House Report 118-585 - DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND RELATED AGENCIES APPROPRIATIONS BILL, 2025

[House Report 118-585]
[From the U.S. Government Publishing Office]

118th Congress } { Report
HOUSE OF REPRESENTATIVES
2d Session } { 118-585
_______________________________________________________________________

DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND
RELATED AGENCIES APPROPRIATIONS BILL, 2025

----------

R E P O R T

OF THE

COMMITTEE ON APPROPRIATIONS
HOUSE OF REPRESENTATIVES

together with

MINORITY VIEWS

[TO ACCOMPANY H.R. 9029]

[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

July 12, 2024.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed

118th Congress } { Report
HOUSE OF REPRESENTATIVES
2d Session } { 118-585
_______________________________________________________________________

DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND
RELATED AGENCIES APPROPRIATIONS BILL, 2025

__________

R E P O R T

OF THE

COMMITTEE ON APPROPRIATIONS

HOUSE OF REPRESENTATIVES

together with

MINORITY VIEWS

[TO ACCOMPANY H.R. 9029]

[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

July 12, 2024.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed

_______

U.S. GOVERNMENT PUBLISHING OFFICE

*56-216 WASHINGTON : 2024

118th Congress } { Report
HOUSE OF REPRESENTATIVES
2d Session } { 118-585

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

DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND
RELATED AGENCIES APPROPRIATIONS BILL, 2025

_______

July 12, 2024.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed

_______

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

R E P O R T

together with

MINORITY VIEWS

[To accompany H.R. 9029]

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, 2025,
and for other purposes.

INDEX TO BILL AND REPORT

Page number

Bill Report
Summary of Estimates and Appropriation..................... 4
General Summary of the Bill................................ 4
Bill Wide Requirements..................................... 5
Title I--Department of Labor:
Employment and Training Administration............. 2 8
Training and Employment Services........... 2 9
Job Corps.................................. 9 13
Community Service Employment for Older
Americans.............................. 14
Federal Unemployment Benefits and
Allowances............................. 10 14
State Unemployment Insurance and Employment
Service Operations..................... 11 14
Advances to the Unemployment Trust Fund and
Other Funds............................ 18 16
Program Administration..................... 18 16
Veterans' Employment and Training.................. 18 17
Employee Benefits Security Administration.......... 22 18
Pension Benefit Guaranty Corporation............... 22 19
Office of Workers' Compensation Programs........... 24 19
Special Benefits........................... 24 20
Energy Employees Occupational Illness
Compensation Fund...................... 26 20
Special Benefits for Disabled Coal Miners.. 27 20
Black Lung Disability Trust Fund........... 27 21
Wage and Hour Division............................. 28 21
Office of Federal Contract Compliance Programs..... 28 22
Office of Labor-Management Standards............... 28 22
Occupational Safety and Health Administration...... 29 22
Mine Safety and Health Administration.............. 31 23
Bureau of Labor Statistics......................... 33 24
Departmental Management............................ 33 25
Office of Disability Employment Policy............. 35 28
General Provisions................................. 35 28
Title II--Department of Health and Human Services:
Health Resources and Services Administration....... 53 30
Primary Health Care........................ 53 31
Health Workforce........................... 53 34
Maternal and Child Health.................. 57 43
Ryan White HIV/AIDS Program................ 58 49
Health Systems............................. 58 49
Rural Health............................... 58 51
HRSA-Wide Activities and Program Support... 59 55
Vaccine Injury Compensation Program........ 60 57
Covered Countermeasures Process Fund....... 60 58
Centers for Disease Control and Prevention......... 60 58
Immunization and Respiratory Diseases...... 60 58
HIV/AIDS, Viral Hepatitis, Sexually
Transmitted Disease, and Tuberculosis
Prevention............................. 61 59
Emerging and Zoonotic Infectious Diseases.. 61 60
Chronic Disease Prevention and Health
Promotion.............................. 61 63
Birth Defects, Developmental Disabilities,
Disabilities and Health................ 62 68
Public Health Scientific Services.......... 62 69
Environmental Health....................... 62 71
Injury Prevention and Control.............. 72
National Institute for Occupational Safety
and Health............................. 62 73
Energy Employees Occupational Illness
Compensation Program................... 63 74
Global Health.............................. 63 75
Public Health Preparedness and Response.... 63 75
CDC-Wide Activities and Program Support.... 64 76
Buildings and Facilities................... 66 80
National Institutes of Health...................... 67 81
National Cancer Institute.................. 67 82
National Institute on Body Systems Research 67 87
National Institute on Neuroscience and
Brain Research......................... 68 91
National Institute on Infectious Diseases.. 68 95
National Institute on the Immune System and
Arthritis.............................. 68 97
National Institute of General Medical
Sciences............................... 68 98
National Institute for Disability Related
Research............................... 69 99
National Institute on Dementia............. 69 103
National Institute on Substance Use........ 69 104
National Institute of Mental Health........ 69 106
National Institute on Health Sciences
Research............................... 70 108
National Institute on Innovation and
Advanced Research...................... 70 111
Office of the Director..................... 70 113
Buildings and Facilities................... 72 125
Substance Abuse and Mental Health Services
Administration................................. 73 125
Mental Health.............................. 73 128
Substance Abuse Treatment.................. 74 135
Substance Abuse Prevention................. 75 140
Health Surveillance and Program Support.... 75 142
Agency for Healthcare Research and Quality......... 142
Centers for Medicare & Medicaid Services........... 76 143
Grants to States for Medicaid.............. 76 143
Payments to the Health Care Trust Funds.... 77 143
Program Management......................... 77 143
Health Care Fraud and Abuse Control Account 79 159
Administration for Children and Families........... 80 159
Payments to States for Child Support
Enforcement and Family Support Programs 80 159
Low Income Home Energy Assistance.......... 81 160
Refugee and Entrant Assistance............. 82 160
Promoting Safe and Stable Families......... 83 164
Child Care and Development Block Grant..... 84 164
Social Services Block Grant................ 85 164
Children and Families Services Programs.... 85 165
Payments for Foster Care and Permanency.... 88 170
Administration for Community Living................ 89 170
Administration for Strategic Preparedness and
Response....................................... 92 176
Research, Development, and Procurement..... 92 180
Operations, Preparedness, and Emergency
Response............................... 94 185
Office of the Secretary............................ 94 187
General Departmental Management............ 94 187
Office for Civil Rights.................... 96 202
Office of the National Coordinator for
Health Information Technology.......... 97 202
Medicare Hearings and Appeals.............. 97 204
Office of Inspector General................ 98 204
General Provisions................................. 98 205
Title III--Department of Education:
Office of Elementary and Secondary Education....... 126 209
Education for the Disadvantaged............ 126 209
Impact Aid................................. 127 213
School Improvement Programs................ 128 214
Safe Schools and Citizenship Education..... 130 216
Indian Education........................... 130 219
Innovation and Improvement................. 131 220
Office of English Language Acquisition............. 223
Office of Special Education and Rehabilitative
Services....................................... 132 224
Special Education.......................... 132 224
Rehabilitation Services.................... 136 226
Special Institutions for Persons with
Disabilities........................... 137 227
American Printing House for the Blind.... 137 227
National Technical Institute for the Deaf 137 228
Gallaudet University..................... 137 228
Office of Career, Technical, and Adult Education... 138 229
Office of Postsecondary Education.................. 138 230
Higher Education........................... 138 230
Howard University.......................... 140 236
College Housing and Academic Facilities
Loans.................................. 140 237
Historically Black College and University
Capital Financing Program Account...... 141 237
Office of Federal Student Aid.............. 141 237
Student Financial Assistance............... 141 239
Student Aid Administration................. 142 240
Institute of Education Sciences.................... 143 243
Departmental Management............................ 144 244
General Provisions................................. 145 249
Title IV--Related Agencies:
Committee for Purchase from People Who Are Blind or
Severely Disabled.............................. 154 251
Corporation for National and Community Service..... 155 251
Corporation for Public Broadcasting................ 253
Federal Mediation and Conciliation Service......... 159 254
Federal Mine Safety and Health Review Commission... 160 254
Institute of Museum and Library Services........... 160 254
Medicaid and CHIP Payment and Access Commission.... 160 255
Medicare Payment Advisory Commission............... 161 256
National Council on Disability..................... 161 256
National Labor Relations Board..................... 161 257
National Mediation Board........................... 162 257
Occupational Safety and Health Review Commission... 163 258
Railroad Retirement Board.......................... 163 258
Social Security Administration..................... 165 259
Title V--General Provisions................................ 170 263
House of Representatives Report Requirements............... 265

Summary of Estimates and Appropriations

The following table compares on a summary basis the
appropriations, including trust funds for fiscal year 2025, the
budget request for fiscal year 2025, and the Committee
recommendation for fiscal year 2025 in the accompanying bill.

2025 LABOR, HHS, EDUCATION BILL
[Discretionary funding in thousands of dollars]
----------------------------------------------------------------------------------------------------------------
Fiscal Year-- 2025 Committee compared to--
-------------------------------------------------------------------------------
Budget Activity 2025
2024 Enacted 2025 Budget Committee 2024 Enacted 2025 Budget
----------------------------------------------------------------------------------------------------------------
Department of Labor............. $13,695,849 $14,174,234 $10,529,223 -3,166,626 -3,645,011
Department of Health and Human 116,122,958 121,558,671 107,640,959 -8,481,999 -13,917,712
Services.......................
Department of Education......... 79,052,238 82,491,976 67,948,452 -11,103,786 -14,543,524
Related Agencies................ 17,071,955 18,421,516 14,962,530 -2,119,425 -3,458,986
----------------------------------------------------------------------------------------------------------------

General Summary of the Bill

For fiscal year 2025, the Committee recommends a total of
$185,797,000,000 in current year discretionary funding--the
302(b) allocation--and $201,081,164,000 in overall programmatic
funding, including offsets and adjustments. The fiscal year
2025 recommendation is a decrease of $8,637,000,000 below the
fiscal year 2024 enacted level. This amount represents 26
percent of total nondefense spending and 12 percent of total
discretionary spending.
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.
Federal government discretionary spending of approximately
$1.7 trillion represents less than half of mandatory
entitlement spending of $3.8 trillion. Mandatory entitlement
spending, like Social Security, Medicare, and Medicaid,
commands a significant portion of the budget due to automatic
funding mechanisms and eligibility criteria set by law.
Mandatory spending accounts for more than 70 percent of total
Federal outlays. Discretionary spending, on the other hand,
accounts for just 28 percent of total Federal outlays.
Discretionary spending covers a far broader spectrum of
government activities, including the nation's defense,
education, roads and bridges, and research infrastructure.
Over the past decade, Federal mandatory spending has
exhibited a notable upward trajectory, driven primarily by
factors such as demographic shifts, economic conditions, and
policy decisions. The rising costs of Federal health care and
social insurance programs have shaped the growth of mandatory
spending. Just ten years ago, mandatory spending was
approximately 12 percent of the U.S. gross domestic product
(GDP), and discretionary spending was approximately 8 percent.
In one decade, the mandatory amount jumped to nearly 14 percent
of GDP and discretionary shrunk to a corresponding 6 percent of
GDP. Over the long term, projections suggest that if current
policies remain unchanged, the Federal government could face
major fiscal imbalances, primarily due to automatic entitlement
spending.

Bill Wide Requirements

In cases where this report directs the submission of a
report, that report is to be submitted to the Committee on
Appropriations of the House of Representatives. Where this
report refers to the Committee or the Committee on
Appropriations, unless otherwise noted, this reference is to
the House of Representatives Subcommittee on Labor, Health and
Human Services, Education, and Related Agencies.
Each department and agency funded in this Act shall follow
the directives set forth in this Act and the accompanying
report and shall not reallocate resources or reorganize
activities except as provided herein. Funds for individual
programs and activities are displayed in the detailed table at
the end of report accompanying this Act. Funding levels that
are not displayed in the detailed table are identified within
this report. Any action to eliminate or consolidate programs,
projects, and activities should be pursued through a proposal
in the President's Budget so it can be considered by the
Committee.
Budget Submission.--As part of the President's Budget
Request, each Department is directed to provide the Committee
in electronic format a table that corresponds with every
program line found in the detailed table at the end of this
report. Such a table shall include a column for the most
recently enacted appropriation, the current year, and the
budget year, assuming current law. In addition, the Committee
continues to expect delivery of all congressional
justifications and budget summary documents no later than the
day of the President's Budget Appendix publication online. The
Department is directed to notify the Committee 24 hours in
advance of any anticipated delay.
Congressional Reports.--Each department or agency is
directed to provide the Committee, within 30 days from the date
of enactment of this Act and quarterly thereafter, a summary
describing each requested report to the Committee along with
related actions completed in the current and prior quarters and
planned actions to be completed in future quarters. Such a
summary shall be cumulative for all fiscal years for which any
report remains outstanding.
Customer Experience.--The Committee continues to support
efforts to improve agency customer experience. The Committee
urges all agencies funded by this Act to develop standards to
improve customer experience and incorporate the standards into
the performance plans required under 31 U.S.C. 1115. The
Committee requests an update from all agencies funded by this
Act to report on their implementation plans regarding this
subject in the fiscal year 2026 congressional justification.
Federal Agency Space Utilization.--The Committee notes with
concern the lack of Federal employees reporting to in person
work. A lack of in office presence is particularly problematic
for agencies whose mission involves direct service to the
public. No later than 90 days after enactment of this Act, all
executive agencies shall establish and maintain on the homepage
of the website of that agency, an accounting of all employees
(as defined in 5 U.S.C. 2105) physically utilizing Washington,
DC-metro area Federal agency space during the previous quarter.
Agencies must provide the Committee information detailing what
methodology was used to calculate utilization at the time of
posting.
Grant Continuation Cost Estimates.--As part of the fiscal
year 2026 congressional justification, each department or
agency funded in this Act with discretionary budget authority
for competitively awarded grants shall include the expected
cost of continuation awards for each competitively awarded
grant and any amount the department or agency would seek to
issue a new competitive funding opportunity announcement for
such grant in fiscal year 2026. In addition, the department
shall include the anticipated number of awards and average
anticipated award for such year.
National Academy of Sciences, Engineering, and Medicine.--
The Committee remains concerned with the lack of objective
nonpartisan research methods, including inaccurate references
to data and removal of panel participants, demonstrated by the
National Academy of Sciences, Engineering, and Medicine
(NASEM). The Committee urges agencies to use caution when
entering into new agreements with NASEM. Agencies are directed
to ensure all contracts are executed with the highest standards
of scientific rigor in an objective, nonpartisan manner. The
full spectrum of scientific views should be represented on a
research committee, council, or panel membership without
conflict of interest or ideology.
Performance Reporting.--As part of the congressional
justification for fiscal year 2026, each department or agency
funded by this Act is directed to include the percentage of the
Senior Executive Service for each performance level (5--
outstanding, 4--exceeds fully successful, 3--fully successful,
2--minimally satisfactory, or 1--unsatisfactory). In addition,
the department or agency shall include in such justification
the total amount spent on performance awards for the Senior
Executive Service for the most recent fiscal year for which
data is available.
Questions for the Record.--The Committee notes the
inclusion of section 526 of this Act, which requires each
Department and agency to provide answers to questions submitted
for the record within 45 business days after receipt. The
Committee expects each Department and agency to notify the
Committees at least 7 days in advance if they do not anticipate
meeting this statutory requirement.
Strengthening Data Capacity and Infrastructure.--The
Committee notes that the Office of Management and Budget (OMB)
has revised the Uniform Grants Guidance to clarify that grant
funds may be spent on data, evaluation, and integrated data
systems as direct or indirect costs and on community
engagement, which can play a critical role in data collection
and analysis as well as evaluation. To ensure grantees receive
consistent guidance from agencies, the Committee directs the
Departments of Education, Labor, Health and Human Services, and
related agencies to coordinate with OMB to communicate this new
guidance and best practices for implementing it.
Voter Registration.--The Committee notes agencies should
remain mission-focused when serving the American public. The
Biden Administration's relentless expansion and mission creep
requiring agencies to include voting promotion efforts as part
of accessing health care, serving a senior, or helping a
student find on campus employment is a direct attack on the
primary focus of these agencies and programs. Efforts to expand
the President's voting base with taxpayer dollars is a clear
violation of executive responsibility.
Whistleblower Protections.--Whistleblowers play a critical
role in the federal government by exposing wrongdoing, fraud,
and misconduct. Their willingness to come forward with
information helps maintain transparency, accountability, and
integrity within government agencies. Offices of Inspectors
General (OIGs) are independent entities responsible for
investigating whistleblower complaints at their parent
agencies. By thoroughly examining whistleblower reports, OIGs
contribute to a healthier and more accountable federal
environment. Federal law protects federal employees from
reprisal for whistleblowing. Additionally, under the National
Defense Authorization Act of 2013 (NDAA), it is illegal for
employees of Federal contractors, subcontractors, or grantees
to face retaliation for making protected whistleblower
disclosures. Recently, the Department of Justice OIG found a
``chilling effect'' on employees hesitant to report wrongdoing
due to fear of disciplinary actions. The Committee requests a
briefing from each Department within 120 days of enactment,
detailing (1) the number of transmitted OIG whistleblower
reports over the past five years, including the date of
transmittal; (2) actions taken or planned regarding each OIG
transmitted report; (3) any evidence of whistleblower
retaliation identified by the OIG; and (4) steps taken to
prevent retaliation against whistleblowers reporting
wrongdoing.

TITLE I--DEPARTMENT OF LABOR

Appropriation, fiscal year 2024....................... $13,695,849,000
Budget request, fiscal year 2025...................... 14,172,234,000
Committee Recommendation.............................. 10,529,223,000
Change from enacted level........................... -3,166,626,000
Change from budget request.......................... -3,643,011,000

This bill provides $10.5 billion in discretionary budget
authority for the Department of Labor, a reduction of 23
percent over fiscal year 2024 enacted level. The Department of
Labor comprises $10.5 billion, or 6 percent of the total 302(b)
allocation for this subcommittee.

Employment and Training Administration

Appropriation, fiscal year 2024....................... $10,381,341,000
Budget request, fiscal year 2025...................... 10,644,060,000
Committee Recommendation.............................. 7,790,577,000
Change from enacted level........................... -2,590,764,000
Change from budget request.......................... -2,853,483,000

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.
Anonymous Workforce Development Talent Portals.--The
Committee directs ETA to publicly release a report within 180
days of enactment of this Act addressing the availability and
effectiveness of existing candidate screening technologies to
accelerate a return to work for dislocated workers including
those that use candidate matching algorithms to match
candidates based off career desires and cultural fit metrics
using artificial intelligence to lower barriers to employment
with a special focus on disadvantaged and underserved
communities. The Committee further directs that such report
include recommendations regarding how to make these
technologies more widely available to Department partners.
Competitive Grantmaking Transparency.--The Committee is
concerned by the Department of Labor's (DOL) lack of
transparency in the evaluation and awarding of competitive
grants. The Committee directs DOL to provide the Committee with
the grant scores for each applicant for competitive funding
evaluated, including all aspects of scoring included in the
Funding Opportunity Announcement and in DOL's award of funds.
Prioritizing High Wage Industries.--The Committee is
concerned that DOL grant making has been ineffective in
targeting high-wage, high-growth occupations to the detriment
of workers and jobseekers. The Committee directs DOL to
prioritize grant applications in industries and occupations
that exceed the average earnings of a high school graduate
based on the Bureau of Labor Statistics (BLS) Occupational
Employment and Wage Statistics when making competitive grant
awards and when not inconsistent with the authorizing statute.
Workforce Development in Innovative Skilled Fields.--The
Committee recognizes the growing need for highly-skilled
mechanics and technicians in the automotive field to prepare
for advances in technology. Therefore, the Committee encourages
DOL, in collaboration with the Department of Education, to work
with industry partners, workforce groups, and nonprofit experts
to better support pathways for mechanics and technicians in
innovative automotive fields. Specifically, the Committee
encourages the Departments to examine their support for
advanced training programs for established career mechanics and
to examine needs related to the operation and repair of
transportation fleets and motorized equipment.

TRAINING AND EMPLOYMENT SERVICES

Appropriation, fiscal year 2024....................... $4,006,421,000
Budget request, fiscal year 2025...................... 3,930,587,000
Committee Recommendation.............................. 2,083,457,000
Change from enacted level........................... -1,922,964,000
Change from budget request.......................... -1,847,130,000

Training and Employment Services provides funding for
Federal job training programs authorized primarily by the
Workforce Innovation and Opportunity Act of 2014 (WIOA). The
Committee recognizes that the House of Representatives has
passed bipartisan legislation to reform and improve the
workforce development activities authorized under the now
expired WIOA, but the legislation has yet to be enacted.

Adult Employment and Training Activities

The Committee provides $173,649,000 for adult training,
which is the same as the fiscal year 2024 enacted level and the
fiscal year 2025 budget request.
The Committee has included a provision reducing the funding
available for fiscal year 2025 by $712,000,000.

Youth Employment and Training Activities

The Committee provides no funding for Youth Employment and
Training Activities. The Committee notes the absence of
evidence that the program improves employment and educational
outcomes for program participants and that the Department has
failed to implement the program in a manner consistent with the
changes enacted in the now expired WIOA. This program is
largely duplicative of the Perkins Career and Technical
Education, 21st Century Community Learning Centers, and Student
Support and Academic Enrichment programs. The Committee further
notes that in DOL's FY 2024 operating plan, DOL transferred
$970,000 from youth service activities to support enforcement
activities in the Occupational Safety and Health
Administration.

Dislocated Worker Employment and Training Activities

For Dislocated Worker Employment and Training Activities,
the Committee provides $1,421,412,000. Of the total provided
for Dislocated Worker Employment and Training Activities,
$1,095,553,000 is designated for State grants that provide core
and intensive services, training, and supportive services for
dislocated workers. In addition, States use these funds for
rapid response assistance to help workers affected by mass
layoffs and plant closures. The remaining amount is available
for the Dislocated Workers National Reserve (DWNR). DWNR
supports national emergency grants, technical assistance, and
demonstration projects as authorized by WIOA. The Committee
provides $1,060,000,000 in advanced appropriations for fiscal
year 2026.
Within the total for Dislocated Worker Employment and
Training Activities, the Committee provides the following
amounts:

------------------------------------------------------------------------
FY 2025
Budget Activity FY 2024 Enacted Committee
------------------------------------------------------------------------
Dislocated Worker Assistance $300,859,000 $325,859,000
National Reserve.................
Workforce Opportunity for 50,000,000 55,000,000
Rural Communities (non-add)..
Community College Grants (non- 65,000,000 65,000,000
add).........................
Cybersecurity Grants (non-add) 10,000,000 25,000,000
Career Pathways for Youth (non- 20,000,000 10,000,000
add).........................
------------------------------------------------------------------------

Dislocated Worker National Reserve Grantee Performance
Reporting.--Consistent with the requirements of section
116(b)(2)(A)(i) of WIOA (29 U.S.C. 3141), the Committee directs
DOL to require that all grantees receiving awards funded
through DWNR report on the employment, earnings, and credential
attainment outcomes of program participants. The Committee
further directs DOL to include program participant outcomes
disaggregated by grantee on its website.
Dislocated Worker National Reserve Disaster Response.--To
better ensure DOL is positioned to provide support to
communities affected by natural disasters and given the
availability of dedicated funding for Treatment, Recovery, and
Workforce Support within the Substance Abuse and Mental Health
Services Administration, the Committee provides no funding for
the purposes of Training and Guidance Letter No. 04-18.
Cybersecurity and Software Development Employment
Opportunities.--The Committee remains concerned about the high,
unmet demand for cybersecurity and software development skills
in both the Department of Defense (DOD) and the private sector
and DOL's continued lack of attention to these critical and
growing industries. Of the total provided for the DWNR, the
Committee directs $25,000,000 for competitive grants to
institutions of higher education as defined in sections 101(a)
and 101(b) of the Higher Education Act (20 U.S.C. 1001), State
Workforce Agencies, local workforce development boards, and
employer associations for the purpose of a targeted highly
skilled job training grant to help increase training capacity
to meet this demand. For purposes of making awards under this
program, DOL is directed to prioritize applicants located in
States with the greatest number of Federally recognized Tribes
and with preexisting DOD partnerships. DOL is directed to
provide the Committee a briefing on this initiative within 120
days of the enactment of this Act.
Career Pathways for Youth.--Multiple career pathways should
be available to young people. The Committee continues to
recognize the need for early workforce readiness, employment,
and training opportunities that help youth develop career-
specific skills for employability, such as responsibility,
organization, time management, and workplace safety. The
Committee provides $10,000,000 to utilize the demonstration
grant authority under DWNR for grants for this program.
Strengthening Community College Training Grants.--From
within the amounts provided for DWNR, the Committee provides
$65,000,000 for the Strengthening Community College Training
Grants (SCCT). The Committee directs the Secretary to make
individual grants to community colleges of at least $1,500,000,
unless grants are awarded in consortia to community colleges
and other eligible institutions of higher education as defined
in section 101(a) of the Higher Education Act. In making grant
awards, the Committee directs the Secretary to ensure
geographic diversity among grant recipients, to require a plan
for third party evaluations in each individual grant proposal,
and to conduct a national assessment of all grantee proposals
once complete. In addition, the Committee directs the Secretary
to ensure grantees incorporate a plan for sustainability of
funding under the grant proposal. While grants may be awarded
to a consortium of institutions of higher education, including
public and private, nonprofit 4 year institutions, the
Committee directs the Secretary to ensure that the lead grantee
in the consortium is a community college. The Committee directs
the Secretary to brief the Committees 7 days in advance of
issuing the funding opportunity announcement and 7 days in
advance of announcing awards.
Degree Apprenticeships.--The Committee encourages DOL to
support the integration of academic programing and on-the-job
training including paid work experience, related instruction,
and industry involvement.
Immersive Technology Education and Training Programs.--The
Committee encourages the Department to support the utilization
by grantees of immersive technology such as augmented reality,
virtual reality, and mixed reality tools. The use of immersive
technologies for training can be cost-efficient and has been
found to expedite training processes, increase skills
retention, and reduce employee turnover. Immersive technologies
can also help expand access to remote training opportunities
which is particularly beneficial for individuals living in
rural areas or individuals with disabilities that have
different access needs.
Workforce Opportunity for Rural Communities.--Within the
funds provided for DWNR, the Committee provides $55,000,000 for
the Workforce Opportunity for Rural Communities (WORC) program,
an increase of $5,000,000, to provide enhanced worker training
in the Appalachian, Delta, and Northern Border regions. The
Committee directs DOL to ensure that this funding increase is
used to support multigenerational workforce training pipelines
developed in collaboration with institutions of higher
education and workforce development system partner agencies in
regions with a WORC program.
The WORC program, in coordination with Delta Regional
Authority and Appalachian Regional Commission, provides
essential worker training to promote economic recovery in the
Delta and Appalachian regions. It is important to bolster
workforce programs for dislocated workers in these underserved
areas. The Committee strongly encourages continued investment
in areas with high rates of unemployment and substance use
disorder impacted by the loss of employment in the coal,
energy, and telecommunications industries. The energy industry
has experienced significant employment reductions in the past
decade resulting in severe economic hardship concentrated in
specific regions, and sustained investment to transition
workers to new industries is needed to offset the challenging
economic conditions.

Native American Programs

For Native American programs, the Committee provides
$65,000,000, an increase of $5,000,000, for these programs.

Migrant and Seasonal Farmworkers

The Committee provides $97,396,000, the same as fiscal year
2024, for this program.

YouthBuild

For the YouthBuild program, the Committee provides
$110,000,000, an increase of $5,000,000. WIOA reformed the
YouthBuild program to prioritize the employment and educational
outcomes of program participants. While the Committee
recognizes the challenges DOL has had in overseeing grant
awards, the Committee notes with concern that in making awards
under this program, DOL has prioritized the administrative
capacity of new grantees rather than their demonstrated
efficacy in securing employment and earnings outcomes for young
adults.

Reintegration of Ex-Offenders

The Committee provides $60,000,000 for training and
reintegration activities for individuals with criminal legal
histories reentering the community and youth offenders.
The Committee directs DOL 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 record is not a barrier
to entry or continued employment. The Committee also directs
DOL to consider the needs of communities that have recently
experienced significant unrest. The Committee also continues to
set aside $30,000,000 for competitive grants to national and
regional intermediaries for activities that prepare for
employment young adults with criminal legal histories and youth
offenders, with a priority for projects serving high-crime,
high-poverty areas. The Committee is aware that reentry
programs are an excellent way to help address workforce
challenges, including those in the advanced manufacturing
sector.

Workforce Data Quality Initiative

The Committee provides $6,000,000 for the Workforce Data
Quality Initiative.
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.

Apprenticeship Programs

The Committee provides $150,000,000 for apprenticeship
State grants. The Committee remains concerned with the modest
increases in the number of apprentices generated by
considerable and sustained congressional investment. Of the
funding made available, the Committee directs DOL to continue
funding State grants at the same level as fiscal year 2024. The
Committee further notes that in fiscal year 2024, DOL
transferred $2,850,000 from this program to support enforcement
activities in the Occupational Safety and Health
Administration.
No later than 180 days after the enactment of this Act, the
Department is directed to publicly disclose on its website
grantees receiving funding, the number of apprentices
attributable to each grantee, and the respective employment and
earnings outcomes of program participants as required under
section 116(b)(2)(A)(i) of WIOA. The Committee further directs
DOL to provide a briefing on its implementation of this
directive within 90 days of the enactment of this Act.
Cyber Workforce.--The Committee encourages DOL to continue
to prioritize efforts and grants centered on launching,
developing, expanding, and promoting registered apprenticeship
programs in cybersecurity, as well as related collaboration
with cyber industry and workforce intermediaries.
Parents of Dependent Children.--The Committee encourages
DOL to provide grantees guidance related to coordinating with
community-based providers of wrap around services to support
parents of dependent children enrolled in registered
apprenticeship and pre-apprenticeship programs.
Wastewater Apprenticeships.--The Committee directs DOL to
make $20,000,000 in grant funding available to establish,
implement, expand, and administer registered apprenticeship
programs consistent with the National Guideline Standards of
Apprenticeship for Water and Wastewater System Operations
Specialists to address nationwide shortages of qualified
drinking water and wastewater operators, especially in rural
America.

JOB CORPS

Appropriation, fiscal year 2024....................... $1,760,155,000
Budget request, fiscal year 2025...................... 1,764,376,000
Committee Recommendation.............................. 1,760,155,000
Change from enacted level........................... - - -
Change from budget request.......................... -4,221,000

Job Corps is a residential education and vocational
training program that helps young people ages 16 through 24
improve the quality of their lives through vocational and
academic training. The Committee continues to be concerned with
the administration of the Job Corps program, including the
underutilization of centers relative to on-board strength,
industry-standard training, and performance incentives.
Additionally, the Committee has concerns with the oversight
of job placement contracts. The DOL Office of Inspector General
(OIG) found evidence that contractors helped only 6 percent of
the sampled participants find work. The others found jobs on
their own, or there was not enough evidence to show the
contractors helped them. The OIG estimated that nearly
$71,000,000 went to contractors for services they could not
show they provided.
Job Corps Programing.--The Committee is concerned that the
relative lack of success is due to instructional content that
does not reflect job-site best practices or the jobs of today's
economy. To better ensure a variety of high-quality programs
are available to Job Corps students, the Committee directs DOL
to limit grants, contracts, or cooperative agreements for
purposes of instructional content to no more than $10,000,000.
Maximizing Employer Partnerships.--The Committee encourages
DOL to fully leverage section 158(f) of WIOA to maximize the
resources available to campuses to develop these partnerships
and meet employers' needs.
Supporting Continuous Campus Improvement.--The Committee
encourages DOL to develop a process involving Job Corps youth
service providers for setting achievable campus performance
expectations to more effectively drive continuous improvement
in student outcomes.

COMMUNITY SERVICE EMPLOYMENT FOR OLDER AMERICANS

Appropriation, fiscal year 2024....................... $405,000,000
Budget request, fiscal year 2025...................... 405,000,000
Committee Recommendation.............................. - - -
Change from enacted level........................... -405,000,000
Change from budget request.......................... -405,000,000

The Committee provides no funding for the Community Service
Employment for Older Americans program, also known as the
Senior Community Service Employment Program (SCSEP). The
Committee notes that the last comprehensive evaluation of SCSEP
found that the program led to unsubsidized employment for less
than half of program participants available for employment with
worse outcomes for participants with a disability, older
adults, and participants with lower levels of education.
Moreover, the largest recipients of SCSEP grants are
organizations based in the Washington, D.C. area rather than
direct service providers.
The Committee further notes that DOL transferred
$4,050,000, the most it is legally allowed, from the SCSEP
program in fiscal year 2024 to enforcement activities in the
Occupational Safety and Health Administration.

FEDERAL UNEMPLOYMENT BENEFITS AND ALLOWANCES

Appropriation, fiscal year 2024....................... $30,700,000
Budget request, fiscal year 2025...................... 33,900,000
Committee Recommendation.............................. 33,900,000
Change from enacted level........................... +3,200,000
Change from budget request.......................... - - -

The Committee provides no funding for the Trade Adjustment
Assistance program in the absence of reauthorization. Funding
included under this section is for the administration of
benefits to individuals whose petitions were approved before
July 1, 2022.

STATE UNEMPLOYMENT INSURANCE AND EMPLOYMENT SERVICE OPERATIONS

Appropriation, fiscal year 2024....................... $4,006,150,000
Budget request, fiscal year 2025...................... 4,325,429,000
Committee Recommendation.............................. 3,740,150,000
Change from enacted level........................... -266,000,000
Change from budget request.......................... -585,279,000

The total includes $3,656,084,000 from the Employment
Security Administration Account in the Unemployment Trust Fund
and $84,066,000 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

In addition, the Committee provides contingency funding for
increased workloads that States may face in the administration
of unemployment insurance (UI). The Committee includes bill
language so that, during fiscal year 2025, for every 100,000
increase in the total average weekly insured unemployment
(AWIU) above 2,124,000, an additional $28,600,000 is made
available to States from the Unemployment Trust Fund.
If additional funds are provided to States under the AWIU
contingency authority, the Department is directed to provide
notification to the Committee 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. If
additional funds are provided on a quarterly basis, the
Department is directed to provide this information to the
Committee on a quarterly basis.
The Committee provides $116,000,000 funding for the
Reemployment Services and Eligibility Assessments (RESEA)
program. The Committee supports the intent of the program to
provide more intensive services to individuals most likely to
use all their unemployment insurance benefits; however, the
Committee is concerned that the program has not achieved the
cost savings projected by the Congressional Budget Office (CBO)
and does not provide additional funding pursuant to the
Balanced Budget and Emergency Deficit Control Act. While CBO
once estimated that such funding generates reductions in UI
benefit exhaustion, the Committee notes that single State
evaluations of the program prior to it being made permanent in
2018 produced mixed results with some States successfully
assisting job seekers to work and others failing to do so.
While a worthy policy objective, the absence of a limitation on
State administrative expenses and inability to effectively
target services to individuals in greatest need of assistance
have undermined the ability to achieve the programmatic savings
CBO misguidedly predicted.

Unemployment Insurance Integrity Center of Excellence

The Committee provides $9,000,000 for the continued support
of Unemployment Insurance Integrity Center of Excellence.

Unemployment Insurance National Activities

The Committee provides $18,000,000 for UI national
activities. This funding is intended to help modernize
information technology systems and support States in
administering the UI program.

Employment Service

The Committee provides $675,052,000 for the Employment
Service allotment to States. The Committee also provides
$25,000,000 for Employment Service National Activities.
Disability Employment.--The Committee notes the continued
underemployment of individuals with disabilities and encourages
the Department, in consultation with the Social Security
Administration, to provide State agencies responsible for
reviewing Work Opportunity Tax Credit certification requests
additional information regarding the Ticket to Work program.

Foreign Labor Certification

The Committee provides $60,528,000 for the Federal
administration of the Foreign Labor Certification program and
$23,282,000 for grants to States.
De Minimis Exemption from Adverse Effect Wage Rate.--The
Committee recognizes that the House of Representatives
Agriculture Committee's bipartisan Ag Labor Working Group
unanimously supported this change in the wage calculation. The
Committee notes that current law requires the highest wage rate
to be paid for all work regardless of how much time a worker
may spend doing the higher rate labor. This overly strict
calculation is driving up costs in the H-2A program and acting
as a barrier to entry to this critical program for employers
and employees. As such, the Committee recommends that DOL adopt
a de minimis exemption that recognizes the real-world realities
of agriculture labor.
Improved Processing of Permanent Labor Certifications and
Prevailing Wage Determinations.--The Committee encourages DOL
to ensure immediate processing of Permanent Labor Certification
Applications filed through the Program Electronic Review
Management process. Historically, processing took less than six
months, but currently takes well over a year. The Committee
further encourages DOL to use existing authority and resources,
such as automating the self-attestation process to speedily
approve submissions while flagging potential bad actors for
further investigation, to reduce the processing backlog.
U.S. Defense Industrial Base.--The Committee notes that DOL
has not updated the Schedule A Shortage Occupation list to
include more than two occupations since 2005. The Committee
encourages DOL to revise the H-1B program to better prioritize
occupations that are critical to the U.S. defense industrial
base.

One-Stop Career Centers/Labor Market Information

The Committee provides $62,653,000 for One-Stop Career
Centers and Labor Market Information.

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 2024....................... $172,915,000
Budget request, fiscal year 2025...................... 184,668,000
Committee Recommendation.............................. 172,915,000
Change from enacted level........................... - - -
Change from budget request.......................... -11,753,000

The Committee provides $118,900,000 from the General Fund
of the Treasury and $54,015,000 from the Employment Security
Administration Account in the Unemployment Trust Fund.
Application and Approval Transparency.--The Committee
directs DOL, within 180 days of enactment of this Act, to
publicly release a report on the number of Registered
Apprenticeship program applicants, approvals, and the average
time between application submittal and approval. The Committee
further directs DOL to disaggregate this data by applicant
industry classification; whether a sponsoring organization is
an employer, employer-association, or an alternative
intermediary; and, in the event an application was not
approved, the reason for DOL's decision.
Office of Apprenticeship.--The Committee notes that for
purposes of performance reporting, DOL attributes the total
number of Registered Apprenticeships to the Apprenticeship
Grants program. The Committee has concerns regarding the
expediency and consistency of the Office of Apprenticeship's
review of program applications and that Registered
Apprenticeships DOL has attributed to the grant program are due
to private sector investment.
Unemployment Insurance Fraud Detection.--For more than 20
years, the DOL's Office of Inspector General has reported on
DOL's challenge to reduce improper payments in the UI program,
which has experienced some of the highest improper payment
rates across the Federal government. The Committee is concerned
that ETA currently does not have direct access to State UI
claims data, nor does it have the capability to analyze such
data, which would allow it to better identify fraud and other
improper payments as well as other trends or emerging issues,
such as timeliness. The Committee notes a report (Report No.
19-23-012-03-315), issued on September 25, 2023, by the OIG,
that recommended the Assistant Secretary of ETA expedite OIG-
related amendments to 20 C.F.R. 603.6(a) to make ongoing
disclosures of UI information to DOL-OIG mandatory by expressly
adding OIG (including its agents and contractors) to the list
of required disclosures that are necessary for the proper
oversight of the UI program without distinction as to purpose
(e.g., audits vs. investigations). The Committee directs DOL to
take such measures as necessary to make ongoing disclosures of
UI information available to OIG for purposes of audit of
investigation. The Committee directs DOL to provide a briefing
on its implementation of this directive within 90 days of
enactment of this Act.

VETERANS' EMPLOYMENT AND TRAINING SERVICE

Appropriation, fiscal year 2024....................... $335,341,000
Budget request, fiscal year 2025...................... 337,301,000
Committee Recommendation.............................. 335,341,000
Change from enacted level........................... - - -
Change from budget request.......................... -1,960,000

The Committee provides $65,500,000 from the General Fund of
the Treasury and $269,841,000 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:

------------------------------------------------------------------------
FY 2025
Budget Activity FY 2024 Enacted Committee
------------------------------------------------------------------------
Jobs for Veterans State Grants.... $185,000,000 $185,000,000
Transition Assistance Program..... 34,379,000 34,379,000
Federal Administration............ 47,048,000 47,048,000
Veterans Employment and Training 3,414,000 3,414,000
Institute........................
Homeless Veterans Reintegration 65,500,000 65,500,000
Program..........................
------------------------------------------------------------------------

The Transition Assistance Program (TAP) for separating
service members and their spouses provides a mandatory one-day
employment workshop, as well as two 2-day career track
workshops on employment preparation and vocational training, as
part of TAP to assist service members' transition to civilian
employment. TAP Employment Workshops are provided on military
installations, both domestically and abroad.
The Committee includes new bill language to allow the Jobs
for Veterans State Grants program to serve the surviving
spouses of individuals who died while members of the Armed
Forces or as a result of a service-connected disability.
The Committee provides $500,000 to support the Honoring
Investments in Recruiting and Employing American Military
Veterans Act of 2017 (HIRE Vets) Medallion program.
Transition Assistance Program.--The Department of Labor
plays an important role in educating veterans about many of
their benefits through the Transition Assistance Program,
including providing job assistance training, business ownership
courses, financial planning resources, and basic understandings
of many other benefits. Despite these efforts, the Committee is
concerned with the growing number of veterans and separating
service members who are unaware of many of the service-
connected benefits that are available to them once they
transition back to civilian life. The Committee directs the
Department of Labor to include in the fiscal year 2026
congressional justification the estimated cost of modifying the
Transition Assistance Program to include a once-a-year workshop
for all service members, regardless of their enlistment status.

Employee Benefits Security Administration

SALARIES AND EXPENSES

Appropriation, fiscal year 2024....................... $191,100,000
Budget request, fiscal year 2025...................... 205,663,000
Committee Recommendation.............................. 181,100,000
Change from enacted level........................... -10,000,000
Change from budget request.......................... -24,563,000

The Employee Benefits Security Administration (EBSA)
assures the security of retirement, health, and other
workplace-related benefits of working Americans.
No Suprises Act Implementation.--The Committee encourages
DOL, in collaboration with the Departments of Health and Human
Services and Treasury, to continue conducting random audits of
insurers' qualifying payment amount calculations as mandated by
the No Surprises Act. Additionally, the Committee is concerned
about delays in payment following Independent Dispute
Resolution determinations, despite the No Surprises Act
requiring that these payments be made within 30 days of the
payment determination. The Committee directs DOL to ensure that
Independent Dispute Resolution entities, payers, and providers
provide and receive the appropriate information to complete
payments within the required timeframe. The Committee also
urges DOL to use all appropriate existing authorities to
achieve timely payment.
Open Investigations.--The Committee is concerned that
prolonged investigations conducted by EBSA have placed
tremendous strain on retirement plan sponsors and have
negatively impacted amounts available for employee benefits. In
May 2021, the Government Accountability Office (GAO) found that
17 percent of all investigations opened in 2017 were still open
four years later. Within 180 days of enactment of this Act, the
Committee directs DOL to publicly release a report on the
number of investigations older than 48 months outstanding and
the measures taken by DOL to expediently address any violations
uncovered by these investigations.

Pension Benefit Guaranty Corporation

PENSION BENEFIT GUARANTY CORPORATION FUND

Appropriation, fiscal year 2024....................... $512,900,000
Budget request, fiscal year 2025...................... 514,063,000
Committee Recommendation.............................. 514,063,000
Change from enacted level........................... +1,163,000
Change from budget request.......................... - - -

Congress established the Pension Benefit Guaranty
Corporation (PBGC) to insure Americans' defined-benefit pension
plans. It operates a single-employer program and a
multiemployer insurance program, financed through premiums,
investment income, and assets from terminated plans.
Delphi Salaried Plan Employees.--In 2009, the PBGC
terminated certain Delphi pension plans, including the Delphi
Retirement Program for Salaried Employees. The Committee notes
that some participants of the Delphi salaried pension plan
received less than their full benefit. PBGC paid benefits are
subject to statutory limitations. The Committee also notes
ongoing legislative efforts to restore full benefits to the
affected participants.

Office of Workers' Compensation Programs

SALARIES AND EXPENSES

Appropriation, fiscal year 2024....................... $122,705,000
Budget request, fiscal year 2025...................... 130,545,000
Committee Recommendation.............................. 115,705,000
Change from enacted level........................... -7,000,000
Change from budget request.......................... -14,840,000

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 provides $113,500,000 in General Funds from
the Treasury and $2,205,000 from the Special Fund established
by the Longshore and Harbor Workers' Compensation Act.
The Committee remains concerned that OWCP has not done
enough to ensure it paid the best price for prescription drugs
in the Federal Employees' Compensation Act (FECA) program. The
Committee notes a report (Report No. 03-23-001-04-431) issued
on March 31, 2023, by the DOL-OIG that recommended OWCP
implement a process to ensure competitive prices for the FECA
program by regularly evaluating alternate pricing methodologies
and other sources--including publicly available benchmark price
lists, State fee schedules, market research, and comparable
payers--and updating its pricing methodology as appropriate.
The Committee urges that all DOL-OIG recommendations be
sufficiently addressed to mitigate recurrence of the issues
identified and directs DOL to provide a briefing on agency
efforts to implement these recommendations within 90 days of
enactment of this Act.

SPECIAL BENEFITS

Appropriation, fiscal year 2024....................... $700,000,000
Budget request, fiscal year 2025...................... 726,670,000
Committee Recommendation.............................. 726,670,000
Change from enacted level........................... +26,670,000
Change from budget request.......................... - - -

These funds provide mandatory benefits under the Federal
Employees' Compensation Act and the Longshore and Harbor
Workers' Compensation Act.
The Committee is aware that OWCP has a backlog in
reimbursing insurance providers for claims under the War
Hazards Compensation Act dating back to 2017. Within 180 days
of enactment of this Act, the Committee directs DOL to provide
a briefing on its work to address the backlog while ensuring
only qualified claims are reimbursed.

ADMINISTRATIVE EXPENSES, ENERGY EMPLOYEES OCCUPATIONAL ILLNESS
COMPENSATION FUND

Appropriation, fiscal year 2024....................... $66,532,000
Budget request, fiscal year 2025...................... 66,966,000
Committee Recommendation.............................. 66,966,000
Change from enacted level........................... +434,000
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 because of their work in producing or testing
nuclear weapons; and uranium workers covered under the
Radiation Exposure Compensation Act.

SPECIAL BENEFITS FOR DISABLED COAL MINERS

Appropriation, fiscal year 2024....................... $29,890,000
Budget request, fiscal year 2025...................... 30,367,000
Committee Recommendation.............................. 30,367,000
Change from enacted level........................... +477,000
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 provides $6,000,000 as an advance
appropriation for the first quarter of fiscal year 2026. These
funds ensure uninterrupted payments to beneficiaries.

BLACK LUNG DISABILITY TRUST FUND

Appropriation, fiscal year 2024....................... $452,511,000
Budget request, fiscal year 2025...................... 485,350,000
Committee Recommendation.............................. 485,350,000
Change from enacted level........................... +32,839,000
Change from budget request.......................... - - -

The Black Lung Disability Trust Fund 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 U.S. 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 Department has not
yet identified the liable mine operator or the liable 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 directs
DOL to provide a quarterly report on the Department's efforts
to improve the speed and quality of black lung claims
processing.

Wage and Hour Division

SALARIES AND EXPENSES

Appropriation, fiscal year 2024....................... $260,000,000
Budget request, fiscal year 2025...................... 294,901,000
Committee Recommendation.............................. 235,000,000
Change from enacted level........................... -25,000,000
Change from budget request.......................... -59,901,000

The Wage and Hour Division (WHD) enforces Federal minimum
wage, overtime pay, recordkeeping, and child labor requirements
of the Fair Labor Standards Act. 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 funding level provided by the Committee reflects the
significant economic threat posed by aggressive WHD rulemakings
which will adversely affect the ability of workers to provide
for their families.
Federal Contractors.--The Committee is concerned that the
``Minimum Wage for Federal Contracts'' notice published by the
Department of Labor in the Federal Register on September 30,
2022 (87 Fed. Reg. 59468) disproportionately affects entities
operating seasonal recreational services and equipment rental
to the public on Federal property or lands.

Office of Federal Contract Compliance Programs

SALARIES AND EXPENSES

Appropriation, fiscal year 2024....................... $110,976,000
Budget request, fiscal year 2025...................... 116,132,000
Committee Recommendation.............................. 99,976,000
Change from enacted level........................... -11,000,000
Change from budget request.......................... -16,156,000

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.
The Committee notes that 48 C.F.R. 22.101-1 requires that
Federal agencies remain impartial concerning labor management
disputes and to not undertake the conciliation, mediation, or
arbitration of any such dispute. The Committee has concerns
that the Presidential Memorandum Strengthening Support for
Federal Contract Labor Practices (M-23-08) proposes that
Federal agencies take a proactive role, consistent with the
stated objective of the White House Task Force on Worker
Organizing and Empowerment, to unbalance labor-management
relations in order to promote union organizing. The Committee
recommendation for OFCCP reflects the Committee's concerns that
the office is promoting and encouraging activities inconsistent
with Federal contracting requirements.
Individuals with Disabilities.--The Committee supports
adherence to section 503 of the Rehabilitation Act of 1973,
which is dedicated to promoting and advancing the employment of
qualified individuals with disabilities.

Office of Labor-Management Standards

SALARIES AND EXPENSES

Appropriation, fiscal year 2024....................... $48,515,000
Budget request, fiscal year 2025...................... 50,845,000
Committee Recommendation.............................. 48,515,000
Change from enacted level........................... - - -
Change from budget request.......................... -2,330,000

The Office of Labor Management Standards administers the
Labor-Management Reporting and Disclosure Act, 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.

Occupational Safety and Health Administration

SALARIES AND EXPENSES

Appropriation, fiscal year 2024....................... $632,309,000
Budget request, fiscal year 2025...................... 655,463,000
Committee Recommendation.............................. 557,772,000
Change from enacted level........................... -74,537,000
Change from budget request.......................... -97,691,000

The Occupational Safety and Health Administration (OSHA)
administers the Occupational Safety and Health Act of 1970, by
setting and enforcing health and safety standards for
workplaces and conducting training, outreach, education, and
compliance assistance.
Within the total for OSHA, the Committee provides the
following amounts:

------------------------------------------------------------------------
FY 2025
Budget Activity FY 2024 Enacted Committee
------------------------------------------------------------------------
Safety and Health Standards....... $21,000,000 $21,000,000
Federal Enforcement............... 243,000,000 182,250,000
Whistleblower Programs............ 22,500,000 22,500,000
State Programs.................... 120,000,000 120,000,000
Technical Support................. 26,000,000 26,000,000
Federal Compliance Assistance..... 78,262,000 78,262,000
State Consultation Grants......... 63,160,000 63,160,000
Training Grants................... 12,787,000 - - -
Safety and Health Statistics...... 35,500,000 35,500,000
Executive Direction and 10,100,000 9,100,000
Administration...................
------------------------------------------------------------------------

Mine Safety and Health Administration

SALARIES AND EXPENSES

Appropriation, fiscal year 2024....................... $387,816,000
Budget request, fiscal year 2025...................... 406,538,000
Committee Recommendation.............................. 367,816,000
Change from enacted level........................... -20,000,000
Change from budget request.......................... -38,772,000

The Mine Safety and Health Administration (MSHA) enforces
the Federal Mine Safety and Health Act of 1977 and the Mine
Improvement and New Emergency Response Act of 2006 in
underground and surface coalmines and metal/non-metal mines.
Within the total for MSHA, the Committee provides the
following amounts:

------------------------------------------------------------------------
FY 2025
Budget Activity FY 2024 Enacted Committee
------------------------------------------------------------------------
Mine Safety and Health Enforcement $265,774,000 $245,774,000
Standards and Regulations 5,000,000 5,000,000
Development......................
Assessments....................... 7,191,000 7,191,000
Educational Policy and Development 39,820,000 39,820,000
Technical Support................. 36,041,000 36,041,000
Program Evaluation and Information 17,990,000 17,990,000
Resources........................
Program Administration............ 16,000,000 16,000,000
------------------------------------------------------------------------

Resources and Activities.--The Committee notes significant
worker dislocations and mine closures because of economic
conditions throughout the mining industry, and particularly in
coal mining. 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 2024....................... $697,952,000
Budget request, fiscal year 2025...................... 712,786,000
Committee Recommendation.............................. 697,952,000
Change from enacted level........................... - - -
Change from budget request.......................... -14,834,000

The Bureau of Labor Statistics 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 $629,952,000 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 for BLS, the Committee provides the
following amounts:

Declining Statistical Survey Response Rates.--The Committee
notes a report (Report No. 17-24-001-11-001) issued on October
26, 2023, by the OIG that describes how the BLS addresses
challenges posed by declining statistical survey response
rates, and the impact of the declining response rates on the
reliability and costs of economic information developed by BLS.
The OIG recommended, among other things, that BLS, based on the
nonresponse bias study or imputation assessment, establish, as
applicable, a threshold at which the Consumer Price Index and
Import and Export Price Index must publicly disclose the number
of imputations used. The OIG also recommended that BLS update
program policies and procedures to include the established
threshold, and document how to publicly disclose when the
threshold is met. The Committee remains concerned that BLS may
not have guidelines that require a sufficient degree of
transparency and urges that all DOL-OIG recommendations be
sufficiently addressed.
Disaggregating Wage Data.--The Committee encourages BLS to
improve its collection and release of data on wages and
earnings by industry of occupation, worker characteristics, and
unemployment at the Federal and State levels disaggregated by
subpopulations.
Military Spouse Employment.--The Committee recognizes the
need for comprehensive data measuring employment among military
spouses over time. The Committee encourages BLS, in
collaboration with DOD, to assess the potential for measuring
labor market outcomes and characteristics of military spouses
with existing survey data and explore options for modifying
such surveys to capture this population.
Nonprofit Data.--BLS is directed to include in the fiscal
year 2026 congressional justification an estimate related to
the incorporation of nonprofit workforce data into the
Quarterly Census of Employment and Wages program.
Survey on Employer Provided Training.--The Committee
directs BLS to include, as part of the fiscal year 2026
congressional justification, a cost estimate of a survey to
better understand the incidence and nature of training provided
to employees by employers.

Departmental Management

SALARIES AND EXPENSES

Appropriation, fiscal year 2024....................... $388,197,000
Budget request, fiscal year 2025...................... 465,601,000
Committee Recommendation.............................. 178,072,000
Change from enacted level........................... -210,125,000
Change from budget request.......................... -287,529,000

The Departmental Management appropriation provides funds
for the staff responsible for Departmental operations,
management, and policy development.
The Committee recommendation includes $177,764,000 from the
General Fund of the Treasury 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:

------------------------------------------------------------------------
FY 2025
Budget Activity FY 2024 Enacted Committee
------------------------------------------------------------------------
Program Direction and Support..... $32,658,000 $25,658,000
Departmental Evaluation........... 4,281,000 3,281,000
Legal Services.................... 131,062,000 86,062,000
International Labor Affairs....... 116,125,000 - - -
Administration and Management..... 30,804,000 20,804,000
Adjudication...................... 37,000,000 30,000,000
Women's Bureau.................... 23,000,000 - - -
Civil Rights Activities........... 7,586,000 6,586,000
Chief Financial Officer........... 5,681,000 5,681,000
------------------------------------------------------------------------

Annual Appropriations.--The Committee notes that the
appropriations process is an annual process. The Committee
believes if the Administration is unable to obligate all annual
funding for salary and expense accounts, funding should be
reduced, not made available for multiple years. The Committee
has repeatedly rejected such requests for extended periods of
availability and requests information in the fiscal year 2026
congressional justification explaining why funding increases
are needed, if the Administration also continues to request
annual salaries be available for multiple fiscal years.
Bill Wide Requirements.--The Committee notes the inclusion
of a bill wide requirements section of this report. This
section contains requirements which apply to all agencies
funded by this Act.
Bureau of International Labor Affairs.--The Committee
provides no funding for the Bureau of International Labor
Affairs.
Coronavirus Aid, Relief, and Economic Security Act Program
Implementation.--The Committee continues to be concerned that
DOL and States struggled to implement the three key Coronavirus
Aid, Relief, and Economic Security Act UI programs (Pandemic
Unemployment Assistance, Pandemic Emergency Unemployment
Compensation, and Federal Pandemic Unemployment Compensation),
which received a total of $392 billion as of January 2, 2021. A
report (Report No. 19-21-004-03-315) issued on May 28, 2021, by
OIG, found that DOL's guidance and oversight did not ensure
States implemented the programs and paid benefits promptly;
performed required and recommended improper payment detection
and recovery activities; and reported accurate and complete
program activities. OIG recommended, among other things, that
DOL continue to work with States to develop, operate, and
maintain a modular set of technological capabilities to
modernize the delivery of UI benefits that is sufficient to
manage and process sudden spikes in claims volume during
emergencies or high unemployment. The Committee encourages that
all OIG recommendations be sufficiently addressed to mitigate
recurrence of the issues identified.
Chief Evaluation Officer.--The Committee notes with concern
the lack of program evaluations performed by the Chief
Evaluation Officer that evaluate programs based on the
employment and labor market outcomes of program participants.
Collaborations Between Manufacturers and Educational
Institutions.--The Committee continues to urge the Department
to develop pilot programs that facilitate education and
training programs in the field of advanced manufacturing.
Employee Stock Ownership Plans.--The Committee is concerned
about the Department's implementation of the SECURE 2.0 Act of
2022 (26 U.S.C. 1042), specifically a key provision related to
employee stock ownership plans (ESOPs). The law directs DOL to
issue formal guidance on the adequate consideration exemption,
as defined in section 407(d)(6) of the Employee Retirement
Income Security Act (ERISA). The Committee is aware that this
critical regulatory guidance for ESOPs has been neglected since
ERISA's passage in 1974, causing both significant enforcement
and investigation issues for decades and a deleterious effect
on ESOP formation. The Committee encourages the Department to
prioritize a timely, formal notice and comment rulemaking on
the adequate consideration exemption that ensures taxpayers
benefit from stakeholder input and experience.
Excess Personal Property.--The Committee directs DOL to
include in the fiscal year 2026 congressional justification
information the value and recipient of excess personal property
provided to apprenticeship programs under section 112 of this
Act.
Health Care Professions.--The Committee encourages DOL to
support efforts that connect unemployed workers with
credentials in health care with employers that have acute
workforce needs.
Interstate and Locality Paid Leave Requirements.--The
Committee recognizes that the patchwork of State and local paid
leave requirements creates difficulty for employers and
employees navigating mandatory paid family and medical leave
programs with varying characteristics and requirements. The
Committee directs DOL to produce and publicly release a report
detailing these paid leave programs, including whether and how
they coordinate with employer-provided leave; the actuarial
value of such programs and employer provided leave, accounting
for differences in programmatic features such as eligibility of
employees, wage replacement rate, maximum benefit amount, and
duration of benefits; and the comparative equivalence of such
programs by jurisdiction. The Committee directs DOL to provide
such report within 180 days of the enactment of this Act.
Investments in Impoverished Areas.--The Committee directs
DOL to update the report provided to the Committee in response
to a House Report 117-403 directive to include persistent
poverty percentages for competitions in fiscal year 2023 once
those data are available.
Return to Work.--Excessive abuse of telework across the
Federal government must end. For the average American showing
up to work every day is a fact of life; they deserve a
government that reflects that reality. Approvals for remote
work should be made on an individual case by case basis and
done only to serve the best interests of the program and the
American public. The agency is directed to provide to the
Committee within 60 days of enactment of this Act a report
detailing the number of full-time employees by subcomponent who
are receiving the Washington D.C. area locality pay but have
not reported to an in person office in the DC area more than
one day a week for the past year. Considering the remote work
abuse seen at several agencies, administrative funding for the
Secretary has been reduced accordingly. The Committee urges the
Secretary to bring Federal employees back to the workplace to
fulfill the mission of serving the American public.
Skilled Trades Workforce Development Outreach
Coordination.--The Committee encourages DOL to support the
development of coordinated State and regional outreach plans to
educate young Americans about the earning potential, career
pathways, benefits, and accessibility of careers in the skilled
trades.
Workforce Impacts Related to Vehicles From Foreign Entities
of Concern.--The Committee is concerned about the potential
impacts on U.S. workers from highly subsidized electric
vehicles and parts built by automakers from foreign entities of
concern. The Committee is also concerned by potential trade
practices inconsistent with the requirements of U.S.-Mexico-
Canada Agreement by these entities. Therefore, within 180 days
of enactment of this Act, the Committee directs the Department
to submit a report analyzing the potential risks to U.S.
workers of highly-subsidized electric vehicles and parts
manufactured by automakers from foreign entities of concern.

IT MODERNIZATION

Appropriation, fiscal year 2024....................... $29,269,000
Budget request, fiscal year 2025...................... 35,286,000
Committee Recommendation.............................. 29,269,000
Change from enacted level........................... - - -
Change from budget request.......................... -6,017,000

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

OFFICE OF INSPECTOR GENERAL

Appropriation, fiscal year 2024....................... $97,028,000
Budget request, fiscal year 2025...................... 106,237,000
Committee Recommendation.............................. 99,028,000
Change from enacted level........................... +2,000,000
Change from budget request.......................... -7,209,000

The Office of Inspector General conducts audits of
Department programs and operations to determine that they
comply with the applicable laws and regulations, that they use
resources effectively, and that they are achieving their
intended results.
The recommendation includes $93,187,000 from the General
Fund of the Treasury and $5,841,000 from the Employment
Security Administration Account in the Unemployment Trust Fund.
Fraud Reduction.--The Committee continues to recognize the
outstanding UI program oversight work performed by the OIG. The
DOL-OIG has shown that access to UI data is vital to hold
fraudsters accountable and perform oversight audits to ensure
efficient program operation and the preservation of precious
taxpayer dollars. Between April 1, 2020, and March 31, 2024,
the OIG's efforts to combat UI fraud resulted in more than
1,700 indictments/initial charges; 1,150 convictions; 26,000
months of incarceration ordered; and $1,000,000,000 in
investigative monetary results. Further, OIG's audit work
resulted in the issuance of 50 audit reports including 150
recommendations, more than $75,000,000,000 in funds put to
better use, and more than $277,000,000 in questioned costs
related to DOL's pandemic-related programs and operations. The
committee directs DOL to ensure that the OIG has timely access
to UI claim and wage data, including access to wage records,
for any authorized purpose under the Inspector General Act of
1978. The Committee directs DOL to report to Congress no later
than 180 days after enactment of this Act, on the steps it has
taken to ensure that OIG has access to UI and wage records for
all oversight activities authorized by the Inspector General
Act of 1978.

Office of Disability Employment Policy

SALARIES AND EXPENSES

Appropriation, fiscal year 2024....................... $43,000,000
Budget request, fiscal year 2025...................... 44,876,000
Committee Recommendation.............................. 43,000,000
Change from enacted level........................... - - -
Change from budget request.......................... -1,876,000

The Office of Disability Employment Policy provides policy
guidance and leadership to eliminate employment barriers to
people with disabilities.

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 more than 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 more than Executive Level II.

(TRANSFER OF FUNDS)

Sec. 106. The Committee modifies 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 modifies 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 modifies a provision relating to
the Fair Labor Standards Act and certain insurance personnel
conducting post-disaster activity.
Sec. 109. The Committee continues a provision relating to
flexibility of H-2B nonimmigrant crossings.
Sec. 110. The Committee continues a provision related to
the prevailing wage in the H-2B program.
Sec. 111. The Committee continues a provision related to
workers in the H-2B program.
Sec. 112. The Committee modifies a provision relating to
surplus property and apprenticeship programs.
Sec. 113. The Committee modifies a provision relating to
the Secretary's security detail.
Sec. 114. The Committee continues a provision relating to
the Treasure Island and Gary Job Corps Centers.
Sec. 115. The Committee continues a provision relating to
Job Corps Civilian Conservation Centers.

(RESCISSION)

Sec. 116. The Committee includes a provision rescinding
balances made available from section 286 of the Immigration and
Nationality Act.
Sec. 117. The Committee includes new a provision extending
the statute of limitations for pandemic UI fraud.
Sec. 118. The Committee includes new a provision related to
Adverse Effect Wage Rate determination.
Sec. 119. The Committee includes new a provision related to
H-2A rulemaking.
Sec. 120. The Committee includes a new prohibition related
to final rules entitled ``Employee or Independent Contractor
Classification Under the Fair Labor Standards Act,'' and
``Defining and Delimiting the Exemptions for Executive,
Administrative, Professional, Outside Sales, and Computer
Employees.''
Sec. 121. The Committee includes a new prohibition related
to final rules, ``Prudence and Loyalty in Selecting Plan
Investments and Exercising Shareholder Rights,'' ``Retirement
Security Rules: Definition on an Investment Advice Fiduciary,''
``Amendment to Prohibited Transaction Exemption 2020-02,''
``Amendment to Prohibited Transaction Exemption 84-24,'' and
``Amendment to Prohibited Transaction Exemptions 75-1, 77-4,
80-83, 83-1, and 86-128.''
Sec. 122. The Committee includes a new provision related to
the proposed rule ``National Apprenticeship System
Enhancements.''
Sec. 123. The Committee includes a new provision related to
the final rule ``Lowering Miners' Exposure to Respirable
Crystalline Silica and Improving Respiratory Protection.''
Sec. 124. The Committee includes a new provision related to
the final rule ``Worker Walkaround Representative Designation
Process.''

TITLE II--DEPARTMENT OF HEALTH AND HUMAN SERVICES

Appropriation, fiscal year 2024................ $116,122,958,000
Budget request, fiscal year 2025............... 121,548,671,000
Committee Recommendation....................... 107,640,959,000
Change from enacted level.................... -8,481,999,000
Change from budget request................... -13,907,712,000

The Department of Health and Human Services (HHS)
anticipates exceeding $1.8 trillion in total spending,
constituting over 6 percent of the U.S.' gross domestic
product. Over 90 percent of this expenditure is mandatory, with
discretionary funding, overseen by the Committee on
Appropriations, comprising only 9 percent. Since 2010, the
percentage spent on discretionary programs has actually
decreased, while mandatory program spending has more than
doubled. The escalating pace of mandatory entitlement driven
spending remains the primary cost driver within the agency.
This bill provides just over $107 billion in discretionary
budget authority for HHS, a reduction of 7 percent over fiscal
year 2024 enacted level. HHS comprises 58 percent of the total
302(b) allocation for this subcommittee.

Health Resources and Services Administration

Appropriation, fiscal year 2024....................... $9,171,787,000
Budget request, fiscal year 2025...................... 8,530,564,000
Committee Recommendation.............................. 7,638,837,000
Change from enacted level........................... -1,532,950,000
Change from budget request.......................... -891,727,000

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
$7,372,110,000 in discretionary budget authority and
$266,727,000 in mandatory funding.

PRIMARY HEALTH CARE

Appropriation, fiscal year 2024....................... $1,858,772,000
Budget request, fiscal year 2025...................... 1,858,772,000
Committee Recommendation.............................. 1,858,772,000
Change from enacted level........................... - - -
Change from budget request.......................... - - -

Health Centers

Health Centers deliver affordable, accessible, quality, and
cost-effective primary health care to millions of people across
the country regardless of their ability to pay. Programs
supported by this funding include community health centers,
migrant health centers, health care for the homeless, and
public housing health service grants.
The Committee includes bill language providing up to
$120,000,000 for the Federal Tort Claims Act program, the same
as the fiscal year 2024 enacted level and the fiscal year 2025
budget request.
Within the total provided for the Health Centers program,
the Committee provides not less than the following amounts:

------------------------------------------------------------------------
FY 2025
Budget Activity FY 2024 Enacted Committee
------------------------------------------------------------------------
Addressing Intimate Partner $2,000,000 $2,000,000
Violence and Project Catalyst....
Alcee L. Hastings Program for 10,000,000 10,000,000
Advancing Cancer Screening.......
Early Childhood Development....... 30,000,000 30,000,000
Native Hawaiian Health Care....... 27,000,000 27,000,000
Papa Ola Lokahi (non-add)..... 10,000,000 10,000,000
School Based Health Centers....... 55,000,000 55,000,000
Technical Assistance.............. 2,500,000 2,500,000
------------------------------------------------------------------------

Alcee L. Hastings Program for Advanced Cancer Screening in
Underserved Communities.--The Committee commends the work of
HRSA in effectively implementing the Alcee L. Hastings Program
for Advanced Cancer Screening in Underserved Communities. This
innovative program focuses on HRSA-funded health centers to
leverage Cancer Center trained and supervised outreach
specialists and patient navigators to conduct patient outreach,
patient education, case management, and other patient support
services in underserved communities served by health centers to
promote early detection and prevention of cancer, connect
patients to screening services, and provide direct assistance
with accessing high quality cancer care and treatment as
needed. This program is progressing as intended with health
centers reporting progress toward stated goals. The grant
funding has made it possible for health centers to improve
access to and affordability of cancer screening, referral for
care, and treatment; to enhance patient experience; and to
recruit, train, and engage cancer-focused professionals. Within
the total for health centers, the Committee provides robust
funding to continue supporting screening initiatives in breast,
cervical, colorectal, and lung cancer; prioritize new grantees
in States where the total number of estimated new cancer cases
and deaths due to cancer are highest; and to support grantees
that can expand existing projects that embrace additional
cancers, and that also work to secure appropriate follow up
screening and access to care for individuals with abnormal
screening results.
Base Grant Adjustments.--The Committee recognizes that
Health Center costs have increased significantly and that it
has been nearly a decade since the last base grant adjustment.
The Committee encourages HRSA to consider the needs of existing
health centers in relation to their current base grants when
allocating increased health center funding.
Expanded Service Grants for Individuals with an
Intellectual or Developmental Disability.--The Committee
supports efforts to expand service grants to health centers for
the planning and delivery of services to individuals with an
intellectual or developmental disability, including for
innovative programs that provide outreach and comprehensive
primary health services and additional health services as
defined in section 330(b) of the Public Health Service (PHS)
Act (42 U.S.C. 254b), including dental care.
Federally Qualified Health Center Look Alike
Participation.--The Committee is concerned that certain health
centers--and in turn, certain groups of patients--throughout
the country are unable to realize the benefits of federal
funding for high-quality primary care services due to Federally
Qualified Health Center Look Alike (FQHC LALs) ineligibility to
apply for supplemental funding awards. In many geographic
regions, FQHC LALs are ideal candidates for supplemental
funding opportunities but are ineligible to apply for them.
Given the access to care issues many communities currently
face, widespread healthcare workforce challenges, and the
ability of many FQHC LALs to help meet the country's current
unmet health care needs, the Committee requests that HRSA
provide an update to the committees of jurisdiction on the
impacts of allowing FQHC LALs to apply for Supplemental Funding
opportunities under section 330(d) of the PHS Act (42 U.S.C.
254b) within 180 days of enactment of this Act.
Additionally, the Committee requests that HRSA provide a
report to the House and Senate Committees on Appropriations;
the House Committee on Energy and Commerce; and the Senate
Committee on Health, Education, Labor and Pensions on the ways
in which FQHC LALs could be better utilized as a pipeline into
the Section 330 Health Center program.
Native Hawaiian Health Care.--The Committee continues
$27,000,000 for the Native Hawaiian Health Care Program. Of the
total amount appropriated for the Native Hawaiian Health Care
Program, not less than $10,000,000 shall be provided to Papa
Ola Lokahi for administrative purposes authorized under 42
U.S.C. 11706, including expanded research and surveillance
related to the health status of Native Hawaiians and
strengthening the capacity of the Native Hawaiian Health Care
Systems.
Parental Consent.--The Committee directs HRSA to ensure
grantees comply with all Federal and State laws for parental
and legal guardian approval for medical decisions involving
minors. Grantees should not provide materials encouraging
health care providers to hide a minor patient's perceived
sexual orientation or any effort that deviates from the
patient's biological sex from the patient's parent or guardian.
Technical assistance and guidance documentation should be
consistent with all Federal and State law regarding parental
consent. Moreover, grantees should not be providing any
guidance to health care practitioners for ways to bypass
parental consent or how to keep medically relevant information
from a patient's medical record.
School-Based Health Centers.--The Committee continues
funding for school based health centers authorized under
section 330 of the PHS Act (42 U.S.C. 254b).
Sleep Disorders.--The Committee notes delays in diagnosis
for some affected by sleep disorders. Advancements in screening
continue to create meaningful opportunities to recognize
conditions and link patients to care, and to mitigate the
negative outcomes that occur when patients, particularly
children, endure undiagnosed and sometimes easily treatable
conditions. The Committee supports efforts to explore
opportunities to enhance sleep screening and related awareness
tools among frontline health providers and to otherwise work
with stakeholders to advance efforts that quickly recognize
sleep disorders and link patients to appropriate care.
Tardive Dyskinesia.--The Committee supports efforts for
screening, diagnosing, and treating Tardive Dyskinesia (TD), a
persistent, irreversible, and potentially disabling
neurological condition that is associated with prolonged
exposure to antipsychotics and other dopamine receptor blocking
agents. The estimated prevalence of TD has increased from
500,000 to 600,000 people in the U.S., with only an estimated
35 percent of people living with this little-known and
challenging movement disorder being diagnosed to date. The
Committee supports HRSA's goal of integrating behavioral health
and primary care.
Testing for Hepatitis C.--The Committee recognizes the
value of point of care testing for the hepatitis C virus and
supports efforts by HRSA to adopt practices and policies to
test for the hepatitis C virus. The Committee further
encourages HRSA to ensure that health centers have access to
and utilize available point of care diagnostic tests to
adequately test the populations they serve.
Type 1 Diabetes.--Health centers remain a major source of
primary health care for millions of Americans. Therefore, the
Committee supports ways to increase type 1 diabetes screenings
at health centers, particularly among high-risk populations.
HHS has reported increased incidents of diabetic ketoacidosis
(DKA) at diagnosis, with rates over 40 percent among youth in
some years. Further, misdiagnosis with type 2 diabetes is a
leading risk factor for adults entering DKA at diagnosis. A
2020 study from Diabetes Care showed that charges associated
with DKA admissions totaled over $6,700,000,000 in 2017. HRSA
is directed to provide a report to the Committee 180 days after
the enactment of this Act addressing the steps needed to
increase screening efforts for type 1 diabetes at health
centers and to make such report available on the agency's
website. The report should include the feasibility and cost
estimate of expanding screening efforts among targeted
populations as well as a plan and timeline to implement such
efforts. When developing the report, HRSA should consult with
the National Institute of Digestive and Kidney Diseases,
patient advocacy organizations, and other type 1 diabetes
stakeholders.
Vaccination.--The Committee encourages HRSA to redouble
efforts to support health center grantees to adopt the
necessary practices and policies to comply with the November
2021 Advisory Committee on Immunization Practices
recommendation that all adults between 19 and 59 be vaccinated
and the March 2023 CDC recommendation that all adults in the
U.S. be screened for hepatitis B. The Committee further
encourages HRSA to provide guidance to health centers about
screening and immunization for patients in the 19-59 age
cohort.
Voting Registrations.--Health centers provide an accessible
option for primary health care to millions of people across the
country. However, the Committee is concerned with health
centers allocating taxpayer funds for uses outside their
intended purpose. HRSA guidance states that, ``Health Center
Program grant funding made available to provide health services
to medically underserved populations under section 330 of the
PHS Act cannot be used to support voter registration efforts.''
While the guidance does allow discretion for health centers to
participate in such activities outside the Health Center
program, the Committee is concerned that health centers' focus
on voter registration activities has grown to such an extent
that it impairs the purpose of the program. The Committee
requests that the Department include an update in the fiscal
year 2026 congressional justification on implementation of
Executive Order 14019 entitled, ``Promoting Access to Voting'',
the use of health center funding for voter registration, and
whether such use violates requirements laid out in statute or
program guidance.

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 2024 enacted level and the fiscal year 2025
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 2024....................... $1,404,376,000
Budget request, fiscal year 2025...................... 1,467,376,000
Committee Recommendation.............................. 1,342,011,000
Change from enacted level........................... -62,365,000
Change from budget request.......................... -125,365,000

The Bureau of Health Workforce supports several health care
workforce programs by providing grants, scholarships, and loan
repayment to help communities recruit and retain health care
providers.
Community Based Clinical Rotations.--An estimated 80
percent of patient care is now provided in a range of
community-based settings rather than the academic hospital
where clinical training has traditionally occurred. Research
shows that providing outpatient training opportunities in
underserved areas--either in conjunction with or outside of
inpatient training programs--encourages long-term, sustainable
physician practice in high-need areas. The Committee recognizes
that prioritizing community-based clinical training in rural
and underserved areas leads to more physicians staying to
practice in these communities. The Committee urges HRSA to work
with medical schools to partner with health centers, rural
health clinics, or other healthcare facilities located in
medically underserved communities to increase medical school
clinical rotations in rural and underserved areas.
Health Professional Shortage Areas in Non-Contiguous
States.--The Committee recognizes the significant geographical
and transportation challenges faced by patients and health
professionals in non-contiguous States, which lead to
difficulties in recruiting and retaining health professionals.
The Committee recognizes that according to HRSA's Report to the
Committee pursuant to the joint explanatory statement which
accompanied the Consolidated Appropriations Act, 2021 (P.L.
116-260), HRSA awarded only 83 new National Health Service
Corps (NHSC) Loan Repayment Program Awards to clinicians
completing an NHSC service obligation in non-contiguous States,
out of 16,229 nationally. The Committee notes that the current
health professional shortage areas designation criteria may not
adequately account for the unique challenges faced by non-
contiguous States.
Health Professions Workforce Enhancement Initiative.--The
Committee notes that over the last 30 years, the U.S. has
introduced several programs and initiatives designed to enhance
the academic success of historically underrepresented groups
and students from underserved areas matriculating into health
professions education programs. The Committee acknowledges the
matriculation challenges from these underserved areas
demonstrate that no single solution is sufficient and
encourages the development of a comprehensive strategy that
identifies, prepares, and trains students in underserved areas
or from historically underrepresented groups for academic
success in health professions education programs.
Interstate Licensure.--The Committee recognizes that almost
100 million Americans live in a primary care health
professional shortage area and over 156 million--almost half of
the U.S. population--live in a mental health care health
professional shortage area. While efforts continue to support
the recruitment and retention of the healthcare workforce,
optimizing the existing workforce is critical. The Interstate
Medical Licensure Compact, created under the Licensure
Portability Grant Program, is a voluntary, expedited pathway to
licensure for qualified health care professionals, including
psychologists, to practice in multiple States. Since 2015, the
compact has grown from 7 member States to 37 member States, as
well as Washington, D.C. and Guam. The Committee encourages
HRSA to expand public awareness of these compacts to encourage
robust provider participation.
Natural Procreative Technology Education and Training.--
Natural Procreative Technology (NaProTECHNOLOGY), a female
specific approach to health, monitors and maintains a woman's
reproductive and gynecological health. The laparoscopic
surgical approach of NaProTECHNOLOGY requires specialization in
the form of gynecologic surgery. The primary aim of the surgery
is to reconstruct the uterus, fallopian tubes, ovaries, and
other organ structures so that endometriosis can be eliminated.
The excision of endometriosis can alleviate pain and increase
the preservation of fertility. At least 7 million women in the
U.S. struggle with endometriosis, and there are only about 22
surgeons adequately trained in NaProTECHNOLOGY. Medical
training in NaProTECHNOLOGY requires an extra fellowship year
for surgeons. Addressing this gap in care is crucial, given the
rising number of endometriosis diagnoses. The Committee
encourages HRSA to explore scholarship and loan opportunities
for medical students and professionals interested in pursuing
this specialty.
Nutrition Education.--The Committee is aware that in the
U.S. today, 42 percent of adults are living with obesity, and
1.5 million Americans die annually from diet-related diseases
such as cardiovascular disease, cancer, and diabetes. Despite
this, the average medical school provides only 19 hours of
nutrition education throughout a student's four years in
medical school, and nutrition-related competencies are limited
or absent from most medical specialties in graduate medical
education. Therefore, the Committee encourages the Department
to pursue all opportunities to encourage medical accrediting
bodies such as the Accreditation Council for Graduate Medical
Education, the Association of American Medical Colleges, the
American Association of Continuing Medical Education (CME), and
State CME organizations, to incorporate nutrition competencies
into their training requirements. The Committee requests an
update on this topic in the fiscal year 2026 congressional
justification.
Real Time Data to Improve U.S. Healthcare Workforce.--The
Committee supports efforts to develop a data dashboard for all
graduate medical education training position participants to
include real-time information on residency applications,
interviewee demographics, and residency fulfillment rates. The
National Center for Health Workforce Analysis has projected
shortages across a wide range of health care occupations,
particularly in rural areas. As a result, HRSA has increased
its focus on rural residency training, including through the
Rural Residency Planning and Development program. The Committee
recognizes the benefit of using real-time information to assess
whether such programs are leading to improved physician supply
in medically underserved areas.
State Based Nursing Workforce Centers.--The Committee notes
interest in State-based nursing workforce centers. Such centers
can collect local workforce research data, conduct strategic
nursing workforce planning and program development, support
programs to decrease workplace violence against nurses, develop
programs to increase the recruitment and retention of nurses,
and coordinate nurse leadership development programs. The
Committee requests an update on the status of State-based
nursing workforce centers in the fiscal year 2026 congressional
justification.

National Health Service Corps

The Committee includes $130,000,000, which is $1,400,000
above the fiscal year 2024 enacted level and $4,400,000 above
the fiscal year 2025 budget request, for the National Health
Service Corps (NHSC) to support competitive awards to health
care providers dedicated to working in underserved communities
in urban, rural, and Tribal areas.
State Loan Repayment Program.--The Committee appreciates
that the State Loan Repayment Program (SLRP) program allows
States to determine how to address healthcare provider
shortages. However, the Committee is concerned that many States
are not focusing on the full range of healthcare providers in
shortage, including in nursing, pharmacy, dentistry, and
behavioral healthcare. The Committee directs HRSA to include in
the fiscal year 2026 congressional justification information
regarding the process for how States determine which health
professions benefit from the SLRP with recommendations to
improve SLRP access to all professions in shortage in the
States.
Tribal Set Aside.--The Committee also includes a set aside
of 15 percent within the discretionary total provided for NHSC
to support awards to participating individuals that provide
health services in Indian Health Service facilities, Tribally-
operated health programs, and Urban Indian Health programs.

Health Professions Education and Training

The Committee recommends $459,882,000 for the health
professions education and training programs authorized under
title VII of the PHS Act, which is $60,422,000 below the fiscal
year 2024 enacted level and $115,922,000 below the fiscal year
2025 budget request.

Centers of Excellence and Health Careers Opportunity Program

The Committee does not include funding for these programs.

Faculty Loan Repayment

The Committee includes $2,310,000 for Faculty Loan
Repayment, equal to the fiscal year 2024 enacted level and the
fiscal year 2025 budget request. This program provides loan
repayment to health professions graduates from disadvantaged
backgrounds who serve as faculty at eligible health professions
academic institutions.

Scholarships for Disadvantaged Students

The Committee includes $55,014,000 for Scholarships for
Disadvantaged Students (SDS), equal to the fiscal year 2024
enacted level and the fiscal year 2025 budget request. The SDS
program provides grants to health professions and nursing
schools to provide scholarships to students from disadvantaged
backgrounds who have financial need. The Committee notes the
success of the program and encourages HRSA to prioritize
institutions with a proven record of both training diverse
practitioners and placing their practitioners in low-income
communities.
Set Aside for Midwifery Training.--Within the total for
SDS, the Committee includes $5,000,000, the same as the fiscal
year 2024 enacted level, to continue grants awarded for the
purpose of educating midwives to address the national shortage
of maternity care providers. The Committee supports HRSA
awarding robust funding in grants to invest in the maternal and
perinatal health nursing workforce by increasing and
diversifying the number of Certified Nurse Midwives,
particularly in rural and underserved communities.

Primary Care Training and Enhancement

The Committee includes $49,924,000, which is the same as
the fiscal year 2024 level and the fiscal year 2025 budget
request, for Primary Care Training and Enhancement programs.
These programs address the primary care workforce by supporting
enhanced training for future primary care clinicians and
faculty and promoting primary care practice, particularly in
rural and underserved areas.

Oral Health Training

The Committee includes $43,673,000 for Oral Health
Training, $1,000,000 above the fiscal year 2024 enacted level
and the fiscal year 2025 budget request. The Oral Health
Training programs increase access to high-quality dental health
services in rural and other underserved communities by
increasing the number of oral health care providers working in
underserved areas and improving training programs for these
providers.
Within the funds provided, the Committee includes not less
than $13,500,000 for general dentistry programs and not less
than $13,500,000 for pediatric dentistry programs, and not less
than $15,000,000 for State oral health workforce grants. The
Committee directs HRSA to provide continuation funding for
section 748 post-doctoral training grants, predoctoral dental
grants, and dental faculty loan repayment grants.

Interdisciplinary Community-Based Linkages

Area Health Education Centers

The Committee includes $47,000,000 for the Area Health
Education Centers program, equal to the fiscal year 2024
enacted level and equal to the fiscal year 2025 budget request.
This program links university health science centers with
community health service delivery systems to provide education
and training networks.

Geriatrics Workforce Enhancement Programs

The Committee includes $48,245,000 for Geriatrics Workforce
Enhancement programs, equal to the fiscal year 2024 level and
$1,000,000 above the fiscal year 2025 budget request. These
programs support training to integrate geriatrics into primary
care delivery and develop academic-primary care-community based
partnerships to address gaps in health care for older adults.

Mental and Behavioral Health Programs

The Committee adopts the budget request to consolidate
activities funded under Mental and Behavioral Health programs
into Behavioral Health Workforce Education and Training.

