[House Report 117-96]
[From the U.S. Government Publishing Office]


117th Congress    }                                    {       Report
                        HOUSE OF REPRESENTATIVES
 1st Session      }                                    {       117-96

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



 
  DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND 
               RELATED AGENCIES APPROPRIATIONS BILL, 2022

                                _______
                                

 July 19, 2021.--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. 4502]

    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, 2022, 
and for other purposes.

                        INDEX TO BILL AND REPORT

                                                            Page number

                                                            Bill Report
Summary of Estimates and Appropriation.....................
                                                                      3
General Summary of the Bill................................
                                                                      3
Title I--Department of Labor:                                   2
                                                                     13
        Employment and Training Administration.............     2
                                                                     13
        Employee Benefits Security Administration..........    20
                                                                     27
        Pension Benefit Guaranty Corporation...............    21
                                                                     28
        Wage and Hour Division.............................    22
                                                                     28
        Office of Labor-Management Standards...............    22
                                                                     30
        Office of Federal Contract Compliance Programs.....    23
                                                                     30
        Office of Workers' Compensation Programs...........    23
                                                                     30
        Occupational Safety and Health Administration......    27
                                                                     33
        Mine Safety and Health Administration..............    28
                                                                     35
        Bureau of Labor Statistics.........................    30
                                                                     36
        Office of Disability Employment Policy.............    30
                                                                     37
        Departmental Management............................    31
                                                                     37
        General Provisions.................................    36
                                                                     45
Title II--Department of Health and Human Services:             46
                                                                     46
        Health Resources and Services Administration.......    46
                                                                     46
        Centers for Disease Control and Prevention.........    56
                                                                     79
        National Institutes of Health......................    63
                                                                    108
        Substance Abuse and Mental Health Services 
            Administration.................................    73
                                                                    166
        Agency for Healthcare Research and Quality.........    79
                                                                    187
        Centers for Medicare & Medicaid Services...........    80
                                                                    191
        Administration for Children and Families...........    84
                                                                    205
        Administration for Community Living................    97
                                                                    225
        Office of the Secretary............................   100
                                                                    232
        Public Health and Social Services Emergency Fund...   104
                                                                    250
        General Provisions.................................   106
                                                                    257
Title III--Department of Education:                           134
                                                                    261
        Education for the Disadvantaged....................   134
                                                                    261
        Impact Aid.........................................   135
                                                                    265
        School Improvement Programs........................   136
                                                                    266
        Indian Education...................................   138
                                                                    270
        Innovation and Improvement.........................   138
                                                                    271
        Safe Schools and Citizenship Education.............   139
                                                                    280
        English Language Acquisition.......................   140
                                                                    283
        Special Education..................................   140
                                                                    284
        Rehabilitation Services............................   145
                                                                    288
        Special Institutions for Persons with Disabilities.   146
                                                                    290
        Career, Technical and Adult Education..............   147
                                                                    291
        Student Financial Assistance.......................   148
                                                                    292
        Federal Direct Student Loan Program Account........
                                                                    294
        Student Aid Administration.........................   148
                                                                    295
        Higher Education...................................   151
                                                                    296
        Howard University..................................   152
                                                                    308
        College Housing and Academic Facilities Loans......   153
                                                                    308
        Historically Black College and University Capital 
            Financing Program Account......................   153
                                                                    308
        Institute of Education Sciences....................   154
                                                                    309
        Departmental Management............................   154
                                                                    311
        General Provisions.................................   156
                                                                    317
Title IV--Related Agencies:                                   163
                                                                    319
        Committee for the Purchase from People Who Are 
            Blind or Severely Disabled.....................   163
                                                                    319
        Corporation for National and Community Service.....   164
                                                                    319
        Corporation for Public Broadcasting................   169
                                                                    323
        Federal Mediation and Conciliation Service.........   170
                                                                    324
        Federal Mine Safety and Health Review Commission...   170
                                                                    324
        Institute of Museum and Library Services...........   171
                                                                    324
        Medicaid and CHIP Payment and Access Commission....   172
                                                                    326
        Medicare Payment Advisory Commission...............   172
                                                                    325
        National Council on Disability.....................   172
                                                                    326
        National Labor Relations Board.....................   172
                                                                    326
        National Mediation Board...........................   173
                                                                    327
        Occupational Safety and Health Review Commission...   173
                                                                    328
        Railroad Retirement Board..........................   173
                                                                    328
        Social Security Administration.....................   175
                                                                    329
Title V--General Provisions:                                  180
                                                                    334
House of Representatives Report Requirements
                                                                    335

                Summary of Estimates and Appropriations

    The following table compares on a summary basis the 
appropriations, including trust funds for fiscal year 2022, the 
budget request for fiscal year 2022, and the Committee 
recommendation for fiscal year 2022 in the accompanying bill.

                                         2022 LABOR, HHS, EDUCATION BILL
                                 [Discretionary funding in thousands of dollars]
----------------------------------------------------------------------------------------------------------------
                                                   Fiscal Year--                   2022 Committee compared to--
         Budget Activity         -------------------------------------------------------------------------------
                                   2021 Enacted     2022 Budget   2022 Committee   2021 Enacted     2022 Budget
----------------------------------------------------------------------------------------------------------------
Department of Labor.............     $12,536,098     $14,320,422     $14,720,051      +2,183,953        +399,629
Department of Health and Human       $96,962,754    $119,972,989    $119,845,125     +22,882,371        -127,864
 Services.......................
Department of Education.........     $73,536,533    $102,823,263    $102,823,263     +29,286,730           - - -
Related Agencies................     $15,428,615     $16,845,305     $16,867,354      +1,438,739         +22,049
----------------------------------------------------------------------------------------------------------------

                      General Summary of the Bill

    For fiscal year 2022, the Committee recommends a total of 
$237,466,000,000 in current year discretionary funding--the 
302(b) allocation--and $253,805,000,000 in overall programmatic 
funding, including offsets and adjustments. The fiscal year 
2022 recommendation is an increase of $55,236,000,000 above the 
fiscal year 2021 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. Many of the bill's programs have been severely 
strained over the past 18 months during the simultaneous public 
health and economic emergencies related to COVID-19. 
Fortunately, the President's fiscal year 2022 budget proposes 
to invest significant resources in these critical programs that 
provide opportunities for millions of families. Through this 
bill, the Committee is moving ambitiously to help the country 
recover from the worst pandemic in a century and move forward 
to strengthen opportunities for every individual to have a 
better chance at a better life--with a good education, a good 
job, and access to affordable health care.
    The Committee recommends historic investments in education 
programs, including meeting the Biden-Harris Administration's 
commitment to more than double federal funding for Title I 
Grants to Local Educational Agencies in fiscal year 2022 to a 
new level of $36,037,000,000. These investments will strengthen 
Federal support for high-poverty schools and support the 
delivery of a high-quality education for all students.
    The Committee also recommends a historic investment in 
rebuilding our public health system. As the country recovers 
from the worst pandemic in a century, the Committee includes 
more than $10,500,000,000 for the Centers for Disease Control 
and Prevention (CDC), an increase of nearly $2,700,000,000, 
which is the largest increase in budget authority ever provided 
to the CDC. This includes a new flexible funding stream of 
$1,000,000,000 for public health infrastructure and capacity, 
as well as an increase of $250,000,000 for CDC's global health 
activities.
    The Committee continues to build on investments made over 
the past six years in biomedical research by increasing funding 
for the National Institutes of Health (NIH) by $6,500,000,000, 
including an increase of $3,500,000,000 for basic biomedical 
research at existing NIH institutes and centers. As part of the 
Committee's investment in health research, the Committee also 
includes $3,000,000,000 to support the President's request to 
establish the Advanced Research Projects Agency for Health, or 
ARPA-H, to accelerate the pace of scientific breakthroughs that 
have the potential to transform health care and address our 
most complex health challenges.
    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 $1,000,000,000 
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 2022 
include:

                     Investing in Public 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 
$65,551,722,000 for Federal K-12 education programs, including 
Individuals with Disabilities Education Act (IDEA), an increase 
of $24,998,971,000 over the fiscal year 2021 enacted level and 
the same as the Biden-Harris Administration's fiscal year 2022 
budget request. The recommendation is a 62 percent increase 
over last year.
    In particular, the Committee recommends an additional 
$19,500,000,000 over the fiscal year 2021 enacted level for 
Title I Grants to Local Educational Agencies for a total of 
$36,036,802,000. 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 
$202,600,000 over the fiscal year 2021 enacted level and 
$82,600,000 above the fiscal year 2022 budget request. 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 $15,537,429,000 for IDEA Part B 
Grants to States, which is $2,599,972,000 above the fiscal year 
2021 enacted level and the same as the fiscal year 2022 budget 
request. 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 first 
step toward fully funding IDEA.

                      Public Health Infrastructure

    The COVID-19 pandemic exposed the inadequacies of the 
current public health ecosystem. After the COVID-19 pandemic is 
over, public health agencies cannot go back to what they were 
and 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 more 
than $10,500,000,000 for the CDC, an increase of nearly 
$2,700,000,000.
    The Committee provides a new, annual funding line to turn 
the tide on the nation's public health infrastructure by 
providing a stable source of disease-agnostic funding so that 
nation's State, local, territorial, and Federal public health 
agencies are better equipped to coordinate together to save 
lives. This bill includes $1,000,000,000 for Public Health 
Infrastructure and Capacity to begin to address mission-
critical gaps nationwide.
    In addition, this bill includes increases of: $50,000,000 
for Public Health Workforce and Career Development to invest in 
essential public health workers who protect our communities and 
are empowered by science; $100,000,000 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; $15,000,000 for the 
National Center for Health Statistics to initiate investments 
in the next generation of surveys; and $250,000,000 for Global 
Health to modernize and expand disease surveillance and 
response capabilities to strengthen global health security.

                              NIH Research

    The unprecedented speed with which scientists were able to 
develop effective COVID-19 vaccines would not have been 
possible without years of sustained investments made by 
Congress in biomedical research supported by the National 
Institutes of Health (NIH). The Committee continues and 
accelerates this investment by providing $46,434,000,000, an 
increase of $6,500,000,000 above the fiscal year 2021 enacted 
level. The bill includes an increase of $3,500,000,000 for 
traditional NIH research and activities, the largest annual 
appropriations increase for NIH since fiscal year 2003.
    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 no less than five percent for each Institute and 
Center. 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 includes $3,000,000,000 to establish the 
Advanced Projects Research Agency for Health (ARPA-H), as 
proposed in the President's budget request. 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, and 
amyotrophic lateral sclerosis (ALS).

                        Employment and Training

    The economic recession resulting from the COVID-19 pandemic 
impacted American families and further exposed existing 
inequities in our society. For example, while the unemployment 
rate peaked at 14.8 percent in April 2020 and is now at 5.9 
percent, the unemployment rate for Black workers peaked in May 
2020 at 16.7 percent and is now at 9.2 percent and the 
unemployment rate for Hispanic workers peaked at 18.9 percent 
in April 2020 and is now at 7.4 percent. The unemployment rate 
for White workers peaked at 14.1 percent in April 2020 and is 
now at 5.2 percent. In addition, COVID-19 had devastating 
impacts on women's participation in the labor force, especially 
for women of color. As our nation emerges from the COVID-19 
pandemic, unemployment assistance and workforce development 
opportunities will continue to play a critical role in our 
recovery.
    As such, the Committee recommendation includes needed 
investments in workforce and training systems. Specifically, 
the recommendation includes $6,237,181,000 for Workforce 
Innovation and Opportunity Act Programs, an increase of 
$825,326,000 above the fiscal year 2021 enacted level and 
$271,750,000 above the fiscal year 2022 budget request. The 
recommendation includes $285,000,000 for registered 
apprenticeships, an increase of $100,000,000 above the fiscal 
year 2021 enacted level and the same as the fiscal year 2022 
budget request. The recommendation also includes $100,000,000 
for the Strengthening Community Colleges Training Grant 
program, an increase of $55,000,000 above the fiscal year 2021 
enacted level and the fiscal year 2022 budget request. This 
program helps community colleges build capacity for training 
workers. The recommendation includes $100,000,000 for a new 
grant program to support communities suffering dislocations 
related to changes in fossil fuel and other energy industries.
    The recommendation also includes $2,866,214,000 for 
Unemployment Compensation State Operations, an increase of 
$509,398,000 over the fiscal year 2021 enacted level and the 
same as the fiscal year 2022 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 struggling 
with the economic consequences of COVID-19 and prepare workers 
for new employment opportunities.

                      Protecting America's Workers

    The Committee recommends $2,095,685,000 for Department of 
Labor agencies responsible for worker protection and worker 
rights. This is an increase of $305,015,000 over the fiscal 
year 2021 enacted level and $1,161,000 over the fiscal year 
2022 budget request.
    The Wage and Hour Division employs fewer investigators 
today than it did in 1948, 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 
$300,000,000, an increase of $54,000,000 over the fiscal year 
2021 enacted level and an increase of $23,500,000 over the 
fiscal year 2022 budget request.
    The Occupational Safety and Health Administration (OSHA) 
currently has the lowest number of health and safety inspectors 
in the agency's 48-year history. OSHA enforcement is critical 
to preventing workplace tragedies from occurring, which is why 
it is concerning that, under current staffing levels, the 
agency would need 165 years to inspect each workplace under its 
jurisdiction just once. To reverse the erosion of enforcement 
capacity at OSHA, the Committee includes $691,787,000, an 
increase of $100,000,000 over the fiscal year 2021 enacted 
level and $27,163,000 over the fiscal year 2022 budget request 
for this critical worker protection agency.
     The Committee also recommends $316,925,000 for the 
National Labor Relations Board, an increase of $42,701,000 over 
the fiscal year 2021 enacted level and $15,000,000 over the 
fiscal year 2022 budget request. This increase will address 
decline in field staff the Board has seen over the past four 
years.

                       Early Childhood Education

    The Committee includes over $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 $3,075,000,000 over the 
fiscal year 2021 enacted level.
    Child care is one of the most critical needs of families 
with young children--it is essential--and yet CCDBG currently 
reaches only 15 percent of children who are eligible to receive 
child care services. The increase included in this bill will 
provide CCDBG-funded child care for approximately 200,000 
additional children, which will also enable more parents in 
low-income families to remain in the workforce. Women, 
particularly women of color, are disproportionately impacted by 
the child care crisis in this country, and the investment in 
this bill builds on the $52,500,000,000 in supplemental funding 
that Congress provided for child care during the coronavirus 
pandemic: $3,500,000,000 in the Coronavirus Aid, Relief, and 
Economic Security (CARES) Act (P.L. 116-136), $10,000,000,000 
through the Coronavirus Response and Relief Supplemental 
Appropriations (CRRSA) Act, 2021 (P.L. 116-260), and 
$39,000,000,000 through the American Rescue Plan (P.L. 117-2).
    The bill includes an increase of $1,434,000,000 for Head 
Start, including increases of $250,000,000 for Quality 
Improvement Funding for Trauma-Informed Care and $750,000,000 
to expand Head Start, Early Head Start, and Early Head Start-
Child Care Partnerships to over 40,000 additional infants and 
toddlers from low-income families. The bill also includes 
$200,000,000 for Head Start programs to extend to full day 
services, to better support working parents and bring 
additional programs into compliance with the 2016 Head Start 
Program Performance Standards.
    The Committee further recommends $450,000,000, an increase 
of $175,000,000, 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 $400 over the fiscal 
year 2021 enacted level, from $6,495 to $6,895, which is the 
same as the fiscal year 2022 discretionary budget request.
    In addition, the Committee recommendation provides 
$1,434,000,000 for Federal Work Study, an increase of 
$244,000,000 over the fiscal year 2021 enacted level and the 
fiscal year 2022 budget request. The Committee recommendation 
also includes $1,028,000,000 for the Federal Supplemental 
Educational Opportunity Grants, an increase of $148,000,000 
over the fiscal year 2021 enacted level and the fiscal year 
2022 budget request.
    The Committee recommendation includes $1,297,761,000 for 
the TRIO programs, an increase of $200,761,000 over the fiscal 
year 2021 enacted level and the same as the fiscal year 2022 
budget request. The recommendation also includes $408,000,000 
for the Gaining Early Awareness and Readiness for Undergraduate 
Programs, which is $40,000,000 more than the fiscal year 2021 
enacted level and the same as the fiscal year 2022 budget 
request.
    In an effort to assist postsecondary institutions in 
addressing barriers in completion and attainment, the Committee 
recommendation includes a total of $1,134,054,000 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 $345,000,000 over the fiscal year 
2021 enacted level and the same as the fiscal year 2022 budget 
request.
    The Committee also includes robust funding to support 
teacher preparation. The recommendation includes $20,000,000 in 
new funding for the Augustus F. Hawkins Centers of Excellence 
program, and the recommendation includes $132,092,000 for the 
Teacher Quality Partnerships program, an increase of 
$80,000,000 over the fiscal year 2021 enacted level and the 
same as the fiscal year 2022 budget request.

                            Maternal Health

    The U.S. has the highest maternal mortality rate among 
developed nations, with a particularly high mortality rate for 
Black and American Indian/Alaska Native women. To help 
eliminate race-based disparities in outcomes among birthing 
people and drive down the rate of maternal mortality, the bill 
provides an increase of $56,000,000 for CDC's Safe Motherhood 
and Infant Health programs. This funding allows for the 
expansion of Maternal Mortality Review Committees and Perinatal 
Quality Collaboratives to all 50 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. The bill includes an increase of over 
$178,000,000 at HRSA to support activities to improve maternal 
health, including an increase of $30,000,000 for State Maternal 
Health Innovation Grants, an increase of $5,300,000 to expand 
the Alliance for Maternal Health Safety Bundles to more States, 
an increase of $2,000,000 to support and expand availability of 
the Maternal Mental Health Hotline, $25,000,000 to conduct a 
demonstration program on pregnancy medical homes, an increase 
of $5,000,000 to double funding for Screening and Treatment for 
Maternal Depression and Related Disorders, an increase of 
$5,400,000 for Rural Maternity and Obstetrics Management 
Strategies. The bill also includes increased investments in 
research related to maternal health and health disparities at 
NIH and the Agency for Healthcare Research and Quality (AHRQ).

                             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 $688,000,000, 
which is an increase of $245,000,000 for the third 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 doubles the total funding to $50,000,000 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.

                      Mental and Behavioral Health

    The existing mental health and substance use disorder 
crises were worsened by the COVID-19 pandemic, with Americans 
reporting increased levels of anxiety, depression, suicidal 
ideation, and substance use. Between September 2019 and August 
2020, more than 85,000 people nationwide died from drug 
overdoses, and 47,000 people died from suicide in 2019.
    The Committee recommendation includes $9,160,277,000 for 
the Substance Abuse 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 
$1,366,020,000 for mental health activities. This includes an 
increase of $825,000,000 for the Mental Health Block Grant and 
an increase of $125,000,000 for Certified Community Behavioral 
Health Clinics. The bill increases the mental health crisis 
set-aside to ten percent, creates a new set-aside for 
prevention and early intervention, and makes investments to 
prepare for the launch of a new three digit National Suicide 
Prevention Lifeline.
    The Committee includes $100,000,000 to establish the Mental 
Health Crisis Response Partnership Pilot Program, to help 
communities 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 
$28,113,000 increase to the National Child Traumatic Stress 
Initiative, a $17,000,000 increase for Infant and Early 
Childhood Mental Health, and an additional $25,000,000 for 
Children's Mental Health services.
    The Committee includes a total increase of $1,657,187,000 
for substance use treatment activities. This includes an 
increase of $1,000,000,000 for the Substance Abuse Prevention 
and Treatment Block Grant and an increase of $500,000,000 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 
$35,284,000 for substance misuse prevention activities.

                   OVERSIGHT OF THE EXECUTIVE BRANCH

    The Committee has also fulfilled its responsibility to 
maintain oversight of the Executive Branch by holding seven 
oversight hearings--in addition to annual hearings on the 
fiscal year 2022 budget request. The Committee has focused on 
ongoing crises in health care, education, and labor, which have 
highlighted unjust racial disparities which were further 
exacerbated by the COVID-19 pandemic. These oversight hearings 
have informed many of the decisions in the fiscal year 2022 
Labor-HHS Education bill.

COVID-19 and the Child Care Crisis

    The Committee held a virtual hearing to discuss the 
devastating impacts that the COVID-19 pandemic had on a child 
care industry already in crisis. Affordable child care was 
already a significant and severe issue, but rising operating 
costs and decreased enrollment as a result of the pandemic were 
too much for the razor thin margins of many child care 
providers, and other providers were left grasping for financial 
assistance. The Committee heard from policy experts, a State 
administrator, and a program director, about the critical 
financial needs of child care providers struggling to stay 
afloat, the necessity of child care for parents and especially 
for women in the workforce, and the impact that the child care 
shortage has on job reports and unemployment statistics. The 
hearing highlighted how COVID-19 exacerbated the child care 
crisis, and exposed the necessity for a financially stable 
child care industry, to support women and communities of color, 
and for post-pandemic economic recovery. Soon after the 
Committee's hearing, House and Senate Democrats passed the 
American Rescue Plan (P.L. 117-2) which included 
$39,000,000,000 for the Child Care and Development Block Grant 
program.

Ready or Not: U.S. Public Health Infrastructure

    The Committee held a virtual hearing to examine the status 
and challenges of our nation's public health infrastructure, 
with a particular focus on public health data, laboratories, 
and workforce. The COVID-19 pandemic exposed the inadequacies 
of the current public health ecosystem, and the Committee heard 
from State and local public health officials about the 
importance of flexible, long-term investments in public health. 
As a result of this hearing, this bill includes a new funding 
line of $1,000,000,000 for Public Health Infrastructure and 
Capacity. The Committee's action denotes that the tide has 
turned for public health funding, as it establishes a disease-
agnostic source of funding to address mission-critical gaps in 
public health infrastructure nationwide.

Health and Safety Protections for Meatpacking, Poultry, and 
        Agricultural Workers

    The Committee held a virtual hearing to examine dangerous 
conditions faced by meat, poultry, and farm workers, especially 
during the COVID-19 pandemic, and to highlight the role strong 
federal enforcement from the Occupational Health and Safety 
Administration (OSHA) can play in addressing the problem. The 
Committee heard from a worker safety and health expert, a 
farmworker advocate, and the child of a Smithfield meatpacking 
worker about the concerning hazards workers faced during the 
pandemic and the need for urgent action from OSHA to hold these 
industries accountable to protect vulnerable workers. As a 
result of this hearing, this bill includes an increase of 
$100,000,000 for OSHA above the fiscal year 2021 enacted level. 
The recommendation, a 17 percent increase over last year, will 
support additional OSHA inspectors and restore the agency's 
capacity to conduct more complex, labor-intensive inspections.

COVID-19 and the Mental Health and Substance Use Crises

    The Committee held a virtual hearing to examine the impact 
of the COVID-19 pandemic on the mental health and substance use 
crises and the responses to this emergency, and heard 
recommendations on how to build a stronger behavioral health 
system capable of meeting the demand for services. The COVID-19 
pandemic dramatically worsened these existing crises, creating 
new barriers to treatment while increasing numbers of Americans 
are reporting anxiety, depression, and substance use. People 
with existing vulnerabilities have been disproportionately 
affected--including communities of color, underserved 
communities, essential workers, people who were already 
struggling with a mental illness or substance use disorder or 
were otherwise in poor health, children, and families 
struggling economically. As a result of this hearing, the 
Committee is making substantial investments to strengthen the 
behavioral health continuum of care to increase access to 
prevention, screening, treatment and other critical services.

Addressing the Maternal Health Crisis

    The Committee held a virtual hearing to identify the 
reasons why the U.S. lags behind other industrialized nations 
in maternal health outcomes; examine the disparities in 
maternal health outcomes by race, socioeconomic status, 
residence, and other factors; and identify opportunities to 
address these issues through investments in HHS programs. As a 
result of this hearing, the bill increases funding for programs 
across HRSA, CDC, NIH, and AHRQ to improve access to quality 
maternal and postpartum health care and reduce disparities in 
maternal health outcomes.

Building Capacity, Building Community: Increasing Investments in 
        Community Colleges

    The Committee held a virtual hearing that explored the 
importance of community colleges, as well as their strengths 
and challenges. Today, there are more than 1,000 community 
colleges. Community colleges touch upon the lives of 
individuals in every State and even the outlying areas. 
Community colleges are typically open access institutions, 
serving a diverse student body with unique challenges. While, 
typically, the associate's degree is the highest degree awarded 
at community colleges, these institutions also offer a wide 
variety of postsecondary credentials. In this way, community 
colleges are uniquely positioned to meet the workforce 
development and educational needs of our country 
simultaneously. As a result of this hearing, the recommendation 
includes robust increases for programs that help support 
community colleges and their students: the WIOA programs, the 
Strengthening Community Colleges Training Grant program, the 
Apprenticeship Grants program, the Strengthening Institutions 
program, and the Child Care Access Means Parents in School 
program.

Mental Health Emergencies: Building a Robust Crisis Response System

    The Committee held a virtual hearing on how to create a 
robust mental health crisis care system with services available 
to anyone, anywhere, anytime, with a goal of diverting people 
experiencing a mental health crisis from the criminal justice 
system into mental health treatment. The lack of sufficient 
mental health care resources in communities means mental 
illness often goes untreated, which can lead to law enforcement 
responding to mental health emergencies because there are no 
alternatives to respond to the crisis. As a result of this 
hearing, the bill increases funding for mental health crisis 
services and creates a Mental Health Crisis Response 
Partnership Pilot 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.

                      TITLE I--DEPARTMENT OF LABOR


                 Employment and Training Administration


 
 
 
Appropriation, fiscal year 2021.......................   $10,025,760,000
Budget request, fiscal year 2022......................    11,254,695,000
Committee Recommendation..............................    11,625,914,000
    Change from enacted level.........................    +1,600,154,000
    Change from budget request........................      +371,219,000
 

    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 2021.......................    $3,663,200,000
Budget request, fiscal year 2022......................     4,210,672,000
Committee Recommendation..............................     4,407,108,000
    Change from enacted level.........................      +743,908,000
    Change from budget request........................      +196,436,000
 

    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 
$923,174,000, which is $60,525,000 more than the fiscal year 
2021 enacted level and $23,187,000 more than the fiscal year 
2022 budget request.
    Youth Employment and Training Activities.--For Youth 
Employment and Training Activities, the Committee recommends 
$988,604,000, which is $67,474,000 more than the fiscal year 
2021 enacted level and $24,767,000 more than the fiscal year 
2022 budget request.
    Dislocated Worker Employment and Training Activities.--For 
Dislocated Worker Employment and Training Activities, the 
Committee recommends $1,183,554,000, which is $122,001,000 more 
than the fiscal year 2021 enacted level and $28,276,000 more 
than the fiscal year 2022 budget request.
    Dislocated Worker Assistance National Reserve.--The 
Committee recommends $435,859,000 for the Dislocated Workers 
National Reserve, an increase of $155,000,000 more than the 
fiscal year 2021 enacted level and $55,000,000 over the fiscal 
year 2022 budget request.
    The Committee recommendation includes $100,000,000, an 
increase of $55,000,000 over the fiscal year 2021 enacted level 
and the fiscal year 2022 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 recommendation 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 $100,000,000 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 includes $10,000,000, the same as the fiscal 
year 2021 enacted level, for grants to support national out-of-
school time organizations that serve youth and teens and place 
an emphasis on age-appropriate workforce readiness programming 
to expand job training and workforce pathways for youth and 
disconnected youth, including soft skill development, career 
exploration, job readiness and certification, summer jobs, 
year-round job opportunities, and registered apprenticeships. 
Funding will also support partnerships between workforce 
investment boards and youth serving organizations.
    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 includes $5,000,000 in fiscal year 2022 for a 
demonstration program to provide fulltime, work-based learning 
coordinators in underserved communities with an already proven 
track record for secondary career and technical education. 
Work-based learning coordinators will conduct outreach, 
engagement, recruitment and coordination of work-based learning 
activities, including, but not limited to, paid internships or 
pre-apprenticeships for high school students, with local 
community employers, especially with in-demand industries of 
information technology, health sciences, and engineering. The 
work-based learning coordinators may be employed by the local 
education agency, local workforce development board or local 
workforce development agency, a group of employers, or a 
consortium of eligible entities. In making grant awards, the 
Committee directs the Secretary to ensure to require a plan for 
evaluations in each individual grant proposal, including types 
of work-based learning opportunities completed, demographics of 
participating students, and students' post-secondary career 
plan, as well as to conduct a national assessment of all 
grantee proposals once complete.
    Native Americans.--For the Indian and Native American 
programs, the Committee recommends $58,000,000, which is 
$2,500,000 more than the fiscal year 2021 enacted level and the 
same as the fiscal year 2022 budget request.
    Migrant and Seasonal Farmworkers.--For the National 
Farmworker Jobs program, the Committee recommends $96,711,000, 
which is $2,815,000 more than the fiscal year 2021 enacted 
level and the same as the fiscal year 2022 budget request.
    YouthBuild.--For the YouthBuild program, the Committee 
recommends $145,000,000, which is $48,466,000 more than the 
fiscal year 2021 enacted level and the same as the fiscal year 
2022 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 $49,921,000 more than the 
fiscal year 2021 enacted level and the same as the fiscal year 
2022 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 
or have been disproportionately impacted by the COVID-19 
pandemic.
    The Committee also continues the set-aside of $25,000,000 
for competitive grants to national and regional intermediaries 
for activities that prepare young adults with criminal legal 
histories or who have been justice system-involved or who have 
dropped out of school or other educational programs, with a 
priority for projects serving high-crime, high-poverty areas. 
The Committee directs the Department to consult data from the 
Department of Education and prioritize grants in communities 
where students of color have disproportionate rates of 
expulsions and suspensions.
    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 
2023 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 $7,250,000 for the Workforce Data Quality 
Initiative, which is $1,250,000 more than the fiscal year 2021 
enacted level and the fiscal year 2022 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 
$285,000,000 for the apprenticeship grants program, which is 
$100,000,000 more than the fiscal year 2021 enacted level and 
the same as the fiscal year 2022 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 is encouraged by the Administration's actions 
to restore the Federal Government's role in ensuring high-
quality training opportunities by taking steps to rescind the 
industry registered apprenticeship program. The national 
apprenticeship program is in dramatic need of modernization 
through expansion of registered apprenticeship, 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, beginning with cybersecurity workforce and 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 strongly supports efforts to expand 
Registered Apprenticeships to traditionally underrepresented 
communities and encourages the Department to explore the 
feasibility and expansion of Registered Apprenticeship programs 
within the arts, theater, film, and television industries. 
Specifically, the Committee requests that the Department 
explore expanding the Registered Apprenticeship model to create 
career training strategies for all roles in the entertainment 
industry such as creative, production, technical, marketing and 
public relations roles.
    In addition, the Committee notes that apprenticeships are 
an important path to the middle-class. 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 is also concerned about shortages nationwide 
of qualified drinking water and wastewater operation 
professionals, especially in rural areas, and encourages the 
Secretary to make funding available to address these 
challenges. Further, the Committee directs the Department to 
work with eligible community organizations to support the 
creation of new training programs focused on filling identified 
gaps in the maritime workforce.
    The Committee also supports the use of apprenticeship 
grants that provide worker education based on public-private 
partnerships in in-demand fields, including first responders, 
as well as in goods movement sectors such as global logistics, 
rail and other freight-related employment.
    The Committee encourages the Department to support 
apprenticeship programs that increase the number of trained 
workers in cybersecurity.
    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 
encourages 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.
    National Youth Employment Program.--For the National Youth 
Employment Program, the Committee recommends $50,000,000, which 
is the same as the fiscal year 2022 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 
$20,000,000, which is the same as the fiscal year 2022 budget 
request. This new competitive grant program will prepare 
veterans and their spouses for careers in clean energy.
    Community Project Funding.--Within the funds included in 
this account, $63,956,000 shall be used for the following 
projects in the following amounts:

------------------------------------------------------------------------
                       Project                               Amount
------------------------------------------------------------------------
AIDS Service Center of Lower Manhattan, Inc. dba              $1,000,000
 Alliance for Positive Change, New York, NY for a
 workforce development initiative....................
Anne Arundel County Government, Annapolis, MD for               $500,000
 Youthworks!.........................................
Arizona Opportunities Industrialization Center,               $1,200,000
 Phoenix, AZ for the provision of comprehensive
 training courses and job placement in the
 hospitality industry................................
Avivo, Minneapolis, MN for workforce training related         $1,000,000
 to clean energy and green building, including
 equipment...........................................
Benedict College, Columbia, SC for workforce                  $2,000,000
 development activities, including technology,
 equipment, and supportive services..................
Beyond the Sanctuary, Inc., Rochester, NY for job               $525,000
 readiness program, including equipment and
 supportive services.................................
Bristol County Chamber Foundation, Fall River, MA for           $500,000
 workforce development activities....................
Broward College, Ft. Lauderdale, FL for workforce             $2,000,000
 development initiative, including mobile training
 units...............................................
Buffalo Sewer Authority, Buffalo, NY for a workforce            $575,000
 development initiative related to green
 infrastructure, including equipment, stipends, and
 supportive services.................................
California Mobility Center, Sacremento, CA for a              $2,000,000
 workforce development initiative, including
 equipment...........................................
City of Boston, MA for short-term training programs,          $1,000,000
 including stipends..................................
City of East Providence, RI for a training program...           $350,000
City of Greensboro, NC for a workforce development            $1,600,000
 initiative, including technology and supportive
 services............................................
City of Houston, TX for a workforce development                 $750,000
 initiative related to a solar initiative, including
 job-placement, stipends, and supportive services....
City of Perris, CA for a workforce development                $1,000,000
 initiative..........................................
City of South San Francisco, CA, for workforce                  $500,000
 development services, including career services and
 job placement.......................................
Coalition for Responsible Community Development, Los            $250,000
 Angeles, CA for transitional employment and training
 for formerly incarcerated adults, including
 supportive services.................................
College of Eastern Idaho, Idaho Falls, ID for                   $100,000
 workforce training program and equipment............
College of Lake County, Grayslake, IL for a workforce           $900,000
 development initiative related to manufacturing,
 including equipment.................................
Colonial Farmhouse Restoration Society of Bellerose,            $200,000
 Inc., Floral Park, NY for a workforce training
 initiative, including equipment.....................
Community Assistance Programs, Chicago, IL for job              $100,000
 training, job placement and supportive services.....
Comunidades Organizando el Poder y la Accion Latina           $1,000,000
 Education Fund, Minneapolis, MN for workforce
 development activities, including equipment.........
Cornerstone Revitalization Foundation, Inc.,                  $1,500,000
 Birmingham, AL for workforce development activities,
 including opprtunities to obtain a GED,
 postsecondary credentials, and stipends.............
Council for Native Hawaiian Advancement, Kapolei, HI          $1,200,000
 for workforce training programs.....................
Covenant House Florida, Ft. Lauderdale, FL for work-            $300,000
 based learning and supportive services for homeless
 youth...............................................
DC Central Kitchen, Washington, DC for culinary job             $500,000
 training, including stipends and equipment..........
Dream It Do It Western New York Inc., Jamestown, NY             $250,000
 for job training and placement......................
Eclectic Soul VOICES Corporation, Indianapolis, IN              $100,000
 for a job training program, including supportive
 services and stipends...............................
Emerald Isle Immigration Center, Woodside, NY for                $60,000
 workforce development activities, including career
 and supportive services.............................
Fairfax County Government, Fairfax, VA for a job              $1,000,000
 training program for pregnant and parenting teens
 and non-parenting young adults, including equipment.
Fairfax County Government, Fairfax, VA for an                   $400,000
 apprenticeship training program, including stipends.
Florida Endowment Foundation for Florida's Graduates,         $1,500,000
 Flagler Beach, FL for an at-risk youth jobs program.
Frederick County Government, Frederick, MD for a                $250,000
 mobile career center................................
Hire Heroes USA, Alpharetta, GA for job placement and           $625,000
 career services for veterans........................
iFoster, Inc., Las Vegas, NV for a workforce                    $150,000
 development and readiness program...................
Jewish Family Service of Colorado, Denver, CO for               $500,000
 workforce development activities, including
 technology and equipment............................
Kent State University at Tuscarawas, New                        $250,000
 Philadelphia, OH for advanced manufacturing
 equipment and training..............................
Kentucky Capital Development Corporation, Frankfort,            $440,000
 KY for cybersecurity/IT workforce development.......
La Colaborativa/Chelsea Collaborative, Chelsea, MA              $300,000
 for workforce development initiative................
Lansing Community College, Lansing, MI for mobile               $400,000
 skills laboratories, including equipment............
Living Classrooms Foundation, Baltimore, MD for                 $750,000
 workforce development activities, including
 technology..........................................
Macomb County, Clinton Township, MI for workforce               $525,000
 development and certification courses, including
 technology and supportive services..................
Make the Road New York, Jackson Heights, NY for                 $400,000
 workforce development, including adult education and
 equipment...........................................
Mary's Mercy Center, Inc., San Bernadino, CA for a              $300,000
 training program and supportive services............
Mecklenburg County, Charlotte, NC for a training              $1,000,000
 program and supportive services.....................
Meristem, Inc., Fair Oaks, CA for a training program            $450,000
 for individuals with autism, including stipends.....
Mi Casa Resource Center, Denver, CO for a workforce              $20,000
 development program.................................
Milwaukee Metropolitan Sewerage District, Milwaukee,          $1,000,000
 WI for a workforce development initiative, including
 equipment and stipends..............................
Montgomery County Office of Broadband Programs,               $1,000,000
 Rockville, MD for a technology job training pilot
 program, including equipment and supportive services
Multi-Craft Apprenticeship Preparation Program, Inc.,           $200,000
 Rochester, NY for workforce development initiative,
 including stipends and equipment....................
National Institute for Medical Assistant Advancement,           $450,000
 Denver, CO for a training program, including
 technology and equipment............................
Neighborhood House Incorporated, Seattle, WA for job            $275,000
 placement and career services.......................
Neighbors and Neighbors Association, Inc., Miami, FL            $500,000
 for work readiness and vocational training..........
New Century Careers, Pittsburgh, PA for pre-                    $500,000
 apprenticeship and apprenticeship programs in
 advanced manufacturing, including job placement
 services............................................
New Jersey Chamber of Commerce Foundation, Trenton,             $270,000
 NJ for student training and equipment, including
 information technology..............................
Newark Emergency Services for Families (NESF),                  $325,000
 Newark, NJ for a workforce readiness program for
 hard-to-serve target populations....................
Northern Maine Community College, Presque Isle, ME            $1,000,000
 for a mechanized logging operations training
 program, including equipment........................
Opportunities Industrialization Center (d/b/a                   $575,000
 Philadelphia OIC), Philadelphia, PA for a healthcare-
 related job training program, including equipment...
Opportunity Village, Las Vegas, NV for workforce                $525,000
 development initiative for individuals with
 intellectual and related disabilities...............
Para Los Ninos, Los Angeles, CA for a youth workforce           $350,000
 development initiative, including career and
 supportive services.................................
Passaic County Community College, Patterson, NJ for           $1,950,000
 workforce training and career coaching, including
 equipment...........................................
Path of Life Ministries, Riverside, CA for workforce            $250,000
 development activities, including supportive
 services and stipends...............................
Philadelphia Works, Inc., Philadelphia, PA for                $1,000,000
 workforce development activities, including
 transitional employment.............................
PIDC Community Capital, Philadelphia, PA for                    $525,000
 workforce development activities, including
 technology and stipends.............................
Presbyterian Villages of Michigan, Flint, MI for a              $600,000
 workforce development iniatitive, including a
 certification program...............................
Prince George's County Office of Human Resources              $2,000,000
 Management, Largo, MD for a job training program....
Project QUEST, Inc., San Antonio, TX for an education         $1,000,000
 and training program, including supportive services.
Proyecto Del Barrio Inc., Arleta, CA for a job                  $300,000
 training program....................................
Quad County Urban League, Inc., Aurora, IL for                  $425,000
 education and skills training to enter
 apprenticeships or positions in construction or TDL
 industries, including equipment.....................
San Jose Conservation Corps & Charter School for                $275,000
 workforce development iniatitive for youth,
 including stipends and technology...................
Second Harvest Food Bank of Central Florida, Orlando,           $775,000
 FL for a culinary workforce training program,
 including internships, equipment, and supportive
 services............................................
South Bay Workforce Investment Board, Hawthorne, CA             $500,000
 for workforce development activities, including
 supportive services.................................
Southeast Michigan Community Alliance Inc., Taylor,             $850,000
 MI for a work-based learning program for at-risk in-
 school youth age 14 or older, including stipends and
 supportive services.................................
Southern California Regional Occupational Center,             $1,000,000
 Torrance, CA for a workforce development initiative.
Southern Maine Community College, South Portland, ME          $1,000,000
 for welding workforce training, including equipment.
State of Hawaii Workforce Development Council, State            $975,000
 of Hawaii Department of Labor and Industrial
 Relations, Honolulu, HI for digital skills literacy
 training............................................
Sunnyside Community Services, Sunnyside, NY for a               $175,000
 workforce development initiative....................
SUNY Maritime College, Bronx, NY for offshore wind              $800,000
 energy training program, including equipment........
The Corporate Source, Garden City, NY for IT training           $125,000
 and certification training program for people with
 disabilities, including equipment and supportive
 services............................................
The HOPE Program, Bronx, NY for a job training                  $800,000
 program for green jobs to support justice-impacted
 invididuals, including technology and equipment.....
Tri-Council Development Fund, Aurora, IL for a pre-             $975,000
 apprenticeship program, including equipment and
 supportive services.................................
TXRX LABS, Houston, TX for employment and training              $550,000
 activities, an apprenticeship program, and a youth
 STEM initiative.....................................
Uintah Basin Technical College, Roosevelt, UT for               $515,000
 electrical apprentice training program and the
 purchase of equipment...............................
United Community Services for Working Families,                 $450,000
 Reading, PA for job training for youth, including
 stipends, technology, and supportive services.......
United Northeast Community Development Corporation,             $600,000
 Indianapolis, IN for a job training iniativie,
 including supportive services.......................
United Way of Central Jersey, Milltown, NJ for                  $425,000
 workforce development activities, including career
 and supportive services.............................
United Way of Chester County, Exton, PA for job                 $100,000
 training services...................................
United Way of Long Island, Deer Park, NY for a                  $700,000
 YouthBuild program, including stipends..............
United Way of Miami-Dade Inc., Miami, FL for job                $250,000
 training activities and supportive services for
 veterans and their families, including stipends,
 technology, and supportive services.................
University of Rochester, Rochester, NY for youth                $300,000
 workforce development initiative for youth,
 including technology and equipment..................
UPROSE, Brooklyn, NY for workforce development                  $175,000
 initiative..........................................
Urban League of Hillsborough County, Inc., Tampa, FL            $300,000
 for preapprenticeships and paid internship programs,
 including supportive services.......................
Vehicles for Change, Halethorpe, MD for a workforce             $750,000
 training initiative, including stipends and
 equipment...........................................
Warren County Employment & Training Administration,             $205,000
 Glens Falls, NY for job recruitment and training
 program, including the purchase of information
 technology..........................................
Workforce Connections, Las Vegas, NV for a workforce            $800,000
 development initiative..............................
WorkSystems, Inc., Portland, OR for registered                $1,000,000
 apprenticeship opportunities in construction,
 including supportive services.......................
WV Council for Community and Technical College                  $300,000
 Education, Charleston, WV for aerospace training,
 equipment, and curriculum...........................
------------------------------------------------------------------------

                               JOB CORPS

 
 
 
Appropriation, fiscal year 2021.......................    $1,748,655,000
Budget request, fiscal year 2022......................     1,754,759,000
Committee Recommendation..............................     1,830,073,000
    Change from enacted level.........................       +81,418,000
    Change from budget request........................       +75,314,000
 

    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 $1,653,325,000, which is $50,000,000 more than the 
fiscal year 2021 enacted level and $50,314,000 more than the 
fiscal year 2022 budget request.
    Construction, Rehabilitation, and Acquisition.--The 
Committee recommends $138,000,000 for construction, 
rehabilitation, and acquisition activities, which is 
$25,000,000 more than the fiscal year 2021 enacted level and 
the fiscal year 2022 budget request.
    Administration.--The Committee recommends $38,748,000 for 
the administrative expenses of the Job Corps program, which is 
the same as the fiscal year 2021 enacted level and the same as 
the fiscal year 2022 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.
    In addition, the Committee is 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.
    To better utilize Job Corps centers, the Committee directs 
the Department to include an update in the fiscal year 2023 
Congressional Budget Justification on Job Corps application and 
enrollment data to evaluate the relative efficacy of different 
investments in producing Job Corps-eligible applicants, 
arrivals, and their families, including social media, national 
television or radio buys, and local outreach efforts targeted 
at eligible youth, guardians, and influencers.
    As millions of disconnected youth struggle with housing, 
food insecurity, and unemployment, the Committee supports the 
efforts to resume operations at Job Corps centers as safely and 
rapidly as possible. Like other schools across the country, 
once Job Corps staff are vaccinated, the Committee encourages 
full resumption of Job Corps operations. The Committee directs 
the Department to include an update in the fiscal year 2023 
Congressional Budget Justification on the requirements and 
measures the Department will utilize to approve Job Corps 
centers resuming operations at full capacity.
    The Committee has previously expressed its concern that the 
transition to fixed price Job Corps contracts may negatively 
impact students and staff by prioritizing reducing costs over 
improving student outcomes. The Committee encourages the 
Department to ensure that Job Corps contracts offer competitive 
wages and benefits. The Committee directs the Department to 
include an update in the fiscal year 2023 Congressional Budget 
Justification on the process by which the Department evaluates 
cost-realism in bid evaluations, particularly with respect to 
budgeting to pay prevailing wages, and data on the rate of 
contract turnover over each of the last ten years.

            COMMUNITY SERVICE EMPLOYMENT FOR OLDER AMERICANS

 
 
 
Appropriation, fiscal year 2021.......................      $405,000,000
Budget request, fiscal year 2022......................       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 2021 enacted level and 
the fiscal year 2022 budget request.

              FEDERAL UNEMPLOYMENT BENEFITS AND ALLOWANCES

 
 
 
Appropriation, fiscal year 2021.......................      $633,600,000
Budget request, fiscal year 2022......................       551,000,000
Committee Recommendation..............................       551,000,000
    Change from enacted level.........................       -82,600,000
    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.
    The authorization for this program is set to expire on July 
1, 2022, and a sunsetting provision took effect on July 1, 
2021, causing the program to revert to limited eligibility for 
the program. The amount for fiscal year 2022 reflects this 
reversion.

     STATE UNEMPLOYMENT INSURANCE AND EMPLOYMENT SERVICE OPERATIONS

 
 
 
Appropriation, fiscal year 2021.......................    $3,416,649,000
Budget request, fiscal year 2022......................     4,121,761,000
Committee Recommendation..............................     4,176,230,000
    Change from enacted level.........................      +759,581,000
    Change from budget request........................       +54,469,000
 

    The total includes $4,087,164,000 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 
$3,125,214,000, which is $559,398,000 more than the fiscal year 
2021 enacted level and the same as the fiscal year 2022 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 2022, for every 
100,000 increase in the total average weekly insured 
unemployment (AWIU) above 2,008,000, 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 
$133,000,000 is made available pursuant to the Bipartisan 
Budget Act of 2018 (P.L. 115-123), which is $50,000,000 more 
than the fiscal year 2021 enacted level and equal to the fiscal 
year 2022 budget request.
    UI Integrity Center of Excellence (UIICE).--The 
recommendation provides $9,000,000 for the continued support of 
UIICE, including $6,000,000 for the benefit of States to the 
entity operating the UIICE.
    GAO Study on Unemployment Insurance Compensation.--The 
Committee notes that the significant increase in Unemployment 
Insurance (UI) Compensation claims during the COVID-19 
pandemic, which Congress provided to address the corresponding 
economic crisis, has strained the ability of state agencies 
responsible for administering UI Compensation in a timely and 
reliable manner. In a few short months, the unemployment rate 
increased from 3.5 percent in February 2020 to 14.8 percent in 
April 2020, requiring States to respond to unexpected 
workloads. Moreover, fraudulent filing for, and receipt of, UI 
Compensation, increased significantly as well. The Committee 
directs GAO to study existing deficiencies in the 
administration of UI Compensation, including but not limited to 
the need for investment in technological improvements at the 
state-level, and provide the Committees on Appropriations with 
its findings and recommendations.
    Pandemic Unemployment Assistance.--The Coronavirus Aid, 
Relief, and Economic Security Act (CARES Act, P.L. 116-136) 
established the Pandemic Unemployment Assistance (PUA) program, 
which delivered billions of dollars in emergency assistance to 
individuals who became unemployed due to the economic effects 
of the COVID-19 public health emergency. Further, this program 
sustained American families and provided needed economic 
relief. The Committee notes that critical emergency assistance 
during simultaneous public health and financial crises should 
be targeted to individuals who are eligible for benefits. The 
Department and States should ensure that proper safeguards--
including program integrity and fraud prevention tools and 
procedures--are in place to identify any schemes to defraud 
this emergency program. The Committee urges the Department to 
work with the Office of the Inspector General on this matter 
and to utilize the UIICE to assist States in efforts to ensure 
benefits are delivered to individuals and families who qualify 
for them.
    Unemployment Compensation National Activities.--The 
Committee recommends $118,108,000 for National Activities, 
which is $100,108,000 more than the fiscal year 2021 enacted 
level and the same as the fiscal year 2022 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 urges the department to 
develop a comprehensive long-term strategy for delivery of 
assistance to state workforce agencies that would: develop an 
open-systems approach and modular program of unemployment 
management systems that can be adapted for state-by-state usage 
plans; standardize employment and wage records reporting 
requirements; incorporate 21st century accessibility standards; 
develop enforcement and oversight methods so that states meet 
established US DOL technology guidance such as Unemployment 
Insurance Program Letter 2-1; avoid use of high-risk automated 
decision-making and identity-proofing systems to deny claims; 
standardize dashboard and claimant portal information; require 
public dissemination of by-county demographic data on benefits 
denials, delays, overpayments, and fraud determinations; 
correct past inequities in benefits distribution by taking into 
account user-experiences of historically disadvantaged groups; 
conduct user testing and a full consultation with state-level 
stakeholders, users, and worker organizations.
    Employment Service.--The Committee recommends $748,862,000 
for the Employment Service allotment to States, which is 
$78,810,000 more than the fiscal year 2021 enacted level and 
$50,000,000 more than the fiscal year 2022 budget request.
    The Committee also recommends $22,318,000 for Employment 
Service National Activities, which is the same as the fiscal 
year 2021 enacted level and the fiscal year 2022 budget 
request. Within the total, the Committee provides $2,500,000 to 
reduce the processing backlog for the work opportunity tax 
credit program and for assisting States in adopting or 
modernizing information technology for processing of 
certification requests, which may include training and 
technical assistance to States.
    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 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 
$94,075,000 for the Foreign Labor Certification (FLC) program, 
which is $16,265,000 more than the fiscal year 2021 enacted 
level and the same as the fiscal year 2022 budget request. The 
recommendation includes $67,793,000 for Federal administration, 
an increase of $10,265,000 over the fiscal year 2021 enacted 
level and the same as the fiscal year 2022 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 $6,000,000 over the fiscal year 2021 
enacted level and the same as the fiscal year 2022 budget 
request.
    H-2A Program.--Given the rapid growth of the H-2A program, 
the role of farm labor contractors, and the troubling rate of 
violations within the program, the Committee directs the 
Secretary to submit a report to the Committee on Appropriations 
on the Department's enforcement of farm labor contractors 
(FLCs) within 180 days of enactment of this Act. The report 
shall contain, at a minimum, the following information for each 
of the last 5 years: an analysis of H-2A certifications for 
fixed-site employers and FLCs; an analysis of the inspections, 
audits, investigations, administrative complaints, and judicial 
litigation regarding findings of violations by farm labor 
contractors in the H-2A program, including remedies; and 
recommendations to deter violations and improve compliance by 
farm labor contractors in the H-2A program and how to ensure 
that farmworkers obtain adequate relief for any violations. The 
content of the final report shall be made publicly available on 
the agency's website.
    H-2B visa disbursements.--The Committee directs the 
Department to include an update in its fiscal year 2023 
Congressional Budget Justification on the number of labor 
certifications granted through the H-2B non-immigrant visa 
program. At a minimum, the report shall contain, but is not 
limited to, the number of job openings published on 
seasonaljobs.dol.gov each fiscal year, categorized by industry 
and occupation.
    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 2021 enacted level and the same as the fiscal year 
2022 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 2021.......................      $158,656,000
Budget request, fiscal year 2022......................       211,503,000
Committee Recommendation..............................       211,503,000
    Change from enacted level.........................        52,847,000
    Change from budget request........................             - - -
 

    The recommendation includes $144,497,000 from the General 
Fund of the Treasury and $67,006,000 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 encourages 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.
    Long-term Unemployed.--The Committee notes the economic 
challenges millions of individuals now face due to the 
coronavirus pandemic and high-unemployment. Within a matter of 
months, a nine-year period of sustained economic recovery and 
growth was swept away by a wave of pathogen, shuttering 
businesses and creating economic uncertainty. The Committee 
also notes that the economic prospects for many individuals 
unemployed prior to the start of the national emergency were 
worsened as a result of COVID-19. Prior to the pandemic, these 
individuals faced significant barriers to employment, having 
been unemployed for 27 weeks or more. While it is essential 
that the Department supports policies and practices that put 
Americans back to work in a safe and sustainable way, the 
Department must also ensure that the long-term unemployed do 
not fall through the cracks of our economic recovery. To 
advance this effort, the Committee encourages the Department to 
support reemployment programs targeting long-term unemployed 
workers.
    Open Data Formats.--The Committee notes that Congress has 
made a significant investment in our workforce development, 
postsecondary, and career and technical education systems. As a 
result of this investment, the number of credentials in the 
U.S. continues to rise. However, the Committee is aware that 
many workers and students may face challenges in navigating an 
intricate network of diplomas, licenses, certifications, and 
badges. Therefore, the Department is encouraged to require any 
information publicly disclosed related to occupational and 
professional licenses and certifications, as well as 
credentials and competencies earned through apprenticeships, 
whether directly or through contracts, be published using an 
open source description language that is designed to allow for 
public search and comparison of such data, including any such 
data on credentials and competencies. Such information may be 
published through open data formats such as the credential 
transparency description language specifications or a 
substantially similar approach. The Department is further 
encouraged to provide a briefing to the Committees within 120 
days of enactment of this Act, outlining a plan for providing 
such data, including any challenges, barriers to 
implementation, as well as anticipated costs.
    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 Act 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.
    Collaborations between manufacturers and educational 
institutions.--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.
    Justice Involved Workers.--The Committee supports the 
Department'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 urges the Department 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 encourages the Department 
to work with national nonprofit organizations that have proven 
track records in this area, including organizations with 
partnerships with the SNAP Employment and Training program.

               Employee Benefits Security Administration


                         SALARIES AND EXPENSES

 
 
 
Appropriation, fiscal year 2021.......................      $181,000,000
Budget request, fiscal year 2022......................       218,475,000
Committee Recommendation..............................       218,475,000
    Change from enacted level.........................       +37,475,000
    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 $218,475,000 for EBSA, which is 
$37,475,000 above the fiscal year 2021 enacted level and the 
same as the fiscal year 2022 budget request.
    Mental Health Parity and Addiction Equity Act (MHPAEA) 
Compliance.--The Committee has included resources for 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.
    These funds will enable EBSA to hire additional health 
investigators who will focus exclusively on MHPAEA NQTL 
compliance and contract with external consultants with 
expertise in NQTL comparative analyses to assist and train 
investigators. 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 2021.......................      $465,289,000
Budget request, fiscal year 2022......................       472,955,000
Committee Recommendation..............................       472,955,000
    Change from enacted level.........................        +7,666,000
    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 2021.......................      $246,000,000
Budget request, fiscal year 2022......................       276,500,000
Committee Recommendation..............................       300,000,000
    Change from enacted level.........................       +54,000,000
    Change from budget request........................       +23,500,000
 

    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 $300,000,000 for WHD, which is 
$54,000,000 above the fiscal year 2021 enacted level and 
$23,500,000 above the fiscal year 2022 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.
    Language Access.--In hiring investigators, the Committee 
encourages WHD to focus on employing and retaining a greater 
number of multilingual investigators. In the fiscal year 2023 
Congressional Budget Justification, WHD is directed to include 
information outlining the WHD's goals for meeting critical 
language access needs through its investigator workforce.
    Retaliation.--Because retaliation and the threat of 
retaliation remain critical challenges 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 protect workers from retaliation in the 
fiscal year 2023 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 identified. 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 be otherwise 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 2022 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.

                  Office of Labor-Management Standards


                         SALARIES AND EXPENSES

 
 
 
Appropriation, fiscal year 2021.......................       $44,437,000
Budget request, fiscal year 2022......................        51,554,000
Committee Recommendation..............................        44,437,000
    Change from enacted level.........................             - - -
    Change from budget request........................        -7,117,000
 

    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 $44,437,000 for OLMS, which is the 
same as the fiscal year 2021 enacted level and $7,117,000 below 
the fiscal year 2022 budget request.

             Office of Federal Contract Compliance Programs


                         SALARIES AND EXPENSES

 
 
 
Appropriation, fiscal year 2021.......................      $105,976,000
Budget request, fiscal year 2022......................       140,732,000
Committee Recommendation..............................       140,732,000
    Change from enacted level.........................       +34,756,000
    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 $140,732,000 for OFCCP, which is 
$34,756,000 above the fiscal year 2021 enacted level and the 
same as the fiscal year 2022 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 2021.......................      $117,601,000
Budget request, fiscal year 2022......................       140,809,000
Committee Recommendation..............................       140,809,000
    Change from enacted level.........................       +23,208,000
    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 $138,604,000 in 
General Funds from the Treasury, which is $23,180,000 above the 
fiscal year 2021 enacted level and the same as the fiscal year 
2022 request, and $2,205,000 from the Special Fund established 
by the Longshore and Harbor Workers' Compensation Act.
    National Commission.--The Committee is concerned by an 
ongoing and systematic decline in the adequacy of benefits 
provided to injured workers under the State-based workers' 
compensation system. Costs for disabling workplace injuries are 
being shifted to Federal programs, such as Social Security 
Disability Insurance, because of reduced coverage under State 
laws. With the growth of the gig economy and misclassification 
of workers as independent contractors, millions of workers are 
falling through the cracks in State workers' compensation 
systems. Given the impact to the Federal government, the 
Committee believes that State workers' compensation programs 
should be monitored on an ongoing basis. Following the issuance 
of the report of the National Commission on State Workmen's 
Compensation Laws in 1972, the Department prepared an annual 
report on the operations of State workers' compensation 
programs, but ceased doing so in 2004. Since then, there has 
been no reporting or analysis as State legislatures have 
passed, and governors have signed, significant legislation 
affecting the availability and adequacy of workers' 
compensation. The Committee requests that the Department, 
through the Office of Workers' Compensation Programs, include 
in the fiscal year 2023 Congressional Budget Justification an 
assessment of the resources necessary to reinstate OWCP's 
monitoring of State workers' compensation programs and 
preparation of an annual report.

                            SPECIAL BENEFITS

 
 
 
Appropriation, fiscal year 2021.......................      $239,000,000
Budget request, fiscal year 2022......................       244,000,000
Committee Recommendation..............................       244,000,000
    Change from enacted level.........................        +5,000,000
    Change from budget request........................             - - -
 

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

               SPECIAL BENEFITS FOR DISABLED COAL MINERS

 
 
 
Appropriation, fiscal year 2021.......................       $40,970,000
Budget request, fiscal year 2022......................        32,970,000
Committee Recommendation..............................        32,970,000
    Change from enacted level.........................        -8,000,000
    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 $32,970,000 for Special Benefits 
for Disabled Coal Miners. This amount is in addition to the 
$14,000,000 appropriated in fiscal year 2021 as an advance for 
the first quarter of fiscal year 2022. The total program level 
recommendation is $8,000,000 less than the fiscal year 2021 
enacted level and the same as the fiscal year 2022 budget 
request.
    The Committee recommendation also provides $11,000,000 as 
an advance appropriation for the first quarter of fiscal year 
2023. These funds ensure uninterrupted payments to 
beneficiaries.

    ADMINISTRATIVE EXPENSES, ENERGY EMPLOYEES OCCUPATIONAL ILLNESS 
                           COMPENSATION FUND

 
 
 
Appropriation, fiscal year 2021.......................       $62,507,000
Budget request, fiscal year 2022......................        63,428,000
Committee Recommendation..............................        63,428,000
    Change from enacted level.........................          +921,000
    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.

                    BLACK LUNG DISABILITY TRUST FUND

 
 
 
Appropriation, fiscal year 2021.......................      $382,991,000
Budget request, fiscal year 2022......................       331,505,000
Committee Recommendation..............................       331,505,000
    Change from enacted level.........................       -51,486,000
    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 that the 
Secretary provide an update on the Department's efforts to 
improve the speed and quality of its black lung claims 
processing in the fiscal year 2023 Congressional Budget 
Justification.

             Occupational Safety and Health Administration


                         SALARIES AND EXPENSES

 
 
 
Appropriation, fiscal year 2021.......................      $591,787,000
Budget request, fiscal year 2022......................       664,624,000
Committee Recommendation..............................       691,787,000
    Change from enacted level.........................      +100,000,000
    Change from budget request........................       +27,163,000
 

    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 2022 Committee
------------------------------------------------------------------------
 Safety and Health Standards.........................        $28,450,000
Federal Enforcement..................................        274,634,000
Whistleblower Programs...............................         30,000,000
State Programs.......................................        118,737,000
Technical Support....................................         26,394,000
Federal Compliance Assistance........................         86,175,000
State Consultation Grants............................         63,500,000
Training Grants......................................         14,787,000
Safety and Health Statistics.........................         39,479,000
Executive Direction and Administration...............          9,631,000
------------------------------------------------------------------------

    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.
    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 Smithfield and a JBS plant. For context, in 2019, JBS' 
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 full penalties or a 
penalty multiplier for serious violations in large businesses.
    Whistleblower Protection Program.--The Committee is 
concerned with 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 with three more added in the 
past two years. OSHA's already-overburdened Whistleblower 
Protection Program staff faced an unprecedented surge in 
complaints during the COVID-19 pandemic. During the first four 
months of the pandemic, the average number of whistleblower 
complaints received per investigator increased by 30 percent--
39 percent of these were COVID-19 related. At the same time, 
the Whistleblower Protection Program's FTEs decreased between 
2019 to 2020 to only 120 investigators, causing an increase in 
the number of cases handled by each investigator. 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 
$10,936,000 above the fiscal year 2021 enacted level. This 
increase will support OSHA's efforts to update its decades-old 
Whistleblower database 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 Latino 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. In addition, 
the Committee encourages OSHA to support grants for 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, like WHD, 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.
    COVID-19 Testing for Meatpacking Workers.--The Committee is 
supportive of workplace health and safety procedures that 
include adequate COVID-19 testing for meatpacking workers. Even 
before the pandemic, meatpacking, poultry, and agriculture have 
been dangerous industries for workers. The pandemic exacerbated 
these hazards, which are disproportionately felt by workers of 
color.
    OSHA Noise Standard.--The Committee is aware that the 
National Institute for Occupational Safety and Health (NIOSH) 
estimates that 22 million US 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 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 encourages 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.
    Needlestick Safety.--The Committee recognizes the risks 
posed by the COVID-19 pandemic to our nation's essential 
healthcare workforce as they continue to ensure the 
administration of FDA-approved COVID-19 vaccines. With the 
increase in demand for syringe-administered vaccines comes the 
increased risk of exposure not only to COVID-19, but also to 
bloodborne pathogens including, but not limited to, hepatitis 
B, hepatitis C and human immunodeficiency virus. OSHA should 
continue to work with the Department of Health and Human 
Services (HHS) to monitor the supply of safety-engineered 
devices for COVID-19 vaccinations. If OSHA and HHS determine 
that there is a shortage of these devices, the Committee 
requests that OSHA include cost estimates that will ensure the 
standards prescribed in the Needlestick Safety and Prevention 
Act are enforced to the extent feasible in the fiscal year 2023 
Congressional Budget Justification. The authorization includes 
a standard which states that employers are required to 
evaluate, select, and use engineering controls to eliminate or 
minimize exposure to contaminated sharps.
    Occupational Heat Stress Protection Standard.--The 
Committee recognizes the urgency of developing a workplace 
safety standard to protect workers from excessive heat, and is 
aware that a standard has already proven to be feasible to 
implement, and in light of rising temperatures urges OSHA to 
take all necessary steps to issue a proposed occupational heat 
stress protection standard by the end of fiscal year 2022. The 
Secretary is directed to submit a schedule to the Committee 
within 90 days of enactment of this Act on the action steps it 
will be taking to promulgate an occupational heat stress 
protection standard.

                 Mine Safety and Health Administration


                         SALARIES AND EXPENSES

 
 
 
Appropriation, fiscal year 2021.......................      $379,816,000
Budget request, fiscal year 2022......................       447,201,000
Committee Recommendation..............................       404,816,000
    Change from enacted level.........................       +25,000,000
    Change from budget request........................       -42,385,000
 

    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.
    Coal, Metal, and Non-metal Mines.--MSHA is directed to 
include in the fiscal year 2023 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 2021.......................      $655,000,000
Budget request, fiscal year 2022......................       700,653,000
Committee Recommendation..............................       700,653,000
    Change from enacted level.........................      + 45,653,000
    Change from budget request........................             - - -
 

    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 $632,653,000 from the 
General Fund of the Treasury and $68,000,000 from the 
Employment Security Administration Account in the Unemployment 
Trust Fund. Within the total amount for BLS, the Committee 
includes $28,470,000 to continue the relocation of the BLS 
headquarters, which was initiated in fiscal year 2020.
    Within the total for BLS, the Committee provides the 
following amounts:

------------------------------------------------------------------------
                                                            FY 2022
                   Budget Activity                         Committee
------------------------------------------------------------------------
Employment and Unemployment Statistics...............       $221,000,000
Labor Market Information.............................         68,000,000
Prices and Cost of Living............................        233,033,000
Compensation and Working Conditions..................         89,875,000
Productivity and Technology..........................         12,375,000
Executive Direction and Staff Services...............         66,329,000
------------------------------------------------------------------------

    National Longitudinal Survey of Youth (NLSY).--The 
Committee is supportive of BLS' plan for the planning, 
development, and implementation of a new NLSY cohort and 
provides sufficient resources to implement this plan without 
delay. Specifically, the Committee supports the Department's 
plan to increase spending on the new NLSY cohort in fiscal year 
2023 to $14,500,000 and requests an update on future spending 
plans in the fiscal year 2023 Congressional Budget 
Justification.
    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 2021 full-time equivalent ceiling.
    Artificial Intelligence.--The Committee is aware of the 
development of artificial intelligence and encourages BLS to 
examine this trend's impact on the economy.
    Job Openings and Labor Turnover Survey (JOLTS).--The 
Committee recognizes the need for enhancements to JOLTS to 
better understand national labor market dynamics. Therefore, 
the Committee requests for the Department to provide cost 
estimates in the fiscal year 2023 Congressional Budget 
Justification for expanding the JOLTS sample level and for 
releasing JOLTS data monthly to improve timeliness.

                 Office of Disability Employment Policy


                         SALARIES AND EXPENSES

 
 
 
Appropriation, fiscal year 2021.......................       $38,500,000
Budget request, fiscal year 2022......................        42,711,000
Committee Recommendation..............................        42,711,000
    Change from enacted level.........................        +4,211,000
    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 $42,711,000, which 
is $4,211,000 above the fiscal year 2021 enacted level and the 
same as the fiscal year 2022 budget request. The Committee is 
supportive of the budget proposal for ODEP to invest in 
research and demonstration projects related to testing 
effective ways to promote greater labor force participation of 
people with disabilities.

                        Departmental Management


                         SALARIES AND EXPENSES

 
 
 
Appropriation, fiscal year 2021.......................      $349,364,000
Budget request, fiscal year 2022......................       439,970,000
Committee Recommendation..............................       457,219,000
    Change from enacted level.........................      +107,855,000
    Change from budget request........................       +17,249,000
 

    The Departmental Management appropriation provides funds 
for the staff responsible for Departmental operations, 
management, and policy development.
    The Committee recommendation includes $456,911,000 from the 
General Fund of the Treasury, $107,855,000 above the fiscal 
year 2021 enacted level and $17,249,000 above the fiscal year 
2022 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 2022 Committee
------------------------------------------------------------------------
Program Direction and Support........................        $35,023,000
Departmental Evaluation..............................         10,040,000
Legal Services.......................................        154,629,000
International Labor Affairs..........................        136,000,000
Administration and Management........................         39,308,000
Adjudication.........................................         41,013,000
Women's Bureau.......................................         25,000,000
Civil Rights Activities..............................         10,344,000
Chief Financial Officer..............................          5,862,000
------------------------------------------------------------------------

    International Labor Affairs Bureau (ILAB).--Of the 
$136,000,000 recommended for the International Labor Affairs 
Bureau (ILAB), the Committee directs the Secretary to allocate 
not less than $40,175,000 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. The Committee directs 
ILAB to use its fiscal year 2022 funding increase to place 
additional labor attaches in strategic countries focused on 
fundamental worker rights such as freedom of association, 
collective bargaining, protection from sex discrimination, and 
acceptable conditions of work. The Committee urges ILAB to 
prioritize these additional attaches in areas of strategic 
importance such as Honduras, Guatemala, Vietnam, and 
Bangladesh.
    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 
2022 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 2023 Congressional Budget Justification, 
ILAB is directed to include spending plans for resources 
provided in the USMCA Implementation Act for fiscal years 2020 
through 2023. Spending plans should include descriptions and 
amounts for projects and staffing.
    Sex Discrimination in Employment and the Workplace.--The 
Committee recognizes the vital role ILAB plays in building the 
capacity of other countries to enforce and improve labor 
protections for workers and in enforcing the labor provisions 
of U.S. trade agreements and preference programs; however, the 
Committee is concerned that the issue of sex discrimination has 
not received enough attention in the Bureau's capacity-
building, monitoring, and enforcement activities. It is 
essential that workers around the world are protected from 
pregnancy- and maternity-based discrimination, discriminatory 
recruitment and hiring, and the manifestation of unconscious 
bias in the workplace. Further, many female workers receive 
unequal access to training opportunities and work schedules 
that prevent them from acting as primary care givers and 
accepting positions that would help them advance. In addition, 
the Committee is concerned by the complete absence of gender 
mainstreaming in labor inspections; lack of labor inspector 
training on best practices for identifying and addressing sex 
discrimination; and inadequate complaint mechanisms for women 
to anonymously report sex discrimination in employment and the 
workplace. Finally, the Committee believes workers should 
receive equal pay for work of equal value. In response, the 
Committee urges ILAB to prioritize these areas of concern 
through its capacity-building, monitoring, and enforcement 
efforts.
    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 $25,000,000 appropriated to the 
Women's Bureau, the Committee provides no less than $6,794,000 
for the Women in Apprenticeship and Nontraditional Occupations 
(WANTO) program, which is $5,000,000 above the fiscal year 2021 
enacted level and the fiscal year 2022 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.
    Women's Unemployment.--The Committee is concerned by the 
dramatic increase in the unemployment rate for women as a 
result of the COVID-19 pandemic. The Committee encourages the 
Women's Bureau to make it an agency-wide priority to mitigate 
and reverse this trend in fiscal year 2022. Additionally, the 
Committee is supportive of the recommendations from GAO's 
report on the gender pay gap in the federal workforce (GAO-21-
67) and is supportive of GAO's ongoing work to identify 
improvements regarding measures taken by the Department of 
Labor to mitigate women's unemployment, including the immediate 
and long-term effects of COVID-19 on women's employment. The 
Committee is interested in the impacts of COVID-19 on 
unemployment rates for low-income women and women of color, 
groups that have been disproportionately impacted by the 
pandemic
    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 2023 
Congressional Budget Justification: Expenditures for fiscal 
year 2021 and expected expenditures for fiscal years 2022 and 
2023, 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.
    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 2019, 2020 and 2021 
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 2020 
or 2021 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.
    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 2023 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 2023 
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 2023 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, 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 2023 Congressional Budget Justification.
    Family-Friendly Workplaces Certification.--The Committee 
recognizes the importance of promoting family-friendly 
workplaces. The pandemic has placed an unexpected burden on 
working parents, particularly working mothers who have left the 
labor force in disproportionate numbers since March 2020. 
Therefore, the Committee directs the Secretary to evaluate the 
feasibility of establishing a certification program that 
recognizes exemplary family-friendly businesses and 
incentivizes businesses to adapt best practices that reflect 
the challenges faced by working parents. Modeled off the 
Environmental Protection Agency's Energy Star Program, this 
Family-Friendly Workplaces Certification would evaluate 
businesses based on a number of policies including; paid sick 
days, paid family leave of at least 12 weeks per year, 
childcare subsidies, lactation support, assistance paying for 
or referring employees to fertility or adoption services, and 
accommodations for pregnant workers. The Committee directs the 
Secretary to submit this feasibility report within 270 days of 
enactment of this Act.

