiscal years, the amount of the 
allotment of a State under section 1911 shall not be less than 
the amount the State received under such section for fiscal 
year 1998.
  (c) Territories.--
          (1) Determination under formula.--Subject to 
        paragraphs (2) and (4), the amount of an allotment 
        under section 1911 for a territory of the United States 
        for a fiscal year shall be the product of--
                  (A) an amount equal to the amounts reserved 
                under paragraph (3) for the fiscal year; and
                  (B) a percentage equal to the quotient of--
                          (i) the civilian population of the 
                        territory, as indicated by the most 
                        recently available data; divided by
                          (ii) the aggregate civilian 
                        population of the territories of the 
                        United States, as indicated by such 
                        data.
          (2) Minimum allotment for territories.--The amount of 
        an allotment under section 1911 for a territory of the 
        United States for a fiscal year shall be the greater 
        of--
                  (A) the amount determined under paragraph (1) 
                for the territory for the fiscal year;
                  (B) $50,000; and
                  (C) with respect to fiscal years 1993 and 
                1994, an amount equal to 20.6 percent of the 
                amount received by the territory from 
                allotments made pursuant to this part for 
                fiscal year 1992.
          (3) Reservation of amounts.--The Secretary shall each 
        fiscal year reserve for the territories of the United 
        States 1.5 percent of the amounts appropriated under 
        section 1920(a) for allotments under section 1911 for 
        the fiscal year.
          (4) Availability of data on population.--With respect 
        to data on the civilian population of the territories 
        of the United States, if the Secretary determines for a 
        fiscal year that recent such data for purposes of 
        paragraph (1)(B) do not exist regarding a territory, 
        the Secretary shall for such purposes estimate the 
        civilian population of the territory by modifying the 
        data on the territory to reflect the average extent of 
        change occurring during the ensuing period in the 
        population of all territories with respect to which 
        recent such data do exist.
          (5) Applicability of certain provisions.--For 
        purposes of subsection (a), the term ``State'' does not 
        include the territories of the United States.

           *       *       *       *       *       *       *


  Subpart II--Block Grants for Prevention and Treatment of Substance 
                                 Abuse

SEC. 1921. FORMULA GRANTS TO STATES.

  (a) In General.--For the purpose described in subsection (b), 
the Secretary, acting through the [Center for Substance Abuse 
Treatment] Center for Substance Use Services, shall make an 
allotment each fiscal year for each State in an amount 
determined in accordance with section 1933. The Secretary shall 
make a grant to the State of the allotment made for the State 
for the fiscal year if the State submits to the Secretary an 
application in accordance with section 1932.
  (b) Authorized Activities.--A funding agreement for a grant 
under subsection (a) is that, subject to section 1931, the 
State involved will expend the grant only for the purpose of 
carrying out the plan developed in accordance with section 
1932(b) and for planning, carrying out, and evaluating 
activities to prevent and treat substance use disorders and for 
related activities authorized in section 1924.

           *       *       *       *       *       *       *


SEC. 1932. APPLICATION FOR GRANT; APPROVAL OF STATE PLAN.

  (a) In General.--For purposes of section 1921, an application 
for a grant under such section for a fiscal year is in 
accordance with this section if, subject to subsection (c)--
          (1) the application is received by the Secretary not 
        later than October 1 of the fiscal year for which the 
        State is seeking funds;
          (2) the application contains each funding agreement 
        that is described in this subpart or subpart III for 
        such a grant (other than any such agreement that is not 
        applicable to the State);
          (3) the agreements are made through certification 
        from the chief executive officer of the State;
          (4) with respect to such agreements, the application 
        provides assurances of compliance satisfactory to the 
        Secretary;
          (5) the application contains the report required in 
        section 1942(a);
          (6)(A) the application contains a plan in accordance 
        with subsection (b) and the plan is approved by the 
        Secretary; and
          (B) the State provides assurances satisfactory to the 
        Secretary that the State complied with the provisions 
        of the plan under subparagraph (A) that was approved by 
        the Secretary for the most recent fiscal year for which 
        the State received a grant under section 1921; and
          (7) the application (including the plan under 
        paragraph (6)) is otherwise in such form, is made in 
        such manner, and contains such agreements, assurances, 
        and information as the Secretary determines to be 
        necessary to carry out this subpart.
  (b) State Plan.--
          (1) In general.--In order for a State to be in 
        compliance with subsection (a)(6), the State shall 
        submit to the Secretary a plan that, at a minimum, 
        includes the following:
                  (A) A description of the State's system of 
                care that--
                          (i) identifies the single State 
                        agency responsible for the 
                        administration of the program, 
                        including any third party who 
                        administers substance use disorder 
                        services and is responsible for 
                        complying with the requirements of the 
                        grant;
                          (ii) provides information on the need 
                        for substance use disorder prevention 
                        and treatment services in the State, 
                        including estimates on the number of 
                        individuals who need treatment, who are 
                        pregnant women, women with dependent 
                        children, individuals with a co-
                        occurring mental health and substance 
                        use disorder, persons who inject drugs, 
                        and persons who are experiencing 
                        homelessness;
                          (iii) provides aggregate information 
                        on the number of individuals in 
                        treatment within the State, including 
                        the number of such individuals who are 
                        pregnant women, women with dependent 
                        children, individuals with a co-
                        occurring mental health and substance 
                        use disorder, persons who inject drugs, 
                        and persons who are experiencing 
                        homelessness;
                          (iv) provides a description of the 
                        system that is available to provide 
                        services by modality, including the 
                        provision of recovery support services;
                          (v) provides a description of the 
                        State's comprehensive statewide 
                        prevention efforts, including the 
                        number of individuals being served in 
                        the system, target populations, and 
                        priority needs, and provides a 
                        description of the amount of funds from 
                        the prevention set-aside expended on 
                        primary prevention;
                          (vi) provides a description of the 
                        financial resources available;
                          (vii) describes the existing 
                        substance use disorders workforce and 
                        workforce trained in treating co-
                        occurring substance use and mental 
                        disorders;
                          (viii) includes a description of how 
                        the State promotes evidence-based 
                        practices; and
                          (ix) describes how the State 
                        integrates substance use disorder 
                        services and primary health care, which 
                        in the case of those individuals with 
                        co-occurring mental health and 
                        substance use disorders may include 
                        providing both mental health and 
                        substance use disorder services in 
                        primary care settings or providing 
                        primary and specialty care services in 
                        community-based mental health and 
                        substance use disorder service 
                        settings.
                  (B) The establishment of goals and objectives 
                for the period of the plan, including targets 
                and milestones that are intended to be met, and 
                the activities that will be undertaken to 
                achieve those targets.
                  (C) A description of how the State will 
                comply with each funding agreement for a grant 
                under section 1921 that is applicable to the 
                State, including a description of the manner in 
                which the State intends to expend grant funds.
          (2) Modifications.--
                  (A) Authority of secretary.--As a condition; 
                of making a grant under section 1921 to a State 
                for a fiscal year, the Secretary may require 
                that the State modify any provision of the plan 
                submitted by the State under subsection (a)(6) 
                (including provisions on priorities in carrying 
                out authorized activities). If the Secretary 
                approves the plan and makes the grant to the 
                State for the fiscal year, the Secretary may 
                not during such year require the State to 
                modify the plan.
                  (B) State request for modification.--If the 
                State determines that a modification to such 
                plan is necessary, the State may request the 
                Secretary to approve the modification. Any such 
                modification shall be in accordance with 
                paragraph (1) and section 1941.
          (3) Authority of [center for substance abuse 
        prevention] center for substance use prevention 
        services.--With respect to plans submitted by the 
        States under subsection (a)(6), including any 
        modification under paragraph (2), the Secretary, acting 
        through the Director of the [Center for Substance Abuse 
        Prevention] Center for Substance Use Prevention 
        Services, shall review and approve or disapprove the 
        provisions of the plans that relate to prevention 
        activities.
  (c) Waivers Regarding Certain Territories.--In the case of 
any territory of the United States except Puerto Rico, the 
Secretary may waive such provisions of this subpart and subpart 
III as the Secretary determines to be appropriate, other than 
the provisions of section 1931.
  (d) Issuance of Regulations; Precondition to Making Grants.--
          (1) Regulations.--Not later than August 25, 1992, the 
        Secretary, acting as appropriate through the Director 
        of the Center for Treatment Improvement or the Director 
        of the [Center for Substance Abuse Prevention] Center 
        for Substance Use Prevention Services, shall by 
        regulation establish standards specifying the 
        circumstances in which the Secretary will consider an 
        application for a grant under section 1921 to be in 
        accordance with this section.
          (2) Issuance as precondition to making grants.--The 
        Secretary may not make payments under any grant under 
        section 1921 for fiscal year 1993 on or after January 
        1, 1993, unless the Secretary has issued standards 
        under paragraph (1).
  (e) Waiver Authority for Certain Requirements.--
          (1) In general.--Upon the request of a State, the 
        Secretary may waive the requirements of all or part of 
        the sections described in paragraph (2) using objective 
        criteria established by the Secretary by regulation 
        after consultation with the States and other interested 
        parties including consumers and providers.
          (2) Sections.--The sections described in paragraph 
        (1) are sections 1922(b), 1923, 1924 and 1928.
          (3) Date certain for acting upon request.--The 
        Secretary shall approve or deny a request for a waiver 
        under paragraph (1) and inform the State of that 
        decision not later than 120 days after the date on 
        which the request and all the information needed to 
        support the request are submitted.
          (4) Annual reporting requirement.--The Secretary 
        shall annually report to the general public on the 
        States that receive a waiver under this subsection.

           *       *       *       *       *       *       *


SEC. 1935. FUNDING.

  (a) Authorization of Appropriations.--For the purpose of 
carrying out this subpart, subpart III and section 505(d) with 
respect to substance abuse, and section 515(d), there are 
authorized to be appropriated $1,858,079,000 for each of fiscal 
years 2018 through 2022..
  (b) Allocations for Technical Assistance, National Data Base, 
Data Collection, and Program Evaluations.--
          (1) In general.--
                  (A) For the purpose of carrying out section 
                1948(a) with respect to substance abuse, 
                section 515(d), and the purposes specified in 
                subparagraphs (B) and (C), the Secretary shall 
                obligate 5 percent of the amounts appropriated 
                under subsection (a) each fiscal year.
                  (B) The purpose specified in this 
                subparagraph is the collection of data in this 
                paragraph is carrying out sections 505(d) and 
                1971 with respect to substance abuse.
                  (C) The purpose specified in this 
                subparagraph is the conduct of evaluations of 
                authorized activities to determine methods for 
                improving the availability and quality of such 
                activities.
          (2) Activities of [center for substance abuse 
        prevention] center for substance use prevention 
        services.--Of the amounts reserved under paragraph (1) 
        for a fiscal year, the Secretary, acting through the 
        Director of the [Center for Substance Abuse Prevention] 
        Center for Substance Use Prevention Services, shall 
        obligate 20 percent for carrying out paragraph (1)(C), 
        section 1948(a) with respect to prevention activities, 
        and section 515(d).
          (3) Core data set.--A State that receives a new 
        grant, contract, or cooperative agreement from amounts 
        available to the Secretary under paragraph (1), for the 
        purposes of improving the data collection, analysis and 
        reporting capabilities of the State, shall be required, 
        as a condition of receipt of funds, to collect, 
        analyze, and report to the Secretary for each fiscal 
        year subsequent to receiving such funds a core data set 
        to be determined by the Secretary in conjunction with 
        the States.

           *       *       *       *       *       *       *

                              ----------                              


                  COMPREHENSIVE SMOKING EDUCATION ACT




           *       *       *       *       *       *       *
              smoking research, education, and information

  Sec. 3. (a) The Secretary of Health and Human Services 
(hereinafter in this section referred to as the ``Secretary'') 
shall establish and carry out a program to inform the public of 
any dangers to human health presented by cigarette smoking. In 
canning out such program, the Secretary shall--
          (1) conduct and support research on the effect of 
        cigarette smoking on human health and develop materials 
        for informing the public of such effect;
          (2) coordinate all research and educational programs 
        and other activities within the Department of Health 
        and Human Services (hereinafter in this section 
        referred to as the ``Department'') which relate to the 
        effect of cigarette smoking on human health and 
        coordinate, through the Interagency Committee on 
        Smoking and Health (established under subsection (b)), 
        such activities with similar activities of other 
        Federal agencies and of private agencies;
          (3) establish and maintain a liaison with appropriate 
        private entities, other Federal agencies, and State and 
        local public agencies respecting activities relating to 
        the effect of cigarette smoking on human health;
          (4) collect, analyze, and disseminate (through 
        publications, bibliographies, and otherwise) 
        information, studies, and other data relating to the 
        effect of cigarette smoking on human health, and 
        develop standards, criteria, and methodologies for 
        improved information programs related to smoking and 
        health;
          (5) compile and make available information on State 
        and local laws relating to the use and consumption of 
        cigarettes; and
          (6) undertake any other additional information and 
        research activities which the Secretary determines 
        necessary and appropriate to carry out this section.
  (b)(1) To carry out the activities described in paragraphs 
(2) and (3) of subsection (a) there is established an 
Interagency Committee on Smoking and Health. The Committee 
shall be composed of--
          (A) members appointed by the Secretary from 
        appropriate institutes and agencies of the Department, 
        which may include the National Cancer Institute, the 
        National Heart, Lung, and Blood Institute, the Eunice 
        Kennedy Shriver National Institute of Child Health and 
        Human Development, the [National Institute on Drug 
        Abuse] National Institute on Drugs and Addiction, the 
        Health Resources and Services Administration, and the 
        Centers for Disease Control and Prevention;
          (B) at least one member appointed from the Federal 
        Trade Commission, the Department of Education, the 
        Department of Labor, and any other Federal agency 
        designated by the Secretary, the appointment of whom 
        shall be made by the head of the entity from which the 
        member is appointed; and
          (C) five members appointed by the Secretary from 
        physicians and scientists who represent private 
        entities involved in informing the public about the 
        health effects of smoking.
The Secretary shall designate the chairman of the Committee.
  (2) While away from their homes or regular places of business 
in the performance of services for the Committee, members of 
the Committee shall be allowed travel expenses, including per 
diem in lieu of subsistance, in the manner provided by sections 
5702 and 5703 of title 5 of the United States Code.
  (3) The Secretary shall make available to the Committee such 
staff, information, and other assistance as it may require to 
carry out its activities effectively.
  (c) The Secretary shall transmit a report to Congress not 
later than January 1, 1986, and biennially thereafter which 
shall contain--
          (1) an overview and assessment of Federal activities 
        undertaken to inform the public of the health 
        consequences of smoking and the extent of public 
        knowledge of such consequences,
          (2) a description of the Secretary's and Committee's 
        activities under subsection (a),
          (3) information regarding the activities of the 
        private sector taken in response to the effects of 
        smoking on health, and
          (4) such recommendations as the Secretary may 
        consider appropriate.

           *       *       *       *       *       *       *

                              ----------                              


            COMPREHENSIVE ADDICTION AND RECOVERY ACT OF 2016




           *       *       *       *       *       *       *
TITLE I--PREVENTION AND EDUCATION

           *       *       *       *       *       *       *


SEC. 103. COMMUNITY-BASED COALITION ENHANCEMENT GRANTS TO ADDRESS LOCAL 
                    DRUG CRISES.

  (a) Definitions.--In this section:
          (1) Administrator.--The term ``Administrator'' means 
        the Administrator of the Substance Abuse and Mental 
        Health Services Administration.
          (2) Director.--The term ``Director'' means the 
        Director of the Office of National Drug Control Policy.
          (3) Drug-free communities act of 1997.--The term 
        ``Drug-Free Communities Act of 1997'' means chapter 2 
        of the National Narcotics Leadership Act of 1988 (21 
        U.S.C. 1521 et seq.).
          (4) Eligible entity.--The term ``eligible entity'' 
        means an organization that--
                  (A) on or before the date of submitting an 
                application for a grant under this section, 
                receives or has received a grant under the 
                Drug-Free Communities Act of 1997; and
                  (B) has documented, using local data, rates 
                of abuse of opioids or methamphetamines at 
                levels that are--
                          (i) significantly higher than the 
                        national average as determined by the 
                        Secretary (including appropriate 
                        consideration of the results of the 
                        Monitoring the Future Survey published 
                        by the [National Institute on Drug 
                        Abuse] National Institute on Drugs and 
                        Addiction and the National Survey on 
                        Drug Use and Health published by the 
                        Substance Abuse and Mental Health 
                        Services Administration); or
                          (ii) higher than the national 
                        average, as determined by the Secretary 
                        (including appropriate consideration of 
                        the results of the surveys described in 
                        clause (i)), over a sustained period of 
                        time.
          (5) Emerging drug abuse issue.--The term ``emerging 
        drug abuse issue'' means a substance use disorder 
        within an area involving--
                  (A) a sudden increase in demand for 
                particular drug abuse treatment services 
                relative to previous demand; and
                  (B) a lack of resources in the area to 
                address the emerging problem.
          (6) Local drug crisis.--The term ``local drug 
        crisis'' means, with respect to the area served by an 
        eligible entity--
                  (A) a sudden increase in the abuse of opioids 
                or methamphetamines, as documented by local 
                data;
                  (B) the abuse of prescription medications, 
                specifically opioids or methamphetamines, that 
                is significantly higher than the national 
                average, over a sustained period of time, as 
                documented by local data; or
                  (C) a sudden increase in opioid-related 
                deaths, as documented by local data.
          (7) Opioid.--The term ``opioid'' means any drug 
        having an addiction-forming or addiction-sustaining 
        liability similar to morphine or being capable of 
        conversion into a drug having such addiction-forming or 
        addiction-sustaining liability.
  (b) Program Authorized.--The Director, in coordination with 
the Administrator, may make grants to eligible entities to 
implement comprehensive community-wide strategies that address 
local drug crises and emerging drug abuse issues within the 
area served by the eligible entity.
  (c) Application.--
          (1) In general.--An eligible entity seeking a grant 
        under this section shall submit an application to the 
        Director at such time, in such manner, and accompanied 
        by such information as the Director may require.
          (2) Criteria.--As part of an application for a grant 
        under this section, the Director shall require an 
        eligible entity to submit a detailed, comprehensive, 
        multisector plan for addressing the local drug crisis 
        or emerging drug abuse issue within the area served by 
        the eligible entity.
  (d) Use of funds.--An eligible entity shall use a grant 
received under this section--
          (1) for programs designed to implement comprehensive 
        community-wide prevention strategies to address the 
        local drug crisis in the area served by the eligible 
        entity, in accordance with the plan submitted under 
        subsection (c)(2);
          (2) to obtain specialized training and technical 
        assistance from the organization funded under section 4 
        of Public Law 107-82 (21 U.S.C. 1521 note); and
          (3) for programs designed to implement comprehensive 
        community-wide strategies to address emerging drug 
        abuse issues in the community.
  (e) Supplement Not Supplant.--An eligible entity shall use 
Federal funds received under this section only to supplement 
the funds that would, in the absence of those Federal funds, be 
made available from other Federal and non-Federal sources for 
the activities described in this section, and not to supplant 
those funds.
  (f) Evaluation.--A grant under this section shall be subject 
to the same evaluation requirements and procedures as the 
evaluation requirements and procedures imposed on the recipient 
of a grant under the Drug-Free Communities Act of 1997, and may 
also include an evaluation of the effectiveness at reducing 
abuse of opioids or methamphetamines.
  (g) Limitation on Administrative Expenses.--Not more than 8 
percent of the amounts made available to carry out this section 
for a fiscal year may be used to pay for administrative 
expenses.
  (h) Delegation Authority.--The Director may enter into an 
interagency agreement with the Administrator to delegate 
authority for the execution of grants and for such other 
activities as may be necessary to carry out this section.
  (i) Authorization of Appropriations.--For the purpose of 
carrying out this section, there are authorized to be 
appropriated $5,000,000 for each of fiscal years 2017 through 
2021.

           *       *       *       *       *       *       *

                              ----------                              


                           PUBLIC LAW 92-255


 AN ACT To establish a Special Action Office for Drug Abuse Prevention 
 and to concentrate the resources of the Nation against the problem of 
                              drug abuse.



           *       *       *       *       *       *       *
TITLE IV--OTHER FEDERAL PROGRAMS

           *       *       *       *       *       *       *



Sec. 406. Additional drug abuse prevention functions of the Secretary 
                    of Health and Human Services.

  (b) After December 31, 1974, the Secretary shall carry out 
his functions under subsection (a) through the [National 
Institute on Drug Abuse] National Institute on Drugs and 
Addiction.

           *       *       *       *       *       *       *


Sec. 410. Grants and contracts for the demonstration of new and more 
                    effective prevention, treatment, and rehabilitation 
                    programs.

  (a) The Secretary acting through the [National Institute on 
Drug Abuse] National Institute on Drugs and Addiction, may make 
grants to and enter into contracts with individuals and public 
and private nonprofit entities--
          (1) to provide training seminars, educational 
        programs, and technical assistance for the development, 
        demonstration, and evaluation of drug abuse prevention, 
        treatment, and rehabilitation programs; and
          (2) to conduct demonstration and evaluation projects, 
        with a high priority on prevention and early 
        intervention projects and on identifying new and more 
        effective drug abuse prevention, treatment, and 
        rehabilitation programs.
In the implementation of his authority under this section, the 
Secretary shall accord a high priority to applications for 
grants or contracts for primary prevention programs. For 
purposes of the preceding sentence, primary prevention programs 
include programs designed to discourage persons from beginning 
drug abuse. To the extent that appropriations authorized under 
this section are used to fund treatment services, the Secretary 
shall not limit such funding to treatment for opiate abuse, but 
shall also provide support for treatment for nonopiate drug 
abuse including polydrug abuse. Furthermore, nothing shall 
prevent the use of funds provided under this section for 
programs and projects aimed at the prevention, treatment, and 
rehabilitation of alcohol abuse and alcoholism as well as drug 
abuse.
  (b) There are authorized to be appropriated $25,000,000 for 
the fiscal year ending June 30, 1972; $65,000,000 for the 
fiscal year ending June 30, 1973; $100,000,000 for the fiscal 
year ending June 30, 1974; $160,000,000 for each of the fiscal 
years ending June 30, 1975 and June 30, 1976; $40,000,000 for 
the period July 1, 1976, through September 30, 1976; and 
$160,000,000 for each of the fiscal years ending September 30, 
1977, and September 30, 1978, to carry out this section. For 
the fiscal year ending September 30, 1979, there is authorized 
to be appropriated (1) $153,000,000 for grants and contracts 
under paragraphs (3) and (6) of subsection (a) for drug abuse 
treatment programs, and (2) $24,000,000 for grants and 
contracts under such subsection for other programs and 
activities. For grants and contracts under paragraphs (3) and 
(6) of subsection (a) for drug abuse treatment programs there 
is authorized to be appropriated $149,000,000 for the fiscal 
year ending September 30, 1980, and $155,000,000 for the fiscal 
year ending September 30, 1981; and for grants and contracts 
under such subsection for other programs and activities there 
is authorized to be appropriated $20,000,000 for the fiscal 
year ending September 30, 1980, and $30,000,000 for the fiscal 
year ending September 30, 1981. Of the funds appropriated under 
the preceding sentence for the fiscal year ending September 30, 
1980, at least 7 percent of the funds shall be obligated for 
grants and contracts for primary prevention and intervention 
programs designed to discourage individuals, particularly those 
in high risk populations, from abusing drugs; and of the funds 
appropriated under the preceding sentence for the next fiscal 
year, at least 10 percent of the funds shall be obligated for 
such grants and contracts. For carrying out the purposes of 
this section, there are authorized to be appropriated 
$15,000,000 for the fiscal year ending September 30, 1982. Of 
the funds appropriated under the preceding sentence, at least 
25 per centum of the funds shall be obligated for grants and 
contracts for primary prevention and intervention programs 
designed to discourage individuals, particularly individuals in 
high risk populations, from abusing drugs.
  (c)(1) In carrying out this section, the Secretary shall 
require coordination of all applications for programs in a 
State and shall not give precedence to public agencies over 
private agencies, institutions, and organizations, or to State 
agencies over local agencies.
  (2) Each applicant within a State, upon filing its 
application with the Secretary for a grant or contract under 
this section, shall submit a copy of its application for review 
by the State agency (if any) responsible for the administration 
of drug abuse prevention activities. Such State agency shall be 
given not more than thirty days from the date of receipt of the 
application to submit to the Secretary, in writing, an 
evaluation of the project set forth in the application. Such 
evaluation shall include comments on the relationship of the 
project to other projects pending and approved and to any State 
comprehensive plan for treatment and prevention of drug abuse. 
The State shall furnish the applicant a copy of any such 
evaluation. A State if it so desires may, in writing, waive its 
rights under this paragraph.
  (3) Approval of any application for a grant or contract under 
this section by the Secretary, including the earmarking of 
financial assistance for a program or project, may be granted 
only if the application substantially meets a set of criteria 
that
          (A) provide that the activities and services for 
        which assistance under this section is sought will be 
        substantially administered by or under the supervision 
        of the applicant;
          (B) provide for such methods of administration as are 
        necessary for the proper and efficient operation of 
        such programs or projects; and
          (C) provide for such fiscal control and fund 
        accounting procedures as may be necessary to assure 
        proper disbursement of and accounting for Federal funds 
        paid to the applicant.
  (4) Each applicant within a State, upon filing its 
application with the Secretary for a grant or contract to 
provide treatment or rehabilitation services shall provide a 
proposed performance standard or standards, to measure, or 
research protocol to determine, the effectiveness of such 
treatment or rehabilitation program or project.
  (d) The Secretary shall encourage the submission of and give 
special consideration to applications under this section to 
programs and projects aimed at underserved populations such as 
racial and ethnic minorities, Native Americans (including 
Native Hawaiians and Native American Pacific Islanders, youth, 
the elderly, women, handicapped individuals, and families of 
drug abusers.
  (e) Payment under grants or contracts under this section may 
be made in advance or by way of reimbursement and in such 
installments as the Secretary may determine.
  (f) Projects and programs for which grants and contracts are 
made or entered into under this section shall, in the case of 
prevention and treatment services, seek to (1) be responsive to 
special requirements of handicapped individuals in receiving 
such services; (2) whenever possible, be community based, 
insure care of good quality in general community care 
facilities and under health insurance plans, and be integrated 
with, and provide for the active participation of, a wide range 
of public and nongovernmental agencies, organizations, 
institutions, and individuals; (3) where a substantial number 
of the individuals in the population served by the project or 
program are of limited English-speaking ability (A) utilize the 
services of outreach workers fluent in the language spoken by a 
predominant number of such individuals and develop a plan and 
make arrangements responsive to the needs of such population 
for providing services to the extent practicable in the 
language and cultural context most appropriate to such 
individuals, and (B) identify an individual who is fluent both 
in that language and English and whose responsibilities shall 
include providing guidance to the individuals of limited 
English speaking ability and to appropriate staff members with 
respect to cultural sensitivities and bridging linguistic and 
cultural differences; and (4) where appropriate, utilize 
existing community resources (including community mental health 
centers).
  (g)(1) No grant may be made under this section to a State or 
to any entity within the government of a State unless the grant 
application has been duly authorized by the chief executive 
officer of such State.
  (2) No grant or contract may be made under this section for a 
period in excess of five years.
  (3)(A) The amount of any grant or contract under this section 
may not exceed 100 per centum of the cost of carrying out the 
grant or contract in the first fiscal year for which the grant 
or contract is made under this section, 80 per centum of such 
cost in the second fiscal year for which the grant or contract 
is made under this section, 70 per centum of such cost in the 
third fiscal year for which the grant or contract is made under 
this section, and 60 per centum of such cost in each of the 
fourth and fifth fiscal years for which the grant or contract 
is made under this section.
  (B) For purposes of this paragraph, no grant or contract 
shall be considered to have been made under this section for a 
fiscal year ending before September 30, 1981.

           *       *       *       *       *       *       *


Sec. 412. National Drug Abuse Training Center.

  (a) The Director shall establish a National Drug Abuse 
Training Center (hereinafter in this section referred to as the 
``Center'') to develop, conduct, and support a full range of 
training programs relating to drug abuse prevention functions. 
The Director shall consult with the National Advisory Council 
for Drug Abuse Prevention regarding the general policies of the 
Center. The Director may supervise the operation of the Center 
initially, but shall transfer the supervision of the operation 
of the Center to the [National Institute on Drug Abuse] 
National Institute on Drugs and Addiction not later than 
December 31, 1974.
  (b) The Center shall conduct or arrange for training 
programs, seminars, meetings, conferences, and other related 
activities, including the furnishing of training and 
educational materials for use by others.
  (c) The services and facilities of the Center shall, in 
accordance with regulations prescribed by the Director, be 
available to (1) Federal, State, and local government 
officials, and their respective staffs, (2) medical and 
paramedical personnel, and educators, and (3) other persons, 
including drug dependent persons, requiring training or 
education in drug abuse prevention.
  (d)(1) For the purpose of carrying out this section, there 
are authorized to be appropriated $1,000,000 for the fiscal 
year ending June 30, 1972, $3,000,000 for the fiscal year 
ending June 30, 1973, $5,000,000 for the fiscal year ending 
June 30, 1974, and $6,000,000 for the fiscal year ending June 
30, 1975.
  (2) Sums appropriated under this subsection shall remain 
available for obligation or expenditure in the fiscal year for 
which appropriated and in the fiscal year next following.

           *       *       *       *       *       *       *

                              ----------                              


           OMNIBUS CRIME CONTROL AND SAFE STREETS ACT OF 1968


   Be it enacted by the Senate and House of Representatives of 
the United States of America in Congress assembled, That this 
Act may be cited as the ``Omnibus Crime Control and Safe 
Streets Act of 1968''.

TITLE I--JUSTICE SYSTEM IMPROVEMENT

           *       *       *       *       *       *       *



             PART FF--OFFENDER REENTRY AND COMMUNITY SAFETY

SEC. 2976. ADULT AND JUVENILE OFFENDER STATE AND LOCAL REENTRY 
                    DEMONSTRATION PROJECTS.

  (a) Grant Authorization.--The Attorney General shall make 
grants to States, local governments, territories, or Indian 
tribes, or any combination thereof (in this section referred to 
as an ``eligible entity''), in partnership with interested 
persons (including Federal corrections and supervision 
agencies), service providers, and nonprofit organizations for 
the purpose of strategic planning and implementation of adult 
and juvenile offender reentry projects.
  (b) Adult Offender Reentry Demonstration Projects.--Funds for 
adult offender demonstration projects may be expended for--
          (1) providing offenders in prisons, jails, or 
        juvenile facilities with educational, literacy, 
        vocational, and job placement services to facilitate 
        re-entry into the community;
          (2) providing substance abuse treatment and services 
        (including providing a full continuum of substance 
        abuse treatment services that encompasses outpatient 
        and comprehensive residential services and recovery);
          (3) providing coordinated supervision and 
        comprehensive services for offenders upon release from 
        prison, jail, or a juvenile facility, including housing 
        and mental and physical health care to facilitate re-
        entry into the community, or reentry courts, and which, 
        to the extent applicable, are provided by community-
        based entities (including coordinated reentry veteran-
        specific services for eligible veterans);
          (4) providing programs that--
                  (A) encourage offenders to develop safe, 
                healthy, and responsible family relationships 
                and parent-child relationships; and
                  (B) involve the entire family unit in 
                comprehensive reentry services (as appropriate 
                to the safety, security, and well-being of the 
                family and child);
          (5) encouraging the involvement of prison, jail, or 
        juvenile facility mentors in the reentry process and 
        enabling those mentors to remain in contact with 
        offenders while in custody and after reentry into the 
        community;
          (6) providing victim-appropriate services, 
        encouraging the timely and complete payment of 
        restitution and fines by offenders to victims, and 
        providing services such as security and counseling to 
        victims upon release of offenders;
          (7) protecting communities against dangerous 
        offenders by using validated assessment tools to assess 
        the risk factors of returning inmates and developing or 
        adopting procedures to ensure that dangerous felons are 
        not released from prison prematurely; and
          (8) promoting employment opportunities consistent 
        with the Transitional Jobs strategy (as defined in 
        section 4 of the Second Chance Act of 2007 (34 U.S.C. 
        60502)).
  (c) Juvenile Offender Reentry Demonstration Projects.--Funds 
for the juvenile offender reentry demonstration projects may be 
expended for any activity described in subsection (b).
  (d) Combined Grant Application; Priority Consideration.--
          (1) In general.--The Attorney General shall develop a 
        procedure to allow applicants to submit a single 
        application for a planning grant under subsection (e) 
        and an implementation grant under subsection (f).
          (2) Priority consideration.--The Attorney General 
        shall give priority consideration to grant applications 
        under subsections (e) and (f) that include a commitment 
        by the applicant to partner with a local evaluator to 
        identify and analyze data that will--
                  (A) enable the grantee to target the intended 
                offender population; and
                  (B) serve as a baseline for purposes of the 
                evaluation.
  (e) Planning Grants.--
          (1) In general.--Except as provided in paragraph (3), 
        the Attorney General may make a grant to an eligible 
        entity of not more than $75,000 to develop a strategic, 
        collaborative plan for an adult or juvenile offender 
        reentry demonstration project as described in 
        subsection (h) that includes--
                  (A) a budget and a budget justification;
                  (B) a description of the outcome measures 
                that will be used to measure the effectiveness 
                of the program in promoting public safety and 
                public health;
                  (C) the activities proposed;
                  (D) a schedule for completion of the 
                activities described in subparagraph (C); and
                  (E) a description of the personnel necessary 
                to complete the activities described in 
                subparagraph (C).
          (2) Maximum total grants and geographic diversity.--
                  (A) Maximum amount.--The Attorney General may 
                not make initial planning grants and 
                implementation grants to 1 eligible entity in a 
                total amount that is more than a $1,000,000.
                  (B) Geographic diversity.--The Attorney 
                General shall make every effort to ensure 
                equitable geographic distribution of grants 
                under this section and take into consideration 
                the needs of underserved populations, including 
                rural and tribal communities.
          (3) Period of grant.--A planning grant made under 
        this subsection shall be for a period of not longer 
        than 1 year, beginning on the first day of the month in 
        which the planning grant is made.
  (f) Implementation Grants.--
          (1) Applications.--An eligible entity desiring an 
        implementation grant under this subsection shall submit 
        to the Attorney General an application that--
                  (A) contains a reentry strategic plan as 
                described in subsection (h), which describes 
                the long-term strategy and incorporates a 
                detailed implementation schedule, including the 
                plans of the applicant to fund the program 
                after Federal funding is discontinued;
                  (B) identifies the local government role and 
                the role of governmental agencies and nonprofit 
                organizations that will be coordinated by, and 
                that will collaborate on, the offender reentry 
                strategy of the applicant, and certifies the 
                involvement of such agencies and organizations;
                  (C) describes the evidence-based methodology 
                and outcome measures that will be used to 
                evaluate the program funded with a grant under 
                this subsection, and specifically explains how 
                such measurements will provide valid measures 
                of the impact of that program; and
                  (D) describes how the project could be 
                broadly replicated if demonstrated to be 
                effective.
          (2) Requirements.--The Attorney General may make a 
        grant to an applicant under this subsection only if the 
        application--
                  (A) reflects explicit support of the chief 
                executive officer, or their designee, of the 
                State, unit of local government, territory, or 
                Indian tribe applying for a grant under this 
                subsection;
                  (B) provides discussion of the role of 
                Federal corrections, State corrections 
                departments, community corrections agencies, 
                juvenile justice systems, and tribal or local 
                jail systems in ensuring successful reentry of 
                offenders into their communities;
                  (C) provides evidence of collaboration with 
                State, local, or tribal government agencies 
                overseeing health, housing, child welfare, 
                education, substance abuse, victims services, 
                and employment services, and with local law 
                enforcement agencies;
                  (D) provides a plan for analysis of the 
                statutory, regulatory, rules-based, and 
                practice-based hurdles to reintegration of 
                offenders into the community;
                  (E) includes the use of a State, local, 
                territorial, or tribal task force, described in 
                subsection (i), to carry out the activities 
                funded under the grant;
                  (F) provides a plan for continued 
                collaboration with a local evaluator as 
                necessary to meeting the requirements under 
                subsection (h); and
                  (G) demonstrates that the applicant 
                participated in the planning grant process or 
                engaged in comparable planning for the reentry 
                project.
          (3) Priority considerations.--The Attorney General 
        shall give priority to grant applications under this 
        subsection that best--
                  (A) focus initiative on geographic areas with 
                a disproportionate population of offenders 
                released from prisons, jails, and juvenile 
                facilities;
                  (B) include--
                          (i) input from nonprofit 
                        organizations, in any case where 
                        relevant input is available and 
                        appropriate to the grant application;
                          (ii) consultation with crime victims 
                        and offenders who are released from 
                        prisons, jails, and juvenile 
                        facilities;
                          (iii) coordination with families of 
                        offenders;
                          (iv) input, where appropriate, from 
                        the juvenile justice coordinating 
                        council of the region;
                          (v) input, where appropriate, from 
                        the reentry coordinating council of the 
                        region; or
                          (vi) input, where appropriate, from 
                        other interested persons;
                  (C) demonstrate effective case assessment and 
                management abilities in order to provide 
                comprehensive and continuous reentry, 
                including--
                          (i) planning for prerelease 
                        transitional housing and community 
                        release that begins upon admission for 
                        juveniles and jail inmates, and, as 
                        appropriate, for prison inmates, 
                        depending on the length of the 
                        sentence;
                          (ii) establishing prerelease planning 
                        procedures to ensure that the 
                        eligibility of an offender for Federal, 
                        tribal, or State benefits upon release 
                        is established prior to release, 
                        subject to any limitations in law, and 
                        to ensure that offenders obtain all 
                        necessary referrals for reentry 
                        services, including assistance 
                        identifying and securing suitable 
                        housing; or
                          (iii) delivery of continuous and 
                        appropriate mental health services, 
                        drug treatment, medical care, job 
                        training and placement, educational 
                        services, vocational services, and any 
                        other service or support needed for 
                        reentry;
                  (D) review the process by which the applicant 
                adjudicates violations of parole, probation, or 
                supervision following release from prison, 
                jail, or a juvenile facility, taking into 
                account public safety and the use of graduated, 
                community-based sanctions for minor and 
                technical violations of parole, probation, or 
                supervision (specifically those violations that 
                are not otherwise, and independently, a 
                violation of law);
                  (E) provide for an independent evaluation of 
                reentry programs that include, to the maximum 
                extent possible, random assignment and 
                controlled studies to determine the 
                effectiveness of such programs;
                  (F) target moderate and high-risk offenders 
                for reentry programs through validated 
                assessment tools; or
                  (G) target offenders with histories of 
                homelessness, substance abuse, or mental 
                illness, including a prerelease assessment of 
                the housing status of the offender and 
                behavioral health needs of the offender with 
                clear coordination with mental health, 
                substance abuse, and homelessness services 
                systems to achieve stable and permanent housing 
                outcomes with appropriate support service.
          (4) Period of grant.--A grant made under this 
        subsection shall be effective for a 2-year period--
                  (A) beginning on the date on which the 
                planning grant awarded under subsection (e) 
                concludes; or
                  (B) in the case of an implementation grant 
                awarded to an eligible entity that did not 
                receive a planning grant, beginning on the date 
                on which the implementation grant is awarded.
  (g) Uses of Grant Funds.--
          (1) Federal share.--
                  (A) In general.--The Federal share of a grant 
                received under this section may not exceed 50 
                percent of the project funded under such grant.
                  (B) In-kind contributions.--
                          (i) In general.--Subject to clause 
                        (ii), the recipient of a grant under 
                        this section may meet the matching 
                        requirement under subparagraph (A) by 
                        making in-kind contributions of goods 
                        or services that are directly related 
                        to the purpose for which such grant was 
                        awarded.
                          (ii) Maximum percentage.--Not more 
                        than 50 percent of the amount provided 
                        by a recipient of a grant under this 
                        section to meet the matching 
                        requirement under subparagraph (A) may 
                        be provided through in-kind 
                        contributions under clause (i).
          (2) Supplement not supplant.--Federal funds received 
        under this section shall be used to supplement, not 
        supplant, non-Federal funds that would otherwise be 
        available for the activities funded under this section.
  (h) Reentry Strategic Plan.--
          (1) In general.--As a condition of receiving 
        financial assistance under subsection (f), each 
        application shall develop a comprehensive reentry 
        strategic plan that--
                  (A) contains a plan to assess inmate reentry 
                needs and measurable annual and 3-year 
                performance outcomes;
                  (B) uses, to the maximum extent possible, 
                randomly assigned and controlled studies, or 
                rigorous quasi-experimental studies with 
                matched comparison groups, to determine the 
                effectiveness of the program funded with a 
                grant under subsection (f); and
                  (C) includes as a goal of the plan to reduce 
                the rate of recidivism for offenders released 
                from prison, jail or a juvenile facility with 
                funds made available under subsection (f).
          (2) Local evaluator.--A partnership with a local 
        evaluator described in subsection (d)(2) shall require 
        the local evaluator to use the baseline data and target 
        population characteristics developed under a subsection 
        (e) planning grant to derive a target goal for 
        recidivism reduction during the 3-year period beginning 
        on the date of implementation of the program.
          (3) Coordination.--In developing a reentry plan under 
        this subsection, an applicant shall coordinate with 
        communities and stakeholders, including persons in the 
        fields of public safety, juvenile and adult 
        corrections, housing, health, education, substance 
        abuse, children and families, victims services, 
        employment, and business and members of nonprofit 
        organizations that can provide reentry services.
          (4) Measurements of progress.--Each reentry plan 
        developed under this subsection shall measure the 
        progress of the applicant toward increasing public 
        safety by reducing rates of recidivism and enabling 
        released offenders to transition successfully back into 
        their communities.
  (i) Reentry Task Force.--
          (1) In general.--As a condition of receiving 
        financial assistance under subsection (f), each 
        applicant shall establish or empower a Reentry Task 
        Force, or other relevant convening authority, to--
                  (A) examine ways to pool resources and 
                funding streams to promote lower recidivism 
                rates for returning offenders and minimize the 
                harmful effects of offenders' time in prison, 
                jail, or a juvenile facility on families and 
                communities of offenders by collecting data and 
                best practices in offender reentry from 
                demonstration grantees and other agencies and 
                organizations; and
                  (B) provide the analysis described in 
                subsection (f)(2)(D).
          (2) Membership.--The task force or other authority 
        under this subsection shall be comprised of--
                  (A) relevant State, Tribal, territorial, or 
                local leaders; and
                  (B) representatives of relevant--
                          (i) agencies;
                          (ii) service providers;
                          (iii) nonprofit organizations; and
                          (iv) stakeholders.
  (j) Strategic Performance Outcomes.--
          (1) In general.--Each applicant for an implementation 
        grant under subsection (f) shall identify in the 
        reentry strategic plan developed under subsection (h), 
        specific performance outcomes relating to the long-term 
        goals of increasing public safety and reducing 
        recidivism.
          (2) Performance outcomes.--The performance outcomes 
        identified under paragraph (1) shall include, with 
        respect to offenders released back into the community--
                  (A) reduction in recidivism rates, which 
                shall be reported in accordance with the 
                measure selected by the Director of the Bureau 
                of Justice Statistics under section 234(c)(2) 
                of the Second Chance Act of 2007;
                  (B) reduction in crime;
                  (C) increased employment and education 
                opportunities;
                  (D) reduction in violations of conditions of 
                supervised release;
                  (E) increased payment of child support, where 
                appropriate;
                  (F) increased number of staff trained to 
                administer reentry services;
                  (G) increased proportion of individuals 
                served by the program among those eligible to 
                receive services;
                  (H) increased number of individuals receiving 
                risk screening needs assessment, and case 
                planning services;
                  (I) increased enrollment in, and completion 
                of treatment services, including substance 
                abuse and mental health services among those 
                assessed as needing such services;
                  (J) increased enrollment in and degrees 
                earned from educational programs, including 
                high school, GED, vocational training, and 
                college education;
                  (K) increased number of individuals obtaining 
                and retaining employment;
                  (L) increased number of individuals obtaining 
                and maintaining housing;
                  (M) increased self-reports of successful 
                community living, including stability of living 
                situation and positive family relationships;
                  (N) reduction in drug and alcohol use; and
                  (O) reduction in recidivism rates for 
                individuals receiving reentry services after 
                release, as compared to either baseline 
                recidivism rates in the jurisdiction of the 
                grantee or recidivism rates of the control or 
                comparison group.
          (3) Other outcomes.--A grantee under this section may 
        include in the reentry strategic plan developed under 
        subsection (h) other performance outcomes that increase 
        the success rates of offenders who transition from 
        prison, jails, or juvenile facilities, including a 
        cost-benefit analysis to determine the cost 
        effectiveness of the reentry program.
          (4) Coordination.--A grantee under subsection (f) 
        shall coordinate with communities and stakeholders 
        about the selection of performance outcomes identified 
        by the applicant, and shall consult with the Attorney 
        General for assistance with data collection and 
        measurement activities as provided for in the grant 
        application materials.
          (5) Report.--Each grantee under subsection (f) shall 
        submit to the Attorney General an annual report that--
                  (A) identifies the progress of the grantee 
                toward achieving its strategic performance 
                outcomes; and
                  (B) describes other activities conducted by 
                the grantee to increase the success rates of 
                the reentry population, such as programs that 
                foster effective risk management and treatment 
                programming, offender accountability, and 
                community and victim participation.
  (k) Performance Measurement.--
          (1) In general.--The Attorney General, in 
        consultation with grantees under subsection (f), 
        shall--
                  (A) identify primary and secondary sources of 
                information to support the measurement of the 
                performance indicators identified under 
                subsection (f);
                  (B) identify sources and methods of data 
                collection in support of performance 
                measurement required under subsection (f);
                  (C) provide to all grantees technical 
                assistance and training on performance measures 
                and data collection for purposes of subsection 
                (f); and
                  (D) consult with the Substance Abuse and 
                Mental Health Services Administration and the 
                [National Institute on Drug Abuse] National 
                Institute on Drugs and Addiction on strategic 
                performance outcome measures and data 
                collection for purposes of subsection (f) 
                relating to substance abuse and mental health.
          (2) Coordination.--The Attorney General shall 
        coordinate with other Federal agencies to identify 
        national and other sources of information to support 
        performance measurement of grantees.
          (3) Standards for analysis.--Any statistical analysis 
        of population data conducted pursuant to this section 
        shall be conducted in accordance with the Federal 
        Register Notice dated October 30, 1997, relating to 
        classification standards.
  (l) Future Eligibility.--To be eligible to receive a grant 
under this section in any fiscal year after the fiscal year in 
which a grantee receives a grant under this section, a grantee 
shall submit to the Attorney General such information as is 
necessary to demonstrate that--
          (1) the grantee has adopted a reentry plan that 
        reflects input from nonprofit organizations, in any 
        case where relevant input is available and appropriate 
        to the grant application;
          (2) the reentry plan of the grantee includes 
        performance measures to assess progress of the grantee 
        toward a 10 percent reduction in the rate of recidivism 
        over a 2-year period beginning on the date on which the 
        most recent implementation grant is made to the grantee 
        under subsection (f);
          (3) the grantee will coordinate with the Attorney 
        General, nonprofit organizations (if relevant input 
        from nonprofit organizations is available and 
        appropriate), and other experts regarding the selection 
        and implementation of the performance measures 
        described in subsection (k); and
          (4) the grantee has made adequate progress, as 
        determined by the Attorney General, toward reducing the 
        rate of recidivism by 10 percent during the 2-year 
        period described in paragraph (2).
  (m) National Adult and Juvenile Offender Reentry Resource 
Center.--
          (1) Authority.--The Attorney General may, using 
        amounts made available to carry out this subsection, 
        make a grant to an eligible organization to provide for 
        the establishment of a National Adult and Juvenile 
        Offender Reentry Resource Center.
          (2) Eligible organization.--An organization eligible 
        for the grant under paragraph (1) is any national 
        nonprofit organization approved by the Interagency Task 
        Force on Federal Programs and Activities Relating to 
        the Reentry of Offenders Into the Community, that 
        provides technical assistance and training to, and has 
        special expertise and broad, national-level experience 
        in, offender reentry programs, training, and research.
          (3) Use of funds.--The organization receiving a grant 
        under paragraph (1) shall establish a National Adult 
        and Juvenile Offender Reentry Resource Center to--
                  (A) provide education, training, and 
                technical assistance for States, tribes, 
                territories, local governments, service 
                providers, nonprofit organizations, and 
                corrections institutions;
                  (B) collect data and best practices in 
                offender reentry from demonstration grantees 
                and others agencies and organizations;
                  (C) develop and disseminate evaluation tools, 
                mechanisms, and measures to better assess and 
                document coalition performance measures and 
                outcomes;
                  (D) disseminate information to States and 
                other relevant entities about best practices, 
                policy standards, and research findings;
                  (E) develop and implement procedures to 
                assist relevant authorities in determining when 
                release is appropriate and in the use of data 
                to inform the release decision;
                  (F) develop and implement procedures to 
                identify efficiently and effectively those 
                violators of probation, parole, or supervision 
                following release from prison, jail, or a 
                juvenile facility who should be returned to 
                prisons, jails, or juvenile facilities and 
                those who should receive other penalties based 
                on defined, graduated sanctions;
                  (G) collaborate with the Interagency Task 
                Force on Federal Programs and Activities 
                Relating to the Reentry of Offenders Into the 
                Community, and the Federal Resource Center for 
                Children of Prisoners;
                  (H) develop a national reentry research 
                agenda; and
                  (I) establish a database to enhance the 
                availability of information that will assist 
                offenders in areas including housing, 
                employment, counseling, mentoring, medical and 
                mental health services, substance abuse 
                treatment, transportation, and daily living 
                skills.
          (4) Limit.--Of amounts made available to carry out 
        this section, not more than 4 percent of the authorized 
        level shall be available to carry out this subsection.
  (n) Administration.--Of amounts made available to carry out 
this section--
          (1) not more than 2 percent of the authorized level 
        shall be available for administrative expenses in 
        carrying out this section; and
          (2) not more than 2 percent of the authorized level 
        shall be made available to the National Institute of 
        Justice to evaluate the effectiveness of the 
        demonstration projects funded under this section, using 
        a methodology that--
                  (A) includes, to the maximum extent feasible, 
                random assignment of offenders (or entities 
                working with such persons) to program delivery 
                and control groups; and
                  (B) generates evidence on which reentry 
                approaches and strategies are most effective.
  (o) Authorization of Appropriations.--
          (1) In general.--To carry out this section, there are 
        authorized to be appropriated $35,000,000 for each of 
        fiscal years 2019 through 2023.
          (2) Limitation; equitable distribution.--
                  (A) Limitation.--Of the amount made available 
                to carry out this section for any fiscal year, 
                not more than 3 percent or less than 2 percent 
                may be used for technical assistance and 
                training.
                  (B) Equitable distribution.--The Attorney 
                General shall ensure that grants awarded under 
                this section are equitably distributed among 
                the geographical regions and between urban and 
                rural populations, including Indian Tribes, 
                consistent with the objective of reducing 
                recidivism among criminal offenders.
  (p) Definition.--In this section, the term ``reentry court'' 
means a program that--
          (1) monitors juvenile and adult eligible offenders 
        reentering the community;
          (2) provides continual judicial supervision;
          (3) provides juvenile and adult eligible offenders 
        reentering the community with coordinated and 
        comprehensive reentry services and programs, such as--
                  (A) drug and alcohol testing and assessment 
                for treatment;
                  (B) assessment for substance abuse from a 
                substance abuse professional who is approved by 
                the State or Indian tribe and licensed by the 
                appropriate entity to provide alcohol and drug 
                addiction treatment, as appropriate;
                  (C) substance abuse treatment, including 
                medication-assisted treatment, from a provider 
                that is approved by the State or Indian tribe, 
                and licensed, if necessary, to provide medical 
                and other health services;
                  (D) health (including mental health) services 
                and assessment;
                  (E) aftercare and case management services 
                that--
                          (i) facilitate access to clinical 
                        care and related health services; and
                          (ii) coordinate with such clinical 
                        care and related health services; and
                  (F) any other services needed for reentry;
          (4) convenes community impact panels, victim impact 
        panels, or victim impact educational classes;
          (5) provides and coordinates the delivery of 
        community services to juvenile and adult eligible 
        offenders, including--
                  (A) housing assistance;
                  (B) education;
                  (C) job training;
                  (D) conflict resolution skills training;
                  (E) batterer intervention programs; and
                  (F) other appropriate social services; and
          (6) establishes and implements graduated sanctions 
        and incentives.