Behavioral Health Workforce Education and Training

The Committee includes $158,053,000 for the Behavioral
Health Workforce Education and Training (BHWET) program,
$1,000,000 above the comparable fiscal year 2024 enacted level
and $95,500,000 below the fiscal year 2025 budget request. This
program establishes and expands internships or field placement
programs in behavioral health, serving populations in rural and
medically underserved areas.
Within the total for BHWET, the Committee recommends not
less than the following amounts:

------------------------------------------------------------------------
FY 2025
Budget Activity FY 2024 Enacted Committee
------------------------------------------------------------------------
Graduate Psychology Education..... $25,000,000 $25,000,000
Mental and Substance Use Disorder 34,700,000 34,700,000
Workforce Training Demonstration.
Addiction Medicine Fellowship 25,000,000 25,000,000
(non-add)....................
Peer Support Specialists.......... 14,000,000 15,000,000
------------------------------------------------------------------------

Crisis Service Models.--Crisis service models present
opportunities for cost savings and more effective use of the
behavioral health workforce. By stabilizing individuals
experiencing behavioral health crises in settings that are less
intensive and less costly than traditional acute care, these
models align the level of intervention needed by a client to
address a crisis with the level of training and credentials of
a provider. The Committee encourages HRSA to include crisis
workforce development, as appropriate, in the BHWET programs.
Graduate Psychology Education.--The interprofessional
Graduate Psychology Education program increases the number of
health service psychologists trained to provide integrated
services to high-need, underserved populations in rural and
urban communities. The Committee notes new data from CDC
demonstrating a rise in mental health issues for youth and
adolescents and urges HRSA to strengthen investments in the
training of health service psychologists to help address this
population.
Mental and Substance Use Disorder Workforce Training
Demonstration.--This program makes grants to institutions,
including but not limited to medical schools and Federally
qualified health centers, to support training for medical
residents and fellows in psychiatry and addiction medicine, as
well as nurse practitioners, physician assistants, and others,
to provide substance use disorder (SUD) treatment in
underserved communities. Within the total included for this
activity, the Committee directs HRSA to use no less than 50
percent of the total funds to award grants to expand the number
of nurse practitioners, physician assistants, health service
psychologists, counselors, nurses, and social workers trained
to provide mental health and substance use disorder services in
underserved and rural community-based settings, including such
settings that serve pediatric populations, as authorized under
section 760 of the PHS Act.
The Addiction Medicine Fellowship program provides
fellowships to train addiction medicine physicians and
addiction psychiatrists who work in underserved, community-
based settings that integrate primary care with mental health
disorder and SUD prevention and treatment services. One major
cause of the existing treatment gap is that physicians in
traditional medical settings lack the necessary training and
overall confidence to provide comprehensive assessments of
adolescents with SUD and subsequent evidence-based treatment.
The fellowship opportunities funded by this program provide
advanced training opportunities to a wide range of specialists,
including those in family medicine, internal medicine,
psychiatry, and emergency medicine.
Peer Support Specialists.--The Committee supports community
based experiential training for students preparing to become
peer support specialists and other types of behavioral health-
related paraprofessionals. The Committee includes a $1,000,000
increase for this activity.
Youth Behavioral Health Workforce.--The Committee
recognizes the access limitations for child and youth
behavioral health services. Some children are impacted by
socioeconomic or geographic factors. The Committee requests an
update in the fiscal year 2026 congressional justification
outlining funding available for child and adolescent behavioral
health workforce development. The update should note the type
of child and adolescent behavioral health professionals being
trained with HHS funding and the number of individuals being
trained in each type.

Substance Use Disorder Treatment and Recovery (STAR) Loan
Repayment Program

The Committee includes $40,000,000 for this program, the
same as the fiscal year 2024 enacted level. 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 HPSA or a county where the overdose
death rate exceeds the national average.

National Center for Health Workforce Analysis

The Committee includes $5,663,000 for this program, the
same as the fiscal year 2024 enacted level and the fiscal year
2025 budget request. The National Center for Health Workforce
Analysis (NCHWA) is the primary Federal entity that collects,
analyzes, and reports on data and information regarding the
U.S. health workforce. NCHWA also evaluates the effectiveness
of HRSA's workforce investment programs.

Public Health and Preventive Medicine Training Programs

The Committee does not include funding for these programs.

Nursing Workforce Development

The Committee recommends $287,129,000 for the Nursing
Workforce Development programs authorized under title VIII of
the PHS Act, $18,343,000 below the fiscal year 2024 enacted
level and $33,343,000 below the fiscal year 2025 budget
request.
Nursing Workforce Programs.--The Committee recognizes the
important role of hospital-based schools of nursing in
preparing a highly skilled nursing workforce with the clinical
experience to meet the growing demand for nurses to provide
care at the bedside. The Committee encourages HRSA to identify
opportunities to increase participation from hospital-based
schools of nursing in HRSA workforce programs.

Advanced Nursing Education

The Committee includes $89,581,000 for Advanced Nursing
Education, equal to the fiscal year 2024 enacted level. This
program supports traineeships and faculty and curriculum
development to increase the number of qualified nurses in the
primary care workforce.
Certified Nurse Midwives.--The Committee continues
$8,000,000 for Certified Nurse Midwives within Advanced Nursing
Education.
Sexual Assault Nurse Examiners.--The Committee continues
$15,000,000 for this activity. HRSA is encouraged to prioritize
rural, Tribal, and underserved communities, and urban areas
without full-time coverage for this program. This program shall
provide training and supervision to nurses with the purpose of
increasing sexual assault forensic nurse capacity in rural
areas, and in support of population-specific programs and
hospitals including, but not limited to, underserved or
historically underfunded communities. Entities receiving these
funds shall promote best practices in forensic nursing
throughout a region, while continuing to research and develop
the highest standards of care.

Nursing Education, Practice, Quality, and Retention

The Committee includes $69,413,000 for the Nursing
Education, Practice, Quality, and Retention (NEPQR) programs,
an increase of $5,000,000 above the fiscal year 2024 enacted
level and equal to the fiscal year 2025 budget request. These
programs support academic, service, and continuing education
projects to enhance nursing education, improve the quality of
care, increase nurse retention, and strengthen the nursing
workforce.
Community Colleges.--The Committee recognizes the important
role that community colleges play in the education of our
health workforce, including in nursing. The Committee provides
an increase of $5,000,000 above the fiscal year 2024 enacted
level to further support community college participation within
NEPQR. The Committee directs HRSA to give priority to
applications from community colleges or eligible partnerships
that include a community college with this additional funding.
Experiential Learning.--Nursing schools are facing
unprecedented challenges in delivering high quality clinical
experiences necessary for training practice-ready nurses. In-
person labs and clinical rotations have been limited, making it
challenging to ensure students gain clinical reasoning skills
through realistic interactions. And there continues to be a
shortage of clinical practice sites, so use of experiential
learning can help alleviate the capacity shortages and enable
nursing schools to scale programs. Nursing schools are eligible
to apply for HRSA simulation education training grants and use
of simulations will increase the practice readiness of nurses,
which can improve retention once nurses enter clinical practice
and reduce stress and burnout. Within the total for NEPQR, the
Committee continues $10,750,000 for grants to enhance nurse
education through the expansion of experiential learning
opportunities. The grants shall include as an allowable use the
purchase of simulation training equipment.
Nursing Workforce Shortages.--The U.S. Bureau of Labor
Statistics projects 203,200 openings for nurses in the U.S.
each year through 2031. With an aging population with greater
health care needs, an aging clinical and faculty workforce, and
a decline in the number of students in entry-level nursing
programs, the Committee believes action must be taken to
alleviate this crisis and ensure an ample, well-trained nursing
workforce for the future. The Committee supports efforts to
expand the nursing workforce at all levels to meet the growing
health needs of our population. The Committee encourages
efforts to greatly expand the number of nursing faculty and
clinical preceptor sites to educate students at all levels.

Nurse Practitioner Optional Fellowship Program

The Committee provides $7,000,000, which is $1,000,000
above the fiscal year 2024 enacted level. This program supports
grants to establish or expand community-based nurse
practitioner residency and fellowship training programs for
practicing postgraduate nurse practitioners in primary care or
behavioral health.

Nursing Workforce Diversity

The Committee does not include funding for this program.

Nurse Corps Scholarship and Loan Repayment

The Committee includes $92,635,000 for Nurse Corps, equal
to the fiscal year 2024 enacted level and the fiscal year 2025
budget request. This program supports scholarships and loan
repayment assistance for nurses and nursing students committed
to working in communities with inadequate access to care.

Nursing Faculty Loan Program

The Committee includes $28,500,000 for the Nursing Faculty
Loan Program, the same as the fiscal year 2024 enacted level
and the fiscal year 2025 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.
Nursing School Faculty Shortage Assessment.--The Committee
urges HRSA to make available, to the extent practicable, data
on nursing school teaching faculty and educators in the U.S.

Children's Hospitals Graduate Medical Education

The Committee includes $395,000,000 for the Children's
Hospitals Graduate Medical Education (GME) program, which is
$5,000,000 above the fiscal year 2024 enacted level and
$10,000,000 above the fiscal year 2025 budget request. This
program helps eligible hospitals maintain GME 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 $70,000,000, which is $10,000,000
above the fiscal year 2024 enacted level to support colleges of
medicine at public universities located in the top quartile of
States projected to have a primary care provider shortage.
The Committee directs HRSA to give priority to applications
from academic institutions located in States with the greatest
number of Federally recognized Tribes. The Committee also
directs HRSA to give priority to applications from public
universities with a demonstrated public-private partnership.

Pediatric Specialty Loan Repayment Program

The Committee includes $10,000,000, equal to the fiscal
year 2024 enacted level and the fiscal year 2025 budget
request, for the pediatric specialty loan repayment program
authorized by section 775 of the PHS Act.
The Committee is concerned that once again the 2024
application process does not adequately reflect the way
pediatric specialty care is provided nor the Committee's
feedback from the fiscal year 2024 joint explanatory statement.
The Committee remains concerned that pediatric medical
specialists, pediatric surgical specialists, and child and
adolescent psychiatrists, were underrepresented in the initial
awards of the program despite the intent of the program. The
Committee strongly urges HRSA to work with stakeholders to
ensure that the program's application process includes clinical
hour requirements and site eligibility criteria that are
consistent with pediatric specialty practice and reflects the
regionalization of pediatric specialty care.

National Practitioner Data Bank

The Committee includes $18,814,000 for the National
Practitioner Data Bank (NPDB), the same as the fiscal year 2024
enacted level and the fiscal year 2025 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 2024....................... $1,170,430,000
Budget request, fiscal year 2025...................... 1,234,944,000
Committee Recommendation.............................. 1,018,582,000
Change from enacted level........................... -151,848,000
Change from budget request.......................... -216,362,000

The mission of the Maternal and Child Health Bureau is to
improve the physical and mental health, safety, and well-being
of the nation's women, infants, children, adolescents, and
their families.
Nutrition.--The U.S. continues to experience higher rates
of maternal morbidity and mortality relative to other nations.
Poor nutrition combined with chronic health conditions
threatens the health and wellbeing of mothers and infants
alike. The Committee supports efforts by HRSA to work with
community-based organizations to develop interventions for
maternal populations at risk of poor health outcomes due to
poor nutrition and other health related risk factors. Such
efforts could target maternal populations in low income and
underserved urban and rural areas and demonstrate improvements
in fruit and vegetable intake; health outcomes, such as
gestational weight gain; overall physical and mental health;
and wellbeing for a cohort of pregnant women, as well as
positive birth outcomes.

Maternal and Child Health Services Block Grant

The Committee recommends $608,584,000 for the maternal and
child health (MCH) services block grant, which is $5,000,000
above the fiscal year 2024 enacted level and the fiscal year
2025 budget request. States use these funds 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.
Community Integrated Service Systems.--The Committee
recommends $10,276,000 for community integrated service system,
which is the same as the fiscal year 2024 enacted level and the
fiscal year 2025 budget request. These grants help States and
communities build a comprehensive, integrated system of care to
improve access and outcomes for all children, including
children with special health care needs.
Congenital Cytomegalovirus.--Congenital Cytomegalovirus
(CCMV) is the most common viral infection infants are born with
in the U.S. and the leading non-genetic cause of hearing loss.
One-in-five of those infected will have serious health
complications such as epilepsy, visual impairment, or
developmental delays. Emerging research has shown that early
intervention treatments, such as anti-viral drugs, may prevent
or lessen the severity of hearing loss in infants born with
CCMV. The Committee urges HRSA to expand efforts to provide
CCMV education during pregnancy, ensure infants born with CCMV
are identified and provided with opportunities for treatment,
hearing screening, and early intervention, and increase
screening and testing for CCMV during pregnancy.
Self-Measured Blood Pressure Monitoring.--The Committee
notes the promise of the Healthy Start blood pressure
monitoring pilot, including the distribution of cuff kits to 15
sites in 12 States. The Committee would like to see more States
benefit from this project and urges continued support and
expansion of this effort to the extent practicable. The self-
measured blood pressure monitoring pilot works to identify
preeclampsia at an earlier stage in high-risk communities by
distributing blood pressure cuffs and patient information.
Preeclampsia, the most dangerous form of hypertension, is a
pregnancy complication that effects as many as 1 in 12
pregnancies and can be easily monitored.

MCH Block Grant Special Projects of Regional and National
Significance

The Committee recommends $194,268,000 for the special
projects of regional and national significance (SPRANS), which
is $15,848,000 below the fiscal year 2024 enacted level and
$33,862,000 below the fiscal year 2025 budget request. The
Committee continues bill language identifying a specific amount
for SPRANS. The Committee provides not less than the following
within SPRANS:

------------------------------------------------------------------------
FY 2025
Budget Activity FY 2024 Enacted Committee
------------------------------------------------------------------------
Early Childhood Development Grants $10,000,000 $10,000,000
Epilepsy.......................... 3,642,000 3,642,000
Fetal Alcohol Syndrome............ 1,000,000 1,000,000
Fetal Infant and Child Death 5,000,000 5,000,000
Review...........................
Hereditary Hemorrhagic 2,000,000 2,000,000
Telangiectasia...................
Infant-Toddler Court Teams........ 18,000,000 20,000,000
Minority Serving Institutions..... 10,000,000 10,000,000
Oral Health....................... 5,250,000 5,250,000
Regional Pediatric Pandemic 25,000,000 25,000,000
Network..........................
Sickle Cell Disease............... 7,000,000 7,000,000
State Maternal Health Innovation 55,000,000 55,000,000
Grants...........................
------------------------------------------------------------------------

Infant Toddler Court Teams.--The Committee includes an
increase of $2,000,000 for research-based Infant-Toddler Court
Teams to change child welfare practices to improve well-being
for infants, toddlers, and their families. The Committee
directs HRSA to allocate funding to ensure continuation of
existing grantees, technical assistance, and support other
expansion activities.
Oral Health and Primary Care Integration.--Within the total
from oral health withing SPRANS, the Committee includes
$250,000 to continue demonstration projects to increase the
implementation of oral health and primary care practice
integration. 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
strongly urges the Chief Dental Officer to continue to direct
the design, monitoring, oversight, and implementation of these
projects.
Regional Pediatric Pandemic Network.--The pediatric
pandemic network is made up of 10 children's hospitals that
coordinate the development and dissemination of the best
evidence and practices to pediatric communities across the
country. The Network's major functions are focused on
preparation and mobilization for future pandemics, other global
threats, and other disasters. Preparation includes emergency
preparedness, training, and surveillance in advance of a
pandemic. Mobilization includes response, detection, testing,
tracking and recovery planning during a pandemic. Robust
research, innovation, and technology transformation--including
telemedicine--are critical to helping close knowledge and
performance gaps.
The Committee does not include funding for the Doula
Workforce or the Addressing Emerging Issues and Social
Determinants of Maternal Health as proposed in the fiscal year
2025 budget request.

Sickle Cell Disease Treatment Demonstration Program

The Committee includes $8,205,000 for this program, which
is the same as the fiscal year 2024 enacted level and the
fiscal year 2025 budget request. The sickle cell disease
treatment demonstration program helps individuals with sickle
cell disease (SCD) access quality, coordinated, comprehensive
care by building comprehensive sickle cell disease care teams
that extend specialty care from centrally based SCD experts in
hospitals, clinics, or university health centers to the
communities where people live.

Autism and Other Developmental Disabilities

The Committee recommends $57,344,000 for autism and other
developmental disabilities programs, which is $1,000,000 above
the fiscal year 2024 enacted level and the fiscal year 2025
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.--The Committee provides not less than
$38,245,000, the same as the fiscal year 2024 enacted level,
for the Leadership Education in Neurodevelopmental and Related
Disabilities (LEND) program to allow the existing 60 LEND sites
to maintain their capacity to train interdisciplinary
professionals to screen, diagnose, and provide evidence-based
interventions to individuals with autism spectrum disorder and
other developmental disabilities. The LEND program is essential
to increasing the number of professionals with advanced
interdisciplinary training in a broad array of professional
disciplines to train professionals to improve the evaluation,
diagnosis, and treatment of people with autism and other
developmental disabilities. The funding provides the LENDs with
support needed to address the critical shortage of
professionals, increase the number of trainees, serve
underrepresented communities, and fulfill the expanded
statutory mandate to serve persons with autism and
developmental disabilities across the lifespan.

Heritable Disorders in Newborns and Children

The Committee provides $21,383,000 for the Heritable
Disorders program, which is $500,000 above the fiscal year 2024
enacted level and the fiscal year 2025 budget request. This
program assists States to improve and expand their newborn
screening programs and to promote parental and provider
education. HRSA also supports the work of the Advisory
Committee on Heritable Disorders in Newborns and Children,
which provides States with a Recommended Uniform Screening
Panel (RUSP) to help ensure every infant is screened for
conditions that have a recognized treatment.
Advisory Committee on Heritable Disorders in Newborns and
Children.--The Committee recognizes the authority of Advisory
Committee on Heritable Disorders in Newborns and Children
(ACHDNC) to recommend conditions for inclusion in the RUSP. In
March 2023, Duchenne Muscular Dystrophy (DMD) was nominated for
review, but not recommended to be added to the RUSP by ACHDNC
due to concerns with the characteristics of the screening test,
clinical utility, and the diagnostic process. In August 2023,
ACHDNC voted to reconsider DMD and undertake a full evidence
review. As of January 2024, ACHDNC is conducting another
literature review to consider DMD as an included condition.
With emerging gene therapies regarding treatment of DMD,
newborn screening may be more impactful regarding early
diagnosis and treatment of DMD. The Committee is encouraged by
ACHDNC's choice to review DMD as a qualifying condition for the
RUSP and encourages a swift and full review of evidence gaps
and other barriers to issuing guidance.
Severe Combined Immune Deficiency.--Within the total amount
for Heritable Disorders, the Committee provides $4,500,000,
which is $500,000 above the fiscal year 2024 enacted level, to
support wider implementation, education, and awareness of
newborn screening and follow-up for Severe Combined Immune
Deficiency and other newborn screening disorders.

Healthy Start

The Committee does not recommend funding for this program.
Funding for these activities is provided by the Maternal,
Infant, and Early Childhood Home Visiting (MIECHV) program,
also administered by HRSA. For fiscal year 2025, the MIECHV
program received a mandatory appropriation of $600,000,000.

Early Hearing Detection and Intervention

The Committee includes $18,818,000 for the early hearing
detection and intervention program, the same as the fiscal year
2024 enacted level and the fiscal year 2025 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 $24,834,000 for emergency medical
services for children, an increase of $500,000 from the fiscal
year 2024 enacted level and the fiscal year 2025 budget
request. Funding is available to every State's 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 Mental Health and
Substance Use Disorders

The Committee provides $11,500,000, which is $500,000 above
the fiscal year 2024 enacted level and $4,000,000 below the
fiscal year 2025 budget request for the Screening and Treatment
for Maternal Mental Health and Substance Use Disorder (MMHSUD)
program. The program helps expand health care providers'
capacity to screen, assess, treat, and refer pregnant and
postpartum women for maternal mental health and substance use
disorders.
The Committee continues to support MMHSUD. According to
Maternal Mortality Review Committee data reported to the
Centers for Disease Control and Prevention, suicide and
overdose are the leading causes of maternal mortality,
accounting for 22 percent of maternal deaths. Maternal mental
health conditions impact 1 in 5 pregnant or postpartum women,
including as many as 1 in 3 in high-risk populations including
military service members, costing the U.S. economy $14 billion
annually. MMHSUD trains health care providers to screen,
assess, and treat MMH conditions and provides specialized
psychiatric consultation to health care providers. The
Committee encourages HRSA to reduce the administrative burden
on current grantees and work to create uniform evaluation
metrics across all States with perinatal psychiatric access
programs. The Committee urges HRSA to provide guidance for the
MMHSUD and Pediatric Mental Health Care Access program State
grantees to foster collaboration and promote cost efficiencies
by integrating the States' maternal and child psychiatric
consultation lines, if applicable. The Committee supports HRSA
providing technical assistance to support States that desire to
increase collaboration between maternal and child health
consultation lines. The Committee requests a report within 180
days after the enactment of this Act detailing the technical
assistance HRSA has provided to States to promote collaboration
between maternal and child health psychiatric consultation
lines; such report shall be made available on the agency's
website.

Pediatric Mental Health Care Access

The Committee includes $13,000,000 for the pediatric mental
health care access program, which is equal to the fiscal year
2024 enacted level and the fiscal year 2025 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.

Innovation for Maternal Health

The Committee includes $15,300,000 for the Innovation for
Maternal Health program, which is the same as the fiscal year
2024 enacted level and $15,000,000 below the fiscal year 2025
budget request. The Innovation for Maternal Health program
authorizes the establishment or continuation of a program to
identify, develop, or disseminate best practices to improve
maternal health care quality and outcomes, improve maternal and
infant health, and eliminate preventable maternal mortality and
severe maternal morbidity, among other activities.

Maternal Mental Health Hotline

The Committee includes $7,500,000 for the Maternal Mental
Health Hotline, which is $500,000 above the fiscal year 2024
enacted level and the fiscal year 2025 budget request. This
program provides 24/7 free, confidential emotional support,
information, and referrals for pregnant or postpartum women and
their families.
The Committee continues to support the Maternal Mental
Health Hotline. Maternal mental health conditions impact 1 in 5
pregnant and postpartum women and 1 in 3 female servicemembers
and military spouses. The hotline provides 24-hour voice and
text maternal mental health support services for pregnant and
postpartum mothers and their families in English and Spanish.
Since its launch on Mother's Day 2022, the hotline has served
more than 30,000 women and families with average response times
of less than 30 seconds. The average amount of time hotline
operators spend on text conversations is 32 minutes and the
average time on the phone is 17 minutes. The Committee directs
HRSA to coordinate with the Department of Veterans Affairs and
DOD to increase awareness and utilization of the hotline by
servicemembers, veterans, and military spouses, including
promotion at military treatment facilities, hospitals,
lactation spaces, and locations frequented by servicemembers
and veterans. The Committee requests a report within 180 days
after the enactment of this Act detailing current data on
hotline usage, caller demographics to include active duty or
veteran status, and the most common reasons for calling the
hotline; such report shall be made available on the agency's
website.

Poison Control Centers

The Committee includes $27,846,000 for Poison Control
Centers, which is $1,000,000 above the fiscal year 2024 enacted
level and the fiscal year 2025 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.

Integrated Services for Pregnant and Postpartum Women

The Committee includes $10,000,000 for integrated services
for pregnant and postpartum women, the same as the fiscal year
2024 enacted level and the fiscal year 2025 budget request. The
Integrated Services for Pregnant and Postpartum Women program
helps States, Indian Tribes, and Tribal organizations establish
or operate innovative programs to effectively deliver care for
pregnant and postpartum women while considering their social,
behavioral, and health care needs.

RYAN WHITE HIV/AIDS PROGRAM

Appropriation, fiscal year 2024....................... $2,571,041,000
Budget request, fiscal year 2025...................... 2,581,041,000
Committee Recommendation.............................. 2,381,041,000
Change from enacted level........................... -190,000,000
Change from budget request.......................... -200,000,000

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 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 2025
Budget Activity FY 2024 Enacted Committee
------------------------------------------------------------------------
Emergency Assistance.............. $680,752,000 $680,752,000
Comprehensive Care Programs....... 1,364,878,000 1,364,878,000
AIDS Drug Assistance Program 900,313,000 900,313,000
(non-add)....................
Early Intervention Program........ 208,970,000 208,970,000
Children, Youth, Women, and 77,935,000 77,935,000
Families.........................
AIDS Dental Services.............. 13,620,000 13,620,000
Education and Training Centers.... 34,886,000 34,886,000
Special Projects of National 25,000,000 - - -
Significance.....................
Ending the HIV/AIDS Epidemic...... 165,000,000 - - -
------------------------------------------------------------------------

Ryan White Formula Funding.--The Committee is concerned
that the Ryan White Part A funding formula, which is calculated
based on jurisdiction of diagnosis, disadvantages jurisdictions
that experience increasing population sizes due to incoming new
residents. When HRSA last studied this issue in 2019, it found
jurisdictions were over- and under-represented in the funding
formula by up to 50 percent. The Committee urges HRSA to renew
its analysis on discrepancies between where Ryan White patients
are diagnosed and where they currently reside. The Committee
requests an update in the fiscal year 2026 congressional
justification on these findings and potential courses of action
and considerations for a residence-based formula.

HEALTH SYSTEMS

Appropriation, fiscal year 2024....................... $122,009,000
Budget request, fiscal year 2025...................... 135,009,000
Committee Recommendation.............................. 126,009,000
Change from enacted level........................... +4,000,000
Change from budget request.......................... -9,000,000

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

Organ Transplantation

The Committee includes $58,049,000 for the Organ
Transplantation program, which is $4,000,000 above fiscal year
2024 enacted level and $9,000,000 below the fiscal year 2025
budget request.
Human Cell and Tissue Product Transplant Public Awareness
Campaign.--The Committee includes $1,000,000 for a new program
to develop and disseminate educational materials to inform
health care professionals and other appropriate stakeholders
about organ, tissue, and eye donation, the availability of any
donor screening tests, and other relevant aspects of organ
donation.
Living Organ Donation Reimbursement Program.--The Committee
includes an increase of $1,000,000 for the living organ
donation reimbursement program. This program reduces financial
disincentives to living organ donation by providing
reimbursement to living organ donors up to $6,000 for many
expenses related to donating an organ (e.g., travel, lost
wages, and child care). Research suggests that many of these
donors could not have donated without this program. However,
current restrictions (largely due to funding constraints)
severely limit this program's impact, which in turn limits the
number of donors who can afford to donate a lifesaving organ.
The increase in funding will enable the program to
significantly expand income eligibility and total reimbursement
levels to allow more donors to qualify.
Modernization Initiative.--The Committee includes an
increase of $2,000,000 above the fiscal year 2024 enacted level
to support the modernization initiative. The Committee
encourages HRSA to promote competition for the Organ
Procurement and Transplantation Network contracts, in line with
the Securing the U.S. Organ Procurement and Transplantation
Network Act of 2023 (P.L. 118-14). HRSA is directed to include
an update on this effort in the fiscal year 2026 congressional
justification.

National Cord Blood Inventory

The Committee includes $19,266,000 for the national cord
blood inventory (NCBI) program, the same as the fiscal year
2024 enacted level and the same as the fiscal year 2025 budget
request. The NCBI program supports cord blood banks to build a
genetically and ethnically diverse inventory of the highest
quality cord blood units for transplantation.

C.W. Bill Young Cell Transplantation

The Committee includes $33,009,000 for the C.W. Bill Young
Cell Transplantation program, the same as the fiscal year 2024
enacted level and the same as the fiscal year 2025 budget
request. This program supports coordinating the procurement of
bone marrow and umbilical cord blood units for transplantation.

Hansen's Disease Program

The Committee includes $13,706,000 for the Hansen's disease
program, the same as the fiscal year 2024 enacted level and the
fiscal year 2025 budget request. The Committee also includes
$122,000 for Hansen's disease buildings and facilities and
$1,857,000 for payments to Hawaii for treatment of Hansen's
disease, both of which are the same as the fiscal year 2024
enacted level and the fiscal year 2025 budget request.
These programs support outpatient and short-term
residential care, as well as outreach and education, and
research in Baton Rouge, Louisiana; 11 outpatient clinic
programs in the continental U.S. and Puerto Rico; facility-
related expenses for the buildings of the Gillis W. Long
Hansen's Disease Center; and medical care and treatment of
persons with Hansen's disease throughout the Hawaiian Islands.

RURAL HEALTH

Appropriation, fiscal year 2024....................... $364,607,000
Budget request, fiscal year 2025...................... 352,407,000
Committee Recommendation.............................. 400,907,000
Change from enacted level........................... +36,300,000
Change from budget request.......................... +48,500,000

The Federal Office of Rural Health Policy's (FORHP)
programs provide funding to improve access, quality, and
coordination of care in rural communities; for research on
rural health issues; for technical assistance and recruitment
of health care providers; for screening activities for
individuals affected by the mining, transport, and processing
of uranium; and for the outreach and treatment of coal miners
and others with occupation-related respiratory and pulmonary
impairments.
Cancer Mobile Screening.--Early detection of cancer has
been shown to significantly reduce cancer mortality, especially
with lung cancer, making treatments more timely, effective, and
cost-efficient. Mobile screening units can increase access to
preventive care and significantly reduce disparities in health
care access. Mobile units play a crucial role in reaching
populations that are traditionally underserved, thereby
enhancing outcomes in communities often neglected in
healthcare. The Committee supports efforts by HRSA to include
cancer mobile screening as appropriate in the rural health
program portfolio. The Committee requests an update on
implementation in the 2026 congressional justification.
Rural Healthcare.--While current spending for all rural
health discretionary programs is relatively small, it plays a
critical role in solidifying the fragile healthcare
infrastructure in rural communities. The Committee supports
programs seeking to address the severe health care crisis
escalating in rural America and preventing any additional rural
hospitals from closing. Health care workforce shortages
continue to plague rural communities, and, while health care
innovations, such as telehealth technologies, show promise in
rural areas, the Committee believes that action needs to be
taken to address the workforce shortages in rural communities.
The Committee continues to support HHS' efforts to implement
programs and policies to improve rural health outcomes,
strengthen care delivery, and address the immediate issues
facing rural communities.
Trauma Care in Rural Areas.--The Committee notes the access
challenges to trauma care in rural areas. The Committee
supports efforts by HRSA to address this access gap and
requests an update on this topic in the fiscal year 2026
congressional justification.

Rural Health Outreach Programs

The Committee includes $108,975,000 for rural health
outreach programs, an increase of $8,000,000 above the fiscal
year 2024 enacted level and $16,000,000 above the fiscal year
2025 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.
Delta States.--The Delta States region consists of Alabama,
Arkansas, Illinois, Kentucky, Louisiana, Mississippi, Missouri,
and Tennessee. The Committee includes an increase of $2,000,000
to support the Delta States program. The Committee includes no
more than $12,000,000 for the Delta States Rural Development
Network Grant program and not less than $15,000,000 for the
Delta Region Community Health Systems Development program.
Within the total for Delta States, the Committee includes no
less than the amount provided in fiscal year 2024 for the
following activities: community health systems development
technical assistance program, rural health workforce training
program, health systems implementation program, and the
maternal program.
Rural Maternity and Obstetrics Management Strategies.--The
Committee includes no less than $14,000,000 for rural maternity
and obstetrics management strategies (RMOMS), an increase of
$2,000,000 above the fiscal year 2024 enacted level. RMOMS
supports grants to improve access to and continuity of maternal
and obstetrics care in rural communities by increasing the
delivery of and access to preconception, pregnancy, labor and
delivery, and postpartum services, as well as developing
sustainable financing models for the provision of maternal and
obstetrics care.

Rural Health Research and Policy Development

The Committee includes $11,576,000 for Rural Health
Research and Policy Development, which is $500,000 above the
fiscal year 2024 enacted level and the fiscal year 2025 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.
The Rural Health Research Center Program funds publicly
available and policy relevant research on rural health to
assist providers and Federal, State, and local governments in
addressing challenges faced by rural communities. Access to
health services in rural areas is under extreme stress with
patients forced to travel extended distances for even basic
health care, while more than 30 percent of rural hospitals are
at risk of closing. Additional research is needed on the
significant and pervasive challenges faced by rural Americans
in accessing health care related to mental health, drug and
alcohol use, nutrition and healthy eating, and chronic health
management, among other critical needs. This results in a need
for additional policy research capacity to inform solutions to
these important issues. The Committee provides an increase for
FORHP to fund additional core research centers to increase the
number of studies on rural health and support policy solutions
that improve access to health care, health outcomes, and
population health.

Rural Hospital Flexibility Grants

The Committee includes $74,277,000 for Rural Health
Flexibility Grants, $10,000,000 above the fiscal year 2024
enacted level and $10,000,000 above the fiscal year 2025 budget
request. These programs help States to assist small and
critical access rural hospitals to remain economically viable
and to provide high-quality care.
Within this total, the Committee includes no less than
$5,000,000 for the Rural Emergency Hospitals Technical
Assistance Program and up to $25,942,000 for the Small Rural
Hospital Improvement Program.
Rare Disease Education.--The Committee is keenly aware of
the significant challenges facing emergency care for rare and
chronic disease patients in rural America. Rural emergency
medical service providers have gaps in education that can lead
to disparate outcomes for rural rare and chronic disease
patients based on delays in proper care, administration of
emergency prescription medications, or unforeseen side effects
or drug interactions occurring during medical interventions.
Without closing these care gaps, rare and chronic disease
patients face risks to their health and lives in the event of
an emergency, solely because they live in rural America.
Therefore, the Committee urges HRSA to support efforts to
provide education for the administration of patient-held drugs
for rural rare and chronic disease patients for rural emergency
medical services personnel as an eligible use of funding from
the Emergency Services Supplement of the Medicare Rural
Hospital Flexibility Grant Program.

State Offices of Rural Health

The Committee includes $13,000,000 for State Offices of
Rural Health, $500,000 above the fiscal year 2024 enacted level
and the fiscal year 2025 budget request. HRSA supports the
establishment and operation of State offices of rural health to
strengthen the rural health care delivery system.

Black Lung Clinics

The Committee includes $12,190,000 for Black Lung Clinics,
equal to the fiscal year 2024 enacted level and the same as the
fiscal year 2025 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

The Committee includes $1,889,000 for the radiation
exposure screening and education program, equal to the fiscal
year 2024 enacted level and the fiscal year 2025 budget
request. This program provides grants for the education,
prevention, and early detection of radiogenic cancers and
diseases resulting from exposure to uranium during mining and
milling at nuclear test sites.

Rural Communities Overdose Response Program

The Committee includes $145,000,000, the same as the fiscal
year 2024 enacted level and the fiscal year 2025 budget
request, for this program. Within the funding provided, the
Committee includes $10,000,000 to continue the three Rural
Centers of Excellence (Centers), as established by P.L. 115-245
and continued through P.L. 117-328. The Committee recognizes
the success of the three Centers in reducing substance use
disorders within rural communities, through various evidence-
based treatment and recovery models. The Committee supports
HRSA's continued investment in the current Centers and
encourages HRSA to consider how the Centers can expand their
outreach into other underserved communities.

Rural Residency Planning and Development

The Committee includes $14,000,000 for the rural residency
planning and development program, an increase of $1,300,000
above the fiscal year 2024 enacted level and $1,500,000 above
the fiscal year 2025 budget request. This program funds
physician residency training programs that support physician
workforce expansion in rural areas.
The Committee commends FORHP for their efforts to expand
the physician workforce in rural areas and supports the
continuation and expansion of the program to develop new rural
residency programs.

Financial and Community Sustainability for At Risk Hospitals

The Committee includes $5,000,000 for this activity as
proposed in the fiscal year 2024 budget request. First proposed
in fiscal year 2024, this program will target technical
assistance to rural hospitals severely at-risk for imminent
closure and struggling to maintain health care services.
Small rural hospitals are often the only health care
available in rural counties, and populations most affected by
hospital closings tend to be poor, minorities, and elderly
patients with chronic health conditions. There have been 143
rural hospital closures from 2010 through January 2023, peaking
with a high of 19 in 2020 just as the pandemic hit. Closures
are happening more often in communities of color. Historically,
about half of the closures result in a complete loss of
services at those facilities.

Rural Hospital Stabilization Program

The Committee includes $15,000,000, which is an increase of
$11,000,000 above the fiscal year 2024 enacted level and
$15,000,000 above the fiscal year 2025 budget request for this
program. Launched in fiscal year 2024, this program provides
support to at-risk rural hospitals to enhance or expand service
lines to retain health care services locally and increase
service volume and revenue that will enhance hospitals'
financial viability.

FAMILY PLANNING

Appropriation, fiscal year 2024....................... $286,479,000
Budget request, fiscal year 2025...................... 390,000,000
Committee Recommendation.............................. - - -
Change from enacted level........................... -286,479,000
Change from budget request.......................... -390,000,000

The Committee does not recommend funding for the Family
Planning program. The Family Planning program administers Title
X of the PHS Act.
The Committee continues to note its disappointment with the
Department's suspension and termination of Title X grants to
projects serving rural and low-income individuals based on the
project's refusal to refer or counsel for abortion, thereby
limiting access to services provided by such projects. Instead
of putting political constituencies first, the Committee urges
the Department to work with the previous grantees to resolve
such suspensions and terminations, in accordance with all
applicable Federal law to ensure Title X services are
accessible and that no project is discriminated against for
refusing to refer or counsel for abortion. The Committee
directs the Department to provide an update on this effort in
the fiscal year 2026 congressional justification.

HRSA-WIDE ACTIVITIES AND PROGRAM SUPPORT

Appropriation, fiscal year 2024....................... $1,110,376,000
Budget request, fiscal year 2025...................... 214,088,000
Committee Recommendation.............................. 222,088,000
Change from enacted level........................... -888,288,000
Change from budget request.......................... +8,000,000

This account supports telehealth programs, operation of the
340B drug pricing program and the cost of Federal staff and
related activities to coordinate, direct, and manage the
programs of HRSA.
Addressing Health Disparities with Faith-Based and
Community-Based Organizations.--The Committee notes the impact
of ongoing efforts and local partnerships focused on addressing
health disparities HRSA is encouraged to support these
promising partnerships to preserve innovative access through
houses of worship and community organizations.
Digital Innovation for Rural Healthcare.--The Committee
supports efforts to develop digital innovation for rural
healthcare. Such efforts could foster the development and
improvement of technologies including telehealth and remote
monitoring to bridge the health access gap and ensure access to
quality, affordable healthcare, regardless of location.
HRSA Chief Dental Officer.--The Committee notes with strong
concern that despite its directive to have HRSA ensure that the
Chief Dental Officer (CDO) is functioning at an executive level
with resources and staff to lead oral health programs and
initiatives across HRSA, such authority has not been delegated.
The Committee urges HRSA to restore this position with
authority and resources to oversee and lead oral health dental
programs and initiatives across the agency. The CDO is also
expected to serve as the agency representative on oral health
issues to international, national, State, and/or local
government agencies, universities, and oral health stakeholder
organizations.
Oral Health Literacy.--The Committee includes $300,000, the
same as the fiscal year 2024 enacted level, to continue the
development of an oral health awareness and education campaign
across relevant HRSA bureaus, including Health Centers, Health
Workforce, Maternal and Child Health, Ryan White HIV/AIDS
Program, and Rural Health. The Committee directs HRSA to
identify oral health literacy strategies that are evidence-
based and focused on oral health care prevention and education,
including prevention of oral disease such as early childhood
and other caries, periodontal disease, and oral cancer. The
Committee encourages HRSA to ensure that the Chief Dental
Officer plays a key role in the design, monitoring, oversight,
and implementation of this project.
Targeted Investments in Impoverished Areas.--The Committee
requests an update to the report under this heading in House
Report 117-403.
Tribal Engagement.--HRSA's core mission is to improve
health outcomes and build the health workforce. HRSA
historically has had lower participation by Indian Tribes in
several core program areas, despite the great Tribal need in
all of HRSA's mission areas. Within 180 days of enactment of
this Act, HRSA shall provide to the Committee a detailed
description of funding provided to Tribal entities, grants
Tribal entities are eligible to apply for, and an action plan
by HRSA on how it will provide technical assistance to improve
Tribal participation in HRSA programs. Such report shall be
made available on the agency's website.
Uninsured Program.--The Committee notes the uninsured
program stopped accepting new claims in March and April of 2022
due to the conclusion of funding provided by supplemental
appropriations. The Committee is aware of successfully
submitted claims for payment for COVID-related medical care
that were not paid, including claims submitted for care prior
to the suspension of the program. The Committee directs HRSA to
provide a report to the committees of jurisdiction no later
than 180 days after enactment of this Act that details the
number of unpaid claims that were successfully submitted for
payment for COVID-related medical services provided prior to
suspension of the program. In addition, such report should
include data detailing any funds returned or recovered as a
result of fraudulent claims or improper payments through this
and other HRSA pandemic relief accounts. Such report shall be
made available on the agency's website.

Office of Pharmacy Affairs

The Committee includes $12,238,000 for the Office of
Pharmacy Affairs, equal to the fiscal year 2024 enacted level.
This office administers the 340B drug discount program, which
was designed to enable health care providers that serve low-
income and uninsured patients to purchase drugs at lower costs.
This office 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
program lowers the cost of outpatient drugs to health clinics
and nonprofit and public hospitals that serve a
disproportionate share of low-income and rural patients. The
Committee recognizes that 340B is a critical lifeline to
safety-net providers, including children's hospitals, Ryan
White HIV/AIDS clinics, safety-net hospitals, health centers,
and other providers. These covered entities reinvest 340B
savings to reach more patients and provide more services.
The Committee is concerned with some manufacturers who may
not be in full compliance with the 340B statute. Several
manufacturers have implemented limits on access to 340B
pricing, limiting the ability of covered entities to access
these drugs. The Committee is pleased that HRSA continues to
take steps to enforce the 340B statute, to refer violations of
the statute to the HHS Office of Inspector General, and to
appeal litigation in these matters. The Committee encourages
HRSA to continue to use its authority and other appropriate
measures to implement the program consistent with Federal law.

Office for the Advancement of Telehealth

The Committee includes $44,550,000 for the Office for the
Advancement of Telehealth, an increase of $2,500,000 above the
fiscal year 2024 enacted level and $6,500,000 above the fiscal
year 2025 budget request. Funds for the Office for the
Advancement of Telehealth promote 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.--Within the funds
provided for Telehealth, the Committee provides $9,000,000 for
Telehealth Centers of Excellence, an increase of $500,000 above
the fiscal year 2024 enacted level. These Centers identify best
practices, serve as national training resources, and test the
efficacy of different telehealth clinical applications. These
Centers 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. Funding should serve to promote the adoption
of telehealth services nationwide and help address the access
to care issue faced by rural America.
Telehealth Technology Enabled Learning.--The Committee
recognizes the significance of telementoring in transforming
healthcare training, education, and delivery. Specifically, the
Committee encourages HRSA to integrate and implement a robust
telementoring initiative at an academic medical center with
existing Federal support and expertise in the field. This
should include technology enabled delivery of evidence-based
curricula, offering of practice-based, culturally responsive
care, advancing the skill set of health care workers,
facilitating task shifting, increasing access to specialized
care, including for adolescent behavioral health. The Committee
further encourages this initiative to increase community level
health literacy that will lead to healthier behaviors and
prepare for this telementoring service to be used during public
health emergencies. Telementoring, in partnership with
community-based organizations, can be rapidly deployed to
deliver support and training across a broad cross-section of
clinical and non-clinical disciplines. The Committee includes a
$2,000,000 increase for this effort.

VACCINE INJURY COMPENSATION PROGRAM

Appropriation, fiscal year 2024....................... $15,200,000
Budget request, fiscal year 2025...................... 20,200,000
Committee Recommendation.............................. 15,700,000
Change from enacted level........................... +500,000
Change from budget request.......................... -4,500,000

The Vaccine Injury Compensation Program provides
compensation for individuals with vaccine-associated injuries
or deaths. The Committee also includes $266,727,000 in
mandatory funding, the same as the fiscal year 2025 budget
request for claims.

COVERED COUNTERMEASURES PROCESS FUND

Appropriation, fiscal year 2024....................... $7,000,000
Budget request, fiscal year 2025...................... 10,000,000
Committee Recommendation.............................. 7,000,000
Change from enacted level........................... - - -
Change from budget request.......................... -3,000,000

The countermeasures injury compensation program provides
benefits to individuals who are seriously injured because 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 2024....................... $9,222,090,000
Budget request, fiscal year 2025...................... 9,738,690,000
Committee Recommendation.............................. 7,446,058,000
Change from enacted level........................... -1,776,032,000
Change from budget request.......................... -2,292,632,000

The Committee recommendation for the Centers for Disease
Control and Prevention (CDC) program level includes
$6,204,500,000 in discretionary budget authority, $55,358,000
in mandatory funds under the terms of the Energy Employees
Occupational Illness Compensation Program Act, and
$1,186,200,000 in transfers from the Prevention and Public
Health Fund (PPHF).

IMMUNIZATION AND RESPIRATORY DISEASES

Appropriation, fiscal year 2024....................... $919,291,000
Budget request, fiscal year 2025...................... 969,291,000
Committee Recommendation.............................. 919,291,000
Change from enacted level........................... - - -
Change from budget request.......................... -50,000,000

The Committee recommendation includes $237,358,000 in
discretionary budget authority and $681,933,000 in transfers
from PPHF.
Immunization cooperative agreements are awarded to State
and local public health departments for planning, developing,
and conducting childhood, adolescent, and adult immunization
programs, including enhancement of the vaccine delivery
infrastructure. CDC directly maintains a stockpile of vaccines,
supports consolidated purchase of vaccines for State and local
health agencies, and conducts surveillance, investigations, and
research into the safety and efficacy of new and presently used
vaccines.
Within the total for Immunization and Respiratory Diseases,
the Committee recommends the following amounts:

------------------------------------------------------------------------
FY 2025
Budget Activity FY 2024 Enacted Committee
------------------------------------------------------------------------
Immunization and Other Respiratory $681,933,000 $681,933,000
Diseases.........................
Budget Authority.............. 262,583,000 - - -
PPHF.......................... 419,350,000 681,933,000
Acute Flaccid Myelitis............ 6,000,000 6,000,000
Influenza Planning and Response... $231,358,000 $231,358,000
------------------------------------------------------------------------

Decline of Routine Immunizations.--The Committee is
concerned about recent data which shows a significant decline
in the rates of routine and seasonal childhood and adult
immunizations. Seasonal influenza vaccination declined for the
third year in a row and kindergarten vaccinations continue to
decline. These declines have already had a measurable impact on
public health as demonstrated by recent outbreaks of measles in
Ohio, Illinois, and Pennsylvania. Therefore, the Committee
directs CDC, in consultation with FDA, ASPR, and NIH, to
develop and include in the fiscal year 2026 congressional
justification, a comprehensive research agenda to better
understand the decline in routine vaccine uptake and confidence
among Americans and develop a comprehensive strategy to educate
physicians regarding the safety and efficacy of routine
vaccines and how best to communicate with patients and to
identify and engage partners/stakeholders needed to implement
the strategies related to routine vaccinations.
Immunization During Pregnancy.--To increase access to
recommended immunizations, the Committee encourages CDC to
increase its efforts to educate health care providers about the
importance of immunization during pregnancy, which can provide
protection for children from 0-6 months from diseases such as
flu, pertussis (whooping cough), and respiratory syncytial
virus, when the children are at their most vulnerable. The
Committee also encourages CDC to work with Federal partners to
improve awareness and coordination among Federal partners to
increase immunization during pregnancy.

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

Appropriation, fiscal year 2024....................... $1,391,056,000
Budget request, fiscal year 2025...................... 1,391,056,000
Committee Recommendation.............................. 1,177,135,000
Change from enacted level........................... -213,921,000
Change from budget request.......................... -213,921,000

CDC provides national leadership and support for HIV/AIDS
prevention research and the development, implementation, and
evaluation of evidence-based HIV prevention programs serving
persons affected by, or at risk for, HIV infection. 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 the National Center for HIV/AIDS,
Viral Hepatitis, Sexually Transmitted Diseases, and
Tuberculosis Prevention, the Committee provides the following
amounts:

------------------------------------------------------------------------
FY 2025
Budget Activity FY 2024 Enacted Committee
------------------------------------------------------------------------
Domestic HIV/AIDS Prevention and $1,013,712,000 $793,712,000
Research.........................
HIV Prevention by Health 755,631,000 755,631,000
Department...................
School Health--HIV BA......... 38,081,000 38,081,000
Ending HIV/HIV Initiative..... 220,000,000 - - -
Viral Hepatitis................... 43,000,000 53,000,000
Sexually Transmitted Infections... 174,310,000 164,310,000
Tuberculosis (TB)................. 137,034,000 137,034,000
Infectious Diseases and Opioids... 23,000,000 29,079,000
------------------------------------------------------------------------

Sexually Transmitted Infections.--The Sexually Transmitted
Infections programs included $10,000,000 in both fiscal years
2023 and 2024 to advance the grant period. For fiscal year
2025, the Committee provides $164,310,000, which will allow the
program to operate at the same fiscal level and grant year as
provided for fiscal year 2024.
Syndemic Approaches to Sexually Transmitted Infections.--
The Committee urges CDC to take syndemic approaches to address
HIV, viral hepatitis, sexually transmitted infections, and TB.
This approach bolsters collaborative work across disease areas
and continues to integrate services to improve efficiency, cost
effectiveness, and achieve optimal health outcomes. CDC is
encouraged to look across diseases, conditions, communities,
and service sites to identify opportunities to integrate
delivery of services to the public more efficiently and
effectively (e.g., multi-pathogen testing).
Viral Hepatitis.--The Committee provides $53,000,000 for
Viral Hepatitis, an increase of $10,000,000 from fiscal year
2024. This increase will support health departments conducting
viral hepatitis outbreak response and surveillance, support
viral hepatitis elimination planning and implementation in
target jurisdictions, and work with health clinics and
community organizations to promote awareness and uptake of
updated national viral hepatitis testing and vaccination
recommendations.

EMERGING AND ZOONOTIC INFECTIOUS DISEASES

Appropriation, fiscal year 2024....................... $760,272,000
Budget request, fiscal year 2025...................... 780,772,000
Committee Recommendation.............................. 780,772,000
Change from enacted level........................... +20,500,000
Change from budget request.......................... - - -

The Committee recommendation includes $728,772,000 in
discretionary appropriations and $52,000,000 in transfers from
PPHF.
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:

Alpha-Gal Syndrome.--The Committee directs CDC, within 180
days of enactment of this Act, to develop a two-year plan
(fiscal years 2025 through 2026) for conducting evaluation
reviews of the information on its website for tickborne
diseases (TBDs), including any TBD overviews and information on
individual TBDs, including alpha-gal syndrome, the non-
infectious allergic disease related to a tick bite that is less
understood than other allergic conditions, and for developing
educational materials for clinicians and the public for each
TBD and tickborne condition, with priority based on disease
burden, determined by prevalence and level of disability.
The CDC is further directed, within 180 days of the
enactment of this Act, to publicly release a report on alpha-
gal syndrome, including prevalence, etiology, treatment,
outcomes, and prognosis.
Antimicrobial and Antibiotic Resistance.--The Committee
notes the complexities in conducting surveillance of
antimicrobial resistance (AMR) and providing treatments across
healthcare, veterinary medicine, and agriculture. In addition
to detection, prevention, and control initiatives used to
combat the spread of AMR, expanded capacity for monitoring
resistance is critical for combating AMR and preventing the
spread of infections. As such, of the amounts allocated for the
CDC's Antimicrobial Resistance Initiative, the Committee
encourages CDC to incorporate AMR monitoring into its response
efforts.
Chronic Fatigue Syndrome.--The Committee supports CDC's
work related to provider education and public awareness for
postural orthostatic tachycardia syndrome (POTS) and similar
forms of dysautonomia, common chronic conditions that impact
millions of Americans and cause severe disability. The
Committee is concerned that 28 States do not have a board-
certified autonomic specialist resulting in POTS patients
facing on average a 5-year diagnostic delay and encourages the
CDC to work with patient advocates, clinicians, and researchers
to develop an education program for health care providers to
increase access to care for POTS and similar dysautonomia
patients.
Epidemiology and Laboratory Capacity.--The Committee
recognizes the importance of the Epidemiology and Laboratory
Capacity (ELC) program, which provides flexibility to State,
territorial, and local health departments to address gaps not
funded by the disease specific sections of the ELC cooperative
agreement. The ELC program provides critical foundational
support for these health departments to fund epidemiology,
surveillance, laboratory, and data science staff positions that
provide the backbone for public health programs. This funding
will allow public health departments to build their
foundational public health workforce and infrastructure and
will better prepare them to respond to emerging infectious
disease threats more quickly.
Harmful Algal Blooms.--The Committee notes that harmful
algal blooms (HABs) are on the rise globally, particularly
across the Great Lakes region, and encourages CDC to study the
health effects of exposure to cyanotoxins in the air and water,
including, but not limited to, the Great Lakes region. CDC has
a unique role in better understanding the intersection of
public health and environmental impacts of HABs. The Committee
encourages CDC to continue building interagency cooperation
surrounding health effects of HABs. The scope of future
research may expand to include improving laboratory methods for
identifying and quantifying HAB-related toxins in biological
specimens, 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.
Lyme Disease--Lyme disease can be found in at least 80
countries around the globe and is endemic in many regions. In
the U.S., Lyme disease is the most common disease transmitted
from animals to humans. After years of uncertainty, CDC
continues to note the number of reported Lyme disease cases in
the U.S. is likely far below the estimated number of actual
cases that are diagnosed and treated annually. According to
CDC, in 2022, approximately 63,000 cases of the disease were
reported, compared to estimates showing that more than 475,000
may be diagnosed and treated with Lyme disease annually in the
U.S. The Committee continues to support CDC's efforts to
improve testing and treatment related to Lyme and other vector-
borne diseases and encourages CDC to consider expanding
activities related to the development of more accurate
diagnostic tools and tests for Lyme disease and steps to
educate high risk workers and their employers regarding the
occupational risks of tickborne diseases.
Maternal Fetal Transmission of Lyme Disease.--Within 180
days of the enactment of this Act, the Committee directs CDC to
provide a report on its plans to better understand maternal-
fetal transmission of Lyme disease and gestational Lyme disease
and plans to improve education for the public and for
healthcare providers about the risks of Lyme disease during
pregnancy and adverse birth outcomes. CDC is encouraged to
identify resources required and potential obstacles to
progress.
Mycotic Diseases.--The Committee provides an increase of
$15,000,000 in Emerging Infectious Diseases for mycotic
diseases, including, 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 continues to support the
CDC's collaboration with the Valley Fever Institute and the
Cocci Study Group. The Committee requests an update in the
fiscal year 2026 congressional justification on how this
funding is being utilized.
Novel Emerging and Dangerous Pathogens.--The Committee
commends CDC for advancing research in the critical area of
lethal bacteria, viruses, and other special pathogens. However,
the Committee remains concerned about the increasingly
dangerous threat to public health of emerging and dangerous
bacterial and viral pathogens that can be difficult or
impossible to grow in laboratory settings. Further research is
required in advanced DNA sequencing to speed the development of
diagnostics, therapeutics, and vaccines. Therefore, the
Committee encourages CDC to prioritize advanced DNA sequencing
and detection of novel emerging and dangerous pathogens.
Prion Disease.--The Committee is concerned that Chronic
wasting disease (CWD), a fatal condition in cervids (deer, elk,
and moose) caused by misfolded prions, has been detected in
over 30 States and all four regions of the country. Monitoring
the prevalence of prion diseases, including determining a
disease's incidence and whether it was acquired from animals or
other humans, is critical. In light of scientific observations
regarding the nationwide spread of CWD and concerns about the
potential for cross-species transmissions to humans and food
production animals, the Committee includes $8,500,000 for
surveillance efforts of human prion diseases, including
Creutzfeldt-Jakob Disease, through the National Prion Disease
Pathology Surveillance Center and CDC.
Quarantine.--The Committee provides $58,772,000, an
increase of $5,000,000, to support the Traveler-Based Genomic
Surveillance (TGS) program. The Committee is aware of the
expansion of the TGS program to include over 4 core pathogens
collected through air, aircraft wastewater, and nasal swabs
from travelers arriving at 9 U.S.-based international airports
and recommends the continuation of these activities through
resources made available in this bill and from previous
appropriations balances. This capability has been effective in
advancing the nation's pathogen surveillance capabilities to
provide early warning for detection, characterization,
migratory disease origin, and if needed, medical countermeasure
research and development.
Southern Tick Associated Rash Illness.--The Committee
directs CDC to publicly release a report on Southern Tick
Associated Rash Illness (STARI) including its prevalence, the
tick-vector or vectors causing STARI, and the progress in
identifying the causative pathogen of STARI or any suspected
non-infectious disease-causing mechanism. The Committee directs
CDC to provide a briefing to the Committee on this topic within
180 days of the enactment of this Act.
Tick Borne Diseases External Engagement.--The Committee
strongly encourages CDC to establish a panel of expert outside
stakeholders to evaluate and review the Lyme disease
information on its website for its inclusion of a balance of
scientifically valid perspectives, primarily regarding the
state of the science for diagnostics and treatments. The stated
goals and purposes of the review and the identity of review
participants, including the balanced panel of experts,
including experienced TBD clinicians, researchers, and
educators, should be fully transparent.

CHRONIC DISEASE PREVENTION AND HEALTH PROMOTION

Appropriation, fiscal year 2024....................... $1,433,914,000
Budget request, fiscal year 2025...................... 1,559,414,000
Committee Recommendation.............................. 1,154,153,000
Change from enacted level........................... -279,761,000
Change from budget request.......................... -405,261,000

The Committee recommendation includes $912,886,000 in
discretionary appropriations and $241,267,000 in transfers from
PPHF. 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 provides the
following amounts:

------------------------------------------------------------------------
FY 2025
Budget Activity FY 2024 Enacted Committee
------------------------------------------------------------------------
Tobacco........................... $246,500,000 - - -
Tobacco....................... 120,650,000 - - -
Tobacco (PPHF)................ 125,850,000 - - -
Nutrition, Physical Activity, and 58,420,000 $58,420,000
Obesity..........................
High Obesity Rate Countries 16,500,000 16,500,000
(non-add)....................
School Health..................... 19,400,000 - - -
Food Allergies (non-add)...... 2,000,000 - - -
Farm-to-School (non-add)...... 2,000,000 - - -
Health Promotion.................. 64,100,000 66,200,000
Vision and Eye Health......... 6,500,000 6,500,000
Alzheimer's Disease........... 39,500,000 39,500,000
Inflammatory Bowel Disease.... 2,000,000 3,000,000
Interstitial Cystitis......... 1,100,000 1,200,000
Excessive Alcohol Use......... 6,000,000 6,000,000
Chronic Kidney Disease........ 4,500,000 5,500,000
Chronic Disease Education and 4,500,000 4,500,000
Awareness....................
Prevention Research Centers....... 28,961,000 - - -
Heart Disease and Stroke.......... 155,105,000 155,105,000
Heart Disease and Stroke (BA). 125,850,000 44,346,000
Heart Disease and Stroke 29,255,000 110,759,000
(PPHF).......................
Diabetes.......................... 156,129,000 156,129,000
Diabetes (BA)................. 89,717,000 45,371,000
Diabetes (PPHF)............... 66,412,000 110,758,000
National Diabetes Prevention 37,300,000 37,300,000
Program..........................
Cancer Prevention and Control..... 410,049,000 417,049,000
Oral Health....................... 20,250,000 22,250,000
Safe Motherhood/Infant Health..... 110,500,000 110,500,000
Arthritis and Other Chronic 32,500,000 42,500,000
Diseases.........................
Arthritis/Other............... 11,000,000 11,000,000
Epilepsy...................... 11,500,000 11,500,000
National Lupus Registry....... 10,000,000 20,000,000
Community Grants.................. 68,950,000 68,950,000
Racial and Ethnic Approaches 44,950,000 38,950,000
to Community Health..........
Good Health and Wellness in 24,000,000 30,000,000
Indian Country...............
Social Determinants of Health 6,000,000 - - -
Pilot Program....................
Million Hearts (PPHF)............. 5,000,000 5,000,000
Healthy Weight Task Force Obesity 5,000,000 5,000,000
Activities/Early Child Care
Collaboration (PPHF).............
Hospitals Promoting Breastfeeding 9,750,000 9,750,000
(PPHF)...........................
------------------------------------------------------------------------

Breast and Cervical Cancer.--The Committee is concerned
with the decline in screening rates, and the increase in
diagnosis of advanced cervical cancers, especially in rural and
underserved communities. Provided within the increase, the
Committee encourages the National Breast and Cervical Cancer
Early Detection Program to build on existing programs by
finding new and innovative outreach and education strategies to
engage women to increase early screening rates. The use of
navigators has proven especially successful in reaching women
with low rates of screening. The Committee requests CDC
publicly release a report on these activities within 180 days
of enactment of this Act.
The committee recognizes findings that African American
women have twice the odds of being diagnosed with Triple-
Negative Breast Cancers (TNBCs). The Committee therefore
directs CDC to issue a report to the Committee on current and
planned future efforts to promote awareness of TNBC diagnosis
and treatment, including any findings of best practices for the
use of educational or related tools to increase the uptake of
awareness and treatment no later than 180 days after enactment
of this Act.
Cancer Prevention and Control.--The Committee provides
$417,049,000 for CDC cancer prevention and control activities,
a $7,000,000 increase from the fiscal year 2024 enacted level.
The Committee directs CDC to fund the following activities at
not less than the fiscal year 2024 enacted level: breast and
cervical cancer including WISEWOMEN, breast cancer awareness
for young women, cancer registries, colorectal cancer,
comprehensive cancer control, Johanna's Law, ovarian cancer,
prostate cancer, skin cancer, and the cancer survivorship
resource center. In addition, under this heading in the fiscal
year 2026 congressional justification, CDC is directed to
include a discussion of planned efforts for each of the areas
identified in the preceding sentence. Within the amounts
provided, the Committee includes increases of $2,000,000 for
Breast and Cervical Cancer programs, $500,000 for Ovarian
Cancer programs, and $500,000 for Johanna's Law programs.
Chronic Disease Education and Awareness Program.--The
Committee notes the progress and opportunities facilitated by
the Chronic Disease Education and Awareness program and has
provided $4,500,000 for fiscal year 2025 to support grants for
chronic health conditions, including rare diseases, that lack a
specific funding line within the CDC's budget.
Chronic Kidney Disease.--Chronic kidney disease (CKD)
affects more than 35 million adults in the U.S., with an
additional 80 million Americans at risk of developing CKD due
to diabetes, cardiovascular disease, or family history.
Approximately 25 percent of Medicare's annual budget is spent
on care for CKD patients, however, CKD is not detected early
enough to initiate treatment regimens to reduce death and
disability. A public health approach would contribute toward
earlier detection to allow more time for interventions targeted
to improve outcomes. The Committee encourages investments to
educate the public about their risk for kidney disease, educate
clinical professionals, and spur innovation by entities serving
the kidney disease community. By improving surveillance, early
detection, and treatment, the progression of kidney disease can
be slowed, and complications can be reduced which will
dramatically improve the quality of life of patients.
Diabetes.--According to CDC's 2021 data from the National
Diabetes Statistics Report, approximately 2 million Americans
have type 1 diabetes (T1D), with 304,000 of these individuals
under the age of 20. The incidence of T1D has increased
significantly over the past 20 years. Millions of individuals
are at an increased risk of developing T1D because they have a
first-degree relative with the condition, and a subset of these
individuals are in the early stages of T1D. Screening can help
improve outcomes for people at risk of developing T1D,
including delaying progression, preventing complications, and
reducing the incidence of diabetic ketoacidosis (DKA) at
diagnosis. All of these outcomes pose increased morbidity and
mortality risk in the short and long term. The Committee is
concerned that CDC has not adequately focused education and
awareness efforts on T1D possible risk factors, screening, and
potential avenues to delay onset, including available
treatments and clinical trials. The Committee directs CDC to
update its website to include comprehensive information about
screening, risks of DKA at diagnosis, and information about
accessing possible treatments and clinical trials to delay the
onset of T1D. CDC is encouraged to include information
targeting physicians, school health workers, parents, and
adults regarding screenings; provide information about
populations that should be prioritized for screening; and
direct patients to appropriate resources if their screening
results indicate that they are at increased risk of developing
T1D. CDC is further encouraged to enact a process to review the
scientific literature on screening for T1D and update
information on its website to reflect new information in a more
timely manner.
Early Child Care Collaboratives.--The Committee includes
$5,000,000 to enable training of early care and education
providers in the implementation of healthy eating and physical
activity best practices. The Committee is concerned that
consolidation in resource management within the Division of
Nutrition, Physical Activity, and Obesity has resulted in less
on-the-ground support for health promotion efforts. The
Committee directs that such funds not only support activities
currently funded by the Division but also support States not
currently funded by the Division.
Epilepsy.--The Committee commends CDC for its ongoing
leadership of this successful program and effective community
collaborations, and encourages further efforts to eliminate
stigma, improve awareness and education, and better connect
people with epilepsy to health and community services. The
Committee recognizes the importance of data to accurately
understand the incidence, prevalence, and mortality rate of
epilepsies, along with individual and social risk factors that
influence health outcomes. The Committee appreciates CDC's
ongoing epilepsy-related surveillance and funding of
epidemiologic studies on epilepsy. The Committee encourages CDC
to enhance surveillance and epidemiologic studies of epilepsies
to generate data that can guide interventions to improve
outcomes for people with epilepsy.
Heart Disease and Stroke.--The Committee continues to
support heart valve disease education and awareness, encourages
CDC to support the implementation of the Cardiovascular
Advances in Research and Opportunities Legacy Act, and
encourages CDC to increase the programmatic emphasis on heart
valve disease education and awareness.
High Obesity Rate Counties.--The Committee recognizes the
cost associated with diet-related disease and its comorbidities
to the U.S. taxpayer and overall healthcare system and directs
that within the amount provided, no less than $5,000,000 is
directed to remain available for public institutions with
expertise in the fields of obesity, diabetes, and related
chronic diseases in an effort to support the national strategy
on nutrition and reducing diet-related diseases.
CDC grantees work with State and local public health
departments and other partners to support measurable outcomes
through community and population-level, evidenced-based obesity
intervention and prevention programs. Projects integrate
evidence-based policy, systems, and environmental approaches to
better understand and address the environmental and societal
implications of obesity. The Committee encourages CDC to
consider including high childhood obesity rates in its
eligibility criteria for the High Obesity Program as well as
the preponderance of obesity by State based on the CDC
Behavioral Risk Factor Surveillance System.
Inflammatory Bowel Diseases.--The Committee provides
$3,000,000, an increase of $1,000,000, to support CDC's work to
improve the public health response to Inflammatory Bowel
Disease (IBD). The Committee commends CDC's ongoing efforts to
continue epidemiological studies on Crohn's disease and
ulcerative colitis, known collectively as IBD, and to establish
awareness and education activities for patients and healthcare
professionals to improve time to diagnosis and disease
management, including in medically underserved populations.
National Lupus Registry.--Guided by the National Public
Health Agenda for Lupus, CDC funds population registries and
cohort studies to increase public health knowledge about lupus
as well as supporting activities to improve awareness of the
signs and symptoms of Lupus. The Committee provides $20,000,000
for CDC's Lupus activities, an increase of $10,000,000, to
support both research and awareness activities.
Oral Health.--The Committee understands the importance of
CDC's Division of Oral Health and its role in reducing oral
disease rates among vulnerable populations. Therefore, the
Committee provides $22,250,000, an increase of $2,000,000, for
the Division of Oral Health. Within the increase for the
Division of Oral Health, the Committee provides funding to
evaluate and enhance the nation's surveillance systems to
better identify oral health burden at the national, State, and
local levels. Such enhancements will make data available more
quickly, enable exploration and evaluation of methods to track
adherence to infection prevention, provide information for
dental settings to support educational efforts, and increase
awareness of the importance of oral health to overall health.
Prostate Cancer.--The Committee is aware of the continued
rise in prostate cancer deaths and supports the CDC's work to
increase public awareness of prostate cancer risks, screening
and treatment in high-risk populations.
Psoriatic Disease.--The Committee commends CDC for
supporting the development of a national health indicator
report on the burden of psoriasis and psoriatic arthritis in
the U.S. This report noted that approximately 8 million
Americans are affected by psoriatic disease and that the
systemic inflammation that characterizes psoriatic disease also
leads to comorbidities including heart disease, diabetes, and
depression. The Committee also recognizes CDC for piloting
activities to demonstrate the success of public health
interventions to reduce this burden, particularly among rural
populations and those that are underdiagnosed. The Committee
encourages CDC to leverage these evidence-based learnings into
outcomes by partnering with stakeholders to implement promising
interventions.
Safe Motherhood and Infant Health.--The Committee includes
a total of $110,500,000 for this portfolio of programs to
improve the health of pregnant and postpartum women and their
infants. The Committee directs CDC to use the funding increase
to support Maternal Mortality Review Committees (MMRCs),
Perinatal Quality Collaboratives, and other programs including
the Sudden Unexpected Infant Death and Sudden Death in the
Young Case Registry. The Committee encourages CDC to prioritize
funding to help MMRCs build stronger data systems and improve
data collection at the State level to ensure accuracy and
completeness in data collection, analysis, and reporting across
State MMRCs. This investment is necessary to provide accurate
statistics on U.S. maternal mortality rates and inform data-
driven actions to prevent these deaths.
The Committee directs CDC to provide a briefing to the
Committees within 180 days of enactment of this Act on barriers
to effective and consistent data collection and opportunities
to improve coordination among State MMRCs.
Vision and Eye Health.--The Committee provides $6,500,000
for activities related to vision and eye health including
glaucoma, the same as fiscal year 2024 enacted level. The
Committee supports national-level surveillance on the
prevalence and risk of vision loss and eye disease in the
Vision and Eye Health Surveillance System. Data on risk of
vision loss and existence of vision loss in the U.S. is
necessary to inform State and community partnerships that
emphasize early detection and intervention and to address
challenges in access to eye care that can prevent eye disease
from progressing to permanent vision loss.

BIRTH DEFECTS, DEVELOPMENTAL DISABILITIES, DISABILITIES AND HEALTH

Appropriation, fiscal year 2024....................... $206,060,000
Budget request, fiscal year 2025...................... 205,560,000
Committee Recommendation.............................. 206,060,000
Change from enacted level........................... - - -
Change from budget request.......................... +500,000

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 2025
Budget Activity FY 2024 Enacted Committee
------------------------------------------------------------------------
Child Health and Development BA... $71,300,000 $71,300,000
Birth Defects................. 19,000,000 19,000,000
Fetal Death................... 900,000 900,000
Fetal Alcohol Syndrome........ 11,500,000 11,500,000
Folic Acid.................... 3,150,000 3,150,000
Infant Health................. 8,650,000 8,650,000
Autism........................ 28,100,000 28,100,000
Health and Development with 86,410,000 86,410,000
Disabilities BA..................
Special Olympics.............. 19,500,000 19,500,000
Tourette Syndrome............. 2,500,000 2,500,000
Early Hearing Detection and 10,760,000 10,760,000
Intervention.................
Muscular Dystrophy............ 8,000,000 8,000,000
Attention Deficit 1,900,000 1,900,000
Hyperactivity Disorder.......
Fragile X..................... 2,000,000 2,000,000
Spina Bifida.................. 7,500,000 7,500,000
Congenital Heart Defects...... 8,250,000 8,250,000
Public Health Approach to Blood 10,400,000 10,400,000
Disorders........................
Hemophilia Activities............. 3,500,000 3,500,000
Hemophilia Treatment Centers...... 5,100,000 5,100,000
Thalassemia....................... 2,100,000 2,100,000
Neonatal Abstinence Syndrome...... 4,250,000 4,250,000
Surveillance for Emerging Threats 23,000,000 23,000,000
to Mothers and Babies............
------------------------------------------------------------------------

Cerebral Palsy.--Cerebral palsy (CP) is the most common,
lifelong motor disability caused by an early developmental
brain injury. The mechanism and type of injury underlying CP is
still not well understood, which can include perinatal stroke,
maternal infection, genetics and/or hypoxic ischemic
encephalopathy. The Committee encourages CDC to consider
supporting efforts to expand scientific knowledge on
prevalence, risk factors, early detection, and co-morbidities
of CP in order to determine if the CP population is rising,
dropping, or staying the same.
Fetal Death.--The Committee provides continued funding to
support CDC's implementation of the recommendations of the
Stillbirth Task Force.
Blood Clots.--As part of the fiscal year 2026 congressional
justification, the Committee directs CDC to include a cost
estimate to expand its nationwide public awareness campaign to
recognize the symptoms of blood clots.
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 mutations. The Committee also
recommends the National Center on Birth Defects and
Developmental Disabilities (NCBDDD) work to ensure populations
with FX conditions are being properly diagnosed and made aware
of available medical services. Finally, the Committee
recommends the NCBDDD support research across the lifespan of
individuals living with FX and the associated conditions and
disorders.
Hemophilia Treatment Centers.--The Committee encourages the
CDC to utilize resources to pursue partnerships with additional
community stakeholders to enhance program activities and access
in rural and underserved communities, particularly stakeholders
that have shown success reaching patients who do not have
regular access to a treatment center.
Muscular Dystrophy.--The Committee includes $8,000,000 to
support Muscular Dystrophy research and monitoring initiatives.
The Committee encourages CDC to continue its efforts through
the Muscular Dystrophy Surveillance, Tracking, and Research
Network to provide information and monitoring to better
understand the outcomes for Duchenne and Becker muscular
dystrophy treated both in and out of Certified Duchenne Care
Centers; examine impacts of the condition on bone health,
cardiovascular, and cognitive function; and investigate care
and outcomes for adults with Duchenne and Becker, including
those receiving multiple therapies including gene therapy, and
various demographic subpopulations.
Spina Bifida.--The Committee recognizes that Spina Bifida
is the most common permanently disabling congenital disability
compatible with life in the U.S., affecting 1,500 babies in the
country each year. While Spina Bifida and related neural tube
defects are sometimes preventable through education and
adequate daily folic acid consumption, there are an estimated
166,000 individuals, more than 65 percent of whom are adults,
living with all forms of this complex birth defect. The
Committee understands that there is a significant need for
support at CDC to address the transitional and adult care needs
of the growing, aging Spina Bifida community, and the Committee
requests an update in the fiscal year 2026 congressional
justification on efforts to address these needs.
The Committee provides funding for the National Spina
Bifida Program to be used 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 the best treatment options for
people living with Spina Bifida; and to support the National
Spina Bifida Patient Registry to allow for both the inclusion
of more clinics and the examination of mental health issues in
the Spina Bifida community.

PUBLIC HEALTH SCIENTIFIC SERVICES

Appropriation, fiscal year 2024....................... $754,497,000
Budget request, fiscal year 2025...................... 804,097,000
Committee Recommendation.............................. 754,497,000
Change from enacted level........................... - - -
Change from budget request.......................... -49,600,000

The Committee recommendation includes $594,497,000 in
discretionary appropriations and $160,000,000 in transfers from
PPHF.
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 provides the following
amounts:

------------------------------------------------------------------------
FY 2025
Budget Activity FY 2024 Enacted Committee
------------------------------------------------------------------------
Health Statistics................. $187,397,000 $187,397,000
Surveillance, Epidemiology, and 298,100,000 298,100,000
Informatics......................
Public Health Data Modernization 175,000,000 175,000,000
Initiative.......................
Advancing Laboratory Science...... 23,000,000 23,000,000
Public Health Workforce........... 71,000,000 71,000,000
------------------------------------------------------------------------

Assisted Reproductive Reporting Requirements.--The
Committee recognizes that Congress passed the Fertility Clinic
Success Rate and Certification Act in 1992, which ``mandates
that clinics performing assisted reproductive technology
annually provide data for all procedures performed to CDC and
sets forth definitions and reporting requirements.'' The
Committee acknowledges the importance of oversight to ensure
ethical assisted reproductive technology practices and to
address the long-term health outcomes and complications for
women and children. The Committee directs CDC to provide and
publicly release a report within 180 days of enactment of this
Act. This report shall address key outcomes, accrediting
information, and the status of consumer education materials as
they relate to infertility treatments.
CDC is further directed to include data related to the
number of fertilized eggs, blastocysts, and embryos created in
each cycle of assisted reproductive technology; the number that
perish due to natural causes in the course of in vitro
fertilization or a related procedure; the number that perish
due to preimplantation genetic diagnosis testing in the course
of in vitro fertilization or a related procedure; and the
number that are intentionally destroyed. In the event such data
are not available, CDC is directed to revise the National
Assisted Reproductive Technology Surveillance System to allow
their collection and publication in future years.
Data Modernization.--The Committee is pleased to see
progress towards the implementation of CDC's data modernization
efforts and encourages the agency to continue to invest in the
five key pillars of data modernization: (1) electronic case
reporting; (2) laboratory information management systems; (3)
syndromic surveillance; (4) electronic vital records systems;
and (5) the national notifiable disease surveillance system.
The Committee also recognizes CDC's efforts to engage with
States, Tribes, localities, and territories through data use
agreements for core data sources as well as key recommendations
from the Advisory Committee to the Director Data and
Surveillance Workgroup. The Committee directs CDC, within 90
days of the enactment of this Act, to provide a report
regarding how these efforts are advancing the agency towards
the development and implementation of enterprise-level public
health data systems.
Eating Disorders.--The Committee remains concerned that
mental health problems among youth are at an all-time high,
with eating disorders-related emergency room admissions for
youth doubling during the pandemic. For 23 years, CDC conducted
surveillance of the signs and symptoms of eating disorders
within the Youth Risk Behavioral Surveillance System (YRBSS),
but the YRBSS coordinators voted to remove the question from
the 2015 survey. The resulting gap in data collection has left
public health experts and researchers with limited data to
address current eating disorders among youth. The Committee
directs CDC to include one standard question on unhealthy
weight control practices for eating disorders for consideration
by State directors in the development of the 2025 YRBSS survey.

Surveillance, Epidemiology, and Informatics

National Neurological Conditions Surveillance System.--The
Committee provides $5,000,000, the same as the fiscal year 2024
enacted level to continue efforts on the two initial conditions
multiple sclerosis and Parkinson's disease.
Primary Immunodeficiencies.--The Committee includes
$3,500,000 for education, awareness, and genetic sequencing
surveillance related to primary immunodeficiencies. This
program has proven effective in identifying undiagnosed
patients and linking them to centers of care.

ENVIRONMENTAL HEALTH

Appropriation, fiscal year 2024....................... $242,850,000
Budget request, fiscal year 2025...................... 266,850,000
Committee Recommendation.............................. 145,600,000
Change from enacted level........................... -97,250,000
Change from budget request.......................... -121,250,000

The Committee recommendation includes $94,600,000 in
discretionary appropriations and $51,000,000 in transfers from
PPHF.
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 provides the following
amounts:

------------------------------------------------------------------------
FY 2025
Budget Activity FY 2024 Enacted Committee
------------------------------------------------------------------------
Environmental Health Laboratory... $70,750,000 $34,500,000
Other Environmental Health 48,500,000 12,000,000
Laboratory...................
Newborn Screening Quality 21,000,000 21,000,000
Assurance Program............
Newborn Screening/Severe 1,250,000 1,500,000
Combined Immunodeficiency
Diseases.....................
Environmental Health Activities... 48,600,000 21,600,000
Safe Water.................... 8,600,000 8,600,000
Amyotrophic Lateral Sclerosis 10,000,000 10,000,000
(ALS) Registry...............
Trevor's Law.................. 3,000,000 3,000,000
Climate and Health............ 10,000,000 - - -
All Other Environmental Health 17,000,000 - - -
Environmental and Health Outcome 34,000,000 - - -
Tracking Network.................
Asthma............................ 33,500,000 33,500,000
Childhood Lead Poisoning (PPHF)... 51,000,000 51,000,000
Lead Exposure Registry............ 5,000,000 5,000,000
------------------------------------------------------------------------

Amyotrophic Lateral Sclerosis.--The Committee provides a
funding level of $10,000,000 for the National Amyotrophic
Lateral Sclerosis (ALS) Registry and encourages CDC to continue
investing in research that will reduce incidence of ALS through
ALS prevention and risk mitigation strategies among civilians,
active military personnel, and veterans in the U.S.
Additionally, the Committee encourages CDC to continue to
collaborate with the Departments of Defense and Veterans
Affairs on risk reduction strategies that will lower the
incidence of ALS among active-duty personnel and veterans.
Asthma.--The Committee recognizes the significance of
asthma as a chronic disease with implications for public
health, productivity at work and at school, and healthcare
utilization. The Committee directs CDC to provide a briefing on
the current economic burden of asthma in the U.S. to help guide
public health efforts and resource allocation within 180 days
of the enactment of this Act. The CDC last published this data
in 2018 in a report titled, ``The Economic Burden of Asthma in
the U.S., 2008-2013.'' Specifically, the Committee directs CDC
to provide a thorough assessment of the following key aspects:
prevalence, medical costs, absenteeism, and mortality.
Pediatric Reference Intervals.--The Committee supports
CDC's work to ensure the reliable diagnosis and treatment of
children in a cost-effective manner. A 2022 CDC study found
that many reference intervals used for children do not
accurately reflect the biology of child development. The
Committee encourages CDC to develop pediatric reference
intervals and directs the CDC to include information on the
funding needed for this activity as part of the fiscal year
2026 congressional justification.

INJURY PREVENTION AND CONTROL

Appropriation, fiscal year 2024....................... $761,379,000
Budget request, fiscal year 2025...................... 943,379,000
Committee Recommendation.............................. 40,000,000
Change from enacted level........................... -721,379,000
Change from budget request.......................... -903,379,000

To restore public confidence and better focus CDC on
controlling and preventing communicable diseases, the Committee
provides no funding for the National Center for Injury
Prevention and Control (Injury Center). The Committee remains
concerned that CDC, under the Biden Administration, continues
to request funding for politically-motivated projects at the
expense of CDC core preparedness and response activities. While
Director Cohen has stated in relation to pandemic preparedness
that CDC must ``be ready to respond, and that is our top
priority at CDC,'' the fiscal year 2025 budget request called
for $182,000,000 in additional funding for the Injury Center, a
24 percent increase above the fiscal year 2023 level and the
largest requested funding increase of any CDC center.
The Committee further notes that the activities of the
Injury Center are duplicative of other programs, projects, and
activities at other agencies, and taxpayers see less services
from CDC-funded activities due to high program support costs.
The Department of Justice's Office on Violence Against Women is
better positioned to implement Violence Against Women Act
programs, the Department of Health and Human Services'
Administration for Children and Families is better positioned
to support children and families, and the Administration on
Community Living is better positioned to implement programs for
seniors. Finally, of the $506,079,000 provided for the CDC
opioid program in fiscal year 2024, $114,000,000, or 23
percent, has been allocated for administrative costs. The
transfer of this funding to SAMSHA will increase the funding
available to States for prevention, response, and recovery
services by $63,000,000 in reduced Federal administrative
expenses alone.
Rape Prevention.--The Committee includes $40,000,000 to
support rape prevention and education programs.

NATIONAL INSTITUTE FOR OCCUPATIONAL SAFETY AND HEALTH

Appropriation, fiscal year 2024....................... $362,800,000
Budget request, fiscal year 2025...................... 363,200,000
Committee Recommendation.............................. 263,700,000
Change from enacted level........................... -99,100,000
Change from budget request.......................... -99,500,000

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, the Committee recommends the following
amounts:

------------------------------------------------------------------------
FY 2025
Budget Activity FY 2024 Enacted Committee
------------------------------------------------------------------------
National Occupational Research $119,500,000 $119,500,000
Agenda...........................
Agricultural, Forestry, and 29,000,000 29,000,000
Fishing (non-add)............
Education and Research Centers.... 32,000,000 33,500,000
Personal Protective Technology.... 23,000,000 23,000,000
Mining Research................... 66,500,000 68,000,000
National Mesothelioma Registry and 1,200,000 1,200,000
Tissue Bank......................
Firefighter Cancer Registry....... 5,500,000 5,500,000
Total Worker Health............... 11,800,000 13,000,000
------------------------------------------------------------------------

Agricultural, Forestry, and Fishing.--The Committee
provides $29,000,000 to protect workers in this sector by
providing leadership in applied research, disease and injury
surveillance, education, and prevention.
Chronic Obstructive Pulmonary Disease.--The Committee notes
the opportunity for CDC's implementation of the Chronic
Obstructive Pulmonary Disease (COPD) National Action Plan
developed by CDC and the NIH's National Heart, Lung, and Blood
Institute. The Committee urges CDC and the National Center for
Chronic Disease Prevention and Health Promotion to support
surveillance and awareness activities on COPD through existing
funding mechanisms.
Health and Safety of Firefighters including Environmental
Exposures.--The Committee is aware that firefighting is an
inherently dangerous and vitally important occupation. In
addition to injuries and deaths in the line of duty,
firefighters are also at risk for cancer and other illnesses.
Despite a recognition of the risks associated with firefighter
and first responders' environmental exposures, there has been
no large-scale, systematic examination of the mechanisms by
which the environmental exposures experienced by these
frontline responders can contribute to cancer risk. The
Committee directs CDC to establish a Total Worker Health Center
of Excellence and conduct research to examine the health and
safety of firefighters and first responders, including building
upon existing scientific evidence-based research, and to
further develop new solutions and best practices for complex
occupational safety and health problems such as the toxic
exposures, higher cancer incidence rates in this population,
personal protective equipment, and wildland fire fighting.
Firefighter Cancer Registry.--The Committee recognizes the
inherent dangers of firefighting and the corresponding
importance of investigating traumatic and medical firefighter
line of duty deaths. The Committee includes $5,500,000 for
CDC's National Firefighter Registry for Cancer as the registry
continues to recruit and enroll participants.
Mine Health and Safety.--The Committee supports research
related to air pollutant exposure risks to miners in metal and
non-metal surface and underground mines. The Committee provides
increased funding for CDC to partner with western institutions
with demonstrated expertise in air pollution, familiarity with
western mining challenges, and accredited environmental
analytical laboratories to evaluate airborne pollutant exposure
risks of miners, develop novel respirable dust and crystalline
silica exposure monitoring technologies, work with mine
operators to implement exposure monitoring and mitigation
measures, train mineworkers to reduce air pollutant exposures,
and transfer the knowledge gained to other industries and parts
of the country.
World Trade Center Health Program (WTCHP).--The Committee
recognizes that thousands of eligible members of WTCHP reside
outside the New York metropolitan area, including Florida,
North Carolina, Pennsylvania, and Virginia. In consideration of
migration trends, and with a greater need to provide clinical
services, in particular monitoring and treatment of WTCHP-
certified conditions and improve access to research within
regions where eligible members live, the Committee encourages
CDC to include an assessment in the fiscal year 2026
congressional justification on the value and impact on
sustainability of the program in establishing an additional
Clinical Center of Excellence outside the New York metropolitan
area.