                    VETERANS EMPLOYMENT AND TRAINING

 
 
 
Appropriation, fiscal year 2021.......................      $316,341,000
Budget request, fiscal year 2022......................       324,831,000
Committee Recommendation..............................       334,841,000
    Change from enacted level.........................       +18,490,000
    Change from budget request........................       +10,000,000
 

    The recommendation includes $67,500,000 from the General 
Fund of the Treasury and $267,331,000 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 2022 Committee
------------------------------------------------------------------------
State Administration Grants..........................       $180,000,000
Transition Assistance Program........................         31,379,000
Federal Administration...............................         52,538,000
Veterans Employment and Training Institute...........          3,414,000
Homeless Veterans Reintegration Program..............         67,500,000
------------------------------------------------------------------------

    The Committee recommendation includes $31,379,000 for the 
Transition Assistance Program, which is the same as the fiscal 
year 2021 enacted level and the fiscal year 2022 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 $67,500,000 for the Homeless 
Veterans Reintegration Program, which is $10,000,000 more than 
the fiscal year 2021 enacted level and the fiscal year 2022 
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 2021 enacted level and the fiscal year 2022 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 
2021 enacted level 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 
directs 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 2023 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.
    Military Spouse Occupational License and Certification 
Portability.--The Committee encourages the Department of Labor 
to work with states to encourage them to implement occupational 
license and certification portability measures for military 
spouses through full license recognition. The current framework 
for license and certification portability often poses a barrier 
to employment, and this is particularly problematic for 
military spouses as they frequently are required to relocate 
due to the nature of their spouse's military employment. The 
number of jobs that require a license has steeply risen from 5 
percent in the 1950s to 30 percent today. The increase in 
licensing requirements and frequent moves contribute to the 
high unemployment rate of military spouses, currently at 24 
percent. Addressing this issue demonstrates the Committee's 
appreciation for the service of military members and the 
sacrifices their families make on a daily basis.
    Veterans' Pilot Program.--The Committee encourages the 
Department to pilot an accelerated veteran transition program 
in regions surrounding military installations in the United 
States, inclusive of exiting soldiers and retired veterans. The 
pilot program would utilize funding under this account for 
direct services to support veterans and transitioning military 
members into in-demand civilian occupations aligned with their 
military training and experience. This project is needed as 
available veteran resources do not fully pay for school, 
transitional benefits (in terms of training), or target 
regional career/trade demands. While transitioning soldiers 
have access to available resources, those sources do not offer 
the job-placement-centric approach that this program would 
prioritize. Additionally, existing allocation from the 
Workforce Innovation and Opportunity Act (WIOA) resources does 
not fund certificate education in prospective targeted 
occupations.

                  INFORMATION TECHNOLOGY MODERNIZATION

 
 
 
Appropriation, fiscal year 2021.......................      $ 27,269,000
Budget request, fiscal year 2022......................        37,269,000
Committee Recommendation..............................        37,269,000
    Change from enacted level.........................       +10,000,000
    Change from budget request........................             - - -
 

    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 2021.......................       $90,847,000
Budget request, fiscal year 2022......................        95,398,000
Committee Recommendation..............................        95,398,000
    Change from enacted level.........................        +4,551,000
    Change from budget request........................             - - -
 

    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 $89,738,000 from the General 
Fund of the Treasury, which is $4,551,000 more than the fiscal 
year 2021 enacted level and the same as the fiscal year 2022 
budget request, and $5,660,000 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 Working Capital Fund.
    Sec. 113. The Committee includes a new provision relating 
to the Consolidated Appropriations Act, 2021 to clarify the 
availability of funds provided under Section 118(a) of division 
BB.
    Sec. 114. The Committee includes a new provision relating 
to the Wagner-Peyser Act Staffing Flexibility regulation.
    Sec. 115. The Committee includes a new provision relating 
to regulations pertaining to industry recognized apprenticeship 
programs.
    Sec. 116. The Committee includes a new provision relating 
to processing of Applications for Temporary Employment 
Certification for certain industries.
    Sec. 117. The Committee includes a new provision relating 
to the determination of prevailing wages.
    Sec. 118. The Committee includes a new provision relating 
to processing of Applications for Temporary Employment 
Certification for employers with violations of labor laws.

           TITLE II--DEPARTMENT OF HEALTH AND HUMAN SERVICES


              Health Resources and Services Administration


 
 
 
Appropriation, fiscal year 2021.......................    $7,207,234,000
Budget request, fiscal year 2022......................     7,813,294,000
Committee Recommendation..............................     8,723,922,000
    Change from enacted level.........................    +1,516,688,000
    Change from budget request........................      +910,628,000
 

    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 
$8,723,922,000 in discretionary budget authority, $316,778,000 
in mandatory funding and $16,200,000 in trust fund 
appropriations for the Vaccine Injury Compensation Program 
Trust Fund, and $5,000,000 for the Countermeasures Injury 
Compensation Program.

                          PRIMARY HEALTH CARE

 
 
 
Appropriation, fiscal year 2021.......................    $1,683,772,000
Budget request, fiscal year 2022......................     1,733,772,000
Committee Recommendation..............................     1,831,772,000
    Change from enacted level.........................      +148,000,000
    Change from budget request........................       +98,000,000
 

Health Centers

    The Committee recommends $1,830,772,000 for the Health 
Centers program, $148,000,000 above the fiscal year 2021 
enacted level and $98,000,000 above the fiscal year 2022 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, 
school-based, and public housing health service grants.
    In addition, the American Rescue Plan (P.L. 117-2) included 
$7,600,000,000 in discretionary appropriations to support 
Health Centers' response to the COVID-19 pandemic.
    The Committee includes bill language providing up to 
$120,000,000 for the Federal Tort Claims Act program, the same 
as the fiscal year 2021 enacted level and the fiscal year 2022 
budget request.
    Alcee L. Hastings Program for Advanced Cancer Screening in 
Underserved Communities.--The Committee is extremely concerned 
about the disparity in cancer screening--and corresponding 
higher levels of cancer incidence and adverse outcomes--in 
medically underserved communities. Several studies have 
demonstrated that this problem has only been made worse by the 
pandemic. The Committee includes $25,000,000 to fund Health 
Centers to increase access and address barriers to cancer 
screening, including patient education, case management, 
outreach, and other enabling services. Grantees must partner 
and coordinate closely with NCI-designated cancer centers to 
deploy cancer-center trained and supervised outreach 
specialists and navigators to improve cancer screening and 
referrals among vulnerable populations in their catchment 
areas.
    Ending the HIV Epidemic (EHE) Initiative.--The Committee 
provides $152,250,000 within the Health Centers program for the 
EHE Initiative, $50,000,000 above the fiscal year 2021 enacted 
level and the same as the fiscal year 2022 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 Center Dental Services.--The Committee recognizes 
the importance of Health Centers in providing comprehensive 
primary and preventive health services to the nation's 
underserved communities. Health Centers provide dental services 
for many who would otherwise face barriers to dental care. The 
Committee is aware that some Health Centers have partnered with 
Community Dental Health Coordinators (CDHCs) to provide 
patients with greater access to dental care. CDHCs provide 
community-based prevention, care coordination, and patient 
navigation to underserved populations in rural, urban, and 
Native American communities. The Committee encourages HRSA to 
work with Health Centers to expand their work in this area.
    Health Center Mental Health Services for Children.--The 
Committee is concerned about the many challenges faced by 
children in need of mental health services because of the 
COVID-19 pandemic. The pandemic has had serious impacts on 
children's mental, psychological, and emotional well-being, 
especially in low-income and minority communities. This impact 
will likely last for an extended period. The Committee strongly 
encourages HRSA to provide funding to Health Centers to support 
vital mental health services for children.
    School-Based Health Centers (SBHCs) and Health Center 
Services at School-Based 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 a 
total increase of $50,000,000 within the total for Health 
Centers to support the delivery of health care services at 
school-based sites. The Committee includes $25,000,000 to make 
grants to establish new school-based health centers 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. The Committee also 
includes $25,000,000, an increase of $20,000,000 above the 
fiscal year 2021 enacted level, for awards to Health Centers 
operating at school-based sites to increase their capacity to 
meet the increasing demand for health services, including 
mental health services. The Committee encourages HRSA to award 
grants to applicants that previously submitted fundable 
applications under HRSA-21-093 but that did not receive such 
funding.
    Health Center Controlled Networks.--Health Center 
Controlled Networks (HCCNs) 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 strongly supports 
the work of HCCNs.
    HRSA Strategy to Address Intimate Partner Violence and 
Project Catalyst.--The Committee includes no less than 
$2,000,000 for the HRSA Strategy to Address Intimate Partner 
Violence, an increase of $500,000 over the fiscal year 2021 
enacted level and the fiscal year 2022 budget request. The 
Committee encourages HRSA to support training, technical 
assistance, and resource development to assist public health 
and health care professionals to better serve individuals and 
communities impacted by intimate partner violence.
    Native Hawaiian Health Care Program.--The Committee 
provides $22,000,000 within the total for Health Centers for 
the Native Hawaiian Health Care Program, $1,500,000 above the 
fiscal year 2021 enacted level and the fiscal year 2022 budget 
request. The Native Hawaiian Healthcare Systems help improve 
the health status of Native Hawaiians by making health 
education, health promotion, disease prevention, and Native 
Hawaiian traditional healing services available.
    The Committee understands the importance of ensuring that 
indigenous people, including Native Hawaiians, have access to 
health care. The Committee requests a report from the 
Government Accountability Office (GAO) on the status of health 
care accessibility and affordability for Native Hawaiians 
living in Hawaii, to include the rural and medically 
underserved islands.

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 2021 enacted level and the fiscal year 2022 
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 2021.......................    $1,224,006,000
Budget request, fiscal year 2022......................     1,380,384,000
Committee Recommendation..............................     1,564,876,000
    Change from enacted level.........................      +340,870,000
    Change from budget request........................      +184,492,000
 

    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.
    In addition to the amounts above, the American Rescue Plan 
(P.L. 117-2) included $1,000,000,000 in discretionary 
appropriations to support health workforce programs in response 
to the COVID-19 pandemic.
    The Committee bill strikes language prohibiting HRSA funds 
from being used to support alternative dental providers. 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.

National Health Service Corps (NHSC)

    The Committee includes $185,000,000, an increase of 
$65,000,000 above the fiscal year 2021 enacted level and the 
same as the fiscal year 2022 budget request, for NHSC to 
support competitive awards to health care providers dedicated 
to working in underserved communities in urban, rural, and 
tribal areas.
    In addition to the amounts above, the American Rescue Plan 
(P.L. 117-2) included $900,000,000 in discretionary 
appropriations to support NHSC in response to the COVID-19 
pandemic.
    Loan Repayment for Opioid and Substance Use Disorder (SUD) 
Treatment.--The Committee includes $155,000,000, $25,000,000 
below the fiscal year 2022 budget request, for loan repayment 
for clinicians that provide opioid and substance use disorder 
treatment. Within this total, the Committee includes 
$15,000,000, the same as the fiscal year 2021 enacted level and 
the fiscal year 2022 budget request, to support NHSC awards to 
participating individuals that provide health services in IHS 
facilities, Tribally-Operated Health Programs, and Urban Indian 
Health Programs.
    Maternity Care Target Areas (MCTAs).--The Committee 
includes $5,000,000, an increase of $5,000,000 above the fiscal 
year 2021 enacted level and the same as the fiscal year 2022 
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.
    National Health Service Corps Rural Demonstration 
Program.--The Committee strongly supports the NHSC program for 
improving access to quality care in rural and underserved 
areas. 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 $25,000,000 within NHSC for a pilot program 
to evaluate the benefit to patient access and practitioner 
recruitment and retention of extending loan repayment for five 
years and $200,000 for providers serving in rural areas that 
are part of a Health Professional Shortage Area. The Committee 
also directs HRSA to include an assessment of program 
utilization and impact in the annual NHSC report to Congress 
and to submit a final report after completion of the pilot.

Health Professions Education and Training

    The Committee includes $565,404,000 for Health Professions 
Education and Training Programs authorized under title VII of 
the PHS Act, $125,870,000 above the fiscal year 2021 enacted 
level and $37,992,000 above the fiscal year 2022 budget 
request.
    Addressing the Shortage of Behavioral Health 
Professionals.--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 found that there will be a shortage 
of 250,000 mental health professionals by 2025. The Committee 
directs HRSA to submit a report addressing the scope of the 
shortage of behavioral health professionals, barriers to 
careers in behavioral health, Federal support available, and 
recommendations to Congress to address the shortage within 180 
days of enactment of this Act.
    Social Work Reinvestment Commission.--The Committee is 
aware that millions of Americans are not receiving the mental, 
behavioral and social care services they need. The COVID-19 
pandemic has increased the need for services. The nation's 
700,000 social workers are the largest provider of these 
services, so it is imperative that we ensure a robust social 
work workforce. As such, the Committee directs HRSA in 
collaboration with SAMHSA, ACF, OMH, and CMS, to conduct a 
study and to report to Congress and the Secretary on policy 
issues related to social work recruitment, retention, research 
and reinvestment. Not later than 18 months after enactment of 
this Act, HRSA shall submit its findings and recommendations 
regarding recommendations and strategies to ensure a sufficient 
and strong social work workforce.

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 
$31,711,000 for COEs, $8,000,000 above the fiscal year 2021 
enacted level and $5,000,000 above the fiscal year 2022 budget 
request. 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. The 
Committee notes that COEs educate a disproportionate share of 
health professionals from minority and underserved backgrounds 
and address the need for a diverse and culturally competent 
American health care workforce.
    Health Careers Opportunity Program (HCOP).--The Committee 
includes $20,500,000 for HCOP, $5,500,000 above the fiscal year 
2021 enacted level and $2,000,000 above the fiscal year 2022 
budget request. The Committee notes that HCOPs assist students 
from minority and economically disadvantaged backgrounds 
navigate careers into 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 $2,310,000 
for Faculty Loan Repayment, $1,120,000 above the fiscal year 
2021 enacted level and the same as the fiscal year 2022 budget 
request. 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 $61,970,000 for SDS, $10,500,000 above the 
fiscal year 2021 enacted level and $10,000,000 above the fiscal 
year 2022 budget request. This program provides grants to 
health professions and nursing schools to provide scholarships 
to students from disadvantaged background who have financial 
need.
    Within this total, the Committee includes $5,000,000, a 
$2,500,000 increase over the fiscal year 2021 enacted level, 
for grants to educate midwives to address the national shortage 
of maternity care providers, and specifically the lack of 
adequate diversity in the maternity care workforce. This amount 
will double the number of five-year grants first made available 
beginning in fiscal year 2020.

Primary Care Training and Enhancement

    The Committee includes $49,924,000, an increase of 
$1,000,000 above the fiscal year 2021 level and the fiscal year 
2022 budget request, for Primary Care Training and Enhancement 
programs, which support training and direct financial 
assistance for future primary care clinicians, teachers, and 
researchers.
    Eating Disorders Screening, Brief Intervention, Referral, 
and Treatment (SBIRT).--The COVID-19 pandemic worsened eating 
disorders across the nation, with one study reporting up to 76 
percent of respondents engaging in eating disorder behaviors. 
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 National 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 (P.L. 114-255).

Oral Health Training

    The Committee includes $42,673,000 for Oral Health 
Training, $2,000,000 above the fiscal year 2021 enacted level 
and the fiscal year 2022 budget request. Within the total, the 
Committee includes not less than $14,000,000 for Pediatric 
Dentistry Programs, an increase of $2,000,000 above the fiscal 
year 2021 enacted level. 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 2018 and 2021. The Committee directs HRSA to 
initiate a new pre-doctoral grant cycle, and to initiate a new 
DFLRP grant cycle with a preference for pediatric dentistry 
faculty supervising dental students or residents and providing 
clinical services in dental clinics located in dental schools, 
hospitals, and community-based affiliated sites.

Interdisciplinary Community-Based Linkages

    Area Health Education Centers (AHEC).--The Committee 
includes $50,000,000 for the AHEC program, an increase of 
$6,750,000 above the fiscal year 2021 level and the fiscal year 
2022 budget request. This program links university health 
science centers with community health service delivery systems 
to provide education and training networks.
    The Committee encourages HRSA to support AHEC oral health 
projects that establish primary points of service and address 
the need to help patients find treatment outside of hospital 
emergency rooms. The Committee encourages HRSA to work with 
programs that have already been initiated by some State dental 
associations to refer emergency room patients to dental 
networks.
    Geriatrics Workforce Enhancement Program (GWEP).--The 
Committee includes $52,737,000 for the GWEP program, an 
increase of $10,000,000 above the fiscal year 2021 level and 
$6,200,000 above the fiscal year 2022 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 $43,916,000 for Mental and Behavioral Health Programs, 
an increase of $6,000,000 above the fiscal year 2021 level.
    Graduate Psychology Education (GPE).--Within the total for 
Mental and Behavioral Health Programs, the Committee includes 
$25,000,000, $6,000,000 above the fiscal year 2021 enacted 
level and the same as the fiscal year 2022 budget request, 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 $181,000,000 for the BHWET 
Program, $69,000,000 above the fiscal year 2021 enacted level 
$43,874,000 below the fiscal year 2022 budget request. This 
program establishes and expands internships or field placement 
programs in behavioral health serving populations in rural and 
medically underserved areas.
    Adolescent Addiction Medicine and Addiction Psychiatry 
Workforce.--The Committee applauds HRSA for issuing a funding 
solicitation for the Addiction Medicine Fellowship (AMF) 
program and the Mental and Substance Use Disorder Workforce 
Training Demonstration, as both programs will build the 
capacity of our nation's addiction medicine physician 
workforce. However, 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 encourages HRSA to 
support fellowship programs focused on increasing the number of 
board certified pediatric and adolescent addiction medicine and 
addiction psychiatry subspecialists.
    Peer Support Specialists in the Opioid Use Disorder 
Workforce.--Within the total for BHWET, the Committee includes 
$15,000,000, an increase of $2,000,000 above the fiscal year 
2021 enacted level and the fiscal year 2022 budget request, to 
fund training, internships, and national certification for 
mental health and substance abuse peer support specialists to 
create an advanced peer workforce prepared to work in clinical 
settings.
    Substance Use Disorder Treatment and Recovery (STAR) Loan 
Repayment Program.--The Committee includes $28,000,000 for this 
program, $12,000,000 above the fiscal year 2021 enacted level 
and the same as fiscal year 2022 budget request. 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.
    An estimated 21 million Americans needed treatment for SUD 
in 2017, but only four million received any form of treatment. 
The Bureau of Labor Statistics data has cited tremendous 
shortfalls in the SUD treatment profession. Without strategic 
investments in the SUD workforce, this gap will not close and 
more lives will be lost. Funding is now needed to increase the 
ranks of a well-trained SUD workforce in communities across 
America. Congress can save lives by equipping the frontline 
professionals who prevent and treat addiction, provide recovery 
support, and help reduce the negative consequences associated 
with substance use. The Committee directs HRSA to provide a 
report to the Committee on the progress and implementation of 
this program within 180 days of enactment of this Act.
    Mental and Substance Use Disorder Workforce Training 
Demonstration.--The Committee includes $34,000,000 for the 
Mental and Substance Use Disorder Workforce Training 
Demonstration program, $4,300,000 above the fiscal year 2021 
enacted level and the same as the fiscal year 2022 budget 
request. This program makes grants to institutions, including 
but not limited to medical schools and Federally-Qualified 
Health Centers (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.

National Center for Health Workforce Analysis (NCHWA)

    The Committee includes $5,663,000, the same as the fiscal 
year 2021 enacted level and the fiscal year 2022 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 $23,000,000 for Public Health and 
Preventive Medicine Training Grant Programs, $6,000,000 above 
the fiscal year 2021 enacted level and $5,000,000 above the 
fiscal year 2022 budget request. Within this total, the 
Committee provides an increase of $3,000,000 for the Preventive 
Medicine Residency Training Program and an increase of 
$3,000,000 for Public Health Training Centers.

Nursing Workforce Development

    The Committee recommends $314,472,000 for Nursing Workforce 
Development programs authorized under title VIII of the PHS 
Act, $50,000,000 above the fiscal year 2021 enacted level and 
$46,500,000 above the fiscal year 2022 budget request.
    In addition to the amounts above, the American Rescue Plan 
(P.L. 117-2) included $200,000,000 in discretionary 
appropriations to support nursing workforce development in 
response to the COVID-19 pandemic.
    Impact of COVID-19 on the Rural Nursing Workforce.--The 
Committee directs HRSA to submit a report within 180 days of 
enactment of this Act on the impact of the current public 
health emergency on the nursing workforce, especially in rural 
areas, and summarize strategies to mitigate and address these 
impacts.
    Registered Nurse Shortages.--The Committee is concerned 
about current and projected shortages of registered nurses 
(RNs) in the U.S. As discussed in the HRSA publication ``Supply 
and Demand Projections of the Nursing Workforce 2014-2030'', 
California, New Jersey, South Carolina, and Texas are projected 
to have a deficit of 10,000 or more full time equivalent RNs by 
2030. The Committee directs HRSA to give priority in new 
funding announcements to public entities for training of 
additional RNs, specifically for acute care settings. In 
addition, the Committee directs HRSA to give priority to 
applicants in States listed by HRSA as having the greatest 
shortages.
    Advanced Nursing Education.--The Committee includes 
$82,081,000 for Advanced Nursing Education, $6,500,000 above 
the fiscal year 2021 enacted level and $1,500,000 above the 
fiscal year 2022 budget request. This program supports 
traineeships and faculty and curriculum development to increase 
the number of qualified nurses in the primary care workforce.
    Nursing Education, Practice, Quality, and Retention 
(NEPQR).--The Committee includes $51,913,000 for NEPQR, 
$5,000,000 above the fiscal year 2021 enacted level and the 
fiscal year 2022 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 $15,000,000, an increase of $10,000,000 
above the fiscal year 2021 enacted level and the fiscal year 
2022 budget request, for grants to establish or expand 
community-based nurse practitioner residency and fellowship 
training programs that are accredited, or in the accreditation 
process, for practicing postgraduate nurse practitioners (NPs) 
in primary care or behavioral health, where supported education 
and training specialties will include family, adult family, 
adult-gerontology, pediatric, women's health care, nurse 
midwife, and psychiatric-mental health. The Committee directs 
HRSA to give preference to FQHCs, as defined by section 
1861(aa)(4) of the Social Security Act. The Committee is 
concerned the Nation is unprepared for health care provider 
shortages and recognizes that postgraduate programs with this 
focus, integrating primary care and behavioral health, will 
help to address this problem. Patients need expert primary care 
and behavioral health providers prepared to manage the social 
and clinical complexities experienced in FQHCs. The program 
provides residency training and fellowships to enable 
postgraduate NPs to transition to an integrated model of care 
consistent with current high standards of NP education and 
practice meeting the needs of our nation's most vulnerable 
populations. The events of 2020, from the global COVID-19 
pandemic to national recognition of the severity of health 
disparities and health inequities in our country, has made this 
even more urgent.
    Nursing Workforce Diversity.--The Committee includes 
$26,343,000 for Nursing Workforce Diversity, $6,500,000 above 
the fiscal year 2021 enacted level and $3,000,000 above the 
fiscal year 2022 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 $108,635,000 for Nurse Corps, $20,000,000 above the 
fiscal year 2021 enacted level and the fiscal year 2022 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.
    In addition, the American Rescue Plan (P.L. 117-2) included 
$200,000,000 in discretionary appropriations to support to 
Nurse Corps in response to the COVID-19 pandemic.
    Nursing Faculty Loan Program.--The Committee includes 
$30,500,000 for the Nursing Faculty Loan Program, $2,000,000 
above the fiscal year 2021 enacted level and the fiscal year 
2022 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 $400,000,000 for the CHGME payment 
program, $50,000,000 above the fiscal year 2021 enacted level 
and the fiscal year 2022 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 $75,000,000, $25,000,000 above the 
fiscal year 2021 enacted level and the fiscal year 2022 budget 
request, to support colleges of medicine at public universities 
located in the top quintile 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 recognizes that there are significant 
shortages of pediatric subspecialists, child psychiatrists, and 
other child mental health providers in underserved areas and 
includes $25,000,000 for the Pediatric Subspecialty Loan 
Repayment Program under section 775 of the PHS Act. The 
Committee 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.

National Practitioner Data Bank (NPDB)

    The Committee includes $18,814,000 for the NPDB, the same 
as the fiscal year 2021 enacted level and the fiscal year 2022 
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 2021.......................      $975,284,000
Budget request, fiscal year 2022......................     1,100,084,000
Committee Recommendation..............................     1,188,784,000
    Change from enacted level.........................      +213,500,000
    Change from budget request........................       +88,700,000
 

    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.
    Congenital Syphilis.--The Committee is concerned with the 
rise in congenital syphilis as well as the need to expand 
efforts to prevent this disease and reduce infant mortality. To 
improve the quality of health care to mothers and their 
children, the Committee encourages MCHB to support efforts to 
increase prenatal screening for congenital syphilis and 
postnatal follow-up for both mothers and babies to ensure that 
congenital syphilis is detected at the earliest possible stage.

Maternal and Child Health (MCH) Block Grant

    The Committee recommends $868,700,000 for the MCH Block 
Grant, $156,000,000 above the fiscal year 2021 enacted level 
and $46,000,000 above the fiscal year 2022 budget request. 
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.
    The Committee recommends that HRSA continue to support MCH 
Block Grant partnerships with Federal and State partners to 
address gaps in services to mothers, children, and their 
families in all 50 States, the District of Columbia, and the 
territories; including densely populated Medically Underserved 
Areas and Medically Underserved Population designated Health 
Professional Shortage Areas.

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 2022
                   Budget Activity                         Committee
------------------------------------------------------------------------
Set-aside for Oral Health............................         $5,250,000
Set-aside for Epilepsy...............................          3,642,000
Set-aside for Sickle Cell Disease....................         10,000,000
Set-aside for Fetal Alcohol Syndrome.................          1,000,000
------------------------------------------------------------------------

    State Oral Health Programs.--The Committee includes 
$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 play a key 
role in the design, monitoring, oversight, and implementation 
of these projects.
    Alliance for Maternal Health Safety Bundles.--The Committee 
includes $14,300,000, an increase of $5,300,000 above the 
fiscal year 2021 enacted level and the same as the fiscal year 
2022 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.
    Children's Health and Development.--There is increasing 
evidence that experiences in early childhood have long-term 
health consequences over the course of one's life. These 
experiences are critical in all areas of children's 
educational, social, and physical development and economic 
well-being. Children living in persistently high poverty 
experience more negative health outcomes. The Committee 
includes $3,500,000 to build upon the work done to address 
these challenges, and directs HRSA to fund projects bringing 
systemic change, such as Statewide systems of early childhood 
developmental screenings and interventions, in States with high 
levels of or disparities in childhood poverty. The goal of the 
program is to yield comprehensive and integrated models for 
other States to utilize in improving child health and 
development outcomes.
    Early Childhood Development Expert Grants.--The Committee 
includes $25,000,000, an increase of $25,000,000 above the 
fiscal year 2021 level and $15,000,000 above the fiscal year 
2022 budget request, to place early childhood development 
experts in pediatrician offices that serve a population with a 
high percentage of Medicaid and CHIP patients.
    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.
    Hereditary Hemorrhagic Telangiectasia (HHT) Centers of 
Excellence.--The Committee includes $2,000,000 to establish a 
new competitive grant program for HHT Centers of Excellence. 
This funding will support 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.
    Implicit Bias and Racism Training for Health Care 
Professionals.--The Committee includes $5,000,000, an increase 
of $5,000,000 above the fiscal year 2021 enacted level and the 
same as the fiscal year 2022 budget request, to make grants to 
train health care providers on identifying and avoiding 
implicit bias.
    Infant-Toddler Court Teams.--The Committee includes 
$25,000,000 to continue and expand research-based Infant-
Toddler Court Teams to change child welfare practices to 
improve well-being for infants, toddlers, and their families. 
The Committee expects this increase of $15,000,000 above the 
fiscal year 2021 enacted level to: (1) build upon the work of 
sites currently supported through the Infant-Toddler Court 
Program provision of training technical assistance, and 
additional support for Infant-Toddler Court teams' efforts 
across the country, and (2) provide grants to plan and support 
additional Infant-Toddler Court Teams.
    Maternal Mental Health Hotline.--The Committee includes 
$5,000,000, an increase of $2,000,000 above the fiscal year 
2021 level and $1,000,000 above the fiscal year 2022 budget 
request, to support a 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 shall provide 24 hours a day voice 
and text support that is culturally and linguistically 
appropriate. Funds provided shall also be used to raise public 
awareness about maternal mental health issues and the hotline.
    NASEM Study on Bias Recognition in Clinical Skills 
Testing.--The Committee includes $1,000,000, $1,000,000 above 
the fiscal year 2021 enacted level and the same as the fiscal 
year 2022 budget request, to support a NASEM study that will 
make recommendations for incorporating bias recognition in 
clinical skills testing for accredited schools of allopathic 
medicine and osteopathic medicine.
    Pregnancy Medical Home Demonstration.--The Committee 
includes $25,000,000, an increase of $25,000,000 above the 
fiscal year 2021 level and the same as the fiscal year 2022 
budget request, 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.
    Regional Pediatric Pandemic Network.--The Committee 
provides $13,000,000, an increase of $3,000,000 above the 
fiscal year 2021 enacted level and the fiscal year 2022 budget 
request, within SPRANS to continue the work of the Regional 
Pediatric Pandemic Network to prepare the pediatric community 
for and coordinate timely research-informed responses to future 
pandemics.
    State Maternal Health Innovation Grants.--The Committee 
includes $53,000,000, $30,000,000 above the fiscal year 2021 
enacted level and the same as the fiscal year 2022 budget 
request, 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.
    Sudden Infant Death Syndrome.--The Committee includes 
$5,100,000, an increase of $4,000,000 above the fiscal year 
2021 enacted level and the fiscal year 2022 budget request, for 
the National Fetal, Infant, and Child Death Review (FIDCR) 
program to expand support and technical assistance to States 
and tribal communities and improve the availability of data on 
sudden unexpected infant deaths (SUID). The Committee urges 
HRSA to consider making grants to support families who have 
experiences SUID by providing information, referrals, or peer 
or follow-up support services.

Maternal and Child Health Programs

Sickle Cell Anemia Demonstration Program

    The Committee includes $9,205,000 for this program, an 
increase of $2,000,000 above the fiscal year 2021 enacted level 
and the fiscal year 2022 budget request. With the start of new 
five-year grant awards in fiscal year 2022, the Committee is 
interested in learning how the program is supporting the growth 
of comprehensive Sickle Cell Disease (SCD) 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. The Committee directs HRSA to provide an update in 
the fiscal year 2023 Congressional Budget Justification on its 
plans to meet these goals.

Autism and Other Developmental Disorders

    The Committee recommends $57,344,000 for Autism and Other 
Developmental Disorders, $4,000,000 above the fiscal year 2021 
enacted level and the same as the fiscal year 2022 budget 
request. 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, 
$2,000,000 above the fiscal year 2021 enacted level and 
$856,000 above the fiscal year 2022 budget request, for the 
LEND program to allow the existing 52 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 $25,883,000 for the Heritable 
Disorders program, $7,000,000 above the fiscal year 2021 
enacted level and the fiscal year 2022 budget request. This 
program supports activities that strengthen the newborn 
screening system to ensure infants born in every State receive 
rapid identification, early intervention, and potentially life-
saving treatment.
    Severe Combined Immune Deficiency (SCID).--Within the total 
amount for Heritable Disorders, the Committee provides 
$4,000,000, an increase of $1,000,000 above the fiscal year 
2021 enacted level and the fiscal year 2022 budget request, to 
support wider implementation, education, and awareness of 
newborn screening and follow-up for SCID and other newborn 
screening disorders. The Committee recognizes the progress that 
has been made in screening for SCID at birth to enable early 
interventions, including bone marrow transplantations and 
emerging investigational gene therapies. This work has been 
extremely beneficial to families who will soon have access to 
additional support with the launch of a virtual, facilitated 
caregiver support group this year. The Committee directs HRSA 
to continue supporting this and related work that focuses on 
helping families understand and navigate the process from 
diagnosis to treatment and follow-up and to expand access to 
these resources for providers and families of infants with SCID 
and other newborn screening disorders with a focus on reaching 
underserved populations.

Healthy Start

    The Committee recommends $145,000,000 for the Healthy Start 
program, $17,000,000 above the fiscal year 2021 enacted level 
and the fiscal year 2022 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.
    Remote Blood Pressure Monitoring Initiative.--Preeclampsia/
eclampsia is the most dangerous form of hypertension that can 
develop during pregnancy or the postpartum period, affecting as 
many as one in twelve pregnancies and resulting in 15 percent 
of premature infant deaths. While new preeclampsia diagnostics 
are being evaluated by the Food and Drug Administration (FDA), 
the Committee understands that medical providers continue to 
rely on regular blood pressure monitoring to identify pregnant 
and postpartum people at highest risk of developing 
preeclampsia. The Committee also understands that preeclampsia 
disproportionately affects racial and ethnic minorities and 
those living in rural communities, and supports efforts to 
improve blood pressure monitoring for people lacking access to 
consistent prenatal care, particularly efforts to support 
remote blood pressure monitoring of pregnant people through use 
of blood pressure cuffs and easy-to-understand patient 
information to identify the signs and symptoms of preeclampsia 
and allow patients to proactively engage their health 
providers. The Committee urges the Healthy Start Program to 
work with States, health care providers, and nonprofit patient 
organizations to design and support an initiative that will 
strengthen remote blood pressure monitoring programs among 
high-risk vulnerable populations and communities.
    Maternal Mortality.--The Committee recognizes the rising 
maternal mortality rate in the U.S. as a pressing public health 
issue. Analysis of maternal mortality review committee data 
indicates that over 60 percent of pregnancy-related deaths are 
preventable. The Committee continues to provide no less than 
$15,000,000, the same as the fiscal year 2021 enacted level and 
the fiscal year 2022 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. 
Clinical staff will provide direct access to well-woman care 
and maternity care services to reduce barriers in access to 
maternity care and help address maternal health disparities 
among high-risk and underserved women, including those in rural 
areas and maternal and infant care deserts. Clinical staff will 
also support health educators by conducting training on 
maternal early warning signs.

Universal Newborn Hearing Screening

    The Committee includes $19,518,000 for the Universal 
Newborn Hearing Screening program, an increase of $1,700,000 
above the fiscal year 2021 enacted level and the fiscal year 
2022 budget request. This program awards grants to 53 States 
and territories to support Statewide systems of newborn hearing 
screening and early intervention programs.

Emergency Medical Services for Children

    The Committee includes $28,134,000 for Emergency Medical 
Services for Children, an increase of $5,800,000 above the 
fiscal year 2021 enacted level and the same as the fiscal year 
2022 budget request. 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 $10,000,000 for the Screening and 
Treatment of Maternal Depression and Related Behavioral 
Disorders Program (MDRBD), an increase of $5,000,000 above the 
fiscal year 2021 enacted level and the same as the fiscal year 
2022 budget request. Maternal mental health (MMH) conditions 
are the most common pregnancy and postpartum complication; 
however, 75 percent of mothers go untreated. 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. 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. Grants shall 
include culturally competent 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 $25,000,000 for Pediatric Mental 
Health Access, an increase of $15,000,000 above the fiscal year 
2021 enacted level and the fiscal year 2022 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.

Maternal, Infant, and Early Childhood Home Visiting Program

    The Committee recognizes that good oral health is an 
important component for improving the health and well-being of 
children and families. The Committee encourages HRSA to explore 
opportunities to facilitate linkages between the agency's Home 
Visiting Program and Community Dental Health Coordinators, 
where available. The Committee also encourages HRSA to work 
with oral health initiatives such as Community Dental Health 
Coordinators that have already been initiated by dental 
organizations to provide dental education, community-based 
prevention, care coordination, and patient navigation to 
children and vulnerable families.

                      RYAN WHITE HIV/AIDS PROGRAM

 
 
 
Appropriation, fiscal year 2021.......................    $2,423,781,000
Budget request, fiscal year 2022......................     2,554,781,000
Committee Recommendation..............................     2,654,781,000
    Change from enacted level.........................      +231,000,000
    Change from budget request........................      +100,000,000
 

    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:

------------------------------------------------------------------------
                                                            FY 2022
                   Budget Activity                         Committee
------------------------------------------------------------------------
Emergency Assistance.................................       $700,876,000
Comprehensive Care Programs..........................      1,387,005,000
    AIDS Drug Assistance Program.....................        900,313,000
Early Intervention Program...........................        207,079,000
Children, Youth, Women, and Families.................         80,088,000
AIDS Dental Services.................................         15,122,000
Education and Training Centers.......................         44,611,000
Special Projects of National Significance............         30,000,000
Ending the HIV Epidemic Initiative...................        190,000,000
------------------------------------------------------------------------

    Ending the HIV Epidemic (EHE) Initiative.--The Committee 
includes $190,000,000 within the Ryan White HIV/AIDS Program 
for the EHE Initiative, an increase of $85,000,000 above the 
fiscal year 2021 enacted level and the same as the fiscal year 
2022 budget request. 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.
    Ryan White Part A Formula Disparities.--The Committee 
directs HRSA to take action to revise and improve the funding 
formula disparities under Part A of the Ryan White HIV/AIDS 
Program. Funding allocations utilized under the Ryan White HIV/
AIDS Treatment Extension Act of 2009 are largely based on a 
formula which considers the place of residence of persons at 
the time of initial diagnosis when making formula-based grants. 
Under current law, if a person diagnosed with HIV in one area 
of the country moves to another part of the country, the 
funding for the case is not transferred to the new location. 
Therefore, the Committee directs HRSA to develop methods for 
calculating RWHAP formula funds to reflect the number of 
persons living with HIV in eligible jurisdictions, as well as 
other factors that reflect variability in funds and other 
resources. Additionally, HRSA should review their methods for 
awarding supplemental funds to effectively and accurately 
address the need for RWHAP Part A funds among eligible 
jurisdictions and report their findings back to the Committee 
within 180 days of enactment of this Act.

                          HEALTH CARE SYSTEMS

 
 
 
Appropriation, fiscal year 2021.......................      $129,093,000
Budget request, fiscal year 2022......................       136,093,000
Committee Recommendation..............................       147,093,000
    Change from enacted level.........................       +18,000,000
    Change from budget request........................       +11,000,000
 

    The Health Care 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; maintaining a national system 
for the recruitment of bone marrow donors; operating the 340B 
drug discount program; and operating a national toll-free 
poison control hotline.

Organ Transplantation

    The Committee includes $34,049,000 for the Organ 
Transplantation program, $5,000,000 above the fiscal year 2021 
enacted level and the fiscal year 2022 budget request.
    Maximizing Deceased Donor Organ Recovery, Acceptance, and 
Utilization.--The Committee supports swift implementation of 
the CMS final rule for Organ Procurement Organizations (OPOs) 
Conditions for Coverage (CMS-3380-F), including efforts to 
decertify underperforming OPOs. OPO failures are 
disproportionately borne by patients of color, which means OPO 
reform is an urgent health equity issue. The Committee believes 
swift and effective implementation of the Final Rule is a first 
step toward ensuring OPOs perform their public duties to secure 
more organs in an inclusive and equitable manner. The Committee 
supports regulatory and enforcement efforts to minimize 
excessive and frivolous expenses reimbursed by Medicare, 
including the CMS proposed rule on Medicare reimbursement for 
organ acquisition costs (CMS-1752-P). The Committee also 
encourages HHS to make all efforts to promote competition for 
the Organ Procurement and Transplantation Network (OPTN) 
contract, and to use the announced movement of the Division of 
Transplantation to the Office of the Assistant Secretary for 
Health to facilitate coordinated organ donation reforms.
    Reimbursement of Travel and Subsistence Expenses Toward 
Living Organ Donation Program.--The Committee includes 
$18,800,000, an increase of $12,800,000 above the fiscal year 
2021 enacted level and $5,000,000 above the fiscal year 2022 
budget request, for the Living Organ Donation Program. The 
Committee supports the expansion of this program to reimburse a 
comprehensive range of living donor expenses for the greatest 
possible number of donors, including lost wages, childcare, 
eldercare, similar expenses for donor caretakers, and removing 
other disincentives to donation. The Committee supports 
significant expansion of income eligibility for the program to 
allow as many donors as possible to qualify and to ensure that 
financial reimbursement and monetary exchange take place 
outside of the organ donor-organ recipient relationship to the 
greatest extent possible.

National Cord Blood Inventory (NCBI)

    The Committee includes $20,266,000 for the NCBI, an 
increase of $2,000,000 above the fiscal year 2021 level and the 
fiscal year 2022 budget request. The NCBI program supports cord 
blood banks to build an inventory of the highest quality cord 
blood units for transplantation. The National Cord Blood 
Inventory program builds a genetically and ethnically diverse 
inventory of high-quality umbilical cord blood for 
transplantation. The Committee applauds HRSA for the growth of 
the number of units collected and maintained under the NCBI.

C.W. Bill Young Cell Transplantation

    The Committee includes $33,009,000 for the C.W. Bill Young 
Cell Transplantation program, an increase of $2,000,000 above 
the fiscal year 2021 level and the fiscal year 2022 budget 
request. This program supports coordinating the procurement of 
bone marrow and 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 has provided funding 
above the budget request 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 donor. Eliminating these barriers would 
allow therapies for patients to be delivered on time and to 
provide equal and successful outcomes for all.

Office of Pharmacy Affairs (OPA)

    The Committee includes $17,238,000 for OPA, $7,000,000 
above the fiscal year 2021 enacted level and the same as the 
fiscal year 2022 budget request. 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. 
Funding will support implementation of 340B Program statutory 
obligations, oversight of participating manufacturers and 
covered entities, operational improvements, and increased 
efficiencies using information technology.
    340B Drug Discount Program.--The Committee recognizes that 
the 340B program is a critical lifeline to safety net 
providers, including Community Health Centers. Health Centers 
are model stewards of the program and reinvest 340B savings to 
``stretch scarce Federal resources as far as possible, reaching 
more eligible patients and providing more comprehensive 
services'', as Congress intended. The Committee is pleased that 
HRSA sent letters to six pharmaceutical companies on May 17, 
2021, determining that ongoing actions by the companies have 
resulted in overcharges to 340B covered entities. Furthermore, 
the Committee notes that HRSA articulated that continued 
failure to provide the 340B price to covered entities utilizing 
contract pharmacies may result in Civil Monetary Penalties, as 
described in the final Civil Monetary Penalty rule. 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 
directs HRSA to provide a report no later than 120 days after 
enactment of this Act on actions taken to safeguard covered 
entities' lawful access to discounted drugs.
    The Committee is aware that in 2011, GAO issued a report 
outlining five recommendations for HRSA to improve performance 
and accountability within the 340B program. The Committee 
commends HRSA for implementing three of those recommendations 
and directs HRSA to report to the Committee within 120 days of 
enactment of this Act on plans to implement the remaining two 
recommendations, which focus on clarifying eligibility criteria 
for 340B patients and providers. The Committee also directs GAO 
to update the 2011 report on the performance of the 340B 
program.

Poison Control Centers

    The Committee includes $26,846,000 for Poison Control 
Centers, an increase of $2,000,000 above the fiscal year 2021 
enacted level and the fiscal year 2022 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.

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 2021 enacted levels and the amounts requested in 
the fiscal year 2022 budget request. The programs support 
inpatient, outpatient, long-term care, as well as training and 
research in Baton Rouge, Louisiana; a residential facility at 
Carville, Louisiana; 11 outpatient clinic sites in the 
continental U.S. and Puerto Rico; repair and maintenance of 
buildings at 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 2021.......................      $329,519,000
Budget request, fiscal year 2022......................       400,209,000
Committee Recommendation..............................       400,209,000
    Change from enacted level.........................       +70,690,000
    Change from budget request........................             - - -
 

    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; for the 
outreach and treatment of coal miners and others with 
occupation-related respiratory and pulmonary impairments; and 
for the expansion of telehealth services.

Rural Health Outreach Programs

    The Committee includes $90,000,000 for Rural Health 
Outreach Programs, an increase of $7,500,000 above the fiscal 
year 2021 enacted level and the same as the fiscal year 2022 
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 $10,400,000 for 
RMOMS, an increase of $5,400,000 above the fiscal year 2021 
enacted level and the same as the fiscal year 2022 budget 
request. 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 $11,576,000 for Rural Health 
Research and Policy Development, an increase of $500,000 above 
the fiscal year 2021 enacted level and the fiscal year 2022 
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 Hospital Flexibility Grants

    The Committee includes $79,009,000 for Rural Hospital 
Flexibility Grants, $23,400,000 above the fiscal year 2021 
enacted level and $21,500,000 above the fiscal year 2022 budget 
request. These programs support States to assist small and 
critical access rural hospitals to remain economically viable 
and to provide high-quality care.
    Small Rural Hospital Improvement Program (SHIP).--The 
Committee recommendation includes $23,242,000 for SHIP, an 
increase of $2,300,000 over the fiscal year 2021 enacted level 
and the fiscal year 2022 budget request.
    Rural Emergency Hospital Technical Assistance Program.--The 
Committee includes $10,000,000 within the total for Rural 
Hospital Flexibility Grants to establish the Rural Emergency 
Hospital Technical Assistance Program. This program will 
provide technical assistance from existing State Flexibility 
Programs and other stakeholders to assist facilities in the 
implementation of the new Rural Emergency Hospital model.
    Rural Provider Modernization Technical Assistance 
Program.--The Committee includes $5,000,000 within the total 
for Rural Hospital Flexibility Grants to establish the Rural 
Provider Modernization Technical Assistance Program. This 
program will provide technical assistance to hospitals and 
other health care providers to implement sustainable models of 
care that address social determinants of health and health 
equity.
    Rural Provider Modernization Grants.--The Committee 
includes $4,000,000 within the total for Rural Hospital 
Flexibility Grants to establish the Rural Provider 
Modernization Grants program. This program will make grants to 
support hospitals, public health departments, clinics, and 
community-based organizations to plan and implement emerging, 
sustainable models of care.

State Offices of Rural Health

    The Committee includes $13,000,000 for State Offices of 
Rural Health, $500,000 above the fiscal year 2021 enacted level 
and the fiscal year 2022 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 $690,000 above the fiscal year 2021 enacted 
level and the same as the fiscal year 2022 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 $900,000 above the fiscal year 2021 enacted level 
and the same as the fiscal year 2022 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.

Telehealth

    The Committee includes $39,000,000 for Telehealth, an 
increase of $5,000,000 above the fiscal year 2021 enacted level 
and $2,500,000 above the fiscal year 2022 budget request. 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.
    Telehealth Centers of Excellence.--The Committee includes 
$7,500,000 for Telehealth Centers of Excellence, an increase of 
$1,000,000 above the fiscal year 2021 enacted level. Grantees 
examine the efficacy of telehealth services in rural and urban 
areas and serve as a national clearinghouse for telehealth 
research and resources. The Centers of Excellence serve to 
promote the adoption of telehealth programs across the country 
by validating technology, establishing training protocols, and 
by providing a comprehensive template for States to integrate 
telehealth into their State health provider network. Additional 
funding for the Centers of Excellence will support the 
development of models of care and best practices for the 
expansion of telemental health.
    Urban Focused Telehealth Network Grant Program.--The 
Committee believes that a fundamental element to ensuring our 
health care system is prepared for pandemic events is the 
development of robust telehealth services and integrated 
systems that can provide a continuum of care across State and 
regional lines. This is especially true in the nation's urban 
areas, where a pandemic event has the potential to 
disproportionately impact and overwhelm the health care and 
delivery system. The Committee believes increased investments 
in urban telehealth services could have a tremendous impact on 
the health and well-being of the nation's most vulnerable 
citizens and medically underserved populations, especially 
during times of national public health emergencies. The 
Committee encourages HRSA to establish a pilot program to 
expand academic health system telehealth programs aimed at 
addressing the health inequities of urban populations.

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 2021 enacted level and the same as the fiscal year 2022 
budget request. This program funds physician residency training 
programs that support physician workforce expansion in rural 
areas.
    The COVID-19 pandemic has exacerbated the challenges in 
access to care faced by Americans in rural areas, particularly 
when they require specialty care. The Committee commends the 
Federal Office of Rural Health Policy for its efforts to expand 
the physician workforce in rural areas and supports 
continuation and expansion of the program to develop new rural 
residency programs, or Rural Training Tracks (RTTs). This 
Committee encourages HRSA to expand the current program to 
include RTTs in obstetrics and gynecology, as women in rural 
communities are more likely to begin prenatal care late and are 
more likely to experience maternal mortality and severe 
maternal morbidity. The Committee requests a report in the 
fiscal year 2023 Congressional Budget Justification on the 
progress made to date and efforts to expand RTTs in obstetrics 
and gynecology.

Rural Communities Opioids Response

    The Committee includes $140,000,000 to continue the Rural 
Communities Opioids Response program, an increase of 
$30,000,000 above the fiscal year 2021 enacted level and 
$25,000,000 below the fiscal year 2022 budget request. The 
Committee recognizes the devastating impact the opioid epidemic 
has had on rural communities and how the COVID-19 pandemic has 
worsened the opioid crisis. The Committee expands funding to 
support treatment for and prevention of substance use 
disorders, including opioid abuse, focusing on rural 
communities with the highest risk for substance use disorders. 
Within the funding provided, the Committee includes $10,000,000 
to continue the three Rural Centers of Excellence, as 
established by Public Law 115-245 and continued in Public Law 
116-94.

                            FAMILY PLANNING

 
 
 
Appropriation, fiscal year 2021.......................      $286,479,000
Budget request, fiscal year 2022......................       340,000,000
Committee Recommendation..............................       400,000,000
    Change from enacted level.........................      +113,521,000
    Change from budget request........................       +60,000,000
 

    The Committee includes $400,000,000 for the Family Planning 
program, $113,521,000 above the fiscal year 2021 enacted level 
and $60,000,000 above the fiscal year 2022 budget request. In 
addition, the American Rescue Plan (P.L. 117-2) included 
$50,000,000 in funding to support emergency needs of the Family 
Planning program due to the COVID-19 public health emergency.
    The Family Planning program administers Title X of the 
Public Health Service Act. This program plays a vital role not 
only in ensuring access to affordable contraceptive education, 
services, and supplies, but also in STD prevention, screening, 
and treatment; cervical and breast cancer screenings; first-
line infertility services; and other community and health care 
services.
    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).
    Telehealth Guidance.--The Committee recognizes that the 
COVID-19 pandemic has increased the importance of access to 
telehealth services across the health care system, including 
for Title X providers and patients. The Committee urges the OPA 
to release telehealth guidance and best practices for Title X 
projects that reiterate the importance of telehealth in 
providing quality family planning services.
    Ensuring Health Equity.--The Committee recognizes that the 
Title X program remains an important component of the health 
care safety net and is essential to addressing health 
inequities. Building a more inclusive Title X program requires 
focusing on grantmaking that will continue this work.
    Recommendations for Quality Family Planning Services.--The 
Committee directs the Secretary to begin the process of 
revising ``Providing Quality Family Planning Services,'' 
evidence-based recommendations from the CDC and OPA that were 
last updated in 2017. Revisions should incorporate new evidence 
and support holistic reproductive and sexual health needs. 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, reflecting the current estimated need for Title X services 
and cost required to provide such updating the 2016 study 
published in the American Journal of Public Health.

                           PROGRAM MANAGEMENT

 
 
 
Appropriation, fiscal year 2021.......................      $155,300,000
Budget request, fiscal year 2022......................       167,971,000
Committee Recommendation..............................       536,407,000
    Change from enacted level.........................      +381,107,000
    Change from budget request........................      +368,436,000
 

    Program management supports 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 in House Report (116-450) to 
have HRSA ensure that the Chief Dental Officer (CDO) is 
functioning at an executive level authority with resources and 
staff to oversee and lead all oral health programs and 
initiatives across HRSA, no such authority has been delegated. 
The Committee directs HRSA to restore the authority of HRSA CDO 
with executive level authority and resources to oversee and 
lead HRSA dental programs and initiatives as well as have a 
role within oral health 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 2023 Congressional Budget Justification on how the 
CDO is serving as the agency representative on oral health 
issues to international, national, State and/or local 
government agencies, universities, and oral health stakeholder 
organizations.
    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 (42 USC Section 256g) 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.
    Oral Health Literacy.--The Committee includes $500,000 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 urges 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. The Committee directs HRSA to develop 
and implement measures to increase the share of investments its 
programs in persistent poverty counties, high-poverty areas, 
and any other impoverished communities that HRSA determines to 
be appropriate areas to target. The Committee appreciates the 
report HRSA provided in response to the Committee's request in 
House Report 116-450 and directs the Department to provide an 
update to the Committee within 180 days of enactment of this 
Act on how HRSA is carrying out this directive.

Community Project Funding

    The Committee includes $367,415,000 for projects financing 
the construction and renovation (including equipment) of health 
care and other facilities and for one-time grants supporting 
other health-related activities. The budget request does not 
include funding for this purpose. The Committee includes 
$4,000,000 within this total for agency administrative 
expenses. The bill includes funding for the following projects 
in the following amounts:

------------------------------------------------------------------------
                       Project                               Amount
------------------------------------------------------------------------
26Health, Orlando, FL for purchase of equipment......           $250,000
Advocate Health and Hospitals Corporation dba                    150,000
 Advocate Christ Medical Center, Oak Lawn, IL for
 facilities and equipment............................
Advocate Illinois Masonic Medical Center, Chicago, IL            300,000
 for facilities and equipment........................
Affinia Healthcare, Saint Louis, MO for facilities             2,000,000
 and equipment.......................................
Aging in PACE Washington, Seattle, WA for facilities             700,000
 and equipment.......................................
AIDS Care Group, Chester, PA for facilities and                1,000,000
 equipment...........................................
Aleutians East Borough, Sand Point, AK for facilities          2,000,000
Alzheimer's Foundation of America, Amityville, NY for            100,000
 education and training services.....................
Andy's Angels, Jackson, MI for facilities............            300,000
Arc of the Ozarks, Springfield, MO for equipment and             800,000
 autism diagnostic and treatment services............
Asian American Drug Abuse Prevention, Los Angeles, CA            250,000
 for a health initiative.............................
Asian American Health Coalition of Greater Houston, d/         1,000,000
 b/a HOPE Clinic, Houston, TX for a health
 initiative, including facilities and equipment......
Asian American Health Coalition of Greater Houston, d/         2,000,000
 b/a HOPE Clinic, Houston, TX for facilities and
 equipment...........................................
Atlantic Health System, Morristown, NJ for facilities            750,000
 and equipment at Atlantic Health System--Newton
 Medical Center......................................
Aurora Community Mental Health Center, Aurora, CO for          1,000,000
 facilities and equipment............................
Autism New Jersey, Robbinsville, NJ for facilities               200,000
 and equipment and purchase of information technology
Avenidas, Palo Alto, CA for facilities and equipment             150,000
 for the Avenidas Rose Kleiner Center................
Ballad Health, Johnson City, TN for facilities.......            450,000
BANJ Health Center Inc., Compton, CA for a health                 50,000
 initiative..........................................
Baptist Health Hardin, Elizabethtown, KY for                     300,000
 facilities and equipment............................
Battle Ground Healthcare, Battle Ground, WA for                  320,000
 facilities and equipment............................
Bay Area Community Health, Fremont, CA for an                  1,000,000
 electronic health records initiative................
Baylor College of Medicine, Houston, TX for                    1,100,000
 facilities and equipment............................
Beach Cities Health District, Redondo Beach, CA for            1,000,000
 facilities and equipment for the Youth Wellness
 Center..............................................
Benton County, Kennewick, WA for facilities..........          2,000,000
Bethel School District #403, Spanaway, WA for                  2,000,000
 facilities and equipment for the School-Based Health
 Clinic at Graham-Kapowsin High School...............
Bexar County Hospital District d/b/a University                  300,000
 Health, San Antonio, TX for a health initiative.....
Blood Bank of Hawaii, Honolulu, HI for facilities and          2,000,000
 equipment...........................................
Bluefield State College, Bluefield, WV for facilities            300,000
Board of Trustees of the University of Illinois,               2,000,000
 Urbana, IL for facilities...........................
Bon Secours Mercy Health Inc., Cincinnati, OH for              1,000,000
 facilities and equipment............................
Bowling Green-Warren County Community Hospital                   250,000
 Corporation dba The Medical Center at Caverna, Horse
 Cave, KY for facilities and equipment...............
Brooklyn Communities Collaborative, Inc., Brooklyn,              875,000
 NY for a telehealth and electronic medical records
 initiative..........................................
Brooklyn Hospital Center, Brooklyn, NY for facilities          2,000,000
 and equipment.......................................
Broward Community and Family Health Centers, Inc.,               225,000
 Hollywood, FL for facilities and equipment..........
Brownsville Community Development Corporation dba BMS          1,000,000
 Family Health and Wellness Centers, Brooklyn, NY for
 facilities and equipment............................
Bucks County Department of Mental Health:                        500,000
 Developmental Programs, Doylestown, PA for
 facilities..........................................
Burre Dental Center, Arcata, CA for facilities and             1,000,000
 equipment...........................................
C.W. Williams Community Health Center, Charlotte, NC           1,150,000
 for facilities and equipment........................
California State University, Dominguez Hills, Carson,            700,000
 CA for facilities and equipment and an electronic
 medical records initiative..........................
Camino Community Development Corp., Charlotte, NC for            200,000
 facilities and equipment and an electronic health
 records initiative..................................
Cape Cod Healthcare, Hyannis, MA for an electronic             1,500,000
 health records initiative...........................
Capital Health System, Inc., Trenton, NJ for purchase            550,000
 of equipment........................................
Capstone Rural Health Center, Parrish, AL for                    725,000
 facilities..........................................
Care Plus Bergen Inc. DBA Bergen New Bridge Medical            2,000,000
 Center, Paramus, NJ for facilities and equipment....
CareSTL Health, Saint Louis, MO for facilities and             1,000,000
 equipment...........................................
Caridad Center, Inc., Boynton Beach, FL for                    1,150,000
 facilities and equipment............................
Cedars-Sinai, Los Angeles, CA for facilities and               1,000,000
 equipment...........................................
Center for African American Health, Denver, CO for             1,000,000
 facilities and equipment............................
Central Michigan University College of Medicine,                 370,000
 Mount Pleasant, MI for telepsychiatry services,
 equipment, and associated information technology....
Centre Volunteers in Medicine, State College, PA for           1,065,000
 facilities and equipment............................
Centro De Salud Familiar La Fe, Inc., El Paso, TX for            925,000
 facilities and equipment............................
Centro Las Americas, Inc., Worcester, MA for a                   975,000
 telehealth and electronic health records initiative,
 including the purchase of equipment.................
Chestnut Health Systems, Bloomington, IL for                     430,000
 facilities and equipment............................
Child Focus, Inc., Cincinnati, OH for facilities and           1,000,000
 equipment...........................................
Children's Health System of Texas, Dallas, TX for                850,000
 facilities and equipment............................
Children's Hospital Colorado, Anschutz Medical                   500,000
 Campus, Aurora, CO for a health training initiative.
Children's Hospital Los Angeles, Los Angeles, CA for             550,000
 equipment...........................................
Children's Hospital Los Angeles, Los Angeles, CA for           1,600,000
 purchase of equipment...............................
Children's Hospital of Wisconsin, Inc., Wauwatosa, WI            400,000
 for equipment.......................................
Children's National Hospital, Washington, DC for               2,000,000
 facilities and equipment............................
Chiricahua Community Health Centers, Inc., Douglas,              625,000
 AZ for facilities and equipment.....................
Christian Community Health Center, Chicago, IL for                20,000
 purchase of equipment...............................
Church Health Center of Memphis, Memphis, TN for                 350,000
 facilities and equipment............................
City of Auburn, WA for facilities and equipment for              500,000
 the Auburn Consolidated Resource Center.............
City of Baltimore, MD for facilities and equipment             2,325,000
 and a telehealth initiative.........................
City of Brooklyn Center, MN for a health initiative..            100,000
City of Hope Duarte Medical Center, Duarte, CA for               450,000
 purchase of equipment...............................
City of Hope National Medical Center, Duarte, CA for             700,000
 equipment...........................................
City of Hope National Medical Center, Duarte, CA for           1,200,000
 equipment...........................................
City of Houston Fire Department, Houston, TX for                 450,000
 facilities and equipment............................
City of Houston Health Department, Houston, TX for               900,000
 facilities and equipment............................
City of Long Branch, NJ for facilities and equipment           2,000,000
 for the City of Long Branch Health Department.......
City of Morgantown, WV for facilities and equipment..            100,000
City of Mount Sterling, KY for facilities and                  1,000,000
 equipment...........................................
City of Rochester Department of Recreation and Human             225,000
 Services, Rochester, NY for facilities and equipment
City of West Wendover, NV for facilities and                     320,000
 equipment...........................................
Clinica Amistad, Tucson, AZ for a telehealth                     185,000
 initiative and purchase of equipment................
Clinicas de Salud del Pueblo, El Centro, CA for                1,000,000
 facilities and equipment............................
Colorado Coalition for the Homeless, Denver, CO for            2,000,000
 facilities and equipment............................
Columbus Neighborhood Health Center, Inc., dba                   500,000
 PrimaryOne Health (P1H), Columbus, OH for facilities
 and equipment.......................................
Commonwealth Healthcare Corporation, Sapian, MP for            1,200,000
 facilities and equipment............................
CommuniCare Health Centers, Davis, CA for facilities             400,000
 and equipment.......................................
Community College District 502, Glen Elyn, IL for                500,000
 purchase of equipment...............................
Community Health Access Network, Newmarket, NH for an            700,000
 electronic medical records initiative...............
Community Health Centers of Pinellas, Inc.,                    2,000,000
 Clearwater, FL for facilities and equipment.........
Compass Health, Everett, WA for facilities and                 2,000,000
 equipment...........................................
ComWell, Red Bud, IL for rural mental health and                 250,000
 psychiatric care....................................
Contra Costa Regional Medical Center, Martinez, CA               900,000
 for a health training and electronic health records
 initiative..........................................
Cooper University Health Care, Camden, NJ for                    500,000
 facilities and equipment............................
Cornerstone Care, Inc., Greensboro, PA for facilities          1,500,000
 and equipment for a facility in Clairton, PA........
Cornerstone Services, Inc., Joliet, IL for facilites           1,050,000
 and equipment.......................................
County of Alameda, Oakland, CA for facilities and              1,250,000
 equipment for the West Oakland Health Council.......
County of Benton, Corvalis, OR for facilities and              1,000,000
 equipment for the Benton County Crisis Respite
 Center..............................................
County of Clear Creek, Georgetown, CO for facilities           1,000,000
 and equipment for the Clear Creek County
 Collaborative Care Center...........................
County of Contra Costa Health Services Department,             1,000,000
 Behavioral Health Division, Martinez, CA for
 facilities and equipment............................
County of Fairfax, Fairfax, VA for facilities and              2,000,000
 equipment for the Merrifield Crisis Response Center.
County of Fairfax, VA for a health information                   375,000
 technology initiative, including purchase of
 equipment...........................................
County of Fairfax, VA for a health IT initiative.....            800,000
County of Franklin, Columbus, OH for facilities and              500,000
 equipment for the Franklin County Mental Health and
 Addiction Crisis Center.............................
County of Henrico, Henrico, VA for facilities and              1,000,000
 equipment...........................................
County of Lane, Eugene, OR for facilities and                  1,500,000
 equipment for a rural community health clinic in
 Cottage Grove, OR...................................
County of Orange, Orlando, FL for a health workforce             300,000
 initiative..........................................
County of Orange, Santa Ana, CA for facilities.......          2,000,000
County of Prince George's Department of Health,                4,000,000
 Largo, MD, for a telehealth initiative, including
 purchase of equipment...............................
County of Prince William, Prince William, VA for a               800,000
 health initiative...................................
County of Santa Barbara, Santa Barbara, CA for                   900,000
 facilities and equipment for the Lompoc Health
 Clinic..............................................
County of Santa Clara, San Jose, CA for a health               1,000,000
 workforce initiative................................
County of Wayne, Honesdale, PA for facilities and              2,000,000
 equipment...........................................
Dallas County Hospital District d/b/a Parkland Health            275,000
 & Hospital System, Dallas, TX for facilities and
 equipment...........................................
Day Kimball Hospital, Putnam, CT for facilities and              550,000
 equipment...........................................
Delaware Division of Libraries, Dover, DE for a                  275,000
 telehealth initiative, including the purchase of
 equipment...........................................
Delaware-Morrow Mental Health & Recovery Services                750,000
 Board, Delaware, OH for facilities..................
Denver Health and Hospital Authority, Denver, CO for           1,200,000
 facilities and equipment............................
Dientes Community Dental Care, Santa Cruz, CA for              1,050,000
 facilities and equipment............................
Dimock Center, Inc. d/b/a The Dimock Center, Roxbury,          1,000,000
 MA for facilities and equipment.....................
Doylestown Health Foundation, Doylestown, PA for                 100,000
 equipment and associated information technology.....
East Los Angeles College, Monterey Park, CA for a                925,000
 health workforce initiative, including facilities
 and equipment.......................................
Easterseals Midwest, St. Louis, MO for equipment,                200,000
 information technology, and support services........
Easterseals of Southwest Florida, Sarasota, FL for             2,000,000
 facilities..........................................
Edward M. Kennedy Community Health Center, Inc.,               1,000,000
 Worcester, MA for an interpreter services program...
El Centro de Corazon, Houston, TX for facilities and             225,000
 equipment...........................................
El Paso County Hospital District/University Medical            1,200,000
 Center of El Paso, El Paso, TX for purchase of
 equipment...........................................
El Proyecto del Barrio, Inc., Winnetka, CA for                 1,000,000
 facilities and equipment............................
El Rio Santa Cruz Neighborhood Health Care, Inc.,              1,450,000
 Tucson, AZ for facilities and equipment.............
Equitas Health, Columbus, OH for purchase of                     150,000
 equipment...........................................
Erie County Health Department, Sandusky, OH for                2,000,000
 facilities and equipment............................
Erie Neighborhood House, Chicago, IL for facilities            2,000,000
 and equipment.......................................
Erlanger Health System, Chattanooga, TN for                    2,000,000
 facilities and equipment............................
EveryMind, Rockville, MD for telehealth..............            325,000
Excela Health, Greensburg, PA for equipment..........            125,000
Excela Health, Greensburg, PA for equipment..........            650,000
Families Flourish Northeast, Lebanon, NH for                     500,000
 facilities and equipment............................
Family Services, Inc., Poughkeepsie, NY for                    1,200,000
 facilities and equipment............................
Jewish Family and Children's Service of Palm Beach               325,000
 County, West Palm Beach, FL for an electronic health
 records initiative..................................
Flanner House of Indianapolis, Inc., Indianapolis, IN            250,000
 for facilities and equipment........................
Floating Hospital, Inc., Long Island City, NY for                925,000
 facilities and equipment............................
Florida International University, Miami, FL for                2,000,000
 facilities and equipment............................
Flushing Hospital and Medical Center, Flushing, NY               750,000
 for facilities and equipment........................
Free Clinic of Meridian Inc., Meridian, MS for                   315,000
 facilities and equipment............................
Fresno City College, Fresno, CA for a health                     475,000
 workforce initiative................................
Friend Family Health Center, Chicago, IL for                     250,000
 facilities and equipment............................
Gardner Family Health Network, Inc., San Jose, CA for            900,000
 facilities and equipment............................
Gateway Community Health Center, Inc., Laredo, TX for          2,000,000
 facilities and equipment............................
Gavin Foundation, Inc., South Boston, MA for                   1,000,000
 facilities and equipment............................
George Mason University, Fairfax, VA for a health              1,150,000
 workforce initiative................................
Glenbrook High School District 225, Glenview, IL for             250,000
 facilities and equipment............................
God's Love We Deliver, Inc., New York, NY for a                  775,000
 health initiative...................................
GoochlandCares Inc., Goochland, VA for facilities and             15,000
 equipment...........................................
Grandview Foundation, Dayton, OH for facilities......          1,250,000
Great Lakes Recovery Centers, Ishpeming, MI for                  680,000
 facilities and equipment............................
Greater Bergen Community Action, Inc., Garfield, NJ            1,500,000
 for facilities and equipment........................
Greater Lawrence Family Health Center, Methuen, MA             2,000,000
 for facilities and equipment........................
Greater New Bedford Community Health Center, New               2,000,000
 Bedford, MA for facilities and equipment............
Green County Human Services, Aging & Disability                  200,000
 Resource Center, Monroe, WI for a rural health
 initiative, including the purchase of equipment.....
H. Lee Moffitt Cancer Center and Research Institute,           2,000,000
 Inc., Tampa, FL for purchase of equipment...........
Habilitative Systems, Inc., Chicago, IL for                      500,000
 facilities and equipment and for an electronic
 health records initiative...........................
Hackensack Meridian Health, Edison, NJ for purchase              775,000
 of equipment........................................
Hackensack Meridian School of Medicine, Nutley, NJ               775,000
 for facilities and equipment........................
Hana Health, Hana, HI for facilities and equipment...          1,000,000
Harbor Community Health Centers, San Pedro, CA for             1,000,000
 facilities and equipment............................
Harbor Hospital, Inc., Baltimore, MD for a telehealth            875,000
 initiative, including the purchase of equipment.....
Harry E. Davis Partnership for Children's Oral                   650,000
 Health, Yarmouth, ME for a telehealth initiative....
Health Care Coalition of Rural Missouri, Lexington,            2,000,000
 MO for facilities and equipment.....................
HealthPoint, Renton, WA for facilities and equipment,            350,000
 including telehealth equipment......................
Hennepin Healthcare System, Inc., Minneapolis, MN for          2,000,000
 facilities and equipment............................
Henry Ford Wyandotte Hospital, Detroit, MI for                   900,000
 facilities and equipment, including telehealth
 equipment...........................................
Henry Ford West Bloomfield Hospital, West Bloomfield,          1,150,000
 MI for purchase of equipment........................
Henry Mayo Newhall Hospital, Valencia, CA for                    610,000
 equipment...........................................
Hepatitis B Foundation, Doylestown, PA for public                475,000
 health programming..................................
Hill Country Mental Health and Developmental                   2,000,000
 Disabilities Centers, Kerrville, TX for facilities
 and equipment.......................................
Hill Hospital, York, AL for facilities and equipment.            575,000
Hurley Medical Center, Flint, MI for purchase of               1,450,000
 equipment...........................................
Illinois College of Optometry, Chicago, IL for                   300,000
 facilities and equipment............................
Independence Health & Therapy, Woodstock, IL for an               60,000
 electronic medical records initiative...............
Ironbound Community Health Center, Newark, NJ for                550,000
 purchase of equipment...............................
It Takes Philly, Inc. d/b/a/ Black Doctors COVID-19            2,000,000
 Consortium, Jenkintown, PA for facilities and
 equipment...........................................
Jackson County School District, Marianna, FL for                  85,000
 facilities..........................................
Jamaica Hospital Medical Center, Richmond Hill, NY             1,500,000
 for facilities and equipment........................
Jessie Trice Community Health Systems Inc., Miami, FL            400,000
 for facilities and equipment........................
Joseph P. Addabbo Family Health Center, Inc.,                  1,500,000
 Arverne, NY for facilities and equipment............
JWCH Institute, Inc., Bell Gardens, CA for purchase              300,000
 of equipment........................................
Kids First Health Care, Commerce City, CO for                    800,000
 facilities and equipment............................
Kokua Kalihi Valley Comprehensive Family Services,             1,050,000
 Honolulu, HI for facilities and equipment...........
La Clinica Tepeyac, Inc., Denver, CO for facilities            2,000,000
 and equipment.......................................
Lake County Health Department & Community Health               1,000,000
 Center, Waukegan, IL for facilities and equipment...
Lakewood Community Services Corporation, Lakewood, NJ            400,000
 for facilities......................................
Lebanon Valley College, Annville, PA for facilities..          1,000,000
Legacy Community Health, Houston, TX for a health                 20,000
 initiative..........................................
LGBT Life Center, Norfolk, VA for facilities and               1,800,000
 equipment...........................................
Linda Crnic Institute for Down Syndrome, Aurora, CO              950,000
 for purchase of equipment...........................
Lions Eye Institute for Transplant and Research                2,000,000
 Foundation Inc., Tampa, FL for facilities and
 equipment...........................................
Loma Linda University Health, Loma Linda, CA for               1,000,000
 facilities and equipment............................
Loma Linda University Medical Center--Murrieta,                  600,000
 Murrieta, CA for equipment..........................
Long Island FQHC, Inc., Westbury, NY for facilities            2,000,000
 and equipment.......................................
Long Island FQHC, Inc., Westbury, NY for facilities            1,000,000
 and equipment.......................................
Loretto Health and Rehabilitation Center, Syracuse,              260,000
 NY for the purchase of equipment and software for a
 medical records system..............................
Los Angeles LGBT Center, Los Angeles, CA for                     775,000
 facilities and equipment............................
Louisiana State University Health New Orleans, New             2,000,000
 Orleans, LA for the purchase of equipment...........
Main St. Missions, Doylestown, PA for facilities.....            200,000
Manet Community Health Center, Quincy, MA for                    500,000
 facilities and equipment............................
Martin Luther King, Jr. Family Clinic, Dallas, TX for            100,000
 a health workforce training initiative, including
 equipment and technology............................
Mary Bird Perkins Cancer Center, Baton Rouge, LA for             775,000
 equipment...........................................
Maverick County Hospital District, Eagle Pass, TX for            500,000
 information technology and telehealth services......
McLaren Northern Michigan, Petoskey, MI for                      500,000
 facilities and equipment............................
McLaren Oakland Hospital, Pontiac, MI for purchase of            400,000
 equipment...........................................
Medstar Southern Maryland Hospital Center, Clinton,              925,000
 MD for facilities and equipment.....................
MedStar Washington Hospital Center, Washington, DC               800,000
 for facilities and equipment and an electronic
 medical records initiative..........................
Meharry Medical College, Nashville, TN for facilities          1,000,000
 and equipment.......................................
Memorial Hospital at Gulfport Foundation, Inc.,                2,000,000
 Gulfport, MS for facilities and equipment...........
MemorialCare Health System, Long Beach, CA for                   575,000
 facilities and equipment and an electronic health
 records initiative..................................
Mental Health Care, Inc., Tampa, FL for facilities             2,000,000
 and equipment for the Mariposa Women's
 Neuropsychiatric Hospital...........................
Methodist Health Services Corporation, Peoria, IL for          2,000,000
 facilities..........................................
Metropolitan Family Health Network, Inc., Jersey                 800,000
 City, NJ for facilities and equipment...............
Miami SCI Wellness Inc., Miami, FL for equipment.....            440,000
Millikin University, Decatur, IL for facilities and            2,000,000
 equipment...........................................
Minnesota State College Southeast, Red Wing, MN for              825,000
 facilities and equipment............................
Mississippi State University, Mississippi State, MS            1,000,000
 for facilities and equipment........................
Missouri Valley College, Marshall, MO for facilities           2,000,000
 and equipment.......................................
Monongahela Valley Hospital Foundation, Monongahela,             455,000
 PA for facilities...................................
Montefiore Medical Center, Bronx, NY for facilities            3,350,000
 and equipment, including telehealth equipment.......
Montefiore St. Luke's Cornwall, Cornwall, NY for               2,000,000
 facilities and equipment............................
Mount St. Mary's Hospital of Niagara Falls, Lewiston,          2,000,000
 NY for facilities and equipment.....................
Muslim Community Center, Inc., Silver Spring, MD for             250,000
 facilities and equipment............................
National Alliance on Mental Illness, Ohio Chapter,             2,000,000
 Toledo, OH, for facilities and equipment............
Nemours Foundation, Jacksonville, FL for equipment               105,000
 and information technology..........................
Nevada State College, Henderson, NV for facilities                35,000
 and equipment.......................................
New Alternatives for Children, Inc., New York, NY for            500,000
 purchase of equipment, including telehealth
 equipment...........................................
New York City Health + Hospitals/Elmhurst, Queens, NY            800,000
 for facilities and equipment........................
New York City Health + Hospitals/Elmhurst, Queens, NY          3,000,000
 for facilities and equipment........................
New York City Health + Hospitals/Queens Hospital,              1,000,000
 Jamaica, NY for facilities and equipment............
New York Community Hospital of Brooklyn, Inc.,                   975,000
 Brooklyn, NY for facilities and equipment...........
Newark Community Health Centers, Inc., Newark, NJ for            760,000
 facilities and equipment............................
Newark-Wayne Community Hospital, Newark, NY for                  180,000
 equipment...........................................
Night Ministry, Chicago, IL for facilities and                   275,000
 equipment...........................................
Norman Regional Hospital Authority, Norman, OK for               650,000
 facilities and equipment............................
North Country Community College, Saranac Lake, NY for          1,000,000
 facilities and equipment............................
North Oakland County Fire Authority, Holly, MI for               500,000
 purchase of equipment...............................
North Shore Community College, Danvers, MA for                   900,000
 facilities and equipment............................
North Shore Community Health, Salem, MA for                    1,000,000
 facilities and equipment............................
Northern Dutchess Hospital/Nuvance Health, Rhinebeck,            300,000
 NY for facilities and equipment.....................
Northern Nye County Hospital District, Tonopah, NV             2,000,000
 for facilities and equipment........................
Northwell Health, New Hyde Park, NY for facilities             2,000,000
 and equipment.......................................
Nursing Care Quality Assurance Commission, Tumwater,           1,000,000
 WA for a health workforce training program..........
NYC Health + Hospitals/Coney Island, Brooklyn, NY for          2,000,000
 equipment...........................................
Oakland LGBTQ Community Center, Oakland, CA for                  350,000
 facilities and equipment............................
Oklahoma Medical Research Foundation, Oklahoma City,             835,000
 OK for facilities and equipment.....................
Oklahoma State University Center for Health Sciences,          2,000,000
 Tulsa, OK for facilities............................
Olivet Nazarene University, Borubonnais, IL for                   90,000
 facilities and equipment............................
One Brooklyn Health System, Inc., Brooklyn, NY for an            425,000
 electronic health records initiative................
One Brooklyn Health System, Inc., Brooklyn, NY for             1,000,000
 purchase of equipment...............................
Oregon Health & Science University Northwest Native              800,000
 American Center of Excellence, Portland, OR for a
 health workforce initiative.........................
OSF St. Joseph Medical Center, Bloomington, IL for               700,000
 facilities and equipment............................
Outer Cape Health Services, Harwich Port, MA for                 250,000
 facilities and equipment............................
Pace Center For Girls Inc., Jacksonville, FL for a               500,000
 telehealth initiative, including the purchase of
 equipment...........................................
Pace Center for Girls, Inc., Jacksonville, FL for              2,000,000
 facilities..........................................
Palm Beach State College, Lake Worth, FL for                     700,000
 facilities and equipment............................
Palo Verde Hospital District, Blythe, CA, for                    350,000
 purchase of equipment...............................
Pascua Yaqui Tribe, Tucson, AZ for facilities and                900,000
 equipment...........................................
Patrick County Economic Development Authority,                   600,000
 Stuart, VA for equipment............................
Penn State Health St. Joseph Medical Center, Reading,            500,000
 PA, for a rural health initiative, including the
 purchase of equipment...............................
Pennsylvania Organization for Women in Recovery,               1,500,000
 Pittsburgh, PA for facilities and equipment.........
People Coordinated Services of Southern California,              600,000
 Inc., Los Angeles, CA for facilities and equipment..
Petaluma Health Center, Inc., Petaluma, CA for                 1,000,000
 facilities and equipment............................
Petaluma Health Center, Petaluma, CA for facilities            1,600,000
 and equipment.......................................
Phoebe Putney Health System, Inc., Albany, GA for              1,000,000
 facilities and equipment............................
Piatt County Nursing Home, Monticello, IL for                    215,000
 facilities and equipment............................
Pierce Center for Arts & Technology, Tacoma, WA for              450,000
 facilities and equipment............................
Pikeville Medical Center, Inc., Pikeville, KY for                675,000
 facilities and equipment............................
Planned Parenthood Mar Monte, San Jose, CA for                 1,000,000
 facilities and equipment............................
Planned Parenthood Mar Monte, San Jose, CA for                 1,000,000
 facilities and equipment............................
Pomona Community Health Center dba ParkTree Community            775,000
 Health Center, Pomona, CA for facilities and
 equipment...........................................
Potomac Valley Hospital, Keyser, WV for facilities               750,000
 and equipment.......................................
Preston Memorial Hospital, Kingwood, WV for                      580,000
 facilities and equipment............................
Primary Health Care, Inc., Des Moines, IA for                    100,000
 facilities and equipment............................
Primary Health Care, Inc., Des Moines, IA for                    200,000
 facilities and equipment............................
Providence Milwaukie Hospital , Milwaukie, OR for                800,000
 facilities and equipment............................
Puerto Rican Organization to Motivate, Enlighten, and            825,000
 Serve Addicts, Inc., Bronx, NY for facilities and
 equipment...........................................
Queens College, The City of New York, Flushing, NY             1,850,000
 for facilities and equipment........................
Refuah Health Center, Inc., Spring Valley, NY for              2,000,000
 facilities and equipment............................
Regents of the University of California, Los Angeles,            600,000
 CA for the purchase of equipment, including
 telehealth equipment................................
Regents of the University of Washington, Seattle, WA             550,000
 for purchase of equipment...........................
Regional One Health, Memphis, TN for purchase of               1,000,000
 equipment...........................................
Research Institute at Nationwide Children's Hospital,            500,000
 Columbus, OH for purchase of equipment..............
Richmond Medical Center of Staten Island, Staten               1,815,000
 Island, NY for facilities and equipment.............
RIDOH Division of State Laboratories and Medical                 900,000
 Examiners, Providence, RI for purchase of equipment.
Rochester General Hospital, Rochester, NY for a                1,000,000
 health workforce initiative.........................
Rockland County Pride Center, Nyack, NY, for                   1,500,000
 facilities and equipment............................
Roosevelt Special Hospital, Portales, NM for                     600,000
 facilities and equipment............................
Rosalynn Carter Institute for Caregivers, Americus,            1,100,000
 GA for purchase of equipment........................
Roswell Park Comprehensive Cancer Center, Buffalo, NY          1,500,000
 for purchase of equipment...........................
Rowan University/Rutgers-Camden Board of Governors,              500,000
 Camden, NJ for facilities and equipment.............
SAC Health System, San Bernadino, CA for purchase of             375,000
 equipment...........................................
Saint Francis University School of Health Sciences               500,000
 and Education, Loretto, PA for facilities...........
Saint Joseph's Health, Paterson, NJ for facilities             1,000,000
 and equipment.......................................
Saint Louis University, Saint Louis, MO for                      500,000
 facilities and equipment............................
San Antonio College, San Antonio, TX for facilities            1,050,000
 and equipment.......................................
San Francisco Community Clinic Consortium, San                 1,000,000
 Francisco, CA for facilities and equipment,
 including an electronic medical records initiative..
San Juan College, Farmington, NM for facilities and            1,100,000
 equipment...........................................
San Juan County, Monticello, UT for cancer screening.            520,000
Savio House, Denver, CO for facilities and equipment.            300,000
Schenectady Family Health Services, Inc., D/B/A                  750,000
 Hometown Health Centers, Schenectady, NY for
 facilities and equipment............................
Sharon Hospital, Sharon, CT for facilities and                   400,000
 equipment, including telehealth equipment...........
Shasta Community Health Center, Redding, CA for                  750,000
 facilities, equipment, and information technology...
Sixteenth Street Community Health Center, Milwaukee,           1,250,000
 WI for facilities and equipment.....................
Snohomish Health District, Everett, WA for a                     250,000
 telehealth and electronic health records initiative,
 including purchase of equipment.....................
Spectrum Health Lakeland, St. Joseph, MI for                     505,000
 facilities and equipment, including information
 technology..........................................
Spokane County, Spokane, WA for equipment............          1,125,000
St. Barnabas Hospital, Bronx, NY for facilities and            1,350,000
 equipment...........................................
St. John's Episcopal Hospital, Far Rockaway, NY for            2,000,000
 facilities and equipment for the Behavioral Health
 Equity Renovation Project...........................
St. John's Episcopal Hospital, Far Rockaway, NY for            2,000,000
 facilities and equipment for the Women and Newborns
 Health Equity Renovation Project....................
St. John's University, Jamaica, NY for facilities and          1,250,000
 equipment...........................................
St. Louis Center for Exceptional Children and Adults,            500,000
 Chelsea, MI for facilities and equipment............
St. Luke's Hospital, New Bedford, MA for facilities              975,000
 and equipment.......................................
St. Luke's Quakertown Hospital, Quakertown, PA for               400,000
 facilities..........................................
St. Mary's University of San Antonio, San Antonio, TX            875,000
 for facilities and equipment........................
St. Tammany Parish Hospital Service District No. 1, d/         1,000,000
 b/a St. Tammany Health System, Covington, LA for
 equipment...........................................
Stanislaus County Behavioral Health and Recovery               2,000,000
 Services, Modesto, CA for facilities and equipment..
Staten Island University Hospital, Staten Island, NY           2,000,000
 for facilities and equipment........................
Stepping Stones Inc., Joliet, IL for facilities and            2,000,000
 equipment...........................................
Stillman College, Tuscaloosa, AL for facilities and              800,000
 equipment...........................................
STOP Inc., Virginia Beach, VA for a telehealth                   250,000
 initiative, including purchase of equipment.........
Summa Health, Akron, OH for facilities and equipment.          1,000,000
SUNY Downstate Health Sciences University, Brooklyn,           1,925,000
 NY for facilities and equipment.....................
Terros, Inc.--DBA Terros Health, Phoenix, AZ for                 600,000
 facilities and equipment for Terros Health--Stapley
 Health Center.......................................
Terros, Inc. DBA Terros Health, Phoenix, AZ for                  900,000
 facilities and equipment............................
Texas Southern University, Houston, TX for facilities          2,000,000
 and equipment.......................................
Thresholds, Chicago, IL for facilities and equipment.          1,000,000
Tidalhealth Nanticoke, Seaford, DE for facilities and            350,000
 equipment...........................................
Tillamook Bay Community College Foundation,                      425,000
 Tillamook, OR for a health workforce training
 initiative, including purchase of equipment.........
Touro University California, Vallejo, CA for                   1,000,000
 facilities and equipment............................
Town of East Millinocket, ME for purchase of                     300,000
 equipment for the East Millinocket Rural Ambulance
 Service.............................................
Town of Randolph, MA for facilities and equipment at           1,000,000
 Randolph High School................................
Truman Medical Center Inc., Kansas City, MO for                2,000,000
 facilities and equipment............................
Tulane University, New Orleans, LA for facilities and          1,000,000
 equipment...........................................
United Way of Tarrant County, TX for a health                     25,000
 initiative..........................................
United Way of the Crossroads, Victoria, TX for a                  40,000
 rural health initiative.............................
Unity Care Northwest, Bellingham, WA for facilities            2,000,000
 and equipment.......................................
Universal Community Health Center, Los Angeles, CA               300,000
 for facilities and equipment........................
University at Albany, Albany, NY for purchase of               1,000,000
 equipment...........................................
University Health System, Inc., Knoxville, TN for              2,000,000
 facilities..........................................
University Health System, Inc., Knoxville, TN for              2,000,000
 facilities and equipment............................
University Hospitals Cleveland Medical Center, Shaker          1,000,000
 Heights, OH for facilities and equipment for the
 University Hospitals Portage Medical Center.........
University of Alaska, Fairbanks, AK for facilities...          2,000,000
University of California San Diego, La Jolla, CA for             950,000
 a telehealth initiative, including purchase of
 equipment...........................................
University of California (San Francisco) Fresno                  475,000
 Regional Campus, Fresno, CA for facilities and
 equipment...........................................
University of California, Davis Health, Sacramento,            1,700,000
 CA for an electronic health record and telehealth
 initiative..........................................
University of California-Davis, Davis, CA for a                1,000,000
 health workforce initiative.........................
University of Cincinnati Medical Center, Cincinnati,           4,000,000
 OH for facilities...................................
University of Colorado Anschutz Medical Campus,                1,000,000
 Aurora, CO for a health workforce initiative........
University of Florida Health Jacksonville,                       705,000
 Jacksonville, FL for facilities and equipment.......
University of Hawaii System, Honolulu, HI for a rural          1,000,000
 health initiative...................................
University of Illinois--Chicago, College of Dentistry            500,000
 and Oral Health, Chicago, IL for facilities and
 equipment...........................................
University of Kansas Medical Center, Kansas City, KS           1,000,000
 for purchase of equipment for the Kansas University
 Cancer Center.......................................
University of Massachusetts Boston, Boston, MA for             1,350,000
 facilities and equipment............................
University of New Mexico, Albuquerque, NM for                  1,500,000
 facilities and equipment............................
University of Pittsburgh Medical Center Northwest,               100,000
 Seneca, PA for facilities and equipment.............
University of Saint Francis--Crown Point Campus, Fort            225,000
 Wayne, IN for facilities and equipment..............
University of Texas at Dallas, TX for facilities and             850,000
 equipment and a telehealth initiative...............
University of Texas Southwestern Medical Center,               1,000,000
 Dallas, TX for facilities and equipment.............
University of Texas Southwestern Medical Center,                 800,000
 Dallas, TX for facilities and equipment.............
University of Toledo Medical Center, Toledo, OH for              500,000
 facilities and equipment............................
Urban Health Plan, Bronx, NY for facilities and                  500,000
 equipment...........................................
Urban Health Plan, Inc., Corona, NY for facilities               100,000
 and equipment, including telehealth equipment.......
Veterans Transition House, New Bedford, MA for a                 375,000
 telehealth and electronic medical records
 initiative, including the purchase of equipment.....
Via Care Community Health Center, Los Angeles, CA for            150,000
 facilities and equipment............................
Village of Dwight, Dwight, IL for equipment..........            250,000
Vinland National Center, Loretto, MN for facilities..            500,000
Virginia Garcia Memorial Health Center, Hillsboro, OR          2,000,000
 for facilities and equipment........................
Visiting Nurse Association of Central Jersey Freehold            700,000
 Family Health Center, Freehold, NJ for facilities
 and equipment.......................................
Visiting Nurse Association of Central Jersey Red Bank            400,000
 Primary Care Center, Red Bank, NJ for facilities and
 equipment...........................................
Washington Hospital Foundation, Washington, PA for             1,210,000
 facilities and equipment............................
WEAVE INC., Sacramento, CA for facilities............            275,000
Wenatchee Valley College, Omak, WA for facilities....          2,000,000
West Central Alabama Area Health Education Center,               300,000
 Demopolis, AL for a community health worker
 initiative and purchase of equipment................
Westchester Public/Private Membership Fund for Aging             375,000
 Services, Mount Vernon, NY for telehealth, including
 telehealth equipment................................
Wheeling Health Right, Wheeling, WV for facilities               350,000
 and equipment.......................................
White Memorial Medical Center, Los Angeles, CA for             1,200,000
 facilities and equipment............................
Will-Grundy Medical Clinic Inc., Joliet, IL for                  300,000
 facilities and equipment............................
William F. Ryan Community Health Center, Inc., New             2,000,000
 York, NY for facilities and equipment...............
WINGS Program Inc., Rolling Meadows, IL for                      250,000
 facilities and equipment............................
Winters Health Foundation, Winters, CA for facilities            500,000
 and equipment.......................................
Wood River Health Services, Hope Valley, RI for                1,000,000
 facilities and equipment............................
Young Men's Christian Association of Greater                   2,000,000
 Charlotte, Charlotte, NC for facilities and
 equipment...........................................
Youthbuild Louisville , Louisville, KY for facilities            600,000
 and equipment.......................................
------------------------------------------------------------------------

