    [House Report 119-271]
    [From the U.S. Government Publishing Office]

     119th Congress }                                            { Report
                             HOUSE OF REPRESENTATIVES
      1st Session   }                                            { 119-271
    _______________________________________________________________________

                        DEPARTMENTS OF LABOR, HEALTH AND
                       HUMAN SERVICES, AND EDUCATION, AND
                        RELATED AGENCIES APPROPRIATIONS
                                   BILL, 2026

                                   ----------

                                  R E P O R T

                                     OF THE

                          COMMITTEE ON APPROPRIATIONS
                            HOUSE OF REPRESENTATIVES

                                 together with

                                 MINORITY VIEWS

                            [TO ACCOMPANY H.R. 5304]

                   [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

     September 11, 2025.--Committed to the Committee of the Whole House on
                the State of the Union and ordered to be printed

      DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND
                   RELATED AGENCIES APPROPRIATIONS BILL, 2026

     119th Congress }                                            { Report
                             HOUSE OF REPRESENTATIVES
      1st Session   }                                            { 119-271
    _______________________________________________________________________

                        DEPARTMENTS OF LABOR, HEALTH AND
                       HUMAN SERVICES, AND EDUCATION, AND
                        RELATED AGENCIES APPROPRIATIONS
                                   BILL, 2026

                                   __________

                                  R E P O R T

                                     OF THE

                          COMMITTEE ON APPROPRIATIONS
                            HOUSE OF REPRESENTATIVES

                                 together with

                                 MINORITY VIEWS

                            [TO ACCOMPANY H.R. 5304]

                   [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

     September 11, 2025.--Committed to the Committee of the Whole House on
                the State of the Union and ordered to be printed
                                    ______

                       U.S. GOVERNMENT PUBLISHING OFFICE

    61-598                     WASHINGTON : 2025

     119th Congress }                                            { Report
                             HOUSE OF REPRESENTATIVES
      1st Session   }                                            { 119-271

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

                     DEPARTMENTS OF LABOR, HEALTH AND HUMAN
                          SERVICES, AND EDUCATION, AND
                   RELATED AGENCIES APPROPRIATIONS BILL, 2026

                                ----------------

     September 11, 2025.--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. 5304]

        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 America First Corps
    (formerly known as AmeriCorps), the Committee for Purchase from
    People Who Are Blind or Severely Disabled, 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, 2026, and for other purposes.