ENERGY EMPLOYEES OCCUPATIONAL ILLNESS COMPENSATION PROGRAM

Appropriation, fiscal year 2024....................... $55,358,000
Budget request, fiscal year 2025...................... 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 2024....................... $692,843,000
Budget request, fiscal year 2025...................... 692,843,000
Committee Recommendation.............................. 563,922,000
Change from enacted level........................... -128,921,000
Change from budget request.......................... -128,921,000

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. In cooperation with ministries of health and
other appropriate organizations, CDC tracks and assesses
evolving global health issues and identifies and develops
activities to apply CDC's technical expertise.
Within the total, the Committee recommends the following
amounts:

Soil Transmitted Helminth and Related Diseases.--The
Committee includes funding 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 2024....................... $938,200,000
Budget request, fiscal year 2025...................... 943,300,000
Committee Recommendation.............................. 874,000,000
Change from enacted level........................... -64,200,000
Change from budget request.......................... -69,300,000

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

------------------------------------------------------------------------
FY 2025
Budget Activity FY 2024 Enacted Committee
------------------------------------------------------------------------
State and Local Preparedness and $744,200,000 $735,000,000
Response Capability..............
Public Health Emergency 735,000,000 735,000,000
Preparedness Cooperative
Agreement....................
Academic Centers for Public 9,200,000 - - -
Health Preparedness..........
Ready Response Enterprise Data 55,000,000 - - -
Integration Platform & Center for
Forecasting Analytics............
CDC Preparedness and Response 139,000,000 139,000,000
Capability.......................
------------------------------------------------------------------------

Emergency Preparedness and Response.--The Committee
supports the CDC's efforts to provide guidance and technical
assistance to communities as they prepare for, withstand, and
recover from emergencies. For example, events such as the
Norfolk Southern train derailment in East Palestine, Ohio,
demonstrates the need to provide rural communities support,
particularly through assistance building public health
emergency preparedness plans and understanding response
capabilities.

CDC-WIDE ACTIVITIES AND PROGRAM SUPPORT

Appropriation, fiscal year 2024....................... $663,570,000
Budget request, fiscal year 2025...................... 723,570,000
Committee Recommendation.............................. 511,570,000
Change from enacted level........................... -152,000,000
Change from budget request.......................... -212,000,000

This account supports the Office of the Director as well as
public health leadership and support activities at CDC.
Within the total, the Committee recommends the following
amounts:

------------------------------------------------------------------------
FY 2025
Budget Activity FY 2024 Enacted Committee
------------------------------------------------------------------------
Preventive Health and Health $160,000,000 - - -
Services Block Grant.............
Office of the Director............ 128,570,000 $116,570,000
Office of Rural Health (non- 5,000,000 5,000,000
add).........................
Infectious Disease Rapid Response 25,000,000 35,000,000
Reserve Fund.....................
Public Health Infrastructure and 350,000,000 360,000,000
Capacity.........................
------------------------------------------------------------------------

CDC Core Capacities.--The Committee has prioritized funding
for CDC Core Capacities necessary to respond to the threats of
infectious disease across 14 accounts. These accounts include
Quarantine; Emerging Infectious Diseases; Advanced Molecular
Detection; Epi and Lab Capacity; Health Statistics; Public
Health Data Modernization; Public Health Workforce; Advancing
Laboratory Science; Surveillance, Epi, and Informatics; Global
Health Protection; Public Health Emergency Preparedness
Cooperative Agreements; Buildings and Facilities; the
Infectious Diseases Rapid Response Reserve Fund; and Public
Health Infrastructure. As part of the fiscal year 2026
congressional justification, CDC is directed to provide a
breakout table detailing the funding requested for these core
capacity program lines.
CDC Public Health Loan Repayments.--The Committee
recognizes the value of the CDC's fellowship program in
improving the technical abilities of public health
professionals prior to their permanent placement with State,
local, Tribal, or territorial public health agencies. The CDC
is directed to provide the Committee, within 180 days of
enactment of this Act, a briefing on the number of CDC
fellowships, the cost of the CDC's fellowship program, and the
placements of CDC fellows and their tenure within relevant
public health offices.
Congressional Relations.--The Committee is extremely
concerned that the bifurcation of responsibilities related to
engagement with the Committee has degraded the quality and
timeliness of information essential to the Committee fulfilling
its Constitutional role and is to the detriment of the CDC in
its engagement with Congress.
Diet and Health.--In making grants related to diet and
health, the Committee directs CDC to fund projects integrating
evidence-based policy, systems, and environmental approaches to
better understand and address the environmental and societal
implications of obesity. CDC is directed to give preference to
proposals that are led by or conducted in coordination with an
academic medical center to ensure that education and outreach
efforts are aligned with best medical practices. The Committee
encourages CDC to consider including high childhood obesity
rates in its eligibility criteria.
Disease Modeling.--The Committee encourages CDC to work
with schools of public health and other academic institutions
to engage the nation's expertise in disease modeling, public
health data analysis, research, and training to build workforce
capacity in this emerging field.
Drowning.--The Committee directs CDC to provide information
to States and national organizations to reduce the risk of
drowning for individuals at greater risk of drowning.
Food Allergies.--The Committee recognizes the serious issue
of food allergies, which affect approximately 8 percent of
children in the U.S. The Committee includes Chronic Disease
Prevention and Health Promotion funding to support school-based
efforts to address food allergies and reduce potentially fatal
anaphylactic reactions.
Gender Dysphoria.--The Committee notes the limited medical
evidence of the long-term effects of hormone drugs and surgical
procedures to alter bodily sex traits. In the United Kingdom,
the National Health Service recently ended social, hormonal,
and surgical interventions to look like the opposite sex for
minors due to the limited evidence to support clinical decision
making for this population. The Committee directs CDC to
conduct a long-term study on the effects of drugs or surgery
used as an intervention for gender dysphoria.
Human Health Risks Posed by Wildlife.--The Committee is
concerned by the CDC's lack of action to implement the GAO
recommendation that the agency comprehensively assess the risk
that imported wildlife could introduce zoonotic diseases to the
U.S. Therefore, the Committee directs CDC to develop a
comprehensive risk analysis framework for purposes of
evaluating current policies to determine whether adjustments
are required for purposes of assessing zoonotic disease risks
related to imported wildlife. The Committee further directs CDC
to provide a briefing on its implementation of this directive
within 180 days of the enactment of this Act.
Importation of Dogs.--The Committee strongly encourages CDC
to modify the final rule entitled, ``Control of Communicable
Disease; Foreign Quarantine: Importation of Dogs and Cats'' in
order to ensure that the transport of dogs into the country by
rescue organizations, U.S. employees stationed overseas
traveling with their pets, and professional pet transportation
companies licensed as Class T carriers is not unreasonably
inhibited.
Infectious Disease Rapid Response Reserve Fund (Reserve
Fund).--The Committee provides funding for the Reserve Fund to
ensure that CDC is positioned to respond quickly to an imminent
public health emergency. The Committee directs CDC to provide a
table to the Committee each month, which shall include all
amounts available in the Reserve Fund for the current fiscal
year and the preceding two fiscal years, including: (1) each
individual obligation above $5,000,000; (2) with respect to
each such obligation, the notification to which it relates; and
(3) the total amount unobligated in the Reserve Fund.
Local Health Departments.--Federal funding intended for
both State and local health departments does not consistently
reach local health departments beyond those directly funded by
CDC. The Committee encourages CDC to require States to fund
local health departments when programmatically appropriate. The
Committee urges CDC to publicly track and report to the
Committee how funds provided to State health departments are
passed through to local health departments, including the
amount and date funds are made available, per grant award, by
local jurisdiction.
Nicotine.--The Committee encourages CDC to study the
psychiatric and physical effect on the body from the use of
nicotine.
Obesity.--The Committee recognizes obesity as a serious
chronic disease and public health and economic issue that must
be addressed. CDC formally recognizes obesity as a disease and
recommends that it be treated as such. Evidence-based
therapies, including innovative and highly effective anti-
obesity medications (AOMs) are available with others in
development. Expanded access to intensive behavioral therapy
and AOMs, in addition to existent surgical procedures, not only
provide significant weight loss reductions but lead to improved
outcomes in over 200 obesity-related health conditions
including diabetes, coronary heart disease, and hypertension.
The Committee encourages CDC to take a comprehensive approach
in treating obesity as a chronic disease and find ways to
improve access to treatment options. The Committee also
encourages CDC to continue to collaborate with other Federal
agencies who are already treating obesity as a chronic disease
as it considers best practices to improve care for people with
obesity.
Office of Rural Health.--The Committee is encouraged by
efforts from the agency to establish the CDC Office of Rural
Health (ORH). The Committee directs the agency to ensure that
the established ORH will guide CDC's rural health leadership
across the entire agency. This includes by developing
purposeful public health guidance for rural health departments,
analyzing and developing initiatives to expand the rural public
health workforce, establishing a formal partnership with the
Federal Office of Rural Health Policy under HRSA, and otherwise
serving as a resource and technical assistance hub for public
health in rural communities. The Committee includes $5,000,000
for the continued efforts of this office.
Overdose Prevention Funding and Naloxone.--The Committee
commends CDC for its leadership in combating opioid drug
overdoses; this funding has been reallocated to SAMHSA to
reduce administrative overhead and expand the resources
available to States and communities to directly respond to
substance misuse. The Committee recognizes that CDC has issued
opioid overdose prevention funding opportunities to States,
territories, and certain localities. The Committee recognizes
the delay in implementation and directs CDC to provide a
written report on how to consider opioid overdoes reversal
education as a criterion when distributing opioid overdose
prevention funds. The Committee notes that when an opioid
overdose reversal medication, like naloxone, and overdose
education are available to community members, overdose deaths
decrease significantly in those communities.
Public Health Infrastructure.--The Committee notes that the
Public Health Infrastructure (PHI) program is intended, as
described in the joint explanatory statement that created it,
to support public health departments. The Committee includes a
new program requirement that 10 percent of PHI funding be
designated specifically for Tribes and Tribal organizations.
The provision of a stable, disease agnostic funding line will
better ensure Tribes and Tribal Organizations are better
equipped to coordinate together to save lives. The Committee
notes that in the absence of this new requirement, CDC has
provided only $5,000,000 to Tribes and Tribal organizations
through the PHI program in fiscal year 2024, while providing
$255,000,000 to national professional and advocacy
organizations. The Committee is concerned that the provision of
funds to national organizations and high programmatic
assessment by the CDC has undermined the ability of the program
to effectively support State, local, Tribal, and territorial
public health organizations and again directs that no less than
70 percent of this funding be awarded to health departments.
Prescription Drug Monitoring Programs.--The Committee
understands that nearly all 50 States and U.S. territories'
prescription drug monitoring programs are connected and
securely sharing critical controlled substance information for
the purposes of identifying and preventing abuse, misuse, or
diversion of prescription drugs. The Committee supports the
removal of a requirement for States to connect to a specific
data hub solution as a condition of funding. However, to adhere
to Congressional intent and ensure the success and continuity
of the program, the Committee encourages CDC to cease any
technical requirements that limit the ability of States to
optimize Federal funding and to continue to utilize the
prescription drug monitoring program data hub of their choice.
Reporting.--The Committee is concerned that CDC abortion
surveillance reports, published annually in the CDC Morbidity
and Mortality Weekly Report, lack adequate participation by
States including incomplete submissions and even total
nonparticipation. The Committee requests a report on the extent
of data inconstancies; steps taken by CDC to improve data
completeness; and recommendations for legislative or regulatory
changes to achieve complete data.
Sexual and Domestic Violence Prevention.--The Committee
provides $10,000,000 to continue support for technical
assistance to sexual and domestic violence prevention
coalitions and organizations committed to breaking the cycle of
interpersonal violence. The Committee encourages CDC to use
this funding to ensure that organizations and coalitions
responding to the needs of survivors of interpersonal violence
have access to the variety of federal programs that provide
support for a continuum of services such as education and
prevention initiatives, medical exams, forensic interviews,
family advocacy, linkages to care, and job training. The
Committee encourages the development of a continuum of services
in order to better help move survivors from crisis to
sustainability.
Traumatic Brain Injury Data.--Currently, fewer than half of
all States have developed and manage their own surveillance
systems for individuals living with a traumatic brain injury
(TBI). While the resources provided to individuals living with
TBI in those States can be most beneficial, it is difficult to
determine resource allocation when the true burden of the
injury is unknown. The Committee encourages CDC to produce
guidance detailing the available resources for States
interested in establishing State-level TBI surveillance systems
to voluntarily collect information from individuals about their
experience living with TBI to inform service planning and
delivery, resources available to such individuals such as where
to seek care, advances in scientific research as well as
information about services, therapies, and co-morbidities
commonly experienced by individuals with TBI.
Unapproved Nicotine Devices.--The Committee recognizes the
risks posed by nicotine delivery devices from uncertain origins
particularly those from foreign entities of concern. The
Committee directs CDC, within 180 days of enactment of this
Act, to publicly release a report on actions taken by States to
improve consumer transparency regarding the risks posed by such
devices. The Committee encourages CDC to provide funding to
States to support the implementation and enforcement of efforts
related to State laws mandating that manufacturers of
electronic nicotine products provide certifications related to
compliance with FDA requirements.
Youth Electronic Cigarette Use.--The Committee recognizes
the growing challenge that schools undergo by increased use of
electronic cigarettes and other vaporizing equipment in their
facilities. These concerns often cause schools to lock bathroom
doors to prevent their use, but this can also pose a safety
risk. The Committee understands that there are commercially-
available off-the-shelf vape detection sensors that can provide
detect vape, smoke, THC, and sound abnormalities in areas where
cameras cannot be placed. The Committee urges CDC to clarify
that funds may be used for this technology and the Committee
encourages CDC to work with States and school districts to
increase awareness of this technology.
Youth Sports Injury Prevention Education.--Across the
country, communities continue to recognize the importance of
physical activity to maintain health, resulting in rapidly
growing youth sports activities. Research and education are
needed to examine sport and recreation injury across various
activities, demographic groups, and health care settings, in
addition to age related education for prevention and
management. The Committee encourages CDC to establish a
national public health information and education initiative
with States who have legislated child and youth sports injury
education requirements for coaches of non-school organized
youth sports activities. The Committee encourages CDC to
coordinate with respective State departments of public health
to develop public service announcements to educate volunteer
coaches and parents of children and youth (ages 5-17) on the
risks and means to prevent and manage sports related injuries.

BUILDINGS AND FACILITIES

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

This account supports capital projects as well as repairs
and improvements to restore, maintain, and improve CDC's assets
and facilities.
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.

NATIONAL INSTITUTES OF HEALTH (NIH)

Appropriation, fiscal year 2024....................... $48,581,000,000
Budget request, fiscal year 2025...................... 49,830,482,000
Committee Recommendation.............................. 48,581,000,000
Change from enacted level........................... - - -
Change from budget request.......................... -1,249,482,000

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 Committee recommendation for the NIH program level is
$48,581,000,000 including funding for the Advanced Research
Projects Agency for Health (ARPA-H). The Committee provides
$47,041,518,000 in discretionary appropriations, $1,412,482,000
in PHS Act section 241 evaluation set aside transfers, and
$127,000,000 as authorized in the 21st Century Cures Act (Cures
Act) (P.L. 114-255).
In coordination with the Committee on Energy and Commerce
of the House of Representatives, the Committee proposes a
reorganization of the National Institutes of Health for the
21st century. The foundational biomedical science pioneered by
NIH does not need to be spread across 27 various institutes and
centers; doing so creates duplication, the potential for
unrecognized gaps, and added administrative costs. The U.S. has
been the world pioneer in basic science and biomedical
research, and as China continues to increase its spending in
this area, it is imperative the U.S. maintain its innovative
edge. Maintaining this advantage builds the nation's economic
base and preserves national security interests. As the threat
from foreign nations increases, it is time Congress recognized
that a reorganization of the NIH is needed to ensure the nation
continues to be a leader in innovation. Several of the proposed
changes to the institutes have been requested by prior
Administrations in budget requests or recommended by scientific
bodies. The new structure seeks to encourage a holistic life
stage approach to all research, with the goal of eliminating
the demographic- or disease-specific siloed nature of the
current structure and ensure each institute or center is
considering the whole individual and all populations across the
entire lifespan. The science of today is not accomplished in a
silo. The nation's premier research institution should not be
structured as such either.
The Committee includes specific funding allocations for
several initiatives and activities detailed in the institute-
and center-specific sections below. For ease of reference the
prior institute and center names have been maintained in the
report language that follows. The funding amounts shown for
each institute or center, reflect the proposed new structure,
and are comparably adjusted to fiscal year 2024, the fiscal
year 2025 budget request, or Committee proposed funding for
fiscal year 2025.

NATIONAL CANCER INSTITUTE

Appropriation, fiscal year 2024....................... $7,224,159,000
Budget request, fiscal year 2025...................... 7,839,141,000
Committee Recommendation.............................. 7,875,289,000
Change from enacted level........................... +651,130,000
Change from budget request.......................... +36,148,000

Biliary Tract Cancers.--The Committee encourages the
National Cancer Institute (NCI) to support novel treatment
strategies in biliary tract cancers. The Committee supports
research on novel cancer vaccines and immunotherapies,
including targeting recurrent cancer neoantigens in these
cancers with novel cancer treatment vaccine in combination with
other drugs that work on the human immune system.
Breast Cancer Screening Evidence Gaps.--The U.S. Preventive
Services Task Force (Task Force) breast cancer screening
recommendation statement, published in April 2024, identifies
several critical research gaps that restrict the Task Force
from making evidence-based recommendations that address
multiple important areas. For example, the Task Force notes
that research is needed: to better understand whether and how
the benefits quantitatively differ for annual vs. biennial
breast cancer screening; to help clinicians and patients
understand the best strategy for breast cancer screening in
women found to have dense breasts on a screening mammogram,
such as supplemental screening; and to understand and address
the higher breast cancer mortality among Black women. Breast
cancer is the second most common cancer among women in the
U.S., and over 40,000 women are expected to die from breast
cancer in 2024. For the Task Force to fulfill its mission to
improve health through actionable preventive services
recommendations, the Committee urges the NIH to continue to
support research in the areas outlined in the Evidence Gaps
Research Taxonomy Table from the Task Force's 2024 Breast
Cancer Screening Recommendation Statement to ensure the Task
Force has the necessary evidence to create the strongest
evidence-based recommendations for all women and further reduce
breast cancer morbidity and mortality, especially among those
with the greatest burden of disease. The Committee encourages
that these efforts should continue to prioritize the inclusion
of women of all racial and ethnic groups to investigate whether
the effectiveness of screening, diagnosis, and treatment vary
by group. The Committee requests an update on this effort in
the fiscal year 2026 congressional justification.
Cancer Clinical Trials.--Clinical Cancer trials are pivotal
to find new medications and treatment options for patients. The
Committee is concerned that the lack of diversity in cancer
clinical trials is compromising our ability to understand how
certain cancers affect populations differently, compounding
health disparities, and hindering future innovative treatment
and therapies. Therefore, the Committee provides $3,000,000 for
NCI to implement a cancer clinical trial patient expense
reimbursement program, including the cost of travel, at an
extramural NCI designated cancer center.
Childhood Cancer Data Initiative (CCDI).--The Committee
includes no less than $75,000,000 for the CCDI, which is
$25,000,000 above the fiscal year 2024 enacted level. Within
this total, the Committee includes no less than $750,000, which
is the same as the fiscal year 2024 enacted level, for
enhancement of the CCDI Molecular Characterization Initiative
and other efforts as applicable through continued expansion to
focus on ultra-rare tumor types, such as atypical teratoid
rhabdoid tumor and other ultra-rare pediatric tumors with
limited therapeutic options. The effort should include
comprehensive clinical and molecular data for each patient to
the extent possible. The dataset should include clinical,
radiographic, histopathologic, and molecular information to the
extent possible and be stored in a manner that allows for
interrogation of patient level data. The data collected will be
used to identify risk factors, aid in prognostication and
treatment recommendations, and assist with the development of
novel therapeutics for these diseases.
Childhood Cancer STAR Act.--The Committee includes no less
than $50,000,000, which is $20,000,000 above the fiscal year
2024 enacted level, for continued implementation of sections of
the Childhood Cancer Survivorship, Treatment, Access, and
Research (STAR) Act (P.L. 115-180). The funding expands
opportunities for childhood cancer research, improves efforts
to identify and track childhood cancer incidences, and enhances
the quality of life for childhood cancer survivors. While some
progress has been made in pediatric cancer research--leading to
a decline in childhood cancer deaths by almost 70 percent over
the last four decades--cancer is still the leading cause of
death by disease past infancy among children in the U.S.,
according to NCI. And while survival rates for some forms of
childhood cancer like leukemia have increased to greater than
85 percent, the median survival rate for other childhood
cancers such as diffuse intrinsic pontine glioma is less than
one year. STAR Act funding goes to critical research
infrastructure, surveillance, and survivorship programs that
fundamentally change the lives of pediatric blood cancer
patients and survivors. For example, the NCI has been able to
expand its efforts to collect cancer tissue specimens from
children with cancer for which current treatments are least
effective, making samples more available to researchers to
develop the next breakthrough. The STAR Act works to improve
the lives of childhood cancer survivors by funding critical
research to further our understanding of the complications
survivors face later in life as well as care models to improve
care as survivors transition to primary care.
Deadliest Cancers.--The Recalcitrant Cancer Research Act of
2012 (P.L. 112-239) focuses on cancers with a 5-year survival
rate below 50 percent, which account for over 40 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 several decades, there has been limited progress in
reducing mortality for these diseases. The Committee encourages
NCI to continue its focus on these cancers, which include
cancers of the brain (including glioblastoma), esophagus, liver
(including cholangiocarcinoma), lung, ovaries, pancreas,
stomach, and mesothelioma and requests an update on research
focused on each of these areas in the fiscal year 2026
congressional justification. Further, given the high mortality
rates for these cancers, the Committee is particularly
concerned about reports of increased incidence of esophageal,
liver, pancreas, and stomach cancer among young adults and
urges the NCI to continue to support much needed research to
understand the causes and risk factors leading to these
increases, as well as potential interventions.
Diffuse Intrinsic Pontine Glioma.--The Committee encourages
NCI to continue its research to better understand Diffuse
Intrinsic Pontine Glioma (DIPG) brain tumors and coordinate its
research efforts with other Federal agencies, including the
Department of Defense, as well as private research foundations
and advocacy groups to improve the detection, treatment, and
prevention of DIPG. DIPG is a rare brain tumor that accounts
for almost 80 percent of pediatric brainstem gliomas and
represents 20 percent of all tumors in children. Due to its
location and highly aggressive nature, its prognosis is almost
always fatal.
Early Detection, Screening, and Prevention for Liver
Cancer.--The Committee commends NCI for seeking input on how
best to address the need to prioritize early detection,
screening, and prevention sciences for primary liver cancer.
Primary liver cancer has a dismal 5-year survival rate of only
22 percent, is the third most common cause of cancer death in
the U.S., and unlike most cancers the rate of liver cancer
mortality continues to increase. Therefore, the Committee urges
NCI to use submitted expert feedback to inform a national
agenda for early detection, screening, and prevention of
primary pancreatic and liver cancers. The Committee commends
NCI for its Early Detection of Liver Cancer consortia
initiatives as a means of fostering progress and collaboration.
The Committee encourages NCI to continue such programs as well
as program projects, cooperative research, and broad agency
announcements, and other mechanisms. The Committee requests an
update on this effort in the fiscal year 2026 congressional
justification.
Esophageal and Gastric Cancer.--The Committee recognizes
the importance of screenings for cancer detection and is
encouraged by the work of NIH in this field. However, the
Committee believes that there is more work to be done,
particularly with screening for gastrointestinal cancers, such
as esophageal and gastric, which have a low five-year survival
rate. The Committee recommends NIH explore developing, testing,
and implementing strategies using non-endoscopic screening
modalities, personalized clinical risk stratification for
screening, and biomarker-based risk stratification for the
surveillance of esophageal adenocarcinoma and gastric cardia
adenocarcinoma.
Functional Precision Medicine.--The Committee has a long
history of working to address refractory cancers and the lack
of treatment options currently available when standard of care
has been exhausted. The Committee is encouraged by the promise
of functional precision medicine approaches to identify
individualized treatment options more rapidly for hard-to-treat
cancers, in particular with minority populations. Recent data
showing the clinical utility of combining patient-specific drug
sensitivity testing and genomic profiling to treat refractory
cancers has proven to be potentially lifesaving. The Committee
supports efforts to establish a national center for functional
precision medicine and artificial intelligence analysis. Such
an effort would serve as the launching point for large-scale
clinical trials needed to demonstrate the real-world clinical
impact of guided treatments, and to quickly develop the
datasets needed to optimize standard cancer treatments that can
be delivered through next generation genomic cancer profiling.
The Committee requests an update on this effort in the fiscal
year 2026 congressional justification.
Human Papillomavirus (HPV)-Associated Cancers.--The
Committee encourages NCI to expand research related to human
papillomavirus and HPV-associated cancers.
HPV Screening and Self-Collection.--The Committee
recognizes the impact and potential of the Last Mile Initiative
and supports innovative efforts, such as the emerging network
to study noninvasive self-collection for HPV testing to further
improve the detection and prevention of cervical cancer to
address disparate health outcomes. NCI is encouraged to work
with a variety of stakeholders and to study various approaches
to sustain scientific progress.
Immunomodulatory Radiopharmaceutical Therapy.--The
Committee supports ongoing efforts for immunomodulatory
radiopharmaceutical therapy to advance translational research
that aims to develop more effective, safe, and potentially
curative treatments for patients with potentially any form of
metastatic cancer using combinations of radiopharmaceutical
therapies and immunotherapies.
Improving Native American Cancer Outcomes.--The Committee
continues to be concerned that Native Americans experience
overall cancer incidence and mortality rates that are
strikingly higher than non-Native populations. The Committee
directs NCI to coordinate with National Institute on Minority
Health and Health Disparities (NIMHD) as NIMHD establishes the
initiative for Improving Native American Cancer Outcomes.
Medical Imaging Technologies in Cancer Screening Trials.--
The Committee supports the establishment of clinical trials
conducted by the NCI to assess the potential role of blood
tests to detect cancer in the body. Medical imaging, as a means
of conducting diagnostic workup following a positive assay and
as a method for disease characterization, is essential to this
clinical trial and assessment process. As the Administration
aims to reach a 50 percent reduction in overall age-
standardized cancer mortality in the U.S. by 2047, imaging is a
known necessity for a cancer diagnosis and treatment and should
continue to hold a core function in the clinical trial process.
The Committee urges NCI to include imaging technologies and
tools in these clinical trials, as they are the essential
component of each precise cancer diagnosis and help ensure
patients receive the most effective and impactful care.
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 Caucasian women and
breast cancer is the second most common cause of death by
cancer for Black women. The Committee encourages a continued
emphasis by NCI on research for MBC, 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 2026 congressional
justification, including updates on actions NCI is taking to
achieve representation of the demographics of the U.S.
population in clinical trials.
Metastatic Cancers.--The Committee applauds NCI and the
Department of Energy for ongoing efforts to modernize the
Surveillance, Epidemiology, and End Results registry and
bolster data collection, including innovative activities to
better capture the prevalence and progression of metastatic
cancers. The Committee encourages NCI to continue to work with
DOE and to provide and update in the fiscal year 2026
congressional justification on ongoing modernization efforts.
Natural Products Research.--Research shows that derivatives
from natural products have been an important source of
clinically useful anti-cancer agents, yet not enough evidence-
based research has been done to strategically identify those
compounds that could provide potential benefits in cancer
treatment. The Committee believes that it is important to fully
explore whether and how natural products could be beneficial to
patients in reducing the toxicity of therapy or by enhancing
therapeutic efficacy as a primary or adjunctive therapy.
Therefore, the Committee urges NCI to expand its support of
research to evaluate the potential value of natural products in
reducing adverse effects of cancer therapy and in enhancing
therapeutic efficacy through basic, translational, and clinical
trials research. NCI is encouraged to seek applicants that have
a demonstrated expertise in natural products research, can
conduct a holistic review of drugs and disease states, have
access to an annotated inventory of natural products, and that
are able to test the safety and efficacy of natural products in
communities experiencing high rates of health care disparities
in access to cancer care.
Optimal Timing and Sequencing of Cancer Immunotherapy.--The
Committee recognizes that cancer immunotherapy is improving
outcomes for an increasing number of cancer patients,
especially those for whom other treatments were ineffective.
New research suggests that more patients might benefit if
immunotherapy were used earlier in the course of their cancer,
or to prevent and intercept cancers before they start.
Therefore, the Committee urges NCI to prioritize research
focused on assessing the optimal timing for the use of cancer
immunotherapy in individual patients. Examples of such research
include studying the effectiveness of cancer immunotherapy in
premalignant conditions, early-stage cancer, and as a
neoadjuvant therapy, prior to additional treatment such as
surgery, radiation, or chemotherapy.
Patient Access to Clinical Trials.--The Committee
recognizes that local health care provider and patient access
to clinical trials is critical for improving equitable access
to research and novel therapies; diversifying the population
participating in research; ensuring the safety and efficacy of
new drugs; and accelerating the dissemination and
implementation of findings and the adoption of newly approved
therapies. As part of the fiscal year 2026 congressional
justification, the Committee requests an update on the Virtual
Clinical Trials Office (VCTO). In future years, as data from
the pilot program become available, the Committee looks forward
to further updates, including whether the VCTO contributed to
increases in local provider and/or patient participation in
clinical trials, especially from rural areas; and challenges
and successes in prescreening/screening of potential trial
candidates, obtaining informed consents, data abstraction,
building protocol-specific treatment plans, and maintaining a
repository for quick adoption into the local sites.
Pediatric Rare Cancer Therapeutic Development.--Childhood
cancers are rare and need specialized treatments, rather than
just lower-dose treatments than adults receive. Each type of
cancer requires appropriate therapeutic approaches to save a
child's life or significantly improve quality of life and
extend a child's lifespan, yet many types of childhood cancer
do not yet have effective curative treatments available. The
Committee encourages NIH to continue to examine novel systems
for identifying how rare cancers develop and progress, and to
continue to support and accelerate development and evaluation
of life-saving therapeutics for pediatric cancer patients.
Prostate Cancer.--Prostate cancer is the most common cancer
diagnosed in men and is the second leading cause of cancer
deaths among men. 1 in 9 men will be diagnosed in their
lifetimes, and 3.4 million men are living with a prostate
cancer diagnosis today. The Committee urges continued support
of prostate cancer research.
Young Adult Cancer Survivorship Research.--NCI has
supported the Childhood Cancer Survivor Study since 1994. This
study, a long-term, retrospective cohort study, has
dramatically enhanced our understanding of the side effects of
cancer treatment in children and adolescents, supported
research to find interventions for childhood cancer survivors,
and improved survival from treatment side effects. The
Committee urges the NCI to conduct a landscape analysis of
young adult cancer survivorship research and provide the
Committee with an update on this effort in the fiscal year 2026
congressional justification.

NATIONAL INSTITUTE ON BODY SYSTEMS RESEARCH

Appropriation, fiscal year 2024....................... $6,978,531,000
Budget request, fiscal year 2025...................... 6,996,774,000
Committee Recommendation.............................. 7,101,721,000
Change from enacted level........................... +123,190,000
Change from budget request.......................... +104,947,000

The report language that follows includes references to the
National Heart, Lung, and Blood Institute (NHLBI), the National
Institute of Arthritis and Musculoskeletal and Skin Diseases
(NIAMS), and the National Institute of Diabetes and Digestive
and Kidney Diseases (NIDDK).
Alopecia Areata.--The Committee notes the importance of
research into autoimmune skin conditions such as alopecia
areata. NIAMS research has uncovered genetic factors that are
associated with alopecia areata, many of which have been
implicated in other autoimmune diseases. The Committee
encourages NIAMS to explore collaborative opportunities with
key stakeholders to advance critical research projects into
causes and treatments. The Committee notes the disproportionate
effect of alopecia areata on people of color, specifically
women. The Committee requests an update in the fiscal year 2026
congressional justification on collaborative efforts between
NIAMS and other relevant NIH institutes and centers and
stakeholders in identifying key research areas of concern.
Atopic Dermatitis.--The Committee recognizes NIAMS ongoing
efforts to incorporate community feedback and otherwise craft a
new Strategic Plan for Fiscal Years 2025-2029. The Committee
notes the tremendous opportunity for cross-NIH
multidisciplinary research into atopic dermatitis and other
forms of eczema and encourages further efforts to coordinate
with other institutes and centers to compliment emerging NIAMS
activities and to effectively coordinate the overall research
portfolio in atopic dermatitis.
Chronic Disease Prevention and Management.--The Committee
commends NIDDK's accomplishments and ongoing activities to
address some of the most common, chronic, costly, and
consequential diseases, including the widespread obesity and
diabetes epidemics. The Committee recognizes that significant
health disparities exist for many NIDDK mission diseases. Such
approaches support the promise of personalized or precision
medicine for disease prevention and management and may aid in
the prevention and management of other chronic diseases. The
Committee requests an update on these efforts in the fiscal
year 2026 congressional justification.
Chronic Kidney Disease.--The Committee notes that
approximately 25 percent of Medicare spending is on individuals
with a chronic kidney disease (CKD) diagnosis, and further that
1 percent of Medicare beneficiaries have end-stage kidney
failure yet account for 6.8 percent of spending. Despite the
significant toll of CKD on Medicare spending, funding for
kidney disease research has lagged behind that of NIH overall.
Thus, the Committee strongly urges NIDDK to increase its
support for kidney research funding in fiscal year 2025. The
Committee supports recent changes to clinical practice in the
diagnosis of kidney disease and concurs with recommendations
for new markers for estimating kidney function. The Committee
encourages NIDDK to prioritize research into endogenous
filtration markers, activities that spur the adoption of new
equations for estimating glomerular filtration rate that do not
include race as a modifier, and interventions to eliminate
racial and ethnic disparities. Finally, the Committee
encourages NIDDK to expand investment in research that bridges
existing deficits in CKD management and treatments to reduce
incidence and progression, increases the number of CKD clinical
trials and diversity of participants, improves the delivery of
evidenced-base care in under-represented populations, and
improves patients' quality of life. The Committee requests an
update on these priorities in the fiscal year 2026
congressional justification.
Chronic Lung Disease.--Chronic lung diseases are among the
leading causes of death and chronic illness in the U.S.,
including the over 15 million Americans diagnosed with chronic
obstructive pulmonary disease (COPD) and related diseases. Most
chronic lung disease research to date has focused on later
stages of disease when substantial loss of lung function and
damage to lung tissue have already occurred. There is a need
for treatments that when applied early in the course of
diseases can more effectively slow the progression and mitigate
the lung tissue damage caused by chronic lung diseases. NHLBI
supports a wide array of basic and translational research in
these conditions. Increased funding is urgently needed to
improve our understanding of early disease to identify
appropriate targets to modulate disease progression before the
irreversible tissue damage has occurred. NHLBI-funded studies
such as the COPD Gene and SPIROMICS projects are critical to
this objective and have already provided significant insight to
begin to understand the biology of early disease. The Committee
encourages NHLBI to increase support for these and other early
disease research in chronic lung disease.
Diabetes.--The Committee includes an increase of
$50,000,000 for diabetes research. The Committee urges NIH to
focus efforts on Type 1 Diabetes.
Duchenne and Becker Muscular Dystrophy.--In light of
improvements in care leading to patients living into their
third decade, the leading cause of death in Duchenne and Becker
Muscular Dystrophy (DBMD) patients is heart failure. The
Committee urges NHLBI to support research that characterizes
fibro-fatty replacement of cardiomyocytes in DBMD. 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 delay or treat heart
disease in individuals diagnosed with Duchenne. There is
growing evidence to support that select individuals with DBMD
would benefit from ventricular assist device placement or heart
transplant. The Committee encourages NHLBI to support research
to further develop criteria for identifying patients who may
benefit from such strategies.
Long COVID.--The Committee notes with concern that the
multi-organ syndrome known as long COVID has long-term
implications for chronic conditions including pulmonary and
cardiovascular complications. The Committee urges NHLBI, in co-
leading researching COVID to enhance recovery, to continue to
ensure that research into the understanding, treatment, and
prevention of post-COVID respiratory and cardiovascular
conditions in adults and children are prioritized.
Mitral Valve Prolapse Workshop.--The Committee urges NHLBI
to convene a workshop composed of subject matter experts and
stakeholders to identify research needs and opportunities to
develop recommendations for treatment of individuals with
mitral valve prolapse.
National Chronic Obstructive Pulmonary Disease Action.--The
Committee notes NHLBI's role in crafting the National Chronic
Obstructive Pulmonary Disease 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.
National Center on Sleep Disorders Research (NCSDR).--The
Committee commends NCSDR for facilitating sustained progress in
advancing research into sleep, circadian biology, and sleep
disorders and recognizes NHLBI for taking steps to refresh the
institute's strategic vision. The Committee encourages NCSDR to
continue its focus towards advancing the goals of the NIH Sleep
Research Plan to ultimately promote sleep health and improve
patient care and treatment for individuals affected by a
variety of sleep and circadian disorders.
Pancreatitis.--The Committee supports the focus on
pancreatitis through the institute's 2024 Recent Advances and
Emerging Opportunities document. The Committee notes the
devastating impact of pancreatitis, the limited treatment
options, and challenges related to health disparities, and
encourages sustained scientific progress in this area.
Pulse Oximeters and Health Disparities.--Pulse oximeters
are frequently used in clinics and in homes to measure a
person's pulmonary health, but the devices tend to overestimate
blood oxygen for some skin types. This discrepancy can have
serious consequences, as people with darker tones are nearly
three times more likely to suffer from silent hypoxia, a
condition in which the oxygen saturation level in a person's
blood is dangerously low but goes unnoticed. The Committee
encourages NHLBI to support development of new noninvasive
technologies for monitoring blood oxygen saturation.
Sickle Cell Disease and Sickle Cell Trait.--The Committee
encourages NIH to further its clinical research in Sickle Cell
Disease (SCD) and Sickle Cell Trait, which includes promising
approaches to eradicate the disease, save lives, and
dramatically reduce the substantial health care complications
and 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 and medicines to treat and cure SCD.
Valvular Heart Disease Research.--Heart valve disease
occurs if one or more of your heart valves malfunctions. 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 commends the NHLBI for their work in advancing
treatments for those with valvular heart disease and encourages
the agency to expand these initiatives to include research that
uses advanced technological imaging and precision medicine to
generate data on valvular disease, identifies individuals who
are at high risk of sudden cardiac death as a result of
valvular disease, develops prediction models for high-risk
patients, and enables interventions and treatment plans to keep
these patients healthy throughout their lives. For these
efforts the Committee continues $20,000,000, the same as the
fiscal year 2024 enacted level, in funding to the NHLBI for
this activity.
Wildland Fire Smoke.--The Committee is concerned that
public health experts do not yet fully understand the risk
posed by exposure to wildland fire smoke particularly acute and
chronic smoke exposure to patients with existing pulmonary and
cardiac disease. The Committee encourages the institute to
support research to understand the risk smoke exposure has for
patients with underlying health conditions and any
interventions that can be implemented to mitigate adverse
health effects.

NATIONAL INSTITUTE ON NEUROSCIENCE AND BRAIN RESEARCH

Appropriation, fiscal year 2024....................... $4,020,637,000
Budget request, fiscal year 2025...................... 4,208,840,000
Committee Recommendation.............................. 4,112,805,000
Change from enacted level........................... +92,168,000
Change from budget request.......................... -96,035,000

The report language that follows includes references to the
National Institute of Dental and Craniofacial Research (NIDCR),
the National Institute of Neurological Disorders and Stroke
(NINDS), and the National Eye Institute (NEI).
Alzheimer's Disease and Alzheimer's Disease-Related
Dementias (AD/ADRD).--The Committee includes an increase of
$100,000,000 above the fiscal year 2024 enacted level for AD/
ADRD research across NIH, split evenly between the National
Institute on Dementia and the National Institute on
Neuroscience and Brain Research.
Amyotrophic Lateral Sclerosis (ALS) Research.--NIH is the
primary federal agency conducting and supporting basic,
clinical, and translational medical research and is
investigating the causes, treatments, and cures for common and
rare diseases. NINDS makes the largest investment in ALS
research. ALS is a rare progressive neurological disease. ALS
is a rapidly progressing 100 percent fatal disease, and most
people only live for 2-5 years after symptom onset. There are
currently very limited treatment options that offer only
marginal benefit to some people. The Committee urges NINDS to
expand its portfolio of research into ALS.
Angelman Syndrome.--The Committee is aware of the Angelman
syndrome (AS) natural history study supported by NIH from
January 2006 to July 2014. The resulting data from over 300
participating American families, along with a later FDA
prospective natural history study, provide a critical
understanding of the most important symptoms of this serious
condition and support the development of specific Angelman
syndrome outcome measures. Further, the recent developments in
cell and gene therapies, including a 2023 National Center for
Advancing Translational Sciences award for the application of a
CRISPR platform technology, hold significant potential for
disease-modifying treatments for rare genetic brain diseases.
To fully support the rapidly increasing array of clinical
studies of these and other treatment modalities being developed
for Angelman syndrome, the Committee urges NINDS, in
cooperation with FDA, to convene relevant research leaders,
patient organizations, and other stakeholders to prepare a
roadmap for clinical outcomes measures and biomarkers for this
condition. NINDS shall provide an update on this effort in the
fiscal year 2026 congressional justification.
Blepharospasm.--The Committee urges continued support for
research into blepharospasm, a form of dystonia, and encourages
continued collaborative efforts amongst stakeholders and other
institutes and centers.
Brain Research through Advancing Innovative
Neurotechnologies (BRAIN) Initiative.--The BRAIN initiative is
an ambitious program to develop and apply new tools and
technologies to answer fundamental questions about the brain
and ultimately to inspire new treatments for brain diseases.
NINDS and NIMH are leading partners in the initiative, working
with eight other NIH Institutes, Centers, and Offices. The
BRAIN Initiative has invested over $3.5 billion in more than
1,500 research projects, engaging scientists from many areas of
expertise as well as mathematicians, engineers, and physicians
in individual labs and inter-disciplinary teams. The BRAIN
Initiative will promote scientific advances that provide
opportunities to understand the structure and function of the
brain at an unprecedented level of detail, helping bring
advanced treatments for brain disorders to clinical use.
Creutzfeldt-Jakob Disease.--The Committee commends the
National Alzheimer's Project Act Advisory Council report from
2023 that acknowledges the scientific connection between prion
diseases and Alzheimer's Disease and Related Dementias (ADRDs)
and continues to encourage NIH to recognize prion diseases as
ADRDs and fund more research for prion diseases, like
Creutzfeldt-Jakob disease (CJD). ADRDs have already benefited
from prion disease research, and further integration of the
fields could lead to beneficial new treatments and improve our
scientific understanding of these devastating diseases. CJD is
caused by the abnormal folding of the prion protein in the
brain, and closely resembles ADRDs. Enhanced research of CJD,
through the BRAIN Initiative and the Alzheimer's Disease
research portfolio, will be valuable to the study of ADRDs and
vice versa, and further integration will benefit scientific
pursuits in both fields with the goal of new treatments for
neurodegenerative diseases.
Dystonia.--The Committee requests an update, in the fiscal
year 2026 congressional justification, on the implementation of
the recommendations from the NINDS workshop Defining Emergent
Opportunities in Dystonia Research that was held in 2018 and
encourages NINDS to continue to collaborate with stakeholders.
Multiple Sclerosis (MS).--The Committee encourages NINDS to
build upon its work in the development of the medical
understanding of the progression of MS and continue to support
research on prevention strategies, treatments, and cures for
MS.
Oral Health Research.--The Committee reaffirms that oral
health care and its maintenance are integral to the medical
management of numerous diseases and medical conditions and that
the lack of medically necessary oral healthcare heightens the
risk of costly medical complications. The Committee appreciates
NIH's support for research that has demonstrated that dental
care is closely linked to the clinical success of other covered
medical services and urges NIH to fund additional research in
this area. Continued research on the causal mechanisms that
link untreated oral microbial infections, oral inflammation,
and chronic systemic conditions will provide clinical evidence
that can be used to support coverage of medically necessary
dental treatment in various benefit programs.
Parkinson's Disease.--The Committee commends NINDS for
taking critical steps in identifying priority research
recommendations to advance research on Parkinson's disease,
which impacts between 500,000 and 1,500,000 Americans and is
the second most prevalent neurodegenerative disease in the U.S.
The Committee recognizes that NINDS is prioritizing public
health concerns with severe gaps in unmet medical needs and
supports the research recommendations set forth by the NINDS
planning strategy to bring us closer to better treatments and a
cure for Parkinson's disease.
Parkinson's Disease and Parkinsonism.--The Committee urges
NIH to support projects studying dementia in Parkinson's
disease and dementia in atypical parkinsonisms (e.g.
progressive supranuclear palsy). Parkinson's disease is the
second most common and fastest growing neurodegenerative
disease and is characterized by the abnormal folding of a
protein in the brain. Channeling resources into research could
help unlock groundbreaking discoveries in crucial areas like
Parkinson's disease, atypical parkinsonisms (e.g. progressive
supranuclear palsy), and other closely associated neurological
disorders.
Pediatric-Onset Epilepsies Network.--The Committee
encourages NIH to establish a pediatric-onset epilepsies
network. Such a network could help coordinate research of
pediatric-onset epilepsies across institutions to maximize the
potential for scientific progress in the era of precision
medicine. This network could create a collaborative,
multidisciplinary research model to enroll patients from many
hospitals in the same system to enable cooperative research
studies, accelerate the development of knowledge about the
epilepsies, and rapidly advance therapeutic options and their
implementation to improve treatments and healthcare outcomes.
Pediatric Rare Disease.--The Committee encourages NIH to
enhance and prioritize pediatric rare disease research at
NINDS. Such an effort would undertake novel technologies to
better diagnose and treat rare diseases such as Tay-Sachs and
glioblastoma in children by using artificial intelligence,
precision medicine, and DNA sequencing. Such research can help
revolutionize pediatric healthcare by leveraging cutting-edge
technologies and innovative approaches in genomics research,
precision medicine, gene therapy, human stem cell research, and
big data analytics to pave the way towards developing
personalized, targeted treatments and improved patient outcomes
for the nation's pediatric population.
Preventive and Early-Treatment Cognitive and Brain Health
Research.--The Committee encourages NIH to give greater
attention to the study of the presymptomatic or preclinical
stages of neurological disorders, that is, alterations in
cognitive and brain health before the first clinical symptoms
of neurological disease when persons typically encounter
medical professionals. Learning what happens during these
stages may guide the development of measures for detection and
monitoring earlier in the course of the disease, including
sensitive neuropsychological measures and biomarkers, which
could improve early intervention development and testing for
neurological disease before it becomes disabling and,
ultimately, prevent diseases like Alzheimer's disease,
Parkinson's disease, multiple sclerosis, stroke, and epilepsy.
Mounting evidence suggests that significant pathologies have
already accumulated by the time symptoms appear and early,
presymptomatic intervention may lead to more effective care.
Such discoveries may also reduce the costs that neurological
diseases pose to our healthcare delivery system.
Retinitis Pigmentosa.--The Committee continues to encourage
NEI to expand research into Retinitis Pigmentosa and requests
an update on collaborative efforts amongst stakeholders and
other Institutes and Centers concerning work toward curative
treatments and therapeutics in the fiscal year 2026
congressional justification.
Spinal Muscular Atrophy.--The Committee commends NIH for
its continued support of research in spinal muscular atrophy
(SMA), a rare neuromuscular disease. The Committee is aware
that past NINDS research has led to greater understanding of
the nervous system and contributed toward approved SMA
treatments that slow or stop future nerve damage. The Committee
also recognizes that current treatments do not cure the disease
or reverse its debilitating symptoms. Without additional SMA
research, the Committee is concerned that adults and children
with SMA who were born after treatments and early diagnosis
were available will continue to face chronic health challenges
and significant barriers to independence. Furthermore, it is
not yet fully known the extent of need among children treated
prior to symptom onset. As such, the Committee encourages NINDS
to expand its research in SMA to address fatigue, muscle
weakness, motor function loss, and other unmet needs that are
pervasive among the largest segment of the SMA community.
Additional research into these common needs may also benefit
individuals with other neuromuscular and rare diseases who face
similar challenges.
Stroke Education and Prevention.--Community awareness of
the signs and symptoms of stroke can lead to early intervention
and life-saving emergency treatment. In addition, education
about the importance of healthy eating, weight management,
tobacco cessation, physical activity training, stress
management, and controlling diabetes and high blood pressure
can help prevent stroke and other cardiovascular complications.
Awareness and education, both in person and online, are
particularly important in low-resourced communities, where the
prevalence of stroke is significantly higher than the national
average. The Committee, therefore, urges the NINDS to
prioritize funding opportunities in high-risk, vulnerable
populations to reach communities with multiple comorbidities
that lead to stroke.
Undiagnosed Diseases Network.--The Committee recommendation
includes $18,000,000 for the Undiagnosed Diseases Network, the
same as the fiscal year 2024 enacted level. The Undiagnosed
Diseases Network (UDN) builds on the success of the Undiagnosed
Diseases Program at the NIH Clinical Center, which is a
nationwide network of clinicians and researchers who use basic
and clinical research to uncover the underlying disease
mechanisms associated with rare and undiagnosed conditions. It
is estimated that approximately 25 million Americans suffer
from a rare disorder. The UDN pioneered a new personalized
medicine model for helping patients who have historically been
the most difficult for the medical community to diagnose,
taking advantage of cutting-edge technologies such as genomic
sequencing, metabolomics and assessing patient variants in
model organisms to give clinicians new, powerful information to
help understand the cause of extremely rare diseases.
Usher Syndrome.--The Committee strongly encourages NIH to
enhance and prioritize Usher syndrome research at NEI. The
Committee requests an update in the fiscal year 2026
congressional justification. The update should include efforts
to stimulate the field and to accelerate viable human treatment
options for those with Usher syndrome.

NATIONAL INSTITUTE ON INFECTIOUS DISEASES

Appropriation, fiscal year 2024....................... $3,281,139,500
Budget request, fiscal year 2025...................... 3,290,645,500
Committee Recommendation.............................. 3,315,552,000
Change from enacted level........................... +34,412,500
Change from budget request.......................... +24,906,500

The report language that follows includes references to the
National Institute of Allergy and Infectious Diseases (NIAID).
Antimicrobial Resistance.--The Committee includes
$565,000,000 to support antimicrobial resistance research, the
same as the fiscal year 2024 enacted level. This funding
supports NIAID research to combat antimicrobial resistance
(AMR) and the training of new investigators to improve AMR
research capacity as outlined in the 2020-2025 National Action
Plan to Combat Antibiotic Resistant Bacteria. The Committee
supports the Action Plan's goal to work with innovators on
therapeutics seeking to establish domestic and/or
biomanufacturing-based supply chains, especially for small
molecules.
Antimicrobial Stewardship.--The Committee is aware that
antibiotic stewardship programs are a key component in
preventing the spread of antibiotic resistance in all
healthcare facilities in the U.S. and across the world. In the
2020 National Action Plan for Combating Antibiotic-Resistant
Bacteria (CARB), 2020-2025, one of the five goals was to
Accelerate Basic and Applied Research and Development for New
Antibiotics, Other Therapeutics, and Vaccines in order to
improve understanding of the many factors that contribute to
the emergence, spread, and persistence of antibiotic resistance
and to support new strategies for preventing and mitigating
infections.
Antiviral Drug Discovery Centers.--Researching and
developing new antivirals is essential for combating new viral
outbreaks and preventing them from spreading into pandemics.
The Committee supports the Antiviral Drug Discovery Centers and
their mission to develop antiviral drugs to serve as our first
line of defense against forthcoming viral outbreaks. The
Committee is concerned that NIH reported to the Comptroller
General of the U.S. that future funding for the Antiviral Drug
Discovery Centers program has been eliminated. The Committee
urges NIH to continue supporting the Antiviral Drug Discovery
Centers to continue the development of antivirals to mitigate
the risk of future viral outbreaks.
Lyme and Other Tick-Borne Diseases.--The Committee includes
not less than $125,000,000 for NIH research into Lyme and Other
Tick-Borne disease research, an increase of $25,000,000 over
the fiscal year 2024 enacted level. NIH is encouraged to
support research to better understand the causes of tick-borne
diseases, including alpha-gal syndrome and allergic or immune/
inflammatory conditions triggered by tick-borne infections, to
support research on Lyme disease and emerging tick-borne
pathogens, and to support the development of reliable
diagnostics and therapies to address this growing health
concern that affects more than 476,000 Americans annually. The
Committee encourages NIH to periodically review progress on
activity to address tick-borne infection-triggered chronic
illnesses, such as long COVID, long Lyme, Bartonella henselae,
West Nile virus, and multiple sclerosis and to include a status
report in the fiscal year 2026 congressional justification. In
addition, the Committee encourages NIH, in consultation with
CDC and FDA, to consider the potential benefits of establishing
a National Network of Academic Research and Clinical Centers of
Excellence for Tick-Borne Diseases.
Microbicides.--The Committee recognizes that NIH research
has shown that microbicides and pre-exposure prophylaxis
products work to prevent HIV. The Committee supports NIH
efforts to advance microbicide development efforts to produce
next generation solutions for HIV prevention.
Neglected Diseases.--The Committee acknowledges that the
growing presence of neglected diseases, including Valley fever
and other fungal diseases, across the U.S. represents a
significant health and economic burden, and therefore strongly
supports neglected disease research programs at NIAID. NIH is
the world's single largest funder of neglected disease research
and has supported the development of high-impact technologies
for health areas that receive little attention from industry.
Many innovation gaps persist, the Committees urges NIAID to
prioritize research into this area as these diseases expand
across the U.S.
In addition, the Committee is aware of the increasing
prevalence of neglected tropical diseases (NTDs) in the U.S.
and the staggering global burden of these threats across the
globe and is encouraged by the granting of more than 11
priority review vouchers for new NTD interventions. Considering
the magnitude of the NTD threat, the Committee requests an
update in the fiscal year 2026 congressional justification on
efforts to address market failures hindering antimicrobial
innovation, and what efforts are needed to stimulate NTD
research and development.
Regional Biocontainment Laboratories.--The Committee
includes $52,000,000 for the 12 regional biocontainment
laboratories (RBLs) to support resources for biosafety level 3
lab containment and resources within the RBL space that promote
medical countermeasure development and ability to contribute to
NIAID Preclinical Services. This funding supports research
facilities and personnel to be prepared for any national or
regional need related to research on an emerging biodefense or
infectious disease. Of this amount, the Committee directs that
no less than $3,500,000 shall be provided to each of the 12
RBLs for any of the following activities: (1) investments in
the research workforce, (2) maintenance or improvement of
facilities, or (3) to purchase, service, or maintain equipment,
or (4) developing and contributing to an organizational
structure to ensure the RBL network is prepared to respond
effectively to national needs. The Committee directs that the
remaining funding shall be available for competitive awards for
the RBLs and/or participation in NIAID Preclinical Services, a
collection of preclinical resources to support the development
of medical countermeasures intended for use in the
investigation, control, prevention, and treatment of a wide
range of infectious agents.
Swine Resource and Research Centers.--The Committee
recognizes the biomedical advances made utilizing swine models
of human health and disease and supports the efforts of the
swine research centers. These centers support innovative basic
and translational research on human diseases.
Universal Influenza Vaccine.--The Committee includes no
less than $270,000,000, the same as the fiscal year 2024 level,
for this activity. NIAID's influenza research program is
working to develop a universal flu vaccine, or a vaccine that
provides robust, long-lasting protection against multiple
subtypes of flu, rather than a select few. Such vaccines would
provide protection against zoonotic flu and eliminate the need
to update the seasonal flu vaccine each year. Universal flu
vaccine research includes the improvement of current vaccines
and could provide important foundational work in outbreak
responses. In February 2018, NIAID released its Universal
Influenza Vaccine Strategic Plan, which focuses on 3 research
areas to broaden knowledge around basic influenza immunity and
advance translational research efforts to drive universal flu
vaccine development.

NATIONAL INSTITUTE ON THE IMMUNE SYSTEM AND ARTHRITIS

The report language that follows includes references to the
National Institute of Allergy and Infectious Diseases (NIAID).
Celiac Disease.--The Committee commends the NIH for issuing
a Notice of Special Interest to spur additional research on the
study of celiac disease. Today, the only known treatment for
this disease is a gluten-free diet; however, recent public and
private sector research confirms that such a ``treatment'' is
insufficient for many who suffer from celiac disease.
Therefore, the Committee supports focused research on the study
of celiac disease and encourages the newly created NIH Office
of Autoimmune Disease Research (OADR) to work with NIAID and
other NIH Institutes to: support new research on celiac
disease; to better coordinate existing research; and to focus
new research efforts toward causation, diagnosis, management,
treatment, and, ultimately, a cure of this disease. The
Committee requests NIH to include updates on research,
projects, and programs in the fiscal year 2026 congressional
justification for celiac disease.
Consortium for Food Allergy Research.--The Committee
recognizes the serious issue of food allergies which affect
approximately 8 percent of children and 10 percent of adults in
the U.S. The Committee commends the ongoing work of NIAID in
supporting a total of 24 clinical sites for this research,
including 7 sites as part of the Consortium of Food Allergy
Research (CoFAR). The Committee includes $12,100,000, the same
as the fiscal year 2024 enacted level, for CoFAR to maintain
its clinical research network of centers of excellence in food
allergy clinical care and expertise in food allergy research.
Diagnostics for Primary Immunodeficiency Disease/Inborn
Errors of Immunity.--The Committee recognizes the multiple
challenges that impede access to a timely and accurate
diagnosis of primary immunodeficiency disease/inborn errors of
immunity (PID/IEI). These include needing to improve the
interpretation of genetic tests and the need for identification
of biomarkers and other diagnostic tools to both identify forms
of PI and to inform targeted treatments. The Committee urges
NIAID to convene a scientific workshop on this topic to
identify a research strategy to improve diagnostics of PID/IEI.

NATIONAL INSTITUTE OF GENERAL MEDICAL SCIENCES

Appropriation, fiscal year 2024....................... $4,405,427,000
Budget request, fiscal year 2025...................... 4,439,831,000
Committee Recommendation.............................. 4,451,630,000
Change from enacted level........................... +46,203,000
Change from budget request.......................... +11,799,000

The Committee recommendation includes $3,039,148,000 in
discretionary appropriations and $1,412,482,000 in PHS Act
section 241 evaluation set aside transfers. The report language
that follows includes references to the National Institute of
General Medical Sciences (NIGMS), the National Human Genome
Research Institute (NHGRI), and the National Library of
Medicine (NLM).
Biomedical Research Workforce Training.--Training programs
at the NIH provide a quality standard of training for graduate
students and postdoctoral fellows in biomedical research. The
training grants that support these programs at research
institutions across the country play a vital role in
establishing a biomedical research ecosystem and train the next
generation of researchers for health-related research needs.
Despite the success of training programs, the number of
students and postdoctoral scholars supported on training grants
has remained constant over the years. The Committee applauds
NIH efforts to increase funding for institutional development
awards (IDeA) States and urges the NIH to also emphasize the
importance of supporting training grants in IDeA states. The
Committee directs the NIH to provide a portfolio analysis to
the Committee within 60 days of enactment of this Act on the
distribution of T32 training grants among States, including
number of applicants and success rates per State to ensure NIH
is supporting capacity building and a diverse workforce for the
future biomedical research enterprise. In addition to the
portfolio analysis, in the fiscal year 2026 congressional
justification, NIH is instructed to provide an update on
specific actions NIH will take to identify and remove barriers
for applying for training grants in IDeA States.
Epitranscriptomics Database Standards.--The Committee
recognizes the recent release of a NASEM report titled
``Charting a Future for Sequencing RNA and Its Modifications''
in March 2024. The Committee notes the report's recommendation
that clear and consistent standards for data and databases need
to be established to facilitate data access and sharing. Given
that NLM's National Center for Biotechnology Information (NCBI)
collaborates with the scientific community to support
development of standards for databases and biological
nomenclature, among other responsibilities, the Committee urges
NCBI to establish data and database standards for
epitranscriptomics in collaboration with the scientific
community, consistent with the NASEM report recommendation, and
include an update on this effort in the fiscal year 2026
congressional justification.
Experimental Research.--The Committee recognizes the
success of the NIGMS Maximizing Investigators' Research Award
program and encourages the NIH to continue working to expand
similar experimental research opportunities to other
institutes.
Health Science Analytics.--The Committee supports efforts
to address cutting-edge issues at the interface of artificial
intelligence and big data. The Committee supports research that
improves health data security and analyzes claims data to
determine where care and outcomes can be improved.
Pharmacogenomic Research.--NHGRI supports pharmacogenomic
research and programs in a variety of ways including by working
to develop community resources. The program supports a
pharmacogenomics knowledge resource that provides clinical
information such as clinical guidelines and drug labels,
potentially clinically actionable gene-drug associations, and
genotype-phenotype relationships, to scientific and healthcare
professionals, which in part informs the work of the clinical
pharmacogenetics implementation consortium to develop practice
guidelines for pharmacogenomics use in clinical care. The
Committee encourages NIH to continue to support this research
and similar programs.
Proteomics.--The Committee recognizes the promise of
research into the proteome in the study of biological systems.
The ability to analyze protein patterns and their changes
effectively and efficiently over time has potential to provide
valuable insights into a person's real-time state of health
including identifying existing disease, understanding the
biological drivers of that disease, predicting near-term health
events, and guiding effective therapeutic interventions. The
Committee is encouraged by the value being demonstrated in
population proteomics research but is concerned that the U.S.
is not matching the significant investment being made by other
nations. The Committee urges NHGRI to utilize existing
resources to engage with academia and U.S. industry partners
and laboratories to expand its research and advance American
leadership in this cutting-edge field.

Institutional Development Awards

The Committee provides $445,956,000 for IDeA, $15,000,000
above the fiscal year 2024 enacted level. The IDeA program
increases our Nation's biomedical research capability by
improving research capacity in States that have historically
had lower levels of NIH biomedical research funding. IDeA
supports competitive basic, clinical, and translational
research, faculty development, and infrastructure improvements.
The IDeA program aims to strengthen states' and institutions'
abilities to support biomedical research, enhance the
competitiveness of investigators in securing research funding,
and enable clinical and translational research that addresses
the needs of medically underserved communities.

NATIONAL INSTITUTE FOR DISABILITY RELATED RESEARCH

Appropriation, fiscal year 2024....................... $2,293,411,000
Budget request, fiscal year 2025...................... 2,302,344,000
Committee Recommendation.............................. 2,317,464,000
Change from enacted level........................... +24,053,000
Change from budget request.......................... +15,120,000

The report language that follows includes references to the
Eunice Kennedy Shriver National Institute of Child Health and
Human Development (NICHD) and the National Institute on
Deafness and Other Communication Disorders (NIDCD).
Centers of Excellence to Reduce Maternal Morbidity and
Mortality.--The Committee is aware that NICHD's current
Maternal Health Research Centers provide a platform to further
both research and clinical care in battling maternal morbidity
and mortality. However, the Committee remains concerned that
too few Centers exist in areas of the country that see the
highest rate of both. Therefore, the Committee encourages NICHD
to expand its current Centers of Excellence with a particular
emphasis on establishing new ones in regions of greatest need.
Cerebral Palsy.--The Committee encourages NIH to continue
to prioritize and invest in research on Cerebral Palsy (CP) to
significantly strengthen and accelerate CP research priorities
across the lifespan. The Committee encourages NIH to focus on
basic and translational discoveries, as well as implementation,
observational, and clinical studies aimed at early detection
and intervention, comparative effectiveness, functional
outcomes, and mental health.
Endometriosis.--The Committee urges NICHD to continue
expanding basic, clinical, and translational research into the
mechanisms of endometriosis, including root causes of the
disease and new treatment methods. The Committee encourages
research on the genetic and immune system components of
endometriosis. The Committee further encourages NIH to devote
more resources to support targeted research of endocrine
disrupting chemicals in endometriosis, the relationship of
endometriosis and cancer, prenatal, and epigenetic influences
on the risk for endometriosis. The Committee also encourages
research on non-invasive diagnostics of endometriosis to reduce
diagnosis delay and improve treatment. The Committee encourages
research on the growth of endometriosis and endometriosis
recurrence post-surgical procedures. The Committee further
encourages NIH to devote additional resources to support
targeted endometriosis research on the role of endocrine-
disrupting chemicals, the relationship of endometriosis and
cancer, prenatal and epigenetic influences on the risk for
endometriosis, and in developing new and innovative treatment
methods and therapeutics.
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 infant,
child, and adolescent development. The Committee appreciates
NIH's ongoing engagement on this important topic and urges
expanded support for research into the cognitive, physical, and
mental health impacts of young people's use of technologies as
well as long-term developmental effects on children's social,
communication, and creative skills. The Committee also
encourages NIH to study the repercussions of increased use of
digital media and technologies on suicidal thoughts and
ideation among children. The Committee asks NIH to consider
different forms of digital media and technologies including
mobile devices, smart phones, tablets, computers, and virtual
reality tools, as well as social media content, video games,
and television programming.
Infertility.--The Committee remains concerned about the
rate of infertility suffered by couples trying to conceive. In
the U.S., 1 in 4 women of reproductive age have difficulty
getting pregnant or carrying a pregnancy to term. The Committee
urges NICHD to research female reproductive conditions,
specifically adenomyosis, uterine fibroids, endometriosis,
polycystic ovary syndrome, and interstitial cystitis. This
research could include diagnostic testing, causes of the
conditions, and treatment options, especially non-
pharmacological intervention. Since there is a gap in the
knowledge of how to diagnose and treat male infertility, the
Committee also urges NICHD to continue to support research on
male mechanisms of infertility.
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. 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 influence 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.
Maternal-Fetal Medicine Units Network.--The Maternal-Fetal
Medicine Units Network is a network of 12 centers across the
country that conduct clinical studies to improve maternal,
fetal, and neonatal health that ultimately improves the
clinical practice of obstetrics. Broadly, 24 of 27 institutes
and centers at NIH support at least one grant or project
related to pregnancy which will further improve maternal and
infant health outcomes and address maternal mortality. The
Committee commends the work of the maternal-fetal medicine
units and supports robust funding for this activity.
Pelvic Organ Prolapse.--Pelvic Organ Prolapse (POP) occurs
when the pelvic floor muscles and connective tissue supporting
the pelvic organs fail, causing one or more of the pelvic
organs to fall downward, protruding out of the body. POP is a
common problem, with one out of eight women undergoing surgery
for prolapse at some point in their life. Symptomatic POP is
associated with urinary incontinence, depression, anxiety,
sleep disturbance, deteriorating physical function, and
diminished socialization. The Committee encourages the NICHD to
convene a workshop to design prospective studies that can be
added on to existing maternal-morbidity research, including
research studies being conducted in underserved areas, to
assess preventative strategies for POP, including ways to
decrease pelvic floor trauma or denervation during delivery,
with the goal of reducing the risk of subsequent POP and its
complications. The Committee requests an update on this
workshop and on research activities to advance POP prevention
and treatment in the fiscal year 2026 congressional
justification.
Population Research.--The Committee has consistently
commended NICHD for supporting prospective, population
representative longitudinal studies, including the Panel Study
of Income Dynamics Child Development Supplement, Future of
Families and Child Wellbeing Study, and National Longitudinal
Survey of Youth. Data from these studies are public goods used
widely to inform research and training activities conducted by
thousands of scientists at universities nationwide, including
underserved institutions, and are heavily used by new and
early-stage investigators. In addition, these studies are the
only nationally representative data scientists may use to
analyze, for example, how parental and grandparental
characteristics affect children's outcomes and the impact of
adverse childhood experiences over the life course. The
Committee is concerned to learn that NICHD is proposing
dramatic funding reductions to these surveys, which will result
in the permanent loss of invaluable data that could be used to
assess and track long-term health and wellbeing outcomes in
infants, children, and adolescents. NICHD is strongly
encouraged to prioritize funding for these surveys. The
Committee requests an update on this topic in the fiscal year
2026 congressional justification.
Pregnant and Lactating Women.--The Committee remains
concerned about the lack of pregnant and lactating women in
clinical research. Women with chronic health conditions lack
access to appropriate treatments during pregnancy, putting both
them and their infants at risk. Despite 90 percent of pregnant
women taking prescription medication, only 5 percent of
medications have data on the impact of the medications during
pregnancy. The Committee urges NICHD to conduct priority
research projects on existing medications and therapeutics
prescribed to pregnant and lactating women. NICHD is urged to
prioritize research applications in the following areas as it
relates to pregnant and lactating women: an unmet medical need
or gap in treatment, severity and prevalence of a specific
disease or condition, and cost and availability of treatment or
alternate treatments. The Committee requests an update in the
fiscal year 2026 congressional justification on this effort.
Severe Maternal Morbidity.--The Committee is concerned that
despite the high rate of severe maternal morbidity for all
pregnancy outcomes (live birth, stillbirth, spontaneous
abortion, induced abortion, ectopic pregnancy, and molar
pregnancy) in the U.S., there is not a uniform definition of
severe maternal morbidity. Having a uniform definition would
help Federal, State and local agencies and research
institutions establish standardized and interoperable processes
for billing, surveillance, data collection, and research. The
collected data could then inform the development and deployment
of targeted, evidence-based prevention and treatment programs
to reduce the incidence of severe maternal morbidity for all
pregnancy outcomes (live birth, stillbirth, spontaneous
abortion, induced abortion, ectopic pregnancy, and molar
pregnancy). The Committee encourages the Eunice Kennedy Shriver
National Institute of Child Health and Human Development to
hold a formal convening of subject matter experts and
organizational representatives, including representatives from
the Centers for Disease Control and Prevention, Health
Resources and Services Administration, National Institutes of
Health, Eunice Kennedy Shriver National Institute of Child
Health and Human Development, the Office of the National
Coordinator for Health Information Technology, the Food and
Drug Administration, and public stakeholders, to determine a
uniform definition of severe maternal morbidity for all
pregnancy outcomes (live birth, stillbirth, spontaneous
abortion, induced abortion, ectopic pregnancy, and molar
pregnancy). The Committee requests NICHD provide a report in
the fiscal year 2026 congressional justification on the
proceedings of the convening, including a formal definition for
``severe maternal morbidity'' for all pregnancy outcomes (live
birth, spontaneous abortion, induced abortion, ectopic
pregnancy, and molar pregnancy).
Spasmodic Dysphonia or Laryngeal Dystonia.--The Committee
notes the research NIDCD continues to facilitate on spasmodic
dysphonia and collaborative efforts with relevant institutes
and centers and other stakeholders. The Committee continues to
encourage sustained collaboration with key stakeholders and
agencies.

NATIONAL INSTITUTE ON DEMENTIA

Appropriation, fiscal year 2024....................... $4,507,623,000
Budget request, fiscal year 2025...................... 4,425,295,000
Committee Recommendation.............................. 4,604,899,000
Change from enacted level........................... +97,276,000
Change from budget request.......................... +179,604,000

The report language that follows includes references to the
National Institute on Aging (NIA).
Alzheimer's Disease and Alzheimer's Disease-Related
Dementias (AD/ADRD).--The Committee includes an increase of
$100,000,000 above the fiscal year 2024 enacted level for AD/
ADRD research across NIH, split evenly between the National
Institute on Dementia and the National Institute on
Neuroscience and Brain Research.
Digital Innovation for Aging in Place.--The Committee
strongly encourages NIA to fund research that designs and
develops digital innovations that improve health and medical
treatment. Such efforts could include establishing a smart
living environment leveraging technologies to improve health
and medical treatment, equipping homes to enable varying levels
of remote care and improved diagnosis and treatment, and
encouraging medical facilities to adopt health technologies,
including artificial intelligence and machine learning, to
expand to the home space enabling older adults to age in place.
Geroscience Research.--Recent advances in geroscience
suggest it may be possible to prevent or treat a wide range of
adult-onset health concerns, including functional declines such
as frailty and lost resilience, and overt diseases such as
Alzheimer's disease, cancer, cardiovascular diseases and many
others. This could be achieved by slowing or reversing certain
genetic, molecular and cellular hallmarks of aging discovered
through research on the basic biology of aging. The Committee
strongly encourages NIA to prioritize funding for geroscience
research. The Committee also understands that the enormous
promise of this field is limited by a shortage of investigators
with expertise in the biology of aging and the clinical
translation of basic research findings. Therefore, the
Committee encourages increased support for early career
investigators, especially postdoctoral researchers and junior
faculty, to help attract, retain, and develop top talent in the
field of geroscience. Finally, the Committee encourages NIA to
increase funding for basic and translational research in aging
to provide more options and test more treatments as quickly as
possible.
Project Expanding Capacity for Health Outcomes.--The
Committee supports efforts to implement section 330N of the PHS
Act to continue the use of technology-enabled collaborative
learning and capacity building models and to expand, create,
and support dementia expanding capacity for health outcomes
(ECHO) hubs. These innovative education models, often referred
to as Project ECHO, use a hub-and-spoke approach by linking
expert specialist teams at a ``hub'' with the ``spokes'' of
health providers in local communities to increase on-the-ground
expertise. Using case-based learning, Project ECHO models can
improve the capacity of providers, especially those in rural
and underserved areas, on how to best meet the needs of people
living with many chronic conditions, including Alzheimer's and
other dementias.

NATIONAL INSTITUTE ON SUBSTANCE USE

Appropriation, fiscal year 2024....................... $2,258,013,000
Budget request, fiscal year 2025...................... 2,267,246,000
Committee Recommendation.............................. 2,281,695,000
Change from enacted level........................... +23,682,000
Change from budget request.......................... +14,449,000

The report language that follows includes references to the
National Institute on Alcohol Abuse and Alcoholism (NIAAA) and
the National Institute on Drug Abuse (NIDA).
Cocaine Overdose Reversal Antidote.--The Committee is aware
of NIH's investment into countermeasures for overdoses
attributed to other stimulants such as cocaine. The Committee
remains supportive of NIDA funding targeting the surge in
overdose deaths involving cocaine and is aware of the current
lack of FDA approved cocaine overdose reversal medications to
address the increase in fatalities. The Committee understands
there is ongoing research and development of treatments, which
the NIH contributes, which can rapidly reverse cocaine toxicity
and reduce mortality rates. Therefore, the Committee urges NIDA
to continue to prioritize and fund research to advance a life-
saving treatment for overdoses caused by cocaine.
Fetal Alcohol Spectrum Disorders.--The Committee supports
NIAAA's efforts to accelerate fetal alcohol spectrum disorders
(FASD) basic, prevention, diagnosis, and treatment research.
The Committee encourages NIAAA to continue efforts to support
innovative research and to disseminate research findings to the
public to inform the efforts of States, Tribes, and provider
and nonprofit organizations in increasing FASD diagnostic
capacity, enhancing FASD prevention programs, developing
resources for systems of care, and training services providers
and professionals.
Marijuana Research.--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 public health issues such as
drug-impaired driving. The Committee is aware that the majority
of Federal research has been limited to marijuana from a single
source and encourages NIH to undertake research that strives to
encompass the diversity, quality, and potency of commonly
available cannabis strains within the current constraints of
law. Additionally, the Committee continues to support the
development of an objective standard to measure marijuana
impairment and a related objective field sobriety test to
ensure highway safety.
Methamphetamines and Other Stimulants.--The Committee is
concerned that, according to predicted provisional data
released by CDC, over 26,000 overdose deaths involved cocaine
and over 33,000 involved drugs in the category that includes
methamphetamine in the 12-month period ending in August 2022,
an increase of 35 and 50 percent respectively in just two
years. 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. No FDA approved medications are available for
treating methamphetamine, cocaine, and other stimulant use
disorders. The Committee continues to support NIDA's efforts to
address the opioid crisis, has provided continued funding for
the Helping to End Addiction Long-term (HEAL) Initiative, and
supports NIDA's efforts to combat the growing problem of
methamphetamines and other stimulant use disorders and related
deaths.
Opioid Initiative.--The Committee continues to be concerned
about the high mortality rate due to the overdose epidemic and
appreciates the important role that research plays in the
various Federal initiatives aimed at this crisis. Approximately
295 people die each day in this country from drug overdose
(over 220 of those are directly from opioids), making it one of
the most common causes of non-disease-related deaths for
adolescents and young adults. The Committee is also aware of
increases in opioid deaths from 2020 to 2021, with the primary
driver being the increased overdose deaths involving synthetic
opioids, primarily fentanyl. More research is needed to find
new and better agents to prevent or reverse the effects caused
by this class of chemicals and to provide improved access to
treatments for those with addiction to these drugs. To combat
this crisis, the Committee has provided within NIDA's budget no
less than the fiscal year 2024 enacted level for the
institute's management of its share of the HEAL Initiative and
in response to rising rates of stimulant use and overdose. The
Committee encourages NIDA to support research on the
development of safe and effective medications and new
formulations to treat substance use disorders and prevent or
reverse overdose, and to support research on comprehensive care
models in communities nationwide to prevent opioid misuse,
expand treatment capacity, enhance access to overdose reversal
medications, and enhance prescriber practice; test
interventions in justice system settings to expand the uptake
of medications for opioid use diorder and methods to scale up
these interventions; and develop evidence based strategies to
integrate screening and treatment for opioid use disorders in
emergency department and primary care settings. The Committee
has included language expanding the allowable use of these
funds to include research related to stimulant use and
addiction. Recognizing the increasing severity of the national
opioid crisis and the need to better our options for responding
to, treating, and preventing overdoses, the Committee
encourages NIDA to prioritize research to expedite treatments
for and prevention of overdose from fentanyl and related
analogs.
Pain Management and Addiction.--The Committee urges NIDA to
continue and expand efforts to educate physicians and other
medical professionals on safe prescribing for pain and managing
patients who misuse 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 Misuse and Addiction Prevention and Treatment.--Education
is a critical component of any effort to curb drug use and
addiction, and it must target every segment of society,
including healthcare providers (doctors, nurses, dentists, and
pharmacists), patients, and families. Medical professionals
must be in the forefront of efforts to curb the opioid crisis.
The Committee continues to be pleased with the NIDAMED
initiative, targeting physicians-in-training, including medical
students and resident physicians in primary care specialties
(e.g., internal medicine, family practice, emergency medicine,
and pediatrics). The Committee urges NIDA to continue its
efforts in this area, providing physicians and other medical
professionals with the tools and skills needed to incorporate
substance use and misuse screening and treatment into their
clinical practices.
Wastewater Drug Testing.--The Committee supports NIH's
National Institute on Drug Abuse (NIDA) research of testing
wastewater to detect and understand trends in drug substances.
Wastewater-based drug testing is a technique where wastewater
samples are taken from the sewer system and tested for specific
targets. Wastewater-based testing is intended to be
complementary to other more traditional methods of monitoring
drug use patterns, with the potential to detect such patterns
near real time and in hard-to-reach populations. The Committee
recognizes that wastewater drug testing can be proactive and
may allow agencies and related stakeholders to respond
appropriately when spikes or new trends are identified in
certain areas or of particular drugs. The Committee encourages
NIDA to report data collection and analysis of trends and drugs
from this research so that the field can improved and validate
wastewater testing methods, and ultimately enable local
governments to target support and reduce overdose deaths.

NATIONAL INSTITUTE OF MENTAL HEALTH

Appropriation, fiscal year 2024....................... $2,187,843,000
Budget request, fiscal year 2025...................... 2,503,162,000
Committee Recommendation.............................. 2,210,789,000
Change from enacted level........................... +22,946,000
Change from budget request.......................... -292,373,000

Autism Spectrum Disorder.--The Committee strongly
encourages NIH to support greater investment in research
related to autism, particularly in areas outlined in the
Interagency Autism Coordinating Committee (IACC) Strategic Plan
for Autism Spectrum Disorder (ASD). The Committee requests the
National Institute of Mental Health (NIMH) partner with other
Institutes that serve on the IACC to provide an update in the
fiscal year 2026 congressional justification on the level of
research investment of each of the priority areas outlined in
the IACC Strategic Plan for ASD. Progress has been made in
understanding autism, but there is more to do to improve
outcomes and access to services for people with autism
throughout their lifetime. Research has shown that autistic
individuals have higher rates of some co-occurring physical and
mental health conditions, which can affect quality of life and
increase use of medical services and costs. There are also
unaddressed racial, ethnic, and socioeconomic health challenges
that autistic individuals and their families experience. The
Committee encourages NIMH to collaborate with NIMHD to support
research on such health disparities associated with autism
spectrum disorder, and to collaborate with other institutes,
including NIA, NIEHS and NINDS, to support research on
understanding the impact of social and environmental factors
leading to such co-occurring health conditions.
Impact of Social Media Use on Child and Adolescent Mental
Health.--The Committee remains concerned about the impacts of
social and digital media on youth mental health and development
of mental health-related challenges. The Committee appreciates
NIH's ongoing engagement on this important topic and encourages
NIMH to prioritize research into the behavioral and
psychosocial impacts of young people's use of social media
including its impact on developing or worsening signs of
suicidality, anxiety, depression, disordered eating, sleep
disorders, and isolation.
Mental Health Research.--The Committee supports the high-
quality basic research on serious mental illnesses being
conducted at NIMH. The Committee requests an update in the
fiscal year 2026 congressional justification on the funding
allocations at NIMH detailing the percentage of funds spent on
basic, translational, and clinical research.
Peer Support for Youth.--The Committee understands that
many youths who are struggling with their mental health seek
out peer support services, often because they are not ready to
engage or do not have access to clinical health care. But while
numerous studies have shown that peer support increases help-
seeking behavior and reduces social isolation in adults,
research on youth peer support services and peer-to-peer
counseling programs is limited. Therefore, the Committee
encourages NIMH to prioritize research in these areas,
including how to scale up such services and programs
effectively. In addition, the Committee encourages NIMH to
continue to regularly hear from young people to inform its
future research priorities through its Advisory Council,
strategic planning process, focus groups or similar leadership
methods. The Committee supports the agency's youth-informed
activities and encourages additional efforts to grow youth
engagement in setting its research priorities.
Physician Suicide.--The Committee notes that physician
suicide rates are on a rise and the COVID pandemic has only
exacerbated the spike in suicide rates throughout the nation.
The Committee acknowledges the need to provide resources to
help identify and support at-risk physicians, respond to
suicide risk, and respond compassionately and effectively on
the organizational level after suicide occurs. The Committee
encourages the institute to work with key stakeholders to
support research and resource development aimed at
understanding this connection and opportunities for innovative
discovery.
Reducing Mental Health Disparities in Youth.--The Committee
notes with alarm new CDC data on depression and trauma among
adolescents and acknowledges the NIMH strategic framework for
addressing mental health among underserved and underrepresented
youth, including those in rural communities, by 2031. The
Committee recognizes ongoing collaborative work with NICHD and
NIMHD to execute this framework through research, workforce
development, and stakeholder engagement. The rise in youth
mental health issues will not be resolved without significant
new investments in research to guide recovery.
Study on the Cost of Serious Mental Illness.--The Committee
directs NIH to conduct a thorough study of the cost impact of
serious mental illnesses in the U.S. This study shall take a
multi-systemic approach examining the fiscal implications of
untreated or poorly managed schizophrenia and other severe
mental illnesses on the health care system, criminal courts,
penal facilities including county jails, housing programs, and
nursing facilities. The Committee encourages NIH to collaborate
or consult outside entities with experience in serious mental
illness and conduct extensive studies of government and
nongovernmental entities.
Suicide Prevention.--Suicide is complex, and multiple
factors--biological, psychological, social, and environmental--
play a role. The Committee encourages NIMH to provide
additional attention to suicide prevention research across all
of these areas, as well as the application of novel measurement
techniques, statistical analysis, digital initiatives, and
information systems. The Committee also encourages NIMH to
promote greater collaboration with other NIH institutes and
centers with expertise in research areas that can contribute to
suicide prevention, especially NIA, NICHD, NHGRI, NIAAA and
NIDA.