                  VACCINE INJURY COMPENSATION PROGRAM

 
 
 
Appropriation, fiscal year 2021.......................       $11,200,000
Budget request, fiscal year 2022......................        16,200,000
Committee Recommendation..............................        16,200,000
    Change from enacted level.........................            +5,000
    Change from budget request........................             - - -
 

    The Committee includes $16,200,000 for administrative costs 
associated with the Vaccine Injury Compensation Program, an 
increase of $5,000,000 above the fiscal year 2021 enacted level 
and the same as the fiscal year 2022 budget request. This 
program provides compensation for individuals with vaccine-
associated injuries or deaths.

                  COVERED COUNTERMEASURES PROCESS FUND

 
 
 
Appropriation, fiscal year 2021.......................                $0
Budget request, fiscal year 2022......................         5,000,000
Committee Recommendation..............................         5,000,000
    Change from enacted level.........................        +5,000,000
    Change from budget request........................             - - -
 

    The Committee includes $5,000,000 for administrative costs 
associated with the Countermeasures Injury Compensation Program 
(CICP), an increase of $5,000,000 above the fiscal year 2021 
enacted level and the same as the fiscal year 2022 budget 
request. 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 2021.......................    $7,874,804,000
Budget request, fiscal year 2022......................     9,552,519,000
Committee Recommendation..............................    10,571,419,000
    Change from enacted level.........................    +2,696,615,000
    Change from budget request........................    +1,018,900,000
 

    The Committee recommendation for the Centers for Disease 
Control and Prevention (CDC) program level includes 
$9,612,761,000 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 Americans 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 2021.......................      $821,005,000
Budget request, fiscal year 2022......................       945,930,000
Committee Recommendation..............................       950,930,000
    Change from enacted level.........................      +129,925,000
    Change from budget request........................        +5,000,000
 

    The Committee recommendation includes $531,580,000 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:

------------------------------------------------------------------------
                   Budget Activity                     FY 2022 Committee
------------------------------------------------------------------------
Section 317 Immunization Program.....................       $718,572,000
Acute Flaccid Myelitis...............................          6,000,000
Influenza Planning and Response......................        226,358,000
------------------------------------------------------------------------

    Adult Hepatitis B Vaccination.--The Committee is concerned 
about the rate of adult hepatitis B vaccination, as low rates 
of vaccine coverage among adults represent a missed 
opportunity. The Committee urges CDC to develop a plan to 
achieve adult hepatitis B vaccination goals.
    Cost Estimates.--The Committee looks forward to reviewing 
the fiscal year 2023 report on estimated funding needs of the 
Section 317 Immunization Program and urges that the report be 
updated and submitted not later than February 1, 2022. 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. The fiscal year 2023 
report should 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 and influenza.
    COVID-19 Antibody Testing.--The Committee is aware that 
there is some concern that antibody or serologic testing has 
been underutilized in the response to the COVID-19 pandemic and 
that CDC guidance on the use of these tests may warrant further 
review. The Food and Drug Administration has authorized 
numerous antibody tests. These tests can be deployed to inform 
seroprevalence surveys and to improve patient care. The 
Committee encourages the use of antibody tests, where 
appropriate, and requests an update on this topic in the fiscal 
year 2023 Congressional Budget Justification.
    Enhancing 317 Immunization Program.--The Committee includes 
an increase of $99,925,000 to enhance adult immunization. The 
COVID-19 pandemic illuminated a variety of gaps in our public 
health capacity, including the need for a comprehensive adult 
immunization program. This expansion holds the potential to 
meet longstanding issues of inequity in protection from 
vaccine-preventable diseases and to address vaccine hesitancy.
    Immunization Rates.--The Committee is concerned about the 
marked decline in routine childhood and adolescent vaccines as 
a result of the pandemic. The Committee urges CDC to engage 
providers, health care stakeholders, educators, community 
organizations, and parents/guardians about the importance of 
ensuring that children and adolescents visit their primary care 
provider and receive their routinely recommended vaccinations, 
including HPV vaccination. In addition, the Committee urges 
that immunization reminder recall is prioritized. The Committee 
requests a report within 90 days of enactment of this Act 
regarding the strategy and plan for the public awareness 
campaign to increase childhood and adult routine vaccination 
rates and reduce barriers to routine vaccinations including, 
but not limited to vaccine hesitancy. This report should 
include information on immunization rates of all age groups and 
provide disaggregated data on vaccines rates to determine 
disparities across race, ethnicity, sex, age, and zip code, as 
available, for both routine and COVID-19 vaccinations. In 
addition, the report shall address actions taken and plans to 
strengthen awareness, understanding, and trust in vaccines.
    Improving Immunization Information System Infrastructure 
and Data.--The Committee is concerned about the state of 
interoperability across Immunization Information Systems (IIS), 
especially as vaccine administration information becomes more 
critical with respect to stopping the COVID-19 pandemic. It is 
important that IIS across the country interoperate with each 
other, are capable of transmitting information to public health 
authorities, including CDC, and that each IIS has the capacity 
to intake data and satisfy bidirectional queries. The Committee 
includes $5,000,000 for CDC to consult with stakeholders to 
outline the steps toward a more robust common core data set for 
collection of vaccine administration information and to 
initiate a national framework that includes the minimum 
functional standards for IIS to interoperate.
    Influenza Planning and Response.--The Committee includes an 
increase of $25,000,000 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.
    Respiratory Syncytial Virus.--The Committee applauds the 
ongoing development of novel immunizations to provide 
protection for all infants against Respiratory Syncytial Virus 
(RSV) disease. Currently, there is no licensed immunization 
that can protect all infants from RSV. The Committee encourages 
CDC and the Advisory Committee on Immunization Practices (ACIP) 
to review any novel immunization, including monoclonal 
antibodies, that holds the promise of broad protection for all 
infants and public health benefit to children, for inclusion on 
the Child and Adolescent Immunization Schedule and in the 
Vaccines for Children program.
    Shared Clinical Decision Making.--The Committee encourages 
CDC to work with health professional organizations to utilize 
decision making support tools to promote recent changes made to 
the Evaluation and Management office visit Current Procedural 
Terminology codes which allow for the use of ``Total Time'' or 
the use of ``Medical Decision Making'' as key contributing 
factors, for the basis of payment for vaccination counseling 
and administration. This will ensure that medical professionals 
and patients are informed and have a clear understanding of and 
continued access to the immunizations they should receive 
across the life course.
    Vulnerable Populations.--The Committee commends the CDC 
ACIP recommendations and the Office of Civil Rights for its 
continued vigilance regarding potential discrimination in 
vulnerable populations during the COVID-19 pandemic and for 
working collaboratively with States to ensure State guidelines 
reflect best practices for serving individuals with 
disabilities and the elderly.

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

 
 
 
Appropriation, fiscal year 2021.......................    $1,314,056,000
Budget request, fiscal year 2022......................     1,420,556,000
Committee Recommendation..............................     1,501,556,000
    Change from enacted level.........................      +187,500,000
    Change from budget request........................       +81,000,000
 

    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:

------------------------------------------------------------------------
                   Budget Activity                     FY 2022 Committee
------------------------------------------------------------------------
Domestic HIV/AIDS Prevention and Research............     $1,080,712,000
    HIV Initiative...................................        275,000,000
    School Health-HIV................................         50,081,000
Viral Hepatitis......................................         44,500,000
Sexually Transmitted Infections......................        166,810,000
Tuberculosis.........................................        140,034,000
Infectious Diseases and the Opioid Epidemic..........         69,500,000
------------------------------------------------------------------------

    Congenital Syphilis.--The Committee is concerned about the 
massive interruptions in sexually transmitted infection care 
and preventative services due to the pandemic. The Committee 
urges priority be given to jurisdictions experiencing the 
highest prevalence of congenital syphilis (CS) cases. The 
Committee urges CDC to prioritize CS programming and multi-
point testing of pregnant women in community organizations, and 
STD and drug addiction clinics.
    Hepatitis B.--The Committee urges CDC to maintain its 
investment in hepatitis B grants to support community-based 
organizations that are vital to serving disproportionately 
impacted communities to help ensure these groups receive the 
necessary testing and linkage to care. CDC is also urged to 
expand the viral hepatitis disease tracking and surveillance 
capabilities of the States to permit an effective targeting of 
resources and evaluation of program effectiveness.
    HIV Initiative.--The Committee includes an increase of 
$100,000,000 for the third year of the Ending the HIV Epidemic 
initiative to advance the four key strategies: diagnose, treat, 
prevent, and respond. The Committee recognizes that sexually 
transmitted diseases are associated with increased risk of HIV 
acquisition. The Committee commends CDC for including dedicated 
funding within this initiative for sexually transmitted 
infection clinics.
    Infectious Diseases and the Opioid Epidemic.--The Committee 
includes an increase of $56,500,000 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 
$16,000,000 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 $5,000,000 to address the high rates of sexually 
transmitted infections (STIs). The Committee recognizes that 
direct funding to State and local health departments is 
critical to address STIs and other infectious diseases. In 
addition, the Committee notes the investment of more than 
$1,000,000,000 from the American Rescue Plan (P.L. 117-2) to 
bolster support and enhance the disease intervention specialist 
workforce nationwide to respond to COVID-19 and other 
infectious diseases.
    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 restore funding to 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.
    Viral Hepatitis.--The Committee includes an increase of 
$5,000,000 to enhance efforts to eliminate the public health 
threat of viral hepatitis.

               EMERGING AND ZOONOTIC INFECTIOUS DISEASES

 
 
 
Appropriation, fiscal year 2021.......................      $648,272,000
Budget request, fiscal year 2022......................       678,272,000
Committee Recommendation..............................       726,272,000
    Change from enacted level.........................       +78,000,000
    Change from budget request........................       +48,000,000
 

    The Committee recommendation includes $674,272,000 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 2022 Committee
------------------------------------------------------------------------
Antibiotic Resistance Initiative.....................       $177,000,000
Vector-borne Diseases................................         57,603,000
Lyme Disease.........................................         21,000,000
Prion Disease........................................          7,500,000
Chronic Fatigue Syndrome.............................          5,400,000
Food Safety..........................................         75,000,000
Emerging Infectious Diseases.........................        194,997,000
National Health Care Safety Network..................         26,000,000
Quarantine...........................................         72,772,000
Advanced Molecular Detection.........................         35,000,000
Epidemiology and Laboratory Capacity.................         40,000,000
Healthcare-Associated Infections.....................         12,000,000
Harmful Algal Blooms.................................          2,000,000
------------------------------------------------------------------------

    Advanced Molecular Detection.--The Committee includes an 
increase of $5,000,000 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. The 
Committee is aware that at the start of the COVID-19 pandemic, 
there were only a few public health laboratories capable of 
performing the necessary advanced molecular detection tests. 
The Committee requests a status update on the capabilities at 
public health laboratories in the fiscal year 2023 
Congressional Budget Justification.
    Antibiotic Resistance.--The Committee includes an increase 
of $5,000,000. The Committee recognizes the importance of 
effectively combatting antibiotic resistant bacteria as part of 
CDC's broader efforts to mitigate the clinical and public 
health impacts of the COVID-19 outbreak. Furthermore, 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. The Committee encourages CDC 
to competitively award research activities that address aspects 
of antibiotic resistance related to ``One Health,'' including 
global surveillance and research and development for new tools 
to counter antibiotic resistance among entities, including 
public academic medical centers, veterinary schools with 
agriculture extension services, and public health departments 
whose proposals are in line with CDC's strategy for addressing 
antibiotic resistant bacteria.
    Epidemiology and Laboratory Capacity Awards.--The Committee 
urges CDC to work with States to prioritize funding to local 
health departments based on factors such as population size, 
disease burden, and other public health metrics to promote 
equitable funding distribution.
    Harmful Algal Blooms.--The Committee includes funding to 
support monitoring and health reporting concerns related to 
harmful algal blooms (HABs). The Committee urges CDC to 
continue work to understand and prevent illnesses associated 
with 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 such as the Harmful Algal Bloom and Hypoxia 
Research and Control Act Interagency Working Group and the 
Great Lakes Restoration Initiative. 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 
encouraged to expand their work regionally to understand HABs 
impact on our nation's largest fresh bodies of water.
    Food Safety.--The Committee includes an increase of 
$10,000,000 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.
    Live Animal Imports.--The Committee is aware that 
importation of live animals, particularly dogs, has increased 
substantially during the COVID-19 pandemic and is concerned by 
instances in which live animals have been held at ports of 
entry for hours or days. The Committee emphasizes the 
importance of prioritizing inspection of live cargo by CDC 
personnel to ensure that all due standards of animal welfare 
are maintained and urges CDC to adopt policies limiting the 
maximum amount of time between the arrival of cargo containing 
live animals and inspection to the shortest practicable period.
    Lyme Disease.--The Committee includes an increase of 
$5,000,000 to support efforts to develop improved diagnostics 
with appropriate sensitivity and specificity for the detection 
of subclinical or low-level infection for use in disease 
eradication, and surveillance networks so that disease burden 
can be more accurately determined; and to bolster critical 
prevention and provider and public awareness efforts. 
Furthermore, the Committee encourages CDC to reevaluate the 
practice of utilizing the classification of States as high or 
low incidence as surveillance criteria.
    Mosquito-Borne Diseases.--The COVID-19 pandemic response 
required many State and local health departments to redirect 
staff from other vital tasks such as mosquito control-related 
activities, resulting in less capacity to surveil and mitigate 
potential mosquito-borne public health threats. The Committee 
is concerned about the spread of mosquito-borne diseases, such 
as Zika, 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.
    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 2023 Congressional Budget 
Justification on how this funding is being utilized.
    National Healthcare Safety Network.--The Committee includes 
an increase of $5,000,000 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.
    Natural History Museums.--The Committee notes that the 
nation's natural history museums provide an unparalleled 
resource for studying zoonotic diseases such as COVID-19. These 
museums hold millions of animal samples collected over decades 
from across the globe, offer deep and broad scientific 
expertise, and are uniquely positioned to assist in preparing 
for and predicting the next pandemic-causing viruses. The 
Committee encourages increased utilization and support of this 
largely untapped resource.
    One Health.--The Committee understands that despite 
unprecedented efforts to address the COVID-19 pandemic, many 
questions remain about the prevention of future pandemics, 
especially those caused by zoonotic disease transmission. The 
Committee supports a One Health approach that recognizes that 
human, animal, and environmental health are fundamentally 
interconnected.
    Prion.--The Committee includes an increase of $1,000,000 
and recognizes the critical work of the National Prion Disease 
Pathology Surveillance Center. The workload related to chronic 
wasting disease in deer and elk populations in the U.S. is in 
addition to the Center's ongoing efforts related to human prion 
diseases that includes research, surveillance, tissue banking, 
and technical and supportive assistance to providers to 
families.
    Quarantine.--The Committee includes an increase of 
$30,000,000 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 $15,000,000 to address the steady increase in the incidence 
of vector-borne disease and to sustain the Regional Centers of 
Excellence program, including State-level surveillance and 
research being conducted by partners. The Committee encourages 
CDC to examine options to provide greater coverage of the 
Northwest region for vector-borne disease resources.
    Wastewater Surveillance.--The Committee commends CDC's work 
implementing the National Wastewater Surveillance System with 
partners at State health labs and academic institutions to 
better track COVID-19 and understands the important role 
wastewater testing plays for our nation's biosecurity.

            CHRONIC DISEASE PREVENTION AND HEALTH PROMOTION

 
 
 
Appropriation, fiscal year 2021.......................    $1,276,664,000
Budget request, fiscal year 2022......................     1,452,664,000
Committee Recommendation..............................     1,557,064,000
    Change from enacted level.........................      +280,400,000
    Change from budget request........................      +104,400,000
 

    The Committee recommendation includes $1,302,114,000 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 2022 Committee
------------------------------------------------------------------------
Tobacco..............................................       $250,000,000
Nutrition, Physical Activity, and Obesity............         56,920,000
    High Obesity Rate Counties.......................         15,000,000
School Health........................................         17,400,000
Health Promotion.....................................         47,500,000
    Glaucoma.........................................          4,000,000
    Vision and Eye Health............................          1,000,000
    Alzheimer's Disease..............................         25,000,000
    Inflammatory Bowel Diseases......................          1,500,000
    Interstitial Cystitis............................          1,500,000
    Excessive Alcohol Use............................          5,000,000
    Chronic Kidney Disease...........................          4,500,000
    Chronic Disease Education and Awareness..........          5,000,000
Prevention Research Centers..........................         31,961,000
Heart Disease and Stroke.............................        148,105,000
Diabetes.............................................        153,129,000
National Diabetes Prevention Program.................         34,300,000
Cancer Prevention and Control........................        385,799,000
    Breast and Cervical Cancer.......................        230,000,000
        WISEWOMAN....................................         33,120,000
    Breast Cancer Awareness for Young Women..........          5,960,000
    Cancer Registries................................         51,440,000
    Colorectal Cancer................................         45,294,000
    Comprehensive Cancer.............................         20,425,000
    Johanna's Law....................................         12,000,000
    Ovarian Cancer...................................         14,000,000
    Prostate Cancer..................................         14,205,000
    Skin Cancer......................................          4,000,000
    Cancer Survivorship Resource Center..............            475,000
Oral Health..........................................         21,500,000
Safe Motherhood/Infant Health........................        119,000,000
Arthritis............................................         12,500,000
Epilepsy.............................................         13,000,000
National Lupus Registry..............................         10,500,000
Racial and Ethnic Approaches to Community Health.....         73,950,000
    Good Health and Wellness in Indian Country.......         27,000,000
Social Determinants of Health........................        153,000,000
Million Hearts.......................................         14,000,000
National Early Child Care Collaboratives.............          5,000,000
Hospitals Promoting Breastfeeding....................          9,500,000
------------------------------------------------------------------------

    Alzheimer's Disease.--The Committee includes an increase of 
$4,500,000 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.
    Arthritis.--The Committee includes an increase of 
$1,500,000 to expand the number of State-based arthritis 
programs, provide access to proven arthritis self-management 
and physical activity programs, and improve data collection and 
surveillance.
    Breast and Cervical Cancer.--The National Breast and 
Cervical Cancer Early Detection Program provides critical, 
lifesaving breast cancer screening and diagnostic services to 
uninsured and underinsured women. Patient navigation programs 
have been proven to ensure people who are diagnosed with cancer 
are able to access proper care. The Committee encourages 
recipients to implement navigator programs to ensure patients 
are followed from diagnosis to cure.
    Breast Cancer Awareness for Young Women.--The Committee 
includes an increase of $1,000,000 to expand awareness and 
prevention efforts for young women.
    Chronic Disease Education and Awareness.--The Committee 
includes an increase of $3,500,000 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.
    Chronic Kidney Disease.--The Committee includes an increase 
of $2,000,000 for a public health approach to kidney disease 
screening for early detection and treatment and prevalence 
surveillance, so that the progression of kidney disease can be 
slowed and complications can be reduced, which will 
dramatically improve the quality of life of patients.
    Colorectal Cancer.--The Committee includes an increase of 
$2,000,000 to expand efforts to address disparities in 
colorectal cancer screening rates and to improve access to 
underserved populations.
    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.
    Early Child Care Collaboratives.--The Committee includes an 
increase of $1,000,000 for the expansion of the core program to 
at least one new State and to enhance efforts to address food 
insecurity. The Committee is aware that COVID-19 escalated food 
insecurity for children and families and recognizes the early 
care and education setting is important for promoting healthy 
habits in young children and ensuring that they have access to 
nutritious food. The Committee includes funding for the 
National Early Child Care Collaboratives Program to support 
technical assistance to States for integrating best practices 
into existing State and local systems for early care and 
education, as well as direct provider-level training in 
implementation of comprehensive programming to support healthy 
eating and physical activity best practices. The Committee 
encourages the program to serve a mix of rural, suburban and 
urban areas, including areas with high childhood obesity rates.
    Early Detection of Brain Aneurysms.--The Committee 
recognizes that there are typically no warning signs or 
symptoms unless brain aneurysms rupture. Even when an aneurysm 
has ruptured, the symptoms are not widely known. The Committee 
encourages CDC to capture and disseminate information about 
best practices.
    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 recognizes the opportunity to 
advance public and provider awareness and improve care for the 
epilepsy community through meaningful timely investment in 
successful public health activities.
    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.
    Heart Disease and Stroke.--The Committee includes a total 
increase of $20,000,000 to address cardiovascular diseases. The 
Committee includes an increase of $5,000,000 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 and underserved communities, communities of color, those 
communities with limited access to information about 
cardiovascular health disease, and communities at risk for 
delaying regular monitoring of cardiovascular health as a 
result of the COVID-19 pandemic. The Committee supports CDC's 
efforts to improve our understanding of the outcomes and health 
effects of COVID-19 infection, including cardiovascular 
disease. The Committee includes an increase of $5,000,000 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 $10,000,000 for the 
Million Hearts initiative to increase education and outreach 
about the importance of healthy behaviors, regular heart 
screenings, and prevention measures.
    Inflammatory Bowel Diseases.--The Committee includes an 
increase of $500,000 to support an initial pilot education and 
outreach program targeted toward healthcare providers, 
inflammatory bowel disease (IBD) patients, and people with IBD-
type symptoms, including those from minority populations, and 
focused on improving remission rates by reducing the time to 
diagnosis and the start of effective treatments. Additionally, 
the Committee encourages CDC to collaborate with organizations 
that serve the IBD patient community in planning and executing 
this pilot.
    Interstitial Cystitis.--The Committee includes an increase 
of $400,000 for interstitial cystitis activities.
    Johanna's Law.--The Committee includes an increase of 
$2,000,000 for CDC's Inside Knowledge Campaign that raises 
awareness of the five main types of gynecological cancer: 
cervical, ovarian, uterine, vaginal, and vulvar. This campaign 
educates women of all ages, races, and ethnic groups, and 
healthcare providers.
    Lung Cancer.--The Committee remains concerned about the 
high morbidity and mortality of lung cancer. Early detection 
and treatment of lung cancer translates into higher survival 
rates. The Committee encourages CDC to incorporate lung cancer 
screening awareness and referral into its tobacco prevention 
and control activities.
    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 protect the health of Americans at 
every stage of life by encouraging regular physical activity, 
good nutrition, and preventing adult and childhood obesity. The 
Committee is concerned that the eligibility for the High 
Obesity Program is limited to communities with high obesity 
rates solely among adults, without taking into account 
childhood obesity rates. This exclusion represents a missed 
opportunity to address the important public health problem of 
childhood obesity, which can lead to high blood pressure, sleep 
apnea, high cholesterol, fatty liver disease, psychological 
problems and more. The Committee encourages CDC to consider 
including high childhood obesity rates in its eligibility 
criteria for the High Obesity Program.
    Oral Health.--The Committee includes an increase of 
$2,000,000 to expand support to State and territorial health 
departments in their efforts to reduce oral disease and improve 
oral health through effective interventions.
    Ovarian Cancer.--The Committee includes an increase of 
$2,000,000 to advance ovarian cancer prevention, early 
detection, risk assessment, and access to the standard of care.
    Prevention Research Centers.--The Committee includes an 
increase of $5,000,000 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 supports CDC's efforts to 
increase the public's 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.
    Psoriatic Disease.--The Committee recognizes the value of 
the Public Health Agenda for Psoriasis and Psoriatic Arthritis 
and its impact in interventions to address psoriatic disease 
over the past decade. Despite significant advancements in 
research, treatment options, and care approaches for this 
community, the Committee is concerned that many individuals, 
especially people of color, remain undertreated and are not 
achieving optimal health outcomes. The Committee encourages CDC 
to develop an updated public health agenda and action plan to 
be focused on addressing the systemic nature of the disease, 
unmet needs, heterogeneity of disease and treatment response, 
and diversity of diagnosis, care and outcomes.
    Racial and Ethnic Approaches to Community Health.--The 
Committee includes a total increase of $10,000,000 to continue 
scaling this program to all States and territories, and support 
grantees in building capacity for collaboration and 
disseminating evidence-based strategies in communities. Racial 
and Ethnic Approaches to Community Health (REACH) is a vital 
initiative to help eliminate healthcare disparities in minority 
communities. The Committee's recommended level includes an 
increase of $5,000,000 for Good Health and Wellness in Indian 
Country.
    Safe Motherhood and Infant Health.--The Committee includes 
a total increase of $56,000,000 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. Building on the commitment made in 
FY 2021, the total funding allows for the expansion of Maternal 
Mortality Review Committees (MMRCs) and Perinatal Quality 
Collaboratives (PQCs) to all 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 encourages CDC 
to help MMRCs build stronger data systems and improve data 
collection at the State level to create consistency in data 
collection, analysis, and reporting across State MMRCs. This 
investment is necessary to provide accurate national statistics 
on U.S. maternal mortality rates and will inform data-driven 
actions to prevent these deaths. The Committee requests a 
report within 90 days of enactment of this Act on barriers to 
effective and consistent data collection and opportunities to 
improve coordination among State MMRCs. PQCs improve maternal 
and neonatal outcomes using known prevention strategies such as 
reducing severe pregnancy complications associated with high 
blood pressure and hemorrhage. PQCs help to address the high 
incidence of maternal mortality, particularly among women of 
color, maternal opioid use disorder and neonatal abstinence 
syndrome as a result of the opioid crisis, which has been 
exacerbated by the COVID-19 pandemic. The Committee requests an 
update on the PQC program and challenges faced, including those 
created by the COVID-19 pandemic, within 90 days of enactment 
of this Act. Furthermore, little is known about the tragic, 
sudden, and unexpected deaths of young children because of 
variations in investigations and the way deaths are certified. 
The Committee urges CDC to facilitate data and analysis, 
including the expansion of the SUID and Sudden Death in the 
Young Case Registry, to improve SUID prevention strategies.
    Social Determinants of Health.--The Committee includes an 
increase of $150,000,000 for investments in social determinants 
of health (SDOH) to improve health equity. The Committee 
includes funding to expand activities to address SDOH in 
States, local, tribal and territorial jurisdictions to improve 
outcomes among persons experiencing health disparities and 
inequalities, including, but not limited to, expanding and 
implementing Accelerator Plans, initiating a SDOH 
implementation program, providing technical assistance to 
communities and continuing to build the evidence base and 
advance data collection to better understand health 
disparities. Social Determinants Accelerator Plans should 
include a description of the health and social outcome 
objectives; identify 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 Social Determinants Accelerator Plans.
    Tobacco.--The Committee includes an increase of $12,500,000 
so that CDC and States can more robustly respond to the public 
health threat caused by youth use of e-cigarettes, enhance 
efforts to reduce tobacco use among disparate populations and 
in areas with high tobacco use rates and tobacco-related 
mortality, and expand education efforts to reach youth 
influencers.
    Vision and Eye Health.--The Committee is aware that vision 
impairments and eye disease contribute to or complicate many 
other serious and costly chronic health conditions, including 
diabetes, cardiovascular disease, injuries and death related to 
falling, depression, and cognitive decline. State and community 
partnerships are essential in promoting messages of early 
detection and coordinating access to treatment to prevent eye 
disease from progressing to permanent vision loss.

   BIRTH DEFECTS, DEVELOPMENTAL DISABILITIES, DISABILITIES AND HEALTH

 
 
 
Appropriation, fiscal year 2021.......................      $167,810,000
Budget request, fiscal year 2022......................       172,810,000
Committee Recommendation..............................       186,810,000
    Change from enacted level.........................       +19,000,000
    Change from budget request........................       +14,000,000
 

    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:

------------------------------------------------------------------------
                                                            FY 2022
                   Budget Activity                         Committee
------------------------------------------------------------------------
Child Health and Development.........................        $66,800,000
    Birth Defects....................................         19,000,000
    Fetal Death......................................            900,000
    Fetal Alcohol Syndrome...........................         12,000,000
    Folic Acid.......................................          3,150,000
    Infant Health....................................          8,650,000
    Autism...........................................         23,100,000
Health and Development for People with Disabilities..         80,660,000
    Disability & Health..............................         41,000,000
    Tourette Syndrome................................          2,000,000
    Early Hearing Detection and Intervention.........         10,760,000
    Muscular Dystrophy...............................          8,000,000
    Attention Deficit Hyperactivity Disorder.........          1,900,000
    Fragile X........................................          2,000,000
    Spina Bifida.....................................          7,000,000
    Congenital Heart.................................          8,000,000
Public Health Approach to Blood Disorders............         11,400,000
Hemophilia Activities................................          3,500,000
Hemophilia Treatment Centers.........................          5,100,000
Thalassemia..........................................          2,100,000
Neonatal Abstinence Syndrome.........................          2,250,000
Surveillance for Emerging Threats to Mothers and              15,000,000
 Babies..............................................
------------------------------------------------------------------------

    Blood Disorders.--The Committee includes an increase of 
$5,000,000 to expand sickle cell data collection efforts in 
multiple States. The Committee urges an expansive sickle cell 
surveillance program to better identify affected individuals, 
understand their health outcomes and comorbidities, and 
evaluate their utilization of the most effective and 
appropriate treatments to prevent complications and risk 
factors that affect individuals living with the disease.
    Cerebral Palsy.--The Committee encourages CDC to explore 
cross-divisional funding opportunities, networks, data sets and 
systems to accelerate data-driven public health research to 
improve Cerebral Palsy (CP) surveillance and develop increased 
understanding of the mechanisms leading to earlier diagnosis 
and improved outcomes to reduce the public health burden of CP. 
The Committee also encourages CDC to conduct an updated study 
from the 2003 report on the healthcare and societal costs of CP 
in the U.S.
    Congenital Heart Defects.--The Committee includes an 
increase of $1,000,000 for grants or cooperative agreements to 
provide technical assistance to State and local agencies to 
complement intramural programs and to conduct applied research 
related to screening, evaluation, diagnosis, results reporting, 
data collection, surveillance, intervention programs, systems, 
and follow-up of children identified through Critical 
Congenital Heart Defects screening to better understand the 
long-term outcomes and needs of this population.
    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. The Committee is concerned about the 
rising trend of prenatal alcohol consumption and increased 
rates of fetal alcohol spectrum disorders (FASD). The Committee 
urges CDC to increase support to: expand prevention efforts to 
heighten awareness of FASD and the risks associated with 
prenatal alcohol exposure; and strengthen existing national 
community-based and professional FASD networks to expand access 
to diagnostic, treatment, intervention, and other essential 
services.
    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 $5,000,000 
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 
$2,000,000 to enhance Muscular Dystrophy research and disease 
surveillance initiatives, including the Duchenne Muscular 
Dystrophy Care Considerations. The Committee directs CDC to 
provide a report within 120 days of enactment of this Act 
describing the allocation for specific activities in fiscal 
years 2020 and 2021. The report should, to the extent 
practicable, identify program priorities, including an 
evaluation of the impact of the Duchenne Muscular Dystrophy 
Care Considerations across the country on patient outcomes and 
any remaining gaps, particularly in rural and underserved 
areas. CDC should also address the following three areas of 
unmet need: evaluating the differences in care and outcomes 
between Certified Duchenne Care Centers (CDCC) and non-CDCC MD-
STARnet data and other data sources; the availability of 
consistent and coordinated care for adults with Duchenne as 
they transition from pediatric care settings to adult care 
settings; and the impact of progressive disability on the 
mental health of patients and their caregivers. The Committee 
encourages CDC to partner with stakeholder organizations to 
leverage additional knowledge and resources to advance this 
work.
    Prenatally and Postnatally Diagnosed Conditions Awareness 
Act (P.L. 110-374).--As a response to the growth in prenatal 
screening and testing, Congress passed this Act to ensure women 
receive accurate information on genetic testing, community 
support, and outcomes of care for their children when they 
receive a prenatal or postnatal diagnosis for Down syndrome or 
similar conditions. The Committee requests an update on the 
efforts to implement the Act in the fiscal year 2023 
Congressional Budget Justification.
    Spina Bifida.--The Committee is aware of a growing 
incidence of sudden death in the adult spina bifida population, 
and understands that there is a significant need to study this 
issue and to address the transitional and adult care needs of 
the growing, aging spina bifida community. Therefore, the 
Committee encourages CDC to use funding for the National Spina 
Bifida Program to support the continuation of the Spina Bifida 
Clinical Care Monitoring and Tracking Program, which works with 
the National Spina Bifida Registry, to guide the health care 
community in best treatment options for people living with 
spina bifida; and to expand and modernize data collection, 
including the National Spina Bifida Patient Registry and 
surveillance activities to allow for data collection from more 
clinics and individuals with spina bifida.

                   PUBLIC HEALTH SCIENTIFIC SERVICES

 
 
 
Appropriation, fiscal year 2021.......................      $591,997,000
Budget request, fiscal year 2022......................       741,997,000
Committee Recommendation..............................       756,997,000
    Change from enacted level.........................      +165,000,000
    Change from budget request........................       +15,000,000
 

    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:

------------------------------------------------------------------------
                                                            FY 2022
                   Budget Activity                         Committee
------------------------------------------------------------------------
Health Statistics....................................       $190,397,000
Surveillance, Epidemiology, and Informatics..........        460,600,000
Public Health Workforce..............................        106,000,000
------------------------------------------------------------------------

    Artificial Intelligence Recruitment.--The Committee 
recognizes that there are many challenges in recruiting the 
public health workforce and encourages the consideration of 
human resource technology augmented by cloud-agnostic, 
commercial off-the-shelf automated machine learning decision 
assistance software, while preserving fairness throughout the 
human resource processes.
    Community Health Workers.--The Committee commends CDC for 
integrating community health workers into care teams, 
community-based organizations, and coordinated public health-
led actions to manage COVID-19 among priority populations 
within communities. The Committee urges CDC to continue this 
critical investment by supporting, promoting and expanding 
State investments in the community health worker workforce in 
the COVID-19 response and long-term efforts to address the 
social determinants of health and achieve health equity in 
partnership with community health worker professional 
organizations.
    Disability Data.--The Committee encourages CDC to ensure 
disability data is included as a core demographic component 
across surveys and surveillance systems administered by the 
National Center for Health Statistics. The Committee encourages 
CDC to support and fund research focused on the community of 
people with disabilities as a whole.
    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.--The Committee 
includes an increase of $15,000,000 for the National Center for 
Health Statistics, a component of our nation's public health 
infrastructure, to monitor the health of the American people 
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.
    Overdose and Suicide Data Collection.--The Committee 
recognizes the importance of timely and accurate data to 
understand the incidence and prevalence of health outcomes to 
effectively respond to emerging trends, especially drug 
overdoses and suicides. Data on fatal overdoses and suicide 
become publicly available six months to over a year after they 
occur. These delays hinder the ability of communities to 
respond quickly to preventable deaths. The Committee directs 
CDC to evaluate its current process for fatal overdose, non-
fatal overdose, suicide, and suicide attempts/self-harm data 
collection. The Committee further directs the CDC to develop 
recommendations to reduce reporting lags while maintaining data 
accuracy, and to submit these recommendations to the Committee 
within 180 days of enactment of this Act.
    Primary Immunodeficiencies.--The Committee includes funding 
to continue the existing program of education and awareness 
related to primary immunodeficiencies and to expand allowable 
use of funding to include genetic sequencing surveillance. This 
program has proven effective in identifying undiagnosed 
patients and linking them to centers of care.
    Public Health Data Modernization Initiative.--The Committee 
initiated the funding for the Data Modernization Initiative 
(DMI) to create modern, integrated, and real-time public health 
surveillance with CDC, State, territorial, local and tribal 
partners in fiscal year 2020 and provided significant resources 
through annual and supplemental appropriations, including 
$500,000,000 in the American Rescue Plan (P.L. 117-2). The 
Committee directs CDC to create a standards-based, 
interoperable public health infrastructure where systems can 
communicate and share data seamlessly; advance standards so 
that information can be stored and shared across systems and 
facilitate complete and timely reporting so that our public 
health system has essential data on race, ethnicity, pregnancy 
status, treatments, and co-morbidities that are critical for 
achieving equity in public health responses. The Committee 
urges CDC to consider innovative mechanisms to ensure States 
and local jurisdictions, where appropriate, have access to this 
funding to modernize their vital records data systems in 
accordance with the goals of the initiative. The Committee 
reiterates that the National Center for Health Statistics is to 
be fully integrated in the DMI. The Committee acknowledges the 
need for sustained funding for this public health 
infrastructure and thus, includes $150,000,000, an increase of 
$100,000,000, 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.
    Public Health Workforce.--The Committee includes an 
increase of $50,000,000 to aid in the rebuilding of the public 
health workforce. At this funding level, CDC will double the 
number of Epidemic Intelligence Service and Laboratory 
Leadership Service Fellows, ensuring the opportunity for 
placement of a fellow in every State. The Committee recognizes 
that a robust and well-trained public health workforce is 
critical to maintaining a highly effective public health 
infrastructure.
    Vital Statistics Reporting.--The Committee encourages CDC 
to engage with the National Academies of Science, Engineering, 
and Medicine to improve vital statistics and death reporting.

                          ENVIRONMENTAL HEALTH

 
 
 
Appropriation, fiscal year 2021.......................      $222,850,000
Budget request, fiscal year 2022......................       332,850,000
Committee Recommendation..............................       343,350,000
    Change from enacted level.........................      +120,500,000
    Change from budget request........................       +10,500,000
 

    The Committee recommendation includes $326,350,000 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 2022
                    Budget Activity                         Committee
------------------------------------------------------------------------
Environmental Health Laboratory.......................       $72,750,000
    Newborn Screening Quality Assurance Program.......        23,000,000
    Newborn Screening /Severe Combined                         1,250,000
     Immunodeficiency Diseases........................
Environmental Health Activities.......................        17,000,000
Safe Water............................................         8,600,000
Amyotrophic Lateral Sclerosis (ALS) Registry..........        10,000,000
Climate and Health....................................       110,000,000
Trevor's Law..........................................         2,000,000
Environmental and Health Outcome Tracking Network.....        34,000,000
Asthma................................................        34,000,000
Childhood Lead Poisoning..............................        50,000,000
Lead Exposure Registry................................         5,000,000
------------------------------------------------------------------------

    Amyotrophic Lateral Sclerosis Registry.--The Committee 
directs CDC to present a plan to the Committee within 90 days 
of enactment of this Act to enhance the oversight and advisory 
process for the National ALS Registry to increase transparency 
and better reflect the needs of the ALS community. This plan 
should consider ways to translate Registry findings to human 
application that can lower the risks and disease burden of ALS, 
make disease reporting more representative, more accurate, and 
more inclusive, and include a range of estimates rather than 
point estimates of ALS prevalence. Equally important are 
updates to the survey process to ensure the data they collect 
are impactful and respectful of participant burden. Finally, 
the plan should ensure that the ALS community can view as much 
Registry information as possible without compromising the 
privacy of participants.
    Asthma.--The Committee includes an increase of $4,000,000 
for the National Asthma Control Program to increase the number 
of States carrying out programmatic activities. The Committee 
recognizes that millions of people in the U.S. suffer from 
asthma, and that it disproportionately affects African American 
children.
    Childhood Lead Poisoning.--The Committee includes an 
increase of $11,000,000 to support the expansion of direct CDC 
assistance and funding to additional State and local public 
health departments. The Committee believes that CDC's expertise 
and technical assistance can be a valuable asset. The Committee 
directs CDC to provide a report within 90 days of enactment of 
this Act on plans to make direct assistance and funding 
available to additional State and local programs. 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 
$100,000,000 to expand the Climate and Health program to all 
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.
    Improving Pediatric Reference Intervals.--The Committee 
encourages CDC to initiate efforts to improve the accuracy of 
pediatric reference intervals.
    Lead Exposure Registry.--The Committee includes an increase 
of $500,000 for the Flint, Michigan Lead Exposure Registry.
    Newborn Screening.--The Committee includes an increase of 
$5,000,000 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 urges 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.
    Tuberous Sclerosis Complex.--The Committee encourages CDC 
to take into consideration Tuberous Sclerosis Complex (TSC) as 
a possible cause of autism, epilepsy, and cardiac rhabdomyomas 
in surveillance. The Committee encourages CDC to counsel 
researchers and other stakeholders to facilitate development of 
a viable newborn screening assay for TSC.

                     INJURY PREVENTION AND CONTROL

 
 
 
Appropriation, fiscal year 2021.......................      $682,879,000
Budget request, fiscal year 2022......................     1,103,169,000
Committee Recommendation..............................     1,064,169,000
    Change from enacted level.........................      +381,290,000
    Change from budget request........................       -39,000,000
 

    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 2022
                   Budget Activity                         Committee
------------------------------------------------------------------------
Domestic Violence and Sexual Violence................        $40,200,000
    Child Maltreatment...............................          7,250,000
    Child Sexual Abuse Prevention....................          2,500,000
Community and Youth Violence Prevention..............        115,100,000
Domestic Violence Community Projects.................         10,500,000
Rape Prevention......................................        101,750,000
Suicide Prevention...................................         14,000,000
Adverse Childhood Experiences........................          7,000,000
National Violent Death Reporting System..............         34,500,000
Traumatic Brain Injury...............................          8,750,000
Elderly Falls........................................          2,050,000
Drowning.............................................          2,000,000
Injury Prevention Activities.........................         28,950,000
Opioid Overdose Prevention and Surveillance..........        663,369,000
Injury Control Research Centers......................         11,000,000
Firearm Injury and Mortality Prevention Research.....         25,000,000
------------------------------------------------------------------------

    Adverse Childhood Experiences.--The Committee includes an 
increase of $2,000,000 to expand efforts including technical 
assistance to States to analyze data and burden. The Committee 
requests a report within 120 days of enactment of this Act on 
the viability and utility of a Positive Childhood Experience 
Surveillance System that measures resilience factors in a State 
or community.
    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 $100,000,000 for a new evidence-based 
community violence intervention, which aims to prevent 
intentional violence, such as mass casualty violence or gang 
violence. The Committee encourages CDC to fund a broad range of 
interventions, including programs to provide de-escalation and 
conflict mitigation skills.
    Domestic Violence and Sexual Violence.--The Committee 
includes an increase of $5,000,000 for domestic violence and 
sexual violence. The Committee notes the importance of the 
collection, reporting, and sharing of data on domestic violence 
and sexual violence. In addition, the Committee recognizes that 
the fiscal year 2022 appropriation invests in efforts to end 
gender-based violence across multiple Federal agencies. The 
Committee notes that the United Nations urged countries to 
adopt national action plans to combat gender-based violence and 
violence against women, including domestic violence. The 
Committee directs CDC to work in coordination with the 
Administration for Children and Families, the Office of the 
Surgeon General, and the Department of Justice to create a 
National Domestic Violence Prevention Action Plan to expand, 
intensify, and coordinate domestic violence prevention efforts 
among Federal, State, local, and tribal government agencies and 
with other relevant stakeholders to ensure a whole-of-
government, goal-oriented, community-informed, forward looking 
approach in addressing domestic violence prevention in the U.S. 
and report the plan to the Committee no later than one year 
after enactment of this Act.
    Domestic Violence Community Projects.--The Committee 
includes an increase of $5,000,000 to expand the reach of the 
Domestic Violence Prevention Enhancement and Leadership Through 
Alliances (DELTA) program.
    Drowning.--The Committee includes new dedicated funding to 
scale proven drowning prevention programs, including programs 
working with underserved youth, and to support State drowning 
surveillance efforts and a national plan on water safety. The 
Committee is concerned that protocols for proper lifeguard 
positioning at pools are not based on scientific testing, and 
therefore, lifeguards are often positioned so that they cannot 
identify a patron in distress before drowning leads to serious 
injury or death. The Committee urges CDC to identify gaps in 
scientific evidence for lifeguard positioning to support the 
Model Aquatic Health Code provisions, specifically as it 
relates to Zone of Patron Surveillance requirements. 
Furthermore, the Committee is concerned about drowning rate of 
children with autism. The Committee urges CDC to work with 
State and local organizations to identify subgroups of the 
populations at greater risk for drowning, including autistic 
children and specific racial/ethnic groups, and to develop 
initiatives aimed at preventing drowning among these 
populations.
    Drug Use Surveillance.--The Committee notes that trends in 
drug use change quickly and vary significantly geographically. 
The Committee encourages CDC to develop a strategy to expand 
the use of the National Wastewater Surveillance System for drug 
use surveillance to quickly detect emerging drug-use trends to 
more effectively implement public health interventions.
    Firearm Injury and Mortality Data.--The Committee urges CDC 
to collaborate with the National Institute of Justice to 
compile, share, and improve gun violence data. Such data should 
include the Uniform Crime Report and include data from 
hospitals treating victims of nonfatal gunshot wounds.
    Firearm Injury and Mortality Prevention Research.--The 
Committee includes an increase of $12,500,000 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. The Committee directs CDC to focus on 
activities that will have the greatest potential public health 
impact. 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.
    Injury Control Research Centers.--The Committee includes an 
increase of $2,000,000 to award additional grants.
    National Violent Death Reporting System.--The Committee 
includes an increase of $10,000,000 to collect data on gender 
identity and sexual orientation. This data will increase our 
understanding of violent deaths among disproportionately 
affected groups and inform efforts towards decreasing the 
number of deaths across groups.
    Opioid Abuse and Overdose Prevention.--The Committee 
includes an increase of $187,790,000 and appreciates efforts by 
CDC to ensure that funding for opioid and stimulant abuse and 
overdose prevention reaches local communities to advance local 
understanding of the opioid overdose epidemic and to scale-up 
prevention and response activities, as intended by Congress. 
The Committee encourages CDC to consider community member 
naloxone education as a criterion when distributing overdose 
prevention funds. In addition, the Committee directs that CDC 
report on the results of the investments in local cities, 
counties, and communities and ensure that traditionally 
underrepresented communities, including rural and tribal 
communities, receive equitable access to funds in the fiscal 
year 2023 Congressional Budget Justification. In addition, the 
Committee notes that chronic pain is a disabling and costly 
health condition; who is affected, the extent of resulting 
disability, the nature and accessibility of effective pain 
management, and related costs all remain largely unknown. The 
Committee directs CDC to conduct the collection, analysis, and 
publication of population research data using questions from 
the National Health Interview Survey and other nationally 
representative population-based samples to describe those with 
chronic pain by patient age, comorbidities, part of body 
affected, socio-economic status, geographic location by State, 
county and city, payor source, race, and gender. The Committee 
further directs CDC to analyze and report data from the Medical 
Expenditure Panel Survey regarding the use of and associated 
direct healthcare costs related to pain management treatments 
and services as well as indirect costs related to pain. 
Finally, the Committee directs CDC to report on the status of 
these activities in the fiscal year 2023 Congressional Budget 
Justification.
    Public Health Approach to Violence.--The Committee notes 
House Report 116-450 directed CDC to provide a report under 
this heading. The Committee is still awaiting this report and 
looks forward to its submission.
    Rape Prevention.--The Committee includes an increase of 
$50,000,000 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.
    Traumatic Brain Injury.--The Committee provides an increase 
of $2,000,000 to begin to address concussion surveillance, 
particularly among children and youth.

         NATIONAL INSTITUTE FOR OCCUPATIONAL SAFETY AND HEALTH

 
 
 
Appropriation, fiscal year 2021.......................      $345,300,000
Budget request, fiscal year 2022......................       345,300,000
Committee Recommendation..............................       360,300,000
    Change from enacted level.........................       +15,000,000
    Change from budget request........................       +15,000,000
 

    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:

------------------------------------------------------------------------
                   Budget Activity                     FY 2022 Committee
------------------------------------------------------------------------
National Occupational Research Agenda................       $123,000,000
    Agricultural, Forestry, and Fishing..............         28,500,000
Education and Research Centers.......................         32,000,000
Personal Protective Technology.......................         23,000,000
Mining Research......................................         61,500,000
National Mesothelioma Registry and Tissue Bank.......          1,200,000
Firefighter Cancer Registry..........................          2,500,000
Other Occupational Safety and Health Research........        117,100,000
------------------------------------------------------------------------

    Agricultural, 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.
    Assessment of the Extent of COVID-19 Infections and Deaths 
Among Workers.--The Committee is aware that many groups of 
essential workers faced higher rates of COVID-19 infections and 
death during the pandemic, such as those employed in health 
care, first responders, meat and poultry, corrections, grocery, 
corrections, and transit industries. Many of these are low wage 
workers of color, whose jobs required them to report to work in 
person throughout the pandemic. In order to fully assess the 
extent and impact of the COVID-19 pandemic on workers and to 
protect them from unnecessary future exposure and infection, 
the Committee directs CDC to prepare: (1.) A study quantifying 
COVID-19 deaths by occupation and industry based upon an 
analysis of death certificates. Such report shall compare the 
higher risk occupations and the rate of COVID-19 deaths in the 
general population. Such report shall be provided to the 
Committee on Appropriations and the public 180 days from the 
date of enactment of this Act; and (2.) A report on the extent 
of COVID-19 infections among working populations by occupation, 
the factors that contribute to this increased risk, and a 
description of disparate impacts by race and ethnicity. The 
report should include an assessment of the adequacy of 
reporting and data collection of COVID-19 infections, outbreaks 
and deaths among workers, and recommendations and a 
professional budget justification for improvements in data 
collection and reporting by employers, localities, States and 
the Federal government for COVID-19 and future epidemics. Such 
report shall be provided to the Committee on Appropriations and 
the public within 180 days of enactment of this Act.
    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.
    Mining Program.--The Committee commends CDC for the 
progress outlined in the 2019-2023 mining program strategic 
plan to reduce overexposure to hazardous airborne contaminants 
in the mining environment by conducting studies to: (1) improve 
measurement of exposures to hazardous dusts, and to better 
understand the risks for respiratory diseases among mine 
workers; (2) develop and assess the effectiveness of 
interventions and technologies to prevent overexposure to 
hazardous dusts; and (3) to improve the adoption of control 
interventions and technologies.
    Personal Protective Technologies.--The Committee recognizes 
the important role that CDC continues to provide regarding 
personal protective technologies in response to the COVID-19 
pandemic and to protect workers every day and includes an 
increase of $3,000,000 to support these efforts. The Committee 
directs CDC to review and report back to the Committee within 
180 days of enactment of this Act, a consideration of how 
technology, including voice-activated technology, could save 
PPE and clinicians' lives. This review should include specific 
analysis of the impact on nurses employed in acute care 
hospitals.
    Total Worker Health.--The Committee includes an increase of 
$4,000,000 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.

       ENERGY EMPLOYEES OCCUPATIONAL ILLNESS COMPENSATION PROGRAM

 
 
 
Appropriation, fiscal year 2021.......................       $55,358,000
Budget request, fiscal year 2022......................        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 2021.......................      $592,843,000
Budget request, fiscal year 2022......................       697,843,000
Committee Recommendation..............................       842,843,000
    Change from enacted level.........................      +250,000,000
    Change from budget request........................      +145,000,000
 

    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.
    In addition, the American Rescue Plan (P.L. 117-2) included 
$750,000,000 for global disease detection and emergency 
response.
    Within the total, the Committee recommends the following 
amounts:

------------------------------------------------------------------------
                   Budget Activity                     FY 2022 Committee
------------------------------------------------------------------------
Global AIDS Program..................................       $128,421,000
Global Tuberculosis..................................          9,222,000
Global Immunization Program..........................        226,000,000
    Polio Eradication................................        176,000,000
    Other Global/Measles.............................         50,000,000
Parasitic Diseases and Malaria.......................         31,000,000
Global Public Health Protection......................        448,200,000
------------------------------------------------------------------------

    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. Emerging infectious diseases such as COVID-19 and Zika 
and the global threat of spread of known diseases such as 
Ebola, represent profound challenges to our health system. The 
Committee supports CDC's continued work on 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. The Committee requests an update in the fiscal 
year 2023 Congressional Budget Justification on how CDC is 
working with FDA, BARDA, and NIH to jointly coordinate global 
health research activities with specific measurable metrics 
used to track progress and collaboration toward agreed upon 
health goals.
    Global Public Health Protection.--The Committee includes an 
increase of $245,000,000 to support and enhance 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, including by providing support of 
program implementation and scientific and technical experts in 
Atlanta and in the field with concentrated efforts on 
countries, populations, and programs where resources will have 
the greatest public health impact. In addition, the Committee 
requests an update in the fiscal year 2023 Congressional Budget 
Justification on wastewater-based epidemiology and surveillance 
global detection efforts in the global response to COVID-19, 
including a professional judgement on the necessary budget and 
infrastructure requirements to fully operationalize these 
programs.
    Global Water Strategy.--The Committee recognizes CDC's work 
to provide sustainable Water, Sanitation, & Hygiene (WASH) in 
healthcare facilities, aligned with the 2017 U.S. Global Water 
Strategy, and to support WASH efforts to contribute to the 
elimination of cholera as a public health threat as outlined by 
Ending Cholera--A Global Roadmap to 2030. The Committee urges 
CDC to increase its WASH efforts in areas where Neglected 
Tropical Diseases are endemic.
    Parasitic Disease and Malaria.--The Committee provides an 
increase of $5,000,000 recognizing the important role CDC plays 
in the fight against malaria and parasitic disease. CDC 
provides crucial monitoring and surveillance of transmission, 
evaluation of interventions for effectiveness and impact, 
development of key diagnostics, and testing of tools in a real 
world setting that are critical to ensuring that our global 
health investments are smarter, better, and not wasteful. 
Therefore, the Committee encourages CDC to continue to 
research, monitor, and evaluate efforts for malaria and 
parasitic disease in collaboration across the agency and with 
other agencies.
    Population-based Surveillance Platforms.--The Committee 
directs at least $5,000,000 to be used 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.