                            INDEX TO BILL AND REPORT

                                                                Page number

                                                                Bill Report
    List of Abbreviations......................................
                                                                          5
    Summary of Estimates and Appropriation.....................
                                                                          7
    General Summary of the Bill................................
                                                                          7
    Bill Wide Requirements.....................................
                                                                          8
    Title I--Department of Labor:
            Employment and Training Administration.............     2
                                                                         10
                    Training and Employment Services...........     2
                                                                         11
                    Job Corps..................................     8
                                                                         14
                    Community Service Employment for Older
                        Americans..............................
                                                                         16
                    Federal Unemployment Benefits and
                        Allowances.............................     9
                                                                         16
                    State Unemployment Insurance and Employment
                        Service
                        Operations.............................    10
                                                                         16
                    Advances to the Unemployment Trust Fund and
                        Other Funds............................    16
                                                                         18
                    Program Administration.....................    17
                                                                         19
            Veterans' Employment and Training..................    17
                                                                         21
            Employee Benefits Security Administration..........    20
                                                                         22
            Pension Benefit Guaranty Corporation...............    21
                                                                         22
            Office of Workers' Compensation Programs...........    22
                                                                         22
                    Salaries and Expenses......................    22
                                                                         22
                    Special Benefits...........................    22
                                                                         23
                    Energy Employees Occupational Illness
                        Compensation Fund......................    25
                                                                         23
                    Special Benefits for Disabled Coal Miners..    25
                                                                         23
                    Black Lung Disability Trust Fund...........    26
                                                                         23
            Wage and Hour Division.............................    26
                                                                         24
            Office of Federal Contract Compliance Programs.....
                                                                         24
            Office of Labor-Management Standards...............    27
                                                                         25
            Occupational Safety and Health Administration......    27
                                                                         25
            Mine Safety and Health Administration..............    30
                                                                         26
            Bureau of Labor Statistics.........................    31
                                                                         27
            Office of Disability Employment Policy.............    32
                                                                         28
            Departmental Management............................    33
                                                                         29
            General Provisions.................................    34
                                                                         32
    Title II--Department of Health and Human Services:
            Health Resources and Services Administration.......    49
                                                                         34
                    Primary Health Care........................    49
                                                                         35
                    Health Workforce...........................    50
                                                                         38
                    Maternal and Child Health..................    54
                                                                         47
                    Ryan White HIV/AIDS Program................    54
                                                                         53
                    Health Systems.............................    55
                                                                         54
                    Rural Health...............................    56
                                                                         56
                    HRSA-Wide Activities and Program Support...    57
                                                                         60
                    Vaccine Injury Compensation Program........    58
                                                                         62
            Centers for Disease Control and Prevention.........    59
                                                                         63
                    Immunization and Respiratory Diseases......    59
                                                                         63
                    Viral Hepatitis, Sexually Transmitted
                        Disease, and
                        Tuberculosis Prevention................    59
                                                                         64
                    Emerging and Zoonotic Infectious Diseases..    59
                                                                         65
                    Chronic Disease Prevention and Health
                        Promotion..............................    60
                                                                         69
                    Birth Defects, Developmental Disabilities,
                        Disabilities and Health................    60
                                                                         74
                    Public Health Scientific Services..........    60
                                                                         76
                    Environmental Health.......................    60
                                                                         78
                    Injury Prevention and Control..............    61
                                                                         79
                    National Institute for Occupational Safety
                        and Health.............................    61
                                                                         81
                    Energy Employees Occupational Illness
                        Compensation
                        Program................................    61
                                                                         84
                    Global Health..............................    61
                                                                         85
                    Public Health Preparedness and Response....    62
                                                                         85
                    CDC-Wide Activities and Program Support....    63
                                                                         86
                    Buildings and Facilities...................    64
                                                                         90
            National Institutes of Health......................    65
                                                                         91
                    National Cancer Institute..................    65
                                                                         92
                    National Heart, Lung, and Blood Institute..    66
                                                                         97
                    National Institute of Dental and
                        Craniofacial Research..................    66
                                                                        100
                    National Institute of Diabetes and
                        Digestive and Kidney
                        Diseases...............................    66
                                                                        100
                    National Institute of Neurological
                        Disorders and Stroke...................    66
                                                                        101
                    National Institute of Allergy and
                        Infectious Diseases....................    67
                                                                        105
                    National Institute of General Medical
                        Sciences...............................    67
                                                                        108
                    Eunice Kennedy Shriver National Institute
                        of Child Health and Human Development..    67
                                                                        110
                    National Eye Institute.....................    67
                                                                        113
                    National Institute on Environmental Health
                        and Sciences...........................    68
                                                                        113
                    National Institute on Aging................    68
                                                                        114
                    National Institute of Arthritis and
                        Musculoskeletal and Skin Diseases......    68
                                                                        115
                    National Institute on Deafness and Other
                        Communication Disorders................    68
                                                                        115
                    National Institute of Nursing Research.....    68
                                                                        115
                    National Institute on Alcohol Abuse and
                        Alcoholism.............................    69
                                                                        116
                    National Institute on Drug Abuse...........    69
                                                                        116
                    National Institute of Mental Health........    69
                                                                        118
                    National Human Genome Research Institute...    69
                                                                        119
                    National Institute of Biomedical Imaging
                        and Bioengineering.....................    69
                                                                        120
                    National Center for Complementary and
                        Integrative Health.....................    69
                                                                        120
                    National Institute on Minority Health and