           *       *       *       *       *       *       *

                              ----------                              


              SECTION 7361 OF TITLE 5, UNITED STATES CODE


Sec. 7361. Drug abuse

  (a) The Office of Personnel Management shall be responsible 
for developing, in cooperation with the President, with the 
Secretary of Health and Human Services (acting through the 
[National Institute on Drug Abuse] National Institute on Drugs 
and Addiction), and with other agencies, and in accordance with 
applicable provisions of this subchapter, appropriate 
prevention, treatment, and rehabilitation programs and services 
for drug abuse among employees. Such agencies are encouraged to 
extend, to the extent feasible, such programs and services to 
the families of employees and to employees who have family 
members who are drug abusers. Such programs and services shall 
make optimal use of existing governmental facilities, services, 
and skills.
  (b) Section 527 of the Public Health Service Act (42 U.S.C. 
290ee-3), relating to confidentiality of records, and any 
regulations prescribed thereunder, shall apply with respect to 
records maintained for the purpose of carrying out this 
section.
  (c) Each agency shall, with respect to any programs or 
services provided by such agency, submit such written reports 
as the Office may require in connection with any report 
required under section 7363 of this title.
  (d) For the purpose of this section, the term ``agency'' 
means an Executive agency.
                              ----------                              


                SECTION 303 OF CONTROLLED SUBSTANCES ACT


                       registration requirements

  Sec. 303. (a) The Attorney General shall register an 
applicant to manufacture controlled substances in schedule I or 
II if he determines that such registration is consistent with 
the public interest and with United States obligations under 
international treaties, conventions, or protocols in effect on 
the effective date of this part. In determining the public 
interest, the following factors shall be considered:
          (1) maintenance of effective controls against 
        diversion of particular controlled substances and any 
        controlled substance in schedule I or II compounded 
        therefrom into other than legitimate medical, 
        scientific, research, or industrial channels, by 
        limiting the importation and bulk manufacture of such 
        controlled substances to a number of establishments 
        which can produce an adequate and uninterrupted supply 
        of these substances under adequately competitive 
        conditions for legitimate medical, scientific, 
        research, and industrial purposes;
          (2) compliance with applicable State and local law;
          (3) promotion of technical advances in the art of 
        manufacturing these substances and the development of 
        new substances;
          (4) prior conviction record of applicant under 
        Federal and State laws relating to the manufacture, 
        distribution, or dispensing of such substances;
          (5) past experience in the manufacture of controlled 
        substances, and the existence in the establishment of 
        effective control against diversion; and
          (6) such other factors as may be relevant to and 
        consistent with the public health and safety.
  (b) The Attorney General shall register an applicant to 
distribute a controlled substance in schedule I or II unless he 
determines that the issuance of such registration is 
inconsistent with the public interest. In determining the 
public interest, the following factors shall be considered:
          (1) maintenance of effective controls against 
        diversion of particular controlled substances into 
        other than legitimate medical, scientific, and 
        industrial channels;
          (2) compliance with applicable State and local law;
          (3) prior conviction record of applicant under 
        Federal or State laws relating to the manufacture, 
        distribution, or dispensing of such substances;
          (4) past experience in the distribution of controlled 
        substances; and
          (5) such other factors as may be relevant to and 
        consistent with the public health and safety.
  (c) Registration granted under subsections (a) and (b) of 
this section shall not entitle a registrant to (1) manufacture 
or distribute controlled substances in schedule I or II other 
than those specified in the registration, or (2) manufacture 
any quantity of those controlled substances in excess of the 
quota assigned pursuant to section 306.
  (d) The Attorney General shall register an applicant to 
manufacture controlled substances in schedule III, IV, or V, 
unless he determines that the issuance of such registration is 
inconsistent with the public interest. In determining the 
public interest, the following factors shall be considered:
          (1) maintenance of effective controls against 
        diversion of particular controlled substances and any 
        controlled substance in schedule III, IV, or V 
        compounded therefrom into other than legitimate 
        medical, scientific, or industrial channels;
          (2) compliance with applicable State and local law;
          (3) promotion of technical advances in the art of 
        manufacturing these substances and the development of 
        new substances;
          (4) prior conviction record of applicant under 
        Federal or State laws relating to the manufacture, 
        distribution, or dispensing of such substances;
          (5) past experience in the manufacture, distribution, 
        and dispensing of controlled substances, and the 
        existence in the establishment of effective controls 
        against diversion; and
          (6) such other factors as may be relevant to and 
        consistent with the public health and safety.
  (e) The Attorney General shall register an applicant to 
distribute controlled substances in schedule III, IV, or V, 
unless he determines that the issuance of such registration is 
inconsistent with the public interest. In determining the 
public interest, the following factors shall be considered:
          (1) maintenance of effective controls against 
        diversion of particular controlled substances into 
        other than legitimate medical, scientific, and 
        industrial channels;
          (2) compliance with applicable State and local law;
          (3) prior conviction record of applicant under 
        Federal or State laws relating to the manufacture, 
        distribution, or dispensing of such substances;
          (4) past experience in the distribution of controlled 
        substances; and
          (5) such other factors as may be relevant to and 
        consistent with the public health and safety.
  (f) The Attorney General shall register practitioners 
(including pharmacies, as distinguished from pharmacists) to 
dispense, or conduct research with, controlled substances in 
schedule II, III, IV, or V and shall modify the registrations 
of pharmacies so registered to authorize them to dispense 
controlled substances by means of the Internet, if the 
applicant is authorized to dispense, or conduct research with 
respect to, controlled substances under the laws of the State 
in which he practices. The Attorney General may deny an 
application for such registration or such modification of 
registration if the Attorney General determines that the 
issuance of such registration or modification would be 
inconsistent with the public interest. In determining the 
public interest, the following factors shall be considered:
          (1) The recommendation of the appropriate State 
        licensing board or professional disciplinary authority.
          (2) The applicant's experience in dispensing, or 
        conducting research with respect to controlled 
        substances.
          (3) The applicant's conviction record under Federal 
        or State laws relating to the manufacture, 
        distribution, or dispensing of controlled substances.
          (4) Compliance with applicable State, Federal, or 
        local laws relating to controlled substances.
          (5) Such other conduct which may threaten the public 
        health and safety.
Separate registration under this part for practitioners 
engaging in research with controlled substances in schedule II, 
III, IV, or V, who are already registered under this part in 
another capacity, shall not be required. Registration 
applications by practitioners wishing to conduct research with 
controlled substances in schedule I shall be referred to the 
Secretary, who shall determine the qualifications and 
competency of each practitioner requesting registration, as 
well as the merits of the research protocol. The Secretary, in 
determining the merits of each research protocol, shall consult 
with the Attorney General as to effective procedures to 
adequately safeguard against diversion of such controlled 
substances from legitimate medical or scientific use. 
Registration for the purpose of bona fide research with 
controlled substances in schedule I by a practitioner deemed 
qualified by the Secretary may be denied by the Attorney 
General only on a ground specified in section 304(a). Article 7 
of the Convention on Psychotrophic Substances shall not be 
construed to prohibit, or impose additional restrictions upon, 
research involving drugs or other substances scheduled under 
the convention which is conducted in conformity with this 
subsection and other applicable provisions of this title.
  (g)(1) Except as provided in paragraph (2), practitioners who 
dispense narcotic drugs to individuals for maintenance 
treatment or detoxification treatment shall obtain annually a 
separate registration for that purpose. The Attorney General 
shall register an applicant to dispense narcotic drugs to 
individuals for maintenance treatment or detoxification 
treatment (or both)--
          (A) if the applicant is a practitioner who is 
        determined by the Secretary to be qualified (under 
        standards established by the Secretary) to engage in 
        the treatment with respect to which registration is 
        sought;
          (B) if the Attorney General determines that the 
        applicant will comply with standards established by the 
        Attorney General respecting (i) security of stocks of 
        narcotic drugs for such treatment, and (ii) the 
        maintenance of records (in accordance with section 307) 
        on such drugs; and
          (C) if the Secretary determines that the applicant 
        will comply with standards established by the Secretary 
        (after consultation with the Attorney General) 
        respecting the quantities of narcotic drugs which may 
        be provided for unsupervised use by individuals in such 
        treatment.
  (2)(A) Subject to subparagraphs (D) and (J), the requirements 
of paragraph (1) are waived in the case of the dispensing 
(including the prescribing), by a practitioner, of narcotic 
drugs in schedule III, IV, or V or combinations of such drugs 
if the practitioner meets the conditions specified in 
subparagraph (B) and the narcotic drugs or combinations of such 
drugs meet the conditions specified in subparagraph (C).
  (B) For purposes of subparagraph (A), the conditions 
specified in this subparagraph with respect to a practitioner 
are that, before the initial dispensing of narcotic drugs in 
schedule III, IV, or V or combinations of such drugs to 
patients for maintenance or detoxification treatment, the 
practitioner submit to the Secretary a notification of the 
intent of the practitioner to begin dispensing the drugs or 
combinations for such purpose, and that the notification 
contain the following certifications by the practitioner:
          (i) The practitioner is a qualifying practitioner (as 
        defined in subparagraph (G)).
          (ii) With respect to patients to whom the 
        practitioner will provide such drugs or combinations of 
        drugs, the practitioner has the capacity to provide 
        directly, by referral, or in such other manner as 
        determined by the Secretary--
                  (I) all drugs approved by the Food and Drug 
                Administration for the treatment of opioid use 
                disorder, including for maintenance, 
                detoxification, overdose reversal, and relapse 
                prevention; and
                  (II) appropriate counseling and other 
                appropriate ancillary services.
          (iii)(I) The total number of such patients of the 
        practitioner at any one time will not exceed the 
        applicable number. Except as provided in subclause 
        (II), the applicable number is 30.
          (II) The applicable number is--
                  (aa) 100 if, not sooner than 1 year after the 
                date on which the practitioner submitted the 
                initial notification, the practitioner submits 
                a second notification to the Secretary of the 
                need and intent of the practitioner to treat up 
                to 100 patients;
                  (bb) 100 if the practitioner holds additional 
                credentialing, as defined in section 8.2 of 
                title 42, Code of Federal Regulations (or 
                successor regulations);
                  (cc) 100 if the practitioner provides 
                medication-assisted treatment (MAT) using 
                covered medications (as such terms are defined 
                in section 8.2 of title 42, Code of Federal 
                Regulations (or successor regulations)) in a 
                qualified practice setting (as described in 
                section 8.615 of title 42, Code of Federal 
                Regulations (or successor regulations)); or
                  (dd) 275 if the practitioner meets the 
                requirements specified in sections 8.610 
                through 8.655 of title 42, Code of Federal 
                Regulations (or successor regulations).
          (III) The Secretary may by regulation change such 
        applicable number.
          (IV) The Secretary may exclude from the applicable 
        number patients to whom such drugs or combinations of 
        drugs are directly administered by the qualifying 
        practitioner in the office setting.
  (C) For purposes of subparagraph (A), the conditions 
specified in this subparagraph with respect to narcotic drugs 
in schedule III, IV, or V or combinations of such drugs are as 
follows:
          (i) The drugs or combinations of drugs have, under 
        the Federal Food, Drug, and Cosmetic Act or section 351 
        of the Public Health Service Act, been approved for use 
        in maintenance or detoxification treatment.
          (ii) The drugs or combinations of drugs have not been 
        the subject of an adverse determination. For purposes 
        of this clause, an adverse determination is a 
        determination published in the Federal Register and 
        made by the Secretary, after consultation with the 
        Attorney General, that the use of the drugs or 
        combinations of drugs for maintenance or detoxification 
        treatment requires additional standards respecting the 
        qualifications of practitioners to provide such 
        treatment, or requires standards respecting the 
        quantities of the drugs that may be provided for 
        unsupervised use.
  (D)(i) A waiver under subparagraph (A) with respect to a 
practitioner is not in effect unless (in addition to conditions 
under subparagraphs (B) and (C)) the following conditions are 
met:
          (I) The notification under subparagraph (B) is in 
        writing and states the name of the practitioner.
          (II) The notification identifies the registration 
        issued for the practitioner pursuant to subsection (f).
          (III) If the practitioner is a member of a group 
        practice, the notification states the names of the 
        other practitioners in the practice and identifies the 
        registrations issued for the other practitioners 
        pursuant to subsection (f).
  (ii) Upon receiving a determination from the Secretary under 
clause (iii) finding that a practitioner meets all requirements 
for a waiver under subparagraph (B), the Attorney General shall 
assign the practitioner involved an identification number under 
this paragraph for inclusion with the registration issued for 
the practitioner pursuant to subsection (f). The identification 
number so assigned shall be appropriate to preserve the 
confidentiality of patients for whom the practitioner has 
dispensed narcotic drugs under a waiver under subparagraph (A).
  (iii) Not later than 45 days after the date on which the 
Secretary receives a notification under subparagraph (B), the 
Secretary shall make a determination of whether the 
practitioner involved meets all requirements for a waiver under 
subparagraph (B) and shall forward such determination to the 
Attorney General. If the Secretary fails to make such 
determination by the end of the such 45-day period, the 
Attorney General shall assign the practitioner an 
identification number described in clause (ii) at the end of 
such period.
  (E)(i) If a practitioner is not registered under paragraph 
(1) and, in violation of the conditions specified in 
subparagraphs (B) through (D), dispenses narcotic drugs in 
schedule III, IV, or V or combinations of such drugs for 
maintenance treatment or detoxification treatment, the Attorney 
General may, for purposes of section 304(a)(4), consider the 
practitioner to have committed an act that renders the 
registration of the practitioner pursuant to subsection (f) to 
be inconsistent with the public interest.
  (ii)(I) Upon the expiration of 45 days from the date on which 
the Secretary receives a notification under subparagraph (B), a 
practitioner who in good faith submits a notification under 
subparagraph (B) and reasonably believes that the conditions 
specified in subparagraphs (B) through (D) have been met shall, 
in dispensing narcotic drugs in schedule III, IV, or V or 
combinations of such drugs for maintenance treatment or 
detoxification treatment, be considered to have a waiver under 
subparagraph (A) until notified otherwise by the Secretary, 
except that such a practitioner may commence to prescribe or 
dispense such narcotic drugs for such purposes prior to the 
expiration of such 45-day period if it facilitates the 
treatment of an individual patient and both the Secretary and 
the Attorney General are notified by the practitioner of the 
intent to commence prescribing or dispensing such narcotic 
drugs.
  (II) For purposes of subclause (I), the publication in the 
Federal Register of an adverse determination by the Secretary 
pursuant to subparagraph (C)(ii) shall (with respect to the 
narcotic drug or combination involved) be considered to be a 
notification provided by the Secretary to practitioners, 
effective upon the expiration of the 30-day period beginning on 
the date on which the adverse determination is so published.
  (F)(i) With respect to the dispensing of narcotic drugs in 
schedule III, IV, or V or combinations of such drugs to 
patients for maintenance or detoxification treatment, a 
practitioner may, in his or her discretion, dispense such drugs 
or combinations for such treatment under a registration under 
paragraph (1) or a waiver under subparagraph (A) (subject to 
meeting the applicable conditions).
  (ii) This paragraph may not be construed as having any legal 
effect on the conditions for obtaining a registration under 
paragraph (1), including with respect to the number of patients 
who may be served under such a registration.
  (G) For purposes of this paragraph:
          (i) The term ``group practice'' has the meaning given 
        such term in section 1877(h)(4) of the Social Security 
        Act.
          (ii) The term ``qualifying physician'' means a 
        physician who is licensed under State law and who meets 
        one or more of the following conditions:
                  (I) The physician holds a board certification 
                in addiction psychiatry or addiction medicine 
                from the American Board of Medical Specialties.
                  (II) The physician holds an addiction 
                certification or board certification from the 
                American Society of Addiction Medicine or the 
                American Board of Addiction Medicine.
                  (III) The physician holds a board 
                certification in addiction medicine from the 
                American Osteopathic Association.
                  (IV) The physician has, with respect to the 
                treatment and management of opiate-dependent 
                patients, completed not less than 8 hours of 
                training (through classroom situations, 
                seminars at professional society meetings, 
                electronic communications, or otherwise) that 
                is provided by the American Society of 
                Addiction Medicine, the American Academy of 
                Addiction Psychiatry, the American Medical 
                Association, the American Osteopathic 
                Association, the American Psychiatric 
                Association, or any other organization that the 
                Secretary determines is appropriate for 
                purposes of this subclause. Such training shall 
                include--
                          (aa) opioid maintenance and 
                        detoxification;
                          (bb) appropriate clinical use of all 
                        drugs approved by the Food and Drug 
                        Administration for the treatment of 
                        opioid use disorder;
                          (cc) initial and periodic patient 
                        assessments (including substance use 
                        monitoring);
                          (dd) individualized treatment 
                        planning, overdose reversal, and 
                        relapse prevention;
                          (ee) counseling and recovery support 
                        services;
                          (ff) staffing roles and 
                        considerations;
                          (gg) diversion control; and
                          (hh) other best practices, as 
                        identified by the Secretary.
                  (V) The physician has participated as an 
                investigator in one or more clinical trials 
                leading to the approval of a narcotic drug in 
                schedule III, IV, or V for maintenance or 
                detoxification treatment, as demonstrated by a 
                statement submitted to the Secretary by the 
                sponsor of such approved drug.
                  (VI) The physician has such other training or 
                experience as the State medical licensing board 
                (of the State in which the physician will 
                provide maintenance or detoxification 
                treatment) considers to demonstrate the ability 
                of the physician to treat and manage opiate-
                dependent patients.
                  (VII) The physician has such other training 
                or experience as the Secretary considers to 
                demonstrate the ability of the physician to 
                treat and manage opiate-dependent patients. Any 
                criteria of the Secretary under this subclause 
                shall be established by regulation. Any such 
                criteria are effective only for 3 years after 
                the date on which the criteria are promulgated, 
                but may be extended for such additional 
                discrete 3-year periods as the Secretary 
                considers appropriate for purposes of this 
                subclause. Such an extension of criteria may 
                only be effectuated through a statement 
                published in the Federal Register by the 
                Secretary during the 30-day period preceding 
                the end of the 3-year period involved.
          (VIII) The physician graduated in good standing from 
        an accredited school of allopathic medicine or 
        osteopathic medicine in the United States during the 5-
        year period immediately preceding the date on which the 
        physician submits to the Secretary a written 
        notification under subparagraph (B) and successfully 
        completed a comprehensive allopathic or osteopathic 
        medicine curriculum or accredited medical residency 
        that--
                  (aa) included not less than 8 hours of 
                training on treating and managing opioid-
                dependent patients; and
                  (bb) included, at a minimum--
                          (AA) the training described in items 
                        (aa) through (gg) of subclause (IV); 
                        and
                          (BB) training with respect to any 
                        other best practice the Secretary 
                        determines should be included in the 
                        curriculum, which may include training 
                        on pain management, including 
                        assessment and appropriate use of 
                        opioid and non-opioid alternatives.
          (iii) The term ``qualifying practitioner'' means--
                  (I) a qualifying physician, as defined in 
                clause (ii);
                  (II) a qualifying other practitioner, as 
                defined in clause (iv), who is a nurse 
                practitioner or physician assistant; or
                  (III) for the period beginning on October 1, 
                2018, and ending on October 1, 2023, a 
                qualifying other practitioner, as defined in 
                clause (iv), who is a clinical nurse 
                specialist, certified registered nurse 
                anesthetist, or certified nurse midwife.
          (iv) The term ``qualifying other practitioner'' means 
        a nurse practitioner, clinical nurse specialist, 
        certified registered nurse anesthetist, certified nurse 
        midwife, or physician assistant who satisfies each of 
        the following:
                  (I) The nurse practitioner, clinical nurse 
                specialist, certified registered nurse 
                anesthetist, certified nurse midwife, or 
                physician assistant is licensed under State law 
                to prescribe schedule III, IV, or V medications 
                for the treatment of pain.
                  (II) The nurse practitioner, clinical nurse 
                specialist, certified registered nurse 
                anesthetist, certified nurse midwife, or 
                physician assistant has--
                          (aa) completed not fewer than 24 
                        hours of initial training addressing 
                        each of the topics listed in clause 
                        (ii)(IV) (through classroom situations, 
                        seminars at professional society 
                        meetings, electronic communications, or 
                        otherwise) provided by the American 
                        Society of Addiction Medicine, the 
                        American Academy of Addiction 
                        Psychiatry, the American Medical 
                        Association, the American Osteopathic 
                        Association, the American Nurses 
                        Credentialing Center, the American 
                        Psychiatric Association, the American 
                        Association of Nurse Practitioners, the 
                        American Academy of Physician 
                        Assistants, or any other organization 
                        that the Secretary determines is 
                        appropriate for purposes of this 
                        subclause; or
                          (bb) has such other training or 
                        experience as the Secretary determines 
                        will demonstrate the ability of the 
                        nurse practitioner, clinical nurse 
                        specialist, certified registered nurse 
                        anesthetist, certified nurse midwife, 
                        or physician assistant to treat and 
                        manage opiate-dependent patients.
                  (III) The nurse practitioner, clinical nurse 
                specialist, certified registered nurse 
                anesthetist, certified nurse midwife, or 
                physician assistant is supervised by, or works 
                in collaboration with, a qualifying physician, 
                if the nurse practitioner, clinical nurse 
                specialist, certified registered nurse 
                anesthetist, certified nurse midwife, or 
                physician assistant is required by State law to 
                prescribe medications for the treatment of 
                opioid use disorder in collaboration with or 
                under the supervision of a physician.
The Secretary may, by regulation, revise the requirements for 
being a qualifying other practitioner under this clause.
  (H)(i) In consultation with the Administrator of the Drug 
Enforcement Administration, the Administrator of the Substance 
Abuse and Mental Health Services Administration, the Director 
of the [National Institute on Drug Abuse] National Institute on 
Drugs and Addiction, and the Commissioner of Food and Drugs, 
the Secretary shall issue regulations (through notice and 
comment rulemaking) or issue practice guidelines to address the 
following:
          (I) Approval of additional credentialing bodies and 
        the responsibilities of additional credentialing 
        bodies.
          (II) Additional exemptions from the requirements of 
        this paragraph and any regulations under this 
        paragraph.
          (III) Such other elements of the requirements under 
        this paragraph as the Secretary determines necessary 
        for purposes of implementing such requirements.
Nothing in such regulations or practice guidelines may 
authorize any Federal official or employee to exercise 
supervision or control over the practice of medicine or the 
manner in which medical services are provided.
  (ii) Not later than 18 months after the date of enactment of 
the Opioid Use Disorder Treatment Expansion and Modernization 
Act, the Secretary shall update the treatment improvement 
protocol containing best practice guidelines for the treatment 
of opioid-dependent patients in office-based settings. The 
Secretary shall update such protocol in consultation with 
experts in opioid use disorder research and treatment.
  (I) Notwithstanding section 708, nothing in this paragraph 
shall be construed to preempt any State law that--
          (i) permits a qualifying practitioner to dispense 
        narcotic drugs in schedule III, IV, or V, or 
        combinations of such drugs, for maintenance or 
        detoxification treatment in accordance with this 
        paragraph to a total number of patients that is more 
        than 30 or less than the total number applicable to the 
        qualifying practitioner under subparagraph (B)(iii)(II) 
        if a State enacts a law modifying such total number and 
        the Attorney General is notified by the State of such 
        modification; or
          (ii) requires a qualifying practitioner to comply 
        with additional requirements relating to the dispensing 
        of narcotic drugs in schedule III, IV, or V, or 
        combinations of such drugs, including requirements 
        relating to the practice setting in which the 
        qualifying practitioner practices and education, 
        training, and reporting requirements.
  (h) The Attorney General shall register an applicant to 
distribute a list I chemical unless the Attorney General 
determines that registration of the applicant is inconsistent 
with the public interest. Registration under this subsection 
shall not be required for the distribution of a drug product 
that is exempted under clause (iv) or (v) of section 
102(39)(A). In determining the public interest for the purposes 
of this subsection, the Attorney General shall consider--
          (1) maintenance by the applicant of effective 
        controls against diversion of listed chemicals into 
        other than legitimate channels;
          (2) compliance by the applicant with applicable 
        Federal, State, and local law;
          (3) any prior conviction record of the applicant 
        under Federal or State laws relating to controlled 
        substances or to chemicals controlled under Federal or 
        State law;
          (4) any past experience of the applicant in the 
        manufacture and distribution of chemicals; and
          (5) such other factors as are relevant to and 
        consistent with the public health and safety.
  (i)(1) For purposes of registration to manufacture a 
controlled substance under subsection (d) for use only in a 
clinical trial, the Attorney General shall register the 
applicant, or serve an order to show cause upon the applicant 
in accordance with section 304(c), not later than 180 days 
after the date on which the application is accepted for filing.
  (2) For purposes of registration to manufacture a controlled 
substance under subsection (a) for use only in a clinical 
trial, the Attorney General shall, in accordance with the 
regulations issued by the Attorney General, issue a notice of 
application not later than 90 days after the application is 
accepted for filing. Not later than 90 days after the date on 
which the period for comment pursuant to such notice ends, the 
Attorney General shall register the applicant, or serve an 
order to show cause upon the applicant in accordance with 
section 304(c), unless the Attorney General has granted a 
hearing on the application under section 1008(i) of the 
Controlled Substances Import and Export Act.
  (j) Emergency Medical Services That Administer Controlled 
Substances.--
          (1) Registration.--For the purpose of enabling 
        emergency medical services professionals to administer 
        controlled substances in schedule II, III, IV, or V to 
        ultimate users receiving emergency medical services in 
        accordance with the requirements of this subsection, 
        the Attorney General--
                  (A) shall register an emergency medical 
                services agency if the agency submits an 
                application demonstrating it is authorized to 
                conduct such activity under the laws of each 
                State in which the agency practices; and
                  (B) may deny an application for such 
                registration if the Attorney General determines 
                that the issuance of such registration would be 
                inconsistent with the requirements of this 
                subsection or the public interest based on the 
                factors listed in subsection (f).
          (2) Option for single registration.--In registering 
        an emergency medical services agency pursuant to 
        paragraph (1), the Attorney General shall allow such 
        agency the option of a single registration in each 
        State where the agency administers controlled 
        substances in lieu of requiring a separate registration 
        for each location of the emergency medical services 
        agency.
          (3) Hospital-based agency.--If a hospital-based 
        emergency medical services agency is registered under 
        subsection (f), the agency may use the registration of 
        the hospital to administer controlled substances in 
        accordance with this subsection without being 
        registered under this subsection.
          (4) Administration outside physical presence of 
        medical director or authorizing medical professional.--
        Emergency medical services professionals of a 
        registered emergency medical services agency may 
        administer controlled substances in schedule II, III, 
        IV, or V outside the physical presence of a medical 
        director or authorizing medical professional in the 
        course of providing emergency medical services if the 
        administration is--
                  (A) authorized by the law of the State in 
                which it occurs; and
                  (B) pursuant to--
                          (i) a standing order that is issued 
                        and adopted by one or more medical 
                        directors of the agency, including any 
                        such order that may be developed by a 
                        specific State authority; or
                          (ii) a verbal order that is--
                                  (I) issued in accordance with 
                                a policy of the agency; and
                                  (II) provided by a medical 
                                director or authorizing medical 
                                professional in response to a 
                                request by the emergency 
                                medical services professional 
                                with respect to a specific 
                                patient--
                                          (aa) in the case of a 
                                        mass casualty incident; 
                                        or
                                          (bb) to ensure the 
                                        proper care and 
                                        treatment of a specific 
                                        patient.
          (5) Delivery.--A registered emergency medical 
        services agency may deliver controlled substances from 
        a registered location of the agency to an unregistered 
        location of the agency only if the agency--
                  (A) designates the unregistered location for 
                such delivery; and
                  (B) notifies the Attorney General at least 30 
                days prior to first delivering controlled 
                substances to the unregistered location.
          (6) Storage.--A registered emergency medical services 
        agency may store controlled substances--
                  (A) at a registered location of the agency;
                  (B) at any designated location of the agency 
                or in an emergency services vehicle situated at 
                a registered or designated location of the 
                agency; or
                  (C) in an emergency medical services vehicle 
                used by the agency that is--
                          (i) traveling from, or returning to, 
                        a registered or designated location of 
                        the agency in the course of responding 
                        to an emergency; or
                          (ii) otherwise actively in use by the 
                        agency under circumstances that provide 
                        for security of the controlled 
                        substances consistent with the 
                        requirements established by regulations 
                        of the Attorney General.
          (7) No treatment as distribution.--The delivery of 
        controlled substances by a registered emergency medical 
        services agency pursuant to this subsection shall not 
        be treated as distribution for purposes of section 308.
          (8) Restocking of emergency medical services vehicles 
        at a hospital.--Notwithstanding paragraph (13)(J), a 
        registered emergency medical services agency may 
        receive controlled substances from a hospital for 
        purposes of restocking an emergency medical services 
        vehicle following an emergency response, and without 
        being subject to the requirements of section 308, 
        provided all of the following conditions are satisfied:
                  (A) The registered or designated location of 
                the agency where the vehicle is primarily 
                situated maintains a record of such receipt in 
                accordance with paragraph (9).
                  (B) The hospital maintains a record of such 
                delivery to the agency in accordance with 
                section 307.
                  (C) If the vehicle is primarily situated at a 
                designated location, such location notifies the 
                registered location of the agency within 72 
                hours of the vehicle receiving the controlled 
                substances.
          (9) Maintenance of records.--
                  (A) In general.--A registered emergency 
                medical services agency shall maintain records 
                in accordance with subsections (a) and (b) of 
                section 307 of all controlled substances that 
                are received, administered, or otherwise 
                disposed of pursuant to the agency's 
                registration, without regard to subsection 
                307(c)(1)(B).
                  (B) Requirements.--Such records--
                          (i) shall include records of 
                        deliveries of controlled substances 
                        between all locations of the agency; 
                        and
                          (ii) shall be maintained, whether 
                        electronically or otherwise, at each 
                        registered and designated location of 
                        the agency where the controlled 
                        substances involved are received, 
                        administered, or otherwise disposed of.
          (10) Other requirements.--A registered emergency 
        medical services agency, under the supervision of a 
        medical director, shall be responsible for ensuring 
        that--
                  (A) all emergency medical services 
                professionals who administer controlled 
                substances using the agency's registration act 
                in accordance with the requirements of this 
                subsection;
                  (B) the recordkeeping requirements of 
                paragraph (9) are met with respect to a 
                registered location and each designated 
                location of the agency;
                  (C) the applicable physical security 
                requirements established by regulation of the 
                Attorney General are complied with wherever 
                controlled substances are stored by the agency 
                in accordance with paragraph (6); and
                  (D) the agency maintains, at a registered 
                location of the agency, a record of the 
                standing orders issued or adopted in accordance 
                with paragraph (9).
          (11) Regulations.--The Attorney General may issue 
        regulations--
                  (A) specifying, with regard to delivery of 
                controlled substances under paragraph (5)--
                          (i) the types of locations that may 
                        be designated under such paragraph; and
                          (ii) the manner in which a 
                        notification under paragraph (5)(B) 
                        must be made;
                  (B) specifying, with regard to the storage of 
                controlled substances under paragraph (6), the 
                manner in which such substances must be stored 
                at registered and designated locations, 
                including in emergency medical service 
                vehicles; and
                  (C) addressing the ability of hospitals, 
                emergency medical services agencies, registered 
                locations, and designated locations to deliver 
                controlled substances to each other in the 
                event of--
                          (i) shortages of such substances;
                          (ii) a public health emergency; or
                          (iii) a mass casualty event.
          (12) Rule of construction.--Nothing in this 
        subsection shall be construed--
                  (A) to limit the authority vested in the 
                Attorney General by other provisions of this 
                title to take measures to prevent diversion of 
                controlled substances; or
                  (B) to override the authority of any State to 
                regulate the provision of emergency medical 
                services consistent with this subsection.
          (13) Definitions.--In this section:
                  (A) The term ``authorizing medical 
                professional'' means an emergency or other 
                physician, or another medical professional 
                (including an advanced practice registered 
                nurse or physician assistant)--
                          (i) who is registered under this Act;
                          (ii) who is acting within the scope 
                        of the registration; and
                          (iii) whose scope of practice under a 
                        State license or certification includes 
                        the ability to provide verbal orders.
                  (B) The term ``designated location'' means a 
                location designated by an emergency medical 
                services agency under paragraph (5).
                  (C) The term ``emergency medical services'' 
                means emergency medical response and emergency 
                mobile medical services provided outside of a 
                fixed medical facility.
                  (D) The term ``emergency medical services 
                agency'' means an organization providing 
                emergency medical services, including such an 
                organization that--
                          (i) is governmental (including fire-
                        based and hospital-based agencies), 
                        nongovernmental (including hospital-
                        based agencies), private, or volunteer-
                        based;
                          (ii) provides emergency medical 
                        services by ground, air, or otherwise; 
                        and
                          (iii) is authorized by the State in 
                        which the organization is providing 
                        such services to provide emergency 
                        medical care, including the 
                        administering of controlled substances, 
                        to members of the general public on an 
                        emergency basis.
                  (E) The term ``emergency medical services 
                professional'' means a health care professional 
                (including a nurse, paramedic, or emergency 
                medical technician) licensed or certified by 
                the State in which the professional practices 
                and credentialed by a medical director of the 
                respective emergency medical services agency to 
                provide emergency medical services within the 
                scope of the professional's State license or 
                certification.
                  (F) The term ``emergency medical services 
                vehicle'' means an ambulance, fire apparatus, 
                supervisor truck, or other vehicle used by an 
                emergency medical services agency for the 
                purpose of providing or facilitating emergency 
                medical care and transport or transporting 
                controlled substances to and from the 
                registered and designated locations.
                  (G) The term ``hospital-based'' means, with 
                respect to an agency, owned or operated by a 
                hospital.
                  (H) The term ``medical director'' means a 
                physician who is registered under subsection 
                (f) and provides medical oversight for an 
                emergency medical services agency.
                  (I) The term ``medical oversight'' means 
                supervision of the provision of medical care by 
                an emergency medical services agency.
                  (J) The term ``registered emergency medical 
                services agency'' means--
                          (i) an emergency medical services 
                        agency that is registered pursuant to 
                        this subsection; or
                          (ii) a hospital-based emergency 
                        medical services agency that is covered 
                        by the registration of the hospital 
                        under subsection (f).
                  (K) The term ``registered location'' means a 
                location that appears on the certificate of 
                registration issued to an emergency medical 
                services agency under this subsection or 
                subsection (f), which shall be where the agency 
                receives controlled substances from 
                distributors.
                  (L) The term ``specific State authority'' 
                means a governmental agency or other such 
                authority, including a regional oversight and 
                coordinating body, that, pursuant to State law 
                or regulation, develops clinical protocols 
                regarding the delivery of emergency medical 
                services in the geographic jurisdiction of such 
                agency or authority within the State that may 
                be adopted by medical directors.
                  (M) The term ``standing order'' means a 
                written medical protocol in which a medical 
                director determines in advance the medical 
                criteria that must be met before administering 
                controlled substances to individuals in need of 
                emergency medical services.
                  (N) The term ``verbal order'' means an oral 
                directive that is given through any method of 
                communication including by radio or telephone, 
                directly to an emergency medical services 
                professional, to contemporaneously administer a 
                controlled substance to individuals in need of 
                emergency medical services outside the physical 
                presence of the medical director or authorizing 
                medical professional.
  (k) In this section, the phrase ``factors as may be relevant 
to and consistent with the public health and safety'' means 
factors that are relevant to and consistent with the findings 
contained in section 101.
                              ----------                              


                           PUBLIC LAW 91-616


 AN ACT To provide a comprehensive Federal program for the prevention 
             and treatment of alcohol abuse and alcoholism.



           *       *       *       *       *       *       *
TITLE III--TECHNICAL ASSISTANCE AND FEDERAL GRANTS AND CONTRACTS

           *       *       *       *       *       *       *



                 Part B--Projects Grants and Contracts


 grants and contracts for the demonstration of new and more effective 
alcohol abuse and alcoholism prevention, treatment, and rehabilitation 
                                programs

  Sec. 311. (a) The Secretary, acting through the Institute, 
may make grants to public and nonprofit private entities and 
may enter into contracts with public and private entities and 
with individuals--
          (1) to conduct demonstration and evaluation projects, 
        with a high priority on prevention and early 
        intervention projects in occupational and educational 
        settings and on modified community living and work-care 
        arrangements such as halfway houses, recovery homes, 
        and supervised home care, and with particular emphasis 
        on developing new and more effective alcohol abuse and 
        alcoholism prevention, treatment, and rehabilitation 
        programs,
          (2) to support projects of a demonstration value in 
        developing methods for the effective coordination of 
        all alcoholism treatment, training, prevention, and 
        research resources available within a health service 
        area established under section 1511 of the Public 
        Health Service Act, and
          (3) to provide education and training, which may 
        include additional training to enable treatment 
        personnel to meet certification requirements of public 
        or private accreditation or licensure, or requirements 
        of third-party payors,
for the prevention and treatment of alcohol abuse and 
alcoholism and for the rehabilitation of alcohol abusers and 
alcoholics.
  (b) Projects and programs for which grants and contracts are 
made under this section shall (1) be responsive to special 
requirements of handicapped individuals in receiving such 
services; (2) whenever possible, be community based, seek (in 
the case of prevention and treatment services) to insure care 
of good quality in general community care facilities and under 
health insurance plans, and be integrated with, and provide for 
the active participation of, a wide range of public and 
nongovernmental agencies, organizations, institutions, and 
individuals; (3) where a substantial number of the individuals 
in the population served by the project or program are of 
limited English-speaking ability, utilize the services of 
outreach workers fluent in the language spoken by a predominant 
number of such individuals and develop a plan and make 
arrangements responsive to the needs of such population for 
providing services to the extent practicable in the language 
and cultural context most appropriate to such individuals, and 
identify an individual employed by the project or program, or 
who is available to the project or program on a full-time 
basis, who is fluent both in that language and English and 
whose responsibilities shall include providing guidance to the 
individuals of limited English-speaking ability and to 
appropriate staff members with respect to cultural 
sensitivities and bridging linguistic and cultural differences; 
and (4) where appropriate utilize existing community resources 
(including community mental health centers).
  (c)(1) In administering this section, the Secretary shall 
require coordination of all applications for projects and 
programs in a State.
  (2)(A) Each applicant from within a State, upon filing its 
application with the Secretary for a grant or contract under 
this section, shall submit a copy of its application for review 
by the State agency responsible for the administration of 
alcohol abuse and alcoholism prevention, treatment, and 
rehabilitation activities. Such State agency shall be given not 
more than thirty days from the date of receipt of the 
application to submit to the Secretary, in writing, an 
evaluation of the project or program set forth in the 
application. Such evaluation shall include comments on the 
relationship of the project to other projects and programs 
pending and approved and to any State comprehensive plan for 
treatment and prevention of alcohol abuse and alcoholism. The 
State shall furnish the applicant a copy of any such 
evaluation.
  (B)(i) Except as provided in clause (ii), each application 
for a grant under this section shall be submitted by the 
Secretary to the [National Advisory Council on Alcohol Abuse 
and Alcoholism] National Advisory Council on Alcohol Effects 
and Alcohol-Associated Disorders for its review. The Secretary 
may approve an application for a grant under this section only 
if it is recommended for approval by such Council.
  (ii) Clause (i) shall not apply to an application for a grant 
under this section for a project or program for any period of 
12 consecutive months for which period payments under such 
grant will be less than $250,000, if an application for a grant 
under this section for such project or program and for a period 
of time which includes such 12-month period has been submitted 
to, and approved by, the Secretary.
  (3) Approval of any application for a grant or contract by 
the Secretary, including the earmarking or financial assistance 
for a program or project, may be granted only if the 
application substantially meets a set of criteria established 
by the Secretary that--
          (A) provides that the projects and programs for which 
        assistance under this section is sought will be 
        substantially administered by or under the supervision 
        of the applicant;
          (B) provides for such methods of administration as 
        are necessary for the proper and efficient operation of 
        such programs and projects; and
          (C) provides for such fiscal control and fund 
        accounting procedures as may be necessary to assure 
        proper disbursement of and accounting for Federal funds 
        paid to the applicant.
  (4) The Secretary shall encourage the submission of and give 
special consideration to applications under this section for 
programs and projects aimed at underserved populations such as 
racial and ethnic minorities, Native Americans (including 
Native Hawaiians and Native American Pacific Islanders), youth, 
the elderly, women, handicapped individuals, public inebriates, 
and families of alcoholics.
  (5)(A) No grant may be made under this section to a State or 
to any entity within the government of a State unless the grant 
application has been duly authorized by the chief executive 
officer of such State.
  (B) No grant or contract may be made under this section for a 
period in excess of five years.
  (C)(i) The amount of any grant or contract under this section 
may not exceed 100 per centum of the cost of carrying out the 
grant or contract in the first fiscal year for which the grant 
or contract is made under this section, 80 per centum of such 
cost in the second fiscal year for which the grant or contract 
is made under this section, 70 per centum of such cost in the 
third fiscal year for which the grant or contract is made under 
this section, and 60 per centum of such cost in each of the 
fourth and fifth fiscal years for which the grant or contract 
is made under this section.
  (ii) For purposes of this subparagraph, no grant or contract 
shall be considered to have been made under this section for a 
fiscal year ending before September 30, 1981.
  (6) Each applicant, upon filing its application with the 
Secretary for a grant or contract to provide prevention or 
treatment services, shall provide a proposed performance 
standard or standards to measure, or research protocol to 
determine, the effectiveness of such services.
  (7) Nothing shall prevent the use of funds provided under 
this section for programs and projects aimed at the prevention, 
treatment, or rehabilitation of drug abuse as well as alcohol 
abuse and alcoholism.

           *       *       *       *       *       *       *

                              ----------                              


                           PUBLIC LAW 99-570


 AN ACT To strengthen Federal efforts to encourage foreign cooperation 
  in eradicating illicit drug crops and in halting international drug 
   traffic, to improve enforcement of Federal drug laws and enhance 
   interdiction of illicit drug shipments, to provide strong Federal 
    leadership in establishing effective drug abuse prevention and 
education programs, to expand Federal support for drug abuse treatment 
          and rehabilitation efforts, and for other purposes.



           *       *       *       *       *       *       *
TITLE IV--DEMAND REDUCTION

           *       *       *       *       *       *       *



Subtitle C--Indians and Alaska Natives

           *       *       *       *       *       *       *



            PART II--COORDINATION OF RESOURCES AND PROGRAMS

SEC. 4205. INTER-DEPARTMENTAL MEMORANDUM OF AGREEMENT.

  (a) In General.--Not later than 1 year after the date of 
enactment of the Tribal Law and Order Act of 2010, the 
Secretary of the Interior, the Attorney General, and the 
Secretary of Health and Human Services shall develop and enter 
into a Memorandum of Agreement which shall, among other 
things--
          (1) determine and define the scope of the problem of 
        alcohol and substance abuse for Indian tribes and their 
        members and its financial and human costs, and 
        specifically identify such problems affecting Indian 
        youth,
          (2) identify--
                  (A) the resources and programs of the Bureau 
                of Indian Affairs, Office of Justice Programs, 
                [Substance Abuse and Mental Health Services 
                Administration] Substance Use And Mental Health 
                Services Administration, and Indian Health 
                Service, and
                  (B) other Federal, tribal, State and local, 
                and private resources and programs,
        which would be relevant to a coordinated effort to 
        combat alcohol and substance abuse among Indian people, 
        including those programs and resources made available 
        by this subtitle,
          (3) develop and establish appropriate minimum 
        standards for each agency's program responsibilities 
        under the Memorandum of Agreement which may be--
                  (A) the existing Federal or State standards 
                in effect, or
                  (B) in the absence of such standards, new 
                standards which will be developed and 
                established in consultation with Indian tribes,
          (4) coordinate the Bureau of Indian Affairs, 
        Department of Justice, [Substance Abuse and Mental 
        Health Services Administration] Substance Use And 
        Mental Health Services Administration, and Indian 
        Health Service alcohol and substance abuse programs 
        existing on the date of the enactment of this subtitle 
        with programs or efforts established by this subtitle,
          (5) delineate the responsibilities of the Bureau of 
        Indian Affairs, Department of Justice, [Substance Abuse 
        and Mental Health Services Administration] Substance 
        Use And Mental Health Services Administration, and the 
        Indian Health Service to coordinate alcohol and 
        substance abuse-related services at the central, area, 
        agency, and service unit levels,
          (6) direct Bureau of Indian Affairs agency and 
        education superintendents, where appropriate, and the 
        Indian Health Service service unit directors to 
        cooperate fully with tribal requests made pursuant to 
        section 4206, and
          (7) provide for an annual review of such agreements 
        by the Secretary of the Interior, the Attorney General, 
        and the Secretary of Health and Human Services.
  (b) Character of Activities.--To the extent that there are 
new activities undertaken pursuant to this subtitle, those 
activities shall supplement, not supplant, activities, 
programs, and local actions that are ongoing on the date of the 
enactment of this subtitle. Such activities shall be undertaken 
in the manner least disruptive to tribal control, in accordance 
with the Indian Self-Determination and Education Assistance Act 
(25 U.S.C. 450 et seq.), and local control, in accordance with 
section 1130 of the Education Amendments of 1978 (25 U.S.C. 
2010).
  (c) Consultation.--The Secretary of the Interior, the 
Attorney General, and the Secretary of Health and Human 
Services shall, in developing the Memorandum of Agreement under 
subsection (a), consult with and solicit the comments of--
          (1) interested Indian tribes,
          (2) Indian individuals,
          (3) Indian organizations, and
          (4) professionals in the treatment of alcohol and 
        substance abuse.
  (d) Publication.--The Memorandum of Agreement under 
subsection (a) shall be submitted to Congress and published in 
the Federal Register not later than 130 days after the date of 
enactment of the Tribal Law and Order Act of 2010. At the same 
time as publication in the Federal Register, the Secretary of 
the Interior shall provide a copy of this subtitle and the 
Memorandum of Agreement under subsection (a) to each Indian 
tribe.

SEC. 4206. TRIBAL ACTION PLANS.

  (a) In General.--The governing body of any Indian tribe may, 
at its discretion, adopt a resolution for the establishment of 
a Tribal Action Plan to coordinate available resources and 
programs, including programs and resources made available by 
this subtitle, in an effort to combat alcohol and substance 
abuse among its members. Such resolution shall be the basis for 
the implementation of this subtitle and of the Memorandum of 
Agreement under section 4205.
  (b) Cooperation.--At the request of any Indian tribe pursuant 
to a resolution adopted under subsection (a), the Bureau of 
Indian Affairs agency and education superintendents, where 
appropriate,, the Office of Justice Programs, the [Substance 
Abuse and Mental Health Services Administration] Substance Use 
And Mental Health Services Administration, and the Indian 
Health Service service unit director providing services to such 
tribe shall cooperate with the tribe in the development of a 
Tribal Action Plan to coordinate resources and programs 
relevant to alcohol and substance abuse prevention and 
treatment. Upon the development of such a plan, such 
superintendents and director, as directed by the Memorandum of 
Agreement established under section 4205, shall enter into an 
agreement with the tribe for the implementation of the Tribal 
Action Plan under subsection (a).
  (c) Provisions.--
          (1) Any Tribal Action Plan entered into under 
        subsection (b) shall provide for--
                  (A) the establishment of a Tribal 
                Coordinating Committee which shall--
                          (i) at a minimum, have as members a 
                        tribal representative who shall serve 
                        as Chairman and the Bureau of Indian 
                        Affairs agency and education 
                        superintendents, where appropriate,, 
                        the Office of Justice Programs, the 
                        [Substance Abuse and Mental Health 
                        Services Administration] Substance Use 
                        And Mental Health Services 
                        Administration, and the Indian Health 
                        Service service unit director, or their 
                        representatives,
                          (ii) have primary responsibility for 
                        the implementation of the Tribal Action 
                        Plan,
                          (iii) have the responsibility for on-
                        going review and evaluation of, and the 
                        making of recommendations to the tribe 
                        relating to, the Tribal Action Plan, 
                        and
                          (iv) have the responsibility for 
                        scheduling Federal, tribal or other 
                        personnel for training in the 
                        prevention and treatment of alcohol and 
                        substance abuse among Indians as 
                        provided under section 4228, and
                  (B) the incorporation of the minimum 
                standards for those programs and services which 
                it encompasses which shall be--
                          (i) the Federal or State standards as 
                        provided in section 4205(a)(3), or
                          (ii) applicable tribal standards, if 
                        such standards are no less stringent 
                        than the Federal or State standards.
          (2) Any Tribal Action Plan may, among other things, 
        provide for--
                  (A) an assessment of the scope of the problem 
                of alcohol and substance abuse for the Indian 
                tribe which adopted the resolution for the 
                Plan,
                  (B) the identification and coordination of 
                available resources and programs relevant to a 
                program of alcohol and substance abuse 
                prevention and treatment,
                  (C) the establishment and prioritization of 
                goals and the efforts needed to meet those 
                goals,
                  (D) the identification of the community and 
                family roles in any of the efforts undertaken 
                as part of the Tribal Action Plan,
                  (E) the establishment of procedures for 
                amendment and revision of the plan as may be 
                determined necessary by the Tribal Coordinating 
                Committee, and
                  (F) an evaluation component to measure the 
                success of efforts made.
          (3) All Tribal Action Plans shall be updated every 2 
        years.
  (d) Grants.--(1) The Secretary of the Interior may make 
grants to Indian tribes adopting a resolution pursuant to 
subsection (a) to provide technical assistance in the 
development of a Tribal Action Plan. The Secretary shall 
allocate funds based on need.
  (2) There are authorized to be appropriated for grants under 
this subsection not more than $2,000,000 for the period of 
fiscal years 2011 through 2015.
  (e) Federal Action.--If any Indian tribe does not adopt a 
resolution as provided in subsection (a) within 90 days after 
the publication of the Memorandum of Agreement in the Federal 
Register as provided in section 4205, the Secretary of the 
Interior, the Attorney General, and the Secretary of Health and 
Human Services shall require the Bureau of Indian Affairs 
agency and education superintendents, where appropriate, and 
the Indian Health Service service unit director serving such 
tribe to enter into an agreement to identify and coordinate 
available programs and resources to carry out the purposes of 
this subtitle for such tribe. After such an agreement has been 
entered into for a tribe such tribe may adopt a resolution 
under subsection (a).
  (f)(1) The Secretary of the Interior may make grants to 
Indian tribes adopting a resolution pursuant to subsection (a) 
to implement and develop community and in-school training, 
education, and prevention programs on alcohol and substance 
abuse, fetal alcohol syndrome and fetal alcohol effect.
  (2) Funds provided under this section may be used for, but 
are not limited to, the development and implementation of 
tribal programs for--
          (A) youth employment;
          (B) youth recreation;
          (C) youth cultural activities;
          (D) community awareness programs; and
          (E) community training and education programs.
  (3) There are authorized to be appropriated to carry out the 
provisions of this subsection $5,000,000 for fiscal years 2011 
through 2015.

SEC. 4207. DEPARTMENTAL RESPONSIBILITY.

  (a) Implementation.--The Secretary of the Interior, acting 
through the Bureau of Indian Affairs, the Attorney General, and 
the Secretary of Health and Human Services, acting through the 
Indian Health Service, shall bear equal responsibility for the 
implementation of this subtitle in cooperation with Indian 
tribes.
  (b) Office of Alcohol and Substance Abuse.--
          (1) Establishment.--
                  (A) In general.--To improve coordination 
                among the Federal agencies and departments 
                carrying out this subtitle, there is 
                established within the [Substance Abuse and 
                Mental Health Services Administration] 
                Substance Use And Mental Health Services 
                Administration an office, to be known as the 
                ``Office of Indian Alcohol and Substance 
                Abuse'' (referred to in this section as the 
                ``Office'').
                  (B) Director.--The director of the Office 
                shall be appointed by the Administrator of the 
                [Substance Abuse and Mental Health Services 
                Administration] Substance Use And Mental Health 
                Services Administration--
                          (i) on a permanent basis; and
                          (ii) at a grade of not less than GS-
                        15 of the General Schedule.
          (2) Responsibilities of office.--In addition to other 
        responsibilities which may be assigned to such Office, 
        it shall be responsible for--
                  (A) coordinating with other agencies to 
                monitor the performance and compliance of the 
                relevant Federal programs in achieving the 
                goals and purposes of this subtitle and the 
                Memorandum of Agreement entered into under 
                section 4205;
                  (B) serving as a point of contact for Indian 
                tribes and the Tribal Coordinating Committees 
                regarding the implementation of this subtitle, 
                the Memorandum of Agreement, and any Tribal 
                Action Plan established under section 4206; and
                  (C) not later than 1 year after the date of 
                enactment of the Tribal Law and Order Act of 
                2010, developing, in coordination and 
                consultation with tribal governments, a 
                framework for interagency and tribal 
                coordination that--
                          (i) establish the goals and other 
                        desired outcomes of this Act;
                          (ii) prioritizes outcomes that are 
                        aligned with the purposes of affected 
                        agencies;
                          (iii) provides guidelines for 
                        resource and information sharing;
                          (iv) provides technical assistance to 
                        the affected agencies to establish 
                        effective and permanent interagency 
                        communication and coordination; and
                          (v) determines whether collaboration 
                        is feasible, cost-effective, and within 
                        agency capability.
          (3) Appointment of employees.--The Administrator of 
        the [Substance Abuse and Mental Health Services 
        Administration] Substance Use And Mental Health 
        Services Administration shall appoint such employees to 
        work in the Office, and shall provide such funding, 
        services, and equipment, as may be necessary to enable 
        the Office to carry out the responsibilities under this 
        subsection.
  (c) Indian Youth Programs Officer.--
          (1) There is established in the Office the position 
        to be known as the Indian Youth Programs Officer. The 
        Administrator of the [Substance Abuse and Mental Health 
        Services Administration] Substance Use And Mental 
        Health Services Administration shall appoint the Indian 
        Youth Programs Officer.
          (2) The position of Indian Youth Programs Officer 
        shall be established on a permanent basis at no less 
        than the grade of GS-14 of the General Schedule.
          (3) In addition to other responsibilities which may 
        be assigned to the Indian Youth Programs Officer 
        relating to Indian youth, such Officer shall be 
        responsible for--
                  (A) monitoring the performance and compliance 
                of the applicable Federal programs in meeting 
                the goals and purposes of this subtitle and the 
                Memorandum of Agreement entered into under 
                section 4205 as they relate to Indian youth 
                efforts, and
                  (B) providing advice and recommendations, 
                including recommendations submitted by Indian 
                tribes and Tribal Coordinating Committees, to 
                the Director of the Office as they relate to 
                Indian youth.

           *       *       *       *       *       *       *

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                          SOCIAL SECURITY ACT




           *       *       *       *       *       *       *
TITLE XVIII--HEALTH INSURANCE FOR THE AGED AND DISABLED

           *       *       *       *       *       *       *



                    Part E--Miscellaneous Provisions


              definitions of services, institutions, etc.

  Sec. 1861. For purposes of this title--

                            Spell of Illness

  (a) The term ``spell of illness'' with respect to any 
individual means a period of consecutive days--
          (1) beginning with the first day (not included in a 
        previous spell of illness) (A) on which such individual 
        is furnished inpatient hospital services, inpatient 
        critical access hospital services or extended care 
        services, and (B) which occurs in a month for which he 
        is entitled to benefits under part A, and
          (2) ending with the close of the first period of 60 
        consecutive days thereafter on each of which he is 
        neither an inpatient of a hospital or critical access 
        hospital nor an inpatient of a facility described in 
        section 1819(a)(1) or subsection (y)(1).

                      Inpatient Hospital Services

  (b) The term ``inpatient hospital services'' means the 
following items and services furnished to an inpatient of a 
hospital and (except as provided in paragraph (3)) by the 
hospital--
          (1) bed and board;
          (2) such nursing services and other related services, 
        such use of hospital facilities, and such medical 
        social services as are ordinarily furnished by the 
        hospital for the care and treatment of inpatients, and 
        such drugs, biologicals, supplies, appliances, and 
        equipment, for use in the hospital, as are ordinarily 
        furnished by such hospital for the care and treatment 
        of inpatients; and
          (3) such other diagnostic or therapeutic items or 
        services, furnished by the hospital or by others under 
        arrangements with them made by the hospital, as are 
        ordinarily furnished to inpatients either by such 
        hospital or by others under such arrangements;
excluding, however--
          (4) medical or surgical services provided by a 
        physician, resident, or intern, services described by 
        subsection (s)(2)(K), certified nurse-midwife services, 
        qualified psychologist services, and services of a 
        certified registered nurse anesthetist; and
          (5) the services of a private-duty nurse or other 
        private-duty attendant.
Paragraph (4) shall not apply to services provided in a 
hospital by--
          (6) an intern or a resident-in-training under a 
        teaching program approved by the Council on Medical 
        Education of the American Medical Association or, in 
        the case of an osteopathic hospital, approved by the 
        Committee on Hospitals of the Bureau of Professional 
        Education of the American Osteopathic Association, or, 
        in the case of services in a hospital or osteopathic 
        hospital by an intern or resident-in-training in the 
        field of dentistry, approved by the Council on Dental 
        Education of the American Dental Association, or in the 
        case of services in a hospital or osteopathic hospital 
        by an intern or resident-in-training in the field of 
        podiatry, approved by the Council on Podiatric Medical 
        Education of the American Podiatric Medical 
        Association; or
          (7) a physician where the hospital has a teaching 
        program approved as specified in paragraph (6), if (A) 
        the hospital elects to receive any payment due under 
        this title for reasonable costs of such services, and 
        (B) all physicians in such hospital agree not to bill 
        charges for professional services rendered in such 
        hospital to individuals covered under the insurance 
        program established by this title.

                Inpatient Psychiatric Hospital Services

  (c) The term ``inpatient psychiatric hospital services'' 
means inpatient hospital services furnished to an inpatient of 
a psychiatric hospital.

                                Supplier

  (d) The term ``supplier'' means, unless the context otherwise 
requires, a physician or other practitioner, a facility, or 
other entity (other than a provider of services) that furnishes 
items or services under this title.

                                Hospital

  (e) The term ``hospital'' (except for purposes of sections 
1814(d), 1814(f), and 1835(b), subsection (a)(2) of this 
section, paragraph (7) of this subsection, and subsection (i) 
of this section) means an institution which--
          (1) is primarily engaged in providing, by or under 
        the supervision of physicians, to inpatients (A) 
        diagnostic services and therapeutic services for 
        medical diagnosis, treatment, and care of injured, 
        disabled, or sick persons, or (B) rehabilitation 
        services for the rehabilitation of injured, disabled, 
        or sick persons;
          (2) maintains clinical records on all patients;
          (3) has bylaws in effect with respect to its staff of 
        physicians;
          (4) has a requirement that every patient with respect 
        to whom payment may be made under this title must be 
        under the care of a physician, except that a patient 
        receiving qualified psychologist services (as defined 
        in subsection (ii)) may be under the care of a clinical 
        psychologist with respect to such services to the 
        extent permitted under State law;
          (5) provides 24-hour nursing service rendered or 
        supervised by a registered professional nurse, and has 
        a licensed practical nurse or registered professional 
        nurse on duty at all times; except that until January 
        1, 1979, the Secretary is authorized to waive the 
        requirement of this paragraph for any one-year period 
        with respect to any institution, insofar as such 
        requirement relates to the provision of twenty-four-
        hour nursing service rendered or supervised by a 
        registered professional nurse (except that in any event 
        a registered professional nurse must be present on the 
        premises to render or supervise the nursing service 
        provided, during at least the regular daytime shift), 
        where immediately preceding such one-year period he 
        finds that--
                  (A) such institution is located in a rural 
                area and the supply of hospital services in 
                such area is not sufficient to meet the needs 
                of individuals residing therein,
                  (B) the failure of such institution to 
                qualify as a hospital would seriously reduce 
                the availability of such services to such 
                individuals, and
                  (C) such institution has made and continues 
                to make a good faith effort to comply with this 
                paragraph, but such compliance is impeded by 
                the lack of qualified nursing personnel in such 
                area;
          (6)(A) has in effect a hospital utilization review 
        plan which meets the requirements of subsection (k) and 
        (B) has in place a discharge planning process that 
        meets the requirements of subsection (ee);
          (7) in the case of an institution in any State in 
        which State or applicable local law provides for the 
        licensing of hospitals, (A) is licensed pursuant to 
        such law or (B) is approved, by the agency of such 
        State or locality responsible for licensing hospitals, 
        as meeting the standards established for such 
        licensing;
          (8) has in effect an overall plan and budget that 
        meets the requirements of subsection (z); and
          (9) meets such other requirements as the Secretary 
        finds necessary in the interest of the health and 
        safety of individuals who are furnished services in the 
        institution.
For purposes of subsection (a)(2), such term includes any 
institution which meets the requirements of paragraph (1) of 
this subsection. For purposes of sections 1814(d) and 1835(b) 
(including determination of whether an individual received 
inpatient hospital services or diagnostic services for purposes 
of such sections), section 1814(f)(2), and subsection (i) of 
this section, such term includes any institution which (i) 
meets the requirements of paragraphs (5) and (7) of this 
subsection, (ii) is not primarily engaged in providing the 
services described in section 1861(j)(1)(A) and (iii) is 
primarily engaged in providing, by or under the supervision of 
individuals referred to in paragraph (1) of section 1861(r), to 
inpatients diagnostic services and therapeutic services for 
medical diagnosis, treatment, and care of injured, disabled, or 
sick persons, or rehabilitation services for the rehabilitation 
of injured, disabled, or sick persons. For purposes of section 
1814(f)(1), such term includes an institution which (i) is a 
hospital for purposes of sections 1814(d), 1814(f)(2), and 
1835(b) and (ii) is accredited by a national accreditation body 
recognized by the Secretary under section 1865(a), or is 
accredited by or approved by a program of the country in which 
such institution is located if the Secretary finds the 
accreditation or comparable approval standards of such program 
to be essentially equivalent to those of such a national 
accreditation body.. Notwithstanding the preceding provisions 
of this subsection, such term shall not, except for purposes of 
subsection (a)(2), include any institution which is primarily 
for the care and treatment of mental diseases unless it is a 
psychiatric hospital (as defined in subsection (f)). The term 
``hospital'' also includes a religious nonmedical health care 
institution (as defined in subsection (ss)(1)), but only with 
respect to items and services ordinarily furnished by such 
institution to inpatients, and payment may be made with respect 
to services provided by or in such an institution only to such 
extent and under such conditions, limitations, and requirements 
(in addition to or in lieu of the conditions, limitations, and 
requirements otherwise applicable) as may be provided in 
regulations consistent with section 1821. For provisions 
deeming certain requirements of this subsection to be met in 
the case of accredited institutions, see section 1865. The term 
``hospital'' also includes a facility of fifty beds or less 
which is located in an area determined by the Secretary to meet 
the definition relating to a rural area described in 
subparagraph (A) of paragraph (5) of this subsection and which 
meets the other requirements of this subsection, except that--
          
          (A) with respect to the requirements for nursing 
        services applicable after December 31, 1978, such 
        requirements shall provide for temporary waiver of the 
        requirements, for such period as the Secretary deems 
        appropriate, where (i) the facility's failure to fully 
        comply with the requirements is attributable to a 
        temporary shortage of qualified nursing personnel in 
        the area in which the facility is located, (ii) a 
        registered professional nurse is present on the 
        premises to render or supervise the nursing service 
        provided during at least the regular daytime shift, and 
        (iii) the Secretary determines that the employment of 
        such nursing personnel as are available to the facility 
        during such temporary period will not adversely affect 
        the health and safety of patients;
          (B) with respect to the health and safety 
        requirements promulgated under paragraph (9), such 
        requirements shall be applied by the Secretary to a 
        facility herein defined in such manner as to assure 
        that personnel requirements take into account the 
        availability of technical personnel and the educational 
        opportunities for technical personnel in the area in 
        which such facility is located, and the scope of 
        services rendered by such facility; and the Secretary, 
        by regulations, shall provide for the continued 
        participation of such a facility where such personnel 
        requirements are not fully met, for such period as the 
        Secretary determines that (i) the facility is making 
        good faith efforts to fully comply with the personnel 
        requirements, (ii) the employment by the facility of 
        such personnel as are available to the facility will 
        not adversely affect the health and safety of patients, 
        and (iii) if the Secretary has determined that because 
        of the facility's waiver under this subparagraph the 
        facility should limit its scope of services in order 
        not to adversely affect the health and safety of the 
        facility's patients, the facility is so limiting the 
        scope of services it provides; and
          (C) with respect to the fire and safety requirements 
        promulgated under paragraph (9), the Secretary (i) may 
        waive, for such period as he deems appropriate, 
        specific provisions of such requirements which if 
        rigidly applied would result in unreasonable hardship 
        for such a facility and which, if not applied, would 
        not jeopardize the health and safety of patients, and 
        (ii) may accept a facility's compliance with all 
        applicable State codes relating to fire and safety in 
        lieu of compliance with the fire and safety 
        requirements promulgated under paragraph (9), if he 
        determines that such State has in effect fire and 
        safety codes, imposed by State law, which adequately 
        protect patients.
The term ``hospital'' does not include, unless the context 
otherwise requires, a critical access hospital (as defined in 
section 1861(mm)(1)) or a rural emergency hospital (as defined 
in subsection (kkk)(2)).