                PUBLIC HEALTH PREPAREDNESS AND RESPONSE

 
 
 
Appropriation, fiscal year 2021.......................      $842,200,000
Budget request, fiscal year 2022......................       842,200,000
Committee Recommendation..............................       862,200,000
    Change from enacted level.........................       +20,000,000
    Change from budget request........................       +20,000,000
 

    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:

------------------------------------------------------------------------
                   Budget Activity                     FY 2022 Committee
------------------------------------------------------------------------
Public Health Emergency Preparedness Cooperative            $715,000,000
 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 they are conducting tailored and robust 
outreach efforts to LEP communities. In addition, the Committee 
requests a State distribution table in the fiscal year 2023 
Congressional Budget Justification, 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 2021.......................       $30,000,000
Budget request, fiscal year 2022......................        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 2021.......................      $283,570,000
Budget request, fiscal year 2022......................       708,570,000
Committee Recommendation..............................     1,308,570,000
    Change from enacted level.........................    +1,025,000,000
    Change from budget request........................      +600,000,000
 

    This account supports public health leadership and support 
activities at CDC.
    The Committee recommendation includes $1,148,570,000 in 
discretionary funds and $160,000,000 in transfers from the PPH 
Fund.
    In addition, the American Rescue Plan (P.L. 117-2) provided 
significant supplemental funding for the COVID-19 response, 
including $7,500,000,000 for vaccination efforts and 
$1,000,000,000 for vaccine confidence activities.
    Within the total, the Committee recommends the following 
amounts:

------------------------------------------------------------------------
                   Budget Activity                     FY 2022 Committee
------------------------------------------------------------------------
Preventive Health and Health Services Block Grant....       $160,000,000
Public Health Leadership and Support.................        113,570,000
Infectious Diseases Rapid Response Reserve Fund......         35,000,000
Public Health Infrastructure and Capacity............      1,000,000,000
------------------------------------------------------------------------

    Infectious Diseases Rapid Response Reserve Fund.--The 
Committee includes an increase of $25,000,000. 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 that endangers American 
lives. Funds are available until expended.
    Local Health Departments.--The Committee recognizes that 
COVID-19 has raised awareness of the importance of the role of 
local health departments in our nation's governmental public 
health partnership to protect the public's health. However, 
Federal funding intended for both State and local health 
departments does not consistently reach local health 
departments beyond those directly-funded. The Committee 
encourages CDC to require States to fund local health 
departments when programmatically appropriate.
    National SARS-CoV-2 Genomic Surveillance Program.--The 
Committee recognizes that new SARS-CoV-2 variants continue to 
emerge across the globe, including variants that may have 
increased transmissibility and potential to evade vaccines. 
This dire situation demonstrates the need for a comprehensive 
genomic sequencing and surveillance program to discover and 
track the spread of these variants and devise appropriate 
public health countermeasures. The Committee directs NIH and 
CDC, in coordination with other HHS agencies as appropriate, to 
continue to expand national genomic surveillance to rapidly 
scale up sequencing of viral samples and dissemination of SARS-
CoV-2 genomic data.
    Prevention and Public Health Fund.--The Committee 
encourages the fiscal year 2023 Congressional Budget 
Justification to request Prevention and Public Health funds for 
programs it was intended to assist, such as cardiovascular/
stroke prevention through Million Hearts.
    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 $1,000,000,000 for this new funding line to invest in 
core public health infrastructure and capacity nationwide. The 
COVID-19 pandemic exposed the inadequacies of the current 
public health ecosystem and the message from the Subcommittee 
hearing on Public Health Infrastructure on February 24, 2021 
was clear: flexible, sustainable investments in public health 
are critical. 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 
Committee provides this new, annual funding to turn the tide on 
the nation's public health infrastructure by providing a stable 
source of disease-agnostic funding so that nation's State, 
local, territorial, and Federal public health agencies are 
better equipped to coordinate together to save lives. Each 
year, CDC awards nearly 75 percent of its budget through 
grants, cooperative agreements, and contracts to accomplish its 
mission; the Committee directs no less than 75 percent of this 
funding to be awarded to State, local, and territorial health 
departments.
    Rural Health.--The Committee recognizes the unique 
challenges present in rural areas and encourages CDC to 
consider the importance of reaching those in rural areas.
    Vaccine Outreach with Community Health Workers.--The 
Committee directs CDC to ensure funding made available through 
COVID-19 emergency supplemental appropriations supports a 
vaccine outreach program in partnership with community health 
workers to increase vaccine access in hardest-hit communities 
including Hispanic, Black, Asian, and Native American 
populations. In addition, the Committee requests a report 
within 120 days of enactment of this Act outlining best 
practices for increasing vaccine access in the aforementioned 
communities.

                     National Institutes of Health


 
 
 
Appropriation, fiscal year 2021.......................   $42,934,000,000
Budget request, fiscal year 2022......................    51,732,713,000
Committee Recommendation..............................    49,434,000,000
    Change from enacted level.........................    +6,500,000,000
    Change from budget request........................    -2,298,713,000
 

    The Committee recommendation for the National Institutes of 
Health (NIH) program level includes $48,162,495,000 in 
discretionary appropriations and $1,271,505,000 in Public 
Health Service Act section 241 evaluation set-aside transfers. 
Within the total appropriation, the Committee recommendation 
includes $496,000,000 in budget authority authorized in the 
21st Century Cures Act (P.L.114-255).
    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, including a total of 
$194,000,000 for the Cancer Moonshot Initiative; $541,000,000 
for the ``All of Us'' precision medicine initiative (including 
$150,000,000 from the Cures Act); and $612,000,000 for the 
Brain Research through Application of Innovative 
Neurotechnologies (BRAIN) Initiative (including $152,000,000 
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 2021.......................    $6,559,852,000
Budget request, fiscal year 2022......................     6,733,302,000
Committee Recommendation..............................     6,992,056,000
    Change from enacted level.........................      +432,204,000
    Change from budget request........................      +258,754,000
 

    Mission.--NCI leads, conducts, and supports cancer research 
across the nation to advance scientific knowledge and help all 
people live longer, healthier lives.
    Cancer Data Sharing.--The Committee applauds NIH for 
creating the National COVID Collaborative (N3C), a commercial 
solution leveraged to create a centralized and secure database 
that researchers in academic institutions can use to study 
COVID-19 and identify potential treatments. The Committee 
encourages NIH to continue pursuing similar approaches to other 
critical areas of research, including cancer, where data 
sharing continues to be a barrier to progress. The Committee 
commends NCI's data sharing efforts through the Cancer 
Moonshot, the Childhood Cancer Data Initiative, and other 
programs, and requests an update in the fiscal year 2023 
Congressional Budget Justification on NCI's continued progress 
toward adopting a centralized, secure, national platform to 
share cancer research data to drive new insights and speed 
research efforts across the country.
    Cancer Immunotherapy.--The Committee recognizes that NCI-
supported research exploring cancer immunology, cancer 
immunotherapy, and cancer vaccines that started years before 
the emergence of COVID-19 contributed to the rapid development 
of COVID-19 treatments and vaccines. Applying lessons learned 
from COVID-19 therapeutic development to cancer immunotherapy 
clinical trials has the potential to greatly improve treatment 
options and outcomes for cancer patients. The Committee 
encourages NCI to accelerate the translation of discoveries in 
cancer immunotherapy by means of the same innovations used to 
develop COVID-19 treatments and vaccines. This should include 
expediting consideration and support for potential high-impact 
cancer immunotherapy clinical trials, and for correlative 
science based on planned and ongoing clinical trials.
    Cancer Moonshot.--The Committee directs NIH to transfer 
$194,000,000 from the NIH Innovation Account to NCI to support 
the Cancer Moonshot initiative. These funds were authorized in 
the 21st Century Cures Act (P.L. 114-255).
    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 due to the fact that these 
vaccines were built on messenger RNA technology, or mRNA, an 
approach that had been initiated for cancer research. While 
most traditional vaccines use inactivated viruses to stimulate 
an immune response, a complicated process that can take several 
years, mRNA vaccines use the body's own genetic material, and 
can be developed much more quickly. 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. The 
Committee commends the work of NCI, which is currently 
supporting multiple research projects focusing on the use of 
mRNA vaccines, and encourages its continued commitment to 
moving the field forward for mRNA vaccines as an approach for 
cancer immunotherapy treatment and prevention. To better 
understand NCI's progress to date and the potential of new 
breakthroughs with mRNA, the Committee requests an update in 
the fiscal year 2023 Congressional Budget Justification on 
NCI's work on mRNA vaccines, noting existing barriers or 
challenges, if any.
    Childhood Cancer Data Initiative (CCDI).--The Committee 
includes $50,000,000 for the second year of the CCDI, as 
proposed in the fiscal year 2022 budget request. The 
development of new therapies is important to finding a cure for 
childhood cancers, many of which have not seen new therapies in 
decades. The Committee commends NCI for its support of the 
establishment of the National Childhood Cancer Registry as a 
part of the Childhood Cancer Data Initiative. Data sets for 
childhood cancers are often small and spread out across 
institutions or aggregated into State-wide or Federal 
registries where the particulars of incidence rate by cancer 
are lost. Traditional disease registries such as the Federally-
supported Surveillance Epidemiology and End Results Program 
(SEER) and the CDC's National Program for Cancer Registries 
(NPCR) aggregated into the U.S. Cancer Statistics (USCS) do not 
yet include all of the data relevant to cutting-edge pediatric 
cancer research, such as the molecular characteristics of each 
child's cancer. The Committee urges NCI to use available 
resources to ensure all relevant data needed to assist 
childhood cancer researchers in developing innovative 
treatments for childhood cancer are made available through the 
National Childhood Cancer Registry and other integrated CCDI 
programs. The Committee requests an update on the progress made 
to increase available childhood cancer data in the fiscal year 
2023 Congressional Budget Justification.
    Childhood Cancer STAR Act.--The Committee includes no less 
than $30,000,000, the same as the fiscal year 2021 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. 
Funding provided this year will allow NCI to continue to 
conduct and support childhood cancer survivorship research as 
authorized in the STAR Act.
    Colorectal Cancer Disparities.--Given the impact that 
screening can have on reducing mortality and morbidity in 
colorectal cancer, the Committee encourages NIH to study the 
impact of the COVID-19 pandemic on the incidence of colorectal 
cancer in minority communities. The Committee is hopeful that 
such information will provide policymakers with a better 
understanding of the effects on minority communities and help 
develop strategies to address barriers to screening and reduce 
health inequities and cancer deaths.
    Deadliest Cancers.--The Recalcitrant Cancer Research Act 
(RCRA) of 2012 (P.L. 112-239) focuses on cancers with a five-
year survival rate below 50 percent, which account for 44 
percent of all U.S. cancer deaths. While advances in some 
cancers have made it possible to reduce the overall rate of 
cancer deaths over the last two decades, there has been limited 
progress reducing mortality for these diseases. For fiscal year 
2020, Congress directed NCI to develop a scientific framework 
using the process outlined in the RCRA for stomach and 
esophageal cancers. The Committee notes that in addition to the 
ongoing framework development, NCI has also developed and 
received approval from its Board of Scientific Advisors to 
launch a Program in Origins of Gastroesophageal Cancers. 
Alongside the research and advocacy communities, the Committee 
appreciates NCI's efforts to keep the Committee apprised of 
continued research progress informed by the pancreatic, lung, 
glioblastoma, esophageal, and stomach cancer frameworks. The 
Committee encourages NCI to consider a similar process, as 
appropriate, for primary liver cancer, including 
cholangiocarcinoma. Given the toll all recalcitrant cancers 
exact on society and the lack of diagnostic and treatment 
resources currently available to help patients, the Committee 
also requests an update in the fiscal year 2023 Congressional 
Budget Justification on research goals to advance progress for 
the deadliest cancers (brain, esophagus, liver, lung, ovary, 
pancreas, stomach and mesothelioma).
    Germline RUNX1 Mutations.--The Committee commends NCI for 
supporting NHGRI in running a natural history study of patients 
with germline RUNX1 mutations and their families. These 
mutations frequently lead to blood cancers, especially acute 
myeloid leukemia; more research on how this occurs could 
ultimately lead to treatments that would prevent malignancy. 
Interest in this field has grown significantly in recent years, 
and the Committee strongly urges NCI to initiate funding 
opportunities for NIH intramural and extramural researchers. 
Priority areas of research should include the role of 
inflammation and the immune system on cancer transformation, 
pharmacological approaches to regulating RUNX1 activity, gene 
editing strategies, and support for an extramural clinical 
consortium dedicated to national patient data collection, 
analysis and specimen storage for collaborative research.
    Glioblastoma (GBM).--The Committee commends NCI for its 
establishment and initial implementation of the GBM 
Therapeutics Network (GTN). The GTN's cross-cutting teams' 
capability of preclinical and early-phase clinical trials 
necessary to rapidly evaluate potential treatments, including 
but not limited to 87 drugs, biologics, radiation, and devices, 
is what is needed to continue to advance toward cures and 
improved quality of life. The Committee urges NCI to continue 
to implement the GTN 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. Therefore, the Committee urges NCI to expand the 
number of programs, projects, 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 2023 Congressional 
Budget Justification, including specific grants and strategies 
where the intent is to overcome these racial disparities in 
gynecologic cancers outcomes, including the underrepresentation 
of minority women in gynecologic cancer clinical trials.
    HPV-Associated Cancers.--The Committee encourages NCI to 
expand research related to HPV-associated cancers.
    Liver Cancer.--The Committee notes that liver cancer is the 
second deadliest cancer, with a five-year survival rate of only 
20 percent. The number of liver cancer cases in the U.S. has 
increased by over 250 percent since 2000 and continues to 
increase. Since early detection of cancer in general and liver 
cancer in particular is the most effective way to reduce cancer 
mortality, the Committee urges NCI to support the research 
needed to develop a liver cancer screening test using the blood 
and saliva samples from widespread national COVID testing. This 
extensive and growing inventory of saliva and blood samples 
offers a unique opportunity to develop a liver cancer screening 
test that can soon reach over 100 million citizens, a number 
that will grow as COVID testing is expanded.
    Melanoma.--As UV radiation is established as the primary 
carcinogen for melanoma, the Committee urges NCI 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 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 
support multicenter trials that will determine whether shorter 
courses of therapy will decrease toxicity and costs while 
maintaining benefit, the role of adjuvant therapy and whether 
patients with earlier disease should receive adjuvant therapy 
and that further determine the role of adjuvant therapy in both 
treatment and drug development.
    The Committee encourages NCI to support research on novel 
targets, especially for rare subtypes, and support development 
of registries where populations are not adequate for randomized 
trials. The Committee requests an update on these requests and 
a status of NCI-funded melanoma research in NCI's fiscal year 
2023 Congressional Budget Justification.
    Metastatic Breast Cancer.--The Committee is aware that 
clinical research is of utmost importance to those living with 
metastatic breast cancer (MBC), which is breast cancer that has 
spread to other organs and become incurable. An estimated 
168,000 Americans live with MBC, and nearly all of the more 
than 43,000 deaths from breast cancer are attributed to this 
late stage of disease. Given the mortality associated with MBC 
and the lack of treatment options, research offers the best 
possibility of therapeutic advances and extended life for these 
patients. MBC is also associated with startling health 
disparities, since breast cancer mortality is about 40 percent 
higher for Black women in the U.S. than White women, and breast 
cancer is the second most common cause of death by cancer for 
Black women. The Committee believes that a renewed emphasis by 
NCI on research for MBC, especially in communities of color, is 
needed to discover better treatments and a cure for MBC and to 
address health disparities in this population. The Committee 
requests an update on NCI's activities regarding MBC in the 
fiscal year 2023 Congressional Budget Justification, including 
progress made with respect to inclusion of people of color in 
NCI-funded clinical trials in this area.
    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 provide subject 
matter expertise as appropriate as DoD continues to implement 
recommendations from the report aimed at achieving 
representation of the demographics 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.
    Pancreatic Cancer.--Pancreatic cancer is the third leading 
cause of cancer-related death in the U.S. In 2020, over 60,000 
Americans will be diagnosed with pancreatic cancer; more 
Americans than ever before. The five-year survival rate for 
pancreatic cancer remains at just over ten percent. The 
Committee appreciates that NCI has adhered to and completed all 
reporting requirements of the Recalcitrant Cancer Research Act 
of 2012 (RCRA) as it pertains to the Pancreatic Cancer 
Scientific Framework. The Committee looks forward to updates 
and progress made on the action items identified in the 
pancreatic cancer focus areas. The Committee is encouraged to 
hear that NCI is building upon the RCRA's Strategic Framework 
and taking steps to integrate research efforts across the NCI, 
and that several NCI-supported consortia focused on early 
detection have formed the Alliance of Pancreatic Cancer 
Consortia as a virtual network of researchers, clinicians, and 
advocacies to provide a platform and coordinate resources to 
discover and validate biomarkers and imaging methods for early 
detection. The Committee applauds this effort and requests an 
update in the fiscal year 2023 Congressional Budget 
Justification on progress made within the Alliance since its 
inaugural meeting in December 2016.
    Pediatric Cancer Expertise.--The Committee recognizes that 
the Childhood Cancer STAR Act (P.L. 115-180) calls on NCI to 
ensure that all applicable study sections, committees, advisory 
groups, and panels at NCI include one or more qualified 
pediatric oncologists, as appropriate. The Committee requests 
an update in the fiscal year 2023 Congressional Budget 
Justification on the actions NCI has taken to ensure 
appropriate pediatric cancer expertise is included in such 
groups.
    Prioritizing Underserved Populations in Cancer Clinical 
Trials.--The Committee remains concerned about the lack of 
equity and access to cancer clinical trials across the country. 
Groups that are generally underrepresented in clinical trials 
include racial and ethnic minorities and older and lower-income 
individuals as well as those from rural communities. To better 
identify and address these disparities, the Committee 
encourages NCI to continue to develop and prioritize trial 
recruitment strategies that consider socioeconomic status, 
race/ethnicity, or location and to prioritize grant 
applications that aim to recruit and enroll diverse patient 
cohorts when appropriate. The Committee urges NCI to continue 
collecting and publicly reporting research data on race/
ethnicity, and to encourage the collection of data, when 
appropriate, on sexual orientation, gender identity, and other 
variables that are known to influence clinical outcomes.
    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.
    Research on Cancer Disparities.--The Committee encourages 
NCI to continue its commitment to support the NCI Community 
Oncology Research Program and the activities of the Center to 
Reduce Cancer Health Disparities, two key efforts that 
contribute to building a cadre of community stakeholders and 
medical researchers prepared to engage in transdisciplinary 
approaches to address cancer, including its disparate impact on 
some communities nationwide. Although there have been 
significant advances in the prevention and treatment of cancer, 
evidence shows persistent differences in cancer incidence, 
late-stage diagnosis, and mortality in many States depending on 
socioeconomic status, geography, race, ethnicity, and other 
factors. The Committee encourages NCI to continue to prioritize 
research and training programs aimed at reducing health 
disparities in cancer, including through NCI's continued 
support of its integrated training, education, and outreach 
networks between communities and medical research centers. The 
Committee encourages NCI to prioritize partnerships with 
community groups and other stakeholders to explore the issues 
associated with cancer disparities as identified by local 
communities and include activities to develop curriculum to 
inform health professions education to reduce medical mistrust 
in targeted groups and to highlight relevant research questions 
to address cancer disparities. Additionally, NCI efforts should 
support the development of a cancer research infrastructure to 
identify relevant research questions related to disparities and 
to develop integrated and sustainable approaches to reducing 
cancer disparities, including examining social determinants of 
health and their impacts on such disparities.
    Skin Cancer in Communities of Color.--Research has shown 
that skin cancer in patients with skin of color is often 
diagnosed in its later stages, making treatment more difficult 
and decreasing the chances for survival. The Committee requests 
an update in the fiscal year 2023 Congressional Budget 
Justification regarding research that assesses factors 
contributing to later diagnoses of skin cancer among patients 
with skin of color, as well as research focused on measures to 
raise awareness of risk factors for skin cancer and to 
encourage activities that promote prevention and early 
detection of skin cancers among patients with skin of color and 
other underserved populations.
    Telehealth-Based Services for Vulnerable Patients.--The 
COVID-19 pandemic significantly exacerbated the physical, 
emotional, and mental toll on cancer patients and families. 
Providing clinical and psychosocial services to address these 
challenges is an essential component of comprehensive cancer 
care across a patient's lifespan. Cancer centers across the 
U.S. quickly pivoted to providing patient support and related 
health services by telehealth, although the extent to which all 
patients and families had equitable access to these services 
and the impact for those who have attended them is unknown. For 
example, both rural and urban underserved areas 
disproportionately lack reliable home-based Internet service, 
creating barriers for patients to access telehealth-based 
clinical and psychosocial support services. To overcome this, 
many cancer centers provided technical assistance to patients 
during the pandemic to support their use of telehealth. The 
Committee urges NCI to increase its support of research on the 
delivery and evaluation of telehealth-based clinical and 
psychosocial services, particularly among vulnerable patients 
and disadvantaged communities. This enhanced research would 
lead to evidence-based best practices, so that all patients can 
benefit from the most effective cancer care at all stages of 
the disease.

           NATIONAL HEART, LUNG, AND BLOOD INSTITUTE (NHLBI)

 
 
 
Appropriation, fiscal year 2021.......................    $3,664,811,000
Budget request, fiscal year 2022......................     3,845,681,000
Committee Recommendation..............................     3,866,828,000
    Change from enacted level.........................      +202,017,000
    Change from budget request........................       +21,147,000
 

    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.
    Alzheimer's Disease and Vascular Dementia.--Well-
characterized, longitudinal, population-based cohort studies 
provide value in bringing to light more information about the 
risk factors related to dementia. By studying participants over 
time, much can be learned about cognitive decline and early 
biomarkers; however, mature cohorts naturally dwindle as 
participants pass away, requiring that the research mission be 
adjusted to continue to leverage the previous science and build 
upon it. The Committee urges NHLBI to fund research into next 
generation cohorts, with a focus on understanding the 
development and progression of risk factors and detection of 
early signs of cognitive decline. Funded cohorts should be 
racially and ethnically diverse with broad geographic 
representation.
    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 mention someone's sexual orientation, and 
rather focus on risk factors that might expose a potential 
donor to blood-borne illness. The Committee strongly recommends 
that NHLBI work with the FDA and remove or replace the 
recommended deferment of blood for men who have had sex with 
men in the last 12 months.
    Community Engagement Alliance Against COVID-19 Disparities 
(CEAL) Initiative.--The Committee includes $30,000,000 for the 
new CEAL initiative, the same as the fiscal year 2022 budget 
request. This initiative will connect researchers with 
community organizations and leaders to conduct outreach and 
increase participation of people from underrepresented 
communities in clinical trials for COVID-19 treatments and 
vaccines.
    COVID-19-Associated Illnesses.--The Committee recognizes 
the growing burden of COVID-associated critical illnesses, 
including sepsis and pneumonia. The Committee encourages NHLBI 
to accelerate research into sepsis, pneumonia, and acute lung 
injury.
    Duchenne Muscular Dystrophy.--In light of improvements in 
care leading to patients living into their third decade, the 
leading cause of death in Duchenne Muscular Dystrophy patients 
is heart failure. The Committee urges NHLBI to support research 
that characterizes cardiomyopathy in Duchenne and Becker 
Muscular Dystrophy. There is a gap in the ability to develop 
novel cardiac therapeutics for Duchenne Muscular Dystrophy due 
to a lack of accepted cardiac outcome measures. The Committee 
encourages NHLBI to convene a workshop with research, clinical, 
and patient organization leaders to work towards establishing 
viable cardiac outcome measures for the development of 
therapeutic agents to combat cardiomyopathy.
    Health Disparities Research.--The COVID-19 pandemic has 
highlighted and exacerbated health disparities in the U.S. The 
Committee includes an increase of $50,000,000 for NHLBI to 
support research related to identifying and reducing health 
disparities, the same as the fiscal year 2022 budget request.
    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 ``long haul'' health 
conditions, including serious respiratory diseases such as 
acute respiratory distress syndrome and pulmonary fibrosis. The 
Committee urges NHLBI to prioritize research into the 
understanding, treatment and prevention of ``long haul'' post-
COVID respiratory conditions, particularly among minority 
populations disproportionately impacted by COVID-19.
    Lymphedema (LE).--LE is a chronic, debilitating, and 
incurable swelling that can be a result of damage to the 
lymphatic system due to surgery, cancer treatment, or injury, 
and that can also be inherited. An estimated 10,000,000 
Americans suffer from LE. Additional research is necessary to 
improve our understanding of this condition and expand the 
treatment options available. The Committee directs NHLBI to 
increase support for research on LE and to establish a Research 
Condition Disease Categorization category for research related 
to lymphedema.
    Mitral Valve Prolapse (MVP) Workshop.--MVP is a common 
valve disease that has an estimated 2.4 percent prevalence. 
Though most cases are thought to be benign, reported 
complications such as severe mitral regurgitation and 
arrythmias can result in sudden cardiac death (SCD). Medical 
research has found an association between MVP and SCD. 
Predictors of this outcome, however, are not readily available, 
underlying mechanisms are poorly understood, and indicators of 
high-risk individuals are lacking. Despite several studies, 
there is not sufficient data to generate guidelines for care of 
patients with valvular heart disease, including MVP. The 
Committee encourages NHLBI to convene a workshop of subject 
matter experts to identify research needs and opportunities 
with the goal of informing guidelines for treatment of patients 
with MVP.
    National Commission on Lymphatic Diseases.--The Committee 
directs NIH to establish a National Commission on Lymphatic 
Diseases and to engage with relevant Institutes, Centers, and 
external stakeholders in establishing this Commission. The 
Committee directs NIH to provide an update on progress to 
establish the Commission within 60 days of the enactment of 
this Act.
    National Chronic Obstructive Pulmonary Disease (COPD) 
Action Plan.--The Committee notes NHLBI's role in crafting the 
National COPD Action Plan. NHLBI is encouraged to continue this 
important work by supporting additional research activities and 
collaborating with other Public Health Service agencies to 
facilitate implementation of the plan's recommendations.
    Polycystic Kidney Disease.--The Committee commends NIDDK 
for its continued commitment to Polycystic Kidney Disease 
Research and Translation Centers and the Pediatric Centers of 
Excellence in Nephrology, which improve our understanding of 
the causes of autosomal dominant polycystic kidney disease and 
autosomal recessive polycystic kidney disease. The Committee 
encourages NIDDK to ensure that funds previously committed for 
polycystic kidney disease research centers remain dedicated to 
funding other PKD research efforts.
    Pulmonary Fibrosis (PF).--The Committee recognizes that PF 
is a family of more than 200 different lung diseases that all 
look very much alike despite having a variety of causes. This 
heterogeneity presents significant challenges for diagnosis and 
treatment. The Committee commends NHLBI for its recent efforts 
to apply the principles of precision medicine to PF research, 
especially by funding a major new study that will evaluate a 
promising treatment for a subset of patients with a particular 
gene variant. This study, known as PRECISIONS, also aims to 
identify genetic variants that play a role in certain forms of 
PF. The Committee urges NHLBI to prioritize basic research on 
PF, particularly to better understand the causes and process of 
scarring and the varying impacts on patients.
    Sickle Cell Disease (SCD) Research.--The Committee commends 
NIH for its ongoing support of clinical research for SCD, which 
imposes major morbidity on an estimated 90,000 to 100,000 
individuals in the U.S., with three million Americans carrying 
the sickle cell trait. The Committee encourages NIH to support 
clinical trials for prenatal and postnatal treatment of SCD, 
which includes multiple promising approaches to eradicate this 
disease, save lives, and reduce dramatically the substantial 
health care costs associated with SCD for children and adults. 
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.
    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 the NHLBI to robustly fund The Heart Truth 
program.
    Thalassemia.--Recent studies have shown that the length of 
time between when blood is donated and transfused does not 
impact outcomes for patients in need of an emergency blood 
transfusion, such as in cases of trauma or acute events. 
However, these studies do not determine the impact on 
chronically transfused patients, such as those with 
thalassemia, in which an administration of older red cells may 
exacerbate iron loading in the heart and other internal organs 
and contribute to worse outcomes for patients. The Committee 
urges NHLBI to establish research initiatives to address 
current gaps in clinical understanding in this area.
    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. 
Additionally, the Committee supports efforts by NIH to convene 
a workshop of subject matter experts to identify research needs 
and opportunities with the goal of informing guidelines for 
treatment of patients with valvular heart disease.
    Vascular Dementia.--A growing number of Americans are 
developing severe forms of vascular dementia, conditions 
resulting from many years of living with chronic diseases such 
as hypertension and cardiovascular disease. This prevalence is 
especially high in areas with high rates of hypertension, 
obesity, and lack of access to regular health care. 
Epidemiological studies and human pathology studies have 
demonstrated association of vascular risk factors, vascular 
diseases, and pathology with dementia. Research in animal 
models could further investigate causal relationships, 
understand mechanisms, and test novel interventions (including 
repurposing existing drugs). Study of the mechanisms of 
vascular dementia can help researchers to understand causation, 
develop new treatment therapies and study how to repurpose 
existing drugs to delay or halt disease progression. The 
Committee encourages NHLBI to continue its support for 
investigating potential relationship between vascular disease 
and risk factors for vascular dementia, leveraging the work of 
well-established longitudinal cohort studies of dementia and 
cardiovascular disease and experimental models well 
characterized phenotypes and mechanisms. The Committee 
encourages NHLBI to coordinate this research with NIA and NINDS 
to ensure that the continuum of research from basic science to 
observational cohort to clinical trial to implementation is 
maintained.

     NATIONAL INSTITUTE OF DENTAL AND CRANIOFACIAL RESEARCH (NIDCR)

 
 
 
Appropriation, fiscal year 2021.......................      $484,867,000
Budget request, fiscal year 2022......................       516,197,000
Committee Recommendation..............................       519,010,000
    Change from enacted level.........................       +34,143,000
    Change from budget request........................        +2,813,000
 

    Mission.--The mission of NIDCR is to improve dental, oral, 
and craniofacial health through research, research training, 
and the dissemination of health information.
    Dental Restorative Materials.--To help address one of the 
U.S. commitments under the Minamata Convention on Mercury, the 
Committee encourages NIDCR to conduct additional research on 
durable mercury-free dental restorative materials.
    Opioids and Pain/Pain Management Research.--The Committee 
includes an increase of $18,000,000 for NIDCR to support 
research related to opioids, pain, and pain management, as 
requested in the fiscal year 2022 budget.
    Oral Microbiome.--The Committee appreciates NIDCR's 
leadership in microbiome research, including its support of the 
Human Oral Microbiome Database. The Committee encourages NIDCR 
to build upon its microbiome research to discover and better 
understand the microbiome's connection to overall health, 
including its influence on preventing and treating illness and 
disease.
    SARS-CoV-2.--The Committee thanks NIDCR for its commitment 
to prioritizing research to answer critical research questions 
related to the novel coronavirus. The Institute's research into 
high-impact areas such as transmission risk in dental 
environments is critical for the nation to continue fighting 
COVID-19 and to ensure everyone is as safe as possible.
    Report on Oral Health in America.--The Committee greatly 
appreciates NIDCR's leadership on the upcoming Report ``Oral 
Health in America: Advances and Challenges''. The Committee 
anticipates the final release of the report and encourages 
NIDCR to utilize the findings of the 2021 Report to identify 
research gaps across dental, oral, and craniofacial research 
and to pursue research opportunities to fill those gaps.

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

 
 
 
Appropriation, fiscal year 2021.......................    $2,131,975,000
Budget request, fiscal year 2022......................     2,219,298,000
Committee Recommendation..............................     2,237,625,000
    Change from enacted level.........................      +105,650,000
    Change from budget request........................       +18,327,000
 

    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.
    End-Stage Renal Disease (ESRD).--The Committee continues to 
note the important work in supporting critical kidney research 
that NIDDK has accomplished on ESRD. The Committee encourages 
NIDDK to work with stakeholders to facilitate new opportunities 
for research in related conditions.
    Glomerular Disease.--The Committee continues to support the 
important work that the Cure Glomeruloneuropathy (CureGN) 
initiative has accomplished, which has led to breakthroughs for 
critical clinical trials. The Committee encourages NIDDK to 
continue supporting research on related conditions such as 
minimal change disease.
    Inflammatory Bowel Diseases (IBD).--The Committee 
encourages NIDDK to continue pursuing bedside-to-bench research 
in IBD with a focus on biological and clinical drivers of 
patient remission and relapse in Crohn's disease and ulcerative 
colitis, including mucosal healing as well as environmental 
triggers such as nutrition and psychological stress. The 
Committee recognizes the importance of having common data 
elements (CDE), standardizing the clinical categorization of 
IBD patients, to facilitate the sharing, validation, and 
comparison of results across research studies, and commends the 
work many Institutes and Centers have done to support 
development of CDEs for a number of diseases and disorders. To 
effectively support bedside-to-bench research in IBD, the 
Committee encourages the Institute to support the development 
of CDEs and to collaborate with other IBD researchers and 
organizations.
    Interstitial Cystitis.--The Committee notes the progress of 
interstitial cystitis research through the Multidisciplinary 
Approach to the Study of Chronic Pelvic Pain (MAPP) Program and 
encourages NIDDK and stakeholders to continue collaboration on 
a comprehensive state of the science conference to examine 
mechanisms for scientific opportunity. The Committee requests 
an update on the progress of the conference in the fiscal year 
2023 Congressional Budget Justification.
    Liver Disease and Health Disparities.--The Committee notes 
the relationship between health disparities and a variety of 
conditions of the liver, such as nonalcoholic steatohepatitis 
(NASH) and nonalcoholic fatty liver disease (NAFLD). The 
Committee encourages NIDDK to continue to work with NIMHD and 
other Institutes and Centers to advance liver disease research 
in a comprehensive and impactful way.
    Opioids and Pain/Pain Management Research.--The Committee 
includes an increase of $20,000,000 for NIDDK to support 
research related to opioids, pain, and pain management, as 
requested in the fiscal year 2022 budget.
    Pediatric Nephrology Workforce Diversification.--The 
Committee recognizes that the COVID-19 pandemic caused 
unprecedented disruption in biomedical research, delaying 
awards and dissuading applications for pediatric nephrology 
research. The Committee is concerned that these disruptions 
have disproportionately impacted researchers from traditionally 
underrepresented groups, resulting in even fewer researchers 
from communities of color. Pediatric nephrology studies 
continue to suffer from low enrollment, due in part to the 
disproportionate impact of kidney disease on children of color 
and longstanding challenges of clinical trial recruitment 
within those communities. Because children and families of 
color are more likely to enroll in studies where the research 
team is from the same community, the diversity of pediatric 
nephrology biomedical workforce is paramount to the success of 
this research. The Committee requests that NIDDK consult with 
stakeholder groups to identify barriers to increasing the 
diversity of the pediatric nephrology workforce and identify 
ways to incentivize researchers from traditionally 
underrepresented groups to enter this field. The Committee 
requests that NIDDK include information in the fiscal year 2023 
Congressional Budget Justification on the progress made to 
bolster the diversity of the pediatric nephrology biomedical 
research workforce.
    Prostate Cancer Disparities.--Nearly 250,000 men will be 
diagnosed with and 34,000 men will die from prostate cancer in 
2021. Incidence of prostate cancer is almost 80 percent higher 
in non-Hispanic Black men, and prostate cancer mortality among 
Black men is more than double that of men in every other racial 
or ethnic group, representing a stark example of health 
inequity in cancer outcomes. The Committee supports NCI and 
NIMHD research on Prostate Cancer in Men of African American 
Ancestry: Defining the Roles of Genetics Tumor Markers, and 
Social Stress (RESPOND) Study, intended to identify the 
underlying causes of disparities in prostate cancer incidence 
and mortality. The Committee requests an update on the study in 
the fiscal year 2023 Congressional Budget Justification.

    NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKE (NINDS)

 
 
 
Appropriation, fiscal year 2021.......................    $2,513,393,000
Budget request, fiscal year 2022......................     2,783,300,000
Committee Recommendation..............................     2,799,515,000
    Change from enacted level.........................      +286,122,000
    Change from budget request........................       +16,215,000
 

    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.
    BRAIN Initiative.--The Committee directs NIH to transfer 
$76,000,000 from the NIH Innovation Account to NINDS to support 
the BRAIN Initiative. These funds were authorized in the 21st 
Century Cures Act (P.L. 114-255). 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 (CP) Research.--The Committee commends NIH 
for supporting research on mechanisms leading to CP, health 
outcomes for those affected, biomarkers that may aid in 
diagnosis or treatment selection, and interventions for 
treatment and prevention of CP. The Committee strongly 
encourages NIH to strengthen, accelerate, and coordinate 
cerebral palsy research priorities across the lifespan 
identified in the 2017 NINDS/NICHD Strategic Plan for CP 
Research, such as basic and translational discoveries, 
including neuroprotective, regenerative medicine and mechanisms 
of neuroplasticity, as well as implementation and clinical 
studies aimed at early detection and intervention, comparative 
effectiveness, and functional outcomes. The Committee 
encourages that a follow-up workshop be held in 2022 in 
conjunction with key stakeholders to provide updates on 
promising research performed to date, with the goal to further 
refine or expand the opportunities that were identified in the 
five to 10 year NIH strategic plan, including early detection 
and intervention.
    Duchenne Muscular Dystrophy.--While the expression of the 
dystrophin protein in the brain is recognized, our 
understanding of the link between the absence of dystrophin and 
related neurobehavioral/cognitive diagnosis is not well 
understood. The Committee urges NINDS to support research to 
characterize the role of dystrophin in the brain and to further 
define the relationships between mutation and neurobehavioral 
and cognitive diagnosis.
    Dystonia.--The Committee continues to urge NINDS to 
implement the recommendations from the NINDS workshop 
``Defining Emergent Opportunities in Dystonia Research'' and 
engage with other Institutes and stakeholders on advancing 
translational research that may lead to more treatment options 
for those affected by dystonia.
    Expanded Access to ALS Treatments.--The Committee supports 
efforts to expand access for neurodegenerative diseases with no 
disease modifying treatments. The Committee encourages NINDS to 
collaborate with stakeholders to expand access for patients 
unable to access treatment through clinical trials.
    Headache Disorders.--Migraine is a leading cause of 
disability, affecting more than 17 percent of people in the 
U.S. The statutory language providing authority for Helping End 
Addiction Long-Term (HEAL) Initiative cites the necessity of 
attending to disease burden in prioritizing HEAL research 
programs (42 U.S. Code Sec.  284q 1). The Committee encourages 
NIH to consider HEAL Initiative support of fundamental, 
translational, clinical, and social science research on 
headache disorders, as appropriate to the mission of the HEAL 
initiative, to provide lasting scientific solutions to the 
opioid crisis. HEAL has invested in resources and 
infrastructure developed to support pain research across all 
pain conditions and should continue to encourage application 
submissions on headache disorders, as well as those on pain 
conditions for which opioid use and prescribing is highly 
prevalent. Headache disorders research supported through the 
HEAL initiative should supplement, not supplant, current 
funding for headache disorders research at NIH, which has 
contributed to many of the effective non-opioid treatments for 
headache.
    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 and Stimulant Research.--The Committee includes 
$405,400,000 million within NINDS for the Helping to End 
Addiction Long-Term (HEAL) Initiative, $135,105,000 above the 
fiscal year 2021 enacted level and the same as the fiscal year 
2022 budget request. The HEAL Initiative is a trans-NIH effort 
to accelerate scientific discovery related to prevention and 
treatment of opioid use disorder and developing nonaddictive 
alternatives for pain management. The Committee also includes 
an additional $43,000,000 in NINDS to support basic research 
related to opioids and pain, as requested in the fiscal year 
2022 budget.
    Parkinson's Disease (PD).--The Committee commends NINDS for 
taking critical steps in identifying priority recommendations 
to advance research on PD, which impacts between 500,000 and 
1,500,000 people in the U.S. and is the second most prevalent 
neurodegenerative disease in this country. 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 of 
its progress on implementing these recommendations in the 
fiscal year 2023 Congressional Budget Justification.
    Sleep Disorders.--The Committee notes the leadership of 
NINDS in advancing research into underrepresented sleep 
disorders, such as narcolepsy, restless legs syndrome, and 
Kleine Levin Syndrome. The Committee encourages NINDS to 
bolster these activities and review the state of the science 
around sleep disorders to better advance initiatives that 
advance scientific understanding of specific sleep disorders 
impacting patients.

     NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES (NIAID)

 
 
 
Appropriation, fiscal year 2021.......................    $6,069,619,000
Budget request, fiscal year 2022......................     6,245,926,000
Committee Recommendation..............................     6,557,803,000
    Change from enacted level.........................      +488,184,000
    Change from budget request........................      +311,877,000
 

    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.
    Antiviral Drugs and Pandemic Preparedness.--The Committee 
strongly encourages NIAID efforts to establish a public-private 
partnership focused on global pandemic preparedness and 
antiviral drug discovery, in coordination with BARDA. Such a 
partnership could leverage the best of academia and 
pharmaceutical manufacturers to develop broad-spectrum 
antiviral drugs to address rapidly emerging public health 
threats, helping our nation be better prepared for the next 
global pandemic. The Committee directs NIAID to provide an 
update on this and any related efforts in the fiscal year 2023 
Congressional Budget Justification.
    Celiac Disease.--The Committee encourages NIH to devote 
focused research to the study of celiac disease, including the 
autoimmune causation underpinning the affliction. Today, the 
only known treatment for this disease is a gluten-free diet; 
however, recent public and private sector research confirms 
that such a treatment is insufficient for many who suffer from 
celiac disease. Therefore, the Committee urges NIAID to support 
new research on celiac disease, to better coordinate existing 
research, and to focus new research towards diagnosing and 
effectively treating this condition. The Committee also 
strongly encourages NIH to establish a Research Condition, 
Disease Categorization (RCDC) for celiac disease and a Notice 
of Special Interest to spur additional research.
    Centers for AIDS Research.--As part of the Ending the HIV 
Epidemic initiative, the Committee includes $71,000,000 for the 
Centers for AIDS Research, an increase of $10,000,000 above the 
estimated fiscal year 2021 enacted level and the same as the 
fiscal year 2022 budget request. These Centers offer evidence-
based practices on prevention and treatment to initiative 
partners and support for evaluating the initiative.
    Combating Antibiotic-Resistant Bacteria.--The Committee 
supports NIAID's efforts related to combating antibiotic-
resistant bacteria. These funds enable NIAID to support 
research on antimicrobial (drug) resistance, including basic 
research on how microbes develop resistance, new and faster 
diagnostics, and clinical trials designed to find new vaccines 
and treatments effective against drug-resistant microbes.
    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 $12,200,000, an increase of $6,100,000, 
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.
    Emerging Diseases.--The Committee supports the work of 
NIAID in researching emerging coronaviruses, and urges NIAID to 
fund basic science on a host of deadly viruses, including SARS-
CoV-2, Ebola, Marburg, and Nipah viruses. The Committee notes 
the importance of using high containment BSL-3 and BSL-4 labs 
in this effort. The Committee is aware of the success of non-
animal approaches to identify how viral proteins interact with 
host proteins and their pathways. The Committee notes the 
success of these approaches with SARS-CoV-2 to identify new 
therapeutic approaches. The Committee encourages NIAID to 
support research into viruses, including Ebola, Marburg, and 
Nipah viruses, to help identify small molecule drugs to block 
infection by a host of deadly viruses.
    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 the 
commitment to the HAE research at this critical time.
    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 of the first safe and effective 
microbicide for women and supporting an active ARV-based 
microbicide pipeline to produce additional solutions to prevent 
HIV and to help end the epidemic.
    Rapid Vaccine Development Platforms for Emerging Infectious 
Disease.--The Committee recognizes the importance of being able 
to quickly, efficiently, and safely develop and manufacture 
vaccines against emerging infectious diseases. Vaccines play a 
pivotal role in host protection against infectious diseases and 
have significantly reduced mortality worldwide. Older methods 
of developing vaccines are no match for a host of emerging and 
reemerging pathogens that call for a tailored and speedy 
response, such as the developing coronavirus variants. Today, 
innovations in how vaccines are developed enable faster 
production of platforms capable of making and initially testing 
a new vaccine in less than 120 days that then are tailored to 
specific pathogens as manufacturing begins, based on science 
and data, not speculation. Such rapid vaccine platform 
technologies can vastly decrease the time it takes to develop, 
manufacture and distribute vaccines. Therefore, the Committee 
includes $50,000,000 to support research and development of 
rapid vaccine platform technologies and requests a briefing on 
these efforts within 180 days of enactment of this Act.
    Regional Biocontainment Laboratories (RBLs).--The Committee 
commends NIAID for issuing a Request for Applications (RFA) to 
support the RBLs through the RFA for Facility and Building 
System Upgrades Support for the RBLs. The Committee encourages 
NIAID to continue supporting meritorious research applications 
from investigators conducting research through the RBLs on 
efforts to prevent, prepare for, and respond to infectious 
disease outbreaks, including, but not limited to: (1) 
conducting research on developing testing for antiviral 
compounds, new vaccines, and point of care tests; (2) 
conducting research on validating methods for identifying 
suitable prophylactic methods to prevent infections; and (3) 
training new researchers in biosafety level 3 practices.
    Universal Influenza Vaccine.--The Committee includes no 
less than $250,000,000, an increase of $30,000,000 over the 
fiscal year 2021 level and the fiscal year 2022 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.
    Valley Fever.--The Committee is encouraged by NIAID's 
recent announcement to establish collaborative 
coccidioidomycosis (Valley Fever) research centers. To guide 
this continuing work, the Committee requests, within 180 days 
of enactment of this Act, a 10-year strategic plan from NIH 
with the objective of producing a Valley Fever vaccine by 2031. 
This plan should include, but not be limited to: (1) a 
statement of science on Valley Fever, including disease burden 
in the U.S.; (2) identifiable and achievable benchmarks for 
Valley Fever vaccine development, including vaccine market 
viability; (3) identifying or developing funding priorities and 
opportunities that actively support the development of a Valley 
Fever vaccine; and (4) any recommendations to Congress on 
policy reforms designed to help develop a Valley Fever vaccine. 
Furthermore, the Committee directs NIAID to convene a 
stakeholder and researchers conference in an endemic region to 
help guide the strategic plan's development. The Committee 
requests an update in the fiscal year 2023 Congressional Budget 
Justification on progress towards achieving goals in this 
strategic plan.
    Viral Vector Platforms.--The Committee notes that viral 
vector platforms have a proven track record for successfully 
producing vaccines against infectious diseases for many decades 
and believes well-established viral vectors with a robust 
safety record for use in children, pregnant women, or other 
high-risk populations should be continuously developed and 
adjusted to potential emerging infections in the future. The 
Committee encourages investments in vaccine centers with long-
term experience in the development of viral vectors covering 
multiple virus-based vaccine platforms, with particular 
emphasis on entities that have established collaborations with 
high-security facilities (BSL-4) for preclinical studies.

         NATIONAL INSTITUTE OF GENERAL MEDICAL SCIENCES (NIGMS)

 
 
 
Appropriation, fiscal year 2021.......................    $2,991,417,000
Budget request, fiscal year 2022......................     3,096,103,000
Committee Recommendation..............................     3,139,656,000
    Change from enacted level.........................      +148,239,000
    Change from budget request........................       +43,553,000
 

    Mission.--NIGMS supports basic research that increases our 
understanding of biological processes and lays the foundation 
for advances in disease diagnosis, treatment, and prevention.
    Increasing Diversity in Biomedical Research.--The Committee 
has long sought to promote opportunities for the Nation's next 
generation of researchers and enhance diversity in biomedical 
research. Early-stage researchers, particularly women and 
racial and ethnic minorities, spend longer periods of time in 
postdoctoral positions with lower salaries, receive inadequate 
mentorship, and are offered fewer opportunities for 
professional advancement, resulting in lower retention rates 
for these groups. Even with these obstacles, many early-stage 
researchers tackle riskier projects and have seen positive 
outcomes for the benefit of society. Grant programs offering 
support and opportunities for researchers at key career 
transition points requiring little or no preliminary data, are 
critical to ensuring innovative scientists from diverse 
backgrounds succeed in biomedical research. The Committee 
provides an increase of $20,000,000 for NIGMS for programs, 
including but not limited to the Maximizing Opportunities for 
Scientific and Academic Independent Careers (MOSAIC), Minority 
Access to Research Careers (MARC), Bridges to the 
Baccalaureate, and Undergraduate Research Training Initiative 
for Student Enhancement (U RISE) programs, that train the next 
generation of scientists while enhancing the diversity of the 
biomedical research workforce and enabling promising scientists 
to pursue high-risk, high-reward research.
    Institutional Development Awards (IDeA).--The Committee 
provides $415,000,000 for IDeA, $18,427,000 above the fiscal 
year 2021 enacted level. IDeA supports high-quality research 
and investigators throughout the country in States in which the 
success rate for NIH grants has been historically low.

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

 
 
 
Appropriation, fiscal year 2021.......................    $1,590,337,000
Budget request, fiscal year 2022......................     1,942,117,000
Committee Recommendation..............................     1,689,786,000
    Change from enacted level.........................       +99,449,000
    Change from budget request........................      -252,331,000
 

    Mission.--NICHD investigates human development throughout 
the entire life process, with a focus on understanding 
disabilities and important events that occur during pregnancy.
    The Committee commends the important role that NICHD has 
historically served to support research in the areas of 
behavioral health, cognition, development of young children, 
language, learning differences, and school readiness. The COVID 
pandemic has only increased the importance of research in these 
areas, such as the long-term consequences of social isolation 
or emotional development after a year of inconsistent in-person 
school attendance. Accordingly, the Committee encourages NICHD 
to prioritize ongoing investment in these areas.
    Endometriosis Research.--The Committee urges NICHD to 
expand funding for basic, clinical, and translational research 
into the mechanics of endometriosis, identify early diagnostic 
markets, and develop new treatment methods.
    Human Milk Research.--The Committee encourages NICHD to 
continue to support human milk research through peer-reviewed 
scientific research and graduate and postdoctoral fellowships. 
The Committee encourages NICHD to connect at least four, but 
not more than 10, centers for human milk research to establish 
a research center network to support shared resources and 
facilities for human milk research and any required 
infrastructure.
    Impact of COVID-19 on Children.--The Committee includes an 
increase of $15,000,000, as requested in the fiscal year 2022 
budget, for NICHD to support additional research into 
multisystem inflammatory syndrome in children (MIS-C) and other 
ways in which COVID-19 affects children. The Committee looks 
forward to receiving NIH's SARS-CoV-2 pediatric research agenda 
and asks NIH to continue identifying research needs focused on 
the novel coronavirus impacts on children and adolescents, 
exploring how pediatric patients have been included in current 
NIH SARS-CoV-2 research and clinical trials, investigating any 
disparities that have emerged in how children of different 
communities have been affected, assessing the risk and 
protective factors children may produce against COVID-19 
antigens, investigating longer-term impacts of SARS-CoV-2 on 
child health, and pursuing research focused on treatments and 
prevention methods for SARS-CoV-2 focused on children and 
adolescents when carrying out this agenda.
    Learning Disabilities Research Centers and Learning 
Disabilities Innovation Hubs.--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 
the only 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 supports research to 
identify new proteins and sperm structures that are necessary 
for normal sperm function and, consequently, for fertility and 
healthy embryo development.
    Maternal Health Research.--The Committee includes an 
increase of $30,000,000 for the Implementing a Maternal Health 
and Pregnancy Outcomes Vision for Everyone (IMPROVE) 
Initiative, as requested in the fiscal year 2022 budget. 
Maternal mortality in the U.S. is higher than in other 
industrialized nations, and there are disparities in maternal 
outcomes across the country. For example, Black women 
experience maternal mortality at nearly four times the rate of 
White women. 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. The initiative uses an integrated approach to 
understand biological, behavioral, sociocultural, and 
structural factors that affect severe maternal mortality and 
maternal mortality (SMM/MM) by building an evidence base for 
improved care and outcomes in specific regions of the country. 
IMPROVE will target health disparities associated with SMM/MM 
by (1) implementing and evaluating community-based 
interventions for disproportionately affected women (e.g., 
African American, American Indian/Alaska Native, advanced 
maternal age, low socioeconomic status, and rural populations), 
and (2) identifying risk factors and the underlying biological 
mechanisms associated with leading causes of SMM/MM, including 
cardiovascular disease, infection and immunity, and mental 
health.
    Population Research.--The Committee applauds NICHD for 
supporting many of the Nation's most used prospective, 
population-representative longitudinal studies, including the 
Fragile Families and Child Wellbeing Study, Panel Study of 
Income Dynamics Child Supplement Survey, and National 
Longitudinal Survey of Youth, and also for supporting research 
and research training through the NICHD Population Dynamics 
Centers Research Infrastructure Program. Given the dearth of 
data being collected regarding the short and long-term social, 
economic, developmental, and health effects of the COVID 
pandemic on children and families, the Committee urges NICHD to 
consider expanding data collection and research through these 
existing surveys and the Centers Program. Further, the 
Committee encourages NICHD to explore the use of existing and 
new mechanisms to enhance research regarding the effect of 
COVID on fertility trends and reproductive health overall. 
Finally, the Committee urges NICHD to expand data collection 
and research regarding maternal, infant, child, and adolescent 
mortality. The Committee asks that NICHD report on its progress 
to enhance and expand these research and survey activities 
within 90 days of enactment of this Act.
    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 
(PRGLAC) 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 
NICHD, along with other relevant Institutes and Centers, CDC, 
and FDA, to continue to implement PRGLAC recommendations to the 
extent appropriate and feasible under the legal authorities 
available to the Secretary.
    Additionally, The Committee includes $1,500,000 within 
NICHD to contract with the National Academies of Science, 
Education, and Medicine (NASEM) to convene a panel with 
specific legal, ethical, regulatory, and policy expertise to 
develop a framework for addressing medicolegal and liability 
issues when planning or conducting research specific to 
pregnant people and lactating people. Specifically, this panel 
should include individuals with ethical and legal expertise in 
clinical trials and research; regulatory expertise; plaintiffs' 
attorneys; pharmaceutical representatives with tort liability 
and research expertise; insurance industry representatives; 
Federally funded researchers who work with pregnant and 
lactating women; representatives of institutional review boards 
(IRBs); and health policy experts.
    Uterine Fibroids.--Nationally, an estimated 26,000,000 
individuals ages 15 to 50 have diagnosed uterine fibroids. 
Uterine fibroids are the most common gynecological condition, 
but individuals are frequently unaware that the symptoms of 
this condition, including heavy menstrual bleeding, pain, and 
frequent urination during periods, are abnormal. Fibroids 
contribute to significant negative health outcomes including 
chronic pain, iron deficiency and anemia, miscarriage, and/or 
infertility. The Committee strongly urges the NICHD to 
prioritize funding to expand basic, clinical, and translational 
research into the mechanics of fibroids, identification of 
early diagnostic methods, and fertility-preserving treatments. 
Research focusing on understanding the significant health 
disparities among individuals with fibroids should also be 
prioritized, given that Black women are at increased risk for 
fibroids, tend to develop symptoms at a younger age, and suffer 
more severe symptoms.

                      NATIONAL EYE INSTITUTE (NEI)

 
 
 
Appropriation, fiscal year 2021.......................      $835,714,000
Budget request, fiscal year 2022......................       858,535,000
Committee Recommendation..............................       877,129,000
    Change from enacted level.........................       +41,415,000
    Change from budget request........................       +18,594,000
 

    Mission.--NEI conducts and supports basic and clinical 
research, research training, and other programs with respect to 
blinding eye diseases, visual disorders, and mechanisms of 
visual function, preservation of sight, and the special health 
problems and needs of individuals who are visually-impaired or 
blind.
    Blepharospasm.--The Committee notes the work of NEI in 
expanding research into blepharospasm, a form of dystonia, and 
requests an update on collaboration amongst stakeholders and 
other Institutes and Centers.

      NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES (NIEHS)

 
 
 
Appropriation, fiscal year 2021.......................      $814,675,000
Budget request, fiscal year 2022......................       937,107,000
Committee Recommendation..............................       941,799,000
    Change from enacted level.........................      +127,124,000
    Change from budget request........................        +4,692,000
 

    Mission.--NIEHS's mission is to discover how the 
environment affects people in order to promote healthier lives.
    Climate Change Research.--The Committee includes an 
increase of $100,000,000, the same as the fiscal year 2022 
budget request, for NIEHS to support research on the impact of 
climate change on human health.
    Harmful Algal Blooms Research.--The Committee recognizes 
the value of the NIEHS mission and the NIEHS NSF jointly-funded 
Oceans and Human Health Program as a means to increase 
scientific knowledge about short-term and long-term human 
health effects potentially associated with acute and chronic 
exposures to toxins produced by harmful algal blooms (HABs). 
The Committee recognizes the increasing relevance of this 
scientific research to communities directly affected by HABs, 
including Florida, where a 16-month bloom one of the longest 
documented HABs in the State's history occurred from late 2017 
through early 2019. The Committee encourages NIEHS to continue 
investing in this research area using its competitive, peer-
reviewed grantmaking processes. In particular, the Committee 
notes growing scientific interest in the use of 
multidisciplinary approaches to investigate respiratory 
irritation or illness associated with inhalation of aerosolized 
HAB toxins and with neurotoxic shellfish poisoning arising from 
ingestion of contaminated seafood. 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.
    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 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 2023 Congressional Budget Justification.

                   NATIONAL INSTITUTE ON AGING (NIA)

 
 
 
Appropriation, fiscal year 2021.......................    $3,899,227,000
Budget request, fiscal year 2022......................     4,035,591,000
Committee Recommendation..............................     4,258,049,000
    Change from enacted level.........................      +358,822,000
    Change from budget request........................      +222,458,000
 

    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.--In recognition 
that Alzheimer's disease poses a serious threat to the nation's 
long-term health and economic stability, the Committee 
recommends a total of no less than $3,394,000,000 for 
Alzheimer's disease and related dementias research, 
$200,000,000 above the estimated fiscal year 2021 level and the 
fiscal year 2022 budget request.
    Center on Exposome Studies in Alzheimer's Disease and 
Related Dementias (ADRD).--The Committee recognizes the 
importance of mechanistic research to address ADRD disparities, 
including the social and contextual factors that contribute to 
increased risk for disease. The Committee directs NIA to 
establish research infrastructure in the form of a Center(s) on 
Exposome Studies in ADRD, which would enable the linkage of 
community and health system-level factors to biological 
outcomes including cellular and molecular mechanisms that lead 
to disease. This includes linking social and biological factors 
via characterization of the exposome, the measure of all the 
exposures of an individual over the life course (e.g. physical, 
chemical, environmental, social), characterized through a 
mechanistic disparities lens. The Committee includes 
$15,000,000 to facilitate these efforts to provide a 
cornerstone of health disparities operations to advance 
solutions, innovations, and cures.
    Diversity in Alzheimer's Disease Research.--The Committee 
commends NIA for its leadership in supporting longitudinal, 
population-based cohort studies into the causes of dementia. 
Since rural, poor, and minority populations may be at greater 
risk for dementia, the value and application of these studies 
are enhanced when they include individuals from various 
geographic, ethnic, socioeconomic, and generational 
backgrounds. The Committee urges NIA to continue to support 
diversity in its cohort studies, with the specific goal of 
better understanding disease burden and biomarkers by race and 
geographic region, as well as the underlying pathologies which 
may differ by race.
    Elder Abuse.--The Committee commends NIA for its research 
on developing linguistically and culturally appropriate tools 
to combat elder abuse and financial exploitation and improve 
the identification and reporting of elder abuse. The Committee 
is pleased by efforts to facilitate cross-Institute 
collaborations, such as the 2015 Workshop on Multiple 
Approaches to Understanding and Preventing Elder Abuse and 
Mistreatment. The Committee urges NIH to utilize innovative 
means such as inter-institute workshops, improved cross-agency 
coordination, or the Project ECHO telementoring model with 
aging professionals and housing providers to translate and 
disseminate information to combat elder abuse in diverse 
populations.
    Opioids and Pain/Pain Management Research.--The Committee 
includes an increase of $29,000,000 for NIA to support research 
related to opioids, pain, and pain management, as requested in 
the fiscal year 2022 budget.
    Overactive Bladder and Cognitive Impairment Treatment.--The 
Committee is concerned that anticholinergic medications 
commonly prescribed to treat overactive bladder, a condition 
that affects one in three older Americans, have been shown in 
recent studies to increase the risk of developing ADRD. The 
Committee believes that further research of anticholinergic 
medications as well as on alternatives to these treatments is 
urgently needed to establish certainty regarding the safety of 
these medications as a treatment option for overactive bladder 
in older adults. The Committee urges NIA to prioritize research 
grants and contracts that study the long-term use of 
anticholinergic medications and the risk of cognitive 
impairment and ADRD. The Committee requests an update on this 
issue and on research activities to advance safe and effective 
alternative treatments for overactive bladder in the fiscal 
year 2023 Congressional Budget Justification.
    Population Research.--The Committee praises NIA for 
supporting a scientifically innovative population aging 
research portfolio that reflects some of the Institute's, and 
Nation's, highest scientific priorities, including Alzheimer's 
disease and social inequality in health and the aging process. 
More research, however, is needed to understand the short and 
long-term social, behavioral, and economic health consequences 
of COVID-19 on older people and their families, which NIA is 
uniquely positioned to foster and support. Existing large-
scale, longitudinal and panel surveys, such as the Health and 
Retirement Study, the National Health and Aging Trends Study, 
and Understanding America Study, should be enhanced to 
facilitate scientific research on the complex, multifaceted 
effects of the pandemic on older, diverse populations. Further, 
the Committee encourages NIA to support the further development 
of data infrastructure to promote research on racial, ethnic, 
gender, and socioeconomic disparities in health and well-being 
in later life and the long-term effects of early life 
experiences. The Committee asks that NIA to report on its 
progress to enhance and expand these research and survey 
activities within 90 days of enactment of this Act.
    Prion Diseases.--The Committee encourages NIH to continue 
funding research proposals on prion diseases that could be 
relevant for 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.
    Thalassemia.--Thanks to significant advances in medical 
science, 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. Among these are female and male 
reproductive issues, the impact of non-disease related 
medicines, the relationship to diseases of aging such as ADRD, 
Parkinson's, arthritis, osteoporosis, and more. The Committee 
requests that NIA develop a plan to research comorbidities in 
thalassemia and other rare disease patient populations as they 
continue to age.

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

 
 
 
Appropriation, fiscal year 2021.......................      $634,292,000
Budget request, fiscal year 2022......................       680,186,000
Committee Recommendation..............................       679,410,000
    Change from enacted level.........................       +45,118,000
    Change from budget request........................          -776,000
 

    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.
    Opioids and Pain/Pain Management Research.--The Committee 
includes an increase of $24,000,000 for NIAMS to support 
research related to opioids, pain, and pain management, as 
requested in the fiscal year 2022 budget.
    Skin Disease Research Core Centers.--The Committee 
recognizes the important work at the Core Centers funded by 
NIAMS to conduct basic and clinical research on a variety of 
skin diseases, including inflammatory and infectious skin 
diseases. The Committee urges NIAMS to fund Centers with 
diverse geographic locations, and to encourage proposals that 
incorporate pediatric skin diseases and collaboration with 
diverse stakeholders, such as States or patient and provider 
groups.

   NATIONAL INSTITUTE ON DEAFNESS AND OTHER COMMUNICATION DISORDERS 
                                (NIDCD)

 
 
 
Appropriation, fiscal year 2021.......................      $498,076,000
Budget request, fiscal year 2022......................       511,792,000
Committee Recommendation..............................       522,758,000
    Change from enacted level.........................       +24,682,000
    Change from budget request........................       +10,966,000
 

    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.
    Spasmodic Dysphonia.--The Committee notes the research 
NIDCD continues to facilitate on spasmodic dysphonia. The 
Committee requests an update in the fiscal year 2023 
Congressional Budget Justificationon collaborative efforts with 
related Institutes, Centers, and stakeholders to advance 
critical research into all forms of dystonia, including 
spasmodic dysphonia.

             NATIONAL INSTITUTE OF NURSING RESEARCH (NINR)

 
 
 
Appropriation, fiscal year 2021.......................      $174,957,000
Budget request, fiscal year 2022......................       199,755,000
Committee Recommendation..............................       200,782,000
    Change from enacted level.........................       +25,825,000
    Change from budget request........................        +1,027,000
 

    Mission.--The mission of NINR is to promote and improve the 
health of individuals, families, and communities. To achieve 
this mission, NINR supports and conducts clinical and basic 
research and research training on health and illness, research 
that spans and integrates the behavioral and biological 
sciences, and develops the scientific basis for clinical 
practice.
    Health Disparities Research.--The Committee includes an 
increase of $20,000,000 for NINR to support research related to 
identifying and reducing health disparities, the same as the 
fiscal year 2022 budget request.

       NATIONAL INSTITUTE ON ALCOHOL ABUSE AND ALCOHOLISM (NIAAA)

 
 
 
Appropriation, fiscal year 2021.......................      $554,923,000
Budget request, fiscal year 2022......................       570,165,000
Committee Recommendation..............................       582,422,000
    Change from enacted level.........................       +27,499,000
    Change from budget request........................       +12,257,000
 

    Mission.--NIAAA's mission is to generate and disseminate 
fundamental knowledge about the 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.

                NATIONAL INSTITUTE ON DRUG ABUSE (NIDA)

 
 
 
Appropriation, fiscal year 2021.......................    $1,479,660,000
Budget request, fiscal year 2022......................     1,852,503,000
Committee Recommendation..............................     1,860,329,000
    Change from enacted level.........................      +380,669,000
    Change from budget request........................        +7,826,000
 

    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 related to the addiction in the U.S. The 
number of alcohol-related deaths doubled in the US from 1999 to 
2017, the age-adjusted rate of deaths involving synthetic 
opioids other than methadone increased 1,040 percent from 2013 
to 2019, and the use of psychostimulants increased 317 percent. 
One trait that is evident in every form of addiction is the 
excessive discounting of the future by the addicted person, who 
will value the immediate over benefits of the future. Episodic 
Future Thinking is a promising intervention that helps 
individuals who are predisposed to addiction consider the 
positive consequences of remaining sober 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, decision-science, engineering, 
and computer science to deploy Episodic Future Thinking 
intervention strategies across a range of addictions.
    Cannabis Research.--The Committee encourages NIDA to 
support coordinated, multidisciplinary cannabis research, 
including basic, clinical, and translational cannabis research 
and research on the health effects of cannabis use, potential 
therapeutic effects of cannabis use, and effects of cannabis 
legalization. NIDA is encouraged to support peer-reviewed 
scientific research, graduate and postdoctoral fellowships, and 
any required infrastructure, with priority given to research 
programs in States where State co-funding is available.
    Cannabidiol Research.--The Committee strongly believes that 
cannabidiol (CBD), cannabigerol (CBG), cannabichromene (CBC), 
minor cannabinoids, and terpenes--compounds found in cannabis--
may provide beneficial medicinal effects. However, there is 
insufficient scientific information about the short- and long-
term effects of these compounds. The Committee is also 
concerned that marijuana policies on the Federal level and in 
the States are being changed without the benefit of scientific 
research to help guide those decisions. Additional, coordinated 
research on a national scale is necessary to determine the 
toxicology and medicinal effects of these compounds. The 
Committee believes that NIH should consider significantly 
expanding funds to study the medicinal effects and toxicology 
of CBD, CBG, CBC, minor cannabinoids, and terpenes. This 
expanded effort should include funding of clinical trials with 
academic health centers to study the long-term medicinal 
benefits and toxicology of CBD, CBG, CBC, minor cannabinoids, 
and terpenes. The Committee encourages NIH 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.
    Drug Impairment Standards for Marijuana.--The Committee is 
concerned that development of a drug impairment standard for 
marijuana remains unlikely in the near term and encourages NIH 
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 behaviors that impact 
public health, such as drug-impaired driving. The Committee is 
aware that due to Drug Enforcement Administration restrictions 
on registered growers, the majority of Federal research using 
marijuana has been limited to marijuana produced by a single 
grower and encourages NIH, when possible, to undertake research 
that encompasses the diversity, quality, and potency of 
commonly available cannabis products.
    Kratom.--The Committee recognizes that 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 
directs NIDA to continue to invest in this important research, 
especially considering the increase in overdose deaths during 
the COVID-19 pandemic.
    Methamphetamine and Other Stimulants.--The Committee is 
concerned that, according to CDC, over 30,000 overdose deaths 
involved drugs in the drug categories that include 
methamphetamine and cocaine in 2019, an increase of over 
threefold since 2014. The sharp increase has led some to refer 
to stimulant overdoses as the ``fourth wave'' of the current 
drug addiction crisis in America following the rise of opioid-
related deaths involving prescription opioids, heroin, and 
fentanyl-related substances. Methamphetamine is highly 
addictive and there are no FDA-approved treatments for 
methamphetamine and other stimulant use disorders. The 
Committee continues to support NIDA's efforts to address the 
opioid crisis, has provided continued funding for the HEAL 
Initiative, and supports NIDA's efforts to combat the growing 
problem of methamphetamine and other stimulant use and related 
deaths.
    Opioid and Stimulant Research.--The Committee continues to 
be concerned about the opioid overdose epidemic and appreciates 
the important role that research plays in the various Federal 
initiatives aimed at this crisis. The Committee is also aware 
of the most recent data from CDC that shows opioid overdose 
fatalities increasing from 2018 to 2019, with the primary 
driver being the increased overdose deaths involving synthetic 
opioids, primarily illicitly manufactured fentanyls. To combat 
this crisis, the Committee includes $405,400,000 within NIDA 
for the HEAL Initiative, $135,105,000 above the fiscal year 
2021 enacted level and the same as the fiscal year 2022 budget 
request. The HEAL Initiative is a trans-NIH effort to 
accelerate scientific discovery related to prevention and 
treatment of opioid use disorder and developing nonaddictive 
alternatives for pain management. In response to rising rates 
of stimulant use and overdose, the Committee has included 
language expanding the allowable use of these funds to include 
research related to stimulant use and addiction. The Committee 
also includes an additional $196,300,000 in NIDA to support 
basic research related to opioids and other stimulants, as 
requested in the fiscal year 2022 budget.
    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 directs NIH, in 
consultation with CDC, to provide a report to the Committee no 
later than 180 days after the enactment of this Act that 
provides an updated literature review and evaluation on the 
potential public health impact of overdose prevention centers 
in the U.S.
    Pain Prescribing Education.--The Committee encourages NIDA 
to continue and expand efforts to educate physicians and other 
medical professionals on safe prescribing for pain and managing 
patients who abuse prescription opioids, as well as best 
practices for incorporating substance misuse and addiction 
screening and treatment into their clinical practices.
    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). 
NIDA should 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 
recommends that NIDA continue to support the education of 
scientists and practitioners to find improved prevention and 
treatments for substance use disorders.
    Schedule I Drug Research.--The Committee recognizes that, 
despite marijuana being legalized in some form in 35 States and 
nearly 45,000,000 American adults reporting having used 
marijuana in the past year, research on marijuana and other 
Schedule I substances is extremely limited. The Committee 
directs NIH, in collaboration with FDA, DEA, ONDCP, and any 
other relevant agencies, to develop an approach to facilitate 
access to Schedule I drugs for research.
    Sleep and Circadian-Dependent Mechanisms Contributing to 
Opioid Use Disorder.--The Committee notes NIDA's continued 
support in research to better understand opioid use disorder 
and urges engagement with stakeholders to examine contributing 
factors, including sleep and circadian-dependent mechanisms.
    Tobacco Regulatory Science Program.--The Committee supports 
the Tobacco Regulatory Science Program and encourages NIH to 
increase funding for research into the understanding of 
nicotine addiction and to spur the development of better 
prevention and treatment strategies. Of particular importance 
is funding for research for effective interventions to help 
youth and young adults to quit tobacco use or vaping, and to 
understand the interrelationship between the vaping of tobacco 
and marijuana. The Committee directs NIDA to conduct 
interdisciplinary research on this topic with an emphasis on 
risk perceptions, decision-making and neuroscience.
    Underage 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 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. The NAS 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, the NAS 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, the NAS 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 any completed on marijuana, that are designed to 
change the attitudes and health behaviors of pregnant and 
breast-feeding women.
    Based on its reviews, the NAS 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, 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 2021.......................    $2,103,708,000
Budget request, fiscal year 2022......................     2,213,574,000
Committee Recommendation..............................     2,223,085,000
    Change from enacted level.........................      +119,377,000
    Change from budget request........................        +9,511,000
 

    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 encourages NIH to continue to 
prioritize and invest in research on autism consistent with the 
recommendations included in the Interagency Autism Coordinating 
Committee's (IACC) Strategic Plan for Autism Spectrum Disorder. 
However, while significant progress has been made in our 
understanding of autism because of Federally-funded research, 
large gaps remain that must be addressed to improve outcomes 
and access to services for autistic individuals and their 
families. Research has shown that autistic individuals have 
higher rates of some co-occurring physical and mental health 
conditions, which not only lead to quality of life issues, but 
also increased medical utilization and costs. Similarly, to 
address the racial, ethnic, and socioeconomic health equity 
challenges experienced by autistic individuals and their 
families, it is imperative that greater investment is made to 
address disparities in access to services and interventions. 
The Committee encourages NIH to support greater investment in 
research focused on particular areas in need of growth, 
outlined in the strategic plan, including research on lifespan 
issues to address the needs of transition-age youth and adults 
on the spectrum, research to enable development of evidence-
based services, and research to support the development and 
delivery of new and improved screening tools, treatments and 
interventions. 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.
    BRAIN Initiative.--The Committee directs NIH to transfer 
$76,000,000 from the NIH Innovation Account to NIMH to support 
the BRAIN Initiative. These funds are authorized by the 21st 
Century Cures Act (P.L. 114-255). 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 $25,000,000 for NIMH to expand research on the 
impact of the COVID-19 pandemic on mental health, as requested 
in the fiscal year 2022 budget.
    Suicide Prevention.--The Committee is encouraged that 2019 
was the first year in two decades in which the suicide rate 
decreased. However, death by suicide remains the tenth leading 
cause of death in the U.S., and the Committee remains committed 
to providing the resources necessary to address this alarming 
crisis. 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 continue to prioritize suicide research in fiscal 
year 2022, with special emphasis on producing models that are 
interpretable, scalable, and practical for clinical 
implementation, including utilization of health care, 
education, and criminal justice systems that serve populations 
at risk. 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 
pandemic. The Committee requests that NIMH provide an update on 
these efforts in the fiscal year 2023 Congressional Budget 
Justification.

            NATIONAL HUMAN GENOME RESEARCH INSTITUTE (NHGRI)

 
 
 
Appropriation, fiscal year 2021.......................      $615,780,000
Budget request, fiscal year 2022......................       632,973,000
Committee Recommendation..............................       646,295,000
    Change from enacted level.........................       +30,515,000
    Change from budget request........................       +13,322,000
 

    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.
    Computational Medicine and RNA Molecules.--The Committee is 
encouraged by recent discoveries in the computational medicine 
field that are helping uncover more of the causes behind 
disease onset and disease progression. Multiple reports, in 
many human diseases and conditions, provide compelling evidence 
that an individual's sex, ancestry, and age differentially 
affect the individual's regulatory RNA molecules and their 
impacts. The Committee recognizes that more research in this 
area could lead to new and important biological discoveries, 
improve our understanding of disease processes, and herald 
highly personalized approaches to diagnosis, prognosis, and 
therapy. The Committee urges NHGRI to continue to support 
computational and experimental research on RNA molecules and 
the mechanisms through which they affect biological processes 
that cause disease.
    Emerging Centers of Excellence in Genomic Sciences.--The 
Committee provides no less than $15,000,000 to sustain and grow 
the Emerging Centers of Excellence in Genomic Sciences 
competitive grant program, an increase of $2,500,000 above the 
fiscal year 2021 enacted level. The Committee maintains prior 
direction that present awardees of the Centers for Excellence 
in Genomic Sciences program shall not be eligible to receive 
these grants.
    Germline RUNX1 Mutations.--The Committee commends NHGRI for 
collaborating with NCI to launch and maintain the 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 rare 
opportunity to monitor the genomic evolution of cancer within a 
precancerous population in real time. Currently, the study 
tracks only 50 of the approximately 20,000 people in the U.S. 
with these mutations. The Committee encourages NHGRI to 
continue supporting this study. In addition, the Committee 
encourages NHGRI to continue to work towards the implementation 
of an open source database to share data in real-time for the 
benefit of the entire research community and the patients and 
their families searching for answers.