                        Health Disparities.....................    70
                                                                        120
                    John E. Fogarty International Center.......    70
                                                                        121
                    National Library of Medicine...............    70
                                                                        122
                    National Center for Advancing Translational
                        Sciences...............................    70
                                                                        122
                    Office of the Director.....................    71
                                                                        123
                    Buildings and Facilities...................    72
                                                                        137
                    NIH Innovation Account, Cures Act..........    72
                                                                        137
                    Advanced Research Projects Agency for
                        Health.................................    73
                                                                        137
            Substance Abuse and Mental Health Services
                Administration.................................    73
                                                                        139
                    Mental Health..............................    73
                                                                        141
                    Substance Abuse Treatment..................    75
                                                                        149
                    Substance Abuse Prevention.................    76
                                                                        154
                    Health Surveillance and Program Support....    76
                                                                        157
            Agency for Healthcare Research and Quality.........
                                                                        158
            Centers for Medicare & Medicaid Services...........    77
                                                                        158
                    Grants to States for Medicaid..............    77
                                                                        158
                    Payments to the Health Care Trust Funds....    78
                                                                        158
                    Program Management.........................    78
                                                                        159
                    Health Care Fraud and Abuse Control Account    80
                                                                        170
            Administration for Children and Families...........    81
                                                                        171
                    Payments to States for Child Support
                        Enforcement and
                        Family Support Programs................    81
                                                                        171
                    Low Income Home Energy Assistance..........    82
                                                                        171
                    Refugee and Entrant Assistance.............    83
                                                                        171
                    Promoting Safe and Stable Families.........    84
                                                                        175
                    Child Care and Development Block Grant.....    85
                                                                        176
                    Social Services Block Grant................    86
                                                                        176
                    Children and Families Services Programs....    86
                                                                        177
                    Payments for Foster Care and Permanency....    89
                                                                        183
            Administration for Community Living................    90
                                                                        184
            Administration for Strategic Preparedness and
                Response.......................................    93
                                                                        191
                    Research, Development, and Procurement.....    93
                                                                        194
                    Operations, Preparedness, and Emergency
                        Response...............................    95
                                                                        199
            Office of the Secretary............................    95
                                                                        202
                    General Departmental Management............    95
                                                                        202
                    Medicare Hearings and Appeals..............    98
                                                                        220
                    Office of the National Coordinator for
                        Health Information Technology..........    98
                                                                        220
                    Office of Inspector General................    99
                                                                        222
                    Office for Civil Rights....................    99
                                                                        221
            General Provisions.................................   100
                                                                        223
    Title III--Department of Education:
            Office of Elementary and Secondary Education.......   131
                                                                        227
                    Education for the Disadvantaged............   131
                                                                        227
                    Impact Aid.................................   132
                                                                        230
                    School Improvement Programs................   133
                                                                        231
                    Safe Schools and Citizenship Education.....   135
                                                                        233
                    Indian Education...........................   135
                                                                        236
                    Innovation and Improvement.................   136
                                                                        237
            Office of English Language Acquisition.............
                                                                        241
            Office of Special Education and Rehabilitative
                Services.......................................   138
                                                                        241
                    Special Education..........................   138
                                                                        241
                    Rehabilitation Services....................   142
                                                                        244
                    Special Institutions for Persons with
                        Disabilities...........................   143
                                                                        246
                      American Printing House for the Blind....   143
                                                                        246
                      National Technical Institute for the Deaf   143
                                                                        247
                      Gallaudet University.....................   143
                                                                        247
            Office of Career, Technical, and Adult Education...   144
                                                                        248
            Office of Postsecondary Education..................   144
                                                                        249
                    Higher Education...........................   144
                                                                        249
                    Howard University..........................   146
                                                                        255
                    College Housing and Academic Facilities
                        Loans..................................   146
                                                                        256
                    Historically Black College and University
                        Capital Financing Program Account......   146
                                                                        256
            Office of Federal Student Aid......................   147
                                                                        256
                    Student Financial Assistance...............   147
                                                                        258
                    Student Aid Administration.................   147
                                                                        260
            Institute of Education Sciences....................   148
                                                                        261
            Departmental Management............................   148
                                                                        264
            General Provisions.................................   149
                                                                        268
    Title IV--Related Agencies:
            America First Corps................................   158
                                                                        270
            Committee for Purchase from People Who Are Blind or
                Severely Disabled..............................   163
                                                                        272
            Corporation for Public Broadcasting................
                                                                        273
            Federal Mediation and Conciliation Service.........   164
                                                                        273
            Federal Mine Safety and Health Review Commission...   165
                                                                        273
            Institute of Museum and Library Services...........   165
                                                                        274
            Medicaid and CHIP Payment and Access Commission....   165
                                                                        274
            Medicare Payment Advisory Commission...............   165
                                                                        275
            National Council on Disability.....................   166
                                                                        275
            National Labor Relations Board.....................   166
                                                                        275
            National Mediation Board...........................   167
                                                                        276
            Occupational Safety and Health Review Commission...   167
                                                                        276
            Railroad Retirement Board..........................   167
                                                                        276
            Social Security Administration.....................   169
                                                                        277
    Title V--General Provisions................................   175
                                                                        282
    House of Representatives Report Requirements...............
                                                                        284