NATIONAL INSTITUTE ON HEALTH SCIENCES RESEARCH

Appropriation, fiscal year 2024....................... $1,911,613,000
Budget request, fiscal year 2025...................... 1,908,073,000
Committee Recommendation.............................. 1,931,662,000
Change from enacted level........................... +20,049,000
Change from budget request.......................... +23,589,000

The report language that follows includes references to the
National Institute of Environmental Health Sciences (NIEHS),
the National Institute on Minority Health and Health
Disparities (NIMHD), the National Center for Complementary and
Integrative Health (NCCIH), the National Institute of Nursing
Research (NINR), and the John E. Fogarty International Center
(FIC).
Alopecia Areata.--The Committees notes the disproportionate
effect of alopecia areata on people of color, specifically
women. The Committee requests an update in the fiscal year 2026
congressional justification on collaborative efforts between
NIAMS and other relevant NIH institutes and centers and
stakeholders in identifying key research areas of concern.
Disparities in Digital Health Readiness.--The COVID
pandemic facilitated unprecedented growth in the use of
telehealth, but not all populations benefited equally. For some
individuals and communities, barriers include factors such as
trust, acceptance, relevance of telehealth as a means of
receiving care. Overcoming such barriers is essential to
promoting equitable access to and uptake of health care.
Therefore, the Committee urges NIMHD to support funding
opportunities that are focused on identifying digital health
barriers and developing individually tailored approaches to
addressing them.
Improving Native American Cancer Outcomes.--The Committee
continues to be concerned that Native Americans experience
overall cancer incidence and mortality rates that are
strikingly higher than non-Native populations. The Committee
includes $15,000,000, which is an increase of $9,000,000 above
the fiscal year 2024 enacted level, to continue an initiative
for Improving Native American Cancer Outcomes to support
efforts including research, education, outreach, and clinical
access related to cancer in Native American populations. The
Committee further directs NIMHD to work with NCI to locate this
initiative at an NCI-designated cancer center demonstrating
partnerships with Indian Tribes and Tribal organizations to
improve the screening, diagnosis, and treatment of cancers
among Native Americans, particularly those living in rural
communities.
Interagency Coordinating Committee on the Validation of
Alternative Methods (ICCVAM).--ICCVAM is a committee of NIEHS
under the National Toxicology Program Interagency Center for
the Evaluation of Alternative Toxicology Methods (NICEATM). The
primary mission of ICCVAM is to coordinate Federal agency
collaboration of new, revised, and alternative test methods,
including the development of non-animal testing methods. The
Committee urges robust support for ICCVAM and NICEAM to
facilitate inter-agency efforts on the development and
utilization of non-animal testing methods, and to reduce,
refine, and replace animal use in Federal research when
feasible.
Microplastics.--The Committee recommends that NIH review
primary chemicals in the life cycle analysis of plastic
materials that are negatively impacting the environment and
human health. The Committee urges NIH to research the presence
of microplastics and nanoplastics in the human body, including
in organs and biospecimens and how such presence impacts human
health.
Multiple Chronic Disease Research Centers.--The Committee
is aware and strongly supports the regional chronic disease
centers established by NIMHD. To further the promotion of their
mission, the Committee encourages NIMHD to establish a
dissemination and implementation hub, where investigators could
obtain expert guidance on pragmatic trial design, and
dissemination and implementation frameworks to assist in
evaluating promising interventions in reducing chronic disease
disparities. The Committee strongly urges NIMHD to establish a
hub at one of the regional chronic disease centers aimed at
reducing disparities in diabetes and hypertension.
Native Hawaiian/Pacific Islander Health Research Office.--
The Committee provides $5,000,000, which is an increase of
$1,000,000 above the fiscal year 2024 enacted level, for the
Native Hawaiian/Pacific Islander Health Research Office
(NHPIHRO) with a focus on both addressing Native Hawaiian and
Pacific Islander (NHPI) health disparities, as well as
supporting the pathway and research of NHPI investigators. The
Committee encourages NHPIHRO to develop partnerships with
academic institutions with a proven track record of working
closely with NHPI communities and NHPI-serving organizations
located in states with significant NHPI populations to support
the development of future researchers from these same
communities.
Obstetric Fistula Research.--The Committee notes that an
estimated 500,000 women and girls worldwide live with obstetric
fistula--with thousands of additional cases occurring annually.
Obstetric fistula occurs disproportionately among impoverished,
vulnerable, and marginalized women and girls. It can be
prevented by skilled health personnel at birth and emergency
obstetric and newborn care. The Committee is concerned that
fistula repairs were widely halted or slowed down due to COVID,
as they were deemed non-urgent and unsafe during the pandemic.
This may have resulted in an increased backlog of fistula
cases. The Committee requests a report in the fiscal year 2026
congressional justification on the annual funding level for
this training over the preceding 5 fiscal years, including the
types of grants supported during this period.
Primary Care Research.--The Center for Primary Care
Research conducts vital studies that can lead to significant
improvements in how primary care is delivered and financed. By
focusing on innovative care models, the integration of
technology, and the development of a resilient and well-
supported primary care workforce, this research aims to
transform primary care into a more patient-centered, efficient,
and equitable component of the healthcare system. Investing in
primary care research is not only an investment in the health
of individuals but also in the overall well-being and economic
stability of communities nationwide. Enhanced primary care
services lead to better health outcomes, reduced healthcare
costs, and decreased hospitalizations and emergency department
visits.
Research Endowment Program.--The Committee includes
$12,000,000 for the Research Endowment Program, the same as the
fiscal year 2024 enacted level. The Committee is pleased with
NIMHD's reinvigoration of the Research Endowment Program and
has continued funding for fiscal year 2025. The Committee
supports effort that seek to supplement the funding available
to existing grantees and continue to expand the number of
statutorily eligible institutions receiving grants through a
competitive process.
Research Centers at Minority Institutions (RCMI) Program.--
The Committee notes that NIMHD's budget has experienced
significant growth during the last decade but funding for the
RCMI program has not kept pace despite being a flagship
program. The Committee urges NIMHD to revisit its policies
related to growth in the RCMI program.
State Wide Surgical Quality Collaboratives.--The Committee
is aware that several States have moved 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 these
collaboratives are to improve surgical outcomes, improve the
value of surgical care, and decrease disparities in care. The
Committee urges NIH to support States' development of such
collaborations including their expansion to include more
hospitals, telehealth, and mobile solutions in higher-value
care.
Wildfire Smoke Health Research.--The lack of data about the
health impacts of wildland fire smoke and wildfire management
strategies is a major gap in our firefighting arsenal. The
Committee encourages NIEHS to help fill this gap by pursuing
research to evaluate smoke health impacts for communities
experiencing different times of wildfire and to develop
datasets linking wildfire smoke to health impacts.

John E. Fogarty International Center

The Committee includes $95,162,000 for this center, the
same as the fiscal year 2024 enacted level.

NATIONAL INSTITUTE ON INNOVATION AND ADVANCED RESEARCH

Appropriation, fiscal year 2024....................... $3,541,351,000
Budget request, fiscal year 2025...................... 3,590,431,000
Committee Recommendation.............................. 2,568,004,000
Change from enacted level........................... -973,347,000
Change from budget request.......................... -1,022,427,000

The report language that follows includes references to the
National Institute of Biomedical Imaging and Bioengineering
(NIBIB), the National Center for Advancing Translational
Sciences (NCATS), and the Advanced Research Projects Agency for
Health (ARPA-H).
Diagnostic Technology Development.--The Committee is
pleased with the success of the Rapid Acceleration of
Diagnostics program in accelerating the innovation and
commercialization of diagnostic technologies. The Committee
commends NIBIB's initial efforts to apply the innovation funnel
model beyond COVID testing to address other critical unmet
needs in diagnostic testing and encourages NIBIB to continue
these efforts in fiscal year 2025 in partnership with other
institutes and centers, including NICHD, NIA, NINDS, and NIMH.
The Committee further requests NIBIB provide an update in the
fiscal year 2026 congressional justification on these efforts.
National Clinical Cohort Collaborative.--The Committee
urges strong support for the National Clinical Cohort
Collaborative's (N3C) open-science, privacy-preserved data-
sharing platform to accelerate biomedical research and
discovery. Supported by the Clinical and Translational Science
Awards program, N3C combines electronic health record data with
other types of data such as imaging, mortality, and Medicare
and Medicaid data from CMS to answer key research questions on
a variety of diseases, with 2 diseases being piloted. The
Committee supports the continuation of N3C and encourages NCATS
to coordinate with other HHS agencies to make N3C available as
an underlying common real-world data platform to drive faster
discovery across a range of diseases. The Committee encourages
NCATS to formulate a public-private strategy on the viability
of N3C in the challenging diagnostic odyssey of rare disease
research, to be detailed in a report to the Committee within 1
year of enactment of this Act and made available on the
agency's website.
Rare Disease Research.--The Committee encourages NCATS to
leverage the investments made in NCATS rare disease research to
accelerate the development of new treatments for the over 95
percent of 10,000+ rare diseases with no FDA approved
treatment, to strengthen the innovation of diagnostics to
shorten the average 6.3 yearlong diagnostic odyssey, and to
lower the nearly $1 trillion annual economic burden of rare
diseases. The Committee urges NCATS to increase its support for
rare disease research.

Advanced Research Projects Agency for Health (ARPA-H)

The Committee includes $500,000,000 for this activity,
which is $1,000,000,000 below the fiscal year 2024 enacted
level.
ARPANET-H Network.--The Committee appreciates ARPA-H's
efforts to ensure that communities across the country have
input into and benefit from the agency's innovations. The
ARPANET-H health innovation network brings together
stakeholders from every state from the earliest stages of
program development to the transition to the private market.
The Customer Experience hub facilitates input from patients,
providers, and other partners to ensure ARPA-H develops
technologies that meet their needs and are accessible to all.
The Investor Catalyst hub works with investors and industry so
that solutions developed by ARPA-H thrive after government
contracts have concluded. The Committee requests a report
within 90 days of the date of enactment of this Act on the
ARPANET-H network, including the number of spokes and a summary
of the geographic distribution and types of organizations
participating, as well as descriptions of each activity held by
the hub-and-spoke network.
Artificial Organs.--The Committee recognizes that more than
100,000 Americans across the country are on the organ
transplant waiting list, with more than four in five suffering
from kidney failure requiring grueling and expensive dialysis
treatments. Though some can receive a transplant, 17 Americans
die every day waiting for an organ transplant, with 13 per day
dying due to kidney failure. Medicare spends more than
$50,000,000,000 annually managing kidney failure, which affects
more than 800,000 Americans in total. KidneyX, a public-private
partnership in its 5th year focused on accelerating innovation
in the diagnosis, prevention, and treatment of kidney disease,
has accelerated investment in an underfunded area of
innovation, leading to a variety of promising new technologies
in biotechnology and tissue engineering with an eye toward the
artificial kidney. Given the significant cost of kidney failure
to the Federal government, the promising state of science, and
the need for better and more available organ transplant options
for patients, the Committee encourages ARPA-H to prioritize
research focused on the development of artificial organs,
including kidneys, building on the progress of KidneyX.
Commercialization Network.--Speeding the translation of
innovative health technologies to market is essential for the
success of ARPA-H. This acceleration depends on meaningful
collaboration between researchers, entrepreneurs, and investors
across sectors and geographic areas. The Committee supports the
establishment of the Investor Catalyst Hub in the ARPANET-H
hub-and-spoke network and appreciates its initial efforts to
build a diverse, wide-ranging network of experts to advance
innovation and commercialization of medical technologies.
Lyme and Other Tick-Borne Diseases (TBD).--The Committee
recognizes the value of and encourages ARPA-H to evaluate the
potential benefits of supporting research and development
programs and projects related to TBD. Examples of potential
research and development activities may include research
related to TBD diagnostics and Bartonella unit.
MATRIX Program.--The Committee urges ARPA-H to continue the
Machine Learning/Artificial Intelligence-Aided Therapeutic
Repurposing In eXtended uses (MATRIX) project. The Committee
recognizes the impact of this program to help the 30 million
Americans currently facing a rare disease through the project's
ability to determine if a currently approved drug is suitable
to use against other rare diseases, such as Lowe syndrome,
Leigh syndrome, and Fabry disease.
Mental Health Research.--The Committee urges ARPA-H to
support mental health research, including diagnosis and
treatment of severe mental illness to address widespread
behavioral health issues, and to focus as well on developing
treatments and cures for dementia, given the prevalence and
immense burden of this disease on society, as well as the
potential for such an investment to spur industry developments
and new academic partnerships.
Nanovaccine Research.--The Committee recognizes the
importance to invest in vaccine research at U.S. universities
to improve upon existing vaccines such as room temperature
stable nanovaccines that can be rapidly designed, tested, and
deployed. The Committee urges ARPA-H to support funding to
academic researchers working on nanovaccines.
Retinitis Pigmentosa.--ARPA-H plays a unique role in the
development of high-impact research to deliver transformative
advances in health solutions that strengthen U.S. science and
technology capacity, competitiveness, and leadership. Given the
significant toll Retinitis Pigmentosa exacts on the health care
system every year and the lack of curative therapies currently
available to help these patients, the Committee urges ARPA-H to
identify and invest in high-risk, high-reward biopharmaceutical
research projects that show demonstrated potential to transform
health care and improve public health. The Committee requests
an update from ARPA-H in the fiscal year 2026 budget request on
work related to this topic.

Clinical and Translational Science Awards

The Committee includes $629,560,000 for this activity, the
same as the fiscal year 2024 enacted level.

Cures Acceleration Network

The Committee includes $75,000,000 for this activity, the
same as the fiscal year 2024 enacted level.

OFFICE OF THE DIRECTOR

Appropriation, fiscal year 2024....................... $1,933,113,000
Budget request, fiscal year 2025...................... 2,291,054,000
Committee Recommendation.............................. 2,013,267,000
Change from enacted level........................... +80,154,000
Change from budget request.......................... -277,787,000

The items below include issues and programs specific to the
Office of the Director as well as those that involve multiple
institutes and centers.
ACT for Amyotrophic Lateral Sclerosis Expanded Access.--In
addition encouraging more research broadly for Amyotrophic
Lateral Sclerosis (ALS), the Committee includes $75,000,000,
the same as the fiscal year 2024 enacted level, to support
expanded access grants as authorized in the Accelerating Access
to Critical Therapies for ALS Act (P.L. 117-79). The Committee
continues to direct NIH to handle this funding as separate
from, not competitive with, other funding for research on ALS.
The Committee encourages NINDS and OD to continue to strengthen
the expanded access grant application process as discussed in
the joint explanatory statement which accompanied the fiscal
year 2023 consolidated appropriations Act. The Committee
commends efforts by NINDS to engage stakeholders and grow the
sustainability of this program.
Furthermore, after the review and award of meritorious
applications under Section 2, the Committee recommends NIH
apply any unused funds to programs authorized under ACT for ALS
including Section 3 public-private research partnership and
Section 5 Rare Neurodegenerative Disease Grant Program at FDA,
as well as the NIH ALS Strategic Priorities.
Adult Cellular Therapies.--To support collaborative
evidence development, the agreement encourages HHS--in
coordination with FDA, NIH, and HRSA--to continue efforts to
enhance transparency regarding outcomes from adult (somatic)
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 Gene and Cell Based Therapies.--The Committee
recognizes that cell-based therapies hold promise for a broad
range of conditions, including neurological conditions,
musculoskeletal conditions, cancer, radiation damage,
cardiovascular disease, diabetes, blindness, skin diseases,
wound healing, and autoimmune and immune-medicated disease. The
Committee supports the development and launch of a coordinated
program to support research, development, and specific
activities related to manufacturing of somatic (adult) gene and
cell-based therapies for patients with serious and life-
threatening conditions. Such funding could support large-scale,
randomized, controlled clinical trials or other innovative
clinical trial designs exploring the use of somatic gene and
cell-based therapies for serious and life-threatening
conditions; development, characterization, optimization, and
scaling of manufacturing of gene and cell-based therapies; a
clinical trials network to support sharing of best practices
and lessons learned; workforce development activities; and
collaborative, evidence development, including the development
and operation of an outcomes database. The Committee encourages
support for cell-based therapies to be guided by a committee of
outside experts, including researchers who have conducted
multiple clinical trials involving cell-based therapies.
Initial areas of focus for the program could include
neurological conditions, musculoskeletal conditions, cancer,
radiation damage, immunological disease, and cardiovascular
disease.
All of Us.--The Committee includes $36,000,000 from the
Cures Act for the All of Us Research program. The Committee
continues to support the work on this program to allow for
continued participant enrollment from historically
underrepresented populations and to continue its efforts to
enroll participants from rural communities, including pediatric
enrollment.
Alternatives to Animal Testing.--The Committee supports the
Complement Animal Research In Experimentation (Complement-ARIE)
Program, intended to spur the development, standardization and
use of new approach methodologies (NAMs) intended to more
accurately model human biology. The Committee also encourages
NIH, in new announcements and other indications of funding
opportunities, to prioritize consideration of NAMs as the
preferred option for areas of preclinical research when it is
not appropriate to use human participants.
Amyotrophic Lateral Sclerosis Research.--The Committee
believes it is critically important that NIH continue to
increase its investment in ALS research and grow the research
workforce, in order to find new treatments and a cure for the
disease. Increasing support for ALS research will benefit
people living with ALS now and those diagnosed in the future.
The Committee continues to strongly encourage NIH to increase
support for research, including the Transforming Research Award
program for ALS, that will lead to measurable changes in the
lives of people with ALS.
Atopic Dermatitis.--The committee is encouraged that recent
scientific breakthroughs have led to progress in patient care
and the development of innovative therapies for atopic
dermatitis and other forms of eczema. The committee recognizes
emerging potential in NIH multidisciplinary research and
community engagement for atopic dermatitis to address new
opportunities in a variety of collaborative areas.
Cancer Vaccines.--While much progress has been made in the
study of mRNA cancer vaccines and the mRNA vaccine platform
continues to hold potential, additional advances from ongoing
research are needed to hasten the development of effective
personalized cancer therapies based on mRNA technology.
Findings from the ongoing NCI-supported research will continue
to inform progress in this promising field. The Committee urges
NIH to continue to provide robust funding to support research
that moves the field forward for mRNA vaccines in cancer,
collaborating closely with academic medical centers and cancer
centers. Areas of particular scientific opportunity include
focus on enhancing immune recognition of solid tumors,
overcoming suppression in the tumor microenvironment, and
personalization of mRNA vaccines. Together, these strategies
have high potential for increasing the effectiveness for cancer
immunotherapy treatment and prevention.
Childhood Post Infectious Neuroimmune Disorders, Pediatric
Acute-Onset Neuropsychiatric Syndrome and Pediatric Autoimmune
Neuropsychiatric Disorders Associated with Streptococcus.--The
Committee supports efforts to advance scientific research
related to the devastating diseases of Pediatric Acute-Onset
Neuropsychiatric Syndrome (PANS) & Pediatric Autoimmune
Neuropsychiatric Disorder Associated with Streptococcus
(PANDAS). Although the NIH has undertaken research in this
area, significantly more needs to be done. Understanding the
causes, diagnosis, and treatment of these life-threatening
diseases is essential to expedite early identification and
intervention, thereby reducing the risk of chronic illness and
associated costs to families, school systems, health care
systems, and insurers. PANS/PANDAS research also would further
the understanding of the critical link between neuropsychiatric
illness and COVID and other infections. The Committee urges NIH
to continue to prioritize research on PANS/PANDAS and related
to autoimmune encephalitic conditions.
Crohn's Disease.--The Committee is aware of the strategic
goal within the Strategic Plan for NIH Nutrition Research
focused on improving the use of food as medicine and is
interested in how certain foods, which are prescribed to
support management of a specific condition and administered
under physician supervision, impact the lives of patients, for
example those with digestive diseases including Crohn's disease
and ulcerative colitis. The Committee urges NIH to support
research on the efficacy of food as medicine strategies to
treat various diseases and condition, such as Crohn's Disease
for pediatric patients.
Collaborations with the Department of Energy.--The
Committee supports collaborations between the NIH and the
Department of Energy (DOE) to strategically leverage NIH's
research needs in cancer research, brain mapping, drug
development that requires DOE's high frequency imaging,
supercomputing, instrumentation, materials, modeling
simulation, and data science. Increased and more effective
coordination could be instrumental to assist in the development
of the nation's health, security, biomedical technologies, and
in the development of more strategic enabling technologies. The
Committee requests an update from NIH regarding their current
and projected collaborations with DOE, including the
identification of future opportunities for continued
partnership growth as part of the fiscal year 2026
congressional justification.
Common Data Elements.--The Committee commends the Office of
Data Science Strategy for issuing a request for information
(RFI) to stakeholders focused on development of common data
elements (CDEs) and for convening a workshop on this topic. The
Committee recognizes the importance of CDEs in facilitating
research activities and fostering collaboration amongst the
research and healthcare communities. Specifically, CDEs are
instrumental in standardizing data collection, enhancing data
quality, and enabling more effective data sharing and analysis,
particularly in complex areas such as autoimmune and immune-
mediated diseases. The Committee encourages NIH to build upon
the RFI and workshop and to develop a plan to work with
stakeholders, particularly in the autoimmune and immune-mediate
communities, to develop CDEs and best research practices for
these conditions.
Debarment Policies.--The Committee supports NIH in its
ongoing work focused on changing the culture of sexual
harassment that is pervasive throughout its biomedical research
laboratories. However, the Committee believes NIH should do
more to ensure that proven bad actors are no longer eligible
for Federal funding. In addition, the Committee is concerned
that current regulations do not allow NIH to act quickly and
independently to suspend or debar award recipients that
demonstrate serious or frequent noncompliance and scientists
supported through their institutions by NIH who have engaged in
serious forms of professional misconduct. The Committee urges
NIH to issue regulations implementing Executive Order 12549 and
Executive Order 12689. Such regulations would provide NIH with
the authority to issue a government-wide debarment, thereby
preventing individuals or entities from participating in any
government contracts, subcontracts, loans, grants, and other
assistance programs for a specified period.
Diet and Chronic Disease Research.--The Committee supports
NIH, including the Office of Nutrition Research and NIAID, for
moving ahead with a scientific workshop focused on the role
food and diet play in developing mucosal immunity for
conditions such as Crohn's disease, ulcerative colitis, and
other digestive and autoimmune or immune-mediated diseases.
This workshop is anticipated to provide crucial insights to
inform future Inflammatory Bowel Disease and larger diet and
nutrition research and public health activities. The Committee
urges NIH to promptly disseminate the proceedings of this
workshop, particularly recommendations to inform future
research funding priorities.
Dog and Cat Research.--For over half a century, Congress
has expressed concerns about the harmful use of dogs and cats
in biomedical research. The Committee remains concerned about
this issue and is aware of various promising Federal
initiatives in recent years to refine, reduce and replace the
use of dogs and cats in research with alternative species and
technologies. The Committee directs NIH to submit a report to
the Committee no later than 180 days of enactment of this Act
that includes an explanation of NIH efforts for the reduction
and replacement of the use of dogs and cats in NIH-funded
intramural and extramural research classified in pain category
D or E as defined by the Department of Agriculture (USDA),
including objective performance metrics to assess progress. The
content of the final report shall be made publicly available on
the agency's website.
Female Aging Research.--The Committee acknowledges the NIH
for its pioneering efforts in geroscience and underscores the
importance of investigating female reproductive aging, a
critical yet understudied aspect of women's health and
longevity. For example, aging of the female ovary occurs at a
more accelerated pace compared to other tissues and organs,
posing significant implications for fertility, reproductive
health, and overall well-being. This distinct aging process
highlights the need for a deeper understanding of the cellular,
molecular, genetic, and epigenetic factors driving early onset
of female reproductive aging. To ensure progress in this
pivotal research area, the Committee encourages NIH to convene
a workshop with experts from across NIH, other relevant Federal
agencies, academic institutions, and the private sector to
explore the mechanisms that influence female reproductive
aging, its impact on women's health, and the development of
strategies and interventions to mitigate negative effects.
Focused Ultrasound.--The Committee understands focused
ultrasound is a non-invasive, non-pharmacological, safe, and
cost-effective alternative or complement to conventional
surgery, radiation therapy, or drug-based treatments. Focused
ultrasound is a promising intervention for patients suffering
from serious conditions like Parkinson's disease, essential
tremor, prostate cancer, and uterine fibroids, and is currently
being explored for more than 180 other indications. The
Committee encourages NIH to continue to engage with the focused
ultrasound stakeholder community. Further, the Committee
encourages NIH to explore existing focused ultrasound research
group and ensure research coordination across the institutes
and centers. The Committee requests an update in the fiscal
year 2026 congressional justification, including an NIH-wide
overview of the grants awarded to support focused ultrasound
research and research opportunities for advancing cross-cutting
focused ultrasound research across the institutes and centers
to benefit patients.
Firearm Injury and Mortality Prevention Research.--The
Committee does not include funding for this activity.
Fragile X.--The Committee notes the importance of expanding
the base of researchers and clinicians who are familiar with
and trained in 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 commends the NIH for recognizing
the ethical, legal, and social issues in premutation screening
and testing and encourages to NIH to look at existing pilot
studies that are looking at innovative ways to screen newborns,
study Fragile X across the lifespan, and coordinate efforts and
research with the CDC as they look at screening solutions for
FMR1-related conditions.
Functional Genomics to Improve Outcomes in
Neurodevelopmental and Neurodegenerative Diseases.--The
Committee urges NIH to expand efforts in this area. Additional
funding would allow for the integration of worldwide data and
discoveries using cutting edge tools through the lens of
genomics which could accelerate the discovery of new genetic
variants associated with neurodegenerative and
neurodevelopmental disorders. Such discoveries are instrumental
to understanding risk factors, detecting the disease earlier,
monitoring the effectiveness of clinical trials, and defining
pathways for new drug development.
Gabriella Miller Kids First Pediatric Research Program.--
The Committee includes $12,600,000 to support pediatric
research as authorized by the Gabriella Miller Kids First
Research program, which is the same as the fiscal year 2024
enacted level.
Gene Expression.--The Committee notes recent precision
medicine developments focused on commercialized blood/biopsy
tests that provide clinical decision support by analyzing gene
expression, for example RNA, to determine disease status,
identify abnormalities in drug targets, and predicting drug
options. The benefits of this technology include the ability to
stretch clinical trial resources efficiently to address patient
needs. If properly implemented during the drug development
process, the Committee acknowledges this technology could
increases the likelihood that a drug will be approved by the
FDA and that, after approval, it will reach patients who
desperately need the drug to improve their condition. The
Committee requests an update in the fiscal year 2026
congressional justification on efforts and progress made to
implement clinical decision support that incorporates genomic
information.
INCLUDE Down Syndrome Research Initiative.--The Committee
includes no less than $125,000,000, a $35,000,000 increase
above the fiscal year 2024 enacted level, within OD for the
INCLUDE Initiative. With the Committee's support, NIH launched
the INCLUDE Initiative in June 2018. The Committee remains
pleased with a focus on large cohort studies across the
lifespan, novel clinical trials, and multi-year, trans-NIH
research driving important advances in understanding immune
system dysregulation, Alzheimer's disease, and leukemia that is
contributing to improvements in the health outcomes and quality
of life of individuals with Down syndrome as well as millions
of typical individuals. The Committee directs NIH to provide an
updated plan within 60 days of enactment of this Act that
includes a timeline and description of potential grant
opportunities and deadlines for all expected funding
opportunities so that young investigators and new research
institutions may be further encouraged to explore research in
this space. This plan should also incorporate and increase
pipeline research initiatives specific to Down syndrome and be
made available on the agency's website.
Infection Associated Chronic Conditions and Illnesses
(IACCIs).--These are a related family of diseases with many
overlapping similarities and commonalities. Currently, there is
limited coordination at NIH among these various conditions
leading to duplication, inefficiency, and redundancies. The
Committee encourages NIH to streamline, coordinate, and
synergize research for IACCIs across the NIH institutes,
centers, and offices.
Interagency Framework for Considering the Exercise of March
In Rights.--The Committee notes with strong concern the
Administration's proposed ``Draft Interagency Guidance
Framework for Considering the Exercise of March-in Rights,''
(Framework) which reviews factors, include price, that a
Federal agency may consider when deciding whether to exercise
march-in authority as provided in the Bayh-Dole Act. The
Committee believes that if implemented by Federal agencies,
particularly the National Institutes of Health, the Framework
may adversely impact America's global leadership in
pharmaceutical innovation. The Committee notes that since the
inception of the Bayh-Dole Act over 40 years ago, the U.S. has
never exercised its march-in rights authority. This has
empowered U.S. investment and technology communities,
universities, and research institutions to take risks and
efforts needed to bring new ideas to the pharmaceutical
marketplace. In 2022 alone, 850 new commercial products
utilizing inventions developed by U.S. universities and
research institutions became available to the public in 2022
thanks in large part to the Bayh-Dole Act. If the Framework is
finalized and implemented, the Committee is concerned that it
would have serious negative effects on current and future
scientific advancements in hundreds of promising new therapies
under development to treat cancer, immune disorders, and other
chronic conditions, and would threaten the U.S.' global
leadership in pharmaceuticals.
Lyme and Other Tick-Borne Diseases.--The Committee
encourages the Office of the Secretary to work with the
Director of NIH to evaluate the potential benefits of expanding
the TBD portfolio to other institutes and centers in addition
to NIAID. Because of the profound neurologic involvement of
TBD, such as Lyme disease, NINDS and NIMH may make major
contributions to the study of TBD, such as developing novel
treatments for neurologic symptoms, including severe neurologic
symptoms in children. Because of the severe impacts of TBD on
children, NICHD may also greatly enhance NIH accomplishments in
developing tools to manage pediatric cases of TBD.
Menopause Research.--The Committee is concerned that there
is a significant and unmet need with respect to: basic research
into and knowledge and understanding of menopause and
perimenopause; new treatments for menopause-related symptoms;
and evaluation of the safety and effectiveness of treatments
for menopause-related symptoms. The Committee believes the lack
of attention and investment into these health conditions has
contributed to a lower quality of life and poorer health
outcomes for the nation's middle aged and older women. The
Committee urges NIH to undertake and fund additional research
related to early menopause (<45 years old), menopause,
perimenopause, and mid-life women's health, including research
concerning symptoms and treatments for menopause,
perimenopause, and other related mid-life women's health issues
and a multidisciplinary study of the effects of hormonal
treatment for menopausal symptoms. As part of the fiscal year
2026 congressional justification, the Committee requests the
historical information on research related to menopause,
perimenopause, or mid-life women's health over the preceding 5
fiscal years and an overview of: completed research related to
menopause, perimenopause, and mid-life women's health; status
of ongoing Federally-funded such research; and the safety and
effectiveness of treatments for menopause-related symptoms and
recommendations.
Mental Health, Addiction, and Resilience Research.--
Diseases of the mind and brain can develop early in life,
contribute to the burden of overall health and daily life
function, and contribute to the persistent and rising rates of
deaths of despair from mental illness and addiction. The
Committee encourages NIH to support collaborative research
efforts to uncover the root causes, risk, and resilience/
protective factors of mental health and addiction. These
efforts could include leveraging existing longitudinal research
to examine the biological, psychological, and social factors
and their interactions across multiple layers of analysis that
put people at risk for addiction and mental illness including
patterns of intergenerational transmission of mental illness,
discover ways to better prepare and respond to stress, trauma
and adversity, and inform and guide new strategies for
prevention, recovery, and resilience.
Microplastics.--The Committee notes that research has
identified microplastics and nanoplastics in water, food, and
air, and in the human body. The Committee recommends that NIH
review primary chemicals in the life cycle analysis of plastic
materials and potential impacts on human health. The Committee
also requests that NIH research the presence of microplastics
and nanoplastics in the human body and the impacts on health.
Mitochondrial Disease.--The Committee recognizes the need
for the NIH to prioritize research on primary and secondary
mitochondrial disease. A constellation of rare diseases linked
to impaired mitochondrial function needs further research while
potentially promising interventions work through the FDA
approval process. At the same time, research continues to
validate the substantial connections between mitochondrial
function and major conditions such as Alzheimer's, Parkinson's,
ALS, Muscular Dystrophy, heart failure, and long COVID. The
Committee strongly encourages NIH to advance primary
mitochondrial disease research, continue its ongoing outreach
and collaboration with the FDA related to research that may
lead to future mitochondrial disease-related drug approvals,
ensure that support for long COVID research includes
opportunities for studies to explore the role of mitochondrial
impairment, and ensure that opportunities remain available to
support collaborative research on mitochondrial disease to
centralize a critical mass of research, clinical care, and
provider education.
Mucopolysaccharidoses and Mucolipidosis.--The Committee
recognizes the severity of Mucopolysaccharidoses and
Mucolipidosis (MPS/ML) diseases and the need for additional
research in order to improve life expectancy and quality of
life for patients.
National Primate Research Centers and Caribbean Primate
Research Center.--The Committee does not include funding for
this activity.
Neuroarts Research.--The Committee notes the contribution
of NIH to the burgeoning field of neuroarts, which shows great
promise in advancing health and wellbeing for all.
Neurofibromatosis.--The Committee supports efforts to
increase funding and resources for Neurofibromatosis (NF)
research and treatment at multiple Institutes, including NCI,
NINDS, NIDCD, NHLBI, NICHD, NIMH, NCATS, and NEI. Children and
adults with NF are at elevated risk for the development of many
forms of cancer, deafness, blindness, developmental delays, and
autism. The Committee encourages NCI to 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 support preclinical research and clinical
trials. Because NF can cause blindness, pain, and hearing loss,
the Committee urges NEI, NINDS and NIDCD to continue to support
fundamental basic science research on NF relevant to restoring
normal nerve function. Based on emerging findings from numerous
researchers worldwide demonstrating that children with NF have
a higher chance of developing autism, learning disabilities,
motor delays, and attention deficits, the Committee encourages
NINDS, NIMH, and NICHD to continue their support of research
investigations in these areas. Since NF2 accounts for some
genetic forms of deafness, the Committee encourages NIDCD to
expand its investment in NF2-related research. NF1 can cause
vision loss due to optic gliomas. The Committee encourages NIH
to expand its investment in NF1-focused research on optic
gliomas and vision restoration.
Non-Human Primates.--The Committee recognizes the critical
role of non-human primate research in virtually all areas of
biomedical research. Research with these unique models makes
irreplaceable contributions to understanding the biological
processes that cause diseases. These models are essential in
the discovery and evaluation of new therapeutics before they go
to clinical trials. As the U.S. population ages, and millions
of Americans suffer from chronic and degenerative diseases,
including those that affect the nervous system such as
Alzheimer's and Parkinson's disease, non-human primate research
will continue be vital to understanding both the underlying
mechanisms and potential cures for these diseases. Non-human
primate research remains critical to understand the causes of
age-related degenerative diseases and to improve the
effectiveness of new compounds and non-pharmaceutical
treatments such as deep brain stimulation, neuromodulation,
cancer, chronic pain, and metabolic disorders. The Committee
encourages NIH to award funding to meritorious research
proposals to study these degenerative disorders, including
studies that utilize non-human primates.
Office of AIDS Research.--While great advancements have
been made in HIV prevention, health care, and treatment over
the last 30 years, more must be done to improve the lives of
the more than one million people with HIV in the U.S. and
prevent the more than 31,000 new infections each year. The
targeted HIV/AIDS research funding at the NIH is needed to
develop improved access to health care and services for those
with HIV, better prevention for at-risk populations from
transmission, more effective treatments, and ultimately a cure
for HIV.
Office of Communications and Public Liaison.--The Committee
notes with strong concern the lack of adherence to scientific
terminology and industry-recognized reference standards in the
NIH Style Guide. The promotion and use of politicized and
polarizing language by the nation's premier scientific
institution is a disappointment and serves as yet another
example of the lack of scientific rigor now used across NIH.
Office of the Chief Officer for Scientific Workforce
Diversity.--The Committee does not include funding for this
activity.
Office for Research on Women's Health.--The Committee
provides $100,000,000 for the Office of Research on Women's
Health, which is $23,520,000 above the fiscal year 2024 enacted
level and $53,909,000 below the fiscal year 2025 budget
request. The Committee recognizes research into conditions that
disproportionately or differently affect women will increases
positive health outcomes. Based on an analysis of NIH
extramural grants awarded in fiscal year 2019, doubling
research focused on women-focused funding in just four
conditions, coronary artery disease, lung cancer, Alzheimer's
disease, and rheumatoid arthritis could provide a $14 billion
economic return. Despite progress made, opportunities to
enhance NIH efforts focused on the health of women across the
lifespan could bridge gaps in knowledge about diseases that
affect women differently or disproportionately. Additional NIH-
wide investments in research addressing pressing conditions and
diseases which negatively impact the health of women could
produce significant economic returns. The Committee urges NIH
to focus women's health research on these areas.
Open Access Genetic Sequence Data Repositories.--The
Committee is concerned NIH may not have sufficient safeguards
in place for open access databases with human genetic data. The
Committee directs NIH to submit a report within 180 days of
enactment of this Act on the authentication protocols in place
to restrict the ability for foreign adversary entities to
access such a database.
Osteopathic Medical Schools.--Osteopathic medicine
represents a vibrant portion of the medical student education
and health systems ecosystem. However, the Committee remains
concerned with the historic disparity in NIH funding and
representation for Colleges of Osteopathic Medicine (COMs), as
well as NIH's failure to respond to requests to create an
action plan to address the agency's chronic underfunding of
osteopathic research and underrepresentation of osteopathic
scientists on NIH National Advisory Councils and study
sections. Additionally, the Committee is concerned that NIH
continues to associate osteopathic medicine most strongly with
the National Center for Complementary and Integrative Health
(NCCIH). The Committee encourages the NIH to expand funding
opportunities and representation across NIH Institutes and
Centers, outside of NCCIH. Further, the Committee requests NIH
include in the fiscal year 2026 congressional justifications
information on the representation of COMs in NIH applications
and awards.
Parkinson's Progression Markers Initiative.--The Committee
supports the significant recent advances in Parkinson's disease
(PD) research through public-private partnerships like the
Accelerating Medicines Partnership for PD (AMP-PD) that is a
collaboration between NIH, nonprofit organizations, and
industry. The work of the Michael J. Fox Foundation for
Parkinson's Research PPMI program, one of the cohorts
contributing to AMP-PD, recently independently replicated a
potential diagnostic biomarker for Parkinson's disease. The
Committee encourages NIH and NINDS to continue participation in
such public-private partnership opportunities with patient
advocacy groups and build on these discoveries to accelerate
Parkinson's and atypical parkinsonism disorders (e.g.
progressive supranuclear palsy) research advances.
Pediatric Lyme Disease.--As part of the fiscal year 2026
congressional justification, the Committee requests an update
on the agency's plans to advance research on pediatric Lyme
disease, including the impact on children who are infected in
utero. The Committee encourages NIH, including NIAID, NINDS and
NIMH, to increase study of neurologic symptoms of Lyme disease,
including in children, increasing surveillance of neurologic
symptoms and investigating novel treatments of neurologic
symptoms.
Pelvic Floor Disorders.--Pelvic floor disorders (PFDs) are
common conditions that can significantly affect a woman's
quality of life. Approximately 25 percent of women experience
at least one PFD and this condition becomes more common with
age. Unfortunately, health disparities in the care of pelvic
floor disorders are a prevalent issue, especially impacting
patients in underserved areas, areas with limited access to
health care, barriers to healthcare and care-seeking behaviors
regarding the treatment/management of PFDs. Therefore, the
Committee urges NIH to support research to better understand
disparities in care for diverse patients, which may include
identifying risk factor clusters in geographic regions and
within these diverse populations that suffer from PFDs. The
Committee requests an update on this effort in the fiscal year
2026 congressional justification.
Physician Scientist Workforce.--The Committee urges the NIH
to invest in new incentives for physician-scientists to pursue
biomedical research opportunities. The number of physicians who
opt for academic career paths in biomedical research has
dropped in recent years, and the Committee is concerned that
this troubling trend may inhibit innovation that might
otherwise contribute to the next generation of cures. New
incentives are critically needed to replenish physician-
scientists' ranks. More specifically, the Committee encourages
the NIH to continue support for research-oriented career
development grants with mentorship activities, continue
supporting postdoctoral trainees, and empower researchers to
independently pursue new fields of research, including high-
risk/high-reward projects. It is vital that the NIH build on
the findings of its Physician-Scientist Workforce Working Group
Report (June 2014) a decade ago, which concluded that
physician-scientists may face pressures from institutions to
see patients rather than conduct research.
Polycystic Ovary Syndrome.--The Committee commends OD for
incorporating Polycystic Ovary Syndrome (PCOS) into the NIH
Research, Condition, and Disease Categories (RCDC) reporting,
which provides specificity regarding research projects focused
on PCOS. Despite this progress, the discrepancy between PCOS's
profound impact on 10 percent of women and its annual economic
burden of over $15 billion in the U.S., compared to the $10
million in research projects supported in 2023 as per RCDC, is
pronounced. The Committee recognizes the significant and
pervasive health and economic burden of PCOS, which has
metabolic, cardiovascular, reproductive, maternal health, and
mental health manifestations. Moreover, the Committee
recognizes that there are no FDA approved treatments
specifically for PCOS. To bridge the significant funding gap
and to improve health outcomes for women while reducing
healthcare costs, the Committee strongly urges increased
funding for PCOS research at NIH. The Committee encourages
increased investments into research on the metabolic,
cardiovascular, psychosocial, maternal-fetal, oncologic,
pediatric, dermatologic, neurologic, and reproductive aspects
of PCOS. The Committee encourages the NIH to increase its PCOS
research portfolio to invest in fundamental laboratory science,
patient-oriented research, clinical trials, and longitudinal
studies focused on the cardiometabolic features and
endocrinopathy of PCOS throughout the lifespan. Areas of
interest include closing knowledge gaps in PCOS, researching
novel diagnostics and treatments, exploring the research
opportunities identified from the NHLBI report based on its
2021 NIH workshop on cardiovascular risks across the lifespan
in PCOS, and applying insights from the PCOS Externally-Led
Patient-Focused Drug Development Meeting and Voice of the
Patient Report to address patients' unmet needs and to align
with their treatment priorities.
Sexual and Gender Minority Research Office.--The Committee
does not include funding for this activity.
Spina Bifida Research.--The Committee encourages NIH to
study the causes and care of the neurogenic bladder to improve
the quality of life of children and adults with spina bifida;
to support research to address issues related to the treatment
and management of spina bifida and associated secondary
conditions, such as hydrocephalus and sudden death in the adult
spina bifida population; and to invest in understanding the
myriad co-morbid conditions experienced by individuals with
spina bifida, including those associated with both paralysis
and developmental delay. The Committee requests an update in
the fiscal year 2026 congressional justification on research
findings on spina bifida and issues related to it. The
Committee supports the specific efforts of NICHD to understand
early human development; set the foundation for a 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 support research 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.
Staffing Report.--The Director shall submit to the
Committee, within 90 days of enactment of this Act, a staffing
report detailing the number of Senior Executive Service (SES)
employees and Title 42 public health service excepted employees
broken down by the employing institute or center. These reports
shall include the total number of employees broken down by SES
or Title 42 exempted status and total compensation for each,
including pay, and any awards such as bonuses.
Success Rates.--No later than 180 days after enactment of
this Act, the Agency is directed to publicly post and maintain
on the agency's website a listing of all grant success rates by
institute or center, grant mechanism, and fiscal year. Such
website information shall be easily accessible and include
options to export into an electronic data format. Initial
information should include the last 10 years, to the extent
practicable, and be maintained on the website indefinitely.
Ultra Processed Foods.--The Committee recognizes more
research is required to better understand the health impacts of
ultra-processed foods, and how to best define ultra-processed
foods. The Committee encourages NIH, in coordination with CDC
and FDA, to support research on ultra-processed foods.
Von Hippel Lindau Disease.--The Committee appreciates NIH's
support for research on von Hippel-Lindau (VHL) disease, which
has led to the development of new treatments for not only VHL
but also more prevalent cancers. While significant research has
focused on the role between the VHL Gene and Hypoxia-Inducible
Factor 2 Alpha, the Committee encourages NIH to continue to
support research to identify additional molecular targets. The
Committee requests an update on this research in the fiscal
year 2026 congressional justification.

BUILDINGS AND FACILITIES

Appropriation, fiscal year 2024....................... $350,000,000
Budget request, fiscal year 2025...................... 350,000,000
Committee Recommendation.............................. 353,671,000
Change from enacted level........................... +3,671,000
Change from budget request.......................... +3,671,000

NIH INNOVATION ACCOUNT

Appropriation, fiscal year 2024....................... $407,000,000
Budget request, fiscal year 2025...................... 127,000,000
Committee Recommendation.............................. 127,000,000
Change from enacted level........................... -280,000,000
Change from budget request.......................... - - -

This account supports NIH programs authorized in the Cures
Act. The Committee recommendation includes funding for
initiatives authorized by the Cures Act; $36,000,000 for the
All of Us precision medicine initiative within the Office of
the Director and $91,000,000 for the BRAIN initiative split
equally between NIMH and NINDS.

Substance Abuse and Mental Health Services Administration

Appropriation, fiscal year 2024....................... $7,446,396,000
Budget request, fiscal year 2025...................... 7,715,556,000
Committee Recommendation.............................. 7,542,067,000
Change from enacted level........................... +95,671,000
Change from budget request.......................... -173,489,000

The Committee recommendation for the Substance Abuse and
Mental Health Services Administration (SAMHSA) program level
includes $7,398,400,000 in discretionary budget authority,
$131,667,000 in PHS Evaluation Tap Funding, and $12,000,000 in
transfers from the Prevention and Public Health Fund (PPHF).
SAMHSA is the agency within HHS that leads public health
efforts to reduce the impact of substance use and mental
illness on America's communities. The Committee continues to
include bill language that exempts the Mental Health Services
Block Grant (MHSBG) and the Substance Use Prevention,
Treatment, and Recovery Services Block Grant (SUPTRS) as a
source for the PHS Act section 241 evaluation set aside in
fiscal year 2025.
Eligible Grantees.--Where permitted in the authorizing
statute, the Committee directs SAMHSA, when issuing new funding
opportunity announcements, to include as an eligible applicant
States, political subdivisions of States (including local
governments, communities, and municipalities), Tribes or Tribal
organizations, other public or nonprofit entities, and faith-
based organizations. The Committee encourages SAMHSA to provide
outreach and technical assistance to ensure the maximum level
of awareness and participation in new grant announcements to
ensure robust competition.
Female Adolescent Mental Health.--The Committee notes with
concern the findings in a February 2023 report on the high
rates of mental health challenges and suicidal ideation among
adolescent females. The Committee directs the Secretary of HHS,
through SAMHSA, to work across HHS, and in consultation with
other Departments as appropriate, to develop a comprehensive
interagency coordinating plan to improve adolescent mental
health, with a focus on the unique challenges facing female
adolescents. The Committee requests a briefing outlining these
efforts within 180 days of enactment of this Act.
Gambling.--The Committee understands that the annual
national cost of problem gambling is estimated to be
$7,000,000,000 per year. As part of the fiscal year 2026
congressional justification, the Secretary is encouraged to
include how agency resources can be better utilized to provide
and facilitate gambling addiction prevention and treatment
services.
Harm Reduction.--The Committee is concerned that SAMHSA has
confused the normalization of illegal drug use with its mission
to support prevention and recovery in relation to substance use
disorder. The Committee continues to support the availability
and provision of naloxone to reduce overdose deaths; however,
the Committee provides no funding to support harm-reduction
activities related to supporting the continued misuse of
controlled substances.
Homelessness.--The Committee directs SAMHSA to include in
the fiscal year 2026 congressional justification information on
how the agency currently prioritizes substance use and mental
health programs specifically related to populations that are at
high risk of becoming homeless, evaluates the efficacy of
current policies, and considers new policies that lead toward
better outcomes. The Committee also encourages SAMHSA to
prioritize programs that require treatment, accountability, and
a path to self-sufficiency.
Hair Testing Guidance.--The Committee recognizes that
section 5402 of the Fixing America's Surface Transportation
(FAST) Act (P.L. 114-94) required the Secretary to ``issue
scientific and technical guidelines for hair testing as a
method of detecting the use of a controlled substance for
purposes of section 31306 of title 49, U.S. Code'', which is
the drug and alcohol testing program for operators of
commercial motor vehicles. While more than 7 years have passed
since the enactment of the FAST Act, the Committee notes that
HHS is currently considering hair testing as an alternative
method of drug testing and issued proposed mandatory guidelines
relating to hair testing in September 2020, but has not issued
final guidelines, as required by the FAST Act.
The Committee also recognizes that since the FAST Act was
signed into law, our nation has experienced a crippling
substance use epidemic--particularly from opioids and synthetic
opioids--and Federal inaction to recognize hair testing as a
viable alternative to urinalysis has denied Americans a
legitimate tool to stem the crisis. This is a glaring reminder
that drug-impaired driving remains a serious issue and poses a
tremendous risk to the safety of the motoring public.
Therefore, the Committee directs HHS to produce guidelines for
the use of hair testing as an alternative drug testing method
for commercial motor vehicle operators, in accordance with
section 5402 of the FAST Act. The Committee requests an update
on this effort in the fiscal year 2026 congressional
justification.
National Substance Use and Mental Health Services Survey.--
The Committee encourages SAMHSA to partner with an academic
institution to expand the efforts of the National Substance Use
and Mental Health Services Survey and support the development
and implementation of a dashboard that provides a
comprehensive, interactive snapshot of progress toward
reversing the opioid epidemic. The dashboard should be designed
to support real-time monitoring of prevention, treatment access
and quality, and overdose response capacity, in addition to
existing metrics.
Right to Bear Arms.--The Committee recognizes that firearm
ownership is a constitutionally guaranteed right recognized by
the U.S. Supreme Court. SAMHSA should issue no guidance, nor
make a requirement of any recipient of Federal funding, that
seeks to restrict, limit, hinder, or further diminish this
fundamental right.
Rural Health.--The Committee recognizes the unique
challenges faced by those who live in rural and frontier areas
to access regular mental health and substance use services.
These challenges are further complicated when individuals need
timely substance use disorder and mental health crisis services
led by behavioral health professionals in these areas.
Providers in rural areas also face unique obstacles. They may
lack the full staff or resources to faithfully implement
evidence-based practices or meet requirements for grant
funding. Given these challenges, the Committee directs the
Assistant Secretary of Mental Health and Substance Use in
coordination with the Assistant Secretary for Planning and
Evaluation and the Administrator of HRSA to submit a joint
report to the Committee providing details on what strategies
these agencies are implementing to address the unique concerns
of those in rural communities. The report should address what
resources are needed to improve and sustain access to
prevention, treatment, and recovery-oriented services,
including crisis response services, and to recruit, train, and
sustain sufficient workforce in rural and frontier settings
within 180 days after enactment of this Act. Such report should
be made available on the agency's website.
Rural Opioid Technical Assistance Regional Centers.--The
Committee is gravely concerned with SAMHSA's proposal to
consolidate funding for the Rural Opioid Technical Assistance
Regional Centers into a single State Opioid Response Technical
Assistance Center. If implemented, the proposed consolidation
would have a deleterious effect on the provision of localized
technical assistance to SAMHSA grantees in regions such as
Florida, Wisconsin, Oklahoma, and Washington that host such
centers given the variation in regional and local substance
misuse patterns. The Committee, therefore, directs SAMHSA to
maintain funding for the Rural Opioid Technical Assistance
Regional Centers at not less than the fiscal year 2024 level
and further directs SAMHSA to provide a briefing on this topic
within 90 days of enactment of this Act.
Suicide Prevention.--The Committee recognizes that suicide
is a serious public health problem requiring strategic suicide
prevention solutions, especially among disproportionately
impacted populations. The Committee further recognizes that
suicide prevention requires a strategic public health approach
that addresses multiple risk factors at the individual,
community, and societal levels. States, Tribes, and territories
are most suited to lead a comprehensive public health approach
to suicide prevention, which demands effectively coordinating
with multisector partners to take a data-driven, evidence-based
process that addresses the broad range of risk and protective
factors associated with suicide.

MENTAL HEALTH

Appropriation, fiscal year 2024....................... $2,808,546,000
Budget request, fiscal year 2025...................... 3,112,046,000
Committee Recommendation.............................. 2,676,107,000
Change from enacted level........................... -132,439,000
Change from budget request.......................... -435,939,000

Behavioral Health Integration.--The Committee encourages
SAMHSA to develop school-based and evidence-based best
practices addressing behavioral health intervention training to
support practices that assist children and youth with
behavioral health needs, including behavioral intervention
teams, a team of qualified mental health professionals who are
responsible for identifying, screening, and assessing behaviors
of concern and facilitating the implementation of evidence-
based interventions.

Mental Health Services Block Grant

The Committee provides $1,022,571,000 for the Mental Health
Services Block Grant (MHBG) which is $15,000,000 above the
fiscal year 2024 enacted program level and $20,000,000 below
the fiscal year 2025 budget request. 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 and the 5 percent set aside for
crises-based services. The Committee notes that, consistent
with State plans, communities may choose to direct additional
funding to crises stabilization programs.

Certified Community Behavioral Health Clinics

The Committee provides $385,000,000, the same as the fiscal
year 2024, for Certified Community Behavioral Health Clinics
(CCBHCs). CCBHCs are designed to ensure access to coordinated
comprehensive behavioral health care by providing care for
mental health or substance use to all who request such services
regardless of their age or ability to pay. CCBHCs provide
access to crises services around the clock, support outpatient
mental health and substance use services, and community-based
mental health care for veterans.

Children's Mental Health Services

The Committee provides $130,000,000 for Children's Mental
Health Services, which is the same as the fiscal year 2024
enacted program level and $50,000,000 below the fiscal year
2025 budget request, to fund 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.

Protection and Advocacy for Individuals with Mental Illness

The Committee provides $40,000,000 for the Protection and
Advocacy for Individuals with Mental Illness program, which is
the same as the fiscal year 2024 enacted program level and the
fiscal year 2025 budget request, to support legal-based
advocacy services to ensure the rights of individuals with
mental illness, protect and advocate for these rights, and
investigate incident of abuse and/or neglect.

Projects for Assistance in Transition from Homelessness

The Committee provides $66,635,000 for the Projects for
Assistance in Transition from Homelessness program, which is
the same as the fiscal year 2024 enacted program level and the
fiscal year 2025 budget request, to provide 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 are 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.

National Child Traumatic Stress Initiative

The Committee provides $100,887,000 for the National Child
Traumatic Stress Initiative, which is a $2,000,000 increase
above the fiscal year 2024 enacted program level and $7,000,000
above the fiscal year 2025 budget request, to increase access
to effective trauma and grief focused treatment and services
systems for children, adolescents, and their families, who
experience traumatic events.

988 Suicide & Crisis Lifeline

The Committee provides $519,618,000 for the 988 Suicide &
Crisis Lifeline, which is the same as the fiscal year 2024
enacted program level, to support the national suicide hotline
to continue to support State and local suicide prevention call
centers as well as a national network of backup call centers
and the national coordination of such centers.
Program Integrity.--The Committee remains concerned that
suicide is a leading cause of death in the U.S., with
particular concern regarding the suicide rates among youth and
young adults. The Committee recognizes the vital work of the
988 Lifeline service and the important role of State partners
in suicide prevention and behavioral health. As States
establish and develop 988 programs, the Committee directs
SAMHSA to maintain State choice in their technology platform.
States should have the flexibility to utilize a platform that
best facilities a seamless coordination with local crisis and
emergency response teams, accommodates a connection to follow-
up and community resources, and ensures that sensitive user
data is being safeguarded and protected. In addition, the
Committee requests a briefing within 90 days of enactment of
this Act on SAMHSA's 988 program integrity activities,
including with respect to safeguarding 988 user data and
responding to feedback from States and other 988 program
partners.
Program Transparency.--The Committee recognizes the work of
SAMHSA to implement the expansion of the 988 Suicide & Crises
Lifeline in fiscal year 2023. The Committee, however, remains
concerned that the use of a sole source cooperative agreement
limits the contractual remedies available to ensure effective
implementation. The Committee is extremely concerned that
SAMSHA's decision to limit eligible entities in implementing
the fiscal year 2021 National Suicide Prevention Lifeline and
Disaster Destress Helpline artificially necessitated the use of
an expanded sole source cooperative agreement. The Committee
directs SAMHSA, 180 days prior to any extension of the current
or an amended cooperative agreement or request for proposal for
a sole source contract, to provide the committees of
jurisdiction a description of the services required to meet
agency needs, a demonstration of any potential recipients
unique qualifications, SAMHSA's assessment of other entities
ability to provide the required services, a description of the
market research conducted and the result of such research, and
planned activities to ensure that offers are solicited from as
many potential sources as practicable.
Within the total provided for Mental Health Programs of
Regional and National Significance, the Committee includes the
following amounts:

------------------------------------------------------------------------
FY 2025
Budget Activity FY 2024 Enacted Committee
------------------------------------------------------------------------
Capacity:
Seclusion and Restraint....... $1,147,000 $1,147,000
Project AWARE................. 140,001,000 120,501,000
Tribal Set Aside.......... - - - 10,000,000
Mental Health Awareness 27,963,000 - - -
Training.....................
Healthy Transitions........... 28,451,000 - - -
Infant and Early Childhood 15,000,000 15,000,000
Mental Health................
Children and Family Programs.. 7,229,000 8,229,000
Consumer and Family Network 4,954,000 4,954,000
Grants.......................
Project LAUNCH................ 23,605,000 - - -
Mental Health System 3,779,000 3,779,000
Transformation...............
Primary and Behavioral Health 55,877,000 55,877,000
Care Integration.............
Mental Health Crisis Response 20,000,000 - - -
Grants.......................
National Strategy for Suicide 28,200,000 29,200,000
Prevention...................
Zero Suicide.............. 26,200,000 27,200,000
American Indian and 3,400,000 4,400,000
Alaska Native Set
Aside................
Garrett Lee Smith-Youth
Suicide Prevention
State Grants.............. 43,806,000 43,806,000
Campus Grants............. 8,488,000 8,488,000
American Indian and Alaska 3,931,000 4,931,000
Native Suicide Prevention....
Tribal Behavioral Health 22,750,000 27,750,000
Grants.......................
Homeless Prevention Programs.. 33,696,000 - - -
Minority AIDS................. 9,224,000 - - -
Criminal and Juvenile Justice 11,269,000 11,269,000
Programs.....................
Assisted Outpatient Treatment. 21,420,000 21,420,000
Assertive Community Treatment 9,000,000 9,000,000
for Individuals with Serious
Mental Illness...............
Interagency Task Force on 2,000,000 2,000,000
Trauma-Informed Care.........
Science and Service:
Garrett Lee Smith-Suicide 11,000,000 11,000,000
Prevention Resource Center...
Practice Improvement and 7,828,000 7,828,000
Training.....................
Consumer and Consumer Support 1,918,000 1,918,000
Technical Assistance Centers.
Primary and Behavioral Health 2,991,000 2,991,000
Care Integration Technical
Assistance...................
Minority Fellowship Program... 11,059,000 11,059,000
Disaster Response............. 1,953,000 1,953,000
Homelessness.................. 2,296,000 2,296,000
Eating Disorder - - - 5,000,000
Identification, Treatment,
and Recovery.................
------------------------------------------------------------------------

Capacity:

Seclusion and Restraint.--The Committee provides
$1,147,000, which is the same as the fiscal year 2024 enacted
program level, to reduce the inappropriate use of seclusion and
restraint practices through the provision of technical
assistance and the promotion of alternatives to restraint,
seclusion, and other coercive practices.
Project AWARE.--The Committee provides $120,501,000 for
Project AWARE State and Tribal grants to implement mental
health related promotion, awareness, prevention, intervention,
and resilience activities to ensure that school-aged youth have
access and are connected to appropriate and effective
behavioral health services. The Committee notes the Bipartisan
Safer Communities Act (P.L. 117-159) provided $60,000,000 for
fiscal year 2025 for this program in addition to resources in
this Act and therefore provides no funding for the civil unrest
or school-based programs.
Tribal Set Aside.--Of the funds made available for Project
AWARE, the Committee directs that $10,000,000 be made available
for Tribes and Tribal Organizations.
Mental Health Awareness Training.--The Committee provides
no funding for the Mental Health Awareness Training to better
ensure that SMAHSA prioritizes services and programing for
individuals with severe mental illness. The Committee notes the
Bipartisan Safer Communities Act (P.L. 117-159) provided
$120,000,000 for fiscal year 2025 for this program.
Healthy Transitions.--The Committee provides no dedicated
funding for the Healthy Transitions program. The Committee
notes that to 10 percent of the amounts made available to carry
out the Children's Mental Health Services program may be used
to carry out demonstration grants or contracts for early
interventions with persons not more than 25 years of age at
clinical high risk of developing a first episode of psychosis.
Infant and Early Childhood Mental Health.--The Committee
provides $15,000,000, which is the same as the fiscal year 2024
enacted program level, for the Infant and Early Childhood
Mental Health program, for grants to human service agencies and
nonprofit organizations to provide age-appropriate mental
health promotion and early intervention or treatment for
children with or with significant risk of developing mental
illness including through direct services, assessments, and
trainings for clinicians and education providers.
Children and Family Programs.--The Committee provides
$8,229,000, an increase of $1,000,000, for the Children and
Family program, to provide grants to Tribes for community-based
services and supports for children and youth, with or at risk
for mental illness.
Consumer and Family Network Grants.--The Committee provides
$4,954,000, which is the same as the fiscal year 2024 enacted
program level, for Consumer and Family Network grants. Consumer
grants support Statewide organizations run by adults with
serious mental illness or serious emotional disturbance to
integrate consumer voice into State mental health and allied
systems. Family grants provide education and training to family
organizations to improve their capacity for policy and service
development.
Project Launch.--The Committee provides no funding for
Project Launch. The Committee notes that this program is
duplicative of programs in the Department of Education, the
Administration for Children and Families, and the Centers for
Disease Control and Prevention.
Mental Health System Transformation.--The Committee
provides $3,779,000, which is the same as the fiscal year 2024
enacted program level, for the Mental Health System
Transformation program. The program provides State and
community capacity building grants for supported employment for
individuals with serious mental illness or serious emotional
disturbance.
Primary and Behavioral Health Care Integration.--The
Committee provides $55,877,000, which is the same as the fiscal
year 2024 enacted program level, for the Primary and Behavioral
Health Care Integration program to promote full integration and
collaboration in clinical practice between behavioral
healthcare and primary/physical healthcare. The key goal of
this program is to improve patient access to integrated health
care services which requires bilateral cooperation between
physicians and technical assistance centers.
The Committee notes that integration of primary and
behavioral health has been found to increase access to mental
health and substance use recovery services for communities,
including rural communities, that lack access to such services
and encourages SAMHSA in making awards to prioritize such
communities.
Mental Health Crisis Response Partnership Pilot Program.--
The Committee provides no funding for this program and notes
that the Edward Byrne Memorial Justice Assistance Grant
program, under the Department of Justice, provides funding for
State crisis intervention programs.
National Strategy for Suicide Prevention.--The Committee
provides $29,200,000, an increase of $1,000,000 from the fiscal
year 2024 enacted program level, for the implementation of the
National Strategy for Suicide Prevention including $22,800,000,
the same as fiscal year 2024, for grants to screen adults for
suicide risks and provide referral services, the implementation
of evidence-based practices to provide services to adults at-
risk, or to raise awareness of such risks. Of the funding
provided, $4,400,000 is reserved for grants to American Indian
and Alaska Native health systems.
Garrett Lee Smith Youth Suicide Prevention.--The Committee
provides $52,294,000, which is the same as the fiscal year 2024
enacted program level, for Garrett Lee Smith Youth Suicide
Prevention, this program supports grants to States and Tribes
or their designees for youth suicide prevention activities and
services and grants to institutions of higher education for
services for students with mental health or substance use
disorders.
The Committee recognizes the importance of addressing
mental health and suicide prevention on college campuses,
including at institutions of higher education that are
traditionally under-resourced and serve large proportions of
minority populations. To help meet these growing needs in
access to mental health services, the Committee directs the
Secretary to waive the requirement of matching funds for
minority-serving institutions and community colleges as defined
by the Higher Education Act of 1965.
American Indian/Alaska Native Suicide Prevention
Initiative.--The Committee provides $4,931,000, a $1,000,000
increase from the fiscal year 2024 enacted program level, for
the Tribal Training and Technical Assistance Center to
facilitate the development and implementation of comprehensive
and collaborative community-based prevention plans to reduce
suicide among American Indians/Alaska Natives (AI/AN), prevent
substance misuse, and reduce substance misuse among AI/AN
communities.
Tribal Behavioral Grants.--The Committee provides
$27,750,000, a $5,000,000 increase from the fiscal year 2024
enacted program level, to prevent and reduce suicidal behavior
and substance use, reduce the impact of trauma, and promote
mental health among AI/AN youth, through age 24.
Homelessness Prevention Programs.--The Committee provides
no funding for the Homelessness Prevention Program noting that
the program is duplicative of the Projects for Assistance in
Transition from Homelessness program.
Criminal and Juvenile Justice Activities.--The Committee
provides $11,269,000, which is the same as the fiscal year 2024
enacted program level, for grants to States, political
subdivisions of States, and Tribes or Tribal organizations, to
develop and implement programs to divert individuals with
mental illness from the criminal justice system.
Assisted Outpatient Treatment.--The Committee provides
$21,420,000, which is the same as the fiscal year 2024 enacted
program level, for grants to deliver outpatient treatment under
a civil court order to adults with a serious mental illness who
meet State civil commitment assisted outpatient treatment
criteria.
Assertive Community Treatment for Individuals with Serious
Mental Illness.--The Committee provides $9,000,000, which is
the same as the fiscal year 2024 enacted program level, for
Assertive Community Treatment programs, which include a multi-
disciplinary service-delivery approach for individuals with
severe functional impairments associated with a serious mental
illness.
Interagency Task Force on Trauma Informed Care.--The
Committee provides $2,000,000 for the Interagency Task Force on
Trauma-Informed Care.

Science and Service:

Garrett Lee Smith Suicide Prevention Resource Center.--The
Committee provides $11,000,000, which is the same as the fiscal
year 2024 enacted program level, for the Garrett Lee Smith-
Suicide Prevention Resource Center to build national capacity
for preventing suicide by providing technical assistance,
training, and resources to assist States, Tribes,
organizations, and SAMHSA grantees to develop suicide-
prevention strategies.
Practice Improvement and Training.--The Committee provides
$7,828,000, which is the same as the fiscal year 2024 enacted
program level, to support the dissemination of key information
to the mental health delivery system.
Consumer and Consumer Support Technical Assistance
Centers.--The Committee provides $1,918,000, which is the same
as the fiscal year 2024 enacted program level, to facilitate
quality improvement of the mental health system by the specific
promotion of consumer-directed approaches for adults with
serious mental illness.
Primary and Behavioral Health Care Integration Technical
Assistance.--The Committee provides $2,991,000, which is the
same as the fiscal year 2024 enacted program level, to provide
technical assistance to Primary and Behavioral Health Care
Integration grantees. Of the funds provided, the Committee
directs that $1,000,000 be allocated to the Technical
Assistance activities authorized under section 1301(g) of P.L.
117-328 to implement the psychiatric collaborative care model
in primary care practices/systems. Pursuant to such law, these
technical assistance centers may be funded through cooperative
agreements.
Minority Fellowship Program.--The Committee provides
$11,059,000, which is the same as the fiscal year 2024 enacted
program level, to increase behavioral health practitioners'
knowledge of issues related to prevention, treatment, and
recovery support for mental illness and addiction among
minority populations.
Disaster Response.--The Committee provides $1,953,000,
which is the same as the fiscal year 2024 enacted program
level, to support the Disaster Distress Helpline, the Crisis
Counseling Assistance and Training Program, and the Disaster
Technical Assistance Center.
Eating Disorders.--The Committee provides $5,000,000 to
improve the availability of health care providers to respond to
the needs of individuals with eating disorders including the
work of the National Center of Excellence for Eating Disorders
to increase engagement with primary care providers, including
pediatricians, to provide specialized advice and consultation
related to the treatment of eating disorders. The Committee
provides additional funding to support the development, in
coordination with the departments of Defense and Veterans
Affairs, of a Screening, Brief Intervention and Referral to
Treatment model for service members, veterans, and their
families.

SUBSTANCE ABUSE TREATMENT

Appropriation, fiscal year 2024....................... $4,159,298,000
Budget request, fiscal year 2025...................... 4,194,048,000
Committee Recommendation.............................. 4,516,463,000
Change from enacted level........................... +357,165,000
Change from budget request.......................... +322,415,000

Substance Use Prevention, Treatment, and Recovery Services Block Grant

The Committee includes $2,508,079,000, which is a
$500,000,000 increase to the fiscal year 2024 enacted program
level, for the Substance Use Prevention, Treatment, and
Recovery Services (SUPTRS) Block Grant. The SUPTRS Block Grant
is a critical component of each State's publicly funded
substance use disorder system designed to address all substance
use disorders--including those related to alcohol. SUPTRS Block
Grant funds may support initiatives related to alcohol in
settings such as emergency rooms and primary care offices. In
addition, States utilize SUPTRS Block Grant funds to support
alcohol use disorder treatment services in outpatient,
intensive outpatient, and residential programs. Further, the
Committee is also aware that SUPTRS Block Grant funds may be
allocated to support medications for the treatment of alcohol
use disorders, an important tool that should be available to
those in need. The Committee also understands SUPTRS Block
Grant funds are utilized by States to support recovery
community organizations to provide recovery support for those
with alcohol use disorders.
The Committee recognizes the critical role the block grant
plays in State and Territory systems across the country, giving
States and Territories the flexibility to direct resources to
address the most pressing needs of their communities. The
Committee also recognizes that the 20 percent prevention set
aside within the SUPTRS Block Grant is a vital source of
funding for primary prevention. The Committee further notes
that the transfer of opioid overdose prevention and
surveillance funding from CDC to the SUPTRS Block Grant will
increase the availability of treatment and recovery services
given the dramatic differences in administrative overhead costs
assessed by the respective agencies.
The SUPTRS funding level reflects a transfer of
$500,000,000 from the CDC to SAMHSA. Of the $506,079,000
provide for the CDC program in fiscal year 2024, $114,000,000,
or 23 percent, went to administrative costs. The transfer of
State program funding from CDC to SAMHA should increase the
funding available to States for these activities by more than
$63,000,000 in reduced Federal administration expenses alone.
No Cost Extension.--The Committee directs SAMHSA to allow
States to apply for a one-year no-cost extension to September
2026 for the allocation of supplemental funds to the SUPTRS
Block Grant as provided in P.L. 117-2. States are concerned
about the impending fiscal cliff. An extension as described
allows certain States to work with their providers to implement
spending plans in a more strategic, predictable, and efficient
manner.
Opioid Use Disorder in Rural Communities.--The Committee is
aware that the opioid use disorder 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 identifying, diagnosing, and
treating patients along with supporting recovery from substance
use disorders. The Committee recognizes that the COVID pandemic
exacerbated many of rural America's unique challenges and
resulting needs, creating added isolation for many, and an
increasing number of individuals in crisis. These issues
further emphasize the urgency of a comprehensive approach
including training to provide care for diverse populations; the
use of technologies to ensure improved access to medically
underserved areas; and workforce and skill development
including peer recovery specialist training and other
initiatives to increase effective responsiveness to unique
rural challenges. The Committee encourages SAMHSA to support
initiatives to advance opioid use disorder objectives in rural
areas, specifically focusing on addressing the needs of
individuals with substance use disorders 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.
Prevention Activities.--The SUPTRS Block Grant's prevention
set aside requires States to allocate at least 20 percent of
Block Grant funds to primary prevention. States may use these
prevention set aside funds to support initiatives aimed at
addressing underage drinking; such efforts can reduce access to
alcohol, reduce risk factors, and increase protective factors.
Opioid Use Disorder Relapse and Overdose Prevention.--The
Committee is concerned that relapse following opioid
detoxification is a contributing factor to the overdose crisis.
The Committee notes SAMHSA's efforts to address this within the
Federal grant population and encourages SAMHSA to continue
these programs in all settings where detoxification is offered,
including opioid treatment programs, rehabilitation centers,
and criminal justice settings.
Preventing Prescription Drug and Opioid Overdoses.--The
Committee notes strong concerns about the increasing number of
overdose deaths attributable to opioids, including synthetic
opioids. SAMHSA is encouraged to take steps to support the use
of SUPTRS Block Grant funds for opioid safety education and
training, including initiatives that improve access for
licensed healthcare 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.

State Opioid Response Grants

The Committee includes $1,575,000,000, which is the same as
the fiscal year 2024 enacted program level, for State Opioid
Response (SOR) grants. The Committee supports efforts from
SAMHSA through SOR grants to expand access to SUD treatments in
rural and underserved communities, including through funding
and technical assistance. Within the amount provided, the
Committee includes a set aside for Indian Tribes and Tribal
organizations of 4 percent.
The Committee continues to support the continuum of
prevention, treatment, and recovery support services within SOR
for individuals with opioid or stimulant use disorder including
co-occurring addictions such as alcohol addiction. The
Committee encourages SAMHSA to increase awareness of grantees
regarding the availability of SOR funding to support treatment
and support for co-occurring additions, including alcohol use
disorder.
FDA Approved Medications.--SAMHSA is directed to include as
an allowable use of funds all FDA approved medications for
opioid use disorder and overdose reversal and other clinically
appropriate services to treat opioid use disorder.
Opioid Use Disorder Recurrence.--The Committee is concerned
that relapse following opioid withdrawal management for opioid
use disorder is a contributing factor to the overdose crisis.
The Committee appreciates SAMHSA's efforts to address this
within the Federal grant population by emphasizing the
potential benefits of opioid detoxification followed by
medication to prevent recurrence and encourages SAMHSA to
disseminate and implement this approach in all settings where
detoxification is offered, including opioid treatment programs,
rehabilitation centers, and criminal justice settings.
Technical Assistance.--The Committee provides no funding
for Notice of Funding Opportunity Number TI-24-012. The
Committee directs SAMHSA to continue funding technical
assistance within the administrative portion of the
appropriated amounts for SOR grants, to provide locally based
technical assistance teams as has been done through the Opioid
Response Network. The Committee recognizes the importance and
essential work currently being done by the Opioid Response
Network in delivering technical assistance to State and
territorial SOR grantees, sub-recipients, and others addressing
opioid use disorder and stimulant use disorder in their
communities.
Within the total provided for Programs of Regional and
National Significance, the Committee recommends the following
amounts:

------------------------------------------------------------------------
FY 2025
Budget Activity FY 2024 Enacted Committee
------------------------------------------------------------------------
Capacity:
Opioid Treatment Programs and $10,724,000 $10,724,000
Regulatory Activities........
Screening, Brief Intervention, 33,840,000 - - -
Referral to Treatment........
PHS Evaluation Funds...... 2,000,000 - - -
Targeted Capacity Expansion-- 122,416,000 129,416,000
General......................
Medication-Assisted 111,000,000 118,000,000
Treatment for
Prescription Drug and
Opioid Addiction.......
Tribal Set Aside........ 14,500,000 16,500,000
Grants to Prevent Prescription 16,000,000 16,000,000
Drug Opioid Overdose.........
First Responder Training...... 57,000,000 58,000,000
Rural Emergency Medical 32,000,000 33,000,000
Services Training Grants
(non-add)................
Pregnant and Postpartum Women. 38,931,000 38,931,000
Recovery Community Services 4,434,000 4,434,000
Program......................
Children and Families......... 30,197,000 30,197,000
Treatment Systems for the 37,144,000 - - -
Homeless.....................
Minority AIDS................. 66,881,000 - - -
Criminal Justice Activities... 94,000,000 74,000,000
Drug Courts (non-add)..... 74,000,000 74,000,000
Improving Access to Overdose 1,500,000 1,500,000
Treatment....................
Building Communities of 17,000,000 17,000,000
Recovery.....................
Peer Support Technical 2,000,000 2,000,000
Assistance Center............
Comprehensive Opioid Recovery 6,000,000 6,000,000
Centers......................
Emergency Department 8,000,000 15,000,000
Alternatives to Opioids......
Treatment, Recovery, and 12,000,000 12,000,000
Workforce Support............
Youth Prevention and Recovery 2,000,000 2,000,000
Initiative...................
Science and Service:
Addiction Technology Transfer 9,046,000 9,046,000
Centers......................
Minority Fellowship Program... 7,136,000 7,136,000
------------------------------------------------------------------------

Eligible Grantees.--The Committee directs the Secretary to
expand eligibility for grants under SAMHSA Prevention Programs
of Regional and National Significance and the corresponding
services provided by the Center for the Application of
Prevention Technologies to private, nonprofit, regional
organizations, including faith-based organizations. 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
eligible for such grants.

Capacity:

Opioid Treatment Programs and Regulatory Activities.--The
Committee provides $10,724,000, which is the same as the fiscal
year 2024 enacted program level, to support access to FDA
approved medications for opioid use disorder through opioid
treatment programs and to approve organizations that accredit
opioid treatment programs.
Screening, Brief Intervention, and Referral to Treatment.--
The Committee provides no funding for the Screening, Brief
Intervention, and Referral to Treatment program. The Committee
notes that SAMHSA has labeled the program as supporting ``harm
reduction'' activities. The Committee further notes that
following the decriminalization of drugs for personal use in
Oregon in 2021, overdose deaths increased almost 50 percent.
Targeted Capacity Expansion.--The Committee provides
$129,416,000, an increase of $7,000,000 from the fiscal year
2024 enacted program level, for the Targeted Capacity Expansion
program including the Medication-Assisted Treatment for
Prescription Drug and Opioid Addition program (MAT-PDOA). These
programs support State and local governments, Tribes, nonprofit
organizations, and health facilities respond to treatment and
capacity gaps for purposes of providing services to individuals
with opioid use disorder. MAT-PDOA provides access to FDA
approved medications for opioid use disorders to reduce opioid
use and related deaths. The Committee directs SAMHSA to use the
increase to support nonprofit treatment facilities engaged in
community enhancement projects to improve the provision of
services to rural communities in surrounding regions. Better
access to care mitigates community safety risks while expanding
treatment services and recovery support programs for patients
and their families.
SAMHSA is further directed to include all FDA approved
medications for opioid use disorder as an allowable use to
achieve and maintain remission and recovery.
Grants to Prevent Prescription Drug/Opioid Overdose.--The
Committee provides $16,000,000 for Grants to Prevent
Prescription Drug/Opioid Overdose Deaths (PDO), which is the
same as the fiscal year 2024 program level. The PDO program
trains first responders and other community providers on the
prevention of prescription drug/opioid overdose-related deaths
including through the purchase and distribution of naloxone.
First Responder Training.--The Committee provides
$58,000,000 for First Responder Training. This amount includes
$33,00,000, an increase of $1,000,000 from the fiscal year 2024
enacted program level, for Rural Emergency Medical Services
Training Grants, which provide funding to recruit and train
emergency medical services personnel in rural areas with a
focus on addressing substance use disorders and co-occurring
mental health conditions.
Pregnant and Postpartum Women.--The Committee provides
$38,931,000 for the Pregnant and Postpartum Women program which
is the same as the fiscal year 2024 program level. The Pregnant
and Postpartum Women program supports comprehensive residential
substance use disorder treatment, prevention, and recovery
support services for pregnant and postpartum women, their minor
children, and other family members.
Recovery Community Services Program.--The Committee
provides $4,434,000 for the Recovery Community Services
Program, which is the same as the fiscal year 2024 program
level; this program provides grants to develop, expand, and
enhance community and statewide recovery support services.
Children and Families Program.--The Committee provides
$30,197,000, which is the same as the fiscal year 2024 program
level, to support early identification and services to
children, adolescents, and young adults at risk of substance
use disorders, and treatment for such populations with co-
occurring mental illnesses.
Drug Courts.--The Committee provides $74,000,000 for
SAMSHA's Drug Court initiative. 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 use 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.
Improving Access to Opioid Treatment.--The Committee
provides $1,500,000, which is the same as fiscal year 2024
program level, to support awards to expand access to FDA
approved drugs or devices for emergency treatment of known or
suspected opioid overdose.
Building Communities of Recovery.--The Committee provides
$17,000,000, which is the same as the fiscal year 2024 program
level, to enable the development, expansion, and enhancement of
recovery community organizations.
Peer Support Technical Assistance Center.--The Committee
provides $2,000,000, which is the same as the fiscal year 2024
program level, to provide technical assistance to recovery
community organizations and peer support networks.
Comprehensive Opioid Recovery Centers.--The Committee
provides $6,000,000 for Comprehensive Opioid Recovery Centers,
which is the same as the fiscal year 2024 program level, as
authorized by section 7121 of the SUPPORT Act (P.L. 115-271).
Emergency Department Alternatives to Opioids.--The
Committee provides $15,000,000, an increase of $7,000,000, 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.
Treatment, Recovery, and Workforce Support.--The Committee
provides $12,000,000, which is the same as the fiscal year 2024
program level, for grants to entities that offers treatment or
recovery services for individuals with SUDs to support
individuals in SUDs treatment and recovery live independently
and participate in the workforce.
Youth Prevention and Recovery Initiative.--The Committee
provides $2,000,000, which is the same as the fiscal year 2024
program level, for the for the Youth Prevention and Recovery
Initiative to support early identification and services to
children, adolescents, and young adults at risk of SUDs, and
treatment for such populations including those with co-
occurring mental illnesses, as authorized by the SUPPORT Act
(P.L. 115-271).

Science and Services:

Minority Fellowship Program.--The Committee provides
$7,136,000, which is the same as the fiscal year 2024 program
level, to increase behavioral health practitioners' knowledge
of issues related to prevention, treatment, and recovery
support for mental illness and addiction among minority
populations.
Substance Use Disorder Treatment.--The Committee encourages
SAMHSA to expand the availability of treatment services
tailored to adolescents, pregnant women, and parents.

SUBSTANCE ABUSE PREVENTION

Appropriation, fiscal year 2024....................... $236,879,000
Budget request, fiscal year 2025...................... 236,879,000
Committee Recommendation.............................. 203,174,000
Change from enacted level........................... -33,705,000
Change from budget request.......................... -33,705,000

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

------------------------------------------------------------------------
FY 2025
Budget Activity FY 2024 Enacted Committee
------------------------------------------------------------------------
Capacity:
Strategic Prevention Framework $135,484,000 $140,484,000
Federal Drug-Free Workplace... 5,139,000 5,139,000
Minority AIDS................. 43,205,000 - - -
Sober Truth on Preventing 14,500,000 14,000,000
Underage Drinking............
National Adult-Oriented 2,500,000 2,500,000
Media Public Service
Campaign.................
Community Based Coalition 11,000,000 11,000,000
Enhancement Grants.......
Interagency Coordinating 1,000,000 500,000
Committee to Prevent
Underage Drinking........
Tribal Behavioral Health 23,665,000 28,665,000
Grants.......................
Science and Service:
Center for the Application of 9,493,000 9,493,000
Prevention Technologies......
Science and Service Program 4,072,000 4,072,000
Coordination.................
Minority Fellowship Program... 1,321,000 1,321,000
------------------------------------------------------------------------

Capacity:

Strategic Prevention Framework.--The Committee provides
$140,484,000, an increase of $5,000,000, for the Strategic
Prevention Framework (SPF). SPF provides grants to States,
Tribes, and local governmental organizations to prevent
substance misuse. The Committee provides no funding for SPF Rx
in recognition of the continually evolving nature of substance
addiction and misuse. The Committee strongly believes that
investing in prevention is essential to ending the substance
abuse crisis, and supports the core SPF program, which is
designed to prevent the onset of substance misuse, while
strengthening prevention capacity and infrastructure. The
Committee intends that this program supports 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 additional funding for core the SPF program is based on
the Committee's recognition that substance use prevention is
underutilized relative to its ability to prevent and delay
substance use initiation as well as slow the pathways to
addiction and overdose, and that demand for community-based
primary prevention resources far outpaces available funding.
The Committee directs that the additional funding be split
evenly between States and communities.
Federal Drug Free Workplace.--The Committee provides
$5,139,000, the same as the fiscal year 2024 program level, for
Federal Drug-Free Workplace Programs (DFWP). DFWP ensures
employees in national security, public health, and public
safety positions are tested for the use of illegal drugs and
the misuse of prescription drugs and ensures the laboratories
that perform this regulated drug testing are inspected and
certified by HHS.
Sober Truth on Preventing Underage Drinking Act.--The
Committee provides $14,000,000 for the Sober Truth on
Preventing Underage Drinking (STOP) Act. The STOP Act supports
an adult-oriented national media campaign to provide parents
and caregivers of youth under the age of 21 with information
and resources to discuss the issue of alcohol with their
children, funds the Interagency Coordinating Committee on the
Prevention of Underage Drinking (ICPUD), and provides grants to
prevent and reduce alcohol use among youth under the age of 21.
The Committee is concerned that funding for the ICPUD may
have been diverted for purposes unrelated to underage drinking
and reiterates that the ICPUD is to focus exclusively on
preventing underage drinking. The Committee further directs
SAMHSA to ensure that no funds provided by this Act are
directed for the purpose of input into the Dietary Guidelines.
Tribal Behavioral Grants.--The Committee provides
$28,665,000, an increase of $5,000,000 from fiscal year 2024,
to address the high incidence of substance misuse and suicide
among the AI/AN population.
Fentanyl and Prescription Drug Misuse Prevention.--The
Committee supports efforts to better educate the public on the
potential lethality of fentanyl and prescription drug misuse.

Science and Service:

Center for the Application of Prevention Technologies.--The
Committee provides $9,493,000, the same as the fiscal year 2024
program level, for the Center for the Application of Prevention
Technologies to improve implementation and delivery of
effective substance use prevention interventions and provide
training and technical assistance services to the substance use
prevention field.
The Committee applauds the Center for Substance Abuse
Prevention and the Prevention Technology Transfer Centers for
their work implementing the Prevention Fellowship Program. This
program supported 16 early career prevention fellows throughout
each HHS region where they gained hands on experience working
in State alcohol and drug agencies. Fellows, coached by
mentors, developed leadership skills; received training in
professional development; acquired proficiency in core
competencies to prepare for certified prevention specialist
exams; and prepared for employment opportunities in the
substance use prevention field. The Committee directs the
Secretary to expand eligibility for Center for the Application
of Prevention Technologies to private, nonprofit, regional
organizations, including faith-based organizations. 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.
Minority Fellowship Program.--The Committee provides
$1,321,000, the same as the fiscal year 2024 program level, to
provide stipends to increase the number of SUD and mental
health professionals who teach, administer, conduct services
research, and provide direct mental health or substance use
disorder treatment services for minority populations.
The Committee directs SAMHSA to ensure that Center for
Substance Abuse Prevention funded fellowships focus on
substance use disorder prevention related activities.