  NATIONAL INSTITUTE OF BIOMEDICAL IMAGING AND BIOENGINEERING (NIBIB)

 
 
 
Appropriation, fiscal year 2021.......................      $410,728,000
Budget request, fiscal year 2022......................       422,039,000
Committee Recommendation..............................       431,081,000
    Change from enacted level.........................       +20,353,000
    Change from budget request........................        +9,042,000
 

    Mission.--The NIBIB mission is to improve health by leading 
the development and accelerating the application of biomedical 
technologies.

  NATIONAL INSTITUTE ON MINORITY HEALTH AND HEALTH DISPARITIES (NIMHD)

 
 
 
Appropriation, fiscal year 2021.......................      $390,865,000
Budget request, fiscal year 2022......................       652,244,000
Committee Recommendation..............................       661,879,000
    Change from enacted level.........................      +271,014,000
    Change from budget request........................        +9,635,000
 

    Mission.--NIMHD's mission is to lead scientific research to 
improve minority health and reduce health disparities.
    Focal Segmental Glomerulosclerosis (FSGS).--The Committee 
encourages NIMHD to collaborate with other Institutes, Centers, 
and stakeholders to expand research opportunities on the APOL1 
gene that causes African Americans to be disproportionately 
affected by FSGS.
    Mercury in Beauty Products.--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, are 
disproportionately used by women of color. The Committee 
encourages NIMHD to collaborate with FDA to identify research 
gaps in the understanding of the health effects of these 
products.
    Research Centers at Minority Institutions.--The Committee 
includes $88,000,000, an increase of $8,000,000 above the 
fiscal year 2021 enacted level and the fiscal year 2022 budget 
request, for RCMIs to ensure that infrastructure development in 
historically minority graduate and health professional schools 
continue to enhance to meet these critical needs. The Committee 
also recognizes the importance of the RCMI Coordinating Center 
in ensuring that collectively, institutions can engage in 
multi-site collaborative research, especially as the U.S. and 
NIH positioned themselves to address the challenges imposed by 
the COVID-19 pandemic to our health system and underserved 
populations.
    The Committee encourages the NIMHD to continue following 
Congressional intent for the RCMI program and follow the spirit 
of the original instructions provided to NIH by Congress. The 
Committee notes the original intent of the RCMI program is to 
provide equitable means for health professions institutions 
with historical missions and precedence of serving minorities 
and building research infrastructure.
    Health Disparities Research.--The Committee includes an 
increase of $250,000,000 for NIMHD to support additional 
research related to identifying and reducing health 
disparities, as requested in the fiscal year 2022 budget.
    Rural Health.--Rural Americans are a population group that 
experiences significant health disparities. Health disparities 
are differences in health status when compared to the 
population overall, often characterized by indicators such as 
higher incidence of disease and/or disability, increased 
mortality rates, lower life expectancies, and higher rates of 
pain and suffering. Rural risk factors for health disparities 
include geographic isolation, lower socioeconomic status, 
higher rates of health risk behaviors, limited access to 
healthcare specialists and subspecialists, and limited job 
opportunities. The Committee encourages NIMHD to continue 
research to address the health disparities found in rural 
communities.

    NATIONAL CENTER FOR COMPLEMENTARY AND INTEGRATIVE HEALTH (NCCIH)

 
 
 
Appropriation, fiscal year 2021.......................      $154,162,000
Budget request, fiscal year 2022......................       184,323,000
Committee Recommendation..............................       185,295,000
    Change from enacted level.........................       +31,133,000
    Change from budget request........................          +972,000
 

    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.
    Integrative Health.--The Committee commends NCCIH as the 
lead Federal scientific agency supporting research to determine 
the usefulness and safety of complementary and integrative 
health approaches and their roles in improving health and 
health care. The Committee supports the Center's continued 
leadership of several trans-NIH and inter-agency initiatives, 
including the NIH-DoD-VA Pain Management Collaboratory (PMC) 
and the Health Care Systems Research Collaboratory, both of 
which are investigating best practices for implementing 
complementary health approaches in clinical health care 
settings. Consistent with goals that NCCIH identified in its 
fiscal year 2021-2025 strategic plan, the Center is encouraged 
to maintain its focus on whole person health, promoting 
research on multimodal approaches in treating pain and 
emphasize improving individual health.
    Pain and Pain Management Research.--The Committee includes 
an increase of $26,000,000 for NCCIH to support research 
related to pain and pain management, as requested in the fiscal 
year 2022 budget.

      NATIONAL CENTER FOR ADVANCING TRANSLATIONAL SCIENCES (NCATS)

 
 
 
Appropriation, fiscal year 2021.......................      $855,421,000
Budget request, fiscal year 2022......................       878,957,000
Committee Recommendation..............................       897,812,000
    Change from enacted level.........................       +42,391,000
    Change from budget request........................       +18,855,000
 

    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 $616,183,000 for the CTSA Program, an 
increase of $29,342,000 above the fiscal year 2021 enacted 
level and $14,683,000 above the fiscal year 2022 budget 
request. The Committee notes that while the CTSA program works 
to advance the full spectrum of medical research and modernize 
our research enterprise, as demonstrated by the CTSAs being a 
driving force behind the Federal effort to rapidly develop 
COVID-19 treatments, diagnostic tools, and vaccines. Central to 
the ongoing success of the CTSA consortium are individual CTSA 
hubs that form a nationwide network. The Committee directs 
NCATS to maintain the current size of the core awards 
supporting CTSA hubs, including the institutional partners that 
are part of the hubs, and historic structure of the CTSA 
program. This ongoing approach reflects the central role of the 
hubs, including each hub's partners, as critical national 
research infrastructure and the core of the CTSA Consortium. 
The Committee reiterates previous guidance that NCATS duly 
inform the Committee of any planned changes to the size of 
awards, scope of the program, or strategic direction of 
emerging or ongoing CTSA initiatives. Further, NIH is 
encouraged to further integrate the CTSA program into cross-
agency initiatives that can leverage the full spectrum of 
medical research for progress on a variety of contemporary 
topics.
    CTSA Diversity Supplements.--The Committee supports efforts 
by NCATS to promote diversity in the workforce, especially 
though its research supplements. The Committee encourages NCATS 
to ensure funding is available for its diversity research 
supplements for the CTSA program, and distributed equitability 
across CTSA hubs. Furthermore, the Committee encourages NCATS 
to continue funding, through the existing CTSA hubs, expanded 
programs that address the health inequities and significant 
burden of diseases and other conditions that disproportionally 
affect minority and special populations at both the community 
health and individual levels through a variety of funding 
mechanisms. Enhancing this capacity will contribute to reducing 
health disparities and promote health equity. The Committee 
also encourages continued support for CTSA efforts to engage 
communities for the purposes of educating community 
stakeholders and implementing proven clinical programs and 
treatments, including vaccines. Applying the CTSA model to 
address longstanding regional health disparities can provide 
innovative, multi-disciplinary approaches to reducing the 
burden of disease among vulnerable populations.
    Collaboration with Business Incubators.--The Committee 
urges NCATS to explore ways to increase the success in meeting 
its mission by exploring funding opportunities or potential 
collaborations with business incubators that host small to 
midsize science, research, and pharmaceutical companies that 
use services-based approaches to nurture and guide the member 
companies to success. Collaborations with such business 
incubators may offer the most effective way to advance 
translational science. Priority consideration should be given 
to nonprofit life science incubators that seek to advance 
biotechnology, maximize synergies between nonprofit scientists 
and their commercial colleagues, and launch new ideas and 
discoveries that will make a difference including drug 
discovery, biomarker discovery and translational biotechnology 
around common research themes in an environment conducive to 
interaction, collaboration, and focus.
    Rare Disease Research.--The Committee recognizes the 
incredible unmet need in the rare disease research community 
and encourages NCATS to expand rare disease funding 
opportunities, including, but not limited to, the Rare Diseases 
Clinical Research Network. Accelerating rare disease research 
will allow society to capitalize on the evolution of science in 
rare diseases, leading to new treatments for the more than 95 
percent of rare diseases without approved therapies and 
lowering the nearly $1 trillion annual economic burden of rare 
diseases.
    Cures Acceleration Network.--The Committee includes 
$60,000,000 for the Cures Acceleration Network, the same as the 
fiscal year 2021 enacted level. The Committee does not include 
bill language proposed in the budget that would establish this 
program as a percentage of the NCATS appropriation.

               JOHN E. FOGARTY INTERNATIONAL CENTER (FIC)

 
 
 
Appropriation, fiscal year 2021.......................       $84,044,000
Budget request, fiscal year 2022......................        96,322,000
Committee Recommendation..............................        96,842,000
    Change from enacted level.........................       +12,798,000
    Change from budget request........................          +520,000
 

    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.
    COVID-19 has shown the importance of FIC's essential role 
in global infectious disease health research training, pandemic 
preparedness, and global health security by assisting low- and 
middle-income countries (LMICs) in advancing their own research 
and health solutions and tools. The FIC has developed important 
partnerships in countries to not only fight infectious 
diseases, but also to build their capabilities to detect and 
treat infectious diseases. The COVID-19 pandemic illustrates 
the importance of FIC's efforts to strengthen country capacity 
to enable cutting edge research at the origin of outbreaks, 
improving the likelihood that emerging diseases can be 
addressed at their source--ultimately protecting American 
health security. The Committee believes these longstanding 
relationships and unique capabilities position FIC to play an 
important and expanded role in pandemic preparedness, including 
developing a network of modeling hubs and joint research 
programs to engage LMIC investigators to collaboratively train 
for pandemic preparedness. The Committee requests information 
from FIC in the fiscal year 2023 Congressional Budget 
Justification about how FIC training programs and research 
collaborations have, and with additional resources can, 
increase efforts to advance global health security and pandemic 
preparedness. The Committee is particularly interested in 
understanding FIC's unique capabilities and capacities as well 
as coordination with other Federal government agencies engaged 
in these efforts.
    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 
requested in the fiscal year 2022 budget.

                   NATIONAL LIBRARY OF MEDICINE (NLM)

 
 
 
Appropriation, fiscal year 2021.......................      $463,787,000
Budget request, fiscal year 2022......................       474,864,000
Committee Recommendation..............................       486,769,000
    Change from enacted level.........................       +22,982,000
    Change from budget request........................       +11,905,000
 

    Mission.--The NLM collects and organizes information 
important to biomedicine; 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 national network of libraries of medicine; 
provides grants for research in biomedical communications, 
medical library development, and training health information 
specialists; conducts and supports research in biomedical 
informatics and computational biology; and creates information 
resources for genomics, molecular biology, toxicology, medical 
images, environmental health, emergency preparedness and 
response, and health services research.

                      OFFICE OF THE DIRECTOR (OD)

 
 
 
Appropriation, fiscal year 2021.......................    $2,411,110,000
Budget request, fiscal year 2022......................     2,237,259,000
Committee Recommendation..............................     2,667,385,000
    Change from enacted level.........................      +256,275,000
    Change from budget request........................      +430,126,000
 

    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.
    Addressing Maternal Mental Health Gaps.--The Committee 
recognizes growing evidence that maternal mental health has 
long-reaching effects on the physical, intellectual, and 
emotional development of a woman's children. Pregnancy-related 
mortality in the U.S. has steadily increased from 7.2 deaths 
per 100,000 in 1987 to 17.3 deaths per 100,000 in 2017. Black 
mothers are three to four times more likely than White mothers 
to die from complications related to pregnancy or childbirth. 
Maternal mental health disorders and associated symptoms are 
common, and cases often go unreported and untreated. The 
societal cost of untreated perinatal mood and anxiety disorders 
(PMADs) can reach $14.2 billion, and those with PMADs have a 
higher risk of suicide, cesarean deliveries, and work 
absenteeism and presenteeism. The COVID-19 pandemic has 
exacerbated the mental and physical toll on pregnant and 
postpartum mothers. The Committee directs NIH to provide a 
report within 180 days of enactment of this Act with the number 
and description of research grants awarded over the past three 
fiscal years that address maternal mental health outcomes for 
women who are pregnant and one year postpartum. Further, the 
Committee encourages the Department to ensure mental health is 
incorporated in any efforts to reduce maternal mortality rates.
    Adult Cellular Therapies.--To support collaborative 
evidence development, the Committee encourages NIH, in 
coordination with FDA and HRSA, to continue efforts to enhance 
transparency regarding outcomes from adult cellular therapies 
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 Therapeutic Outcomes Database 
and ClinicalTrials.gov.
    Advancing Cell-Based Therapies.--The Committee recognizes 
that adult 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, including COVID-19. While results of 
early clinical studies are promising, the primary barrier to 
advancing such therapies is the significant cost of conducting 
large-scale, randomized clinical trials--especially among 
academic and research institutions and small biotechnology 
companies--which are a precursor to bringing safe and effective 
therapies to patients.
    Therefore, the Committee directs NIH to develop and submit 
a report within 180 days of enactment of this Act that 
describes current NIH funding for adult cell-based therapies, 
disaggregated by Institute and Center, and plans to support and 
expand investments in such therapies. Such report shall 
describe plans to support clinical trials; the 
characterization, optimization, and scaling of manufacturing of 
cell-based therapies; and collaborative evidence development, 
including the development and operation of an outcomes 
database. The Committee encourages NIH to consult outside 
experts, including researchers who have conducted clinical 
trials involving adult cell-based therapies, to inform its 
activities related to cell-based therapies.
    All of Us Program.--The Committee provides a total of 
$541,000,000 for the All of Us precision medicine initiative, 
$41,000,000 above the fiscal year 2021 enacted level and the 
same as the fiscal year 2022 budget request. The total includes 
$150,000,000 authorized in the 21st Century Cures Act (P.L. 
114-255) to be transferred from the NIH Innovation Account.
    The All of Us initiative is a historic effort to collect 
data from over one million people living in the U.S. to 
accelerate research and improve health and serves as a national 
research resource to support thousands of studies, spanning 
various health conditions including COVID-19. More than 75 
percent of these participants are from communities historically 
underrepresented in biomedical research, and more than 50 
percent are from racial and ethnic minority groups. The 
Committee encourages NIH to increase its outreach through a 
network of trusted community engagement partners to continue 
enrollment of participants from diverse and underserved 
populations.
    ALS Research Coordination and Acceleration.--The Committee 
is aware of the significant need to expand scientific 
understanding of amyotrophic lateral sclerosis (ALS) and to 
translate ALS science more rapidly into effective treatments 
that can make ALS a livable disease. To achieve these outcomes 
as soon as possible, the Committee directs NIH to organize a 
trans-agency initiative to develop an ALS research strategic 
plan. The plan, which should be developed in collaboration with 
the nation's leading ALS patient and biomedical research 
organizations, should: identify the most promising areas of 
research and the specific NIH activities where additional 
funding could lead to more rapid translation of discoveries for 
treatments, prevention, and interventions or technologies that 
can reduce the burden of ALS; identify which Institutes and 
Centers are undertaking ALS and ALS-related research and which 
are not but have a role to play; and uncover any impediments to 
ALS research. As part of this effort, NIH should hold at least 
one public meeting at which stakeholders can provide testimony. 
This effort should include, but not be limited to: NINDS, NIA, 
NIEHS, NIMH, NHGRI, NIAMS, and NCATS.
    Additionally, The Committee strongly supports the 
Transformative Research Award program for ALS and directs the 
Director to continue to fund this critical initiative in fiscal 
year 2022.
    Finally, the Committee includes $1,000,000 to commission a 
study by NASEM to identify and recommend actions for the 
public, private, and nonprofit sectors to undertake to make ALS 
a livable disease within a decade. Given the significant 
adverse physical, financial, psychological impact this 
progressive neurodegenerative disease has on the individuals 
and families affected by it, a comprehensive assessment of what 
is necessary to address its effects is warranted. The study 
should include, but not be limited to: how to develop more 
effective and meaningful treatments and a cure; interventions 
to reduce and prevent the progression and complications of ALS; 
the type and range of care and services people and families 
with ALS need and how to ensure they receive comprehensive, 
quality care; what care, services, and preventive measures 
people at-risk of ALS need; and how to improve the quality of 
life, health, and well-being of affected individuals and 
families. The Committee directs NIH to submit this study to the 
Committee no later than October 2024 and requests an update on 
the status of this study in the fiscal year 2023 Congressional 
Budget Justification.
    Amyloidosis.--The Committee directs NIH to continue its 
expansion of research efforts in amyloidosis, a group of rare 
diseases characterized by abnormally folded protein deposits in 
tissues. Amyloidosis is often fatal, and there is no known 
cure. Current methods of treatment are risky and unsuitable for 
many patients. Average survival without treatment is in months. 
The Committee directs NIH to provide an update in the fiscal 
year 2023 Congressional Budget 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.
    Autoimmune Neuropathies.--The Committee notes the effect 
that the pandemic had on the progress of a state-of-the-science 
conference on autoimmune neuropathies research into conditions 
like Guillain-Barre syndrome and chronic inflammatory 
demyelinating polyneuropathy. The Committee supports continued 
efforts on establishing this critical conference.
    Biomedical Research Facilities.--The Committee includes 
$50,000,000, the same as the fiscal year 2021 enacted level and 
$50,000,000 above the fiscal year 2022 budget request, 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 that are large 
enough to underwrite the cost of a significant portion 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 at risk across career stages. The Committee strongly 
encourages NIH to study the race and gender breakdown of the 
impact of COVID on participation in the workforce by monitoring 
the types of awards applied for and granted by gender, race, 
and ethnicity for two years. If the data demonstrate that fewer 
women are applying for grants, then it is imperative that NIH 
take steps to address this disparity. The Committee requests a 
status update from NIH on this research in the fiscal year 2023 
Congressional Budget Justification as well as the steps being 
taken to maintain and stabilize the diversity of the biomedical 
research workforce.
    Biosafety Labs.--The Biosafety in Microbiological and 
Biomedical Laboratories (BMBL) recommends as a special practice 
the reporting of all laboratory incidents and near misses in 
Biosafety Lab (BSL) BSL-3 and BSL-4 laboratories. The Committee 
directs NIH to ensure all funding for BSL-3, BSL-4, high 
containment laboratory, or any entity involved in managing 
Hazardous Biological Agents both foreign or domestic maintains 
up to date, comprehensive policies, to promote optimal 
Biosafety and Biosecurity practices. Such policies must 
reference (1) incident reporting, (2) roles and 
responsibilities, (3) training, (4) inventory control, and (5) 
inspections and must be reported to NIH and/or related 
agencies.
    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. The Committee directs 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. In addition, the Committee 
recognizes the need to increase the number of biomedical 
research professionals as leaders in critical areas of national 
need. The Committee directs NIH to establish a scholarship 
program that encourages African American students to pursue a 
career in medicine, science, and biomedical research to combat 
the persistent decline of Black male physicians over the last 
decade.
    Brain Cancer.--The Committee recognizes that certain types 
of brain cancers are associated with high mortality and 
morbidity rates. Primary brain tumors, such as glioblastoma 
multiforme, have a five-year survival rate of five percent in 
adults and less than 20 percent in children. 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 in order to evaluate 
and develop treatments and safe delivery systems to benefit 
both species.
    Center for Alternatives to Animals in Research and 
Testing.--The Committee directs NIH to submit a plan not later 
than 180 days after enactment of the Act for the establishment 
of a Center for Alternatives to Animals in Research and Testing 
within NIH, for the purposes of (1) developing, promoting, and 
funding alternatives to animal research and testing, and (2) 
developing a plan for reducing the number of animals used in 
Federally funded research and testing.
    Childhood Post-Infectious Neuroimmune Disorders.--The 
Committee continues to be concerned that some children, 
following streptococcal and other infections, may experience 
the onset of neuropsychiatric and behavioral disorders. These 
auto-inflammatory encephalopathic conditions include Pediatric 
Autoimmune Neuropsychiatric Disorders Associated with 
Streptococcal Infections (PANDAS) and Pediatric Acute-onset 
Neuropsychiatric Syndrome (PANS). Due to a paucity of research 
and limited avenues of treatment, children continue to 
encounter significant delays in identification and treatment, 
resulting in escalation of mental health symptoms and 
associated costs. The incidence of neurological and psychiatric 
symptoms associated with SARS-CoV-2 underscores the need for 
research that expands our understanding of neuropsychiatric 
illness following infection. Because these complications lie at 
the nexus of medical and mental health, investigations into 
their mechanisms have far-reaching implications. The Committee 
encourages NIH to explore cross-disciplinary research in this 
area, including neurobiology, neurology, immunology, 
rheumatology, infectious disease, and mental health, and report 
to the Committee in the fiscal year 2023 Congressional Budget 
Justification on the understanding of the incidence, causes, 
diagnostic criteria, and treatment of these conditions.
    Chronic Fatigue Syndrome.--The Committee encourages NIH to 
expand ME/CFS efforts such as new ME/CFS disease specific 
funding announcements to deliver needed diagnostics and 
treatments as quickly as possible and mechanisms to incentivize 
researchers to enter the field.
    Cockayne Syndrome.--The Committee recognizes that Cockayne 
Syndrome is a rare hereditary autosomal recessive disorder that 
disproportionately impacts children. It has no known 
treatments, therapies, or cures. Cockayne Syndrome presents 
unique research challenges for many reasons, including 
difficulty in accruing enough patients to participate in 
clinical trials and a lack of industry focus on such rare 
genetic diseases due to the relatively small number of patients 
diagnosed with this disease. The Committee strongly encourages 
NIH to expand funding on research on Cockayne Syndrome, 
including but not limited to gene replacement therapy.
    Collection and Reporting of Animal Research Numbers and 
Agency Funding.--The Committee recognizes that Congress has 
long expressed an interest in reducing the use of nonhuman 
animals in NIH-funded research and replacing animals with 
valid, reliable alternatives. In the National Institutes of 
Health Revitalization Act of 1993, Congress first requested 
that 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. 
Integral to that commitment are the accurate counting of 
animals used in research and testing and the accurate reporting 
of NIH funding dedicated to projects involving animals. The 
Committee recognizes that it has been NIH's policy since 1985 
to collect an ``average daily inventory'' of vertebrate animals 
housed in research facilities that wish to receive agency 
funding. The Committee understands that domestic facilities are 
required to file such documentation every four years as part of 
an Animal Welfare Assurance and that copies of the documents 
are available to the public only through Freedom of Information 
Act requests. The Committee requests a report from NIH within 
120 days of enactment of this Act outlining a plan for 
increasing the accuracy and transparency of collecting and 
publicly disseminating research animal numbers. The plan should 
explain how NIH will collect the information annually and 
include a draft form that requires the total number of animals 
per species bred and used in the previous year and assigns all 
animals to a pain and distress category. The plan should also 
include details on how NIH will create a publicly accessible 
online database for dissemination of this information. 
Secondly, the Committee requests that NIH include in its report 
a plan for implementing a system that tracks which agency-
funded projects involve the use of animals and makes the 
information publicly accessible. The Committee recognizes that 
NIH currently collects such information with every grant 
application using the Research & Related Other Project 
Information form, which asks applicants to answer ``Yes'' or 
``No'' to the question ``Are Vertebrate Animals Used?'' NIH's 
plan should ensure that the answer to that question for each 
funded project is searchable via the Expenditures and Results 
module of NIH's Research Portfolio Online Reporting Tools 
website as many other categories of information are.
    Common Fund.--The Committee recommends $657,112,000 for the 
Common Fund (CF), and an additional $12,600,000 provided to 
support the Gabriella Miller Kids First Research Act for the 
seventh year of the ten-year Pediatric Research Initiative. 
This is $21,173,000 above the fiscal year 2021 enacted level 
and $11,173,000 above the fiscal year 2022 budget request.
    COVID-19 Technology Access Pool.--The Committee understands 
that the World Health Organization has developed a COVID-19 
Technology Access Pool (C-TAP), which aims to facilitate access 
to COVID-19 health products by sharing intellectual property 
through pooling and voluntary agreements. The Committee 
strongly urges the Secretary, in partnership with NIH, to 
consider what contributions NIH could make to C-TAP.
    Cybersecurity.--The Committee includes an increase of 
$100,000,000 to support expanded cybersecurity efforts at NIH, 
as requested in the fiscal year 2022 budget. Funding will 
enhance Security Operations Center functions, expand threat 
mitigation and incident response capabilities, implement 
important architectural improvements to the NIH network, and 
implement tools and technologies to allow real time monitoring 
of activity across a variety of sources.
    Diversity at NIH Working Group and Strategic Plan.--The 
Committee is encouraged by NIH's demonstrated commitment to 
diversity and thanks the NIH for acting on the fiscal year 2021 
request to develop a strategic plan that includes long- and 
short-term goals to address disparities at NIH. The Committee 
understands that NIH is beginning robust outreach to 
traditionally marginalized communities to lay the foundation 
for a comprehensive strategic plan and encourages NIH to 
continue this line of work in order to fully understand the 
scope of need in this area, properly make recommendations, then 
develop and implement strategies to increase inclusivity and 
diversity in biomedical science while aligning with Executive 
Order 13985 on Advancing Racial Equity and Support for 
Underserved Communities Through the Federal Government. The 
Committee directs NIH to provide quarterly briefings to the 
Committee on the progress of the development of the strategic 
plan.
    Diversity in NIH Clinical Trials.--While 40 percent of 
Americans belong to a racial or ethnic minority, 80 to 90 
percent of participants in clinical trials are White. Patients 
in underserved communities are often less comfortable enrolling 
in clinical trials or are unaware of how to do so, excluding 
them from the opportunity to access potentially lifesaving 
treatment. Further, it is essential that NIH researchers 
develop a comprehensive understanding of how treatments impact 
various populations. The Committee encourages NIH to increase 
proactive outreach efforts to patients in minority and 
underrepresented communities and providers serving these 
populations, to improve awareness of clinical trials and 
understanding of how patients can participate.
    Duchenne Muscular Dystrophy.--Duchenne muscular dystrophy 
is a severe form of muscular dystrophy for which there is no 
cure and for which life expectancy is in the second or third 
decade. The Committee urges NIH to establish a framework for 
data sharing and sharing of specimens generated or collected 
within six months of completion of any NIH-funded clinical 
study. The Committee also urges NIH to support methodological 
research on challenges related to gene therapies, such as 
enabling delivery to individuals with neutralizing antibodies 
to viral vectors, manufacturing supply to ensure all patients 
can receive treatment, and minimizing potential life-
threatening immune response to high viral doses.
    Early Career Researchers.--The Committee recognizes the 
importance of awards intended to support training of early-
stage researchers, including physician scientists. The 
Committee is also aware of the negative impact the ongoing 
COVID-19 pandemic has had on research career trajectories and 
that these challenges are particularly burdensome on early-
career researchers who have yet to achieve research 
independence. The Committee commends NIH for allowing holders 
of fellowship and career development awards to apply for funded 
and no-cost extensions but is concerned about the possibility 
of uneven levels of support between Institutes and Centers, 
unclear qualifying standards, and demand that may exceed 
resources. To address these concerns, the Committee encourages 
NIH to develop and disseminate a standardized approach to 
support eligible investigators across Institutes and Centers.
    The Committee also encourages NIH to develop a funding 
opportunity for a trans-NIH early career development award 
targeted to investigators working in pediatrics that would 
build upon the Next Generation Researchers Initiative and other 
initiatives and to provide an update on these efforts to 
Congress within 180 days of enactment of this Act.
    Eating Disorders.--The Committee commends NIH for 
supporting multi-Institute research on the chronic, fatal, and 
serious mental illnesses encompassing eating disorders that 
affect 30,000,000 Americans during their lifetimes, and its 
association with other conditions such as diabetes, 
infertility, heart disease, PTSD, substance use, co-morbid 
mental illnesses, and tooth decay. The Committee encourages NIH 
to increase support for eating disorders research and 
encourages the relevant Institutes and Centers, including NIMH, 
NIMHD, NICHD, and NIDA, to collaborate to address research gaps 
in genetics, prevention, diagnosis, and treatment of eating 
disorders.
    Ehlers-Danlos Syndrome.--The Committee encourages NIH to 
support research and 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 2021 enacted level and the fiscal year 2022 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. 
The Committee includes funding for ECHO in the Office of the 
Director, consistent with previous years.
    Federal Advisory Committees Transparency Initiative.--The 
Committee recognizes that Federal advisory committees 
established pursuant to 42 U.S.C. 282(b)(6) fill an important 
role in advising NIH on major decisions on plans and policies. 
However, to guarantee due process, it is vital that all NIH 
Federal advisory committees operate in a transparent way. The 
Committee recognizes that one particular NIH Federal advisory 
committee, the Literature Selection Technical Review Committee 
(LSTRC), has not made its review process clear or transparent. 
As such, the Committee directs the LSTRC, within 60 days of 
enactment of this Act, to make public all documents and any 
other relevant information related to its: (1) processes for 
and standards of review, including the scope of the review, a 
timeline and detailed steps of the review, and any other 
guidelines used to ensure objective reviews; and (2) decision-
making processes and methodologies, including scoring rubrics, 
metrics, and any other guidelines used to ensure objective 
decisions. The Committee further directs the LSTRC, within 60 
days of enactment of this Act, to make available detailed 
instructions regarding how to appeal its decisions. Moreover, 
the Director of NLM shall ensure and certify to the Committee 
that the LSTRC is operating in accordance with the provisions 
of the Federal Advisory Committee Act (FACA), as amended (5 
U.S.C., Appendix 2).
    Firearm Injury and Mortality Prevention Research.--The 
Committee includes $25,000,000 to support research on the 
prevention of gun violence, $12,500,000 above the fiscal year 
2021 enacted level and the same as the fiscal year 2022 budget 
request. The Committee also requires NIH and CDC 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 Animal Research.--The Committee requests additional 
information in the fiscal year 2023 Congressional Budget 
Justification about how NIH monitors and ensures foreign 
institutions' compliance with applicable laws, regulations, and 
policies governing NIH-funded animal research.
    Foreign Threats to Research.--Foreign actors continue to 
engage in the theft of intellectual property from NIH and its 
grantees, posing threats to national security. The Committee 
directs NIH to provide quarterly 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 provide $5,000,000 to the Inspector General to 
continue additional investigations into this issue. The 
Committee also includes an increase of $2,500,000 for the 
Office of Extramural Research to expand its resources dedicated 
to reviewing potential cases of fraud.
    Fragile X.--The Committee commends NIH for funding three 
Fragile X Centers within the guidelines established in the 
Strategic Plan for Research on FMR1-Related Conditions. The 
Committee notes the importance of expanding the base of 
researchers and clinicians who are familiar with and trained in 
the Fragile X-associated disorders and promoting collaboration 
between basic scientists and clinicians to enable researchers 
to better understand phenotypes, document variations in how the 
disorder presents itself, identify potential biomarkers and 
outcome measures, and develop new interventions. The Committee 
also commends NIH for recognizing the ethical, legal, and 
social issues in premutation screening and testing and 
encourages NIH to look at existing pilot studies that are 
exploring innovative ways to screen newborns, and to coordinate 
efforts and research with the CDC as they consider screening 
solutions for FMR1-related conditions.
    Gabriella Miller Kids First Pediatric Research Program.--
The Committee recognizes that pediatric cancer is a leading 
cause of death among children and is 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 Pediatric Research Program enables 
researchers to uncover new insights into the biology of 
childhood disease. 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 disease and provides 
$12,600,000 to support pediatric research as authorized by the 
Gabriella Miller Kids First Research Act (P.L. 113-94).
    Gene-Environment Interactions in Neurodegenerative 
Disorders in the Diverse Populations of African Americans and 
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 21st Century 
Cures Act and the BRAIN Initiative. The Committee recognizes 
the need to better understand the interactions between genetics 
and environmental factors, in particular with older and diverse 
populations of African Americans and Latinos. The Committee 
encourages NIH to accelerate collaborative research across 
relevant Institutes and Centers and the research community to 
address the goal of determining the role of the interaction 
between environmental exposures to toxic chemicals and genetics 
and their impact on neurodegenerative disorders in diverse 
populations of African Americans and Latinos, to allow for 
earlier diagnosis and subsequent treatment to arrest the 
progression of these devastating neurodegenerative disorders.
    Harassment Policies.--The Committee is deeply frustrated by 
NIH's failure to implement its direction to address harassment 
in extramural research settings. Both the Statement of managers 
accompanying the Further Consolidated Appropriations Act, 2020 
(Public Law 116-94) and the Consolidated Appropriations Act, 
2021 (Public Law 116-260) directed NIH to revise its guidance 
to make clear that grantees must identify any changes to key 
personnel on an award that are related to concerns about 
harassment. The Committee has included a new general provision 
to require institutions that receive NIH funding to notify the 
agency when key personnel are removed from their position for 
harassment.
    Health Disparities for Persons with Disabilities.--Despite 
being uniquely affected by COVID-19, people with disabilities 
experienced gaps and inequities in health care in the response 
to the COVID-19 pandemic. This illustrates that there is a need 
for increased data collection to provide policymakers with 
necessary information to improve pandemic planning and 
outcomes. The Committee strongly encourages NIH to examine 
health and health care inequities more broadly for people with 
disabilities, including those with physical, sensory, 
cognitive, intellectual and developmental, and psychological 
disabilities. The Committee strongly encourages NIH to fund 
research on identifying inequities in health and health care 
for people with disabilities and to support research that 
develops and evaluates interventions to reduce these 
disparities, including approaches that focus on addressing 
systemic and community-level barriers.
    HEALthy Brain and Child Development (HBCD) Study.--The 
Committee recognizes and supports the HEALthy Brain and Child 
Development Study, which will establish a large cohort of 
pregnant women from regions of the country significantly 
affected by the opioid crisis and follow them and their 
children for at least 10 years. This knowledge will be critical 
to understanding typical brain development and how pre- and 
postnatal exposure to opioids and other substances or adverse 
environments affect brain development and other outcomes, 
including risk for future substance use, mental health 
disorders, and other behavioral and emotional difficulties and 
disorders. The Committee recognizes that the HBCD Study is 
supported in part by the HEAL Initiative, and NIH Institutes, 
Centers, and Offices, including OBSSR, ORWH, NIMHD, NIBIB, 
NIEHS, NICHD, NINDS, NIAAA, NIMH, and NIDA, and encourages 
other Institutes and Centers to support this important study.
    Hearing Health Screening for Older Americans.--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 
2023 Congressional Budget Justification on hearing screening 
research for older adults across the NIH. The Committee 
encourages NIDCD and NIA to support studies that address the 
research needs and gaps identified by the U.S. Preventive 
Services Task Force (USPSTF) review of hearing screening 
recommendations for older Americans.
    Hepatitis B.--The Committee recognizes the estimated $4 
billion of annual medical costs associated with the care and 
treatment of those infected with the hepatitis B virus and 
urges NIH to redouble its efforts to identify more effective 
treatments for the disease. While there are treatments 
available to control HBV, they must be taken for years if not 
for life. Without treatment, one in four of those infected will 
die prematurely from cirrhosis, liver failure, and/or liver 
cancer. This serious public health threat results in over 
800,000 worldwide deaths each year, making it the tenth leading 
cause of death in the world. The Committee commends NIH for it 
support in the development of the 2019 Strategic Plan for 
Trans-NIH Research to Cure Hepatitis B and urges NIH to help 
implement the plan by issuing new targeted calls for research. 
The Committee requests that NIH support an update of the 
Strategic Plan for Trans-NIH Research to Cure Hepatitis B and 
that it submit it to the Committee, within 180 days of 
enactment of this Act, a specific plan to pursue a cure for 
hepatitis B in coordination with the Trans-NIH Hepatitis B 
Working Group.
    Humane Research Alternatives.--Recognizing that humane, 
cost-effective, and scientifically suitable non-animal methods 
are available but underutilized, the Committee requests that 
NIH assemble a panel to investigate and make recommendations 
regarding incentives for more quickly and effectively moving 
NIH intramural and external research away from methods that 
rely on animals to methods that rely on non-animal methods 
including epidemiological and clinical studies, cell-based 
methods, computer modeling and simulation, and human tissue 
studies. The panel should review and recommend means of 
encouraging greater reliance on human-relevant non-animal 
methods/approaches. Panel membership should include individuals 
with proven knowledge of/experience with non-animal research 
methods; with expertise in evaluating the adequacy of searches 
for non-animal methods/approaches described in research 
proposals; and with knowledge of the welfare concerns and 
scientific limitations of animal-based studies. The Committee 
asks that NIH provide a report of the panel's findings within 
60 days of enactment of this Act.
    Impact of Technology and Digital Media Use Among Infants, 
Children, and Teens.--The Committee remains concerned about the 
impacts of technology use and media consumption on infants, 
children, and adolescents, especially during the COVID-19 
pandemic. COVID-19 has resulted in closures of schools, sports, 
and extracurricular activities giving children less access to 
offline social opportunities and resulting in increased time 
children spend on screens and digital media. 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 encourages 
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.
    INCLUDE Initiative.--The Committee includes no less than 
$80,000,000, an increase of $15,000,000 above the fiscal year 
2021 enacted level, within OD for the INCLUDE Initiative. The 
Committee is pleased that this multi-year, trans-NIH research 
initiative has enabled significant advances in understanding 
immune system dysregulation, new research into the connection 
with Alzheimer's disease, and the creation of national Data 
Coordinating Center, all of which may dramatically improve the 
health and quality of life of individuals with Down syndrome as 
well as millions of typical individuals. The Committee 
encourages NIH to pursue some of the most neglected areas of 
research and care such as health disparities for African 
Americans with Down syndrome, mosaic Down syndrome, those with 
the dual diagnosis of Down syndrome and autism, and new studies 
on metabolic dysregulation. The Committee requests the Director 
provide an updated plan within 60 days of enactment of this Act 
that includes a timeline, description of potential grant 
opportunities and deadlines for all expected funding 
opportunities so that young investigators and new research 
institutions may be further encouraged to explore research in 
this space. This plan should also incorporate and increase 
pipeline research initiatives specific to Down syndrome.
    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 urges NIH to 
expedite planned and ongoing studies already nominated and 
established through the National Toxicology Program (NTP). The 
Committee is concerned that some of these studies were 
nominated in 2001 but have yet to be conducted. The Committee 
also urges NIH to prioritize new research, explore the causal 
links, and interventions to the potential neurotoxic, 
immunosuppressive, immunoreactive, autoimmune, 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. The Committee requests an update 
in the fiscal year 2023 Congressional Budget Justification on 
its efforts.
    Inflammation.--Inflammation is one of the body's major 
defense mechanisms in response to infection or injury, but when 
it is uncontrolled, it causes inflammatory diseases such as 
cardiometabolic diseases (such as hypertension, obesity, and 
diabetes), neurodegenerative diseases (such as Alzheimer's 
disease and dementia), and mood disorders (such as depression). 
The Committee supports and encourages NIH to fund research into 
how inflammation may contribute to these various disorders.
    Inflammatory Bowel Disease (IBD).--The Committee is aware 
of current and emerging NIH priorities focused on nutrition, 
including the recently finalized Strategic Plan for NIH 
Nutrition Research and the Common Fund's Nutrition for 
Precision Health initiative. Given these priorities, the 
Committee encourages NIH to coordinate across Institutes and 
Centers focused on nutrition research to support research to 
understand the relationship between food and immune-mediated 
conditions, including IBD. This may include research on the 
development of evidence-based anti-inflammatory diets and the 
roles such diets can play in managing IBD and other immune-
mediated conditions.
    Lung Cancer Research.--The recent decline in cancer 
mortality that has been fueled by progress in lung cancer is 
directly attributable to NIH-funded research. Advances in the 
understanding of the molecular underpinnings of lung cancer and 
the 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 therefore encourages the NIH to continue supporting 
important research across these areas, to broaden the base of 
lung cancer survivors across different disease types, including 
small cell lung cancer.
    Lyme and Other Tick-Borne Diseases.--The Committee 
encourages NIH to support research on early diagnosis and 
treatment of Lyme and other tick-borne diseases (TBD) to 
prevent the development of late stage disease and more serious 
and longer-term disability, but also to intensify research on 
diagnosis and treatment of late stage and chronic disease. 
Priority should be based on disease burden, which CDC has 
indicated for Lyme disease to be approximately 476,000 people 
diagnosed and treated annually in the U.S. Lyme has a 
significant patient population who are not diagnosed until late 
stage, when treatment is more difficult, and a significant 
percentage of patients who relapse and go on to develop chronic 
symptoms. Along with development of highly sensitive and 
specific diagnostics for all stages of disease, a goal should 
be to develop diagnostics with appropriate sensitivity and 
specificity for the detection of subclinical or low-level 
infection for use in disease eradication. Treatments for all 
stages of Lyme and other TBD, determining optimal combinations 
of new candidate or older drugs and exploring novel 
combinations should be developed. Although a cure may be 
defined to include sustained remission, a goal of treatment 
should be eradication of the pathogen, in which case resurgence 
is not possible.
    The Committee is gratified that NIH officials have 
recognized the need for further exploration of maternal-fetal 
or vertical transmission of Lyme disease and the occurrence of 
adverse outcomes among women with untreated and disseminated 
Lyme disease during pregnancy. 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 U.S. Air Force Bases.--The 
Committee remains concerned about NIH's intention to retain 
government-owned chimpanzees at the Alamogordo Primate Facility 
(APF), a laboratory facility, instead of retiring them to the 
national chimpanzee sanctuary, Chimp Haven. While NIH cites the 
health condition of the chimpanzees as a reason to warehouse 
them at APF, the health condition of the chimpanzees and their 
long history of laboratory use makes it urgent that they be 
provided an opportunity to live the remainder of their lives in 
sanctuary, even if for a short period. The Committee directs 
the NIH to resume transport of government-owned and supported 
chimpanzees beginning with chimpanzees at APF. Movement of 
chimpanzees from Southwest National Primate Research Center 
(SNPRC) and Keeling Center for Comparative Medicine and 
Research (KCCMR) should follow transport of the APF chimpanzees 
to Chimp Haven. The Committee also directs the NIH to provide a 
written report to the Committee every 180 days, beginning no 
later than December 31, 2021, that shall include: (1) the 
number of chimpanzees transported to the national sanctuary 
over the last quarter; (2) a census of all government-owned and 
supported chimpanzees remaining, if any, at APF, SNPRC or 
KCCMR; (3) a list of any chimpanzee deaths that have occurred 
at any time after January 1, 2020, at either APF, SNPRC, KCCMR, 
or the national sanctuary system, and (4) the plan, including 
the timeline, for transferring the chimpanzees from APF, SNPRC, 
and KCCMR to Chimp Haven.
    Maternal Infections.--The Committee requests an update on 
research to better understand and prevent congenital 
cytomegalovirus in the fiscal year 2023 Congressional Budget 
Justification.
    Modeling and Simulation Technology Deployment.--The 
Committee encourages NIAID, NIBIB, and other NIH Institutes and 
Centers as appropriate, to support the development and study of 
in silico approaches to accelerate vaccines for emerging 
infectious diseases including, but not limited to, 
computational simulation, data analytics, and the digital 
patient model, with the objective of reducing the time to 
market for virus vaccines.
    National Laboratories.--NIH funding supports investments 
which are collaborative with the ongoing work of the Department 
of Energy. The Committee directs NIH to provide an update in 
the fiscal year 2023 Congressional Budget Justification 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 would benefit from 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.
    National Primate Research Centers.--The Committee does not 
include funding directed towards expanding non-human primate 
resource infrastructure. The budget request included 
$50,000,000 for this activity.
    National SARS-CoV-2 Genomic Surveillance Program.--New 
SARS-CoV-2 variants continue to emerge across the globe, 
including variants that may have increased transmissibility and 
potential to evade vaccines. This dire situation demonstrates 
the need for a comprehensive genomic sequencing and 
surveillance program to discover and track the spread of these 
variants and devise appropriate public health countermeasures. 
The Committee directs NIH and CDC, in coordination with other 
HHS agencies as appropriate, to continue to expand national 
genomic surveillance to rapidly scale up sequencing of viral 
samples and dissemination of SARS-CoV-2 genomic data.
    Native Hawaiian/Pacific Islander Health Research.--The 
Committee encourages NIH to place high priority on addressing 
the research needs of Native Hawaiian and Pacific Islander 
Health Research. The OD, in coordination with NIMHD and other 
Institutes and Centers, should work closely with NHPI 
communities and NHPI-serving organizations, which are located 
in States with significant NHPI populations to allow for the 
development of future researchers and scientists from these 
same communities.
    Natural History Museums as Critical Contributors to Virus 
Research.--The Committee notes that the nation's natural 
history museums provide an unparalleled resource for studying 
zoonotic diseases such as COVID-19. These museums hold millions 
of animal samples collected over decades from across the globe, 
offer deep and broad scientific expertise, and are uniquely 
positioned to assist in preparing for and predicting the next 
pandemic-causing viruses. The Committee encourages increased 
utilization and support of this largely untapped resource.
    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, as 
well as deafness, blindness, developmental delays, and autism. 
The Committee encourages NCI to continue to support a robust NF 
research portfolio in fundamental laboratory science, patient-
directed research, and clinical trials focused on NF-associated 
benign and malignant cancers. 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 encourages NEI, NINDS, and NIDCD to continue to 
aggressively fund 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 are at significant risk for autism, learning 
disabilities, motor delays, and attention deficits, the 
Committee encourages NINDS, NIMH, and NICHD to support 
laboratory-based and patient-directed research investigations 
in these areas. Since NF2 accounts for some genetic forms of 
deafness, the Committee encourages NIDCD to continue its 
investment NF2-related research. NF1 can cause vision loss due 
to optic gliomas. The Committee encourages NEI to support NF1-
focused research on optic gliomas and vision restoration.
    NIH Division of Police.--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 Director 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 further directs the NIH Division of Police, 
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.
    Office of AIDS Research.--The Committee includes no less 
than $3,290,000,000 for HIV/AIDS research, an increase of 
$200,000,000 above the estimated fiscal year 2021 level.
    Office of Behavioral and Social Sciences Research 
(OBSSR).--The Committee includes $49,827,000 for OBSSR, an 
increase of $20,000,000 above the fiscal year 2021 enacted 
level and $19,523,000 above the fiscal year 2022 budget 
request. The Committee notes that OBSSR has the mission to 
enhance NIH's behavioral science research enterprise across all 
Institutes and Centers. As multiple Surgeons General and NASEM 
have declared that most health problems facing the nation have 
significant behavioral components, the Committee strongly 
supports the continued strengthening of the behavioral science 
enterprise at NIH and urges OBSSR funding be increased to 
accomplish this mission. In this regard, the Committee is 
pleased that an NIH working group has been established to 
review how better to integrate and realize the benefits of 
overall health from behavioral research at NIH, and directs 
that appropriate OBSSR funding levels, authority, and 
organizational structure be included in this review.
    Office of Nutrition Research.--The Committee is encouraged 
by recent efforts to prioritize nutrition research across 
Institutes and Centers, including the release of first NIH-wide 
strategic plan for nutrition research. As such, the Committee 
supports the transfer of the Office of Nutrition Research to OD 
and encourages the Director to allocate sufficient resources to 
this office to ensure it can operate effectively as a trans-NIH 
entity.
    Office of Research on Women's Health.--The Committee 
includes $61,480,000 for the Office of Research on Women's 
Health, an increase of $17,555,000 above the fiscal year 2021 
enacted level and $9,177,000 above the fiscal year 2022 budget 
request. This office ensures women's health research and 
research on the biological and sociocultural influence of sex 
and gender are included within the larger NIH scientific 
framework. Congress recognizes that ORWH is the first public 
health service office to officially promote women's health 
research within and beyond the NIH scientific community. ORWH 
provides critical leadership to develop research programs like 
the Specialized Centers of Research Excellence (SCORE), a 
program designed to expedite the development and application of 
new 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 
Committee applauds ORWH's effort to encourage research across 
many scientific disciplines to examine how sex and gender 
factors influence health and contribute to various diseases. 
Within the total, the Committee includes an additional 
$2,000,000 expand the number of sites in the Building 
Interdisciplinary Research Careers in Women's Health (BIRCWH) 
program, an initiative that aims to increase the number and 
skills of investigators who conduct research on sex and gender 
influences on health and disease. ORWH is encouraged to expand 
the program to less-resourced institutions, such as HBCUs, 
tribal colleges and Institutions of Emerging Excellence.
    Office of the Chief Officer for Scientific Workforce 
Diversity.--The Committee includes $22,000,000 for the Office 
of the Chief Officer for Scientific Workforce Diversity, 
$16,000,000 above the fiscal year 2021 enacted level and the 
same as the fiscal year 2022 budget request.
    OIG Transfer.--The Committee includes $5,000,000, the same 
as the fiscal year 2021 enacted level and the fiscal year 2022 
budget request, for transfer to the HHS OIG to support 
oversight of NIH activities.
    Parkinson's disease (PD) and Dementia.--The Committee 
recognizes that although Parkinson's 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 of Parkinson's, PD represents an under-explored 
opportunity to study the onset and progression of dementia. The 
Committee strongly urges NINDS and NIA 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 2023 
Congressional Budget 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. Emerging data also link the risk of severe COVID-
19 with certain factors such as low vitamin D levels, 
hyperandrogenism, inflammation, and ethnicity predisposition, 
all of which are directly associated with PCOS. The Committee 
encourages NHLBI, NICHD, ORWH, and NIDDK to support research 
investigating the risk of severe SARS-CoV-2 infection in the 
PCOS patient population and the strong overlap of risk factors 
for both worse PCOS cardio-metabolic manifestations and severe 
COVID-19. Findings should be disseminated to health care 
providers, PCOS patients, and the public, as well as 
highlighted for clinical practice. The Committee also 
encourages NIH to report on research that has been conducted on 
PCOS and its impact on cardio-metabolic health to date in the 
fiscal year 2023 Congressional Budget Justification. Finally, 
the Committee requests that PCOS be added to the NIH Research, 
Condition, and Disease Categories reporting.
    Post-acute COVID and Chronic Fatigue Syndrome (ME/CFS).--
The Committee commends NIH on its ongoing ME/CFS efforts, 
including the rapid expansion of research regarding post-acute 
COVID-19 syndrome (PACS) and its potential connections to ME/
CFS, its leadership in the Interagency Working Group for ME/
CFS, and the recent success of mapMECFS and searchMECFS 
projects. The Committee recognizes the scientific and clinical 
opportunities in post-viral research and strongly encourages 
NIH to continue and expand its efforts to understand the 
underlying causes and risk factors for individuals with PACS 
and ME/CFS, with a focus on diagnosis, treatment, and 
prevention. The Committee encourages NIH to accelerate and 
expand efforts related to PACS and ME/CFS; such as (1) 
investing and collaborating to form large data sets through 
patient registries, biobanks, and interdisciplinary research 
investment (2) issuing PACS and ME/CFS disease specific funding 
announcements (3) coordinating an initiative to develop 
consensus on the diagnosis of PACS and the selection criteria 
for study participants involved in ME/CFS research, and (4) 
implementing mechanisms to incentivize new and early career 
researchers to enter and contribute data to the ME/CFS 
scientific field.
    Primary Mitochondrial Disease Research.--The Committee is 
aware that NIH has spearheaded a number of initiatives to 
identify new mitochondrial disorders, discover the linkages 
between mitochondrial disorders, and translate advances in 
mitochondrial research to treatments, cures, and other medical 
interventions for mitochondrial disorders and their secondary 
diseases, such as Alzheimer's disease, Parkinson's disease, and 
cancer. Given the advancements seen through peer-reviewed 
research into mitochondrial disorders at several academic sites 
across the nation, the Committee encourages NIH to increase its 
funding of primary mitochondrial disease research and requests 
the agency provide an update on these efforts within 180 days 
of enactment of this Act.
    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 treatment 
resistant post-traumatic stress disorder (PTSD) and major 
depressive disorder, particularly for veteran participants. 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.
    Rare Disease Research.--The Committee is aware that nearly 
one in ten individuals in the U.S. is affected by a rare 
disease, and that rare diseases frequently are genetic or have 
a genetic component. The Committee urges NIH to expand research 
on rare genetic and chromosomal abnormalities, such as 7q11.23 
Duplication Syndrome and Hereditary Spastic Paraparesis 49 
(TECPR2). The Committee directs NIH to provide an update on 
these two conditions in the fiscal year 2023 Congressional 
Budget Justification.
    Research on Long COVID.--The Committee commends NIH for 
undertaking a major initiative to research the causes of, and 
the best ways to prevent and treat, what is often referred to 
as Long COVID, which occurs when individuals experience a 
variety of symptoms long past the time that they have recovered 
from the initial stages of COVID-19 illness. Symptoms can 
include fatigue, exercise intolerance, shortness of breath, 
trouble with memory and concentration, headache, sleep 
disorders, orthostatic tachycardia, chest, muscle and joint 
pains, fevers, gastrointestinal symptoms, anxiety, post-
traumatic stress disorder, and depression, can last for months 
or longer, and can range from mild to incapacitating. In 
addition, it is unclear to what extent COVID-19 and its long-
term effects may interact with pre-existing conditions such as 
vascular and neurodegenerative diseases, potentially changing 
their course and morbidity. The Committee directs NIH to 
sustain and strengthen its research into Long COVID. As part of 
this research, the Committee urges NIH to study Long COVID in 
children and youth.
    Furthermore, the Committee recognizes that the COVID-19 
pandemic has exposed an array of related health disparities, 
including a difference in severity and outcomes between female 
and male patients due to sex and gender influences. This is 
also true for individuals who continue to experience COVID-19 
symptoms and/or damage to organs to varying degrees months 
after their initial diagnosis. To better understand how sex 
differences are implicated in the severity of the COVID-19 
pandemic, the Committee encourages the Institutes and Centers 
of the NIH in coordination with the NIH Office of the Director 
and Office of Women's Health Research to support research that 
studies how sex as a biological variable impacts short and 
long-term outcomes due to infection with SARS-CoV-2.
    SARS-CoV-2 Genomic Sequence Data.--The Committee is 
concerned by reports that early SARS-CoV-2 genomic sequence 
data from China, specifically the Wuhan region, were withdrawn 
from the Sequence Read Archive (SRA) at the National Institutes 
of Health. The Committee is aware of allegations that the 
Chinese Communist Party has refused to provide raw data to 
international scientists and the World Health Organization to 
impede the investigation into the origins of Covid-19. From the 
beginning of the pandemic, there have been suggestions that the 
Chinese Communist Party barred scientists from releasing data 
and even delayed the release of the genetic map of the virus to 
the world. The Committee understands that it is difficult to 
identify, early in pandemics, what data may be most relevant 
because of the disperse nature of initial reports and the 
uncertainty surrounding an emerging virus--however, some 
scientists have cited difficulties in studying the origins of 
the virus due to a lack of early data from Wuhan. Furthermore, 
the Committee is aware that there are legitimate reasons to 
request the withdrawal of genomic sequence data from SRA, 
including insufficient data quality and incomplete consent 
procedures, however, the early sequence data at issue here may 
be key to understanding the origin of SARS-CoV-2. Within 30 
days of the enactment of this Act, the Director of the National 
Institutes of Health shall report to the Committee on the 
withdrawal of SARS-CoV-2 genomic sequence data from the 
Sequence Read Archive. The report should include the total 
number of requests for withdrawals of SARS-CoV-2 data broken 
down by institution, the number of sequences that were 
subsequently withdrawn from the SRA, the reasons provided by 
the institution for the request for withdrawal, any 
characteristics provided for the sequences and other pertinent 
information, as well as any pending requests for SARS-CoV-2 
genomic sequence withdrawals.
    Sickle Cell Disease (SCD).--The Committee commends NIH for 
its ongoing support of clinical research for SCD, which imposes 
major morbidity on an estimated 90,000 to 100,000 individuals 
in the U.S., with three million Americans carrying the sickle 
cell trait. The Committee encourages NIH to support clinical 
trials for prenatal and postnatal treatment of SCD, which 
includes a wealth of promising approaches to eradicate this 
disease, save lives, and dramatically reduce the substantial 
health care costs associated with SCD for both children and 
adults. The NIH is encouraged 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 to cure SCD. The Committee encourages NHLBI and 
NHGRI to collaborate on research on Sickle Cell Trait. It is 
critical to better understand the risks for health 
complications and the potential link to severe illness and risk 
of death from COVID-19 for the one to three million Americans 
living with Sickle Cell Trait, the single gene mutation for 
SCD.
    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; and report out by Institute 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. 
Finally, the Committee encourages NIH to support research on 
the potential causes behind a growing incidence and prevalence 
of bladder cancer in individuals with Spina Bifida.
    Thalassemia.--Nutrition can be an important tool in the 
management of rare diseases. Currently, there is no 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.
    Trans-NIH Pediatric Research Consortium.--The Committee is 
aware of the Trans-NIH Pediatric Research Consortium (N-PeRC) 
that was established in 2018 to better coordinate and support 
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 as to multi-
Institute or Center pediatric research projects implemented as 
a result of N-PeRC and projects in the planning stage. 
Additionally, the Committee requests a report in the fiscal 
year 2023 Congressional Budget Justification on how N-PeRC 
plans to support 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.
    Undiagnosed Diseases.--The Committee recognizes the 
important role the NIH-funded Undiagnosed Diseases Network 
(UDN) has played to improve diagnosis of rare diseases and 
other undiagnosed conditions and encourages NIH to continue 
supporting this work, including by developing a plan to sustain 
the work of the UDN.

                        BUILDINGS AND FACILITIES

 
 
 
Appropriation, fiscal year 2021.......................      $200,000,000
Budget request, fiscal year 2022......................       250,000,000
Committee Recommendation..............................       250,000,000
    Change from enacted level.........................       +50,000,000
    Change from budget request........................             - - -
 

    Mission.--This account provides for the design, 
construction, improvement, and major repair of clinical, 
laboratory, and office buildings and supporting facilities 
essential to the mission of the 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; and other 
smaller facilities throughout the U.S.

                         NIH INNOVATION ACCOUNT

    This account supports NIH programs authorized in the 21st 
Century Cures Act (P.L. 114-255).

              ADVANCED RESEARCH PROJECTS AGENCY FOR HEALTH

 
 
 
Appropriation, fiscal year 2021.......................                $0
Budget request, fiscal year 2022......................     6,500,000,000
Committee Recommendation..............................     3,000,000,000
    Change from enacted level.........................    +3,000,000,000
    Change from budget request........................    -3,500,000,000
 

    The Committee includes $3,000,000,000 to establish the 
Advanced Research Projects Agency for Health (ARPA-H), 
$3,000,000,000 above the fiscal year 2021 enacted level and 
$3,500,000,000 below the fiscal year 2022 budget request.
    The Committee strongly supports the goals and vision behind 
the proposal for ARPA-H and believes that once established, 
ARPA-H will be able to make pivotal investments in breakthrough 
technologies and broadly applicable platforms that have the 
potential to transform medicine, research, and health. The 
Committee looks forward to working with the Administration to 
establish ARPA-H and expects to expand its capacity to support 
innovative projects in future fiscal years.
    The Committee agrees that ARPA-H projects focused on 
developing treatments and cures for cancer, Alzheimer's 
disease, and diabetes would be a worthy investment, given the 
prevalence and immense burden of these diseases on society, as 
well as the potential for such an investment to achieve 
progress. The Committee strongly encourages NIH to pursue ARPA-
H projects related to finding treatments and a cure for ALS, 
given its devastating impact on those who suffer from ALS and 
their families. The Committee expects to be kept apprised of 
NIH's proposed criteria for selecting and prioritizing projects 
for ARPA-H funding.
    For ARPA-H to be successful, the Committee believes ARPA-H 
must be a distinct Institute within NIH, with a unique culture 
and organization that should focus on time-limited projects 
with goals, benchmarks, and accountability. The Committee 
strongly encourages NIH to recruit an ARPA-H Director with 
extraordinary technical and leadership skills, who has a proven 
track-record in innovation and partnership-building. As the 
success of this endeavor will be largely dependent upon the 
recruitment and empowerment of a diverse cohort of program 
managers, the Committee urges NIH to consider recruiting from a 
wide range of industry, academia, and other sectors. The 
Committee encourages NIH to collaborate with DARPA to develop 
the foundational policies, procedures, and staff training for 
ARPA-H employees.
    The Committee is aware that there may be ongoing activities 
within NIH's current Institutes and Centers that may be better 
aligned with ARPA-H's mission. The Committee encourages NIH to 
closely examine whether there is duplication or misalignment of 
programs once ARPA-H is stood up and to notify the Committee of 
any proposed reorganization.

       SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION

 
 
 
Appropriation, fiscal year 2021.......................    $6,015,508,000
Budget request, fiscal year 2022......................     9,734,011,000
Committee Recommendation..............................     9,160,277,000
    Change from enacted level.........................    +3,144,769,000
    Change from budget request........................      -572,234,000
 

    The Committee recommendation for the Substance Abuse and 
Mental Health Services Administration (SAMHSA) program level 
includes $9,014,610,000 in discretionary budget authority, 
$133,667,000 in PHS Evaluation Tap Funding, and $12,000,000 in 
transfers from the Prevention and Public Health Fund (PPHF).
    In addition, the American Rescue Plan (P.L. 117-2) included 
$3,235,000,000 for SAMHSA to address the increased need for 
mental health and substance use disorder services due to the 
COVID-19 pandemic.
    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 Abuse 
Prevention and Treatment Block Grant as a source for the Public 
Health Service Act section 241 evaluation set aside in fiscal 
year 2022.

                             MENTAL HEALTH

 
 
 
Appropriation, fiscal year 2021.......................    $1,792,275,000
Budget request, fiscal year 2022......................     2,936,528,000
Committee Recommendation..............................     3,161,295,000
    Change from enacted level.........................    +1,369,020,000
    Change from budget request........................      +224,767,000
 

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

------------------------------------------------------------------------
                                                            FY 2022
                   Budget Activity                         Committee
------------------------------------------------------------------------
Capacity:
    Seclusion and Restraint..........................         $1,147,000
    Project AWARE....................................        155,502,000
    Mental Health Awareness Training.................         35,945,000
    Healthy Transitions..............................         31,451,000
    Infant and Early Childhood Mental Health.........         25,000,000
    Children and Family Programs.....................          7,229,000
    Consumer and Family Network Grants...............          4,954,000
    Project LAUNCH...................................         23,605,000
    Mental Health System Transformation..............          3,779,000
    Primary and Behavioral Health Care Integration...         57,877,000
    Behavioral Health Crisis Coordinating Office.....         10,000,000
    National Strategy for Suicide Prevention.........         28,200,000
        Zero Suicide.................................         26,200,000
            American Indian and Alaska Native Set-             3,400,000
             Aside...................................
    Suicide Lifeline.................................        113,621,000
    Garrett Lee Smith-Youth Suicide Prevention
        State Grants.................................         34,427,000
        Campus Grants................................          6,488,000
    American Indian and Alaska Native Suicide                  3,431,000
     Prevention......................................
    Tribal Behavioral Health Grants..................         25,000,000
    Homeless Prevention Programs.....................         30,696,000
    Minority AIDS....................................          9,224,000
    Criminal and Juvenile Justice Programs...........         51,394,000
    Assisted Outpatient Treatment....................         21,420,000
    Assertive Community Treatment for Individuals              9,000,000
     with Serious Mental Illness.....................
Science and Service:
    Garrett Lee Smith-Suicide Prevention Resource              9,000,000
     Center..........................................
    Practice Improvement and Training................          7,828,000
    Consumer and Consumer Support Technical                    1,918,000
     Assistance Centers..............................
    Primary and Behavioral Health Care Integration             1,991,000
     Technical Assistance............................
    Interagency Task Force on Trauma-Informed Care...              1,000
    Minority Fellowship Program......................         11,713,000
    Disaster Response................................          1,953,000
    Homelessness.....................................          2,296,000
------------------------------------------------------------------------

    Assisted Outpatient Treatment.--The Committee includes an 
increase of $420,000 to expand access to evidence-based mental 
health services for individuals with serious mental illness.
    Behavioral Health Crisis Coordinating Office.--The 
Committee includes $10,000,000 for the Office of the Assistant 
Secretary for Mental and Substance Use to create and 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 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. The Committee directs the Secretary to include 
a multi-year plan in the fiscal year 2023 Congressional Budget 
Justification outlining a nationwide crisis care system plan of 
action.
    Criminal Justice Activities.--The Committee includes an 
increase of $45,125,000 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 substance use disorders.
    Garrett Lee Smith (GLS) Youth Suicide Prevention.--The 
Committee includes an increase of $10,000,000 for GLS Youth 
Suicide Prevention, to develop and implement youth suicide 
prevention and early intervention strategies.
    Healthy Transitions.--The Committee includes an increase of 
$2,000,000 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 at risk of developing a 
serious mental health condition.
    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 
$17,000,000 for Infant and Early Childhood Mental Health. This 
will support increased access to a range of evidence-based and 
culturally appropriate infant and early childhood mental health 
services, and aid in addressing the national shortage of mental 
health professionals with infant and early childhood expertise. 
The Committee urges 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.
    Interagency Task Force for Trauma-Informed Care.--The 
Committee includes $1,000,000 for the Interagency Task Force 
for Trauma-Informed Care, as authorized by the SUPPORT Act, to 
develop best practices to identify, prevent, and mitigate the 
effects of trauma on infants, children, youth, and their 
families.
    Minority Fellowship.--The Committee provides $20,289,000, 
an increase of $4,120,000, 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 substance use disorders 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 Zero Suicide model, a comprehensive, multi-setting approach 
to suicide prevention in health care systems. The Committee 
also includes an increase of $500,000 for the AI/AN Suicide 
Prevention Initiative.

National Suicide Prevention Lifeline

    The Committee recognizes that suicide is a leading cause of 
death in the United States, taking the lives of more than 
47,000 Americans 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 an increase of 
$89,621,000, which is $12,000,000 above the fiscal year 2022 
budget request, to enhance the National Suicide Prevention 
Lifeline's (NSPL) infrastructure in preparation for the launch 
to a new 988 number in July 2022. 988 has the potential to make 
it simpler for people experiencing a mental health crisis to 
connect with lifesaving crisis intervention services. However, 
the Committee is disappointed that SAMHSA has not completed the 
report on the resources required to implement 988, as required 
by the National Suicide Hotline Designation Act (P.L. 116-172). 
This report is critical in ensuring the appropriate amount of 
funding is available to strengthen the infrastructure of the 
existing Lifeline to increase the capacity of Lifeline centers 
to be ready to respond to the expected increase in calls, 
chats, and texts from people in crisis seeking assistance. The 
Committee directs SAMHSA to provide this report within 30 days 
of enactment of this Act. The Committee also directs that as 
SAMHSA works to enhance the NSPL infrastructure, it should 
expand existing capabilities for response in a manner that, to 
the extent possible, utilizes existing phone, chat, and text 
capabilities.
    NSPL Specialized Services for LGBTQ Youth.--The Committee 
directs that of the funds made available for NSPL, $7,200,000 
shall be used to provide specialized services for LGBTQ youth 
within the NSPL. SAMHSA shall make this funding competitively 
available to an organization with experience working with LGBTQ 
youth and capable of handling LGBTQ youth callers through 
Integrated Voice Response.
    NSPL Text-Based Crisis Support Capabilities.--The Committee 
is aware that texting for individuals experiencing a mental 
health crisis is important, particularly among young people for 
whom texting is often a preferable means of communication to 
voice calls. The Committee also recognizes the significant 
operational and financial challenge of building the 
infrastructure for text capacity to support implementation of 
text to the 988 number by the network of local crisis centers 
that support the NSPL. Given the high number of individuals 
whose cell phone number does not match the cell phone area code 
in their area, the regional model that is in place for routing 
telephone calls to a local crisis center may not be necessary 
for texters in crisis. Furthermore, both the Veterans Crisis 
Line and the Disaster Distress Hotline have employed national 
backup centers to receive texts. As SAMHSA considers making 
text-based crisis support capabilities available to members of 
the public, the Committee directs SAMHSA to avoid duplicating 
existing capabilities to the extent possible. The Committee 
directs SAMHSA to coordinate and work with existing text and 
chat providers that have the technology to triage text 
conversations based upon severity of risk, to improve risk 
assessment and response capacity.
    NSPL Partnerships.--The Committee recognizes that the 
designation of 988 as the new three-digit dialing code for the 
National Suicide Prevention Lifeline will help increase the 
effectiveness of suicide prevention efforts, increase access to 
crisis services, reduce the stigma of mental health conditions, 
and save lives. As SAMHSA considers partnerships to administer 
988, the Committee encourages SAMHSA to consider partnering 
with non-profit or academic institutions with first-hand 
experience administering a national network of local behavioral 
health crisis call services to ensure the highest level of 
quality and efficiency.
    Primary and Behavioral Health Care Integration.--The 
Committee includes an increase of $5,000,000 to improve the 
coordination and integration of primary care services and 
publicly funded behavioral health services.
    Project AWARE.--To increase access to mental health 
services, as set out by the 2013 ``Now is the Time'' plan, the 
Committee includes a total increase of $48,501,000 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. This includes an increase of $42,251,000 
for Project AWARE state grants, an increase of $6,250,000 for 
Resilience in Communities after Stress and Trauma (ReCAST) 
grants. In addition, the Committee includes an increase of 
$11,982,000 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 American 
Indian/Alaska Native populations.
    Certified Community Behavioral Health Clinics (CCBHC).--The 
Committee includes an increase of $125,000,000 for the CCHBC 
program. In addition, the American Rescue Plan (P.L. 117-2) 
included $420,000,000 to support CCBHCs. 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.--The Committee includes an 
increase of $25,000,000 for the Children's Mental Health 
program, which supports 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.

Mental Health Block Grant

    The Committee includes $1,582,571,000, an increase of 
$825,000,000, for the Mental Health Block Grant (MHBG). In 
addition, the American Rescue Plan (P.L. 117-2) included 
$1,500,000,000 for the 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. The Committee expects SAMHSA to 
continue its collaboration with the National Institute of 
Mental Health (NIMH) and to encourage States to use this 
funding to support programs that demonstrate strong evidence of 
effectiveness. In addition, the Committee urges States to use a 
portion of their MHBG formula funding to provide mental health 
services to the survivors of mass shootings as well as their 
families.
    MHBG Crisis Care Set-Aside.--The Committee includes a 10 
percent set-aside in the MHBG for evidence-based crisis care 
programs addressing 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. The goal is a crisis care 
system where a person in crisis will have someone to talk to, 
someone to respond, and/or somewhere to go for crisis 
intervention at any time.
    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. The 
Committee notes emerging science developed by the NIMH on early 
intervention and prevention of mental disorders. Many 
neuropsychiatric illnesses have a typical age of onset in late 
adolescence, and studies demonstrate that half of those who 
will develop mental health disorders show symptoms by age 14. 
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 0-5.--The Committee strongly 
believes that by investing in early mental health prevention, 
identification, and treatment, we can reduce the need for 
treatment later in life when it becomes much more difficult, 
time intensive, and expensive. Early intervention can change 
the course for children experiencing or at risk of developing 
mental health disorders. The Committee is concerned that there 
has not been a sufficient focus on this population. The 
Committee strongly 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 directs SAMHSA to provide a report, within 
180 days of enactment of this Act, on the portion of MHBG 
funding that States are allocating to services and activities 
for infants and toddlers.
    Mental Health Disparities.--The Committee believes that 
addressing health care disparities experienced by racial and 
ethnic minorities should be a priority in programs funded by 
Federal agencies, including programs funded in whole or part by 
the Community Mental Health Services Block Grant authorized 
under 42 U.S.C. 300x 1. The Committee directs SAMHSA to 
require, in the reporting mandated of states receiving funds 
under 42 U.S.C. 300x 1, that State Mental Health Agencies 
report on the extent to which services are provided to 
individuals from racial and ethnic minorities and the outcomes 
experienced by those individuals. The Committee directs that 
impact and outcomes should be reported for racial and ethnic 
minority adults with serious mental illness and racial and 
ethnic minority children with serious emotional disturbance in 
reports of data submitted relating to diversions from 
hospitalization, arrests, treatment for first episode 
psychosis, reductions in suicide, response through crisis 
services, and treatment of homeless individuals. State Mental 
Health Agencies shall also report on outreach to, and the 
hiring of, racial and ethnic minority providers of mental 
health services.
    Mental Health Crisis Response Partnership Pilot Program.--
The Committee is aware that the lack of sufficient mental 
health care resources in communities too often results in law 
enforcement responding to what is actually a mental health 
emergency. SAMHSA's ``National Guidelines for Behavioral Health 
Crisis Care'' outline a roadmap for robust crisis care services 
that can divert people experiencing a mental health crisis from 
the criminal justice system into mental health treatment. The 
Committee has directed significant resources to improve mental 
health crisis care and increase access to mental health 
services. However, the availability of mental health crisis 
care remains inconsistent across the United States, 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 $100,000,000 for 
a pilot 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 also directs the Department to provide 
a report, within 180 days of enactment of this Act, on existing 
steps being taken to strengthen partnerships between mental 
health providers, behavioral health teams, and first 
responders, as well as a report not later than one year 
following the obligation of awards in fiscal year 2022 for this 
pilot program, including best practices and recommendations for 
subsequent grant cycles.
    National Child Traumatic Stress Initiative.--The Committee 
includes an increase of $28,113,000 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.