                             List of Abbreviations

        The following is a list of commonly used abbreviations and
    acronyms that appear in this report.
      ACL--Administration for Community Living
      AFC--America First Corps
      AHRQ--Agency for Healthcare Research and Quality
      ASPR--Administration for Strategic Preparedness and Response
      BARDA--Biomedical Advanced Research and Development
            Authority
      CBRN--Chemical, Biological, Radiological, and Nuclear
      CCBHC--Certified Community Behavioral Health Clinics
      CDC--Centers for Disease Control and Prevention
      CHIP--Children's Health Insurance Program
      CMS--Centers for Medicare and Medicaid Services
      CTSA--Clinical and Translational Science Awards
      CPB--Corporation for Public Broadcasting
      DHS--Department of Homeland Security
      DOD--Department of Defense
      DOE--Department of Energy
      DOL--Department of Labor
      EBSA--Employee Benefits Security Administration
      ESEA--Elementary and Secondary Education Act
      ETA--Employment and Training Administration
      FDA--Food and Drug Administration
      FIC--Fogarty International Center
      FMSHRC--Federal Mine Safety and Health Review Commission
      FTE--Full-time Equivalent
      FVPSA--Family Violence Prevention and Senior Act
      GAO--Government Accountability Office
      GLS--Garrett Lee Smith Memorial Act
      HBCUs--Historically Black Colleges and Universities
      HCFAC--Health Care Fraud and Abuse Control
      HELP--Health, Education, Labor, and Pensions
      HHS--Health and Human Services
      HRSA--Health Resources and Services Administration
      HIPSA--Health Professional Shortage Area
      IC--Institute and Center
      IDEA--Individuals with Disabilities Education Act
      IHE--Institutions of Higher Education
      IMLS--Institute of Museum and Library Services
      LEA--Local Educational Agency
      MACPAC--Medicaid and CHIP Payment and Access Commission
      MCM--Medical Countermeasures
      MedPAC--Medicare Payment Advisory Commission
      MHBG--Community Mental Health Services Block Grant
      MSHA--Mine Safety and Health Administration
      NCATS--National Center for Advancing Translational Sciences
      NCES--National Center for Education Statistics
      NCI--National Cancer Institute
      NEI--National Eye Institute
      NHGRI--National Human Genome Research Institute
      NHLBI--National Heart, Lung, and Blood Institute
      NIA--National Institute on Aging
      NIAAA--National Institute on Alcohol Abuse and Alcoholism
      NIAID--National Institute of Allergy and Infectious Diseases
      NIAMS--National Institute of Arthritis and Musculoskeletal
            and Skin Diseases
      NIBIB--National Institute of Biomedical Imaging and
            Bio-engineering
      NICHD--Eunice Kennedy Shriver National Institute of Child
            Health and Human Development
      NIDA--National Institute on Drug Abuse
      NIDCD--National Institute on Deafness and Other
            Communication Disorders
      NIDCR--National Institute of Dental and Craniofacial Research
      NIDDK--National Institute of Diabetes and Digestive and
            Kidney Disease
      NIDRR--National Institute on Disability and Rehabilitation
            Research
      NIEHS--National Institute of Environmental Health Sciences
      NIGMS--National Institute of General Medical Sciences
      NIH--National Institutes of Health
      NIMH--National Institute of Mental Health
      NIMHD--National Institute on Minority Health and Health
            Disparities
      NINDS--National Institute of Neurological Disorders and
            Stroke
      NINR--National Institute of Nursing Research
      NLM--National Library of Medicine
      NLRB--National Labor Relations Board
      NSF--National Science Foundation
      NTID--National Technical Institute for the Deaf
      OAA--Older Americans Act
      OAR--Office of AIDS Research
      OCR--Office for Civil Rights
      ODEP--Office of Disability Employment Policy
      OFCCP--Office of Federal Contract Compliance Programs
      OIG--Office of the Inspector General
      OLMS--Office of Labor-Management Standards
      OMB--Office of Management and Budget
      OMH--Office of Minority Health
      OMHA--Office of Medicare Hearings and Appeals
      ONC--Office of the National Coordinator for Health
            Information Technology
      ORR--Office of Refugee Resettlement
      ORWH--Office of Research on Women's Health
      OSHA--Occupational Safety and Health Administration
      OWCP--Office of Workers' Compensation Programs
      OWH--Office of Women's Health
      PBGC--Pension Benefit Guaranty Corporation
      PHS--Public Health Service
      PPHF--Prevention and Public Health Fund
      PRNS--Programs of Regional and National Significance
      RSA--Rehabilitation Services Administration
      SAMHSA--Substance Abuse and Mental Health Services
            Administration
      SEA--State Educational Agency
      SPRANS--Special Projects of Regional and National
            Significance
      SSA--Social Security Administration
      SSI--Supplemental Security Income
      STEM--Science, Technology, Engineering, and Mathematics
      SUPTRS--Substance Use Prevention, Treatment, and Recovery
            Services
      TANF--Temporary Assistance for Needy Families
      UAC--Unaccompanied Alien Children
      UI--Unemployment Insurance
      USAID--U.S. Agency for International Development
      VETS--Veterans' Employment and Training Services
      VISTA--Volunteers in Service to America
      WANTO--Women in Apprenticeship and Non-Traditional
            Occupations
      WHD--Wage and Hour Division
      WIA--Workforce Investment Act
      WIOA--Workforce Innovation and Opportunity Act

                    Summary of Estimates and Appropriations

        The following table compares on a summary basis the
    appropriations, including trust funds for fiscal year 2026, the
    budget request for fiscal year 2026, and the Committee
    recommendation for fiscal year 2026 in the accompanying bill.

                                             2026 LABOR, HHS, EDUCATION BILL
                                     [Discretionary funding in thousands of dollars]
    ----------------------------------------------------------------------------------------------------------------
                                                       Fiscal Year--                   2026 Committee compared to--
             Budget Activity         -------------------------------------------------------------------------------
                                       2025 Enacted     2026 Budget   2026 Committee   2025 Enacted     2026 Budget
    ----------------------------------------------------------------------------------------------------------------
    Department of Labor.............     $13,319,015      $9,627,086      $9,580,713     -$3,738,302        -$46,373
    Department of Health and Human       114,965,801      83,067,660     108,066,863      -6,898,938     +24,999,203
     Services.......................
    Department of Education.........      78,736,810      66,702,839      66,681,178     -12,055,632         -21,661
    Related Agencies................      16,918,955      14,840,697      16,280,246        -638,709      +1,439,549
        Total, Program Level........     223,940,581     174,238,282     200,609,000     -23,331,581     +26,370,718
    ----------------------------------------------------------------------------------------------------------------

                          General Summary of the Bill

        For fiscal year 2026, the Committee recommends a total of
    $184,491,000,000 in current year discretionary funding--the
    302(b) allocation--and $200,609,000,000 in overall programmatic
    funding, including offsets and adjustments. This discretionary
    amount represents 26 percent of total non-defense spending and
    11 percent of total discretionary spending.
        The Committee notes that the President's budget request
    includes a number of important proposals to reform and
    reorganize the Federal government. The Committee applauds these
    efforts to improve efficiency while reducing waste, fraud, and
    abuse. Such reforms are long overdue. The Committee notes that
    the authorizing committees of jurisdiction have not yet had the
    opportunity to consider these reorganizational proposals.
    Accordingly, the Committee's bill and report reflect the
    current organizational structure of the agencies funded herein.
    The Committee looks forward to working with the authorizing
    committees of jurisdiction as they act on the proposed
    organizational reforms submitted by the Office of Management
    and Budget.