HEALTH SURVEILLANCE AND PROGRAM SUPPORT

Appropriation, fiscal year 2024....................... $241,673,000
Budget request, fiscal year 2025...................... 172,583,000
Committee Recommendation.............................. 146,323,000
Change from enacted level........................... -93,350,000
Change from budget request.......................... -26,260,000

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

------------------------------------------------------------------------
Budget Activity FY 2024 Enacted FY 2025 Committee
------------------------------------------------------------------------
Health Surveillance............... $50,623,000 $50,623,000
PHS Evaluation Funds.......... 30,428,000 30,428,000
Program Support................... 84,500,000 84,500,000
Performance and Quality...........
Information Systems........... 10,200,000 10,200,000
Drug Abuse Warning Network........ 10,000,000 - - -
Behavioral Health Workforce....... 1,000,000 1,000,000
PHS Evaluation Funds.......... 1,000,000 1,000,000
------------------------------------------------------------------------

Agency for Healthcare Research and Quality

HEALTHCARE RESEARCH AND QUALITY

Appropriation, fiscal year 2024....................... $369,000,000
Budget request, fiscal year 2025...................... 387,345,000
Committee Recommendation.............................. - - -
Change from enacted level........................... -369,000,000
Change from budget request.......................... -387,345,000

The Committee provides no funding for the Agency for
Healthcare Research and Quality (AHRQ). Similar work is done by
several agencies funded in this bill, including the National
Institutes of Health, the Centers for Disease Control and
Prevention, and the Office of the Assistant Secretary for
Health.

Centers For Medicare & Medicaid Services

GRANTS TO STATES FOR MEDICAID

Appropriation, fiscal year 2024........... $406,956,850,000
Budget request, fiscal year 2025.......... 383,609,399,000
Committee Recommendation.................. 383,609,399,000
Change from enacted level............... -23,347,451,000
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 $245,580,414,000, which was
provided as advance funding for the first quarter of fiscal
year 2025. In addition, the Committee recommends an advance
appropriation of $261,063,820,000 for program costs in the
first quarter of fiscal year 2026, to remain available until
expended.
The Committee continues bill language providing indefinite
budget authority for unanticipated costs in fiscal year 2025.
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 2024........... $476,725,000,000
Budget request, fiscal year 2025.......... 521,757,000,000
Committee Recommendation.................. 521,757,000,000
Change from enacted level............... +45,032,000,000
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 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 if the annual
appropriation is insufficient.

PROGRAM MANAGEMENT

Appropriation, fiscal year 2024........... $3,669,744,000
Budget request, fiscal year 2025.......... 4,329,000,000
Committee Recommendation.................. 3,454,690,000
Change from enacted level............... -215,054,000
Change from budget request.............. -874,310,000

Program Operations

The Committee includes $2,379,823,000 for Program
Operations, which is $100,000,000 below the fiscal year 2024
enacted level and $599,228,000 below the fiscal year 2025
budget request. 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.
Acute Care Mobility.--The Committee is aware that CMS
proposed in the FY 2025 Inpatient Prospective Payment System
proposed rule to adopt a new geriatric hospital measure, the
Age Friendly Hospital Measure, as part of the Inpatient Quality
Reporting (IQR) program that includes mobility screening to
ensure that appropriate management plans are in place to
promote and maintain mobility for acute critical care hospital
patients. No mobility-specific measures in CMS quality
reporting programs apply to acute care in hospitals. Evidence
suggests that mobilization mitigates critical care's physical,
cognitive, and psychological complications in hospitalized
patients and has been linked to decreased days on a mechanical
ventilator, reduced hospital length of stay, and improved
functional outcomes. The Committee requests that CMS include an
update in the fiscal year 2026 congressional justification on
the agency's progress in adopting the Age Friendly Hospital
Measure or a similar mobility-focused measure as part of the
IQR program.
Affordable Care Act Surcharge.--The Patient Protection and
Affordable Care Act (42 U.S.C. 18023) specifies that qualified
health plans that include abortion coverage in circumstances
other than rape, incest, or to save the life of the mother must
collect a ``separate payment'' for such coverage from the
enrollee and deposit that ``separate payment'' of at least $1
per enrollee per month into a ``separate allocation account''
from which such abortions are funded. The Committee is
concerned that the department may not be adequately enforcing
this requirement. The Committee directs HHS to provide a
report, within 30 days of enactment of this Act, detailing all
oversight and investigation activities conducted by HHS to
ensure compliance with this requirement for the prior 4 years.
Such report shall also include detailed information regarding:
(1) how ``separate payments'' are collected by qualified health
plans generally; (2) what the department has done to determine
whether qualified health plans have complied with the
requirement of collecting at least $1 per enrollee per month
and whether such requirement is being followed; and (3) how
qualified health plans collect the ``separate payment'' in the
case of an enrollee who qualifies for fully subsidized premiums
and zero cost sharing.
Algorithm Based Health Services.--Algorithm-based
healthcare services are provided through medical devices
cleared by the FDA that rely on artificial intelligence,
machine learning, or other similar software to produce
quantitative and/or qualitative clinical information for use in
the diagnosis or treatment of a patient's condition. These
services have the potential to improve care delivery and
patient outcomes by providing clinicians with new or additional
information. However, the Committee is concerned there is not a
stable payment pathway for these services, resulting in low
adoption and reduced access to these services. To best support
innovation, adoption, and access, the Committee encourages CMS
to evaluate a formalized payment pathway for algorithm-based
healthcare services as part of its previous statements
regarding Software as a Service. The Committee further
encourages CMS to ensure that the payment pathway provides the
stability and consistency necessary to support provider
adoption and patient access to these services.
Area Wage Index.--The Committee notes the significant
disparities in Medicare reimbursement created by the current
wage index system and that the prior Administration sought to
account for some of these imbalances. These disparities create
financial and operational disadvantages between hospitals,
endangering critical access to care for communities served by
the lowest paid providers, often rural and underserved areas.
The Committee strongly urges CMS to implement a wage index
reclassification mechanism for hospitals in the lowest quartile
of wage indexes. Such a mechanism would ensure that hospitals
located near a higher wage index labor market would be able to
reclassify and receive the same wage index as that paid to
hospitals located in the same geographical area.
Artificial Intelligence in Prior Authorization.--The
Committee acknowledges the use of artificial intelligence (AI)
in the prior authorization process within Federal health
insurance programs such as Medicare, Medicaid, Tricare, and the
Federal Employees Health Benefits Program. The Committee
directs GAO to provide a preliminary briefing to the Committees
on Appropriations, Ways and Means, and Energy and Commerce of
the House of Representatives no later than 12 months following
the enactment of this Act with a report to follow on the
current and planned use of AI as part of prior authorization
processes within a subset of plans across these programs. The
study should examine how the Federal government evaluates the
sources of and updates data used to generate prior
authorization decisions drawn from AI applications, the extent
of human oversight, the accountability measures ensuring
quality of care, and privacy safeguards in place.
Breast Reconstruction.--Breast or chest wall reconstruction
has evolved significantly in the nearly 25 years since the
passage of the Women's Health and Cancer Rights Act. Autologous
perforator flap reconstruction access is particularly important
for patients diagnosed with more advanced diseases and disease
that requires radiation, as implants are less safe in these
populations. The Committee is concerned that, although access
to breast or chest wall reconstruction has improved, gaps may
exist for women who seek autologous perforator flap
reconstruction. The Committee requests an analysis of patient
access to perforator flap breast reconstruction in the fiscal
year 2026 congressional justification.
Breast Reconstruction, Sensory Restoration.--After breast
cancer surgery, nearly 80 percent of women suffer from pain or
numbness. The Committee is aware of research demonstrating that
numbness after mastectomy can lead to functional impairment and
quality of life issues for breast cancer survivors. The
Committee is also aware that significant technological
procedure advancements are now available to shift the focus of
reconstructive breast surgery beyond cosmetic-only results to
include the restoration of typical breast functions, such as
sensation. Sensory restoration as a part of breast
reconstruction can ultimately improve functional impairment,
physical safety, and quality of life for breast cancer
survivors. The Committee requests that CMS, in collaboration
with other relevant HHS agencies, investigate gaps in insurance
coverage to address numbness as a functional impairment after
mastectomy. The Committee requests an update in the fiscal year
2026 congressional justification on this issue.
Cancer Care Planning for Medicare Beneficiaries.--The
Committee notes that chronic care management billing codes,
which are intended to encourage the planning and management of
care for Medicare beneficiaries with chronic conditions, are
underutilized by Medicare providers. The Committee urges CMS to
evaluate utilization of chronic care management billing codes,
including an evaluation of the reasons for poor utilization of
these codes by Medicare providers.
Cancer Survivorship Alternative Payment Model.--The
Oncology Care Model ended in 2022 after a five-year test, and
the successor Enhancing Oncology Model was launched in 2023.
The trigger for an episode of care in these models is the
initiation of cancer drug therapy. However, these delivery
experiments exclude a population of cancer patients who might
benefit from the patient-centered care offered in care models,
such as cancer survivors who have completed active treatment
and are entering a period of long-term survivorship. The
Committee encourages CMS to consider appropriate options for
survivors.
Certified Registered Nurse Anesthetists.--The Committee is
aware of challenges surrounding patient access to anesthesia
services, particularly in rural areas. Therefore, the Committee
supports CMS in its continued consideration of the benefits of
Certified Registered Nurse Anesthetists performing services.
The Committee requests a briefing on how expanding the
anesthesia rural passthrough program to include all types of
anesthesia providers could help mitigate the health workforce
shortage in low patient volume rural hospitals and the
resulting delays in patient care.
Chronic Kidney Disease.--The Committee is committed to
ensuring that patients with Chronic Kidney Disease (CKD) have
access to the most clinically appropriate treatments. More
effective diagnosis and care can help reduce the rates of
kidney failure and cardiovascular complications for patients
and generate substantial savings to the Federal government.
Therefore, the Committee recommends that CMS work to ensure the
Medicare benefit guidelines reflect the most recent clinical
CKD guidelines and increase access to early screening utilizing
both estimated glomerular filtration rate and urine albumin-
creatinine ratio testing, diagnosis, and treatment for high-
risk populations for CKD.
Clarifying Organ Recovery Reimbursement.--The Committee
notes that Organ Procurement Organization (OPO) Recovery
Centers can increase the number of organs available for
transplantation and intensive care unit bed capacity for living
patients. The Committee is concerned that the current
reimbursement guidance pertaining to Certified Transplant
Center organ recovery and reimbursement is opaque and serves as
a financial disincentive to effectively utilize OPO Recovery
Centers. Therefore, the Committee encourages CMS to consider
revising Medicare provider guidance regarding ``Medicare usable
organs''.
Colorectal Cancer Screening Continuum of Care.--The
Committee appreciates CMS's efforts to reduce barriers to
colorectal cancer screening. However, the Committee remains
concerned about increases in colon cancer incidence and death
rates, especially among individuals younger than 50. The
Committee highlights the recommendation of the U.S. Multi-
Society Task Force on Colorectal Cancer that after the initial
screening, asymptomatic individuals with a personal history of
polyps should receive more frequent colonoscopy exams given the
increased risk of new polyps. The Committee encourages CMS to
support updated clinical evidence for colorectal cancer
screenings.
Comprehensive Kidney Care.--The Committee urges CMS to re-
evaluate the impact of the Retrospective Trend Adjustments
(RTA) within the Comprehensive Kidney Care Contracting model
for the End-Stage Renal Disease (ESRD) population for Medicare
ESDR Beneficiaries, considering in particular the differences
between the calculated RTA for Medicare ESDR Beneficiaries and
the calculated RTA for Medicare Parts A and B Beneficiaries for
each performance year.
Contract Center Operations Contract.--The Committee notes
with concern ongoing efforts by the Department to issue a new
solicitation for the CMS Contact Center Operations contract;
such actions appear to be solely for the purpose of including a
labor harmony agreement in the contract. The Committee does not
support such blatant political activism for health program
operations. The Administration cites the need to address
potential disruptions of service as justification for this
action despite any previous disruption of service under the
current contract or threat of future disruption. The Committee
questions the need to incur new costs associated with a new
competition prior to the current contract ending. Additionally,
the Committee is concerned that a rushed competition could
threaten current levels of service. The Committee does not
support this effort and directs CMS to provide a report
detailing: a cost/benefit analysis, the costs and resources
needed to perform a rebid, any cost savings expected to be
derived, what evidence exists of past or potential disruption,
and a performance review of the current contract.
Convenient Access Standards for Medicare Part D
Beneficiaries.--The Committee is concerned that existing
convenient access standards for Medicare Part D beneficiaries
based on geographic distance do not take into consideration
true access to life-saving medications, including those that
are less common or facing shortages. The Committee supports
efforts by CMS to limit barriers to medication and pharmacist
access for Medicare patients and make, as appropriate, updates
to the Medicare Part D pharmacy access standards to improve
patient access to pharmacy services offered by pharmacies not
affiliated with a Pharmacy Benefit Manager. The Committee urges
CMS to consider what updates to Part D network adequacy
standards, including those that do not rely on physical
distance, could improve patient access to drugs and the
expertise of pharmacists.
Digital Mammography Coverage Analysis.--The Committee
recognizes the importance of access to mammography screening
for early detection of breast cancer. Digital Breast
Tomosynthesis, or 3D mammography, offers clinical benefits to
women with dense breasts, detects more invasive cancers,
improves accuracy, reduces patient recalls for additional
testing, and provides rapid and reliable results and storage of
images. The Committee directs the GAO to study any coverage and
copay gaps across States and different forms of private and
public health insurance, as well as trends in usage for 3D
mammography screening.
Direct Deposit Fees.--The Committee is aware that health
insurers and third-party vendors charge fees for medical
practices to receive reimbursement electronically via direct
deposit. Understanding that these fees increase costs for
medical practices, the Committee requests a report on
electronic payment options available to clinicians, such as
commercially available electronic payment options and the
Federal Reserve's FedNow Payment System, and the cost of such
options to clinicians.
Drug Quality.--The Committee continues to be concerned
about the discovery of dangerous levels of carcinogens in
frequently prescribed medications, including angiotensin II
receptor blockers like losartan and valsartan, ranitidine, and
metformin.
Emergency Medical Services Treat In Place Model.--The
Committee is disappointed by CMS's decision not to pursue a
State-specific emergency medical services demonstration project
or Innovation Center model. The Committee urges CMS to
reconsider this decision to allow for improved access to
emergency care in rural areas, as well as savings for Medicare
through the reduction of unnecessary emergency room visits.
Enabling Radiologist Assistant Care.--The Committee notes
that Radiologist Assistants are advanced-level Radiographers
who are critically important members of the Radiologist-led
team. Radiologist Assistants work strictly under the
supervision of a Radiologist to promote high standards of
patient care by assisting Radiologists in performing diagnostic
and interventional image-guided radiology services, as
permitted by State law. The Committee remains concerned about
persistent radiology workforce shortages and is aware that
barriers to care provided by Radiologist Assistants exist
within the Medicare program. As such, CMS should consider how
it may remove barriers to care rendered by Radiologist
Assistants to promote efficiency, improve patient outcomes, and
ensure patient safety. The Committee encourages CMS to
establish effective policies to enable patient access to
Radiologist Assistant care under the supervision of a
Radiologist, as permitted by State law. In developing such
policies, CMS is urged to consult with stakeholders.
Genetically Targeted Technologies.--Genetically targeted
drugs, defined for the first time in the 21st Century Cures Act
(P.L. 114-255), include a set of complex small molecule
products that target predominantly rare, genetic-based
diseases, but can also target broader populations in novel
ways. These genetically targeted technologies are in the
infancy of their commercialization and subjecting these highly
complex drugs to a negotiation timeline intended for simpler
drugs so early in their commercialization will
disproportionally impact these innovative ways to treat
diseases with high unmet medical need. The Committee encourages
CMS to work with Congress to align the timeline for which drugs
made with genetically targeted technologies are eligible for
negotiations, equivalent to that of large molecules.
Home Infusion.--The Committee notes the critical role that
home infusion services can play in improving health outcomes
and quality of life for patients who require infusion of
medications for complex conditions, including patients who
would otherwise need to travel significant distances to receive
drug infusions at a hospital or freestanding infusion center.
The Committee is concerned by the low levels of utilization of
home infusion therapy among beneficiaries in traditional
Medicare Fee-for-Service as compared to more robust use of home
infusion in commercial insurance and across other payers. The
Committee encourages CMS to examine options that could help
ensure that Medicare Fee-for-Service beneficiaries have better
access to drug infusion from the comfort and safety of their
homes.
Hospitals in the U.S. Virgin Islands.--The Committee notes
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. The
two hospitals in the U.S. Virgin Islands are reimbursed based
on 1982 and 1996 costs. As a result, hospitals do not receive
sufficient payment and patients must travel outside the
territory for necessary services, including total joint
replacements and chemotherapy, often at great expense and
personal hardship.
Improving Diagnostic Testing for Neurodegenerative
Diseases.--The Committee supports efforts to prevent and
effectively treat neurodegenerative diseases, including
Parkinson's disease, Lewy body dementia, and other related
disorders. The Committee also recognizes that early detection
is imperative to improving health outcomes and patient quality
of life by delaying or halting the progression of such
diseases. To improve the ability of health care providers to
diagnose and treat neurodegenerative diseases at an earlier
onset, the Committee encourages HHS to work with healthcare-
related entities, manufacturers, and developers, as
appropriate, to promote the awareness and research of novel
diagnostic testing, including tests that detect and visualize
protein markers using the skin, for neurodegenerative diseases.
Improving Veterans Enrollment into Medicare Coverage.--The
Committee is aware that information gaps exist for some
veterans related to the differences between the hospital care
and medical services available in the Veterans Affairs (VA)
system versus coverage provided under Medicare. The Committee
encourages the department to work with the Department of
Veterans Affairs to ensure that veterans have complete
information regarding the differences between the VA system and
Medicare coverage, including for prescription drugs.
Language Access in Telehealth.--The Committee requests an
update in the fiscal year 2026 congressional justification on
access to health care services, in particular behavioral health
services, via telehealth for individuals with limited English
proficiency under the Medicare program.
Medicaid Best Price Rule.--The Committee is concerned that
CMS has exceeded its statutory authority in developing the
latest Medicaid Drug Rebate Program (MDRP) Proposed Rule
(Medicaid Program; Misclassification of Drugs, Program
Administration and Program Integrity Updates Under the Medicaid
Drug Rebate Program (88 Fed. Reg. 34238)). While the Committee
is pleased the Administration has announced that it will not
advance the so-called ``stacking proposal,'' the Committee
remains concerned with the proposed price ``verification''
survey, which goes beyond its purported purpose and agency
authority and targets innovative cell and gene therapies. The
Committee urges CMS to not finalize or implement this MDRP
Proposed Rule until the agency adequately addresses the wide
spectrum of stakeholder concerns.
Medicaid Dental Audits.--The Committee has previously
raised concerns that failure to use professional guidelines or
establish 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
(SMAs) have significant responsibility in managing provider
audits, CMS also has responsibility for oversight of the
Medicaid program. Therefore, it is appropriate for CMS to issue
guidance to SMAs concerning best practices in dental audits and
offer training in such practices. The Committee again strongly
urges CMS to develop such guidance for SMAs.
Medicaid Reimbursement Impact on Rural Maternal Health
Care.--The Committee recognizes the importance of rural
hospitals in providing maternal health care services, educating
patients, and ensuring postpartum safety. The Committee is
concerned that insufficient reimbursement and payments,
increasing costs of operation, and narrowing profit margins
threatens the viability of hospitals in rural areas. The
Committee is aware that Medicaid payment rates are often
insufficient in the costs of labor and delivery for rural
hospitals, leading to the closures of labor and delivery
departments and increased maternal health deserts. The
Committee requests a report within one year from the date of
enactment of this Act that reviews State-by-State payment rates
at rural health care facilities and evaluates if increased
payment rates would help sustain the ability for rural health
care providers to continue maternal health care services. The
report should include, to the extent practicable, how payment
rates impact care options, including how the rates may impact
the utilization of new treatment pathways and devices for birth
complications.
Medical Devices.--The U.S.' manufacturing capacity for
medical devices is at risk due to organized efforts by Chinese
manufacturers to enter the U.S. market. The current shift
toward purchasing Chinese-made medical devices could leave U.S.
hospitals dependent on Chinese supplied devices. The Committee
recommends CMS advance payment policies to support provider
procurement of domestic sources of essential medical supplies.
The Committee requests CMS include in the fiscal year 2026
congressional justification the percentage of Chinese made
devices that hospitals and their group purchasing organizations
purchase from Chinese manufacturers for the 96 device medical
countermeasures published by the FDA in 2020. If such
information is unavailable, the Committee directs CMS to
include what would be necessary for CMS to have this data
collected in the future.
Medicare Coverage for Mobility Assistive Equipment in the
Community.--The Committee notes that Title II of the Americans
with Disabilities Act requires public entities to administer
services, programs, and activities in the most integrated
setting appropriate to the needs of qualified individuals with
disabilities.
Medicare Prescription Payment Plan.--The Committee directs
CMS to provide a report to Congress and post on a publicly
available website: (1) the number of beneficiaries who have
taken up the smoothing option and the total number of
beneficiaries categorized as ``likely to benefit'' by the Part
D plan sponsor; (2) information on the methods that CMS is
utilizing to encourage participation, such as the use of
Medicare.gov, the Medicare and You handbook, 1-800-MEDICARE,
and provider focused communications such as the Medicare
Learning Network; and (3) additional outreach efforts that CMS
is conducting with other stakeholders, including provider
associations and societies, patient and consumer advocacy
groups, and pharmacy benefit managers. Additionally, CMS shall
report on the status of operationalizing point-of-sale
enrollment for the program until such functionality is
available for all Medicare beneficiaries.
Medicare Secondary Payer.--The Committee continues to be
supportive of modernizing the Medicare Secondary Payer Program
and interested in understanding the impacts of the program on
beneficiary access to treatment. In February 2024, CMS released
its low dollar reporting and recovery threshold of $750. The
Committee is particularly concerned that in this calculation
CMS uses as the denominator the total number of demand letters
when, going back to as early as 2000, GAO has found that only a
fraction of demand letters result in recoveries.
Medicare Telehealth Provider Privacy.--The Committee has
concerns with how CMS plans to ensure the safety of Medicare
providers' personal information. Since the beginning of the
COVID-19 pandemic, CMS has allowed Medicare providers who
render telehealth services from their home or other location to
list a practice address rather than their home address on
Medicare enrollment and billing forms. The flexibility has been
extended through the end of calendar year 2024. CMS is urged to
implement a permanent policy solution that is not
administratively or operationally burdensome for health care
systems and ensures provider safety and privacy. This policy
solution should also prioritize program integrity and allow for
monitoring of potential fraud, waste, and abuse. CMS is
encouraged to implement a permanent solution prior to December
31, 2024, or extend the current flexibility until such time
that a permanent solution is reached.
Minimum Staffing Requirements in Rural Areas.--The
Committee recognizes that rural areas are disproportionately
impacted by health workforce shortages. The Committee is
concerned that a one-size-fits-all staffing mandate is
unrealistic in many areas due to the lack of qualified workers
available and that such a mandate could significantly harm the
health care continuum. The Committee urges CMS to reconsider
this rulemaking, to consider the impact minimum staffing
policies have on rural facilities that may be unable to hire
the necessary staff, and to consider the impact of these
policies on access to care for seniors.
Money Follows the Person Demonstration Grant.--The
Committee notes that it is not the intent of the Money Follows
the Person Demonstration Grant (MFP) to eliminate the option of
institutional care. MFP funds may not be used for the wholesale
transfer of residents from certified care facilities to finance
facility closures or downsizing. MFP is a voluntary program
established to facilitate individual transitions to community
settings initiated by the beneficiary at the beneficiary's
choice and request. The Committee requests: (1) mortality data
on those who transfer under the MFP program from certified
facilities, and (2) data by category of disability
(developmental disabilities, mental illness, age, physical
disabilities) for sentinel events (emergency room visits) for
MFP participants.
No Surprises Act Timely Payment.--The Committee recognizes
that the Departments of the Treasury, Health and Human
Services, and Labor are obligated to continue conducting random
audits of insurers' qualifying payment amount calculations as
mandated by the No Surprises Act. Additionally, the Committee
is concerned that, despite being statutorily required to submit
a report to Congress on such audits in 2022, Congress has only
received a perfunctory report detailing the Departments'
failure to complete their audit obligations. The Committee
directs the Secretary to immediately finish such audits,
provide a comprehensive report to Congress, and post such
report publicly on the agency's website; and use all existing
authorities, including PHS Act noncompliance civil monetary
penalties, to enforce timely payments following payment
determinations by Independent Dispute Resolution Entities.
Non-Healing Severe Wound Payment.--Non-healing severe
wounds, such as pressure sores, diabetic ulcers, and surgical
incisions, are a major healthcare concern in Medicare. Current
Medicare payment policies may create incentives for health
professionals to provide care that is suboptimal for wound
treatment, resulting in longer treatment and recovery times and
higher costs. Medicare should explore innovative options for
wound care to help address this healthcare problem. CMS should
include an update on this topic in the fiscal year 2026
congressional justification.
Non-Opioid Pain Medicine.--The Committee believes in the
importance of providing access to non-opioid pain medicine to
patients covered by Medicare and Medicaid. The Committee
requests a report, within 180 days of the enactment of this
Act, addressing uptake and utilization of non-opioid pain
medicine.
Nuclear Diagnostics.--Nuclear medicine scans are often both
the most clinically appropriate and cost-effective way to
diagnose certain diseases, like Alzheimer's and Parkinson's
diseases, as well as prostate, breast, and neuroendocrine
cancers. Initially classified as stand-alone ``drugs,''
radiopharmaceuticals were paid separately from the nuclear
medicine procedure. However, CMS began packaging payments in
2008, which results in underpayment of diagnostic
radiopharmaceuticals, serves to disincentivize hospitals from
using newer diagnostic radiopharmaceuticals in scans, and
limits patients' access as documented in a 2021 GAO report. The
Committee appreciates the recent request for information on
different options to address this issue as part of the calendar
year 2024 Medicare Hospital Outpatient Prospective Payment
System (OPPS) proposed rule. The Committee urges CMS to take
action to unpackage Medicare's OPPS payment for diagnostic
radiopharmaceuticals from the OPPS payment for the accompanying
procedure or scan.
Obesity.--The Committee continues to encourage CMS to work
to ensure beneficiary access to care for obesity if determined
as clinically appropriate by the patient's physician and
consistent with statutory and regulatory authority.
Ongoing Responsibility for Medicals.--The Committee
continues to be supportive of modernizing the Medicare
Secondary Payer (MSP) program and interested in understanding
the impacts of the program on beneficiary access to treatment.
The Ongoing Responsibility for Medicals (ORM) program has been
problematic given that many providers refuse any treatment of
Medicare beneficiaries due to an ORM flag on the file, even if
the treatment is unrelated to the accident or injury giving
rise to the MSP report. Section 111 of the MSP Act requires the
reporting of the assumption of ORM, and CMS requires the
reporting of all cases with claims above $25,000. The committee
is concerned that this number has not kept pace with medical
inflation and does not fairly reflect an appropriate threshold
for ORM reporting. The Committee urges CMS to submit a report
to the committees of jurisdiction on the impact of adjusting
this threshold to medical inflation.
Organ Procurement Organization.--The Committee is aware
that in 2020, CMS issued a final rule to update the Conditions
for Coverage for Organ Procurement Organizations (OPOs), which
established a process to decertify any OPO falling below median
performance on two specified metrics based on 2024 data.
Current preliminary data suggests that 42 percent of OPOs could
face decertification by 2026. The remaining OPOs would undergo
competitive bidding for the decertified OPOs' service areas or
absorb their responsibilities. The Committee urges CMS to
expedite the release of a proposed rule in 2024.
Overestimating Utilization of New Codes in the Fee
Schedule.--The Committee is concerned that CMS estimates for
the utilization of a new code in the initial calendar year in
the Medicare Physician Fee Schedule are inflated and exceed
what is statutorily required. When adjusting the number of
relative value units needed to account for coding changes, new
data on relative value components, or payment for new
procedures, the Committee is concerned that CMS overestimates
utilization, and therefore the overall cost of such changes,
resulting in substantial resources being unnecessarily deducted
from the physician fee schedule required by budget neutrality.
As such, the Committee directs GAO to study the extent it has
overestimated the utilization of new fee schedule codes in each
of the last ten years, including data on related reductions to
the fee schedule for each of those years.
Over the Counter Hearing Aids.--In the calendar year 2023
Physician Fee Schedule Final Rule, CMS finalized a policy to
allow direct access to an audiologist for beneficiaries with
non-acute hearing conditions. The finalized policy will allow
beneficiaries, once every 12 months, direct access to an
audiologist to receive care for non-acute hearing assessments
that are unrelated to disequilibrium, hearing aids, or
examinations for the purpose of prescribing, fitting, or
changing hearing aids. Over-the-counter (OTC) hearing aids are
often recommended for adults with non-acute, mild-to-moderate
hearing loss. The Committee urges CMS to issue a communication
to audiologists to provide information on the availability and
effectiveness of OTC hearing aids for non-acute mild-to-
moderate hearing loss conditions.
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.
Physician Work Payments in Rural Areas.--The Committee
recognizes that the current Medicare Physician Work Geographic
Practice Cost Index formula inadequately reflects the value of
physician work effort in high-cost, geographically rural areas
of the country, especially the non-contiguous areas. The
current formula uses wage as an indicator for the relative
value of a physician's work effort, but this may not adequately
account for differences in the cost of living and other factors
that negatively impact the relative value of physician work
effort in these areas.
Programs of All-Inclusive Care for the Elderly Feasibility
Assessment.--The Committee continues to see the importance of
the Programs of All-Inclusive Care for the Elderly (PACE),
which enables medically complex older adults with significant
long-term care needs to remain living at home. Given the
increasing need for home and community-based care for this
nursing home eligible population, the Secretary was directed to
submit a report outlining an implementation plan for PACE-
specific model tests seeking to increase access and
affordability in Senate Report 118-84. The Committee looks
forward to receipt of the report.
Protecting Medicare Beneficiary Access to Therapy.--The
Committee is concerned with the HHS OIG's findings that payors
have denied or delayed timely Medicare beneficiary access to
medically necessary medication through the use of ``utilization
management'' (including step therapy, prior authorization,
limitations on drug refills, changes in formulary tier, co-pay,
co-insurance, or deductibles) and the implications for
beneficiaries with the implementation of Part D benefit
redesign. The Committee urges CMS to prioritize protecting
beneficiary access to medication therapy, including enhanced
oversight and review of the use of utilization management by
Medicare Part D plan sponsors, ensuring that sufficient
safeguards are in place so plans do not use overly restrictive
clinical criteria, do not request unnecessary documentation,
and are timely in responding to appeals. The Committee requests
an update in the fiscal year 2026 congressional justification
on actions the agency is taking to protect Medicare
beneficiaries by enhancing its oversight of the use of
utilization management by Part D plans to ensure no adverse
impacts to beneficiary access to therapies.
Protecting Medicare Program Integrity and Beneficiary
Choice.--The Committee is concerned that CMS's final rule to
redefine compensation for contract year 2025 represents a price
control that will create unnecessary consequences for the
health care system. The Committee is particularly concerned
with CMS finalizing the rule when it admits it ``lacks the
data'' to quantify the rule's ``economic effects.'' Moreover,
the final rule states CMS cannot ``accurately capture'' the
true cost of administrative services based on the information
it has available. The Committee requests an update in the
fiscal year 2026 congressional justification on the impact such
rule will have on program participants.
Psychosocial Rehabilitation Model.--The Committee
recognizes the high prevalence of loneliness and social
isolation among people with serious mental illness and
encourages CMS to address this issue.
Radiation Oncology.--The Committee remains concerned that
efforts to reform the delivery and payment of certain types of
radiation therapy may negatively affect patient access and
outcomes. The Committee continues to encourage CMS to work
closely with all affected stakeholders to develop reforms that
support patient's access to high quality, innovative care, and
the Medicare trust funds.
Rate Review.--The Committee strongly urges CMS to conduct a
rate review process through which each issuer shall submit a
single bid for each state and rating area that such issuer
plans to offer a qualified health plan.
Reducing False Positive Sepsis Blood Cultures.--The
Committee is aware that more than 40 percent of blood culture
tests used to diagnose bloodstream infections, like sepsis, are
false-positive results due to blood culture contaminations from
a patient's skin and not an actual infection. These false-
positive test results lead to serious morbidity and mortality
among misdiagnosed patients, significant spending on
unnecessary treatment, and the overuse of antibiotics. The
Committee urges CMS to prioritize and expedite the adoption of
a blood culture contamination rate measure that reduces
contaminations.
Reliance on Death Certificate Data for Performance
Management.--The Committee is aware that when establishing the
methodology to evaluate organ procurement organization
performance, the agency elected to rely on death certificate
data to determine the denominator of the donation and
transplant rates. The Committee recognizes that death
certificate data can be unreliable and urges CMS to identify
alternative data sources such as patient-level hospital data.
Remote Monitoring Devices for Pregnant Women.--The
Committee is concerned with the maternal morbidity and
mortality rate, which disproportionately impact the Medicaid
population. Many indicators of potential pregnancy-related
complications can be monitored remotely through devices that
check for irregularities in blood glucose, oxygen saturation,
and weight. The Committee encourages CMS to provide guidance to
States on coverage of remote physiologic devices and related
services under Medicaid for pregnant and postpartum women. The
Committee requests an update on this effort in the fiscal year
2026 congressional justification.
Robotic Stereotactic Radiosurgery.--The Committee remains
concerned that inadequate payment for robotic stereotactic
radiosurgery (SRS) and robotic stereotactic body radiation
therapy (SBRT) may threaten patient access to this important
treatment option for many types of cancer in both the hospital
and freestanding center setting. If CMS pursues any changes to
radiation therapy coding and payment policies, the Committee
urges the agency and contractors administering the Medicare
Part B program to maintain existing codes describing robotic
SRS and robotic SBRT in order to protect Medicare beneficiary
access to these services which safely deliver life-saving and
life-changing cancer treatment in a timely and cost-efficient
manner, improving patient compliance and reducing burdens on
patients, providers, and the health care system. Furthermore,
the Committee notes the promise of value based care for
radiation therapy which promises to improve patient outcomes
over volume.
Rural Hospital Closures.--The Committee is concerned by the
crisis of rural hospital closures. Rural populations are often
older, sicker, and more likely to use public insurance or be
uninsured, leading to unique pressures on rural hospital
finances. The Committee appreciates the investments in certain
rural hospital designations--such as Critical Access Hospital,
Rural Emergency Hospital, or Medicare-Dependent Hospital--but
encourage HHS to continue addressing the community need of
rural hospitals that continue to face challenges. The Committee
requests a report within one year of the date of enactment of
this Act identifying strategies for strengthening
reimbursements for rural hospitals that are too large to be a
Critical Access Hospital, serve populations with high
utilization of Medicare and Medicaid, and are the sole or
primary provider of healthcare services in the community.
Screening for Cervical Cancer with Human Papillomavirus
Self Sampling.--The Committee is pleased that CMS has included
its National Coverage Determination (NCD) for Screening for
Cervical Cancer with HPV Testing on its wait list for
reconsideration. Similar to the approval for self-sampling in
other countries with organized screening programs, the National
Cancer Institute's ``Last Mile'' initiative will also determine
the clinical effectiveness of self-collection-based HPV testing
for screening to be considered for additional labeling by FDA
after review. The Committee recognizes that self-sampling has
the potential to reach individuals who are never screened or
under-screened for HPV, which makes up about half of women who
get cervical cancer in the U.S. Given the promise of HPV self-
sampling, the Committee urges CMS to move this NCD up the wait
list to ensure that there is appropriate coverage for this
screening methodology upon FDA approval.
Special Consideration of Vaccines.--The Committee notes
unique characteristics of vaccine products, including: (1) the
existence, or lack, of any direct financial burden to Medicare
beneficiaries in accessing vaccines, including any cost-sharing
obligations; (2) the importance of vaccines to national
security; (3) the role vaccines play in reducing overall health
care spending; (4) the contribution of vaccines to the national
economy and workforce productivity; (5) the role of vaccines in
potentially preventing or addressing a global or national
public health emergency; (6) the ability of vaccines to prevent
a serious medical condition or address an unmet medical need;
(7) the ability of vaccines to yield savings to Medicare by
eradicating, preventing, and reducing the incidence of diseases
thereby reducing associated hospitalizations and overall burden
on the health care system; and (8) the low cost per unit, and
the use of vaccines by CMS for quality measures such as the
Merit-based Incentive Payment System (MIPS) and the MIPS value
pathways to promote increased vaccine utilization.
Standardized Health Plans.--The Committee is concerned that
CMS is limiting competition and choice in the individual health
insurance market by limiting the number of nongovernment
dictated (``standardized'') plans that issuers may offer. The
Committee believes that Americans are best served by the widest
variety of competition and choice possible, ensuring that they
can pick the health plan that best works for them. As such, the
Committee urges CMS to apply a non-enforcement policy to the
plan limits enacted via regulation at 45 CFR 156.202 to promote
competition and choice.
Stark Law Compliance.--The Committee encourages the agency
to apply the updated definitions of ``commercially reasonable''
and ``fair market value'' as established in the CMS Final Rule
``Medicare Program; Modernizing and Clarifying the Physician
Self-Referral Regulations'' (published December 2, 2020, and
effective January 19, 2021). The Committee is concerned that
these key definitions, which are foundational to compliance
with the Federal Physician Self-Referral Law (commonly referred
to as the ``Stark Law''), are not being applied during the
review of certain hiring practices by hospitals. If these
definitions are not properly applied, arrangements that violate
the Stark Law because they are not commercially reasonable and/
or not consistent with fair market value will continue to go
unaddressed, increasing costs to patients and the healthcare
system.
Timely Access to Alzheimer's Disease Treatment.--The
Committee is encouraged by innovations in diagnostic tools
along with treatments for the underlying biology of Alzheimer's
disease and some of its most serious symptoms. The Committee
urges CMS to recognize its role in facilitating timely and
equitable beneficiary access to these diagnostic tools and
services and encourages continued collaboration between CMS and
other Federal agencies in their collective efforts to shift
standard of care towards timely and accurate detection and
diagnosis.
Treasury Referrals.--The Committee continues to be
supportive of modernizing the Medicare Secondary Payer (MSP)
program and is interested in understanding the impacts of the
program on the Federal government. The Committee understands
that CMS refers the debt of some claims to the Treasury
Department for collection even before the appeal period has
expired. This results in potentially misaligned processes and
the Committee urges CMS to coordinate with Treasury to review
these timeline interactions.
Unified Program Integrity Contractors Audit Improvements.--
The Committee recognizes the importance of using Unified
Program Integrity Contractors to suspend Medicare payments for
credible allegations of fraud. The Committee urges CMS to
assess how the audit system can be improved to increase
communication with providers.
Waiver of 3-Day-Stay COVID Requirement.--The Committee
recognizes the impact of the current 3-day-stay requirement on
Medicare beneficiaries in need of Skilled Nursing Facilities
(SNF) coverage but without a qualifying stay. During the COVID
pandemic, this requirement was waived. The Committee directs
CMS to make data available on the agency website to better
understand the impact of the requirement on SNF utilization and
Medicare spending. Such data made available should include: (1)
total number of stays and total amount of Medicare fee-for-
service (FFS) spending for covered SNF stays; (2) total number
of stays and total amount of Medicare FFS spending for covered
SNF stays preceded by a hospitalization with less than three
consecutive inpatient hospital midnights; and (3) total number
of stays and total amount of Medicare FFS spending for covered
SNF stays for beneficiaries who meet the following waiver
criteria: (a) Are covered under Medicare FFS; (b) Are not
attributed to an accountable care organization; and (c)
Received covered SNF care within 30 days of a hospitalization
of three or more consecutive midnights, with the following
scenarios reported separately: (i) a combination of outpatient
observation and less than 3 consecutive inpatient midnights; or
(ii) exclusively outpatient observation days, and (4) For each
of the above categories, the number or percentage of stays by
patients who resided in an SNF prior to the hospital or
observation stay that preceded a covered SNF stay.
Whole Child Health.--The Committee is aware that social
drivers of health influence health outcomes, particularly for
children and youth. The Committee commends CMS for establishing
the Integrated Care for Kids Model and for supporting state
flexibility to address health-related social needs through
guidance and waivers. To build State capacity to address
stressors impacting youth health and wellbeing through
sustainable payment and delivery models, the Committee
continues to encourage CMS to consider approaches to designing
a whole child health demonstration program centered in primary
care. Such a program could address the mental, developmental,
and social factors impacting children served by Medicaid and
CHIP through pediatric value-based care models, with a
particular focus on locally driven strategies to align
financial incentives and resources across Medicaid and other
programs. The Committee looks forward to the update requested
on this effort in Senate Report 118-84.
Whole Genome Sequencing for Medicaid and CHIP Programs.--
The Committee understands that there are an estimated 30
million Americans who have a rare disease--a disease affecting
200,000 people or less--and the majority of these Americans are
children. The Committee understands that Medicaid is the
largest payer of treatment for rare disease. The Committee
understands there is a growing body of evidence that whole
genome sequencing (WGS), whole exome sequencing (WES), and gene
panel testing (GPT) can save lives and money when used to
diagnose infants and children who are suspected to have a rare
genetic disease. The Committee encourages CMS to examine State
Medicaid programs' current coverage and reimbursement of WGS,
WES, and GPT for infants and children with rare diseases or
suspected genetic disorders.

State Survey and Certification

The Committee provides $402,334,000 for State Survey and
Certification activities, which is $5,000,000 above the fiscal
year 2024 enacted level and $90,000,000 below the fiscal year
2025 budget request. This program 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 as required by CMS.

Federal Administration

The Committee provides $672,533,000 for Federal
Administration activities related to the Medicare and Medicaid
programs, which is $100,000,000 below the fiscal year 2024
enacted level and $185,082,000 below the fiscal year 2025
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.
Health Insurance Exchange Transparency.--The Committee
continues to include bill language requiring CMS to provide
cost information for the following categories: Federal Payroll
and Other Administrative Costs; Exchange related Information
Technology (IT); Non IT Program Costs, including Health Plan
Bid Review, Management and Oversight; Payment and Financial
Management; Eligibility and Enrollment; Consumer Information
and Outreach, including the Call Center, Navigator Grants, and
Consumer Education and Outreach; Exchange Quality Review; Small
Business Health Options Program and Employer Activities; and
Other Marketplace Activities. Cost information should be
provided for each fiscal year since the enactment of the
Patient Protection and Affordable Care Act (P.L. 111-148). CMS
is also required to include the estimated costs for fiscal year
2026.
Quality Improvement Organizations.--The Committee does not
include the Administration's request to remove language
regarding how quality improvement organizations are funded.

HEALTH CARE FRAUD AND ABUSE CONTROL ACCOUNT

Appropriation, fiscal year 2024....................... $915,000,000
Budget request, fiscal year 2025...................... 941,000,000
Committee Recommendation.............................. 941,000,000
Change from enacted level........................... +26,000,000
Change from budget request.......................... - - -

The Health Care Fraud and Abuse Control Account funds
support activities conducted by CMS, the HHS OIG, and the
Department of Justice (DOJ). This appropriation includes a base
amount of $311,000,000 and an additional $630,000,000 through a
discretionary budget cap adjustment provided to meet the terms
of legislation establishing fiscal year 2025 budget enforcement
in the House of Representatives.
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 bill
language to enable the Secretary to provide a total of
$35,000,000 for the Senior Medicare Patrol program, which is
administered by the Administration for Community Living, from
either discretionary or mandatory funds provided to this
account.

Administration for Children and Families

PAYMENTS TO STATES FOR CHILD SUPPORT ENFORCEMENT AND FAMILY SUPPORT
PROGRAMS

Appropriation, fiscal year 2024....................... $3,309,000,000
Budget request, fiscal year 2025...................... 3,924,000,000
Committee Recommendation.............................. 3,924,000,000
Change from enacted level........................... +615,000,000
Change from budget request.......................... - - -

The Committee also provides $1,600,000,000 in advance
funding, as requested, for the first quarter of fiscal year
2026 to ensure timely payments for Child Support Enforcement
programs. These formula and incentive grants to States foster
parental responsibility and promote family independence, self-
sufficiency, and child well-being through services such as
locating noncustodial parents, establishing and enforcing
support orders, and collecting and disbursing child support
payments.

LOW INCOME HOME ENERGY ASSISTANCE PROGRAM

Appropriation, fiscal year 2024....................... $4,025,000,000
Budget request, fiscal year 2025...................... 4,111,000,000
Committee Recommendation.............................. 4,040,000,000
Change from enacted level........................... +15,000,000
Change from budget request.......................... -71,000,000

The Low Income Home Energy Assistance Program provides
formula grants to States to support eligible families and
households through programs providing assistance with energy
costs.
The Committee includes bill language that directs an
additional $7,500,000 in funding to be distributed under the
new formula.

REFUGEE AND ENTRANT ASSISTANCE

Appropriation, fiscal year 2024....................... $6,327,214,000
Budget request, fiscal year 2025...................... 9,341,393,000
Committee Recommendation.............................. 2,691,955,000
Change from enacted level........................... -3,635,259,000
Change from budget request.......................... -6,649,438,000

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 the care of unaccompanied alien
children in Federal custody and survivors of torture.
The Committee continues to direct ORR to provide monthly
updates of arrivals each month by category, including refugees,
asylees, Cuban and Haitian entrants, Special Immigrant Visas,
and unaccompanied alien children.
Within the total, the Committee includes the following:

------------------------------------------------------------------------
FY 2025
Budget Activity FY 2024 Enacted Committee
------------------------------------------------------------------------
Transitional and Medical Services. $564,000,000 $253,700,000
Refugee Support Services.......... 307,201,000 137,500,000
Victims of Trafficking............ 30,755,000 31,755,000
Unaccompanied Alien Children...... 5,406,258,000 2,250,000,000
Survivors of Torture.............. 19,000,000 19,000,000
------------------------------------------------------------------------

Transitional and Medical Services

Consistent with the Refugee Education and Assistance Act of
1980, the Transitional and Medical Services program funds
reimbursements and competitive grants to States and nonprofit
organizations to provide refugees and other eligible
populations with cash and medical assistance.

Victims of Trafficking

The Victims of Trafficking program funds competitive grants
and contracts for services to foreign victims of trafficking
and potential victims in the U.S.
Within the $31,755,000 provided for Victims of Trafficking,
the Committee includes not less than $6,000,000 for the
National Human Trafficking Hotline, which is an increase of
$1,000,000 from the fiscal year 2024 enacted level.
Mandatory Reporting.--The Committee directs HHS to ensure
the National Human Trafficking Hotline (Hotline) is complying
with all Federal, State, and local laws, regulations, or
policies, that require mandatory reporting to law enforcement
for investigations into possible human trafficking. HHS
acknowledges that the goals and operations of the Hotline
include referring actionable tips to law enforcement. As
outlined in the fiscal year 2020 Hotline Notice of Funding, an
objective of the Hotline is to notify law enforcement agencies
of potential cases of human trafficking, as well as instances
when a trafficking victim is in imminent danger, and to
document emerging trafficking schemes to assist in the
detection and investigation of trafficking cases.
Moreover, the Committee notes that the Department of
Homeland Security (DHS) has launched the Blue Campaign, a
national public awareness campaign designed to educate the
public, law enforcement, and other industry partners to
recognize the indicators of human trafficking, and how to
appropriately respond to possible cases. The Committee directs
HHS to consult and coordinate with the DHS Blue Campaign. The
Committee provides a $1,000,000 increase for the Hotline to
update all its materials and to support operational costs to
facilitate increased collaboration and tip sharing with law
enforcement.

Refugee Support Services

Consistent with the Refugee Education and Assistance Act of
1980, the Refugee Support Services program provides formula and
competitive grants to States and nonprofit organizations to
provide services to refugees and other eligible populations.
School Impact Grants.--The Committee directs ORR to include
the amount provided by State for each activity within Refugee
Support Services formula grants, including school impact
grants, in the fiscal year 2026 budget justification.

Unaccompanied Alien Children

The Unaccompanied Alien Children (UAC) program supports the
care and placement of unaccompanied alien children under the
age of 18 apprehended by the DHS at the Southwest border while
attempting to enter the U.S. illegally. The Committee is
concerned this program under the Biden Administration has
served as a catalyst for illegal immigration and child labor
exploitation. Costs to serve this population have skyrocketed
in recent years and remain on a trajectory that is
unsustainable. Numerous legislative proposals have been offered
to address this unacceptable humanitarian situation. The Biden
Administration is on track to spend over $500,000,000 taxpayer
dollars on a facility in North Carolina that has never received
a single unaccompanied alien child. Such rampant waste provides
another stark example of why this program needs to eprioritize
how funding is allocated to address immediate needs. The
Committee proposes reduced funding consistent with the
historical needs of the account.
Age Verification.--For the most recent fiscal year for
which data is available, the Committee directs ORR to submit a
report to the Committee no later than 180 days after enactment
of this Act, detailing the processes and procedures ORR uses to
verify a UAC's age, including, but not limited to, the use of
birth certificate verification with consulates, medical exams,
and verbal confirmation. The Department shall make such a
report available on its website.
Fair and Open Contracting and Grant Making.--The Committee
directs the agency to conduct all public solicitations for
grants or contracts in a manner that is fair, open,
transparent, and free from ideological bias and conflict of
interest. All Federal laws, regulations, and guidelines on
communications with outside vendors should be rigorously
adhered to with appropriate internal controls in place to avoid
undue risk of favoritism or other bias in making selections.
HHS Office of Inspector General Report.--The Committee
notes with concern that the 2024 HHS OIG Report (``Gaps in
Sponsor Screening and Followup Raise Safety Concerns for
Unaccompanied Children,'' OEI-07-21-00250) found that in a
sample of 342 minors who were released to sponsors by HHS in
March and April 2021, for 55 minors, or 16 percent, the minor's
case files lacked any documentation indicating that the
required sponsor safety checks were conducted. These important
safety checks include criminal public record checks, sex
offender registry name checks, and Google address checks.
Moreover, 35 percent of children's case files contained
illegible scans of photo IDs, birth certificates, or legal
documents meant to verify a sponsor's identity. The OIG
recommended that ORR implement additional safeguards to ensure
that all safety checks are conducted and documented within each
child's case file prior to children's release to sponsors and
that ORR ensure sponsor records in the UAC portal accurately
capture sponsorship history. The Committee directs ORR to brief
the Committee within 30 days of the enactment of this Act on
the timeline and steps it will take to meet both
recommendations.
Home Studies.--The Committee notes that the Trafficking
Victims Protection Reauthorization Act requires home studies of
potential sponsors when the child is a victim of trafficking,
special needs/disabled, a victim of physical or sexual abuse,
or if the sponsor clearly presents a risk of abuse,
maltreatment, exploitation, or trafficking. ORR additionally
mandates home studies if a potential sponsor is seeking to
sponsor two or more children and at least one of the children
is unrelated to the potential sponsor, if a potential sponsor
has previously been the sponsor of two or more children and is
now seeking to sponsor an additional child, or if a potential
sponsor is seeking to sponsor an unrelated child who is 12
years or under. Due to repeated reports of ORR releasing minors
into unsafe situations and the concerning findings in the
previously mentioned OIG report, the Committee directs ORR to
conduct a home study for every potential sponsor.
Notification.--The Committee directs ORR to continue to
report the death of any unaccompanied alien child in its
custody within 24 hours, including relevant details regarding
the circumstances of the fatality.
Online Data.--The Committee notes that HHS publishes
updated data on its website on occupancy rates in facilities,
average length of care in HHS custody, UAC demographics, and
releases to sponsors by category.
ORR Employee Vetting.--The Committee notes with concern
that the HHS OIG found in a May 2023 report (``The Office of
Refugee Resettlement Needs To Improve Its Practices for
Background Checks During Influxes,'' A-06-21-07003) that for
some employees, ORR's influx care facilities and emergency
intake sites did not conduct or document all required
background checks for some employees or did not conduct the
checks in a timely manner. In addition, ORR did not require the
transportation services contractor to conduct background checks
on employees as required by ORR minimum standards. The
Committee directs HHS to brief the Committee no later than 30
days after enactment of this Act on the corrective actions
taken by ORR in response to these findings.
Qualified Sponsor Denials.--The Committee notes that ORR
currently has no way to track the reasons that sponsor
applications are denied. The Committee directs ORR to begin
tracking the reasons for sponsor denials in a reportable format
no later than 180 days after enactment of this Act. The
Committee then directs ORR to submit a report to the Committee
on the number of sponsors who completed an application, but for
which a child was not referred. ORR shall include information
regarding why a child was not able to be placed with the
sponsor who successfully completed an application, including,
but not limited to, voluntary withdrawal; a prior criminal,
domestic violence, or child abuse conviction; or providing
false information to ORR.
Referrals Related to Trafficking.--The Committee directs
ORR to submit quarterly reports to the Committee that includes
the number of referrals that ORR has made to the DHS's Homeland
Security Investigations Division.
Report.--The Committee directs ORR to continue to submit
biannual reports to the Committee that include the number of
UACs that remain in HHS care for longer than one year and the
number of UACs that HHS has released to sponsors. The report
should also include an explanation of the methods ORR uses to
follow-up with unaccompanied children after releasing them to a
sponsor, including the follow-up method used and number of
attempts made. The Department shall include the total number of
UACs that ORR has been unable to contact successfully for
follow-up for fiscal years 2021-2024 and shall make such a
report available on its website.
Spend Plan.--The Committee continues to direct the
Secretary of HHS to submit a comprehensive spend plan to the
Committee every 90 days.
Website Updates.--The Committee directs ORR to include on
its website unaccompanied children released to sponsors by
county where five or more children have been released.

Survivors of Torture

The program funds competitive grants to nonprofit
organizations providing services to refugees, asylees, and
asylum seekers to address the effects of torture.

PROMOTING SAFE AND STABLE FAMILIES

Appropriation, fiscal year 2024....................... $417,515,000
Budget request, fiscal year 2025...................... 421,515,000
Committee Recommendation.............................. 414,765,000
Change from enacted level........................... -2,750,000
Change from budget request.......................... -6,750,000

The Committee provides $345,000,000 in mandatory funds and
$69,765,000 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.
The Committee eliminates $2,750,000 in discretionary
funding for the Title IV-E Prevention Services Clearinghouse of
evidence-based programs and notes that the Clearinghouse
receives $1,000,000 in dedicated mandatory funding. As
described in the fiscal year 2020 House Report (House Report
116-62), discretionary funding for the Clearinghouse was
intended to be temporary, while Kinship Navigator programs
eligible for Title IV-E reimbursement were identified. The
Clearinghouse has received $17,750,000 in discretionary funding
since fiscal year 2020, and the Committee believes this funding
is no longer necessary.

PAYMENTS TO STATES FOR THE CHILD CARE AND DEVELOPMENT BLOCK GRANT

Appropriation, fiscal year 2024....................... $8,746,387,000
Budget request, fiscal year 2025...................... 8,521,387,000
Committee Recommendation.............................. 8,771,387,000
Change from enacted level........................... +25,000,000
Change from budget request.......................... +250,000,000

The childcare and development block grant provides formula
grants to States, territories, and Tribes to provide financial
assistance to help low-income working families and families
engaged in training or education activities pay for childcare.
The Committee includes new bill language increasing the
Tribal set aside.

SOCIAL SERVICES BLOCK GRANT

Appropriation, fiscal year 2024....................... $1,700,000,000
Budget request, fiscal year 2025...................... 1,700,000,000
Committee Recommendation.............................. 1,700,000,000
Change from enacted level........................... - - -
Change from budget request.......................... - - -

The Social Services Block Grant (SSBG) program provides
formula grants to the 50 States, the District of Columbia,
Puerto Rico, Guam, American Samoa, the U.S. Virgin Islands, and
the Commonwealth of the Northern Mariana Islands. SSBG funding
targets a broad set of goals, including reducing or eliminating
poverty, achieving, or maintaining individual self-sufficiency,
preventing or remedying neglect, abuse, or exploitation of
children and adults, preventing or reducing inappropriate
institutional care, and supporting institutional care, when
appropriate.
Family Resource Centers.--The Committee recognizes that
Family Resource Centers provide direct assistance to families
through parenting support and education, navigation of care and
social services, mental health counseling, early learning and
afterschool activities, family financial planning, and job
training. The Committee supports States' investments in Family
Resource Centers.

CHILDREN AND FAMILIES SERVICES PROGRAMS

Appropriation, fiscal year 2024....................... $14,829,100,000
Budget request, fiscal year 2025...................... 15,052,128,000
Committee Recommendation.............................. 14,709,694,000
Change from enacted level........................... -119,406,000
Change from budget request.......................... -342,434,000

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 provides the following amounts:

------------------------------------------------------------------------
FY 2025
Budget Activity FY 2024 Enacted Committee
------------------------------------------------------------------------
Programs for Children, Youth, and
Families:
Head Start.................... $12,271,820,000 $12,296,820,000
Preschool Development Grants.. 315,000,000 250,000,000
Runaway and Homeless Youth 125,283,000 125,283,000
Program......................
Prevention Grants to Reduce 21,000,000 21,000,000
Abuse of Runaway Youth.......
Child Abuse State Grants...... 105,091,000 105,091,000
Child Abuse Discretionary 36,000,000 32,000,000
Activities...................
Community Based Child Abuse 70,660,000 70,660,000
Prevention...................
Child Welfare Services........ 268,735,000 268,735,000
Child Welfare Research, 21,984,000 21,984,000
Training, and Demonstration..
Adoption Opportunities........ 53,000,000 54,000,000
Adoption and Legal 75,000,000 75,000,000
Guardianship Incentive
Payments.....................
Social Services Research and 35,012,000 - - -
Demonstration................
Native American Programs...... 60,500,000 65,500,000
Community Services Block Grant
Act Programs:
Community Services Block 770,000,000 780,000,000
Grant....................
Community Economic 22,383,000 - - -
Development..............
Rural Community Facilities 12,000,000 13,000,000
National Domestic Violence 20,500,000 20,500,000
Hotline......................
Family Violence Prevention and 240,000,000 245,000,000
Services.....................
Chafee Education and Training 44,257,000 44,257,000
Vouchers.....................
Disaster Human Services Case 1,864,000 1,864,000
Management...................
Program Direction............. 219,000,000 219,000,000
------------------------------------------------------------------------

Head Start

Head Start and Early Head Start programs fund competitive
grants to promote school readiness of children under 5 from
low-income families through preschool services.
Notice to Congressional Offices.--The Committee directs the
agency to notify a congressional office if a current Head Start
recipient in its congressional district will be required to re-
compete to continue its grant. The agency is directed to notify
the office when the grant forecast for the recipient's service
area and funding is published.
Tribal Colleges and Universities Head Start Partnership
Program.--The Committee includes $12,000,000 for the Tribal
Colleges and Universities Head Start Partnership program, which
is an increase of $4,000,000 from the fiscal year 2024 enacted
level.

Preschool Development Grants

The Committee provides $250,000,000 for these competitive
grants to States to improve existing early childhood programs.
This is a decrease from the fiscal year 2024 enacted level but
equal to the fiscal year 2025 President's budget request. This
funding level will allow HHS to provide continuation of funding
for existing grantees and fund the States and territories
eligible to apply for renewal grants.

Runaway and Homeless Youth Program

This program funds competitive grants to provide street
outreach, emergency shelters, and longer-term transitional
living programs to protect and provide supportive services to
runaway and homeless youth.

Prevention Grants to Reduce Abuse of Runaway Youth

This program funds competitive grants to nonprofit agencies
for the purpose of providing street-based services to runaway,
homeless, and street youth who have been subjected to, or are
at risk of being subjected to sexual abuse, prostitution, human
trafficking, sexual exploitation, or other forms of
victimization.

Child Abuse State Grants

This program provides Child Abuse Prevention and Treatment
Act formula grants to States to improve their child protective
service systems.

Child Abuse Discretionary Activities

This funding supports a variety of competitive grants,
including research and demonstration projects on the causes,
prevention, identification, assessment and treatment of child
abuse and neglect, the development and implementation of
evidence-based training programs, and technical assistance to
grantees and communities through national resource centers and
the Child Welfare Information Gateway.
Child Abuse Hotline.--The Committee supports ongoing
efforts to address and support youth and families impacted by
child abuse and neglect. Within the total, the Committee
continues to provide $2,000,000, which is the same as the
fiscal year 2024 enacted level, for broad, ongoing support for
the national child abuse hotline in order to provide resources
and intervention through multiple modalities, including chat,
text, and call, to respond to the urgent needs of youth and
concerned adults facing these challenges.
The Committee does not provide the $4,000,000 needed for
continuation grants for the field-initiated approach to
addressing racial bias, inequity, and disparity project.

Community Based Child Abuse Prevention

This program provides formula grants to States that then
disburse funds to local community-based organizations to
improve local child abuse prevention and treatment efforts.

Child Welfare Services

This program funds formula grants to State and Tribal child
welfare programs for research, monitoring, and special
initiatives to promote positive outcomes for children and
families involved in child welfare.

Child Welfare Research, Training, and Demonstration Projects

This program funds competitive grants to entities that
prepare personnel for work in the child welfare field and those
engaged in research around child welfare issues.
Strengthening State Indian Child Welfare Act Compliance.--
The Committee recognizes the important role State child welfare
agencies play in ensuring the safety of Indian children who
come into contact with the State child welfare system. The
Committee appreciates the work of the Children's Bureau to
support State compliance with the Indian Child Welfare Act
through technical assistance and through grants to develop
strong working relationships between States and Tribes. The
Committee continues to provide $3,000,000, equal to the fiscal
year 2024 enacted level, for State-Tribal partnership grants to
build collaborations between States and Tribes to better
address the ongoing challenges Tribal communities face.
Moreover, the Committee directs the agency to provide the
guidance required in Senate Report 118-84 to the Committee and
make such guidance available on its website.

Adoption Opportunities

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.
Adoption Agencies.--The Committee encourages HHS to
maintain a public list of licensed adoption agencies so that
birth mothers can make decisions based on verified and
trustworthy information. The list of agencies should include
adoption agencies with current State licenses who are in good
standing with the State.
Adoption-Sensitive Care Training.--The Committee continues
to provide $1,000,000, the same as the fiscal year 2024 enacted
level, for a competitive grant program to improve access to
adoption-sensitive care training for eligible hospital staff as
directed in the explanatory statement that accompanied Division
D of P.L. 118-47.
Family First Prevention Services Clearinghouse.--The
Committee continues to direct not less than $2,000,000, the
same as the fiscal year 2024 enacted level, for the evaluation
of programs to support adoption arrangements at risk of a
disruption or dissolution, as directed in Senate Report 118-84.
National Adoption Competency Mental Health Training
Initiative.--The Committee continues to provide $2,000,000, the
same as the fiscal year 2024 enacted level, for the National
Adoption Competency Mental Health Training Initiative.
National Training and Development Curriculum (NTDC).--The
Committee directs HHS to extend the current grant by 12 months
for the NTDC as directed in the explanatory statement that
accompanied Division D of P.L. 118-47.
Support for Birth Parents.--The Committee recognizes that
birth parents who voluntarily place their children for adoption
often benefit from post-adoption counseling, support, and
resources. The Committee provides $1,000,000 for a
demonstration program to provide support groups, resources, and
services to birth parents. Eligible grantees should be
adoption-focused, nonprofit organizations with experience
working with parents who have placed their children for private
domestic adoption. The Committee directs HHS to brief the
Committee no later than 90 days after enactment of this Act on
its plans for carrying out this competition. In addition, the
Committee directs HHS to provide notice to the Committee at
least seven days before awards are announced.

Adoption and Legal Guardianship Incentive Payments

This program provides formula-based incentive payments to
States to encourage them to increase the number of adoptions of
children from the foster care system.

Social Services Research and Demonstration

The Committee does not provide any funding for this
program. The Committee notes that statutory intent of this
program is to support research, evaluation, and demonstration
efforts that address the goals of preventing and reducing
dependency on government programs. However, the funding for
this program has been directed in recent years to create new,
duplicative demonstration programs.

Native American Programs

These programs fund competitive grants to assist Tribal
governments and Native American institutions and organizations
in their efforts to support and develop stable, diversified
local economies. Tribes and nonprofit organizations use funds
to develop and implement sustainable community based social and
economic programs and services to improve the wellbeing of
Native people.
Within the total, the Committee provides $15,000,000 for
Native American language preservation activities, including no
less than $6,000,000 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 Block Grant Act Programs

Community Services Block Grant.--This Program provides
formula grants to States to alleviate the causes and conditions
of poverty in communities.
Rural Community Facilities.--Rural Community Development is
a competitive grant program that works with regional and Tribal
organizations to manage safe water systems in rural
communities. Under this program's technical assistance
authority, grant recipients can provide assistance to residents
in unserved and underserved populations, including isolated,
unincorporated communities, small, low-income communities that
cannot afford loan/grant financing, and those that lack central
systems and are therefore not regulated under the Clean Water
Act or Safe Drinking Water Act.
Community Economic Development.--Due to budget constraints,
the Committee does not provide funding for these competitive
grants.

National Domestic Violence Hotline

The National Domestic Violence Hotline provides 24-hour,
toll-free and confidential services immediately connecting
callers to local service providers.
Religious Communities.--Individuals in religious
communities experience unique challenges in assessing
appropriate domestic violence resources and support. The
Committee provides $250,000 for the domestic violence hotline
to evaluate and expand its list of resources for contacts from
religious communities.

Family Violence Prevention and Services

The Family Violence Prevention and Services Act (FVPSA)
programs provide funding to support the prevention of incidents
of family violence, domestic violence, and dating violence, and
provide the immediate shelter and supportive services for adult
and youth victims.
Addressing Domestic Violence in Religious Communities.--The
Committee recognizes the unique challenges experienced by
individuals in religious communities, especially populations
underserved because of their religious beliefs, in accessing
appropriate domestic violence services and supports. The
Committee supports the work that FVPSA Resource Centers are
doing to improve outreach to faith-based communities.

Chaffee Education and Training Vouchers

This program funds formula grants to States to provide
vouchers to youth who are, or were formerly, in foster care for
expenses related to post-secondary education assistance, and
vocational training.

Disaster Human Services Case Management

This funding supports work at HHS addressing human service
preparation for, response to, and recovery from, natural
disasters.

Program Direction

This funding supports Federal administrative costs
associated with administering the agency's programs.
Temporary Assistance for Needy Families Rulemaking.--The
Committee is concerned that HHS's October 2, 2023, proposed
rule (Strengthening Temporary Assistance for Needy Families
(TANF) as a Safety Net and Work Program (88 Fed. Reg. 67697))
threatens funding for crisis pregnancy centers. The Committee
encourages HHS to ensure continued funding for pregnancy
centers in any final rulemaking. These centers are a critical
part of the safety net for pregnant and parenting women and
offer a wide range of services including providing material
support free-of-charge, aiding clients in developing critical
life skills to gain economic self-sufficiency, providing sexual
risk avoidance education and sexual integrity counseling, and
offering or referring for both marriage enrichment and
relationship counseling.
TANF Pilot Projects.--The Committee directs HHS to provide
notice to the committees of jurisdiction of the States selected
to participate in the TANF pilot projects authorized under
section 302 of the Fiscal Responsibility Act (P.L. 118-5) at
least seven days prior to public release.

PAYMENTS FOR FOSTER CARE AND PERMANENCY

Appropriation, fiscal year 2024....................... $8,594,000,000
Budget request, fiscal year 2025...................... 6,768,000,000
Committee Recommendation.............................. 6,768,000,000
Change from enacted level........................... -1,826,000,000
Change from budget request.......................... - - -

The Committee also provides an advance appropriation of
$3,600,000,000 for the first quarter of fiscal year 2026 to
ensure timely completion of first-quarter grant awards.
Foster Youth and the Pediatric Care System.--The Committee
directs the agency to include information in its fiscal year
2026 congressional justification detailing its ongoing inter-
agency collaboration with CMS and SSA to ensure that youth
aging out of foster care with medically-complex or special
needs undergo a smooth transition out of the pediatric care
system.
Within the total, the Committee provides $4,796,000,000 for
the Foster Care program. This mandatory program provides funds
to States for foster care maintenance payments for children
living in foster care. These funds also reimburse States for
administrative costs to manage the program and training for
staff and parents.
Within the total, the Committee provides $4,659,000,000 for
Adoption Assistance. This mandatory program provides funds to
States to subsidize families who adopt children with special
needs, such as older children, a member of a minority or
sibling group, or children with physical, mental, and emotional
disabilities. In addition, the program provides training for
adoptive parents and State administrative staff. This annually
appropriated entitlement provides alternatives to long,
inappropriate stays in foster care by developing permanent
placements with families.
Within the total, the Committee provides $365,000,000 for
the Kinship Guardianship Assistance program. This mandatory
program provides subsidies to a relative taking legal
guardianship of a child for whom being returned home, or
adoption are not appropriate permanency options.
Finally, within the total, the Committee provides
$143,000,000 for the Independent Living program. This mandatory
program assists foster children age 16 or older make successful
transitions to independence. Funds support a variety of
services, including educational assistance, career exploration,
vocational training, job placement, life skills training, home
management, health services, substance abuse prevention,
preventive health activities, and room and board. Each State
receives funds based on the number of children on whose behalf
the State receives Federal Foster Care Payments.

Administration for Community Living

AGING AND DISABILITY SERVICES PROGRAMS

Appropriation, fiscal year 2024....................... $2,548,042,000
Budget request, fiscal year 2025...................... 2,634,043,000
Committee Recommendation.............................. 2,498,109,000
Change from enacted level........................... -49,933,000
Change from budget request.......................... -135,934,000

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 provides $415,000,000 for Home and Community-
Based Supportive Services, which is an increase of $5,000,000
from the fiscal year 2024 enacted level. This program provides
formula grants to States and territories to fund a wide range
of social services that enable seniors to remain independent in
their homes for as long as possible.

Preventive Health Services

The Committee provides $26,339,000 for Preventive Health
Services, which is equal to fiscal year 2024 enacted level.
This program funds formula grants to States to help seniors
remain healthy and avoid chronic diseases. Funding supports a
variety of healthy aging programs aimed to reduce disease and
prevent injuries, including evidence-based programs to address
the risk of falls, chronic diseases, mental health, and
medication management.

Protection of Vulnerable Older Americans

The Committee provides $26,658,000 for activities to
protect vulnerable older Americans, which is equal to the
fiscal year 2024 enacted level. These programs provide formula
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 continues to provide $21,885,000 for the
Long-Term Care Ombudsman program. This program works to improve
the quality of life and care for individuals who reside in
long-term care facilities. Ombudsmen work to ensure residents
understand their care options and that strong beneficiary
support systems are in place in all settings.

Family Caregivers

The Committee provides $210,000,000 for the National
Caregiver Support program, which is an increase of $3,000,000
from the fiscal year 2024 enacted level. This program offers a
range of support services to family caregivers, including
assistance in accessing services such as respite care,
counseling, support groups, and caregiver training.

Native American Caregivers Support

The Committee provides $16,000,000 for the Native American
Caregivers Support program, which is an increase of $4,000,000
from the fiscal year 2024 enacted level. This program provides
formula grants to Tribes for the support of American Indian,
Alaskan Native, and Native Hawaiian families caring for older
relatives with chronic illness or disabilities.

Nutrition

The Committee provides a total of $1,041,684,000 for senior
nutrition. This is an overall decrease from the fiscal year
2024 enacted level. Funding for this population is also
available from the Department of Agriculture. The
recommendation includes $543,342,000 for Congregate Meals and
$366,342,000 for Home Delivered Meals, a decrease from the
fiscal year 2024 enacted levels but equal to the fiscal year
2023 enacted levels, and $132,000,000 for the Nutrition
Services Incentives program, an increase of $20,000,000 from
the fiscal year 2024 enacted level. These programs provide
older Americans with 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.
Collaboration with the Department of Agriculture.--The
Committee encourages ACL to deepen collaborations directly with
the Department of Agriculture's Senior Farmers Market Nutrition
Program to ensure seniors can continue to access locally grown
fresh fruits and vegetables while also assisting local
agricultural producers.

Grants for Native Americans

The Committee provides $42,264,000 for Native American
Nutrition and Supportive Services, which is an increase of
$4,000,000 from the fiscal year 2024 enacted level. This
program provides formula 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 provides $21,796,000 for Aging Network
Support Activities, which is a decrease from the fiscal year
2024 enacted level. This program supports activities that
expand public understanding of aging and the aging process.
The Committee does not provide funding for Care Corps, the
Direct Care Workforce Demonstration, or the Older Adult Equity
Collaborative.
Holocaust Survivor Assistance Program.--The Committee
provides $8,500,000, which is equal to the fiscal year 2024
enacted level, for the Holocaust Survivor Assistance program.
This program provides supportive services for aging Holocaust
survivors living in the U.S.
Interagency Coordinating Committee on Healthy Aging and
Age-Friendly Communities.--The Committee continues to provide
$1,000,000 for this effort.
Research, Demonstration, and Evaluation Center for the
Aging Network.--The Committee continues to provide $5,000,000
for the Research, Demonstration, and Evaluation Center for the
Aging Network.

Alzheimer's Disease Program

The Committee provides $31,500,000 for the Alzheimer's
disease program, which is equal to the fiscal year 2024 enacted
level. 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 Committee provides no less than $2,000,000 for the
National Alzheimer's Call Center.

Lifespan Respite Care

The Committee provides $10,000,000 for Respite Care, which
is equal to the fiscal year 2024 enacted level. The program
funds competitive grants to ease the burdens of caregiving by
providing grants to eligible State organizations to improve the
quality of, and access to, respite care for family caregivers.

Chronic Disease Self-Management Program

The Committee provides $8,000,000 for the Chronic Disease
Self-Management program, which is equal to the fiscal year 2024
enacted level. This program funds competitive grants and
cooperative agreements to support 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 Falls Prevention

The Committee provides $7,500,000 for the Falls Prevention
program, which is equal to the fiscal year 2024 enacted level.
Falls prevention competitive grants and cooperative agreements
support the promotion and dissemination of prevention tools
delivered in community settings.
White House Conference on Aging.--The Committee recognizes
that falls are the top cause of fatal and non-fatal injury
among adults over 65. The Committee encourages ACL to
incorporate the topic of elderly falls, including risk factors
and evidence-based prevention strategies, within the 2025 White
House Conference on Aging, including risk factors, evidence-
based prevention strategies, and the cost effectiveness of
policies such as home modification coverage, payments for
physicians to conduct comprehensive fall risk assessments, and
community-based fall prevention programs.

Elder Rights Support Activities

The Committee provides $18,874,000 for Elder Rights Support
Activities, which is a decrease from the fiscal year 2024
enacted level. These programs support efforts that provide
information, training, and technical assistance to legal and
aging services organizations working to prevent and detect
elder abuse and neglect.
The Committee provides no funding for the State Adult
Protective Services formula grant program. This program was
first funded in the American Rescue Plan (P.L. 117-2).

Aging and Disability Resource Centers

The Committee provides $8,619,000 for Aging and Disability
Resource Centers (ADRCs), which is equal to the fiscal year
2024 enacted level. These centers provide information,
counseling, and access for individuals to learn about the
services and support options available to seniors and the
disabled so they may retain their independence.

State Health Insurance Assistance Program

The Committee recommends $55,242,000 for the State Health
Insurance Assistance Program, which is equal to the fiscal year
2024 enacted level. The State Health Insurance Assistance
Program funds grants to provide Medicare beneficiaries with
information, counseling, and enrollment assistance.

Paralysis Resource Center

The Committee provides $10,700,000 for the Paralysis
Resource Center, which is equal to the fiscal year 2024 enacted
level. 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 provides $4,200,000 for the Limb Loss
Resource Center, which is equal to the fiscal year 2024 enacted
level. 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 provides $16,118,000 for the Traumatic Brain
Injury program. The Committee provides an increase of
$3,000,000 from the fiscal year 2024 enacted level for the
State Protection and Advocacy Systems State formula grants. The
program provides grants to States for the development of a
comprehensive, coordinated family and person-centered service
system at the State and community level for individuals who
sustain a traumatic brain injury.

Developmental Disabilities State Councils

The Committee provides $81,000,000 for State Councils on
Developmental Disabilities, which is equal to the fiscal year
2024 enacted level. This program funds formula grants to States
to Developmental Disabilities State Councils, which work to
develop, improve, and expand the system of services and
supports for people with developmental disabilities.
The Committee provides not less than $800,000 for technical
assistance and training for the State Councils on Developmental
Disabilities.

Developmental Disabilities Protection and Advocacy

The Committee provides $45,000,000 for Developmental
Disabilities Protection and Advocacy, which is equal to the
fiscal year 2024 enacted level. This formula grant program
provides funding to States to establish and maintain protection
and advocacy systems to protect the legal rights of persons
with developmental disabilities.
The Committee notes that the Supreme Court decision in
Olmstead v. L.C. (1999) held that the Americans with
Disabilities Act (ADA) does not require removing individuals
from institutional settings when they are unable to handle or
benefit from a community-based setting and that the ADA does
not require the imposition of community-based treatment on
individuals who do not desire it. The Committee notes that
actions to undermine and 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 encourages HHS to ensure
that programs properly account for the needs and desires of
individuals with disabilities, their families, legal
representatives and caregivers, and the importance of affording
individuals the proper setting for their care.
The Committee recognizes that the ADA encourages states to
administer services for people with Intellectual and
Developmental Disabilities (IDDs) in the most integrated
setting appropriate to the needs of qualified individuals with
IDDs. Further, the Committee understands that while center-
based work is not appropriate for every individual with a
disability, center-based adult work programs chosen by
individuals with severe IDDs and their families remain a viable
choice that can provide dignity and purpose for a significant
percentage of the IDD population. These work and service
settings have been determined to be rewarding and appropriate
by the individuals and family members directly involved in the
decision-making process, and the Committee is concerned that
some organizations receiving funding under the Developmental
Disabilities Assistance and Bill of Rights Act have targeted
these setting for closure. The Committee encourages ACL to
encourage stakeholders to coordinate to ensure that individuals
with IDDs appropriately suited to participate in center based
work programs are not deprived of the opportunity to do so.

Developmental Disabilities Voting Access for Individuals with
Disabilities

The Committee provides $10,000,000 for Voting Access for
Individuals with Disabilities program, which is equal to the
fiscal year 2024 enacted level. The Voting Access for
Individuals with Disabilities program authorized by the Help
America Vote Act provides formula grants to States 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 provides $12,250,000 for Developmental
Disabilities Projects of National Significance, which is equal
to the fiscal year 2024 enacted level. This program funds
grants and contracts that develop new technologies and
demonstrate innovative methods to support the independence,
productivity, and integration of those living with a disability
into the community.

University Centers for Excellence in Developmental Disabilities

The Committee provides $43,119,000 for University Centers
for Excellence in Developmental Disabilities, which is equal to
the fiscal year 2024 enacted level. The University Centers for
Excellence in Developmental Disabilities Education, Research,
and Service are a nationwide network of independent but
interlinked centers, funded via competitive grants,
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 provides $128,183,000 for the Independent
Living program, which is equal to the fiscal year 2024 enacted
level. Independent Living programs fund grants to maximize the
leadership, empowerment, independence, and productivity of
individuals with disabilities.

National Institute on Disability, Independent Living, and
Rehabilitation Research

The Committee provides $119,000,000 for the National
Institute on Disability, Independent Living, and Rehabilitation
Research (NIDILRR), which is equal to the fiscal year 2024
enacted level. NIDILRR generates knowledge and promotes its
effective use to enhance the abilities of people with
disabilities to perform activities of their choice in the
community and to expand society's capacity to provide full
opportunities for its citizens with disabilities.
The Committee continues to support the Traumatic Brain
Injury Model Systems National Data and Statistical Center at no
less than the fiscal year 2024 enacted level.

Assistive Technology

The Committee provides $40,000,000 for Assistive Technology
(AT), which is equal to fiscal year 2024 enacted level. AT
supports programs providing formula grants to States for
addressing AT needs of individuals with disabilities. The goal
is to increase awareness of and access to AT 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 provides $49,063,000 for Program
Administration, which is an increase of $1,000,000 from the
fiscal year 2024 enacted level. This funding supports Federal
administrative costs associated with administering ACL's
programs.

Administration for Strategic Preparedness and Response

Appropriation, fiscal year 2024....................... $3,634,606,000
Budget request, fiscal year 2025...................... 3,768,088,000
Committee Recommendation.............................. 3,630,597,000
Change from enacted level........................... -4,009,000
Change from budget request.......................... -137,491,000

This account supports the activities of the Administration
for Strategic Preparedness and Response (ASPR) to prevent,
prepare for, and respond to the health consequences of
chemical, biological, radiological, and nuclear threats and
other public health emergencies, including pandemic influenza.
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.
Active Pharmaceutical Ingredients.--The Committee remains
concerned that the U.S. is dependent on foreign sources for
critical raw materials and manufacturing of essential
medicines, including antivirals. The Committee is aware of the
need to onshore critical raw materials and invest in companies
through public-private partnerships for domestic manufacturing
of essential medicines. Therefore, the Committee encourages
ASPR to prioritize funding for companies that are investing in
domestic manufacturing of medicines, especially products
dependent on China for sourcing of raw materials. Additionally,
within 180 days of enactment of this Act, the Committee directs
ASPR to provide a report to Committee on the progress of
onshoring investments to establish a resilient domestic supply
chain for medicines, including antivirals.
Domestic Antibiotic Manufacturing.--The Committee
recognizes the importance of the domestic pharmaceutical
industrial base and the need to mitigate risks to the U.S.
pharmaceutical supply chain, which is heavily reliant on
foreign suppliers for critical drugs and active pharmaceutical
ingredients, including generic antibiotics. Therefore, the
Committee encourages ASPR, in coordination with the Secretary
of Defense, to jointly implement a plan to evaluate the end-to-
end supply chain for the biomanufacturing of fermentation-based
essential antibiotics to ensure necessary domestic
manufacturing capacity.
Essential Medical Devices.--The Committee supported BARDA's
investments to accelerate the expansion of domestic
manufacturing capacity for ancillary supplies like needles and
syringes during the COVID pandemic. However, to continue to
ensure Americans have the essential medical devices necessary,
the Committee encourages a more concerted effort to shore up
domestic production and the U.S. supply chain. The Committee
encourages the Office of Industrial Base Management and Supply
Chain (IBMSC) to advance programs and policies that preserve
and protect U.S. based manufacturing for essential medical
devices.
Interagency Alignment of Biomedical Countermeasures
Research and Development.--The Committee has prioritized
investments in research and development of biodefense medical
countermeasures to better prepare our country to detect and
respond to biological threats. While funding for such
priorities currently is allocated to different HHS agencies
based on their missions and areas of expertise, the Public
Health Emergency Medical Countermeasures Enterprise Advisory
Committee (PHEMCE) is responsible for ensuring the alignment of
medical countermeasures requirements, priorities, and projects
across these agencies. To improve alignment and efficiency of
research and development activities, the Committee directs ASPR
to establish a formal mechanism to identify and track the
alignment of medical countermeasure research and development
programs of each relevant agency, while tracking them against
prioritized national biodefense countermeasure needs to ensure
the end-to-end development of needed products, technologies, or
platforms; track previous and future transitions of development
projects between agencies to ensure seamless and properly
resourced end-to-end development programs; and identify areas
of continually unmet research and development needs. The
Committee encourages ASPR to coordinate with the Departments of
Defense, Energy, and Homeland Security regarding similar
research and development programs.
The Committee further encourages ASPR to prioritize
research and development programs that focus on early-stage
development and innovative platform-based technologies that can
yield multiple products to address multiple threats. Finally,
the Committee directs ASPR to make public relevant information
on HHS-funded research and development programs, including
development stages and target disease area. The Committee
directs ASPR to provide a report on the status of this effort
within 180 days of enactment of this Act and to include such
information in the fiscal year 2026 congressional
justification.
Interagency Coordination.--The Committee encourages ASPR,
in coordination with DOD, to provide technical expertise to
FDA's Center for Biologics Evaluation and Research, as they
further countermeasures for combatting emerging pathogens.
Neglected Tropical Diseases.--The Committee is aware of the
increasing prevalence of neglected tropical diseases (NTDs) in
the U.S. and the staggering global burden of these threats
across the globe and is encouraged by the granting of more than
11 priority review vouchers for new NTDs interventions.
Considering the magnitude of the NTD threat, the Committee
directs ASPR to provide a report within 180 days of the
enactment of this Act addressing whether additional incentives
to redress market failures hindering antimicrobial innovation,
are needed to stimulate NTD research and development. Such
report shall be made available on the agency's website.
Multiyear Budget.--The Committee notes that 42 U.S.C.
300hh-10 requires annual updates to the PHEMCE multiyear
budget. The Committee appreciates the timely delivery of the
fiscal year 2025 multiyear budget. The Committee continues to
direct ASPR to notify the Committee 14 days in advance of any
anticipated delay.
Public Health Emergency Medical Countermeasures Enterprise
Advisory Committee.--The committee recognizes effective public-
private partnerships are the best way to support our nation's
preparedness and response capabilities, as these private sector
partners are the primary developers of critical medical
countermeasures (MCMs) such as diagnostics, therapeutics, and
vaccines which have no commercial market. The Committee notes
with concern that the PHEMCE, which is chaired by ASPR, has not
established an advisory committee incorporating private sector
and non-Federal partners and stakeholders despite
recommendations from Congress and NASEM. The Committee
encourages ASPR to establish this advisory committee with
urgency to ensure timely and transparent communication with the
government's private sector partners.
Rapid Detection of Bioterrorism Agents.--The Committee is
concerned that the nation is not prepared to rapidly detect
biological agents, such as anthrax, tularemia, melioidosis,
glanders, and plague, even though Biomedical Advanced Research
and Development Authority (BARDA) has successfully supported
development of diagnostic technologies that detect such
biothreats, in some cases simultaneously. The Committee
encourages ASPR, in coordination with CDC, to prioritize
partnerships with domestic manufacturers capable of producing
rapid diagnostics that can detect such threats and develop a
diagnostic testing preparedness plan for use during public
health emergencies, disasters, and other serious public health
threats.
Reporting.--The Committee directs ASPR to brief the
Committee monthly regarding activities funded by this Act and
other available appropriations. The agency is directed to
notify the Committee at least 24 hours in advance of any
obligation greater than $25,000,000 from any appropriation
available to ASPR. Such notification is directed to include the
source of funding, including the applicable legislative
citation, and a description of the obligation. In addition,
ASPR is directed to submit a monthly obligation report in
electronic format summarizing the details of these obligations
to the Committee. ASPR is further directed to provide the
report no later than 30 days after the end of each month and it
is directed to be cumulative for the fiscal year with the most
recent obligations listed at the top.
Strengthening Domestic Manufacturing and Production.--The
Committee appreciates efforts by ASPR to expand upon the
domestic industrial base to end the reliance on foreign-sourced
medical equipment, personal protective equipment (PPE),
diagnostic tests, medical devices, and to secure the pipeline
for critical medicines, including antibiotics, such as through
the National Biopharmaceutical Manufacturing Partnership
(BioMaP) and Industrial Base Expansion. The Committee
encourages IBMSC to use available funds to continue and expand
ongoing work to build and validate advanced manufacturing
processes and facilities capable of storing, producing, and
deploying essential medicines in the event of a national health
emergency. Further, the Committee encourages IBMSC to seek
opportunities to expand domestic manufacturing facilities with
end-to-end capabilities to produce bulk drug substances,
support platform technologies for MCMs, and provide fill-finish
capacity. The Committee encourages ASPR to use available funds
to support manufacturers in building, expanding, upgrading,
modifying, and, if necessary, recommissioning facilities in the
U.S. to increase manufacturing capacity of critical medicines
or their active pharmaceutical ingredients.
The Committee directs ASPR to brief the Committees on
Appropriations of the House of Representatives and the Senate,
the Committee on Energy and Commerce of the House of
Representatives, and the Committee on Health, Education, Labor,
and Pensions of the Senate within 180 days of enactment of this
Act, with an update on IBMSC efforts including programs,
projects, and activities underway designed to ensure
appropriate domestic supply, including domestic manufacturing,
of essential medical equipment, PPE, diagnostic tests, medical
devices, and critical medicines.
Vaccine Manufacturing.--The Committee recognizes the
potential benefits of developing innovative continuous vaccine
manufacturing processes and technology. The Committee
encourages ASPR to support research in developing continuous
downstream purification processes including two aqueous two-
phase extraction steps as necessary.