Projects for Assistance in Transition from Homelessness (PATH)

    The Committee includes an increase of $10,000,000 for the 
PATH program, which supports grants to States and territories 
for assistance to individuals suffering from severe mental 
illness and/or substance use disorders 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. This puts significant strain on public budgets while 
patients do not receive the robust behavioral health care they 
need. The Committee recognizes that housing support paired with 
wraparound services is a successful model and appreciates that 
the fiscal year 2011 President's Budget supported the concept. 
In fiscal year 2021 the Committee requested a report from 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 an increase of $3,854,000, for 
the Protection and Advocacy for Individuals with Mental Illness 
program, which ensures that the rights of mentally ill 
individuals are protected while they are patients in all public 
and private facilities or while they are living in the 
community. 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 encourages 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 
the National Suicide Prevention Lifeline to develop 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 
encourages the Secretary, acting through the Assistant 
Secretary for Mental Health and Substance Use, to develop 
school-based 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 individuals who are responsible for 
identifying and assessing behaviors of concern and facilitating 
the implementation of evidence-based interventions.
    Impact of COVID-19 on the Mental Health of Older 
Americans.--The Committee recognizes the exacerbated impact of 
COVID-19 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. 
Research shows that rates of anxiety and depression among older 
adults during the pandemic are higher among female, Hispanic, 
and low-income seniors. In disbursing MHBG funds, the Committee 
encourages SAMHSA to work with States to address the impact of 
increased isolation of seniors.
    Mental Health Centers of Excellence.--The Committee 
recognizes the need for more effective mental health programs 
and a need to better provide treatment recommendations to meet 
the needs of those experiencing mental illness. The Committee 
encourages 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.
    Perinatal Suicide Prevention.--Perinatal suicides, which 
occur during pregnancy or up to one year postpartum, are a 
leading cause of maternal mortality in the United States. The 
prevalence of suicidal ideation among pregnant and postpartum 
individuals was five times higher in 2017 than in 2006, and 
during that period, Black pregnant and postpartum individuals 
experienced larger increases in suicidality than other racial 
and ethnic groups. Given these trends, the Committee urges 
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.

                       SUBSTANCE ABUSE TREATMENT

 
 
 
Appropriation, fiscal year 2021.......................    $3,854,756,000
Budget request, fiscal year 2022......................     6,408,943,000
Committee Recommendation..............................     5,511,943,000
    Change from enacted level.........................    +1,657,187,000
    Change from budget request........................      -897,000,000
 

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

------------------------------------------------------------------------
                   Budget Activity                     FY 2022 Committee
------------------------------------------------------------------------
Capacity:
    Opioid Treatment Programs and Regulatory                 $13,086,000
     Activities......................................
    Screening, Brief Intervention, Referral to                30,510,000
     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.........................         63,000,000
        Rural Focus..................................         36,000,000
    Pregnant and Postpartum Women....................         49,397,000
    Recovery Community Services Program..............          5,151,000
    Children and Families............................         30,197,000
    Treatment Systems for Homeless...................         40,114,000
    Minority AIDS....................................         66,881,000
    Criminal Justice Activities......................        124,380,000
        Drug Courts..................................        105,000,000
    Improving Access to Overdose Treatment...........          1,500,000
    Building Communities of Recovery.................         20,000,000
    Peer Support Technical Assistance Center.........          1,500,000
    Comprehensive Opioid Recovery Centers............          6,000,000
    Emergency Department Alternatives to Opioids.....          9,000,000
    Treatment, Recovery, and Workforce Support.......          9,000,000
Science and Service:
    Addiction Technology Transfer Centers............          9,046,000
    Minority Fellowship Program......................          7,186,000
------------------------------------------------------------------------

    Building Communities of Recovery.--The Committee includes 
an increase of $10,000,000 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 $2,000,000 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.
    Criminal Justice Activities and Drug Courts.--The Committee 
includes an increase of $35,380,000 for Criminal Justice 
activities. Of this amount, $35,000,000 is directed to Drug 
Court activities. The Committee continues to direct SAMHSA to 
ensure that all funding appropriated for drug treatment courts 
is allocated to serve people diagnosed with a substance use 
disorder as their primary condition. The Committee directs 
SAMHSA to ensure that all drug treatment court grant recipients 
work directly with the corresponding State substance abuse 
agency in the planning, implementation, and evaluation of the 
grant. The Committee further directs SAMHSA to expand training 
and technical assistance to drug treatment court grant 
recipients to ensure evidence-based practices are fully 
implemented.
    Emergency Department Alternatives to Opioids.--The 
Committee includes an increase of $3,000,000 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 $6,000,000 for Grants to Prevent Prescription Drug/Opioid 
Overdose Deaths, and an increase of $21,000,000, for First 
Responder Training for Opioid Overdose Reversal Drugs, which 
includes an increase of $12,000,000 for a rural set-aside. The 
Committee directs that $6,500,000 of funds for First Responder 
Training be made available to SIREN 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, 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 $500,000 to provide technical 
assistance to recovery community organizations and peer support 
networks.
    Pregnant and Postpartum Women SUD Treatment.--The Committee 
includes an increase of $16,466,000 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. A provision in the 
Comprehensive Addiction and Recovery Act (CARA) authorizes 
SAMSHA to allocate a portion of these resources for a pilot 
program to State alcohol and drug agencies to support 
outpatient, intensive outpatient and related services in a 
family centered approach. The Committee again encourages SAMHSA 
to fund an additional cohort of States above and beyond those 
pilots already funded.
    Recovery Community Services.--The Committee includes an 
increase of $2,717,000 to help recovery communities strengthen 
their infrastructure and provide peer recovery support services 
to those in or seeking recovery from SUD. The intent of the 
Recovery Community Services Program Statewide Network (RSCP-SN) 
program is to strengthen the relationships between RCOs 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 (ROSC) landscape.
    Screening, Brief Intervention, and Referral to Treatment 
(SBIRT).--The Committee includes an increase of $2,510,000, for 
SBIRT. The Committee recognizes that SBIRT is still not widely 
adopted by broader health care or social service networks, 
particularly in underserved communities. Failure to routinely 
screen youth and adults for early misuse of opioids and other 
substances is a missed opportunity to stem the substance misuse 
crisis. 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 
CSAT within the existing SBIRT program.
    Targeted Capacity Expansion-Medication Assisted 
Treatment.--The Committee includes an increase of $56,500,000 
for Medication Assisted Treatment (MAT) for Prescription Drug 
and Opioid Addiction; an increase of $5,500,000, for grants to 
Indian tribes, tribal organizations, or consortia; and an 
increase of $224,000 for general Targeted Capacity Expansion 
activities.
    Treatment Systems for Homeless.--The Committee includes an 
increase of $3,728,000 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 $3,000,000 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 substance use disorder 
treatment and recovery to live independently and participate in 
the workforce.

State Opioid Response (SOR) Grants

    The Committee includes $2,000,000,000 for SOR grants, an 
increase of $500,000,000. The Committee directs SAMHSA to 
continue supplemental grants in fiscal year 2022 to States 
whose award from the SOR formula grant declines by more than 40 
percent in fiscal year 2022 compared to fiscal year 2019. 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 Abuse 
Prevention and Treatment Block Grant under part B of title X of 
the Public Health Service Act. This approach will ensure 
continuity of funding, effective coordination of efforts, and 
decrease fragmentation within each State system.
    SOR Funding Cliff.--The Committee continues to include a 15 
percent set-aside for States with the highest age-adjusted 
mortality rate related to opioid use disorders. The Committee 
remains concerned 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 2022, the Committee directs the Assistant Secretary to 
award funds to avoid funding cliffs between States with similar 
mortality rates. The Committee notes that funding cliffs 
between grant cycles can pose a significant challenge for 
States seeking to maintain programs that were instrumental in 
reducing drug overdose fatalities. The Committee requests a 
report within 180 days of enactment of this Act on the extent 
to which such reductions to States in previous grant cycles 
affected outreach and provision of services, as well as 
treatment and recovery outcomes.

Substance Abuse Prevention and Treatment Block Grant

    The Committee includes a program level of $2,858,079,000 
for the Substance Abuse Prevention and Treatment Block Grant 
(SABG), an increase of $1,000,000,000. In addition, the 
American Rescue Plan (P.L. 117-2) included $1,500,000,000 for 
the SABG. SABG provides funding to States to support alcohol 
and drug abuse 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 SABG 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.
    SABG Recovery Set-Aside.--The Committee establishes a ten 
percent set-aside within total SABG 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; (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 support operating costs for organizations that 
provide 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 Abuse Prevention and Treatment Block Grants in 
supporting States' efforts to provide resources for expanded 
mental health and substance use disorder 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 encourages SAMHSA to begin implementing public 
reporting on their existing block grants. The Committee directs 
SAMHSA to submit a report, 180 days after the enactment of this 
Act, to identify any staffing, IT infrastructure, legislative 
policies, or funding barriers that would prevent grantees and 
SAMHSA from collecting and providing outcome data on their 
block grant programs.
    Data Collection for SUD Grants to States.--A December 2020 
GAO report examining SUD grants to States found that SAMHSA 
does not have consistent, relevant, and timely data on the 
number of individuals provided treatment and recovery support 
through the SABG, State Targeted Response to the Opioid Crisis 
Grant (STR), and SOR programs. The Committee recognizes the 
challenges the lack of data poses in evaluating the 
effectiveness of these grants and encourages SAMHSA to adopt 
GAO's recommendation to identify and implement changes to their 
data collection efforts to improve the consistency, relevance, 
and timeliness of data collected on the number of individuals 
who receive substance use disorder treatment and recovery 
support services with funding from the SABG and SOR programs.
    Evidence-Based Practices to Combat the Opioid Crisis.--The 
CDC projects that more than 88,000 drug overdose deaths 
occurred in the United States in the 12 months ending in August 
2020, the highest number of overdose deaths ever recorded in a 
12-month period. Given the acceleration of the drug overdose 
epidemic, due in part to the COVID-19 pandemic, the Committee 
directs SAMSHA to encourage States to use grant funds provided 
to combat this substance use disorder crisis to prioritize 
evidence-based best practices exemplified by the states, 
including but not limited to: Overdose Education and Naloxone 
Distribution (OEND), Medication Assisted Treatment (MAT), 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 the 
development of evidence-based programs and treatments 
specifically tailored for those with alcohol and substance use 
disorder 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.
    National Recovery Month.--The Committee recognizes that 
National Recovery Month is a meaningful observation to 
recognize individuals in recovery from substance use disorders 
and mental illness. Between September 2019 and August 2020, 
more than 85,000 people nationwide died from drug overdoses and 
47,000 nationwide died from suicide in 2019. Promoting 
awareness of treatment for substance use and mental health 
disorders and combating stigma, both goals of National Recovery 
Month, are important steps to help prevent overdoses and 
suicide. The Committee recognizes SAMHSA as an important leader 
in National Recovery Month and encourages SAMHSA to maintain a 
leadership role in these efforts.
    Opioid Use Disorder Relapse.--The Committee recognizes that 
relapse might occur after opioid use disorder 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 
relapse to opioid dependence, and encourages SAMHSA to 
disseminate and emphasize implementation of these practices in 
all settings where treatment is offered, including 
rehabilitation and criminal justice settings.
    Substance Use Disorder Response in Rural America.--The 
Committee is aware that response to the SUD crisis continues to 
pose unique challenges for rural America, which suffers from 
problems related to limited access to both appropriate care and 
health professionals critical to diagnosing and treating 
patients along with supporting recovery. Rural America's unique 
challenges require a comprehensive approach, including training 
to provide care in a culturally responsive manner with an 
understanding of diverse populations; the use of technologies 
to ensure improved access to medically underserved areas 
through the use of telehealth; and workforce and skills 
development to advance data capture and analytics. 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.
    Recovery Housing.--The Committee recognizes the importance 
of recovery housing, in which individuals abstain from use of 
non-prescribed substances in a supportive environment. Research 
shows that individuals with SUD who live in recovery housing 
are more likely to maintain recovery, have higher rates of 
employment, and are less likely to become incarcerated. 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.

                       SUBSTANCE ABUSE PREVENTION

 
 
 
Appropriation, fiscal year 2021.......................      $208,219,000
Budget request, fiscal year 2022......................       216,667,000
Committee Recommendation..............................       243,503,000
    Change from enacted level.........................       +35,284,000
    Change from budget request........................       +26,836,000
 

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

------------------------------------------------------------------------
                   Budget Activity                     FY 2022 Committee
------------------------------------------------------------------------
Capacity:
    Strategic Prevention Framework...................       $139,484,000
        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......         15,000,000
        National Adult-Oriented Media Public Service           2,500,000
         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.          3,000,000
Science and Service:
    Center for the Application of Prevention                   7,493,000
     Technologies....................................
    Science and Service Program Coordination.........          4,072,000
    Minority Fellowship Program......................          1,390,000
------------------------------------------------------------------------

    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. This is too often 
the beginning of a pathway to dependence, substance use 
disorder, and overdose. Furthermore, medication take-back 
programs are difficult to access for many Americans and 
inadequate to broadly impact disposal behavior. Newer 
technologies to deactivate and safely dispose of prescription 
drugs in the home have been shown through independent research 
to lead to improved outcomes. The Committee includes $3,000,000 
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 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.
    Sober Truth on Preventing Underage Drinking (STOP) Act.--
The Committee includes $15,000,000, an increase of $5,000,000, 
for the STOP Act. Of this amount, $11,500,000 is for the 
Community Based Enhancement Grant Program to help community 
coalitions address underage drinking; $2,500,000 is for an 
annual public service campaign on underage drinking; and 
$1,000,000 is for the ICCPUD to carry out its reporting and 
coordination responsibilities. The Committee is disappointed 
that SAMHSA has not released a new Funding Opportunity 
Announcement (FOA) for the STOP Act Community Based Enhancement 
Grant program since 2019 and directs SAMHSA to ensure a new FOA 
for this program is released in fiscal year 2022.
    Strategic Prevention Framework.--The Committee provides 
$139,484,000, an increase of $20,000,000, for the Strategic 
Prevention Framework (SPF). Of the total provided, $124,484,000 
is for SPF-Partnerships for Success (SPF-PFS) and $15,000,000 
is for SPF-Rx. The Committee strongly believes that investing 
in prevention is essential to ending the substance misuse 
crisis, and supports the SPF-PFS program, which is designed to 
prevent the onset of substance misuse, while strengthening 
prevention capacity and infrastructure. The Committee intends 
that this program support comprehensive, multi-sector substance 
use prevention strategies to stop or delay the age of 
initiation of each State or local applicant's most pressing 
substance use issues, as determined by the State and/or local 
epidemiological data. The Committee directs SAMHSA to issue a 
report, within 120 days of enactment of this Act, assessing the 
extent to which the work of local grantees complements and 
align with the primary prevention efforts led by the 
corresponding State alcohol and drug agency.
    SUD Prevention Workforce.--The Committee recognizes that 
the nation's work on SUD prevention relies on an adequate 
supply of educated prevention professionals. The Committee is 
aware that more data and information is needed about the SUD 
prevention workforce. Therefore, the Committee directs SAMHSA 
to conduct a comprehensive national study regarding the 
substance use prevention workforce. The study should include an 
environmental scan of the existing workforce, salaries, current 
challenges in maintaining support for an adequate workforce, a 
plan to address these challenges and potential federal 
programming to help implement the plan. The Committee directs 
SAMHSA to develop the study in consultation with relevant 
stakeholders, including the association representing State 
alcohol and drug agencies, researchers, and others.
    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 American 
Indian/Alaska Native populations.

                HEALTH SURVEILLANCE AND PROGRAM SUPPORT

 
 
 
Appropriation, fiscal year 2021.......................      $160,258,000
Budget request, fiscal year 2022......................       170,373,000
Committee Recommendation..............................       243,536,000
    Change from enacted level.........................       +83,278,000
    Change from budget request........................       +73,163,000
 

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

------------------------------------------------------------------------
                   Budget Activity                     FY 2022 Committee
------------------------------------------------------------------------
Health Surveillance..................................        $47,595,000
    PHS Evaluation Funds.............................         30,428,000
Program Support......................................         84,316,000
Public Awareness and Support.........................         13,260,000
Performance and Quality Information Systems..........         10,200,000
Drug Abuse Warning Network...........................         16,500,000
Behavioral Health Workforce..........................          1,000,000
    PHS Evaluation Funds.............................          1,000,000
------------------------------------------------------------------------

    Within the funds included in this account, $70,665,000 
shall be used for the following projects in the following 
amounts:

------------------------------------------------------------------------
                       Project                               Amount
------------------------------------------------------------------------
Access Community Health Network, Chicago, IL for                $140,000
 behavioral health and supportive services...........
Adult & Teen Challenge USA, Ozark, MO for recovery               475,000
 support services, equipment, and technology.........
AdventHealth, Sanford, FL for substance use treatment            400,000
 and support services................................
All Star Children's Foundation, Sarasota, FL for               1,500,000
 child welfare and trauma services program and
 associated support services.........................
Arlington County Government, Arlington, VA for a                 390,000
 mobile mental health crisis reponse team............
Ashley, Inc., Havre de Grace, MD for a substance use             525,000
 treatment program partnership to identify,
 implement, and broadly disseminate new forms of SUD
 treatment targeted to underserved populations.......
Assisted Recovery Centers of America, St. Louis, MO            1,300,000
 for mental health and substance use treatment and
 other wraparound services...........................
Baltimore City Health Department, Baltimore, MD for a            475,000
 mobile unit providing clinical SUD treatment and
 other services......................................
Behavioral Health Network of Vermont Inc.,                     1,150,000
 Montpelier, VT for Wheels and Waves opiate use
 disorder treatment program..........................
BJC Healthcare, St. Louis, MO for behavioral health              800,000
 services for people experiencing homelessness.......
Capital Clubhouse Inc., Washington, DC for mental                210,000
 health and other support services...................
Cascade AIDS Project, Portland, OR for behavioral                850,000
 health services, including medication assisted
 treatment...........................................
Champions In Service, Pacoima, CA for mental health              200,000
 and substance use disorder treatment and services...
Change the Outcome, Chanhassen, MN for substance use             375,000
 prevention and treatment services for youth and
 young adults........................................
Children's Fund, Inc., San Bernardino, CA for trauma-            100,000
 informed mental health care for children............
Children's Health System of Texas, Dallas, TX for                900,000
 children's mental health services...................
Children's Hospital of Orange County, Orange, CA for             325,000
 mental health treatment services and programs for
 children and families...............................
Chinese-American Planning Council, New York, NY for              500,000
 mental health services, including outreach,
 education and other support services................
City of Augusta, ME for Project Recovery, to increase            265,000
 access to substance use treatment and recovery
 services............................................
City of Azusa, CA for mental health and support                  560,000
 services through the Azusa Teen and Family Center...
City of Dublin, CA for a Mental Health Urgent Care               450,000
 Center to provide access to mental health crisis
 care................................................
City of Indianapolis, IN for mental health and                   500,000
 substance use treatment services for people in need
 of permanent supportive housing.....................
City of Laredo, TX for a substance use treatment               2,000,000
 center..............................................
City of Murrieta, CA for homeless services...........            500,000
City of Oakland, CA for the Oakland Mental Health              1,230,000
 Resilience project..................................
City of Palo Alto, CA for a mental health crisis               2,000,000
 response team.......................................
City of Round Rock, TX for behavioral health services          1,000,000
 mobile outreach and associated information
 technology..........................................
City of Seattle, WA for behavioral health crisis                 775,000
 response through the Health One program.............
City of St. Louis Mental Health Board of Trustees,               600,000
 St. Louis, MO for behavioral health and trauma
 prevention services for people impacted by gun
 violence............................................
Clearfield Educational Foundation Inc., Clearfield,            1,020,000
 PA for mental health and substance abuse services...
Columbia University Irving Medical Center, New York,             750,000
 NY for community-based mental health services,
 including training and service delivery.............
Adventist Health System West, Roseville, CA for                  985,000
 mental health and substance use disorder services,
 including wraparound services.......................
Community Action of Greater Indianapolis Inc,                     75,000
 Indianapolis, IN for behavioral health treatment and
 services, including supportive services.............
Contra Costa County Health Services Department--               1,100,000
 Behavioral Health Division, Martinez, CA for mobile
 behavioral health crisis response teams.............
County of Burlington, Mount Holly, NJ for substance              300,000
 use disorder treatment and recovery services through
 the Hope One initiative.............................
Covenant House Georgia, Atlanta, GA for mental health            190,000
 and supportive services for families experiencing
 homelessness........................................
Delaware County Department of Human Services, Upper              650,000
 Darby, PA for mobile crisis teams to respond to
 behavioral health emergencies.......................
Erie County Department of Health, Buffalo, NY for              1,000,000
 peer support workers to improve access to substance
 use treatment and recovery services.................
Essex County Community Foundation, Danvers, MA for               700,000
 mental health services targeted to populations
 disproportionately affected by COVID-19.............
Fifth Ward Community Redevelopment Corporation,                1,000,000
 Houston, TX for community mental health treatment
 and support services................................
First Behavioral Health Care Center, Turlock, CA to              310,000
 expand access to mental health services, including a
 public awareness campaign...........................
Franciscan Health Olympia Fields, Olympia Fields, IL             625,000
 for behavioral health telemedicine..................
Franklin County Opioid Task Force, Greenfield, MA to             200,000
 support individuals in recovery from alcohol and
 other substance use disorder to re-enter the
 workforce...........................................
Frederick County Government, Frederick, MD for a                 850,000
 behavioral health Crisis Stabilization Center.......
Friends of the Children, Portland, OR for mentoring              750,000
 services for children...............................
Gads Hill Center, Chicago, IL for trauma-informed                350,000
 mental and behavioral health services...............
Garden State Equality, Asbury Park, NJ to address the            175,000
 impacts of trauma on mental health for LGBTQ and
 BIPOC youth.........................................
Georgia Council on Substance Abuse, Atlanta, GA for               30,000
 recovery services, including education, training and
 peer recovery support services......................
Georgia State University, Atlanta, GA for mental                 200,000
 health services and other supports for children who
 have experienced trauma.............................
Great Lakes Dryhootch, Inc., Milwaukee, WI for the               155,000
 Dryhootch Quick Reaction Force program to provide
 mental health services for veterans.................
Greater Flint Health Coalition, Flint, MI for a                  750,000
 Community Information Exchange, for mental health
 prevention and treatment activities, including
 equipment and technology............................
Hartford Communities that Care, Hartford, CT for the             630,000
 Hartford Care Response Team, a hospital linked
 violence intervention program.......................
Healthier Kids Foundation, San Jose, CA for a                    400,000
 preventive mental health program for students.......
Hedwig House, Inc, Lansdale, PA for mental health                270,000
 services, including treatment and other supportive
 services............................................
Holy Redeemer Hospital, Huntingdon Valley, PA for a              250,000
 Neonatal Abstinence Syndrome program, including
 equipment and wraparound services...................
Hope of the Valley Rescue Mission, Pacoima, CA for             2,000,000
 mental health and substance use treatment and
 services for people experiencing homelessness, and
 training for the mental health workforce............
Hope Services, San Jose, CA for mental health                    160,000
 services for people with developmental disabilities.
John Morroni Legacy Foundation, Clearwater, FL for               500,000
 mental health treatment and services for first
 responders..........................................
Kane County State's Attorney's Office, St. Charles,              350,000
 IL for a pre-arrest diversion initiative based on
 the Law Enforcement Assisted Diversion model........
Latino Organization of the Southwest, Chicago, IL for            500,000
 a teen support program, including equipment and
 technology..........................................
Lesbian and Gay Community Services Center, Inc., New             350,000
 York, NY for mental health counseling and substance
 use treatment services..............................
Lexington-Fayette Urban County Government, Lexington,            620,000
 KY for the purchase of equipment and recovery
 support services....................................
Lifeline Connections, Vancouver, WA for a mentor                  50,000
 program.............................................
Long Island Crisis Center, Inc., Bellmore, NY for                150,000
 behavioral health services..........................
LOVE Program, Rialto, CA to provide mental health and            380,000
 substance use disorder treatment services and
 diversion programs for juveniles in the criminal
 justice system......................................
Maimonides Medical Center, Brooklyn, NY for mental               700,000
 health and supportive services for parents and
 infants.............................................
Massachusetts Executive Office for Health and Human            1,650,000
 Services, Boston, MA to establish the Middlesex
 County Restoration Center to provide behavioral
 health crisis and urgent care services, and other
 supportive services.................................
Maui Economic Opportunity, Inc., Wailuku, HI for                 100,000
 alcohol and tobacco prevention activities for youth.
MedCura Health, Stone Mountain, GA for mental health             300,000
 services for people experiencing homelessness.......
Mental Health Association of Essex and Morris, Inc.,             300,000
 Parsippany, NJ for suicide prevention services......
Mental Health Partners, Lafayette, CO to provide                 275,000
 community mental health and well-being services to
 mitigate the long term impacts of trauma............
Mile High United Way, Denver, CO for behavioral                  100,000
 health services for young adults experiencing
 homelessness........................................
Milestone Recovery, Portland, ME for a substance use             690,000
 disorder outpatient treatment and support program...
Monroe County Office of Mental Health, Rochester, NY             265,000
 for peer advocate training..........................
Mount Vernon Neighborhood Health Center, Mount                   100,000
 Vernon, NY for behavioral health services for
 homebound elderly and disabled adults...............
New Hampshire Chapter of the National Alliance on                380,000
 Mental Illness, Concord, NH for the Connect Suicide
 Prevention Program..................................
NYC Health + Hospitals/Jacobi, Bronx, NY for the                 400,000
 Stand Up to Violence program to provide youth mental
 health and substance use treatment services and
 other support services..............................
Oakland County Health Network, Troy, MI for mental               260,000
 health and law enforcement co-response for
 behavioral health crises, including Crisis
 Intervention Team and Mental Health First Aid
 training............................................
Office of the Mayor-President, City of Baton Rouge,            1,000,000
 LA for a resource and service center for recovery
 from trauma.........................................
Oklahoma Children's Hospital, Oklahoma City, OK for            1,000,000
 facilities, equipment, and children's behavioral
 health services.....................................
Orange County Government, Orlando, FL for behavioral             300,000
 health services for students........................
Oswego County Department of Social Services, Oswego,             250,000
 NY for transportation...............................
Para Los Ninos, Los Angeles, CA for early childhood              350,000
 mental health services and family supports,
 including technology to provide telehealth services.
Parents Anonymous, Claremont, CA for mental health             1,000,000
 services for Asian, Latinx and Black/African
 American families...................................
Parkview Legacy Foundation, Riverside, CA for                    625,000
 behavioral health focused programs for students
 returning to school after COVID-19..................
Path with Art, Seattle, WA for mental health and                 210,000
 trauma recovery programming.........................
Penny Lane Centers, North Hills, CA to provide mental            400,000
 health care and supportive services to people
 experiencing homelessness...........................
Polk County Board of Commissioners, Bartow, FL for a             850,000
 behavioral health outreach mobile crisis team.......
PRC, San Francisco, CA for behavioral health services            525,000
 for people experiencing homelessness................
Rales Jewish Family Services, Boca Raton, FL for                 400,000
 telemental health services to address mental illness
 and substance use, including equipment and
 technology..........................................
Reliance Health, Inc., Norwich, CT for a recovery                125,000
 support program.....................................
Rick's Place, Wilbraham, MA for grief support                    100,000
 services............................................
Rosecrance, Inc, Freeport, IL for a behavioral health            300,000
 outpatient clinic...................................
San Francisco AIDS Foundation, San Francisco, CA for             600,000
 mental health and substance use treatment and
 services, including case management services, for
 long term survivors of HIV/AIDS.....................
Sankofa Safe Child Initiative, Chicago, IL for mental            275,000
 health services for teens who have experienced
 trauma..............................................
Santa Clara County Office of Education, San Jose, CA             300,000
 for prevention and early intervention services to
 address student mental health and trauma............
Selfhelp Community Services, New York, NY for mental              15,000
 health and emotional wellness activities for seniors
Sociedad de Educacion y Rehabilitacion (SER) de                  180,000
 Puerto Rico, Inc., San Juan, PR for behavioral
 intervention services...............................
Sonoma County, Santa Rosa, CA for the Accessing                1,600,000
 Coordinated Care and Empowering Self Sufficiency
 program to provide mental health and substance use
 screening, treatment and other services, including
 equipment and technology............................
Stanislaus County Behavioral Health and Recovery               1,810,000
 Services, Modesto, CA for mental health services
 through the Promotores/Community Health Outreach
 Worker program and Community-Based Mental Health
 Clinicians..........................................
Starr Commonwealth, Albion, MI for facilities,                   850,000
 equipment, and mental and behavioral health services
Swords to Plowshares, San Francisco, CA for mental               975,000
 health and substance use treatment services, case
 management and other support services for veterans..
Texas State University, San Marcos, TX for a                   2,000,000
 Community Mental Health Surveillance Collaborative
 to strengthen mental health infrastructure,
 including training, equipment, and technology.......
The Community Rehabilitation Center, Inc.,                       500,000
 Jacksonville, FL to increase access to and improve
 quality of mental health, health care, and substance
 use disorder treatment services.....................
The Greater Scranton YMCA, Dunmore, PA for mental              1,850,000
 health and substance use disorder treatment
 services, including wraparound services.............
The Greater Washington Jewish Coalition Against                  300,000
 Domestic Abuse, Rockville, MD to provide mental
 health and other support services for domestic
 violence survivors and their families...............
The University Corporation dba Strength United,                1,000,000
 Northridge, CA to address the long-term mental
 health needs of children following the COVID-19
 pandemic, including suicide prevention activities,
 equipment and technology............................
TriCounty Community Network, Pottstown, PA for mental            450,000
 health screening and treatment services, and other
 support services....................................
UCHealth Trauma Services, Aurora, CO for an at-risk              450,000
 intervention and mentoring violence prevention
 program, including mental health treatment and other
 services............................................
United Way of Broward County, Ft. Lauderdale, FL for             650,000
 a suicide prevention program........................
Unlawful Narcotics Investigations, Treatment, and                500,000
 Education, Inc., London, KY for substance abuse
 prevention and the purchase of equipment and
 information technology..............................
UPMC Western Behavioral Health at Twin Lakes,                    100,000
 Somerset, PA for recovery support services..........
Valley Youth House, Bethlehem, PA for mental health              400,000
 services for at-risk children and families..........
Veterans Inc., Worcester, MA for behavioral health               430,000
 services for veterans and their families............
Village of Schaumburg, Schaumburg, IL for a mobile               340,000
 response unit for mental health and substance misuse
Vinland National Center, Loretto, MN for mental                  140,000
 health and substance use treatment services, and
 other support services, for people with brain
 injuries............................................
Washington County Health Department, Hagerstown, MD              475,000
 for behavioral health crisis treatment services.....
Woods Services, Inc., Langhorne, PA for mental health            500,000
 services............................................
YWCA NH, Manchester, NH for mental health care and               750,000
 support services for children and families exposed
 to trauma...........................................
------------------------------------------------------------------------

    Drug Abuse Warning Network (DAWN).--The Committee includes 
an increase of $6,500,000 for DAWN, a nationwide public health 
surveillance system to monitor emergency department visits 
related to substance use.
    Health Surveillance.--The Committee includes an increase of 
$337,000 to support activities of the Center for Behavioral 
Health Statistics and Quality and an increase of $200,000 for 
Performance and Quality Information Systems.
    Program Support.--The Committee includes an increase of 
$5,316,000 for SAMHSA personnel costs, the first increase in 
four years, to ensure SAMHSA has the resources to respond to 
the growing mental health and substance use crises.
    Public Awareness and Support.--The Committee includes an 
increase of $260,000 to raise awareness and understanding of 
mental and substance use disorders.
    Data on Substance Misuse in the U.S. Territories.--The 
Committee has serious concerns about the limited availability 
of data regarding drug and substance misuse in Puerto Rico and 
the rest of the U.S. territories. The Committee is particularly 
concerned that the National Survey on Drug Use and Health 
(NSDUH) does not include statistics from these jurisdictions. 
The Committee therefore encourages SAMHSA to take all 
reasonable steps to include Puerto Rico and the rest of the 
territories in the NSDUH, in the same manner that data is 
collected and published for the 50 States and the District of 
Columbia, and to submit a report detailing its efforts not 
later than 180 days after the enactment of this Act.
    PTSD in First Responders.--The Committee is aware of 
research indicating that individuals working in the civilian 
first responder disciplines of law enforcement, fire services, 
and emergency medical services are at greater risk for full or 
partial post-traumatic stress disorder (PTSD) than most other 
occupations because their responsibilities routinely entail 
confrontation with traumatic stressors. Within the funds 
provided for Health Surveillance and Program Support, the 
Committee directs SAMHSA to sponsor a report that examines what 
is known and where there are gaps regarding trauma and 
stressor-related disorders among this population, including 
prevalence rate, risk factors, symptom presentation, course, 
comorbidities, and rates of suicidal thoughts and actions, 
barriers to accessing and seeking care. This report would serve 
as a foundation for future surveillance ad program 
opportunities.
    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 2021.......................      $338,000,000
udget request, fiscal year 2022.......................       353,000,000
Committee Recommendation..............................       380,000,000
    Change from enacted level.........................       +34,650,000
    Change from budget request........................             - - -
 

    The Committee includes $380,000,000 in program level 
funding for the Agency for Healthcare Research and Quality 
(AHRQ), $34,650,000 above the fiscal year 2021 enacted level 
and the same as the fiscal year 2022 budget request. The total 
includes $250,792,000 in discretionary budget authority and 
$129,208,000 in PHS Act section 241 evaluation set-aside 
transfers.
    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 2022 Committee
------------------------------------------------------------------------
Scientific Support for the US Preventive Services             11,542,000
 Task Force..........................................
Digital Health Care Research.........................         16,349,000
Patient Safety Research..............................         72,615,000
Health Services Research, Data, and Dissemination....        127,053,000
Medical Expenditure Panel Survey.....................         71,791,000
Program Management...................................         73,300,000
------------------------------------------------------------------------

    Antimicrobial Resistance.--The Committee continues to 
provide no less than $10,000,000 for activities related to 
combating antibiotic-resistant bacteria.
    Accessibility of Online Telehealth Platforms.--The 
Committee recognizes that the COVID-19 pandemic led to the 
increased use of online portals and web services for patients 
seeking information, scheduling, and accessing remote services. 
However, the Committee is concerned that many online platforms 
are not user-friendly, especially for less digitally literate 
communities, including seniors. The Committee urges AHRQ to 
coordinate with ONC, CMS, and OCR on any Federal efforts that 
could be made to evaluate the accessibility of digital health 
platforms for Federally-supported providers, including any 
assessments of how seniors and persons with disabilities are 
included in the design and testing of the platforms. Further, 
the Committee urges AHRQ to work with ONC, CMS and OCR to 
establish best practices for health care providers to improve 
their online telehealth platforms for seniors, individuals with 
disabilities, and individuals with limited English proficiency.
    Cardiovascular Clinical Outcomes.--The Committee looks 
forward to receiving the study requested in the Consolidated 
Appropriations Act, 2021 that assesses the current evidence for 
lipid control and cardiovascular event reduction and quality 
measures for the improvement of clinical outcomes (e.g. 
coronary heart disease death, myocardial infarction, ischemic 
stroke, or urgent coronary revascularization procedure). The 
Committee also encourages AHRQ to develop and disseminate 
education resources and materials about improving 
cardiovascular clinical outcomes.
    Center for Primary Care Research.--The Committee includes 
$5,000,000 to establish the Center for Primary Care Research 
authorized at 42 USC 299b-4(b). AHRQ is uniquely positioned to 
support primary care clinical and practice research and to help 
disseminate the research nationwide. The 2021 NASEM report on 
High Quality Primary Care supported the importance of targeted 
funding for Primary Care Research (PCR) and recommended 
prioritization of funding for AHRQ's Center for Excellence in 
Primary Care Research. In 2020, the RAND Corporation published 
a report requested by Congress that emphasized the significant 
role AHRQ plays in PCR and recommended providing targeted funds 
to create a proper hub for Federal PCR. The areas of focus 
could include strategies to improve primary care delivery, 
including through the use of clinical pharmacists and inter-
professional; team-based care; advancing the development of 
primary care researchers; expanding research on persons with 
multiple co-morbid conditions; and improving primary care in 
rural and underserved areas, especially in remote and non-
contiguous States.
    Research on Health Equity.--The Committee includes an 
increase of $3,000,000 for AHRQ to support investigator-
initiated research grants related to health equity and an 
additional $1,000,000 to support research supplements related 
to health equity, the same as the fiscal year 2022 budget 
request.
    Health System Innovations Responding to COVID-19.--The 
Committee includes an additional $5,000,000, the same as the 
fiscal year 2022 budget request, to support new investigator-
initiated research grants related to COVID-19, including grants 
focused on improving the quality of care and patient outcomes; 
improving patient safety; understanding the pandemic's impact 
on socially vulnerable populations and people with multiple 
chronic conditions; and understanding how digital health 
innovations such as telehealth contributed to the health system 
response to COVID-19.
    Improving Maternal Morbidity and Mortality State and Local 
Data.--The Committee includes $7,350,000, the same as the 
fiscal year 2022 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.
    Kratom.--The Committee directs the Secretary to maintain 
current Agency policy to not recommend that the substances 
mitragynine and 7-hydroxymitragynine, known as kratom, be 
permanently controlled in Schedule I of the Controlled 
Substances Act, either temporarily or permanently, until 
scientific research can sufficiently support such an action. 
The Committee encourages AHRQ to continue to fund research on 
natural products that are used by many to treat pain in place 
of opioids, including kratom. Given the wide availability and 
increased use of these substances, it is imperative to know 
more about potential risks or benefits, and whether they can 
have a role in finding new and effective non-opioid methods to 
treat pain. The Committee recommends an additional $3,000,000 
for this research and directs AHRQ to make center-based grants 
to address research which will lead to clinical trials in 
geographic regions which are among the hardest hit by the 
opioid crisis.
    Lyme and Other Tick-Borne Diseases (TBD).--The Committee is 
concerned about the experiences of low-income, minority, and 
migrant populations with Lyme and other TBD and believes that 
better data should be developed on the incidence of TBD in 
these populations and the experiences of those populations in 
accessing care for suspected TBD, including provider awareness 
of TBD, diagnostic tools, treatment protocols, and health 
outcomes. The Committee directs AHRQ to coordinate with HRSA 
and its Bureau of Primary Health Care and the Office of Rural 
Health Policy, other HRSA Bureaus and Offices as appropriate, 
and the Indian Health Service to develop a plan for exploratory 
research to assess the extent of the problem of TBD in the low 
income, minority, and migrant populations and in the national 
network of clinics and health centers which provide health 
care, and which in turn receive a large portion of payments 
from CMS.
    Opioids Research.--The Committee includes $5,000,000, an 
increase of $2,000,000 above the fiscal year 2021 enacted level 
and $5,000,000 below the fiscal year 2022 budget request, to 
support expanded research related to opioid use and misuse, 
including research focused on increasing equity in treatment 
access and outcomes, accelerating implementation of effective 
evidence-based care in primary and ambulatory care, and 
developing whole person models of care that address the social 
factors which shape treatment and adherence and long-term 
recovery.
    Patient Safety Risks and Harms.--The Committee recognizes 
the seriousness of diagnostic errors in the health care system. 
Diagnostic error has been under-recognized and leads to a 
quarter-million inpatients experiencing serious hardship each 
year, including approximately 100,000 deaths. The Committee 
provides an increase of $8,000,000 for researching diagnostic 
error and associated risk to patient safety.
    Prenatal Care for Pregnant Individuals.--The Committee 
recognizes the Department's ongoing efforts to address the 
pressing public health issue of rising maternal mortality. 
Research shows prenatal care is a critical component of 
preventative care for pregnant individuals. The Committee 
includes no less than $500,000, the same as the fiscal year 
2021 enacted level, for research that examines the potential 
cost savings to the public health system of providing a special 
enrollment period for pregnant individuals, as well as the 
impact of a special enrollment period on the private insurance 
market.
    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, hospitals 
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 of surgical care, and decrease disparities in care. The 
Committee urges ARHQ 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 provides total funding of $2,000,000 for the purposes 
authorized under the Trafficking Awareness Training for Health 
Care Act to establish a pilot program for the creation, 
distribution, and evaluation of best practices for medical 
professionals to identify and respond to victims of human 
trafficking. Medical professionals are in a unique position to 
identify abuse and help victims of trafficking. Funding this 
program will ensure they are adequately trained to do so.
    USPSTF Clinical Data.--The Committee is concerned about 
significant deficiencies in the process and structure of the 
United States Preventive Services Task Force (USPSTF), as 
illustrated by its recommendations concerning screening 
mammography and cervical cancer screening. Comprehensive USPSTF 
reform is necessary to ensure that its recommendations further 
public health for all Americans and address health inequities. 
USPSTF's process needs to be revised to provide timely 
recommendations, be fully transparent, afford ample opportunity 
for public comment at each stage, make such comments publicly 
available, and provide meaningful responses to such comments. 
The comment process for USPSTF must provide a more robust and 
transparent opportunity for and public disclosure of expert and 
patient input, as well as an external advisory board of 
clinical experts that serves as a check, throughout the 
process. Moreover, USPSTF's methodologies should be firmly 
grounded in evidence that most accurately represents the 
Nation's racial and ethnic subpopulations; this evidence must 
include high quality real-world data sets and longitudinal or 
observational studies and not just randomized controlled 
trials. Specifically, the Committee calls for action on the 
established lack of data specific to health equity and racial 
diversity to more clearly inform the USPSTF decision-making. 
Furthermore, USPSTF should review a recommendation upon a 
showing of new evidence. In addition, USPSTF's composition 
should reflect an appropriate breadth of practicing physician 
expertise, including specialist expertise, as well as public 
input reflecting diverse patient populations. The Committee 
encourages the USPSTF to adopt these reforms to its process for 
developing recommendations.

                Centers for Medicare & Medicaid Services


                     GRANTS TO STATES FOR MEDICAID

 
 
 
Appropriation, fiscal year 2021................         $313,904,098,000
Budget request, fiscal year 2022...............          368,666,106,000
Committee Recommendation.......................          368,666,106,000
    Change from enacted level..................          +54,762,007,000
    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 $148,732,315,000, which was 
provided as advance funding for the first quarter of fiscal 
year 2022. In addition, the Committee recommends an advance 
appropriation of $165,722,018,000 for program costs in the 
first quarter of fiscal year 2023, to remain available until 
expended.
    The Committee continues bill language providing indefinite 
budget authority for unanticipated costs in fiscal year 2022. 
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 2021................          439,514,000,000
Budget request, fiscal year 2022...............          487,862,000,000
Committee Recommendation.......................          487,862,000,000
    Change from enacted level..................          +48,348,000,000
    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 2021.......................    $3,669,744,000
Budget request, fiscal year 2022......................     4,315,843,000
Committee Recommendation..............................     4,315,843,000
    Change from enacted level.........................      +646,099,000
    Change from budget request........................             - - -
 

Program Operations

    The Committee includes $4,315,843,000 for Program 
Operations, which is $646,099,000 more than the fiscal year 
2021 enacted level and equal to the fiscal year 2022 budget 
request. This appropriation includes $25,400,000 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.
    In addition, the American Rescue Plan (P.L. 117-2) included 
$500,000,000 for the survey and certification program, for 
strike teams to provide onsite technical assistance and 
education to nursing homes to reduce transmission and spread of 
COVID-19.
    Addressing Domestic Violence and Homelessness.--The 
Committee recognizes that the COVID-19 pandemic has increased 
both domestic violence and homelessness, as the pandemic has 
placed great stress on families. CMS has recognized both 
homelessness and domestic violence as social determinants of 
health impacting Medicaid and Medicare beneficiaries. Model 
interventions such as Domestic Violence Housing First programs 
can address this challenge. The Committee requests, within 120 
days of enactment of this Act, a report outlining the actions 
the agency is taking to address the combination of homelessness 
and domestic violence, including how the Center for Medicare & 
Medicaid Innovation (CMMI) and other parts of CMS are 
considering the feasibility of creating demonstration programs, 
in collaboration with the Administration for Children and 
Families and the Department of Housing and Urban Development, 
that will engage Medicare and Medicaid providers to address 
this dual problem.
    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, 
developmental delays, suicide, and substance misuse, among 
others. 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 H. Rept. 
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 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 adverse childhood experiences.
    Ambulatory Surgical Centers.--The Committee looks forward 
to receiving the report on ambulatory surgical centers, as 
requested in H. Rept. 116-450.
    Antimicrobial Resistance.--The Committee recognizes 
antimicrobial resistance is a serious threat to seniors. 
Medicare beneficiaries are more likely than the general 
population to become acutely ill with a multi-drug resistant 
bacterial infection and are potentially more susceptible to 
adverse events associated with older antibiotics used in the 
current standard of care. The Committee supports the ability of 
seniors to receive access to the most clinically appropriate 
antibiotic therapies available.
    Blue Button.--The Committee believes that the Blue Button 
program can play an important patient safety and care 
coordination role for Medicare beneficiaries and their health 
care providers, particularly in relation to COVID-19 
vaccination efforts and the increasing use of telehealth. 
Unfortunately, Blue Button has had a low participation rate. 
The Committee urges the Secretary to examine barriers to 
participation, including health and technology related 
inequities, and widely educate beneficiaries about Blue Button.
    CMS Contact Center Operations (CCO).--The Committee 
understands that the CCO is one of the largest federal service 
contracts, and that CMS is anticipating awarding another 10-
year contract for these critical services. The Committee is 
concerned that there has been insufficient competition for the 
CCO contract, and the Beneficiary Contact Center contract that 
preceded it, over the past 15 years. The Committee includes a 
provision to prevent fiscal year 2022 funds from being used for 
a new CCO contract or to issue any solicitation for a contract 
with a performance period of more than 24 months. In addition, 
the Committee directs CMS to conduct a review of the 
acquisition strategy for the CCO services to ensure genuine 
full and open competition for the award of a new definitive CCO 
contract, and to ensure this contract is structured to 
guarantee that taxpayer dollars are spent responsibly and with 
accountability. The Committee requests a report on the results 
of this review within 180 days of enactment of this Act.
    Community Health Workers.--The Committee recognizes the 
importance of community health workers, who are trusted members 
of their communities and comprise a vital frontline health 
workforce that help to address social, economic, behavioral and 
preventive health needs, and appreciates CMS highlighting their 
role in a January 7, 2021 letter to State Health Officials. The 
Committee further recognizes the ongoing role of community 
health workers in an equitable, resilient recovery from the 
COVID-19 pandemic and in achieving long-term, sustainable 
health equity. Given their proven effectiveness in improving 
health outcomes, reducing costs in underserved communities, and 
advancing health equity, the Committee urges CMS to continue to 
work with States, in partnership with community health workers 
and their professional organizations, to incorporate community 
health workers into coverage in a way that aligns with 
scientific evidence and fully leverages their expertise and 
skills.
    Complex Rehabilitation Technology.--The Committee is aware 
that provisions in P.L. 116-94 were intended to empower 
Medicare beneficiaries with severe disabilities through 
improved access to specialized Complex Rehabilitation 
Technology (CRT) manual wheelchairs and accessories. The 
Committee encourages CMS to provide adequate and equal access 
to users of CRT manual wheelchairs and accessories and to 
consider making that protection permanent.
    Compounded Medications.--The Committee requests a report, 
within 120 days of enactment of this Act, assessing Medicare's 
current policy for reimbursement to Part D plans for 
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.
    Consumer Assistance Program.--The Committee encourages the 
Secretary to allocate up to $400,000,000 derived from 
Affordable Care Act (ACA) user fees to restore Consumer 
Assistance Program (CAP) 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.
    Critical Access Hospitals and Sole Community Hospitals.--
The Committee looks forward to receiving the GAO study 
requested in H. Rept. 116-450, which will examine the cost of 
emergency mental and behavioral health services provided at 
Critical Access Hospitals (CAH). Behavioral health providers 
are scarcer in rural areas, but more patients are suffering 
from mental health concerns due to the COVID-19 pandemic. 
However, new treatment pathways (such as tele-mental health 
care) are not always accessible in rural areas. The Committee 
requests HHS provide a briefing on behavioral health services 
furnished at CAHs, sole community and other rural hospitals, 
whether the mix of services furnished at these hospitals 
changed during the COVID-19 pandemic, and identify 
opportunities to improve mental health care in these settings.
    Diabetes Self-Management Training Benefit.--The Committee 
is aware that one in four health care dollars in the U.S. is 
spent on people living with diabetes, totaling more than $300 
billion a year. Nearly 70 percent of that cost is provided by 
federal health care programs (e.g., Medicare, Medicaid, 
TRICARE). The Committee is also aware that 13 percent of all 
adults and nearly one-third of individuals aged 65 years or 
older are living with diabetes. Given the prevalence and cost 
of diabetes, particularly among communities of color, the 
Committee is concerned that barriers to accessing the Medicare 
diabetes self-management training benefit have resulted in 
utilization by only 5 percent of newly diagnosed Medicare 
beneficiaries. The Committee encourages CMS to explore the 
barriers to accessing the diabetes self-management training 
benefit and to provide a report, within 120 days of enactment, 
on efforts to address these barriers.
    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.
    Drug Quality.--The Committee is deeply 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 requests a report, within 
180 days of enactment, on the amount that the Medicare and 
Medicaid programs spent on medication in the previous three 
fiscal years that was subsequently recalled by manufacturers. 
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.
    Evidence-Based Home Visiting Programs.--The Committee 
recognizes the wide range of improved outcomes and cost-savings 
that evidence-based home visiting programs provide to first-
time mothers and their children. Additionally, in light of the 
impact of the COVID-19 pandemic on care and the rising rates of 
maternal and infant health disparities among families of color, 
the need for quality supports in the home is even greater, 
especially for mothers and babies. The Committee is pleased 
that CMS is assisting States that choose to design a Medicaid 
benefit package to provide home visiting services for pregnant 
and postpartum women, and for families with young children. The 
Committee urges CMS to continue to build upon its 2016 Joint 
Informational Bulletin to clearly articulate how Medicaid 
dollars can be blended and braided appropriately in home 
visiting programs to reach eligible families, provide 
streamlined coverage options for home visiting services, and 
cover specific components of home visiting programs.
    Fraud and Abuse in Electrodiagnostic (EDX) Medicine.--The 
Committee notes the ongoing investment in activities to address 
health care fraud and abuse along with enhanced interagency 
coordination. The Committee encourages HHS and the Department 
of Justice to continue working with the stakeholder community, 
as they do through the Healthcare Fraud Prevention Partnership, 
on innovative strategies to address persistent forms of fraud 
and abuse that exploit gaps in the current oversight framework 
and undermine quality patient care throughout the health care 
system, including systemic efforts by criminal actors and 
mobile labs in EDX testing.
    Finding Alternatives to Use of Quality-Adjusted Life Years 
for Drug Price Indexing.--The Committee encourages CMS to study 
appropriate alternatives for using Quality-Adjusted Life Years 
in determining indexes for prices and coverage for medications, 
treatments, and other services. The Committee supports the 
National Council on Disability's analysis in its 2019 report, 
``Quality-Adjusted Life Years and the Devaluation of Life with 
Disability,'' and recognizes the significance of determining 
alternative methodologies for establishing pricing mechanisms 
that are not discriminatory to individuals with disabilities. 
The Committee requests a report within 180 days of enactment of 
this Act on alternative methodologies, including analysis as to 
whether or not these alternatives themselves may be 
discriminatory if used incorrectly, as well as if there are 
different best practices which can and should be used 
separately for the pricing of medications and treatments versus 
decisions related to benefits and coverage.
    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.
    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. Congress urges CMS to pursue a pilot program 
allowing select IMDs that provide the majority of their care to 
those suffering from acute psychiatric distress to receive 
Medicaid funding. CMS should focus on the institutions that 
receive the largest volumes of cases in States that do not 
currently have the mental health treatment waiver and which 
offer longstanding, effective treatment regimens.
    IMD Exclusion Report.--The Committee requests a report, 
within 2 years of enactment of this Act, 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.
    Implementation of Medicaid PDMP Expansion.--Data show that 
prescription drug monitoring programs (PDMPs) integrated into 
state Medicaid systems can reduce over-prescribing and misuse 
of opiates and other prescription drugs. The Committee requests 
a report, within one year of enactment of this Act, on the 
interoperability of existing state PDMP infrastructure, the 
status of implementation of Sec. 5042 of the SUPPORT for 
Patients and Communities Act, the actions being taken to 
further improve interoperability, and how CMS intends build on 
existing interoperability infrastructure to avoid duplication 
and waste of allocated funding.
    Kidney Transplant Availability, Recovery, Long-Term 
Outcomes.--The Committee recognizes the significant costs to 
the Medicare program resulting from care for end-stage renal 
disease and kidney dialysis and supports the goal of 
significantly reducing dialysis use. The Committee supports 
efforts to identify ways to increase kidney transplant 
availability and to improve recovery and long-term outcomes. 
The Committee requests a report within 180 days of enactment of 
this Act on recommendations for quality measures to be 
implemented for improved studying and tracking long-term kidney 
transplant outcomes, including for patients transitioning 
between Medicare and commercial coverage, as well as means of 
improving data interoperability in order to facilitate long-
term tracking of long-term transplant patient data.
    Limited Wraparound Coverage.--The Committee remains 
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 requests a 
report, within 90 days of enactment of this Act, 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. This report should 
include an analysis of the outcomes of the pilot program and an 
explanation for CMS' decision not to extend it. The Committee 
continues to recommend this pilot program be made permanent and 
encourages CMS to restore the program.
    Long Term Care Facility Licensing.--The Committee is aware 
that certain facilities that are owned or operated by 
individuals who have been denied by their respective state 
licensing body can still receive CMS funds. The Committee 
directs CMS to provide a publicly available report, no later 
than 180 days after enactment of this Act, on the number of 
long term care facilities that receive CMS funds that are owned 
and or operated by individuals who have been denied licenses to 
do so by their respective state licensing body.
    Lung Cancer Screening.--The Committee is concerned with the 
persistently low rate of lung cancer screening across the 
United States. Lung cancer remains the deadliest form of 
cancer, with significant racial disparities in outcomes. People 
of color are more likely to be diagnosed with and die from lung 
cancer, but they are also less likely to undergo screening. In 
March 2021, the United States Preventive Services Task Force 
(USPSTF) revised its recommendations on lung cancer screening 
eligibility, significantly increasing the number of individuals 
who should be screened. The Committee encourages CMS to 
evaluate what steps it can take to improve access to lung 
cancer screening, including decreasing the cost to participate 
in registries, expanding the number of CMS-approved lung cancer 
screening registries, and promoting the development of quality 
measures in lung cancer screening and care to focus on reducing 
racial disparities in lung cancer screening. The Committee 
requests CMS provide a report within 120 days of enactment of 
this Act on its findings from this evaluation.
    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 report within 90 days of 
enactment of this Act on steps taken to develop such guidance.
    Medicare Advantage and Long-Term Acute Care Hospitals 
(LTCHs).--The Committee is aware there is concern that 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 Appropriate Use Criteria Program.--The Committee 
is aware that the Protecting Access to Medicare Act established 
the Medicare Appropriate Use Criteria (AUC) Program for 
advanced diagnostic imaging. While the Committee recognizes the 
value of encouraging physicians and other health care 
professionals to consult AUC and clinical guidelines to support 
medical decision making, more than seven years have passed 
since Congress created the AUC program, which has not advanced 
beyond educational and operations testing. The Committee 
requests a report within 180 days of enactment of this Act on 
implementation of this program, including challenges and 
successes. In this report, CMS shall consider existing quality 
improvement programs and relevant models authorized under 
Sec.1115A of the Social Security Act and their influence on 
encouraging appropriate use of advanced diagnostic imaging. The 
Committee directs CMS to consult with stakeholders, including 
medical professional societies and developers of AUC and 
clinical guidelines, when formulating its report.
    Medicare Promotion.--The Committee reiterates its direction 
that CMS avoid taking any action that actively promotes one 
form of Medicare coverage over another, particularly with 
respect to the choice between traditional Medicare and Medicare 
Advantage. The Committee further directs CMS to design and 
maintain its online coverage options tool in a manner that 
provides complete and unbiased information, particularly as CMS 
works to replace the Medicare Plan Finder with the new Medicare 
Coverage Tools platform. CMS should remain objective and 
neutral in its education and outreach materials concerning 
options that beneficiaries have during the open enrollment 
period and at any other time.
    Molecular Diagnostics.--More than 550,000 Americans are 
diagnosed with a rare form of cancer every year. Rare cancers 
account for 380 of 400 distinct forms of cancer and almost one-
third of all diagnoses and include all pediatric-specific 
cancers. Molecular diagnostics are an important part of 
determining the form of cancer and which treatment is the best 
option. Each subtype of cancer requires a targeted therapy in 
order to save a life or to significantly improve life span, and 
data is required for each cancer to inform where targeted 
therapies can be used. However, this data is frequently lacking 
for rare cancers, leading to the use of older and less 
effective therapies. The Committee understands that CMS has 
established Medicare national coverage policies for molecular 
diagnostics at the time of diagnosis for only certain cancers. 
The Committee encourages CMS to issue guidance to their plans 
on how to determine if molecular diagnostics are reasonable and 
necessary, and update the Medicare coverage guidelines for 
molecular diagnostics for all cancers where it is determined to 
be reasonable and necessary at the time of diagnosis.
    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.
    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 and encourages CMS to explore the development of a 
MIPS quality improvement activity related to nuclear medicine 
injection quality as well as the feasibility of a MIPS quality 
measure to allow for the meaningful evaluation and improvement 
of nuclear medicine injection quality.
    Nutrition Education.--The Committee encourages CMS to 
coordinate with the HRSA to develop recommendations for 
expanded nutrition education in medical school and graduate 
medical education curricula.
    Nursing and Allied Health Workforce Shortages.--The 
Committee notes that in a March 2021 survey conducted by the 
HHS Office of the Inspector General, hospitals reported that 
nursing shortages during the COVID-19 pandemic significantly 
strained health care delivery and were a significant obstacle 
to addressing the public health emergency. The survey found 
that these shortages exacerbated longstanding challenges in 
health care delivery, access to care, and health outcomes. The 
Committee requests a report within 180 days of enactment of 
this Act addressing the role of Medicare funding in supporting 
the training of nursing and allied health professionals. Such 
report should also include an assessment of how CMS can 
exercise its discretion under existing payment rules to further 
address shortfalls in the nursing and allied health workforce.
    Oral Health Services.--The Committee is pleased that CMS is 
moving forward to fill the Chief Dental Officer position, which 
has been vacant since October 2017. This left a significant gap 
of clinical oral health expertise within CMS. Medicaid provides 
oral health services to millions of people, including 
vulnerable populations such as children (including those with 
special health care needs), pregnant women, and disabled 
adults. The Committee notes that States have flexibility to 
determine dental benefits for adult Medicaid enrollees and 
while most States provide at least emergency dental services 
for adults, less than half currently provide comprehensive 
dental care. The Committee urges the Chief Dental Officer to 
examine opportunities within existing statutory authority to 
expand Medicare coverage of dental services. The Committee also 
urges CMS to provide recommendations no later than one year 
after enactment of this Act regarding policies to increase 
coverage of, and access to, comprehensive dental benefits for 
adults in State Medicaid programs.
    Patient Access to Home Health Care.--The Committee supports 
the intent of the network adequacy rules of CMS for Medicare 
Advantage organizations under 42 C.F.R. 417 and 422 and for 
Medicaid managed care organizations under 42 C.F.R. 438 and 457 
as maintaining a network of qualified providers sufficient to 
provide adequate access for covered services to meet the health 
care needs of the patient population served.
    Payment Structures Impact on ESRD Patients.--The Committee 
is concerned that patient outcomes may be negatively impacted 
by dialysis provider behaviors resulting from the 2021 bundled 
payment change affecting calcimimetics. Absent calcimimetic 
therapies, patients being treated for End Stage Renal Disease 
(ESRD) are at greater risk of requiring parathyroid surgeries, 
exposing them to further health care risk while shifting 
dialysis providers' financial burden to the federal government. 
Like ESRD, such outcomes are likely to impact marginalized and 
communities of color disproportionately. The Committee requests 
CMS monitor utilization and certain beneficiary health outcomes 
under the ESRD PPS resulting from the 2021 bundled payment 
change. The Committee encourages CMS to consider issuing a 
report highlighting statistical changes in the clinical 
administration of calcimimetic therapies (including on 
marginalized and communities of color subpopulations), any 
instances of incentive payment structures from dialysis 
providers, and any recommendations on treatment protocols or 
policy changes.
    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 on how to reduce 
amputations no later than one year after enactment of this Act.
    Pharmacists and COVID-19 Authorities.--The Committee is 
pleased with CMS' clarification that medication management 
services provided by pharmacists services incident to 
physicians and other qualified health care professionals (QHPs) 
are covered under Medicare Part B. This clarification was 
designed to encourage team-based care during the COVID-19 
public health emergency (PHE) and increase access of 
individuals with substance use disorder to services. The 
Committee appreciates CMS' recognition of the expanding roles 
of pharmacists with broadened scopes of practice. The Committee 
requests CMS hear from physicians, pharmacists, and other 
qualified health professionals on their efforts to work with 
the American Medical Association (AMA) CPT Editorial Panel to 
develop mechanisms to attribute, report, and sustain 
pharmacists' medication management and other patient care 
contributions to beneficiaries in the Medicare Part B program. 
In addition, the Committee is aware of the Secretary's request 
for information to determine whether regulatory actions taken 
by HHS to expand clinician's authorities to mitigate and 
prevent COVID-19 during the PHE should be made permanent. The 
Committee requests the Secretary report within 180 days of 
enactment of this Act on the outcomes that pharmacists and 
pharmacies provided during the COVID-19 pandemic.
    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.
    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 
2022, so this community-based model of care may be evaluated as 
to whether it increases access and affordability for Medicare 
or Medicaid beneficiaries.
    Radiation Oncology (RO) Model.--Despite the delay in 
implementation, the Committee is concerned that the 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 H. Rpt. 116-450.
    Regulatory and Payment Reforms.--The Committee urges CMS to 
work with hospitals, community-based organizations, and other 
stakeholders to identify substantive regulatory delivery and 
payment reforms that integrate behavioral health in primary 
care; create new and evaluate existing delivery models to 
improve efficiency and value-based care; and incentivize the 
health care workforce to meet the unmet care needs of Medicare 
beneficiaries in underserved areas.
    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.
    Screening and Diagnostic Testing in Cancer Treatment.--The 
Committee understands that the use of pre-treatment 
interventions, such as screening for signs of cancer or testing 
with a companion diagnostic to determine a specific cancer 
type, can help health care providers select treatment options 
with a greater probability of success, leading to better 
outcomes for patients. The Committee also recognizes that the 
use of these interventions can reduce unnecessary health care 
costs by avoiding ineffective treatments and that awareness of 
genetic risk factors can encourage preventive care and early 
diagnosis. This is particularly important now, as the Committee 
recognizes that during the COVID-19 pandemic, providers and 
hospitals have reported a decrease in non-COVID related patient 
visits, including vital cancer screenings and follow-up 
appointments. The Committee urges CMS to identify ways to 
expand access to screening and testing, especially among the 
most at-risk patient populations, eligibility criteria for 
testing and screenings recommended by USPSTF and relevant 
medical societies, and increase public and health care provider 
awareness of the importance of appropriate testing and 
diagnostics.
    Sepsis.--The Committee requests that CMS task their 
contracted Quality Improvement Organizations (QIOs) to engage 
with hospitals to provide technical assistance that reflects 
recent advances in sepsis treatment to help them comply and 
report SEP-1 standards of care. The Committee further requests 
that CMS report to the Committee within one year of enactment 
of this Act with an assessment of the impact of the QIO 
engagement on SEP-1 rates and with feedback on any revisions to 
the SEP-1 standards of care that will improve treatment of 
sepsis by U.S. hospitals.
    Site Neutral Reimbursement.--The Committee encourages CMS 
to evaluate the financial impacts on rural hospitals and 
Critical Access Hospitals in all rulemaking relating to payment 
rates, including all pending rules relating to CMS outpatient 
prospective payment system and the Medicare ambulatory surgical 
center payment system.
    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 CHIP authority, or through waivers, 
to address social determinants of health 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 social determinants of health through contracts.
    Specimen Collection and Counseling Services for Pharmacist-
Delivered COVID-19 Testing.--The Committee is aware that CMS 
made it easier for pharmacies to enroll in Medicare as 
independent clinical laboratories and permitted any health care 
professional authorized under state law to order COVID-19 tests 
(and influenza and RSV tests when conducted concurrently with 
COVID-19 tests) during the COVID-19 public health emergency. 
The Committee is aware that CMS clarified coding for symptom 
assessment, specimen collection, and patient counseling, all 
standard components of COVID-19 testing services conducted by 
other health care professionals. However, CMS' only option for 
symptom assessment, specimen collection, and patient counseling 
by pharmacists is to enter into an incident to arrangement with 
a physician or non-physician practitioner (NPP). The Committee 
is concerned that most community pharmacists do not have 
incident to arrangements with physician practices or NPPs, 
which inhibits the goal of widely accessible COVID-19 testing 
in community pharmacies. The Committee requests CMS hear from 
physicians and other qualified health care professionals on 
their efforts to work with the AMA CPT Editorial Panel to 
develop coding options for pharmacists provision of symptom 
assessment, specimen collection, and patient counseling, when 
ordering and administering COVID-19 point of care tests at 
community pharmacies equivalent to all other health care 
professionals.
    Step-Down Care for Psychiatric Patients.--The Committee is 
aware of the potential health benefits and cost savings of 
step-down care options for inpatient psychiatric care as it 
relates to an overall consumption of health services and costs 
without increased hospital admissions while also freeing up 
much needed inpatient beds. The lack of step-down care and 
housing options for psychiatric patients being discharged from 
local hospitals has led to long and expensive waits in 
hospitals that burden patients, families and hospital staff. 
The Committee requests CMS to, within 180 days of enactment of 
this Act, conduct an assessment of the benefits of step-down 
care options for patient care and consideration of payment 
policy.
    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.
    Telehealth and Homelessness.--The Committee recognizes the 
role that behavioral and mental illnesses play in the homeless 
population and that telehealth offers a unique possibility to 
meet these individuals where they are in providing all health 
services, but particularly for mental health. The Committee 
encourages CMS to identify and share with States best practices 
regarding ways in which telehealth and remote patient 
monitoring can be leveraged through the Medicaid and Medicare 
programs for the homeless population. This should include 
identification of barriers to mental health services via 
telehealth coverage, as well as strategies to address those 
barriers.
    Telehealth for Pediatric ESRD.--The Committee understands 
that due to the scarcity of pediatric nephrologists and 
precautions following the COVID-19 pandemic, more children are 
successfully receiving care for end stage renal disease at home 
through telehealth technology. However, persistent inequalities 
in access to broadband and information technology prevent many 
children from accessing this technology. The Committee requests 
that, within 120 days of enactment of this Act, the Secretary 
provide a report on the usage of telehealth technology for 
pediatric end stage renal disease patients covered by Medicare 
and Medicaid during the COVID-19 pandemic, including an 
analysis of use in HRSA-designated rural counties and 
designated eligible census tracts in metropolitan counties and 
HRSA-designated medically underserved areas.
    Zero Trust Program.--The Committee encourages CMS to 
increase support for the Zero Trust Program for CMS health 
information and data security modernization to address, 
mitigate, and reduce security risks.

State Survey and Certification

    The Committee provides $472,163,000 for State Survey and 
Certification activities, which is $74,829,000 above the fiscal 
year 2021 enacted level and equal to the fiscal year 2022 
budget request. 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 $864,000,000 for Federal 
Administration activities related to the Medicare and Medicaid 
programs, which is $91,467,000 above the fiscal year 2021 
enacted level and equal to the fiscal year 2022 budget request. 
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 2021.......................      $807,000,000
Budget request, fiscal year 2022......................       872,793,000
Committee Recommendation..............................       872,793,000
    Change from enacted level.........................       +65,793,000
    Change from budget request........................             - - -
 

    The Health Care Fraud and Abuse Control Account (HCFAC) 
supports activities conducted by CMS, the HHS Office of 
Inspector General, and the Department of Justice (DOJ). This 
appropriation includes a base amount of $317,000,000 and an 
additional $555,793,000 through a discretionary budget cap 
adjustment provided to meet the terms of H. Res. 467. This is 
$65,793,000 above the fiscal year 2021 enacted level and equal 
to the fiscal year 2022 budget request.
    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.
    Senior Medicare Patrol.--The Committee includes 
$30,000,000, an increase of $10,000,000, for the Senior 
Medicare Patrol program. The Committee continues to include 
modified bill language to enable the Secretary to fund the 
Senior Medicare Patrol, which is administered by the 
Administration for Community Living, from either discretionary 
or mandatory funds provided to this account.
    Health Care Fraud Unit.--These units prosecute health care 
fraud-related cases involving patient harm or large financial 
loss to the public fisc. Protecting vulnerable populations and 
ensuring program integrity lie at the core of their work. The 
strike force model involves a cross-agency collaborative 
approach, bringing together both investigative and analytical 
resources of several Federal agencies, along with the 
prosecutorial resources of U.S. Attorney's Offices and state 
and local law enforcement partners. The Committee includes an 
increase to expand offices into more areas in the western 
United States.

                Administration for Children and Families


  PAYMENTS TO STATES FOR CHILD SUPPORT ENFORCEMENT AND FAMILY SUPPORT 
                                PROGRAMS

 
 
 
Appropriation, fiscal year 2021.......................    $3,039,000,000
Budget request, fiscal year 2022......................     2,795,000,000
    Committee Recommendation..........................     2,795,000,000
    Change from enacted level.........................      -245,000,000
    Change from budget request........................             - - -
 

    The Committee also recommends $1,300,000,000 in advance 
funding, as requested, for the first quarter of fiscal year 
2023 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 2021.......................    $3,750,304,000
Budget request, fiscal year 2022......................     3,850,304,000
Committee Recommendation..............................     3,900,304,000
    Change from enacted level.........................      +150,000,000
    Change from budget request........................       +50,000,000
 

    The Committee recommends $3,900,304,000 for the Low Income 
Home Energy Assistance program, which is $150,000,000 above the 
fiscal year 2021 enacted level and $50,000,000 above the fiscal 
year 2022 budget request. The Low Income Home Energy Assistance 
Program (LIHEAP) supports eligible families and households 
through programs providing assistance with energy costs.
    In addition, the Coronavirus Aid, Relief, and Economic 
Security (CARES) Act (P.L. 116-136) included $900,000,000 and 
the American Rescue Plan (P.L. 117-2) included $4,500,000,000 
in funding 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, the same amount of funding to each 
State, territory, and Tribe as was appropriated in the 
Consolidated Appropriations Act, 2021.
    Formula and Allocations Report.--The Committee continues to 
express strong support for LIHEAP, but remains concerned about 
the complexities of the LIHEAP formulation process. The 
Committee strongly urges ACF to explore ways to simplify and 
automate its funding formula calculations to increase the 
ability of staff to complete calculations quickly, and 
administer funding more readily. Given the significant amount 
of spending dedicated to LIHEAP in fiscal years 2020 and 2021, 
including emergency funding from the CARES Act (P.L. 116-136) 
and the American Rescue Plan (P.L. 117-2), the Committee 
directs ACF to submit, and make publicly available on its 
website, a report detailing the program's formula and State 
allocations for each source of funding from fiscal years 2020 
and 2021. ACF is encouraged to include any additional 
information that may provide context for funding allocations.

                     REFUGEE AND ENTRANT ASSISTANCE

 
 
 
Appropriation, fiscal year 2021.......................    $1,910,201,000
Budget request, fiscal year 2022......................     4,404,947,000
Committee Recommendation..............................     4,504,947,000
    Change from enacted level.........................    +2,594,746,000
    Change from budget request........................      +100,000,000
 

    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, and to 
include any updates in estimated funding needs as a result of 
changes in trends in those categories.
    In times of sudden reductions in refugee arrivals, the 
Committee encourages HHS, to the extent practicable, to ensure 
that resettlement agencies are able to maintain their 
infrastructure and capacity at a level to continue to serve new 
refugees, previously arrived refugees, and other populations of 
concern who remain statutorily eligible for integration 
services, and to ensure that there is capacity for future 
arrivals to be adequately served.
    Within the total, the Committee includes the following:

------------------------------------------------------------------------
                                                            FY 2022
                   Budget Activity                         Committee
------------------------------------------------------------------------
Transitional and Medical Services....................       $605,000,000
Victims of Trafficking...............................         39,480,000
Refugee Support Services.............................        450,000,000
Unaccompanied Children...............................      3,383,467,000
Survivors of Torture.................................         27,000,000
------------------------------------------------------------------------

Transitional and Medical Services

    The Committee includes $605,000,000, which is $251,000,000 
above the fiscal year 2021 enacted level and equal to the 
fiscal year 2022 budget request. 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 $39,480,000 for the Victims of 
Trafficking program, which is $10,725,000 above the fiscal year 
2021 enacted level and equal to the fiscal year 2022 budget 
request. The recommendation includes $4,500,000 for the 
National Human Trafficking Hotline.
    The Committee encourages ACF to use a portion of increased 
funding for legal services for victims, increasing funds 
equally for 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 
$242,799,000 above the fiscal year 2021 enacted level and equal 
to the fiscal year 2022 budget request. 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.