                             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 shall 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 2027 congressional justification.
        Grant Continuation Cost Estimates.--As part of the fiscal
    year 2027 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 2027. In addition, the department
    shall include the anticipated number of awards and average
    anticipated award for such year.
        Grant Oversight.--The new Administration has identified
    numerous discrepancies within existing grant programs
    throughout the bill. In response to these issues the Committee
    directs, within 30 days of enactment of this Act, and every 30
    days thereafter until November 30, 2026, to brief the Committee
    on the status of all formula and competitive grants. Each
    briefing is to include a summary of competitive and formula
    awards made in the prior 30 days, Notices of Funding
    Opportunities (NOFOs) the respective department anticipates
    issuing within the next 30 days, and a summary of Notices of
    Funding Opportunities issued in the preceding 30 days. As
    applicable per grant program, award and NOFO summaries are to
    indicate whether such awards are continuation awards,
    supplemental grant awards, and/or new competitions and if such
    amounts are forward funded. NOFO summaries are to include new
    competitive criteria, changes from the prior year, expected
    number of awards, expected amount per award, and status of
    review panels.
        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 and to consider
    alternative means for obtaining objective scientific review.
    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 of 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.

                          TITLE I--DEPARTMENT OF LABOR

    Appropriation, fiscal year 2025.......................   $13,319,015,000
    Budget request, fiscal year 2026......................     9,627,086,000
    Committee Recommendation..............................     9,580,713,000
        Change from enacted level.........................    -3,738,302,000
        Change from budget request........................       -46,373,000

        This bill provides $9.6 billion in discretionary budget
    authority for the Department of Labor, a reduction of 28
    percent from the fiscal year 2025 enacted level. The Department
    of Labor comprises $9.6 billion, or 5 percent of the total
    302(b) allocation for this subcommittee.

                     Employment and Training Administration

    Appropriation, fiscal year 2025.......................   $10,270,657,000
    Budget request, fiscal year 2026......................     6,749,333,000
    Committee Recommendation..............................     6,672,600,000
        Change from enacted level.........................    -3,598,057,000
        Change from budget request........................       -76,733,000

        The 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.
        Competitive Grantmaking Transparency.--The Committee is
    concerned by DOL's historic lack of transparency in the
    evaluation and awarding of competitive grants. The Committee
    directs DOL to provide the Committee with grant scores for each
    applicant for competitive funding evaluated; this is to include
    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 under the previous Administration, DOL
    grantmaking 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
    authorizing statutes.
        Upskilling Workers in Industrial Sectors.--The Committee
    acknowledges in today's technology-driven industrial
    environment, workers are expected to continuously upskill,
    particularly in industries where generations of technology
    outpace generations of workers. Immersive technology can equip
    the workforce with the skills and knowledge necessary for the
    future of work. The committee encourages the Department of
    Labor to assess the ways in which use of immersive technology
    can be leveraged to train and upskill workers in industrial
    sectors including but not limited to energy, manufacturing,
    construction, mining, and automotive assembly.
        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 Department 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 2025.......................    $3,895,587,000
    Budget request, fiscal year 2026......................     2,965,905,000
    Committee Recommendation..............................     1,882,412,000
        Change from enacted level.........................    -2,013,175,000
        Change from budget request........................    -1,083,493,000

        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 appreciates the potential value of the
    Administration's proposed streamlining of ETA program. While
    the Committee regrets that the pace of the budget cycle
    precludes their consideration by the respective authorizing
    committees of jurisdiction, the Committee looks forward to
    continuing to partner with the Administration to improve the
    skills of American youth, workers, and job seekers.

    Adult Employment and Training Activities

        The Committee provides $712,000,000 in advance funding for
    adult training, which is the same as the fiscal year 2024
    enacted level. The Committee provides no funding for fiscal
    year 2025 for this program.
        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.

    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. Within this
    total. The Committee provides $860,000,000 in advanced
    appropriations for fiscal year 2027.
        Dislocated Worker National Reserve Grantee Performance
    Reporting.--Consistent with the requirements of 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.
        Within the total for Dislocated Worker Employment and
    Training Activities, the Committee provides the following
    amounts:

    ------------------------------------------------------------------------
                                                                FY 2026
                       Budget Activity                         Committee
    ------------------------------------------------------------------------
    Dislocated Worker Assistance National Reserve........       $325,859,000
        Workforce Opportunity for Rural Communities (non-         55,000,000
         add)............................................
        Community College Grants (non-add)...............         65,000,000
        Cybersecurity Grants (non-add)...................         25,000,000
        Career Pathways for Youth (non-add)..............         10,000,000
    ------------------------------------------------------------------------

        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.
        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.
        Cybersecurity and Software Development Employment
    Opportunities.--The Committee remains concerned about the high,
    unmet demand for cybersecurity and software development skills
    in both the DOD and the private sector. Of the total provided
    for the DWNR, the Committee directs $25,000,000 for competitive
    grants to institutions of higher education as defined in 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 with 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.

    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 no fiscal year 2026 funding for this
    program.

    YouthBuild

        For the YouthBuild program, the Committee provides
    $105,000,000. 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 under the
    previous administration, DOL 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 no fiscal year 2026 funding for this
    program.