                          Psychiatric Hospital

  (f) The term ``psychiatric hospital'' means an institution 
which--
          (1) is primarily engaged in providing, by or under 
        the supervision of a physician, psychiatric services 
        for the diagnosis and treatment of mentally ill 
        persons;
          (2) satisfies the requirements of paragraphs (3) 
        through (9) of subsection (e);
          (3) maintains clinical records on all patients and 
        maintains such records as the Secretary finds to be 
        necessary to determine the degree and intensity of the 
        treatment provided to individuals entitled to hospital 
        insurance benefits under part A; and
          (4) meets such staffing requirements as the Secretary 
        finds necessary for the institution to carry out an 
        active program of treatment for individuals who are 
        furnished services in the institution.
In the case of an institution which satisfies paragraphs (1) 
and (2) of the preceding sentence and which contains a distinct 
part which also satisfies paragraphs (3) and (4) of such 
sentence, such distinct part shall be considered to be a 
``psychiatric hospital''.

                Outpatient Occupational Therapy Services

  (g) The term ``outpatient occupational therapy services'' has 
the meaning given the term ``outpatient physical therapy 
services'' in subsection (p), except that ``occupational'' 
shall be substituted for ``physical'' each place it appears 
therein.

                         Extended Care Services

  (h) The term ``extended care services'' means the following 
items and services furnished to an inpatient of a skilled 
nursing facility and (except as provided in paragraphs (3), (6) 
and (7)) by such skilled nursing facility--
          (1) nursing care provided by or under the supervision 
        of a registered professional nurse;
          (2) bed and board in connection with the furnishing 
        of such nursing care;
          (3) physical or occupational therapy or speech-
        language pathology services furnished by the skilled 
        nursing facility or by others under arrangements with 
        them made by the facility;
          (4) medical social services;
          (5) such drugs, biologicals, supplies, appliances, 
        and equipment, furnished for use in the skilled nursing 
        facility, as are ordinarily furnished by such facility 
        for the care and treatment of inpatients;
          (6) medical services provided by an intern or 
        resident-in- training of a hospital with which the 
        facility has in effect a transfer agreement (meeting 
        the requirements of subsection (l)), under a teaching 
        program of such hospital approved as provided in the 
        last sentence of subsection (b), and other diagnostic 
        or therapeutic services provided by a hospital with 
        which the facility has such an agreement in effect; and
          (7) such other services necessary to the health of 
        the patients as are generally provided by skilled 
        nursing facilities, or by others under arrangements 
        with them made by the facility;
excluding, however, any item or service if it would not be 
included under subsection (b) if furnished to an inpatient of a 
hospital.

                  Post-Hospital Extended Care Services

  (i) The term ``post-hospital extended care services'' means 
extended care services furnished an individual after transfer 
from a hospital in which he was an inpatient for not less than 
3 consecutive days before his discharge from the hospital in 
connection with such transfer. For purposes of the preceding 
sentence, items and services shall be deemed to have been 
furnished to an individual after transfer from a hospital, and 
he shall be deemed to have been an inpatient in the hospital 
immediately before transfer therefrom, if he is admitted to the 
skilled nursing facility (A) within 30 days after discharge 
from such hospital, or (B) within such time as it would be 
medically appropriate to begin an active course of treatment, 
in the case of an individual whose condition is such that 
skilled nursing facility care would not be medically 
appropriate within 30 days after discharge from a hospital; and 
an individual shall be deemed not to have been discharged from 
a skilled nursing facility if, within 30 days after discharge 
therefrom, he is admitted to such facility or any other skilled 
nursing facility.

                        Skilled Nursing Facility

  (j) The term ``skilled nursing facility'' has the meaning 
given such term in section 1819(a).

                           Utilization Review

  (k) A utilization review plan of a hospital or skilled 
nursing facility shall be considered sufficient if it is 
applicable to services furnished by the institution to 
individuals entitled to insurance benefits under this title and 
if it provides--
          (1) for the review, on a sample or other basis, of 
        admissions to the institution, the duration of stays 
        therein, and the professional services (including drugs 
        and biologicals) furnished, (A) with respect to the 
        medical necessity of the services, and (B) for the 
        purpose of promoting the most efficient use of 
        available health facilities and services;
          (2) for such review to be made by either (A) a staff 
        committee of the institution composed of two or more 
        physicians (of which at least two must be physicians 
        described in subsection (r)(1) of this section), with 
        or without participation of other professional 
        personnel, or (B) a group outside the institution which 
        is similarly composed and (i) which is established by 
        the local medical society and some or all of the 
        hospitals and skilled nursing facilities in the 
        locality, or (ii) if (and for as long as) there has not 
        been established such a group which serves such 
        institution, which is established in such other manner 
        as may be approved by the Secretary;
          (3) for such review, in each case of inpatient 
        hospital services or extended care services furnished 
        to such an individual during a continuous period of 
        extended duration, as of such days of such period 
        (which may differ for different classes of cases) as 
        may be specified in regulations, with such review to be 
        made as promptly as possible, after each day so 
        specified, and in no event later than one week 
        following such day; and
          (4) for prompt notification to the institution, the 
        individual, and his attending physician of any finding 
        (made after opportunity for consultation to such 
        attending physician) by the physician members of such 
        committee or group that any further stay in the 
        institution is not medically necessary.
The review committee must be composed as provided in clause (B) 
of paragraph (2) rather than as provided in clause (A) of such 
paragraph in the case of any hospital or skilled nursing 
facility where, because of the small size of the institution, 
or (in the case of a skilled nursing facility) because of lack 
of an organized medical staff, or for such other reason or 
reasons as may be included in regulations, it is impracticable 
for the institution to have a properly functioning staff 
committee for the purposes of this subsection. If the Secretary 
determines that the utilization review procedures established 
pursuant to title XIX are superior in their effectiveness to 
the procedures required under this section, he may, to the 
extent that he deems it appropriate, require for purposes of 
this title that the procedures established pursuant to title 
XIX be utilized instead of the procedures required by this 
section.

    Agreements for Transfer Between Skilled Nursing Facilities and 
                               Hospitals

  (l) A hospital and a skilled nursing facility shall be 
considered to have a transfer agreement in effect if, by reason 
of a written agreement between them or (in case the two 
institutions are under common control) by reason of a written 
undertaking by the person or body which controls them, there is 
reasonable assurance that--
          (1) transfer of patients will be effected between the 
        hospital and the skilled nursing facility whenever such 
        transfer is medically appropriate as determined by the 
        attending physician; and
          (2) there will be interchange of medical and other 
        information necessary or useful in the care and 
        treatment of individuals transferred between the 
        institutions, or in determining whether such 
        individuals can be adequately cared for otherwise than 
        in either of such institutions.
Any skilled nursing facility which does not have such an 
agreement in effect, but which is found by a State agency (of 
the State in which such facility is situated) with which an 
agreement under section 1864 is in effect (or, in the case of a 
State in which no such agency has an agreement under section 
1864, by the Secretary) to have attempted in good faith to 
enter into such an agreement with a hospital sufficiently close 
to the facility to make feasible the transfer between them of 
patients and the information referred to in paragraph (2), 
shall be considered to have such an agreement in effect if and 
for so long as such agency (or the Secretary, as the case may 
be) finds that to do so is in the public interest and essential 
to assuring extended care services for persons in the community 
who are eligible for payments with respect to such services 
under this title.

                          Home Health Services

  (m) The term ``home health services'' means the following 
items and services furnished to an individual, who is under the 
care of a physician, a nurse practitioner or a clinical nurse 
specialist (as those terms are defined in subsection (aa)(5)), 
or a physician assistant (as defined in subsection (aa)(5)), by 
a home health agency or by others under arrangements with them 
made by such agency, under a plan (for furnishing such items 
and services to such individual) established and periodically 
reviewed by a physician, a nurse practitioner, a clinical nurse 
specialist, or a physician assistant, which items and services 
are, except as provided in paragraph (7), provided on a 
visiting basis in a place of residence used as such 
individual's home--
          (1) part-time or intermittent nursing care provided 
        by or under the supervision of a registered 
        professional nurse;
          (2) physical or occupational therapy or speech-
        language pathology services;
          (3) medical social services under the direction of a 
        physician, a nurse practitioner, a clinical nurse 
        specialist, or a physician assistant;
          (4) to the extent permitted in regulations, part-time 
        or intermittent services of a home health aide who has 
        successfully completed a training program approved by 
        the Secretary;
          (5) medical supplies (including catheters, catheter 
        supplies, ostomy bags, and supplies related to ostomy 
        care, and a covered osteoporosis drug (as defined in 
        subsection (kk)), but excluding other drugs and 
        biologicals) and durable medical equipment and 
        applicable disposable devices (as defined in section 
        1834(s)(2)) while under such a plan;
          (6) in the case of a home health agency which is 
        affiliated or under common control with a hospital, 
        medical services provided by an intern or resident-in-
        training of such hospital, under a teaching program of 
        such hospital approved as provided in the last sentence 
        of subsection (b); and
          (7) any of the foregoing items and services which are 
        provided on an outpatient basis, under arrangements 
        made by the home health agency, at a hospital or 
        skilled nursing facility, or at a rehabilitation center 
        which meets such standards as may be prescribed in 
        regulations, and--
                  (A) the furnishing of which involves the use 
                of equipment of such a nature that the items 
                and services cannot readily be made available 
                to the individual in such place of residence, 
                or
                  (B) which are furnished at such facility 
                while he is there to receive any such item or 
                service described in clause (A),
        but not including transportation of the individual in 
        connection with any such item or service;
excluding, however, any item or service if it would not be 
included under subsection (b) if furnished to an inpatient of a 
hospital and home infusion therapy (as defined in subsection 
(iii)(i)). For purposes of paragraphs (1) and (4), the term 
``part-time or intermittent services'' means skilled nursing 
and home health aide services furnished any number of days per 
week as long as they are furnished (combined) less than 8 hours 
each day and 28 or fewer hours each week (or, subject to review 
on a case-by-case basis as to the need for care, less than 8 
hours each day and 35 or fewer hours per week). For purposes of 
sections 1814(a)(2)(C) and 1835(a)(2)(A), ``intermittent'' 
means skilled nursing care that is either provided or needed on 
fewer than 7 days each week, or less than 8 hours of each day 
for periods of 21 days or less (with extensions in exceptional 
circumstances when the need for additional care is finite and 
predictable).

                       Durable Medical Equipment

  (n) The term ``durable medical equipment'' includes iron 
lungs, oxygen tents, hospital beds, and wheelchairs (which may 
include a power-operated vehicle that may be appropriately used 
as a wheelchair, but only where the use of such a vehicle is 
determined to be necessary on the basis of the individual's 
medical and physical condition and the vehicle meets such 
safety requirements as the Secretary may prescribe) used in the 
patient's home (including an institution used as his home other 
than an institution that meets the requirements of subsection 
(e)(1) of this section or section 1819(a)(1)), whether 
furnished on a rental basis or purchased, and includes blood-
testing strips and blood glucose monitors for individuals with 
diabetes without regard to whether the individual has Type I or 
Type II diabetes or to the individual's use of insulin (as 
determined under standards established by the Secretary in 
consultation with the appropriate organizations) and eye 
tracking and gaze interaction accessories for speech generating 
devices furnished to individuals with a demonstrated medical 
need for such accessories; except that such term does not 
include such equipment furnished by a supplier who has used, 
for the demonstration and use of specific equipment, an 
individual who has not met such minimum training standards as 
the Secretary may establish with respect to the demonstration 
and use of such specific equipment. With respect to a seat-lift 
chair, such term includes only the seat-lift mechanism and does 
not include the chair.

                           Home Health Agency

  (o) The term ``home health agency'' means a public agency or 
private organization, or a subdivision of such an agency or 
organization, which--
          (1) is primarily engaged in providing skilled nursing 
        services and other therapeutic services;
          (2) has policies, established by a group of 
        professional personnel (associated with the agency or 
        organization), including one or more physicians, nurse 
        practitioners or clinical nurse specialists (as those 
        terms are defined in subsection (aa)(5)), certified 
        nurse-midwives (as defined in subsection (gg)), or 
        physician, nurse practitioner, clinical nurse 
        specialist, certified nurse-midwife, physician 
        assistant, assistants (as defined in subsection 
        (aa)(5)) and one or more registered professional 
        nurses, to govern the services (referred to in 
        paragraph (1)) which it provides, and provides for 
        supervision of such services by a physician, nurse 
        practitioner, clinical nurse specialist, certified 
        nurse-midwife, physician assistant, or registered 
        professional nurse;
          (3) maintains clinical records on all patients;
          (4) in the case of an agency or organization in any 
        State in which State or applicable local law provides 
        for the licensing of agencies or organizations of this 
        nature, (A) is licensed pursuant to such law, or (B) is 
        approved, by the agency of such State or locality 
        responsible for licensing agencies or organizations of 
        this nature, as meeting the standards established for 
        such licensing;
          (5) has in effect an overall plan and budget that 
        meets the requirements of subsection (z);
          (6) meets the conditions of participation specified 
        in section 1891(a) and such other conditions of 
        participation as the Secretary may find necessary in 
        the interest of the health and safety of individuals 
        who are furnished services by such agency or 
        organization;
          (7) provides the Secretary with a surety bond--
                  (A) in a form specified by the Secretary and 
                in an amount that is not less than the minimum 
                of $50,000; and
                  (B) that the Secretary determines is 
                commensurate with the volume of payments to the 
                home health agency; and
          (8) meets such additional requirements (including 
        conditions relating to bonding or establishing of 
        escrow accounts as the Secretary finds necessary for 
        the financial security of the program) as the Secretary 
        finds necessary for the effective and efficient 
        operation of the program;
except that for purposes of part A such term shall not include 
any agency or organization which is primarily for the care and 
treatment of mental diseases. The Secretary may waive the 
requirement of a surety bond under paragraph (7) in the case of 
an agency or organization that provides a comparable surety 
bond under State law.

                  Outpatient Physical Therapy Services

  (p) The term ``outpatient physical therapy services'' means 
physical therapy services furnished by a provider of services, 
a clinic, rehabilitation agency, or a public health agency, or 
by others under an arrangement with, and under the supervision 
of, such provider, clinic, rehabilitation agency, or public 
health agency to an individual as an outpatient--
          (1) who is under the care of a physician (as defined 
        in paragraph (1), (3), or (4) of section 1861(r)), and
          (2) with respect to whom a plan prescribing the type, 
        amount, and duration of physical therapy services that 
        are to be furnished such individual has been 
        established by a physician (as so defined) or by a 
        qualified physical therapist and is periodically 
        reviewed by a physician (as so defined);
excluding, however--
          (3) any item or service if it would not be included 
        under subsection (b) if furnished to an inpatient of a 
        hospital; and
          (4) any such service--
                  (A) if furnished by a clinic or 
                rehabilitation agency, or by others under 
                arrangements with such clinic or agency, unless 
                such clinic or rehabilitation agency--
                          (i) provides an adequate program of 
                        physical therapy services for 
                        outpatients and has the facilities and 
                        personnel required for such program or 
                        required for the supervision of such a 
                        program, in accordance with such 
                        requirements as the Secretary may 
                        specify,
                          (ii) has policies, established by a 
                        group of professional personnel, 
                        including one or more physicians 
                        (associated with the clinic or 
                        rehabilitation agency) and one or more 
                        qualified physical therapists, to 
                        govern the services (referred to in 
                        clause (i)) it provides,
                          (iii) maintains clinical records on 
                        all patients,
                          (iv) if such clinic or agency is 
                        situated in a State in which State or 
                        applicable local law provides for the 
                        licensing of institutions of this 
                        nature, (I) is licensed pursuant to 
                        such law, or (II) is approved by the 
                        agency of such State or locality 
                        responsible for licensing institutions 
                        of this nature, as meeting the 
                        standards established for such 
                        licensing; and
                          (v) meets such other conditions 
                        relating to the health and safety of 
                        individuals who are furnished services 
                        by such clinic or agency on an 
                        outpatient basis, as the Secretary may 
                        find necessary, and provides the 
                        Secretary on a continuing basis with a 
                        surety bond in a form specified by the 
                        Secretary and in an amount that is not 
                        less than $50,000, or
                  (B) if furnished by a public health agency, 
                unless such agency meets such other conditions 
                relating to health and safety of individuals 
                who are furnished services by such agency on an 
                outpatient basis, as the Secretary may find 
                necessary.
The term ``outpatient physical therapy services'' also includes 
physical therapy services furnished an individual by a physical 
therapist (in his office or in such individual's home) who 
meets licensing and other standards prescribed by the Secretary 
in regulations, otherwise than under an arrangement with and 
under the supervision of a provider of services, clinic, 
rehabilitation agency, or public health agency, if the 
furnishing of such services meets such conditions relating to 
health and safety as the Secretary may find necessary. In 
addition, such term includes physical therapy services which 
meet the requirements of the first sentence of this subsection 
except that they are furnished to an individual as an inpatient 
of a hospital or extended care facility. Nothing in this 
subsection shall be construed as requiring, with respect to 
outpatients who are not entitled to benefits under this title, 
a physical therapist to provide outpatient physical therapy 
services only to outpatients who are under the care of a 
physician or pursuant to a plan of care established by a 
physician. The Secretary may waive the requirement of a surety 
bond under paragraph (4)(A)(v) in the case of a clinic or 
agency that provides a comparable surety bond under State law.

                          Physicians' Services

  (q) The term ``physicians' services'' means professional 
services performed by physicians, including surgery, 
consultation, and home, office, and institutional calls (but 
not including services described in subsection (b)(6)).

                               Physician

  (r) The term ``physician'', when used in connection with the 
performance of any function or action, means (1) a doctor of 
medicine or osteopathy legally authorized to practice medicine 
and surgery by the State in which he performs such function or 
action (including a physician within the meaning of section 
1101(a)(7)), (2) a doctor of dental surgery or of dental 
medicine who is legally authorized to practice dentistry by the 
State in which he performs such function and who is acting 
within the scope of his license when he performs such 
functions, (3) a doctor of podiatric medicine for the purposes 
of subsections (k), (m), (p)(1), and (s) of this section and 
sections 1814(a), 1832(a)(2)(F)(ii), and 1835 but only with 
respect to functions which he is legally authorized to perform 
as such by the State in which he performs them, (4) a doctor of 
optometry, but only for purposes of subsection (p)(1) and with 
respect to the provision of items or services described in 
subsection (s) which he is legally authorized to perform as a 
doctor of optometry by the State in which he performs them, or 
(5) a chiropractor who is licensed as such by the State (or in 
a State which does not license chiropractors as such, is 
legally authorized to perform the services of a chiropractor in 
the jurisdiction in which he performs such services), and who 
meets uniform minimum standards promulgated by the Secretary, 
but only for the purpose of sections 1861(s)(1) and 
1861(s)(2)(A) and only with respect to treatment by means of 
manual manipulation of the spine (to correct a subluxation) 
which he is legally authorized to perform by the State or 
jurisdiction in which such treatment is provided. For the 
purposes of section 1862(a)(4) and subject to the limitations 
and conditions provided in the previous sentence, such term 
includes a doctor of one of the arts, specified in such 
previous sentence, legally authorized to practice such art in 
the country in which the inpatient hospital services (referred 
to in such section 1862(a)(4)) are furnished.

                   Medical and Other Health Services

  (s) The term ``medical and other health services'' means any 
of the following items or services:
          (1) physicians' services;
          (2)(A) services and supplies (including drugs and 
        biologicals which are not usually self-administered by 
        the patient) furnished as an incident to a physician's 
        professional service, of kinds which are commonly 
        furnished in physicians' offices and are commonly 
        either rendered without charge or included in the 
        physicians' bills (or would have been so included but 
        for the application of section 1847B);
          (B) hospital services (including drugs and 
        biologicals which are not usually self-administered by 
        the patient) incident to physicians' services rendered 
        to outpatients and partial hospitalization services 
        incident to such services;
          (C) diagnostic services which are--
                  (i) furnished to an individual as an 
                outpatient by a hospital or by others under 
                arrangements with them made by a hospital, and
                  (ii) ordinarily furnished by such hospital 
                (or by others under such arrangements) to its 
                outpatients for the purpose of diagnostic 
                study;
          (D) outpatient physical therapy services, outpatient 
        speech-language pathology services, and outpatient 
        occupational therapy services;
          (E) rural health clinic services and Federally 
        qualified health center services;
          (F) home dialysis supplies and equipment, self-care 
        home dialysis support services, and institutional 
        dialysis services and supplies, and, for items and 
        services furnished on or after January 1, 2011, renal 
        dialysis services (as defined in section 
        1881(b)(14)(B)), including such renal dialysis services 
        furnished on or after January 1, 2017, by a renal 
        dialysis facility or provider of services paid under 
        section 1881(b)(14) to an individual with acute kidney 
        injury (as defined in section 1834(r)(2));
          (G) antigens (subject to quantity limitations 
        prescribed in regulations by the Secretary) prepared by 
        a physician, as defined in section 1861(r)(1), for a 
        particular patient, including antigens so prepared 
        which are forwarded to another qualified person 
        (including a rural health clinic) for administration to 
        such patient, from time to time, by or under the 
        supervision of another such physician;
          (H)(i) services furnished pursuant to a contract 
        under section 1876 to a member of an eligible 
        organization by a physician assistant or by a nurse 
        practitioner (as defined in subsection (aa)(5)) and 
        such services and supplies furnished as an incident to 
        his service to such a member as would otherwise be 
        covered under this part if furnished by a physician or 
        as an incident to a physician's service; and
          (ii) services furnished pursuant to a risk-sharing 
        contract under section 1876(g) to a member of an 
        eligible organization by a clinical psychologist (as 
        defined by the Secretary) or by a clinical social 
        worker (as defined in subsection (hh)(2)), and such 
        services and supplies furnished as an incident to such 
        clinical psychologist's services or clinical social 
        worker's services to such a member as would otherwise 
        be covered under this part if furnished by a physician 
        or as an incident to a physician's service;
          (I) blood clotting factors, for hemophilia patients 
        competent to use such factors to control bleeding 
        without medical or other supervision, and items related 
        to the administration of such factors, subject to 
        utilization controls deemed necessary by the Secretary 
        for the efficient use of such factors;
          (J) prescription drugs used in immunosuppressive 
        therapy furnished, to an individual who receives an 
        organ transplant for which payment is made under this 
        title;
          (K)(i) services which would be physicians' services 
        and services described in subsections (ww)(1) and (hhh) 
        if furnished by a physician (as defined in subsection 
        (r)(1)) and which are performed by a physician 
        assistant (as defined in subsection (aa)(5)) under the 
        supervision of a physician (as so defined) and which 
        the physician assistant is legally authorized to 
        perform by the State in which the services are 
        performed, and such services and supplies furnished as 
        incident to such services as would be covered under 
        subparagraph (A) if furnished incident to a physician's 
        professional service, but only if no facility or other 
        provider charges or is paid any amounts with respect to 
        the furnishing of such services,
          (ii) services which would be physicians' services and 
        services described in subsections (ww)(1) and (hhh) if 
        furnished by a physician (as defined in subsection 
        (r)(1)) and which are performed by a nurse practitioner 
        or clinical nurse specialist (as defined in subsection 
        (aa)(5)) working in collaboration (as defined in 
        subsection (aa)(6)) with a physician (as defined in 
        subsection (r)(1)) which the nurse practitioner or 
        clinical nurse specialist is legally authorized to 
        perform by the State in which the services are 
        performed, and such services and supplies furnished as 
        an incident to such services as would be covered under 
        subparagraph (A) if furnished incident to a physician's 
        professional service, but only if no facility or other 
        provider charges or is paid any amounts with respect to 
        the furnishing of such services;
          (L) certified nurse-midwife services;
          (M) qualified psychologist services;
          (N) clinical social worker services (as defined in 
        subsection (hh)(2));
          (O) erythropoietin for dialysis patients competent to 
        use such drug without medical or other supervision with 
        respect to the administration of such drug, subject to 
        methods and standards established by the Secretary by 
        regulation for the safe and effective use of such drug, 
        and items related to the administration of such drug;
          (P) prostate cancer screening tests (as defined in 
        subsection (oo));
          (Q) an oral drug (which is approved by the Federal 
        Food and Drug Administration) prescribed for use as an 
        anticancer chemotherapeutic agent for a given 
        indication, and containing an active ingredient (or 
        ingredients), which is the same indication and active 
        ingredient (or ingredients) as a drug which the carrier 
        determines would be covered pursuant to subparagraph 
        (A) or (B) if the drug could not be self-administered;
          (R) colorectal cancer screening tests (as defined in 
        subsection (pp));
          (S) diabetes outpatient self-management training 
        services (as defined in subsection (qq));
          (T) an oral drug (which is approved by the Federal 
        Food and Drug Administration) prescribed for use as an 
        acute anti-emetic used as part of an anticancer 
        chemotherapeutic regimen if the drug is administered by 
        a physician (or as prescribed by a physician)--
                  (i) for use immediately before, at, or within 
                48 hours after the time of the administration 
                of the anticancer chemotherapeutic agent; and
                  (ii) as a full replacement for the anti-
                emetic therapy which would otherwise be 
                administered intravenously;
          (U) screening for glaucoma (as defined in subsection 
        (uu)) for individuals determined to be at high risk for 
        glaucoma, individuals with a family history of glaucoma 
        and individuals with diabetes;
          (V) medical nutrition therapy services (as defined in 
        subsection (vv)(1)) in the case of a beneficiary with 
        diabetes or a renal disease who--
                  (i) has not received diabetes outpatient 
                self-management training services within a time 
                period determined by the Secretary;
                  (ii) is not receiving maintenance dialysis 
                for which payment is made under section 1881; 
                and
                  (iii) meets such other criteria determined by 
                the Secretary after consideration of protocols 
                established by dietitian or nutrition 
                professional organizations;
          (W) an initial preventive physical examination (as 
        defined in subsection (ww));
          (X) cardiovascular screening blood tests (as defined 
        in subsection (xx)(1));
          (Y) diabetes screening tests (as defined in 
        subsection (yy));
          (Z) intravenous immune globulin for the treatment of 
        primary immune deficiency diseases in the home (as 
        defined in subsection (zz));
          (AA) ultrasound screening for abdominal aortic 
        aneurysm (as defined in subsection (bbb)) for an 
        individual--
                  (i) who receives a referral for such an 
                ultrasound screening as a result of an initial 
                preventive physical examination (as defined in 
                section 1861(ww)(1));
                  (ii) who has not been previously furnished 
                such an ultrasound screening under this title; 
                and
                  (iii) who--
                          (I) has a family history of abdominal 
                        aortic aneurysm; or
                          (II) manifests risk factors included 
                        in a beneficiary category recommended 
                        for screening by the United States 
                        Preventive Services Task Force 
                        regarding abdominal aortic aneurysms;
          (BB) additional preventive services (described in 
        subsection (ddd)(1));
                  (CC) items and services furnished under a 
                cardiac rehabilitation program (as defined in 
                subsection (eee)(1)) or under a pulmonary 
                rehabilitation program (as defined in 
                subsection (fff)(1));
                  (DD) items and services furnished under an 
                intensive cardiac rehabilitation program (as 
                defined in subsection (eee)(4));
          (EE) kidney disease education services (as defined in 
        subsection (ggg));
          (FF) personalized prevention plan services (as 
        defined in subsection (hhh));
          (GG) home infusion therapy (as defined in subsection 
        (iii)(1)); and
          (HH) opioid use disorder treatment services (as 
        defined in subsection (jjj)).
          (3) diagnostic X-ray tests (including tests under the 
        supervision of a physician, furnished in a place of 
        residence used as the patient's home, if the 
        performance of such tests meets such conditions 
        relating to health and safety as the Secretary may find 
        necessary and including diagnostic mammography if 
        conducted by a facility that has a certificate (or 
        provisional certificate) issued under section 354 of 
        the Public Health Service Act), diagnostic laboratory 
        tests, and other diagnostic tests;
          (4) X-ray, radium, and radioactive isotope therapy, 
        including materials and services of technicians;
          (5) surgical dressings, and splints, casts, and other 
        devices used for reduction of fractures and 
        dislocations;
          (6) durable medical equipment;
          (7) ambulance service where the use of other methods 
        of transportation is contraindicated by the 
        individual's condition, but, subject to section 
        1834(l)(14), only to the extent provided in 
        regulations;
          (8) prosthetic devices (other than dental) which 
        replace all or part of an internal body organ 
        (including colostomy bags and supplies directly related 
        to colostomy care), including replacement of such 
        devices, and including one pair of conventional 
        eyeglasses or contact lenses furnished subsequent to 
        each cataract surgery with insertion of an intraocular 
        lens;
          (9) leg, arm, back, and neck braces, and artificial 
        legs, arms, and eyes, including replacements if 
        required because of a change in the patient's physical 
        condition;
          (10)(A) pneumococcal vaccine and its administration 
        and, subject to section 4071(b) of the Omnibus Budget 
        Reconciliation Act of 1987, influenza vaccine and its 
        administration, and COVID-19 vaccine and its 
        administration; and
          (B) hepatitis B vaccine and its administration, 
        furnished to an individual who is at high or 
        intermediate risk of contracting hepatitis B (as 
        determined by the Secretary under regulations);
          (11) services of a certified registered nurse 
        anesthetist (as defined in subsection (bb));
          (12) subject to section 4072(e) of the Omnibus Budget 
        Reconciliation Act of 1987, extra-depth shoes with 
        inserts or custom molded shoes with inserts for an 
        individual with diabetes, if--
                  (A) the physician who is managing the 
                individual's diabetic condition (i) documents 
                that the individual has peripheral neuropathy 
                with evidence of callus formation, a history of 
                pre-ulcerative calluses, a history of previous 
                ulceration, foot deformity, or previous 
                amputation, or poor circulation, and (ii) 
                certifies that the individual needs such shoes 
                under a comprehensive plan of care related to 
                the individual's diabetic condition;
                  (B) the particular type of shoes are 
                prescribed by a podiatrist or other qualified 
                physician (as established by the Secretary); 
                and
                  (C) the shoes are fitted and furnished by a 
                podiatrist or other qualified individual (such 
                as a pedorthist or orthotist, as established by 
                the Secretary) who is not the physician 
                described in subparagraph (A) (unless the 
                Secretary finds that the physician is the only 
                such qualified individual in the area);
          (13) screening mammography (as defined in subsection 
        (jj));
          (14) screening pap smear and screening pelvic exam; 
        and
          (15) bone mass measurement (as defined in subsection 
        (rr)).
No diagnostic tests performed in any laboratory, including a 
laboratory that is part of a rural health clinic, or a hospital 
(which, for purposes of this sentence, means an institution 
considered a hospital for purposes of section 1814(d)) shall be 
included within paragraph (3) unless such laboratory--
          (16) if situated in any State in which State or 
        applicable local law provides for licensing of 
        establishments of this nature, (A) is licensed pursuant 
        to such law, or (B) is approved, by the agency of such 
        State or locality responsible for licensing 
        establishments of this nature, as meeting the standards 
        established for such licensing; and
          (17)(A) meets the certification requirements under 
        section 353 of the Public Health Service Act; and
          (B) meets such other conditions relating to the 
        health and safety of individuals with respect to whom 
        such tests are performed as the Secretary may find 
        necessary.
There shall be excluded from the diagnostic services specified 
in paragraph (2)(C) any item or service (except services 
referred to in paragraph (1)) which would not be included under 
subsection (b) if it were furnished to an inpatient of a 
hospital. None of the items and services referred to in the 
preceding paragraphs (other than paragraphs (1) and (2)(A)) of 
this subsection which are furnished to a patient of an 
institution which meets the definition of a hospital for 
purposes of section 1814(d) shall be included unless such other 
conditions are met as the Secretary may find necessary relating 
to health and safety of individuals with respect to whom such 
items and services are furnished.

                         Drugs and Biologicals

  (t)(1) The term ``drugs'' and the term ``biologicals'', 
except for purposes of subsection (m)(5) and paragraph (2), 
include only such drugs (including contrast agents) and 
biologicals, respectively, as are included (or approved for 
inclusion) in the United States Pharmacopoeia, the National 
Formulary, or the United States Homeopathic Pharmacopoeia, or 
in New Drugs or Accepted Dental Remedies (except for any drugs 
and biologicals unfavorably evaluated therein), or as are 
approved by the pharmacy and drug therapeutics committee (or 
equivalent committee) of the medical staff of the hospital 
furnishing such drugs and biologicals for use in such hospital.
  (2)(A) For purposes of paragraph (1), the term ``drugs'' also 
includes any drugs or biologicals used in an anticancer 
chemotherapeutic regimen for a medically accepted indication 
(as described in subparagraph (B)).
  (B) In subparagraph (A), the term ``medically accepted 
indication'', with respect to the use of a drug, includes any 
use which has been approved by the Food and Drug Administration 
for the drug, and includes another use of the drug if--
          (i) the drug has been approved by the Food and Drug 
        Administration; and
          (ii)(I) such use is supported by one or more 
        citations which are included (or approved for 
        inclusion) in one or more of the following compendia: 
        the American Hospital Formulary Service-Drug 
        Information, the American Medical Association Drug 
        Evaluations, the United States Pharmacopoeia-Drug 
        Information (or its successor publications), and other 
        authoritative compendia as identified by the Secretary, 
        unless the Secretary has determined that the use is not 
        medically appropriate or the use is identified as not 
        indicated in one or more such compendia, or
          (II) the carrier involved determines, based upon 
        guidance provided by the Secretary to carriers for 
        determining accepted uses of drugs, that such use is 
        medically accepted based on supportive clinical 
        evidence in peer reviewed medical literature appearing 
        in publications which have been identified for purposes 
        of this subclause by the Secretary.
The Secretary may revise the list of compendia in clause 
(ii)(I) as is appropriate for identifying medically accepted 
indications for drugs. On and after January 1, 2010, no 
compendia may be included on the list of compendia under this 
subparagraph unless the compendia has a publicly transparent 
process for evaluating therapies and for identifying potential 
conflicts of interests.

                          Provider of Services

  (u) The term ``provider of services'' means a hospital, 
critical access hospital, rural emergency hospital, skilled 
nursing facility, comprehensive outpatient rehabilitation 
facility, home health agency, hospice program, or, for purposes 
of section 1814(g) and section 1835(e), a fund.

                            Reasonable Cost

  (v)(1)(A) The reasonable cost of any services shall be the 
cost actually incurred, excluding therefrom any part of 
incurred cost found to be unnecessary in the efficient delivery 
of needed health services, and shall be determined in 
accordance with regulations establishing the method or methods 
to be used, and the items to be included, in determining such 
costs for various types or classes of institutions, agencies, 
and services; except that in any case to which paragraph (2) or 
(3) applies, the amount of the payment determined under such 
paragraph with respect to the services involved shall be 
considered the reasonable cost of such services. In prescribing 
the regulations referred to in the preceding sentence, the 
Secretary shall consider, among other things, the principles 
generally applied by national organizations or established 
prepayment organizations (which have developed such principles) 
in computing the amount of payment, to be made by persons other 
than the recipients of services, to providers of services on 
account of services furnished to such recipients by such 
providers. Such regulations may provide for determination of 
the costs of services on a per diem, per unit, per capita, or 
other basis, may provide for using different methods in 
different circumstances, may provide for the use of estimates 
of costs of particular items or services, may provide for the 
establishment of limits on the direct or indirect overall 
incurred costs or incurred costs of specific items or services 
or groups of items or services to be recognized as reasonable 
based on estimates of the costs necessary in the efficient 
delivery of needed health services to individuals covered by 
the insurance programs established under this title, and may 
provide for the use of charges or a percentage of charges where 
this method reasonably reflects the costs. Such regulations 
shall (i) take into account both direct and indirect costs of 
providers of services (excluding therefrom any such costs, 
including standby costs, which are determined in accordance 
with regulations to be unnecessary in the efficient delivery of 
services covered by the insurance programs established under 
this title) in order that, under the methods of determining 
costs, the necessary costs of efficiently delivering covered 
services to individuals covered by the insurance programs 
established by this title will not be borne by individuals not 
so covered, and the costs with respect to individuals not so 
covered will not be borne by such insurance programs, and (ii) 
provide for the making of suitable retroactive corrective 
adjustments where, for a provider of services for any fiscal 
period, the aggregate reimbursement produced by the methods of 
determining costs proves to be either inadequate or excessive.
  (B) In the case of extended care services, the regulations 
under subparagraph (A) shall not include provision for specific 
recognition of a return on equity capital.
  (C) Where a hospital has an arrangement with a medical school 
under which the faculty of such school provides services at 
such hospital, an amount not in excess of the reasonable cost 
of such services to the medical school shall be included in 
determining the reasonable cost to the hospital of furnishing 
services--
          (i) for which payment may be made under part A, but 
        only if--
                  (I) payment for such services as furnished 
                under such arrangement would be made under part 
                A to the hospital had such services been 
                furnished by the hospital, and
                  (II) such hospital pays to the medical school 
                at least the reasonable cost of such services 
                to the medical school, or
          (ii) for which payment may be made under part B, but 
        only if such hospital pays to the medical school at 
        least the reasonable cost of such services to the 
        medical school.
  (D) Where (i) physicians furnish services which are either 
inpatient hospital services (including services in conjunction 
with the teaching programs of such hospital) by reason of 
paragraph (7) of subsection (b) or for which entitlement exists 
by reason of clause (II) of section 1832(a)(2)(B)(i), and (ii) 
such hospital (or medical school under arrangement with such 
hospital) incurs no actual cost in the furnishing of such 
services, the reasonable cost of such services shall (under 
regulations of the Secretary) be deemed to be the cost such 
hospital or medical school would have incurred had it paid a 
salary to such physicians rendering such services approximately 
equivalent to the average salary paid to all physicians 
employed by such hospital (or if such employment does not 
exist, or is minimal in such hospital, by similar hospitals in 
a geographic area of sufficient size to assure reasonable 
inclusion of sufficient physicians in development of such 
average salary).
  (E) Such regulations may, in the case of skilled nursing 
facilities in any State, provide for the use of rates, 
developed by the State in which such facilities are located, 
for the payment of the cost of skilled nursing facility 
services furnished under the State's plan approved under title 
XIX (and such rates may be increased by the Secretary on a 
class or size of institution or on a geographical basis by a 
percentage factor not in excess of 10 percent to take into 
account determinable items or services or other requirements 
under this title not otherwise included in the computation of 
such State rates), if the Secretary finds that such rates are 
reasonably related to (but not necessarily limited to) analyses 
undertaken by such State of costs of care in comparable 
facilities in such State. Notwithstanding the previous 
sentence, such regulations with respect to skilled nursing 
facilities shall take into account (in a manner consistent with 
subparagraph (A) and based on patient-days of services 
furnished) the costs (including the costs of services required 
to attain or maintain the highest practicable physical, mental, 
and psychosocial well-being of each resident eligible for 
benefits under this title) of such facilities complying with 
the requirements of subsections (b), (c), and (d) of section 
1819 (including the costs of conducting nurse aide training and 
competency evaluation programs and competency evaluation 
programs).
  (F) Such regulations shall require each provider of services 
(other than a fund) to make reports to the Secretary of 
information described in section 1121(a) in accordance with the 
uniform reporting system (established under such section) for 
that type of provider.
  (G)(i) In any case in which a hospital provides inpatient 
services to an individual that would constitute post-hospital 
extended care services if provided by a skilled nursing 
facility and a quality improvement organization (or, in the 
absence of such a qualified organization, the Secretary or such 
agent as the Secretary may designate) determines that inpatient 
hospital services for the individual are not medically 
necessary but post-hospital extended care services for the 
individual are medically necessary and such extended care 
services are not otherwise available to the individual (as 
determined in accordance with criteria established by the 
Secretary) at the time of such determination, payment for such 
services provided to the individual shall continue to be made 
under this title at the payment rate described in clause (ii) 
during the period in which--
          (I) such post-hospital extended care services for the 
        individual are medically necessary and not otherwise 
        available to the individual (as so determined),
          (II) inpatient hospital services for the individual 
        are not medically necessary, and
          (III) the individual is entitled to have payment made 
        for post-hospital extended care services under this 
        title,
except that if the Secretary determines that there is not an 
excess of hospital beds in such hospital and (subject to clause 
(iv)) there is not an excess of hospital beds in the area of 
such hospital, such payment shall be made (during such period) 
on the basis of the amount otherwise payable under part A with 
respect to inpatient hospital services.
  (ii)(I) Except as provided in subclause (II), the payment 
rate referred to in clause (i) is a rate equal to the estimated 
adjusted State-wide average rate per patient-day paid for 
services provided in skilled nursing facilities under the State 
plan approved under title XIX for the State in which such 
hospital is located, or, if the State in which the hospital is 
located does not have a State plan approved under title XIX, 
the estimated adjusted State-wide average allowable costs per 
patient-day for extended care services under this title in that 
State.
  (II) If a hospital has a unit which is a skilled nursing 
facility, the payment rate referred to in clause (i) for the 
hospital is a rate equal to the lesser of the rate described in 
subclause (I) or the allowable costs in effect under this title 
for extended care services provided to patients of such unit.
  (iii) Any day on which an individual receives inpatient 
services for which payment is made under this subparagraph 
shall, for purposes of this Act (other than this subparagraph), 
be deemed to be a day on which the individual received 
inpatient hospital services.
  (iv) In determining under clause (i), in the case of a public 
hospital, whether or not there is an excess of hospital beds in 
the area of such hospital, such determination shall be made on 
the basis of only the public hospitals (including the hospital) 
which are in the area of the hospital and which are under 
common ownership with that hospital.
  (H) In determining such reasonable cost with respect to home 
health agencies, the Secretary may not include--
          (i) any costs incurred in connection with bonding or 
        establishing an escrow account by any such agency as a 
        result of the surety bond requirement described in 
        subsection (o)(7) and the financial security 
        requirement described in subsection (o)(8);
          (ii) in the case of home health agencies to which the 
        surety bond requirement described in subsection (o)(7) 
        and the financial security requirement described in 
        subsection (o)(8) apply, any costs attributed to 
        interest charged such an agency in connection with 
        amounts borrowed by the agency to repay overpayments 
        made under this title to the agency, except that such 
        costs may be included in reasonable cost if the 
        Secretary determines that the agency was acting in good 
        faith in borrowing the amounts;
          (iii) in the case of contracts entered into by a home 
        health agency after the date of the enactment of this 
        subparagraph for the purpose of having services 
        furnished for or on behalf of such agency, any cost 
        incurred by such agency pursuant to any such contract 
        which is entered into for a period exceeding five 
        years; and
          (iv) in the case of contracts entered into by a home 
        health agency before the date of the enactment of this 
        subparagraph for the purpose of having services 
        furnished for or on behalf of such agency, any cost 
        incurred by such agency pursuant to any such contract, 
        which determines the amount payable by the home health 
        agency on the basis of a percentage of the agency's 
        reimbursement or claim for reimbursement for services 
        furnished by the agency, to the extent that such cost 
        exceeds the reasonable value of the services furnished 
        on behalf of such agency.
  (I) In determining such reasonable cost, the Secretary may 
not include any costs incurred by a provider with respect to 
any services furnished in connection with matters for which 
payment may be made under this title and furnished pursuant to 
a contract between the provider and any of its subcontractors 
which is entered into after the date of the enactment of this 
subparagraph and the value or cost of which is $10,000 or more 
over a twelve-month period unless the contract contains a 
clause to the effect that--
          (i) until the expiration of four years after the 
        furnishing of such services pursuant to such contract, 
        the subcontractor shall make available, upon written 
        request by the Secretary, or upon request by the 
        Comptroller General, or any of their duly authorized 
        representatives, the contract, and books, documents and 
        records of such subcontractor that are necessary to 
        certify the nature and extent of such costs, and
          (ii) if the subcontractor carries out any of the 
        duties of the contract through a subcontract, with a 
        value or cost of $10,000 or more over a twelve-month 
        period, with a related organization, such subcontract 
        shall contain a clause to the effect that until the 
        expiration of four years after the furnishing of such 
        services pursuant to such subcontract, the related 
        organization shall make available, upon written request 
        by the Secretary, or upon request by the Comptroller 
        General, or any of their duly authorized 
        representatives, the subcontract, and books, documents 
        and records of such organization that are necessary to 
        verify the nature and extent of such costs.
The Secretary shall prescribe in regulation criteria and 
procedures which the Secretary shall use in obtaining access to 
books, documents, and records under clauses required in 
contracts and subcontracts under this subparagraph.
  (J) Such regulations may not provide for any inpatient 
routine salary cost differential as a reimbursable cost for 
hospitals and skilled nursing facilities.
  (K)(i) The Secretary shall issue regulations that provide, to 
the extent feasible, for the establishment of limitations on 
the amount of any costs or charges that shall be considered 
reasonable with respect to services provided on an outpatient 
basis by hospitals (other than bona fide emergency services as 
defined in clause (ii)) or clinics (other than rural health 
clinics), which are reimbursed on a cost basis or on the basis 
of cost related charges, and by physicians utilizing such 
outpatient facilities. Such limitations shall be reasonably 
related to the charges in the same area for similar services 
provided in physicians' offices. Such regulations shall provide 
for exceptions to such limitations in cases where similar 
services are not generally available in physicians' offices in 
the area to individuals entitled to benefits under this title.
  (ii) For purposes of clause (i), the term ``bona fide 
emergency services'' means services provided in a hospital 
emergency room after the sudden onset of a medical condition 
manifesting itself by acute symptoms of sufficient severity 
(including severe pain) such that the absence of immediate 
medical attention could reasonably be expected to result in--
          (I) placing the patient's health in serious jeopardy;
          (II) serious impairment to bodily functions; or
          (III) serious dysfunction of any bodily organ or 
        part.
  (L)(i) The Secretary, in determining the amount of the 
payments that may be made under this title with respect to 
services furnished by home health agencies, may not recognize 
as reasonable (in the efficient delivery of such services) 
costs for the provision of such services by an agency to the 
extent these costs exceed (on the aggregate for the agency) for 
cost reporting periods beginning on or after--
          (I) July 1, 1985, and before July 1, 1986, 120 
        percent of the mean of the labor-related and nonlabor 
        per visit costs for freestanding home health agencies,
          (II) July 1, 1986, and before July 1, 1987, 115 
        percent of such mean,
          (III) July 1, 1987, and before October 1, 1997, 112 
        percent of such mean,
          (IV) October 1, 1997, and before October 1, 1998, 105 
        percent of the median of the labor-related and nonlabor 
        per visit costs for freestanding home health agencies, 
        or
          (V) October 1, 1998, 106 percent of such median.
  (ii) Effective for cost reporting periods beginning on or 
after July 1, 1986, such limitations shall be applied on an 
aggregate basis for the agency, rather than on a discipline 
specific basis. The Secretary may provide for such exemptions 
and exceptions to such limitation as he deems appropriate.
  (iii) Not later than July 1, 1991, and annually thereafter 
(but not for cost reporting periods beginning on or after July 
1, 1994, and before July 1, 1996, or on or after July 1, 1997, 
and before October 1, 1997), the Secretary shall establish 
limits under this subparagraph for cost reporting periods 
beginning on or after such date by utilizing the area wage 
index applicable under section 1886(d)(3)(E) and determined 
using the survey of the most recent available wages and wage-
related costs of hospitals located in the geographic area in 
which the home health service is furnished (determined without 
regard to whether such hospitals have been reclassified to a 
new geographic area pursuant to section 1886(d)(8)(B), a 
decision of the Medicare Geographic Classification Review Board 
under section 1886(d)(10), or a decision of the Secretary).
  (iv) In establishing limits under this subparagraph for cost 
reporting periods beginning after September 30, 1997, the 
Secretary shall not take into account any changes in the home 
health market basket, as determined by the Secretary, with 
respect to cost reporting periods which began on or after July 
1, 1994, and before July 1, 1996.
  (v) For services furnished by home health agencies for cost 
reporting periods beginning on or after October 1, 1997, 
subject to clause (viii)(I), the Secretary shall provide for an 
interim system of limits. Payment shall not exceed the costs 
determined under the preceding provisions of this subparagraph 
or, if lower, the product of--
          (I) an agency-specific per beneficiary annual 
        limitation calculated based 75 percent on 98 percent of 
        the reasonable costs (including nonroutine medical 
        supplies) for the agency's 12-month cost reporting 
        period ending during fiscal year 1994, and based 25 
        percent on 98 percent of the standardized regional 
        average of such costs for the agency's census division, 
        as applied to such agency, for cost reporting periods 
        ending during fiscal year 1994, such costs updated by 
        the home health market basket index; and
          (II) the agency's unduplicated census count of 
        patients (entitled to benefits under this title) for 
        the cost reporting period subject to the limitation.
  (vi) For services furnished by home health agencies for cost 
reporting periods beginning on or after October 1, 1997, the 
following rules apply:
          (I) For new providers and those providers without a 
        12-month cost reporting period ending in fiscal year 
        1994 subject to clauses (viii)(II) and (viii)(III), the 
        per beneficiary limitation shall be equal to the median 
        of these limits (or the Secretary's best estimates 
        thereof) applied to other home health agencies as 
        determined by the Secretary. A home health agency that 
        has altered its corporate structure or name shall not 
        be considered a new provider for this purpose.
          (II) For beneficiaries who use services furnished by 
        more than one home health agency, the per beneficiary 
        limitations shall be prorated among the agencies.
  (vii)(I) Not later than January 1, 1998, the Secretary shall 
establish per visit limits applicable for fiscal year 1998, and 
not later than April 1, 1998, the Secretary shall establish per 
beneficiary limits under clause (v)(I) for fiscal year 1998.
  (II) Not later than August 1 of each year (beginning in 1998) 
the Secretary shall establish the limits applicable under this 
subparagraph for services furnished during the fiscal year 
beginning October 1 of the year.
  (viii)(I) In the case of a provider with a 12-month cost 
reporting period ending in fiscal year 1994, if the limit 
imposed under clause (v) (determined without regard to this 
subclause) for a cost reporting period beginning during or 
after fiscal year 1999 is less than the median described in 
clause (vi)(I) (but determined as if any reference in clause 
(v) to ``98 percent'' were a reference to ``100 percent''), the 
limit otherwise imposed under clause (v) for such provider and 
period shall be increased by \1/3\ of such difference.
  (II) Subject to subclause (IV), for new providers and those 
providers without a 12-month cost reporting period ending in 
fiscal year 1994, but for which the first cost reporting period 
begins before fiscal year 1999, for cost reporting periods 
beginning during or after fiscal year 1999, the per beneficiary 
limitation described in clause (vi)(I) shall be equal to the 
median described in such clause (determined as if any reference 
in clause (v) to ``98 percent'' were a reference to ``100 
percent'').
  (III) Subject to subclause (IV), in the case of a new 
provider for which the first cost reporting period begins 
during or after fiscal year 1999, the limitation applied under 
clause (vi)(I) (but only with respect to such provider) shall 
be equal to 75 percent of the median described in clause 
(vi)(I).
  (IV) In the case of a new provider or a provider without a 
12-month cost reporting period ending in fiscal year 1994, 
subclause (II) shall apply, instead of subclause (III), to a 
home health agency which filed an application for home health 
agency provider status under this title before September 15, 
1998, or which was approved as a branch of its parent agency 
before such date and becomes a subunit of the parent agency or 
a separate agency on or after such date.
  (V) Each of the amounts specified in subclauses (I) through 
(III) are such amounts as adjusted under clause (iii) to 
reflect variations in wages among different areas.
  (ix) Notwithstanding the per beneficiary limit under clause 
(viii), if the limit imposed under clause (v) (determined 
without regard to this clause) for a cost reporting period 
beginning during or after fiscal year 2000 is less than the 
median described in clause (vi)(I) (but determined as if any 
reference in clause (v) to ``98 percent'' were a reference to 
``100 percent''), the limit otherwise imposed under clause (v) 
for such provider and period shall be increased by 2 percent.
  (x) Notwithstanding any other provision of this subparagraph, 
in updating any limit under this subparagraph by a home health 
market basket index for cost reporting periods beginning during 
each of fiscal years 2000, 2002, and 2003, the update otherwise 
provided shall be reduced by 1.1 percentage points. With 
respect to cost reporting periods beginning during fiscal year 
2001, the update to any limit under this subparagraph shall be 
the home health market basket index.
  (M) Such regulations shall provide that costs respecting care 
provided by a provider of services, pursuant to an assurance 
under title VI or XVI of the Public Health Service Act that the 
provider will make available a reasonable volume of services to 
persons unable to pay therefor, shall not be allowable as 
reasonable costs.
  (N) In determining such reasonable costs, costs incurred for 
activities directly related to influencing employees respecting 
unionization may not be included.
  (O)(i) In establishing an appropriate allowance for 
depreciation and for interest on capital indebtedness with 
respect to an asset of a provider of services which has 
undergone a change of ownership, such regulations shall 
provide, except as provided in clause (iii), that the valuation 
of the asset after such change of ownership shall be the 
historical cost of the asset, as recognized under this title, 
less depreciation allowed, to the owner of record as of the 
date of enactment of the Balanced Budget Act of 1997 (or, in 
the case of an asset not in existence as of that date, the 
first owner of record of the asset after that date).
  (ii) Such regulations shall not recognize, as reasonable in 
the provision of health care services, costs (including legal 
fees, accounting and administrative costs, travel costs, and 
the costs of feasibility studies) attributable to the 
negotiation or settlement of the sale or purchase of any 
capital asset (by acquisition or merger) for which any payment 
has previously been made under this title.
  (iii) In the case of the transfer of a hospital from 
ownership by a State to ownership by a nonprofit corporation 
without monetary consideration, the basis for capital 
allowances to the new owner shall be the book value of the 
hospital to the State at the time of the transfer.
  (P) If such regulations provide for the payment for a return 
on equity capital (other than with respect to costs of 
inpatient hospital services), the rate of return to be 
recognized, for determining the reasonable cost of services 
furnished in a cost reporting period, shall be equal to the 
average of the rates of interest, for each of the months any 
part of which is included in the period, on obligations issued 
for purchase by the Federal Hospital Insurance Trust Fund.
  (Q) Except as otherwise explicitly authorized, the Secretary 
is not authorized to limit the rate of increase on allowable 
costs of approved medical educational activities.
  (R) In determining such reasonable cost, costs incurred by a 
provider of services representing a beneficiary in an 
unsuccessful appeal of a determination described in section 
1869(b) shall not be allowable as reasonable costs.
  (S)(i) Such regulations shall not include provision for 
specific recognition of any return on equity capital with 
respect to hospital outpatient departments.
  (ii)(I) Such regulations shall provide that, in determining 
the amount of the payments that may be made under this title 
with respect to all the capital-related costs of outpatient 
hospital services, the Secretary shall reduce the amounts of 
such payments otherwise established under this title by 15 
percent for payments attributable to portions of cost reporting 
periods occurring during fiscal year 1990, by 15 percent for 
payments attributable to portions of cost reporting periods 
occurring during fiscal year 1991, and by 10 percent for 
payments attributable to portions of cost reporting periods 
occurring during fiscal years 1992 through 1999 and until the 
first date that the prospective payment system under section 
1833(t) is implemented.
  (II) The Secretary shall reduce the reasonable cost of 
outpatient hospital services (other than the capital-related 
costs of such services) otherwise determined pursuant to 
section 1833(a)(2)(B)(i)(I) by 5.8 percent for payments 
attributable to portions of cost reporting periods occurring 
during fiscal years 1991 through 1999 and until the first date 
that the prospective payment system under section 1833(t) is 
implemented.
  (III) Subclauses (I) and (II) shall not apply to payments 
with respect to the costs of hospital outpatient services 
provided by any hospital that is a sole community hospital (as 
defined in section 1886(d)(5)(D)(iii)) or a critical access 
hospital (as defined in section 1861(mm)(1)).
  (IV) In applying subclauses (I) and (II) to services for 
which payment is made on the basis of a blend amount under 
section 1833(i)(3)(A)(ii) or 1833(n)(1)(A)(ii), the costs 
reflected in the amounts described in sections 
1833(i)(3)(B)(i)(I) and 1833(n)(1)(B)(i)(I), respectively, 
shall be reduced in accordance with such subclause.
  (T) In determining such reasonable costs for hospitals, no 
reduction in copayments under section 1833(t)(8)(B) shall be 
treated as a bad debt and the amount of bad debts otherwise 
treated as allowable costs which are attributable to the 
deductibles and coinsurance amounts under this title shall be 
reduced--
          (i) for cost reporting periods beginning during 
        fiscal year 1998, by 25 percent of such amount 
        otherwise allowable,
          (ii) for cost reporting periods beginning during 
        fiscal year 1999, by 40 percent of such amount 
        otherwise allowable,
          (iii) for cost reporting periods beginning during 
        fiscal year 2000, by 45 percent of such amount 
        otherwise allowable,
          (iv) for cost reporting periods beginning during 
        fiscal years 2001 through 2012, by 30 percent of such 
        amount otherwise allowable, and
          (v) for cost reporting periods beginning during 
        fiscal year 2013 or a subsequent fiscal year, by 35 
        percent of such amount otherwise allowable.
  (U) In determining the reasonable cost of ambulance services 
(as described in subsection (s)(7)) provided during fiscal year 
1998, during fiscal year 1999, and during so much of fiscal 
year 2000 as precedes January 1, 2000, the Secretary shall not 
recognize the costs per trip in excess of costs recognized as 
reasonable for ambulance services provided on a per trip basis 
during the previous fiscal year (after application of this 
subparagraph), increased by the percentage increase in the 
consumer price index for all urban consumers (U.S. city 
average) as estimated by the Secretary for the 12-month period 
ending with the midpoint of the fiscal year involved reduced by 
1.0 percentage point. For ambulance services provided after 
June 30, 1998, the Secretary may provide that claims for such 
services must include a code (or codes) under a uniform coding 
system specified by the Secretary that identifies the services 
furnished.
  (V) In determining such reasonable costs for skilled nursing 
facilities and (beginning with respect to cost reporting 
periods beginning during fiscal year 2013) for covered skilled 
nursing services described in section 1888(e)(2)(A) furnished 
by hospital providers of extended care services (as described 
in section 1883), the amount of bad debts otherwise treated as 
allowed costs which are attributable to the coinsurance amounts 
under this title for individuals who are entitled to benefits 
under part A and--
          (i) are not described in section 1935(c)(6)(A)(ii) 
        shall be reduced by--
          (I) for cost reporting periods beginning on or after 
        October 1, 2005, but before fiscal year 2013, 30 
        percent of such amount otherwise allowable; and
          (II) for cost reporting periods beginning during 
        fiscal year 2013 or a subsequent fiscal year, by 35 
        percent of such amount otherwise allowable.
          (ii) are described in such section--
          (I) for cost reporting periods beginning on or after 
        October 1, 2005, but before fiscal year 2013, shall not 
        be reduced;
          (II) for cost reporting periods beginning during 
        fiscal year 2013, shall be reduced by 12 percent of 
        such amount otherwise allowable;
          (III) for cost reporting periods beginning during 
        fiscal year 2014, shall be reduced by 24 percent of 
        such amount otherwise allowable; and
          (IV) for cost reporting periods beginning during a 
        subsequent fiscal year, shall be reduced by 35 percent 
        of such amount otherwise allowable.
  (W)(i) In determining such reasonable costs for providers 
described in clause (ii), the amount of bad debts otherwise 
treated as allowable costs which are attributable to 
deductibles and coinsurance amounts under this title shall be 
reduced--
          (I) for cost reporting periods beginning during 
        fiscal year 2013, by 12 percent of such amount 
        otherwise allowable;
          (II) for cost reporting periods beginning during 
        fiscal year 2014, by 24 percent of such amount 
        otherwise allowable; and
          (III) for cost reporting periods beginning during a 
        subsequent fiscal year, by 35 percent of such amount 
        otherwise allowable.
  (ii) A provider described in this clause is a provider of 
services not described in subparagraph (T) or (V), a supplier, 
or any other type of entity that receives payment for bad debts 
under the authority under subparagraph (A).
  (2)(A) If the bed and board furnished as part of inpatient 
hospital services (including inpatient tuberculosis hospital 
services and inpatient psychiatric hospital services) or post-
hospital extended care services is in accommodations more 
expensive than semi-private accommodations, the amount taken 
into account for purposes of payment under this title with 
respect to such services may not exceed the amount that would 
be taken into account with respect to such services if 
furnished in such semi-private accommodations unless the more 
expensive accommodations were required for medical reasons.
  (B) Where a provider of services which has an agreement in 
effect under this title furnishes to an individual items or 
services which are in excess of or more expensive than the 
items or services with respect to which payment may be made 
under part A or part B, as the case may be, the Secretary shall 
take into account for purposes of payment to such provider of 
services only the items or services with respect to which such 
payment may be made.
  (3) If the bed and board furnished as part of inpatient 
hospital services (including inpatient tuberculosis hospital 
services and inpatient psychiatric hospital services) or post-
hospital extended care services is in accommodations other 
than, but not more expensive than, semi-private accommodations 
and the use of such other accommodations rather than semi-
private accommodations was neither at the request of the 
patient nor for a reason which the Secretary determines is 
consistent with the purposes of this title, the amount of the 
payment with respect to such bed and board under part A shall 
be the amount otherwise payable under this title for such bed 
and board furnished in semi-private accommodations minus the 
difference between the charge customarily made by the hospital 
or skilled nursing facility for bed and board in semi-private 
accommodations and the charge customarily made by it for bed 
and board in the accommodations furnished.
  (4) If a provider of services furnishes items or services to 
an individual which are in excess of or more expensive than the 
items or services determined to be necessary in the efficient 
delivery of needed health services and charges are imposed for 
such more expensive items or services under the authority 
granted in section 1866(a)(2)(B)(ii), the amount of payment 
with respect to such items or services otherwise due such 
provider in any fiscal period shall be reduced to the extent 
that such payment plus such charges exceed the cost actually 
incurred for such items or services in the fiscal period in 
which such charges are imposed.
  (5)(A) Where physical therapy services, occupational therapy 
services, speech therapy services, or other therapy services or 
services of other health-related personnel (other than 
physicians) are furnished under an arrangement with a provider 
of services or other organization, specified in the first 
sentence of subsection (p) (including through the operation of 
subsection (g)) the amount included in any payment to such 
provider or other organization under this title as the 
reasonable cost of such services (as furnished under such 
arrangements) shall not exceed an amount equal to the salary 
which would reasonably have been paid for such services 
(together with any additional costs that would have been 
incurred by the provider or other organization) to the person 
performing them if they had been performed in an employment 
relationship with such provider or other organization (rather 
than under such arrangement) plus the cost of such other 
expenses (including a reasonable allowance for traveltime and 
other reasonable types of expense related to any differences in 
acceptable methods of organization for the provision of such 
therapy) incurred by such person, as the Secretary may in 
regulations determine to be appropriate.
  (B) Notwithstanding the provisions of subparagraph (A), if a 
provider of services or other organization specified in the 
first sentence of section 1861(p) requires the services of a 
therapist on a limited part-time basis, or only to perform 
intermittent services, the Secretary may make payment on the 
basis of a reasonable rate per unit of service, even though 
such rate is greater per unit of time than salary related 
amounts, where he finds that such greater payment is, in the 
aggregate, less than the amount that would have been paid if 
such organization had employed a therapist on a full- or part-
time salary basis.
  (6) For purposes of this subsection, the term ``semi-private 
accommodations'' means two-bed, three-bed, or four-bed 
accommodations.
  (7)(A) For limitation on Federal participation for capital 
expenditures which are out of conformity with a comprehensive 
plan of a State or areawide planning agency, see section 1122.
  (B) For further limitations on reasonable cost and 
determination of payment amounts for operating costs of 
inpatient hospital services and waivers for certain States, see 
section 1886.
  (C) For provisions restricting payment for provider-based 
physicians' services and for payments under certain percentage 
arrangements, see section 1887.
  (D) For further limitations on reasonable cost and 
determination of payment amounts for routine service costs of 
skilled nursing facilities, see subsections (a) through (c) of 
section 1888.
  (8) Items unrelated to patient care.--Reasonable costs do not 
include costs for the following--
          
          (i) entertainment, including tickets to sporting and 
        other entertainment events;
          (ii) gifts or donations;
          (iii) personal use of motor vehicles;
          (iv) costs for fines and penalties resulting from 
        violations of Federal, State, or local laws; and
          (v) education expenses for spouses or other 
        dependents of providers of services, their employees or 
        contractors.