Unaccompanied Children

    The Committee includes $3,383,467,000 for the Unaccompanied 
Children (UC) Program, which is $2,080,222,000 above the fiscal 
year 2021 enacted level and $100,000,000 above the fiscal year 
2022 budget request. The Committee urges ORR to redesign the UC 
program with an increased focus on compassionately caring for 
unaccompanied children in State-licensed, small-scale, and 
community-based settings, and safely and expeditiously 
discharging children to vetted sponsors. The Committee is 
extremely concerned about reliance on expensive, unlicensed 
facilities when capacity is strained. The Committee appreciates 
that the increase requested in the budget is intended to avoid 
continued reliance on unlicensed facilities, but is concerned 
that budget estimates may not adequately reflect the impact 
that the COVID-19 pandemic continues to have on State-licensed 
capacity. The Committee expects HHS to continue to refine 
estimates as it recovers from the pandemic. The Committee 
recommends additional funding above the fiscal year 2022 budget 
request and includes directives in this report for ORR to raise 
standards of care; expand services for children; rebuild, 
support and train staff on trauma-informed care; establish an 
independent office to better serve children in ORR's care; and 
increase planning for future humanitarian responses at the 
border.
    The Committee recognizes the critical importance of post-
release legal and social services and child advocates, and 
notes that the Congressional Budget Justification did not 
include sufficient details of ORR's plans for providing such 
priority services to children in fiscal year 2022. The 
Committee directs ORR to significantly increase services for 
children, and includes not less than $300,000,000, an increase 
of $88,000,000 over the fiscal year 2021 enacted level, for 
legal services, post-release services, and child advocates. The 
Committee recognizes that increased referrals of children 
during fiscal year 2021 may require ORR to expend greater sums 
in fiscal year 2022, and the Committee encourages the program 
to spend additional funds on such services, as necessary, 
commensurate with referrals from U.S. Customs and Border Patrol 
(CBP) and the needs of the children, including the need for 
legal services for children after their release from ORR 
custody. It is critical that ORR report regularly to the 
Committee and include in its required spend plans, the number 
of referrals from CBP, 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. The Committee expects 
ORR to set targets for the number and percentage of children 
that will be provided such services, and to regularly 
communicate with the Committee to ensure that the number of 
children with access to such services significantly increases 
over fiscal year 2021.
    Age-Outs.--The Committee directs 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 has been 
identified for the child, along with any necessary social 
support services, prior to discharge from ORR.
    Bond Hearings and Placement Reviews.--The Committee 
believes it is incumbent upon HHS to ensure that children's 
rights to placement in the least restrictive setting are 
protected, and strongly supports an unaccompanied child's right 
to challenge their placement in restrictive settings in front 
of the HHS Departmental Appeals Board (DAB) with representation 
of legal counsel and with an ORR-appointed child advocate. The 
Committee expects the HHS DAB to ensure that administrative law 
judges (ALJs) for UC hearings operate separate and apart from 
all ORR staff who take part in, review, or adjudicate placement 
of unaccompanied children, and that they will have training and 
expertise on the Flores Settlement Agreement, the Trafficking 
Victims Protection Reauthorization Act, and the particular 
vulnerabilities of unaccompanied children.
    In addition, the Committee understands that ORR recently 
launched a Placement Review Panel (PRP) pilot, with the intent 
of providing unaccompanied children who are placed in secure 
and residential treatment center programs a venue by which to 
request a review of their ORR placement in such facilities. The 
Committee does not expect this PRP to replace or in any way 
limit a child's right to appeal their placement before any U.S. 
District Court with jurisdiction over the child. However, if 
the PRP can serve as an additional venue for children to 
challenge their placement, the Committee expects the 
participants on the panel to operate separate and apart from 
ORR staff who take part in, review, or adjudicate placement of 
unaccompanied children, and requests that ORR brief the 
Committee within 60 days of enactment of this Act on the role 
of the PRP, and the distinction between the PRP and the DAB.
    Case Management and Community Support Services.--To expand 
the scope of case management programs and to increase 
participation in these services, the Committee directs HHS to 
coordinate with DHS to provide an analysis of existing 
programs, including existing case management services funded 
through U.S. Immigration and Customs Enforcement, as well as 
the recently funded Alternatives to Detention Case Management 
Pilot Program to provide these services though FEMA-
administered grants to community-based organizations, which 
will be overseen by the DHS Office for Civil Rights and Civil 
Liberties. Further, the Committee directs HHS and DHS to 
explore the feasibility of funding and managing case management 
services currently offered by DHS through agencies or offices 
within HHS that serve similar populations and to provide the 
Committee a briefing within 180 days of enactment of this Act 
on the results of the analysis and their evaluation, which 
shall also include a recommendation for the appropriate 
organizational placement for case management services to serve 
additional populations through community-based organizations 
seeking to provide case management and social services focused 
on fair and equitable outcomes for individuals and families. 
The briefing shall outline the risks and opportunities 
associated with existing and proposed programs, and mitigation 
strategies that could be deployed to address those, along with 
any funding and staffing impacts.
    Child Advocates.--The recommendation includes funding 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, and to 
children who are expected to remain in ORR custody for 
prolonged periods of time. The Committee directs ORR to ensure 
the continued independence of the Child Advocate program from 
other contracted service providers to avoid any conflicts of 
interest.
    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 in Prolonged Detention.--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. Finally, 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.
    Facility Oversight.--The Committee expects ORR to maintain 
strict oversight of all ORR-funded care provider facilities and 
to correct violations of Federal, State or local codes related 
to the standards of childcare or the well-being of children, as 
well as violations of ORR policies and procedures, or any 
requirements as listed in the Flores Settlement Agreement, 
regardless of the status of the underlying agreement. The 
Committee directs ORR to submit, within 60 days of enactment of 
this Act, an updated version of the report submitted to the 
Committee pursuant to House Report 115-862. The updated report 
should include new or updated information on facility 
violations, and any systemic trends in noncompliance, along 
with efforts to remedy noncompliance across the provider 
facility network.
    Humanitarian Response Operating Plan.--The Committee 
recognizes the challenges that ORR has with quickly adding 
personnel and building capacity to meet demands during 
significant increases of unaccompanied children at the border. 
The Committee directs HHS and ORR to coordinate with DHS, FEMA, 
CBP, USCIS, and relevant stakeholders to develop a Humanitarian 
Response Operating Plan for how priority personnel from across 
the government, in coordination with national and local non-
government organizations, can be rapidly deployed to the 
southern border as necessary during migration surges. The plan 
should assess the existing capabilities and capacity of HHS, 
DHS, and relevant stakeholders to provide the specialized 
services necessary to prioritize the welfare of children while 
they are in government custody, and to avoid unnecessary delays 
in releasing children safely to vetted sponsors. The plan 
should identify mechanisms for participating Federal agencies 
to identify and quickly deploy, in coordination with affected 
State and local jurisdictions and national and local non-
government humanitarian organizations, priority personnel 
licensed in case management, social work, and child welfare, 
along with an estimate of the funding requirements associated 
with such deployments. The Committee expects any groups 
identified as potential deployment resources to be trained in 
providing trauma-informed care.
    In developing the plan, HHS and DHS should consult with 
experienced caseworkers, social workers, and child welfare 
experts to incorporate best practices into the plan. The 
Committee directs HHS to submit the plan to the Committee 
within 180 days of enactment of this Act, and to update it 
annually to reflect new information and lessons learned. As 
part of the plan, the Committee requests a cost estimate for 
the resources necessary to keep identified personnel 
sufficiently trained, to fund rapid deployments to the border, 
and to have emergency case management contracts or grants 
available to deploy additional case managers or other priority 
services.
    In-Kind Donations.--The Committee continues to request ORR 
include information on the use of this provision in future 
Congressional Budget Justifications, including examples of 
donations that are offered, donations that are accepted, and 
donations that care providers believe they cannot accept.
    Legal Services.--The Committee supports the continued 
expansion of independent legal services for unaccompanied 
children and notes that services provided by qualified and 
independent legal counsel to unaccompanied children can 
increase the efficiency and effectiveness 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. Post-release direct 
representation shall 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.
    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 $5,500,000 
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 expansion of such services, 
including contracting with governmental and non-governmental 
entities, while instituting policies that prevent disclosure of 
this information to immigration enforcement officials. These 
services shall include mental health services which are 
developmentally appropriate for children and which assist staff 
to respond to trauma based on age and the nature of the trauma 
given the diversity of children in custody.
    In response to the growing number of children with 
specialized needs in ORR custody, including children under 12, 
children with disabilities, and children with mental health 
needs, the Committee expects ORR to further expand mental 
health services and the use of other interventions, in 
consultation with context-focused specialists and experts in 
early childhood development, the needs of children with 
disabilities, mental health, child trauma and immigration 
trauma, and to provide in-person and continuous training to 
ORR-contracted staff on these specialized needs. Further, 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 groups of 
children listed in this paragraph, including regarding 
appropriateness of residential treatment centers as a form of 
residential care. The Committee directs ORR to include in its 
fiscal year 2023 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 recognizes that a 
number of children referred to ORR from CBP as unaccompanied 
were traveling with a non-parental relative, and believes there 
may be opportunities to collaborate with DHS in order to 
significantly reduce the amount of time a child may be 
separated from a family member. The Committee directs HHS, in 
coordination with DHS, to develop a mechanism for reporting the 
number of children who were processed by CBP with adults 
claiming a relationship as non-parental relatives but referred 
to ORR as unaccompanied. The Committee directs ORR to submit a 
report within 120 days of enactment of this Act proposing any 
process changes, IT modifications, or authorities that would be 
necessary for ORR to regularly report the number of children 
referred from CBP who were processed with Category 2a or 2b 
relatives, and for HHS and ORR case managers to have the 
visibility necessary to locate, with DHS cooperation, a non-
parental relative that arrived with a child at the border so 
that HHS can begin the process of verifying the relationship 
and assessing that adult for sponsor suitability.
    Office of the Ombudsperson.--The Committee directs ORR to 
establish an Office of the Ombudsperson within HHS to act as an 
advocate for upholding the rights of immigrant children in 
custody, and to independently advise the Secretary on the 
challenges of, and ways to systemically evaluate, refocus and 
rebuild, the UC program. The Office shall be headed by an 
Ombudsperson, who should have demonstrated experience in 
immigration law and child advocacy or child welfare, and shall 
be appointed by, and report directly to the Secretary of HHS. 
The Committee requests a briefing within 120 days of enactment 
of this Act on a strategy for establishment of such an Office, 
including any actions the Secretary will take to position the 
Ombudsperson within ORR in such a way that does not duplicate 
existing functions of other independent offices, including the 
Office of Inspector General and the Office of Civil Rights.
    The Ombudsperson shall have access to information on 
unaccompanied children in HHS's care in order to identify 
trends or to further investigate cases that may need additional 
resources in order to shorten a child's length of stay. 
Additionally, the Ombudsperson shall have access to facilities 
data, reviews, and recommendations of the HHS Office of 
Inspector General, in order to investigate systemic issues or 
improvements of facilities or grantees. The Committee urges the 
Ombudsperson to regularly meet with stakeholders, to ensure 
they are aware of stakeholder concerns and priorities, and to 
provide feedback on stakeholder requests.
    The Committee directs the Ombudsperson to submit a report 
to Congress no less than once each fiscal year on the 
accomplishments and challenges of the UC program, highlighting 
trends and recommendations for future actions and improvements, 
and outlining the activities of the Ombudsperson for the next 
fiscal year.
    Operational Directives and Field Guidance for Safe, 
Expeditious Discharge.--The Committee believes the operational 
directives issued in response to the previous Administration's 
misguided Memorandum of Agreement (MOA) on Information Sharing 
reduced the damage that had been done to the sponsor 
suitability determination process and appropriately reduced the 
length of time children spent in ORR's care. The Committee 
expects ORR to retain and improve on such policies to place 
children safely and expeditiously with vetted sponsors. The 
Committee recognizes that ORR has issued a series of field 
guidance documents to its care provider network to further 
expedite safe discharge to sponsors. The Committee directs ORR 
to continue to review any policies that may be prolonging a 
child's stay in custody, including those related to the 
sponsorship review process, and to work with child welfare 
experts as it continues to evaluate ways to safely reduce a 
child's time in care.
    Policies for Engaging with Law Enforcement.--The Committee 
believes that it is critical for ORR to have policies in place 
for staff to use for when it is appropriate to contact local 
law enforcement, as well as policies that stipulate how local 
law enforcement should engage with children in ORR's care to 
ensure that those interactions account for the trauma a child 
might be facing. The Committee urges ORR to create and make 
publicly available the policies and procedures for staff and 
children's interactions with local law enforcement.
    Post-Release Services.--The Committee includes an increase 
in funding for post-releases 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, and 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 requests ORR 
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.
    Separated Families Services Fund.--The Committee strongly 
supports the mission and efforts of the Interagency Task Force 
on the Reunification of Families and includes $30,000,000, as 
requested, to support ongoing mental health and other 
supportive services for children, parents, and legal guardians 
who were separated at the U.S.-Mexico border under the previous 
administration.
    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 2023 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 notes that HHS has 
significantly expanded its unlicensed shelter capacity as high 
numbers of children have sought protection at the Southern 
border and amid ongoing challenges posed by the COVID-19 
pandemic. 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 continues to have serious 
concerns about HHS's continued reliance on unlicensed 
facilities, including ``emergency intake sites'', that lack 
critical services and safeguards. 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 shelters where a substantial number 
of children reside in the same room. The Committee directs ORR 
to submit, within 30 days of enactment of this Act, its plan 
for discontinuing use of any open unlicensed facilities, 
including the anticipated closure dates for each unlicensed 
facility, and the target dates by which each such facility will 
comply with required standards while in use.
    The Committee expects ORR to adopt systemic changes to 
eliminate future reliance on unlicensed facilities and directs 
ORR to ensure sufficient bed capacity for unaccompanied 
children in permanent, small, State-licensed shelters, group 
homes, and transitional and long-term foster care. The 
Committee directs ORR to submit a report within 180 days of 
enactment of this Act on strategies ORR can pursue to ensure 
that ORR maintains access to, and can expeditiously activate as 
necessary, sufficient licensed bed capacity to serve 
unaccompanied children during periods of higher referrals or 
emergencies. The report should also assess ORR's ability to 
address any staffing issues, or add case management and other 
priority services for children placed in reactivated licensed 
settings.

Survivors of Torture

    The Committee includes $27,000,000 for the Survivors of 
Torture program, which is $10,000,000 above the fiscal year 
2021 enacted level and equal to the fiscal year 2022 budget 
request. 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 2021.......................    $5,911,000,000
Budget request, fiscal year 2022......................     7,377,000,000
Committee Recommendation..............................     7,377,000,000
    Change from enacted level.........................    +1,466,000,000
    Change from budget request........................             - - -
 

    The Committee recommends $7,377,000,000 for the Child Care 
and Development Block Grant (CCDBG) program, which is 
$1,466,000,000 above the fiscal year 2021 enacted level and 
equal to the fiscal year 2022 budget request. The Committee 
strongly supports the commitment in the budget to allot three 
percent for Indian Tribes, in addition to the $177,330,000 set-
aside included in the accompanying bill. 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.
    In addition, the Coronavirus Response and Relief 
Supplemental Appropriations (CRRSA) Act (P.L. 116-260) included 
$10,000,000,000 and the American Rescue Plan (P.L. 117-2) 
included $39,000,000,000 in CCDBG funding to support children, 
families, and child care providers during the pandemic, and to 
stabilize the child care industry with flexible funding that 
could be used for personnel costs, rent, cleaning supplies, and 
mental health support for children and staff.
    Assistant Secretary for Planning and Evaluation/CCDBG 
Eligibility and Receipt.--The Committee expects HHS ASPE to 
provide and make publicly accessible updated annual estimates 
and factsheets of Child Care Eligibility and Receipt under 
Federal and State rules as promptly as practicable. Within six 
months of enactment of this Act, the Committee directs ASPE to 
post on its website estimates and factsheets for fiscal year 
2018, along with a timeline for when the agency intends to 
provide updates for 2019 and subsequent years.
    Child Care Facilities Needs Assessment.--The Committee 
appreciates that ACF is in the process of conducting a 
feasibility study to determine how States could conduct needs 
assessments of their child care and early education facilities. 
The Committee directs ACF to continue to dedicate a portion of 
Federal CCDBG research funding (42 U.S.C. 9858m) as it 
evaluates possible methodologies for conducting facilities 
needs assessments and prepares cost estimates for the funding 
that would be necessary for experts to conduct Statewide needs 
assessments. As part of that evaluation, the Committee expects 
the Office of Child Care (OCC) to engage with key experts and 
stakeholders who have worked on recent facilities standards 
reports, conducted Statewide facilities needs assessments, and 
who have experience in conducting Statewide needs assessments 
or working on child care and early childhood education 
facilities issues. OCC shall brief the Committee on its 
findings as soon as practicable, and include the recommended 
methodology, along with the resources that would be necessary 
to fund such Statewide needs assessments in the fiscal year 
2023 Congressional Budget Justification.
    The Committee encourages HHS to coordinate with the 
Department of Housing and Urban Development and the Bureau of 
Indian Affairs as it assesses the child care infrastructure and 
early learning needs in underserved rural and tribal 
communities, including for Head Start and early Head Start 
facilities. Further, the Committee encourages HHS to consult 
with the Department of Agriculture Rural Development, Small 
Business Administration, and the Department of Treasury 
Community Development Financial Institutions Fund, on potential 
opportunities to leverage resources available to bolster early 
childhood learning and development in rural America.
    Child Care Relief and Recovery GAO Study.--The Committee 
directs GAO to study the State implementation of the various 
coronavirus relief and recovery packages to identify long-term 
strategies for improving the child care industry and supporting 
child care businesses including the use of grants and/or 
contracts, improving payment practices, and strategies to 
recruit and retain the workforce.
    Homelessness Data.--The Committee encourages OCC to provide 
technical assistance to 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 2021.......................    $1,700,000,000
Budget request, fiscal year 2022......................    $1,700,000,000
Committee Recommendation..............................     1,900,000,000
    Change from enacted level.........................      +200,000,000
    Change from budget request........................      +200,000,000
 

    The Social Services Block Grants 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.
    In addition, the bill includes $200,000,000 for the 
purposes of creating a diaper distribution grant program, to 
provide much-needed resources to social service agencies or 
other non-profit organizations specifically for diaper and 
diapering supply needs.

                CHILDREN AND FAMILIES SERVICES PROGRAMS

 
 
 
Appropriation, fiscal year 2021.......................   $13,040,511,000
Budget request, fiscal year 2022......................    14,902,760,000
Committee Recommendation..............................    15,232,981,000
    Change from enacted level.........................    +2,192,470,000
    Change from budget request........................      +330,221,000
 

    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 2022 Committee
                   Budget Activity
------------------------------------------------------------------------
Programs for Children, Youth, and Families:
    Head Start....................................       $12,182,095,000
    Preschool Development Grants..................           450,000,000
    Runaway/Homeless Youth........................           126,787,000
    Abuse of Runaway Youth Prevention.............            23,000,000
    State Child Abuse Prevention..................           125,000,000
    Discretionary Child Abuse Prevention..........            42,000,000
    Community-based Child Abuse Prevention........            90,000,000
    Child Welfare Services........................           275,000,000
    Child Welfare Training........................           121,000,000
    Adoption Opportunities........................            46,100,000
    Adoption Incentives...........................            75,000,000
    Social Services/Income Maintenance Research...             9,512,000
    Native American Programs......................            65,000,000
Community Services:
    Community Services Block Grant................           800,000,000
    Community Economic Development................            23,000,000
    Rural Community Facilities....................            11,000,000
Domestic Violence Hotline.........................            25,780,000
Family Violence/Battered Women's Shelters.........           463,450,000
Independent Living Training Vouchers..............            48,257,000
Disaster Human Services Case Management...........             4,000,000
Program Direction.................................           227,000,000
------------------------------------------------------------------------

Head Start

    The Committee recommends $12,182,095,000 for the Head Start 
program, which is $1,434,000,000 above the fiscal year 2021 
enacted level and $250,000,000 above the fiscal year 2022 
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 
$234,000,000 for a cost-of-living adjustment.
    Early Head Start (EHS) Expansion and Early Head Start-Child 
Care (EHS-CC) Partnerships.--The Committee provides 
$750,000,000 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 45 days of enactment of 
this Act on how the Office of Head Start intends to award EHS 
expansion funding, including EHS-CCP funds, without making 
awards 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 2023 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.
    Extended Duration.--The Committee understands the need for 
Head Start programs to offer longer hours of service to better 
align with K-12 schedules and support working parents, and 
includes $200,000,000 for programs to expand program hours of 
service consistent with the 2016 Head Start Program Performance 
Standards.
    Migrant and Seasonal Head Start (MSHS) Eligibility 
Requirements.--The Committee remains concerned about how 
enrollment and eligibility requirements for the MSHS program 
may act as barriers for low-income farmworker families seeking 
MSHS services. The Committee reiterates the need for the report 
on the Impact of the Federal Poverty Guideline, as requested in 
House Report 116-450, including the section examining how such 
requirements may be affecting MSHS. The Committee expects the 
OHS to brief the Committees on the findings and recommendations 
of that report as soon as practicable, but not later than 30 
days after enactment of this Act, so that it can continue to 
discuss possible solutions to expand access to such families.
    In addition, the Committee is concerned that families 
applying for MSHS services may be deemed ineligible based on 
the disruption to the lives of agricultural workers as a result 
of the COVID-19 pandemic. The Committee understands that 
several flexibilities exist with regard to how a farmworker can 
demonstrate eligibility for MSHS programs, and directs OHS to 
issue guidance within 30 days of enactment of this Act on the 
flexibilities MSHS programs can offer farmworker families with 
regard to demonstrating income eligibility, or residency, if 
they were unable to migrate as a result of the pandemic.
    Most Vulnerable Communities GAO Study.--The Committee 
directs GAO to conduct a study identifying whether Head Start 
meets the needs of the most vulnerable children and communities 
around the country, or whether flexibility could be given in 
order to allocate funds to communities, age groups, or families 
that are in greatest need around the country.
    Quality Improvement Funding for Trauma-Informed Care.--The 
Committee continues to recognize that children affected by 
trauma face significant challenges that require specialized 
care. The Committee provides $250,000,000 in quality 
improvement funding for programs to increase services for 
mental health professionals to provide expert care and 
counseling to families and the Head Start workforce; provide 
staff training on trauma-informed approaches to service 
delivery; and add staff to Head Start classrooms.
    Supporting Families.--The Committee strongly supports Head 
Start's efforts to support families' well-being and economic 
security by partnering with parents on employment, education, 
and career goals. The Committee encourages programs to invest 
in parents through parent-to-teacher training programs, 
partnerships with local community colleges, apprenticeship 
programs, and local employers committed to helping Head Start 
and Early Head Start families find meaningful employment and 
career tracks.
    Tribal Colleges and Universities-Head Start Partnership 
Program.--The Committee recommends $8,000,000 for the Tribal 
Colleges and Universities (TCU)-Head Start Partnership Program.

Preschool Development Grants

    The Committee recommends $450,000,000 for Preschool 
Development Grants, which is $175,000,000 above the fiscal year 
2021 enacted level and equal to the fiscal year 2022 budget 
request. 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.

Runaway and Homeless Youth

    The Committee recommends $149,787,000 for the Runaway and 
Homeless Youth (RHY) program, which is $13,007,000 above the 
fiscal year 2021 enacted level and $4,800,000 above the fiscal 
year 2022 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 (i.e., 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 $125,000,000 for Child Abuse 
Prevention and Treatment Act (CAPTA) State Grants, which is 
$34,909,000 above the fiscal year 2021 enacted level and 
$5,000,000 above the fiscal year 2022 budget request.

Child Abuse Discretionary Activities

    The Committee recommends $42,000,000 for Child Abuse 
Discretionary Activities, which is $7,000,000 above the fiscal 
year 2021 enacted level and the fiscal year 2022 budget 
request.
    Child Abuse Hotline.--The Committee recommends $2,000,000 
to support and expand a national child abuse hotline, to 
increase outreach efforts and provide additional resources and 
intervention through multiple modalities, including chat, text, 
and call, to 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 including a category of animal abuse to the caregiver 
characteristics and environmental factors fields in NCANDS as 
an additional factor that could place a child at risk for 
maltreatment.
    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 $90,000,000 for Community-Based 
Child Abuse Prevention, which is $29,340,000 above the fiscal 
year 2021 enacted level and $10,000,000 above the fiscal year 
2022 budget request. 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 provide 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 $121,000,000 for the Child Welfare 
Research, Training and Demonstration program, which is 
$102,016,000 above the fiscal year 2021 enacted level and equal 
to the fiscal year 2022 budget request. 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.
    Addressing Racial Inequity in the Child Welfare System.--
The Committee recognizes the need for reforms in the child 
welfare system, and supports the request to provide 
$100,000,000 for a new competitive grant program to address 
racial inequity in the child welfare field and reorient systems 
towards a prevention-first model. This funding would allow 
State, local, and tribal child welfare agencies to partner with 
other government and community stakeholders across the 
education, health, human services, and early childhood sectors 
to advance comprehensive policy and practice reforms focused on 
advancing racial equity and safely reducing the number of 
children entering foster care, particularly in communities 
over-represented in the child welfare system.
    Child Advocacy Studies Training.--The Committee continues 
to support enhancing Statewide multi-disciplinary child 
advocacy studies training through undergraduate and graduate 
curricula to improve training in how to prevent, identify, and 
respond to incidences of child abuse.
    Child Protection Simulation Training.--The Committee 
provides an additional $2,000,000 to fund partnerships with 
child protection simulation training laboratories that have 
established capabilities and State partnerships, and that 
provide in-person and online, trauma-informed, evidence-based 
training. Funding may be used to provide logistical and other 
support for personnel and program development and expansion.
    Race Equity in the Child Welfare Workforce.--The Committee 
supports efforts to increase the hiring, retention, and 
leadership development of a racially diverse workforce at all 
levels of public and private child welfare agencies and 
provides an additional $2,000,000, as requested.

Adoption Opportunities

    The Committee recommends $46,100,000 for the Adoption 
Opportunities program, which is $2,000,000 above the fiscal 
year 2021 enacted level and equal to the fiscal year 2022 
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 recommendation includes $1,000,000 for the National 
Adoption Competency Mental Health Training Initiative and 
encourages 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 $9,512,000 for Social Services and 
Income Maintenance Research, which is $2,000,000 above the 
fiscal year 2021 enacted level and $1,000,000 above the fiscal 
year 2022 budget request.

Native American Programs

    The Committee recommends $65,000,000 for Native American 
Programs, which is $7,950,000 above the fiscal year 2021 
enacted level and $4,527,000 above the fiscal year 2022 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 
$15,000,000 for Native American language preservation 
activities, including not less than $10,000,000 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 $55,000,000 above the fiscal year 2021 enacted level 
and $46,100,000 above the fiscal year 2022 budget request. The 
CSBG provides funds to alleviate the causes and conditions of 
poverty in communities.
    Community Economic Development.--The Committee recommends 
$23,000,000 for Community Economic Development, which is 
$2,617,000 above the fiscal year 2021 enacted level and 
$1,394,000 above the fiscal year 2022 budget request. 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.
    The Committee understands that the COVID-19 pandemic may 
have resulted in project delays and that funds previously 
awarded and available to grantees may have since been 
cancelled. The Committee encourages the program to prioritize 
funding to applicants seeking reimbursement for projects for 
which funding had been obligated but not expended, and has 
since been returned to the U.S. Treasury.
    Rural Community Facilities Development.--The Committee 
recommends $11,000,000 for the Rural Community Facilities 
Development program, which is $1,000,000 above the fiscal year 
2021 enacted level and $400,000 above the fiscal year 2022 
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 $25,780,000 for the Domestic 
Violence Hotline, which is $12,780,000 above the fiscal year 
2021 enacted level and equal to the fiscal year 2022 budget 
request. The Hotline provides 24-hour, toll-free and 
confidential services immediately connecting callers to local 
service providers.
    The Committee believes The Hotline may be well positioned 
to support people that reach out and indicate that they have 
caused harm, and in doing so, may be able to play a critical 
part of ending the cycle of abuse and ultimately decreasing 
rates of domestic violence. The recommendation includes 
$1,000,000 for a pilot project to explore best practices, 
intervention, and prevention methods, and establish a hotline 
to reduce incidents of domestic violence by addressing people 
that cause harm.

Family Violence Prevention and Battered Women's Shelters

    The Committee recommends $463,450,000 for the Family 
Violence Prevention and Battered Women's Shelters programs, 
which is $280,950,000 above the fiscal year 2021 enacted level 
and equal to the fiscal year 2022 budget request. The Family 
Violence Prevention and Services Act 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).
    Access to Integrated Health Care Services.--The Committee 
supports the proposal to partner health care providers with 
domestic violence service providers to provide families with 
access to primary health care, vaccinations, and behavioral 
health services at a local shelter, transitional housing 
program, or safe home. The recommendation includes $20,000,000, 
as requested, for demonstration grants and technical assistance 
for local domestic violence programs and Tribes to provide 
access to integrated health care services, including mobile 
health units for families experiencing domestic violence who 
are living in shelters or placed in temporary housing within 
their local 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 yet survivors of color have limited access to 
services that incorporate culturally specific healing 
modalities by providers who reflect their cultural community. 
The Committee believes that the needs of women of color 
intersect with broader public health and social issues 
including access to health care, transportation, safe and 
affordable housing, and economic equity, and includes 
$35,000,000 for culturally specific communities of color 
organizations to develop or enhance appropriate services that 
are specific to their community.
    National Domestic Violence Prevention Action Plan.--The 
Committee recognizes that the fiscal year 2022 Congressional 
Budget Justification invests in efforts to end gender-based 
violence across multiple Federal agencies, and notes that the 
United Nations has urged countries to adopt national action 
plans to combat gender-based violence and violence against 
women, including domestic violence. The Committee directs ACF 
to coordinate with CDC to create a National Domestic Violence 
Prevention Action Plan to expand, intensify, and coordinate 
domestic violence prevention efforts among Federal, State, 
local, and tribal government agencies and with other relevant 
stakeholders to ensure a whole-of-government, goal-oriented, 
community-informed, forward looking approach in addressing 
domestic violence prevention in the U.S. and report the plan to 
the Committee no later than one year after enactment of this 
Act.
    Native Hawaiian Resource Center on Domestic Violence.--
Within the recommendation, the Committee includes $1,000,000 
for a 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.

Program Direction

    The Committee recommends $227,000,000 for Program 
Direction, which is $19,500,000 above the fiscal year 2021 
enacted level and equal to the fiscal year 2022 budget request.

                   PROMOTING SAFE AND STABLE FAMILIES

 
 
 
Appropriation, fiscal year 2021.......................      $427,515,000
Budget request, fiscal year 2022......................       451,000,000
Committee Recommendation..............................       451,000,000
    Change from enacted level.........................       +23,485,000
    Change from budget request........................             - - -
 

    The Committee recommends $345,000,000 in mandatory funds 
and $106,000,000 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.
    The recommendation includes $30,000,000 for formula grants 
to States and tribal agencies operating title IV-E programs to 
develop, enhance, or evaluate Kinship Navigator programs, and 
$7,000,000 for Regional Partnership Grants (RPGs), as 
requested. In addition, the Committee provides $9,000,000 for 
the Prevention Services Clearinghouse and to support evaluation 
and technical assistance relating to the evaluation of child 
and family serving programs and services.

                PAYMENTS FOR FOSTER CARE AND PERMANENCY

 
 
 
Appropriation, fiscal year 2021.......................    $7,011,538,000
Budget request, fiscal year 2022......................     6,963,000,000
Committee Recommendation..............................     6,963,000,000
    Change from enacted level.........................       -48,538,000
    Change from budget request........................             - - -
 

    The Committee also recommends an advance appropriation of 
$3,200,000,000 for the first quarter of fiscal year 2023 to 
ensure timely completion of first quarter grant awards.
    Adoption and Foster Care Analysis and Reporting System 
(AFCARS) Data Elements.--The Committee believes that collecting 
LGBTQ and Indian Child Welfare Act (ICWA) data would help HHS 
track and improve outcomes for foster youth and families living 
at the intersections of race, sexual orientation, gender, and 
tribal affiliation and encourages HHS to incorporate LGBTQ and 
ICWA data elements into AFCARS.
    Mental Health Screenings for Foster Youth.--The Committee 
recognizes that States are required to develop a plan for the 
ongoing oversight and coordination of health care services for 
any child in a foster care placement and emphasizes the 
importance of including mental health as part of these 
screenings within the first 30 days of entering foster care. 
The Committee urges HHS to provide technical assistance to 
States as they incorporate mental health screenings into State 
oversight plans.

                  Administration for Community Living


                 AGING AND DISABILITY SERVICES PROGRAMS

 
 
 
Appropriation, fiscal year 2021.......................    $2,206,000,000
Budget request, fiscal year 2022......................     2,953,665,000
Committee Recommendation..............................     3,047,414,000
    Change from enacted level.........................      +841,414,000
    Change from budget request........................       +93,749,000
 

    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 $550,574,000 for Home and 
Community-Based Supportive Services, which is $158,000,000 
above the fiscal year 2021 enacted level and equal to the 
fiscal year 2022 budget request. 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 $31,339,000 for Preventive Health 
Services, which is $6,491,000 above the fiscal year 2021 
enacted level and $5,000,000 above the fiscal year 2022 budget 
request. This program funds activities that help seniors remain 
healthy and avoid chronic diseases.

Protection of Vulnerable Older Americans

    The Committee recommends $34,944,000 for activities to 
protect vulnerable older Americans, which is $11,286,000 above 
the fiscal year 2021 enacted level and equal to the fiscal year 
2022 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. The Committee provides an $11,000,000 increase to the 
Long-Term Care Ombudsman program, as requested, to build on 
funding provided in the American Rescue Plan, to safely 
transition State Long-Term Care Ombudsman programs from virtual 
back to in person contact and visitation in facilities, and to 
expand coverage to other residential care facilities.

Family Caregiver Support Services

    The Committee recommends $249,936,000 for the National 
Caregiver Support program, which is $61,000,000 above the 
fiscal year 2021 enacted level and equal to the fiscal year 
2022 budget request. 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.
    Youth Caregivers.--The Committee appreciates that ACL has 
included caregiving youth in its review and activities of the 
RAISE Family Caregiver Advisory Council and looks forward to 
reviewing the recommended actions reflecting the unique issues 
and needs of youth caregivers in the forthcoming National 
Family Caregiving Strategy.

Native American Caregiver Support Services

    The Committee recommends $15,806,000 for the Native 
American Caregiver Support program, which is $5,000,000 above 
the fiscal year 2021 enacted level and equal to the fiscal year 
2022 budget request. 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 $1,387,773,000 for 
senior nutrition. The recommendation includes: $515,342,000 for 
Congregate Nutrition Services; $703,431,000 for Home-Delivered 
Meal Services; and $169,000,000 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 $70,208,000 for Native American 
Nutrition and Supportive Services, which is $35,000,000 above 
the fiscal year 2021 enacted level and equal to the fiscal year 
2022 budget request. 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 $27,446,000 for Aging Network 
Support Activities, which is $10,985,000 above the fiscal year 
2021 enacted level and $8,000,000 above the fiscal year 2022 
budget request. This program supports activities that expand 
public understanding of aging and the aging process.
    Direct Care Workforce Demonstration.--The 2020 Older 
Americans Act Reauthorization authorized ACL, in coordination 
with the Secretary of Labor, to implement a 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. The Committee recognizes the 
success of the PCTI-based programs that have been implemented 
through the Holocaust Survivor Assistance Program, and includes 
an additional $5,000,000 in fiscal year 2022 for the program to 
expand its application to other adults that have been exposed 
to traumatic events, including aging military veterans, first 
responders, victims of childhood and domestic violence, and 
survivors of man-made or natural disasters, including aging 
survivors of the COVID-19 pandemic.

Alzheimer's Disease Program

    The Committee recommends $34,700,000 for the Alzheimer's 
disease program, which is $7,200,000 above the fiscal year 2021 
enacted level and $4,640,000 above the fiscal year 2022 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 $3,000,000 for the National 
Alzheimer's Call Center.

Respite Care

    The Committee recommends $14,220,000 for Respite Care, 
which is $7,110,000 above the fiscal year 2021 enacted level 
and equal to the fiscal year 2022 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 $5,000,000 to be transferred from 
the PPH Fund to ACL for the Falls Prevention program, which is 
equal to the fiscal year 2021 enacted level and the fiscal year 
2022 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 2021 enacted level 
and the fiscal year 2022 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 $19,400,000 for Elder Rights 
Support Activities, which is $1,526,000 above the fiscal year 
2021 enacted level and equal to the fiscal year 2022 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.

Aging and Disability Resource Centers

    The Committee recommends $23,457,000 for Aging and 
Disability Resource Centers (ADRCs), which is $15,338,000 above 
the fiscal year 2021 enacted level and equal to the fiscal year 
2022 budget request. 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 $57,115,000 for the State Health 
Insurance Assistance Program, which is $5,000,000 above the 
fiscal year 2021 enacted level and $1,873,000 above the fiscal 
year 2022 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 $9,000,000 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 2021 
enacted level and equal to the fiscal year 2022 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 $15,321,000 for the Traumatic 
Brain Injury program, which is $4,000,000 above the fiscal year 
2021 enacted level and $3,434,000 above the fiscal year 2022 
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. The Committee 
provides increased funding for the program to sustain and 
expand existing programs, and to award funding to additional 
States.

Developmental Disabilities State Councils

    The Committee recommends $88,480,000 for State Councils on 
Developmental Disabilities, which is $9,480,000 above the 
fiscal year 2021 enacted level and equal to the fiscal year 
2022 budget request. 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 $46,798,000 for Developmental 
Disabilities Protection and Advocacy, which is $5,014,000 above 
the fiscal year 2021 enacted level and equal to the fiscal year 
2022 budget request. 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 $12,963,000 for Voting Access for 
Individuals with Disabilities program, which is $5,000,000 
above the fiscal year 2021 enacted level and $3,000,000 above 
the fiscal year 2022 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 $13,100,000 for Developmental 
Disabilities Projects of National Significance, which is 
$850,000 above the fiscal year 2021 enacted level and equal to 
the fiscal year 2022 budget request. 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 $47,173,000 for University Centers 
for Excellence in Developmental Disabilities, which is 
$5,054,000 above the fiscal year 2021 enacted level and equal 
to the fiscal year 2022 budget request. 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 $148,228,000 for the Independent 
Living program, of which $28,423,000 is for the Independent 
Living State Grants program and $119,805,000 is for the Centers 
for Independent Living program. This funding level is 
$32,045,000 above the fiscal year 2021 enacted level and equal 
to the fiscal year 2022 budget request. 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 $124,800,000 for the National 
Institute on Disability, Independent Living, and Rehabilitation 
Research (NIDILRR), which is $11,830,000 above the fiscal year 
2021 enacted level and $6,181,000 above the fiscal year 2022 
budget request. 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 
recommendation includes funds to increase annual grant funding 
to competitively funded model systems centers, and a $100,000 
increase for the Traumatic Brain Injury Model Systems National 
Data and Statistical Center (NDSC).
    Spinal Cord Injury Model Systems (SCIMS).--The Committee is 
concerned with the growing number of people living with a 
spinal cord injury in the U.S. and recommends $2,000,000 to 
increase the number of Federally-funded SCIMS Centers.

Assistive Technology

    The Committee recommends $44,000,000 for Assistive 
Technology, which is $6,500,000 above the fiscal year 2021 
enacted level and equal to the fiscal year 2022 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 $47,063,000 for Program 
Administration, which is $6,000,000 above the fiscal year 2021 
enacted level and equal to the fiscal year 2022 budget request. 
This funding supports Federal administrative costs associated 
with administering ACL's programs.
    Congressional Budget Justification Accessibility.--The 
Committee appreciates efforts by ACL to make Congressional 
Budget Justifications compliant with section 508 of the 
Rehabilitation Act of 1973. However, in recent fiscal years, 
such justifications have not been made available online at the 
same time as justifications for the other operating divisions 
of HHS. The Committee requests ACL post on its website a 
version of its fiscal year 2023 Congressional Budget 
Justification at the same time other justifications for other 
operating divisions of HHS become available, and to post 
justifications compliant with section 508 as soon as 
practicable thereafter.
    Interagency Committee on Disability Research.--In 2014, 
Congress enacted bipartisan legislation mandating the design 
and implementation of a Government-Wide Strategic Plan for 
Disability, Independent Living, and Rehabilitation Research 
(``the Plan'') to maximize the Federal return on investment in 
this crucial area of research. Congress directed the Secretary 
of Health and Human Services in his capacity as chair of the 
Interagency Committee on Disability Research to fulfill this 
mandate. The Committee urges the Secretary to emphasize ICDR's 
importance to the field of disability research and to continue 
to acknowledge role in promoting interagency collaboration to 
carry out the Administration's priorities including the 
Executive Order on Advancing Racial Equity. The Committee also 
urges the ICDR to promote the work of the Federal Equitable 
Data Working Group to coordinate the collection of disability-
specific data.
    Simplifying State Program Reports.--As a result of the 
COVID-19 pandemic, States and area agencies on aging face an 
unprecedented reporting challenge during fiscal year 2022. 
These entities will be responsible for reporting on Federal 
fiscal year 2020 and fiscal year 2021 regular appropriations 
spending, as well as spending related to the four COVID-19 
emergency funding packages. The Committee urges ACL to explore 
ways to facilitate and simplify reporting requirements to 
alleviate burdens that could impact the important work of 
providing needed services to older adults.

                        Office of the Secretary


                    GENERAL DEPARTMENTAL MANAGEMENT

 
 
 
Appropriation, fiscal year 2021.......................      $550,622,000
Budget request, fiscal year 2022......................       661,309,000
Committee Recommendation..............................       657,809,000
    Change from enacted level.........................      +107,187,000
    Change from budget request........................        -3,500,000
 

    Of the funds provided, $74,828,000 shall be derived from 
evaluation set-aside funds available under section 241 of the 
Public Health Service Act, which is $10,000,000 above the 
fiscal year 2021 enacted level and $9,500,000 below the fiscal 
year 2022 budget request.
    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 2023 Congressional Budget Justification: 
expenditures for fiscal year 2021 and expected expenditures for 
fiscal year 2023 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.
    Autism Related Programs.--The Committee is aware that 
treatment regimens and care plans for autism will continue 
throughout the life of the patient and that clinicians often 
spend additional time on patient care by providing supportive 
services or helping caregivers connect with additional 
specialists and resources. These additional services are not 
typically reimbursable. The Committee directs the Secretary to 
identify the supportive services that are most beneficial to 
improved outcomes for autism patients, review existing coverage 
policies for these services, and provide a report on its 
interim findings no later than 180 days after the date of 
enactment of this Act.
    Behavioral Science and the COVID-19 National Strategy.--The 
Committee applauds the Administration's robust National 
Strategy for the COVID-19 Response and Pandemic Preparedness 
and appreciates that the strategy reflects the best advice of 
scientists and public health experts. As our success in these 
areas depends on our scientific understanding of human 
behavior, the Committee urges the Department to include 
psychological scientists at every level of the Department's 
response to COVID-19 and future public health emergencies to 
most effectively meet these common goals.
    Cancer Risk Study on Populations Near Commercial Nuclear 
Power Plants.--The Committee encourages the Department to 
contract with the National Academy of Sciences (NAS) to carry 
out a pilot study of cancer risk in populations near nuclear 
facilities, which was recommended by the NAS in a May 2012 
study entitled ``Analysis of Cancer Risks in Populations Near 
Nuclear Facilities.''
    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, and American Indian/
Alaska Native families. Data shows that COVID-19 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), USAID and other federal agencies to 
address these pressing problems. To foster greater 
coordination, collaboration, and transparency on child policy 
across agency lines, the Committee directs the Secretary to 
establish a Children's Interagency Coordinating Council. Among 
other tasks, the Council shall enter into an agreement with the 
NAS 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.
    COVID-19 Services for Medically Underserved Communities.--
The Committee is concerned about the high rate of COVID-19-
related cases, hospitalizations, and deaths of historically 
medically underserved communities. According to HRSA, more than 
18 million people reside in medically underserved areas or 
populations across the United States. The Committee recognizes 
that targeted resources and services--such as mobile and pop-up 
clinics and connections to housing, food, and other forms of 
support--for communities most affected by COVID-19 is essential 
to enable many low-income individuals to successfully isolate 
and quarantine. In addition, to deliver on vaccine equity, 
outreach, and social determinants of health, investment in 
trusted messengers such as faith leaders, community health 
workers, direct care workers, social support specialists, and 
navigators employed by community-based organizations, faith-
based organizations, and nonprofit organizations are necessary 
to reach medically underserved communities. The Committee urges 
the Secretary develop a strategy to dedicate a specific 
percentage of COVID-19 funding to community-based organizations 
proportional to the needs of people living in medically 
underserved areas.
    Data Collection to Measure Disparities.--The Committee 
recognizes that geographic place is a powerful predictor of 
social determinants of health. The Committee is concerned that 
due to residential segregation and subsequent disinvestment, 
the lack of access to health care, safe recreational 
facilities, quality education, and other resources, is often 
magnified in highly segregated communities. To fully assess 
population health, distribution of disease, and the extent of 
health disparities, health services data should be collected 
based on residency as opposed to where services are provided. A 
similar approach was taken to address the HIV/AIDS epidemic. 
The Committee recommends that all health services data include 
racial and ethnic data by subgroup, geographic indicators to 
the lowest levels (i.e., zip code tabulation area), 
nationality, sex, age, and primary language. This data should 
be collected in a standardized, uniform manner and include with 
it the capacity for linkages to various federal data sets. The 
Committee requests a report within 120 days of enactment of 
this Act describing the specific steps taken to ensure that 
geographic disparities were measured in COVID-19 data 
collection, documentation, and reporting from health care 
providers to public health agencies. The report shall also 
include recommendations to sustain data harmonization efforts 
to expand reporting for all infectious diseases and chronic 
health conditions and to address emergency prevention 
preparedness and response in the event of additional future 
pandemics and other catastrophes.
    Early Detection of 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 H. Rept. 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 
consult with appropriate stakeholders to develop a strategy for 
disseminating information about the best practices and begin 
implementing this strategy within one year after 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.
    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.
    Fair Access to Science and Technology Research.--The 
Committee commends the HHS agencies--the Administration for 
Community Living (ACL), Agency for Healthcare Research and 
Quality, Assistant Secretary for Preparedness and Response 
(ASPR), Centers for Disease Control (CDC), Food and Drug 
Administration (FDA), and National Institutes for Health 
(NIH)--that have issued plans in response to the White House 
Office of Science and Technology Policy Directive issued on 
February 22, 2013. The Committee urges these agencies to 
continue their efforts toward full implementation of the plan 
and requests an update in the fiscal year 2023 Congressional 
Budget Justification.
    Global Alzheimer's Disease and Dementia Action Plan.--The 
Committee urges the Secretary to enter into negotiations with 
the World Health Organization to implement a plan for 
addressing Alzheimer's Disease and other forms of dementia 
globally, to be known as the Global Alzheimer's Disease and 
Dementia Action Plan, focused on the following areas: research, 
including the development of a stable and sustained 
international commitment to research; regulatory issues; 
clinical care; supportive services for patients and caregivers, 
including innovative technologies; prevention and health 
promotion; public awareness and education, particularly efforts 
aimed at reducing stigmas, and increasing the inclusion of 
persons with Alzheimer's disease and dementia within civil 
society.
    Global Health Research.--The Committee requests an update 
in the fiscal year 2023 Congressional Budget Justification on 
how 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 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.
    Impact of COVID-19 on Health Care Personnel.--The Committee 
recognizes the incredible sacrifice that health care and direct 
care workers have made on the frontlines to care for Americans 
with COVID-19. Investigative journalists have revealed through 
tracking obituaries that 3,600 U.S. health care workers died 
from COVID-19. Two-thirds of these casualties are among people 
of color. Lower paid workers, including nurses, support staff, 
and nursing home employees, were the most likely to pass away 
from COVID-19. During the pandemic, the federal government did 
not comprehensively track the number of lives lost among health 
care workers and support staff. The Committee directs HHS to 
undertake a comprehensive count of the total number of lives 
lost among health care workers and direct service workers at 
health care facilities, nursing homes, and long-term care 
facilities and emergency care providers, including paramedics 
and medical personnel who transport patients to the hospital. 
The Committee directs HHS, in coordination with OSHA, to 
develop and submit to the Committee a plan within 90 days of 
enactment of this Act for how it will collect, record, and 
report health care worker mortality and morbidity data 
associated with COVID-19, including suicides connected to the 
mental health impact of the pandemic. The Committee further 
directs the Secretary to submit a report within 180 days of 
enactment of this Act on initial findings of the long-term 
health impacts of the pandemic on health care workers, 
including physical health, mental trauma leading to disability, 
and contraction of COVID-19.
    Improving Accuracy of Diagnosis of Rare Diseases.--The 
Committee is aware that the lack of a precise diagnostic code 
makes disease surveillance, including understanding the true 
prevalence of a condition, more difficult and hinders 
diagnosis, treatment, and access to approved therapies. The 
Committee encourages HHS to work with federal agency partners 
to establish a pathway for rare disease stakeholders to pursue 
a diagnosis code, including resources to advise stakeholders as 
to data and other needs and to help facilitate the application 
process for rare disease codes.
    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. The Committee looks forward to receiving 
the multi-year plan outlining innovation initiatives for 
conquering Lyme disease, which is due in December 2021.
    Maximizing Syringe Safety.--The Committee is concerned that 
on COVID-19 vaccine deployment, administrative inconsistencies 
with procured syringes have resulted in wasted vaccine doses 
while potentially exposing front line health care workers to 
bloodborne pathogens; both of which could impede efforts for a 
thorough, safe, and timely administration of FDA-authorized 
COVID-19 vaccines. The Committee directs the Secretary, in 
consultation with relevant agencies within HHS who maintain 
jurisdiction in the administration of vaccines including FDA, 
NIH, ASPR, Office of Minority Health, and Office on Women's 
Health to submit a report within 90 days of enactment of this 
Act on the specific steps the Department is taking to ensure 
that procurement of syringes for the deployment and 
administration of COVID-19 vaccines provide the maximum dose 
while ensuring our frontline health care workers remain safe 
from the risk of exposure to bloodborne pathogens.
    Mental Health Parity.--The Committee continues to be 
concerned that 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 Department of Labor (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 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 Secretaries shall also report annually 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 strongly supports efforts to advance health equity 
and reduce disparities for communities of color. Persistent 
racial and ethnic health disparities can be largely attributed 
to poor social and physical determinants of health in these 
communities. Advancing health equity requires a multifactorial 
response to address issues such as high unemployment, 
inadequate housing, lack of quality education, and inability to 
access health care. Reducing health disparities also requires 
solutions that are informed by and tailored to the specific 
racial, ethnic, socioeconomic, and geographic communities at 
which they are aimed. The Committee supports the Office of 
Minority Health (OMH) and its efforts to advance health 
equity--however, the Committee believes the OMH currently lacks 
sufficient capacity to lead a broad and bold effort to address 
health disparities and that HHS should establish a National 
Center on Antiracism and Health Equity (Center) 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. The Committee 
directs the Secretary to submit a report, not later than 180 
days after enactment of this Act, that provides detailed 
proposals to establish a National Center on Antiracism and 
Health Equity within the Department. The proposals shall 
include (1) a charter and goals for a National Center on 
Antiracism and Health Equity; (2) rationale for creating a new 
entity within the Department or restructuring an existing 
entity; (3) budgetary resources necessary to establish the 
Center; (4) the number of full-time equivalent employees needed 
to effectively carry out the Center's mission; (5) the 
resources needed for the Center to establish, through grants or 
cooperative agreements, at least three regional centers of 
excellence, located in racial and ethnic minority communities; 
(6) the resources needed to award grants and cooperative 
agreements to eligible public and nonprofit private entities, 
including community-based organizations, to collaborate with 
underserved communities and for research and collection, 
analysis, and reporting of data on the public health impacts of 
health disparities; and (7) the resources needed for the Center 
to work with eligible public and nonprofit private entities, 
including community-based organizations, to provide information 
and education to the public on the public health impacts of 
health disparities and on health equity interventions, among 
other details.
    National Health Care Workforce Commission.--The Committee 
includes $3,000,000 to establish the National Health Care 
Workforce Commission, as authorized by the Affordable Care Act. 
The Commission is intended to serve as a resource on health 
care workforce policy for Congress, the Administration, States, 
and localities and is tasked with evaluating health care 
workforce needs, assessing education and training activities, 
identifying barriers to improved coordination at the Federal, 
State, and local levels and recommending changes to address 
those barriers.
    National Poverty Center Cooperative Agreement.--The 
Committee includes sufficient funding for the Office of the 
Assistant Secretary for Planning and Evaluation to fund a 
Poverty Research Center cooperative agreement in fiscal year 
2022, in an amount not less than the current level of funding.
    One Health Federal Interagency Network.--The Committee 
understands that despite unprecedented efforts to address the 
COVID-19 pandemic, many questions remain about the prevention 
of future pandemics, especially those caused by zoonotic 
disease transmission. The Committee recognizes that current 
federal efforts regarding a One Health approach to preventing 
and responding to pandemics stemming from zoonotic disease, 
vector-borne disease, and antimicrobial-resistant pathogens is 
inadequate, fragmented, and associated with limited 
coordination and collaboration within and across Federal 
agencies. The Committee supports a One Health approach to 
pandemic prevention that recognizes that human, animal, and 
environmental health are fundamentally interconnected. The 
Committee directs the Secretary or his designee to formalize 
the One Health Network and to provide a professional judgement 
within 180 days of enactment of this Act regarding the 
Network's funding and resource requirements. This report shall 
also include an assessment of current agency capabilities, as 
well as current and planned activities related to pandemic 
preparedness and One Health, particularly regarding the 
Network's efforts to expand, integrate, and enhance support for 
global surveillance efforts to effectively and efficiently 
implement early detection and rapid response measures. The 
Committee further directs HHS to include a cross-cut budget of 
current One Health activities being implemented.
    Pain Management.--The Committee has previously expressed 
concern about the public health epidemic of acute and chronic 
pain, including its inter-relationship with the opioid crisis. 
The COVID-19 pandemic has exacerbated each of these problems. 
As recommended in the CARA-mandated HHS Pain Management Best 
Practices Inter-Agency Task Force report, the Committee urges 
the Department to coordinate with the Department of Defense 
(DOD) and the VA to launch a public awareness campaign to 
educate Americans about the differences between acute and 
chronic pain and available evidence-based non-opioid treatment 
options. The Committee again urges the Department to widely 
disseminate the report's recommendations, including the 
importance of individualized, multidisciplinary, patient-
centered care in the treatment of pain to health care providers 
and other public health stakeholders, and to update relevant 
pain management policies and educational tools to reflect Task 
Force recommended best practices across all relevant HHS 
agencies, including the CDC, CMS and SAMHSA. The Committee 
urges the Department to include an update on dissemination of 
these materials and progress on the public awareness campaign 
in the fiscal year 2023 Congressional Budget Justification.
    Plasma Protein Therapies.--The Committee recognizes that 
plasma protein therapies are unique and non-interchangeable 
treatments for individuals afflicted with a variety of rare 
chronic and life-threatening conditions. The availability of 
plasma protein therapies is dependent on the collection of 
donated plasma which is developed into plasma protein 
therapies. The Committee urges the Department to conduct an 
education and awareness campaign on the importance of source 
plasma donation and the safety of the process as part of the 
larger campaign around the safety of blood donation broadly.
    Polycystic Ovary Syndrome.--The Committee requests a 
report, not later than one year after enactment of this Act, 
outlining the number of women in America currently suffering 
from polycystic ovary syndrome (PCOS); the annual cost to 
patients for treatment of PCOS; the annual cost to patients 
resulting from misdiagnosis or missed diagnosis of PCOS; the 
economic burden of PCOS on the United States; the effectiveness 
of current testing methods for PCOS; recommended ages for 
testing of PCOS; cost benefits of testing all women at 
recommended age; and feasibility of testing for PCOS before 
symptoms are present.
    Post-Acute COVID-19 Syndrome Advisory Committee.--The 
Committee encourages HHS to foster interagency and stakeholder 
collaboration in addressing the crisis of post-acute COVID-19 
syndrome by forming the Post-Acute COVID-19 Syndrome Advisory 
Committee.
    Preventing Mental Health and Substance Use Crises.--The 
Committee recognizes that the severity of the mental health and 
substance use crises has worsened during the COVID-19 public 
health emergency. Research showing increases in anxiety, 
depression, suicidal ideation, and substance use warrant 
further examination and the development of a response plan for 
the next public health emergency. The Committee requests an 
assessment of the response of the Federal government with 
respect to mental health and substance use during and after the 
onset of the COVID-19 public health emergency, as well as 
recommendations for a national strategy for preventing mental 
health and substance use crises during a future public health 
emergency.
    Repatriation.--An April 2021 GAO report on HHS's COVID-19 
emergency repatriation efforts found that HHS experienced 
coordination and safety issues that put repatriates, HHS 
personnel, and nearby communities at risk. The Committee 
directs HHS to revise or develop emergency preparedness and 
response plans to include the U.S. Repatriation Program and 
other human services programs, and to further clarify agency 
roles and responsibilities, including safety protocol for an 
evacuation and quarantine, during a pandemic. The Committee 
also directs the Department to plan and conduct regular 
exercises with relevant stakeholders--including federal 
partners, State, local, territorial, and tribal governments--to 
test repatriation plans in response to a pandemic and update 
relevant plans based on lessons learned.
    Report on the Effects of Social Media Use.--The Committee 
continues to support efforts by the Secretary to investigate 
whether there is a relationship between the use of social media 
and negative social and individual outcomes, including clinical 
and undiagnosed depression; self-harm, such as suicide, 
attempted suicide, and suicidal ideation; harm to others; cyber 
bullying; chronic anxiety; or social isolation. Such 
investigation should consider the role of content and 
presentation in social media that is linked to negative 
outcomes, as well as the design of algorithms to prioritize 
user engagement. In addition, the report should include 
consideration of the following questions: what type of content 
drives user participation on these platforms; how is that 
content most frequently presented to users on these platforms; 
and does that presentation lead to negative physical, mental or 
emotional health outcomes; what types of emotions characterize 
social media interactions; how do these companies design their 
algorithms to engage users; and is that design prioritizing 
engagement over user well-being. The Committee encourages the 
Secretary to provide a report within 90 days of enactment of 
this Act on the continued progress in this research area.
    Research on Pregnant and Lactating Women.--The Committee 
encourages the Secretary to work with the NIH, FDA, the Office 
of Human Research Protections (OHRP), and other relevant 
agencies to implement recommendations from the Task Force on 
Research Specific to Pregnant Women and Lactating Women 
(PRGLAC). The Committee encourages the Secretary to direct NIH 
and FDA to implement guidance and templates surrounding the 
inclusion of pregnant and lactating individuals within clinical 
trials in order to require justification for the exclusion of 
these populations within clinical trials, and to clarify that 
exclusion of these populations within clinical trials should 
not be the default practice in the development and evaluation 
of drugs and therapeutics. The Secretary should work with OHRP 
and FDA to harmonize FDA regulations with changes to the 
protected status of pregnant women in federally funded research 
included in the 2018 revisions to the Federal Policy for the 
Protection of Human Subjects.
    Social Determinants of Health Council.--The Committee 
directs the Social Determinants Council created by H. Rpt. 116-
450 to continue to provide technical assistance to State, 
local, and tribal jurisdictions seeking to develop Social 
Determinants Accelerator Plans. The Committee directs a report 
be submitted, no later than 30 days after enactment of this 
Act, regarding the status of the selection of all Council 
members outlined in H. Rpt. 116-450.
    Stigmatizing Language.--The Committee recognizes stigma and 
discrimination against individuals with a substance use 
disorder is a barrier to accessing treatment and supports 
removing stigmatizing language from the U.S. Code and federal 
agency and program names. To support these efforts, the 
Committee encourages the Secretary to identify names of 
agencies, institutes, centers, and programs that include 
stigmatizing language and to develop a strategy to remove 
language with a negative bias from these names.
    Stillbirth Task Force.--Stillbirth affects one in 160 
pregnancies, with 24,000 babies stillborn each year. Despite 
medical advances, the rate of early stillbirth has remained the 
same over the past 30 years. The Committee provides $1,000,000 
for the Secretary to develop a task force on stillbirth in the 
United States. The task force should include the CDC, NIH, 
outside specialty organizations, and maternal and fetal 
medicine specialists. The task force should focus on the 
current barriers to collecting data on stillbirths throughout 
the United States, communities at higher risk of stillbirth, 
the psychological impact and treatment for mothers following 
stillbirth, and known risk factors for stillbirth. The task 
force should provide a report on these issues within one year 
of enactment of this Act.
    Study on Animal Abuse and Future Acts of Violence.--The 
Committee is concerned about the link between animal abuse and 
future violence, and recognizes the need for further study into 
the underlying factors that contribute to acts of violence 
against animals and animal violence as a predictor of future 
violence against humans. The Committee directs the Secretary to 
enter into an agreement with the National Academy of Sciences, 
Engineering, and Medicine (NASEM), and includes $1,000,000 for 
the NASEM to conduct a study on the underlying factors that 
contribute to one's decision to commit acts of violence against 
animals; and analyzes acts of violence against animals as a 
predictor of future violence against humans.
    Study on Child Marriages.--The Committee requests a report, 
within one year of enactment of this Act, on the status of 
child marriages in the United States, including information on 
the prevalence of child marriages that have received exceptions 
through parental consent, judicial approval, emancipation, or 
pregnancy. The report should include information on the 
prevalence of child marriages that take place under force, 
fraud, or coercion and a study of provisions that States have 
enacted to help identify and prevent the marriage of minors due 
to force, fraud, or coercion. Finally, the report shall outline 
the impact of state-wide legislative reforms on the number of 
marriage licenses given to minors. The Committee requests a 
briefing on the report findings within 30 days of its 
submission.
    Study on the Manufacture and Sale of Nitrous Oxide.--The 
Committee understands that more than one million adolescents 
and young adults in the United States have used nitrous oxide 
illicitly for recreational purposes. This can cause headaches, 
drowsiness, breathing difficulty, or asphyxia, which can lead 
to a lapse into unconsciousness or death. The FDA's Office of 
Criminal Investigations has investigated businesses that 
purport to sell nitrous oxide for car racing applications but 
knowingly sell it for recreational drug use. The Committee 
believes that studying the effectiveness of state laws 
prohibiting the recreational use of nitrous oxide is a 
necessary first step in examining what role the Federal 
government should play to protect the public health in regard 
to recreational use of nitrous oxide. The Committee directs the 
Department, in consultation with CDC, FDA, SAMHSA, EPA, and 
CPSC, to submit a report containing (1) the results of a study 
of State regulatory requirements with respect to nitrous oxide 
that is manufactured and sold for use in consumer applications 
and (2) recommendations for Federal requirements with respect 
to such manufacture and sale that are needed to protect human 
health and safety.
    Supporting Community Violence Intervention Programs.--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 can be 
used to support community-based violence intervention programs 
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.
    Tardive Dyskinesia (TD).--The Committee understands that TD 
is a persistent, irreversible, and potentially disabling 
neurological condition that is associated with prolonged 
exposure to antipsychotics and other dopamine receptor blocking 
agents. It is characterized by involuntary movements and 
affects at least 500,000 people in the U.S. TD can 
significantly disrupt a patient's life, not only due to the 
symptoms themselves, but also the impact these symptoms have on 
social and emotional well-being and mental health. The 
Committee encourages HHS to prioritize the importance of 
screening, diagnosing, and treating TD as part of one's mental 
health. The Committee directs the Secretary to submit a report, 
no later than 180 days after the enactment of this Act, which 
(1) outlines the Department's existing resources for patients, 
providers, and caregivers related to TD, (2) identifies 
opportunities to update and expand such resources, and (3) lays 
out the Department's strategy to carry out this paragraph.
    Teacher Stress.--The Committee is concerned about the high 
levels of stress our nation's teachers have gone through both 
before and during the COVID-19 pandemic. The Committee directs 
the Secretary, in coordination with the Secretary of Education, 
to conduct a study within one year of enactment of this Act on 
teacher stress and increasing teacher retention and well-being. 
This study should look at the effectiveness of some of the 
following programs in reducing stress and increasing retention: 
workplace wellness programs that improve teacher health, social 
emotional learning programs, mentoring and induction programs 
for teachers throughout the year, other evidence based 
approaches to reducing stress and increasing well-being.
    Telehealth Standards.--The Committee believes that the 
flexibility afforded to telehealth providers has played an 
essential role in ensuring that Americans receive timely and 
quality care throughout the COVID-19 pandemic; however, quality 
standards remain important no matter the health care delivery 
method to ensure quality and safety. The Committee urges the 
Secretary to establish an advisory group to study issues 
relating to the provision of telehealth and associated quality 
of care. Such a study should generate recommendations regarding 
the applicability of telehealth modalities for various clinical 
scenarios. The Secretary shall assemble a technical advisory 
group that includes experts in the delivery of telehealth 
services. The advisory group shall also evaluate whether equity 
exists in access to appropriate telehealth modalities 
throughout the country, including broadband, computers, 
smartphones, landline telephones, and cell phones that only 
allow for audio-only communications. The Committee requests the 
Secretary deliver a report from the advisory group, no later 
than one year after enactment of this Act, with recommendations 
as to whether quality of care criteria should be applied to the 
specific use of any telehealth modality in different clinical 
scenarios.
    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 $3,000,000 as a tribal set-aside within 
the Minority HIV/AIDS Prevention and Treatment program.
    U.S.-Mexico Border Health Commission Vaccine Deployment 
Strategy.--The Committee recognizes the impact the COVID-19 
pandemic has had on communities along the Southern border, 
which are interconnected with their Mexican sister cities, with 
thousands of people and billions of dollars in trade crossing 
daily regardless of border closures. To ensure a full economic 
recovery both in border communities and nationally, the U.S. 
must work with Mexico to implement a binational COVID-19 
strategy. 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.
    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 $2,000,000 for 
the Commission, an increase of $900,000. Further, the Committee 
urges the Secretary to build upon the framework established by 
Healthy Border 2020 for border region public health goals and 
the actions needed to improve the health of U.S. and Mexico 
border residents, and to commence work on Healthy Border 2030 
as part of the Department's Healthy People 2030 initiative with 
a focus on addressing health disparities and to help border 
communities become more resilient to public health threats.
    USPSTF Clinical Data.--The Committee encourages the United 
States Preventive Services Task Force (USPSTF) to ensure that 
its recommendations further public health for all Americans and 
address health inequities. USPSTF should strive to provide 
timely recommendations, be fully transparent, and allow for 
public comment. USPSTF's methodologies should be firmly 
grounded in evidence and consider data specific to health 
equity and racial diversity to inform its decision making. 
Furthermore, USPSTF should review a recommendation upon a 
showing of new evidence. In addition, USPSTF's composition 
should reflect an appropriate breadth of practicing physician 
expertise, including specialist expertise, as well as public 
input reflecting diverse patient populations.
    Viral Hepatitis National Strategic Plan.--The Committee 
applauds the Department's update of the Viral Hepatitis 
National Strategic Plan, which was released in January 2021. 
The Viral Hepatitis Plan sets clear goals on how the United 
States can prevent, diagnose, treat, and manage viral 
hepatitis. The Committee urges the Department to implement the 
strategies laid out in this plan to reverse the rates of viral 
hepatitis, prevent new infections, improve care and treatment, 
and ultimately eliminate viral hepatitis as a public health 
threat.
    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.
    Zoonotic and Vector-Borne Disease Prevention, Early 
Detection, and Warning System Strategy.--The Committee directs 
the Secretary or his designee to work with the One Health 
Network to establish a 5-year strategy and framework for 
contributing to the building and implementation of the Zoonotic 
and Vector-Borne Disease Prevention, Early Detection, and 
Warning System (System), and to report on the status of such 
effort within 120 days of enactment of this Act. The strategy 
should identify the knowledge and information needs that the 
System will meet; key indicators (including indicators that 
span human, animal, and ecological determinants of spillover); 
existing domestic and international data sources (including 
basic data sources such as wastewater monitoring); knowledge 
and data gaps; plans for harnessing and strengthening existing 
domestic and international data sources; plans for building and 
strengthening new domestic and international data sources, 
triangulating data, plans for making the System and its data 
and analyses widely available and easily accessible to policy 
and programming decision makers and the general public; plans 
for strengthening the capacity of intergovernmental, nonprofit 
and other institutions to collect, analyze, and use relevant 
data and the overall system, especially in low- and middle-
income countries; plans for harnessing and contributing to 
global private and public activities and partnerships; and 
plans for communicating findings, especially when a spillover 
event is imminent or detected. The Committee recognizes that 
some countries are not accessible or open to data collection, 
and therefore encourages partnerships with other organizations, 
including intergovernmental organizations, to support data 
collection and collaboration.

Office of the Assistant Secretary for Health

    Commissioned Corps of the U.S. Public Health Service 
(USPHS).--The Committee urges the Department to ensure that the 
Commissioned Corps' policies on the inclusion of employees with 
chronic hepatitis B are consistent with up-to-date medical 
knowledge and that the USPHS adopt comprehensive, evidence-
based HBV policies consistent with CDC recommendations for 
current and incoming personnel.
    Dietary Guidelines for Americans.--The Committee recognizes 
the importance of communicating the new 2020-2025 Dietary 
Guidelines for Americans to health care providers in order to 
achieve the intended population impact, particularly given the 
introduction of new nutrition recommendations for children from 
birth through 24 months and pregnant and lactating women. The 
Committee encourages the Department to develop materials for a 
comprehensive public education campaign aimed at educating 
health care professionals on how to talk with their patients 
about aligning their dietary choices with the Dietary 
Guidelines. The campaign should be informed by scientific 
research on health behavior change, as well as input from key 
stakeholder groups, including nutrition assistance program 
participants and administrators, health care providers, 
community leaders, and health and nutrition advocates. The 
campaign should incorporate educational materials representing 
wide diversity of cultural food preferences and should be 
available in languages that meet the needs of populations at 
risk for diet-related disease. The Office of Disease Prevention 
and Health Promotion should work in collaboration with the USDA 
Center for Nutrition Policy and Promotion to develop this 
campaign.
    Health and Housing Initiatives.--The Committee is aware of 
promising initiatives developed by non-profit community groups 
in collaboration with local health systems and housing 
authorities that are targeted at homeless and precariously 
housed individuals who are high utilizers of medical care 
provided at hospital emergency departments. These programs work 
across different areas of core competency to provide safe, 
affordable housing together with ancillary medical, behavioral, 
substance use disorder, nutritional and employment or job 
training services. Participants demonstrate significant 
improvements in their health, sustainable incomes, and reduced 
use of emergency department and other expensive medical 
services. The Committee encourages the Department to support 
these types of initiatives through research, innovation models, 
health workforce and homeless programs, and other appropriate 
initiatives.
    National Strategy for Herpes Simplex Virus (HSV), Types 1 
and 2.--The Committee recognizes that an estimated 1 in 3 
Americans has Herpes, and that most Americans with HSV do not 
have symptoms and do not realize they have it. In light of the 
national prioritization of ending the HIV/AIDS epidemic, 
maternal health, neonatal health, and the all-time high of 
STIs, the Committee urges the Assistant Secretary for Health to 
develop a national strategy and strategic plan for the 
treatment and prevention of HSV types 1 and 2.
    Public Health Service Corps Eligibility Requirements.--The 
Committee is concerned that the Office of the Surgeon General 
has not complied with language in the Joint Explanatory 
Statement for P.L. 116-260 which encouraged the Secretary to 
update accreditation and eligibility requirements for the 
Public Health Service Corps to allow access to the best 
qualified applicants, including those who graduate from 
Psychological Clinical Science Accreditation System programs. 
The Committee urges the Department to make the necessary 
changes to its eligibility requirements.
    Teen Pregnancy Prevention.--The Committee strongly supports 
the Teen Pregnancy Prevention (TPP) Program and provides 
$130,000,000, an increase of $29,000,000 over 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 Assistant Secretary for 
Planning and Evaluation to reactivate the TPP Evidence Review. 
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 $75,835,000 for the Office of 
Minority Health (OMH), which is $14,000,000 above the fiscal 
year 2021 enacted level and the fiscal year 2022 budget 
request. 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 $3,000,000, an increase of $1,000,000 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.
    Public Health Pilot Program to Address Structural Racism in 
Public Health.--The Committee strongly supports OMH grant 
programs that support public and non-profit entities, including 
community-based organizations, to build and strengthen 
coalitions focused on addressing structural racism in public 
health. The Committee directs the OMH to establish a pilot 
program to advance these goals and includes $10,000,000 to fund 
20 eligible applicants. The OMH Director shall submit a report 
to the Committee, not later than 180 days of enactment of this 
Act, on the progress of this pilot program.
    The Committee is concerned that current grants to advance 
health equity and reduce disparities are not as targeted as 
necessary to address structural racism in public health and 
promote policies and practices that counter the disparate 
impact on the health and well-being of communities of color. 
Therefore, the Committee directs the Secretary to submit a 
report, not later than 90 days after enactment of this Act, 
providing details on entities awarded funding in prior fiscal 
years for efforts that address structural racism in public 
health, selection criteria used, and the funding amount for 
each grant or contract. In addition, the report shall detail 
steps the OMH plans to take to ensure grant funding is awarded 
to public and non-profit entities, including community-based 
organizations, that demonstrate the ability to implement 
innovative models to address structural racism.
    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 Committee requests a briefing on this 
initiative within 180 days of enactment of this Act.
    Physician Shortage Report.--The Committee directs the 
Advisory Committee on Minority Health to issue a report 
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. 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.
    Vaccine and Testing Equity Study.--The Committee recognizes 
that Hispanic and immigrant communities face unique barriers 
regarding COVID-19 vaccination and testing, including a lack of 
reliable information in their languages, misinformation, and 
fear of deportations. The Committee requests a study by the 
Advisory Committee on Minority Health, within 120 days of 
enactment of this Act, on further steps and recommendations 
that can help HHS address vaccine and testing equity in 
Hispanic and immigrant communities during the COVID-19 
pandemic.