RESEARCH, DEVELOPMENT, AND PROCUREMENT

Appropriation, fiscal year 2024....................... $3,135,000,000
Budget request, fiscal year 2025...................... 3,082,991,000
Committee Recommendation.............................. 3,277,991,000
Change from enacted level........................... +142,991,000
Change from budget request.......................... +195,000,000

Biomedical Advanced Research and Development Authority

The Committee includes $1,100,000,000 for the Biomedical
Advanced Research and Development Authority, which is
$85,000,000 above the fiscal year 2024 enacted level and
$130,000,000 above the fiscal year 2025 budget request. BARDA
supports the advanced development of vaccines, therapeutics,
diagnostics, and devices for potential serious public health
threats, including chemical, biological, radiological, and
nuclear threats, pandemic influenza, and emerging and re-
emerging infectious diseases. The Committee supports ASPR's
ongoing work to build and validate advanced manufacturing
processes and facilities capable of storing, producing, and
deploying essential medicines in the event of a national health
emergency.
Antifungal Research and Development.--The Committee
continues to support the research and development of novel
antifungal therapies, particularly for multi-drug resistant
fungal pathogens, to bolster national health security and
minimize their impact on public health. Antifungal development
faces similar challenges to antibacterial development and
BARDA's Advanced Research and Development program support will
be critical to generate additional antifungal products,
including for endemic fungal diseases, like Valley Fever. In
addition, the Committee encourages the Secretary to update the
scope of support for the CARB-X program to include pathogens
listed in the 2019 CDC Antibiotic Resistant Threats report,
which includes products that target fungal pathogens. The
Committee requests a report within the 180 days of the date of
enactment of this Act on actions taken.
Acceleration of Antibiotic Combination Drug Development.--
The Committee is concerned about the increasing public health
threat of antimicrobial resistance and the lack of new
antibiotics entering the market. The Committee is encouraged
that BARDA has invested in combination antibiotic drug
development for both oral and intravenous administration.
Therefore, the Committee encourages BARDA to continue to
prioritize the development of combination drugs, particularly
those with activity against CDC urgent threat pathogens which
can offer increased efficacy, reduced costs, and reduce the
emergence of AMR infections.
Antimicrobial Resistance.--The Committee continues to
support advanced research and development of broad-spectrum
antimicrobials, particularly for multi-drug resistant
pathogens, and next-generation therapeutics that address the
increasing incidence of antimicrobial resistance, including
Combating Antibiotic-Resistant Bacteria Biopharmaceutical
Accelerator (CARB-X).
Chemical, Biological, Radiological, and Nuclear Threats.--
The Committee notes with concern the elevated risk posed by
chemical, biological, radiological, and nuclear (CBRN) weapons
across the globe and provides robust funding for BARDA's core
national security mission to protect Americans against these
deliberate, man-made threats. The Committee directs ASPR to
provide, within 180 days of enactment of this Act, a report on
the Rapid Response Partnership Vehicle (RRPV). The Committee
encourages ASPR and BARDA to engage more frequently with
private sector partners via the RRPV process to ensure adequate
prioritization, timely development of new MCMs and stockpiling
of existing MCMs against CBRN threats.
Drug Resistant Tuberculosis.--Drug resistant TB is
identified as a serious threat level pathogen to the U.S. by
CARB-X. As drug resistant TB cases are on the rise globally,
the threat to the U.S. also grows and BARDA's investment in new
TB diagnostics, drugs, and vaccines is critical. The Committee
directs ASPR to provide a briefing on BARDA's investments in
drug resistant diseases including TB within 180 days of the
enactment of this Act.
Infectious Disease Outbreaks with Pandemic Potential.--The
Committee supports robust funding for BARDA to engage in
public-private partnerships to support advanced research and
development of innovative platform technologies and medical
countermeasure programs focused on vaccines, therapeutics, and
other medical countermeasures for emerging infectious diseases,
including novel pathogens and viral families with pandemic
potential. The Committee encourages ASPR to prioritize the
identification and development of promising technologies that
can be leveraged to address a range of future pathogens,
including virus families with significant pandemic potential.
Pathogen Reduction Technologies.--The Committee urges BARDA
to continue investments in red blood cell pathogen reduction
technology to ensure the completion of urgently needed nucleic
acid targeted pathogen reduction technology to significantly
improve red blood cell transfusion safety for all blood
products in the nation's blood supply.
Pharmaceutical Platform Technologies.--The Committee
encourages BARDA to support the research, development, and
facilitation of pharmaceutical platform technologies. The
Committee notes that platform technologies supported by strong
data production and computer power provide flexible systems for
the discovery of novel cures at a much faster rate and a lower
cost than traditional pharmaceutical discovery processes across
a broad array of disease targets. Furthermore, the Committee
recognizes the potential for machine learning, artificial
intelligence, and high throughput systems to improve the
development of foundational models. The Committee encourages
BARDA to partner with domestic entities to bolster domestic
capacity to respond to a variety of new threats more
efficiently in the future.
Radiological and Nuclear Threats.--The Committee supports
BARDA's effort to develop MCMs effective against radiological
and nuclear threats and encourages BARDA to support innovative
radioprotective technologies to enhance the nation's
preparedness and response capabilities by supporting the
advancement of novel therapeutic agents that mitigate the
effects of radiation exposure.
Sustainable Blood Supply and National Blood Response
Capability.--The Committee remains concerned regarding the
continued vulnerability of the blood supply after the peak
COVID shortages and receiving the report from the HHS Advisory
Committee on Blood and Tissue Safety and Availability. That
report indicated that, ``the continued availability of a robust
blood supply faces significant threats and challenges in the
current environment,'' and recommended the ``implementation of
new technologies to improve the safety and reliability of the
blood supply.'' The Committee encourages BARDA to meet its
strategic objective of developing next generation blood
products by including products that can be used regardless of
the patient's blood group, expand availability to all
hospitals, prevent shortages, and are suitable for use
throughout the continuum of care, including first responders.
The Committee encourages ASPR to rapidly expand the development
of freeze-dried hemostatic products, especially platelet-
derived products, to include a wide range of indications
encompassing treatment of hemorrhagic disease, use in general
surgery, obstetrics and trauma.
Strengthening Domestic Supply Chain Resiliency.--The
Committee appreciates ASPR taking steps to strengthen our
nation's medical countermeasure enterprise, including through
BioMaP and BARDA's Pharmaceutical Countermeasures
Infrastructure (PIC) Division, and supports efforts to expand
domestic manufacturing infrastructure for medical
countermeasures. Given the global nature of certain clinical
research, development, and manufacturing activities, it is
critical for BARDA to strengthen, expand, and make progress in
onshoring these programs. Within 180 days of enactment of this
Act, ASPR is directed to brief the Committee on ASPR's fiscal
year 2025 plans to support the onshoring of medical
countermeasure development activities, including actions taken
by BioMAP and PIC.

Project BioShield

The Committee provides $850,000,000 for Project BioShield,
which is $25,000,000 above the fiscal year 2024 enacted level
and $30,000,000 above the fiscal year 2025 budget request.
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 provides $1,000,000,000 for the Strategic
National Stockpile, which is $20,000,000 above the fiscal year
2024 enacted level and $35,000,000 above the fiscal year 2025
budget request.
Addressing Domestic Personal Protective Equipment
Purchasing.--The Committee recognizes the COVID pandemic
highlighted both the vulnerability and necessity of maintaining
a robust domestic supply of PPE. It is critical the U.S.
maintain a robust domestic production base. Doing so is vital
for both the national security interests and protection of
public health in the face of international infectious disease
threats. The Committee strongly recommends ASPR allocate not
less than 10 percent of the budget of the Strategic National
Stockpile (SNS) for the purchase of domestically manufactured
personal protective equipment. In addition, the Committee
directs ASPR to submit a report within 90 days of enactment of
this Act for all PPE purchases for the prior fiscal year and
current levels of each type of PPE in the SNS, including expiry
dates.
The Committee includes a new provision prohibiting ASPR
from purchasing MCMs from Chinese owned company.
Antimicrobial Resistance Class Review.--The Committee
encourages the ASPR, in coordination with FDA and CDC, to
implement a review system to regularly assess the safety,
efficacy, and vulnerability to antimicrobial resistance of
existing SNS assets that could be used to respond to CBRN and
public health threats and to support efforts to maintain an
inventory of medical countermeasures appropriate to respond to
the continued evolution of antimicrobial resistant organisms.
Guidance to States.--The Committee recognizes that SNS
focuses on chemical, biological, radiological, and nuclear
threats, and therefore the Committee supports States' efforts
to secure appropriate drugs, vaccines, and other biological
products, medical devices, and other medical supplies necessary
to respond to a public health emergency or a major disaster.
The Committee recognizes the importance of guidance to States
on how best to establish, expand, procure, replenish, maintain,
and manage their own State stockpile, while ensuring
appropriate collaboration with the SNS. ASPR is directed to
provide a briefing to the committees of jurisdiction within 180
days of enactment of this Act on guidance and technical
assistance related to State stockpiles.
Influenza MCM Diversification.--The Committee remains
concerned about the perennial threat of pandemic influenza,
which could be exacerbated by expiring antivirals in the
Strategic National Stockpile. The Committee strongly urges HHS
to diversify and replenish its stockpile of emergency influenza
antivirals to ensure the nation has multiple current treatment
options in the event of an influenza pandemic.
Pending Product Expiration.--The Committee directs ASPR to
provide a report within 180 days of enactment of this Act,
regarding agency awareness, planning, and utilization of
products that have expired or will expire within 18 months.
Persistent Procurement Challenges.--The Committee is
concerned about the Strategic National Stockpile's procurement
process that has been mired by successful bid protests,
repeated unanswered sources sought notices, and misuse of sole
source awards under GAO determined faulty pretexts. The
Committee has invested in efforts to bolster that nation's
medical countermeasure preparedness against health security
threats, especially for those chemical, biological,
radiological, and nuclear countermeasures that lack a
traditional marketplace. The Committee directs ASPR to have an
independent outside audit performed to improve the procurement
process and align strategic preparedness with CBRN threats. The
Committee further directs ASPR to provide a briefing on the
implementation of this directive within 180 days of the
enactment of this Act.
Poxvirus Countermeasures.--The Committee notes that
Administration decisions, including the decision to ship
vaccine oversees, has depleted medical countermeasures that
were previously developed, purchased, and stockpiled for
domestic smallpox preparedness. The Committee is concerned
there may now be an insufficient supply of poxvirus vaccine for
immunocompromised individuals as well as poxvirus treatments in
the stockpile, especially considering the continued national
security threat of an intentional or accidental release of
smallpox. Therefore, the Committee encourages ASPR to
prioritize replenishment of medical countermeasures used during
the monkey pox outbreak and directs ASPR to provide a briefing
within 90 days of the date of enactment of this Act on the
stockpiling requirements for poxvirus vaccine.
Shelf-Life Extension Program.--The Committee acknowledges
the benefits of the Shelf-Life Extension Program (SLEP) and
takes into consideration public skepticism of certain
countermeasures in the program. In the annual SNS threat-based
review, the Committee encourages ASPR to include the quantity
of each countermeasure that is beyond 10 years of the initial
FDA expiration date and the number of these aged products in
the SLEP program that have no industry sponsor.
Security Countermeasures Modeling.--The Committee believes
that robust quantitative modeling tools will help ensure ASPR
is addressing the most significant threats to national security
and implementing the most impactful and cost effective
solutions. To build quantitative and economics analytics and
modeling capabilities that effectively evaluate medical
countermeasure programs, the Committee directs ASPR to provide
a detailed analysis of the resources required and their
potential deployment in the fiscal year 2026 congressional
justification.
SNS Requirements.--The Committee notes with concern the
Medical Countermeasure Preparedness Report, submitted to
Congress as part of the required annual threat based review of
SNS, found that SNS has not maintained adequate supplies of
many medical countermeasures to reflect requirements
established by PHEMCE. In addition, GAO has recently upheld
multiple bid protest decisions evidencing a concerning lack of
quality control in the contract solicitation and review
process. Therefore, the Committee directs ASPR, within 180 days
of the enactment of this Act, to provide a report on processes
put in place to better ensure adherence to all Federal
contracting requirements.
Thermal Radiation Burns.--The Committee notes ASPR has the
responsibility of developing and procuring MCMs for naturally
occurring and intentional threat agents while ensuring that
these are quickly available in the event of an emergency, and
that these threats include nuclear and radiological events. The
Committee encourages ASPR to ensure that an appropriate supply
of these MCMs are available.
Warm Base Manufacturing for Diagnostics.--The Committee
remains concerned the COVID pandemic has demonstrated the need
for warm base manufacturing to ensure access to necessary
diagnostics in the event of a future pandemic. The Committee
encourages ASPR to continue to support the investments for
testing, supply chain, and surge capacity for U.S. diagnostic
manufacturing to maintain U.S. readiness and future
preparedness. Further, the Committee encourages ASPR to promote
policies for flexible contracting to improve public health.

Pandemic Influenza Preparedness

The Committee includes $327,991,000, for the pandemic
influenza preparedness program. This funding supports efforts
to modernize influenza research and development of vaccines and
preparedness testing and evaluation, as well as critical
domestic vaccine manufacturing infrastructure.
The Committee encourages ASPR to support the development of
pandemic influenza therapeutics and vaccines to ensure a robust
pipeline of influenza countermeasures.

OPERATIONS AND EMERGENCY RESPONSE

Appropriation, fiscal year 2024....................... $499,606,000
Budget request, fiscal year 2025...................... 685,097,000
Committee Recommendation.............................. 352,606,000
Change from enacted level........................... -147,000,000
Change from budget request.......................... -332,491,000

Office of Administration & Preparedness and Emergency Operations

The Committee includes $80,407,000 for activities within
the Assistant Secretary's Immediate Office; the Office of the
Chief Operating Officer; the Office of Acquisitions Management,
Contracts, and Grants; the Office of Financial Planning and
Analysis; and for Preparedness and Emergency Operations. The
Preparedness and Emergency Operations account also 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.
Addressing Emergency Medical Services Workforce Shortages
and Readiness.--The Committee is keenly aware of the
significant challenges the emergency medical services (EMS)
community faces. Across the Federal government, there are a
host of resources available to assist public, private, and
nonprofit EMS agencies. Within 180 days of enactment of this
Act, the Committee directs ASPR, in consultation with SAMHSA
and the National Highway Traffic Safety Administration, to
provide an overview of its resources available to address EMS
readiness and workforce shortages; any actions taken to address
EMS readiness and the workforce shortage; and recommendations
on what additional resources and authorities are necessary to
support EMS and community access to emergency healthcare
services. Such overview shall be made available on the agency's
website.
Healthcare and Public Health Sector Cybersecurity
Performance Goals.--The Committee notes its significant
concerns with cybersecurity threats to the healthcare and
public health sector and urges HHS to rapidly roll out its
proposed program to support the implementation of essential
cybersecurity performance goals.
Supply Chain Control Tower.--The Committee recognizes the
potential value of the Supply Chain Control Tower (SCCT)
program, a voluntary collaboration between industry partners
and ASPR, to provide end-to-end visibility for supply chain
monitoring and readiness. In addition to providing insights for
demand and supply forecasting, the Committee encourages ASPR to
coordinate with FDA and CDC to use SCCT to monitor the
availability of a broader list of essential health and medical
products.

National Disaster Medical System

The Committee provides $76,904,000 for the National
Disaster Medical System (NDMS). NDMS deploys trained medical,
mortuary, and veterinarian teams to communities impacted by
public health and medical emergencies due to natural and
manmade incidents. The Committee provides no funding for next
generation air equipment.
Mission Zero.--The Committee provides $4,000,000, for
civilian trauma centers to train and incorporate military
trauma care providers and teams into care centers, the same as
the fiscal year 2024 enacted level.
Pediatric Disaster Care.--The Committee provides $7,000,000
for the pediatric disaster care program, the same as the fiscal
year 2024 enacted level.

Hospital Preparedness Program

The Committee provides $185,055,000 for the Hospital
Preparedness Program (HPP) formula grants, which is
$120,000,000 below the fiscal year 2024 enacted level and
$132,000,000 below the fiscal year 2025 budget request. HPP
supports a variety of programs to strengthen the preparedness
and response of the health care sector. Due to funding
constraints, the Committee reduces funding for this program.
Emergency Medical Service Preparedness and Response.--The
Committee encourages ASPR to clarify the extent to which the
hospital preparedness program can better integrate emergency
medical service operations, including both governmental and
nongovernmental emergency medical services, into regional
health care coalitions.
National Special Pathogen System.--The Committee provides
$28,500,000 for the National Special Pathogen System which is
the same as the fiscal year 2024 enacted level.
National Emerging Special Pathogens Training and Education
Center.--The Committee provides $7,500,000 for the National
Emerging Special Pathogens Training and Education Center.
Regional Emerging Special Pathogen Treatment Centers.--The
Committee provides $21,000,000 for Regional Emerging Special
Pathogen Treatment Centers program and Special Pathogen
Treatment Centers.

Medical Reserve Corps

The Committee provides $6,240,000 for the Medical Reserve
Corps, which is the same as the fiscal year 2024 enacted level
and the fiscal year 2025 budget request.

Preparedness and Response Innovation

The Committee provides $4,000,000, which is the same as the
fiscal year 2024 enacted level and $4,000,000 above the fiscal
year 2025 budget request, for a bilateral cooperative program
with the Government of Israel for the development of health
technologies.
In the fiscal year 2026 congressional justification the
Committee requests an update on the investments this funding
has produced since the program's inception.

Office of the Secretary

GENERAL DEPARTMENTAL MANAGEMENT (GDM)

Appropriation, fiscal year 2024....................... $710,955,000
Budget request, fiscal year 2025...................... 607,434,000
Committee Recommendation.............................. 467,164,000
Change from enacted level........................... -223,791,000
Change from budget request.......................... -120,270,000

Of the funds provided, $58,028,000 shall be derived from
evaluation set aside funds available under section 241 of the
PHS Act, which is $6,800,000 less than fiscal year 2024 enacted
level and $16,466,000 below the fiscal year 2025 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.
Within the total provided for GDM, the Committee provides
not less than the following amounts:

------------------------------------------------------------------------
FY 2025
Budget Activity FY 2024 Enacted Committee
------------------------------------------------------------------------
Children's Interagency $3,000,000 $3,000,000
Coordinating Council.............
Embryo Adoption................... 1,000,000 2,000,000
Interagency Coordinating Committee 2,000,000 2,000,000
on the Promotion of Optimal Birth
Outcomes.........................
KidneyX........................... 5,000,000 5,000,000
LymeX............................. 5,000,000 5,000,000
Stillbirth Working Group.......... 1,750,000 1,750,000
------------------------------------------------------------------------

Advisory Council on Alzheimer's Research, Care, and
Services.--The bipartisan National Alzheimer's Project Act
(P.L. 111-375) requires the Secretary of HHS, in collaboration
with the Advisory Council on Alzheimer's Research, Care, and
Services (Advisory Council), to create and maintain an annually
updated National Alzheimer's Plan. The Committee supports
efforts to establish the Advisory Council as outlined. The
Advisory Council, made of both Federal members and expert non-
Federal members, is an integral part of the planning process as
it advises the Secretary in developing the annual National
Alzheimer's Plan, makes recommendations to the Secretary and
Congress, and assists in coordinating the work of Federal
agencies involved in Alzheimer's research, care and services.
Artificial Intelligence Mammography.--The Committee is
aware of the growing use of artificial intelligence (AI) in
breast cancer screening and wants to ensure transparency in the
use of AI and that such use of AI does not inadvertently
exacerbate health disparities in breast cancer due to
algorithms based on narrow data sets and lack of
standardization. The Committee urges HHS to prioritize
transparency in the use of AI by ensuring that patients are
notified on their written report if their mammogram is analyzed
using AI-assisted technology. The Committee also urges the NIH
to support research to help validate the use, scaling, and
outcomes of AI in breast cancer screening. The Committee
requests an update on this topic in the fiscal year 2026
congressional justification.
Bill Wide Requirements.--The Committee notes the inclusion
of a bill wide requirements section of this report. This
section contains requirements which apply to all agencies
funded by this Act.
Biomarkers.--The Committee is pleased with the progress
made in precision medicine with the creation of tests that
examine biomarkers to guide clinical decisions. This
advancement holds potential for improving clinical trials and
speeding up the creation of new treatments for patients
requiring them. The Committee requests HHS to provide an update
on the Department's work towards promoting and incorporating
precision medicine tools into the healthcare system in the
fiscal year 2026 congressional justification.
Brain Aneurysms.--The Committee recognizes that although 1
in 50 Americans have a brain aneurysm, there are typically no
warning signs or symptoms unless they rupture. Currently, 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 healthcare professionals, such as first responders
and emergency room physicians. The Committee reiterates the
language provided in fiscal year 2019 (H. Rept. 115-862 and S.
Rept. 115-289) which directed the Secretary, in consultation
with appropriate stakeholders--including healthcare providers
(e.g., neurosurgeons, neurologists, neuro-interventional
surgeons, emergency physicians), 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. In doing so, 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 is urged, in
consultation with appropriate stakeholders, to develop a
strategy for disseminating information about the best practices
and begin implementation.
Child Cancer Survivorship.--The Committee urges the
Secretary to convene a stakeholder group to develop best
practices to improve survivorship care as children and
adolescents transition from active oncological care to primary
care. The stakeholder group will evaluate the best mechanisms
and practices for every childhood cancer survivor to receive a
comprehensive care summary and follow-up plan, based on
guidelines, once they complete their cancer care. The Committee
directs the Secretary to make a report publicly available
online within 180 days of the date of enactment of this Act
based on the stakeholder group's recommendations.
Children's Interagency Coordinating Council.--The Committee
continues to include $3,000,000 for the Children's Interagency
Coordinating Council and supports the continued partnership
between the Assistant Secretary for Planning and Evaluation and
NASEM.
Cognitive Decline and Dementia.--The Committee encourages
the Department of Health and Human Services to identify and
implement a comprehensive set of actions that assesses risk,
reserve, and resilience factors for cognitive decline and
dementia, with an emphasis on historically underserved
communities. Actions should include: conducting health risk
assessments, such as the detection of cognitive impairment
included as part of the Medicare Annual Wellness Visit;
identifying opportunities to address cognitive strength and
possible risk for cognitive decline and dementia by addressing
known factors, including patient and provider education;
offering reimbursement incentives to providers to promote
cognitive and brain health; providing payments for prevention
and care delivery models that incorporate cognitive and brain
health as part of care and treatment of other conditions that
may modify dementia risk, reserve, and resilience; and
developing and implementing quality measures specifically
related to cognitive and brain health.
Creative Arts Therapies and Mental Health.--The Committee
supports continued collaboration between HHS and the National
Endowment for the Arts to better understand the role of
creative arts therapies in addressing mental health, including
for youth and other vulnerable populations, drawing on the
NEA's successful Creative Forces program in partnership with
the Department of Defense.
Cybersecurity Threats in Grantmaking.--The Committee
strongly urges the Department to adopt more proactive measures
to strengthen its cybersecurity infrastructure against the
ever-evolving threat of social engineering attacks. As the
custodian of vast repositories of sensitive data, HHS is a
prime target for malicious actors seeking to exploit system
vulnerabilities. Implementing training programs to educate
staff about the tactics employed in social engineering attacks,
as well as bolstering technological defenses, are crucial steps
in safeguarding HHS' systems. Moreover, HHS is urged to
maintain robust communication channels with other Federal
grant-making agencies to promptly alert them of cybersecurity
incidents that may put their systems at risk. The Committee
urges an interagency collaborative approach to create a shared
defense for grant-making agencies and their IT systems,
enabling them to share insights quickly and effectively, and
fortifying their defenses against ongoing cybersecurity
threats.
Drug Shortages.--The Committee notes that prescription drug
shortages persist as a pressing issue across various treatment
categories. While previous efforts have examined the frequency
of these shortages, there remains a gap in understanding their
full impact on consumer expenses and the healthcare system.
Increased out-of-pocket expenses, elevated insurance premiums,
and compromised health outcomes can result if shortages are not
addressed. The Committee urges ASPE to research options to
address drug shortages.
In addition, the Committee notes that certain generic drugs
have consistently made up most drugs in a shortage, and that
the lowest cost generics are often the most impacted.
Additionally, some shortages have lasted for years, and in some
cases have risen to their highest levels in a decade. The
Committee is concerned about these persistent generic drug
shortages, particularly impacting generic sterile injectables,
which include cancer drugs, emergency medicines, and
anesthesiology medications. Accordingly, the Committee directs
HHS to provide a report to the Committee and to post on a
publicly available website no later than 180 days after
enactment of this Act examining how payment policy can impact
the supply chain, including economic dynamics that influence
market stability for generic drugs.
Electric Vehicle.--The Committee does not include funding
for a new electric vehicle program.
Embryo Adoption Awareness Campaign.--The Committee
increases funding 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.
Federal Poverty Guidelines.--The Committee directs HHS to
include in its fiscal year 2026 congressional justification
information on how the agency calculates and determines the
Federal poverty guidelines, most recently published by the
Department in the Federal Register on January 19, 2023 (88 Fed.
Reg. 3424). Additionally, the Committee directs HHS to make
publicly available on its website no later than 90 days after
enactment of this Act, a list of all Federal means tested
public benefit programs, within the jurisdiction of the
Department, that utilize such guidelines for eligibility
determination or for purposes of or determining the allocation
of Federal funds to state or local grantees.
Food as Medicine.--The Department developed a Food as
Medicine initiative in response to direction from the Committee
in fiscal year 2023. The Committee includes $3,000,000, an
increase of $1,000,000 above the fiscal year 2024 enacted
level, to continue the Food as Medicine pilot program, an
integrative model for healthcare that uses healthy, nutritious,
and affordable foods to prevent, treat, and manage chronic
conditions to advance health. As part of the pilot program, the
Department will need to better understand challenges and
opportunities to advance Food as Medicine models. The Committee
urges HHS to include in its annual reports details on how
community pharmacies may be able to play a critical role in the
Food as Medicine approach, specifically how they can help
improve nutrition-related outcomes and prevent chronic
diseases. These reports should also be posted on the agency's
website.
Global Health Research.--The Committee requests an update
in the fiscal year 2026 congressional budget justification on
how CDC, FDA, BARDA, NIH--including the Fogarty International
Center-- and other agencies jointly coordinate global health
research activities with specific metrics to track progress and
collaboration toward agreed upon health goals.
Highly Pathogenic Avian Influenza.--The Committee notes the
Department's response to the outbreak of avian influenza among
cattle in multiple states including transmission to humans in
Texas and Michigan. Within 30 days of the enactment of this
Act, the Committee directs the Department to publicly release a
report on the Department's response to the outbreak detailing
the Department's response including State requests for
assistance from CDC and ASPR. The Department is further
directed to detail State and community requests for supplies
from the strategic national stockpile.
Hospital Acquired Pneumonia.--The Committee notes concern
with the current rate of non-ventilator hospital acquired
pneumonia (NVHAP) with a recent study of over six million
hospital admissions finding that NVHAP may account for 1 in 14
hospital deaths. Regular oral care during inpatient stays might
help prevent such incidents according to results from the
Department of Veterans Affairs (VA) Hospital-Acquired Pneumonia
Prevention by Engaging Nurses initiative that has been
implemented at every VA medical center in the nation and showed
declines in NVHAP of 40 to 60 percent. The Committee urges the
Secretary to prioritize the prevention of NVHAP, including by
working with CDC and CMS to review such health system
initiatives and, building off CDC's recently issued Oral Health
in Healthcare Settings to Prevent Pneumonia Toolkit, establish
a concrete plan to reduce the prevalence and associated patient
harm from this potentially preventable hospital-acquired
condition.
Hospital Closures.--The Committee is deeply concerned with
the accelerated rate of community hospital closures and the
impact of closures on access to health care for vulnerable
patient populations. The Committee directs GAO to conduct a
study that identifies hospital closures across the U.S. over
the last 10 years, the ownership model of each closure, and the
impact these closures have had on health care outcomes for
communities. The study shall be completed within 180 days of
enactment of this Act.
Interagency Task Force on Improving Access to Treatment for
Myopic Children and Myopic Patients in Underserved Areas.--The
Committee urges HHS to establish a task force to improve access
to treatment for myopic children and other myopic patients in
underserved areas. Such a task force could identify, evaluate,
and make recommendations regarding best practices with respect
to children who have been diagnosed as myopic and have been
unable to get access to treatment and ways in which Federal
agencies can better coordinate with each other in D.C. and
through all regional offices across the country to inform the
public regarding treatment options that are available through
Federal programs to underserved patients.
Joint Funding Arrangement.--The Committee continues to
direct the agency to include all amounts assessed from any
operating division and the methodology used to determine such
amounts.
Laboratory Biosecurity.--The Committee is committed to
ensuring improved and comprehensive laboratory biosecurity.
Currently, laboratory biosafety and biosecurity reporting are
fractured across different agencies and data recorded is not
used to create evidence-based biosafety and biosecurity
standards. The rapid advancement of biotechnology necessitates
a single comprehensive laboratory incident reporting system
that is non-punitive (also referred to as ``no-fault''), and
which accommodates privacy considerations. Such a reporting
system would collect information on laboratory accidents and
near misses to learn from real-world incidents, generating data
to develop evidence-based standards for biosafety and
biocontainment. The Committee directs HHS to conduct a
deliberative study in consultation with biosafety officers to
determine the design of such a laboratory incident reporting
system. Further, the Federal Select Agent Program (FSAP) is
uniquely positioned to pilot the laboratory incident reporting
system once the study has been concluded and prior to any
department-wide implementation. Within 1 year of enactment of
this Act, the Committee directs HHS to report on the study
results and deliver an FSAP pilot implementation plan.
Lyme and Other Tick-Borne Diseases.--The Committee strongly
encourages the Secretary to establish within the Office of the
Assistant Secretary for Health a TBD coordinating office to
track, monitor and provide technical assistance on TBD
activities throughout HHS, including its operating divisions,
and to serve as an HHS-wide facilitator for TBD activities. The
coordinating office would be able to monitor and report to the
Secretary on implementing the ``National Public Health Strategy
to Prevent and Control Vector-Borne Diseases in People.'' The
Committee further encourages such office to establish a program
for temporary agency/stakeholder panels or commissions to
address a need or gaps related to TBD goals and objectives in
an HHS agency or across agencies. The agency/stakeholder panels
could consist of a range of stakeholders, similarly to the TBD
working groups, except on a smaller scale, to operate for a
short period of time, e.g., 120 days, to address a particular
need or gap in the TBD knowledge base or TBD activity. The
overarching purpose is to facilitate transitioning products to
patients, health care practitioners, researchers, academia--
including Vector-Borne Diseases (VBD) Centers of Excellence,
industry, State, and local governments. In addition, the
Committee urges the Office of the Secretary and NIH, in
consultation with CDC and FDA, to enter into discussions on the
potential benefits of establishing a National Network of
Academic Research and Clinical Centers of Excellence for Tick-
Borne diseases.
Marijuana Research.--The Committee is concerned about
reports of the mental health hazards of regular use of high-
potency marijuana, particularly among youth. The Committee
encourages HHS to support research on high-potency marijuana
and its effects on the adolescent brain, specifically regarding
addiction and mental illness such as schizophrenia or
psychosis.
Medically Tailored Meals.--The Committee notes the use of
medically tailored meals (MTMs) and produce prescription
programs. MTMs are home-delivered meals tailored to the
nutrition needs of individuals living with severe, complex, and
chronic illness by a Registered Dietician Nutritionist through
a referral from a medical professional or health care plan. The
Committee urges the Secretary to identify programs that could
allow coverage for MTMs. Produce prescriptions programs are a
medical treatment or preventative service for diet-related
health risks and are referred by a healthcare provider or
health insurance plan. These produce prescriptions are
fulfilled through food retail or delivery and enable patients
to access healthy produce at low or no cost to the patient. The
Committee supports efforts to include, where permissible, such
meals and produce plans as a component of a program.
Nonrecurring Expenses Fund.--The Committee directs HHS to
provide quarterly reports for all ongoing projects. The report
shall include the following for each project: the agency each
project is funded under; a description for each project; the
date the project was notified to the Committee; total
obligations to date; obligations for the prior fiscal year;
anticipated obligations for current fiscal year; and any
expected future obligations. For any project ongoing for more
than 3 years, the report should include a narrative describing
the cause of delay and steps being taken by the agency to
ensure prompt completion. In addition, the Committee requests
biannual reports on expired balances that are eligible for
transfer to the Nonrecurring Expenses Fund (NEF). Such report
shall include the Treasury Account Fund Symbol, program name,
unobligated balance, and unexpended balance. Such report shall
be transmitted 30 days after the close of the second quarter
and within 45 days after the close of the fourth quarter of the
fiscal year. To ensure appropriate Congressional oversight into
use of the NEF, the Committee includes a new provision limiting
the amount for additional notifications for use of the NEF.
Obesity Therapies.--The advent of a new class of anti-
obesity medications, glucagon-like peptide-1 (GLP-1) receptor
agonists, has given physicians effective new tools to address
the obesity epidemic. Combined with preventative measures,
these new medicines have transformed the treatment of obesity
as a disease and could improve quality of life for individuals
with obesity across the country. Emerging research suggests
that these drugs may also have a potential benefit for
individuals suffering from alcohol and other substance use
disorders. The Committee urges the Department to evaluate the
work being done across agencies on the risks and benefits of
GLP-1 agonists, including clinical trials and basic research
that enhances our understanding of the physiological processes
and pathways affected by these drugs, with an appreciation of
the potential for sex-specific effects. The Secretary shall
provide an update on scientific progress and discoveries,
including research opportunities that can be addressed by NIH,
FDA, SAMHSA and other agencies as appropriate in the fiscal
year 2026 congressional justification.
Other Transaction Authority.--Congress has authorized HHS
and several offices within the Department, to use other
transaction authority (OTA). Under this authority, agencies may
develop agreements that are not required to follow a standard
format or include terms and conditions that are typically
required when using traditional mechanisms. Agreements executed
using traditional mechanisms, such as a contract, grant,
cooperative agreement, or cooperative research and development
agreement, contain terms and conditions to ensure compliance
with statutory requirements applicable to those mechanisms
(such as the Federal Acquisition Regulation (FAR)). Conversely,
OTA agreements are not generally subject to these requirements,
and the terms and conditions of each individual agreement may
be tailored to meet the specific situation and need. The
Committee notes, however, that GAO and others have previously
reported that agencies' use of OTA has caused reduced
accountability and transparency, in part because other
transaction agreements are usually exempt from the FAR and
government cost accounting standards. Recognizing these issues,
the Committee directs HHS to submit a consolidated report no
later than 120 days following enactment of this Act, that
details a comprehensive narrative of OTA usage within the
Department for the most recent fiscal year for which data is
available. The report shall include the following for each
active OTA award: agency the award is funded under; the OTA
authority cited for the award; the justification for using OTA
authority instead of a traditional acquisition mechanism; a
description for each award; the date of award; the anticipated
date of completion; and total obligations to date. For any
award ongoing for more than 5 years in excess of $25,000,000,
the report should include a narrative describing the status of
the project.
Patient Advocate Program.--The Committee is concerned about
barriers patients face during hospitalization, time of
discharge, and the subsequent coordination of care at and after
discharge. While some patients are able to contribute to the
decision-making process regarding healthcare, there are other
patients who are unable to access the comprehensive
coordination of care from acute care or acute rehabilitation
facilities, including access to nurse case managers, social
workers, or mental health care providers. Where applicable, the
Committee encourages the Secretary to coordinate efforts across
the agency related to this issue.
Primary Care Physician Shortages.--The Committee urges the
Assistant Secretary for Planning and Evaluation to conduct a
review of trends and factors contributing to the nation's
challenges with primary care physician recruitment and
retention. Such a report could include a review and analysis of
challenges recruiting and retaining primary care physicians;
what Federal policies and programs are effective in recruitment
and retention, including increased reimbursement, loan
forgiveness and repayment programs, and training programs
serving underserved and diverse patient populations; and
geographic and demographic characteristics of areas facing the
greatest challenges or shortages. The Committee supports such
report being made available on the agency's website and to
include recommended policies to address primary care physician
shortages, improve primary care physician recruitment and
retention, and enhance primary care access for all Americans.
Program Support Center.--The Committee is concerned by the
status of operations at the Program Support Center (PSC).
According to its website, PSC provides more than 40 services
and products that support financial management, occupational
health, and real estate, logistics, and operations. The
Committee is aware that many HHS operating divisions and staff
divisions are no longer using PSC for its services. Rather,
these offices are outsourcing for their needs, several choosing
the Department of Interior. The Committee requests a briefing
with PSC and the Assistant Secretary for Administration within
120 days of enactment of this Act detailing: (1) the number of
HHS operating divisions and staff divisions where PSC acted as
the main service provider for each of the last 5 years; (2) the
name and location of each PSC office; (3) the number of full-
time staff (including Federal employees and contractors) at
each office; (4) the number of full-time staff (including
Federal employees and contractors) that are fully remote; (4)
the number of outside agencies where PSC acted as the main
service provider for each of the last 5 years; and (5) what
efforts PSC is undertaking to ensure HHS and external customers
are being provided a high-level of customer service.
Rare Diseases.--The Committee recognizes that multiple
Federal departments, agencies, and programs exist to address
the needs of people impacted by rare diseases and improve the
lives of members of the rare disease community. The Committee
would like to see enhanced coordination and collaboration
across the Federal government and urges the Secretary of HHS to
develop a framework for an Interagency Coordinating Committee
for Rare Diseases. The coordinating committee should focus on
optimizing rare disease activities across the government and
produce a report assessing all agency activities concerning
rare diseases, including regulatory flexibilities in rare
disease therapy reviews, current and emerging biomedical
research opportunities, current and future rare disease
surveillance and epidemiological activities, programs to
support rare disease patients and caregivers, overall
programmatic funding, and other topics to be added by the
committee members.
Return to Work.--Excessive abuse of telework across the
Federal government must end. For the average American showing
up to work every day is a fact of life; they deserve a
government that reflects that reality. Approvals for remote
work should be made on an individual case by case basis and
done only to serve the best interests of the program and the
American public. The agency is directed to provide to the
Committee within 60 days of enactment of this Act a report
detailing the number of full-time employees by subcomponent who
are receiving the Washington D.C. area locality pay but have
not reported to an in person office in the DC area more than
one day a week for the past year. Considering the remote work
abuse seen at several agencies, administrative funding for the
Secretary has been reduced accordingly. The Committee urges the
Secretary to bring Federal employees back to the workplace to
fulfill the mission of serving the American public.
Rural News Media and Advertising Campaigns.--The Committee
continues to recognize the critical role that local media plays
in delivering lifesaving messages to small and rural
communities. Therefore, the Committee urges the Secretary to
ensure that local media in small and rural markets are a key
component in the Department's public health advertising
campaigns which is critical in improving the delivery of public
health messages to these small and rural communities. To
further this goal the Committee urges the Secretary, in
coordination with the Assistant Secretary for Public Affairs
and the Department's buyer contractors, to utilize local news
media in small and rural areas for public health advertising
campaigns for HHS and its related agencies to reach citizens
with key health messages. Local media includes newspapers,
specifically non-daily newspapers, television, and radio. The
Committee directs the Office of the Secretary within 90 days of
enactment of this Act to provide an update to the Committee on
the efforts of the Department in its utilization of local media
in small and rural areas as part of the Department's public
health advertising campaigns for the most recent fiscal year
for which data is available and plans for subsequent fiscal
years. The Committee also directs the Assistant Secretary for
Public Affairs in consultation with the CDC's Office of Rural
Health to undertake a review of the use of local media in small
and rural communities in an HHS public Health advertising
campaign for the most recent fiscal year for which data is
available, in several states to better understand their role as
a key delivery system to reach small and rural communities with
critically important health messages. The Committee requests an
update from the Assistant Secretary for Public Affairs within
180 days of enactment of the Act on the status of this review
and requests a final report by the end of the fiscal year.
Safe Patient Handling.--The Committee is concerned that
preventable injuries and musculoskeletal disorders related to
patient handling are forcing nurses and nurse assistants to
leave the profession, thus exacerbating the nationwide nurse
shortage and negatively impacting patient care. The Committee
notes that voluntary national guidelines based on best
practices on safe patient handling and injury prevention that
incorporate the use of lift equipment to move patients may
significantly improve workplace safety outcomes in healthcare
settings. The Committee encourages the Department to identify
ways to help existing training and nurse education programs
adopt the use of safe patient handling equipment and requests
an update on these efforts in the fiscal year 2026
congressional justification.
Self-Governance.--For over forty years, Indian Tribes have
proven that utilizing self-governance through the Indian Self-
Determination and Education Assistance Act in Federal funding
is a successful approach for improving program performance. For
decades, Indian Tribes have requested the Department to expand
this authority beyond the Indian Health Service to other
critical HHS programs serving Tribes. Over twenty years,
multiple reports and workgroups have produced evidence of the
feasibility of the expansion of self-determination and self-
governance within the Department. The Committee directs HHS to
work with Tribal representatives to provide a plan for the
expansion of self-governance at HHS including specific actions
the Department can take to advance this process. Such plan is
due within 180 days of enactment of this Act. In addition, the
Department shall report to the Committee the amount of funding
that is going to Indian Tribes for the 4 largest block grants
administered by HHS within 90 days of enactment of this Act.
Sickle Cell Trait.--Sickle Cell Trait (SCT) status is
currently identified at birth through universal newborn
screening (NBS) in all 50 States, the District of Columbia, and
U.S. territories. Based on screening results, about 1 in 13
Black or African American babies is born with SCT. Despite the
effectiveness of NBS, there are no standards for States' short-
and long-term follow-up practices regarding screening results
for those identified as carriers. To address these challenges
and leverage the existing newborn screening data, the Committee
encourages the Office of the Secretary to work with relevant
federal agencies, including the CDC and the Office of the
National Coordinator for Health Information Technology, and
States to standardize methods to determine and communicate to
adults their sickle cell trait status, especially among the
Black or African American community. This should include the
communication of NBS data that is positive for SCT to
individuals to make them aware of their status as carriers of
the trait and ensure access to needed support and services. HHS
should engage HRSA, other relevant agencies, and external
stakeholders to develop and implement a provider education
program on sickle cell trait.
Smoking Cessation.--The Committee acknowledges the
Department's work on smoking cessation but remains concerned
that its approach does not include a focus on the need for new
smoking cessation therapies to help adult smokers be more
successful in quitting. The Committee urges the Department to
acknowledge the importance of advancing smoking cessation
treatment innovation and requests an update from the Department
on how it will incorporate a focus on smoking cessation
treatment innovation in the Department's smoking cessation work
in the fiscal year 2026 congressional justification.
Staffing Reports.--The Committee includes a general
provision requiring the Department to submit a biannual
staffing report to the Committee. The Excel table shall
include: the names, titles, grades, agencies, and divisions of
all of the political appointees, special government employees,
and detailees that were employed by or assigned to the
Department during the previous 180 days.
Stillbirth Working Group.--The Committee includes funding
for the Secretary to prioritize implementation of the
Stillbirth Working Group's recommendations across the
Department and continue to engage in efforts to promote
evidence-based stillbirth awareness and prevention activities.
The Committee looks forward to reviewing the Department's
report on its progress, as requested in the joint explanatory
statement which accompanied the Further Consolidated
Appropriations Act, 2024 (P.L. 118-47).
Supply Chain.--The Committee directs the Secretary, in
consultation with the Secretaries of Defense and Homeland
Security as well as with the Director of the Office of Pandemic
Preparedness and Response Policy, to provide a comprehensive
risk assessment of the pharmaceutical supply chain within 18
months of enactment of this Act. The assessment shall identify,
in coordination with the private sector, a list of medicines
that: (1) are reasonably likely to be required to respond to a
public health emergency or CBRN threat; (2) whose shortage
would pose a significant threat to the U.S. health care system
or at-risk populations; and (3) whose shortage would pose a
risk to national security. The assessment shall also assess and
identify: (1) key starting materials and excipients used in
manufacturing the active pharmaceutical ingredients and drugs
on the essential medicines list; (2) current domestic
manufacturing capabilities with respect to drugs, including key
starting materials, excipients, and active pharmaceutical
ingredients; (3) critical vulnerabilities, including
cybersecurity threats; and (4) any deficiencies, lack of
authorities, or limitations in policy or process that limit the
Departments of Health and Human Services, Defense, or Homeland
Security to address vulnerabilities in the pharmaceutical
supply chain and how it will mitigate such vulnerabilities.
Support for New Hospitals.--The Committee understands HHS
assured acute care hospitals that opened in 2019 and 2020 and
impacted financially by the COVID pandemic, that although they
were eligible for no or very little Provider Relief Funding in
phases 1, 2, or 3, their concerns would be addressed in phase
4. In addition, the Committee notes legacy hospitals eligible
for Provider Relief Fund (PRF) payment in phases 1, 2, and 3
received up to 88 percent of lost annual revenues, while phase
4 funding provided to new acute care hospitals resulted in
between 0.5 percent and 1 percent of their annual financial
losses, far less than many of these hospitals anticipated based
on prior expectations. The Committee strongly encourages HHS to
explore what opportunities may be available to address the
underpayments to these acute care hospitals, particularly those
that are not owned by other hospitals or are part of hospital
systems, and operated emergency rooms at any time during the
COVID Public Health Emergency.
Suspension and Debarment.--The Committee notes with concern
the infrequent utilization of suspensions and debarments, as
well as the associated timeliness challenges and the
underutilization of suspensions prior to debarment, within HHS.
These concerns were also noted in a 2022 report from the Office
of Inspector General, entitled, ``HHS's Suspension and
Debarment Program Helped Safeguard Federal Funding, But
Opportunities for Improvement Exist (Report No. OEI-04-19-
00570).'' As the largest grantmaking agency in the Federal
government, HHS awarded over $778 billion in grants during
fiscal year 2023. Federal suspension and debarment programs
play a critical role in maintaining the integrity of Federal
grant programs and ensure that the government conducts business
only with responsible individuals or entities. If recipients
lack honesty, integrity, or satisfactory business performance,
they can be suspended or debarred from receiving further
Federal grants. These mechanisms are essential for
accountability and proper allocation of taxpayer funds. The
Committee requests a report within 120 days of enactment of
this Act. Such a report shall include: (1) the number of
suspension or debarment referrals received by the HHS Office of
Recipient Integrity Coordination for each of the last 5 years;
(2) the number of final decisions issued by the Suspension and
Debarment Official for each of the last 5 years; (3) the number
of referrals and final decisions that were fact-based; (4) the
number of referrals and final decisions that were conviction-
based; and (5) the procedures the Department has in place to
ensure bad actors are timely listed as suspended or debarred on
SAM.gov.
Test-To-Treat.--The Committee believes the home test-to-
treat model can make treatments for infectious diseases
available more quickly and reduce disease transmission and
illness severity. The availability of accurate diagnostics and
the rapid prescription of treatments is especially critical
given the recent co-circulation of multiple respiratory
diseases during the winter season. The Committee believes the
home test-to-treat model should be evaluated for the confluence
of influenza, COVID, and RSV, given the availability of
multiple diagnostic tests and antivirals. The Committee
requests HHS provide an update in the fiscal year 2026
congressional justification on the findings of the NIH Home
Test-to-Treat demonstration for influenza, lessons learned from
the COVID Federal Retail Pharmacy Program, and the design of a
potential test-to-treat demonstration for COVID, influenza, and
RSV to serve vulnerable populations.
Tuberculosis.--The Committee remains concerned regarding
the repeated instances of TB cases associated with viable bone
matrix material. The repeated contamination of the biologics
market and the failure to implement effective quality control
measures cost the lives of ten Americans. The Committee directs
the Secretary, no later than 90 days following the enactment of
this Act, to initiate an internal review of existing guidance
for determining eligibility of donors of human cell and tissue
products, and if necessary, issue or update any Food and Drug
Administration guidance related to reducing the risk of
transmission of mycobacterium tuberculosis by human cells,
tissues, and cellular and tissue-based products. Within 180
days of enactment of this Act, the Secretary is directed to
provide the Committee a briefing on the actions being taken by
the Department to ensure that immunocompromised Americans are
not exposed to TB through the biologic supply chain.

Minority HIV/AIDS Fund

The Committee includes $45,000,000 for the Minority HIV/
AIDS Fund (MHAF), which is $15,000,000 below the fiscal year
2024 enacted level and the fiscal year 2025 budget request.
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 increases the Tribal set aside within the MHAF to
$6,000,000, which is $1,000,000 above the fiscal year 2024
enacted level.

Office of the Assistant Secretary for Health

Abortion Hotline.--The Committee includes a new provision
prohibiting funds for the abortion hotline.
Reproductive Rights.--No funds are provided to support
www.reproductiverights.gov nor any similar website.
Traumatic Brain Injury Data Summit.--The Committee
recognizes the need for standardized data collection practices
across the care continuum to capture and integrate real world
data on TBI with data collected for research purposes to
improve patients' identification and outcomes. In 2022, at the
request of the U.S. Army Medical Research and Development
Command, NASEM published a TBI Roadmap that stated, ``Data
cannot be integrated across the care continuum from prehospital
care environments to hospital-based care, rehabilitation
settings, and community services.'' Further, the report notes
the lack of standardized TBI information from electronic health
records that limits research, such as comparative effectiveness
trials using causal inference methods. The Committee urges the
Office of the Assistant Secretary for Health to convene a
summit of Federal agency staff, including representatives from
HHS, the Departments of Defense, Veterans Affairs, and
Transportation, and others, and private sector researchers and
stakeholders to identify and recommend key data elements and
terms that should be collected to improve the consistency of
TBI health data derived from different sources to improve
patient outcomes. Additional items that could be addressed at
this meeting include: utilizing data from the National
Concussion Surveillance System to determine accurate numbers on
national incidence of TBI; identifying the parameters and
elements necessary to conceptualize a national TBI registry;
addressing patient privacy and securing patient information;
and determining how best to leverage data from and improve the
interoperability with existing national programs and State
registries.

Office of Climate Change and Health Equity

No funds are provided for the Office of Climate Change and
Health Equity.

Office of Minority Health

The Committee includes $59,835,000 for the Office of
Minority Health (OMH), which is $15,000,000 below the fiscal
year 2024 enacted level and the fiscal year 2025 budget
request.
The OMH works with public health service agencies and other
agencies of the Department to address the health status and
quality of life for minority populations in the U.S. OMH
develops and implements new policies; partners with States,
Tribes, and communities through cooperative agreements;
supports research, demonstration, and evaluation projects; and
disseminates information.
Within the total provided for OMH, the Committee provides
not less than the following amounts:

------------------------------------------------------------------------
FY 2025
Budget Activity FY 2024 Enacted Committee
------------------------------------------------------------------------
Achieving Equitable Maternal $7,000,000 $7,000,000
Health Outcomes..................
Center for Indigenous Innovation 4,000,000 4,000,000
and Health Equity................
National Lupus Training, Outreach, 2,000,000 2,000,000
and Clinical Trial Education.....
Promoting Language Access Services 4,000,000 4,000,000
------------------------------------------------------------------------

Center for Indigenous Innovation and Health Equity.--The
Committee continues funding for this center to advance
Indigenous solutions for improved health outcomes. The
Committee recognizes the center's efforts to partner with
Tribal nations and institutions of higher education with a
focus on Indigenous health research, education, and policy
among American Indians and Alaska Natives, as well as Native
Hawaiian and Pacific Islander organizations and institutions of
higher education with a focus on Indigenous health research,
education, and policy and innovation among Native Hawaiians and
Pacific Islanders. The Committee encourages OMH to both
continue and expand these efforts.
Kidney Disease Initiative.--Rates of severe kidney disease
are significantly higher in Black Americans than in other
ethnic groups, with approximately 13 percent of African
Americans carrying two APOL1 variants. The Committee encourages
OMH to support activities to reduce genetic kidney disease
among populations disproportionally affected by the disease,
including a health education program on genetic kidney disease
and coordination with NIH to develop clinical trial education
interventions to recruit and retain minority populations
affected by the disease.
Language Access and Communications Services for Limited
English Proficient Communities.--The Committee supports efforts
to improve communications, which should include mediums such as
television and radio, to reach limited English proficient (LEP)
communities. However, to improve implementation, the Committee
encourages the Department to review the communication practices
and create uniform applications across all agencies to
strengthen communication practices to include digital,
television, and radio advertising when working with LEP
communities. The Committee further urges agencies under HHS
with annual advertising budgets to include information in the
fiscal year 2026 congressional justification on funding
allocated to local media advertising to include digital,
television, and radio. The Committee encourages agencies to
support outreach funding to ethnic media outlets that work with
hard-to-reach communities to ensure equal access across all
media outlets.

Office on Women's Health

The Committee includes $34,140,000 for the Office on
Women's Health (OWH), which is $10,000,000 below the fiscal
year 2024 enacted level and $20,000,000 below the fiscal year
2025 budget request.
OWH provides consultation to the Secretary on women's
health and establishes short and long-range goals and
objectives for women's health within the Department. OWH
monitors activities regarding women's health and coordinates
across the Department on disease prevention, health promotion,
service delivery, research, and public and health care
professional education, and other women's health concerns
throughout their lifespan. OWH leads the coordination of
activities to promote women's health programs and policies with
the private sector and to share information with the public.
OWH also leads the Coordinating Committee on Women's Health and
the National Women's Health Information Center.
Within the total provided for OWH, the Committee provides
not less than the following amounts:

------------------------------------------------------------------------
FY 2025
Budget Activity FY 2024 Enacted Committee
------------------------------------------------------------------------
Committee Combatting Violence $10,100,000 $10,100,000
Against Women....................
Eating Disorders Research......... 750,000 750,000
Pregnant and Lactating Women's 200,000 200,000
Advisory Committee...............
------------------------------------------------------------------------

Eating Disorders Research.--The Committee remains concerned
that eating disorders have one of the highest fatality rates of
any psychiatric illness, with girls and women at heightened
risk for developing an eating disorder during their lifetime.
The Committee recognizes OWH's efforts to address the rise in
eating disorders amongst adolescent girls. The Committee
continues funding and urges focus on early detection and
treatment protocols for women and girls with or at-risk of
developing an eating disorder. The Committee encourages OWH to
prioritize projects to address the lack of pediatric and
adolescent screening in the primary care and pediatrics
settings. The Committee urges OWH to coordinate with outside
organizations, eating disorders specialists, and other groups
as necessary to identify research needs of eating disorders
amongst women and girls.
Pregnant Women and Lactating Women Advisory Committee.--The
Committee continues funding for the advisory committee to
continue activities within the 2020 Task Force on Research
Specific to Pregnant and Lactating Women (PRGLAC)
Implementation Plan. The Committee requests an update in the
fiscal year 2026 congressional justification on progress and
Federal activities undertaken to implement the PRGLAC
recommendations and recommendations for further implementation
of PRGLAC recommendations.

Office of the Assistant Secretary for Administration

Cybersecurity
The Committee provides $100,000,000, the same as the fiscal
year 2024 enacted level and $20,500,000 below the fiscal year
2025 budget request, for information technology cybersecurity
in the Office of the Chief Information Officer and HHS-wide to
strengthen the Department's cybersecurity posture.
In addition, the Committee permits the transfer of
$20,000,000 from the Nonrecurring Expenses Fund.

Office of National Security

The Committee provides $9,983,000, which is $1,000,000
above the fiscal year 2024 enacted level and $5,000,000 below
the fiscal year 2025 budget request, for the Office of National
Security to maintain the security of the Department's
personnel, systems, and critical infrastructure.

Office of Global Affairs

The Committee provides $7,009,000, the same as the fiscal
year 2024 enacted level and $1,000,000 below the fiscal year
2025 budget request, for the Office of Global Affairs work
related to pandemic influenza.

OFFICE FOR CIVIL RIGHTS

Appropriation, fiscal year 2024....................... $39,798,000
Budget request, fiscal year 2025...................... 56,798,000
Committee Recommendation.............................. 39,798,000
Change from enacted level........................... - - -
Change from budget request.......................... -17,000,000

The Office for Civil Rights (OCR) is responsible for
enforcing civil rights statutes that prohibit discrimination in
health and human services programs. OCR implements the civil
rights laws through a compliance program designed to generate
voluntary compliance among all HHS recipients.
National Council on Disability Recommendations.--The
Committee is aware of a National Council on Disability report
entitled, ``The Danger of Assisted Suicide Laws,'' which raises
concern that such laws could lead to a two-tiered system that
results disproportionately in the deaths of people with
disabilities. Accordingly, the Committee strongly encourages
the OCR to clarify that all HHS suicide prevention grants and
services must comply with existing disability rights laws,
including the Americans with Disabilities Act, sections 504 and
508 of the Rehabilitation Act, and section 1557 of the
Affordable Care Act, including the provisions requiring
accessible communications, so that all videos, documents, and
other products ensure access to persons with disabilities. The
Committee further strongly encourages OCR to clarify that
sections 504 and 508 of the Rehabilitation Act require
physicians to provide people with disabilities with information
on the full array of available clinical treatments and
available long-term services and supports and to require that
referrals to such treatments and services be given if
requested.

OFFICE OF THE NATIONAL COORDINATOR FOR HEALTH INFORMATION TECHNOLOGY

Appropriation, fiscal year 2024....................... $69,238,000
Budget request, fiscal year 2025...................... 86,000,000
Committee Recommendation.............................. 69,238,000
Change from enacted level........................... - - -
Change from budget request.......................... -16,762,000

The Office of the National Coordinator for Health
Information Technology (ONC) is the principal Federal entity
charged with coordinating efforts to implement and use health
information technology and exchange electronic health
information.
Health Artificial Intelligence.--The Committee appreciates
efforts by HHS--including FDA and ONC--to accelerate adoption
of artificial intelligence-based tools to improve patient care,
health care payment, operations, and public health. The
Committee is concerned, however, that new policies could
duplicate existing authorities and negatively affect U.S.
competitiveness in the development of artificial intelligence
innovations. Within 9 months of enactment of this Act, the
Committee directs the Secretary to submit a report outlining
all existing authorities that could apply to the development
and use of artificial intelligence-based tools, including those
that may either be artificial intelligence as stand-alone and/
or interface with, enabled by, or supplied by medical devices,
health information technology, and decision support
interventions. The report shall provide an update to the
Department's response to OMB M-21-06 and explain how existing
authorities that were not initially developed for artificial
intelligence can still apply to artificial intelligence-based
technologies used in care. The report should clearly explain
what gaps, if any, exist in HHS authorities and proposed
approaches to fill those gaps.
Information Blocking.--The Committee recognizes that ONC's
rule to implement the interoperability and information blocking
provisions of the 21st Century Cures Act took significant steps
forward to give patients greater access to and improve the
electronic flow of electronic health information across care
settings. Given the significant penalties and other
consequences for information blocking, the Committee urges ONC
to provide regulated entities and other stakeholders with
clear, practical guidance regarding the rule, which should
include how regulated entities can evaluate their circumstances
and scenarios under the rule, and answer inquiries by covered
actors about how ONC interprets its regulations and how the
regulations apply to a specific set of facts. ONC and OIG
should only apply standards of conduct that have been publicly
stated in a manner that would not cause unfair surprise.
Patient Matching.--The Committee is concerned there is no
consistent and accurate way to link patients to their health
information as they seek care across the continuum. Health
information must be accurate, timely, and robust to inform
clinical care decisions for every patient. The recommendation
includes $3,000,000, the same as the fiscal year 2024 enacted
level, for ONC to work with industry to develop matching
standards that prioritize interoperability, patient safety, and
patient privacy.
Standards for Interoperability.--ONC and CMS have published
final rules to implement interoperability provisions contained
in the Cures Act, including the ONC final rule, 21st Century
Cures Act: Interoperability, Information Blocking, and the ONC
Health IT Certification Program and the related CMS final rule,
including the adoption of Fast Healthcare Interoperability
Resources (FHIR) as the foundational standard to support health
information sharing without ``special effort'' on the part of
the user. FHIR-based application programming interfaces are now
required for all health stakeholders that exchange data in
compliance with the rules that support the Act. The Committee's
recommendation includes not less than $5,000,000, the same as
the fiscal year 2024 enacted level, to support interoperability
and information sharing efforts related to the implementation
of implementation standards.
The Committee urges ONC to ensure that the post-acute Fast
Healthcare Interoperability Resources standard for cognitive
status is implemented in electronic health record systems and
should offer guidance on including fields for cognitive status
by default without configuration being necessary.

MEDICARE HEARINGS AND APPEALS

Appropriation, fiscal year 2024....................... $196,000,000
Budget request, fiscal year 2025...................... 196,000,000
Committee Recommendation.............................. 196,000,000
Change from enacted level........................... - - -
Change from budget request.......................... - - -

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

OFFICE OF INSPECTOR GENERAL

Appropriation, fiscal year 2024....................... $87,000,000
Budget request, fiscal year 2025...................... 97,384,000
Committee Recommendation.............................. 87,000,000
Change from enacted level........................... - - -
Change from budget request.......................... -10,384,000

The Committee recommends $87,000,000 for OIG, which is the
same as the fiscal year 2024 enacted level and $10,384,000
below the fiscal year 2025 budget request.
In addition, within the Health Care Fraud and Abuse Control
(HCFAC) program discretionary appropriations for fiscal year
2025, the Committee provides the OIG with $111,508,000, which
is $3,773,000 above the fiscal year 2024 enacted level and the
same as the fiscal year 2025 budget request. Mandatory
appropriations for this office are also contained in the HCFAC
program and the Health Insurance Portability and Accountability
Act of 1996.
The Committee supports the OIG as an independent and
objective entity charged with conducting oversight, preventing
waste, fraud and abuse, and promoting economy, efficiency, and
effectiveness in the Department's programs and operations.
Marijuana Scheduling.--The Committee is also concerned
about deviations from established drug scheduling evaluation
standards in the FDA 2023 marijuana scheduling review. The
Committee supports efforts to compile a report on the 2023
marijuana scheduling review including: (1) deviations from the
established five-factor currently accepted medical use test,
(2) justification for a new, two-factor currently accepted
medical use test and whether this will be the standard for all
future reviews, (3) use of a limited number of hand-selected
comparator substances, and (4) inclusion of research results
that are not statistically significant or inconclusive.

RETIREMENT PAY AND MEDICAL BENEFITS FOR COMMISSIONED OFFICERS

Appropriation, fiscal year 2024....................... $792,691,000
Budget request, fiscal year 2025...................... 894,795,000
Committee Recommendation.............................. 894,795,000
Change from enacted level........................... +102,104,000
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.

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
use of 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 modifies a provision providing 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 limiting the
assignment of employees for work with certain organizations.
Sec. 212. The Committee modifies a provision to allow
funding for HHS international HIV/AIDS and other infectious
diseases, chronic and environmental disease, and other health
activities abroad to be spent under the State Department Basic
Authorities Act of 1956.

(TRANSFER OF FUNDS)

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

(TRANSFER OF FUNDS)

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

(TRANSFER OF FUNDS)

Sec. 217. The Committee continues a provision transferring
one percent of the funding made available for National
Institutes of Health National Research Service Awards to the
Health Resources and Services Administration.
Sec. 218. The Committee continues the Biomedical Advanced
Research and Development Authority ten-year contract authority.
Sec. 219. The Committee modifies a provision requiring HHS
to include information regarding full-time Federal employees
and contractors working on the Affordable Care Act in the
fiscal year 2026 budget request.
Sec. 220. The Committee modifies a provision for a report
on CMS's Health Insurance Exchange activities in the fiscal
year 2026 budget request.
Sec. 221. The Committee continues a provision prohibiting
the CMS Program Management account from being used to support
risk corridor payments.

(TRANSFER OF FUNDS)

Sec. 222. The Committee modifies a provision directing the
spending of the Prevention and Public Health Fund.

PREVENTION AND PUBLIC HEALTH FUND

In fiscal year 2025, the level appropriated for the fund is
$1,225,900,000 after accounting for sequestration. The
Committee includes bill language in section 222 of this Act
that requires that funds be transferred within 45 days of
enactment of this Act to the following accounts, for the
following activities, and in the following amounts:

----------------------------------------------------------------------------------------------------------------
Agency Budget Activity FY 2024 Enacted FY 2025 Committee
----------------------------------------------------------------------------------------------------------------
ACL........................................ Alzheimer's Disease Program.. $14,700,000 $14,700,000
ACL........................................ Chronic Disease Self- 8,000,000 8,000,000
Management.
ACL........................................ Falls Prevention............. 5,000,000 5,000,000
CDC........................................ Hospitals Promoting 9,750,000 9,750,000
Breastfeeding.
CDC........................................ Diabetes..................... 66,412,000 110,758,000
CDC........................................ Epidemiology and Laboratory 40,000,000 40,000,000
Capacity Grants.
CDC........................................ Healthcare Associated 12,000,000 12,000,000
Infections.
CDC........................................ Heart Disease and Stroke 29,255,000 110,759,000
Prevention Program.
CDC........................................ Million Hearts Program....... 5,000,000 5,000,000
CDC........................................ Section 317 Immunization 681,933,000 681,933,000
Grants.
CDC........................................ Lead Poisoning Prevention.... 51,000,000 51,000,000
CDC........................................ Public Health Data - - - 160,000,000
Modernization.
CDC........................................ Early Care Collaboratives.... 5,000,000 5,000,000
SAMHSA..................................... Garrett Lee Smith--Youth 12,000,000 12,000,000
Suicide.
----------------------------------------------------------------------------------------------------------------

Sec. 223. The Committee modifies a provision related to
breast cancer screening.

(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 a provision related to
certain Congressional notification requirements.
Sec. 226. The Committee continues a provision related to
funding for the Medicare program.
Sec. 227. The Committee continues a provision related to a
report on staffing.
Sec. 228. 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. 229. The Committee continues a provision related to
donations for unaccompanied alien 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 alien
children.
Sec. 231. The Committee continues 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 continues a provision related to
primary and secondary school costs for eligible dependents of
personnel stationed in a U.S. territory.
Sec. 234. The Committee includes a new provision modifying
the Community Services Block Grant Act.

(RESCISSION AND INCLUDING TRANSFER OF FUNDS)

Sec. 235. The Committee modifies a provision related to
unobligated balances in the Nonrecurring Expenses Fund.
Sec. 236. The Committee includes a new provision related to
NIH and workplace investigations related to a principal
investigator or key personnel.
Sec. 237. The Committee includes a new provision related to
facilities and administration costs.
Sec. 238. The Committee includes a new provision related to
fetal tissue.
Sec. 239. The Committee includes a new provision related to
physician training for abortions.
Sec. 240. The Committee includes a new provision
restricting funding to certain health care entities.
Sec. 241. The Committee includes a new provision related to
providing information on abortion.
Sec. 242. The Committee includes a new provision related to
referral for abortions.
Sec. 243. The Committee includes a new provision related to
executive orders addressing reproductive services.
Sec. 244. The Committee includes a new provision limiting
funds for a proposed rule for the Temporary Assistance for
Needy Families program.
Sec. 245. The Committee includes a new provision regarding
a CMS rule related to vaccination requirements.
Sec. 246. The Committee includes a new provision regarding
Executive Order 13988 (Executive Order on Preventing and
Combating Discrimination on the Basis of Gender Identity or
Sexual Orientation).
Sec. 247. The Committee includes a new provision limiting
funding for certain elective services.
Sec. 248. The Committee includes a new provision related to
rulemaking for section 1557 of the Affordable Care Act.
Sec. 249. The Committee includes a new provision related to
placement under Titles IV-E and IV-B of the Social Security
Act.
Sec. 250. The Committee includes a new provision related to
the unaccompanied alien children foundational rule.
Sec. 251. The Committee includes a new provision related to
placement of unaccompanied alien children.
Sec. 252. The Committee includes a new provision related to
nursing home staffing standards.
Sec. 253. The Committee includes a new provision related to
a final rule for short term, limited duration health plans.
Sec. 254. The Committee includes a new provision related to
a proposed rule for the Medicaid program.
Sec. 255. The Committee includes a new provision related to
a public health emergency and a citizen's Second Amendment
rights.

TITLE III--DEPARTMENT OF EDUCATION

Appropriation, fiscal year 2024........... $79,052,238,000
Budget request, fiscal year 2025.......... 82,491,976,000
Committee Recommendation.................. 67,948,452,000
Change from enacted level............... -11,103,786,000
Change from budget request.............. -14,543,524,000

The U.S. Department of Education's (Education)
discretionary spending encompasses the budget allocated to
various education programs, determined through annual
appropriations. In 2012, Education's discretionary funding
stood at approximately $68 billion, while the student loan
portfolio balance was $950 billion. By fiscal year 2024,
Education's discretionary funding had increased to just under
$80 billion; yet, in that same time, the Federal student loan
portfolio exceeded $1.6 trillion, with nearly 43 million
borrowers, and 90 percent of the outstanding balances owned by
Education. This growth in student loan debt has substantially
outpaced Education's discretionary spending, reflecting the
rapidly increasing cost associated with direct loans for higher
education.
Notably, much of the growth in Education's student loan
balance is not being driven by undergraduate loans. Instead, it
stems from individuals pursuing advanced graduate degrees--such
as master's, doctoral, and professional programs--often facing
substantial financial strain to attain such degrees. These
graduate students rely heavily on Federal loans to cover
tuition, expenses, and living costs. Unfortunately, the
earnings potential after completing these degrees often does
not align with the debt incurred, leading to a significant
burden on the borrower and the American taxpayer who financed
the direct loan. Consequently, the sustainability and long-term
implications of Education overseeing and administering a
rapidly growing Federal loan portfolio is in question, as new
loans are disbursed at a faster rate than existing loans are
repaid.
This bill provides just under $69 billion in discretionary
budget authority for the Department of Education, a reduction
of 13 percent over fiscal year 2024 enacted level. The
Department of Education comprises 37 percent of the total
302(b) allocation for this subcommittee.

Office of Elementary and Secondary Education

EDUCATION FOR THE DISADVANTAGED

Appropriation, fiscal year 2024....................... $19,107,790,000
Budget request, fiscal year 2025...................... 19,287,790,000
Committee Recommendation.............................. 14,389,212,000
Change from enacted level........................... -4,718,578,000
Change from budget request.......................... -4,898,578,000

This appropriation account includes compensatory education
programs authorized under title I and subpart 2 of part B of
title II of the Elementary and Secondary Education Act of 1965
(ESEA) and section 418A of the Higher Education Act (HEA).
Of the total amount available, $4,399,178,000 is
appropriated for fiscal year 2025 for obligation on or after
July 1, 2025, and $10,841,177,000 is appropriated for fiscal
year 2026 for obligation on or after October 1, 2025.

Grants to Local Educational Agencies

For fiscal year 2025, the Committee provides
$14,626,490,000, for Title I grants to Local Educational
Agencies (LEAs or school districts), which is $3,780,312,000
below the fiscal year 2024 enacted level.
The Committee proposes reduced formula funding for public
schools. The Committee notes that despite annual increases in
funding for Title I formula grants, student test scores
continue to decline. The latest test scores published by the
Department showed that overall math and reading scores for both
fourth and eighth graders have fallen sharply. Math scores for
eighth graders in 2022 fell to a 20-year low. Nationwide, only
36 percent of fourth graders and 26 percent of eighth graders
are proficient in math, and only 33 percent of fourth graders
and 31 percent of eighth graders are proficient in reading.
Federal tax dollars have not been shown to result in meaningful
improvement in student achievement. Moreover, the partisan
American Rescue Plan (P.L. 117-2) invested more than
$150,000,000,000 into American schools. Despite the
unprecedented direct Federal support for schools, U.S. student
achievement continues to lag other industrialized nations.
The Committee also notes that traditional public schools
were quick to shut down in 2020 at the behest of teachers'
unions and stayed closed for nearly two years, while most
private and charter schools reopened. During the pandemic,
these public schools failed their students, and the effects
will be felt by an entire generation of students. In December
2023, EdChoice polling showed that nearly two-thirds of
American parents feel that K-12 education is on the wrong
track. The same polling showed that 71 percent of parents
support charter schools. Predictably, public school enrollment
has been declining and charter school enrollment accelerated
during the pandemic. Between 2010 and 2021, according to data
from the Department of Education, enrollment in public
elementary and secondary schools declined by 3 percent. During
this same period, charter school enrollment more than doubled
by nearly 2 million students. The National Center for Education
Statistics projects additional losses of 2.4 million students
by 2031. The Committee recognizes this shift in demand for
alternatives to traditional public schools and responds by
increasing funding for charter schools in this bill.
The Committee also notes that both Democrat and Republican
led States are taking advantage of budget surpluses due to
Federal stimulus dollars and high tax revenues and making
record investments in their education budgets. South Dakota,
Arkansas, and Iowa have all passed teacher pay raises this
year, and similar efforts are being considered in Alabama,
Virginia, South Carolina, and Missouri this legislative
session. According to the National Education Association, the
national average public school teacher salary in 2022-2023
increased 4.1 percent from the previous year and is projected
to grow a further 3.1 percent in 2023-2024. These are the
largest teacher pay increases in over a decade.
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
or guardians serving full-time in the military often 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 more
than half a 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.

Basic Grants

Of the amounts provided for Title I programs, the Committee
provides $3,614,089,000 for Basic Grants to LEAs, which is
$2,845,312,000 below the fiscal year 2024 enacted level. Of
this amount, $763,776,000 is available for fiscal year 2026.
Basic grants are awarded to school districts with at least 10
low-income children who make up more than 2 percent of the
school-age population.
High-Quality Tutoring.--The Committee encourages the
Department to promote and provide technical assistance to LEAs
and support partnerships between LEAs and education-related
community based organizations to implement evidence-based
tutoring models.

Concentration Grants

The Committee provides $1,362,301,000, the same as the
fiscal year 2024 enacted level for Title I Concentration
Grants. These 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.

Targeted Grants

The Committee provides $4,825,050,000, which is
$467,500,000 below the fiscal year 2024 enacted level for Title
I Targeted Grants. Within this amount, $4,357,550,000 is
available for fiscal year 2026. Targeted Grants provide higher
payments to school districts with high numbers or percentages
of low-income students.

Education Finance Incentive Grants

The Committee provides $4,825,050,000, which is
$467,500,000 below the fiscal year 2024 enacted level for Title
I Education Finance Incentive Grants (EFIGs). Within this
amount, $4,357,550,000 is available for fiscal year 2026. EFIGs
are allocated according to one of the four allocation formulas
authorized under ESEA Title I, Part A for providing Federal
education funding to the States for the education of
disadvantaged pupils.

Innovative Approaches to Literacy

The Committee provides $30,000,000 for Innovative
Approaches to Literacy, which is the same as the fiscal year
2024 enacted level. This program provides competitive grants to
support school libraries.
The Committee is supportive of efforts to equip educators
with comprehensive literacy resources via a free, website
format with a specific focus on children in kindergarten
through sixth grade. The Committee encourages the Department to
build upon existing programs that leverage public partnerships
and multidisciplinary tools and have demonstrated outcomes of
success.
Pediatric Literacy Program.--The Committee encourages the
Department to support pediatric literacy programs that are
provided during well-child visits by medical providers trained
in research-based methods of early language and literacy.

Comprehensive Literacy Development Grants

The Committee provides $194,000,000 for Comprehensive
Literacy Development Grants, which is the same as the fiscal
year 2024 enacted level. Competitive grants are awarded to
States to subgrant to school districts and/or early education
programs to improve literacy instruction for disadvantaged
students.
Science of Reading.--The Committee notes with concern that
many school districts continue to use reading instruction
methods that have been shown to be ineffective at helping all
students, and especially struggling readers, learn to read. The
Committee is aware of recent reporting which has demonstrated
that many schools in our country continue to use ineffective
reading programs that teach students to guess words rather than
to learn how to read words. Neuroscience research has shown
that skilled readers process all of the letters in words when
they read them. After several exposures, the word becomes
recognizable on sight, through a process called orthographic
mapping. Even so, many early reading programs are designed to
teach students to make better guesses to learn words, a process
known as three-cueing. This method teaches children that they
don't need to look at all of the letters that make up words in
order to read them. As they progress in grades and do not have
pictures or other context to learn words, many students
struggle with reading and, as a result, may even be identified
as in need of special education services when they may just not
have been taught to read properly.
The Committee is aware that many teachers may not know that
cueing strategies do not comport with the scientific evidence
base around teaching reading. The Committee intends that funds
provided under the comprehensive literacy development grants
program be used solely for reading programs that promote
science-based reading instruction and therefore directs the
Department to ensure that all grants funded through this
program adhere to the highest evidence-based standards of
research for practices for teaching reading, supporting
struggling readers, and developing them into strong readers.
Programs must include systematic instruction in phonological
awareness, phonics, and fluency and should be externally
validated to show reading success with the lowest-achieving
students rather than relying on a proprietary reading program's
own self-assessment.

State Agency Programs: Migrant

The Committee provides $375,626,000 for the State Agency
Program for Migrant Education, which is the same as the fiscal
year 2024 enacted level. This formula grant 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/High Risk Youth

For the State Agency Program for Neglected and Delinquent
Children, the Committee provides $49,239,000, which is the same
as the fiscal year 2024 enacted level. This formula grant
program supports educational services for children and youth
under age 21 in State-run institutions, attending community day
programs, and in correctional facilities. A portion of these
funds is provided for projects that support the successful re-
entry of youth from the criminal justice system into
postsecondary and vocational programs.

Special Programs for Migrant Students

The Committee provides $52,123,000 for the Special Programs
for Migrant Students, which is the same as the fiscal year 2024
enacted level. These programs make competitive 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 recruits migrant students aged 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 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 2024....................... $1,625,151,000
Budget request, fiscal year 2025...................... 1,618,112,000
Committee Recommendation.............................. 1,630,000,000
Change from enacted level........................... +4,849,000
Change from budget request.......................... +11,888,000

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 provides $1,477,000,000 for Basic Support
Payments to LEAs, which is an increase of $3,000,000 from the
fiscal year 2024 enacted level. Basic Support Payments
compensate school districts for lost tax revenue and are made
on behalf of Federally connected children, such as children of
members of the uniformed services who live on Federal property.
Special Education Needs at Impact Aid Schools.--In the
fiscal year 2026 congressional justification, the Committee
requests data and analysis on special education needs at Impact
Aid schools, including data on the percent of students at
Impact Aid schools who receive special education services
compared to the percent of such students at non-Impact Aid
schools.

Payments for Children with Disabilities

The Committee provides $49,000,000 for Payments for
Children with Disabilities, which is an increase of $684,000
from the fiscal year 2024 enacted level. These payments
compensate school districts for the increased costs of serving
Federally connected children with disabilities.

Facilities Maintenance

The Committee provides $4,835,000 for Facilities
Maintenance, which is the same as the fiscal year 2024 enacted
level. Capital payments are authorized for maintenance of
certain facilities owned by the Department.

Construction

The Committee provides $19,000,000 for the Construction
program, which is the same as the fiscal year 2024 enacted
level. This program provides formula grants for building and
renovating school facilities to school districts that educate
Federally connected students or have Federally-owned land.

Payments for Federal Property

The Committee provides $80,165,000 for payments for Federal
property, which is an increase of $1,165,000 from the fiscal
year 2024 enacted level. Funds are awarded to school districts
to compensate for lost tax revenue as the result of Federal
acquisition of real property since 1938.

SCHOOL IMPROVEMENT PROGRAMS

Appropriation, fiscal year 2024....................... $5,776,178,000
Budget request, fiscal year 2025...................... 5,781,178,000
Committee Recommendation.............................. 3,164,523,000
Change from enacted level........................... -2,611,655,000
Change from budget request.......................... -2,616,655,000

The School Improvement account includes programs authorized
under Titles I, II, IV, VI, and VII of the ESEA; the McKinney-
Vento Homeless Assistance Act; Title IV-A of the Civil Rights
Act; and section 203 of the Educational Technical Assistance
Act of 2002.

Supporting Effective Instruction State Grants

The Committee does not provide fiscal year 2025 funding for
these formula grants to States. This funding has not been shown
to improve teacher quality or advance student achievement.
Additionally, the Committee notes that according to the
Department's August 2023 report (``State and District Use of
Title II, Part A Funds in 2021-2022''), professional
development was the most popular use of Title II-A funds among
school districts. Seventy five percent of districts reported
funding professional development for teachers, and 56 percent
of districts reported funding professional development for
principals and other school leaders. Among districts that
invested Title II-A funds in teacher professional development,
78 percent funded topics related to ``content knowledge.'' The
Committee is concerned that school districts are using these
Federal funds to train teachers in divisive ideologies.
For these reasons, the Committee directs the Department in
the Departmental Management section of this report to submit a
report to the Committee on the specific uses of these funds by
school district and schools.

State Assessments

The Committee does not provide funding for this program.
The Committee believes that State and local funds should cover
these activities.

Education for Homeless Children and Youth

The Committee provides $129,000,000 for the Education for
Homeless Children and Youth program, which is the same as the
fiscal year 2024 enacted level. Formula grants are allocated to
States in proportion to the total each State receives under the
Title I program.

Training and Advisory Services

The Committee does not provide funding for this program.
The Committee is concerned that this funding is used to push
divisive trainings and ideologies on public school teachers and
other officials through training on how to address racial and
sexual bias in teaching materials, school discipline policies,
and school climates.

Nita M. Lowey 21st Century Community Learning Centers

The Committee provides $1,329,673,000 for Nita M. Lowey
21st Century Community Learning Centers, which is the same as
the fiscal year 2024 enacted level. This program awards formula
grants to States, which in turn distribute funds on a
competitive basis to local school districts, nonprofit
organizations, and other public entities. Funds may be used to
provide activities that complement and reinforce the regular
school-day program for participating students and may also fund
local activities that are included as part of an expanded
learning time program.

Student Support and Academic Enrichment Grants

The Committee provides $1,390,000,000 for Student Support
and Academic Enrichment State Grants, which is an increase of
$10,000,000 from the fiscal year 2024 enacted level. The Every
Student Succeeds Act eliminated several narrowly focused
competitive grant programs and replaced them with this formula
grant program. States and school districts have flexibility to
focus these resources on locally determined priorities to
provide students with access to a well-rounded education,
including rigorous coursework, and to improve school conditions
and the use of technology.
Protecting Hunting Heritage.--The Committee notes passage
of the Protecting Hunting Heritage and Education Act (P.L. 118-
17), which authorizes the use of funds for archery, hunting, or
other shooting sports.

Rural Education

The Committee provides $225,000,000 for Rural Education
programs, which is an increase of $5,000,000 from the fiscal
year 2024 enacted level. There are two dedicated programs to
assist rural school districts with improving teaching and
learning in their schools: the Small, Rural Schools Achievement
program, which provides funds to rural districts that serve a
small number of students; and the Rural and Low-Income Schools
program, which provides funds to rural districts that serve
concentrations of poor students, regardless of the number of
students served by the district. Funds appropriated for Rural
Education shall be divided equally between these two programs.

Native Hawaiian Education

The Committee provides $45,897,000 for the Education for
Native Hawaiian program, which is the same as the fiscal year
2024 enacted level. These funds are used to provide competitive
grants for supplemental education services to the Native
Hawaiian population.
The Committee is supportive of resources to public
elementary and secondary schools that serve Native Hawaiian
students, including activities for construction, renovation,
and modernization of any public elementary school, secondary
school, or structure related to a public elementary school or
secondary school, as authorized under part B of Title VI. The
Committee encourages the Department to prioritize funding to
organizations with construction needs that have experience
providing supplemental education services to Native Hawaiian
children and youth. In addition, the Committee continues to
support the Native Hawaiian Education Council.

Alaska Native Education

The Committee provides $44,953,000 for the Alaska Native
Education program, which is the same as the fiscal year 2024
level. These funds are used to provide competitive grants for
supplemental education services to the Alaska Native
population.