                   Arrangements for Certain Services

  (w)(1) The term ``arrangements'' is limited to arrangements 
under which receipt of payment by the hospital, critical access 
hospital, skilled nursing facility, home health agency, or 
hospice program (whether in its own right or as agent), with 
respect to services for which an individual is entitled to have 
payment made under this title, discharges the liability of such 
individual or any other person to pay for the services.
  (2) Utilization review activities conducted, in accordance 
with the requirements of the program established under part B 
of title XI of the Social Security Act with respect to services 
furnished by a hospital or critical access hospital to patients 
insured under part A of this title or entitled to have payment 
made for such services under part B of this title or under a 
State plan approved under title XIX, by a quality improvement 
organization designated for the area in which such hospital or 
critical access hospital is located shall be deemed to have 
been conducted pursuant to arrangements between such hospital 
or critical access hospital and such organization under which 
such hospital or critical access hospital is obligated to pay 
to such organization, as a condition of receiving payment for 
hospital or critical access hospital services so furnished 
under this part or under such a State plan, such amount as is 
reasonably incurred and requested (as determined under 
regulations of the Secretary) by such organization in 
conducting such review activities with respect to services 
furnished by such hospital or critical access hospital to such 
patients.

                        State and United States

  (x) The terms ``State'' and ``United States'' have the 
meaning given to them by subsections (h) and (i), respectively, 
of section 210.

     Extended Care in Religious Nonmedical Health Care Institutions

  (y)(1) The term ``skilled nursing facility'' also includes a 
religious nonmedical health care institution (as defined in 
subsection (ss)(1)), but only (except for purposes of 
subsection (a)(2)) with respect to items and services 
ordinarily furnished by such an institution to inpatients, and 
payment may be made with respect to services provided by or in 
such an institution only to such extent and under such 
conditions, limitations, and requirements (in addition to or in 
lieu of the conditions, limitations, and requirements otherwise 
applicable) as may be provided in regulations consistent with 
section 1821.
  (2) Notwithstanding any other provision of this title, 
payment under part A may not be made for services furnished an 
individual in a skilled nursing facility to which paragraph (1) 
applies unless such individual elects, in accordance with 
regulations, for a spell of illness to have such services 
treated as post-hospital extended care services for purposes of 
such part; and payment under part A may not be made for post-
hospital extended care services--
          (A) furnished an individual during such spell of 
        illness in a skilled nursing facility to which 
        paragraph (1) applies after--
                  (i) such services have been furnished to him 
                in such a facility for 30 days during such 
                spell, or
                  (ii) such services have been furnished to him 
                during such spell in a skilled nursing facility 
                to which such paragraph does not apply; or
          (B) furnished an individual during such spell of 
        illness in a skilled nursing facility to which 
        paragraph (1) does not apply after such services have 
        been furnished to him during such spell in a skilled 
        nursing facility to which such paragraph applies.
  (3) The amount payable under part A for post-hospital 
extended care services furnished an individual during any spell 
of illness in a skilled nursing facility to which paragraph (1) 
applies shall be reduced by a coinsurance amount equal to one-
eighth of the inpatient hospital deductible for each day before 
the 31st day on which he is furnished such services in such a 
facility during such spell (and the reduction under this 
paragraph shall be in lieu of any reduction under section 
1813(a)(3)).
  (4) For purposes of subsection (i), the determination of 
whether services furnished by or in an institution described in 
paragraph (1) constitute post-hospital extended care services 
shall be made in accordance with and subject to such 
conditions, limitations, and requirements as may be provided in 
regulations.

                         Institutional Planning

  (z) An overall plan and budget of a hospital, skilled nursing 
facility, comprehensive outpatient rehabilitation facility, or 
home health agency shall be considered sufficient if it--
          (1) provides for an annual operating budget which 
        includes all anticipated income and expenses related to 
        items which would, under generally accepted accounting 
        principles, be considered income and expense items 
        (except that nothing in this paragraph shall require 
        that there be prepared, in connection with any budget, 
        an item-by-item identification of the components of 
        each type of anticipated expenditure or income);
          (2)(A) provides for a capital expenditures plan for 
        at least a 3-year period (including the year to which 
        the operating budget described in paragraph (1) is 
        applicable) which includes and identifies in detail the 
        anticipated sources of financing for, and the 
        objectives of, each anticipated expenditure in excess 
        of $600,000 (or such lesser amount as may be 
        established by the State under section 1122(g)(1) in 
        which the hospital is located) related to the 
        acquisition of land, the improvement of land, 
        buildings, and equipment, and the replacement, 
        modernization, and expansion of the buildings and 
        equipment which would, under generally accepted 
        accounting principles, be considered capital items;
          (B) provides that such plan is submitted to the 
        agency designated under section 1122(b), or if no such 
        agency is designated, to the appropriate health 
        planning agency in the State (but this subparagraph 
        shall not apply in the case of a facility exempt from 
        review under section 1122 by reason of section 
        1122(j));
          (3) provides for review and updating at least 
        annually; and
          (4) is prepared, under the direction of the governing 
        body of the institution or agency, by a committee 
        consisting of representatives of the governing body, 
        the administrative staff, and the medical staff (if 
        any) of the institution or agency.

  Rural Health Clinic Services and Federally Qualified Health Center 
                                Services

  (aa)(1) The term ``rural health clinic services'' means --
          (A) physicians' services and such services and 
        supplies as are covered under section 1861(s)(2)(A) if 
        furnished as an incident to a physician's professional 
        service and items and services described in section 
        1861(s)(10),
          (B) such services furnished by a physician assistant 
        or a nurse practitioner (as defined in paragraph (5)), 
        by a clinical psychologist (as defined by the 
        Secretary) or by a clinical social worker (as defined 
        in subsection (hh)(1)), and such services and supplies 
        furnished as an incident to his service as would 
        otherwise be covered if furnished by a physician or as 
        an incident to a physician's service, and
          (C) in the case of a rural health clinic located in 
        an area in which there exists a shortage of home health 
        agencies, part-time or intermittent nursing care and 
        related medical supplies (other than drugs and 
        biologicals) furnished by a registered professional 
        nurse or licensed practical nurse to a homebound 
        individual under a written plan of treatment (i) 
        established and periodically reviewed by a physician 
        described in paragraph (2)(B), or (ii) established by a 
        nurse practitioner or physician assistant and 
        periodically reviewed and approved by a physician 
        described in paragraph (2)(B),
when furnished to an individual as an outpatient of a rural 
health clinic.
  (2) The term ``rural health clinic'' means a facility which 
--
          (A) is primarily engaged in furnishing to outpatients 
        services described in subparagraphs (A) and (B) of 
        paragraph (1);
          (B) in the case of a facility which is not a 
        physician-directed clinic, has an arrangement 
        (consistent with the provisions of State and local law 
        relative to the practice, performance, and delivery of 
        health services) with one or more physicians (as 
        defined in subsection (r)(1)) under which provision is 
        made for the periodic review by such physicians of 
        covered services furnished by physician assistants and 
        nurse practitioners, the supervision and guidance by 
        such physicians of physician assistants and nurse 
        practitioners, the preparation by such physicians of 
        such medical orders for care and treatment of clinic 
        patients as may be necessary, and the availability of 
        such physicians for such referral of and consultation 
        for patients as is necessary and for advice and 
        assistance in the management of medical emergencies; 
        and, in the case of a physician-directed clinic, has 
        one or more of its staff physicians perform the 
        activities accomplished through such an arrangement;
          (C) maintains clinical records on all patients;
          (D) has arrangements with one or more hospitals, 
        having agreements in effect under section 1866, for the 
        referral and admission of patients requiring inpatient 
        services or such diagnostic or other specialized 
        services as are not available at the clinic;
          (E) has written policies, which are developed with 
        the advice of (and with provision for review of such 
        policies from time to time by) a group of professional 
        personnel, including one or more physicians and one or 
        more physician assistants or nurse practitioners, to 
        govern those services described in paragraph (1) which 
        it furnishes;
          (F) has a physician, physician assistant, or nurse 
        practitioner responsible for the execution of policies 
        described in subparagraph (E) and relating to the 
        provision of the clinic's services;
          (G) directly provides routine diagnostic services, 
        including clinical laboratory services, as prescribed 
        in regulations by the Secretary, and has prompt access 
        to additional diagnostic services from facilities 
        meeting requirements under this title;
          (H) in compliance with State and Federal law, has 
        available for administering to patients of the clinic 
        at least such drugs and biologicals as are determined 
        by the Secretary to be necessary for the treatment of 
        emergency cases (as defined in regulations) and has 
        appropriate procedures or arrangements for storing, 
        administering, and dispensing any drugs and 
        biologicals;
          (I) has a quality assessment and performance 
        improvement program, and appropriate procedures for 
        review of utilization of clinic services, as the 
        Secretary may specify;
          (J) has a nurse practitioner, a physician assistant, 
        or a certified nurse-midwife (as defined in subsection 
        (gg)) available to furnish patient care services not 
        less than 50 percent of the time the clinic operates; 
        and
          (K) meets such other requirements as the Secretary 
        may find necessary in the interest of the health and 
        safety of the individuals who are furnished services by 
        the clinic.
For the purposes of this title, such term includes only a 
facility which (i) is located in an area that is not an 
urbanized area (as defined by the Bureau of the Census) and in 
which there are insufficient numbers of needed health care 
practitioners (as determined by the Secretary), and that, 
within the previous 4-year period, has been designated by the 
chief executive officer of the State and certified by the 
Secretary as an area with a shortage of personal health 
services or designated by the Secretary either (I) as an area 
with a shortage of personal health services under section 
330(b)(3) or 1302(7) of the Public Health Service Act, (II) as 
a health professional shortage area described in section 
332(a)(1)(A) of that Act because of its shortage of primary 
medical care manpower, (III) as a high impact area described in 
section 329(a)(5) of that Act, of (IV) as an area which 
includes a population group which the Secretary determines has 
a health manpower shortage under section 332(a)(1)(B) of that 
Act, (ii) has filed an agreement with the Secretary by which it 
agrees not to charge any individual or other person for items 
or services for which such individual is entitled to have 
payment made under this title, except for the amount of any 
deductible or coinsurance amount imposed with respect to such 
items or services (not in excess of the amount customarily 
charged for such items and services by such clinic), pursuant 
to subsections (a) and (b) of section 1833, (iii) employs a 
physician assistant or nurse practitioner, and (iv) is not a 
rehabilitation agency or a facility which is primarily for the 
care and treatment of mental diseases. A facility that is in 
operation and qualifies as a rural health clinic under this 
title or title XIX and that subsequently fails to satisfy the 
requirement of clause (i) shall be considered, for purposes of 
this title and title XIX, as still satisfying the requirement 
of such clause if it is determined, in accordance with criteria 
established by the Secretary in regulations, to be essential to 
the delivery of primary care services that would otherwise be 
unavailable in the geographic area served by the clinic. If a 
State agency has determined under section 1864(a) that a 
facility is a rural health clinic and the facility has applied 
to the Secretary for approval as such a clinic, the Secretary 
shall notify the facility of the Secretary's approval or 
disapproval not later than 60 days after the date of the State 
agency determination or the application (whichever is later).
  (3) The term ``Federally qualified health center services'' 
means--
          (A) services of the type described in subparagraphs 
        (A) through (C) of paragraph (1) and preventive 
        services (as defined in section 1861(ddd)(3)); and
          (B) preventive primary health services that a center 
        is required to provide under section 330 of the Public 
        Health Service Act,
when furnished to an individual as an outpatient of a Federally 
qualified health center by the center or by a health care 
professional under contract with the center and, for this 
purpose, any reference to a rural health clinic or a physician 
described in paragraph (2)(B) is deemed a reference to a 
Federally qualified health center or a physician at the center, 
respectively.
  (4) The term ``Federally qualified health center'' means an 
entity which--
          (A)(i) is receiving a grant under section 330 of the 
        Public Health Service Act, or
          (ii)(I) is receiving funding from such a grant under 
        a contract with the recipient of such a grant, and (II) 
        meets the requirements to receive a grant under section 
        330 of such Act;
          (B) based on the recommendation of the Health 
        Resources and Services Administration within the Public 
        Health Service, is determined by the Secretary to meet 
        the requirements for receiving such a grant;
          (C) was treated by the Secretary, for purposes of 
        part B, as a comprehensive Federally funded health 
        center as of January 1, 1990; or
          (D) is an outpatient health program or facility 
        operated by a tribe or tribal organization under the 
        Indian Self-Determination Act or by an urban Indian 
        organization receiving funds under title V of the 
        Indian Health Care Improvement Act.
  (5)(A) The term ``physician assistant'' and the term ``nurse 
practitioner'' mean, for purposes of this title, a physician 
assistant or nurse practitioner who performs such services as 
such individual is legally authorized to perform (in the State 
in which the individual performs such services) in accordance 
with State law (or the State regulatory mechanism provided by 
State law), and who meets such training, education, and 
experience requirements (or any combination thereof) as the 
Secretary may prescribe in regulations.
  (B) The term ``clinical nurse specialist'' means, for 
purposes of this title, an individual who--
          (i) is a registered nurse and is licensed to practice 
        nursing in the State in which the clinical nurse 
        specialist services are performed; and
          (ii) holds a master's degree in a defined clinical 
        area of nursing from an accredited educational 
        institution.
  (6) The term ``collaboration'' means a process in which a 
nurse practitioner works with a physician to deliver health 
care services within the scope of the practitioner's 
professional expertise, with medical direction and appropriate 
supervision as provided for in jointly developed guidelines or 
other mechanisms as defined by the law of the State in which 
the services are performed.
  (7)(A) The Secretary shall waive for a 1-year period the 
requirements of paragraph (2) that a rural health clinic employ 
a physician assistant, nurse practitioner or certified nurse 
midwife or that such clinic require such providers to furnish 
services at least 50 percent of the time that the clinic 
operates for any facility that requests such waiver if the 
facility demonstrates that the facility has been unable, 
despite reasonable efforts, to hire a physician assistant, 
nurse practitioner, or certified nurse-midwife in the previous 
90-day period.
  (B) The Secretary may not grant such a waiver under 
subparagraph (A) to a facility if the request for the waiver is 
made less than 6 months after the date of the expiration of any 
previous such waiver for the facility, or if the facility has 
not yet been determined to meet the requirements (including 
subparagraph (J) of the first sentence of paragraph (2)) of a 
rural health clinic.
  (C) A waiver which is requested under this paragraph shall be 
deemed granted unless such request is denied by the Secretary 
within 60 days after the date such request is received.

          Services of a Certified Registered Nurse Anesthetist

  (bb)(1) The term ``services of a certified registered nurse 
anesthetist'' means anesthesia services and related care 
furnished by a certified registered nurse anesthetist (as 
defined in paragraph (2)) which the nurse anesthetist is 
legally authorized to perform as such by the State in which the 
services are furnished.
  (2) The term ``certified registered nurse anesthetist'' means 
a certified registered nurse anesthetist licensed by the State 
who meets such education, training, and other requirements 
relating to anesthesia services and related care as the 
Secretary may prescribe. In prescribing such requirements the 
Secretary may use the same requirements as those established by 
a national organization for the certification of nurse 
anesthetists. Such term also includes, as prescribed by the 
Secretary, an anesthesiologist assistant.

       Comprehensive Outpatient Rehabilitation Facility Services

  (cc)(1) The term ``comprehensive outpatient rehabilitation 
facility services'' means the following items and services 
furnished by a physician or other qualified professional 
personnel (as defined in regulations by the Secretary) to an 
individual who is an outpatient of a comprehensive outpatient 
rehabilitation facility under a plan (for furnishing such items 
and services to such individual) established and periodically 
reviewed by a physician--
          (A) physicians' services;
          (B) physical therapy, occupational therapy, speech-
        language pathology services, and respiratory therapy;
          (C) prosthetic and orthotic devices, including 
        testing, fitting, or training in the use of prosthetic 
        and orthotic devices;
          (D) social and psychological services;
          (E) nursing care provided by or under the supervision 
        of a registered professional nurse;
          (F) drugs and biologicals which cannot, as determined 
        in accordance with regulations, be self-administered;
          (G) supplies and durable medical equipment; and
          (H) such other items and services as are medically 
        necessary for the rehabilitation of the patient and are 
        ordinarily furnished by comprehensive outpatient 
        rehabilitation facilities,
excluding, however, any item or service if it would not be 
included under subsection (b) if furnished to an inpatient of a 
hospital. In the case of physical therapy, occupational 
therapy, and speech pathology services, there shall be no 
requirement that the item or service be furnished at any single 
fixed location if the item or service is furnished pursuant to 
such plan and payments are not otherwise made for the item or 
service under this title.
  (2) The term ``comprehensive outpatient rehabilitation 
facility'' means a facility which--
          (A) is primarily engaged in providing (by or under 
        the supervision of physicians) diagnostic, therapeutic, 
        and restorative services to outpatients for the 
        rehabilitation of injured, disabled, or sick persons;
          (B) provides at least the following comprehensive 
        outpatient rehabilitation services: (i) physicians' 
        services (rendered by physicians, as defined in section 
        1861(r)(1), who are available at the facility on a 
        full- or part-time basis); (ii) physical therapy; and 
        (iii) social or psychological services;
          (C) maintains clinical records on all patients;
          (D) has policies established by a group of 
        professional personnel (associated with the facility), 
        including one or more physicians defined in subsection 
        (r)(1) to govern the comprehensive outpatient 
        rehabilitation services it furnishes, and provides for 
        the carrying out of such policies by a full- or part-
        time physician referred to in subparagraph (B)(i);
          (E) has a requirement that every patient must be 
        under the care of a physician;
          (F) in the case of a facility in any State in which 
        State or applicable local law provides for the 
        licensing of facilities of this nature (i) is licensed 
        pursuant to such law, or (ii) is approved by the agency 
        of such State or locality, responsible for licensing 
        facilities of this nature, as meeting the standards 
        established for such licensing;
          (G) has in effect a utilization review plan in 
        accordance with regulations prescribed by the 
        Secretary;
          (H) has in effect an overall plan and budget that 
        meets the requirements of subsection (z);
          (I) provides the Secretary on a continuing basis with 
        a surety bond in a form specified by the Secretary and 
        in an amount that is not less than $50,000; and
          (J) meets such other conditions of participation as 
        the Secretary may find necessary in the interest of the 
        health and safety of individuals who are furnished 
        services by such facility, including conditions 
        concerning qualifications of personnel in these 
        facilities.
The Secretary may waive the requirement of a surety bond under 
subparagraph (I) in the case of a facility that provides a 
comparable surety bond under State law.

                     Hospice Care; Hospice Program

  (dd)(1) The term ``hospice care'' means the following items 
and services provided to a terminally ill individual by, or by 
others under arrangements made by, a hospice program under a 
written plan (for providing such care to such individual) 
established and periodically reviewed by the individual's 
attending physician and by the medical director (and by the 
interdisciplinary group described in paragraph (2)(B)) of the 
program--
          (A) nursing care provided by or under the supervision 
        of a registered professional nurse,
          (B) physical or occupational therapy, or speech-
        language pathology services,
          (C) medical social services under the direction of a 
        physician,
          (D)(i) services of a home health aide who has 
        successfully completed a training program approved by 
        the Secretary and (ii) homemaker services,
          (E) medical supplies (including drugs and 
        biologicals) and the use of medical appliances, while 
        under such a plan,
          (F) physicians' services,
          (G) short-term inpatient care (including both respite 
        care and procedures necessary for pain control and 
        acute and chronic symptom management) in an inpatient 
        facility meeting such conditions as the Secretary 
        determines to be appropriate to provide such care, but 
        such respite care may be provided only on an 
        intermittent, nonroutine, and occasional basis and may 
        not be provided consecutively over longer than five 
        days,
          (H) counseling (including dietary counseling) with 
        respect to care of the terminally ill individual and 
        adjustment to his death, and
          (I) any other item or service which is specified in 
        the plan and for which payment may otherwise be made 
        under this title.
The care and services described in subparagraphs (A) and (D) 
may be provided on a 24-hour, continuous basis only during 
periods of crisis (meeting criteria established by the 
Secretary) and only as necessary to maintain the terminally ill 
individual at home.
  (2) The term ``hospice program'' means a public agency or 
private organization (or a subdivision thereof) which--
          (A)(i) is primarily engaged in providing the care and 
        services described in paragraph (1) and makes such 
        services available (as needed) on a 24-hour basis and 
        which also provides bereavement counseling for the 
        immediate family of terminally ill individuals and 
        services described in section 1812(a)(5),
          (ii) provides for such care and services in 
        individuals' homes, on an outpatient basis, and on a 
        short-term inpatient basis, directly or under 
        arrangements made by the agency or organization, except 
        that--
                  (I) the agency or organization must routinely 
                provide directly substantially all of each of 
                the services described in subparagraphs (A), 
                (C), and (H) of paragraph (1), except as 
                otherwise provided in paragraph (5), and
                  (II) in the case of other services described 
                in paragraph (1) which are not provided 
                directly by the agency or organization, the 
                agency or organization must maintain 
                professional management responsibility for all 
                such services furnished to an individual, 
                regardless of the location or facility in which 
                such services are furnished; and
          (iii) provides assurances satisfactory to the 
        Secretary that the aggregate number of days of 
        inpatient care described in paragraph (1)(G) provided 
        in any 12-month period to individuals who have an 
        election in effect under section 1812(d) with respect 
        to that agency or organization does not exceed 20 
        percent of the aggregate number of days during that 
        period on which such elections for such individuals are 
        in effect;
          (B) has an interdisciplinary group of personnel 
        which--
                  (i) includes at least--
                          (I) one physician (as defined in 
                        subsection (r)(1)),
                          (II) one registered professional 
                        nurse, and
                          (III) one social worker,
        employed by or, in the case of a physician described in 
        subclause (I), under contract with the agency or 
        organization, and also includes at least one pastoral 
        or other counselor,
                  (ii) provides (or supervises the provision 
                of) the care and services described in 
                paragraph (1), and
                  (iii) establishes the policies governing the 
                provision of such care and services;
          (C) maintains central clinical records on all 
        patients;
          (D) does not discontinue the hospice care it provides 
        with respect to a patient because of the inability of 
        the patient to pay for such care;
          (E)(i) utilizes volunteers in its provision of care 
        and services in accordance with standards set by the 
        Secretary, which standards shall ensure a continuing 
        level of effort to utilize such volunteers, and (ii) 
        maintains records on the use of these volunteers and 
        the cost savings and expansion of care and services 
        achieved through the use of these volunteers;
          (F) in the case of an agency or organization in any 
        State in which State or applicable local law provides 
        for the licensing of agencies or organizations of this 
        nature, is licensed pursuant to such law; and
          (G) meets such other requirements as the Secretary 
        may find necessary in the interest of the health and 
        safety of the individuals who are provided care and 
        services by such agency or organization.
  (3)(A) An individual is considered to be ``terminally ill'' 
if the individual has a medical prognosis that the individual's 
life expectancy is 6 months or less.
  (B) The term ``attending physician'' means, with respect to 
an individual, the physician (as defined in subsection (r)(1)), 
the nurse practitioner (as defined in subsection (aa)(5)), or 
the physician assistant (as defined in such subsection), who 
may be employed by a hospice program, whom the individual 
identifies as having the most significant role in the 
determination and delivery of medical care to the individual at 
the time the individual makes an election to receive hospice 
care.
  (4)(A) An entity which is certified as a provider of services 
other than a hospice program shall be considered, for purposes 
of certification as a hospice program, to have met any 
requirements under paragraph (2) which are also the same 
requirements for certification as such other type of provider. 
The Secretary shall coordinate surveys for determining 
certification under this title so as to provide, to the extent 
feasible, for simultaneous surveys of an entity which seeks to 
be certified as a hospice program and as a provider of services 
of another type.
  (B) Any entity which is certified as a hospice program and as 
a provider of another type shall have separate provider 
agreements under section 1866 and shall file separate cost 
reports with respect to costs incurred in providing hospice 
care and in providing other services and items under this 
title.
  (5)(A) The Secretary may waive the requirements of paragraph 
(2)(A)(ii)(I) for an agency or organization with respect to all 
or part of the nursing care described in paragraph (1)(A) if 
such agency or organization--
          (i) is located in an area which is not an urbanized 
        area (as defined by the Bureau of the Census);
          (ii) was in operation on or before January 1, 1983; 
        and
          (iii) has demonstrated a good faith effort (as 
        determined by the Secretary) to hire a sufficient 
        number of nurses to provide such nursing care directly.
  (B) Any waiver, which is in such form and containing such 
information as the Secretary may require and which is requested 
by an agency or organization under subparagraph (A) or (C), 
shall be deemed to be granted unless such request is denied by 
the Secretary within 60 days after the date such request is 
received by the Secretary. The granting of a waiver under 
subparagraph (A) or (C) shall not preclude the granting of any 
subsequent waiver request should such a waiver again become 
necessary.
  (C) The Secretary may waive the requirements of paragraph 
(2)(A)(i) and (2)(A)(ii) for an agency or organization with 
respect to the services described in paragraph (1)(B) and, with 
respect to dietary counseling, paragraph (1)(H), if such agency 
or organization--
          (i) is located in an area which is not an urbanized 
        area (as defined by the Bureau of Census), and
          (ii) demonstrates to the satisfaction of the 
        Secretary that the agency or organization has been 
        unable, despite diligent efforts, to recruit 
        appropriate personnel.
  (D) In extraordinary, exigent, or other non-routine 
circumstances, such as unanticipated periods of high patient 
loads, staffing shortages due to illness or other events, or 
temporary travel of a patient outside a hospice program's 
service area, a hospice program may enter into arrangements 
with another hospice program for the provision by that other 
program of services described in paragraph (2)(A)(ii)(I). The 
provisions of paragraph (2)(A)(ii)(II) shall apply with respect 
to the services provided under such arrangements.
  (E) A hospice program may provide services described in 
paragraph (1)(A) other than directly by the program if the 
services are highly specialized services of a registered 
professional nurse and are provided non-routinely and so 
infrequently so that the provision of such services directly 
would be impracticable and prohibitively expensive.

                       Discharge Planning Process

  (ee)(1) A discharge planning process of a hospital shall be 
considered sufficient if it is applicable to services furnished 
by the hospital to individuals entitled to benefits under this 
title and if it meets the guidelines and standards established 
by the Secretary under paragraph (2).
  (2) The Secretary shall develop guidelines and standards for 
the discharge planning process in order to ensure a timely and 
smooth transition to the most appropriate type of and setting 
for post-hospital or rehabilitative care. The guidelines and 
standards shall include the following:
          (A) The hospital must identify, at an early stage of 
        hospitalization, those patients who are likely to 
        suffer adverse health consequences upon discharge in 
        the absence of adequate discharge planning.
          (B) Hospitals must provide a discharge planning 
        evaluation for patients identified under subparagraph 
        (A) and for other patients upon the request of the 
        patient, patient's representative, or patient's 
        physician.
          (C) Any discharge planning evaluation must be made on 
        a timely basis to ensure that appropriate arrangements 
        for post-hospital care will be made before discharge 
        and to avoid unnecessary delays in discharge.
          (D) A discharge planning evaluation must include an 
        evaluation of a patient's likely need for appropriate 
        post-hospital services, including hospice care and 
        post-hospital extended care services, and the 
        availability of those services, including the 
        availability of home health services through 
        individuals and entities that participate in the 
        program under this title and that serve the area in 
        which the patient resides and that request to be listed 
        by the hospital as available and, in the case of 
        individuals who are likely to need post-hospital 
        extended care services, the availability of such 
        services through facilities that participate in the 
        program under this title and that serve the area in 
        which the patient resides.
          (E) The discharge planning evaluation must be 
        included in the patient's medical record for use in 
        establishing an appropriate discharge plan and the 
        results of the evaluation must be discussed with the 
        patient (or the patient's representative).
          (F) Upon the request of a patient's physician, the 
        hospital must arrange for the development and initial 
        implementation of a discharge plan for the patient.
          (G) Any discharge planning evaluation or discharge 
        plan required under this paragraph must be developed 
        by, or under the supervision of, a registered 
        professional nurse, social worker, or other 
        appropriately qualified personnel.
          (H) Consistent with section 1802, the discharge plan 
        shall--
                  (i) not specify or otherwise limit the 
                qualified provider which may provide post-
                hospital home health services, and
                  (ii) identify (in a form and manner specified 
                by the Secretary) any entity to whom the 
                individual is referred in which the hospital 
                has a disclosable financial interest (as 
                specified by the Secretary consistent with 
                section 1866(a)(1)(S)) or which has such an 
                interest in the hospital.
  (3) With respect to a discharge plan for an individual who is 
enrolled with a Medicare+Choice organization under a 
Medicare+Choice plan and is furnished inpatient hospital 
services by a hospital under a contract with the organization--
          (A) the discharge planning evaluation under paragraph 
        (2)(D) is not required to include information on the 
        availability of home health services through 
        individuals and entities which do not have a contract 
        with the organization; and
          (B) notwithstanding subparagraph (H)(i), the plan may 
        specify or limit the provider (or providers) of post-
        hospital home health services or other post-hospital 
        services under the plan.

                    Partial Hospitalization Services

  (ff)(1) The term ``partial hospitalization services'' means 
the items and services described in paragraph (2) prescribed by 
a physician and provided under a program described in paragraph 
(3) under the supervision of a physician pursuant to an 
individualized, written plan of treatment established and 
periodically reviewed by a physician (in consultation with 
appropriate staff participating in such program), which plan 
sets forth the physician's diagnosis, the type, amount, 
frequency, and duration of the items and services provided 
under the plan, and the goals for treatment under the plan.
  (2) The items and services described in this paragraph are--
          (A) individual and group therapy with physicians or 
        psychologists (or other mental health professionals to 
        the extent authorized under State law),
          (B) occupational therapy requiring the skills of a 
        qualified occupational therapist,
          (C) services of social workers, trained psychiatric 
        nurses, and other staff trained to work with 
        psychiatric patients,
          (D) drugs and biologicals furnished for therapeutic 
        purposes (which cannot, as determined in accordance 
        with regulations, be self-administered),
          (E) individualized activity therapies that are not 
        primarily recreational or diversionary,
          (F) family counseling (the primary purpose of which 
        is treatment of the individual's condition),
          (G) patient training and education (to the extent 
        that training and educational activities are closely 
        and clearly related to individual's care and 
        treatment),
          (H) diagnostic services, and
          (I) such other items and services as the Secretary 
        may provide (but in no event to include meals and 
        transportation);
that are reasonable and necessary for the diagnosis or active 
treatment of the individual's condition, reasonably expected to 
improve or maintain the individual's condition and functional 
level and to prevent relapse or hospitalization, and furnished 
pursuant to such guidelines relating to frequency and duration 
of services as the Secretary shall by regulation establish 
(taking into account accepted norms of medical practice and the 
reasonable expectation of patient improvement).
  (3)(A) A program described in this paragraph is a program 
which is furnished by a hospital to its outpatients or by a 
community mental health center (as defined in subparagraph 
(B)), and which is a distinct and organized intensive 
ambulatory treatment service offering less than 24-hour-daily 
care other than in an individual's home or in an inpatient or 
residential setting.
  (B) For purposes of subparagraph (A), the term ``community 
mental health center'' means an entity that--
          (i)(I) provides the mental health services described 
        in section 1913(c)(1) of the Public Health Service Act; 
        or
          (II) in the case of an entity operating in a State 
        that by law precludes the entity from providing itself 
        the service described in subparagraph (E) of such 
        section, provides for such service by contract with an 
        approved organization or entity (as determined by the 
        Secretary);
          (ii) meets applicable licensing or certification 
        requirements for community mental health centers in the 
        State in which it is located;
          (iii) provides at least 40 percent of its services to 
        individuals who are not eligible for benefits under 
        this title; and
          (iv) meets such additional conditions as the 
        Secretary shall specify to ensure (I) the health and 
        safety of individuals being furnished such services, 
        (II) the effective and efficient furnishing of such 
        services, and (III) the compliance of such entity with 
        the criteria described in section 1931(c)(1) of the 
        Public Health Service Act.

                    Certified Nurse-Midwife Services

  (gg)(1) The term ``certified nurse-midwife services'' means 
such services furnished by a certified nurse-midwife (as 
defined in paragraph (2)) and such services and supplies 
furnished as an incident to the nurse-midwife's service which 
the certified nurse-midwife is legally authorized to perform 
under State law (or the State regulatory mechanism provided by 
State law) as would otherwise be covered if furnished by a 
physician or as an incident to a physicians' service.
  (2) The term ``certified nurse-midwife'' means a registered 
nurse who has successfully completed a program of study and 
clinical experience meeting guidelines prescribed by the 
Secretary, or has been certified by an organization recognized 
by the Secretary.

        Clinical Social Worker; Clinical Social Worker Services

  (hh)(1) The term ``clinical social worker'' means an 
individual who--
          (A) possesses a master's or doctor's degree in social 
        work;
          (B) after obtaining such degree has performed at 
        least 2 years of supervised clinical social work; and
          (C)(i) is licensed or certified as a clinical social 
        worker by the State in which the services are 
        performed, or
          (ii) in the case of an individual in a State which 
        does not provide for licensure or certification--
                  (I) has completed at least 2 years or 3,000 
                hours of post-master's degree supervised 
                clinical social work practice under the 
                supervision of a master's level social worker 
                in an appropriate setting (as determined by the 
                Secretary), and
                  (II) meets such other criteria as the 
                Secretary establishes.
  (2) The term ``clinical social worker services'' means 
services performed by a clinical social worker (as defined in 
paragraph (1)) for the diagnosis and treatment of mental 
illnesses (other than services furnished to an inpatient of a 
hospital and other than services furnished to an inpatient of a 
skilled nursing facility which the facility is required to 
provide as a requirement for participation) which the clinical 
social worker is legally authorized to perform under State law 
(or the State regulatory mechanism provided by State law) of 
the State in which such services are performed as would 
otherwise be covered if furnished by a physician or as an 
incident to a physician's professional service.

                    Qualified Psychologist Services

  (ii) The term ``qualified psychologist services'' means such 
services and such services and supplies furnished as an 
incident to his service furnished by a clinical psychologist 
(as defined by the Secretary) which the psychologist is legally 
authorized to perform under State law (or the State regulatory 
mechanism provided by State law) as would otherwise be covered 
if furnished by a physician or as an incident to a physician's 
service.

                         Screening Mammography

  (jj) The term ``screening mammography'' means a radiologic 
procedure provided to a woman for the purpose of early 
detection of breast cancer and includes a physician's 
interpretation of the results of the procedure.

                       Covered Osteoporosis Drug

  (kk) The term ``covered osteoporosis drug'' means an 
injectable drug approved for the treatment of post-menopausal 
osteoporosis provided to an individual by a home health agency 
if, in accordance with regulations promulgated by the 
Secretary--
          (1) the individual's attending physician, nurse 
        practitioner or clinical nurse specialist (as those 
        terms are defined in subsection (aa)(5)), certified 
        nurse-midwife (as defined in subsection (gg)), or 
        physician assistant (as defined in subsection (aa)(5)) 
        certifies that the individual has suffered a bone 
        fracture related to post-menopausal osteoporosis and 
        that the individual is unable to learn the skills 
        needed to self-administer such drug or is otherwise 
        physically or mentally incapable of self-administering 
        such drug; and
          (2) the individual is confined to the individual's 
        home (except when receiving items and services referred 
        to in subsection (m)(7)).

         Speech-Language Pathology Services; Audiology Services

  (ll)(1) The term ``speech-language pathology services'' means 
such speech, language, and related function assessment and 
rehabilitation services furnished by a qualified speech-
language pathologist as the speech-language pathologist is 
legally authorized to perform under State law (or the State 
regulatory mechanism provided by State law) as would otherwise 
be covered if furnished by a physician.
  (2) The term ``outpatient speech-language pathology 
services'' has the meaning given the term ``outpatient physical 
therapy services'' in subsection (p), except that in applying 
such subsection--
          (A) ``speech-language pathology'' shall be 
        substituted for ``physical therapy'' each place it 
        appears; and
          (B) ``speech-language pathologist'' shall be 
        substituted for ``physical therapist'' each place it 
        appears.
  (3) The term ``audiology services'' means such hearing and 
balance assessment services furnished by a qualified 
audiologist as the audiologist is legally authorized to perform 
under State law (or the State regulatory mechanism provided by 
State law), as would otherwise be covered if furnished by a 
physician.
  (4) In this subsection:
          (A) The term ``qualified speech-language 
        pathologist'' means an individual with a master's or 
        doctoral degree in speech-language pathology who--
                  (i) is licensed as a speech-language 
                pathologist by the State in which the 
                individual furnishes such services, or
                  (ii) in the case of an individual who 
                furnishes services in a State which does not 
                license speech-language pathologists, has 
                successfully completed 350 clock hours of 
                supervised clinical practicum (or is in the 
                process of accumulating such supervised 
                clinical experience), performed not less than 9 
                months of supervised full-time speech-language 
                pathology services after obtaining a master's 
                or doctoral degree in speech-language pathology 
                or a related field, and successfully completed 
                a national examination in speech-language 
                pathology approved by the Secretary.
          (B) The term ``qualified audiologist'' means an 
        individual with a master's or doctoral degree in 
        audiology who--
                  (i) is licensed as an audiologist by the 
                State in which the individual furnishes such 
                services, or
                  (ii) in the case of an individual who 
                furnishes services in a State which does not 
                license audiologists, has successfully 
                completed 350 clock hours of supervised 
                clinical practicum (or is in the process of 
                accumulating such supervised clinical 
                experience), performed not less than 9 months 
                of supervised full-time audiology services 
                after obtaining a master's or doctoral degree 
                in audiology or a related field, and 
                successfully completed a national examination 
                in audiology approved by the Secretary.

      Critical Access Hospital; Critical Access Hospital Services

  (mm)(1) The term ``critical access hospital'' means a 
facility certified by the Secretary as a critical access 
hospital under section 1820(e).
  (2) The term ``inpatient critical access hospital services'' 
means items and services, furnished to an inpatient of a 
critical access hospital by such facility, that would be 
inpatient hospital services if furnished to an inpatient of a 
hospital by a hospital.
  (3) The term ``outpatient critical access hospital services'' 
means medical and other health services furnished by a critical 
access hospital on an outpatient basis.

               Screening Pap Smear; Screening Pelvic Exam

  (nn)(1) The term ``screening pap smear'' means a diagnostic 
laboratory test consisting of a routine exfoliative cytology 
test (Papanicolaou test) provided to a woman for the purpose of 
early detection of cervical or vaginal cancer and includes a 
physician's interpretation of the results of the test, if the 
individual involved has not had such a test during the 
preceding 2 years, or during the preceding year in the case of 
a woman described in paragraph (3).
  (2) The term ``screening pelvic exam'' means a pelvic 
examination provided to a woman if the woman involved has not 
had such an examination during the preceding 2 years, or during 
the preceding year in the case of a woman described in 
paragraph (3), and includes a clinical breast examination.
  (3) A woman described in this paragraph is a woman who--
          (A) is of childbearing age and has had a test 
        described in this subsection during any of the 
        preceding 3 years that indicated the presence of 
        cervical or vaginal cancer or other abnormality; or
          (B) is at high risk of developing cervical or vaginal 
        cancer (as determined pursuant to factors identified by 
        the Secretary).

                    Prostate Cancer Screening Tests

  (oo)(1) The term ``prostate cancer screening test'' means a 
test that consists of any (or all) of the procedures described 
in paragraph (2) provided for the purpose of early detection of 
prostate cancer to a man over 50 years of age who has not had 
such a test during the preceding year.
  (2) The procedures described in this paragraph are as 
follows:
          (A) A digital rectal examination.
          (B) A prostate-specific antigen blood test.
          (C) For years beginning after 2002, such other 
        procedures as the Secretary finds appropriate for the 
        purpose of early detection of prostate cancer, taking 
        into account changes in technology and standards of 
        medical practice, availability, effectiveness, costs, 
        and such other factors as the Secretary considers 
        appropriate.

                   Colorectal Cancer Screening Tests

  (pp)(1) The term ``colorectal cancer screening test'' means 
any of the following procedures furnished to an individual for 
the purpose of early detection of colorectal cancer:
          (A) Screening fecal-occult blood test.
          (B) Screening flexible sigmoidoscopy.
          (C) Screening colonoscopy.
          (D) Such other tests or procedures, and modifications 
        to tests and procedures under this subsection, with 
        such frequency and payment limits, as the Secretary 
        determines appropriate, in consultation with 
        appropriate organizations.
  (2) An ``individual at high risk for colorectal cancer'' is 
an individual who, because of family history, prior experience 
of cancer or precursor neoplastic polyps, a history of chronic 
digestive disease condition (including inflammatory bowel 
disease, Crohn's Disease, or ulcerative colitis), the presence 
of any appropriate recognized gene markers for colorectal 
cancer, or other predisposing factors, faces a high risk for 
colorectal cancer.

         Diabetes Outpatient Self-Management Training Services

  (qq)(1) The term ``diabetes outpatient self-management 
training services'' means educational and training services 
furnished (at such times as the Secretary determines 
appropriate) to an individual with diabetes by a certified 
provider (as described in paragraph (2)(A)) in an outpatient 
setting by an individual or entity who meets the quality 
standards described in paragraph (2)(B), but only if the 
physician who is managing the individual's diabetic condition 
certifies that such services are needed under a comprehensive 
plan of care related to the individual's diabetic condition to 
ensure therapy compliance or to provide the individual with 
necessary skills and knowledge (including skills related to the 
self-administration of injectable drugs) to participate in the 
management of the individual's condition.
  (2) In paragraph (1)--
          (A) a ``certified provider'' is a physician, or other 
        individual or entity designated by the Secretary, that, 
        in addition to providing diabetes outpatient self-
        management training services, provides other items or 
        services for which payment may be made under this 
        title; and
          (B) a physician, or such other individual or entity, 
        meets the quality standards described in this paragraph 
        if the physician, or individual or entity, meets 
        quality standards established by the Secretary, except 
        that the physician or other individual or entity shall 
        be deemed to have met such standards if the physician 
        or other individual or entity meets applicable 
        standards originally established by the National 
        Diabetes Advisory Board and subsequently revised by 
        organizations who participated in the establishment of 
        standards by such Board, or is recognized by an 
        organization that represents individuals (including 
        individuals under this title) with diabetes as meeting 
        standards for furnishing the services.

                         Bone Mass Measurement

  (rr)(1) The term ``bone mass measurement'' means a radiologic 
or radioisotopic procedure or other procedure approved by the 
Food and Drug Administration performed on a qualified 
individual (as defined in paragraph (2)) for the purpose of 
identifying bone mass or detecting bone loss or determining 
bone quality, and includes a physician's interpretation of the 
results of the procedure.
  (2) For purposes of this subsection, the term ``qualified 
individual'' means an individual who is (in accordance with 
regulations prescribed by the Secretary)--
          (A) an estrogen-deficient woman at clinical risk for 
        osteoporosis;
          (B) an individual with vertebral abnormalities;
          (C) an individual receiving long-term glucocorticoid 
        steroid therapy;
          (D) an individual with primary hyperparathyroidism; 
        or
          (E) an individual being monitored to assess the 
        response to or efficacy of an approved osteoporosis 
        drug therapy.
  (3) The Secretary shall establish such standards regarding 
the frequency with which a qualified individual shall be 
eligible to be provided benefits for bone mass measurement 
under this title.

              Religious Nonmedical Health Care Institution

  (ss)(1) The term ``religious nonmedical health care 
institution'' means an institution that--
                  (A) is described in subsection (c)(3) of 
                section 501 of the Internal Revenue Code of 
                1986 and is exempt from taxes under subsection 
                (a) of such section;
                  (B) is lawfully operated under all applicable 
                Federal, State, and local laws and regulations;
                  (C) provides only nonmedical nursing items 
                and services exclusively to patients who choose 
                to rely solely upon a religious method of 
                healing and for whom the acceptance of medical 
                health services would be inconsistent with 
                their religious beliefs;
                  (D) provides such nonmedical items and 
                services exclusively through nonmedical nursing 
                personnel who are experienced in caring for the 
                physical needs of such patients;
                  (E) provides such nonmedical items and 
                services to inpatients on a 24-hour basis;
                  (F) on the basis of its religious beliefs, 
                does not provide through its personnel or 
                otherwise medical items and services (including 
                any medical screening, examination, diagnosis, 
                prognosis, treatment, or the administration of 
                drugs) for its patients;
                  (G)(i) is not owned by, under common 
                ownership with, or has an ownership interest 
                in, a provider of medical treatment or 
                services;
                  (ii) is not affiliated with--
                          (I) a provider of medical treatment 
                        or services, or
                          (II) an individual who has an 
                        ownership interest in a provider of 
                        medical treatment or services;
                  (H) has in effect a utilization review plan 
                which--
                          (i) provides for the review of 
                        admissions to the institution, of the 
                        duration of stays therein, of cases of 
                        continuous extended duration, and of 
                        the items and services furnished by the 
                        institution,
                          (ii) requires that such reviews be 
                        made by an appropriate committee of the 
                        institution that includes the 
                        individuals responsible for overall 
                        administration and for supervision of 
                        nursing personnel at the institution,
                          (iii) provides that records be 
                        maintained of the meetings, decisions, 
                        and actions of such committee, and
                          (iv) meets such other requirements as 
                        the Secretary finds necessary to 
                        establish an effective utilization 
                        review plan;
                  (I) provides the Secretary with such 
                information as the Secretary may require to 
                implement section 1821, including information 
                relating to quality of care and coverage 
                determinations; and
                  (J) meets such other requirements as the 
                Secretary finds necessary in the interest of 
                the health and safety of individuals who are 
                furnished services in the institution.
  (2) To the extent that the Secretary finds that the 
accreditation of an institution by a State, regional, or 
national agency or association provides reasonable assurances 
that any or all of the requirements of paragraph (1) are met or 
exceeded, the Secretary may treat such institution as meeting 
the condition or conditions with respect to which the Secretary 
made such finding.
  (3)(A)(i) In administering this subsection and section 1821, 
the Secretary shall not require any patient of a religious 
nonmedical health care institution to undergo medical 
screening, examination, diagnosis, prognosis, or treatment or 
to accept any other medical health care service, if such 
patient (or legal representative of the patient) objects 
thereto on religious grounds.
  (ii) Clause (i) shall not be construed as preventing the 
Secretary from requiring under section 1821(a)(2) the provision 
of sufficient information regarding an individual's condition 
as a condition for receipt of benefits under part A for 
services provided in such an institution.
  (B)(i) In administering this subsection and section 1821, the 
Secretary shall not subject a religious nonmedical health care 
institution or its personnel to any medical supervision, 
regulation, or control, insofar as such supervision, 
regulation, or control would be contrary to the religious 
beliefs observed by the institution or such personnel.
  (ii) Clause (i) shall not be construed as preventing the 
Secretary from reviewing items and services billed by the 
institution to the extent the Secretary determines such review 
to be necessary to determine whether such items and services 
were not covered under part A, are excessive, or are 
fraudulent.
  (4)(A) For purposes of paragraph (1)(G)(i), an ownership 
interest of less than 5 percent shall not be taken into 
account.
  (B) For purposes of paragraph (1)(G)(ii), none of the 
following shall be considered to create an affiliation:
          (i) An individual serving as an uncompensated 
        director, trustee, officer, or other member of the 
        governing body of a religious nonmedical health care 
        institution.
          (ii) An individual who is a director, trustee, 
        officer, employee, or staff member of a religious 
        nonmedical health care institution having a family 
        relationship with an individual who is affiliated with 
        (or has an ownership interest in) a provider of medical 
        treatment or services.
          (iii) An individual or entity furnishing goods or 
        services as a vendor to both providers of medical 
        treatment or services and religious nonmedical health 
        care institutions.

 Post-Institutional Home Health Services; Home Health Spell of Illness

  (tt)(1) The term ``post-institutional home health services'' 
means home health services furnished to an individual--
          (A) after discharge from a hospital or critical 
        access hospital in which the individual was an 
        inpatient for not less than 3 consecutive days before 
        such discharge if such home health services were 
        initiated within 14 days after the date of such 
        discharge; or
          (B) after discharge from a skilled nursing facility 
        in which the individual was provided post-hospital 
        extended care services if such home health services 
        were initiated within 14 days after the date of such 
        discharge.
  (2) The term ``home health spell of illness'' with respect to 
any individual means a period of consecutive days--
          (A) beginning with the first day (not included in a 
        previous home health spell of illness) (i) on which 
        such individual is furnished post-institutional home 
        health services, and (ii) which occurs in a month for 
        which the individual is entitled to benefits under part 
        A, and
          (B) ending with the close of the first period of 60 
        consecutive days thereafter on each of which the 
        individual is neither an inpatient of a hospital or 
        critical access hospital nor an inpatient of a facility 
        described in section 1819(a)(1) or subsection (y)(1) 
        nor provided home health services.

                         Screening for Glaucoma

  (uu) The term ``screening for glaucoma'' means a dilated eye 
examination with an intraocular pressure measurement, and a 
direct ophthalmoscopy or a slit-lamp biomicroscopic examination 
for the early detection of glaucoma which is furnished by or 
under the direct supervision of an optometrist or 
ophthalmologist who is legally authorized to furnish such 
services under State law (or the State regulatory mechanism 
provided by State law) of the State in which the services are 
furnished, as would otherwise be covered if furnished by a 
physician or as an incident to a physician's professional 
service, if the individual involved has not had such an 
examination in the preceding year.

 Medical Nutrition Therapy Services; Registered Dietitian or Nutrition 
                              Professional

  (vv)(1) The term ``medical nutrition therapy services'' means 
nutritional diagnostic, therapy, and counseling services for 
the purpose of disease management which are furnished by a 
registered dietitian or nutrition professional (as defined in 
paragraph (2)) pursuant to a referral by a physician (as 
defined in subsection (r)(1)).
  (2) Subject to paragraph (3), the term ``registered dietitian 
or nutrition professional'' means an individual who--
          (A) holds a baccalaureate or higher degree granted by 
        a regionally accredited college or university in the 
        United States (or an equivalent foreign degree) with 
        completion of the academic requirements of a program in 
        nutrition or dietetics, as accredited by an appropriate 
        national accreditation organization recognized by the 
        Secretary for this purpose;
          (B) has completed at least 900 hours of supervised 
        dietetics practice under the supervision of a 
        registered dietitian or nutrition professional; and
          (C)(i) is licensed or certified as a dietitian or 
        nutrition professional by the State in which the 
        services are performed; or
          (ii) in the case of an individual in a State that 
        does not provide for such licensure or certification, 
        meets such other criteria as the Secretary establishes.
  (3) Subparagraphs (A) and (B) of paragraph (2) shall not 
apply in the case of an individual who, as of the date of the 
enactment of this subsection, is licensed or certified as a 
dietitian or nutrition professional by the State in which 
medical nutrition therapy services are performed.

                Initial Preventive Physical Examination

  (ww)(1) The term ``initial preventive physical examination'' 
means physicians' services consisting of a physical examination 
(including measurement of height, weight body mass index,, and 
blood pressure) with the goal of health promotion and disease 
detection and includes education, counseling, and referral with 
respect to screening and other preventive services described in 
paragraph (2), end-of-life planning (as defined in paragraph 
(3)) upon the agreement with the individual, and the furnishing 
of a review of any current opioid prescriptions (as defined in 
paragraph (4)), but does not include clinical laboratory tests.
  (2) The screening and other preventive services described in 
this paragraph include the following:
          (A) Pneumococcal, influenza, and hepatitis B vaccine 
        and administration under subsection (s)(10).
          (B) Screening mammography as defined in subsection 
        (jj).
          (C) Screening pap smear and screening pelvic exam as 
        defined in subsection (nn).
          (D) Prostate cancer screening tests as defined in 
        subsection (oo).
          (E) Colorectal cancer screening tests as defined in 
        subsection (pp).
          (F) Diabetes outpatient self-management training 
        services as defined in subsection (qq)(1).
          (G) Bone mass measurement as defined in subsection 
        (rr).
          (H) Screening for glaucoma as defined in subsection 
        (uu).
          (I) Medical nutrition therapy services as defined in 
        subsection (vv).
          (J) Cardiovascular screening blood tests as defined 
        in subsection (xx)(1).
          (K) Diabetes screening tests as defined in subsection 
        (yy).
          (L) Ultrasound screening for abdominal aortic 
        aneurysm as defined in section 1861(bbb).
          (M) An electrocardiogram.
          (N) Screening for potential substance use disorders.
          (O) Additional preventive services (as defined in 
        subsection (ddd)(1)).
  (3) For purposes of paragraph (1), the term ``end-of-life 
planning'' means verbal or written information regarding--
          (A) an individual's ability to prepare an advance 
        directive in the case that an injury or illness causes 
        the individual to be unable to make health care 
        decisions; and
          (B) whether or not the physician is willing to follow 
        the individual's wishes as expressed in an advance 
        directive.
  (4) For purposes of paragraph (1), the term ``a review of any 
current opioid prescriptions'' means, with respect to an 
individual determined to have a current prescription for 
opioids--
          (A) a review of the potential risk factors to the 
        individual for opioid use disorder;
          (B) an evaluation of the individual's severity of 
        pain and current treatment plan;
          (C) the provision of information on non-opioid 
        treatment options; and
          (D) a referral to a specialist, as appropriate.