    Workforce Data Quality Initiative

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

    Apprenticeship Programs

        The Committee provides $285,000,000 for apprenticeship
    grants including $100,000,000 for apprenticeship State grants.
    The Committee notes the modest increase in the number of
    apprentices generated by considerable and sustained
    congressional investment.
        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 29
    U.S.C. 3141. The Committee further directs DOL to provide a
    briefing on its implementation of this directive within 90 days
    of the enactment of this Act.
        Apprenticeship Degree.--The Committee encourages DOL to
    support apprenticeship degree programs where institutions of
    higher education integrate the awarding of affordable college
    degrees with the hallmarks of registered apprenticeships. The
    Committee further encourages DOL to prioritize funding for
    apprenticeship degrees in future Funding Opportunity
    Announcements.
        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.
        Defense Industrial Base-Focused Apprenticeship Programs.--
    The Committee encourages DOL to prioritize increased funding
    for existing training programs in advance manufacturing,
    defense technology, and other high-demand industries supporting
    the defense industrial base. The Committee further encourages
    DOL to continue facilitating partnerships between industry,
    academia, and government agencies to establish and promote
    pathway programs that would grow the defense industrial base
    workforce.
        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. The rapid expansion and adoption of
    teacher and educator apprenticeships is an example of how
    apprenticeships can align education and workforce development.
    The Committee encourages the Department to collaborate with the
    Department of Education in supporting the establishment of
    apprenticeship degree programs at 4-year institutions of higher
    education to align workforce development efforts and post-
    secondary education in industries such as advanced
    manufacturing, information technology, healthcare, and energy.
        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.
        Technology-Related Fields.--The Committee recognizes the
    growing need to invest in registered apprenticeship programs
    that prepare workers to meet the demands of an evolving labor
    market. The Committee encourages the Department to prioritize
    grant applications in new, emerging, and in-demand industry
    sectors and occupations, including in technology-related
    fields.
        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 2025.......................    $1,760,155,000
    Budget request, fiscal year 2026......................       176,370,000
    Committee Recommendation..............................       880,078,000
        Change from enacted level.........................      -880,077,000
        Change from budget request........................      +703,708,000

        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 has concerns with the historical 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.
        Industry-Standard Training.--The Committee supports the
    Department's intention to make investments in Job Corps
    facilities to ``support high-quality training that meets
    existing industry standards.''
        Job Corps Competitiveness.--The Committee recognizes the
    benefits of well-run, successful Job Corps programs in
    providing vocational education to the youth of the United
    States. On the other hand, underperforming Job Corps programs
    have been weighing the appropriation down and undermining the
    potential value of the program. Within the funds appropriated,
    the Committee directs the Department of Labor to direct
    appropriated funds to the top 50 percent of Job Corps programs
    based on the 2023 graduation rate.
        Job Corps Slot Utilization.--The Committee is concerned
    with the persistent under-utilization of Job Corps centers. The
    Committee requests a briefing regarding Job Corps application
    and enrollment data to evaluate the relative efficacy of
    different investments in producing Job Corps-eligible
    applicants and arrivals.
        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.
        Job Corps Pilot Programs.--The Committee provides
    $8,000,000 in funding for the expansion of pilot programs that
    leverage partnerships with industry to improve job relevancy
    and placement to provide Job Corps students programing aligned
    with cybersecurity industry-recognized credentials,
        Maximizing Employer Partnerships.--The Committee encourages
    DOL to fully leverage section 29 U.S.C. 3208 to maximize the
    resources available to campuses to develop these partnerships
    and meet employers' needs.
        Outcome-Focused Metrics and Budgeting.--The Committee
    encourages DOL to strengthen Job Corps by incorporating
    performance-based budgeting and outcome-focused metrics that
    demonstrate program effectiveness in preparing young people for
    the workforce. The Committee further urges DOL to identify
    opportunities for greater efficiency, cost savings, and
    improved contract oversight.
        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 2025.......................      $400,950,000
    Budget request, fiscal year 2026......................             - - -
    Committee Recommendation..............................             - - -
        Change from enacted level.........................      -400,950,000
        Change from budget request........................             - - -

        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.

                  FEDERAL UNEMPLOYMENT BENEFITS AND ALLOWANCES

    Appropriation, fiscal year 2025.......................       $33,900,000
    Budget request, fiscal year 2026......................        50,300,000
    Committee Recommendation..............................        50,300,000
        Change from enacted level.........................       +16,400,000
        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 2025.......................    $4,007,150,000
    Budget request, fiscal year 2026......................     3,421,838,000
    Committee Recommendation..............................     3,724,890,000
        Change from enacted level.........................      -282,260,000
        Change from budget request........................      +303,052,200

        The total includes $3,650,584,000 from the Employment
    Security Administration Account in the Unemployment Trust Fund
    and $74,306,000 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 2026, 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. The Committee
    directs DOL, within 180 days of the enactment of this Act, to
    publicly release a report detailing the Department's
    methodology in determining that services provided regardless of
    an individual's likelihood to exhaust benefits generates an
    approximate savings of three dollars for every one spent.