Comprehensive Centers

The Committee does not provide funding for this program.
The Committee is concerned that the Department is providing
technical assistance via comprehensive centers on social and
emotional learning rather than on efforts to improve academic
achievement.

SAFE SCHOOLS AND CITIZENSHIP EDUCATION

Appropriation, fiscal year 2024....................... $457,000,000
Budget request, fiscal year 2025...................... 507,000,000
Committee Recommendation.............................. 291,000,000
Change from enacted level........................... -166,000,000
Change from budget request.......................... -216,000,000

This appropriation account includes programs authorized
under parts of Title IV of the ESEA.

Promise Neighborhoods

The Committee does not provide funding for these
competitive grants. The Committee notes that this program
provides neighborhood social services such as healthcare,
counseling, and job training that are duplicative of other free
and subsidized government programs that serve the same
population. The Committee believes the core role of the
Department should be to support schools and districts in
educating children in areas such as reading, writing, and math.
The Committee also believes that these initiatives to broaden
the role and influence of schools in a child's upbringing, in
some cases, can present a negative impact on parental rights
and decrease parental responsibility.

School Safety National Activities

The Committee provides $216,000,000 for School Safety
National Activities, which is the same as the fiscal year 2024
enacted level. The Committee's recommendation provides up to
$10,000,000 for the Project School Emergency Response to
Violence (Project SERV) program, which is an increase of
$5,000,000 from the fiscal year 2024 enacted level. The Project
SERV program provides counseling and referral to mental health
services as well as other education-related services to LEAs
and Institutions of Higher Education (IHEs) in which the
learning environment has been disrupted by a natural disaster
or violent crisis.
Elementary and Secondary School Emergency Relief Funds
Uses.--As the deadline of September 30, 2024, approaches for
districts to obligate these funds, the Committee encourages the
Department to clarify that the following are eligible uses of
Elementary and Secondary School Emergency Relief funds: video
surveillance; student monitoring; updated doors, locks, and
window panels; universal master key access boxes; mental health
training; information technology that is able to transmit a
text or video notification; crowd flow security technology;
removable, semi-permanent, or permanent barriers or shields;
and traffic pattern analytic software.
The Committee also notes that funds made available through
the Bipartisan Safer Communities Act (P.L. 117-159), for the
Stronger Connections Grant program may be used for information
technology to improve the safety of the school environment in
high need LEAs. Guidance documentation published by the
Department also includes information regarding other related
eligible uses of funds including equipment and minor
remodeling.
Grants to Schools for Federal Law Enforcement Training.--
The Committee recognizes that highly trained School Resource
Officers (SROs) play a crucial role in ensuring the safety and
well-being of students, faculty, and staff within K-12 schools.
Their specialized training equips them with the skills to
effectively handle various situations, including emergencies,
conflicts, and other potential threats. Beyond security, SROs
also serve as mentors, mediators, and positive role models,
fostering a sense of trust and community within schools.
However, many K-12 schools do not have the necessary funding
available to provide continued training to their SROs. As such,
the Committee provides $20,000,000 for a new competitive grant
program for K-12 schools to provide SROs with enhanced training
at the Federal Law Enforcement Training Centers (FLETC). The
FLETC offers a variety of training that focuses on maintaining
a safe K-12 school environment. These types of specialized
trainings are vital in supporting the unique, important, and
varied roles that SROs must fulfill to ensure the safety and
well-being of K-12 school communities. The Committee directs
the Department to provide a briefing within 90 days of
enactment of this Act to the Committee on its plans for
carrying out these competitive grants. In addition, the
Committee directs the Department to provide notice to the
Committees at least seven days before any notice of funding
opportunity is published or any grantee is announced.
Parental Consent.--The Committee encourages the Department
to provide technical assistance and guidance to School-Based
Mental Health Services grantees to ensure that they are
following all applicable district, State, and Federal laws and
policies regarding parental consent.
Rural Grant Applications.--The Committee is concerned with
the difficulties that underserved and rural communities face
accessing and applying for Federal school safety grants. The
committee encourages the Department to prioritize technical
assistance to rural and underserved grant applicants.
School Infrastructure.--The Committee provides $136,000,000
for a new competitive grant program to help schools implement
best practices to improve school safety. This includes several
things that were recommended in the Department of Justice's
January 18, 2024, report, ``Critical Incident Review: Active
Shooter at Robb Elementary School,'' such as updated doors and
locks that can be locked from the inside, metal detectors, or
other deterrent measures; wi-fi to ensure emergency alerts are
received in a timely manner; universal master key access boxes;
school resource officers and security personnel; and training
and preparedness exercises coordinated between students, school
personnel, local law enforcement and first responders, and
local government agencies. The Committee directs the Department
to provide a briefing within 90 days of enactment of this Act
to the Committee on its plans for carrying out these
competitive grants. In addition, the Committee directs the
Department to provide notice to the Committees at least seven
days before any notice of funding opportunity is published or
any grantees for a new competition are announced. The Committee
encourages the Department to prioritize grant applications from
under resourced schools with a demonstrated need as part of the
new competitive grant program.
Student Mental Health Grants.--The Committee provides
$25,000,000 for the Mental Health Services Professional
Demonstration Grants program. The Committee also provides
$25,000,000 for the School-Based Mental Health Services Grants
program with the requirements established in the explanatory
statement accompanying P.L. 116-94, including that no less than
50 percent of grants support LEA recipients, that awards
include a 25 percent match from grantees, and that the awards
do not supplant existing mental health funding. The Committee
notes that the Bipartisan Safer Communities Act (P.L. 117-159)
provides $100,000,000 each fiscal year over fiscal years 2022-
2026 to support each program. The Department is directed to
provide quarterly obligation and expenditure reports to the
Committee for each program funded in such Act.

Full Service Community Schools

The Committee provides $75,000,000 for Full-Service
Community Schools, which is a decrease of $75,000,000 from the
fiscal year 2024 enacted level. This program makes competitive
grants to support school-based comprehensive services for
students, families, and communities, such as mental health and
nutrition services. The Full-Service Community Schools program
provides support for the planning, implementation, and
operation of full-service community schools that improve the
integration, accessibility, and effectiveness of services for
children and families, particularly for children attending
high-poverty schools, including high-poverty rural schools. The
Committee appreciates the potential of these Federal
investments to improve student outcomes and school performance.
However, the Committee is concerned that the program is not
adequately supporting projects that meet program criteria in
high-poverty rural areas. Additionally, the Department is
awarding multiple awards to some entities while other entities
with qualifying projects are being overlooked. Therefore, the
Department is urged to prioritize the equitable distribution of
awards to include high-poverty rural areas, and to limit
granting multiple awards to entities in a given fiscal year
when qualifying projects exist without awards in that year.

INDIAN EDUCATION

Appropriation, fiscal year 2024....................... $194,746,000
Budget request, fiscal year 2025...................... 194,746,000
Committee Recommendation.............................. 202,246,000
Change from enacted level........................... +7,500,000
Change from budget request.......................... +7,500,000

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

Grants to Local Educational Agencies

The Committee provides $110,381,000 for Grants to Local
Educational Agencies, which is the same as the fiscal year 2024
enacted level. This program provides assistance through formula
grants to school districts and schools supported or operated by
the Bureau of Indian Education. The purpose of this program is
to improve elementary and secondary school programs that serve
American Indian students, including preschool children.
Grantees must develop a comprehensive plan and ensure that the
programs they carry out will help American 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 provides $72,000,000 for Special Programs for
Indian Children, which is the same as the fiscal year 2024
enacted level. These programs make competitive grants to
improve the quality of education for American Indian students.
Demonstration Grants.--The Committee directs the Department
to award $5,000,000 in new demonstration grants to eligible
nonprofits who provide education and related services to
students with disabilities to establish on-site, early
intervention, and special education services for K-12 students
in Bureau of Indian Education Resource Centers. The grantees
shall design and provide services for an educational,
behavioral, therapeutic, and vocational program for individuals
with special needs from birth to 21 years of age.

National Activities

The Committee provides $19,865,000 for National Activities,
which is an increase of $7,500,000 from the fiscal year 2024
enacted level. Of that amount, $9,800,000 is provided for
State-Tribal Education Partnerships, $7,000,000 is provided for
Native Language Immersion Schools and Programs, and $3,065,000
is provided for Native American Language Resource Centers.
Funds under this authority support: (1) research,
evaluation, and data collection to provide information about
the educational status of Indian students and the effectiveness
of Indian education programs; (2) grants to support Native
language immersion schools and programs; and (3) grants to
Tribes for education administrative planning, development, and
coordination.

Office of Innovation and Improvement

INNOVATION AND IMPROVEMENT

Appropriation, fiscal year 2024....................... $1,115,000,000
Budget request, fiscal year 2025...................... 1,208,000,000
Committee Recommendation.............................. 892,000,000
Change from enacted level........................... -223,000,000
Change from budget request.......................... -316,000,000

This appropriation account includes programs authorized
under portions of Titles II and IV of the ESEA.

American History and Civics Academies

The Committee provides $3,000,000 for this program, which
is the same as the fiscal year 2024 enacted level. This program
supports academies for teachers and high school students to
strengthen their knowledge on American history, Civic, and
government education.

American History and Civics National Activities

The Committee does not provide funding for these
competitive grants. The Committee is concerned that the
Department is using these grants to push divisive ideology onto
school children, such as the widely discredited 1619 project.
The Committee notes that the most recent Nation's Report Card
scores found only 13 percent of eighth graders were proficient
in U.S. history and only 22 percent proficient in civics. This
program has become over politicized under the current
Administration and fails to sufficiently address the
educational needs of students.

Teacher and School Leader Incentive Grants

Due to funding constraints, the Committee does not provide
funding for these competitive grants.

Supporting Effective Educator Development

The Committee does not provide funding for these
competitive grants. The Committee is unaware of any findings
demonstrating that these grants have improved teacher quality
or student achievement. Additionally, the Committee is
concerned that school districts are using these Federal funds
to train teachers in divisive ideology.

Charter Schools Grants

The Committee provides $460,000,000 for Charter School
Program (CSP) Grants, which is an increase of $20,000,000 from
the fiscal year 2024 enacted level.
The Charter Schools Grants program awards competitive
grants to State Educational Agencies (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.
The Committee believes, in contrast to the Department's
flawed justification in its fiscal year 2025 budget proposal
for cutting this program, that increased funding for CSP is
strongly supported by recent research and data on charter
school performance and increasing demand for charter schools,
despite efforts by the Administration to decrease the amount of
successful grant applicants through burdensome regulations and
inadequately staffing the program office. For example, the
office at the Department that oversees social and emotional
learning, mental health, trauma, and school climate has 40
percent more staff than the charter school program office but
oversees less competitive grant funding.
The Committee notes that high-quality charter schools
continue to yield strong academic results, especially for
students from low-income families and students of color. A 2020
Harvard study (``Changes in the Performance of Students in
Charter and District Sectors of U.S. Education: An Analysis of
Nationwide Trends'') found greater academic gains for students
in charter schools, with the difference amounting to almost an
additional half year of learning for students in charter
schools over the course of the study, and the most significant
gains found for Black and low-income students. Additionally, a
2021 meta-analysis of three decades of research, conducted by
the National Institute of Economic Research (``Charter Schools'
Effectiveness, Mechanisms, and Competitive Influence''), found
that charter schools located in urban areas boost student test
scores, particularly those of Black, Hispanic, and low-income
students, that charter school attendance is associated with
increases in college enrollment and voter turnout, and that the
presence of a charter school can have a beneficial influence on
neighboring public schools. Recognizing these impacts, the
Congressional Black Caucus Institute's 21st Century Council
2023 Annual Report supports the CSP's effectiveness in leveling
the playing field for public charter schools, including through
equal treatment of public charter schools as public schools and
expanding access to public charter schools.
The Committee also notes that parents' support for charter
schools is strong, and charter school enrollment continues to
climb, while district public school enrollment falls. A 2022
Harris poll found that three in four parents support expanding
the number of slots in charter schools in their communities,
and the same percentage said that they would consider sending
their child to a charter school if one were available. Further,
84 percent of parents responding to the poll stated that
charter schools should be an available option for parents and
students. The Committee also notes that the Department's 2023
Report on the Condition of Education found that between fall
2019 and fall 2020, while traditional public-school enrollment
decreased by 4 percent, public charter school enrollment
increased by 7 percent. Moreover, from the 2021-2022 to the
2022-2023 school year, charter school enrollment increased
again by 72,241 students (2 percent) while enrollment remained
flat for traditional public schools.
Facilities Grants.--The Committee provides an increase of
$5,000,000 for State Charter School Facilities Incentive Grants
and the Credit Enhancement for Charter School Facilities
Program. The Committee is supportive of construction and
renovation of charter school facilities, including storm
shelters, safe rooms, and other infrastructure improvements
such as fortified roof and wall construction to improve
windstorm, tornado, and hurricane resilience.

Magnet Schools Assistance

The Committee provides $139,000,000 for this program, which
is the same as the fiscal year 2024 enacted level. This program
makes competitive grants to support the establishment and
operation of magnet schools that are a part of a court-ordered
or Federally-approved voluntary desegregation plan.

Ready to Learn Television Programming

The Committee provides $31,000,000 for this program, which
is the same as the fiscal year 2024 enacted level. This program
supports the development and distribution of educational video
programming for preschool and elementary school children and
their parents, caregivers, and teachers.

Arts in Education

The Committee does not provide funding for these
competitive grants. The Committee believes that considering the
continued decline of public-school performance and student
achievement across the country, funding provided by the
Department should be focused on core education such as reading,
writing, and math.

Javits Gifted and Talented Education

The Committee does not provide funding for these
competitive grants. The Committee is concerned that the
Department's focus on equity within the gifted and talented
program further divides American students and leaves them less
prepared to compete in a challenging global economy. The
Committee believes this program should be merit based.

Statewide Family Engagement Centers

The Committee does not provide funding for these
competitive grants. The Committee is concerned that despite the
millions of dollars appropriated for these grants in recent
years, there is no evidence that the grants have fostered
trusting relationships between families and schools. In fact,
the country witnessed the deterioration of that relationship
during and in the aftermath of the COVID pandemic for reasons
these grants are not designed to address.

Education Innovation and Research

The Committee provides $259,000,000 for the Education
Innovation and Research (EIR) program, which is the same as the
fiscal year 2024 enacted level. This program makes competitive
grants to support the replication and scaling-up of evidence-
based education innovations.
Grant Priorities.--The Committee notes there is significant
demand from the field to test many types of strategies and to
examine promising techniques that can be scaled up in different
settings. The Committee encourages the Department to continue
to support diverse and field-initiated interventions, rather
than a single nationwide program or award focused solely on one
area of educational innovation.
Publicizing Research Findings.--The Committee continues to
be supportive of efforts by the Department to publicize
research findings from the EIR program as described in House
Report 117-96. The Committee encourages the Department to take
additional steps to publicly release, widely publicize, and
support the use of research findings from this critical program
and its predecessor, the Investing in Innovation program, to
stakeholders at the Federal, State, and local levels. The
Committee specifically encourages the Department to 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
Committee directs the Department to submit a report to the
Committee no later than 120 days after enactment of this Act,
with an update on the Department's goals, outcome measures, and
corrective measures for achieving the widest possible
dissemination and use of this information in SEA and LEA
decision making.
Rural Set Aside.--The Committee supports the required 25
percent set aside within the EIR program for rural areas and
encourages the Department to invest in rural, high-need
communities by ensuring grants are awarded to a diverse set of
institutions, affecting varied geographic locations, including
areas with substantial minority students, which have submitted
high-quality applications meeting EIR program requirements.
School Readiness.--The Committee encourages the Department
to support EIR awards that promote evidence-based school
readiness programming in preschool, elementary, and secondary
education.
STEM and Computer Science Grants.--In addition, within the
total for EIR, the Committee provides $87,000,000 for STEM
education, including computer science, the same as the fiscal
year 2024 enacted level.
Tutoring.--The Committee notes the importance of high-
dosage tutoring in accelerating student learning and supporting
student success. As States and districts are implementing and
scaling up tutoring programs aligned with research-based
components, the Committee encourages the Department to support
high-dosage tutoring through new EIR awards.

Office of English Language Acquisition

ENGLISH LANGUAGE ACQUISITION

Appropriation, fiscal year 2024....................... $890,000,000
Budget request, fiscal year 2025...................... 940,000,000
Committee Recommendation.............................. - - -
Change from enacted level........................... -890,000,000
Change from budget request.......................... -940,000,000

Due to funding constraints, the Committee does not provide
funding for these formula and competitive grants.

Office of Special Education and Rehabilitative Services

SPECIAL EDUCATION

Appropriation, fiscal year 2024....................... $15,467,264,000
Budget request, fiscal year 2025...................... 15,673,264,000
Committee Recommendation.............................. 15,497,264,000
Change from enacted level........................... +30,000,000
Change from budget request.......................... -176,000,000

These grants help States and localities pay for a free,
appropriate education for students with disabilities aged 3
through 21.
Teachers of Blind or Visually Impaired Children.--The
Committee encourages the Department to support continuing
education opportunities for teachers of blind or visually
impaired children, enrichment projects to improve the capacity
of blind or visually impaired children to learn and live
independently, programs within institutions of higher education
for the preparation of teachers of children who are blind or
visually impaired, and facilitate cooperation with nonprofit
organizations with expertise and experience serving children
who are blind or visually impaired.
Intervener Services.--The Committee encourages the
Department to make technical assistance available to SEAs and
LEAs in matters related to supporting students who are
deafblind to address the unique needs of these students. In
addition, the Committee encourages the Department to assist
SEAs and LEAs seeking to facilitate the availability of
intervener services at State and local levels, so students who
are deafblind have access to information, communication, and
interaction in educational environments.

Grants to States

The Committee provides $14,238,704,000 for Part B Grants to
States, which is an increase of $25,000,000 from the fiscal
year 2024 enacted level. 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.

Preschool Grants

The Committee provides $420,000,000 for Preschool Grants,
which is the same as the fiscal year 2024 enacted level. These
funds provide additional assistance to States to help them make
free, appropriate public education available to children with
disabilities ages 3 through 5.

Grants for Infants and Families

The Committee provides $540,000,000 for Grants for Infants
and Families, which is the same as the fiscal year 2024 enacted
level. These funds provide additional assistance to States to
help them make free, appropriate public education available to
children with disabilities from birth through age 2. The
Committee continues bill language to promote the continuity of
services for eligible infants and their families.

IDEA National Activities

The Committee provides $257,560,000 for IDEA National
Activities, which is the same as the fiscal year 2024 enacted
level. The IDEA National Activities programs support State
efforts to improve early intervention and education results for
children with disabilities.
State Personnel Development.--The Committee provides
$38,630,000 for State Personnel Development, which is the same
as the fiscal year 2024 enacted level. This program supports
grants to States to assist with improving personnel preparation
and professional development related to early intervention and
educational and transition services that improve outcomes for
students with disabilities.
Technical Assistance and Dissemination.--The Committee
provides $39,345,000 for Technical Assistance and
Dissemination, which is the same as the fiscal year 2024
enacted level. Funding supports technical assistance,
demonstration projects, and information dissemination. These
funds support efforts by State and local educational agencies,
IHEs, and other entities to build State and local capacity to
improve results for children with disabilities.
Personnel Preparation.--The Committee provides $115,000,000
for Personnel Preparation, which is the same as the fiscal year
2024 enacted level. This program supports competitive grants 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.
Parent Information Centers.--The Committee provides
$33,152,000 for Parent Information Centers, which is the same
as the fiscal year 2024 enacted level. This program makes
awards to parent organizations to support Parent Training and
Information Centers, including community parent resource
centers. These centers provide training and information to meet
the needs of parents of children with disabilities living in
the areas served by the centers, particularly underserved
parents and parents of children who may be inappropriately
identified. Technical assistance is also provided under this
program for developing, assisting, and coordinating centers
receiving assistance under this program.
Educational Technology, Media, and Materials.--The
Committee provides $31,433,000 for Educational Technology,
Media, and Materials, which is the same as the fiscal year 2024
enacted level. This program makes competitive grants to support
the development, demonstration, and use of technology and
educational media activities of educational value to children
with disabilities. The Committee encourages the Department to
expand this program's reach to students with disabilities in
higher education, given the value that exists to both K-12 and
higher education through educational technology improvements
and the importance of providing seamless pathways for students
with disabilities to improve their completion of postsecondary
education.

Special Olympics Education Programs

The Committee provides $41,000,000 for Special Olympics
Education Programs, which is an increase of $5,000,000 from the
fiscal year 2024 level, to support activities authorized by the
Special Olympics Sport and Empowerment Act. 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.

REHABILITATION SERVICES

Appropriation, fiscal year 2024....................... $4,110,241,000
Budget request, fiscal year 2025...................... 4,118,156,000
Committee Recommendation.............................. 4,118,156,000
Change from enacted level........................... +7,915,000
Change from budget request.......................... - - -

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

Vocational Rehabilitation State Grants

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.
Randolph-Sheppard Program.--The Committee directs the
Department to provide participants in the Randolph-Sheppard
program with technical assistance and support in applying for
funding opportunities available under the Office of Special
Education and Rehabilitative Services. In the fiscal year 2026
congressional justification, the Committee requests an update
on such efforts from fiscal year 2024 and planned efforts in
fiscal years 2025 and 2026.

Client Assistance State Grants

The Committee provides $13,000,000 for Client Assistance
State Grants, which is the same as the fiscal year 2024 enacted
level. Client Assistance State Grants support services for
eligible individuals and applicants of the vocational
rehabilitation 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 provides $29,388,000 for the Training
program, which is the same as the fiscal year 2024 enacted
level. The program supports long-term and short-term training,
in-service personnel training, and training of interpreters for
deaf persons. Projects in a broad array of disciplines are
funded to ensure that skilled personnel are available to serve
the vocational needs of persons with disabilities.

Demonstration and Training Programs

The Committee provides $5,796,000 for Demonstration and
Training Programs, which is the same as the fiscal year 2024
enacted level. These programs authorize competitive grants to
public and private organizations to support demonstrations,
direct services, and related activities for persons with
disabilities.

Protection and Advocacy of Individual Rights

The Committee provides $20,150,000 for Protection and
Advocacy of Individual Rights, which is the same as the fiscal
year 2024 enacted level. Grants are awarded to entities that
have the authority to pursue legal, administrative, and other
appropriate remedies to protect and advocate for the rights of
persons with disabilities.

Supported Employment State Grants

The Committee provides $22,548,000 for Supported Employment
State Grants, which is the same as the fiscal year 2024 enacted
level. These formula grants assist States in developing
collaborative programs with public agencies and nonprofit
agencies for training and post-employment services leading to
supported employment. In supported employment programs, persons
with the most significant disabilities are given special
supervision and assistance to enable them to work in integrated
settings.

Services for Older Blind Individuals

The Committee provides $33,317,000 for Services for Older
Blind Individuals, which is the same as the fiscal year 2024
enacted level. Funds are distributed to States according to a
formula based on the population of individuals who are 55 or
older and provide support for services to persons 55 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 provides $19,000,000 for the Helen Keller
National Center for Deafblind Youth and Adults, which is the
same as the fiscal year 2024 enacted level. These funds are
used for the operation of a national center that provides
intensive services for deafblind 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 2024....................... $303,292,000
Budget request, fiscal year 2025...................... 301,292,000
Committee Recommendation.............................. 305,792,000
Change from enacted level........................... +2,500,000
Change from budget request.......................... +4,500,000

AMERICAN PRINTING HOUSE FOR THE BLIND

Appropriation, fiscal year 2024....................... $43,431,000
Budget request, fiscal year 2025...................... 43,431,000
Committee Recommendation.............................. 44,431,000
Change from enacted level........................... +1,000,000
Change from budget request.......................... +1,000,000

This funding subsidizes the production of educational
materials for legally blind persons enrolled in pre-college
programs. The American Printing House for the Blind (Printing
House), which is chartered by the Commonwealth of Kentucky,
manufactures, and maintains an inventory of educational
materials in accessible formats that are distributed free of
charge to schools and States based on the number of blind
students in each State. The Printing House also conducts
research and field activities to inform educators about the
availability of materials and how to use them.
The Committee provides $44,431,000 to meet 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. In addition, within amounts provided for the Printing
House, the Committee includes up to $6,000,000, which is an
increase of $1,000,000 from fiscal year 2024 enacted level, to
support additional field testing and initial production and
distribution of an innovative braille and tactile display
products developed by the Printing House and its partners.
Center for Assistive Technology Training.--The Committee
includes $6,000,000, which is equal to the fiscal year 2024
enacted level, to continue the current Center for Assistive
Technology regional partnership.

NATIONAL TECHNICAL INSTITUTE FOR THE DEAF

Appropriation, fiscal year 2024....................... $92,500,000
Budget request, fiscal year 2025...................... 92,500,000
Committee Recommendation.............................. 93,000,000
Change from enacted level........................... +500,000
Change from budget request.......................... +500,000

Congress established the National Technical Institute for
the Deaf (Institute) in 1965 to provide a residential facility
for postsecondary technical training and education for deaf
persons with the purpose of promoting the employment of these
individuals. The Institute also conducts applied research and
provides training related to various aspects of deafness. The
Secretary of Education administers these activities through a
contract with the Rochester Institute of Technology in
Rochester, New York.
Regional STEM Center.--The Committee includes $9,500,000,
which is equal to the fiscal year 2024 enacted level, to
continue NTID's current Regional STEM Center partnership.

GALLAUDET UNIVERSITY

Appropriation, fiscal year 2024....................... $167,361,000
Budget request, fiscal year 2025...................... 165,361,000
Committee Recommendation.............................. 168,361,000
Change from enacted level........................... +1,000,000
Change from budget request.......................... +3,000,000

Gallaudet University is a private, nonprofit 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.
Early Learning Acquisition Project.--The Committee includes
$9,000,000, which is an increase of $500,000 from the fiscal
year 2024 enacted level, to continue the current regional
partnership through the Early Learning Acquisition Project with
the current partner as the lead agent for program expansion.

Office of Career, Technical, and Adult Education

CAREER, TECHNICAL, AND ADULT EDUCATION

Appropriation, fiscal year 2024....................... $2,181,436,000
Budget request, fiscal year 2025...................... 2,268,436,000
Committee Recommendation.............................. 2,186,436,000
Change from enacted level........................... +5,000,000
Change from budget request.......................... -82,000,000

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

Career and Technical Education: State Grants

The Committee provides $1,449,848,000 for Career and
Technical Education (CTE) State Grants, which is an increase of
$10,000,000 from the fiscal year 2024 enacted level.
State Grants support a variety of career and technical
education programs developed in accordance with a State's
submitted 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.
Upcoming Regulatory Actions.--The Committee is concerned
about the Department's recently announced plans to regulate the
Carl D. Perkins Career and Technical Education Act (Perkins V).
The Committee notes that Congress included a provision in the
2018 Strengthening Career and Technical Education for the 21st
Century Act, section 218, which specifically limits the
issuance of regulations under this Act unless it is necessary
to administer and ensure compliance with the specific
requirements of Perkins V. The Committee encourages the
Department to explicitly, and expeditiously, clarify the scope
and content of these forthcoming regulations.

Career and Technical Education: National Programs

The Committee provides $7,421,000 for National Programs,
which is a decrease of $5,000,000 from the fiscal year 2024
enacted level. This program supports the conduct and
dissemination of research in career and technical education.

Adult Education State Grants

The Committee provides $715,455,000 for Adult Basic and
Literacy Education State Grants, which is the same as the
fiscal year 2024 enacted level. State formula grants,
authorized under the AEFLA, support programs to enable adults
to acquire basic literacy skills, to enable those who so desire
to complete secondary education, and to make available to
adults the means to become more employable, productive, and
responsible citizens.

Adult Education National Leadership Activities

The Committee provides $13,712,000 for National Leadership
Activities, which is the same as the fiscal year 2024 enacted
level. This program supports applied research, development,
dissemination, evaluation, and program improvement efforts to
strengthen the quality of adult education services.
The Committee recognizes the potential that innovative
technologies have in addressing adult literacy challenges and
directs no less than $2,000,000 to the Department to partner
with an institution of higher education that specializes in
high performance computing to develop a pilot program utilizing
innovative technologies including artificial intelligence and
machine learning to develop a personalized literacy program for
adults.

Office of Postsecondary Education

HIGHER EDUCATION

Appropriation, fiscal year 2024....................... $3,283,296,000
Budget request, fiscal year 2025...................... 3,343,247,000
Committee Recommendation.............................. 2,849,272,000
Change from enacted level........................... -434,024,000
Change from budget request.......................... -493,975,000

Aid for Institutional Development

Strengthening Institution

The Strengthening Institutions program under Part A of
title III of the Higher Education Act supports competitive
grants for general operating subsidies to institutions with
below average educational and general expenditures per student
and significant percentages of low-income students. Funds may
be used for faculty and academic program development,
management, joint use of libraries and laboratories,
acquisition of equipment, and student services.
The Committee provides $117,070,000 for the Strengthening
Institutions program, which is $5,000,000 above the fiscal year
2024 enacted level and $22,930,000 below the fiscal year 2025
budget request.
The Committee directs the Department to establish a
competitive preference priority for eligible institutions with
needs for developing and improving academic programs or
construction, maintenance, and related improvements in
classrooms, laboratories, and other instructional facilities,
that are within the geographic area of the Delta Regional
Authority (7 U.S.C. 2009aa et seq.), the Northern Border
Regional Commission (40 U.S.C. 15101 et seq.), or the
Appalachian Regional Commission (40 U.S.C. 14101 et seq.). The
Committee further directs the Department to prioritize grants
for academic programs that address workforce shortages in the
healthcare and aviation fields.

Developing Hispanic-Serving Institutions

The Committee provides $232,890,000 for the Developing
Hispanic-Serving Institutions (HSI) program, which is
$4,000,000 above the fiscal year 2024 enacted level and
$13,657,000 below the fiscal year 2025 budget request.
The Developing HSIs program provides operating subsidies to
schools that serve at least 25 percent Hispanic students. Funds
may be used for faculty and academic program development,
management, joint use of libraries and laboratories,
acquisition of equipment, and student services.
New Hispanic-Serving Institutions.--The Committee
recognizes the importance of supporting HSIs, particularly
those that have recently received this designation. The
Committee encourages the Department to provide technical
assistance to newly designated HSIs on all Federal resources
and grants available to them.

Promoting Postbaccalaureate Opportunities for Hispanic Americans

The Committee provides $27,451,000 for the Promoting
Postbaccalaureate Opportunities for Hispanic Americans program,
the same as the fiscal year 2024 enacted level. This program
provides expanded postbaccalaureate educational opportunities
for the academic attainment of Hispanic and low-income
students. In addition, it expands academic offerings and
enhances program quality at IHEs educating the majority of
Hispanic college students.

Strengthening Historically Black Colleges and Universities

The Committee provides $407,966,000 for Strengthening
Historically Black Colleges and Universities (HBCUs), which is
$7,000,000 more than the fiscal year 2024 enacted level. This
program provides operating subsidies to accredited HBCUs that
were established prior to 1964, with the principal mission of
educating Black Americans. Funds are distributed through a
formula grant based on the enrollment of Pell Grant recipients,
number of graduates, and the number of graduates entering
graduate or professional schools in which Black students are
underrepresented.
The Committee recognizes that many students' postsecondary
education and career goals are well-supported by two-year
programs offered by Historically Black Community Colleges and
seeks to further support educational opportunities for students
at these schools. The Committee continues language and funding
for this program, dedicating this increased funding for
supplemental awards to junior or community colleges that are
eligible under the Historically Black Colleges and Universities
program.

Strengthening Historically Black Graduate Institutions

The Committee provides $101,286,000 for the Strengthening
Historically Black Graduate Institutions program, which is the
same as the fiscal year 2024 enacted level. The program
provides five-year grants to postsecondary institutions that
are specified in section 326(e)(1) of the HEA. Institutions may
use funds to build endowments, provide scholarships and
fellowships, and to assist students with the enrollment and
completion of postbaccalaureate and professional degrees.

Strengthening Predominantly Black Institutions

The Committee provides $22,412,000 for the Strengthening
Predominantly Black Institutions (PBIs) program, which is the
same as the fiscal year 2024 enacted level. This program
provides grants to PBIs to increase their capacity to serve the
academic needs of students.

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

The Committee provides $18,682,000 for the Strengthening
Asian American and Native American Pacific-Islander-Serving
Institutions program, which is the same as the fiscal year 2024
enacted level. This program provides grants to undergraduate
institutions that have an undergraduate student enrollment of
at least 10 percent Asian American or Native American Pacific
Islander.

Strengthening Alaska Native and Native Hawaiian-Serving Institutions

The Committee provides $24,555,000 for the Strengthening
Alaska Native and Native Hawaiian-Serving Institutions program,
which is the same as the fiscal year 2024 enacted level.
Through the Strengthening Alaska Native and Native Hawaiian-
Serving Institutions program, the Department provides grants to
assist institutions of higher education in serving Alaska
Native and Native Hawaiian students.

Strengthening Native American Serving Non-Tribal
Institutions

The Committee provides $14,462,000 for the Native American
Serving Non-Tribal Institutions program, which is $3,000,000
more than the fiscal year 2024 enacted level. This program
makes grants to IHEs at which enrollment is at least 10 percent
Native American students and that are not Tribally Controlled
Colleges or Universities.

Strengthening Tribally Controlled Colleges and Universities

The Committee provides $55,807,000 for the Strengthening
Tribally Controlled Colleges and Universities (TCCUs) program,
which is $4,000,000 more than the fiscal year 2024 enacted
level. This program makes grants to TCCUs to increase their
capacity to serve the academic needs of students.

Strengthening HBCU Masters Program

The Committee provides $20,037,000 for the Strengthening
HBCU Masters Programs, which is the same as the fiscal year
2024 enacted level. This program provides grants to specified
colleges and universities making a substantial contribution to
graduate education opportunities at the Master's level in
mathematics, engineering, the physical or natural sciences,
computer science, information technology, nursing, allied
health, or other scientific disciplines.

International Education and Foreign Language Studies

Authorized by Title VI of the HEA, these programs include
National resource centers, foreign language and area studies
fellowships, undergraduate international studies and foreign
language programs, international research and studies projects,
business and international education projects, international
business education centers, language resource centers, American
overseas research centers, and technological innovation and
cooperation for foreign information access.
Domestic Programs
The Committee provides $73,282,000 for the Domestic
Programs of the International Education and Foreign Languages
Studies program, which is $2,071,000 less than the fiscal year
2024 enacted level.
Overseas Programs
The Committee provides $8,249,000 for the Overseas
Programs, which is $2,062,000 less than the fiscal year 2024
enacted level and the same as the budget request.

Model Comprehensive Transition and Postsecondary Programs for Students
with Intellectual Disabilities

The Committee provides $13,800,000 for the Model
Comprehensive Transition and Postsecondary Programs for
Students with Intellectual Disabilities (TPSID) program, which
is the same as the fiscal year 2024 enacted level. TPSID
supports grants to create model transition programs into
postsecondary education for students with intellectual
disabilities.

Minority Science and Engineering Improvement

The Committee provides $16,370,000 for the Minority Science
and Engineering Improvement Program, which is the same as the
fiscal year 2024 enacted level. This program awards grants to
improve mathematics, science, and engineering programs at
institutions serving primarily minority students and to
increase the number of minority students who pursue advanced
degrees and careers in those fields.

Tribally Controlled Postsecondary Career and Technical
Institutions

The Committee provides $15,953,000 for the Tribally
Controlled Postsecondary Career and Technical Institutions
program, which is $4,000,000 more than the fiscal year 2024
enacted level. This program awards competitive grants to
Tribally controlled postsecondary career and technical
institutions to provide career and technical education to
Native American students.

Federal TRIO Programs

The Committee provides $1,191,000,000 for TRIO programs,
which is the same as the fiscal year 2024 enacted level. The
TRIO programs provide a variety of outreach and support
services to encourage low-income, first-generation college
students and individuals with disabilities to enter and
complete college. Discretionary grants of up to four or five
years are awarded competitively to IHEs and other nonprofit
organizations. At least two thirds of the eligible participants
in TRIO must be low-income, first-generation college students.

Gaining Early Awareness and Readiness for Undergraduate
Programs

The Committee provides $388,000,000 for Gaining Early
Awareness and Readiness for Undergraduate Programs (GEAR UP),
which is the same as the fiscal year 2024 enacted level. GEAR
UP provides grants to States and partnerships of low-income
middle and high schools, IHEs, and community organizations to
target entire grades of students and give them skills,
encouragement, and scholarships successfully to pursue
postsecondary education.
The Committee continues bill language allowing the
Department to maintain the GEAR UP evaluation set aside at 1.5
percent to work with the GEAR UP community and grantees to
standardize data collection, including through the use of
third-party data systems. Additionally, the Committee continues
to direct the Department to ensure that no request from a State
Grant applicant to receive an exception to the GEAR UP
scholarship (as described in section 404E(b)(2) of the HEA)
shall be denied on the basis of 34 CFR 694.14(c)(3).

Graduate Assistance in Areas of National Need

The Committee does not provide funding for the Graduate
Assistance in Areas of National Need program. This program
funds fellowships for students pursuing a doctoral degree or
the highest degree in the field available at their institution,
and who are studying in areas considered to be of national
need. The Committee recognizes that institutions of higher
education or non-Federal sources of postsecondary funding could
more appropriately support such graduate fellowships. The
Committee is concerned that the program performance is not
meeting its targets. The target completion rate for fellows to
finish their degree is only 65 percent, but the actual
completion rate in 2021 was 63 percent. Additionally, the
program's cost per PhD and for students who pass preliminary
exams exceeded the target of $68,000 in both 2020 and 2021, for
which data is most recently available.

Teacher Quality Partnership Grants

The Committee does not provide funding for the Teacher
Quality Partnerships program. The Committee notes this
program's purpose duplicates those of other Federal programs
related to teacher preparation and development. The Committee
recognizes that K-12 education is inherently local in nature,
and therefore States and districts can be most responsive to
needs regarding teacher recruitment and development in local
schools. Therefore, they are best positioned to make funding
decisions for such activities.

Child Care Access Means Parents in School

The Committee does not provide funding for the Child Care
Access Means Parents in School program. The Committee notes
that this program has a duplicative function of the Child Care
and Development Block Grant, which supports childcare for low-
income families and for which the Committee has provided
resources.

Fund for the Improvement of Postsecondary Education

The Committee recommendation includes $100,000,000 for the
Fund for the Improvement of Postsecondary Education, which is
$71,000,000 less than the fiscal year 2024 enacted level and
$162,000,000 below the fiscal year 2025 budget request.
Within the total provided, the Committee includes the
following amounts:

Hispanic-Serving Institutions and Local Educational
Agencies Partnerships.--The Committee includes $2,500,000 for
grants to promote and support collaboration between Hispanic-
Serving Institutions and local educational agencies that serve
a significant number or percentage of Hispanic or Latino
students for the purpose of improving educational attainment,
including increasing high school graduation rates and
postsecondary enrollment, transfer and completion rates among
Hispanic or Latino students, such as by strengthening pathways
to postsecondary and workforce development programs. The
Department shall also ensure such funds are used to improve
educational outcomes for English learners served by such local
educational agencies, including recently arrived English
learners and long-term English learners.
Increasing Hispanic-Serving Institutions PhDs Pilot.--The
Committee recognizes that Hispanic professionals are
underrepresented in postsecondary education. The Committee
includes $2,500,000 for competitive grants to HSIs or
consortiums of HSIs that award PhDs. The Department is directed
to make awards to at least four institutions of higher
education, as defined by section 101 of the HEA, to support
programs that seek to bolster PhD attainment. Grant priority
will go to institutions with 25 percent or higher Pell
enrollment, and HSIs located in areas with 25 percent or higher
Hispanic or Latino population. Funding should be used to
develop and test new models of cross-institutional partnerships
that facilitate mutually reinforcing activities such as
resource-sharing learning communities, mentorship programs for
PhD students, graduate research experiences, faculty mentor
capacity-building, and other associated uses.
Mapping Articulated Pathways.--Individuals eligible to
attend college, such as veterans and tradespeople with
significant but academically unrecognized prior learning
coursework, can be proactively credentialed, eliminating
tuition costs for those credits and shortening the
matriculation to graduation process. A comprehensive Credit-
for-Prior-Learning (CPL) system suitable for nationwide
application should be available at no cost to students and
include: (1) a robust, reliable, and scalable technology
platform; (2) demonstrated training for a variety of receiving/
deploying institutions; (3) cultural support for faculty who
authorize CPL within their institutions; (4) support for local
institutions to evaluate, document, and share non-college
certifications and training for CPL; and (5) a public dashboard
of all available CPL for all approved occupations,
certifications, and military training at each institution. In
order to prepare for broader application, the Committee directs
the Department to work in partnership with community colleges
on a possible expansion of the Mapping Articulated Pathways
initiative and report back to the Committee within 180 days of
enactment of this Act.
Postsecondary Student Success Grants.--The Committee
provides $45,000,000, which is the same as the fiscal year 2024
enacted level, for grants to support evidence-based activities
to improve postsecondary retention and completion rates,
including critical persistence benchmarks. Eligible applicants
may include institutions of higher education, a consortium of
institutions of higher education, Statewide systems of higher
education, a nonprofit organization, or any of the preceding
entities in partnership with a nonprofit or business.
Rural Postsecondary and Economic Development Grants.--The
Committee provides $50,000,000, which is $5,000,000 above the
fiscal year 2024 enacted level, for the Rural Postsecondary and
Economic Development Grants (RPED) program. The Committee is
aware that although rural students graduate from high school at
rates that may exceed their urban and suburban peers, they are
also significantly less likely than their peers in other areas
to attend post-secondary education opportunities. The Committee
recognizes that rural-serving institutions and communities face
unique challenges and barriers when compared to their urban and
suburban counterparts. Smaller, rural-serving colleges,
universities, and nonprofit organizations may have
significantly fewer staff, and less experience, in preparing to
respond to Federal grant opportunities. The Committee
encourages the Department of Education to consider ways to
better support rural applicants by recognizing the unique
challenges facing rural communities, including but not limited
to providing greater flexibility, longer application timelines,
and targeted technical assistance for RPED grants and other
funding opportunities across the Department.

Augustus F. Hawkins Centers of Excellence

The Committee does not provide funding for the Hawkins
Centers of Excellence program, recognizing there are
duplicative Federal programs related to improving and expanding
the availability of teachers. The Committee instead prioritizes
resources for other programs providing aid to institutions of
higher education and aid that goes directly to students, such
as Pell Grants.

HOWARD UNIVERSITY

Appropriation, fiscal year 2024....................... $304,018,000
Budget request, fiscal year 2025...................... 297,018,000
Committee Recommendation.............................. 253,928,000
Change from enacted level........................... -50,090,000
Change from budget request.......................... -43,090,000

The Committee provides $253,928,000 for Howard University,
which is $50,090,000 less than the fiscal year 2024 enacted
level. Howard University is a leading research university
located in the District of Columbia and provides undergraduate
liberal arts, graduate, and professional instruction to
students. Of the amounts provided, the Committee recommendation
includes no less than $3,405,000 for the matching endowment
grant, which is the same as the fiscal year 2024 enacted level
and the fiscal year 2025 budget request.
Howard University Hospital.--Within the funds provided for
Howard University, the Committee recommends $70,235,000 for the
Howard University Hospital. Of this amount, $27,235,000 is for
ongoing hospital operations, the same as the fiscal year 2024
enacted level. The Committee also includes new language in
section 311 providing legislative authority for the Secretary
to transfer up to $43,000,000 in unobligated amounts from the
Department of Education's Nonrecurring Expenses Fund to Howard
University for completion of the construction of the new Howard
University Hospital. This funding follows the $257,000,000 for
hospital construction that Congress has provided since fiscal
year 2021. This funding will complete the University's request
of $300,000,000.

COLLEGE HOUSING AND ACADEMIC FACILITIES LOANS PROGRAM

Appropriation, fiscal year 2024....................... $298,000
Budget request, fiscal year 2025...................... 328,000
Committee Recommendation.............................. 298,000
Change from enacted level........................... - - -
Change from budget request.......................... -30,000

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

HISTORICALLY BLACK COLLEGE AND UNIVERSITY CAPITAL FINANCING PROGRAM
ACCOUNT

Appropriation, fiscal year 2024....................... $20,678,000
Budget request, fiscal year 2025...................... 20,731,000
Committee Recommendation.............................. 20,678,000
Change from enacted level........................... - - -
Change from budget request.......................... -53,000

The Committee provides $20,678,000 for the HBCU Capital
Financing program, which is the same as the fiscal year 2024
enacted level. This program is authorized under part D of Title
III of the HEA and makes capital available for repair and
renovation of facilities at HBCUs.
Within the total provided for this program, the Committee
recommendation includes $528,000 for the administrative
expenses to carry out the program and $20,150,000 for loan
subsidy costs.

Office of Federal Student Aid (FSA)

90/10 Rule.--The 90/10 rule under the HEA requires
proprietary institutions of higher education to derive at least
10 percent of their tuition and fee revenue from non-Title IV
sources. In October 2022, the Department updated the rule to
include other Federal education assistance funds from other
Federal agencies, not just Title IV funds, as required by P.L.
117-2. The rule is effective July 1, 2023, for institutional
fiscal years that begin on or after January 1, 2023, such that
some institutions were required to comply starting January 1.
The Committee is aware that some commenters raised questions
about this timing and asked for clarification on the statutory
authority the Department used to determine the timing. Others
questioned the rule's requirement that institutions cannot
count as non-Federal revenue the funds they get from distance
learning programs that are ineligible for Title IV funds, for
calculating 90/10 compliance. They noted that distance learning
is a valuable form of education. The Committee continues to be
concerned with the Department's use of preamble language to
regulate distance education. Given the complexities of the rule
and its significant effects on proprietary institutions and
students, the Committee urges the Department to ensure it
provides clear communication and information on these
regulations.
Collective Adjudication of Borrower Defense Claims.--The
Committee acknowledges concerns regarding the recent expansion
of borrower defense that allows the Department to collectively
apply an adjudicated decision of an individual claim for
borrower defense to another group of borrowers, including
groups formed by third-party requestors, rather than
adjudicating individual claims separately. The Committee is
concerned that such ``group'' processing of borrower claims may
result in the inadvertent approval of meritless claims solely
based on their grouping with legitimate claims. The Committee
directs the Department to ensure that the adjudication and
review process for borrower defense claims involving groups of
borrowers, including those formed by third-party requestors,
shall be conducted on an individual basis, and reviewed for
materiality. The Department is encouraged to establish clear
criteria for assessing the materiality and reliability of
third-party submitted claims and is directed to report to the
Committee within 180 days of enactment of this Act on the
implementation of these procedures and any additional measures
taken to mitigate the risk of improper claim approvals.
Consolidation Loans.--The Committee is concerned that the
Department of Education does not have adequate processes and
safeguards in place to ensure it is upholding the statutory and
regulatory requirements regarding the consolidation of Federal
Family Education Loan (FFEL) Consolidation Loans into the
Direct Loan program under the HEA. HEA permits borrowers who
consolidated their loans into a single Consolidation Loan to
receive a subsequent consolidation loan only in specified
circumstances. The Department is directed to provide to the
Committee within 60 days of enactment of this Act a report
detailing the processes and safeguards in place to ensure that
FFEL Consolidation Loans are consolidated into the Direct Loan
program for a legally permitted purpose.
Public Service Loan Forgiveness.--The Committee remains
concerned about the fiscal and distributional impact associated
with the Public Service Loan Forgiveness (PSLF) program,
particularly considering executive actions and new regulations
issued by the Department. The Committee requests a report be
provided to the Committee and the Committee on Education and
the Workforce of the House of Representatives, the Committee on
Health, Education, Labor, and Pensions and the Committee on
Appropriations of the Senate within 90 days of enactment of
this Act and published on the Department's website describing
the distributional impact of the PSLF program. The report shall
include information on the amounts forgiven under PSLF based on
borrower characteristics, including, type of employment,
household income, highest level of degree obtained, and amount
borrowed. The Secretary shall develop employment categories for
purposes of meeting this requirement, which may include using
information from the Department's eligible employer database,
aligning categories with the Bureau of Labor Statistics
standard occupation classification system, or other methods.
Responsiveness to GAO Information Requests.--The Committee
notes that the Department of Education has unreasonably and
unnecessarily delayed the routine production of information to
GAO in response to GAO information requests regarding ongoing
reviews of the rollout of the simplified Free Application for
Federal Student Aid (FAFSA) (engagement code 107407) and the
FAFSA processing system launch (engagement code 107396). Such
information requested by GAO is necessary for GAO to complete
its work. The Committee directs FSA to immediately comply with
all ongoing GAO information requests related to the two FAFSA
reviews and to comply fully with all future GAO information
requests related to the two FAFSA reviews no later than 7
calendar days after each GAO request or such other timeframe as
GAO may specify. GAO has well-established statutory authority
to access agency records under 31 U.S.C. 716(a), and there is
no question that the information GAO has requested from the
Department for its reviews falls squarely within GAO's
authority. The Committee further directs GAO to provide the
Committee periodic updates on the Department's responsiveness
to GAO's information requests on the two FAFSA reviews. The
Department shall include in the fiscal year 2026 congressional
justification the status of any outstanding recommendation, not
fully implemented, from any prior GAO publication.
Student Loan Debt Relief.--The Committee expresses growing
concern about the fiscal and distributional impact associated
with the Department's student debt relief efforts. The
Department's stated total debt relief provided as of May 21,
2024, through various waivers, executive actions, and new
regulations is $167 billion, and hundreds of billions more is
expected to be realized over the next decade. The Committee
requests a report be provided to the Committee and the
Committee on Education and the Workforce of the House of
Representatives, and the Committee on Health, Education, Labor,
and Pensions and the Committee on Appropriations of the Senate
within 30 days of enactment of this Act and published on the
Department's website. This report shall describe the
distributional impact of the Department's debt relief efforts.
The report shall include the amounts cancelled, waived, or
otherwise discharged through each of the Administration's debt
relief actions carried out under the Higher Education Act of
1965 and the Higher Education Relief Opportunities Act of 2003
and cover actions undertaken since January 1, 2021. In
addition, such information shall be disaggregated by household
income, highest level of degree obtained, and amount borrowed.

STUDENT FINANCIAL ASSISTANCE

Appropriation, fiscal year 2024....................... $24,615,352,000
Budget request, fiscal year 2025...................... 26,716,352,000
Committee Recommendation.............................. 23,545,352,000
Change from enacted level........................... -1,070,000,000
Change from budget request.......................... -3,171,000,000

Pell Grants

The Committee provides $22,475,352,000 in discretionary
funding for the Pell Grant program, the same as the fiscal year
2024 enacted level. These funds will support Pell Grants to
students for the 2025-2026 award year.
The Committee recommendation includes $6,335 for the
discretionary portion of the maximum Pell grant award, the same
as the fiscal year 2024 enacted level. Combined with mandatory
funding of $1,060, this would provide a total maximum award of
$7,395 for the 2025-2026 award year.
Pell Grants are the foundation of Federal postsecondary
student aid programs. Pell Grants increase access to
educational and economic opportunities for low- and middle-
income students by providing need-based financial assistance.
Grants are determined according to a statutory formula, which
considers income, assets, household size, and the number of
family members in college, among other factors.

Federal Supplemental Educational Opportunity Grants

The Federal Supplemental Educational Opportunity Grant
program provides need-based grant aid to eligible undergraduate
students to help reduce financial barriers to postsecondary
education. Federal funding allocations are awarded to
qualifying postsecondary institutions under a statutory
formula. The Committee provides $455,000,000, which is
$455,000,000 below the fiscal year 2024 enacted level and the
fiscal year 2025 budget request.

Federal Work Study

The Federal work study (FWS) program provides funds for
part-time employment to help low income students to finance the
costs of postsecondary education. Students can receive FWS
funds at approximately 3,400 participating postsecondary
institutions. The Committee provides $615,000,000, which is
$615,000,000 below the fiscal year 2024 enacted level and the
fiscal year 2025 budget request.

STUDENT AID ADMINISTRATION

Appropriation, fiscal year 2024....................... $2,058,943,000
Budget request, fiscal year 2025...................... 2,659,126,000
Committee Recommendation.............................. 1,529,472,000
Change from enacted level........................... -529,471,000
Change from budget request.......................... -1,129,654,000

Programs administered under the Student Aid Administration
(SAA) include Pell Grants, campus-based aid programs, Teacher
Education Assistance for College and Higher Education grants,
and Federal student loan programs.

Salaries and Expenses

Within the total provided for SAA, the Committee provides
$529,472,000 for salaries and expenses, which is $529,471,000
less than the fiscal year 2024 enacted level and below the
fiscal year 2025 budget request.

Servicing Activities

Within the total provided for SAA, the Committee provides
$1,000,000,000 for Loan Servicing Activities, which is the same
as the fiscal year 2024 enacted level, and $324,383,000 below
the budget request. The Committee notes that in fiscal year
2024, SAA received a $25,000,000 increase in funding
specifically designated for the continuation of student loan
servicing activities, including supporting borrowers reentering
repayment. The Committee underscores the importance of
prioritizing loan servicing and assisting borrowers in repaying
their loans. The Committee urges the Department to abandon its
unfair and fiscally irresponsible student loan forgiveness
schemes.
Enforcement.--The Committee expresses growing concern about
the escalating frequency of targeted enforcement actions
against specific categories of postsecondary institutions.
Objective, unbiased oversight, devoid of ideology and conflicts
of interest, is essential. Any punitive measures, fines, or
penalties must be impartially assessed based on neutral
criteria. The department has repeatedly conducted specific
investigations into individual colleges and universities,
certain types of institutions, and companies in the education
sector, often based on unfounded claims, a de minimis basis for
opening an investigation, or sheer political motives. The
failure to adhere to professional audit, oversight, and
enforcement standards negatively impacts the institution and
undermines service provisions. As part of the Administration's
announcement to modernize the Office of Federal Student Aid,
the Committee strongly recommends increased caution and a
thorough evaluation of ongoing, and any planned future,
investigations to ensure objective and unbiased results.
In 2021, the Department established an Enforcement Office
within FSA. The Committee is aware of concerns that the
Enforcement Office is targeting proprietary schools, rather
than investigating all institutions of higher education. The
Committee directs the Department to provide the Committees with
a briefing on the Office's investigations work, particularly
its targeted, proactive investigations and the resources
allocated for such activities, including across different
sectors of higher education, within 90 days of enactment of
this Act. Such briefing should include information on the
Office's methods for prioritizing investigations. Additionally,
the Committee requests that the Department include, in the
fiscal year 2026 congressional justification, information on
the number of staff in the Enforcement Office as of the end of
each fiscal year since it was established.
Free Application for Federal Student Aid.--The Committee
notes the myriad problems with the implementation of the 2024-
2025 FAFSA. This chaotic rollout has caused repeated delays in
the Department sending completed FAFSA information to college
financial aid administrators, in turn delaying when students
and their families can receive information on their financial
aid eligibility. It has caused tremendous frustration and
confusion among students and their families. The Committee is
concerned that the Department prioritized resources for its
repeated student loan forgiveness efforts at the expense of
adequately preparing for the FAFSA implementation. The
Committee requests an update in the fiscal year 2026
congressional justification on the estimated resources, both
monetary and employees and contractors, the Department spent on
FAFSA and the various loan cancellation initiatives. The
Committee notes the Department's regular communications
regarding the FAFSA implementation and strongly encourages it
to continue this practice, especially as it relates to the
anticipated timeline for the 2025-2026 FAFSA release.
Quarterly Briefings.--The Department is directed to provide
quarterly briefings to the Committee on the implementation of
the Unified Servicing and Data Solution.
Reprogramming of Funds.--Any reallocation of funds between
administrative costs and servicing activities within this
account should be treated as a reprogramming of funds, and the
Department is directed to notify the Committee in advance of
any such changes, pursuant to section 514 of this Act.
Spend Plans.--No later than 45 days after enactment of this
act, the Committee directs the Department to provide a detailed
spend plan of anticipated uses of funds made available in this
account for fiscal year 2025 and provide quarterly updates on
this plan (including contracts awarded, change orders, bonuses
paid to staff, reorganization costs, and any other activity
carried out using amounts provided under this heading for
fiscal year 2025). The Department is expected to conduct
briefings with appropriate subject matter experts to answer
questions on these topics to limit the need for follow up
information after the briefing.

Student Loan Forgiveness.--The Committee is deeply
disappointed by the Department's continued partisan effort to
cancel student loans, rather than focus taxpayer resources on
ensuring a successful return to repayment for borrowers. This
massive accumulation of loan forgiveness is on top of the
income-based repayment plan, called SAVE or Saving on a
Valuable Education, that the Department created through
regulatory action. It is the most generous income-based
repayment plan ever, and the Congressional Budget Office
estimates it will cost taxpayers more than $150,000,000,000.
The plan makes more borrowers eligible to have $0 monthly
payments, and for borrowers who still must pay some amount, it
cuts their monthly payments in half. Additionally, the
Department announced even more loan cancellation efforts it
will pursue through regulation, including waiving potentially
thousands of dollars in accrued interest per borrower
regardless of their income. Another concerning aspect of this
new scheme is a proposal for the Secretary of Education to be
able to cancel debt for borrowers that the Department
``predicts'' will be in default within a specified time frame.
Despite the Supreme Court's decision to overturn the
Department's blanket student loan cancellation plan, the
Department has demonstrated its obstinate determination to
cancel as much in student loans as possible incrementally. The
Administration's repeated promises of future loan cancellation
further weakens any message it gives borrowers about reentering
repayment and paying back their loans. Such mixed messages
create the wrong incentives for future students, who may make
borrowing decisions based on assumptions that little if any of
their loans will have to be repaid. The Committee includes
legislative language to stop the taxpayer funded bailout of
student loans.

Institute of Education Sciences

Appropriation, fiscal year 2024....................... $793,106,000
Budget request, fiscal year 2025...................... 815,455,000
Committee Recommendation.............................. 740,373,000
Change from enacted level........................... -52,733,000
Change from budget request.......................... -75,082,000

This account supports education research, statistics,
dissemination, evaluation, and assessment activities.

Research, Development, and Dissemination

The Committee provides $245,000,000 for Research,
Development, and Dissemination, which is the same as the fiscal
year 2024 enacted level. This account supports research,
development, and national dissemination activities that are
aimed at expanding fundamental knowledge of education and
promoting the use of research and development findings in the
design of efforts to improve education.

Statistics

The Committee provides $122,500,000 for the activities of
the National Center for Education Statistics (NCES), which is
$1,000,000 above the fiscal year 2024 enacted level. Statistics
activities are authorized under Title I of the Education
Sciences Reform Act of 2002. NCES collects, analyzes, and
reports statistics on all levels of education in the U.S.
Activities are carried out directly and through grants and
contracts and include projections of enrollments, teacher
supply and demand, and educational expenditures. NCES also
provides technical assistance to State and local educational
agencies and postsecondary institutions.
Civics Assessment.--The Committee requests an update from
NCES and the National Assessment Governing Board on the plans,
budgetary requirements, and timeline for the National
Assessment of Educational Progress Civics Assessment in the
fiscal year 2026 congressional justification.
School Phone Usage.--The Committee directs NCES to study
and issue a report on cell phone use in schools and any
policies that limit cell phone use in K-12 schools, and any
correlation between phone use and student academic achievement.
The Committee provides an increase of $1,000,000 for this
purpose.

Regional Educational Laboratories

The Committee does not provide funding for this program.
The Regional Education Laboratories support dissemination and
technical assistance activities that are duplicative of
existing investments in areas of training, technical
assistance, and professional development to build State
capacity to provide high-quality education. States can use
Title I funds to pay for these services directly. States may
reserve funds under Title I that may be used to obtain needed
technical assistance, and LEAs are not limited in the amount of
Title I funds that may be used for reasonable and necessary
technical assistance services related to the effective
implementation of Title I program requirements.

Research in Special Education

The Committee provides $64,255,000 for Research in Special
Education, which is the same as the fiscal year 2024 enacted
level. This program supports competitive grants to produce and
advance the use of knowledge to improve services and results
for children with disabilities. The program focuses on
producing new knowledge, integrating research and practice, and
improving the use of knowledge.

Special Education Studies and Evaluations

The Committee provides $13,318,000 for Special Education
Studies and Evaluations, which is the same as the fiscal year
2024 enacted level. This program awards competitive grants,
contracts, and cooperative agreements to assess the
implementation of the IDEA and the effectiveness of State and
local efforts to provide special education and early
intervention programs and services to infants, toddlers, and
children with disabilities.

Statewide Longitudinal Data Systems

The Committee provides $28,500,000 for this program, which
is the same as the fiscal year 2024 enacted level. These
competitive grants are awarded to States to design and maintain
longitudinal data systems.

Assessment

The Committee provides $193,300,000 for Assessment, which
is the same as the fiscal year 2024 enacted level. This amount
includes $8,300,000 for the National Assessment Governing Board
(NAGB), the same as the fiscal year 2024 enacted level. The
National Assessment of Educational Progress (NAEP) is the only
nationally representative and continuing survey of educational
ability and achievement of students in the U.S. The primary
goal of the assessment is to determine and report the status
and trends of the knowledge and skills of students, subject by
subject. Subject areas assessed in the past have included
reading, writing, mathematics, science, history, citizenship,
literature, art, and music. The NAEP is operated by contractors
through competitive grants made by the NCES. The NAGB
formulates the policy guidelines for the program.

Program Administration

The Committee provides $73,500,000 for Program
Administration, which is the same as the fiscal year 2024
enacted level.
Operating Plan.--The Committee directs the Director to
submit an operating plan within 90 days of enactment of this
Act to the Committees detailing how IES plans to allocate
funding available to the Institute for research, evaluation,
statistics, administration, and other activities.

Departmental Management

Appropriation, fiscal year 2024....................... $627,407,000
Budget request, fiscal year 2025...................... 716,702,000
Committee Recommendation.............................. 418,407,000
Change from enacted level........................... -209,000,000
Change from budget request.......................... -298,295,000

PROGRAM ADMINISTRATION

Appropriation, fiscal year 2024....................... $419,907,000
Budget request, fiscal year 2025...................... 476,846,000
Committee Recommendation.............................. 210,907,000
Change from enacted level........................... -209,000,000
Change from budget request.......................... -265,939,000

The Committee recommends $210,907,000 for Program
Administration, which is $209,000,000 less than the fiscal year
2024 enacted level and $265,939,000 below the fiscal year 2025
budget request. These funds are used for expenses related to
staff and other costs of administering programs and activities
at the Department. Such expenses include personnel
compensation, health, retirement, and other benefits, as well
as travel, rent, telephones, utilities, postage fees, data
processing, printing, equipment, supplies, technology training,
consultants, and other contractual services.
Bill-Wide Requirements.--The Committee notes the inclusion
of a bill-wide requirements section of this report. This
section contains requirements which apply to all agencies
funded by this Act.
Chronic Absenteeism.--The Committee is concerned about the
rise in chronic student absenteeism across the country and the
effectiveness of efforts at the Federal level to address it.
Therefore, the Committee directs the GAO to review (1) how the
Department of Education assesses States' efforts to improve
chronic absenteeism for States that include it as an indicator
in their Statewide accountability systems, and (2) any
opportunities to improve Federal oversight of these efforts.
GAO should begin this work no later than September 30, 2024,
and issue a final report on a date thereafter as agreed between
GAO and the Committee.
Cost Savings of Inclusive Access Programs Study.--The
Committee is concerned the Department's proposed changes to the
Cash Management regulations related to Books and Supplies for
Title IV funds could unintentionally increase prices and limit
first-day access for students receiving Federal financial aid.
The Committee directs GAO to report on the potential cost
savings and accessibility of ``Inclusive Access'' and other
``first-day'' programs that provide students with books and
materials at below market rates by the first day of class. The
report shall consider the potential impact of ``Inclusive
Access'' and other ``first-day'' programs on access and
affordability for students receiving Federal financial aid, as
well as other topics GAO determines appropriate.
Credit Transfer.--The Committee is aware that students face
challenges when seeking to transfer credits to institutions of
higher education, and this can result in the loss of credit.
The Committee is also aware of barriers to students in
obtaining college credit, certification, or advanced standing
toward further education through learning outside the
traditional academic environment. The Committee emphasizes that
credit for prior learning can be beneficial to students, by
helping them accelerate their program completion, saving them
time and money.
Cybersecurity Training.--The Committee recognizes the rapid
changes and costs of cybersecurity training and urges the
Department of Education to recognize and support public,
private, and proprietary institutions of higher education that
have accelerated their programs within the field of training
cybersecurity professionals for the emerging national need
demonstrated by the estimated 700,000 open public and private
cybersecurity jobs.
Nonrecurring Expenses Fund.--The Committee directs the
Department to provide quarterly reports for all ongoing
projects. The report shall include the following for each
project: agency project is funded under; a description for each
project; the date the project was notified to the Committees;
total obligations to date; obligations for the prior fiscal
year; anticipated obligations for current fiscal year; and any
expected future obligations. For any project ongoing for more
than 3 years, the report should include a narrative describing
the cause for delay and steps being taken by the agency to
ensure prompt completion. In addition, the Committee requests
biannual reports on expired balances that are eligible for
transfer to the Nonrecurring Expenses Fund (NEF). Such report
shall include the Treasury Account Fund Symbol, program name,
unobligated balance, and unexpended balance. Such report shall
be transmitted 30 days after the close of the second quarter
and within 45 days after the close of the fourth quarter of the
fiscal year. To ensure appropriate Congressional oversight into
use of the NEF, the Committee includes a new provision limiting
the amount for additional notifications for use of the NEF.
Opioid Overdose Reversal Agents.--The U.S. continues to see
a rise in known or suspected opioid overdoses at educational
institutions to include both colleges and universities. The
Committee commends the Department of Education for preparing
for opioid-related emergencies for K-12 Schools and
institutions of higher education. However, the Committee
remains concerned that schools have inconsistent policies and
may have uncertainty around the purchasing and use of overdose
reversal medication to respond to a student or employee
emergency. The Committee supports efforts to ensure schools and
institutions of higher education have access to overdose
reversal medication in the event of an emergency. Therefore,
the Committee also supports efforts to train employees on
overdose reversal as appropriate.
Office of Communications and Outreach.--The Department is
reminded of the statutory anti-lobbying restrictions in place
in 18 U.S.C. 1913, which prohibits lobbying by Federal
agencies. The Secretary is directed to ensure compliance with
these laws on all public statements, and to make all central
office based employees receive training on the Hatch Act and
its application to ensure official Department resources are
being used in a nonpartisan manner.
Program Administration.--The Committee remains concerned
about the Department's prioritization of staff resources in the
Program Administration account. The fiscal year 2023 agreement
directed the Department to begin rebalancing the agency's ratio
of career staff to non-career staff, to prioritize career staff
for executing core programs at the Department, and not to
expand its non-career staff on board above the December 2022
levels. Despite the clear Congressional directive, the level of
non-career staff remained above the December 2022 level for all
fiscal year 2023. For this reason, the fiscal year 2024 bill
included new language prohibiting funds from being used on or
after August 15, 2024, to support a non-career employee number
that is above the number of non-career employees as of December
31, 2022. The Committee continues bill language prohibiting
funds from being used to support a number of non-career
employees that is above the number of non-career employees as
of December 31, 2022 for fiscal year 2025.
Reports to Congress.--The Department is directed to provide
5 business days' notice to the Committees before release of any
congressionally directed report.
Responsiveness to GAO.--The Committee notes that there have
been prior engagements where the Department of Education
unnecessarily delayed in providing GAO with timely and complete
information in response to GAO requests. The Committee directs
the Department to provide timely and complete information to
GAO on its engagements within timeframes as GAO may specify.
The Committee further directs GAO to develop timeliness
criteria to measure the Department of Education's
responsiveness to GAO requests for information. GAO activities
are crucial to Congressional oversight, and the development of
such criteria will assist GAO in the timely completion of work.
GAO should consult with the Department, as GAO determines
appropriate, in developing such criteria.
Return to Work.--Excessive abuse of telework across the
Federal government must end. For the average American showing
up to work every day is a fact of life; they deserve a
government that reflects that reality. Approvals for remote
work should be made on an individual case by case basis and
done only to serve the best interests of the program and the
American public. The agency is directed to provide to the
Committee within 60 days of enactment of this Act a report
detailing the number of full-time employees by subcomponent who
are receiving the Washington D.C. area locality pay but have
not reported to an in person office in the D.C. area more than
one day a week for the past year. Considering the remote work
abuse seen at several agencies, administrative funding for the
Secretary has been reduced accordingly. The Committee urges the
Secretary to bring Federal employees back to the workplace to
fulfill the mission of serving the American public.
Staffing Report.--Consistent with the fiscal year 2024
explanatory statement, the Committee continues to request, no
later than 30 days after enactment of this Act, an operating
plan identifying the total full time equivalent (FTE) and non-
personnel allocations supported by the program administration
appropriation in total for the Department, and FTE and non-
personnel allocations for each program office supported by the
program administration appropriation provided by this Act. In
addition, the Department shall provide monthly the number of
on-board staff, attrition, approved hires not yet on-board and
projected full-year FTE usage, including approved hires, and
actual non-personnel expenses, for each program office
supported by, and in total for, the program administration
appropriation provided by this Act. The monthly reports should
be detailed by career and non-career staff. In addition, the
Department shall separately identify in such plans and reports
total FTE allocations supported by other funding sources. The
Department shall also provide the Committee on a biannual basis
an excel file which includes the names, titles, grades, program
office, and date of hire of all political appointees employed
by the Department for the previous 180 days.
Title II-A Funds.--The Department is directed to provide
the Committee, within 180 days from the date of enactment of
this Act, a report that lists any use of this funding for the
most recent year data is available, by schools or school
districts to pay outside consultants or firms for the purposes
of teacher and/or school leader training or professional
development. The report shall include the specific names of any
applicable consultants or firms who were paid using Title II-A
funds and where possible a description of the training or other
materials provided.
Transparency about Foreign Influence in American
Postsecondary Education.--The Committee remains concerned about
the ongoing risks associated with malign foreign influence in
American postsecondary education, as well as the Department's
limited enforcement of section 117 of the Higher Education Act.
The Committee requests a report be provided to the Committee
and the Committee on Education and the Workforce of the House
of Representatives and the Committee on Health, Education,
Labor, and Pensions and the Committee on Appropriations of the
Senate no later than 60 days after enactment of this Act and
published on the Department's website describing how the
Department is enforcing section 117. This report shall include
staffing levels for enforcement, enforcement actions taken,
section 117 compliance reviews opened and closed for the most
recent fiscal year for which data is available, how the
Department verifies data submitted by institutions, and a
description of how the Department shares information with other
Federal agencies. The report shall also include totals of
disclosed foreign contributions reported by postsecondary
institutions by type of contribution and country of origin,
year to year comparisons by type of contribution and country of
origin, and the number of disclosures submitted anonymously.
The Department is urged to modernize its College Foreign
Gift and Contract Report website to allow disclosed information
to be individually identified and compared and searchable and
sortable by date received, type, date filed, and country of
origin. The Department is urged to implement technical
improvements to its public database, including improving upload
functionality by allowing institutions to batch upload one file
with all required information. The Department is further
encouraged to publish a database users guide, including
information on how to edit an entry and how to report errors.
Women's Health Education and Training on Reproductive
Conditions.--The Committee recognizes the importance of
empowering women with a medically sound knowledge of their
reproductive system, fertility window, tracking their monthly
cycle, the health risks related to hormonal birth control and
medically induced menopausal medication, medical and non-
medical approaches to reproductive conditions excluding
abortion, and what symptoms to consider as it relates to
hormonal imbalances, endometriosis, polycystic ovary syndrome,
adenomyosis, uterine fibroids, interstitial cystitis, and
irregular menstrual cycles. To ensure that women receive such
information, they need to give informed consent. This includes
age-appropriate coursework and resources. Materials that should
be taught (or available) in both middle school and high school
sex education courses. Teacher licensing requirements for sex
education courses should also include training and education
materials to prepare teachers to cover these topics. The
Committee encourages the Department of Education to explore
funding opportunities for these educational trainings and
resources.

OFFICE FOR CIVIL RIGHTS

Appropriation, fiscal year 2024....................... $140,000,000
Budget request, fiscal year 2025...................... 162,359,000
Committee Recommendation.............................. 130,000,000
Change from enacted level........................... -10,000,000
Change from budget request.......................... -32,359,000

The Office for Civil Rights (OCR) is responsible for
enforcing laws that prohibit discrimination on the basis of
race, color, national origin, sex, disability, and age in all
programs and institutions that receive funds from the
Department. These laws extend to SEAs, LEAs, and IHEs,
including proprietary schools. They also extend to State
rehabilitation agencies, libraries, museums, and other
institutions receiving Federal funds.
The Committee supports efforts by the Office for Civil
Rights to provide technical assistance regarding antisemitism
on campus and to complete pending investigations of complaints
relating to antisemitism under Title VI of the Civil Rights Act
of 1964.
Antisemitism Investigations.--The Committee is concerned by
the explosion of antisemitism at IHEs across the U.S. following
the terrorist attack on Israel and the subsequent failure of
many IHEs to address antisemitic conduct on their campuses. It
is unclear what actions OCR has taken to date in response to
the numerous complaints received. The Committee requests that
OCR produce a quarterly report on the status of OCR shared
ancestry investigations and provide an initial report to the
Committee and the Committee on Education and the Workforce of
the House of Representatives and the Committee on Health,
Education, Labor, and Pensions and the Committee on
Appropriations of the Senate no later than 30 days after
enactment of this Act. Such report should include a brief
overview, including timeline, status of the investigation, and
any actions taken by the Department.

OFFICE OF INSPECTOR GENERAL

Appropriation, fiscal year 2024....................... $67,500,000
Budget request, fiscal year 2025...................... 77,497,000
Committee Recommendation.............................. 67,500,000
Change from enacted level........................... - - -
Change from budget request.......................... -9,997,000

The Office of Inspector General has authority to inquire
into all program and administrative activities of the
Department, as well as related activities of grant and contract
recipients. It conducts audits and investigations to determine
compliance with applicable laws and regulations, to check
alleged fraud and abuse, efficiency of operations, and
effectiveness of results.

General Provisions

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

(TRANSFER OF FUNDS)

Sec. 302. The Committee continues a provision regarding
transfer authority.
Sec. 303. The Committee modifies a provision allowing ESEA
funds consolidated for evaluation purposes to be available from
July 1, 2025 through September 30, 2026.
Sec. 304. The Committee modifies a provision allowing
certain institutions to continue to use endowment income for
student scholarships.
Sec. 305. The Committee modifies a provision extending the
authorization of the National Advisory Committee on
Institutional Quality and Integrity.
Sec. 306. The Committee modifies a provision extending the
authority to provide account maintenance fees to guaranty
agencies for Federal student loans.
Sec. 307. The Committee continues a provision allowing
administrative funds to cover outstanding Perkins loans
servicing costs.
Sec. 308. The Committee modifies a provision allowing up to
0.5 percent of funds appropriated in this Act for programs
authorized under the HEA, except for the Pell Grant program, to
be used for evaluation of any HEA program.

(INCLUDING TRANSFER OF FUNDS)

Sec. 309. The Committee continues a provision regarding
centralized support costs for the Institute of Education
Sciences.

(RESCISSION)

Sec. 310. The Committee includes a new provision rescinding
various unobligated balances.

(RESCISSION AND INCLUDING TRANSFER OF FUNDS)

Sec. 311. The Committee includes a new provision rescinding
amounts from the Nonrecurring Expenses Fund and transferring
funds to Howard University.
Sec. 312. The Committee includes a new provision regarding
participation in athletic programs.
Sec. 313. The Committee includes a new provision
prohibiting certain rules regarding Title IX of the Education
Amendments of 1972.
Sec. 314. The Committee includes a new provision regarding
protection for religious student groups at institutions of
higher education.
Sec. 315. The Committee includes a new provision
prohibiting certain Federal student loan cancellations, and
rules related to income-driven repayment, borrower defense to
repayment, 90/10, and gainful employment.

TITLE IV--RELATED AGENCIES

Appropriation, fiscal year 2024....................... $17,081,955,000
Budget request, fiscal year 2025...................... 18,421,516,000
Committee Recommendation.............................. 14,962,530,000
Change from enacted level........................... -2,119,425,000
Change from budget request.......................... -3,458,986,000

This bill provides just under $15 billion in discretionary
budget authority for the title IV Related Agencies, a reduction
of 12 percent over fiscal year 2024 enacted level. The agencies
within title IV comprise 8 percent of the total 302(b)
allocation for this subcommittee.

Committee for Purchase From People Who Are Blind or Severely Disabled

SALARIES AND EXPENSES

Appropriation, fiscal year 2024....................... $13,124,000
Budget request, fiscal year 2025...................... 14,800,000
Committee Recommendation.............................. 13,124,000
Change from enacted level........................... - - -
Change from budget request.......................... -1,676,000

The Committee for Purchase from People Who Are Blind or
Severely Disabled, an independent Federal agency, oversees and
manages the AbilityOne Program, which uses the purchasing power
of the Federal government to buy products and services from
participating, community-based nonprofit agencies nationwide
dedicated to training and employing individuals with
disabilities.
Office of Inspector General.--The Committee provides not
less than $3,150,000 for the Office of Inspector General, the
same as the fiscal year 2024 enacted level.

Corporation for National and Community Service

OPERATING EXPENSES

Appropriation, fiscal year 2024....................... $975,525,000
Budget request, fiscal year 2025...................... 1,046,276,000
Committee Recommendation.............................. 361,158,000
Change from enacted level........................... -614,367,000
Change from budget request.......................... -685,118,000

The Corporation for National and Community Service (CNCS)
funds various service and volunteer programs.
Data Collection.--The Committee directs CNCS to clearly
communicate with grantees involved in any data collection,
whether the information being collected is optional for
reporting or required information as part of a grant.
The Committee is concerned that several audits have found
the agency does not conduct proper oversight of its grants:
2016: Major AmeriCorps Grantee Allowed
Members to Provide Abortion-Related Services Prohibited
by Law (OIG-2016-003)
2017: Grants Management: Monitoring Efforts
by Corporation for National and Community Service Could
Be Improved (GAO-17-90)
2017: Grants Management: Corporation for
National and Community Service's Grant Monitoring
Process Could Be Improved (GAO-17-528T)
2017: Information Technology Modernization:
Corporation for National and Community Service Needs to
Develop a System That Supports Grant Monitoring (GAO-
17-267)
2024: Grants: AmeriCorps Should Take
Multiple Actions to Better Manage Fraud Risks (GAO-24-
106564)
2024: Performance Audit of AmeriCorps Grants
Awarded to YouthBuild USA (OIG-AR-24-05)
Due to the lack of oversight and financial management
necessary for Federal funding, the Committee does not provide
funding for several programs. Given the agency's longstanding
inability to properly manage its grants, CNCS should focus on
oversight of existing grantees and improved program operations
and management. Instead, the agency is dedicating significant
attention, staff time, and resources to the newly launched
American Climate Corps.

Domestic Volunteer Service Programs

The Committee includes $103,285,000 for Volunteers in
Service to America, which is the same as the fiscal year 2024
enacted level and $33,232,000 below the fiscal year 2025 budget
request.

National Senior Volunteer Corps

The funding breakout by program is as follows:

------------------------------------------------------------------------
FY 2025
Budget Activity FY 2024 Enacted Committee
------------------------------------------------------------------------
National Senior Volunteer Corps:
Foster Grandparents Program... 125,363,000 $125,363,000
Senior Companion Program...... 56,449,000 56,449,000
Retired Senior Volunteer 55,105,000 55,105,000
Program......................
------------------------------------------------------------------------

The Retired Senior Volunteer Program provides grants to
organizations to engage Americans aged 55 years and older in
volunteer service.

National and Community Service Programs

The Committee does not include funding for AmeriCorps State
and National grants, which is $557,094,000 below the fiscal
year 2024 enacted level and $591,336,000 below the fiscal year
2025 budget request.
The Committee does include $14,706,000 for innovation,
assistance, and other activities, which is the same as the
fiscal year 2024 enacted level and the fiscal year 2025 budget
request.
The Committee does include $6,250,000 for evaluation, which
is the same as the fiscal year 2024 enacted level and the
fiscal year 2025 budget request.
The Committee does not include funding for the National
Civilian Community Corps, which is $37,735,000 below the fiscal
year 2024 enacted level and $42,491,000 below the fiscal year
2025 budget request.
The Committee does not include funding for the State
Commission Support grants, which is $19,538,000 below both the
fiscal year 2024 enacted level and the fiscal year 2025 budget
request.

Innovation, Assistance, and Other Activities

National Days of Service.--The Committee continues to
support the September 11 National Day of Service and
Remembrance and the Martin Luther King, Jr. National Day of
Service--two important national events. The Committee
encourages CNCS to prioritize eligible organizations with
expertise in representing families of victims of the September
11, 2001, terrorist attacks and other impacted constituencies
when planning for the September 11 National Day of Service and
Remembrance.

Payment to the National Service Trust

Appropriation, fiscal year 2024....................... $180,000,000
Budget request, fiscal year 2025...................... 159,951,000
Committee Recommendation.............................. - - -
Change from enacted level........................... -180,000,000
Change from budget request.......................... -159,951,000

The National Service Trust makes payments for Segal
education awards, pays interest that accrues on qualified
student loans for AmeriCorps participants during terms of
service in approved national service positions, and makes other
payments entitled to members who serve in the programs of the
Corporation for National and Community Service.
The Committee rescinds $140,000,000 from the National
Service Trust.

SALARIES AND EXPENSES

Appropriation, fiscal year 2024....................... $99,686,000
Budget request, fiscal year 2025...................... 127,104,000
Committee Recommendation.............................. 79,686,000
Change from enacted level........................... -20,000,000
Change from budget request.......................... -47,418,000

OFFICE OF INSPECTOR GENERAL

Appropriation, fiscal year 2024....................... $7,595,000
Budget request, fiscal year 2025...................... 8,762,000
Committee Recommendation.............................. 8,595,000
Change from enacted level........................... +1,000,000
Change from budget request.......................... -167,000

ADMINISTRATIVE PROVISIONS

Sec. 401. The Committee modifies a provision requiring the
agency to make any significant changes to program requirements
or policy through rulemaking.
Sec. 402. The Committee continues a provision related to
National Service Trust minimum share requirements.
Sec. 403. The Committee continues a provision related to
donations.
Sec. 404. The Committee continues a provision related to
veterans.
Sec. 405. The Committee continues a provision related to
criminal history background checks.
Sec. 406. The Committee continues a provision related to
1,200 hours of service positions.
Sec. 407. The Committee continues a provision related to
Volunteers in Service to America members' education awards.

(RESCISSION)

Sec. 408. The Committee includes a new provision rescinding
unobligated balances.

Corporation for Public Broadcasting

Appropriation, fiscal year 2024....................... $525,000,000
Budget request, fiscal year 2025...................... 655,000,000
Committee Recommendation.............................. - - -
Change from enacted level (for FY 2025)............. -60,000,000
Change from budget request.......................... -655,000,000

The Committee continues $535,000,000 in funding for the
Corporation of Public Broadcasting (CPB) for fiscal year 2025.
The Committee does not believe CPB should receive a two-
year advance appropriation and does not provide the fiscal year
2027 advance request of $595,000,000. The Committee does not
provide funding for the interconnection system, which is
$60,000,000 below the fiscal year 2024 enacted level and the
fiscal year 2025 budget request.

Federal Mediation and Conciliation Service

SALARIES AND EXPENSES

Appropriation, fiscal year 2024....................... $53,705,000
Budget request, fiscal year 2025...................... 53,705,000
Committee Recommendation.............................. 53,705,000
Change from enacted level........................... - - -
Change from budget request.......................... - - -

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

Federal Mine Safety and Health Review Commission

SALARIES AND EXPENSES

Appropriation, fiscal year 2024....................... $18,012,000
Budget request, fiscal year 2025...................... 17,572,000
Committee Recommendation.............................. 18,012,000
Change from enacted level........................... - - -
Change from budget request.......................... +440,000

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

Institute of Museum and Library Services

OFFICE OF MUSEUM AND LIBRARY SERVICES: GRANTS AND ADMINISTRATION

Appropriation, fiscal year 2024....................... $294,800,000
Budget request, fiscal year 2025...................... 280,000,000
Committee Recommendation.............................. 249,515,000
Change from enacted level........................... -45,285,000
Change from budget request.......................... -30,485,000

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

------------------------------------------------------------------------
FY 2025
Budget Activity FY 2024 Enacted Committee
------------------------------------------------------------------------
Library Services Technology Act:
Grants to States.............. $180,000,000 $180,000,000
Native American Library 5,763,000 5,763,000
Services.....................
National Leadership: Libraries 15,287,000 - - -
Laura Bush 21st Century 10,000,000 - - -
Librarian....................
Museum Services Act:
Museums for America........... 30,330,000 30,330,000
Native American/Hawaiian 3,772,000 3,772,000
Museum Service...............
National Leadership: Museums.. 9,348,000 - - -
African American History and
Culture Act:
Museum Grants for African 6,000,000 6,000,000
American History and Culture.
National Museum of the American
Latino Act:
Museum Grants for American 6,000,000 6,000,000
Latino History and Culture...
Museum and Library Services Act
General Provisions:
Research, Analysis and Data 5,650,000 - - -
Collection...................
Program Administration............ 22,650,000 17,650,000
------------------------------------------------------------------------

America250.--The Committee recognizes IMLS's commitment to
the 250th Anniversary of the U.S. IMLS has a key role in
supporting existing activities and new projects at the State
and local levels that enhance civic engagement, innovation, and
community collaboration in preparation for the 250th
Anniversary. The Committee fully funds IMLS library formula
grants to States and museums for America formula grants to
States to support local libraries and museums interested in
hosting historical programming ahead of the celebration.
Grant Decision Making.--The Committee encourages IMLS in
its grant review process to consider the full scope of an
organization's work or activities before awarding grants,
regardless of whether the IMLS grant will directly fund such
work or activities.