                  Cardiovascular Screening Blood Test

  (xx)(1) The term ``cardiovascular screening blood test'' 
means a blood test for the early detection of cardiovascular 
disease (or abnormalities associated with an elevated risk of 
cardiovascular disease) that tests for the following:
          (A) Cholesterol levels and other lipid or 
        triglyceride levels.
          (B) Such other indications associated with the 
        presence of, or an elevated risk for, cardiovascular 
        disease as the Secretary may approve for all 
        individuals (or for some individuals determined by the 
        Secretary to be at risk for cardiovascular disease), 
        including indications measured by noninvasive testing.
The Secretary may not approve an indication under subparagraph 
(B) for any individual unless a blood test for such is 
recommended by the United States Preventive Services Task 
Force.
  (2) The Secretary shall establish standards, in consultation 
with appropriate organizations, regarding the frequency for 
each type of cardiovascular screening blood tests, except that 
such frequency may not be more often than once every 2 years.

                        Diabetes Screening Tests

  (yy)(1) The term ``diabetes screening tests'' means testing 
furnished to an individual at risk for diabetes (as defined in 
paragraph (2)) for the purpose of early detection of diabetes, 
including--
          (A) a fasting plasma glucose test; and
          (B) such other tests, and modifications to tests, as 
        the Secretary determines appropriate, in consultation 
        with appropriate organizations.
  (2) For purposes of paragraph (1), the term ``individual at 
risk for diabetes'' means an individual who has any of the 
following risk factors for diabetes:
          (A) Hypertension.
          (B) Dyslipidemia.
          (C) Obesity, defined as a body mass index greater 
        than or equal to 30 kg/m2.
          (D) Previous identification of an elevated impaired 
        fasting glucose.
          (E) Previous identification of impaired glucose 
        tolerance.
          (F) A risk factor consisting of at least 2 of the 
        following characteristics:
                  (i) Overweight, defined as a body mass index 
                greater than 25, but less than 30, kg/
                m2.
                  (ii) A family history of diabetes.
                  (iii) A history of gestational diabetes 
                mellitus or delivery of a baby weighing greater 
                than 9 pounds.
                  (iv) 65 years of age or older.
  (3) The Secretary shall establish standards, in consultation 
with appropriate organizations, regarding the frequency of 
diabetes screening tests, except that such frequency may not be 
more often than twice within the 12-month period following the 
date of the most recent diabetes screening test of that 
individual.

                      Intravenous Immune Globulin

  (zz) The term ``intravenous immune globulin'' means an 
approved pooled plasma derivative for the treatment in the 
patient's home of a patient with a diagnosed primary immune 
deficiency disease, but not including items or services related 
to the administration of the derivative, if a physician 
determines administration of the derivative in the patient's 
home is medically appropriate.

     Extended Care in Religious Nonmedical Health Care Institutions

  (aaa)(1) The term ``home health agency'' also includes a 
religious nonmedical health care institution (as defined in 
subsection (ss)(1)), but only with respect to items and 
services ordinarily furnished by such an institution to 
individuals in their homes, and that are comparable to items 
and services furnished to individuals by a home health agency 
that is not religious nonmedical health care institution.
  (2)(A) Subject to subparagraphs (B), payment may be made with 
respect to services provided by such an institution only to 
such extent and under such conditions, limitations, and 
requirements (in addition to or in lieu of the conditions, 
limitations, and requirements otherwise applicable) as may be 
provided in regulations consistent with section 1821.
  (B) Notwithstanding any other provision of this title, 
payment may not be made under subparagraph (A)--
          (i) in a year insofar as such payments exceed 
        $700,000; and
          (ii) after December 31, 2006.

           Ultrasound Screening for Abdominal Aortic Aneurysm

  (bbb) The term ``ultrasound screening for abdominal aortic 
aneurysm'' means--
          (1) a procedure using sound waves (or such other 
        procedures using alternative technologies, of 
        commensurate accuracy and cost, that the Secretary may 
        specify) provided for the early detection of abdominal 
        aortic aneurysm; and
          (2) includes a physician's interpretation of the 
        results of the procedure.

                        Long-Term Care Hospital

  (ccc) The term ``long-term care hospital'' means a hospital 
which--
          (1) is primarily engaged in providing inpatient 
        services, by or under the supervision of a physician, 
        to Medicare beneficiaries whose medically complex 
        conditions require a long hospital stay and programs of 
        care provided by a long-term care hospital;
          (2) has an average inpatient length of stay (as 
        determined by the Secretary) of greater than 25 days, 
        or meets the requirements of clause (II) of section 
        1886(d)(1)(B)(iv);
          (3) satisfies the requirements of subsection (e); and
          (4) meets the following facility criteria:
                  (A) the institution has a patient review 
                process, documented in the patient medical 
                record, that screens patients prior to 
                admission for appropriateness of admission to a 
                long-term care hospital, validates within 48 
                hours of admission that patients meet admission 
                criteria for long-term care hospitals, 
                regularly evaluates patients throughout their 
                stay for continuation of care in a long-term 
                care hospital, and assesses the available 
                discharge options when patients no longer meet 
                such continued stay criteria;
                  (B) the institution has active physician 
                involvement with patients during their 
                treatment through an organized medical staff, 
                physician-directed treatment with physician on-
                site availability on a daily basis to review 
                patient progress, and consulting physicians on 
                call and capable of being at the patient's side 
                within a moderate period of time, as determined 
                by the Secretary; and
                  (C) the institution has interdisciplinary 
                team treatment for patients, requiring 
                interdisciplinary teams of health care 
                professionals, including physicians, to prepare 
                and carry out an individualized treatment plan 
                for each patient.

          Additional Preventive Services; Preventive Services

  (ddd)(1) The term ``additional preventive services'' means 
services not described in subparagraph (A) or (C) of paragraph 
(3) that identify medical conditions or risk factors and that 
the Secretary determines are--
          (A) reasonable and necessary for the prevention or 
        early detection of an illness or disability;
          (B) recommended with a grade of A or B by the United 
        States Preventive Services Task Force; and
          (C) appropriate for individuals entitled to benefits 
        under part A or enrolled under part B.
  (2) In making determinations under paragraph (1) regarding 
the coverage of a new service, the Secretary shall use the 
process for making national coverage determinations (as defined 
in section 1869(f)(1)(B)) under this title. As part of the use 
of such process, the Secretary may conduct an assessment of the 
relation between predicted outcomes and the expenditures for 
such service and may take into account the results of such 
assessment in making such determination.
  (3) The term ``preventive services'' means the following:
          (A) The screening and preventive services described 
        in subsection (ww)(2) (other than the service described 
        in subparagraph (M) of such subsection).
          (B) An initial preventive physical examination (as 
        defined in subsection (ww)).
          (C) Personalized prevention plan services (as defined 
        in subsection (hhh)(1)).

   Cardiac Rehabilitation Program; Intensive Cardiac Rehabilitation 
                                Program

  (eee)(1) The term ``cardiac rehabilitation program'' means a 
program (as described in paragraph (2)) that furnishes the 
items and services described in paragraph (3) under the 
supervision of a physician (as defined in subsection (r)(1)) or 
a physician assistant, nurse practitioner, or clinical nurse 
specialist (as those terms are defined in subsection (aa)(5)).
  (2) A program described in this paragraph is a program under 
which--
          (A) items and services under the program are 
        delivered--
                  (i) in a physician's office;
                  (ii) in a hospital on an outpatient basis; or
                  (iii) in other settings determined 
                appropriate by the Secretary;
          (B) a physician (as defined in subsection (r)(1)) or 
        a physician assistant, nurse practitioner, or clinical 
        nurse specialist (as those terms are defined in 
        subsection (aa)(5)) is immediately available and 
        accessible for medical consultation and medical 
        emergencies at all times items and services are being 
        furnished under the program, except that, in the case 
        of items and services furnished under such a program in 
        a hospital, such availability shall be presumed; and
          (C) individualized treatment is furnished under a 
        written plan established, reviewed, and signed by a 
        physician every 30 days that describes--
                  (i) the individual's diagnosis;
                  (ii) the type, amount, frequency, and 
                duration of the items and services furnished 
                under the plan; and
                  (iii) the goals set for the individual under 
                the plan.
  (3) The items and services described in this paragraph are--
          (A) physician-prescribed exercise;
          (B) cardiac risk factor modification, including 
        education, counseling, and behavioral intervention (to 
        the extent such education, counseling, and behavioral 
        intervention is closely related to the individual's 
        care and treatment and is tailored to the individual's 
        needs);
          (C) psychosocial assessment;
          (D) outcomes assessment; and
          (E) such other items and services as the Secretary 
        may determine, but only if such items and services 
        are--
                  (i) reasonable and necessary for the 
                diagnosis or active treatment of the 
                individual's condition;
                  (ii) reasonably expected to improve or 
                maintain the individual's condition and 
                functional level; and
                  (iii) furnished under such guidelines 
                relating to the frequency and duration of such 
                items and services as the Secretary shall 
                establish, taking into account accepted norms 
                of medical practice and the reasonable 
                expectation of improvement of the individual.
  (4)(A) The term ``intensive cardiac rehabilitation program'' 
means a program (as described in paragraph (2)) that furnishes 
the items and services described in paragraph (3) under the 
supervision of a physician (as defined in subsection (r)(1)) or 
a physician assistant, nurse practitioner, or clinical nurse 
specialist (as those terms are defined in subsection (aa)(5)) 
and has shown, in peer-reviewed published research, that it 
accomplished--
          (i) one or more of the following:
                  (I) positively affected the progression of 
                coronary heart disease; or
                  (II) reduced the need for coronary bypass 
                surgery; or
                  (III) reduced the need for percutaneous 
                coronary interventions; and
          (ii) a statistically significant reduction in 5 or 
        more of the following measures from their level before 
        receipt of cardiac rehabilitation services to their 
        level after receipt of such services:
                  (I) low density lipoprotein;
                  (II) triglycerides;
                  (III) body mass index;
                  (IV) systolic blood pressure;
                  (V) diastolic blood pressure; or
                  (VI) the need for cholesterol, blood 
                pressure, and diabetes medications.
  (B) To be eligible for an intensive cardiac rehabilitation 
program, an individual must have--
          (i) had an acute myocardial infarction within the 
        preceding 12 months;
          (ii) had coronary bypass surgery;
          (iii) stable angina pectoris;
          (iv) had heart valve repair or replacement;
          (v) had percutaneous transluminal coronary 
        angioplasty (PTCA) or coronary stenting;
          (vi) had a heart or heart-lung transplant;
                  (vii) stable, chronic heart failure (defined 
                as patients with left ventricular ejection 
                fraction of 35 percent or less and New York 
                Heart Association (NYHA) class II to IV 
                symptoms despite being on optimal heart failure 
                therapy for at least 6 weeks); or
                  (viii) any additional condition for which the 
                Secretary has determined that a cardiac 
                rehabilitation program shall be covered, unless 
                the Secretary determines, using the same 
                process used to determine that the condition is 
                covered for a cardiac rehabilitation program, 
                that such coverage is not supported by the 
                clinical evidence.
  (C) An intensive cardiac rehabilitation program may be 
provided in a series of 72 one-hour sessions (as defined in 
section 1848(b)(5)), up to 6 sessions per day, over a period of 
up to 18 weeks.
  (5) The Secretary shall establish standards to ensure that a 
physician with expertise in the management of individuals with 
cardiac pathophysiology who is licensed to practice medicine in 
the State in which a cardiac rehabilitation program (or the 
intensive cardiac rehabilitation program, as the case may be) 
is offered--
          (A) is responsible for such program; and
          (B) in consultation with appropriate staff, is 
        involved substantially in directing the progress of 
        individual in the program.

                    Pulmonary Rehabilitation Program

  (fff)(1) The term ``pulmonary rehabilitation program'' means 
a program (as described in subsection (eee)(2) with respect to 
a program under this subsection) that furnishes the items and 
services described in paragraph (2) under the supervision of a 
physician (as defined in subsection (r)(1)) or a physician 
assistant, nurse practitioner, or clinical nurse specialist (as 
those terms are defined in subsection (aa)(5)).
  (2) The items and services described in this paragraph are--
          (A) physician-prescribed exercise;
          (B) education or training (to the extent the 
        education or training is closely and clearly related to 
        the individual's care and treatment and is tailored to 
        such individual's needs);
          (C) psychosocial assessment;
          (D) outcomes assessment; and
          (E) such other items and services as the Secretary 
        may determine, but only if such items and services 
        are--
                  (i) reasonable and necessary for the 
                diagnosis or active treatment of the 
                individual's condition;
                  (ii) reasonably expected to improve or 
                maintain the individual's condition and 
                functional level; and
                  (iii) furnished under such guidelines 
                relating to the frequency and duration of such 
                items and services as the Secretary shall 
                establish, taking into account accepted norms 
                of medical practice and the reasonable 
                expectation of improvement of the individual.
  (3) The Secretary shall establish standards to ensure that a 
physician with expertise in the management of individuals with 
respiratory pathophysiology who is licensed to practice 
medicine in the State in which a pulmonary rehabilitation 
program is offered--
          (A) is responsible for such program; and
          (B) in consultation with appropriate staff, is 
        involved substantially in directing the progress of 
        individual in the program.

                   Kidney Disease Education Services

  (ggg)(1) The term ``kidney disease education services'' means 
educational services that are--
          (A) furnished to an individual with stage IV chronic 
        kidney disease who, according to accepted clinical 
        guidelines identified by the Secretary, will require 
        dialysis or a kidney transplant;
          (B) furnished, upon the referral of the physician 
        managing the individual's kidney condition, by a 
        qualified person (as defined in paragraph (2)); and
          (C) designed--
                  (i) to provide comprehensive information 
                (consistent with the standards set under 
                paragraph (3)) regarding--
                          (I) the management of comorbidities, 
                        including for purposes of delaying the 
                        need for dialysis;
                          (II) the prevention of uremic 
                        complications; and
                          (III) each option for renal 
                        replacement therapy (including 
                        hemodialysis and peritoneal dialysis at 
                        home and in-center as well as vascular 
                        access options and transplantation);
                  (ii) to ensure that the individual has the 
                opportunity to actively participate in the 
                choice of therapy; and
                  (iii) to be tailored to meet the needs of the 
                individual involved.
  (2)(A) The term ``qualified person'' means--
          (i) a physician (as defined in section 1861(r)(1)) or 
        a physician assistant, nurse practitioner, or clinical 
        nurse specialist (as defined in section 1861(aa)(5)), 
        who furnishes services for which payment may be made 
        under the fee schedule established under section 1848; 
        and
          (ii) a provider of services located in a rural area 
        (as defined in section 1886(d)(2)(D)).
  (B) Such term does not include a provider of services (other 
than a provider of services described in subparagraph (A)(ii)) 
or a renal dialysis facility.
  (3) The Secretary shall set standards for the content of such 
information to be provided under paragraph (1)(C)(i) after 
consulting with physicians, other health professionals, health 
educators, professional organizations, accrediting 
organizations, kidney patient organizations, dialysis 
facilities, transplant centers, network organizations described 
in section 1881(c)(2), and other knowledgeable persons. To the 
extent possible the Secretary shall consult with persons or 
entities described in the previous sentence, other than a 
dialysis facility, that has not received industry funding from 
a drug or biological manufacturer or dialysis facility.
  (4) No individual shall be furnished more than 6 sessions of 
kidney disease education services under this title.

                         Annual Wellness Visit

  (hhh)(1) The term ``personalized prevention plan services'' 
means the creation of a plan for an individual--
          (A) that includes a health risk assessment (that 
        meets the guidelines established by the Secretary under 
        paragraph (4)(A)) of the individual that is completed 
        prior to or as part of the same visit with a health 
        professional described in paragraph (3); and
          (B) that--
                  (i) takes into account the results of the 
                health risk assessment; and
                  (ii) may contain the elements described in 
                paragraph (2).
  (2) Subject to paragraph (4)(H), the elements described in 
this paragraph are the following:
          (A) The establishment of, or an update to, the 
        individual's medical and family history.
          (B) A list of current providers and suppliers that 
        are regularly involved in providing medical care to the 
        individual (including a list of all prescribed 
        medications).
          (C) A measurement of height, weight, body mass index 
        (or waist circumference, if appropriate), blood 
        pressure, and other routine measurements.
          (D) Detection of any cognitive impairment.
          (E) The establishment of, or an update to, the 
        following:
                  (i) A screening schedule for the next 5 to 10 
                years, as appropriate, based on recommendations 
                of the United States Preventive Services Task 
                Force and the Advisory Committee on 
                Immunization Practices, and the individual's 
                health status, screening history, and age-
                appropriate preventive services covered under 
                this title.
                  (ii) A list of risk factors and conditions 
                for which primary, secondary, or tertiary 
                prevention interventions are recommended or are 
                underway, including any mental health 
                conditions or any such risk factors or 
                conditions that have been identified through an 
                initial preventive physical examination (as 
                described under subsection (ww)(1)), and a list 
                of treatment options and their associated risks 
                and benefits.
          (F) The furnishing of personalized health advice and 
        a referral, as appropriate, to health education or 
        preventive counseling services or programs aimed at 
        reducing identified risk factors and improving self-
        management, or community-based lifestyle interventions 
        to reduce health risks and promote self-management and 
        wellness, including weight loss, physical activity, 
        smoking cessation, fall prevention, and nutrition.
          (G) Screening for potential substance use disorders 
        and referral for treatment as appropriate.
          (H) The furnishing of a review of any current opioid 
        prescriptions (as defined in subsection (ww)(4)).
          (I) Any other element determined appropriate by the 
        Secretary.
  (3) A health professional described in this paragraph is--
          (A) a physician;
          (B) a practitioner described in clause (i) of section 
        1842(b)(18)(C); or
          (C) a medical professional (including a health 
        educator, registered dietitian, or nutrition 
        professional) or a team of medical professionals, as 
        determined appropriate by the Secretary, under the 
        supervision of a physician.
  (4)(A) For purposes of paragraph (1)(A), the Secretary, not 
later than 1 year after the date of enactment of this 
subsection, shall establish publicly available guidelines for 
health risk assessments. Such guidelines shall be developed in 
consultation with relevant groups and entities and shall 
provide that a health risk assessment--
          (i) identify chronic diseases, injury risks, 
        modifiable risk factors, and urgent health needs of the 
        individual; and
          (ii) may be furnished--
                  (I) through an interactive telephonic or web-
                based program that meets the standards 
                established under subparagraph (B);
                  (II) during an encounter with a health care 
                professional;
                  (III) through community-based prevention 
                programs; or
                  (IV) through any other means the Secretary 
                determines appropriate to maximize 
                accessibility and ease of use by beneficiaries, 
                while ensuring the privacy of such 
                beneficiaries.
  (B) Not later than 1 year after the date of enactment of this 
subsection, the Secretary shall establish standards for 
interactive telephonic or web-based programs used to furnish 
health risk assessments under subparagraph (A)(ii)(I). The 
Secretary may utilize any health risk assessment developed 
under section 4004(f) of the Patient Protection and Affordable 
Care Act as part of the requirement to develop a personalized 
prevention plan to comply with this subparagraph.
  (C)(i) Not later than 18 months after the date of enactment 
of this subsection, the Secretary shall develop and make 
available to the public a health risk assessment model. Such 
model shall meet the guidelines under subparagraph (A) and may 
be used to meet the requirement under paragraph (1)(A).
  (ii) Any health risk assessment that meets the guidelines 
under subparagraph (A) and is approved by the Secretary may be 
used to meet the requirement under paragraph (1)(A).
  (D) The Secretary may coordinate with community-based 
entities (including State Health Insurance Programs, Area 
Agencies on Aging, Aging and Disability Resource Centers, and 
the Administration on Aging) to--
          (i) ensure that health risk assessments are 
        accessible to beneficiaries; and
          (ii) provide appropriate support for the completion 
        of health risk assessments by beneficiaries.
  (E) The Secretary shall establish procedures to make 
beneficiaries and providers aware of the requirement that a 
beneficiary complete a health risk assessment prior to or at 
the same time as receiving personalized prevention plan 
services.
  (F) To the extent practicable, the Secretary shall encourage 
the use of, integration with, and coordination of health 
information technology (including use of technology that is 
compatible with electronic medical records and personal health 
records) and may experiment with the use of personalized 
technology to aid in the development of self-management skills 
and management of and adherence to provider recommendations in 
order to improve the health status of beneficiaries.
  (G) A beneficiary shall be eligible to receive only an 
initial preventive physical examination (as defined under 
subsection (ww)(1)) during the 12-month period after the date 
that the beneficiary's coverage begins under part B and shall 
be eligible to receive personalized prevention plan services 
under this subsection each year thereafter provided that the 
beneficiary has not received either an initial preventive 
physical examination or personalized prevention plan services 
within the preceding 12-month period.
  (H) The Secretary shall issue guidance that--
          (i) identifies elements under paragraph (2) that are 
        required to be provided to a beneficiary as part of 
        their first visit for personalized prevention plan 
        services; and
          (ii) establishes a yearly schedule for appropriate 
        provision of such elements thereafter.
  (iii) Home Infusion Therapy.--(1) The term ``home infusion 
therapy'' means the items and services described in paragraph 
(2) furnished by a qualified home infusion therapy supplier (as 
defined in paragraph (3)(D)) which are furnished in the 
individual's home (as defined in paragraph (3)(B)) to an 
individual--
          (A) who is under the care of an applicable provider 
        (as defined in paragraph (3)(A)); and
          (B) with respect to whom a plan prescribing the type, 
        amount, and duration of infusion therapy services that 
        are to be furnished such individual has been 
        established by a physician (as defined in subsection 
        (r)(1)) and is periodically reviewed by a physician (as 
        so defined) in coordination with the furnishing of home 
        infusion drugs (as defined in paragraph (3)(C)) under 
        part B.
  (2) The items and services described in this paragraph are 
the following:
          (A) Professional services, including nursing 
        services, furnished in accordance with the plan.
          (B) Training and education (not otherwise paid for as 
        durable medical equipment (as defined in subsection 
        (n)), remote monitoring, and monitoring services for 
        the provision of home infusion therapy and home 
        infusion drugs furnished by a qualified home infusion 
        therapy supplier.
  (3) For purposes of this subsection:
          (A) The term ``applicable provider'' means--
                  (i) a physician;
                  (ii) a nurse practitioner; and
                  (iii) a physician assistant.
          (B) The term ``home'' means a place of residence used 
        as the home of an individual (as defined for purposes 
        of subsection (n)).
          (C) The term ``home infusion drug'' means a 
        parenteral drug or biological administered 
        intravenously, or subcutaneously for an administration 
        period of 15 minutes or more, in the home of an 
        individual through a pump that is an item of durable 
        medical equipment (as defined in subsection (n)). Such 
        term does not include the following:
                  (i) Insulin pump systems.
                  (ii) A self-administered drug or biological 
                on a self-administered drug exclusion list.
        Clause (ii) shall not apply to a self-administered drug 
        or biological on a self-administered drug exclusion 
        list if such drug or biological was included as a 
        transitional home infusion drug under subparagraph 
        (A)(iii) of section 1834(u)(7) and was identified by a 
        HCPCS code described in subparagraph (C)(ii) of such 
        section.
          (D)(i) The term ``qualified home infusion therapy 
        supplier'' means a pharmacy, physician, or other 
        provider of services or supplier licensed by the State 
        in which the pharmacy, physician, or provider or 
        services or supplier furnishes items or services and 
        that--
                  (I) furnishes infusion therapy to individuals 
                with acute or chronic conditions requiring 
                administration of home infusion drugs;
                  (II) ensures the safe and effective provision 
                and administration of home infusion therapy on 
                a 7-day-a-week, 24-hour-a-day basis;
                  (III) is accredited by an organization 
                designated by the Secretary pursuant to section 
                1834(u)(5); and
                  (IV) meets such other requirements as the 
                Secretary determines appropriate, taking into 
                account the standards of care for home infusion 
                therapy established by Medicare Advantage plans 
                under part C and in the private sector.
          (ii) A qualified home infusion therapy supplier may 
        subcontract with a pharmacy, physician, provider of 
        services, or supplier to meet the requirements of this 
        subparagraph.
  (jjj) Opioid Use Disorder Treatment Services; Opioid 
Treatment Program.--
          (1) Opioid use disorder treatment services.--The term 
        ``opioid use disorder treatment services'' means items 
        and services that are furnished by an opioid treatment 
        program for the treatment of opioid use disorder, 
        including--
                  (A) opioid agonist and antagonist treatment 
                medications (including oral, injected, or 
                implanted versions) that are approved by the 
                Food and Drug Administration under section 505 
                of the Federal Food, Drug, and Cosmetic Act for 
                use in the treatment of opioid use disorder;
                  (B) dispensing and administration of such 
                medications, if applicable;
                  (C) substance use counseling by a 
                professional to the extent authorized under 
                State law to furnish such services;
                  (D) individual and group therapy with a 
                physician or psychologist (or other mental 
                health professional to the extent authorized 
                under State law);
                  (E) toxicology testing, and
                  (F) other items and services that the 
                Secretary determines are appropriate (but in no 
                event to include meals or transportation).
          (2) Opioid treatment program.--The term ``opioid 
        treatment program'' means an entity that is an opioid 
        treatment program (as defined in section 8.2 of title 
        42 of the Code of Federal Regulations, or any successor 
        regulation) that--
                  (A) is enrolled under section 1866(j);
                  (B) has in effect a certification by the 
                [Substance Abuse and Mental Health Services 
                Administration] Substance Use And Mental Health 
                Services Administration for such a program;
                  (C) is accredited by an accrediting body 
                approved by the [Substance Abuse and Mental 
                Health Services Administration] Substance Use 
                And Mental Health Services Administration; and
                  (D) meets such additional conditions as the 
                Secretary may find necessary to ensure--
                          (i) the health and safety of 
                        individuals being furnished services 
                        under such program; and
                          (ii) the effective and efficient 
                        furnishing of such services.

       Rural Emergency Hospital Services; Rural Emergency Hospital

  (kkk)(1) Rural emergency hospital services.--
          (A) In general.--The term ``rural emergency hospital 
        services'' means the following services furnished by a 
        rural emergency hospital (as defined in paragraph (2)) 
        that do not exceed an annual per patient average of 24 
        hours in such rural emergency hospital:
                  (i) Emergency department services and 
                observation care.
                  (ii) At the election of the rural emergency 
                hospital, with respect to services furnished on 
                an outpatient basis, other medical and health 
                services as specified by the Secretary through 
                rulemaking.
          (B) Staffed emergency department.--For purposes of 
        subparagraph (A)(i), an emergency department of a rural 
        emergency hospital shall be considered a staffed 
        emergency department if it meets the following 
        requirements:
                  (i) The emergency department is staffed 24 
                hours a day, 7 days a week.
                  (ii) A physician (as defined in section 
                1861(r)(1)), nurse practitioner, clinical nurse 
                specialist, or physician assistant (as those 
                terms are defined in section 1861(aa)(5)) is 
                available to furnish rural emergency hospital 
                services in the facility 24 hours a day.
                  (iii) Applicable staffing and staffing 
                responsibilities under section 485.631 of title 
                42, Code of Federal Regulations (or any 
                successor regulation).
  (2) Rural emergency hospital.--The term ``rural emergency 
hospital'' means a facility described in paragraph (3) that--
          (A) is enrolled under section 1866(j), submits the 
        additional information described in paragraph (4)(A) 
        for purposes of such enrollment, and makes the detailed 
        transition plan described in clause (i) of such 
        paragraph available to the public, in a form and manner 
        determined appropriate by the Secretary;
          (B) does not provide any acute care inpatient 
        services, other than those described in paragraph 
        (6)(A);
          (C) has in effect a transfer agreement with a level I 
        or level II trauma center;
          (D) meets--
                  (i) licensure requirements as described in 
                paragraph (5);
                  (ii) the requirements of a staffed emergency 
                department as described in paragraph (1)(B);
                  (iii) such staff training and certification 
                requirements as the Secretary may require;
                  (iv) conditions of participation applicable 
                to--
                          (I) critical access hospitals, with 
                        respect to emergency services under 
                        section 485.618 of title 42, Code of 
                        Federal Regulations (or any successor 
                        regulation); and
                          (II) hospital emergency departments 
                        under this title, as determined 
                        applicable by the Secretary;
                  (v) such other requirements as the Secretary 
                finds necessary in the interest of the health 
                and safety of individuals who are furnished 
                rural emergency hospital services; and
                  (vi) in the case where the rural emergency 
                hospital includes a distinct part unit of the 
                facility that is licensed as a skilled nursing 
                facility, such distinct part meets the 
                requirements applicable to skilled nursing 
                facilities under this title.
  (3) Facility described.--A facility described in this 
paragraph is a facility that as of the date of the enactment of 
this subsection--
          (A) was a critical access hospital; or
          (B) was a subsection (d) hospital (as defined in 
        section 1886(d)(1)(B)) with not more than 50 beds 
        located in a county (or equivalent unit of local 
        government) in a rural area (as defined in section 
        1886(d)(2)(D)), or was a subsection (d) hospital (as so 
        defined) with not more than 50 beds that was treated as 
        being located in a rural area pursuant to section 
        1886(d)(8)(E).
  (4) Additional information.--
          (A) Information.--For purposes of paragraph (2)(A), a 
        facility that submits an application for enrollment 
        under section 1866(j) as a rural emergency hospital 
        shall submit the following information at such time and 
        in such form as the Secretary may require:
                  (i) An action plan for initiating rural 
                emergency hospital services (as defined in 
                paragraph (1)), including a detailed transition 
                plan that lists the specific services that the 
                facility will--
                          (I) retain;
                          (II) modify
                          (III) add; and
                          (IV) discontinue.
                  (ii) A description of services that the 
                facility intends to furnish on an outpatient 
                basis pursuant to paragraph (1)(A)(ii).
                  (iii) Information regarding how the facility 
                intends to use the additional facility payment 
                provided under section 1834(x)(2), including a 
                description of the services covered under this 
                title that the additional facility payment 
                would be supporting, such as furnishing 
                telehealth services and ambulance services, 
                including operating the facility and 
                maintaining the emergency department to provide 
                such services covered under this title.
                  (iv) Such other information as the Secretary 
                determines appropriate.
          (B) Effect of enrollment.--Such enrollment shall 
        remain effective with respect to a facility until such 
        time as--
                  (i) the facility elects to convert back to 
                its prior designation as a critical access 
                hospital or a subsection (d) hospital (as 
                defined in section 1886(d)(1)(B)), subject to 
                requirements applicable under this title for 
                such designation and in accordance with 
                procedures established by the Secretary; or
                  (ii) the Secretary determines the facility 
                does not meet the requirements applicable to a 
                rural emergency hospital under this subsection.
  (5) Licensure.--A facility may not operate as a rural 
emergency hospital in a State unless the facility--
          (A) is located in a State that provides for the 
        licensing of such hospitals under State or applicable 
        local law; and
          (B)(i) is licensed pursuant to such law; or
          (ii) is approved by the agency of such State or 
        locality responsible for licensing hospitals, as 
        meeting the standards established for such licensing.
  (6) Discretionary authority.--A rural emergency hospital 
may--
          (A) include a unit of the facility that is a distinct 
        part licensed as a skilled nursing facility to furnish 
        post-hospital extended care services; and
          (B) be considered a hospital with less than 50 beds 
        for purposes of the exception to the payment limit for 
        rural health clinics under section 1833(f).
  (7) Quality measurement.--
          (A) In general.--The Secretary shall establish 
        quality measurement reporting requirements for rural 
        emergency hospitals, which may include the use of a 
        small number of claims-based outcomes measures or 
        surveys of patients with respect to their experience in 
        the rural emergency hospital, in accordance with the 
        succeeding provisions of this paragraph.
          (B) Quality reporting by rural emergency hospitals.--
                  (i) In general.--With respect to each year 
                beginning with 2023, (or each year beginning on 
                or after the date that is one year after one or 
                more measures are first specified under 
                subparagraph (C)), a rural emergency hospital 
                shall submit data to the Secretary in 
                accordance with clause (ii).
                  (ii) Submission of quality data.--With 
                respect to each such year, a rural emergency 
                hospital shall submit to the Secretary data on 
                quality measures specified under subparagraph 
                (C). Such data shall be submitted in a form and 
                manner, and at a time, specified by the 
                Secretary for purposes of this subparagraph.
          (C) Quality measures.--
                  (i) In general.--Subject to clause (ii), any 
                measure specified by the Secretary under this 
                subparagraph must have been endorsed by the 
                entity with a contract under section 1890(a).
                  (ii) Exception.--In the case of a specified 
                area or medical topic determined appropriate by 
                the Secretary for which a feasible and 
                practical measure has not been endorsed by the 
                entity with a contract under section 1890(a), 
                the Secretary may specify a measure that is not 
                so endorsed as long as due consideration is 
                given to measures that have been endorsed or 
                adopted by a consensus organization identified 
                by the Secretary.
                  (iii) Consideration of low case volume when 
                specifying performance measures.--The Secretary 
                shall, in the selection of measures specified 
                under this subparagraph, take into 
                consideration ways to account for rural 
                emergency hospitals that lack sufficient case 
                volume to ensure that the performance rates for 
                such measures are reliable.
          (D) Public availability of data submitted.--The 
        Secretary shall establish procedures for making data 
        submitted under subparagraph (B) available to the 
        public regarding the performance of individual rural 
        emergency hospitals. Such procedures shall ensure that 
        a rural emergency hospital has the opportunity to 
        review, and submit corrections for, the data that is to 
        be made public with respect to the rural emergency 
        hospital prior to such data being made public. Such 
        information shall be posted on the Internet website of 
        the Centers for Medicare & Medicaid Services in an 
        easily understandable format as determined appropriate 
        by the Secretary.
  (8) Clarification regarding application of provisions 
relating to off-campus outpatient department of a provider.--
Nothing in this subsection, section 1833(a)(10), or section 
1834(x) shall affect the application of paragraph (1)(B)(v) of 
section 1833(t), relating to applicable items and services (as 
defined in subparagraph (A) of paragraph (21) of such section) 
that are furnished by an off-campus outpatient department of a 
provider (as defined in subparagraph (B) of such paragraph).
  (9) Implementation.--There shall be no administrative or 
judicial review under section 1869, 1878, or otherwise of the 
following:
          (A) The determination of whether a rural emergency 
        hospital meets the requirements of this subsection.
          (B) The establishment of requirements under this 
        subsection by the Secretary, including requirements 
        described in paragraphs (2)(D), (4), and (7).
          (C) The determination of payment amounts under 
        section 1834(x), including the additional facility 
        payment described in paragraph (2) of such section.

           *       *       *       *       *       *       *


SEC. 1866F. OPIOID USE DISORDER TREATMENT DEMONSTRATION PROGRAM.

  (a) Implementation of 4-Year Demonstration Program.--
          (1) In general.--Not later than January 1, 2021, the 
        Secretary shall implement a 4-year demonstration 
        program under this title (in this section referred to 
        as the ``Program'') to increase access of applicable 
        beneficiaries to opioid use disorder treatment 
        services, improve physical and mental health outcomes 
        for such beneficiaries, and to the extent possible, 
        reduce expenditures under this title. Under the 
        Program, the Secretary shall make payments under 
        subsection (e) to participants (as defined in 
        subsection (c)(1)(A)) for furnishing opioid use 
        disorder treatment services delivered through opioid 
        use disorder care teams, or arranging for such services 
        to be furnished, to applicable beneficiaries 
        participating in the Program.
          (2) Opioid use disorder treatment services.--For 
        purposes of this section, the term ``opioid use 
        disorder treatment services''--
                  (A) means, with respect to an applicable 
                beneficiary, services that are furnished for 
                the treatment of opioid use disorders and that 
                utilize drugs approved under section 505 of the 
                Federal Food, Drug, and Cosmetic Act for the 
                treatment of opioid use disorders in an 
                outpatient setting; and
                  (B) includes--
                          (i) medication-assisted treatment;
                          (ii) treatment planning;
                          (iii) psychiatric, psychological, or 
                        counseling services (or any combination 
                        of such services), as appropriate;
                          (iv) social support services, as 
                        appropriate; and
                          (v) care management and care 
                        coordination services, including 
                        coordination with other providers of 
                        services and suppliers not on an opioid 
                        use disorder care team.
  (b) Program Design.--
          (1) In general.--The Secretary shall design the 
        Program in such a manner to allow for the evaluation of 
        the extent to which the Program accomplishes the 
        following purposes:
                  (A) Reduces hospitalizations and emergency 
                department visits.
                  (B) Increases use of medication-assisted 
                treatment for opioid use disorders.
                  (C) Improves health outcomes of individuals 
                with opioid use disorders, including by 
                reducing the incidence of infectious diseases 
                (such as hepatitis C and HIV).
                  (D) Does not increase the total spending on 
                items and services under this title.
                  (E) Reduces deaths from opioid overdose.
                  (F) Reduces the utilization of inpatient 
                residential treatment.
          (2) Consultation.--In designing the Program, 
        including the criteria under subsection (e)(2)(A), the 
        Secretary shall, not later than 3 months after the date 
        of the enactment of this section, consult with 
        specialists in the field of addiction, clinicians in 
        the primary care community, and beneficiary groups.
  (c) Participants; Opioid Use Disorder Care Teams.--
          (1) Participants.--
                  (A) Definition.--In this section, the term 
                ``participant'' means an entity or individual--
                          (i) that is otherwise enrolled under 
                        this title and that is--
                                  (I) a physician (as defined 
                                in section 1861(r)(1));
                                  (II) a group practice 
                                comprised of at least one 
                                physician described in 
                                subclause (I);
                                  (III) a hospital outpatient 
                                department;
                                  (IV) a federally qualified 
                                health center (as defined in 
                                section 1861(aa)(4));
                                  (V) a rural health clinic (as 
                                defined in section 
                                1861(aa)(2));
                                  (VI) a community mental 
                                health center (as defined in 
                                section 1861(ff)(3)(B));
                                  (VII) a clinic certified as a 
                                certified community behavioral 
                                health clinic pursuant to 
                                section 223 of the Protecting 
                                Access to Medicare Act of 2014; 
                                or
                                  (VIII) any other individual 
                                or entity specified by the 
                                Secretary;
                          (ii) that applied for and was 
                        selected to participate in the Program 
                        pursuant to an application and 
                        selection process established by the 
                        Secretary; and
                          (iii) that establishes an opioid use 
                        disorder care team (as defined in 
                        paragraph (2)) through employing or 
                        contracting with health care 
                        practitioners described in paragraph 
                        (2)(A), and uses such team to furnish 
                        or arrange for opioid use disorder 
                        treatment services in the outpatient 
                        setting under the Program.
                  (B) Preference.--In selecting participants 
                for the Program, the Secretary shall give 
                preference to individuals and entities that are 
                located in areas with a prevalence of opioid 
                use disorders that is higher than the national 
                average prevalence.
          (2) Opioid use disorder care teams.--
                  (A) In general.--For purposes of this 
                section, the term ``opioid use disorder care 
                team'' means a team of health care 
                practitioners established by a participant 
                described in paragraph (1)(A) that--
                          (i) shall include--
                                  (I) at least one physician 
                                (as defined in section 
                                1861(r)(1)) furnishing primary 
                                care services or addiction 
                                treatment services to an 
                                applicable beneficiary; and
                                  (II) at least one eligible 
                                practitioner (as defined in 
                                paragraph (3)), who may be a 
                                physician who meets the 
                                criterion in subclause (I); and
                          (ii) may include other practitioners 
                        licensed under State law to furnish 
                        psychiatric, psychological, counseling, 
                        and social services to applicable 
                        beneficiaries.
                  (B) Requirements for receipt of payment under 
                program.--In order to receive payments under 
                subsection (e), each participant in the Program 
                shall--
                          (i) furnish opioid use disorder 
                        treatment services through opioid use 
                        disorder care teams to applicable 
                        beneficiaries who agree to receive the 
                        services;
                          (ii) meet minimum criteria, as 
                        established by the Secretary; and
                          (iii) submit to the Secretary, in 
                        such form, manner, and frequency as 
                        specified by the Secretary, with 
                        respect to each applicable beneficiary 
                        for whom opioid use disorder treatment 
                        services are furnished by the opioid 
                        use disorder care team, data and such 
                        other information as the Secretary 
                        determines appropriate to--
                                  (I) monitor and evaluate the 
                                Program;
                                  (II) determine if minimum 
                                criteria are met under clause 
                                (ii); and
                                  (III) determine the incentive 
                                payment under subsection (e).
          (3) Eligible practitioner defined.--For purposes of 
        this section, the term ``eligible practitioner'' means 
        a physician or other health care practitioner, such as 
        a nurse practitioner, that--
                  (A) is enrolled under section 1866(j)(1);
                  (B) is authorized to prescribe or dispense 
                narcotic drugs to individuals for maintenance 
                treatment or detoxification treatment; and
                  (C) has in effect a waiver in accordance with 
                section 303(g) of the Controlled Substances Act 
                for such purpose and is otherwise in compliance 
                with regulations promulgated by the [Substance 
                Abuse and Mental Health Services 
                Administration] Substance Use And Mental Health 
                Services Administration to carry out such 
                section.
  (d) Participation of Applicable Beneficiaries.--
          (1) Applicable beneficiary defined.--In this section, 
        the term ``applicable beneficiary'' means an individual 
        who--
                  (A) is entitled to, or enrolled for, benefits 
                under part A and enrolled for benefits under 
                part B;
                  (B) is not enrolled in a Medicare Advantage 
                plan under part C;
                  (C) has a current diagnosis for an opioid use 
                disorder; and
                  (D) meets such other criteria as the 
                Secretary determines appropriate.
        Such term shall include an individual who is dually 
        eligible for benefits under this title and title XIX if 
        such individual satisfies the criteria described in 
        subparagraphs (A) through (D).
          (2) Voluntary beneficiary participation; limitation 
        on number of beneficiaries.--An applicable beneficiary 
        may participate in the Program on a voluntary basis and 
        may terminate participation in the Program at any time. 
        Not more than 20,000 applicable beneficiaries may 
        participate in the Program at any time.
          (3) Services.--In order to participate in the 
        Program, an applicable beneficiary shall agree to 
        receive opioid use disorder treatment services from a 
        participant. Participation under the Program shall not 
        affect coverage of or payment for any other item or 
        service under this title for the applicable 
        beneficiary.
          (4) Beneficiary access to services.--Nothing in this 
        section shall be construed as encouraging providers to 
        limit applicable beneficiary access to services covered 
        under this title, and applicable beneficiaries shall 
        not be required to relinquish access to any benefit 
        under this title as a condition of receiving services 
        from a participant in the Program.
  (e) Payments.--
          (1) Per applicable beneficiary per month care 
        management fee.--
                  (A) In general.--The Secretary shall 
                establish a schedule of per applicable 
                beneficiary per month care management fees. 
                Such a per applicable beneficiary per month 
                care management fee shall be paid to a 
                participant in addition to any other amount 
                otherwise payable under this title to the 
                health care practitioners in the participant's 
                opioid use disorder care team or, if 
                applicable, to the participant. A participant 
                may use such per applicable beneficiary per 
                month care management fee to deliver additional 
                services to applicable beneficiaries, including 
                services not otherwise eligible for payment 
                under this title.
                  (B) Payment amounts.--In carrying out 
                subparagraph (A), the Secretary may--
                          (i) consider payments otherwise 
                        payable under this title for opioid use 
                        disorder treatment services and the 
                        needs of applicable beneficiaries;
                          (ii) pay a higher per applicable 
                        beneficiary per month care management 
                        fee for an applicable beneficiary who 
                        receives more intensive treatment 
                        services from a participant and for 
                        whom those services are appropriate 
                        based on clinical guidelines for opioid 
                        use disorder care;
                          (iii) pay a higher per applicable 
                        beneficiary per month care management 
                        fee for the month in which the 
                        applicable beneficiary begins treatment 
                        with a participant than in subsequent 
                        months, to reflect the greater time and 
                        costs required for the planning and 
                        initiation of treatment, as compared to 
                        maintenance of treatment; and
                          (iv) take into account whether a 
                        participant's opioid use disorder care 
                        team refers applicable beneficiaries to 
                        other suppliers or providers for any 
                        opioid use disorder treatment services.
                  (C) No duplicate payment.--The Secretary 
                shall make payments under this paragraph to 
                only one participant for services furnished to 
                an applicable beneficiary during a calendar 
                month.
          (2) Incentive payments.--
                  (A) In general.--Under the Program, the 
                Secretary shall establish a performance-based 
                incentive payment, which shall be paid (using a 
                methodology established and at a time 
                determined appropriate by the Secretary) to 
                participants based on the performance of 
                participants with respect to criteria, as 
                determined appropriate by the Secretary, in 
                accordance with subparagraph (B).
                  (B) Criteria.--
                          (i) In general.--Criteria described 
                        in subparagraph (A) may include 
                        consideration of the following:
                                  (I) Patient engagement and 
                                retention in treatment.
                                  (II) Evidence-based 
                                medication-assisted treatment.
                                  (III) Other criteria 
                                established by the Secretary.
                          (ii) Required consultation and 
                        consideration.--In determining criteria 
                        described in subparagraph (A), the 
                        Secretary shall--
                                  (I) consult with 
                                stakeholders, including 
                                clinicians in the primary care 
                                community and in the field of 
                                addiction medicine; and
                                  (II) consider existing 
                                clinical guidelines for the 
                                treatment of opioid use 
                                disorders.
                  (C) No duplicate payment.--The Secretary 
                shall ensure that no duplicate payments under 
                this paragraph are made with respect to an 
                applicable beneficiary.
  (f) Multipayer Strategy.--In carrying out the Program, the 
Secretary shall encourage other payers to provide similar 
payments and to use similar criteria as applied under the 
Program under subsection (e)(2)(C). The Secretary may enter 
into a memorandum of understanding with other payers to align 
the methodology for payment provided by such a payer related to 
opioid use disorder treatment services with such methodology 
for payment under the Program.
  (g) Evaluation.--
          (1) In general.--The Secretary shall conduct an 
        intermediate and final evaluation of the program. Each 
        such evaluation shall determine the extent to which 
        each of the purposes described in subsection (b) have 
        been accomplished under the Program.
          (2) Reports.--The Secretary shall submit to 
        Congress--
                  (A) a report with respect to the intermediate 
                evaluation under paragraph (1) not later than 3 
                years after the date of the implementation of 
                the Program; and
                  (B) a report with respect to the final 
                evaluation under paragraph (1) not later than 6 
                years after such date.
  (h) Funding.--
          (1) Administrative funding.--For the purposes of 
        implementing, administering, and carrying out the 
        Program (other than for purposes described in paragraph 
        (2)), $5,000,000 shall be available from the Federal 
        Supplementary Medical Insurance Trust Fund under 
        section 1841.
          (2) Care management fees and incentives.--For the 
        purposes of making payments under subsection (e), 
        $10,000,000 shall be available from the Federal 
        Supplementary Medical Insurance Trust Fund under 
        section 1841 for each of fiscal years 2021 through 
        2024.
          (3) Availability.--Amounts transferred under this 
        subsection for a fiscal year shall be available until 
        expended.
  (i) Waivers.--The Secretary may waive any provision of this 
title as may be necessary to carry out the Program under this 
section.

           *       *       *       *       *       *       *


TITLE XIX--GRANTS TO STATES FOR MEDICAL ASSISTANCE PROGRAMS

           *       *       *       *       *       *       *


  Sec. 1945. State Option To Provide Coordinated Care Through a 
Health Home for Individuals With Chronic Conditions.--
  (a) In General.--Notwithstanding section 1902(a)(1) (relating 
to statewideness), section 1902(a)(10)(B) (relating to 
comparability), and any other provision of this title for which 
the Secretary determines it is necessary to waive in order to 
implement this section, beginning January 1, 2011, a State, at 
its option as a State plan amendment, may provide for medical 
assistance under this title to eligible individuals with 
chronic conditions who select a designated provider (as 
described under subsection (h)(5)), a team of health care 
professionals (as described under subsection (h)(6)) operating 
with such a provider, or a health team (as described under 
subsection (h)(7)) as the individual's health home for purposes 
of providing the individual with health home services.
  (b) Health Home Qualification Standards.--The Secretary shall 
establish standards for qualification as a designated provider 
for the purpose of being eligible to be a health home for 
purposes of this section.
  (c) Payments.--
          (1) In general.--A State shall provide a designated 
        provider, a team of health care professionals operating 
        with such a provider, or a health team with payments 
        for the provision of health home services to each 
        eligible individual with chronic conditions that 
        selects such provider, team of health care 
        professionals, or health team as the individual's 
        health home. Payments made to a designated provider, a 
        team of health care professionals operating with such a 
        provider, or a health team for such services shall be 
        treated as medical assistance for purposes of section 
        1903(a), except that, subject to paragraph (4), during 
        the first 8 fiscal year quarters that the State plan 
        amendment is in effect, the Federal medical assistance 
        percentage applicable to such payments shall be equal 
        to 90 percent.
          (2) Methodology.--
                  (A) In general.--The State shall specify in 
                the State plan amendment the methodology the 
                State will use for determining payment for the 
                provision of health home services. Such 
                methodology for determining payment--
                          (i) may be tiered to reflect, with 
                        respect to each eligible individual 
                        with chronic conditions provided such 
                        services by a designated provider, a 
                        team of health care professionals 
                        operating with such a provider, or a 
                        health team, as well as the severity or 
                        number of each such individual's 
                        chronic conditions or the specific 
                        capabilities of the provider, team of 
                        health care professionals, or health 
                        team; and
                          (ii) shall be established consistent 
                        with section 1902(a)(30)(A).
                  (B) Alternate models of payment.--The 
                methodology for determining payment for 
                provision of health home services under this 
                section shall not be limited to a per-member 
                per-month basis and may provide (as proposed by 
                the State and subject to approval by the 
                Secretary) for alternate models of payment.
          (3) Planning grants.--
                  (A) In general.--Beginning January 1, 2011, 
                the Secretary may award planning grants to 
                States for purposes of developing a State plan 
                amendment under this section. A planning grant 
                awarded to a State under this paragraph shall 
                remain available until expended.
                  (B) State contribution.--A State awarded a 
                planning grant shall contribute an amount equal 
                to the State percentage determined under 
                section 1905(b) (without regard to section 5001 
                of Public Law 111-5) for each fiscal year for 
                which the grant is awarded.
                  (C) Limitation.--The total amount of payments 
                made to States under this paragraph shall not 
                exceed $25,000,000.
          (4) Special rule relating to substance use disorder 
        health homes.--
                  (A) In general.--In the case of a State with 
                an SUD-focused State plan amendment approved by 
                the Secretary on or after October 1, 2018, the 
                Secretary may, at the request of the State, 
                extend the application of the Federal medical 
                assistance percentage described in paragraph 
                (1) to payments for the provision of health 
                home services to SUD-eligible individuals under 
                such State plan amendment, in addition to the 
                first 8 fiscal year quarters the State plan 
                amendment is in effect, for the subsequent 2 
                fiscal year quarters that the State plan 
                amendment is in effect. Nothing in this section 
                shall be construed as prohibiting a State with 
                a State plan amendment that is approved under 
                this section and that is not an SUD-focused 
                State plan amendment from additionally having 
                approved on or after such date an SUD-focused 
                State plan amendment under this section, 
                including for purposes of application of this 
                paragraph.
                  (B) Report requirements.--In the case of a 
                State with an SUD-focused State plan amendment 
                for which the application of the Federal 
                medical assistance percentage has been extended 
                under subparagraph (A), such State shall, at 
                the end of the period of such State plan 
                amendment, submit to the Secretary a report on 
                the following, with respect to SUD-eligible 
                individuals provided health home services under 
                such State plan amendment:
                          (i) The quality of health care 
                        provided to such individuals, with a 
                        focus on outcomes relevant to the 
                        recovery of each such individual.
                          (ii) The access of such individuals 
                        to health care.
                          (iii) The total expenditures of such 
                        individuals for health care.
                For purposes of this subparagraph, the 
                Secretary shall specify all applicable measures 
                for determining quality, access, and 
                expenditures.
                  (C) Best practices.--Not later than October 
                1, 2020, the Secretary shall make publicly 
                available on the internet website of the 
                Centers for Medicare & Medicaid Services best 
                practices for designing and implementing an 
                SUD-focused State plan amendment, based on the 
                experiences of States that have State plan 
                amendments approved under this section that 
                include SUD-eligible individuals.
                  (D) Definitions.--For purposes of this 
                paragraph:
                          (i) Sud-eligible individuals.--The 
                        term ``SUD-eligible individual'' means, 
                        with respect to a State, an individual 
                        who satisfies all of the following:
                                  (I) The individual is an 
                                eligible individual with 
                                chronic conditions.
                                  (II) The individual is an 
                                individual with a substance use 
                                disorder.
                                  (III) The individual has not 
                                previously received health home 
                                services under any other State 
                                plan amendment approved for the 
                                State under this section by the 
                                Secretary.
                          (ii) Sud-focused state plan 
                        amendment.--The term ``SUD-focused 
                        State plan amendment'' means a State 
                        plan amendment under this section that 
                        is designed to provide health home 
                        services primarily to SUD-eligible 
                        individuals.
  (d) Hospital Referrals.--A State shall include in the State 
plan amendment a requirement for hospitals that are 
participating providers under the State plan or a waiver of 
such plan to establish procedures for referring any eligible 
individuals with chronic conditions who seek or need treatment 
in a hospital emergency department to designated providers.
  (e) Coordination.--A State shall consult and coordinate, as 
appropriate, with the [Substance Abuse and Mental Health 
Services Administration] Substance Use And Mental Health 
Services Administration in addressing issues regarding the 
prevention and treatment of mental illness and substance abuse 
among eligible individuals with chronic conditions.
  (f) Monitoring.--A State shall include in the State plan 
amendment--
          (1) a methodology for tracking avoidable hospital 
        readmissions and calculating savings that result from 
        improved chronic care coordination and management under 
        this section; and
          (2) a proposal for use of health information 
        technology in providing health home services under this 
        section and improving service delivery and coordination 
        across the care continuum (including the use of 
        wireless patient technology to improve coordination and 
        management of care and patient adherence to 
        recommendations made by their provider).
  (g) Report on Quality Measures.--As a condition for receiving 
payment for health home services provided to an eligible 
individual with chronic conditions, a designated provider shall 
report to the State, in accordance with such requirements as 
the Secretary shall specify, on all applicable measures for 
determining the quality of such services. When appropriate and 
feasible, a designated provider shall use health information 
technology in providing the State with such information.
  (h) Definitions.--In this section:
          (1) Eligible individual with chronic conditions.--
                  (A) In general.--Subject to subparagraph (B), 
                the term ``eligible individual with chronic 
                conditions'' means an individual who--
                          (i) is eligible for medical 
                        assistance under the State plan or 
                        under a waiver of such plan; and
                          (ii) has at least--
                                  (I) 2 chronic conditions;
                                  (II) 1 chronic condition and 
                                is at risk of having a second 
                                chronic condition; or
                                  (III) 1 serious and 
                                persistent mental health 
                                condition.
                  (B) Rule of construction.--Nothing in this 
                paragraph shall prevent the Secretary from 
                establishing higher levels as to the number or 
                severity of chronic or mental health conditions 
                for purposes of determining eligibility for 
                receipt of health home services under this 
                section.
          (2) Chronic condition.--The term ``chronic 
        condition'' has the meaning given that term by the 
        Secretary and shall include, but is not limited to, the 
        following:
                  (A) A mental health condition.
                  (B) Substance use disorder.
                  (C) Asthma.
                  (D) Diabetes.
                  (E) Heart disease.
                  (F) Being overweight, as evidenced by having 
                a Body Mass Index (BMI) over 25.
          (3) Health home.--The term ``health home'' means a 
        designated provider (including a provider that operates 
        in coordination with a team of health care 
        professionals) or a health team selected by an eligible 
        individual with chronic conditions to provide health 
        home services.
          (4) Health home services.--
                  (A) In general.--The term ``health home 
                services'' means comprehensive and timely high-
                quality services described in subparagraph (B) 
                that are provided by a designated provider, a 
                team of health care professionals operating 
                with such a provider, or a health team.
                  (B) Services described.--The services 
                described in this subparagraph are--
                          (i) comprehensive care management;
                          (ii) care coordination and health 
                        promotion;
                          (iii) comprehensive transitional 
                        care, including appropriate follow-up, 
                        from inpatient to other settings;
                          (iv) patient and family support 
                        (including authorized representatives);
                          (v) referral to community and social 
                        support services, if relevant; and
                          (vi) use of health information 
                        technology to link services, as 
                        feasible and appropriate.
          (5) Designated provider.--The term ``designated 
        provider'' means a physician, clinical practice or 
        clinical group practice, rural clinic, community health 
        center, community mental health center, home health 
        agency, or any other entity or provider (including 
        pediatricians, gynecologists, and obstetricians) that 
        is determined by the State and approved by the 
        Secretary to be qualified to be a health home for 
        eligible individuals with chronic conditions on the 
        basis of documentation evidencing that the physician, 
        practice, or clinic--
                  (A) has the systems and infrastructure in 
                place to provide health home services; and
                  (B) satisfies the qualification standards 
                established by the Secretary under subsection 
                (b).
          (6) Team of health care professionals.--The term 
        ``team of health care professionals'' means a team of 
        health professionals (as described in the State plan 
        amendment) that may--
                  (A) include physicians and other 
                professionals, such as a nurse care 
                coordinator, nutritionist, social worker, 
                behavioral health professional, or any 
                professionals deemed appropriate by the State; 
                and
                  (B) be free standing, virtual, or based at a 
                hospital, community health center, community 
                mental health center, rural clinic, clinical 
                practice or clinical group practice, academic 
                health center, or any entity deemed appropriate 
                by the State and approved by the Secretary.
          (7) Health team.--The term ``health team'' has the 
        meaning given such term for purposes of section 3502 of 
        the Patient Protection and Affordable Care Act.

           *       *       *       *       *       *       *

                              ----------                              


                CHILD ABUSE PREVENTION AND TREATMENT ACT




           *       *       *       *       *       *       *
TITLE I--GENERAL PROGRAM

           *       *       *       *       *       *       *


SEC. 105. GRANTS TO STATES, INDIAN TRIBES OR TRIBAL ORGANIZATIONS, AND 
                    PUBLIC OR PRIVATE AGENCIES AND ORGANIZATIONS.