    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
    $17,500,000 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 $62,528,000, an increase of
    $2,000,000, 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 directs the Secretary to
    utilize a primary duties evaluation when setting the Adverse
    Effect Wage Rate pursuant to 20 C.F.R. 655.120(b) and shall not
    require or enforce a wage under the Occupational Employment and
    Wage Statistics program without the agricultural labor or
    services required exceeding 50 percent of the duties of the six
    Standard Occupational Classifications surveyed by the United
    States Department of Agriculture's (USDA) Farm Labor Reports or
    Farm Labor Survey.
        Skilled Health Professionals.--The Committee directs DOL to
    evaluate the H-1B program to consider necessary revisions to
    the Schedule A Shortage Occupation list to respond to regional
    health care workforce challenges.
        Timely Processing of Permanent Labor Certification
    Applications.--The Committee strongly encourages the Department
    to take appropriate actions using existing authority and
    resources to improve the processing of Permanent Labor
    Certification Applications, including Prevailing Wage
    Determinations filed through Foreign Labor Application Gateway
    system. Historically, processing took less than 6 months, but
    it currently takes well over a year. Within 90 days of
    enactment, the Department is directed to provide the Committee
    with a report detailing efforts being taken to improve
    processing timeframes by using existing authority and
    resources, including automating the self-attestation process to
    speedily approve submissions, while flagging potential bad
    actors for further investigation and audits.
        U.S. Defense Industrial Base.--The Committee notes that the
    DOL has not updated the Schedule A Shortage Occupation list to
    include more than two occupations since 2005. The Committee
    directs DOL to evaluate the H-1B program to better prioritize
    occupations including STEM and other non-STEM occupations that
    are critical to the U.S. defense industrial base. Additionally,
    the Committee directs DOL to evaluate the wage disparity
    between American workers in these occupations and workers in
    these occupations brought in under both the Schedule A Shortage
    Occupation list and the H-1B visa program, and evaluate what
    effect these programs have on U.S. citizens competing for STEM
    and other similar occupations. The Committee requests an update
    on this effort within 90 days of the enactment of the Act.

    One-Stop Career Centers/Labor Market Information

        The Committee provides $52,893,000 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 2025.......................      $172,915,000
    Budget request, fiscal year 2026......................       134,920,000
    Committee Recommendation..............................       134,920,000
        Change from enacted level.........................       -37,995,000
        Change from budget request........................             - - -

        The Committee provides $83,979,000 from the General Fund of
    the Treasury and $50,941,000 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.
        Mixed Earners Unemployment Compensation.--The Committee
    notes a report (Report No. 19-24-005-03-315) issued on October
    26, 2023, by the DOL OIG that described that, under the
    enacting law and agreements between the Department and the
    State workforce agencies (SWA), SWAs are entitled to the
    reimbursement of 100 percent of the cost of eligible benefits
    paid under the Mixed Earners Unemployment Compensation (MEUC)
    program. Funds for this program, like most pandemic
    unemployment insurance programs, were appropriated by Congress
    without fiscal year limitation. Because of this, ETA continues
    to set aside pandemic funds to reimburse SWAs for eligible MEUC
    claims. ETA must reimburse States until all eligible claims
    from the program period have been administered--even if this
    requires ETA to do so years after the conclusion of the program
    period in September 2021. However, paying pandemic-related
    claims, long after the pandemic has ended and the U.S. economy
    has recovered, is counterproductive to the original intent of
    the funds--even if claimants are eligible under the program
    period. DOL-OIG recommended the Assistant Secretary for
    Employment and Training perform an assessment of previous
    emergency UI programs and the pandemic-related UI programs to
    determine an appropriate historically based time limit for
    States' acceptance of emergency program benefit claims after
    the expiration of the UI programs' eligibility periods and
    consider making a legislative proposal to Congress to use the
    determined time limit on future emergency programs. The
    Committee remains concerned that these funds cannot be
    sufficiently reprogrammed to support other critical needs and
    encourages the Department to timely address the DOL-OIG
    recommendation to prevent similar issues during the next
    emergency.
        Office of Apprenticeship.--The Committee notes that for
    purposes of performance reporting, previous DOL budget requests
    attributed 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. As part of the
    Fiscal Year 2027 budget submission, the Committee directs DOL
    to include the number of Registered Apprenticeship program
    applicants, approvals, the average time between application
    submittal and approval, and the average time between
    application and initial notification that an application was
    not approved.
        Skilled Trades Workforce Development.--The Committee
    encourages the Department of Labor to support the development
    of coordinated State and regional outreach plans, in
    coordination with Registered Apprenticeship programs, to
    educate young Americans about the earning potential, career
    pathways, benefits, and accessibility of careers in the skilled
    trades.
        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.
        Unused Pandemic-Related Federal Funding.--The Committee
    remains concerned about the risk of unused pandemic-related
    Federal funding in State UI accounts not being returned to the
    Treasury. The Committee notes a report (Report No. 19-23-010-
    03-315) issued by the DOL-OIG on September 21, 2023,
    recommended in part that the ETA determine the proper
    disposition of excess funds and take necessary actions,
    including the recovery of questioned costs. Approximately $844
    million of Emergency Unemployment Relief for Governmental
    Entities and Nonprofit Organizations funds (19 percent of the
    total $4.5 billion allocated) remained unused in 32 States'
    unemployment insurance trust funds. The Committee remains
    concerned that these funds have yet to be returned to the
    Treasury and encourages the Department of Labor to timely
    address the DOL-OIG recommendation.