Medicaid and CHIP Payment and Access Commission

SALARIES AND EXPENSES

Appropriation, fiscal year 2024....................... $9,405,000
Budget request, fiscal year 2025...................... 10,698,000
Committee Recommendation.............................. 9,405,000
Change from enacted level........................... - - -
Change from budget request.......................... -1,293,000

The Medicaid and CHIP Payment and Access Commission
(MACPAC) is an independent agency tasked with advising the
Congress on issues affecting Medicaid and the State Children's
Health Insurance Program (CHIP). MACPAC conducts policy and
data analysis on Medicaid and CHIP to support policymakers and
support program accountability.
The Committee supports the role played by MACPAC in
providing nonpartisan policy recommendations and data analysis
on a wide array of issues affecting Medicaid and CHIP. The
Medicaid program is at a unique juncture. Growing costs for the
program, driven by the maldistribution of resources away from
the nation's most vulnerable towards individuals who qualify
for other forms of coverage or are otherwise ineligible for the
program, threaten to undermine access in the State budgets to
afford reimbursement rate increases for providers or an
expansion of new services. As the program continues to navigate
these uncertain times, the Committee encourages MACPAC to
include in their policy recommendations additional specific
recommended policy changes to the program that can result in
savings to help improve access to care for beneficiaries or
accompany any policy changes that may entail additional costs
to offset those proposed increases in spending. Additionally,
the Committee encourages MACPAC to include more detailed cost
estimates and actuarial analyses for costs that would be
incurred by the Federal government and the States to better
understand the actual implications of the Commission's
recommendations.

Medicare Payment Advisory Commission

SALARIES AND EXPENSES

Appropriation, fiscal year 2024....................... $13,824,000
Budget request, fiscal year 2025...................... 14,477,000
Committee Recommendation.............................. 14,477,000
Change from enacted level........................... +653,000
Change from budget request.......................... - - -

The Medicare Payment Advisory Commission (MedPAC) is an
independent agency tasked with advising the Congress on issues
affecting the Medicare program. In addition to advising on
payments to private health plans participating in Medicare and
providers in Medicare's traditional fee-for-service (FFS)
program, MedPAC is also responsible for providing analysis on
access to care, quality of care, and other issues affecting
Medicare.
Differential Coding in Medicare Fee For Service.--The
Committee is aware of the dynamic noted in MedPAC's 2024 Report
to the Congress that FFS Medicare claims offer little incentive
to record all relevant diagnoses of FFS patients. The Committee
directs MedPAC to, within 12 months of enactment of this Act,
issue a report estimating the extent to which this incentive
results in different relative rates of diagnostic coding for
Medicare Advantage and FFS beneficiaries and the extent to
which such coding differences may result in payment
differentials between Medicare Advantage and FFS.
Medicare Beneficiaries' Access to Care.--The Committee is
concerned that despite MedPAC's conclusion in its March 2024
Report to the Congress, Medicare and Medicare Advantage
patients report longer wait times for routine health care
appointments than patients with private health insurance plans.
The Committee requests a report on Medicare beneficiaries'
access to care, including the share of primary care providers
that refuse to accept or limit the acceptance of new Medicare
patients and data on Medicare patients' wait times for visits
with new primary care providers.

National Council on Disability

SALARIES AND EXPENSES

Appropriation, fiscal year 2024....................... $3,850,000
Budget request, fiscal year 2025...................... 4,000,000
Committee Recommendation.............................. 3,850,000
Change from enacted level........................... - - -
Change from budget request.......................... -150,000

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

National Labor Relations Board

SALARIES AND EXPENSES

Appropriation, fiscal year 2024....................... $299,224,000
Budget request, fiscal year 2025...................... 320,002,000
Committee Recommendation.............................. 200,000,000
Change from enacted level........................... -99,224,000
Change from budget request.......................... -120,002,000

The National Labor Relations Board (NLRB) is responsible
for enforcing U.S. labor law related to collective bargaining
and unfair labor practices, including the National Labor
Relations Act of 1935.
The Committee notes with significant concern that NLRB
resources are being used to support regulatory and enforcement
actions inconsistent with the National Labor Relations Act.
These actions include:
General Counsel Memo 22-04 asserting that
employer discussions of statutory labor rights are
``inherently'' unlawful in contradiction of NLRB v.
Agents' Int'l Union, Chamber of Commerce v. Brown, and
Thomas v. Collins;
Denying employees the privacy of the voting
booth and disregarding the outcomes of secret-ballot
elections established in Gissel Packing Co. v. NLRB and
Linden Lumber v. NLRB;
Proposing an employment status test rejected
by the U.S. Court of Appeals for the D.C. Circuit in
FedEx Home Delivery v. NLRB;
General Council Memo 21-04 asserting that
the NLRB has enforcement powers in contradiction of H.
K. Porter Co. v. NLRB.
The Committee further notes that the allocation of staff
time and resources to curtail employer rights protected under
the First Amendment, circumvents due process, and undermines
civil rights laws. Moreover, such actions contradict the
agency's claims that additional resources are necessary to
perform core functions in a manner consistent with its
authorized responsibilities. Given such pronouncements, the
Committee directs the Board to include case intake statistics
at the regional level disaggregated by unfair labor practice
and representation in the NLRB's fiscal year 2026 congressional
justification. The Committee further directs the NLRB to
include information detailing the number of full-time
equivalent staff assigned to each regional office.

ADMINISTRATIVE PROVISIONS

Sec. 409. The Committee continues language restricting the
use of electronic voting.
Sec. 410. The Committee includes a new provision related to
joint employer status.

National Mediation Board

SALARIES AND EXPENSES

Appropriation, fiscal year 2024....................... $15,113,000
Budget request, fiscal year 2025...................... 15,113,000
Committee Recommendation.............................. 15,113,000
Change from enacted level........................... - - -
Change from budget request.......................... - - -

The National Mediation Board coordinates labor-management
relations within the U.S. railroads and airlines industries.

Occupational Safety and Health Review Commission

SALARIES AND EXPENSES

Appropriation, fiscal year 2024....................... $15,449,000
Budget request, fiscal year 2025...................... 16,278,000
Committee Recommendation.............................. 15,449,000
Change from enacted level........................... - - -
Change from budget request.......................... -829,000

The Occupational Safety and Health Review Commission
provides administrative trial and appellate review related to
contests of citations or penalties resulting from Occupational
Safety and Health Administration (OSHA) inspections of American
workplaces.

Railroad Retirement Board

DUAL BENEFITS PAYMENTS ACCOUNT

Appropriation, fiscal year 2024....................... $8,000,000
Budget request, fiscal year 2025...................... 7,000,000
Committee Recommendation.............................. 7,000,000
Change from enacted level........................... -1,000,000
Change from budget request.......................... - - -

This appropriation is authorized by the Railroad Retirement
Act of 1974 to fund vested dual benefits received by railroad
retirees who, under prior law, would have become covered by
both the railroad retirement system and the Social Security
system because railroad retirement was not fully coordinated
with Social Security from 1937 to 1974.
The Committee is concerned that the Railroad Retirement
Board (RRB) has yet to implement and integrate an enterprise
risk management (ERM) system including a lack of measurable
goals and implementation timeline. The Committee notes that the
RRB's pervasive challenges in risk management extend to program
integrity, as evidenced by persistent findings of material
weaknesses in financial reporting that the RRB's Office of
Inspector General (OIG) has identified. The Committee also
notes that the RRB has not had its current internal assessment
substantiated by the OIG or an independent auditor or
contractor. The Committee, therefore, notes that the RRB's ERM
process merits further evaluation.
The Committee also notes that in prior years, the OIG
issued a disclaimer of opinion for the RRB's overall financial
statements. RMA Associates, an independent public accounting
firm, audited the RRB's fiscal year 2022 financial statements.
RMA identified 9 material weaknesses and 1 non-compliance with
laws and regulations, and it made 15 recommendations to address
the material weaknesses identified. RMA did not make
recommendations for two findings, because they were repeated
from prior OIG reports and remain open. The Committee is
concerned that the RRB non-concurred with the RMA findings.
Additionally, the Committee notes that RMA did not express
an opinion on the fiscal year 2022 financial statements. RMA
did not express an opinion on the effectiveness of the RRB's
internal control over financial reporting, and RRB could not
provide sufficient appropriate evidential matter to support its
internal control over financial reporting due to inadequate
process, controls, and records.
The RRB is directed to provide the Committee with a
corrective action plan explaining how the RRB will address
these areas of concern, within 120 days of enactment of this
Act. Additionally, the RRB's Audit Compliance Section (ACS)
does not provide adequate audit coverage of railroad employees.
Such a deficiency is troubling, and therefore the RRB is
directed to brief the Committee within 120 days of enactment of
this Act on the ACS and how it plans to provide adequate
coverage in this area.

FEDERAL PAYMENT TO THE RAILROAD RETIREMENT ACCOUNTS

Appropriation, fiscal year 2024....................... $150,000
Budget request, fiscal year 2025...................... 150,000
Committee Recommendation.............................. 150,000
Change from enacted level........................... - - -
Change from budget request.......................... - - -

LIMITATION ON ADMINISTRATION

Appropriation, fiscal year 2024....................... $126,000,000
Budget request, fiscal year 2025...................... 134,000,000
Committee Recommendation.............................. 100,000,000
Change from enacted level........................... -26,000,000
Change from budget request.......................... -34,000,000

LIMITATION ON THE OFFICE OF INSPECTOR GENERAL

Appropriation, fiscal year 2024....................... $14,000,000
Budget request, fiscal year 2025...................... 14,600,000
Committee Recommendation.............................. 14,000,000
Change from enacted level........................... - - -
Change from budget request.......................... -600,000

Social Security Administration

In fiscal year 2024, the Social Security Administration
(SSA) anticipates exceeding $1.5 trillion in total spending on
social security retirement, disability insurance, and
supplemental security income (SSI) payments. SSA's total
outlays have grown a staggering 145 percent since 2008 as
mandatory entitlement programs continue to grow on autopilot.
The SSA Old-Age and Survivors Insurance Trust Fund, which funds
retirement and survivor benefit payments, is projected to be
depleted in 2033, at which time, Americans will see a 21
percent cut to their benefits. SSA's discretionary budget
authority for fiscal year 2024, which funds the agency's
administrative expenses, totals $14 billion, an increase of
only 42 percent since 2008. The escalating pace of mandatory
entitlement-driven spending remains the primary cost driver
within SSA.

PAYMENTS TO SOCIAL SECURITY TRUST FUNDS

Appropriation, fiscal year 2024....................... $10,000,000
Budget request, fiscal year 2025...................... 15,000,000
Committee Recommendation.............................. 15,000,000
Change from enacted level........................... +5,000,000
Change from budget request.......................... - - -

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

SUPPLEMENTAL SECURITY INCOME PROGRAM

Appropriation, fiscal year 2024....................... $45,365,042,000
Budget request, fiscal year 2025...................... 46,555,635,000
Committee Recommendation.............................. 46,159,083,000
Change from enacted level........................... +794,041,000
Change from budget request.......................... -396,552,000

The Committee provides $22,100,000,000 in advance funding
for the first quarter of fiscal year 2026, as requested.

Research and Demonstration

Section 1110 of the Social Security Act provides authority
to the Social Security Administration for conducting research
and demonstration projects related to SSA's programs. Within
the appropriation for Supplemental Security Income, the
Committee provides $91,000,000 for research and demonstration
activities.

Administration

Within the appropriation for SSI, the Committee provides
$4,516,083,000. This funding is for payment to the Social
Security trust funds for SSI's share of the administrative
expenses of SSA.

LIMITATION ON ADMINISTRATIVE EXPENSES

Appropriation, fiscal year 2024....................... $14,225,978,000
Budget request, fiscal year 2025...................... 15,400,924,000
Committee Recommendation.............................. 13,824,776,000
Change from enacted level........................... -401,202,000
Change from budget request.......................... -1,576,148,000

The Limitation on Administrative Expenses (LAE) funds the
administrative and operational costs for administering the Old
Age and Survivors Insurance, Disability Insurance, and
Supplemental Security Income (SSI) programs, and associated
costs for support to the Centers for Medicare and Medicaid
Services in administering their programs.
Within the total for LAE, the Committee provides not less
than $1,450,000,000 for Information Technology and not less
than $4,050,000,000 for field offices, equal to fiscal year
2024 levels.
The Committee notes that SSA's budget for fiscal year 2024
allocates close to $3,000,000,000 or 20 percent, of agency
costs to the Baltimore and Washington, D.C. offices, including
automatic pay increases and career ladder promotions. However,
of the 5,900 employees across these offices, only 39 percent
are reporting to work in the office at least three days a week.
Moreover, the Committee is disappointed by the agency's
decision to provide all SSA employees with administrative leave
and close all SSA offices on the afternoons of Friday, May 10,
2024, and Friday, May 24, 2024, with less than 48 hours advance
notice to the public. Each day, approximately 170,000 Americans
visit and 250,000 call one of SSA's 1,200 field offices
nationwide for various reasons, such as to file disability
claims, ask questions, or update their information. Americans
who had appointments at SSA field offices for those afternoons
had to wait longer, and those without appointments or who
picked up the phone to call found offices closed with no
explanation. This shortsighted decision, especially during a
customer service crisis, was a disservice to those Americans
who rely on SSA services.
Given SSA's bloated budget for the Baltimore and
Washington, D.C. offices, including excessive use of telework,
and the agency's disappointing decision to close all SSA
offices with limited notice, the Committee proposes reduced
funding for SSA. For the average American showing up to work
every day is a fact of life; they deserve a government that
reflects that reality. Approvals for remote work should be made
on an individual case by case basis and done only to serve the
best interests of the program and the American public. The
Committee urges the Commissioner to bring Federal employees
back to the workplace to fulfill the mission of serving the
American public and directs the agency to provide to the
Committee within 60 days of enactment of this Act a report
detailing the number of full-time employees by subcomponent who
are receiving the Washington D.C. area locality pay but have
not reported to an in person office in the Baltimore or D.C.
area more than one day a week for the past year.
Bill Wide Requirements.--The Committee notes the inclusion
of a bill wide requirements section of this report. This
section contains requirements which apply to all agencies
funded by this Act.
Disability Backlogs.--The Committee continues to direct SSA
to submit to the Committee quarterly reports on disability
hearings backlogs until SSA has eliminated the hearings backlog
and achieved its monthly average processing time goal.
Hiring and Retention.--The Committee continues to direct
SSA to provide a quarterly staffing report to the Committee
detailing full-time equivalents and new hires by component and
retention rates of new hires by component.
Information Technology (IT).--The Committee is concerned
that the SSA's antiquated IT service management system is
adversely impacting agency staff's ability to deliver the
value, service, and efficiency that the public expects and
deserves. The Committee recognizes that the SSA began
modernizing its IT Service Management tools in fiscal year 2021
and directs SSA to continue working on IT solutions to improve
customer service, ensure high availability and service
continuity, optimize operational efficiency, and maximize
enterprise productivity.
Occupational Information System (OIS).--The Committee
continues to direct SSA to include information in its
congressional justifications detailing efforts to fully
implement the OIS project, including the status of
implementation and timeline for transitioning entirely to OIS,
an action plan to accomplish said timeline, and the costs
associated with the project.
Report on LAE Expenditures.--The Committee continues to
request that the data referenced under this heading in House
Report 114-699 be included in future congressional
justifications. In addition, the Committee requests the fiscal
year 2026 congressional justification include a historical
table of costs and fiscal year 2026 requests for personnel and
benefits, by major SSA component to include Operations (field
offices, teleservice centers, processing centers, and regional
offices); Office of Hearings Operations; Systems; Office of
Analytics, Review, and Oversight; and Headquarters.
SSI Income Support and Maintenance (ISM).--The Committee
directs SSA to complete an assessment and submit to the
committees of jurisdiction a report within 120 days of
enactment of this Act on the effects that omitting food from
the ISM calculation would have on supplemental State program
financing and administration. Additionally, the Committee
directs the agency to make such information publicly available
on its website.
Work Incentives Planning and Assistance and Protection and
Advocacy for Beneficiaries of Social Security.--The
recommendation includes $23,000,000 for Work Incentives
Planning and Assistance grants and $10,000,000 for Protection
and Advocacy for Beneficiaries of Social Security.

Continuing Disability Reviews, Redeterminations, and Program
Integrity Activities

The Committee provides $1,903,000,000 for program integrity
activities as authorized by section 251 of the Balanced Budget
and Emergency Deficit Control Act of 1985.
The bill includes language transferring up to $20,000,000
to the OIG for the cost of jointly operating co-operative
disability investigation units.

Social Security Advisory Board

The Committee provides $2,700,000 for the Social Security
Advisory Board, which is the same as the fiscal year 2024
enacted level.

User Fees

In addition to the other amounts provided, the Committee
provides $171,000,000 for administrative activities funded from
user fees. Of this amount, $170,000,000 is derived from fees
collected from States that request SSA to administer State SSI
supplementary payments. The remaining $1,000,000 is derived
from fees charged to non-attorneys who apply for certification
to represent claimants under titles II and XVI of the Social
Security Act.

OFFICE OF THE INSPECTOR GENERAL

Appropriation, fiscal year 2024....................... $114,665,000
Budget request, fiscal year 2025...................... 121,254,000
Committee Recommendation.............................. 114,665,000
Change from enacted level........................... - - -
Change from budget request.......................... -6,589,000

The Office of the Inspector General is responsible for
meeting the statutory mission of promoting economy, efficiency,
and effectiveness in the administration of SSA programs and
operations and to prevent and detect fraud, waste, abuse, and
mismanagement in such programs and operations. To accomplish
this mission, the OIG directs, conducts, and supervises audits,
evaluations, and investigations. In addition, the OIG searches
for and reports on systemic weaknesses in SSA programs and
operations and makes recommendations for needed improvements
and corrective actions.
Nonwork Social Security Numbers.--The Committee encourages
the OIG to update its 2020 audit report, ``Assignment of
Nonwork Social Security Numbers'' (A-08-18-50500) that examined
whether SSA appropriately assigned Social Security numbers to
noncitizens with a valid nonwork reason.

TITLE V--GENERAL PROVISIONS

(TRANSFER OF FUNDS)

Sec. 501. The Committee continues a provision allowing the
Secretaries of Labor, Health and Human Services, and Education
to transfer unexpended balances of prior appropriations to
accounts corresponding to current appropriations to be used for
the same purposes and for the same periods of time for which
they were originally appropriated.
Sec. 502. The Committee continues a provision prohibiting
the obligation of funds beyond the current fiscal year unless
expressly so provided.
Sec. 503. The Committee continues a provision prohibiting
funds from being used to support or defeat legislation.
Sec. 504. The Committee continues a provision limiting the
amount available for official reception and representation
expenses for the Secretaries of Labor and Education, the
Director of the Federal Mediation and Conciliation Service, and
the Chairman of the National Mediation Board.
Sec. 505. The Committee continues a provision requiring
grantees receiving Federal funds to clearly state the
percentage of the total cost of the program or project that
will be financed with Federal money.
Sec. 506. The Committee continues a provision prohibiting
the use of funds for any abortion.
Sec. 507. The Committee continues a provision providing
exceptions to section 506 and a provision prohibiting funds
from being made available to a Federal agency or program, or to
a State or local government, if such agency, program, or
government discriminates against institutional or individual
health care entities because they do not provide, pay for,
provide coverage of, or refer for abortions.
Sec. 508. The Committee continues a provision prohibiting
use of funds for certain research involving human embryos.
Sec. 509. The Committee continues a provision prohibiting
use of funds for any activity that promotes the legalization of
any drug or substance included in schedule I of the schedules
of controlled substances.
Sec. 510. The Committee continues a provision prohibiting
use of funds to promulgate or adopt any final standard
providing for a unique health identifier until legislation is
enacted specifically approving the standard.
Sec. 511. The Committee continues a provision related to
annual reports to the Secretary of Labor.
Sec. 512. The Committee continues a provision prohibiting
transfer of funds made available in this Act except by
authority provided in this Act or another appropriations Act.
Sec. 513. The Committee continues a provision to limit
funds in the bill for public libraries to those that comply
with the requirements of the Children's Internet Protection
Act.
Sec. 514. The Committee modifies a provision regarding
procedures for reprogramming of funds.
Sec. 515. The Committee continues a provision pertaining to
appointments to scientific advisory committees.
Sec. 516. The Committee modifies a provision requiring each
department and related agency funded through this Act to submit
an operating plan within 45 days of enactment, detailing any
funding allocations that are different than those specified in
this Act, the accompanying detailed table, or budget request.
Sec. 517. The Committee modifies a provision requiring the
Secretaries of Labor, Health and Human Services, and Education
to submit a quarterly report to the Committees on
Appropriations containing certain information on noncompetitive
contracts, grants, and cooperative agreements exceeding
$500,000 in value.
Sec. 518. The Committee continues a provision prohibiting
the use of funds to process claims for credit for quarters of
coverage based on work performed under a Social Security number
that was not the claimant's number, where the performance of
such work under such number has formed the basis for a
conviction of the claimant of a violation of section 208(a)(6)
or (7) of the Social Security Act.
Sec. 519. The Committee continues a provision prohibiting
the use of funds to implement a Social Security totalization
agreement with Mexico.
Sec. 520. The Committee continues a provision prohibiting
the use of funds for the downloading or exchanging of
pornography.
Sec. 521. The Committee continues a provision related to
reporting requirements for conference expenditures.
Sec. 522. The Committee continues a provision related to
disclosure of U.S. taxpayer funding for programs used in
advertising.
Sec. 523. The Committee modifies a provision requesting
quarterly reports on the status of balances of appropriations
from the Departments of Labor, Health and Human Services and
Education.
Sec. 524. The Committee continues a provision related to
grant notifications.
Sec. 525. The Committee modifies a provision related to
needle exchange.
Sec. 526. The Committee continues a provision related to
questions for the record.
Sec. 527. The Committee modifies a provision related to
research and evaluation funding flexibility.
Sec. 528. The Committee modifies a provision to make funds
from the Child Enrollment Contingency Fund unavailable for
obligation in fiscal year 2025.

(RESCISSION)

Sec. 529. The Committee includes a new provision rescinding
unobligated balances from the American Rescue Plan.
Sec. 530. The Committee includes a new provision
prohibiting certain actions related to a sincerely held
religious belief.
Sec. 531. The Committee includes a new provision related to
the display of flags over Federal facilities.
Sec. 532. The Committee includes a new provision related to
executive orders related to climate change.
Sec. 533. The Committee includes a new provision related to
certain executive orders related to diversity, equity, and
inclusion.
Sec. 534. The Committee includes a new provision related to
diversity, equity, and inclusion.
Sec. 535. The Committee includes a new provision related to
Critical Race Theory.
Sec. 536. The Committee includes a new provision related to
teaching and training activities.
Sec. 537. The Committee includes a new provision related to
antisemitism.
Sec. 538. The Committee includes a new provision related to
gain of function research in certain countries.
Sec. 539. The Committee includes a new provision related to
COVID mask and vaccine mandates.
Sec. 540. The Committee includes a new provision related to
certain actions with specific entities or subsidiaries.

SPENDING REDUCTION ACCOUNT

Sec. 541. The Committee includes a Spending Reduction
Account.

House of Representatives Report Requirements

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

Statement of General Performance Goals and Objectives

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

Program Duplication

No provision of this bill establishes or reauthorizes a
program of the Federal Government known to be duplicative of
another Federal program, a program that was included in any
report from the Government Accountability Office to Congress
pursuant to section 21 of Public Law111-139, or a program
related to a program identified in the most recent Catalog of
Federal Domestic Assistance.

Transfers of Funds

Pursuant to clause 3(f)(2) of rule XIII of the Rules of the
House of Representatives, the following list includes the
transfers included in the accompanying bill:

TITLE I--DEPARTMENT OF LABOR

OFFICE OF DISABILITY EMPLOYMENT POLICY

Language is included under ``Office of Disability
Employment Policy'' which provides for the transfer of funds to
the ``State Unemployment Insurance and Employment Service
Operations.''

SPECIAL BENEFITS

Language is included under ``Special Benefits'' which
provides for the transfer of funds from the ``Postal Service''
account.

BLACK LUNG DISABILITY TRUST FUND

Language is included under ``Black Lung Disability Trust
Fund'' which provides for the transfer of funds to the ``Office
of Workers' Compensation Programs,'' ``Departmental
Management,'' and ``Office of Inspector General'' salaries and
expenses accounts and to the ``Department of the Treasury,
Miscellaneous Expenses'' account.

OFFICE OF DISABILITY EMPLOYMENT POLICY

Language is included under ``Office of Disability
Employment Policy'' which provides for the transfer of funds to
``State Unemployment Insurance and Employment Service
Operations.''

GENERAL PROVISIONS

A general provision is included permitting up to one
percent of any discretionary appropriation to be transferred
between an existing program, project, or activity of the
Department of Labor, provided that no program, project, or
activity is increased by more than three percent by any such
transfer.
A general provision is included permitting the transfer of
``Employment and Training Administration'' funds for technical
assistance to ``Program Administration'' when such activities
would be more effectively performed by Federal employees. The
provision also authorizes the transfer of 0.5 percent of
``Employment and Training Administration'' discretionary grants
to ``Program Administration'' for purposes of program integrity
activities.
A general provision is included that allows for the
transfer of up to 0.75 of funds under the ``Training and
Employment Services,'' State Unemployment Insurance and
Employment Service Operations,'' Employee Benefits Security
Administration,'' Office of Workers Compensation Services,''
Wage and Hour Division,'' Office of Federal Contract Compliance
Programs,'' ``Office of Labor Management Standards,''
Occupational Safety and Health Administration,'' ``Mine Safety
and Health Administration,'' Office of Disability Employment
Policy,'' and ``Veterans' Employment and Training'' accounts to
``Departmental Management'' for purposes of evaluating programs
or activities funded under such accounts.

TITLE II--DEPARTMENT OF HEALTH AND HUMAN SERVICES

CENTERS FOR DISEASE CONTROL AND PREVENTION

Language is included under ``Centers for Disease Control
and Prevention, Buildings and Facilities'' that directs that
prior-year unobligated balances from individual learning
accounts for former employees be credited and merged with the
amounts made available for the replacement of the mine safety
research facility.
Language is included under ``Centers for Disease Control
and Prevention, CDC-Wide Activities and Program Support'' for
funds to be transferred to and merged with the Infectious
Diseases Rapid Response Reserve Fund.

NATIONAL INSTITUTES OF HEALTH

Language is included under the ``National Institutes of
Health, Innovation Account'' to allow the transfer of funds to
other Institutes and Centers to support activities authorized
in the 21st Century Cures Act (P.L. 114-255).

ADMINISTRATION FOR COMMUNITY LIVING

Language is included under the ``Administration for
Community Living, Aging and Disability Services Programs'' for
the transfer to the Secretary of Agriculture to carry out
section 311 of the Older Americans Act of 1965.

GENERAL PROVISIONS

A general provision that allows up to one percent of any
discretionary funds to be transferred between existing
appropriations accounts of the ``Department of Health and Human
Services,'' provided that no appropriation account is increased
by more than three percent by such transfer.
A general provision is included that allows the transfer of
up to 3 precent among the institutes and centers of the
``National Institutes of Health'' from amounts identified as
funding research pertaining to the human immunodeficiency
virus.
A general provision is included that allows for the
transfer of funding determined to be related to the human
immunodeficiency virus to the ``Office of AIDS Research.''
A general provision is included that transfers 1 percent of
the amounts made available for the ``National Research Service
Awards'' to the ``Health Resources and Services
Administration.''
A general provision is included to direct the transfer of
the ``Prevention and Public Health Fund'' as specified in the
committee report accompanying the Act.
A general provision is included that allows the transfer of
funds related to research on opioid addiction, opioid
alternatives, stimulant misuse and addiction, pain management,
and addiction treatment between the institutes and centers of
the ``National Institutes of Health.''

TITLE III--DEPARTMENT OF EDUCATION

GENERAL PROVISIONS

A general provision is included that allows not to exceed
one percent of any discretionary funds to be transferred
between existing appropriations accounts of the Department of
Educations, provided that not appropriation accounts is
increased by more than three percent by such transfer.
A general provision is included that allows up to
$20,000,000,000 of funding made available for ``Institute of
Education Sciences'' to be available for the Secretary of
Education to provides support services to the Institute of
Education Sciences.

TITLE IV--RELATED AGENCIES

SOCIAL SECURITY ADMINISTRATION

A provision is included under ``Social Security
Administration, Limitation on Administrative Expenses''
allowing for the transfer of unobligated balances to be
available until expended for information technology and
telecommunications hardware and software infrastructure.
A provision is included under ``Social Security
Administration'' allowing for the transfer of up to $20,000,000
to the ``Social Security Administration, Office of Inspector
General,'' for the costs of jointly operated-co-operative
disability investigation units.

TITLE V--BILL-WIDE GENERAL PROVISIONS

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

RESCISSIONS

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

------------------------------------------------------------------------
Program or Activity Amount
------------------------------------------------------------------------
Department of Labor
Training and Employment Services, H-1B Fees....... $217,000,000
Adult Training FY 2024 Advance.................... 712,000,000
Department of Health and Human Services
Nonrecurring Expenses Fund........................ 2,352,000,000
Department of Education
Institute of Education Sciences................... 25,000,000
Nonrecurring Expenses Fund........................ 76,000,000
Education for the Disadvantaged FY 2025 Advance... 147,266,000
Supporting Effective Instruction State Grants FY 1,681,441,000
2025 Advance.....................................
Rehabilitation Services........................... 415,000,000
Corporation for National and Community Service
National Service Trust............................ 140,000,000
Title V--General Provisions
American Rescue Plan.............................. 245,000,000
------------------------------------------------------------------------

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

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

ACT OF MARCH 4, 1913

AN ACT To create a Department of Labor.

* * * * * * *
SEC. 12. SECURITY DETAIL.

(a) In General.--The Secretary of Labor is authorized to
employ law enforcement officers or special agents to--
(1) provide protection for the Secretary of Labor
during the workday of the Secretary and during any
activity that is preliminary or postliminary to the
performance of official duties by the Secretary;
(2) provide protection, incidental to the protection
provided to the Secretary, to a member of the immediate
family of the Secretary who is participating in an
activity or event relating to the official duties of
the Secretary;
(3) provide continuous protection to the Secretary
(including during periods not described in paragraph
(1)) and to the members of the immediate family of the
Secretary if there is a unique and articulable threat
of physical harm, in accordance with guidelines
established by the Secretary; and
(4) provide protection to the Deputy Secretary of
Labor or another senior officer representing the
Secretary of Labor at a public event if there is a
unique and articulable threat of physical harm, in
accordance with guidelines established by the
Secretary.
(b) Authorities.--The Secretary of Labor may authorize a law
enforcement officer or special agent employed under subsection
(a), for the purpose of performing the duties authorized under
subsection (a), to--
(1) carry firearms;
(2) make arrests without a warrant for any offense
against the United States committed in the presence of
such officer or special agent;
(3) perform protective intelligence work, including
identifying and mitigating potential threats and
conducting advance work to review security matters
relating to sites and events;
(4) coordinate with local law enforcement agencies;
and
(5) initiate criminal and other investigations into
potential threats to the security of the Secretary, in
coordination with the Inspector General of the
Department of Labor.
(c) Compliance With Guidelines.--A law enforcement officer or
special agent employed under subsection (a) shall exercise any
authority provided under this section in accordance with any--
(1) guidelines issued by the Attorney General; and
(2) guidelines prescribed by the Secretary of Labor.
----------

COMMUNITY SERVICES BLOCK GRANT ACT

Subtitle B--Community Services Block Grant Program

SEC. 671. SHORT TITLE.

This subtitle may be cited as the ``Community Services Block
Grant Act''.

* * * * * * *

SEC. 675C. USES OF FUNDS.

(a) Grants to Eligible Entities and Other Organizations.--
(1) In general.--Not less than 90 percent of the
funds made available to a State under section 675A or
675B shall be used by the State to make grants for the
purposes described in section 672 to eligible entities.
(2) Obligational authority.--Funds distributed to
eligible entities through grants made in accordance
with paragraph (1) for a fiscal year shall be available
for obligation during that fiscal year and the
succeeding fiscal year[, subject to paragraph (3)].
[(3) Recapture and redistribution of unobligated
funds.--
[(A) Amount.--Beginning on October 1, 2000, a
State may recapture and redistribute funds
distributed to an eligible entity through a
grant made under paragraph (1) that are
unobligated at the end of a fiscal year if such
unobligated funds exceed 20 percent of the
amount so distributed to such eligible entity
for such fiscal year.
[(B) Redistribution.--In redistributing funds
recaptured in accordance with this paragraph,
States shall redistribute such funds to an
eligible entity, or require the original
recipient of the funds to redistribute the
funds to a private, nonprofit organization,
located within the community served by the
original recipient of the funds, for activities
consistent with the purposes of this subtitle.]
(b) Statewide Activities.--
(1) Use of remainder.--If a State uses less than 100
percent of the grant or allotment received under
section 675A or 675B to make grants under subsection
(a), the State shall use the remainder of the grant or
allotment under section 675A or 675B (subject to
paragraph (2)) for activities that may include--
(A) providing training and technical
assistance to those entities in need of such
training and assistance;
(B) coordinating State-operated programs and
services, and at the option of the State,
locally-operated programs and services,
targeted to low-income children and families
with services provided by eligible entities and
other organizations funded under this subtitle,
including detailing appropriate employees of
State or local agencies to entities funded
under this subtitle, to ensure increased access
to services provided by such State or local
agencies;
(C) supporting statewide coordination and
communication among eligible entities;
(D) analyzing the distribution of funds made
available under this subtitle within the State
to determine if such funds have been targeted
to the areas of greatest need;
(E) supporting asset-building programs for
low-income individuals, such as programs
supporting individual development accounts;
(F) supporting innovative programs and
activities conducted by community action
agencies or other neighborhood-based
organizations to eliminate poverty, promote
self-sufficiency, and promote community
revitalization;
(G) supporting State charity tax credits as
described in subsection (c); and
(H) supporting other activities, consistent
with the purposes of this subtitle.
(2) Administrative cap.--No State may spend more than
the greater of $55,000, or 5 percent, of the grant
received under section 675A or State allotment received
under section 675B for administrative expenses,
including monitoring activities. Funds to be spent for
such expenses shall be taken from the portion of the
grant under section 675A or State allotment that
remains after the State makes grants to eligible
entities under subsection (a). The cost of activities
conducted under paragraph (1)(A) shall not be
considered to be administrative expenses. The startup
cost and cost of administrative activities conducted
under subsection (c) shall be considered to be
administrative expenses.
(c) Charity Tax Credit.--
(1) In general.--Subject to paragraph (2), if there
is in effect under State law a charity tax credit, the
State may use for any purpose the amount of the
allotment that is available for expenditure under
subsection (b).
(2) Limit.--The aggregate amount a State may use
under paragraph (1) during a fiscal year shall not
exceed 100 percent of the revenue loss of the State
during the fiscal year that is attributable to the
charity tax credit, as determined by the Secretary of
the Treasury without regard to any such revenue loss
occurring before January 1, 1999.
(3) Definitions and rules.--In this subsection:
(A) Charity tax credit.--The term ``charity
tax credit'' means a nonrefundable credit
against State income tax (or, in the case of a
State that does not impose an income tax, a
comparable benefit) that is allowable for
contributions, in cash or in kind, to qualified
charities.
(B) Qualified charity.--
(i) In general.--The term ``qualified
charity'' means any organization--
(I) that is--
(aa) described in
section 501(c)(3) of
the Internal Revenue
Code of 1986 and exempt
from tax under section
501(a) of such Code;
(bb) an eligible
entity; or
(cc) a public housing
agency as defined in
section 3(b)(6) of the
United States Housing
Act of 1937 (42 U.S.C.
1437a(b)(6));
(II) that is certified by the
appropriate State authority as
meeting the requirements of
clauses (iii) and (iv); and
(III) if such organization is
otherwise required to file a
return under section 6033 of
such Code, that elects to treat
the information required to be
furnished by clause (v) as
being specified in section
6033(b) of such Code.
(ii) Certain contributions to
collection organizations treated as
contributions to qualified charity.--
(I) In general.--A
contribution to a collection
organization shall be treated
as a contribution to a
qualified charity if the donor
designates in writing that the
contribution is for the
qualified charity.
(II) Collection
organization.--The term
``collection organization''
means an organization described
in section 501(c)(3) of such
Code and exempt from tax under
section 501(a) of such Code--
(aa) that solicits
and collects gifts and
grants that, by
agreement, are
distributed to
qualified charities;
(bb) that distributes
to qualified charities
at least 90 percent of
the gifts and grants
the organization
receives that are
designated for such
qualified charities;
and
(cc) that meets the
requirements of clause
(vi).
(iii) Charity must primarily assist
poor individuals.--
(I) In general.--An
organization meets the
requirements of this clause
only if the appropriate State
authority reasonably expects
that the predominant activity
of such organization will be
the provision of direct
services within the United
States to individuals and
families whose annual incomes
generally do not exceed 185
percent of the poverty line in
order to prevent or alleviate
poverty among such individuals
and families.
(II) No recordkeeping in
certain cases.--An organization
shall not be required to
establish or maintain records
with respect to the incomes of
individuals and families for
purposes of subclause (I) if
such individuals or families
are members of groups that are
generally recognized as
including substantially only
individuals and families
described in subclause (I).
(III) Food aid and homeless
shelters.--Except as otherwise
provided by the appropriate
State authority, for purposes
of subclause (I), services to
individuals in the form of--
(aa) donations of
food or meals; or
(bb) temporary
shelter to homeless
individuals;
shall be treated as provided to
individuals described in
subclause (I) if the location
and provision of such services
are such that the service
provider may reasonably
conclude that the beneficiaries
of such services are
predominantly individuals
described in subclause (I).
(iv) Minimum expense requirement.--
(I) In general.--An
organization meets the
requirements of this clause
only if the appropriate State
authority reasonably expects
that the annual poverty program
expenses of such organization
will not be less than 75
percent of the annual aggregate
expenses of such organization.
(II) Poverty program
expense.--For purposes of
subclause (I)--
(aa) In general.--The
term ``poverty program
expense'' means any
expense in providing
direct services
referred to in clause
(iii).
(bb) Exceptions.--
Such term shall not
include any management
or general expense, any
expense for the purpose
of influencing
legislation (as defined
in section 4911(d) of
the Internal Revenue
Code of 1986), any
expense for the purpose
of fundraising, any
expense for a legal
service provided on
behalf of any
individual referred to
in clause (iii), any
expense for providing
tuition assistance
relating to compulsory
school attendance, and
any expense that
consists of a payment
to an affiliate of the
organization.
(v) Reporting requirement.--The
information required to be furnished
under this clause about an organization
is--
(I) the percentages
determined by dividing the
following categories of the
organization's expenses for the
year by the total expenses of
the organization for the year:
expenses for direct services,
management expenses, general
expenses, fundraising expenses,
and payments to affiliates; and
(II) the category or
categories (including food,
shelter, education, substance
abuse prevention or treatment,
job training, or other) of
services that constitute
predominant activities of the
organization.
(vi) Additional requirements for
collection organizations.--The
requirements of this clause are met if
the organization--
(I) maintains separate
accounting for revenues and
expenses; and
(II) makes available to the
public information on the
administrative and fundraising
costs of the organization, and
information as to the
organizations receiving funds
from the organization and the
amount of such funds.
(vii) Special rule for states
requiring tax uniformity.--In the case
of a State--
(I) that has a constitutional
requirement of tax uniformity;
and
(II) that, as of December 31,
1997, imposed a tax on personal
income with--
(aa) a single flat
rate applicable to all
earned and unearned
income (except insofar
as any amount is not
taxed pursuant to tax
forgiveness
provisions); and
(bb) no generally
available exemptions or
deductions to
individuals;
the requirement of paragraph (2) shall
be treated as met if the amount of the
credit described in paragraph (2) is
limited to a uniform percentage (but
not greater than 25 percent) of State
personal income tax liability
(determined without regard to credits).
(4) Limitation on use of funds for startup and
administrative activities.--Except to the extent
provided in subsection (b)(2), no part of the aggregate
amount a State uses under paragraph (1) may be used to
pay for the cost of the startup and administrative
activities conducted under this subsection.
(5) Prohibition on use of funds for legal services or
tuition assistance.--No part of the aggregate amount a
State uses under paragraph (1) may be used to provide
legal services or to provide tuition assistance related
to compulsory education requirements (not including
tuition assistance for tutoring, camps, skills
development, or other supplemental services or
training).
(6) Prohibition on supplanting funds.--No part of the
aggregate amount a State uses under paragraph (1) may
be used to supplant non-Federal funds that would be
available, in the absence of Federal funds, to offset a
revenue loss of the State attributable to a charity tax
credit.

* * * * * * *

SEC. 680. DISCRETIONARY AUTHORITY OF THE SECRETARY.

(a) Grants, Contracts, Arrangements, Loans, and Guarantees.--
(1) In general.--The Secretary shall, from funds
reserved under section 674(b)(3), make grants, loans,
or guarantees to States and public agencies and
private, nonprofit organizations, or enter into
contracts or jointly financed cooperative arrangements
with States and public agencies and private, nonprofit
organizations (and for-profit organizations, to the
extent specified in paragraph (2)(E)) for each of the
objectives described in paragraphs (2) through (4).
(2) Community economic development.--
(A) Economic development activities.--The
Secretary shall make grants described in
paragraph (1) on a competitive basis to
private, nonprofit organizations that are
community development corporations to provide
technical and financial assistance for economic
development activities designed to address the
economic needs of low-income individuals and
families by creating employment and business
development opportunities.
(B) Consultation.--The Secretary shall
exercise the authority provided under
subparagraph (A) after consultation with other
relevant Federal officials.
(C) Governing boards.--For a community
development corporation to receive funds to
carry out this paragraph, the corporation shall
be governed by a board that shall consist of
residents of the community and business and
civic leaders and shall have as a principal
purpose planning, developing, or managing low-
income housing or community development
projects.
(D) Geographic distribution.--In making
grants to carry out this paragraph, the
Secretary shall take into consideration the
geographic distribution of funding among States
and the relative proportion of funding among
rural and urban areas.
(E) Reservation.--Of the amounts made
available to carry out this paragraph, the
Secretary may reserve not more than 1 percent
for each fiscal year to make grants to private,
nonprofit organizations or to enter into
contracts with private, nonprofit or for-profit
organizations to provide technical assistance
to aid community development corporations in
developing or implementing activities funded to
carry out this paragraph and to evaluate
activities funded to carry out this paragraph.
(F) Uses of funds.--Funds made available to
carry out this paragraph may be used for
financing construction and rehabilitation, and
for loans or investments, in private business
enterprises, including those owned by community
development corporations.
(G) Ownership of intangible property and
earnings.--The Secretary shall establish
procedures regarding the disposition of
intangible assets and program income that
permit such assets acquired with, and program
income derived from, grants made under this
paragraph, to become the sole property of the
grantees after a period of not more than 12
years after the end of the.grant period for any
activity consistent with subsection (a)(2)(A).
(H) Use of intangible assets.--Intangible
assets in the form of loans, equity investments
and other debt instruments, and program income
may be used by grantees for any eligible
purpose consistent with subsection (a)(2)(A).
(3) Rural community development activities.--The
Secretary shall provide the assistance described in
paragraph (1) for rural community development
activities, which shall include providing--
(A) grants to private, nonprofit corporations
to enable the corporations to provide
assistance concerning home repair to rural low-
income families and concerning planning and
developing low-income rural rental housing
units; and
(B) grants to multistate, regional, private,
nonprofit organizations to enable the
organizations to provide training and technical
assistance to small, rural communities
concerning meeting their community facility
needs.
(4) Neighborhood innovation projects.--The Secretary
shall provide the assistance described in paragraph (1)
for neighborhood innovation projects, which shall
include providing grants to neighborhood-based private,
nonprofit organizations to test or assist in the
development of new approaches or methods that will aid
in overcoming special problems identified by
communities or neighborhoods or otherwise assist in
furthering the purposes of this subtitle, and which may
include providing assistance for projects that are
designed to serve low-income individuals and families
who are not being effectively served by other programs.
(b) Evaluation.--The Secretary shall require all activities
receiving assistance under this section to be evaluated for
their effectiveness. Funding for such evaluations shall be
provided as a stated percentage of the assistance or through a
separate grant awarded by the Secretary specifically for the
purpose of evaluation of a particular activity or group of
activities.
(c) Annual Report.--The Secretary shall compile an annual
report containing a summary of the evaluations required in
subsection (b) and a listing of all activities assisted under
this section. The Secretary shall annually submit the report to
the Chairperson of the Committee on Education and the Workforce
of the House of Representatives and the Chairperson of the
Committee on Labor and Human Resources of the Senate.

* * * * * * *

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PUBLIC HEALTH SERVICE ACT

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

* * * * * * *

PART B--MISCELLANEOUS PROVISIONS

* * * * * * *

SEC. 245A. CIVIL ACTION FOR CERTAIN VIOLATIONS.

(a) In General.--A qualified party may, in a civil action,
obtain appropriate relief with regard to a designated
violation.
(b) Definitions.--For purposes of this section:
(1) Designated violation.--The term ``designated
violation'' means an actual or threatened violation
of--
(A) section 507(d) of the Departments of
Labor, Health and Human Services, and Education
and Related Agencies Appropriations Act, 2025
(or any subsequent substantially similar
provision); or
(B) any funding condition imposed by the
Federal Government pursuant to such section
507(d) (or such provision).
(2) Qualified party.--The term ``qualified party''
means--
(A) the Attorney General of the United
States;
(B) any attorney general of a State; or
(C) any person or entity adversely affected
by the designated violation without regard to
whether such person or entity is a health care
provider.
(3) State governmental entity.--The term ``State
governmental entity'' means a State, a local government
within a State, and any agency or other governmental
unit or subdivision of a State, or of such a local
government.
(c) Administrative Remedies Not required.--An action under
this section may be commenced, and relief may be granted,
without regard to whether the party commencing the action has
sought or exhausted any available administrative remedies.
(d) Defendants.--An action under this section may be
maintained against a Federal agency committing a designated
violation described in subsection (b)(1)(A) or any recipient or
subrecipient of Federal assistance committing a designated
violation described in subsection (b)(1)(B), including a State
governmental entity.
(e) Nature of Relief.--In an action under this section, the
court shall grant--
(1) all appropriate relief, including injunctive
relief, declaratory relief, and compensatory damages to
prevent the occurrence, continuance, or repetition of
the designated violation and to compensate for losses
resulting from the designated violation; and
(2) to a prevailing plaintiff, reasonable attorneys'
fees and litigation costs.
Relief in an action under this section may include money
damages even if the defendant is a governmental entity.
(f) Abrogation of State Immunity.--No State or governmental
official that commits a designated violation shall be immune
under the Tenth Amendment to the Constitution of the United
States, the Eleventh Amendment to the Constitution of the
United States, or any other source of law, from an action under
subsection (a).

* * * * * * *

Changes in the Application of Existing Law

Pursuant to clause 3(f)(1)(A) of rule XIII of the Rules of
the House of Representatives, the following statements are
submitted describing the effect of provisions in the
accompanying bill that directly or indirectly change the
application of existing law.
The bill includes provisions which place limitations on the
use of funds in the bill or change existing limitations and
that might, under some circumstances, be construed as changing
the application of existing law:

TITLE I--DEPARTMENT OF LABOR

Language is included under ``Employment and Training
Administration'' providing that allotments to outlying areas
are not required to be made through the Pacific Region
Educational Laboratory as provided by section 127 of the
Workforce Innovation and Opportunity Act (WIOA).
Language is included under ``Employment and Training
Administration'' providing that outlying areas may submit a
single application for consolidated grant awards and may use
the funds for any of the programs and activities authorized
under subtitle B of title I of WIOA.
Language is included under ``Employment and Training
Administration'' providing amounts made available for
dislocated workers may be used for State activities or across
multiple local areas where workers remain dislocated.
Language is included under ``Employment and Training
Administration'' providing that technical assistance and
demonstration projects may provide assistance to new entrants
in the workforce and incumbent workers.
Language is included under ``Employment and Training
Administration'' providing that the Secretary may reserve a
higher percentage of funds for technical assistance than what
is provided in section 168(b) of the WIOA.
Language is included under ``Employment and Training
Administration'' providing that the Department of Labor may
take no action to limit the number or proportion of eligible
applicants receiving related assistance services in the migrant
and seasonal farmworkers programs.
Language is included under ``Employment and Training
Administration'' providing that an individual may qualify as an
``eligible seasonal farmworker'' under section 167(i)(3) of the
WIOA if such individual is a member of a family with a total
family income equal to or less than 150 percent of the poverty
line.
Language is included under ``State Unemployment Insurance
and Employment Service Operations'' providing for reemployment
services and eligibility assessments.
Language is included under ``State Unemployment Insurance
and Employment Service Operations'' providing that funds
available for integrated Unemployment Insurance and Employment
Service automation may be used by States notwithstanding cost
allocation principles prescribed under the Office of Management
and Budget ``Uniform Administrative Requirements, Cost
Principles, and Audit Requirements for Federal Awards.''
Language is included under ``State Unemployment Insurance
and Employment Service Operations'' providing that the
Department of Labor may reallot funds among States
participating in a consortium.
Language is included under ``State Unemployment Insurance
and Employment Service Operations'' allowing the Secretary to
collect fees for the costs associated with additional data
collection, analyses, and reporting services related to the
National Agricultural Workers Survey.
Language is included under ``Veterans' Employment and
Training'' providing that funds may be used for support
specialists providing intensive services to wounded service
members, spouses or other family caregivers of the service
member, and to surviving spouses of individuals who died while
members of the Armed Forces.
Language is included under ``Veterans' Employment and
Training'' related to consultation requirements under section
2023 of Title 38 U.S. Code.
Language is included under ``Veterans' Employment and
Training'' related to eligibility under sections 2002(a)(1) and
2023 of Title 38 U.S. Code.
Language is included under ``Veterans' Employment and
Training'' providing that data systems and contract support may
be provided directly or through grant or contract.
Language is included under ``Veterans' Employment and
Training'' related to HIRE Vets Medallion Award Program
eligibility.
Language is included under ``Special Benefits'' providing
that the Department of Labor may use authority to reimburse an
employer who is not the employer at the time of injury for
portions of the salary of a re-employed, disabled beneficiary.
Language is included under ``Special Benefits'' providing
that funds shall be transferred to the appropriation from
entities required under 5 U.S.C. 8147(c) as determined by the
Department of Labor.
Language is included under ``Special Benefits'' providing
that the Secretary may prescribe regulations requiring
identification for the filing of benefit claims.
Language is included under ``Administrative Expenses,
Energy Employees Occupational Illness Compensation Fund''
providing that the Secretary may prescribe regulations for
identification for the filing of benefit claims.
Language is included under ``Occupational Safety and Health
Administration'' providing that up to a certain amount of fees
collected from the training institute may be retained and used
for related training and education.
Language is included under ``Occupational Safety and Health
Administration'' providing that fees collected from Nationally
Recognized Testing Laboratories may be used to administer
laboratory recognition programs that ensure safety of equipment
used in the workplace.
Language is included under ``Mine Safety and Health
Administration'' providing that a specific amount may be
collected by the National Mine Health and Safety Academy and
made available for mine safety and health education and
training.
Language is included under ``Mine Safety and Health
Administration'' providing that a specific amount may be
collected from the approval and certification of equipment and
materials and made available for other such activities.
Language is included under ``Mine Safety and Health
Administration'' providing that the Department of Labor may
accept lands, buildings, equipment, and other contributions
from public and private sources for cooperative projects.
Language is included under ``Mine Safety and Health
Administration'' providing that the Department of Labor may
recognize the Joseph A. Holmes Safety Association as the
principal safety association and may provide funds or personnel
as officers in local chapters or the national organization.
Language is included under ``General Provisions''
prohibiting the use of any funds appropriated for grants under
section 414(c) of the American Competitiveness and Workforce
Improvement Act of 1998, for purposes other than competitive
grants for training individuals over the age of 16 who are not
currently enrolled in school in the occupations and industries
for which employers are using H-1B visa to hire foreign
workers.
Language is included under ``General Provisions'' related
to the implementation of the Fair Labor Standards Act.
Language is included under ``General Provisions'' modifying
certain authorities related to the Secretary's security detail.
Language is included under ``General Provisions'' allowing
the Secretary to furnish a certain amount of excess personal
property to apprenticeship programs through grants, contracts,
and other arrangements.
Language is included under ``General Provisions'' modifying
certain authorities related to the Secretary's security detail.
Language is included under ``General Provisions'' providing
that the Secretary may dispose or divest of certain Job Corps
center property and use the proceeds to carry out the program
in the same geographic location.
Language is included under ``General Provisions'' modifying
certain authorities related to the Inspector General.

TITLE II--DEPARTMENT OF HEALTH AND HUMAN SERVICES

Language is included under ``Health Resources and Services
Administration--Health Workforce'' overriding the proportional
funding requirements in the Public Health Service Act for
sections 751 and 756.
Language is included under ``Health Resources and Services
Administration--Health Workforce'' providing permissive
authority to the Secretary to waive requirements for entities
awarded funds from sections 751(d)(2)(A) and 751(d)(2)(B).
Language is included under ``Health Resources and Services
Administration--Health Workforce'' allowing funds for the Nurse
Corps and National Health Service Corps Scholarship and Loan
programs to be used to make prior year adjustments.
Language is included under ``Health Resources and Services
Administration--Health Workforce'' providing funding under the
National Health Service Corps Loan Repayment Program for
substance use disorder counselors and placement in Indian
Health Service facilities.
Language is included under ``Centers for Disease Control
and Prevention--CDC-Wide'' permitting CDC to operate and
maintain an aircraft.
Language is included under ``Centers for Disease Control
and Prevention--CDC-Wide'' permitting CDC to exclude CDC and
Public Health Service employees on overseas assignments or
detailed to States, municipalities, or other organizations to
be treated as non-federal employees.
Language is included under ``Centers for Disease Control
and Prevention--Buildings and Facilities'' providing funds from
former employees with existing Individual Learning Accounts
unobligated to be available to support acquisition, renovation,
or replacement, of the National Institute for Occupational
Safety and Health's underground and surface coal mining
research capacity.
Language is included under ``Substance Use And Mental
Health Services Administration--Mental Health'' requiring that
5 percent of the Mental Health Block Grant funding be available
to support evidence-based crisis systems.
Language is included under ``Substance Use And Mental
Health Services Administration--Mental Health'' allowing up to
10 percent of the amounts made available to carry out the
Children's Mental Health Services program may be used to carry
out demonstration grants or contracts for early interventions
for people 25 years and younger at high risk of developing a
first episode of psychosis.
Language is included under ``Substance Use And Mental
Health Services Administration--Mental Health'' exempting the
Mental Health Block Grant from the evaluation set-aside in
section 241 of the Public Health Service Act.
Language is included under Substance Use And Mental Health
Services Administration--Substance Use Services'' requiring
that 4 percent of State Opioid Response grant funding be made
available for Indian Tribes or tribal organizations.
Language is included under ``Substance Use And Mental
Health Services Administration--Substance Use Services''
exempting the Substance Use Prevention and Treatment Block
Grant and State Opioid Response grants from the evaluation set-
aside in section 241 of the Public Health Service Act.
Language is included under ``Centers for Medicare and
Medicaid Services--Program Management'' limiting the amount of
funding available under that heading for quality improvement
organizations.
Language is included under ``Centers for Medicare and
Medicaid Services--Health Care Fraud and Abuse Control
Account'' providing funds to support the cost of the Senior
Medicare Patrol program.
Language is included under ``Administration for Children
and Families--Low Income Home Energy Assistance'' modifying the
formula distribution of funds.
Language is included under ``Administration for Children
and Families--Refugee and Entrant Assistance'' to exempt the
matching requirements of certain funds as required in section
235(c)(6)(C)(iii) of the William Wilberforce Trafficking
Victims Protection Reauthorization Act of 2008.
Language is included under ``Administration for Children
and Families--Payments to States for the Child Care and
Development Block Grant'' increasing the tribal set-aside.
Language is included under ``Administration for Children
and Families--Children and Families Services Programs'' related
to the calculation of base grants, the Tribal Colleges and
Universities Head Start Partnership program, and selection
criteria for Head Start programs operated by Indian tribes.
Language is included under Administration for Community
Living to allow funding provided for adult protective services
grants under section 2042 of title XX of the Social Security
Act to be set-aside for Tribes and Tribal organizations.
Language is included under Administration for Community
Living continuing an assistive technology alternative financing
program.
Language is included under Administration for Community
Living prohibiting the use of the funds provided in the bill to
pursue legal action on behalf of a protection and advocacy
system described in section 103 of the Protection and Advocacy
for Individuals with Mental Illness Act unless public notice
has been provided within 90 days of instituting action to the
named person or their legal guardian.
Language is included under Administration for Community
Living waiving the public notice requirement for individuals
without a guardian, who are not competent to consent, who are
wards of the State or subject to public guardianship.
Language is included increasing the percentage of
appropriations available for this section to 2.5 percent.
Language is included modifying the timeframe when a
contract may be terminated.
Language is included requiring that providers of Title X
services adhere to state laws requiring notification or the
reporting of child abuse, child molestation, sexual abuse,
rape, or incest.
Language is included prohibiting the Secretary from denying
participation in the Medicare Advantage program to entities who
do not provide coverage or referrals for abortion services.
Language is included prohibiting funds from being used to
advocate or promote gun control.
Language is included limiting assignments of Public Health
Service staff to assist in child survival activities to not
more than 60 employees.
Language is included permitting 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.
Language is included 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
the Director deems appropriate.
Language is included providing the Biomedical Advanced
Research and Development Authority ten-year contract authority.
Language is included directing the Secretary to consider
current recommendations of the United State Preventive Services
Task Force with respect to breast cancer screening,
mammography, and prevention as if such recommendations were a
reference to such recommendations issued before 2009.
Language is included allowing HHS to cover travel expenses
when necessary for employees to obtain medical care when they
are assigned to duty in a location in response to a public
health emergency.
Language is included allowing HHS to accept donations in
certain circumstances.
Language is included limiting the circumstances when the
Secretary may enter into a contract or agreement related to the
housing of unaccompanied alien children in any facility that is
not state licensed.
Language is included related to the use of intangible
assets in the Community Services Block Grant.
Language is included limiting the use NIH funding for
buildings and facilities.
Language is included prohibiting the provision of funds to
organizations described in section 501(c)(3) of the Internal
Revenue Code of 1986 that provides abortions except in certain
circumstances.
Language is included to prohibit funding for social
transitioning.

TITLE III--DEPARTMENT OF EDUCATION

Language is included under ``Impact Aid'' allowing
continued eligibility for students affected by the deployment
or death of their military parent so long as the children
attend school in the same local education agency they attended
prior to the parent's death or deployment.
Language is included under ``Special Education'' clarifying
the amounts required to be transferred to the Department of the
Interior under the Grants to States program.
Language is included under ``Special Education'' outlining
procedures for reducing a State's award because of a failure to
meet the maintenance of State financial support requirements of
the Individuals with Disabilities Education Act.
Language is included under ``Special Education''
authorizing the Department to use certain funds to provide
technical assistance and support to States to improve data
collection capacity.
Language is included under ``Special Education''
authorizing the Department to use funds appropriated for the
State Personnel Development Grants program to evaluate program
performance.
Language is included under ``Special Education'' permitting
States to subgrant funds that they reserve for ``Other State-
Level Activities'' under the Grants to States, Preschool Grants
to States, and Grants for Infants and Families programs.
Language is included under ``Special Education'' allowing
the Department to provide all States that apply for the State
Incentive Grants program, in years in which five or fewer
States apply for funding, 20 percent of the funds reserved for
the program.
Language is included under ``Special Education'' to promote
continuity of services for eligible infants and their families.
Language is included under ``Special Education'' to
increase access for infants and families who have been
traditionally underrepresented in the Grants for Infants and
Families program, eliminate out-of-pocket costs for
participating families, and conduct certain activities with
individuals expecting to become parents of infants or toddlers
with disabilities.
Language is included under ``Special Institutions for
Persons with Disabilities'' allowing the National Technical
Institute for the Deaf to use, at its discretion, funds for the
endowment program as authorized under section 207 of the
Education of the Deaf Act of 1986.
Language is included under ``Special Institutions for
Persons with Disabilities'' allowing Gallaudet University to
use, at its discretion, funds for the endowment program as
authorized under section 207 of the Education of the Deaf Act
of 1986.
Language is included under ``Higher Education'' allowing
funds to carry out Title VI of the Higher Education Act to be
used to support visits and study in foreign countries for
participants in advanced foreign countries by individuals who
are participating in advanced foreign language training and
international studies in areas that are vital to U.S. national
security and who plan to apply their language skills and
knowledge of these countries in the fields of government, the
professions, or international development.
Language is included under ``Higher Education'' stating the
section 313(d) of the Higher Education Act does not apply to an
institution of higher education that is eligible to receive
funding under section 318 of such Act.
Language is included under ``Higher Education'' related to
loans to HBCUs.
Language is included under ``General Provisions'' allowing
certain institutions to continue to use endowment income for
student scholarships.
Language is included under ``General Provisions'' related
to the National Advisory Committee on Institutional Quality and
Integrity.

TITLE IV--RELATED AGENCIES

Language is included under ``The Committee for Purchase
from People Who are Blind or Severely Disabled'' requiring that
written agreements, with certain oversight provisions, be in
place in order for authorized fees to be charged by certified
nonprofit agencies.
Language is included under ``Corporation for National and
Community Service'' requiring the Corporation to make awards on
a competitive basis pursuant to section 501(a)(4)(F) of the
1990 Act, section 198B notwithstanding.
Language is included under ``Corporation for National and
Community Service'' allowing the requirements of section
112(c)(1)(D) to be met through a determination of need by the
local community.
Language is included under ``Corporation for National and
Community Service'' regarding changes to program requirements
or policy through rulemaking.
Language is included under ``Corporation for National and
Community Service'' limiting the use of an educational award
under section 148(a)(4) to individuals who are veterans.
Language is included under ``Corporation for National and
Community Service'' related to criminal background checks.
Language is included under ``Corporation for National and
Community Service'' related to 1,200 hour service positions.
Language is included under ``Federal Mediation and
Conciliation Service--Salaries and Expenses'' providing that
fees charged for special training and other services and be
retained and used for authorized purposes, that fees for
arbitration services may only be used for training agency
personnel, and that the Director may accept gifts and services
in aid of any projects under the Director's jurisdiction.

TITLE V--GENERAL PROVISIONS

Language is included requiring receiving Federal funds to
clearly state the percentage of the total cost of the program
or project that will be financed with Federal money.
Language is included limiting ability for trust funds
receiving funding appropriated by this act to fund health
benefits coverage that includes abortion.
Language is included limiting the availability for
obligation of funds deposited in the Child Enrollment
Contingency Fund.
Language is included prohibiting discriminatory action
being taken against a person on the basis of their sincerely
held religious beliefs.
Language is included prohibiting the provision of funding
to particular institutions.

Appropriations Not Authorized by Law

Pursuant to clause 3(f)(1)(B) of rule XIII of the Rules of
the House of Representatives, the following table lists the
appropriations in the accompanying bill which are not
authorized by law for the period concerned:

----------------------------------------------------------------------------------------------------------------
Appropriations in
Agency Program Last Year of Authorization Last Year of Appropriations in
Authorization Level Authorization this Bill
----------------------------------------------------------------------------------------------------------------
DEPARTMENT OF LABOR ETA
Adult Training.............. FY2020............ $899,987,000...... $885,649,000...... $885,649,000
Dislocated Worker Employment FY2020............ 1,436,137,000..... 1,052,053,000..... 1,421,412,000
and Training Activities.
Native Americans............ FY2020............ 54,137,000........ 55,000,000........ 65,000,000
Migrant and Seasonal FY2020............ 96,211,000........ 91,896,000........ 97,396,000
Farmworker programs.
YouthBuild.................. FY2020............ 91,087,000........ 94,534,000........ 110,000,000
Job Corps................... FY2020............ 1,983,236,000..... 1,743,655,000..... 1,760,155,000
Reintegration of Ex- N/A............... N/A............... N/A............... 60,000,000
Offenders.
Apprenticeship Grants....... N/A............... N/A............... N/A............... 150,000,000
One-Stop Career Centers/ FY2020............ 70,667,000........ 62,653,000........ 62,653,000
Labor Market Information.
DEPARTMENT OF HEALTH AND HUMAN
SERVICES HRSA
Nurse Practitioner Optional N/A............... N/A............... N/A............... 7,000,000
Fellowship Program.
Medical Student Education... N/A............... N/A............... N/A............... 70,000,000
Heritable Disorders......... FY 2019........... 19,900,000........ 18,883,000........ 21,383,000
Emergency Relief--Part A.... FY 2013........... 789,471,000....... 649,373,000....... 680,752,000
Comprehensive Care--Part B.. FY 2013........... 1,562,169,000..... 1,314,446,000..... 1,364,878,000
Early Intervention--Part C.. FY 2013........... 285,766,000....... 205,544,000....... 208,970,000
Coordinated Services and FY 2013........... 87,273,000........ 75,088,000........ 77,935,000
Access to Research for
Women, Infants, Children
and Youth--Part D.
AIDS Dental Services--Part F FY 2013........... 15,802,000........ 12,991,000........ 13,620,000
Educ. & Training Centers-- FY 2013........... 42,178,000........ 33,275,000........ 34,886,000
Part F.
Organ Transplantation....... FY 1993........... Such Sums......... 2,767,000......... 58,049,000
Rural Hospital Flexibility FY 2012........... Such Sums......... 41,040,000........ 74,277,000
Grants.
CDC
Sexually Transmitted FY 1998........... Such Sums......... 112,117,000....... 164,310,000
Infections.
National Center for Health FY 2003........... Such Sums......... 125,899,000....... 187,397,000
Statistics.
WISEWOMAN................... FY 2003........... Such Sums......... 12,419,000........ 34,620,000
National Cancer Registries.. FY 2003........... Such Sums......... N/A............... 53,440,000
Asthma Surveillance & Grants FY 2005........... Such Sums......... 32,422,000........ 33,500,000
Folic Acid.................. FY 2005........... Such Sums......... 2,188,000......... 3,150,000
Oral Health Promotion....... FY 2005........... Such Sums......... 11,204,000........ 22,250,000
Screening, Referrals, and FY 2005........... 40,000,000........ 36,474,000........ 51,000,000
Education Regarding Lead
Poisoning.
Birth Defects, Developmental FY 2007........... Such Sums......... 122,242,000....... 205,560,000
Disability, Disability and
Health.
Breast and Cervical Cancer.. FY 2012........... 275,000,000....... 204,779,000....... 237,500,000
Public Health Workforce..... FY 2013........... 39,500,000........ 64,000,000........ 71,000,000
National Diabetes Prevention FY 2014........... Such Sums......... 10,000,000........ 37,300,000
Program.
Johanna's Law............... FY 2014........... 18,000,000........ 4,972,000......... 12,000,000
Section 317 Immunization.... FY 2014........... Such Sums......... 610,847,000....... 681,993,000
Young Women's Breast Health FY 2019........... 4,900,000......... 4,960,000......... 6,960,000
Awareness and Support of
Young Women Diagnosed with
Breast Cancer (PHSA 399NN).
Preventive Health Measures FY 2004........... Such Sums......... 14,091,000........ 15,205,000
with regard to Prostate
Cancer.
Combating Antimicrobial FY 2006........... Such Sums......... 17,443,000........ 197,000,000
Resistance.
National Strategy for FY 2013........... 243,101,000....... 132,997,000....... 137,034,000
Combating and Eliminating
Tuberculosis.
Newborn Screening Quality FY 2019........... 8,000,000......... 17,250,000........ 21,000,000
Assurance.
Early Hearing Detection and FY 2022........... 11,852,000........ 10,760,000........ 10,760,000
Intervention.
Firefighter Cancer Registry. FY 2022........... 2,500,000......... 2,500,000......... 5,500,000
NIH
National Institutes of FY 2020........... 36,472,442,775.... 40,954,400,000.... 47,168,518,000
Health.
SAMHSA
Protection and Advocacy for FY 2003........... 19,500,000........ 36,146,000........ 40,000,000
Individuals with Mental
Illness.
ACF
Low Income Home Energy FY 2007........... 5,100,000,000..... 2,161,170,000..... 4,040,000,000
Assistance Program.
Child Care and Development FY 2020........... 2,748,591,018..... 5,826,000,000..... 8,771,387,000
Block Grant.
Children and Families .................. .................. .................. ..................
Services Programs.
Adoption and Legal FY 2016........... 43,000,000........ 37,943,000........ 75,000,000
Guardianship Incentive
Payments.
Native American Programs.... FY 2002........... Such Sums......... 45,826,000........ 65,500,000
Community Services Block FY 2003........... Such Sums......... 645,762,000....... 778,000,000
Grant.
Rural Community Development. FY 2003........... Such Sums......... 7,203,000......... 13,000,000
Head Start.................. FY 2012........... Such Sums......... 7,968,544,000..... 12,296,820,000
Runaway and Homeless Youth FY 2013........... Such Sums......... 107,852,000....... 146,283,000
Programs.
CAPTA programs.............. FY 2015........... Such Sums......... 143,981,000....... 105,091,000
Family Violence Programs.... FY 2015........... 178,500,000....... 139,500,000....... 245,000,000
National Domestic Violence FY 2015........... Such Sums......... 4,500,000......... 20,500,000
Hotline.
Child Welfare Services...... FY 2016........... 325,000,000....... 268,735,000....... 268,735,000
Refugee and Entrant .................. .................. .................. ..................
Assistance Programs.
Refugee Support Services.... FY 2002........... Such Sums......... 212,912,000....... 137,500,000
Transitional and Medical FY 2002........... Such Sums......... 227,243,000....... 253,700,000
Services.
Survivors of Torture........ FY 2007........... 25,000,000........ 9,817,000......... 19,000,000
Anti-Trafficking in Persons FY2021............ 28,755,000........ 28,755,000........ 31,755,000
Programs.
ACL
Lifespan Respite Care....... FY 2011........... 94,810,000........ 2,495,000......... 10,000,000
State Health Insurance FY 1996........... 10,000,000........ N/A............... 55,242,000
Assistance Program.
Developmental Disabilities.. FY 2007........... Such Sums......... 155,115,000....... 191,369,000
Voting Access for People FY 2005........... 17,410,000........ 13,879,000........ 10,000,000
with Disabilities.
Assistive Technology........ FY 2010........... Such Sums......... 25,000,000........ 40,000,000
Traumatic Brain Injury...... FY 2019........... 8,600,000......... 11,321,000........ 16,118,000
Paralysis Resource Center... FY 2011........... 25,000,000........ 6,352,000......... 10,700,000
Limb Loss................... N/A............... N/A............... N/A............... 4,200,000
Independent Living and the FY 2020........... 214,135,000....... 228,153,000....... 247,183,000
National Institute on
Disability, Independent
Living and Rehabilitation
Research.
DEPARTMENT OF EDUCATION
Title I Grants to LEAs...... FY 2020........... 16,182,345,000.... 16,309,802,000.... 14,626,490,000
Innovative Approaches to FY 2020........... 180,014,000 (for 27,000,000........ 30,000,000
Literacy (IAL). IAL and CLSD).
Comprehensive Literacy FY 2020........... 180,014 (for IAL 192,000,000....... 194,000,000
Development (CLSD). and CLSD).
Migrant..................... FY 2020........... 374,751,000....... 375,626,000....... 375,626,000
Neglected and Delinquent/ FY 2020........... 47,614,000........ 47,614,000........ 49,239,000
High Risk Youth.
Impact Aid.................. FY 2020........... 1,388,603,000..... 1,486,112,000..... 1,630,000,000
Nita M. Lowey 21st Century FY 2020........... 1,100,000,000..... 1,249,673,000..... 1,329,673,000
Community Learning Centers.
Education for Homeless FY 2020........... 85,000,00......... 101,500,000....... 129,000,000
Children and Youth.
Education for Native FY 2020........... 32,397,000........ 36,897,000........ 44,897,000
Hawaiians.
Alaska Native Education FY 2020........... 31,453,000........ 35,953,000........ 44,953,000
Equity.
Rural Education............. FY 2020........... 169,840,000....... 185,840,000....... 225,000,000
Student Support and Academic FY 2020........... 1,600,000,000..... 1,210,000,000..... 1,390,000,000
Enrichment Grants.
Indian Education Grants to FY 2020........... 106,525,000....... 105,381,000....... 110,381,000
Local Educational Agencies.
Special Programs for Indian FY 2020........... 17,993,000........ 67,993,000........ 72,000,000
Children.
Indian Education National FY 2020........... 5,565,000......... 7,365,000......... 19,865,000
Activities.
Education Innovation and FY 2020........... 90,611,000........ 190,000,000....... 259,000,000
Research.
Charter Schools Grants...... FY 2020........... 300,000,000....... 440,000,000....... 460,000,000
School Safety National FY 2020........... 5,000,000......... 105,000,000....... 216,000,000
Activities.
Vocational Rehabilitation FY 2021........... 3,675,021,000..... 3,675,021,000..... 4,389,957,000
State Grants.
Client Assistance State FY 2021........... 14,098,000........ 13,000,000........ 13,000,000
Grants.
Supported Employment State FY 2021........... 32,363,000........ 22,548,000........ 22,548,000
Grants.
Training.................... FY 2021........... 39,540,000........ 29,388,000........ 29,388,000
Demonstration and Training FY 2021........... 6,809,000......... 5,796,000......... 5,796,000
Programs.
Services for Older Blind FY 2021........... 39,141,000........ 33,317,000........ 33,317,000
Individuals.
Protection and Advocacy of FY 2021........... 20,735,000........ 18,150,000........ 21,150,000
Individual Rights.
Helen Keller National Center FY 2004........... Such Sums......... 8,666,000......... 19,000,000
for Deaf-Blind Youths and
Adults.
National Technical Institute FY 2015........... Such Sums......... 67,016,000........ 93,000,000
for the Deaf.
Gallaudet University........ FY 2015........... Such Sums......... 120,275,000....... 168,361,000
Adult Basic and Literacy FY 2021........... 665,067,000....... 674,955,000....... 715,455,000
Education State Grants.
Adult Education National FY 2021........... 13,573,000........ 13,712,000........ 13,712,000
Leadership Activities.
Aid for Institutional FY 2015........... Such Sums......... 429,762,000....... 1,042,618,000
Development.
Aid for Hispanic-Serving FY 2015........... Such Sums......... 109,223,000....... 232,890,000
Institutions.
International Education And FY 2015........... Such Sums......... 72,164,000........ 81,531,000
Foreign Language.
Federal TRIO Programs....... FY 2015........... Such Sums......... 839,752,000....... 1,191,000,000
IDEA National Activities.... FY 2010........... Such Sums......... 260,203,000....... 257,560,000
IDEA Grants for Infants and FY 2010........... Such Sums......... 439,427,000....... 540,000,000
Families.
Special Programs for Migrant FY 2015........... Such Sums......... 37,474,000........ 52,123,000
Students.
RELATED AGENCIES
Corporation for National and FY 2014........... Such Sums......... 1,049,954,000..... 309,349,000
Community Service.
----------------------------------------------------------------------------------------------------------------

BUDGETARY IMPACT OF THE FY 2025 DEPARTMENTS OF LABOR, HEALTH AND HUMAN
SERVICES, AND EDUCATION, AND RELATED AGENCIES APPROPRIATIONS ACT
PREPARED IN CONSULTATION WITH THE CONGRESSIONAL BUDGET OFFICE PURSUANT
TO SECTION 308(A) OF THE CONGRESSIONAL BUDGET ACT OF 1974

[In millions of dollars]

COMPARISON WITH BUDGET RESOLUTION

Pursuant to clause 3(c)(2) of rule XIII of the Rules of the
House of Representatives and section 308(a)(1)(A) of the
Congressional Budget Act of 1974, the following table compares
the levels of new budget authority provided in the bill with
the appropriate allocation under section 302(b) of the Budget
Act.

[In millions of dollars]
----------------------------------------------------------------------------------------------------------------
302(b) Allocation This Bill
---------------------------------------------------------------
Budget Budget
Authority Outlays Authority Outlays
----------------------------------------------------------------------------------------------------------------
Comparison of amounts in the bill with Committee
allocations to its subcommittees: Subcommittee
on Labor, Health and Human Services, Education,
and Related Agencies
Discretionary............................... .............. 185,797 188,057 \1\234,972
Mandatory................................... .............. .............. 1,195,275 \1\1,194,183
----------------------------------------------------------------------------------------------------------------
\1\Includes outlays from prior-year budget authority.
NOTE.--The bill reported to the House contains an additional $2,260 million in discretionary budget authority
and $1,664 million in associated outlays for those recommended amounts, which are designated as being for
program integrity activities. Pursuant to section 251(b)(2) of the Balanced Budget and Emergency Deficit
Control Act of 1985, as amended by the Fiscal Responsibility Act of 2023 (P.L. 118-5), these amounts are
considered adjustments to the discretionary spending limits.
In addition, amounts provided pursuant to the 21st Century Cures Act (Public Law 114-255) are not reflected
because such funding does not count against the Committee's allocations in the House of Representatives for
the purposes of the Congressional Budget Act of 1974 or the Balanced Budget and Emergency Deficit Control Act
of 1985.

FIVE-YEAR OUTLAY PROJECTIONS

Pursuant to clause 3(c)(2) of rule XIII and section
308(a)(1)(B) of the Congressional Budget Act of 1974, the
following table contains five-year projections associated with
the budget authority provided in the accompanying bill as
provided to the Committee by the Congressional Budget Office.

[In millions of dollars]
------------------------------------------------------------------------
Outlays
------------------------------------------------------------------------
Projection of outlays associated with the
recommendation:
2025............................................. \1\1,250,110
2026............................................. 102,545
2027............................................. 32,863
2028............................................. 4,988
2029 and future years............................ 62
------------------------------------------------------------------------
\1\Excludes outlays from prior-year budget authority.

FINANCIAL ASSISTANCE TO STATE AND LOCAL GOVERNMENTS

Pursuant to clause 3(c)(2) of rule XIII and section
308(a)(1)(C) of the Congressional Budget Act of 1974, the
Congressional Budget Office has provided the following
estimates of new budget authority and outlays provided by the
accompanying bill for financial assistance to State and local
governments.

[In millions of dollars]
------------------------------------------------------------------------
Budget Authority Outlays
------------------------------------------------------------------------
Financial assistance to State and 445,693 \1\636,217
local governments for 2025.......
------------------------------------------------------------------------
\1\Excludes outlays from prior-year budget authority.

Committee Hearings

Pursuant to clause 3(c)(6) of rule XIII of the Rules of the
House of Representatives, the following hearings were used to
develop or consider the Labor, Health and Human Services, and
Education, and Related Agencies Appropriations Bill, 2025:
The Subcommittee on Labor, Health and Human Services,
Education, and Related Agencies held a budget hearing on March
20, 2024, entitled ``Fiscal Year 2025 Request for the
Department of Health and Human Services.'' The Subcommittee
received testimony from:
The Honorable Xavier Becerra, Secretary, Department
of Health and Human Services
The Subcommittee on Labor, Health and Human Services, and
Education, and Related Agencies held a budget hearing on April
10, 2024, entitled ``Fiscal Year 2025 Request for the
Department of Education.'' The Subcommittee received testimony
from:
The Honorable Miguel Cardona, Secretary, Department
of Education
The Subcommittee on Labor, Health and Human Services, and
Education, and Related Agencies held a budget hearing on April
17, 2024, entitled ``Fiscal Year 2025 Request for the
Department of Labor.'' The Subcommittee received testimony
from:
The Honorable Julie Su, Acting Secretary, Department
of Labor
The Subcommittee on Labor, Health and Human Services, and
Education, and Related Agencies held a hearing on April 30,
2024, entitled ``Fiscal Year 2025 Member Day.'' The
Subcommittee received testimony from:
James McGovern, Member of Congress, and
Raul Ruiz, Member of Congress.

Disclosure of Earmarks and Congressionally Directed Spending Items

Pursuant to clause 9 of rule XXI of the Rules of the House
of Representatives, neither the bill nor this report contains
any congressional earmarks, limited tax benefits, or limited
tariff benefits as defined in clause 9 of rule XXI of the Rules
of the House of Representatives.

Comparative Statement Of Budget Authority

[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

MINORITY VIEWS

This bill continues the Republican Party's full-scale
assault on public education, abandons ongoing health crises,
and eliminates funding for reproductive health. The Republican
majority's Fiscal Year 2025 appropriations bill for the
Subcommittee on Labor, Health and Human Services, Education,
and Related Agencies cuts discretionary spending by $24.6
billion, or 11 percent, below the fiscal year 2024 level.
For the second year in a row, the majority's bill
prophesies the complete destruction of public education. Last
year, the Republican majority put forth a Labor-HHS-Education
bill that would have taken 224,000 teachers out of classrooms;
eliminated job opportunities for young adults, seniors, and
working families; and jeopardized maternal, pediatric, and
public health.
This year, the bill once again decimates support for K-12
education--including cuts that would take at least 72,000
teachers out of low-income classrooms--and it abandons college
students and lower-income workers trying to gain an education
or advance their career for their chance at the American Dream.
The Republican majority's bill would harm women's health,
children's health, and public health. The bill would surrender
the safety and wellbeing of the American people to multiple
ongoing health crises.
And the majority's cuts to the Social Security
Administration would mean closures and shorter operating hours
at Social Security field offices, and longer processing and
wait times for seniors and those with disabilities.
This bill will never become law. But the Republican
majority once again demonstrates beyond any doubt where it
seeks to take public education in this country. American
families deserve to know not only how the Republican majority's
bill decimates support for K-12 education--they deserve to know
how it would abandon students, young adults, workers and
seniors through all stages of their education and careers.
In this bill, the Republican majority cuts funding for the
Department of Education by $11 billion, including a cut of $5
billion to Title I Grants to Local Educational Agencies, which
would take at least 72,000 teachers out of low-income
classrooms, in the midst of a teacher shortage.
More than 600 teachers in Connecticut would be shown the
door. Pink slips would be handed out to over 8,800 teachers in
California, 4,000 teachers in Florida, and 7,300 teachers in
Texas.
This bill eliminates funding for English language
acquisition--disadvantaging and discriminating against five
million English learners nationwide who primarily speak another
language, hurting their future ability to compete and succeed
in the American economy. Funding for Supporting Effective
Instruction State grants--which provide professional
development opportunities for educators--is eliminated as well.
This bill cuts funding for Federal Work Study by 50
percent--limiting the potential earnings and future success of
330,000 students who need work-based financial aid to help
finance their post-secondary education. The bill also cuts
funding Supplemental Educational Opportunity Grants--which is
need-based financial aid--by 50 percent for more than 800,000
low-income students who use it to finance their education.
This bill eliminates funding for Workforce Innovation and
Opportunity Act Youth Job Training grants--denying job training
opportunities for 135,000 youth.
And beyond education and job training, this bill would
endanger the health of women, children, and families around the
country. This bill eliminates funding for Title X Family
Planning, which would be the end of support for preventive
health care services, including contraception and cancer
screenings, for 2.6 million low-income women and men.
This bill launches a full-blown assault on HIV/AIDS
programs, with total eliminations of funding for the Ending HIV
Epidemic initiative and Minority AIDS prevention.
The Republican majority also eliminates funding for Gun
Violence Prevention Research, Tobacco Prevention, and Suicide
Prevention. The bill cuts funding for SAMHSA's mental health
programs by $150 million, and funding for programs that were
created following the tragedy at Sandy Hook elementary school
in Newtown, Connecticut, is completely eliminated.
In addition, the majority includes a short-sighted proposal
to reorganize the National Institutes of Health (NIH) in a
partisan appropriations bill.
The House needs to hold public hearings and engage in a
thoughtful process to incorporate the best ideas to advance NIH
as the crown jewel of biomedical research. Any discussion to
reauthorize the NIH needs to be bipartisan and bicameral--
unfortunately, the proposed reorganization in today's partisan
bill falls short.
Moreover, the bill cuts funding for the Advanced Research
Projects Agency for Health (ARPH-H) by $1 billion below the
2024 enacted level, and proposes to consolidate ARPA-H into the
NIH, which would destroy ARPA-H as an independent research
agency less than three years after Congress established it.
In keeping with the majority's other partisan bills, this
bill includes dozens of policy riders, including multiple
provisions that attack women's freedom and block abortion and
reproductive health care services. Policy riders in this bill
would create an open season for discrimination against LGBTQI+
people, and they would prohibit policies and programs intended
to promote diversity in the federal government.
Like last year, these new policy riders will need to be
removed from the bill before it can be enacted.
Full Committee Markup
During full committee markup, House Democrats offered an
amendment to restore funding to the Department of Education's
Title I Grants to Local Educational Agencies, but it was
rejected by the majority.
House Democrats offered an amendment to restore funding for
the Social Security Administration's operating budget, but it
was rejected by the majority.
House Democrats offered an amendment to strike six new
policy riders that would block access to abortion and
reproductive health services, but it was rejected by the
majority.
House Democrats offered an amendment to strike 32 new
policy riders that would harm workers, patients, students, and
families, but it was rejected by the majority.
Conclusion
This bill would abandon and endanger Americans--from the
classroom, to the examination room, to the workplace--so I
cannot support it.
This bill, like the 11 other appropriations bills, will
need support from Republicans and Democrats in the House and
Senate in order to become law.
The law provides for--and Democrats will accept nothing
less than--a one percent increase in fiscal year 2025 for
Labor-HHS-Education and each of the other appropriations bills,
including parity with any additional funding increases for
defense programs.
Democrats are at the table and ready to pass legislation
that protects Americans' schools, health, and economic
opportunity. We implore the majority to join us. It is time to
govern.
Rosa DeLauro.

[all]