  (a) Grants for Programs and Projects.--The Secretary may make 
grants to, and enter into contracts with, entities that are 
States, Indian tribes or tribal organizations, or public 
agencies or private agencies or organizations (or combinations 
of such entities) for programs and projects for the following 
purposes:
          (1) Training programs.--The Secretary may award 
        grants to public or private organizations under this 
        subsection--
                  (A) for the training of professional and 
                paraprofessional personnel in the fields of 
                health care, medicine, law enforcement, 
                judiciary, social work and child protection, 
                education, child care, and other relevant 
                fields, or individuals such as court appointed 
                special advocates (CASAs) and guardian ad 
                litem, who are engaged in, or intend to work 
                in, the field of prevention, identification, 
                and treatment of child abuse and neglect, 
                including the links between domestic violence 
                and child abuse and neglect;
                  (B) to improve the recruitment, selection, 
                and training of volunteers serving in public 
                and private children, youth, and family service 
                organizations in order to prevent child abuse 
                and neglect;
                  (C) for the establishment of resource centers 
                for the purpose of providing information and 
                training to professionals working in the field 
                of child abuse and neglect;
                  (D) for training to enhance linkages among 
                child protective service agencies and health 
                care agencies, entities providing physical and 
                mental health services, community resources, 
                and developmental disability agencies, to 
                improve screening, forensic diagnosis, and 
                health and developmental evaluations, and for 
                partnerships between child protective service 
                agencies and health care agencies that support 
                the coordinated use of existing Federal, State, 
                local, and private funding to meet the health 
                evaluation needs of children who have been 
                subjects of substantiated cases of child abuse 
                or neglect;
                  (E) for the training of personnel in best 
                practices to meet the unique needs of children 
                with disabilities, including promoting 
                interagency collaboration;
                  (F) for the training of personnel in best 
                practices to promote collaboration with the 
                families from the initial time of contact 
                during the investigation through treatment;
                  (G) for the training of personnel regarding 
                the legal duties of such personnel and their 
                responsibilities to protect the legal rights of 
                children and families;
                  (H) for the training of personnel in 
                childhood development including the unique 
                needs of children under age 3;
                  (I) for improving the training of supervisory 
                and nonsupervisory child welfare workers;
                  (J) for enabling State child welfare agencies 
                to coordinate the provision of services with 
                State and local health care agencies, alcohol 
                and drug abuse prevention and treatment 
                agencies, mental health agencies, other public 
                and private welfare agencies, and agencies that 
                provide early intervention services to promote 
                child safety, permanence, and family stability;
                  (K) for cross training for child protective 
                service workers in research-based strategies 
                for recognizing situations of substance abuse, 
                domestic violence, and neglect;
                  (L) for developing, implementing, or 
                operating information and education programs or 
                training programs designed to improve the 
                provision of services to infants or toddlers 
                with disabilities with life-threatening 
                conditions for--
                          (i) professionals and 
                        paraprofessional personnel concerned 
                        with the welfare of infants or toddlers 
                        with disabilities with life-threatening 
                        conditions, including personnel 
                        employed in child protective services 
                        programs and health care facilities; 
                        and
                          (ii) the parents of such infants; and
                  (M) for the training of personnel in best 
                practices relating to the provision of 
                differential response.
          (2) Triage procedures.--The Secretary may award 
        grants under this subsection to public and private 
        agencies that demonstrate innovation in responding to 
        reports of child abuse and neglect, including programs 
        of collaborative partnerships between the State child 
        protective services agency, community social service 
        agencies and family support programs, law enforcement 
        agencies, developmental disability agencies, substance 
        abuse treatment entities, health care entities, 
        domestic violence prevention entities, mental health 
        service entities, schools, churches and synagogues, and 
        other community agencies, to allow for the 
        establishment of a triage system that--
                  (A) accepts, screens, and assesses reports 
                received to determine which such reports 
                require an intensive intervention and which 
                require voluntary referral to another agency, 
                program, or project;
                  (B) provides, either directly or through 
                referral, a variety of community-linked 
                services to assist families in preventing child 
                abuse and neglect; and
                  (C) provides further investigation and 
                intensive intervention when the child's safety 
                is in jeopardy.
          (3) Mutual support programs.--The Secretary may award 
        grants to private organizations to establish or 
        maintain a national network of mutual support, 
        leadership, and self-help programs as a means of 
        strengthening families in partnership with their 
        communities.
          (4) Kinship care.--The Secretary may award grants to 
        public and private entities to assist such entities in 
        developing or implementing procedures using adult 
        relatives as the preferred placement for children 
        removed from their home, where such relatives are 
        determined to be capable of providing a safe nurturing 
        environment for the child and where such relatives 
        comply with the State child protection standards.
          (5) Linkages among child protective service agencies 
        and public health, mental health, substance abuse, 
        developmental disabilities, and domestic violence 
        service agencies.--The Secretary may award grants to 
        entities that provide linkages among State or local 
        child protective service agencies and public health, 
        mental health, substance abuse, developmental 
        disabilities, and domestic violence service agencies, 
        and entities that carry out community-based programs, 
        for the purpose of establishing linkages that are 
        designed to ensure that a greater number of 
        substantiated victims of child maltreatment have their 
        physical health, mental health, and developmental needs 
        appropriately diagnosed and treated, in accordance with 
        all applicable Federal and State privacy laws.
          (6) Collaborations between child protective service 
        entities and domestic violence service entities.--The 
        Secretary may award grants to public or private 
        agencies and organizations under this section to 
        develop or expand effective collaborations between 
        child protective service entities and domestic violence 
        service entities to improve collaborative investigation 
        and intervention procedures, provision for the safety 
        of the nonabusing parent involved and children, and 
        provision of services to children exposed to domestic 
        violence that also support the caregiving role of the 
        non-abusing parent.
          (7) Grants to states to improve and coordinate their 
        response to ensure the safety, permanency, and well-
        being of infants affected by substance use.--
                  (A) Program authorized.--The Secretary is 
                authorized to make grants to States for the 
                purpose of assisting child welfare agencies, 
                social services agencies, substance use 
                disorder treatment agencies, hospitals with 
                labor and delivery units, medical staff, public 
                health and mental health agencies, and maternal 
                and child health agencies to facilitate 
                collaboration in developing, updating, 
                implementing, and monitoring plans of safe care 
                described in section 106(b)(2)(B)(iii). Section 
                112(a)(2) shall not apply to the program 
                authorized under this paragraph.
                  (B) Distribution of funds.--
                          (i) Reservations.--Of the amounts 
                        made available to carry out 
                        subparagraph (A), the Secretary shall 
                        reserve--
                                  (I) no more than 3 percent 
                                for the purposes described in 
                                subparagraph (G); and
                                  (II) up to 3 percent for 
                                grants to Indian Tribes and 
                                tribal organizations to address 
                                the needs of infants born with, 
                                and identified as being 
                                affected by, substance abuse or 
                                withdrawal symptoms resulting 
                                from prenatal drug exposure or 
                                a fetal alcohol spectrum 
                                disorder and their families or 
                                caregivers, which to the extent 
                                practicable, shall be 
                                consistent with the uses of 
                                funds described under 
                                subparagraph (D).
                          (ii) Allotments to states and 
                        territories.--The Secretary shall allot 
                        the amount made available to carry out 
                        subparagraph (A) that remains after 
                        application of clause (i) to each State 
                        that applies for such a grant, in an 
                        amount equal to the sum of--
                                  (I) $500,000; and
                                  (II) an amount that bears the 
                                same relationship to any funds 
                                made available to carry out 
                                subparagraph (A) and remaining 
                                after application of clause 
                                (i), as the number of live 
                                births in the State in the 
                                previous calendar year bears to 
                                the number of live births in 
                                all States in such year.
                          (iii) Ratable reduction.--If the 
                        amount made available to carry out 
                        subparagraph (A) is insufficient to 
                        satisfy the requirements of clause 
                        (ii), the Secretary shall ratably 
                        reduce each allotment to a State.
                  (C) Application.--A State desiring a grant 
                under this paragraph shall submit an 
                application to the Secretary at such time and 
                in such manner as the Secretary may require. 
                Such application shall include--
                          (i) a description of--
                                  (I) the impact of substance 
                                use disorder in such State, 
                                including with respect to the 
                                substance or class of 
                                substances with the highest 
                                incidence of abuse in the 
                                previous year in such State, 
                                including--
                                          (aa) the prevalence 
                                        of substance use 
                                        disorder in such State;
                                          (bb) the aggregate 
                                        rate of births in the 
                                        State of infants 
                                        affected by substance 
                                        abuse or withdrawal 
                                        symptoms or a fetal 
                                        alcohol spectrum 
                                        disorder (as determined 
                                        by hospitals, insurance 
                                        claims, claims 
                                        submitted to the State 
                                        Medicaid program, or 
                                        other records), if 
                                        available and to the 
                                        extent practicable; and
                                          (cc) the number of 
                                        infants identified, for 
                                        whom a plan of safe 
                                        care was developed, and 
                                        for whom a referral was 
                                        made for appropriate 
                                        services, as reported 
                                        under section 
                                        106(d)(18);
                                  (II) the challenges the State 
                                faces in developing, 
                                implementing, and monitoring 
                                plans of safe care in 
                                accordance with section 
                                106(b)(2)(B)(iii);
                                  (III) the State's lead agency 
                                for the grant program and how 
                                that agency will coordinate 
                                with relevant State entities 
                                and programs, including the 
                                child welfare agency, the 
                                substance use disorder 
                                treatment agency, hospitals 
                                with labor and delivery units, 
                                health care providers, the 
                                public health and mental health 
                                agencies, programs funded by 
                                the [Substance Abuse and Mental 
                                Health Services Administration] 
                                Substance Use And Mental Health 
                                Services Administration that 
                                provide substance use disorder 
                                treatment for women, the State 
                                Medicaid program, the State 
                                agency administering the block 
                                grant program under title V of 
                                the Social Security Act (42 
                                U.S.C. 701 et seq.), the State 
                                agency administering the 
                                programs funded under part C of 
                                the Individuals with 
                                Disabilities Education Act (20 
                                U.S.C. 1431 et seq.), the 
                                maternal, infant, and early 
                                childhood home visiting program 
                                under section 511 of the Social 
                                Security Act (42 U.S.C. 711), 
                                the State judicial system, and 
                                other agencies, as determined 
                                by the Secretary, and Indian 
                                Tribes and tribal 
                                organizations, as appropriate, 
                                to implement the activities 
                                under this paragraph;
                                  (IV) how the State will 
                                monitor local development and 
                                implementation of plans of safe 
                                care, in accordance with 
                                section 106(b)(2)(B)(iii)(II), 
                                including how the State will 
                                monitor to ensure plans of safe 
                                care address differences 
                                between substance use disorder 
                                and medically supervised 
                                substance use, including for 
                                the treatment of a substance 
                                use disorder;
                                  (V) if applicable, how the 
                                State plans to utilize funding 
                                authorized under part E of 
                                title IV of the Social Security 
                                Act (42 U.S.C. 670 et seq.) to 
                                assist in carrying out any plan 
                                of safe care, including such 
                                funding authorized under 
                                section 471(e) of such Act (as 
                                in effect on October 1, 2018) 
                                for mental health and substance 
                                abuse prevention and treatment 
                                services and in-home parent 
                                skill-based programs and 
                                funding authorized under such 
                                section 472(j) (as in effect on 
                                October 1, 2018) for children 
                                with a parent in a licensed 
                                residential family-based 
                                treatment facility for 
                                substance abuse; and
                                  (VI) an assessment of the 
                                treatment and other services 
                                and programs available in the 
                                State to effectively carry out 
                                any plan of safe care 
                                developed, including 
                                identification of needed 
                                treatment, and other services 
                                and programs to ensure the 
                                well-being of young children 
                                and their families affected by 
                                substance use disorder, such as 
                                programs carried out under part 
                                C of the Individuals with 
                                Disabilities Education Act (20 
                                U.S.C. 1431 et seq.) and 
                                comprehensive early childhood 
                                development services and 
                                programs such as Head Start 
                                programs;
                          (ii) a description of how the State 
                        plans to use funds for activities 
                        described in subparagraph (D) for the 
                        purposes of ensuring State compliance 
                        with requirements under clauses (ii) 
                        and (iii) of section 106(b)(2)(B); and
                          (iii) an assurance that the State 
                        will comply with requirements to refer 
                        a child identified as substance-exposed 
                        to early intervention services as 
                        required pursuant to a grant under part 
                        C of the Individuals with Disabilities 
                        Education Act (20 U.S.C. 1431 et seq.).
                  (D) Uses of funds.--Funds awarded to a State 
                under this paragraph may be used for the 
                following activities, which may be carried out 
                by the State directly, or through grants or 
                subgrants, contracts, or cooperative 
                agreements:
                          (i) Improving State and local systems 
                        with respect to the development and 
                        implementation of plans of safe care, 
                        which--
                                  (I) shall include parent and 
                                caregiver engagement, as 
                                required under section 
                                106(b)(2)(B)(iii)(I), regarding 
                                available treatment and service 
                                options, which may include 
                                resources available for 
                                pregnant, perinatal, and 
                                postnatal women; and
                                  (II) may include activities 
                                such as--
                                          (aa) developing 
                                        policies, procedures, 
                                        or protocols for the 
                                        administration or 
                                        development of 
                                        evidence-based and 
                                        validated screening 
                                        tools for infants who 
                                        may be affected by 
                                        substance use 
                                        withdrawal symptoms or 
                                        a fetal alcohol 
                                        spectrum disorder and 
                                        pregnant, perinatal, 
                                        and postnatal women 
                                        whose infants may be 
                                        affected by substance 
                                        use withdrawal symptoms 
                                        or a fetal alcohol 
                                        spectrum disorder;
                                          (bb) improving 
                                        assessments used to 
                                        determine the needs of 
                                        the infant and family;
                                          (cc) improving 
                                        ongoing case management 
                                        services;
                                          (dd) improving access 
                                        to treatment services, 
                                        which may be prior to 
                                        the pregnant woman's 
                                        delivery date; and
                                          (ee) keeping families 
                                        safely together when it 
                                        is in the best interest 
                                        of the child.
                          (ii) Developing policies, procedures, 
                        or protocols in consultation and 
                        coordination with health professionals, 
                        public and private health facilities, 
                        and substance use disorder treatment 
                        agencies to ensure that--
                                  (I) appropriate notification 
                                to child protective services is 
                                made in a timely manner, as 
                                required under section 
                                106(b)(2)(B)(ii);
                                  (II) a plan of safe care is 
                                in place, in accordance with 
                                section 106(b)(2)(B)(iii), 
                                before the infant is discharged 
                                from the birth or health care 
                                facility; and
                                  (III) such health and related 
                                agency professionals are 
                                trained on how to follow such 
                                protocols and are aware of the 
                                supports that may be provided 
                                under a plan of safe care.
                          (iii) Training health professionals 
                        and health system leaders, child 
                        welfare workers, substance use disorder 
                        treatment agencies, and other related 
                        professionals such as home visiting 
                        agency staff and law enforcement in 
                        relevant topics including--
                                  (I) State mandatory reporting 
                                laws established under section 
                                106(b)(2)(B)(i) and the 
                                referral and process 
                                requirements for notification 
                                to child protective services 
                                when child abuse or neglect 
                                reporting is not mandated;
                                  (II) the co-occurrence of 
                                pregnancy and substance use 
                                disorder, and implications of 
                                prenatal exposure;
                                  (III) the clinical guidance 
                                about treating substance use 
                                disorder in pregnant and 
                                postpartum women;
                                  (IV) appropriate screening 
                                and interventions for infants 
                                affected by substance use 
                                disorder, withdrawal symptoms, 
                                or a fetal alcohol spectrum 
                                disorder and the requirements 
                                under section 
                                106(b)(2)(B)(iii); and
                                  (V) appropriate 
                                multigenerational strategies to 
                                address the mental health needs 
                                of the parent and child 
                                together.
                          (iv) Establishing partnerships, 
                        agreements, or memoranda of 
                        understanding between the lead agency 
                        and other entities (including health 
                        professionals, health facilities, child 
                        welfare professionals, juvenile and 
                        family court judges, substance use and 
                        mental disorder treatment programs, 
                        early childhood education programs, 
                        maternal and child health and early 
                        intervention professionals (including 
                        home visiting providers), peer-to-peer 
                        recovery programs such as parent 
                        mentoring programs, and housing 
                        agencies) to facilitate the 
                        implementation of, and compliance with, 
                        section 106(b)(2) and clause (ii) of 
                        this subparagraph, in areas which may 
                        include--
                                  (I) developing a 
                                comprehensive, multi-
                                disciplinary assessment and 
                                intervention process for 
                                infants, pregnant women, and 
                                their families who are affected 
                                by substance use disorder, 
                                withdrawal symptoms, or a fetal 
                                alcohol spectrum disorder, that 
                                includes meaningful engagement 
                                with and takes into account the 
                                unique needs of each family and 
                                addresses differences between 
                                medically supervised substance 
                                use, including for the 
                                treatment of substance use 
                                disorder, and substance use 
                                disorder;
                                  (II) ensuring that treatment 
                                approaches for serving infants, 
                                pregnant women, and perinatal 
                                and postnatal women whose 
                                infants may be affected by 
                                substance use, withdrawal 
                                symptoms, or a fetal alcohol 
                                spectrum disorder, are designed 
                                to, where appropriate, keep 
                                infants with their mothers 
                                during both inpatient and 
                                outpatient treatment; and
                                  (III) increasing access to 
                                all evidence-based medication-
                                assisted treatment approved by 
                                the Food and Drug 
                                Administration, behavioral 
                                therapy, and counseling 
                                services for the treatment of 
                                substance use disorders, as 
                                appropriate.
                          (v) Developing and updating systems 
                        of technology for improved data 
                        collection and monitoring under section 
                        106(b)(2)(B)(iii), including existing 
                        electronic medical records, to measure 
                        the outcomes achieved through the plans 
                        of safe care, including monitoring 
                        systems to meet the requirements of 
                        this Act and submission of performance 
                        measures.
                  (E) Reporting.--Each State that receives 
                funds under this paragraph, for each year such 
                funds are received, shall submit a report to 
                the Secretary, disaggregated by geographic 
                location, economic status, and major racial and 
                ethnic groups, except that such disaggregation 
                shall not be required if the results would 
                reveal personally identifiable information on, 
                with respect to infants identified under 
                section 106(b)(2)(B)(ii)--
                          (i) the number who experienced 
                        removal associated with parental 
                        substance use;
                          (ii) the number who experienced 
                        removal and subsequently are reunified 
                        with parents, and the length of time 
                        between such removal and reunification;
                          (iii) the number who are referred to 
                        community providers without a child 
                        protection case;
                          (iv) the number who receive services 
                        while in the care of their birth 
                        parents;
                          (v) the number who receive post-
                        reunification services within 1 year 
                        after a reunification has occurred; and
                          (vi) the number who experienced a 
                        return to out-of-home care within 1 
                        year after reunification.
                  (F) Secretary's report to congress.--The 
                Secretary shall submit an annual report to the 
                Committee on Health, Education, Labor, and 
                Pensions and the Committee on Appropriations of 
                the Senate and the Committee on Education and 
                the Workforce and the Committee on 
                Appropriations of the House of Representatives 
                that includes the information described in 
                subparagraph (E) and recommendations or 
                observations on the challenges, successes, and 
                lessons derived from implementation of the 
                grant program.
                  (G) Assisting states' implementation.--The 
                Secretary shall use the amount reserved under 
                subparagraph (B)(i)(I) to provide written 
                guidance and technical assistance to support 
                States in complying with and implementing this 
                paragraph, which shall include--
                          (i) technical assistance, including 
                        programs of in-depth technical 
                        assistance, to additional States, 
                        territories, and Indian Tribes and 
                        tribal organizations in accordance with 
                        the substance-exposed infant initiative 
                        developed by the National Center on 
                        Substance Abuse and Child Welfare;
                          (ii) guidance on the requirements of 
                        this Act with respect to infants born 
                        with and identified as being affected 
                        by substance use or withdrawal symptoms 
                        or fetal alcohol spectrum disorder, as 
                        described in clauses (ii) and (iii) of 
                        section 106(b)(2)(B), including by--
                                  (I) enhancing States' 
                                understanding of requirements 
                                and flexibilities under the 
                                law, including by clarifying 
                                key terms;
                                  (II) addressing state-
                                identified challenges with 
                                developing, implementing, and 
                                monitoring plans of safe care, 
                                including those reported under 
                                subparagraph (C)(i)(II);
                                  (III) disseminating best 
                                practices on implementation of 
                                plans of safe care, on such 
                                topics as differential 
                                response, collaboration and 
                                coordination, and 
                                identification and delivery of 
                                services for different 
                                populations, while recognizing 
                                needs of different populations 
                                and varying community 
                                approaches across States; and
                                  (IV) helping States improve 
                                the long-term safety and well-
                                being of young children and 
                                their families;
                          (iii) supporting State efforts to 
                        develop information technology systems 
                        to manage plans of safe care; and
                          (iv) preparing the Secretary's report 
                        to Congress described in subparagraph 
                        (F).
                  (H) Sunset.--The authority under this 
                paragraph shall sunset on September 30, 2023.
  (b) Discretionary Grants.--In addition to grants or contracts 
made under subsection (a), grants or contracts under this 
section may be used for the following:
          (1) Respite and crisis nursery programs provided by 
        community-based organizations under the direction and 
        supervision of hospitals.
          (2) Respite and crisis nursery programs provided by 
        community-based organizations.
          (3) Programs based within children's hospitals or 
        other pediatric and adolescent care facilities, that 
        provide model approaches for improving medical 
        diagnosis of child abuse and neglect and for health 
        evaluations of children for whom a report of 
        maltreatment has been substantiated.
          (4)(A) Providing hospital-based information and 
        referral services to--
                  (i) parents of children with disabilities; 
                and
                  (ii) children who have been victims of child 
                abuse or neglect and their parents.
          (B) Except as provided in subparagraph (C)(iii), 
        services provided under a grant received under this 
        paragraph shall be provided at the hospital involved--
                  (i) upon the birth or admission of a child 
                with disabilities; and
                  (ii) upon the treatment of a child for child 
                abuse and neglect.
          (C) Services, as determined as appropriate by the 
        grantee, provided under a grant received under this 
        paragraph shall be hospital-based and shall consist 
        of--
                  (i) the provision of notice to parents that 
                information relating to community services is 
                available;
                  (ii) the provision of appropriate information 
                to parents of a child with disabilities 
                regarding resources in the community, 
                particularly parent training resources, that 
                will assist such parents in caring for their 
                child;
                  (iii) the provision of appropriate 
                information to parents of a child who has been 
                a victim of child abuse or neglect regarding 
                resources in the community, particularly parent 
                training resources, that will assist such 
                parents in caring for their child and reduce 
                the possibility of child abuse and neglect;
                  (iv) the provision of appropriate follow-up 
                services to parents of a child described in 
                subparagraph (B) after the child has left the 
                hospital; and
                  (v) where necessary, assistance in 
                coordination of community services available to 
                parents of children described in subparagraph 
                (B).
        The grantee shall assure that parental involvement 
        described in this subparagraph is voluntary.
          (D) For purposes of this paragraph, a qualified 
        grantee is an acute care hospital that--
                  (i) is in a combination with--
                          (I) a health-care provider 
                        organization;
                          (II) a child welfare organization;
                          (III) a disability organization; and
                          (IV) a State child protection agency;
                  (ii) submits an application for a grant under 
                this paragraph that is approved by the 
                Secretary;
                  (iii) maintains an office in the hospital 
                involved for purposes of providing services 
                under such grant;
                  (iv) provides assurances to the Secretary 
                that in the conduct of the project the 
                confidentiality of medical, social, and 
                personal information concerning any person 
                described in subparagraph (A) or (B) shall be 
                maintained, and shall be disclosed only to 
                qualified persons providing required services 
                described in subparagraph (C) for purposes 
                relating to conduct of the project; and
                  (v) assumes legal responsibility for carrying 
                out the terms and conditions of the grant.
          (E) In awarding grants under this paragraph, the 
        Secretary shall--
                  (i) give priority under this section for two 
                grants under this paragraph, provided that one 
                grant shall be made to provide services in an 
                urban setting and one grant shall be made to 
                provide services in rural setting; and
                  (ii) encourage qualified grantees to combine 
                the amounts received under the grant with other 
                funds available to such grantees.
          (5) Such other innovative programs and projects that 
        show promise of preventing and treating cases of child 
        abuse and neglect as the Secretary may approve.
  (c) Evaluation.--In making grants for projects under this 
section, the Secretary shall require all such projects to be 
evaluated for their effectiveness. Funding for such evaluations 
shall be provided either as a stated percentage of a 
demonstration grant or as a separate grant or contract entered 
into by the Secretary for the purpose of evaluating a 
particular demonstration project or group of projects. In the 
case of an evaluation performed by the recipient of a grant, 
the Secretary shall make available technical assistance for the 
evaluation, where needed, including the use of a rigorous 
application of scientific evaluation techniques.

           *       *       *       *       *       *       *

                              ----------                              


                      HIGHER EDUCATION ACT OF 1965




           *       *       *       *       *       *       *
TITLE III--INSTITUTIONAL AID

           *       *       *       *       *       *       *



PART D--HISTORICALLY BLACK COLLEGE AND UNIVERSITY CAPITAL FINANCING

           *       *       *       *       *       *       *


SEC. 344. LIMITATIONS ON FEDERAL INSURANCE FOR BONDS ISSUED BY THE 
                    DESIGNATED BONDING AUTHORITY.

  (a) Limit on Amount.--At no time shall the aggregate 
principal amount of outstanding bonds insured under this part 
together with any accrued unpaid interest thereon exceed 
$1,100,000,000, of which--
          (1) not more than $733,333,333 shall be used for 
        loans to eligible institutions that are private 
        historically Black colleges and universities; and
          (2) not more than $366,666,667 shall be used for 
        loans to eligible institutions which are historically 
        Black public colleges and universities.
For purposes of paragraphs (1) and (2), Lincoln University of 
Pennsylvania is an historically Black public institution. [No 
institution of higher education that has received assistance 
under section 8 of the Act of March 2, 1867 (20 U.S.C. 123) 
shall be eligible to receive assistance under this part.]
  (b) Limitation on Credit Authority.--The authority of the 
Secretary to issue letters of credit and insurance under this 
part is effective only to the extent provided in advance by 
appropriations Acts.
  (c) Religious Activity Prohibition.--No loan may be made 
under this part for any educational program, activity or 
service related to sectarian instruction or religious worship 
or provided by a school or department of divinity or to an 
institution in which a substantial portion of its functions is 
subsumed in a religious mission.
  (d) Discrimination Prohibition.--No loan may be made to an 
institution under this part if the institution discriminates on 
account of race, color, religion, national origin, sex (to the 
extent provided in title IX of the Education Amendments of 
1972), or disabling condition; except that the prohibition with 
respect to religion shall not apply to an institution which is 
controlled by or which is closely identified with the tenets of 
a particular religious organization if the application of this 
section would not be consistent with the religious tenets of 
such organization.

           *       *       *       *       *       *       *


TITLE IV--STUDENT ASSISTANCE

           *       *       *       *       *       *       *



Part G--General Provisions Relating to Student Assistance Programs

           *       *       *       *       *       *       *



SEC. 484. STUDENT ELIGIBILITY.

  (a) In General.--In order to receive any grant, loan, or work 
assistance under this title, a student must--
          (1) be enrolled or accepted for enrollment in a 
        degree, certificate, or other program (including a 
        program of study abroad approved for credit by the 
        eligible institution at which such student is enrolled) 
        leading to a recognized educational credential at an 
        institution of higher education that is an eligible 
        institution in accordance with the provisions of 
        section 487, except as provided in subsections (b)(3) 
        and (b)(4), and not be enrolled in an elementary or 
        secondary school;
          (2) if the student is presently enrolled at an 
        institution, be maintaining satisfactory progress in 
        the course of study the student is pursuing in 
        accordance with the provisions of subsection (c);
          (3) not owe a refund on grants previously received at 
        any institution under this title, or be in default on 
        any loan from a student loan fund at any institution 
        provided for in part E, or a loan made, insured, or 
        guaranteed by the Secretary under this title for 
        attendance at any institution;
          (4) file with the Secretary, as part of the original 
        financial aid application process, a certification, 
        which need not be notarized, but which shall include--
                  (A) a statement of educational purpose 
                stating that the money attributable to such 
                grant, loan, or loan guarantee will be used 
                solely for expenses related to attendance or 
                continued attendance at such institution; and
                  (B) such student's social security number;
          (5) be a citizen or national of the United States, a 
        permanent resident of the United States, or a DACA 
        recipient (as defined in subsection (u)), have 
        temporary protected status under section 244 of the 
        Immigration and Nationality Act (8 U.S.C. 1254a), have 
        or able be to provide evidence from the Immigration and 
        Naturalization Service that he or she is in the United 
        States for other than a temporary purpose with the 
        intention of becoming a citizen or permanent resident; 
        and
          (6) if the student has been convicted of, or has pled 
        nolo contendere or guilty to, a crime involving fraud 
        in obtaining funds under this title, have completed the 
        repayment of such funds to the Secretary, or to the 
        holder in the case of a loan under this title obtained 
        by fraud.
  (b) Eligibility for Student Loans.--(1) In order to be 
eligible to receive any loan under this title (other than a 
loan under section 428B or 428C, or under section 428H pursuant 
to an exercise of discretion under section 479A) for any period 
of enrollment, a student who is not a graduate or professional 
student (as defined in regulations of the Secretary), and who 
is enrolled in a program at an institution which has a 
participation agreement with the Secretary to make awards under 
subpart 1 of part A of this title, shall--
          (A)(i) have received a determination of eligibility 
        or ineligibility for a Pell Grant under such subpart 1 
        for such period of enrollment; and (ii) if determined 
        to be eligible, have filed an application for a Pell 
        Grant for such enrollment period; or
          (B) have (A) filed an application with the Pell Grant 
        processor for such institution for such enrollment 
        period, and (B) received from the financial aid 
        administrator of the institution a preliminary 
        determination of the student's eligibility or 
        ineligibility for a grant under such subpart 1.
  (2) In order to be eligible to receive any loan under section 
428A for any period of enrollment, a student shall--
          (A) have received a determination of need for a loan 
        under section 428(a)(2)(B) of this title;
          (B) if determined to have need for a loan under 
        section 428, have applied for such a loan; and
          (C) has applied for a loan under section 428H, if 
        such student is eligible to apply for such a loan.
  (3) A student who--
          (A) is carrying at least one-half the normal full-
        time work load for the course of study that the student 
        is pursuing, as determined by an eligible institution, 
        and
          (B) is enrolled in a course of study necessary for 
        enrollment in a program leading to a degree or 
        certificate,
shall be, notwithstanding paragraph (1) of subsection (a), 
eligible to apply for loans under part B or D of this title. 
The eligibility described in this paragraph shall be restricted 
to one 12-month period.
  (4) A student who--
          (A) is carrying at least one-half the normal full-
        time work load for the course of study the student is 
        pursuing, as determined by the institution, and
          (B) is enrolled or accepted for enrollment in a 
        program at an eligible institution necessary for a 
        professional credential or certification from a State 
        that is required for employment as a teacher in an 
        elementary or secondary school in that State,
shall be, notwithstanding paragraph (1) of subsection (a), 
eligible to apply for loans under part B, D, or E or work-study 
assistance under part C of this title.
  (5) Notwithstanding any other provision of this subsection, 
no incarcerated student is eligible to receive a loan under 
this title.
  (c) Satisfactory Progress.--(1) For the purpose of subsection 
(a)(2), a student is maintaining satisfactory progress if--
          (A) the institution at which the student is in 
        attendance, reviews the progress of the student at the 
        end of each academic year, or its equivalent, as 
        determined by the institution, and
          (B) the student has a cumulative C average, or its 
        equivalent or academic standing consistent with the 
        requirements for graduation, as determined by the 
        institution, at the end of the second such academic 
        year.
  (2) Whenever a student fails to meet the eligibility 
requirements of subsection (a)(2) as a result of the 
application of this subsection and subsequent to that failure 
the student has academic standing consistent with the 
requirements for graduation, as determined by the institution, 
for any grading period, the student may, subject to this 
subsection, again be eligible under subsection (a)(2) for a 
grant, loan, or work assistance under this title.
  (3) Any institution of higher education at which the student 
is in attendance may waive the provisions of paragraph (1) or 
paragraph (2) of this subsection for undue hardship based on--
          (A) the death of a relative of the student,
          (B) the personal injury or illness of the student, or
          (C) special circumstances as determined by the 
        institution.
  (d) Students Who Are Not High School Graduates.--
          (1) Student eligibility.--In order for a student who 
        does not have a certificate of graduation from a school 
        providing secondary education, or the recognized 
        equivalent of such certificate, to be eligible for any 
        assistance under subparts 1, 3, and 4 of part A and 
        parts B, C, D, and E of this title, the student shall 
        meet the requirements of one of the following 
        subparagraphs:
                  (A) The student is enrolled in an eligible 
                career pathway program and meets one of the 
                following standards:
                          (i) The student shall take an 
                        independently administered examination 
                        and shall achieve a score, specified by 
                        the Secretary, demonstrating that such 
                        student can benefit from the education 
                        or training being offered. Such 
                        examination shall be approved by the 
                        Secretary on the basis of compliance 
                        with such standards for development, 
                        administration, and scoring as the 
                        Secretary may prescribe in regulations.
                          (ii) The student shall be determined 
                        as having the ability to benefit from 
                        the education or training in accordance 
                        with such process as the State shall 
                        prescribe. Any such process described 
                        or approved by a State for the purposes 
                        of this section shall be effective 6 
                        months after the date of submission to 
                        the Secretary unless the Secretary 
                        disapproves such process. In 
                        determining whether to approve or 
                        disapprove such process, the Secretary 
                        shall take into account the 
                        effectiveness of such process in 
                        enabling students without secondary 
                        school diplomas or the equivalent 
                        thereof to benefit from the instruction 
                        offered by institutions utilizing such 
                        process, and shall also take into 
                        account the cultural diversity, 
                        economic circumstances, and educational 
                        preparation of the populations served 
                        by the institutions.
                          (iii) The student shall be determined 
                        by the institution of higher education 
                        as having the ability to benefit from 
                        the education or training offered by 
                        the institution of higher education 
                        upon satisfactory completion of 6 
                        credit hours or the equivalent 
                        coursework that are applicable toward a 
                        degree or certificate offered by the 
                        institution of higher education.
                  (B) The student has completed a secondary 
                school education in a home school setting that 
                is treated as a home school or private school 
                under State law.
          (2) Eligible career pathway program.--In this 
        subsection, the term ``eligible career pathway 
        program'' means a program that combines rigorous and 
        high-quality education, training, and other services 
        that--
                  (A) aligns with the skill needs of industries 
                in the economy of the State or regional economy 
                involved;
                  (B) prepares an individual to be successful 
                in any of a full range of secondary or 
                postsecondary education options, including 
                apprenticeships registered under the Act of 
                August 16, 1937 (commonly known as the 
                ``National Apprenticeship Act''; 50 Stat. 664, 
                chapter 663; 29 U.S.C. 50 et seq.) (referred to 
                individually in this Act as an 
                ``apprenticeship'', except in section 171);
                  (C) includes counseling to support an 
                individual in achieving the individual's 
                education and career goals;
                  (D) includes, as appropriate, education 
                offered concurrently with and in the same 
                context as workforce preparation activities and 
                training for a specific occupation or 
                occupational cluster;
                  (E) organizes education, training, and other 
                services to meet the particular needs of an 
                individual in a manner that accelerates the 
                educational and career advancement of the 
                individual to the extent practicable;
                  (F) enables an individual to attain a 
                secondary school diploma or its recognized 
                equivalent, and at least 1 recognized 
                postsecondary credential; and
                  (G) helps an individual enter or advance 
                within a specific occupation or occupational 
                cluster.
  (e) Certification for GSL Eligibility.--Each eligible 
institution may certify student eligibility for a loan by an 
eligible lender under part B of this title prior to completing 
the review for accuracy of the information submitted by the 
applicant required by regulations issued under this title, if--
          (1) checks for the loans are mailed to the eligible 
        institution prior to disbursements;
          (2) the disbursement is not made until the review is 
        complete; and
          (3) the eligible institution has no evidence or 
        documentation on which the institution may base a 
        determination that the information submitted by the 
        applicant is incorrect.
  (f) Loss of Eligibility for Violation of Loan Limits.--(1) No 
student shall be eligible to receive any grant, loan, or work 
assistance under this title if the eligible institution 
determines that the student fraudulently borrowed in violation 
of the annual loan limits under part B, part D, or part E of 
this title in the same academic year, or if the student 
fraudulently borrowed in excess of the aggregate maximum loan 
limits under such part B, part D, or part E.
  (2) If the institution determines that the student 
inadvertently borrowed amounts in excess of such annual or 
aggregate maximum loan limits, such institution shall allow the 
student to repay any amount borrowed in excess of such limits 
prior to certifying the student's eligibility for further 
assistance under this title.
  (g) Verification of Immigration Status.--
          (1) In general.--The Secretary shall implement a 
        system under which the statements and supporting 
        documentation, if required, of an individual declaring 
        that such individual is in compliance with the 
        requirements of subsection (a)(5) shall be verified 
        prior to the individual's receipt of a grant, loan, or 
        work assistance under this title.
          (2) Special rule.--The documents collected and 
        maintained by an eligible institution in the admission 
        of a student to the institution may be used by the 
        student in lieu of the documents used to establish both 
        employment authorization and identity under section 
        274A(b)(1)(B) of the Immigration and Nationality Act (8 
        U.S.C. 1324a) to verify eligibility to participate in 
        work-study programs under part C of this title.
          (3) Verification mechanisms.--The Secretary is 
        authorized to verify such statements and supporting 
        documentation through a data match, using an automated 
        or other system, with other Federal agencies that may 
        be in possession of information relevant to such 
        statements and supporting documentation.
          (4) Review.--In the case of such an individual who is 
        not a citizen or national of the United States, if the 
        statement described in paragraph (1) is submitted but 
        the documentation required under paragraph (2) is not 
        presented or if the documentation required under 
        paragraph (2)(A) is presented but such documentation is 
        not verified under paragraph (3)--
                  (A) the institution--
                          (i) shall provide a reasonable 
                        opportunity to submit to the 
                        institution evidence indicating a 
                        satisfactory immigration status, and
                          (ii) may not delay, deny, reduce, or 
                        terminate the individual's eligibility 
                        for the grant, loan, or work assistance 
                        on the basis of the individual's 
                        immigration status until such a 
                        reasonable opportunity has been 
                        provided; and
                  (B) if there are submitted documents which 
                the institution determines constitute 
                reasonable evidence indicating such status--
                          (i) the institution shall transmit to 
                        the Immigration and Naturalization 
                        Service either photostatic or other 
                        similar copies of such documents, or 
                        information from such documents, as 
                        specified by the Immigration and 
                        Naturalization Service, for official 
                        verification,
                          (ii) pending such verification, the 
                        institution may not delay, deny, 
                        reduce, or terminate the individual's 
                        eligibility for the grant, loan, or 
                        work assistance on the basis of the 
                        individual's immigration status, and
                          (iii) the institution shall not be 
                        liable for the consequences of any 
                        action, delay, or failure of the 
                        Service to conduct such verification.
  (h) Limitations of Enforcement Actions Against 
Institutions.--The Secretary shall not take any compliance, 
disallowance, penalty, or other regulatory action against an 
institution of higher education with respect to any error in 
the institution's determination to make a student eligible for 
a grant, loan, or work assistance based on citizenship or 
immigration status--
          (1) if the institution has provided such eligibility 
        based on a verification of satisfactory immigration 
        status by the Immigration and Naturalization Service,
          (2) because the institution, under subsection 
        (g)(4)(A)(i), was required to provide a reasonable 
        opportunity to submit documentation, or
          (3) because the institution, under subsection 
        (g)(4)(B)(i), was required to wait for the response of 
        the Immigration and Naturalization Service to the 
        institution's request for official verification of the 
        immigration status of the student.
  (i) Validity of Loan Guarantees for Loan Payments Made Before 
Immigration Status Verification Completed.--Notwithstanding 
subsection (h), if--
          (1) a guaranty is made under this title for a loan 
        made with respect to an individual,
          (2) at the time the guaranty is entered into, the 
        provisions of subsection (h) had been complied with,
          (3) amounts are paid under the loan subject to such 
        guaranty, and
          (4) there is a subsequent determination that, because 
        of an unsatisfactory immigration status, the individual 
        is not eligible for the loan,
the official of the institution making the determination shall 
notify and instruct the entity making the loan to cease further 
payments under the loan, but such guaranty shall not be voided 
or otherwise nullified with respect to such payments made 
before the date the entity receives the notice.
  (k) Special Rule for Correspondence Courses.--A student shall 
not be eligible to receive grant, loan, or work assistance 
under this title for a correspondence course unless such course 
is part of a program leading to an associate, bachelor or 
graduate degree.
  (l) Courses Offered Through Distance Education.--
          (1) Relation to correspondence courses.--
                  (A) In general.--A student enrolled in a 
                course of instruction at an institution of 
                higher education that is offered principally 
                through distance education and leads to a 
                recognized certificate, or recognized 
                associate, recognized baccalaureate, or 
                recognized graduate degree, conferred by such 
                institution, shall not be considered to be 
                enrolled in correspondence courses.
                  (B) Exception.--An institution of higher 
                education referred to in subparagraph (A) shall 
                not include an institution or school described 
                in section 3(3)(C) of the Carl D. Perkins 
                Career and Technical Education Act of 2006.
          (2) Reductions of financial aid.--A student's 
        eligibility to receive grants, loans, or work 
        assistance under this title shall be reduced if a 
        financial aid officer determines under the 
        discretionary authority provided in section 479A that 
        distance education results in a substantially reduced 
        cost of attendance to such student.
          (3) Special rule.--For award years beginning prior to 
        July 1, 2008, the Secretary shall not take any 
        compliance, disallowance, penalty, or other action 
        based on a violation of this subsection against a 
        student or an eligible institution when such action 
        arises out of such institution's prior award of student 
        assistance under this title if the institution 
        demonstrates to the satisfaction of the Secretary that 
        its course of instruction would have been in 
        conformance with the requirements of this subsection.
  (m) Students With a First Baccalaureate or Professional 
Degree.--A student shall not be ineligible for assistance under 
parts B, C, D, and E of this title because such student has 
previously received a baccalaureate or professional degree.
  (n) Data Base Matching.--To enforce the Selective Service 
registration provisions of section 12(f) of the Military 
Selective Service Act (50 U.S.C. App. 462(f)), the Secretary 
shall conduct data base matches with the Selective Service, 
using common demographic data elements. Appropriate 
confirmation, through an application output document or through 
other means, of any person's registration shall fulfill the 
requirement to file a separate statement of compliance. In the 
absence of a confirmation from such data matches, an 
institution may also use data or documents that support either 
the student's registration, or the absence of a registration 
requirement for the student, to fulfill the requirement to file 
a separate statement of compliance. The mechanism for reporting 
the resolution of nonconfirmed matches shall be prescribed by 
the Secretary in regulations.
  (o) Study Abroad.--Nothing in this Act shall be construed to 
limit or otherwise prohibit access to study abroad programs 
approved by the home institution at which a student is 
enrolled. An otherwise eligible student who is engaged in a 
program of study abroad approved for academic credit by the 
home institution at which the student is enrolled shall be 
eligible to receive grant, loan, or work assistance under this 
title, without regard to whether such study abroad program is 
required as part of the student's degree program.
   (p) Verification of Social Security Number.--The Secretary 
of Education, in cooperation with the Commissioner of the 
Social Security Administration, shall verify any social 
security number provided by a student to an eligible 
institution under subsection (a)(4) and shall enforce the 
following conditions:
          (1) Except as provided in paragraphs (2) and (3), an 
        institution shall not deny, reduce, delay, or terminate 
        a student's eligibility for assistance under this part 
        because social security number verification is pending.
          (2) If there is a determination by the Secretary that 
        the social security number provided to an eligible 
        institution by a student is incorrect, the institution 
        shall deny or terminate the student's eligibility for 
        any grant, loan, or work assistance under this title 
        until such time as the student provides documented 
        evidence of a social security number that is determined 
        by the institution to be correct.
          (3) If there is a determination by the Secretary that 
        the social security number provided to an eligible 
        institution by a student is incorrect, and a correct 
        social security number cannot be provided by such 
        student, and a loan has been guaranteed for such 
        student under part B of this title, the institution 
        shall notify and instruct the lender and guaranty 
        agency making and guaranteeing the loan, respectively, 
        to cease further disbursements of the loan, but such 
        guaranty shall not be voided or otherwise nullified 
        with respect to such disbursements made before the date 
        that the lender and the guaranty agency receives such 
        notice.
          (4) Nothing in this subsection shall permit the 
        Secretary to take any compliance, disallowance, 
        penalty, or other regulatory action against--
                  (A) any institution of higher education with 
                respect to any error in a social security 
                number, unless such error was a result of fraud 
                on the part of the institution; or
                  (B) any student with respect to any error in 
                a social security number, unless such error was 
                a result of fraud on the part of the student.
  (r) Suspension of Eligibility for Drug-Related Offenses.--
          (1) In general.--A student who is convicted of any 
        offense under any Federal or State law involving the 
        possession or sale of a controlled substance for 
        conduct that occurred during a period of enrollment for 
        which the student was receiving any grant, loan, or 
        work assistance under this title shall not be eligible 
        to receive any grant, loan, or work assistance under 
        this title from the date of that conviction for the 
        period of time specified in the following table:

**ERR02If convicted of an offense involving: 
  The possession of   con-
  trolled substance: Ineligibility period is: 
  First offense..... 1 year  ...........................................
  Second offense.... 2 years  ..........................................
  Third offense..... Indefinite. .......................................
  The sale of a cont olled
  substance:        Ineligibility period is: 
  First offense..... 2 years  ..........................................
  Second offense.... Indefinite.........................................

          (2) Rehabilitation.--A student whose eligibility has 
        been suspended under paragraph (1) may resume 
        eligibility before the end of the ineligibility period 
        determined under such paragraph if--
                  (A) the student satisfactorily completes a 
                drug rehabilitation program that--
                          (i) complies with such criteria as 
                        the Secretary shall prescribe in 
                        regulations for purposes of this 
                        paragraph; and
                          (ii) includes two unannounced drug 
                        tests;
                  (B) the student successfully passes two 
                unannounced drug tests conducted by a drug 
                rehabilitation program that complies with such 
                criteria as the Secretary shall prescribe in 
                regulations for purposes of subparagraph 
                (A)(i); or
                  (C) the conviction is reversed, set aside, or 
                otherwise rendered nugatory.
          (3) Definitions.--In this subsection, the term 
        ``controlled substance'' has the meaning given the term 
        in section 102(6) of the Controlled Substances Act (21 
        U.S.C. 802(6)).
  (s) Students With Intellectual Disabilities.--
          (1) Definitions.--In this subsection the terms 
        ``comprehensive transition and postsecondary program 
        for students with intellectual disabilities'' and 
        ``student with an intellectual disability'' have the 
        meanings given the terms in section 760.
          (2) Requirements.--Notwithstanding subsections (a), 
        (c), and (d), in order to receive any grant or work 
        assistance under section 401, subpart 3 of part A, or 
        part C, a student with an intellectual disability 
        shall--
                  (A) be enrolled or accepted for enrollment in 
                a comprehensive transition and postsecondary 
                program for students with intellectual 
                disabilities at an institution of higher 
                education;
                  (B) be maintaining satisfactory progress in 
                the program as determined by the institution, 
                in accordance with standards established by the 
                institution; and
                  (C) meet the requirements of paragraphs (3), 
                (4), (5), and (6) of subsection (a).
          (3) Authority.--Notwithstanding any other provision 
        of law unless such provision is enacted with specific 
        reference to this section, the Secretary is authorized 
        to waive any statutory provision applicable to the 
        student financial assistance programs under section 
        401, subpart 3 of part A, or part C (other than a 
        provision of part F related to such a program), or any 
        institutional eligibility provisions of this title, as 
        the Secretary determines necessary to ensure that 
        programs enrolling students with intellectual 
        disabilities otherwise determined to be eligible under 
        this subsection may receive such financial assistance.
          (4) Regulations.--Notwithstanding regulations 
        applicable to grant or work assistance awards made 
        under section 401, subpart 3 of part A, and part C 
        (other than a regulation under part F related to such 
        an award), including with respect to eligible programs, 
        instructional time, credit status, and enrollment 
        status as described in section 481, the Secretary shall 
        promulgate regulations allowing programs enrolling 
        students with intellectual disabilities otherwise 
        determined to be eligible under this subsection to 
        receive such awards.
   (t) Data Analysis on Access to Federal Student Aid For 
Certain Populations.--
          (1) Development of the system.--Within one year of 
        enactment of the Higher Education Opportunity Act, the 
        Secretary shall analyze data from the FAFSA containing 
        information regarding the number, characteristics, and 
        circumstances of students denied Federal student aid 
        based on a drug conviction while receiving Federal aid.
          (2) Results from analysis.--The results from the 
        analysis of such information shall be made available on 
        a continuous basis via the Department website and the 
        Digest of Education Statistics.
          (3) Data updating.--The data analyzed under this 
        subsection shall be updated at the beginning of each 
        award year and at least one additional time during such 
        award year.
          (4) Report to congress.--The Secretary shall prepare 
        and submit to the authorizing committees, in each 
        fiscal year, a report describing the results obtained 
        by the establishment and operation of the data system 
        authorized by this subsection.
                  (u) DACA Recipient.--In this section the term 
                ``DACA recipient'' means an alien (as defined 
                in section 101(a)(3) of the Immigration and 
                Nationality Act (8 U.S.C. 1101(a)(3)) who is 
                inadmissible to the United State or deportable 
                from the United States under the immigration 
                laws (as defined in section 101(a)(17) of such 
                Act (8 U.S.C. 1101(a)(17)), and who the 
                Secretary of Homeland Security has, in his or 
                her discretion, determined should be afforded a 
                grant of deferred action under the Deferred 
                Action for Childhood Arrivals (DACA) policy.

           *       *       *       *       *       *       *


SEC. 487. PROGRAM PARTICIPATION AGREEMENTS.