Office on Women's Health

    The Committee includes $42,140,000 for the Office on 
Women's Health (OWH), which is $7,000,000 above the fiscal year 
2021 enacted level and the fiscal year 2022 budget request.
    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. In addition, the Committee continues to recommend OWH 
create a State-level pilot program to incentivize substance use 
disorder treatment providers to be trained on intimate partner 
violence.
    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 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.

                     MEDICARE HEARINGS AND APPEALS

 
 
 
Appropriation, fiscal year 2021.......................      $191,881,000
Budget request, fiscal year 2022......................       196,000,000
Committee Recommendation..............................       196,000,000
    Change from enacted level.........................         4,119,000
    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.
    Bond Hearings and Placement Reviews.--The Committee 
believes it is incumbent upon HHS to ensure that children's 
rights to placement in the least restrictive setting are 
protected, and strongly supports the right of an unaccompanied 
child (UC) to challenge their placement in restrictive settings 
in front of the HHS Departmental Appeals Board (DAB) with 
representation of legal counsel, and with an ORR-appointed 
child advocate. The Committee expects that the HHS DAB will 
ensure that the Administrative Law Judges (ALJs) for UC 
hearings will operate separate and apart from all ORR staff who 
take part in, review, or adjudicate placement of unaccompanied 
children and that they will have training and expertise on the 
Flores Settlement Agreement, the Trafficking Victim Protection 
Reauthorization Act, and the particular vulnerabilities of 
unaccompanied children.

             OFFICE OF THE NATIONAL COORDINATOR FOR HEALTH

                         INFORMATION TECHNOLOGY

 
 
 
Appropriation, fiscal year 2021.......................       $62,367,000
Budget request, fiscal year 2022......................        86,614,000
Committee Recommendation..............................        86,614,000
    Change from enacted level.........................       +24,247,000
    Change from budget request........................             - - -
 

    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.
    Accessibility of Online Telehealth Platforms.--The 
Committee recognizes that the COVID-19 pandemic led to the 
increased use of online portals and web services for patients 
seeking information, scheduling, and accessing remote services. 
However, the Committee is concerned that many online platforms 
are not user-friendly, especially for less digitally literate 
communities, including seniors. The Committee urges the 
Secretary, working through ONC, to coordinate with the Agency 
for Healthcare Research & Quality (AHRQ), the Centers for 
Medicare & Medicaid Services (CMS), and Office for Civil Rights 
(OCR) on any Federal efforts that can be made to evaluate the 
accessibility of digital health platforms for Federally-
supported providers, including any assessments of how seniors 
and persons with disabilities are included in the design and 
testing of the platforms. Further, the Committee directs the 
Secretary, working through ONC, AHRQ, CMS, and OCR, to 
establish best practices for healthcare providers to improve 
their online telehealth platforms for seniors, individuals with 
disabilities, and individuals with limited English proficiency.
    Public Health Data Utility.--The Committee notes the COVID-
19 pandemic has exposed serious gaps in our health care system 
and the challenges of responding to major public health 
threats. Real-time data is essential for responding to a 
pandemic and for improving public health outcomes broadly. The 
Committee acknowledges some States have advanced capacities to 
collect and share real-time data and effectively respond to 
public health threats through their Health Information Exchange 
(HIE). These States can lead the way by maximizing current 
capabilities and sharing across the Nation. The Committee 
encourages the Office of the National Coordinator, in 
coordination with the Assistant Secretary for Preparedness and 
Response, to coordinate with State-based health data utilities 
to better plan and prepare for a public health threat.
    Recording Vaping in Electronic Health Records.--The 
Committee understands that despite the prevalence of e-
cigarette use among youths and the potential risk of serious 
side effects, consensus on how to screen adolescents for e-
cigarette use is lacking. Providers may not ask about use of 
these devices, and electronic health records (EHRs) currently 
do not provide options for recording use of e-cigarettes, water 
pipes, and other types of smoking in consistent computable 
ways, potentially resulting in underreporting, and a dearth of 
data that can be used to understand long-term health outcomes. 
The Committee urges the Secretary, working through the Centers 
for Disease Control and Prevention, Food and Drug 
Administration, and ONC, to consider developing strategies to 
enhance accurate data collection and timely reporting of e-
cigarette use, including consideration of the role of EHRs, as 
aligned with applicable clinicalpractice guidelines.
    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 2021.......................       $80,000,000
Budget request, fiscal year 2022......................       100,000,000
Committee Recommendation..............................       100,000,000
    Change from enacted level.........................       +20,000,000
    Change from budget request........................             - - -
 

    The Committee recommends $100,000,000 for the Office of 
Inspector General (OIG), which is $20,000,000 above the fiscal 
year 2021 enacted level and equal to the fiscal year 2022 
budget request. The bill includes language making a portion of 
funding available for two years, as requested in the 
Congressional Budget Justification, for the investigation and 
enforcement of information blocking.
    In addition, within the Health Care Fraud and Abuse Control 
(HCFAC) program discretionary appropriations for fiscal year 
2022, the Committee provides the OIG with $109,145,000. 
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 2021.......................       $38,000,000
Budget request, fiscal year 2022......................        47,931,000
Committee Recommendation..............................        47,931,000
    Change from enacted level.........................        +9,133,000
    Change from budget request........................             - - -
 

    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.
    Disability Ombudsperson.--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 long-term services and support 
options and choices are made available.
    Rehabilitation Act.--The Committee directs the Secretary to 
fully enforce the Rehabilitation Act of 1973 and the Americans 
with Disabilities Act. The Committee requests a report within 
180 days of enactment of this Act on enforcement of section 504 
of the Rehabilitation Act. Where available, the Department 
shall disaggregate data by age.

     RETIREMENT PAY AND MEDICAL BENEFITS FOR COMMISSIONED OFFICERS

 
 
 
Appropriation, fiscal year 2021.......................      $653,023,000
Budget request, fiscal year 2022......................       656,504,000
Committee Recommendation..............................       656,504,000
    Change from enacted level.........................        +3,481,000
    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 2021.......................    $2,847,458,000
Budget request, fiscal year 2022......................     3,523,116,000
Committee Recommendation..............................     3,518,036,000
    Change from enacted level.........................      +670,578,000
    Change from budget request........................        -5,080,000
 

    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.
    In addition, the Coronavirus Response and Relief 
Supplemental Appropriations Act, 2021 (P.L. 116-260) provided 
$19,695,000,000 for the manufacturing and procurement of 
vaccines and therapeutics, as well as ancillary supplies 
necessary for the administration of vaccines and therapeutics. 
The American Rescue Plan (P.L. 117-2) provided $6,050,000,000 
for research, development, manufacturing, production, and the 
purchase of vaccines, therapeutics, and ancillary medical 
products and supplies to prevent, prepare, or respond to COVID-
19 or any disease with potential for creating a pandemic.

Office of the Assistant Secretary for Preparedness and Response

    The Committee provides $2,997,937,000 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.
    BARDA and BioShield Professional Judgement Budget.--The 
Committee directs ASPR to submit a report to the Committee in 
conjunction with the fiscal year 2023 Congressional Budget 
Justification detailing a professional judgement on the 
necessary budget and infrastructure requirements to fully 
operationalize these programs in fiscal year 2023. This report 
shall also include an assessment of current agency 
capabilities, as well as current and planned activities related 
to pandemic preparedness.
    Cold Chain Technologies.--The Committee recognizes the 
limitations that are presented by cold chain requirements for 
vaccine distribution and storage. The Committee directs the 
Secretary 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 on such efforts in the fiscal year 
2023 Congressional Budget Justification.
    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 encourages 
the further development of freeze-dried hemostatic products, 
especially platelet-derived products, to include a wide range 
of indications.
    Modeling and Simulation.--The Committee encourages ASPR to 
support the development and study of in silico approaches to 
accelerate vaccines for emerging infectious diseases including, 
but not limited to, computational simulation, data analytics, 
and the digital patient model, with the objective of reducing 
the time to market for virus vaccines.
    Pandemic Preparedness.--The Committee encourages efforts to 
partner with one or more academic health centers leading 
regional coordination efforts through the existing Regional 
Disaster Health Response System. The Committee encourages 
efforts to expand cooperative agreements for pilots to advance 
comprehensive regional preparedness built on real time data and 
convening of relevant stakeholders from local, State, and 
Federal governments, and civic and corporate leaders to improve 
pandemic preparedness and response. These pilots would allow 
for an integrated plan for preparedness and response including 
recommendations for table-top exercises to assure future 
systems are in place to respond to pandemics. In addition, the 
Committee encourages the consideration of improved airborne 
infectious disease monitoring capabilities.
    State Emergency Operations Centers.--The Committee urges 
ASPR, in coordination with other relevant agencies, to conduct 
a study to examine the differences in State emergency operation 
center responses to the COVID-19 pandemic to identify best 
practices to inform future public health emergency preparedness 
and response.

Operations

    The Committee includes $32,176,000, an increase of 
$1,238,000, 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.

Preparedness and Emergency Operations

    The Committee includes $25,640,000, an increase of 
$986,000, 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 $91,807,000, an increase of 
$28,403,000, 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 $5,000,000 for 
civilian trauma centers to train and incorporate military 
trauma care providers and teams into care centers.
    Pediatric Disaster Care.--The Committee includes $6,000,000 
for the continuation pediatric disaster care program.

Hospital Preparedness Program

    The Committee includes $319,777,000, an increase of 
$39,222,000, 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 $240,000,000, an increase of $8,500,000, for 
critical support to State, local and regional partners to 
advance health care system preparedness and response.
    Locally-based Health Response.--The Committee recognizes 
the lack of essential health services is often a significant 
impediment to economic development and prosperity for low-
income communities located in rural areas and regions of 
persistent poverty. Strategically placed and locally driven 
health response stations could help these communities overcome 
barriers. The Committee encourages ASPR to address health 
disparities in emergency health response.
    National Special Pathogen System.--The Committee recognizes 
that our national health care readiness capacity and 
capabilities were severely tested by the COVID-19 pandemic. The 
Committee commends ASPR for establishing the National Special 
Pathogen System of Care (NSPS), working with the National 
Emerging Special Pathogens Training and Education Center 
(NETEC) to set the NSPS strategy and implementation plan. To 
ensure coordination, the Committee directs NETEC to serve as 
the coordinating body. The Committee includes $8,000,000, an 
increase of $3,000,000, for the NETEC. In addition, given the 
knowledge and expertise generated over the course of the 
pandemic, now is an opportune time to expand the regional 
network to include additional centers with a proven track 
record in combatting emerging infectious diseases. To that end, 
the Committee includes $31,000,000, an increase of $25,000,000, 
to increase the number of Regional Ebola and Other Special 
Pathogen Treatment Centers (RESPTCs) to improve preparedness 
for future pandemic threats. The RESPTC expansion shall be a 
competitive process and health care entities applying to join 
the RESPTC system must demonstrate a commitment to health 
equity and delivery of health care services to diverse and 
under-served low-income populations; an emphasis on population 
health; the capacity to serve pediatric patients; and the 
ability to translate lessons observed and health systems 
research into actionable health care emergency response 
implementation plans. The Committee requests both a written 
report and a briefing, within 90 days of enactment of this Act, 
on progress in establishing a robust NSPS and integrating NSPS 
with other health care delivery systems of care for 
emergencies, such as the trauma system.

Biomedical Advanced Research and Development Authority

    The Committee includes $823,380,000, an increase of 
$226,680,000, for the Biomedical Advanced Research and 
Development Authority (BARDA). BARDA, through the Strategic 
Investor Program and other efforts, 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 has played 
an essential role in the response to COVID-19. The Committee 
encourages BARDA to expand its portfolio of partnerships for 
broader success.
    Active Pharmaceutical Ingredients.--The Committee is 
concerned with the national security risk of our increased 
reliance on foreign-based sources of active pharmaceutical 
ingredients, their chemical components, and off-shore drug 
production. The Committee recognizes the importance of domestic 
drug manufacturing and onshore production of medicine and 
provided supplemental emergency funding in pandemic relief 
legislation to support increased U.S.-based manufacturing 
capabilities. The successful work of BARDA in addressing public 
health vulnerabilities and securing a national stockpile of 
drugs has unique potential to consider program expansion to 
include at-risk drug ingredients. The Committee urges BARDA to 
engage in public-private partnerships for U.S.-based advanced 
manufacturing for active pharmaceutical ingredients including 
their chemical precursors for the Strategic National Stockpile. 
The Committee directs BARDA to provide a report within 180 days 
of enactment of this Act detailing their efforts to promote 
domestic drug manufacturing, including efforts during the 
COVID-19 public health emergency, and recommendations for 
Congress to support onshore pharmaceutical production.
    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.
    At-Home Rapid COVID Tests.--The Committee urges BARDA to 
continue efforts on Rapid Acceleration of Diagnostics (RADx) to 
continue innovation to make at-home rapid COVID tests 
accessible.
    Broad Spectrum Antimicrobials and CARB-X.--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. BARDA's Broad Spectrum 
Antimicrobials program is developing medical countermeasures 
that counter identified biothreats and address healthcare and 
community-acquired multi-drug resistant pathogens.These 
programs leverage public/private partnerships to develop 
products that directly support the government wide National 
Action Plan for Combating Antibiotic Resistant Bacteria and 
have a proven track record in developing new FDA approved 
antibiotics.
    Ebola.--The Committee recognizes BARDA's efforts to address 
the threat of Ebola with an active portfolio of therapeutics, 
diagnostics, and vaccines.
    Pathogen-Reduced Red Blood Cell Technology.--The Committee 
recognizes BARDA's investments for clinical trial development 
of nucleic acid targeted pathogen reduction technology to 
improve red blood cell transfusion safety. Such investments 
will ensure protection for blood products in the nation's blood 
supply. The Committee requests an update of these activities in 
the fiscal year 2023 Congressional Budget Justification.
    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. The COVID-19 pandemic 
demonstrated the weaknesses in the U.S. supply chain and the 
dependence of the U.S. healthcare system on other countries. 
The Committee remains concerned that there could be shortages 
of products and components, including elastomeric components. 
The Committee is also concerned about the emergence of 
counterfeit personal protective equipment products. This is a 
safety and public health risk. The Committee recognizes the 
importance of domestic manufacturing and raw materials, 
supported by $10,000,000,000 in the American Rescue Plan (P.L. 
117-2) for the Defense Production Act, and urges HHS to 
undertake efforts to ensure a long-term sustainable domestic 
supply chain for medical products.
    Use of Funds.--The Committee awaits the results of the HHS 
internal review of the use of advanced research and development 
funding, and the external audit of the use of ASPR funds for 
administrative services. The Committee requests a briefing on 
the findings, recommendations, and corrective action plan no 
later than 30 days after enactment of this Act.

Policy and Planning

    The Committee includes $19,917,000, an increase of 
$5,040,000, 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 $770,000,000 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 $905,000,000, an increase of 
$200,000,000, for the Strategic National Stockpile (SNS). In 
addition, the CARES Act (P.L. 116-136) included up to 
$16,000,000,000 and the Coronavirus Response and Relief 
Supplemental Appropriations Act, 2021 (P.L. 116-260) included 
$3,250,000,000 for the 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.
    COVID-19 Variant Therapeutics.--The Committee recognizes 
that COVID-19 variants present a public health challenge even 
as more Americans become vaccinated. The Committee encourages 
the SNS to have a sufficient stockpile of monoclonal antibody 
therapeutics for the treatment of COVID-19 emerging variants, 
and strongly encourages the acquisition of therapeutics that 
will provide effective treatment for the broadest possible 
range of new variants.
    Influenza Antivirals.--The Committee remains concerned 
about the perennial threat of pandemic influenza. In addition 
to vaccines, antivirals are a critical medical countermeasure. 
Currently, the SNS includes only one type of influenza 
antiviral. The Committee urges ASPR to review this strategy.
    Re-Envisioning the Strategic National Stockpile.--The 
Committee is concerned about the mission and operations of the 
SNS. Early in the pandemic, there was extensive confusion about 
the role of the SNS, the content of the SNS inventory, and 
policies and processes for distribution of SNS inventory. The 
U.S. must maintain transparent, elastic, and highly available 
health assets, medical countermeasures framework and associated 
supply chains to effectively plan and respond as needed. The 
Committee is aware of current review efforts being conducted by 
the HHS Office of Inspector General, Government Accountability 
Office, and non-governmental entities. To benefit from these 
external reviews and to improve efforts, the Committee directs 
the Secretary to engage in a re-envisioning process considering 
a variety of topics including real-time inventory transparency; 
data and analytics to enhance evidenced-based policy decisions 
and risk mitigation strategies; elasticity to readily scale 
responses; modeling and simulation to plan and exercise; supply 
chain risk management, including the identification and 
mitigation of over-reliance on foreign sources of critical 
supplies; and revolving management of inventory. The Committee 
requests a report and briefing on these efforts, including a 
timeline of key activities and an update on activities required 
by Executive Order 14001 within 60 days of enactment of this 
Act.
    Saline.--The Committee encourages the review of the 
stockpile quantity of normal IV saline and related medical 
supplies, and to include an update in the fiscal year 2023 
Congressional Budget Justification.
    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, an increase of $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 
$2,000,000, for a bilateral cooperative program with the 
Government of Israel for the development of health 
technologies.

Cybersecurity

    The Committee provides $159,116,000, an increase of 
$101,296,000, for information technology cybersecurity in the 
Office of the Chief Information Officer and HHS-wide to 
strengthen the Department's cybersecurity posture. The 
Committee does not include funding to continue HHS Protect, as 
capabilities shall no longer be duplicated at the Departmental 
level or shall be delegated to the appropriate operating 
division.

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 $17,000,000 for preparedness and 
readiness.
    Interagency COVID-19 Testing Strategy.--The Committee 
provided significant investments for COVID-19 testing in 
multiple supplemental appropriations bills, including the 
American Rescue Plan (P.L. 117-2), and understands a robust 
COVID-19 testing strategy is necessary for sustained normalcy 
and to prevent and respond to future outbreaks. Therefore, the 
Committee urges HHS to develop an interagency testing strategy. 
Recognizing the importance of partnerships and coordination 
across agencies, and the vital accomplishments of the Testing 
and Diagnostics Working Group, including the Industry 
Engagement and Industrial Base Expansion teams, coordination 
across HHS and with other departments is necessary to ensure 
corresponding comprehensive guidance.
    Readiness and Training Programs.--The Committee requests an 
assessment of HHS deployable personnel, including but not 
limited to Public Health Service Commission Corps Officers and 
National Disaster Medical System intermittent personnel. The 
assessment should include the coordination of established 
forces and identification of remaining gaps. The report is to 
be submitted with the fiscal year 2023 Congressional Budget 
Justification.

Pandemic Influenza Preparedness

    The Committee includes $335,000,000, an increase of 
$48,000,000, 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.

                           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 
enacted level for 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 $3,500,000 per project with a total limit for NIH of 
$45,000,000.

                          (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 2020 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 2022, 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 2022 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                9,500,000
                                   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              14,000,000
                                   Program.
CDC.............................  Preventive Health          160,000,000
                                   and Health
                                   Services Block
                                   Grant.
CDC.............................  Tobacco............        117,100,000
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.
------------------------------------------------------------------------

    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 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 alien 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 alien children.
    Sec. 232. The Committee continues a provision requiring 
monthly reporting on unaccompanied alien 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 alien 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 alien 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 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.
    Sec. 237. The Committee modifies a provision related to the 
Nonrecurring Expenses Fund.
    Sec. 238. The Committee includes a new provision 
authorizing the use of funds for a Separated Families Services 
Fund, for children, parents, and legal guardians who were 
separated at the United States-Mexico border in connection with 
the Zero-Tolerance Policy.
    Sec. 239. The Committee includes a new provision related to 
facilities at CDC.
    Sec. 240. The Committee includes a new provision related to 
premium pay authority.
    Sec. 241. 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. 242. The Committee includes a new provision related to 
reimbursable agreements.
    Sec. 243. The Committee includes a new provision 
prohibiting funds from being used to award a contract for the 
CMS Medicare Contact Center Operations with a total period of 
performance that exceeds 24 months.
    Sec. 244. The Committee includes a new provision related to 
notification requirements in the Social Security Act.
    Sec. 245. The Committee includes a new provision to 
continue NIH transfer authority.
    Sec. 246. The Committee includes a new provision to 
increase flexibility for grantees of the Ryan White HIV/AIDS 
program.
    Sec. 247. The Committee includes a new provision requiring 
institutions that receive NIH grants to notify NIH if personnel 
funded by the grant are disciplined due to concerns about 
harassment.
    Sec. 248. The Committee includes a new provision extending 
the availability of multi-year grant funding for research 
projects that were delayed due to COVID-19.

                   TITLE III--DEPARTMENT OF EDUCATION


                    EDUCATION FOR THE DISADVANTAGED

 
 
 
Appropriation, fiscal year 2021.......................   $17,226,790,000
Budget request, fiscal year 2022......................    37,246,790,000
Committee Recommendation..............................    36,756,790,000
    Change from enacted level.........................   +19,530,000,000
    Change from budget request........................      -490,000,000
 

    This account provides foundational funding to help ensure 
all children receive a fair, equitable and high-quality 
education.
    Of the total amount available, $25,813,490,000 is 
appropriated for fiscal year 2022 for obligation on or after 
July 1, 2023 and $10,841,177,000 is appropriated for fiscal 
year 2022 for obligation on or after October 1, 2023.

Grants to Local Educational Agencies

    For fiscal year 2022, the Committee recommends 
$36,036,802,000 for Title I grants to LEAs, an increase of 
$19,500,000,000 over the fiscal year 2021 enacted level and 
$500,000,000 below the fiscal year 2022 budget request. 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 Local 
Educational Agencies (LEAs or school districts), which is the 
same as the fiscal year 2021 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, 2021, 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 2021 
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 $14,107,550,000 for Title I 
Targeted Grants, which is $9,750,000,000 above the fiscal year 
2021 enacted level. Targeted Grants provide higher payments to 
school districts with high numbers or percentages of low-income 
students.
    The Committee recommends $14,107,550,000 for Title I 
Education Finance Incentive Grants (EFIGs) which is 
$9,750,000,000 above the fiscal year 2021 enacted level. EFIGs 
provide payments to States and school districts that 
incorporate equity and effort factors to improve the equity of 
State funding systems.
    Equity.--The Committee is supportive of the fiscal year 
2022 budget request's goals of improving educator compensation, 
expanding access to high-quality pre-K, and improving the 
equity and adequacy of State and local school finance systems. 
In addition, the Committee strongly supports the Department's 
efforts to close funding gaps between high- and low-poverty 
school districts and schools. The Committee agrees there is 
merit in exploring how State and local funding structures 
impact school resource equity, which approaches have most 
effectively decreased inequities, and what reforms could help 
further address longstanding equity and opportunity gaps 
experienced by students from low-income backgrounds and 
students of color in high-poverty districts and schools. The 
Committee therefore encourages the Department to continue its 
efforts in this area and to develop further recommendations, 
including recommendations on effective methods for promoting a 
more equitable distribution of State and local funds.
    Reservation for Homeless Students.--The Committee urges 
that the Department support LEAs' development of plans under 
section 1112(b)(6) of the Elementary and Secondary Education 
Act (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 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.
    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.
    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 is 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 directs 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.
    Comprehensive and Targeted Support and Improvement.--The 
Committee notes that an increase in Title I funding overall 
also increases aid for the Section 1003 Title I set-aside which 
provides funding for schools identified for comprehensive and 
targeted support and improvement. The Committee notes that 
funds under Section 1003 can be used to support socioeconomic 
and racial integration in schools as an evidence-based strategy 
to improve schools identified for improvement under ESEA. The 
Committee encourages the Department to provide technical 
assistance to school districts on how Section 1003 funds can be 
used to make progress on these critical goals.
    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 undeserved students, the 
Committee encourages the Department to resume collecting data 
on passing rates for all Advanced Placement subject areas.

Comprehensive Literacy Development Grants

    The Committee recommends $192,000,000 for Comprehensive 
Literacy Development Grants, which is the same as the fiscal 
year 2021 enacted level and the 2022 budget request. 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 $3,000,000 above the 
fiscal year 2021 enacted level and the fiscal year 2022 
request. 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 the fiscal year 2022 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 $382,626,000 for the State Agency 
Program for Migrant Education, which is $7,000,000 above the 
fiscal year 2021 enacted level and the fiscal year 2022 
request. 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 2021 enacted level and the fiscal year 2022 
request. 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.

Special Programs for Migrant Students

    The Committee recommends $66,123,000 for the Special 
Programs for Migrant Students, which is $20,000,000 above the 
fiscal year 2021 enacted level and the same as the fiscal year 
2022 budget request. 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 2021.......................    $1,501,112,000
Budget request, fiscal year 2022......................     1,541,112,000
Committee Recommendation..............................     1,552,112,000
    Change from enacted level.........................       +51,000,000
    Change from budget request........................       +11,000,000
 

    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 $1,404,242,000 for Basic Support 
Payments to LEAs, which is $50,000,000 above the fiscal year 
2021 enacted level and $10,000,000 above the fiscal year 2022 
budget request. 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 both the 
fiscal year 2021 enacted level and the fiscal year 2022 budget 
request. 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 both the fiscal year 2021 
enacted level and the fiscal year 2022 budget request. 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 both the fiscal year 2021 enacted 
level and the fiscal year 2022 budget request. 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 $77,313,000 for Payments for 
Federal Property, which is $1,000,000 above the fiscal year 
2021 enacted level and the fiscal year 2022 budget request. 
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 appreciates the Department's 
assessment of Impact Aid surveying flexibilities for the 2020-
2021 school year included in the fiscal year 2022 Congressional 
Budget Justification and requests that the Department assess 
the merits of such flexibilities in future years, along with 
other potential process modifications, in the fiscal year 2023 
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 2021.......................    $5,444,217,000
Budget request, fiscal year 2022......................     5,532,675,000
Committee Recommendation..............................     5,803,539,000
    Change from enacted level.........................      +359,322,000
    Change from budget request........................      +270,864,000
 

    The Committee recommendation includes $5,803,539,000 for 
the School Improvement Programs account.

Supporting Effective Instruction State Grants

    The Committee recommends $2,293,080,000 for Supporting 
Effective Instruction State Grants (Title II-A), which is 
$150,000,000 above the fiscal year 2021 enacted level and 
$144,500,000 above the fiscal year 2022 budget request. 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.
    Whole Child Professional Development.--The Committee notes 
that Title II, Part A funds can be targeted toward effective 
preparation and professional development designs that enable 
teachers and school leaders to expand their knowledge and 
skills regarding the sciences of child and adolescent learning 
and development, including teaching challenging content, 
teaching diverse learners, and supporting social-emotional and 
academic development in culturally and linguistically 
responsive ways.
    Materials from Teacher Professional Development.--Given the 
importance of funds under Title II, Part 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. But the funding streams for professional development 
and associated instructional materials are misaligned, 
particularly in science, technology, engineering, and math 
(STEM) fields, which can result in teachers participating in 
professional development programs that they are unable to share 
with their students. The Committee supports efforts by the 
Secretary to offer guidance on how an LEA may use Title II, 
Part A funds on instructional materials that are directly 
connected to teacher professional development training. In 
addition, the Committee notes the benefits of posting guidance 
online and communicating about guidance with outside 
stakeholders, particularly district superintendents.

Supplemental Education Grants

    The Committee recommends $23,021,000 for Supplemental 
Education Grants to the Federated States of Micronesia and the 
Republic of the Marshall Islands, which is $6,322,000 more than 
the fiscal year 2021 enacted level and $3,364,000 more than the 
fiscal year 2022 budget request. The Compact of Free 
Association Amendments Act of 2003 (P.L. 108-188) authorizes 
these entities to receive funding for general education 
assistance. The Committee provides sufficient funding to meet 
authorized funding levels established in P.L. 108-188.

Nita M. Lowey 21st Century Community Learning Centers

    The Committee recommends $1,359,673,000 for Nita M. Lowey 
21st Century Community Learning Centers, $100,000,000 more than 
the fiscal year 2021 enacted level and $50,000,000 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 $100,000,000 increase over fiscal year 2021 will help 
communities providing afterschool programs serve 120,000 more 
students than in fiscal year 2021.

State Assessments

    The Committee recommends $378,000,000 for State 
Assessments, which is the same as the fiscal year 2021 enacted 
level and the fiscal year 2022 budget request. 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 $116,500,000 for the Education for 
Homeless Children and Youth program, which is $10,000,000 more 
than the fiscal year 2021 enacted level and the fiscal year 
2022 budget request. 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 both the fiscal year 2021 enacted 
level and the fiscal year 2022 budget request. 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.
    Countering Anti-Semitism.--The Committee supports efforts 
by the Department to ensure the services available through EACs 
include training, developing materials, strategies, and 
professional development activities to assist schools and 
communities in preventing and countering anti-Semitic 
harassment.

Education for Native Hawaiians

    The Committee recommends $40,397,000 for the Education for 
Native Hawaiian program, which is $3,000,000 more than the 
fiscal year 2021 enacted level and the fiscal year 2022 budget 
request. Funds are used to provide competitive awards for 
supplemental education services to the Native Hawaiian 
population.

Alaska Native Education Equity

    The Committee recommends $36,453,000 for the Alaska Native 
Education Equity program, which is the same as the fiscal year 
2021 level and the fiscal year 2022 budget request. Funds are 
used to provide competitive awards for supplemental education 
services to the Alaska Native population.

Rural Education

    The Committee recommends $192,840,000 for Rural Education 
programs, which is $5,000,000 more than the fiscal year 2021 
enacted level and the same as the fiscal year 2022 budget 
request. 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 $52,000,000 for Comprehensive 
Centers, which is the same as the fiscal year 2021 enacted 
level and the fiscal year 2022 budget request. 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. The Committee notes the 
critical role Comprehensive Centers play in helping States vet 
evidence and strategies to implement ESEA and provide children 
with a high-quality education.

Student Support and Academic Enrichment State Grants

    The Committee recommends $1,305,000,000 for Student Support 
and Academic Enrichment (SSAE) State Grants, which is 
$85,000,000 above the fiscal year 2021 enacted level and the 
fiscal year 2022 budget request. 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 
encourages 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 supports 
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. The Committee 
directs the Secretary to provide technical assistance to LEAs 
and SEAs on effective strategies for offering information about 
free menstrual product programs, as an option for safe and 
healthy student programming under SSAE.
    Safe and Healthy Learning Environments.--The Committee 
continues to note that SEAs and LEAs can use SSAE funds for 
activities that contribute to a well-rounded education, 
including supports for safe, culturally responsive classroom 
communities. The Committee also notes that SSAE funds can 
support implementation of the effective community school model 
by using funds for designating a site resource coordinator at a 
school or LEA, expanding school-based mental health services, 
and providing integrated systems of student and family support. 
The Committee believes the use of funds on strategies that 
improve school climate are vital in reducing harmful, 
disproportionate suspensions, expulsions, and arrests of 
students of color.
    Computer Science and Art.--The Committee notes that States 
and school districts may use funds available under the SSAE 
grant program to strengthen instruction in science, technology, 
engineering, arts, and mathematics (STEAM) fields, including 
computer science, and improve access to Pre-K 12 computer 
science and STEAM programming for underserved students, such as 
minorities, girls, and youth from families living at or below 
the poverty line. The Committee recognizes that supporting 
education in the STEAM fields, particularly computer science, 
is critical to ensuring that our nation continues to lead in 
innovation. As computer science is a basic skill in the 21st 
century global economy, the Committee intends for investments 
in Title IV-A to reduce the computer science enrollment and 
achievement gaps.
    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.

                            INDIAN EDUCATION

 
 
 
Appropriation, fiscal year 2021.......................      $181,239,000
Budget request, fiscal year 2022......................       186,239,000
Committee Recommendation..............................       187,739,000
    Change from enacted level.........................        +6,500,000
    Change from budget request........................        +1,500,000
 

    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 $5,000,000 above the fiscal year 
2021 enacted level and same as the fiscal year 2022 budget 
request. 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 $67,993,000 for Special Programs 
for Indian Children, which is the same as the fiscal year 2021 
enacted level and the fiscal year 2022 budget request. 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.

National Activities

    The Committee recommends $9,365,000 for National 
Activities, which is $1,500,000 above the fiscal year 2021 
enacted level and the fiscal year 2022 budget request. The 
fiscal year 2022 increase to National Activities is directed to 
support the Department's Native American language immersion 
grant program and to the State-Tribal Education Partnership 
program.
    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.

                       INNOVATION AND IMPROVEMENT

 
 
 
Appropriation, fiscal year 2021.......................    $1,114,250,000
Budget request, fiscal year 2022......................     1,284,250,000
Committee Recommendation..............................     1,385,286,000
    Change from enacted level.........................      +271,036,000
    Change from budget request........................      +101,036,000
 

    The Committee recommends $1,385,286,000 for programs within 
the Innovation and Improvement account.

Education Innovation and Research

    The Committee recommends $254,000,000 for the Education 
Innovation and Research (EIR) program, which is $60,000,000 
above the fiscal year 2021 enacted level and the fiscal year 
2022 budget request. This program makes competitive grants to 
support the replication and scaling-up of evidence-based 
education innovations.
    Social and Emotional Learning.--Within the total for EIR, 
the agreement includes $112,000,000, $45 million above the 
fiscal year 2021 enacted level, to provide grants for social 
and emotional learning (SEL) interventions and provide 
evidence-based, field-initiated innovations that address 
student social, emotional, and cognitive needs. A 2019 National 
Commission on Social, Emotional and Academic Development report 
chronicles decades of research showing ``that the social, 
emotional, and cognitive dimensions of learning are deeply 
linked'' and that educating the whole student involves 
integrating and sustaining these dimensions throughout the day. 
In addition, the Collaborative for Academic, Social, and 
Emotional Learning found that students who received SEL 
interventions showed lasting positive impacts on variables such 
as high school graduation rates and college attendance and 
lower likelihoods of being arrested or being diagnosed with a 
clinical mental health disorder. Further, RAND Corporation 
finds that there are at least 60 SEL interventions that have 
been evaluated and that meet the Every Student Succeeds Act 
(ESSA) evidence requirements.
    The Committee is encouraged by the robust, growing evidence 
base behind SEL strategies, trauma-informed services, and whole 
child approaches to learning, and makes funding for these 
interventions a top priority. Children across the country have 
been significantly impacted by disruptions related to COVID-19. 
The increase to EIR in fiscal year 2022 for SEL is intended to 
address these concerns and provide additional support for the 
SEL initiative, which can include trauma-informed practices and 
services within schools.
    To fulfill the SEL set-aside, the Committee urges 
prioritization of SEL or 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 
to the Committees at least seven days before grantees are 
announced.
    STEAM and Computer Science.--In addition, within the total 
for EIR, the Committee recommendation includes $82,000,000 for 
States, school districts, and school-based afterschool programs 
to provide or strengthen instruction in STEAM fields, including 
computer science, $15 million above the fiscal year 2021 
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.
    Publicizing Research Findings.--Given the significant 
Federal investment in the EIR program (and its predecessor 
program, Investing in Innovation), the Committee encourages the 
Department to take stronger steps to publicly release and 
widely publicize the research findings from this critical 
program. More specifically, the Department is encouraged to 
post research findings on its own website and issue related 
press releases and Dear Colleague letters. The Department is 
also encouraged to provide summaries of the research findings 
to the Committees on Appropriations. The Committee encourages 
the Secretary to better showcase those programs that have 
demonstrated, through rigorous research as required by the 
ESEA, that their innovations show specific evidence of 
achievement in educational outcomes. The Department is also 
encouraged to communicate any research findings that 
demonstrate successful outcomes to outside stakeholders, 
particularly chief State school officers and district 
superintendents. The Committee believes that publicizing these 
research findings will provide critical information for State 
governments, State and local education agencies, and others, 
particularly in unserved and underserved communities.
    Educator Preparation.--Within EIR, the Committee is 
supportive of efforts to provide grants to eligible 
institutions that will seek to reform educator preparation at 
institutions of higher education for preservice teachers and 
leaders or to reform professional development for current 
educators by applying research about student learning and 
development to their preparation and professional development. 
The Committee is supportive of efforts for grantees to develop 
partnerships between state education agencies, the Bureau of 
Indian Education or high-need local education agencies and 
institutions of higher education with educator preparation 
programs.

Teacher and School Leader Incentive Grants

    The Committee recommends $200,000,000 for the Teacher and 
School Leader Incentive Grants program, which is the same as 
the fiscal year 2021 enacted level and the fiscal year 2022 
budget request. 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 $6,500,000 for American History 
and Civics Academies, which is $3,250,000 more than the fiscal 
year 2021 enacted level and the fiscal year 2022 budget 
request.

American History and Civics National Activities

    The Committee recommends $4,000,000 for American History 
and Civics National Activities, which is $2,000,000 more than 
the fiscal year 2021 enacted level and the fiscal year 2022 
budget request.
    Diverse Representations in History.--The Committee 
recognizes the importance of incorporating diverse stories of 
American history and leaders that have been absent in history 
and civics education. Accurate portrayals of history that 
include diverse representation are essential for combating 
stereotypes and myths about racial and ethnic groups. 
Therefore, the Committee encourages the Department to promote 
diversity in the teaching of American history and civics 
programs.

Supporting Effective Educator Development

    The Committee recommends $90,000,000 for the Supporting 
Effective Educator Development (SEED) grant program, which is 
$10,000,000 more than the fiscal year 2021 level and the fiscal 
year 2022 budget request. 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.--Within SEED, the Department 
is directed to support professional development that helps 
educators incorporate SEL practices into teaching, and to 
support pathways into teaching that provide a strong foundation 
in child development and learning, including skills for 
implementing SEL strategies in the classroom. The Committee is 
supportive of the Department's competitive preference priority 
for SEL in the fiscal year 2020 SEED competition and directs 
the Department to include a similar competitive preference 
priority in any new SEED competition in fiscal year 2022.
    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 to the Committees at least 
seven days before grantees are announced.
    Diverse Entities.--The Committee encourages the Department 
to ensure that SEED grants are awarded to a diverse set of 
eligible entities, including national nonprofit organizations 
implementing evidence-based activities (as defined in section 
8101(21)(A)(i) of the ESEA) across a number of sites which can 
help bring to scale evidence-based programs of national 
significance across the country.
    Computer Science and Native Students.--The Committee 
encourages the Department, through the SEED program, to fund 
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 2021 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 Committee is concerned by a 
recent report that identified more than 440 charter schools 
operated by for-profit entities that received CSP grants 
totaling approximately $158 million between 2006 and 2017. The 
Committee believes that Federal funding for K-12 education 
should strengthen and improve our public systems and should not 
enrich private entities with a profit motive. In response, the 
Committee includes new bill language preventing Federal funds 
from being awarded to charter schools run by for-profit 
entities.
    GAO Mandate from House Report 116-450.--The Committee is 
supportive of GAO's initial 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 supports 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.
    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.
    National Activities.--The Committee recognizes that one 
purpose of CSP is to evaluate the impact of charter schools on 
student achievement, families, and communities, and share best 
practices between charter schools and other public schools. The 
Committee encourages the Department to use funding within CSP 
National Activities to prepare a report summarizing grant 
recipients responses to reporting requirements in ESEA, 
regarding the identification or sharing of best practices 
between charter schools and other public schools, and the 
extent to which such practices were adopted and implemented by 
other public schools. The Committee encourages the Department 
to examine these responses in light of the student populations 
served.
    Students with Disabilities.--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.

Magnet Schools Assistance

    The Committee recommends $149,000,000 for the Magnet 
Schools Assistance program (MSAP), which is $40,000,000 more 
than the fiscal year 2021 enacted level and the same as the 
fiscal year 2021 budget request. 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 
directs the Department to include a priority for applicants 
seeking to establish new inter-district magnet schools.
    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 $31,776,000 for Ready to Learn 
Programming, which is $2,276,000 more than the fiscal year 2021 
enacted level and the fiscal year 2022 budget request. 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 $33,000,000 for Arts in Education, 
which is $2,500,000 more than the fiscal year 2021 level and 
the fiscal year 2022 budget request. 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 $15,500,000 for the Javits Gifted 
and Talented Education Program, which is $2,000,000 more than 
the fiscal year 2021 enacted level and the fiscal year 2022 
budget request. 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 $13,500,000 for the Statewide 
Family Engagement Centers program, which is $1,000,000 more 
than the fiscal year 2021 enacted level and the fiscal year 
2022 budget request. 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 same as the 
fiscal year 2022 budget request. 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, 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.

Fund for the Improvement of Education

    The Committee includes $88,010,000 for early learning, 
elementary, and secondary education activities. The bill 
includes funding for the following projects in the following 
amounts:

------------------------------------------------------------------------
                       Project                               Amount
------------------------------------------------------------------------
Achievable Dream, Newport News, VA for extended                 $900,000
 learning and whole child supports...................
Albright College, Reading, PA for STEAM learning.....          1,450,000
Aliento Education Fund, Mesa, AZ for student support             300,000
 and college access programs.........................
An Achievable Dream Certified Academy at Highland              1,500,000
 Springs Elementary, Highland Springs, VA for student
 wrap-around services and supports...................
Arab Community Center for Economic & Social Services,          1,000,000
 Dearborn, MI for integrated services, literacy
 education, and social and emotional learning........
Austin People's Action Center, Chicago, IL for                   450,000
 technology skills instruction.......................
Bayshore Jointure Commission, Tinton Falls, NJ for a              60,000
 life skills and training program....................
Best Buddies International, Friday Harbor, WA for                 75,000
 services for students with intellectual and
 developmental disabilities..........................
Best Buddies International, Las Vegas, NV for                    125,000
 inclusion programs supporting students with
 intellectual and developmental disabilities.........
Best Buddies, Spokane, WA for a mentor program.......             55,000
Big Brothers, Big Sisters, Santa Fe, NM for mentoring            225,000
 services and social programs........................
Boys & Girls Club of Burbank and Greater East Valley,            250,000
 Burbank, CA for education technology................
Boys & Girls Club of San Fernando Valley, Pacoima, CA            450,000
 for STEM and SEL programs...........................
Boys & Girls Clubs of Dundee Township,                           250,000
 Carpentersville, IL for an academic and SEL support
 program.............................................
Boys & Girls Clubs of Greater Anaheim-Cypress,                 1,000,000
 Cypress, CA for academic support and youth
 engagement..........................................
Boys & Girls Clubs of the Los Angeles Harbor, San                500,000
 Pedro, CA for the Wilmington College Bound Program..
Boys & Girls Club of Palm Beach County, West Palm                525,000
 Beach, FL for its College and Work Readiness STEM
 program.............................................
Boys & Girls Clubs of Rochester, NY for a                        100,000
 comprehensive afterschool and summer program........
Bright Leadership Institute, Chicago, IL for youth               500,000
 mentoring and enrichment activities.................
Broward County Public Schools, Ft. Lauderdale, FL for            500,000
 a peer mentoring program............................
California State University, Long Beach, CA for                  500,000
 teacher development and student academic support....
CDF Action, Clarkston, GA for the READY School                   325,000
 initiative..........................................
Chicago Public Schools, Chicago, IL for arts and STEM            500,000
 education...........................................
Chicago Public Schools, Chicago, IL for arts and STEM            500,000
 education...........................................
Chicago Public Schools, Chicago, IL for arts and STEM            500,000
 education...........................................
Chicago Public Schools, Chicago, IL for arts and STEM            500,000
 education...........................................
Chicago Public Schools, Chicago, IL for arts and STEM            500,000
 education...........................................
Chicago Zoological Society, Chicago, IL for the King             825,000
 Conservation Leadership Academy.....................
Children's Museum, Oak Lawn, IL for the Wee Ones                  50,000
 program.............................................
City of Commerce, CA for a homework help and online              300,000
 learning initiative.................................
City of Long Beach, CA for early childhood education             250,000
 and literacy programs at the Michelle Obama Library.
City of Long Beach, NY for early childhood learning..            400,000
City of Rancho Cordova, CA for the Rancho Cordova                350,000
 Youth Center........................................
Clark County School District, Las Vegas, NV for                  950,000
 school social workers...............................
Common Threads, Chicago, IL for food nutrition                    65,000
 education programs..................................
Common Threads, Staten Island, NY for culinary and                50,000
 nutrition education.................................
Commonwealth of the Northern Mariana Islands Public              350,000
 School System, Saipan, MP for indigenous language
 immersion...........................................
Commonwealth of the Northern Mariana Islands Public              150,000
 School System, Saipan, MP for school library
 expansion...........................................
Commonwealth of the Northern Mariana Islands Public              150,000
 School System, Saipan, MP for student health and
 well-being..........................................
Communities in Schools of San Antonio, TX for                    500,000
 wraparound services and whole-child supports........
Community Bridges, Silver Spring, MD for academic                 80,000
 enrichment and wrap-around services.................
Contra Costa County Office of Education, Pleasant                900,000
 Hill, CA for internet connectivity..................
dA Center for the Arts, Pomona, CA for early learning            125,000
 and arts education..................................
DeKalb County Regional Office of Education, Dekalb,              150,000
 IL for kindergarten readiness.......................
Desert Research Institute, Las Vegas, NV for STEM                975,000
 education...........................................
Dr. Phillips Center for the Performing Arts, Orlando,            250,000
 FL for arts education...............................
DuPage Regional Office of Education, Wheaton, IL for             250,000
 high school work-based learning.....................
Early Learning Coalition of Palm Beach County,                   125,000
 Boynton Beach, FL for an early learning program.....
East Bay Performing Arts, Oakland, CA for music                  500,000
 education...........................................
Eastern Michigan University, Ypsilanti, MI for early             300,000
 childhood educational services......................
Eastern Queens Alliance, Springfield Gardens, NY for             350,000
 environmental education.............................
Edward M. Kennedy Institute for the United States              1,000,000
 Senate, Boston, MA for civics education.............
El Puente de Williamsburg, Brooklyn, NY for                      500,000
 environmental studies programming...................
ESP Education & Leadership Institute, Long Beach, CA              50,000
 for STEM education and college access...............
Evanston/Skokie District 65, Evanston, IL for a                  600,000
 teacher residency program...........................
Finishing Trades Institute of the Upper Midwest,               2,000,000
 Little Canada, MN for apprenticeship pathways for
 middle and high school students.....................
Forsyth County School District, Cumming, GA for the              750,000
 Spark! Igniting Learning, Birth and Beyond program..
Friends of Marcy Houses, Brooklyn, NY for tutoring               150,000
 and mentoring.......................................
Ft. Smith School District, Ft. Smith, AR for a                   400,000
 student training program............................
Futures Without Violence, San Francisco, CA for                1,000,000
 trauma-informed social and emotional learning
 programs............................................
Gannon University, Erie, PA for a science technology             500,000
 engineering and mathematics pathway program.........
Genesee Intermediate School District, Flint, MI for a          1,000,000
 school nursing pilot program........................
George Mason University, Fairfax, VA for the Quantum             650,000
 Science Workforce initiative........................
Georgia Family Connection Partnership, Atlanta, GA             1,500,000
 for the Get Georgia Reading Campaign................
Groton Public Schools, Groton, CT for a high school              150,000
 career pathways program.............................
Guilford County Schools, Greensboro, NC for an                 2,000,000
 intensive tutoring program..........................
Gwinnett County Schools Foundation, Suwanee, GA for              775,000
 an early childhood education initiative.............
Hamilton Area Young Men's Christian Association,                 200,000
 Hamilton, NJ for a supplementary education program..
Harry S. Truman Middle College, Chicago, IL for                   25,000
 career pathways and vocational education............
Hazleton Integration Project, Hazleton, PA for a               1,150,000
 STEAM-based education program.......................
Henry Ford College, Dearborn, MI for technology and            2,000,000
 manufacturing education.............................
Highline Public Schools, Burien, WA for maritime               1,050,000
 education...........................................
Holocaust Memorial Center, Farmington Hills, MI for              550,000
 Holocaust education and teacher training............
Houston Independent School District, Houston, TX for           1,000,000
 social and emotional learning supports..............
I Have A Dream Foundation, Newark, NJ for STEAM                  500,000
 education...........................................
Illinois Central College, Peoria, IL for its Cradle              500,000
 to Career Initiative................................
Jamel Gaines Creative Outlet, Brooklyn, NY for arts              750,000
 education...........................................
Kennedy Krieger Institute, Baltimore, MD for an early          1,250,000
 childhood education program.........................
Kent Intermediate School District, Grand Rapids, MI              900,000
 for equipment.......................................
Leader Valley Foundation, Waterloo, IA for training,              50,000
 curriculum, course materials, and expanding program
 access..............................................
Leo High School, Chicago, IL for STEM and robotics               150,000
 education...........................................
Life Camp, Jamaica, NY for a youth engagement program          2,000,000
Livermore Valley Joint Unified School District.                  375,000
 Livermore, CA for a community and parent engagement
 program.............................................
Lone Star Flight Museum, Houston, TX for student                 615,000
 education programs..................................
Madera Unified School District, Madera, CA for                   625,000
 English learner academic support....................
Mahoning County High School, Youngstown, OH for a                850,000
 community learning center...........................
Mass Audubon, Boston, MA for an environmental                    250,000
 education program...................................
Middlesex County, New Brunswick, NJ for agricultural             300,000
 and acquacultural training..........................
Milwaukee Public Schools, Milwaukee, WI for mental               600,000
 health services and driver's education..............
Mount Holyoke College, South Hadley, MA for teacher              250,000
 professional development in social and emotional
 learning and mental health needs....................
National Atomic Testing Museum, Las Vegas, NV for              2,000,000
 STEM education and technology.......................
New Directions for Youth, Los Angeles, CA for                    125,000
 education technology................................
New Haven Public Schools, New Haven, CT for a                  2,000,000
 manufacturing education and pathways program........
New Mexico Black Leadership Council, Albuquerque, NM             125,000
 for enrichment and youth development................
New York Sun Works, New York, NY for STEM and                    800,000
 sustainability education............................
Niswonger Foundation, Greeneville, TN for a literacy             345,000
 tutoring program....................................
Norristown Area School District, Norristown, PA for              200,000
 high school library technology and education
 programs............................................
North Carolina State University, Raleigh, NC for                 350,000
 computer science professional development...........
NYC Mission Society, New York, NY for its Level Up             1,100,000
 program.............................................
Oceanside Museum of Art, Oceanside, CA for literacy              150,000
 instruction and arts education......................
Old Colony YMCA, Brockton, MA for early education                800,000
 curriculum and teacher training.....................
Old Dominion University, Norfolk, VA for a maritime            1,000,000
 trades magnet school................................
P.E.A.C.E. Afterschool Program, Hempstead, NY for                100,000
 afterschool and summer STEAM programs...............
Pace Center for Girls, Jacksonville, FL for                      500,000
 educational services, counseling, and training......
Pasadena Independent School District, Pasadena, TX             2,000,000
 for education technology............................
PAST Foundation, Columbus, OH for its STEM 2022                  500,000
 program.............................................
Pioneer Works Art Foundation, Brooklyn, NY for youth           1,000,000
 development programs................................
Queens Community House, Queens, NY for family support            225,000
 counselors..........................................
Randolph Public Schools, Randolph, MA for culturally             275,000
 relevant digital literacy...........................
Riverside County Office of Education Division of               1,000,000
 Early Learning Services, Riverside, CA for early
 learning and literacy...............................
Rohingya Culture Center, Chicago, IL for a homework               50,000
 help program........................................
Saint Peter's University, Jersey City, NJ for                  1,100,000
 educator development and training...................
Salt Creek School District 48, Villa Park, IL, for an             80,000
 afterschool program.................................
School District of Osceola, St. Cloud, FL for STEM               450,000
 education...........................................
Skokie-Morton Grove School District 69, Skokie, IL               375,000
 for community school supports, technology, and
 academic enrichment.................................
South Kitsap School District 402, Port Orchard, WA               450,000
 for the West Sound STEM Network.....................
Southern Methodist University, Dallas, TX for its                900,000
 learning loss program for underserved students......
Southwestern Ohio Council for Higher Education,                1,000,000
 Dayton, OH for an internship program................
Spelman College, Atlanta, GA for a student literacy              325,000
 initiative..........................................
Sunnyside Community Services, Sunnyside, NY for a                100,000
 student support and college access program..........
Sylvester Broome Empowerment Village, Flint, MI for a            650,000
 youth empowerment and afterschool program...........
Syrian Community Network, Chicago, IL for hybrid                 100,000
 learning support....................................
Texas State University, San Marcos, TX for workforce           1,000,000
 research initiative and educator professional
 development focused on science, technology,
 engineering, and mathematics........................
Toledo City School District, Toledo, OH for a high             1,250,000
 school auto mechanic training program...............
Town of Milton, MA for assessment resources and                  100,000
 instructional tools.................................
Town of Monroe, CT for STEM education and technology.            200,000
U.S. Space & Rocket Center, Huntsville, AL for                   400,000
 equipment and outreach..............................
United Way of Central Jersey, Milltown, NJ for the               550,000
 Summer STEAM Stars program..........................
United Way of Forsyth County, Winston-Salem, NC for              450,000
 tutoring and enrichment programs....................
United Way of Greater Lehigh Valley, Allentown, PA               575,000
 for summer enrichment and technology supports.......
United Way of Northern New Jersey, Cedar Knolls, NJ            1,100,000
 for early childhood education.......................
United Way of the Titusville Region, Titusville, PA               55,000
 for a literacy program..............................
University of Central Florida, Orlando, FL for early             500,000
 learning and parent engagement......................
University of North Carolina at Greensboro, NC for             1,500,000
 the High-Speed Education Network Access Pilot.......
University of South Florida, Tampa, FL for STEM                1,000,000
 teacher preparation.................................
Urban Transformation Network, Chicago, IL for the                275,000
 Urban Youth Green Afterschool program...............
Virginia Commonwealth University, Richmond, VA for a             400,000
 teacher residency program...........................
West Indian American Day Carnival Association,                 1,000,000
 Brooklyn, NY for Caribbean culture, arts, and
 history education programs..........................
Whittier Public Library Foundation, Whittier, CA for             450,000
 youth services and early learning...................
Wildlife Conservation Society, Bronx, NY for STEM                300,000
 learning and career exploration.....................
Wilmington Area School District, New Wilmington, PA               55,000
 for computer and robotics equipment.................
Wood Dale Public Library District, Wood Dale, IL for             225,000
 early childhood learning............................
YMCA Mid Valley, Van Nuys, CA for learning recovery            1,000,000
 activities, including online and in-person tutoring
 supports............................................
YMCA of Greater Houston, TX for the Early Childhood              700,000
 English Language Learner Initiative.................
YMCA of Greater New York, NY for youth development             1,000,000
 programs............................................
YMCA of New Rochelle, NY for its Educational                     500,000
 Achievement Gap Project.............................
Youth Development, Albuquerque, NM for student and               850,000
 family wraparound services..........................
YWCA Metropolitan Chicago, IL, for early childhood               500,000
 learning............................................
------------------------------------------------------------------------

                 SAFE SCHOOLS AND CITIZENSHIP EDUCATION

 
 
 
Appropriation, fiscal year 2021.......................      $217,000,000
Budget request, fiscal year 2022......................     1,650,000,000
Committee Recommendation..............................     1,666,000,000
    Change from enacted level.........................    +1,449,000,000
    Change from budget request........................       +16,000,000
 

    The Committee recommends a total of $1,666,000,000 for 
activities to promote safe schools, healthy students, and 
citizenship education, which is $1,449,000,000 more than the 
fiscal year 2021 enacted level and $16,000,000 more than the 
fiscal year 2022 budget request.

Promise Neighborhoods

    The Committee recommends $96,000,000 for Promise 
Neighborhoods, which is $15,000,000 above the fiscal year 2021 
enacted level and $5,000,000 above the fiscal year 2022 budget 
request. 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.--Within the funding provided for Promise 
Neighborhoods, the Committee recommendation includes $5,000,000 
and new bill language for planning grants intended to 
strengthen communities' abilities to scale city and regional 
reinvestment strategies and allow for direct services. These 
planning grants will support the alignment of resources and 
efforts across multiple sectors and focus on measurable shared 
goals.

School Safety National Activities

    The Committee recommends $1,127,000,000 for School Safety 
National Activities, which is $1,021,000,000 more than the 
fiscal year 2021 enacted level and $11,000,000 more than the 
fiscal year 2022 budget request. 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 2022 budget request for 
school-based mental health professionals to the Mental Health 
Services Professional Demonstration Grants program established 
in the Department of Education Appropriations Act, 2019 and the 
School-Based Mental Health Services Grants program established 
in the Department of Education Appropriations Act, 2020.
    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 
the fiscal year 2022 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. 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 requests a briefing within 90 days of 
enactment of this Act on plans for carrying out the fiscal year 
2022 Mental Health Services Professional Demonstration Grants 
and the School-Based Mental Health Services Grants 
competitions. In addition, the Department shall provide notice 
to the Committees at least seven days before grantees are 
announced.
    Project SERV.--The Project SERV program provides counseling 
and referral to mental health services as well as other 
education-related services to LEAs and IHEs in which the 
learning environment has been disrupted by a violent or 
traumatic crisis. The Committee directs the Department to 
report to the Committees on Appropriations within 180 days of 
enactment of this Act on how fiscal years 2018, 2019, and 2020 
grant recipients used Project SERV funds; recommendations from 
grant recipients on how the program could be improved; and, 
information on how these funds helped them recover from a 
violent or traumatic crisis.
    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 the fiscal year 
2022 increase to School Safety National Activities, the 
Committee recommends $10,000,000 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. 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.
    Adverse Childhood Experience.--The Committee recognizes 
that the ratio of school-based mental health care professionals 
to students is not sufficient to meet students' mental health 
needs in schools. Research shows one in three children under 18 
has suffered at least one adverse childhood experience (ACE) in 
their lifetime and 14 percent experienced two or more ACEs. 
However, only about 20 percent of children with mental, 
emotional, or behavioral disorders receive care from a 
specialized mental health care provider. The Committee 
encourages the Department to develop strategies to increase the 
training and hiring of counselors and other mental health 
providers in educational settings.
    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 recognizes 
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 strongly urges 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.
    Grants for Student Trauma Support and Mental Health.--The 
Committee notes that the SUPPORT Act (P.L. 115-271) created new 
grants to expand evidence-based trauma support services in 
schools to improve access to research-supported interventions. 
The SUPPORT Act authorizes the Secretary, in coordination with 
the Assistant Secretary of Mental Health and Substance Use, to 
use grants to link educational agencies with mental health 
systems, increasing student access to evidence-based services 
to help prevent and mitigate trauma that youth experience. The 
Committee encourages the Department to support these activities 
in fiscal year 2022.

Full-Service Community Schools

    The Committee recommends $443,000,000 for Full-Service 
Community Schools, which is $413,000,000 more than the fiscal 
year 2021 level and the same as the fiscal year 2022 budget 
request. This program makes competitive grants to support 
school-based comprehensive services for students, families, and 
communities.
    Technical Assistance.--The Full-Service Community Schools 
program supports evidence-based models to meet the holistic 
needs of children and families. The Committee is encouraged by 
research that shows comprehensive community schools as a 
strategy that can improve educational quality and equity for 
students from diverse backgrounds. Therefore, the Committee 
urges the Department to provide technical assistance to SEAs 
and LEAs that are interested in leveraging Full-Service 
Community Schools grants to meet local school improvement 
needs.

                      ENGLISH LANGUAGE ACQUISITION

 
 
 
Appropriation, fiscal year 2021.......................      $797,400,000
Budget request, fiscal year 2022......................       917,400,000
Committee Recommendation..............................     1,000,000,000
    Change from enacted level.........................      +202,600,000
    Change from budget request........................       +82,600,000
 

    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 in fiscal year 2022, which is $202,600,000 
above the fiscal year 2021 enacted level and $82,600,000 above 
the fiscal year 2022 budget request. 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 $60,000,000; 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 2022.
    Office of English Language Acquisition (OELA).--The 
Committee understands that the nation's EL student population 
is rapidly growing and becoming more diverse. The Committee is 
deeply concerned by the academic achievement gap that persists 
between ELs and their peers and understands that addressing 
this challenge has been difficult for many States. These States 
rely on Federal technical assistance in crafting and 
administering their State and local plans under Title III of 
the ESEA, and the Committee recognizes the need to provide them 
with timely, accurate guidance. OELA already disseminates 
research and resources for teaching ELs and has the expertise 
needed to provide this guidance to States. Therefore, the 
Committee strongly encourages all assistance duties required 
under section 6823(f) of the ESEA to be conducted by OELA.
    Children from Puerto Rico.--The Committee is aware that 
children and youth who relocate from the U.S. territory of 
Puerto Rico, where Spanish is the primary language of 
instruction, to one of the 50 States or the District of 
Columbia are not counted in the statutory formula used to make 
English Language Acquisition allotments to States, set forth in 
section 3111(c) of the ESEA.
    Seal of Biliteracy Programs.--The Committee recognizes that 
State seal of biliteracy programs, adopted and implemented in 
more than 80 percent of the States, enrich society by 
encouraging bilingual and multilingual education and 
demonstrating to employers and higher education institutions 
that students have attained proficiency in English and one 
other language. The Committee recognizes that ELs and heritage 
language learners lag behind world language students in 
attaining seals of biliteracy. To that end, the Committee is 
strongly supportive of LEAs using funds available under ESEA 
for costs associated with seal of biliteracy benchmark 
proficiency assessments and final assessments for EL and 
heritage language learners. The Committee notes that funds 
available under ESEA may be used to purchase the hardware and 
software necessary to administer these critical assessments.
    Translation and Interpretation Services.--The Committee 
recognizes 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 OELA to support LEAs and SEAs in providing robust 
translation and interpretation services for parents and 
guardians of ELs.

                           SPECIAL EDUCATION

 
 
 
Appropriation, fiscal year 2021.......................   $14,070,743,000
Budget request, fiscal year 2022......................    17,193,256,000
Committee Recommendation..............................    17,200,256,000
    Change from enacted level.........................    +3,129,513,000
    Change from budget request........................        +7,000,000
 

    Of the total amount available, $7,488,516,000 is available 
for obligation on July 1, 2022, and $9,283,383,000 is available 
for obligation on October 1, 2022. 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 $15,537,429,000 for Part B Grants 
to States, which is $2,599,972,000 above the fiscal year 2021 
enacted level and the same as the fiscal year 2022 budget 
request.

Preschool Grants

    The Committee recommends $502,620,000 for Preschool Grants, 
which is $105,000,000 above the fiscal year 2021 enacted level 
and the same as the fiscal year 2022 budget request. 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 $731,850,000 for Grants for 
Infants and Families, which is $250,000,000 above the fiscal 
year 2021 enacted level and the same as the fiscal year 2022 
budget request. 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 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 promote 
continuity of services for eligible infants and their families.

IDEA National Activities

    The Committee recommends $428,357,000 for IDEA National 
Activities, which is $174,541,000 above the fiscal year 2021 
enacted level and $7,000,000 more than the fiscal year 2022 
budget request. 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 $31,547,000 for Educational Technology, 
Media, and Materials, which is $2,000,000 above the fiscal year 
2021 enacted level and the fiscal year 2022 budget request. 
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.
    The Committee continues to recognize the ongoing progress 
made with the tools and services provided under this program 
that have allowed more than 620,000 students with disabilities 
free access to more than 700,000 books in digitally accessible 
formats. The Committee strongly encourages continued effort to 
expand this program's reach to K-12 students in underserved 
areas.
    Parent Information Centers.--The Committee recommends 
$30,152,000 for Parent Information Centers, which is $2,741,000 
above the 2021 enacted level and the same as the fiscal year 
2022 budget request. 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 $159,800,000 
above the fiscal year 2021 enacted level and the same as the 
fiscal year 2022 budget request. 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.
    The Committee is strongly supportive of the fiscal year 
2022 proposed increase 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.
    As LEAs make determinations about how to invest Elementary 
and Secondary School Emergency Relief (ESSER) funds, the 
Committee encourages the Department to provide technical 
assistance to LEAs and highlight the benefits of partnerships 
with educator preparation programs in higher education to 
address the shortage of special educators. The Committee notes 
that residency programs, grow-your-own programs, and special 
education preparation programs are allowable uses of funds 
under ESSER. Such programs allow candidates to be supported so 
that school districts will be able to address their needs for 
fully-prepared special educators.
    State Personnel Development.--The Committee recommends 
$38,630,000 for State Personnel Development, which is the same 
as the fiscal year 2021 enacted level and the fiscal year 2022 
budget request. 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 $49,345,000 for Technical Assistance and 
Dissemination, which is $5,000,000 above the fiscal year 2021 
enacted level and the same as the fiscal year 2022 budget 
request. 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 $28,683,000 for Special Olympics Education Programs, 
which is $5,000,000 above the fiscal year 2021 enacted level 
and the fiscal year 2022 budget request, 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.
    Autism.--The Committee supports efforts by the Office of 
Special Education and Rehabilitative Services (OSERS) to 
disseminate research and best practices to LEAs and SEAs 
regarding services and improving results for children with 
autism. The Committee is supportive of efforts to share new 
knowledge, integrate research and practice, and work with LEAs 
and SEAs on high-quality implementation of research.
    Assistive Technology Usage.--The Committee notes that 
assistive technology (AT) is an essential tool for students 
with disabilities. As mandated under IDEA, assistive technology 
must be made available to all children with a disability 
needing AT as determined by the team developing the student's 
Individualized Education Program (IEP). However, too little is 
known regarding access to and use of assistive technology for 
students who require it. The Committee is concerned that 
children with disabilities who could benefit from the use of AT 
are not accessing these resources. The Committee encourages 
OSERS to study State and district practices in making AT 
available to students; the percentage of students with IEPs by 
disability category accessing AT; the availability of training 
for school personnel and parents to support a child's use of 
AT; budgeting practices regarding the annual acquisition of AT 
for eligible children; and, any other factors impacting the 
policies and practices of providing AT so that all children 
with disabilities have equitable access to grade-level 
curriculum, assessments and the learning environment 
commensurate with their peers. In addition, the Committee 
encourages OSERS to issue guidance to States that: clarifies 
the requirements of the IDEA regarding providing AT to children 
with disabilities; assures States have updated plans to provide 
technical assistance to district leaders in the financing and 
acquisition of AT; provides training to IEP teams in 
determining whether a child qualifies for AT; and trains all 
school personnel involved, including the child's parents, on 
the use of the AT to ensure children with disabilities have 
equitable access to grade-level curriculum, assessment, and the 
learning environment commensurate with their peers.
    Special Education Expenditure Project.--The Committee notes 
that no data has been collected by the Federal government on 
special education expenditures since 2004 when the Department 
released the Special Education Expenditure Project (SEEP). To 
assist policymakers and advocates with critical questions 
regarding special education spending, the Committee encourages 
the Department to conduct a large-scale, nationally 
representative study of special education expenditures of 
similar scale, scope, and design as the 1999-2004 SEEP.
    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.

                        REHABILITATION SERVICES

 
 
 
Appropriation, fiscal year 2021.......................    $3,814,220,000
Budget request, fiscal year 2022......................     3,894,820,000
Committee Recommendation..............................     3,896,820,000
    Change from enacted level.........................       +82,600,000
    Change from budget request........................        +2,000,000
 

    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 $3,719,121,000 in mandatory 
funding for Vocational Rehabilitation (VR) State Grants, which 
is $44,100,000 above the fiscal year 2021 enacted level and the 
same as the fiscal year 2022 budget request.
    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 2021 enacted 
level and the fiscal year 2022 budget request. 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 2021 enacted 
level and the fiscal year 2022 budget request. 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 $40,796,000 for Demonstration and 
Training Programs, which is $35,000,000 above the fiscal year 
2021 enacted level and the same as the fiscal year 2022 budget 
request. 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 2021 enacted level for 
parent information and training programs.

Protection and Advocacy of Individual Rights

    The Committee recommends $20,150,000 for Protection and 
Advocacy of Individual Rights, which is $2,000,000 more than 
the fiscal year 2021 enacted level and the fiscal year 2022 
budget request. 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 
2021 enacted level and the fiscal year 2022 budget request. 
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 both the fiscal year 2021 enacted level and the fiscal year 
2022 budget request. 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 $18,500,000 for the Helen Keller 
National Center for Deaf-Blind Youth and Adults, which is 
$1,500,000 more than the fiscal year 2021 enacted level and the 
same as the fiscal year 2022 budget request. 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 2021.......................      $256,292,000
Budget request, fiscal year 2022......................       265,292,000
Committee Recommendation..............................       265,292,000
    Change from enacted level.........................        +9,000,000
    Change from budget request........................             - - -
 

    The Committee recommends $265,292,000 for Special 
Institutions for Persons with Disabilities, which is $9,000,000 
above the fiscal year 2021 enacted level and the same as the 
fiscal year 2022 budget request.

                 AMERICAN PRINTING HOUSE FOR THE BLIND

 
 
 
Appropriation, fiscal year 2021.......................       $34,431,000
Budget request, fiscal year 2022......................        37,431,000
Committee Recommendation..............................        37,431,000
    Change from enacted level.........................        +3,000,000
    Change from budget request........................             - - -
 

    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.
    The Committee applauds the Printing House for rapidly 
developing training resources to assist schools, teachers, 
parents, and students to adapt to the changes in education 
brought about because of the COVID pandemic. The increase in 
funding will help provide the resources necessary to develop 
and distribute assistive technologies, books in accessible 
formats and specially designed educational aids that will allow 
students who are blind or visually impaired to fully 
participate in and benefit from education programs.

               NATIONAL TECHNICAL INSTITUTE FOR THE DEAF

 
 
 
Appropriation, fiscal year 2021.......................       $81,500,000
Budget request, fiscal year 2022......................        84,500,000
Committee Recommendation..............................        84,500,000
    Change from enacted level.........................        +3,000,000
    Change from budget request........................             - - -
 

    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 2021.......................      $140,361,000
Budget request, fiscal year 2022......................       143,361,000
Committee Recommendation..............................       143,361,000
    Change from enacted level.........................        +3,000,000
    Change from budget request........................             - - -
 

    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 2021.......................    $2,030,936,000
Budget request, fiscal year 2022......................     2,183,936,000
Committee Recommendation..............................     2,238,981,000
    Change from enacted level.........................      +208,045,000
    Change from budget request........................       +55,045,000
 

    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 $1,384,848,000 for Career and 
Technical Education (CTE) State Grants, which is $50,000,000 
above the fiscal year 2021 enacted level and $30,000,000 more 
than the fiscal year 2022 budget request. Of these funds, 
$593,848,000 will become available on July 1, 2022, and 
$791,000,000 will become available for obligation on October 1, 
2022.
    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.

National Programs

    The Committee recommends $115,421,000 for National 
Programs, which is $108,000,000 more than the fiscal year 2021 
enacted level and the same as the fiscal year 2022 budget 
request. The recommendation includes new language supporting 
the Administration's proposal for Innovation and Modernization 
grants.
    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 career and technical education (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 IET models that blend basic 
skills instruction and occupational training to expand 
equitable access to skills training, high-quality credentials 
and family-supporting careers.

Adult Basic and Literacy Education State Grants

    The Committee recommends $700,000,000 for Adult Basic and 
Literacy Education State Grants, which is $25,045,000 more than 
the fiscal year 2021 enacted level and the fiscal year 2022 
budget request. 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 $38,712,000 for National 
Leadership Activities, which is $25,000,000 more than the 
fiscal year 2021 enacted level and the same as the fiscal year 
2022 budget request. This program supports applied research, 
development, dissemination, evaluation, and program improvement 
efforts to strengthen the quality of adult education services.
    The Committee encourages the provision of technical 
assistance to States to foster and scale IET models by ensuring 
collaboration with CTE providers. IET is a service approach 
that provides adult education and literacy activities 
concurrently and contextually with workforce preparation for a 
specific occupation or occupational cluster for the purpose of 
educational and career advancement.

                      STUDENT FINANCIAL ASSISTANCE

 
 
 
Appropriation, fiscal year 2021.......................   $24,545,352,000
Budget request, fiscal year 2022......................    27,545,352,000
Committee Recommendation..............................    27,187,352,000
    Change from enacted level.........................    +2,642,000,000
    Change from budget request........................      -358,000,000
 

Pell Grants

    The Committee recommends $24,725,352,000 in discretionary 
funding for the Pell Grant program, which is $2,250,000,000 
more than the fiscal year 2021 enacted level and $750,000,000 
less than the fiscal year 2022 budget request. These funds will 
support Pell grants to students for the 2022-2023 academic 
year.
    Combined with mandatory funding streams, the Committee 
recommendation supp