  (a) Required for Programs of Assistance; Contents.--In order 
to be an eligible institution for the purposes of any program 
authorized under this title, an institution must be an 
institution of higher education or an eligible institution (as 
that term is defined for the purpose of that program) and 
shall, except with respect to a program under subpart 4 of part 
A, enter into a program participation agreement with the 
Secretary. The agreement shall condition the initial and 
continuing eligibility of an institution to participate in a 
program upon compliance with the following requirements:
          (1) The institution will use funds received by it for 
        any program under this title and any interest or other 
        earnings thereon solely for the purpose specified in 
        and in accordance with the provision of that program.
          (2) The institution shall not charge any student a 
        fee for processing or handling any application, form, 
        or data required to determine the student's eligibility 
        for assistance under this title or the amount of such 
        assistance.
          (3) The institution will establish and maintain such 
        administrative and fiscal procedures and records as may 
        be necessary to ensure proper and efficient 
        administration of funds received from the Secretary or 
        from students under this title, together with 
        assurances that the institution will provide, upon 
        request and in a timely fashion, information relating 
        to the administrative capability and financial 
        responsibility of the institution to--
                  (A) the Secretary;
                  (B) the appropriate guaranty agency; and
                  (C) the appropriate accrediting agency or 
                association.
          (4) The institution will comply with the provisions 
        of subsection (c) of this section and the regulations 
        prescribed under that subsection, relating to fiscal 
        eligibility.
          (5) The institution will submit reports to the 
        Secretary and, in the case of an institution 
        participating in a program under part B or part E, to 
        holders of loans made to the institution's students 
        under such parts at such times and containing such 
        information as the Secretary may reasonably require to 
        carry out the purpose of this title.
          (6) The institution will not provide any student with 
        any statement or certification to any lender under part 
        B that qualifies the student for a loan or loans in 
        excess of the amount that student is eligible to borrow 
        in accordance with sections 425(a), 428(a)(2), and 
        428(b)(1) (A) and (B).
          (7) The institution will comply with the requirements 
        of section 485.
          (8) In the case of an institution that advertises job 
        placement rates as a means of attracting students to 
        enroll in the institution, the institution will make 
        available to prospective students, at or before the 
        time of application (A) the most recent available data 
        concerning employment statistics, graduation 
        statistics, and any other information necessary to 
        substantiate the truthfulness of the advertisements, 
        and (B) relevant State licensing requirements of the 
        State in which such institution is located for any job 
        for which the course of instruction is designed to 
        prepare such prospective students.
          (9) In the case of an institution participating in a 
        program under part B or D, the institution will inform 
        all eligible borrowers enrolled in the institution 
        about the availability and eligibility of such 
        borrowers for State grant assistance from the State in 
        which the institution is located, and will inform such 
        borrowers from another State of the source for further 
        information concerning such assistance from that State.
          (10) The institution certifies that it has in 
        operation a drug abuse prevention program that is 
        determined by the institution to be accessible to any 
        officer, employee, or student at the institution.
          (11) In the case of any institution whose students 
        receive financial assistance pursuant to section 
        484(d), the institution will make available to such 
        students a program proven successful in assisting 
        students in obtaining a certificate of high school 
        equivalency.
          (12) The institution certifies that--
                  (A) the institution has established a campus 
                security policy; and
                  (B) the institution has complied with the 
                disclosure requirements of section 485(f).
          (13) The institution will not deny any form of 
        Federal financial aid to any student who meets the 
        eligibility requirements of this title on the grounds 
        that the student is participating in a program of study 
        abroad approved for credit by the institution.
          (14)(A) The institution, in order to participate as 
        an eligible institution under part B or D, will develop 
        a Default Management Plan for approval by the Secretary 
        as part of its initial application for certification as 
        an eligible institution and will implement such Plan 
        for two years thereafter.
          (B) Any institution of higher education which changes 
        ownership and any eligible institution which changes 
        its status as a parent or subordinate institution 
        shall, in order to participate as an eligible 
        institution under part B or D, develop a Default 
        Management Plan for approval by the Secretary and 
        implement such Plan for two years after its change of 
        ownership or status.
          (C) This paragraph shall not apply in the case of an 
        institution in which (i) neither the parent nor the 
        subordinate institution has a cohort default rate in 
        excess of 10 percent, and (ii) the new owner of such 
        parent or subordinate institution does not, and has 
        not, owned any other institution with a cohort default 
        rate in excess of 10 percent.
          (15) The institution acknowledges the authority of 
        the Secretary, guaranty agencies, lenders, accrediting 
        agencies, the Secretary of Veterans Affairs, and the 
        State agencies under subpart 1 of part H to share with 
        each other any information pertaining to the 
        institution's eligibility to participate in programs 
        under this title or any information on fraud and abuse.
          (16)(A) The institution will not knowingly employ an 
        individual in a capacity that involves the 
        administration of programs under this title, or the 
        receipt of program funds under this title, who has been 
        convicted of, or has pled nolo contendere or guilty to, 
        a crime involving the acquisition, use, or expenditure 
        of funds under this title, or has been judicially 
        determined to have committed fraud involving funds 
        under this title or contract with an institution or 
        third party servicer that has been terminated under 
        section 432 involving the acquisition, use, or 
        expenditure of funds under this title, or who has been 
        judicially determined to have committed fraud involving 
        funds under this title.
          (B) The institution will not knowingly contract with 
        or employ any individual, agency, or organization that 
        has been, or whose officers or employees have been--
                  (i) convicted of, or pled nolo contendere or 
                guilty to, a crime involving the acquisition, 
                use, or expenditure of funds under this title; 
                or
                  (ii) judicially determined to have committed 
                fraud involving funds under this title.
          (17) The institution will complete surveys conducted 
        as a part of the Integrated Postsecondary Education 
        Data System (IPEDS) or any other Federal postsecondary 
        institution data collection effort, as designated by 
        the Secretary, in a timely manner and to the 
        satisfaction of the Secretary.
          (18) The institution will meet the requirements 
        established pursuant to section 485(g).
          (19) The institution will not impose any penalty, 
        including the assessment of late fees, the denial of 
        access to classes, libraries, or other institutional 
        facilities, or the requirement that the student borrow 
        additional funds, on any student because of the 
        student's inability to meet his or her financial 
        obligations to the institution as a result of the 
        delayed disbursement of the proceeds of a loan made 
        under this title due to compliance with the provisions 
        of this title, or delays attributable to the 
        institution.
          (20) The institution will not provide any commission, 
        bonus, or other incentive payment based directly or 
        indirectly on success in securing enrollments or 
        financial aid to any persons or entities engaged in any 
        student recruiting or admission activities or in making 
        decisions regarding the award of student financial 
        assistance, except that this paragraph shall not apply 
        to the recruitment of foreign students residing in 
        foreign countries who are not eligible to receive 
        Federal student assistance.
          (21) The institution will meet the requirements 
        established by the Secretary and accrediting agencies 
        or associations, and will provide evidence to the 
        Secretary that the institution has the authority to 
        operate within a State.
          (22) The institution will comply with the refund 
        policy established pursuant to section 484B.
          (23)(A) The institution, if located in a State to 
        which section 4(b) of the National Voter Registration 
        Act of 1993 (42 U.S.C. 1973gg-2(b)) does not apply, 
        will make a good faith effort to distribute a mail 
        voter registration form, requested and received from 
        the State, to each student enrolled in a degree or 
        certificate program and physically in attendance at the 
        institution, and to make such forms widely available to 
        students at the institution.
          (B) The institution shall request the forms from the 
        State 120 days prior to the deadline for registering to 
        vote within the State. If an institution has not 
        received a sufficient quantity of forms to fulfill this 
        section from the State within 60 days prior to the 
        deadline for registering to vote in the State, the 
        institution shall not be held liable for not meeting 
        the requirements of this section during that election 
        year.
          (C) This paragraph shall apply to general and special 
        elections for Federal office, as defined in section 
        301(3) of the Federal Election Campaign Act of 1971 (2 
        U.S.C. 431(3)), and to the elections for Governor or 
        other chief executive within such State).
                  (D) The institution shall be considered in 
                compliance with the requirements of 
                subparagraph (A) for each student to whom the 
                institution electronically transmits a message 
                containing a voter registration form acceptable 
                for use in the State in which the institution 
                is located, or an Internet address where such a 
                form can be downloaded, if such information is 
                in an electronic message devoted exclusively to 
                voter registration.
          (24) In the case of a proprietary institution of 
        higher education (as defined in section 102(b)), such 
        institution will derive not less than [ten percent] 
        fifteen percent of such institution's revenues from 
        sources other than Federal funds that are disbursed or 
        delivered to or on behalf of a student to be used to 
        attend such institution (referred to in this paragraph 
        and subsection (d) as ``Federal education assistance 
        funds''), as calculated in accordance with subsection 
        (d)(1), or will be subject to the sanctions described 
        in subsection (d)(2).
          (25) In the case of an institution that participates 
        in a loan program under this title, the institution 
        will--
                  (A) develop a code of conduct with respect to 
                such loans with which the institution's 
                officers, employees, and agents shall comply, 
                that--
                          (i) prohibits a conflict of interest 
                        with the responsibilities of an 
                        officer, employee, or agent of an 
                        institution with respect to such loans; 
                        and
                          (ii) at a minimum, includes the 
                        provisions described in subsection (e);
                  (B) publish such code of conduct prominently 
                on the institution's website; and
                  (C) administer and enforce such code by, at a 
                minimum, requiring that all of the 
                institution's officers, employees, and agents 
                with responsibilities with respect to such 
                loans be annually informed of the provisions of 
                the code of conduct.
          (26) The institution will, upon written request, 
        disclose to the alleged victim of any crime of violence 
        (as that term is defined in section 16 of title 18, 
        United States Code), or a nonforcible sex offense, the 
        report on the results of any disciplinary proceeding 
        conducted by such institution against a student who is 
        the alleged perpetrator of such crime or offense with 
        respect to such crime or offense. If the alleged victim 
        of such crime or offense is deceased as a result of 
        such crime or offense, the next of kin of such victim 
        shall be treated as the alleged victim for purposes of 
        this paragraph.
          (27) In the case of an institution that has entered 
        into a preferred lender arrangement, the institution 
        will at least annually compile, maintain, and make 
        available for students attending the institution, and 
        the families of such students, a list, in print or 
        other medium, of the specific lenders for loans made, 
        insured, or guaranteed under this title or private 
        education loans that the institution recommends, 
        promotes, or endorses in accordance with such preferred 
        lender arrangement. In making such list, the 
        institution shall comply with the requirements of 
        subsection (h).
          (28)(A) The institution will, upon the request of an 
        applicant for a private education loan, provide to the 
        applicant the form required under section 128(e)(3) of 
        the Truth in Lending Act (15 U.S.C. 1638(e)(3)), and 
        the information required to complete such form, to the 
        extent the institution possesses such information.
          (B) For purposes of this paragraph, the term 
        ``private education loan'' has the meaning given such 
        term in section 140 of the Truth in Lending Act.
          (29) The institution certifies that the institution--
                  (A) has developed plans to effectively combat 
                the unauthorized distribution of copyrighted 
                material, including through the use of a 
                variety of technology-based deterrents; and
                  (B) will, to the extent practicable, offer 
                alternatives to illegal downloading or peer-to-
                peer distribution of intellectual property, as 
                determined by the institution in consultation 
                with the chief technology officer or other 
                designated officer of the institution.
  (b) Hearings.--(1) An institution that has received written 
notice of a final audit or program review determination and 
that desires to have such determination reviewed by the 
Secretary shall submit to the Secretary a written request for 
review not later than 45 days after receipt of notification of 
the final audit or program review determination.
  (2) The Secretary shall, upon receipt of written notice under 
paragraph (1), arrange for a hearing and notify the institution 
within 30 days of receipt of such notice the date, time, and 
place of such hearing. Such hearing shall take place not later 
than 120 days from the date upon which the Secretary notifies 
the institution.
  (c) Audits; Financial Responsibility; Enforcement of 
Standards.--(1) Notwithstanding any other provisions of this 
title, the Secretary shall prescribe such regulations as may be 
necessary to provide for--
          (A)(i) except as provided in clauses (ii) and (iii), 
        a financial audit of an eligible institution with 
        regard to the financial condition of the institution in 
        its entirety, and a compliance audit of such 
        institution with regard to any funds obtained by it 
        under this title or obtained from a student or a parent 
        who has a loan insured or guaranteed by the Secretary 
        under this title, on at least an annual basis and 
        covering the period since the most recent audit, 
        conducted by a qualified, independent organization or 
        person in accordance with standards established by the 
        Comptroller General for the audit of governmental 
        organizations, programs, and functions, and as 
        prescribed in regulations of the Secretary, the results 
        of which shall be submitted to the Secretary and shall 
        be available to cognizant guaranty agencies, eligible 
        lenders, State agencies, and the appropriate State 
        agency notifying the Secretary under subpart 1 of part 
        H, except that the Secretary may modify the 
        requirements of this clause with respect to 
        institutions of higher education that are foreign 
        institutions, and may waive such requirements with 
        respect to a foreign institution whose students receive 
        less than $500,000 in loans under this title during the 
        award year preceding the audit period;
          (ii) with regard to an eligible institution which is 
        audited under chapter 75 of title 31, United States 
        Code, deeming such audit to satisfy the requirements of 
        clause (i) for the period covered by such audit; or
          (iii) at the discretion of the Secretary, with regard 
        to an eligible institution (other than an eligible 
        institution described in section 102(a)(1)(C)) that has 
        obtained less than $200,000 in funds under this title 
        during each of the 2 award years that precede the audit 
        period and submits a letter of credit payable to the 
        Secretary equal to not less than \1/2\ of the annual 
        potential liabilities of such institution as determined 
        by the Secretary, deeming an audit conducted every 3 
        years to satisfy the requirements of clause (i), except 
        for the award year immediately preceding renewal of the 
        institution's eligibility under section 498(g);
          (B) in matters not governed by specific program 
        provisions, the establishment of reasonable standards 
        of financial responsibility and appropriate 
        institutional capability for the administration by an 
        eligible institution of a program of student financial 
        aid under this title, including any matter the 
        Secretary deems necessary to the sound administration 
        of the financial aid programs, such as the pertinent 
        actions of any owner, shareholder, or person exercising 
        control over an eligible institution;
          (C)(i) except as provided in clause (ii), a 
        compliance audit of a third party servicer (other than 
        with respect to the servicer's functions as a lender if 
        such functions are otherwise audited under this part 
        and such audits meet the requirements of this clause), 
        with regard to any contract with an eligible 
        institution, guaranty agency, or lender for 
        administering or servicing any aspect of the student 
        assistance programs under this title, at least once 
        every year and covering the period since the most 
        recent audit, conducted by a qualified, independent 
        organization or person in accordance with standards 
        established by the Comptroller General for the audit of 
        governmental organizations, programs, and functions, 
        and as prescribed in regulations of the Secretary, the 
        results of which shall be submitted to the Secretary; 
        or
          (ii) with regard to a third party servicer that is 
        audited under chapter 75 of title 31, United States 
        Code, such audit shall be deemed to satisfy the 
        requirements of clause (i) for the period covered by 
        such audit;
          (D)(i) a compliance audit of a secondary market with 
        regard to its transactions involving, and its servicing 
        and collection of, loans made under this title, at 
        least once a year and covering the period since the 
        most recent audit, conducted by a qualified, 
        independent organization or person in accordance with 
        standards established by the Comptroller General for 
        the audit of governmental organizations, programs, and 
        functions, and as prescribed in regulations of the 
        Secretary, the results of which shall be submitted to 
        the Secretary; or
          (ii) with regard to a secondary market that is 
        audited under chapter 75 of title 31, United States 
        Code, such audit shall be deemed to satisfy the 
        requirements of clause (i) for the period covered by 
        the audit;
          (E) the establishment, by each eligible institution 
        under part B responsible for furnishing to the lender 
        the statement required by section 428(a)(2)(A)(i), of 
        policies and procedures by which the latest known 
        address and enrollment status of any student who has 
        had a loan insured under this part and who has either 
        formally terminated his enrollment, or failed to re-
        enroll on at least a half-time basis, at such 
        institution, shall be furnished either to the holder 
        (or if unknown, the insurer) of the note, not later 
        than 60 days after such termination or failure to re-
        enroll;
          (F) the limitation, suspension, or termination of the 
        participation in any program under this title of an 
        eligible institution, or the imposition of a civil 
        penalty under paragraph (3)(B) whenever the Secretary 
        has determined, after reasonable notice and opportunity 
        for hearing, that such institution has violated or 
        failed to carry out any provision of this title, any 
        regulation prescribed under this title, or any 
        applicable special arrangement, agreement, or 
        limitation, except that no period of suspension under 
        this section shall exceed 60 days unless the 
        institution and the Secretary agree to an extension or 
        unless limitation or termination proceedings are 
        initiated by the Secretary within that period of time;
          (G) an emergency action against an institution, under 
        which the Secretary shall, effective on the date on 
        which a notice and statement of the basis of the action 
        is mailed to the institution (by registered mail, 
        return receipt requested), withhold funds from the 
        institution or its students and withdraw the 
        institution's authority to obligate funds under any 
        program under this title, if the Secretary--
                  (i) receives information, determined by the 
                Secretary to be reliable, that the institution 
                is violating any provision of this title, any 
                regulation prescribed under this title, or any 
                applicable special arrangement, agreement, or 
                limitation,
                  (ii) determines that immediate action is 
                necessary to prevent misuse of Federal funds, 
                and
                  (iii) determines that the likelihood of loss 
                outweighs the importance of the procedures 
                prescribed under subparagraph (D) for 
                limitation, suspension, or termination,
        except that an emergency action shall not exceed 30 
        days unless limitation, suspension, or termination 
        proceedings are initiated by the Secretary against the 
        institution within that period of time, and except that 
        the Secretary shall provide the institution an 
        opportunity to show cause, if it so requests, that the 
        emergency action is unwarranted;
          (H) the limitation, suspension, or termination of the 
        eligibility of a third party servicer to contract with 
        any institution to administer any aspect of an 
        institution's student assistance program under this 
        title, or the imposition of a civil penalty under 
        paragraph (3)(B), whenever the Secretary has 
        determined, after reasonable notice and opportunity for 
        a hearing, that such organization, acting on behalf of 
        an institution, has violated or failed to carry out any 
        provision of this title, any regulation prescribed 
        under this title, or any applicable special 
        arrangement, agreement, or limitation, except that no 
        period of suspension under this subparagraph shall 
        exceed 60 days unless the organization and the 
        Secretary agree to an extension, or unless limitation 
        or termination proceedings are initiated by the 
        Secretary against the individual or organization within 
        that period of time; and
          (I) an emergency action against a third party 
        servicer that has contracted with an institution to 
        administer any aspect of the institution's student 
        assistance program under this title, under which the 
        Secretary shall, effective on the date on which a 
        notice and statement of the basis of the action is 
        mailed to such individual or organization (by 
        registered mail, return receipt requested), withhold 
        funds from the individual or organization and withdraw 
        the individual or organization's authority to act on 
        behalf of an institution under any program under this 
        title, if the Secretary--
                  (i) receives information, determined by the 
                Secretary to be reliable, that the individual 
                or organization, acting on behalf of an 
                institution, is violating any provision of this 
                title, any regulation prescribed under this 
                title, or any applicable special arrangement, 
                agreement, or limitation,
                  (ii) determines that immediate action is 
                necessary to prevent misuse of Federal funds, 
                and
                  (iii) determines that the likelihood of loss 
                outweighs the importance of the procedures 
                prescribed under subparagraph (F), for 
                limitation, suspension, or termination,
        except that an emergency action shall not exceed 30 
        days unless the limitation, suspension, or termination 
        proceedings are initiated by the Secretary against the 
        individual or organization within that period of time, 
        and except that the Secretary shall provide the 
        individual or organization an opportunity to show 
        cause, if it so requests, that the emergency action is 
        unwarranted.
  (2) If an individual who, or entity that, exercises 
substantial control, as determined by the Secretary in 
accordance with the definition of substantial control in 
subpart 3 of part H, over one or more institutions 
participating in any program under this title, or, for purposes 
of paragraphs (1) (H) and (I), over one or more organizations 
that contract with an institution to administer any aspect of 
the institution's student assistance program under this title, 
is determined to have committed one or more violations of the 
requirements of any program under this title, or has been 
suspended or debarred in accordance with the regulations of the 
Secretary, the Secretary may use such determination, 
suspension, or debarment as the basis for imposing an emergency 
action on, or limiting, suspending, or terminating, in a single 
proceeding, the participation of any or all institutions under 
the substantial control of that individual or entity.
  (3)(A) Upon determination, after reasonable notice and 
opportunity for a hearing, that an eligible institution has 
engaged in substantial misrepresentation of the nature of its 
educational program, its financial charges, or the 
employability of its graduates, the Secretary may suspend or 
terminate the eligibility status for any or all programs under 
this title of any otherwise eligible institution, in accordance 
with procedures specified in paragraph (1)(D) of this 
subsection, until the Secretary finds that such practices have 
been corrected.
  (B)(i) Upon determination, after reasonable notice and 
opportunity for a hearing, that an eligible institution--
          (I) has violated or failed to carry out any provision 
        of this title or any regulation prescribed under this 
        title; or
          (II) has engaged in substantial misrepresentation of 
        the nature of its educational program, its financial 
        charges, and the employability of its graduates,
the Secretary may impose a civil penalty upon such institution 
of not to exceed $25,000 for each violation or 
misrepresentation.
  (ii) Any civil penalty may be compromised by the Secretary. 
In determining the amount of such penalty, or the amount agreed 
upon in compromise, the appropriateness of the penalty to the 
size of the institution of higher education subject to the 
determination, and the gravity of the violation, failure, or 
misrepresentation shall be considered. The amount of such 
penalty, when finally determined, or the amount agreed upon in 
compromise, may be deducted from any sums owing by the United 
States to the institution charged.
  (4) The Secretary shall publish a list of State agencies 
which the Secretary determines to be reliable authority as to 
the quality of public postsecondary vocational education in 
their respective States for the purpose of determining 
eligibility for all Federal student assistance programs.
  (5) The Secretary shall make readily available to appropriate 
guaranty agencies, eligible lenders, State agencies notifying 
the Secretary under subpart 1 of part H, and accrediting 
agencies or associations the results of the audits of eligible 
institutions conducted pursuant to paragraph (1)(A).
  (6) The Secretary is authorized to provide any information 
collected as a result of audits conducted under this section, 
together with audit information collected by guaranty agencies, 
to any Federal or State agency having responsibilities with 
respect to student financial assistance, including those 
referred to in subsection (a)(15) of this section.
  (7) Effective with respect to any audit conducted under this 
subsection after December 31, 1988, if, in the course of 
conducting any such audit, the personnel of the Department of 
Education discover, or are informed of, grants or other 
assistance provided by an institution in accordance with this 
title for which the institution has not received funds 
appropriated under this title (in the amount necessary to 
provide such assistance), including funds for which 
reimbursement was not requested prior to such discovery or 
information, such institution shall be permitted to offset that 
amount against any sums determined to be owed by the 
institution pursuant to such audit, or to receive reimbursement 
for that amount (if the institution does not owe any such 
sums).
  (d) Implementation of Non-Federal Revenue Requirement.--
          (1) Calculation.--In making calculations under 
        subsection (a)(24), a proprietary institution of higher 
        education shall--
                  (A) use the cash basis of accounting, except 
                in the case of loans described in subparagraph 
                (D)(i) that are made by the proprietary 
                institution of higher education;
                  (B) consider as revenue only those funds 
                generated by the institution from--
                          (i) tuition, fees, and other 
                        institutional charges for students 
                        enrolled in programs eligible for 
                        assistance under this title;
                          (ii) activities conducted by the 
                        institution that are necessary for the 
                        education and training of the 
                        institution's students, if such 
                        activities are--
                                  (I) conducted on campus or at 
                                a facility under the control of 
                                the institution;
                                  (II) performed under the 
                                supervision of a member of the 
                                institution's faculty; and
                                  (III) required to be 
                                performed by all students in a 
                                specific educational program at 
                                the institution; and
                          (iii) funds paid by a student, or on 
                        behalf of a student by a party other 
                        than the institution, for an education 
                        or training program that is not 
                        eligible for funds under this title, if 
                        the program--
                                  (I) is approved or licensed 
                                by the appropriate State 
                                agency;
                                  (II) is accredited by an 
                                accrediting agency recognized 
                                by the Secretary; or
                                  (III) provides an industry-
                                recognized credential or 
                                certification;
                  (C) presume that any Federal education 
                assistance funds that are disbursed or 
                delivered to or on behalf of a student will be 
                used to pay the student's tuition, fees, or 
                other institutional charges, regardless of 
                whether the institution credits those funds to 
                the student's account or pays those funds 
                directly to the student, except to the extent 
                that the student's tuition, fees, or other 
                institutional charges are satisfied by--
                          (i) grant funds provided by non-
                        Federal public agencies or private 
                        sources independent of the institution;
                          (ii) funds provided under a 
                        contractual arrangement with a Federal, 
                        State, or local government agency for 
                        the purpose of providing job training 
                        to low-income individuals who are in 
                        need of that training;
                          (iii) funds used by a student from 
                        savings plans for educational expenses 
                        established by or on behalf of the 
                        student and which qualify for special 
                        tax treatment under the Internal 
                        Revenue Code of 1986; or
                          (iv) institutional scholarships 
                        described in subparagraph (D)(iii);
                  (D) include institutional aid as revenue to 
                the school only as follows:
                          (i) in the case of loans made by a 
                        proprietary institution of higher 
                        education on or after July 1, 2008 and 
                        prior to July 1, 2012, the net present 
                        value of such loans made by the 
                        institution during the applicable 
                        institutional fiscal year accounted for 
                        on an accrual basis and estimated in 
                        accordance with generally accepted 
                        accounting principles and related 
                        standards and guidance, if the loans--
                                  (I) are bona fide as 
                                evidenced by enforceable 
                                promissory notes;
                                  (II) are issued at intervals 
                                related to the institution's 
                                enrollment periods; and
                                  (III) are subject to regular 
                                loan repayments and 
                                collections;
                          (ii) in the case of loans made by a 
                        proprietary institution of higher 
                        education on or after July 1, 2012, 
                        only the amount of loan repayments 
                        received during the applicable 
                        institutional fiscal year, excluding 
                        repayments on loans made and accounted 
                        for as specified in clause (i); and
                          (iii) in the case of scholarships 
                        provided by a proprietary institution 
                        of higher education, only those 
                        scholarships provided by the 
                        institution in the form of monetary aid 
                        or tuition discounts based upon the 
                        academic achievements or financial need 
                        of students, disbursed during each 
                        fiscal year from an established 
                        restricted account, and only to the 
                        extent that funds in that account 
                        represent designated funds from an 
                        outside source or from income earned on 
                        those funds;
                  (E) in the case of each student who receives 
                a loan on or after July 1, 2008, and prior to 
                July 1, 2011, that is authorized under section 
                428H or that is a Federal Direct Unsubsidized 
                Stafford Loan, treat as revenue received by the 
                institution from sources other than funds 
                received under this title, the amount by which 
                the disbursement of such loan received by the 
                institution exceeds the limit on such loan in 
                effect on the day before the date of enactment 
                of the Ensuring Continued Access to Student 
                Loans Act of 2008; and
                  (F) exclude from revenues--
                          (i) the amount of funds the 
                        institution received under part C, 
                        unless the institution used those funds 
                        to pay a student's institutional 
                        charges;
                          (ii) the amount of funds the 
                        institution received under subpart 4 of 
                        part A;
                          (iii) the amount of funds provided by 
                        the institution as matching funds for a 
                        program under this title;
                          (iv) the amount of funds provided by 
                        the institution for a program under 
                        this title that are required to be 
                        refunded or returned; and
                          (v) the amount charged for books, 
                        supplies, and equipment, unless the 
                        institution includes that amount as 
                        tuition, fees, or other institutional 
                        charges.
          (2) Sanctions.--
                  (A) Ineligibility.--A proprietary institution 
                of higher education that fails to meet a 
                requirement of subsection (a)(24) for two 
                consecutive institutional fiscal years shall be 
                ineligible to participate in the programs 
                authorized by this title for a period of not 
                less than two institutional fiscal years. To 
                regain eligibility to participate in the 
                programs authorized by this title, a 
                proprietary institution of higher education 
                shall demonstrate compliance with all 
                eligibility and certification requirements 
                under section 498 for a minimum of two 
                institutional fiscal years after the 
                institutional fiscal year in which the 
                institution became ineligible.
                  (B) Additional enforcement.--In addition to 
                such other means of enforcing the requirements 
                of this title as may be available to the 
                Secretary, if a proprietary institution of 
                higher education fails to meet a requirement of 
                subsection (a)(24) for any institutional fiscal 
                year, then the institution's eligibility to 
                participate in the programs authorized by this 
                title becomes provisional for the two 
                institutional fiscal years after the 
                institutional fiscal year in which the 
                institution failed to meet the requirement of 
                subsection (a)(24), except that such 
                provisional eligibility shall terminate--
                          (i) on the expiration date of the 
                        institution's program participation 
                        agreement under this subsection that is 
                        in effect on the date the Secretary 
                        determines that the institution failed 
                        to meet the requirement of subsection 
                        (a)(24); or
                          (ii) in the case that the Secretary 
                        determines that the institution failed 
                        to meet a requirement of subsection 
                        (a)(24) for two consecutive 
                        institutional fiscal years, on the date 
                        the institution is determined 
                        ineligible in accordance with 
                        subparagraph (A).
          (3) Publication on college navigator website.--The 
        Secretary shall publicly disclose on the College 
        Navigator website--
                  (A) the identity of any proprietary 
                institution of higher education that fails to 
                meet a requirement of subsection (a)(24); and
                  (B) the extent to which the institution 
                failed to meet such requirement.
          (4) Report to congress.--Not later than July 1, 2009, 
        and July 1 of each succeeding year, the Secretary shall 
        submit to the authorizing committees a report that 
        contains, for each proprietary institution of higher 
        education that receives assistance under this title, as 
        provided in the audited financial statements submitted 
        to the Secretary by each institution pursuant to the 
        requirements of subsection (a)(24)--
                  (A) the amount and percentage of such 
                institution's revenues received from sources 
                under this title; and
                  (B) the amount and percentage of such 
                institution's revenues received from other 
                sources.
  (e) Code of Conduct Requirements.--An institution of higher 
education's code of conduct, as required under subsection 
(a)(25), shall include the following requirements:
          (1) Ban on revenue-sharing arrangements.--
                  (A) Prohibition.--The institution shall not 
                enter into any revenue-sharing arrangement with 
                any lender.
                  (B) Definition.--For purposes of this 
                paragraph, the term ``revenue-sharing 
                arrangement'' means an arrangement between an 
                institution and a lender under which--
                          (i) a lender provides or issues a 
                        loan that is made, insured, or 
                        guaranteed under this title to students 
                        attending the institution or to the 
                        families of such students; and
                          (ii) the institution recommends the 
                        lender or the loan products of the 
                        lender and in exchange, the lender pays 
                        a fee or provides other material 
                        benefits, including revenue or profit 
                        sharing, to the institution, an officer 
                        or employee of the institution, or an 
                        agent.
          (2) Gift ban.--
                  (A) Prohibition.--No officer or employee of 
                the institution who is employed in the 
                financial aid office of the institution or who 
                otherwise has responsibilities with respect to 
                education loans, or agent who has 
                responsibilities with respect to education 
                loans, shall solicit or accept any gift from a 
                lender, guarantor, or servicer of education 
                loans.
                  (B) Definition of gift.--
                          (i) In general.--In this paragraph, 
                        the term ``gift'' means any gratuity, 
                        favor, discount, entertainment, 
                        hospitality, loan, or other item having 
                        a monetary value of more than a de 
                        minimus amount. The term includes a 
                        gift of services, transportation, 
                        lodging, or meals, whether provided in 
                        kind, by purchase of a ticket, payment 
                        in advance, or reimbursement after the 
                        expense has been incurred.
                          (ii) Exceptions.--The term ``gift'' 
                        shall not include any of the following:
                                  (I) Standard material, 
                                activities, or programs on 
                                issues related to a loan, 
                                default aversion, default 
                                prevention, or financial 
                                literacy, such as a brochure, a 
                                workshop, or training.
                                  (II) Food, refreshments, 
                                training, or informational 
                                material furnished to an 
                                officer or employee of an 
                                institution, or to an agent, as 
                                an integral part of a training 
                                session that is designed to 
                                improve the service of a 
                                lender, guarantor, or servicer 
                                of education loans to the 
                                institution, if such training 
                                contributes to the professional 
                                development of the officer, 
                                employee, or agent.
                                  (III) Favorable terms, 
                                conditions, and borrower 
                                benefits on an education loan 
                                provided to a student employed 
                                by the institution if such 
                                terms, conditions, or benefits 
                                are comparable to those 
                                provided to all students of the 
                                institution.
                                  (IV) Entrance and exit 
                                counseling services provided to 
                                borrowers to meet the 
                                institution's responsibilities 
                                for entrance and exit 
                                counseling as required by 
                                subsections (b) and (l) of 
                                section 485, as long as--
                                          (aa) the 
                                        institution's staff are 
                                        in control of the 
                                        counseling, (whether in 
                                        person or via 
                                        electronic 
                                        capabilities); and
                                          (bb) such counseling 
                                        does not promote the 
                                        products or services of 
                                        any specific lender.
                                  (V) Philanthropic 
                                contributions to an institution 
                                from a lender, servicer, or 
                                guarantor of education loans 
                                that are unrelated to education 
                                loans or any contribution from 
                                any lender, guarantor, or 
                                servicer that is not made in 
                                exchange for any advantage 
                                related to education loans.
                                  (VI) State education grants, 
                                scholarships, or financial aid 
                                funds administered by or on 
                                behalf of a State.
                          (iii) Rule for gifts to family 
                        members.--For purposes of this 
                        paragraph, a gift to a family member of 
                        an officer or employee of an 
                        institution, to a family member of an 
                        agent, or to any other individual based 
                        on that individual's relationship with 
                        the officer, employee, or agent, shall 
                        be considered a gift to the officer, 
                        employee, or agent if--
                                  (I) the gift is given with 
                                the knowledge and acquiescence 
                                of the officer, employee, or 
                                agent; and
                                  (II) the officer, employee, 
                                or agent has reason to believe 
                                the gift was given because of 
                                the official position of the 
                                officer, employee, or agent.
          (3) Contracting arrangements prohibited.--
                  (A) Prohibition.--An officer or employee who 
                is employed in the financial aid office of the 
                institution or who otherwise has 
                responsibilities with respect to education 
                loans, or an agent who has responsibilities 
                with respect to education loans, shall not 
                accept from any lender or affiliate of any 
                lender any fee, payment, or other financial 
                benefit (including the opportunity to purchase 
                stock) as compensation for any type of 
                consulting arrangement or other contract to 
                provide services to a lender or on behalf of a 
                lender relating to education loans.
                  (B) Exceptions.--Nothing in this subsection 
                shall be construed as prohibiting--
                          (i) an officer or employee of an 
                        institution who is not employed in the 
                        institution's financial aid office and 
                        who does not otherwise have 
                        responsibilities with respect to 
                        education loans, or an agent who does 
                        not have responsibilities with respect 
                        to education loans, from performing 
                        paid or unpaid service on a board of 
                        directors of a lender, guarantor, or 
                        servicer of education loans;
                          (ii) an officer or employee of the 
                        institution who is not employed in the 
                        institution's financial aid office but 
                        who has responsibility with respect to 
                        education loans as a result of a 
                        position held at the institution, or an 
                        agent who has responsibility with 
                        respect to education loans, from 
                        performing paid or unpaid service on a 
                        board of directors of a lender, 
                        guarantor, or servicer of education 
                        loans, if the institution has a written 
                        conflict of interest policy that 
                        clearly sets forth that officers, 
                        employees, or agents must recuse 
                        themselves from participating in any 
                        decision of the board regarding 
                        education loans at the institution; or
                          (iii) an officer, employee, or 
                        contractor of a lender, guarantor, or 
                        servicer of education loans from 
                        serving on a board of directors, or 
                        serving as a trustee, of an 
                        institution, if the institution has a 
                        written conflict of interest policy 
                        that the board member or trustee must 
                        recuse themselves from any decision 
                        regarding education loans at the 
                        institution.
          (4) Interaction with borrowers.--The institution 
        shall not--
                  (A) for any first-time borrower, assign, 
                through award packaging or other methods, the 
                borrower's loan to a particular lender; or
                  (B) refuse to certify, or delay certification 
                of, any loan based on the borrower's selection 
                of a particular lender or guaranty agency.
          (5) Prohibition on offers of funds for private 
        loans.--
                  (A) Prohibition.--The institution shall not 
                request or accept from any lender any offer of 
                funds to be used for private education loans 
                (as defined in section 140 of the Truth in 
                Lending Act), including funds for an 
                opportunity pool loan, to students in exchange 
                for the institution providing concessions or 
                promises regarding providing the lender with--
                          (i) a specified number of loans made, 
                        insured, or guaranteed under this 
                        title;
                          (ii) a specified loan volume of such 
                        loans; or
                          (iii) a preferred lender arrangement 
                        for such loans.
                  (B) Definition of opportunity pool loan.--In 
                this paragraph, the term ``opportunity pool 
                loan'' means a private education loan made by a 
                lender to a student attending the institution 
                or the family member of such a student that 
                involves a payment, directly or indirectly, by 
                such institution of points, premiums, 
                additional interest, or financial support to 
                such lender for the purpose of such lender 
                extending credit to the student or the family.
          (6) Ban on staffing assistance.--
                  (A) Prohibition.--The institution shall not 
                request or accept from any lender any 
                assistance with call center staffing or 
                financial aid office staffing.
                  (B) Certain assistance permitted.--Nothing in 
                paragraph (1) shall be construed to prohibit 
                the institution from requesting or accepting 
                assistance from a lender related to--
                          (i) professional development training 
                        for financial aid administrators;
                          (ii) providing educational counseling 
                        materials, financial literacy 
                        materials, or debt management materials 
                        to borrowers, provided that such 
                        materials disclose to borrowers the 
                        identification of any lender that 
                        assisted in preparing or providing such 
                        materials; or
                          (iii) staffing services on a short-
                        term, nonrecurring basis to assist the 
                        institution with financial aid-related 
                        functions during emergencies, including 
                        State-declared or federally declared 
                        natural disasters, federally declared 
                        national disasters, and other localized 
                        disasters and emergencies identified by 
                        the Secretary.
          (7) Advisory board compensation.--Any employee who is 
        employed in the financial aid office of the 
        institution, or who otherwise has responsibilities with 
        respect to education loans or other student financial 
        aid of the institution, and who serves on an advisory 
        board, commission, or group established by a lender, 
        guarantor, or group of lenders or guarantors, shall be 
        prohibited from receiving anything of value from the 
        lender, guarantor, or group of lenders or guarantors, 
        except that the employee may be reimbursed for 
        reasonable expenses incurred in serving on such 
        advisory board, commission, or group.
  (f) Institutional Requirements for Teach-Outs.--
          (1) In general.--In the event the Secretary initiates 
        the limitation, suspension, or termination of the 
        participation of an institution of higher education in 
        any program under this title under the authority of 
        subsection (c)(1)(F) or initiates an emergency action 
        under the authority of subsection (c)(1)(G) and its 
        prescribed regulations, the Secretary shall require 
        that institution to prepare a teach-out plan for 
        submission to the institution's accrediting agency or 
        association in compliance with section 496(c)(3), the 
        Secretary's regulations on teach-out plans, and the 
        standards of the institution's accrediting agency or 
        association.
          (2) Teach-out plan defined.--In this subsection, the 
        term ``teach-out plan'' means a written plan that 
        provides for the equitable treatment of students if an 
        institution of higher education ceases to operate 
        before all students have completed their program of 
        study, and may include, if required by the 
        institution's accrediting agency or association, an 
        agreement between institutions for such a teach-out 
        plan.
  (g) Inspector General Report on Gift Ban Violations.--The 
Inspector General of the Department shall--
          (1) submit an annual report to the authorizing 
        committees identifying all violations of an 
        institution's code of conduct that the Inspector 
        General has substantiated during the preceding year 
        relating to the gift ban provisions described in 
        subsection (e)(2); and
          (2) make the report available to the public through 
        the Department's website.
  (h) Preferred Lender List Requirements.--
          (1) In general.--In compiling, maintaining, and 
        making available a preferred lender list as required 
        under subsection (a)(27), the institution will--
                  (A) clearly and fully disclose on such 
                preferred lender list--
                          (i) not less than the information 
                        required to be disclosed under section 
                        153(a)(2)(A);
                          (ii) why the institution has entered 
                        into a preferred lender arrangement 
                        with each lender on the preferred 
                        lender list, particularly with respect 
                        to terms and conditions or provisions 
                        favorable to the borrower; and
                          (iii) that the students attending the 
                        institution, or the families of such 
                        students, do not have to borrow from a 
                        lender on the preferred lender list;
                  (B) ensure, through the use of the list of 
                lender affiliates provided by the Secretary 
                under paragraph (2), that--
                          (i) there are not less than three 
                        lenders of loans made under part B that 
                        are not affiliates of each other 
                        included on the preferred lender list 
                        and, if the institution recommends, 
                        promotes, or endorses private education 
                        loans, there are not less than two 
                        lenders of private education loans that 
                        are not affiliates of each other 
                        included on the preferred lender list; 
                        and
                          (ii) the preferred lender list under 
                        this paragraph--
                                  (I) specifically indicates, 
                                for each listed lender, whether 
                                the lender is or is not an 
                                affiliate of each other lender 
                                on the preferred lender list; 
                                and
                                  (II) if a lender is an 
                                affiliate of another lender on 
                                the preferred lender list, 
                                describes the details of such 
                                affiliation;
                  (C) prominently disclose the method and 
                criteria used by the institution in selecting 
                lenders with which to enter into preferred 
                lender arrangements to ensure that such lenders 
                are selected on the basis of the best interests 
                of the borrowers, including--
                          (i) payment of origination or other 
                        fees on behalf of the borrower;
                          (ii) highly competitive interest 
                        rates, or other terms and conditions or 
                        provisions of loans under this title or 
                        private education loans;
                          (iii) high-quality servicing for such 
                        loans; or
                          (iv) additional benefits beyond the 
                        standard terms and conditions or 
                        provisions for such loans;
                  (D) exercise a duty of care and a duty of 
                loyalty to compile the preferred lender list 
                under this paragraph without prejudice and for 
                the sole benefit of the students attending the 
                institution, or the families of such students;
                  (E) not deny or otherwise impede the 
                borrower's choice of a lender or cause 
                unnecessary delay in loan certification under 
                this title for those borrowers who choose a 
                lender that is not included on the preferred 
                lender list; and
                  (F) comply with such other requirements as 
                the Secretary may prescribe by regulation.
          (2) Lender affiliates list.--
                  (A) In general.--The Secretary shall maintain 
                and regularly update a list of lender 
                affiliates of all eligible lenders, and shall 
                provide such list to institutions for use in 
                carrying out paragraph (1)(B).
                  (B) Use of most recent list.--An institution 
                shall use the most recent list of lender 
                affiliates provided by the Secretary under 
                subparagraph (A) in carrying out paragraph 
                (1)(B).
  (i) Definitions.--For the purpose of this section:
          (1) Agent.--The term ``agent'' has the meaning given 
        the term in section 151.
          (2) Affiliate.--The term ``affiliate'' means a person 
        that controls, is controlled by, or is under common 
        control with another person. A person controls, is 
        controlled by, or is under common control with another 
        person if--
                  (A) the person directly or indirectly, or 
                acting through one or more others, owns, 
                controls, or has the power to vote five percent 
                or more of any class of voting securities of 
                such other person;
                  (B) the person controls, in any manner, the 
                election of a majority of the directors or 
                trustees of such other person; or
                  (C) the Secretary determines (after notice 
                and opportunity for a hearing) that the person 
                directly or indirectly exercises a controlling 
                interest over the management or policies of 
                such other person's education loans.
          (3) Education loan.--The term ``education loan'' has 
        the meaning given the term in section 151.
          (4) Eligible institution.--The term ``eligible 
        institution'' means any such institution described in 
        section 102 of this Act.
          (5) Officer.--The term ``officer'' has the meaning 
        given the term in section 151.
          (6) Preferred lender arrangement.--The term 
        ``preferred lender arrangement'' has the meaning given 
        the term in section 151.
  (j) Construction.--Nothing in the amendments made by the 
Higher Education Amendments of 1992 shall be construed to 
prohibit an institution from recording, at the cost of the 
institution, a hearing referred to in subsection (b)(2), 
subsection (c)(1)(D), or subparagraph (A) or (B)(i) of 
subsection (c)(2), of this section to create a record of the 
hearing, except the unavailability of a recording shall not 
serve to delay the completion of the proceeding. The Secretary 
shall allow the institution to use any reasonable means, 
including stenographers, of recording the hearing.

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                              ----------                              


                        FAFSA SIMPLIFICATION ACT




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DIVISION FF--OTHER MATTER

           *       *       *       *       *       *       *


TITLE VII--FAFSA SIMPLIFICATION

           *       *       *       *       *       *       *


SEC. 702. MAKING IT EASIER TO APPLY FOR FEDERAL AID AND MAKING THAT AID 
                    PREDICTABLE.

  [Subsections (a) through (l)--omitted-Amends other Acts]
  (m) FAFSA.--
          (1) [Omitted-Amends other Act]
          (2) Reports.--Notwithstanding section 701(b) of this 
        title, the Secretary of Education shall have the 
        authority to issue reports and begin consumer testing 
        prior to July 1, 2023, as provided in the amendment 
        made by paragraph (1).
  (n) Student Eligibility.--
          (1) Amendments.--
                  (A) In general.--Section 484 of the Higher 
                Education Act of 1965 (20 U.S.C. 1091) is 
                amended--
                          (i) by striking subsections (n) and 
                        (r);
                          (ii) by redesignating subsections 
                        (o), (p), (s), and (t), as subsections 
                        (n), (o), (q), and (r), respectively;
                          (iii) by inserting between 
                        subsections (o) and (q), as 
                        redesignated under clause (i), the 
                        following:
  ``(p) Use of Income Data With IRS.--The Secretary, in 
cooperation with the Secretary of the Treasury, shall fulfill 
the data transfer requirements under section 6103(l)(13) of the 
Internal Revenue Code of 1986 and the procedure and 
requirements outlined in section 494.''; and
                          (iv) [by adding at the end] by 
                        inserting after subsection (r), as 
                        redesignated under clause (i), the 
                        following:
  ``(s) Exception to Required Registration With the Selective 
Service System.--Notwithstanding section 12(f) of the Military 
Selective Service Act (50 U.S.C. 3811(f)), an individual shall 
not be ineligible for assistance or a benefit provided under 
this title if the individual is required under section 3 of 
such Act (50 U.S.C. 3802) to present himself for and submit to 
registration under such section and fails to do so in 
accordance with any proclamation issued under such section, or 
in accordance with any rule or regulation issued under such 
section.
  ``(t) Confined or Incarcerated Individuals.--
          ``(1) Definitions.--In this subsection:
                  ``(A) Confined or incarcerated individual.--
                The term `confined or incarcerated 
                individual'--
                          ``(i) means an individual who is 
                        serving a criminal sentence in a 
                        Federal, State, or local penal 
                        institution, prison, jail, reformatory, 
                        work farm, or other similar 
                        correctional institution; and
                          ``(ii) does not include an individual 
                        who is in a halfway house or home 
                        detention or is sentenced to serve only 
                        weekends.
                  ``(B) Prison education program.--The term 
                `prison education program' means an education 
                or training program that--
                          ``(i) is an eligible program under 
                        this title offered by an institution of 
                        higher education (as defined in section 
                        101 or 102(a)(1)(B));
                          ``(ii) is offered by an institution 
                        that has been approved to operate in a 
                        correctional facility by the 
                        appropriate State department of 
                        corrections or other entity that is 
                        responsible for overseeing correctional 
                        facilities, or by the Bureau of 
                        Prisons;
                          ``(iii) has been determined by the 
                        appropriate State department of 
                        corrections or other entity that is 
                        responsible for overseeing correctional 
                        facilities, or by the Bureau of 
                        Prisons, to be operating in the best 
                        interest of students, the determination 
                        of which shall be made by the State 
                        department of corrections or other 
                        entity or by the Bureau of Prisons, 
                        respectively, and may be based on--
                                  ``(I) rates of confined or 
                                incarcerated individuals 
                                continuing their education 
                                post-release;
                                  ``(II) job placement rates 
                                for such individuals;
                                  ``(III) earnings for such 
                                individuals;
                                  ``(IV) rates of recidivism 
                                for such individuals;
                                  ``(V) the experience, 
                                credentials, and rates of 
                                turnover or departure of 
                                instructors;
                                  ``(VI) the transferability of 
                                credits for courses available 
                                to confined or incarcerated 
                                individuals and the 
                                applicability of such credits 
                                toward related degree or 
                                certificate programs; or
                                  ``(VII) offering relevant 
                                academic and career advising 
                                services to participating 
                                confined or incarcerated 
                                individuals while they are 
                                confined or incarcerated, in 
                                advance of reentry, and upon 
                                release;
                          ``(iv) offers transferability of 
                        credits to at least 1 institution of 
                        higher education (as defined in section 
                        101 or 102(a)(1)(B)) in the State in 
                        which the correctional facility is 
                        located, or, in the case of a Federal 
                        correctional facility, in the State in 
                        which most of the individuals confined 
                        or incarcerated in such facility will 
                        reside upon release;
                          ``(v) is offered by an institution 
                        that has not been subject, during the 5 
                        years preceding the date of the 
                        determination, to--
                                  ``(I) any suspension, 
                                emergency action, or 
                                termination of programs under 
                                this title;
                                  ``(II) any adverse action by 
                                the institution's accrediting 
                                agency or association; or
                                  ``(III) any action by the 
                                State to revoke a license or 
                                other authority to operate;
                          ``(vi) satisfies any applicable 
                        educational requirements for 
                        professional licensure or 
                        certification, including licensure or 
                        certification examinations needed to 
                        practice or find employment in the 
                        sectors or occupations for which the 
                        program prepares the individual, in the 
                        State in which the correctional 
                        facility is located or, in the case of 
                        a Federal correctional facility, in the 
                        State in which most of the individuals 
                        confined or incarcerated in such 
                        facility will reside upon release; and
                          ``(vii) does not offer education that 
                        is designed to lead to licensure or 
                        employment for a specific job or 
                        occupation in the State if such job or 
                        occupation typically involves 
                        prohibitions on the licensure or 
                        employment of formerly incarcerated 
                        individuals in the State in which the 
                        correctional facility is located, or, 
                        in the case of a Federal correctional 
                        facility, in the State in which most of 
                        the individuals confined or 
                        incarcerated in such facility will 
                        reside upon release.
          ``(2) Technical assistance.--The Secretary, in 
        collaboration with the Attorney General, shall provide 
        technical assistance and guidance to the Bureau of 
        Prisons, State departments of corrections, and other 
        entities that are responsible for overseeing 
        correctional facilities in making determinations under 
        paragraph (1)(B)(iii).
          ``(3) Federal pell grant eligibility.--
        Notwithstanding subsection (a), in order for a confined 
        or incarcerated individual who otherwise meets the 
        eligibility requirements of this title to be eligible 
        to receive a Federal Pell Grant under section 401, the 
        individual shall be enrolled or accepted for enrollment 
        in a prison education program.
          ``(4) Evaluation.--
                  ``(A) In general.--Not later than 1 year 
                after the date of enactment of the FAFSA 
                Simplification Act, in order to evaluate and 
                improve the impact of activities supported 
                under this subsection, the Secretary, in 
                partnership with the Director of the Institute 
                of Education Sciences, shall award 1 or more 
                grants or contracts to, or enter into 
                cooperative agreements with, experienced public 
                and private institutions and organizations to 
                enable the institutions and organizations to 
                conduct an external evaluation that shall--
                          ``(i) assess the ability of confined 
                        or incarcerated individuals to access 
                        and complete the Free Application for 
                        Federal Student Aid;
                          ``(ii) examine in-custody outcomes 
                        and post-release outcomes related to 
                        providing Federal Pell Grants to 
                        confined or incarcerated individuals, 
                        including--
                                  ``(I) attainment of a 
                                postsecondary degree or 
                                credential;
                                  ``(II) safety in penal 
                                institutions with prison 
                                education programs;
                                  ``(III) the size of waiting 
                                lists for prison education 
                                programs;
                                  ``(IV) the extent to which 
                                such individuals continue their 
                                education post-release;
                                  ``(V) employment and earnings 
                                outcomes for such individuals; 
                                and
                                  ``(VI) rates of recidivism 
                                for such individuals;
                          ``(iii) track individuals who 
                        received Federal Pell Grants under 
                        subpart 1 of part A at 1, 3, and 5 
                        years after the individuals' release 
                        from confinement or incarceration; and
                          ``(iv) examine the extent to which 
                        institutions provide re-entry or 
                        relevant career services to 
                        participating confined or incarcerated 
                        individuals as part of the prison 
                        education program and the efficacy of 
                        such services, if offered.
                  ``(B) Report.--Beginning not later than 1 
                year after the Secretary awards the grant, 
                contract, or cooperative agreement described in 
                subparagraph (A) and annually thereafter, each 
                institution of higher education operating a 
                prison education program under this subsection 
                shall submit a report to the Secretary on 
                activities assisted and students served under 
                this subsection, which shall include the 
                information, as applicable, contained in 
                clauses (i) through (iv) of subparagraph (A).
          ``(5) Report.--Not later than 1 year after the date 
        of enactment of the FAFSA Simplification Act and on at 
        least an annual basis thereafter, the Secretary shall 
        submit to the authorizing committees, and make publicly 
        available on the website of the Department, a report on 
        the--
                  ``(A) impact of this subsection which shall 
                include, at a minimum--
                          ``(i) the names and types of 
                        institutions of higher education 
                        offering prison education programs at 
                        which confined or incarcerated 
                        individuals are enrolled and receiving 
                        Federal Pell Grants;
                          ``(ii) the number of confined or 
                        incarcerated individuals receiving 
                        Federal Pell Grants through each prison 
                        education program;
                          ``(iii) the amount of Federal Pell 
                        Grant expenditures for each prison 
                        education program;
                          ``(iv) the average amount of Federal 
                        Pell Grant expenditures per full-time 
                        equivalent students in a prison 
                        education program compared to the 
                        average amount of Federal Pell Grant 
                        expenditures per full-time equivalent 
                        students not in prison education 
                        programs;
                          ``(v) the demographics of confined or 
                        incarcerated individuals receiving 
                        Federal Pell Grants;
                          ``(vi) the cost of attendance for 
                        such individuals;
                          ``(vii) the mode of instruction (such 
                        as distance education, in-person 
                        instruction, or a combination of such 
                        modes) for each prison education 
                        program;
                          ``(viii) information on the academic 
                        outcomes of such individuals (such as 
                        credits attempted and earned, and 
                        credential and degree completion) and 
                        any information available from student 
                        satisfaction surveys conducted by the 
                        applicable institution or correctional 
                        facility;
                          ``(ix) information on post-release 
                        outcomes of such individuals, 
                        including, to the extent practicable, 
                        continued postsecondary enrollment, 
                        earnings, credit transfer, and job 
                        placement;
                          ``(x) rates of recidivism for 
                        confined or incarcerated individuals 
                        receiving Federal Pell Grants;
                          ``(xi) information on transfers of 
                        confined or incarcerated individuals 
                        between prison education programs;
                          ``(xii) the most common programs and 
                        courses offered in prison education 
                        programs; and
                          ``(xiii) rates of instructor turnover 
                        or departure for courses offered in 
                        prison education programs;
                  ``(B) results of each prison education 
                program at each institution of higher 
                education, including the information described 
                in clauses (ii) through (xiii) of subparagraph 
                (A); and
                  ``(C) findings regarding best practices with 
                respect to prison education programs.''.
                  (B) Conforming amendment.--Section 428B(f)(2) 
                of the Higher Education Act of 1965 (20 U.S.C. 
                1078-2(f)(2)) is amended by striking ``section 
                484(p)'' and inserting ``section 484(o)''.
                  (C) Institutional and financial assistance 
                information for students.--Section 485 of the 
                Higher Education Act of 1965 (20 U.S.C. 1092) 
                is amended by repealing subsection (k).
          (2) Early effective date permitted.--Notwithstanding 
        section 701(b) of this Act, sections 401(b)(6) and 
        484(r) of the Higher Education Act of 1965 (20 U.S.C. 
        1070a(b)(6); 1091(r)) as in effect on the date of 
        enactment of this Act, and section 12(f) of the 
        Military Selective Service Act (50 U.S.C. 3811(f)), the 
        Secretary of Education may implement the amendments 
        made by paragraph (1) of this subsection before (but 
        not later than) July 1, 2023. The Secretary shall 
        specify in a designation on what date, under what 
        conditions, and for which award years the Secretary 
        will implement such amendments prior to July 1, 2023. 
        The Secretary shall publish any designation under this 
        paragraph in the Federal Register at least 60 days 
        before implementation.
  (o) [Omitted-Amend other Act]
  (p) [Omitted-Amend other Act]

           *       *       *       *       *       *       *


               Changes in the Application of Existing Law

    Pursuant to clause 3(f)(1)(A) of rule XIII of the Rules of 
the House of Representatives, the following statements are 
submitted describing the effect of provisions in the 
accompanying bill that directly or indirectly change the 
application of existing law.

                      TITLE I--DEPARTMENT OF LABOR

    Language is included under ``Employment and Training 
Administration'' providing that allotments to outlying areas 
are not required to be made through the Pacific Region 
Educational Laboratory as provided by section 127 of the 
Workforce Innovation and Opportunity Act (WIOA).
    Language is included under ``Employment and Training 
Administration'' providing that outlying areas may submit a 
single application for consolidated grant awards and may use 
the funds for any of the programs and activities authorized 
under subtitle B of title I of WIOA.
    Language is included under ``Employment and Training 
Administration'' providing amounts made available for 
dislocated workers may be used for State activities or across 
multiple local areas where workers remain dislocated.
    Language is included under ``Employment and Training 
Administration'' providing that technical assistance and 
demonstration projects may provide assistance to new entrants 
in the workforce and incumbent workers.
    Language is included under ``Employment and Training 
Administration'' providing that the Secretary may reserve a 
higher percentage of funds for technical assistance than what 
is provided in section 168(b) of the WIOA.
    Language is included under ``Employment and Training 
Administration'' providing that the Department of Labor may 
take no action to limit the number or proportion of eligible 
applicants receiving related assistance services in the migrant 
and seasonal farmworkers programs.
    Language is included under ``Employment and Training 
Administration'' providing that an individual may qualify as an 
``eligible seasonal farmworker'' under section 167(i)(3) of the 
WIOA if such individual is a member of a family with a total 
family income equal to or less than 150 percent of the poverty 
line.
    Language is included under ``Job Corps'' providing that 
amounts made available for construction and rehabilitation may 
include acquisition and maintenance of major items of 
equipment.
    Language is included under ``Job Corps'' providing 
authority to transfer up to 15 percent of construction and 
rehabilitation funds for operational needs with prior written 
notice to the Committee and that any such transfers are 
available for obligation through June 30, 2023.
    Language is included under ``Job Corps'' providing that no 
funds from any other appropriation may be used for meal 
services at Job Corps.
    Language is included under ``Community Service Employment 
for Older Americans'' allowing funds to be recaptured and 
reobligated.
    Language in included under ``Federal Unemployment Benefits 
and Allowances'' providing that funding may be available beyond 
the current year in accordance with section 245(c) of the Trade 
Act of 1974.
    Language is included under ``State Unemployment Insurance 
and Employment Service Operations'' providing for reemployment 
services and eligibility assessments.
    Language is included under ``State Unemployment Insurance 
and Employment Service Operations'' providing funds to States 
to improve operations and modernize State Unemployment 
Insurance systems.
    Language is included under ``State Unemployment Insurance 
and Employment Service Operations'' providing that the 
Department of Labor may make payments from funds appropriated 
for States' grants on behalf of States to the entity operating 
the Unemployment Insurance Integrity Center of Excellence.
    Language is included under ``State Unemployment Insurance 
and Employment Service Operations'' providing for additional 
administrative funds from the Unemployment Trust Fund if 
unemployment claims exceed certain levels.
    Language is included under ``State Unemployment Insurance 
and Employment Service Operations'' providing authority for 
States to use funds to assist other States to carry out 
authorized activities in cases of a major disaster declared by 
the President under the Robert T. Stafford Disaster Relief and 
Emergency Assistance Act.
    Language is included under ``State Unemployment Insurance 
and Employment Service Operations'' providing that the 
Department of Labor may make payments on behalf of States for 
the use of the National Directory of New Hires.
    Language is included under ``State Unemployment Insurance 
and Employment Service Operations'' providing that the 
Department of Labor may make payments from funds appropriated 
for States' grants on behalf of States to the entity operating 
the State Information Data Exchange System.
    Language is included under ``State Unemployment Insurance 
and Employment Service Operations'' providing that 
appropriations for establishing a national one-stop career 
system may be obligated in contracts, grants or agreements with 
States or non-State entities.
    Language is included under ``State Unemployment Insurance 
and Employment Service Operations'' providing that States 
awarded grants to support national activities of the Federal-
State unemployment insurance system may award subgrants to 
other States.
    Language is included under ``State Unemployment Insurance 
and Employment Service Operations'' providing that funds 
available for integrated Unemployment Insurance and Employment 
Service automation may be used by States notwithstanding cost 
allocation principles prescribed under the Office of Management 
and Budget ``Uniform Administrative Requirements, Cost 
Principles, and Audit Requirements for Federal Awards.''
    Language is included under ``State Unemployment Insurance 
and Employment Service Operations'' providing that the 
Department of Labor may reallot funds among States 
participating in a consortium.
    Language is included under ``State Unemployment Insurance 
and Employment Service Operations'' allowing the Secretary to 
collect fees for the costs associated with additional data 
collection, analyses, and reporting services related to the 
National Agricultural Workers Survey.
    Language is included under ``Pension Benefit Guarantee 
Corporation'' providing for additional administrative funds if 
participants with plans terminated during the period exceed a 
certain level.
    Language is included under ``Pension Benefit Guarantee 
Corporation'' providing that obligations may exceed amounts 
provided for unforeseen and extraordinary pre-termination or 
termination expenses or unforeseen and extraordinary 
multiemployer program expenses if approved by the Office of 
Management and Budget.
    Language is included under ``Special Benefits'' providing 
that the Department of Labor may use authority to reimburse an 
employer who is not the employer at the time of injury for 
portions of the salary of a re-employed, disabled beneficiary.
    Language is included under ``Special Benefits'' providing 
that unobligated balances of reimbursements shall remain 
available until expended for the payment of compensation, 
benefits, and expenses.
    Language is included under ``Special Benefits'' providing 
that funds shall be transferred to the appropriation from 
entities required under 5 U.S.C. 8147(c) as determined by the 
Department of Labor.
    Language is included under ``Special Benefits'' providing 
that funds transferred from entities under 5 U.S.C 8147(c), 
specified amounts may be used by the Department of Labor for 
maintenance and data and communications systems, workload 
processing, roll disability management and medical review, and 
program integrity with remaining amounts paid into the 
Treasury.
    Language is included under ``Special Benefits'' providing 
that the Secretary may prescribe regulations requiring 
identification for the filing of benefit claims.
    Language is included under ``Administrative Expenses, 
Energy Employees Occupational Illness Compensation Fund'' 
providing that the Secretary may prescribe regulations for 
requiring identification for the filing of benefit claims.
    Language is included under ``Occupational Safety and Health 
Administration'' providing that up to a certain amount of fees 
collected from the training institute may be retained and used 
for related training and education.
    Language is included under ``Occupational Safety and Health 
Administration'' providing that fees collected from Nationally 
Recognized Testing Laboratories may be used to administer 
laboratory recognition programs that ensure safety of equipment 
used in the workplace.
    Language is included under ``Mine Safety and Health 
Administration'' providing that a specific amount may be 
collected by the National Mine Health and Safety Academy and 
made available for mine safety and health education and 
training.
    Language is included under ``Mine Safety and Health 
Administration'' providing that a specific amount may be 
collected from the approval and certification of equipment and 
materials and made available for other such activities.
    Language is included under ``Mine Safety and Health 
Administration'' providing that the Department of Labor may 
accept lands, buildings, equipment, and other contributions 
from public and private sources for cooperative projects.
    Language is included under ``Mine Safety and Health 
Administration'' providing that the Department of Labor may 
promote health and safety education and training through 
cooperative agreements with States, industry and safety 
associations.
    Language is included under ``Mine Safety and Health 
Administration'' providing that the Department of Labor may 
recognize the Joseph A. Holmes Safety Association as the 
principal safety association and may provide funds or personnel 
as officers in local chapters or the national organization.
    Language is included under ``Mine Safety and Health 
Administration'' providing that the Department of Labor may use 
appropriated funds to provide for costs associated with mine 
rescue and survival operations in the event of a major 
disaster.
    Language is included under ``Departmental Management--
Salaries and Expenses'' providing that the Bureau of 
International Labor Affairs may administer international labor 
activities through grants, subgrants or other arrangements.
    Language is included under ``Departmental Management--
Salaries and Expenses'' providing that funds available for 
program evaluation may be used to administer grants for 
evaluation purposes subject to certain conditions.
    Language is included under ``Departmental Management--
Salaries and Expenses'' providing that funds available to the 
Women's Bureau may be used for grants to service and promote 
the interests of women in the workplace.
    Language is included under ``Departmental Management--
Salaries and Expenses'' providing that certain amounts made 
available to the Women's Bureau shall be used for grants 
authorized by the Women in Apprenticeship and Nontraditional 
Occupations Act.
    Language is included under ``Veterans' Employment and 
Training'' providing that up to three percent of States' grants 
may be used for federal expenditures for data systems and 
contract support.
    Language is included under ``Veterans' Employment and 
Training'' providing that funds may be used for support 
specialists providing intensive services to wounded service 
members, spouses or other family caregivers of the service 
member, and to Gold Star Spouses.
    Language is included under ``Veterans' Employment and 
Training'' providing that Department of Labor may reallocate up 
to three percent of funds provided among appropriated accounts.
    Language is included under ``Veterans' Employment and 
Training'' providing that the Department may award grants under 
section 2023 of Title 38, United States Code.
    Language is included under ``Veterans' Employment and 
Training'' providing that services may be provided to certain 
homeless or recently incarcerated veterans under section 2021, 
2021A, and 2023 of Title 38, United States Code.
    Language is included under ``Veterans' Employment and 
Training'' providing that funds made available to assist 
homeless veterans may be used for data systems and contract 
support track participant and performance information.
    Language is included under ``Veterans' Employment and 
Training'' providing that the fees assessed pursuant to the 
HIRE Vets Medallion Award Fund shall be available to the 
Secretary for expenses of the HIRE Vets Medallion Award Program 
and that the start date prescribed in the Act shall not apply.
    Language is included under ``General Provisions'' 
prohibiting the use of Job Corps funds to pay the salaries and 
bonuses at a rate in excess of Executive Level II.
    Language is included under ``General Provisions'' 
prohibiting the use funds for procurement of goods or services 
rendered by forced or indentured child labor.
    Language is included under ``General Provisions'' 
prohibiting the use of any funds appropriated for grants under 
section 414(c) of the American Competitiveness and Workforce 
Improvement Act of 1998, for purposes other than competitive 
grants for training individuals over the age of 16 who are not 
currently enrolled in school in the occupations and industries 
for which employers are using H-1B visa to hire foreign 
workers.
    Language is included under ``General Provisions'' 
prohibiting the use of any funds appropriated for Employment 
and Training Administration programs to be used to pay the 
salaries and bonuses at a rate in excess of Executive Level II, 
except under specific exclusions.
    Language is included under ``General Provisions'' allowing 
the Secretary to furnish a certain amount of excess personal 
property to apprenticeship programs through grants, contracts, 
and other arrangements.
    Language is included under ``General Provisions'' modifying 
certain authorities related to the Secretary's security detail.
    Language is included under ``General Provisions'' providing 
that the Secretary may dispose or divest of certain Job Corps 
center property and use the proceeds to carry out the program 
in the same geographic location.
    Language is included under ``General Provisions'' 
preventing appropriated funds from being used to close any 
Civilian Conservation Center, except when necessary for the 
health and safety of students.
    Language is included under ``General Provisions'' 
prohibiting the Secretary from using any of the funds in the 
Act to implement the ``Wagner-Peyser Act Staffing Flexibility'' 
final rule.
    Language is included under ``General Provisions'' 
prohibiting the Secretary from using any of the funds in the 
Act to implement the ``Industry Recognized Apprenticeship 
Programs'' final rule.

           TITLE II--DEPARTMENT OF HEALTH AND HUMAN SERVICES

    Language is included under ``Health Resources and Services 
Administration--Health Workforce'' overriding the proportional 
funding requirements in the Public Health Service Act for 
sections 751 and 756.
    Language is included under ``Health Resources and Services 
Administration--Health Workforce'' providing permissive 
authority to the Secretary to waive requirements for entities 
awarded funds from sections 751(d)(2)(A) and 751 (d)(2)(B).
    Language is included under ``Health Resources and Services 
Administration--Health Workforce'' applying the requirements 
for the minimum number of awards made to HBCUs and MSIs to 
additional health workforce grant programs.
    Language is included under ``Health Resources and Services 
Administration--Health Workforce'' providing that fees 
collected for the disclosure of information under the 
information reporting requirement program authorized by section 
1921 of the Social Security Act shall be sufficient to recover 
the full costs of the operation program and shall remain 
available until expended to carry out that Act.
    Language is included under ``Health Resources and Services 
Administration--Health Workforce'' allowing funds for the Nurse 
Corps and National Health Service Corps Scholarship and Loan 
programs to be used to make prior year adjustments.
    Language is included under ``Health Resources and Services 
Administration--Health Workforce'' providing funding under the 
National Health Service Corps Loan Repayment Program for 
substance use disorder counselors and placement in Indian 
Health Service facilities.
    Language is included under ``Health Resources and Services 
Administration--Health Workforce'' making funds available for 
loan repayment to mental and behavioral health providers, 
including peer support specialists.
    Language is included under ``Health Resources and Services 
Administration--Health Workforce'' to provide funds for the 
purpose of establishing or expanding optional community-based 
nurse practitioner fellowship programs.
    Language is included under ``Health Resources and Services 
Administration--Health Workforce'' to provide funds for the 
purpose of supporting graduate education for physicians 
provided by public institutions of higher education and shall 
remain available until expended.
    Language is included under ``Health Resources and Services 
Administration--Health Workforce'' to provide funds for grants 
to public institutions of higher education meeting certain 
requirements for graduate education for physicians.
    Language is included under ``Health Resources and Services 
Administration--Ryan White HIV/AIDS Program'' to make funds 
available to the Secretary to carry out grants and contracts 
under title XXVI or 311(c) for the purposes of ending the HIV/
AIDS epidemic.
    Language is included under ``Health Resources and Services 
Administration--Rural Health'' to provide funding for State 
Offices of Rural Health notwithstanding section 338J(k), which 
terminates the program after an aggregate funding amount.
    Language is included under ``Health Resources and Services 
Administration--Family Planning'' placing additional 
restrictions on the use of funds.
    Language is included under ``Centers for Disease Control 
and Prevention--Environmental Health'' providing funds for the 
Vessel Sanitation Program.
    Language is included under ``Centers for Disease Control 
and Prevention--Buildings and Facilities'' providing the use of 
funds to support acquisition, renovation, or replacement, of 
the National Institute Occupational Safety and Health's 
underground and surface coal mining research capacity.
    Language is included under ``Centers for Disease Control 
and Prevention--Buildings and Facilities'' providing funds from 
former employees with existing Individual Learning Accounts 
unobligated to be available to support acquisition, renovation, 
or replacement, of the National Institute for Occupational 
Safety and Health's underground and surface coal mining 
research capacity.
    Language is included under ``Centers for Disease Control 
and Prevention--CDC-Wide'' permitting CDC to operate and 
maintain an aircraft.
    Language is included under ``National Institutes of 
Health--Office of the Director'' allowing funds to be used for 
the Research Policy Board authorized by section 2034(f) of the 
21st Century Cures Act (P.L. 114-255).
    Language is included under ``Substance Use And Mental 
Health Services Administration--Mental Health'' requiring 
states to spend 10 percent of the Mental Health Block Grant for 
programs for individuals with early serious mental illness.
    Language is included under ``Substance Use And Mental 
Health Services Administration--Mental Health'' requiring 
states to spend 10 percent of the Mental Health Block Grant for 
programs for crisis care programs for individuals with early 
serious mental illness and children with serious mental and 
emotional disturbances.
    Language is included under ``Substance Use And Mental 
Health Services Administration--Mental Health'' requiring 
states to spend at least 10 percent of the Mental Health Block 
Grant for programs that address early intervention and 
prevention of mental disorders among at-risk children and 
adults.
    Language is included under ``Substance Use And Mental 
Health Services Administration--Mental Health'' exempting the 
Mental Health Block Grant from the evaluation set-aside in 
section 241 of the Public Health Service Act.
    Language is included under Substance Use And Mental Health 
Services Administration--Substance Use Services'' requiring 
states to use the rate of HIV cases instead of the AIDS cases 
to calculate the HIV set-aside in the Substance Use Prevention 
and Treatment Block Grant.
    Language is included under ``Substance Use And Mental 
Health Services Administration--Substance Use Services'' 
requiring states to spend not less than 10 percent of the 
Substance Use Prevention and Treatment Block Grant for recovery 
support services.
    Language is included under ``Substance Use And Mental 
Health Services Administration--Substance Use Services'' 
exempting the Substance Use Prevention and Treatment Block 
Grant from the evaluation set-aside in section 241 of the 
Public Health Service Act.
    Language is included under ``Centers for Medicare and 
Medicaid Services--Program Management'' limiting the amount of 
funding available under that heading for quality improvement 
organizations.
    Language is included under ``Centers for Medicare and 
Medicaid Services--Health Care Fraud and Abuse Control 
Account'' providing funds to support the cost of the Senior 
Medicare Patrol program.
    Language is included under ``Administration for Children 
and Families--Low Income Home Energy Assistance'' modifying the 
formula distribution of funds.
    Language is included under ``Administration for Children 
and Families--Refugee and Entrant Assistance'' to specify the 
purposes of specified funds.
    Language is included under ``Administration for Children 
and Families--Refugee and Entrant Assistance'' to exempt the 
matching requirements of certain funds as required in section 
235(c)(6)(C)(iii) of the William Wilberforce Trafficking 
Victims Protection Reauthorization Act of 2008.
    Language is included under ``Administration for Children 
and Families--Refugee and Entrant Assistance'' to provide the 
Director of the Office of Refugee Resettlement flexibility to 
allocate certain funds.
    Language is included under ``Administration for Children 
and Families--Payments to States for the Child Care and 
Development Block Grant'' increasing the tribal set-aside.
    Language is included under ``Administration for Children 
and Families--Payments to States for the Child Care and 
Development Block Grant'' to make amounts available for Federal 
administrative expenses.
    Language is included under ``Administration for Children 
and Families--Children and Families Services Programs'' to 
allow amounts to be available for Grants to Support Culturally 
Specific Populations and Grants to Support Survivors of Sexual 
Assault.
    Language is included under ``Administration for Children 
and Families--Children and Families Services Programs'' 
providing for payments under the Head Start Act for a cost of 
living adjustment, the calculation of a base grant, quality 
improvement funding, including quality improvement funding for 
Migrant and Seasonal Head Start, expansion funding for Head 
Start and Early Head Start programs, including necessary 
administrative costs, and the Tribal Colleges and Universities 
Head Start Partnership program.
    Language is included under ``Administration for Children 
and Families--Children and Families Services Programs'' 
modifying the definition of the poverty line as defined in 
section 673(2) of the CSBG Act.
    Language is included under ``Administration for Children 
and Families--Children and Families Services Programs'' 
allowing for the direct payments of cash assistance to victims 
of family, domestic, or dating violence as limited in section 
308(d)(1) of the Family Violence Prevention and Services Act.
    Language is included under Administration for Community 
Living to allow funding provided for adult protective services 
grants under section 2042 of title XX of the Social Security 
Act to be set-aside for Tribes and Tribal organizations.
    Language is included under Administration for Community 
Living continuing an assistive technology alternative financing 
program.
    Language is included under Administration for Community 
Living prohibiting the use of the funds provided in the bill to 
pursue legal action on behalf of a protection and advocacy 
system described in section 103 of the Protection and Advocacy 
for Individuals with Mental Illness Act unless public notice 
has been provided within 90 days of instituting action to the 
named person or their legal guardian.
    Language is included under Administration for Community 
Living waiving the public notice requirement for individuals 
without a guardian, who are not competent to consent, who are 
wards of the State or subject to public guardianship.
    Language is included under ``Office of the Secretary'' to 
provide funding for the Advanced Research Projects Agency for 
Health and establish requirements regarding the appointment of 
the director, hiring authorities, and compensation.
    Section 201 limits the amount available for official 
reception and representation expenses.
    Section 202 limits the salary of an individual through an 
HHS grant or other extramural mechanism to not more than the 
rate of Executive Level II.
    Section 203 prohibits the Secretary from using evaluation 
set-aside funds until the Committees on Appropriations of the 
House of Representatives and the Senate receive a report 
detailing the planned use of such funds.
    Section 204 sets the PHS evaluation set-aside to 2.5 
percent.
    Section 205 permits the Secretary of HHS to transfer up to 
one percent of any discretionary funds between appropriations, 
provided that no appropriation is increased by more than three 
percent by any such transfer to meet emergency needs. 
Notification must be provided to the Committees on 
Appropriations at least 15 days in advance of any transfer.
    Section 206 modifies the 60-day flexibility for National 
Health Service Corps contract terminations to provide more 
flexibility.
    Section 207 prohibits the use of Title X funds unless the 
applicant for the award certifies to the Secretary that it 
encourages family participation in the decision of minors to 
seek family planning services and that it provides counseling 
to minors on how to resist attempts to coerce minors into 
engaging in sexual activities.
    Section 208 states that no provider of services under Title 
X shall be exempt from any state law requiring notification or 
the reporting of child abuse, child molestation, sexual abuse, 
rape, or incest.
    Section 209 prohibits the Secretary from denying 
participation in the Medicare Advantage program to entities who 
do not provide coverage or referrals for abortion services.
    Section 210 prohibits funds from being used to advocate or 
promote gun control.
    Section 211 limits assignments of Public Health Service 
staff to assist in child survival activities to not more than 
60 employees.
    Section 212 permits funding for HHS international HIV/AIDS 
and other infectious disease, chronic and environmental 
disease, and other health activities abroad to be spent under 
the State Department Basic Authorities Act of 1956.
    Section 213 provides the Director of NIH, jointly with the 
Director of the Office of AIDS Research, the authority to 
transfer up to three percent of human immunodeficiency virus 
funds.
    Section 214 makes NIH funds available for human 
immunodeficiency virus research available to the Office of AIDS 
Research.
    Section 215 grants authority to the Office of the Director 
of the NIH to enter directly into transactions in order to 
implement the NIH Common Fund for medical research and 
permitting the Director to utilize peer review procedures, as 
appropriate, to obtain assessments of scientific and technical 
merit.
    Section 216 clarifies that funds appropriated to NIH 
institutes and centers may be used for minor repairs or 
improvements to their buildings, up to $5,000,000 per project 
with a total limit for NIH of $100,000,000.
    Section 217 transfers one percent of the funding made 
available for National Institutes of Health National Research 
Service Awards to the Health Resources and Services 
Administration and Agency for Healthcare Research and Quality.
    Section 218 continues the Biomedical Advanced Research and 
Development Authority ten year contract authority.
    Section 219 includes specific report requirements for CMS's 
marketplaces activities in the fiscal year 2024 budget request.
    Section 220 prohibits CMS Program Account from being used 
to support risk corridor payments.
    Section 221 directs the spending and transfer of amount in 
the Prevention and Public Health fund.
    Section 222 modifies a provision relating to breast cancer 
screening.
    Section 223 requires the NIH to continue to use existing 
guidance for calculating indirect cost negotiated rates.
    Section 224 permits transfer authority within NIH, to the 
Director of NIH for activities related to opioid misuse, opioid 
alternatives, pain management, and substance use disorder 
treatment.
    Section 225 includes certain Congressional notification 
requirements.
    Section 226 includes a provision related to a report on 
staffing.
    Section 227 allows HHS to cover travel expenses when 
necessary for employees to obtain medical care when they are 
assigned to duty in a location with a public health emergency.
    Sec. 228. The Committee modifies a provision related to 
donations for unaccompanied children.
    Sec. 229. The Committee modifies a provision related to the 
use of funds to house unaccompanied children in facilities that 
are not State-licensed for the care of unaccompanied children.
    Sec. 230. The Committee continues a provision related to 
the notification requirements regarding the use of facilities 
that are not State-licensed for the care of unaccompanied 
children.
    Sec. 231. The Committee modifies a provision related to 
Members of Congress and oversight of facilities responsible for 
the care of unaccompanied children.
    Sec. 232. The Committee continues a provision requiring 
monthly reporting on unaccompanied children who were separated 
from their parents or legal guardians and transferred to the 
care of the Office of Refugee Resettlement.
    Sec. 233. The Committee includes a new provision 
prohibiting the use of funds for sharing any information 
pertaining to unaccompanied children for use or reference in 
removal proceedings or immigration enforcement.
    Sec. 234. The Committee includes a new provision ensuring 
that efforts are taken to place unaccompanied children who are 
siblings together.
    Sec. 235. The Committee includes a new provision requiring 
the Secretary to submit a detailed spend plan outlining 
anticipated uses of funds in the Refugee and Entrant Assistance 
account.
    Sec. 236. The Committee includes a new provision 
authorizing the use of funds in the Refugee and Entrant 
Assistance account for services to children, parents, and legal 
guardians who were separated at the United States-Mexico border 
in connection with the Zero-Tolerance Policy.
    Section 237 allows for primary and secondary school costs 
for eligible dependents of HHS personnel stationed in a U.S. 
territory.
    Section 238 rescinds balances from the Nonrecurring 
Expenses Fund.
    Section 239 increases flexibility for grantees of the Ryan 
White HIV/AIDS program.
    Section 240 prohibits funds from being awarded to an 
organization that does not comply with Federal 
nondiscrimination regulations.
    Section 241 provides certain administrative flexibility to 
be available during a public health emergency.
    Section 242 changes the name of the National Institute on 
Drug Abuse to the National Institute on Drugs and Addiction.
    Section 243 changes the name of the National Institute of 
Alcohol Abuse and Alcoholism to the National Institute of 
Alcohol Effects and Alcohol-Related Disorders.
    Section 244 amends the PHS Act and related statutes to 
revise references to the Substance Abuse and Mental Health 
Services Administration.
    Section 245 includes notification requirements in the 
Social Security Act.
    Section 246 extends the availability of NIH multi-year 
research grants awarded in fiscal year 2017.
    Section 247 amends the PHS Act for CDC fellowship or 
training participants.

                   TITLE III--DEPARTMENT OF EDUCATION

    Language is included under ``Impact Aid'' allowing 
continued eligibility for students affected by the deployment 
or death of their military parent so long as the children 
attend school in the same local education agency they attended 
prior to the parent's death or deployment.
    Language is included under ``School Improvement Programs'' 
allowing the Secretary of Education to reserve up to 5 percent 
of Supplemental Education Grants funds to provide technical 
assistance for these grants.
    Language is included under ``Special Education'' clarifying 
the amounts required to be transferred to the Department of the 
Interior under the Grants to States program.
    Language is included under ``Special Education'' outlining 
procedures for reducing a State's award because of a failure to 
meet the maintenance of State financial support requirements of 
the Individuals with Disabilities Education Act.
    Language is included under ``Special Education'' 
authorizing the Department to use certain funds to provide 
technical assistance and support to States to improve data 
collection capacity.
    Language is included under ``Special Education'' 
authorizing the Department to use funds appropriated for the 
State Personnel Development Grants program to evaluate program 
performance.
    Language is included under ``Special Education'' permitting 
States to subgrant funds that they reserve for ``Other State-
level activities'' under the Grants to States, Preschool Grants 
to States, and Grants for Infants and Families programs.
    Language is included under ``Special Education'' allowing 
the Department to provide all States that apply for the State 
Incentive Grants program, in years in which five or fewer 
States apply for funding, 20 percent of the funds reserved for 
the program.
    Language is included under ``Special Education'' to promote 
continuity of services for eligible infants and their families.
    Language is included under ``Special Education'' to 
increase access for infants and families who have been 
traditionally underrepresented in the Grants for Infants and 
Families program, eliminate out-of-pocket costs for 
participating families, and conduct certain activities with 
individuals expecting to become parents of infants or toddlers 
with disabilities.
    Language is included under ``Rehabilitation Services'' 
allowing the Secretary to use amounts that remain available 
after the reallotment of funds to States under the Vocational 
Rehabilitation State Grants program for innovative activities 
designed to increase competitive integrated employment for 
youth and other individuals with disabilities.
    Language is included under ``Special Institutions for 
Persons with Disabilities'' allowing the National Technical 
Institute for the Deaf to use, at its discretion, funds for the 
endowment program as authorized under section 207 of the 
Education of the Deaf Act of 1986.
    Language is included under ``Special Institutions for 
Persons with Disabilities'' allowing Gallaudet University to 
use, at its discretion, funds for the endowment program as 
authorized under section 207 of the Education of the Deaf Act 
of 1986.
    Language is included under ``Career, Technical, and Adult 
Education'' permitting accredited registered apprenticeship 
programs to be eligible for funding under the Perkins Act.
    Language is included under ``Student Aid Administration'' 
requiring that servicers be evaluated on their ability to meet 
contract requirements, future performance on the contracts, and 
history of compliance with applicable consumer protections 
laws, including Federal and State law.
    Language is included under ``Student Aid Administration'' 
requiring that FSA hold prime contractors accountable for 
meeting the requirements of the contract where subcontracting 
is permitted, and that contractors have the capacity to meet 
and are held accountable for performance on service levels and 
have a history of compliance with applicable consumer 
protection laws, including Federal and State law.
    Language is included under ``Higher Education'' allowing 
funds to carry out Title VI of the Higher Education Act and 
section 102(b)(6) of the Mutual Educational and Cultural 
Exchange Act of 1961 to be used to support visits and study in 
foreign countries for participants in advanced foreign 
countries by individuals who are participating in advanced 
foreign language training and international studies in areas 
that are vital to United States national security and who plan 
to apply their language skills and knowledge of these countries 
in the fields of government, the professions, or international 
development.
    Language is included under ``Higher Education'' allowing 
one percent of funds to carry out Title VI of the Higher 
Education Act and section 102(b)(6) of the Mutual Educational 
and Cultural Exchange Act of 1961 to be used for program 
evaluation, national outreach, and information dissemination 
activities.
    Language is included under ``Higher Education'' allowing up 
to one-and-one-half percent of the funds made available under 
chapter 2 of subpart 2 of part A of Title IV of the Higher 
Education Act to be used for evaluation.
    Language is included under ``Higher Education'' stating the 
section 313(d) of the Higher Education Act (HEA) does not apply 
to an institution of higher education that is eligible to 
receive funding under section 318 of the HEA.
    Language is included under ``Departmental Management'' 
restricting the Department from dissolving the Budget Service 
of the Department of Education, relative to the organization 
and operation of the Budget Service as in effect on January 1, 
2018.
    Language is included under ``General Provisions'' 
authorizing the transfer of up to one percent of discretionary 
funds between programs, projects, or activities as long as the 
transfer does not increase any program, project, or activity by 
more than three percent and no new program, project, or 
activity is created by such transfer.
    Language is included under ``General Provisions'' allowing 
ESEA funds consolidated for evaluation purposes to be available 
from July 1, 2023 through September 30, 2024.
    Language is included under ``General Provisions'' allowing 
certain institutions to continue to use endowment income for 
student scholarships.
    Language is included under ``General Provisions'' extending 
the authorization of the National Advisory Committee on 
Institutional Quality and Integrity.
    Language is included under ``General Provisions'' extending 
the authority to provide account maintenance fees to guaranty 
agencies for Federal student loans.
    Language is included under ``General Provisions'' allowing 
funds to be made available for payments for student loan 
servicing to an institution of higher education for loans under 
part E of Title IV of the HEA.
    Language is included under ``General Provisions'' amending 
section 401(b)(7)(A)(iv)(XI) of the HEA.
    Language is included under ``General Provisions'' providing 
funds for outreach to certain borrowers of loans made under 
part D of title IV of the Higher Education Act.
    Language is included under ``General Provisions'' modifying 
terms for unobligated funds for loan cancellation for certain 
borrowers of loans under part B or D of title IV of the Higher 
Education Act.
    Language is included under ``General Provisions'' allowing 
up to 0.5 percent of funds appropriated in this Act for 
programs authorized under the Higher Education Act, except for 
the Pell Grant program, to be used for evaluation of any Higher 
Education Act program.
    Language is included under ``General Provisions'' 
prohibiting the use of funds for charter schools that contract 
with a for-profit entity to operate, oversee or manage the 
activities of the school.
    Language is included under ``General Provisions'' 
prohibiting the Department from withholding appropriated funds 
from an institution of higher education because of an 
institution's scientific research on marihuana.
    Language is included under ``General Provisions'' 
prohibiting the use of funds for schools that use electric 
shock devices and equipment on students.
    Language is included under ``General Provisions'' amending 
the HEA to provide for greater accountability of for-profit 
institutions of higher education.
    Language is included under ``General Provisions'' allowing 
individuals who are DREAMERs or have temporary protected status 
to receive federal financial assistance.
    Language is included under ``General Provisions'' amending 
section 344(a) of the Higher Education Act.

                       TITLE IV--RELATED AGENCIES

    Language is included under ``The Committee for Purchase 
from People Who are Blind or Severely Disabled'' requiring that 
written agreements, with certain oversight provisions, be in 
place in order for authorized fees to be charged by certified 
nonprofit agencies.
    Language is included under ``Corporation for National and 
Community Service'' requiring the Corporation to make awards on 
a competitive basis pursuant to section 501(a)(4)(F) of the 
1990 Act, section 198P notwithstanding.
    Language is included under ``Corporation for National and 
Community Service'' regarding changes to program requirements 
or policy through rulemaking.
    Language is included under ``Corporation for National and 
Community Service'' regarding National Service Trust minimum 
share requirements.
    Language is included under ``Corporation for National and 
Community Service'' limiting the use of an educational award 
under section 148(a)(4) to individuals who are veterans.
    Language is included under ``Corporation for National and 
Community Service'' related to criminal background checks.
    Language is included under ``Corporation for National and 
Community Service'' related to 1,200 hour service positions.
    Language is included under ``Corporation for National and 
Community Service'' related to allowing VISTA members age 55 
and older to transfer education awards to eligible individuals.
    Language is included under ``Corporation for National and 
Community Service'' related to allowing individuals with 
Deferred Action for Childhood Arrivals (DACA) status who 
successfully serve a term in AmeriCorps State and National, 
NCCC, or VISTA, to be eligible for a Segal AmeriCorps Education 
Award.
    Language is included under ``Corporation for National and 
Community Service'' related to allowing AmeriCorps NCCC to keep 
teams in place over the 12-month statutory restriction for work 
on disaster response or recovery.
    Language is included under ``Corporation for National and 
Community Service'' related to allowing AmeriCorps NCCC members 
ages 18-26 to participate for a period of three to six months.
    Language is included under ``Federal Mediation and 
Conciliation Service--Salaries and Expenses'' providing that 
fees charged for special training and other services and be 
retained and used for authorized purposes, that fees for 
arbitration services may only be used for training agency 
personnel, and that the Director may accept gifts and services 
in aid of any projects under the Director's jurisdiction.

                      TITLE V--GENERAL PROVISIONS

    Section 501 permits the Secretaries of Labor, Health and 
Human Services, and Education to transfer unexpended balances 
of prior appropriations to accounts corresponding to current 
appropriations to be used for the same purpose and for the same 
periods of time for which they were originally appropriated.
    Section 502 prohibits the obligation of funds beyond the 
current fiscal year unless expressly so provided.
    Section 503 prohibits funds from being used to support or 
defeat legislation.
    Section 504 limits the amount available for official 
reception and representation expenses for the Secretaries of 
Labor and Education, the Director of the Federal Mediation and 
Conciliation Service, and the Chairman of the National 
Mediation Board.
    Section 505 requires grantees receiving Federal funds to 
clearly state the percentage of the total cost of the program 
or project that will be financed with Federal money.
    Section 506 prohibits use of funds for certain research 
involving human embryos.
    Section 507 prohibits use of funds for any activity that 
promotes the legalization of any drug or substance included in 
schedule I of the schedules of controlled substances.
    Section 508 prohibits funds to be obligated or expended on 
a contract with an entity that has not submitted a report on 
qualified veteran employees as required under 38 U.S.C. 
4212(d).
    Section 509 prohibits any transfer of funds made available 
in this Act except by the authority provided in this Act or 
another appropriation Act.
    Section 510 limits funds in the bill for public libraries 
to those that comply with the requirements of the Children's 
Internet Protection Act.
    Section 511 dictates the procedures for the reprogramming 
of any funds provided in the bill.
    Section 512 continues a provision pertaining to 
appointments to federal scientific advisory committees to 
prevent the disclosure of information like political 
affiliation of candidates for appointment.
    Section 513 requires each department and related agency 
funded through this Act to submit an operating plan within 45 
days of enactment, detailing any funding allocations that are 
different than those specified in this Act, the accompanying 
detailed table, or budget request.
    Section 514 requires the Secretaries of Labor, Health and 
Human Services, and Education to submit a quarterly report to 
the Committees on Appropriations of the House of 
Representatives and the Senate containing certain information 
on noncompetitive contracts, grants, and cooperative agreements 
exceeding $500,000 individually or in total.
    Section 515 prohibits use of funds to process claims for 
credit for quarters of coverage based on work performed under a 
Social Security number that was not the claimant's number, 
where the performance of such work under such number has formed 
the basis for a conviction of the claimant of a violation of 
section 208(a)(6) or (7) of the Social Security Act.
    Section 516 prohibits use of funds to implement a Social 
Security totalization agreement with Mexico.
    Section 517 prohibits the use of funds for the downloading 
or exchanging of pornography.
    Section 518 directs certain reporting requirements for 
conference expenditures.
    Section 519 requires disclosure of U.S. taxpayer funding 
for programs used in advertising.
    Section 520 authorizes performance partnership pilots.
    Section 521 requires quarterly reports on the status of 
balances of appropriations from the Departments of Labor, 
Health and Human Services and Education.
    Section 522 requires the Departments of Labor, Health and 
Human Services, and Education to provide a list of any new or 
competitive grant award notifications, including supplements, 
not less than three business days prior to the announcement of 
recipients of such awards.
    Section 523 requires each Department and related agency 
funded through this Act to provide answers to questions 
submitted for the record by Members of the Committee within 45 
business days after receipt.
    Section 524 makes funds from the Children's Health 
Insurance Program Performance Bonus Fund unavailable for 
obligation in fiscal year 2023.
    Section 525 provides additional authorities for funds made 
available for research or evaluation purposes.

                  Appropriations Not Authorized by Law

    Pursuant to clause 3(f)(1)(B) of rule XIII of the Rules of 
the House of Representatives, the following table lists the 
appropriations in the accompanying bill which are not 
authorized by law for the period concerned (dollars in 
thousands):

----------------------------------------------------------------------------------------------------------------
                                                                           Appropriations in
         Agency Program              Last Year of        Authorization       Last Year of     Appropriations  in
                                     Authorization           Level           Authorization         this Bill
----------------------------------------------------------------------------------------------------------------
DEPARTMENT OF LABOR ETA
    Adult Employment and          FY 2020...........  $899,987,000......  $854,649,000......  $940,649,000
     Training Activities.
    Youth Employment and          FY 2020...........  963,837,000.......  913,130,000.......  1,033,130,000
     Training Activities.
    Dislocated Worker Employment  FY 2020...........  1,436,137,000.....  1,052,053,000.....  1,161,553,000
     and Training Activities.
    Native Americans............  FY 2020...........  54,137,000........  55,000,000........  63,800,000
    Migrant and Seasonal          FY 2020...........  96,211,000........  91,896,000........  105,000,000
     Farmworker programs.
    YouthBuild..................  FY 2020...........  91,087,000........  94,534,000........  145,000,000
    Reintegration of Ex-          FY 2020...........  106,906,000.......  98,079,000........  150,000,000
     Offenders.
    Job Corps...................  FY 2020...........  1,983,236,000.....  1,743,655,000.....  1,798,000,000
    One-Stop Career Centers/      FY 2020...........  70,667,000........  62,653,000........  67,653,000
     Labor Market Information.
DEPARTMENT OF HEALTH AND HUMAN
 SERVICES HRSA
    School-Based Health Centers.  FY 2013...........  50,000,000........  47,450,000........  50,000,000
    Nurse Practitioner Optional   N/A...............  N/A...............  N/A...............  6,000,000
     Fellowship Program.
    Medical Student Education...  N/A...............  N/A...............  N/A...............  60,000,000
    Early Hearing Detection and   FY 2022...........  19,522,758........  17,818,000........  18,818,000
     Intervention.
    Heritable Disorders.........  FY 2019...........  19,900,000........  18,883,000........  21,883,000
    Pediatric Mental Health       FY 2022...........  9,000,000.........  10,000,000........  14,000,000
     Access.
    Screening and Treatment for   FY 2022...........  5,000,000.........  5,000,000.........  11,500,000
     Maternal Depression.
    Emergency Relief--Part A....  FY 2013...........  789,471,000.......  649,373,000.......  691,045,000
    Comprehensive Care--Part B..  FY 2013...........  1,562,169,000.....  1,314,446,000.....  1,385,517,000
    Early Intervention--Part C..  FY 2013...........  285,766,000.......  205,544,000.......  211,861,000
    Coordinated Services and      FY 2013...........  87,273,000........  75,088,000........  79,114,000
     Access to Research for
     Women, Infants, Children
     and Youth--Part D.
    Dental Reimbursement--Part F  FY 2013...........  15,802,000........  12,991,000........  13,826,000
    AIDS Education and Training   FY 2013...........  42,178,000........  33,275,000........  35,413,000
     Centers--Part F.
    Special Projects of National  FY 2013...........  25,000,000........  25,000,000........  28,000,000
     Significance--Part F.
    Ending the HIV/AIDS Epidemic  N/A...............  N/A...............  N/A...............  250,000,000
    Organ Transplantation.......  FY 1993...........  Such Sums.........  2,767,000.........  31,049,000
    Rural Hospital Flexibility    FY 2012...........  Such Sums.........  41,040,000........  68,500,000
     Grants.
    State Offices of Rural        FY 2002...........  Such Sums.........  4,000,000.........  12,500,000
     Health.
    Family Planning Grants......  FY 1985...........  158,400,000.......  142,500,000.......  500,000,000
CDC
    Sexually Transmitted          FY 1998...........  Such Sums.........  112,117,000.......  179,310,000
     Infections.
    National Center for Health    FY 2003...........  Such Sums.........  125,899,000.......  190,397,000
     Statistics.
    WISEWOMAN...................  FY 2003...........  Such Sums.........  12,419,000........  37,620,000
    National Cancer Registries..  FY 2003...........  Such Sums.........  N/A...............  56,440,000
    Asthma Surveillance & Grants  FY 2005...........  Such Sums.........  32,422,000........  33,500,000
    Folic Acid..................  FY 2005...........  Such Sums.........  2,188,000.........  3,150,000
    Injury Prevention and         FY 2005...........  Such Sums.........  138,237,000.......  897,779,000
     Control.
    Oral Health Promotion.......  FY 2005...........  Such Sums.........  11,204,000........  20,750,000
    Screening, Referrals, and     FY 2005...........  40,000,000........  36,474,000........  66,000,000
     Education Regarding Lead
     Poisoning.
    Birth Defects, Developmental  FY 2007...........  Such Sums.........  122,242,000.......  225,060,000
     Disability, Disability and
     Health.
    Breast and Cervical Cancer..  FY 2012...........  275,000,000.......  204,779,000.......  206,880,000
    Public Health Workforce and   FY 2013...........  39,500,000........  64,000,000........  106,000,000
     Career Development.
    National Diabetes Prevention  FY 2014...........  Such Sums.........  10,000,000........  38,300,000
     Program.
    Johanna's Law...............  FY 2014...........  18,000,000........  4,972,000.........  12,500,000
    Section 317 Immunization....  FY 2014...........  Such Sums.........  610,847,000.......  825,797,000
    Young Women's Breast Health   FY 2019...........  4,900,000.........  4,960,000.........  8,960,000
     Awareness and Support of
     Young Women Diagnosed with
     Breast Cancer (PHSA 399NN).
    Center for Research and       FY 2003...........  Such Sums.........  26,830,000........  29,961,0000
     Demonstration of Health
     Promotion and Disease
     Prevention.
    Preventive Health Measures    FY 2004...........  Such Sums.........  14,091,000........  15,205,000
     with regard to Prostate
     Cancer.
    Combating Antimicrobial       FY 2006...........  Such Sums.........  17,443,000........  202,000,000
     Resistance.
    National Strategy for         FY 2013...........  243,101,000.......  132,997,000.......  140,034,000
     Combating and Eliminating
     Tuberculosis.
    Newborn Screening Laboratory  FY 2019...........  8,000,000.........  17,250,000........  23,250,000
     Quality and Surveillance.
    Rape Prevention.............  FY 2018...........  50,000,000........  49,430,000........  71,750,000
    Early Hearing Detection and   FY 2022...........  11,852,000........  10,760,000........  10,760,000
     Intervention.
    Firefighter Cancer Registry.  FY 2022...........  2,500,000.........  2,500,000.........  5,500,000
NIH
    National Institutes of        FY 2020...........  36,472,442,775....  40,954,400,000....  47,459,000,000
     Health.
SAMHSA
    Protection and Advocacy for   FY 2003...........  19,500,000........  36,146,000........  40,000,000
     Individuals with Mental
     Illness.
    State Opioid Response Grants  N/A...............  N/A...............  N/A...............  1,775,000,000
AHRQ
    Research on Health Costs,     FY 2005...........  Such Sums.........  324,000,000.......  385,000,000
     Quality, and Outcomes.
ACF
    Low Income Home Energy        FY 2007...........  5,100,000,000.....  2,161,170,000.....  4,000,000,000
     Assistance Program.
    Child Care and Development    FY 2020...........  2,748,591,018.....  5,826,000,000.....  7,165,330,000
     Block Grant.
    Children and Families
     Services Programs.
    Adoption and Legal            FY 2016...........  43,000,000........  37,943,000........  75,000,000
     Guardianship Incentive
     Payments.
    Native American Programs....  FY 2002...........  Such Sums.........  45,826,000........  63,762,000
    Community Services Block      FY 2003...........  Such Sums.........  645,762,000.......  800,000,000
     Grant.
    Community Economic            FY 2003...........  Such Sums.........  27,082,000........  22,383,000
     Development.
    Rural Community Development.  FY 2003...........  Such Sums.........  7,203,000.........  12,000,000
    Head Start..................  FY 2012...........  Such Sums.........  7,968,544,000.....  12,396,820,000
    Preschool Development Grants  FY 2021...........  Such Sums.........  275,000,000.......  350,000,000
    Runaway and Homeless Youth    FY 2013...........  Such Sums.........  107,852,000.......  155,000,000
     Programs.
    CAPTA programs..............  FY 2015...........  Such Sums.........  143,981,000.......  226,000,000
    Family Violence Programs....  FY 2015...........  178,500,000.......  139,500,000.......  300,000,000
    National Domestic Violence    FY 2015...........  Such Sums.........  4,500,000.........  27,360,000
     Hotline.
    Child Welfare Services......  FY 2016...........  325,000,000.......  268,735,000.......  273,735,000
    Refugee and Entrant
     Assistance Programs.
    Refugee Support Services....  FY 2002...........  Such Sums.........  212,912,000.......  450,000,000
    Transitional and Medical      FY 2002...........  Such Sums.........  227,243,000.......  760,000,000
     Services.
    Survivors of Torture........  FY 2007...........  25,000,000........  9,817,000.........  20,000,000
    Anti-Trafficking in Persons   FY 2021...........  28,755,000........  28,755,000........  35,000,000
     Programs.
ACL
    Lifespan Respite Care.......  FY 2011...........  94,810,000........  2,495,000.........  14,220,000
    State Health Insurance        FY 1996...........  10,000,000........  N/A...............  58,115,000
     Assistance Program.
    Developmental Disabilities..  FY 2007...........  Such Sums.........  155,115,000.......  203,283,000
    Voting Access for People      FY 2005...........  17,410,000........  13,879,000........  12,414,000
     with Disabilities.
    Elder Justice/ Adult          FY 2014...........  129,000,000.......  0.................  100,000,000
     Protective Services.
    Assistive Technology........  FY 2010...........  Such Sums.........  25,000,000........  44,000,000
    Traumatic Brain Injury......  FY 2019...........  8,600,000.........  11,321,000........  13,118,000
    Paralysis Resource Center...  FY 2011...........  25,000,000........  6,352,000.........  10,185,000
    Limb Loss...................  N/A...............  N/A...............  N/A...............  4,200
    Independent Living and the    FY 2020...........  214,135,000.......  228,153,000.......  257,470,000
     National Institute on
     Disability, Independent
     Living and Rehabilitation
     Research.
PHSSEF
    Preparedness and Emergency    N/A...............  N/A...............  N/A...............  28,300,000
     Operations.
    Policy and Planning.........  N/A...............  N/A...............  N/A...............  17,877,000
    ASPR Operations.............  N/A...............  N/A...............  N/A...............  34,376,000
    Cybersecurity...............  N/A...............  N/A...............  N/A...............  153,815,000
    Office of National Security.  N/A...............  N/A...............  N/A...............  8,983,000
ARPA-H
    Advanced Research Projects..  N/A...............  N/A...............  N/A...............  2,750,000,000
DEPARTMENT OF EDUCATION
    Title I Grants to LEAs......  FY 2020...........  16,182,345,000....  16,309,802,000....  20,536,802,000
    Innovative Approaches to      FY 2020...........  180,014,000 (for    27,000,000........  31,000,000
     Literacy (IAL).                                   IAL and CLSD).
    Comprehensive Literacy        FY 2020...........  180,014 (for IAL    192,000,000.......  192,000,000
     Development (CLSD).                               and CLSD).
    Migrant.....................  FY 2020...........  374,751,000.......  375,626,000.......  375,626,000
    Neglected and Delinquent/     FY 2020...........  47,614,000........  47,614,000........  48,239,000
     High Risk Youth.
    Impact Aid..................  FY 2020...........  1,388,603,000.....  1,486,112,000.....  1,614,112,000
    Supporting Effective          FY 2020...........  2,295,830,000.....  2,131,830,000.....  2,270,080,000
     Instruction State Grants.
    Nita M. Lowey 21st Century    FY 2020...........  1,100,000,000.....  1,249,673,000.....  1,409,673,000
     Community Learning Centers.
    State Assessments...........  FY 2020...........  378,000,000.......  378,000,000.......  390,000,000
    Education for Homeless        FY 2020...........  85,000,00.........  101,500,000.......  122,000,000
     Children and Youth.
    Education for Native          FY 2020...........  32,397,000........  36,897,000........  40,897,000
     Hawaiians.
    Alaska Native Education       FY 2020...........  31,453,000........  35,953,000........  37,953,000
     Equity.
    Rural Education.............  FY 2020...........  169,840,000.......  185,840,000.......  195,000,000
    Student Support and Academic  FY 2020...........  1,600,000,000.....  1,210,000,000.....  1,355,000,000
     Enrichment Grants.
    Indian Education Grants to    FY 2020...........  106,525,000.......  105,381,000.......  110,381,000
     Local Educational Agencies.
    Special Programs for Indian   FY 2020...........  17,993,000........  67,993,000........  72,000,000
     children.
    Indian Education National     FY 2020...........  5,565,000.........  7,365,000.........  12,865,000
     Activities.
    Education Innovation and      FY 2020...........  90,611,000........  190,000,000.......  384,000,000
     Research.
    American History and Civics.  FY 2020...........  19,567,000........  4,815,000.........  15,500,000
    Charter Schools Grants......  FY 2020...........  300,000,000.......  440,000,000.......  400,000,000
    Magnet Schools Assistance...  FY 2020...........  108,530,000.......  107,000,000.......  149,000,000
    Teacher and School Leader     FY 2020...........  229,909,000.......  200,000,000.......  88,500,000
     Incentive Grants.
    Ready-to-Learn Programming    FY 2020...........  56,093,000 (for     29,000,000........  32,500,000
     (RTL).                                            RTL, Arts, and
                                                       Javits).
    Supporting Effective          FY 2020...........  Up to 55,022,000    80,000,000........  90,000,000
     Educator Development.                             (minimum
                                                       53,574,000).
    Arts in Education (Arts)....  FY 2020...........  56,093,000 (for     30,000,000........  38,500,000
                                                       RTL, Arts, and
                                                       Javits).
    Javits Gifted and Talented    FY 2020...........  56,093,000 (for     13,000,000........  16,500,000
     Students (Javits).                                RTL, Arts, and
                                                       Javits).
    Statewide Family Engagement   FY 2020...........  10,000,000........  10,000,000........  16,000,000
     Centers.
    Promise Neighborhoods (PN)..  FY 2020...........  69,037,000 (for PN  80,000,000........  96,000,000
                                                       and FSCS).
    School Safety National        FY 2020...........  5,000,000.........  105,000,000.......  1,134,000
     Activities.
    Full-Service Community        FY 2020...........  69,037,000 (for PN  25,000,000........  468,000,000
     Schools (FSCS).                                   and FSCS).
    English Language Acquisition  FY 2020...........  884,960,000.......  787,400,000.......  1,000,000,000
    Vocational Rehabilitation     FY 2021...........  3,675,021,000.....  3,675,021,000.....  3,949,707,000
     State Grants.
    Client Assistance State       FY 2021...........  14,098,000........  13,000,000........  13,000,000
     Grants.
    Supported Employment State    FY 2021...........  32,363,000........  22,548,000........  22,548,000
     Grants.
    Training....................  FY 2021...........  39,540,000........  29,388,000........  29,388,000
    Demonstration and Training    FY 2021...........  6,809,000.........  5,796,000.........  15,796,000
     Programs.
    Services for Older Blind      FY 2021...........  39,141,000........  33,317,000........  33,317,000
     Individuals.
    Protection and Advocacy of    FY 2021...........  20,735,000........  18,150,000........  21,150,000
     Individual Rights.
    Helen Keller National Center  FY 2004...........  Such Sums.........  8,666,000.........  20,000,000
     for Deaf-Blind Youths and
     Adults.
    National Technical Institute  FY 2015...........  Such Sums.........  67,016,000........  91,500,000
     for the Deaf.
    Gallaudet University........  FY 2015...........  Such Sums.........  120,275,000.......  156,361,000
    Adult Basic and Literacy      FY 2021...........  665,067,000.......  674,955,000.......  714,000,000
     Education State Grants.
    Adult Education National      FY 2021...........  13,573,000........  13,712,000........  18,712,000
     Leadership Activities.
    Aid for Institutional         FY 2015...........  Such Sums.........  429,762,000.......  1,110,117,000
     Development.
    Aid for Hispanic-Serving      FY 2015...........  Such Sums.........  109,223,000.......  246,732,000
     Institutions.
    International Education And   FY 2015...........  Such Sums.........  72,164,000........  88,664,000
     Foreign Language.
    Teacher Quality Partnerships  FY 2011...........  Such Sums.........  43,000,000........  132,092,000
    Federal TRIO Programs.......  FY 2015...........  Such Sums.........  839,752,000.......  1,297,761,000
    IDEA National Activities....  FY 2010...........  Such Sums.........  260,203,000.......  440,560,000
    IDEA Grants for Infants and   FY 2010...........  Such Sums.........  439,427,000.......  621,306,000
     Families.
    Special Programs for Migrant  FY 2015...........  Such Sums.........  37,474,000........  58,123,000
     Students.
    Comprehensive Centers.......  FY 2008...........  Such Sums.........  57,113,000........  54,000,000
RELATED AGENCIES
    Corporation for Public        FY 1996...........  425,000,000.......  275,000,000.......  585,000,000
     Broadcasting.
    Corporation for National and  FY 2014...........  Such Sums.........  1,049,954,000.....  1,315,266,000
     Community Service.
----------------------------------------------------------------------------------------------------------------

                          Program Duplication

    Pursuant to clause 3(c)(5) of rule XIII of the Rules of the 
House of Representatives, no provision of this bill establishes 
or reauthorizes a program of the Federal Government known to be 
duplicative of another Federal program, a program that was 
included in any report from the Government Accountability 
Office to Congress pursuant to section 21 of Public Law 111-
139, or a program related to a program identified in the most 
recent Catalog of Federal Domestic Assistance.

                           Committee Hearings

    In compliance with clause 3(c)(6) of rule XIII (117th 
Congress) the following hearings were used to develop the 
fiscal year 2023 Bill:
    The Subcommittee on Labor, Health and Human Services, 
Education, and Related Agencies held a budget hearing on March 
31, 2022, entitled ``FY 2023 Budget Request for the Department 
of Health and Human Services.'' The Subcommittee received 
testimony from:
    The Honorable Xavier Becerra, Secretary, Department of 
Health and Human Services.
    The Subcommittee on Labor, Health and Human Services, 
Education, and Related Agencies held an oversight hearing on 
April 6, 2022, entitled ``Social and Emotional Learning and 
Whole Child Approaches in K-12 Education.'' The Subcommittee 
received testimony from:
    Pamela Cantor, M.D., Founder & Science Advisor, Turnaround 
for Children.
    Linda Darling-Hammond, Ed.D., President & CEO, Learning 
Policy Institute.
    Max Eden, Research Fellow, American Enterprise Institute.
    Tim Shriver, Ph.D., Co-founder and Board Chair, 
Collaborative for Academic, Social, and Emotional Learning.
    The Subcommittee on Labor, Health and Human Services, 
Education, and Related Agencies held a budget hearing on April 
28, 2022, entitled ``FY 2023 Budget Request for the Department 
of Education.'' The Subcommittee received testimony from:
    The Honorable Miguel Cardona, Secretary, Department of 
Education
    The Subcommittee on Labor, Health and Human Services, 
Education, and Related Agencies held a budget hearing on May 
11, 2022, entitled ``FY 2023 Budget Request for the National 
Institutes of Health.'' The Subcommittee received testimony 
from:
    Dr. Lawrence Tabak, Acting Director, National Institutes of 
Health
    The Subcommittee on Labor, Health and Human Services, 
Education, and Related Agencies held an oversight hearing on 
May 12, 2022, entitled ``Healthy Aging: Maximizing the 
Independence, Well-being, and Health of Older Adults.'' The 
Subcommittee received testimony from:
    Dr. Martha B. Pelaez, Board Member, National Council on 
Aging and Evidence-Based Leadership Collaborative.
    Patricia Lyons, President and CEO, Senior Citizens, Inc.
    Karen Orsi, Director, Oklahoma Mental Health and Aging 
Coalition.
    Robert B. Blancato, National Coordinator, Elder Justice 
Coalition
    The Subcommittee on Labor, Health and Human Services, 
Education, and Related Agencies held a budget hearing on May 
17, 2022, entitled ``FY 2023 Budget Request for the Department 
of Labor.'' The Subcommittee received testimony from:
    The Honorable Martin Walsh, Secretary, Department of Labor
    The Subcommittee on Labor, Health and Human Services, 
Education, and Related Agencies held a hearing on May 24, 2022, 
entitled ``FY 2023 Member Day.'' The Subcommittee received 
testimony from:
    The Honorable Mikie Sherrill, Member of Congress
    The Honorable Veronica Escobar, Member of Congress
    The Honorable Sylvia Garcia, Member of Congress
    The Honorable Kim Schrier, Member of Congress
    The Subcommittee on Labor, Health and Human Services, 
Education, and Related Agencies held an oversight hearing on 
May 25, 2022, entitled ``Tackling Teacher Shortages.'' The 
Subcommittee received testimony from:
    Desiree Carver-Thomas, Researcher and Policy Analyst, 
Learning Policy Institute
    Dr. Lindsey Burke, Director of the Center for Education 
Policy, Heritage Foundation
    Randi Weingarten, President, American Federation of 
Teachers
    Dr. Jane West, Education Policy Consultant
    The Subcommittee on Labor, Health and Human Services, 
Education, and Related Agencies held a hearing on May 26, 2022, 
entitled ``Public Witness Day.'' The Subcommittee received 
testimony from:
    Bob Lanter, Executive Director, California Workforce 
Association
    Jodi Grant, Executive Director, Afterschool Alliance
    Mark Jenkins, Executive Director, Connecticut Harm 
Reduction Alliance
    Jane Weintraub, DDS, MPH, FACD, FICD, Professor, University 
of North Carolina at Chapel Hill Adams School of Dentistry, 
American Association for Dental, Oral, and Craniofacial 
Research
    Marwan Haddad, MD, MPH, Medical Director of the Center for 
Key Populations at Community Health Center, Inc., HIVMA 
Medicine Association
    Cynthia McCurren, PHD, RN, Board Chair, American 
Association of Colleges of Nursing
    Julie Ajinkya, PHD, Senior Vice President & Chief Strategy 
Officer, APIA Scholars
    Brian Wallach, Co-Founder, I AM ALS
    Karen Knudsen, MBA, PHD, Chief Executive Officer, American 
Cancer Society and American Cancer Action Network
    Belinda Pettiford, MPH, President, Association of Maternal 
and Child Health Programs
    Dr. Anne Matthews, Chair, Polio Eradication Advocacy Task 
Force for the United States, The Rotary Foundation of Rotary 
International
    Mairead Painter, Connecticut State Long-Term Care 
Ombudsman, National Association of State Long-Term Care 
Ombudsman Programs
    Hannah Wesolowski, Chief Advocacy Officer, National 
Alliance on Mental Illness
    Thomas Fleisher, MD, FAAAAI, Executive Vice President, 
American Academy of Allergy, Asthma, & Immunology
    Dr. Sandra Harris-Hooker, Senior Vice President for 
Research Administration and Professor of Pathology, Morehouse 
School of Medicine
    Katie Ray-Jones, Chief Executive Officer, The National 
Domestic Violence Hotline
    Rick Ginsberg, Dean of the School of Education, University 
of Kansas, The Learning and Education Academic Research Network 
(LEARN) Coalition
    Antonio Flores, PHD, President & CEO, Hispanic Association 
of Colleges and Universities
    Janet Hamilton, Executive Director, Council of State and 
Territorial Epidemiologists
    Moira Szilagyi, MD, PHD, FAAP, President, American Academy 
of Pediatrics
    Mark Anthony Figueroa, GEAR UP Alumnus, National Council 
for Community and Education Partnerships
    Esther Lucero, President & CEO, Seattle Indian Health Board
    Lodriguez Murray, Senior Vice President, Public Policy and 
Government Affairs, United Negro College Fund
    Nancy Gonzales, Owner, Lil' Bears Family Day Care, American 
Federation of State, County, and Municipal Employees

   BUDGETARY IMPACT OF THE FY 2023 LABOR, HEALTH AND HUMAN SERVICES, 
    EDUCATION, AND RELATED AGENCIES APPROPRIATIONS BILL PREPARED IN 
 CONSULTATION WITH THE CONGRESSIONAL BUDGET OFFICE PURSUANT TO SECTION 
             308(A) OF THE CONGRESSIONAL BUDGET ACT OF 1974

                        [In millions of dollars]


                   COMPARISON WITH BUDGET RESOLUTION

    Pursuant to clause 3(c)(2) of rule XIII of the Rules of the 
House of Representatives and section 308(a)(1)(A) of the 
Congressional Budget Act of 1974, the following table compares 
the levels of new budget authority provided in the bill with 
the appropriate allocation under section 302(b) of the Budget 
Act.

                                            [In millions of dollars]
----------------------------------------------------------------------------------------------------------------
                                                        302 (b) Allocation                   This Bill
                                                 ---------------------------------------------------------------
                                                      Budget                          Budget
                                                     Authority        Outlays        Authority        Outlays
----------------------------------------------------------------------------------------------------------------
Comparison of amounts in the bill with Committee
 allocations to its subcommittees: Subcommittee
 on Labor, Health and Human Services, and
 Education, and Related Agencies
    General Purpose Discretionary...............         224,399         303,500         224,399      \1\293,642
    Mandatory...................................       1,134,027       1,130,832       1,134,027    \1\1,130,832
----------------------------------------------------------------------------------------------------------------
\1\Includes outlays from prior-year budget authority.
NOTE.--The amounts in this report do not include $495 million in discretionary budget authority and $548 million
  in associated outlays from amounts becoming available in fiscal year 2023 that were previously designated as
  being for an emergency requirement pursuant to a concurrent resolution on the budget. Consistent with the
  Congressional Budget Act of 1974, in the House of Representatives such amounts do not count against the
  Committee's allocation.
In addition, the amounts in this report do not include $1,085 million in discretionary budget authority and $561
  million in associated outlays provided for the purposes specified in the 21st Century Cures Act (Public Law
  114-255). Pursuant to title I of that Act, such funding does not count for the purposes of the Congressional
  Budget Act of 1974 or the Balanced Budget and Emergency Deficit Control Act of 1985.
In addition, consistent with the funding recommended in the bill for program integrity initiatives, in
  accordance with the Congressional Budget Act of 1974 and subsections (h), (i), and (j) of section 1 of H. Res.
  1151 (117th Congress), and after the bill is reported to the House, the chair of the Committee on the Budget
  will provide a revised section 302(a) allocation reflecting an additional $2,345 million in discretionary
  budget authority and $,1892 million in associated outlays for those recommended amounts. That new allocation
  will eliminate the technical difference prior to floor consideration.

                      FIVE-YEAR OUTLAY PROJECTIONS

    Pursuant to clause 3(c)(2) of rule XIII and section 
308(a)(1)(B) of the Congressional Budget Act of 1974, the 
following table contains five-year projections associated with 
the budget authority provided in the accompanying bill as 
provided to the Committee by the Congressional Budget Office.

                        [In millions of dollars]
------------------------------------------------------------------------
                                                            Outlays
------------------------------------------------------------------------
Projection of outlays associated with the
 recommendation:
    2023.............................................       \1\1,220,966
    2024.............................................            128,005
    2025.............................................             31,447
    2026.............................................              8,972
    2027 and future years............................              2,759
------------------------------------------------------------------------
\1\Excludes outlays from prior-year budget authority.

          FINANCIAL ASSISTANCE TO STATE AND LOCAL GOVERNMENTS

    Pursuant to clause 3(c)(2) of rule XIII and section 
308(a)(1)(C) of the Congressional Budget Act of 1974, the 
Congressional Budget Office has provided the following 
estimates of new budget authority and outlays provided by the 
accompanying bill for financial assistance to State and local 
governments.

                        [In millions of dollars]
------------------------------------------------------------------------
                                     Budget Authority       Outlays
------------------------------------------------------------------------
Financial assistance to State and             468,414         \1\642,004
 local governments for 2023.......
------------------------------------------------------------------------
\1\Excludes outlays from prior-year budget authority.




                             MINORITY VIEWS

    We appreciate the efforts of the Majority in producing a 
Labor, Health and Human Services, Education, and Related 
Agencies (Labor-HHS) Appropriations bill for Fiscal Year 2023 
that funds priorities of Members on both sides of the aisle. We 
were pleased the Committee adopted an amendment proposed by a 
Republican Member that maintains enforcement of Title 42, an 
important public health policy used at our Nation's borders, 
until the Administration provides a plan for its safe removal. 
We were also pleased the Majority included language proposed by 
Republicans, which ensures taxpayer money cannot be used to 
purchase crack pipes for consuming illegal substances and 
ensures taxpayer money will not go to the Wuhan Institute of 
Virology, or any other laboratory located in a country 
determined by the Secretary of State to be a foreign adversary, 
including China, Russia, North Korea, and Iran. These common 
sense funding restrictions improved this bill, and we are 
hopeful they will be retained in the final package.
    Despite the many good programs supported in the bill, 
Republicans are unanimous in our opposition to this measure. It 
is simply too extreme and out of step with the American people.
    First, the bill provides a hefty 14 percent, nearly $30 
billion, increase in funding over current levels. The price tag 
alone is unrealistic, revealing radical left-wing spending 
priorities and a total disregard for fiscal responsibility.
    While American families are experiencing the highest 
inflation rates and consumer prices seen in four decades, the 
Majority has chosen to exacerbate these problems by dumping 
millions of dollars into new, unauthorized social programs.
    Another reason we oppose this radical measure is the 
Majority's removal of the Hyde Amendment, which protects life 
and prevents federal taxpayer-funded abortions. Since it was 
first enacted in 1976, it is estimated this provision has saved 
more than two million lives while protecting the conscience 
rights of the great majority of Americans who are opposed to 
publicly funded abortions for religious, moral, or fiscal 
reasons.
    Republicans offered an amendment in Committee to reinstate 
this important protection for all Americans. The amendment was 
cosponsored by every Republican on the Committee, and this 
language must be reinstated to complete work on a final 
spending bill.
    The amendment also sought to continue longstanding 
protections for healthcare workers who refuse to participate 
directly in abortions against their own moral beliefs and 
consciences. Disappointingly, the Majority rejected an 
amendment to reinstate the Hyde/Weldon language in Committee.
    Beyond these extreme positions, the bill includes many 
other troubling policies and provisions. Amendments were 
offered by Republican Members to:
           stop new regulations proposed by the Biden 
        Administration that will make it difficult for charter 
        schools to operate;
           strike language that limits apprenticeship 
        programs to only those run by labor unions;
           prevent the Biden Administration from 
        authorizing en-masse cancellation of student loan debt 
        that will only exacerbate our economic problems;
           prohibit the development, administration, or 
        enforcement of new rules that mandate COVID-19 
        vaccination; and
           prohibit the Administration from declaring a 
        public health emergency under the guise of imposing 
        restrictions on second amendment rights.
    Unfortunately, each of these amendments were defeated by 
the Majority in Committee. Long-standing language should be 
retained and poison pills must be removed to achieve a final 
bipartisan spending deal.
    We urge the Majority to abandon their pursuit of radical, 
extremist views and move back toward the bipartisan compromise 
they know is necessary to fund the government.
    We are hopeful that in the weeks ahead, we will be able to 
address both the policy and funding issues, including 
reinstatement of the bipartisan Hyde/Weldon language. Without 
this, these spending bills will not become law. Our goal should 
be to avoid a long-term continuing resolution and build on the 
good progress we have made in the past by working together.

                                   Kay Granger.
                                   Tom Cole.