                   VETERANS' EMPLOYMENT AND TRAINING SERVICE

    Appropriation, fiscal year 2025.......................      $335,341,000
    Budget request, fiscal year 2026......................       342,341,000
    Committee Recommendation..............................       342,341,000
        Change from enacted level.........................        +7,000,000
        Change from budget request........................             - - -

        The Committee provides $65,500,000 from the General Fund of
    the Treasury and $276,841,000 from the Employment Security
    Administration Account in the Unemployment Trust Fund.
        The Veterans Employment and Training Service (VETS) program
    serves America's veterans and separating service members by
    preparing them for meaningful careers, providing employment
    resources and expertise, and protecting their employment
    rights.
        Within the total for VETS, the Committee provides the
    following amounts:

    ------------------------------------------------------------------------
                       Budget Activity                     FY 2026 Committee
    ------------------------------------------------------------------------
    Jobs for Veterans State Grants.......................       $185,000,000
    Transition Assistance Program........................         34,379,000
    Federal Administration...............................         54,048,000
    Veterans Employment and Training Institute...........          3,414,000
    Homeless Veterans Reintegration Program..............         65,500,000
    ------------------------------------------------------------------------

        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 provides $500,000 to support the Honoring
    Investments in Recruiting and Employing American Military
    Veterans Act of 2017 (HIRE Vets) Medallion program.
        Off-Base Transition Training.--The Committee continues to
    support the implementation of the Off-Base Transition Training
    pilot program and encourages the Department of Labor to
    collaborate with the Department of Veterans Affairs to offer
    resources on benefit eligibility.
        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 2027
    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 2025.......................      $191,100,000
    Budget request, fiscal year 2026......................       181,100,000
    Committee Recommendation..............................       181,100,000
        Change from enacted level.........................       -10,000,000
        Change from budget request........................             - - -

        The Employee Benefits Security Administration (EBSA)
    assures the security of retirement, health, and other
    workplace-related benefits of working Americans.

                      Pension Benefit Guaranty Corporation

                   PENSION BENEFIT GUARANTY CORPORATION FUND

    Appropriation, fiscal year 2025.......................      $512,900,000
    Budget request, fiscal year 2026......................       494,264,000
    Committee Recommendation..............................       494,264,000
        Change from enacted level.........................       -18,636,000
        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 2025.......................      $122,705,000
    Budget request, fiscal year 2026......................       110,000,000
    Committee Recommendation..............................       110,000,000
        Change from enacted level.........................       -12,705,000
        Change from budget request........................             - - -

        The Office of Workers' Compensation Programs (OWCP)
    administers the Federal Employees' Compensation Act, the
    Longshore and Harbor Workers' Compensation Act, the Energy
    Employees Occupational Illness Compensation Program Act, and
    the Black Lung Benefits Act. These programs provide eligible
    injured and disabled workers and their survivors with
    compensation, medical benefits, and services including
    rehabilitation, supervision of medical care, and technical and
    advisory counseling.
        The Committee provides $107,823,000 in General Funds from
    the Treasury and $2,177,000 from the Special Fund established
    by the Longshore and Harbor Workers' Compensation Act.

                                SPECIAL BENEFITS

    Appropriation, fiscal year 2025.......................      $726,670,000
    Budget request, fiscal year 2026......................     1,298,385,000
    Committee Recommendation..............................     1,298,385,000
        Change from enacted level.........................      +571,715,000
        Change from budget request........................             - - -

        These funds provide mandatory benefits under the Federal
    Employees' Compensation Act and the Longshore and Harbor
    Workers' Compensation Act.

        ADMINISTRATIVE EXPENSES, ENERGY EMPLOYEES OCCUPATIONAL ILLNESS
                               COMPENSATION FUND

    Appropriation, fiscal year 2025.......................       $66,966,000
    Budget request, fiscal year 2026......................        68,148,000
    Committee Recommendation..............................        68,148,000
        Change from enacted level.........................        +1,182,000
        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 2025.......................       $30,367,000
    Budget request, fiscal year 2026......................        30,485,000
    Committee Recommendation..............................        30,485,000
        Change from enacted level.........................          +118,000
        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 $5,900,000 as an advance
    appropriation for the first quarter of fiscal year 2027. These
    funds ensure uninterrupted payments to beneficiaries.

                        BLACK LUNG DISABILITY TRUST FUND

    Appropriation, fiscal year 2025.......................      $485,706,000
    Budget request, fiscal year 2026......................       477,295,000
    Committee Recommendation..............................       477,295,000
        Change from enacted level.........................        -8,411,000
        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 2025.......................      $260,000,000
    Budget request, fiscal year 2026......................       235,000,000
    Committee Recommendation..............................       235,000,000
        Change from enacted level.........................       -25,000,000
        Change from budget request........................             - - -

        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.
        Federal Contractors.--The Committee is concerned that the
    Minimum Wage for Federal Contracts notice published by the
    Department 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 2025.......................      $110,976,000
    Budget request, fiscal year 2026......................             - - -
    Committee Recommendation..............................             - - -
        Change from enacted level.........................      -110,976,000
        Change from budget request........................             - - -

        The Committee does not provide funding for OFCCP,
    consistent with the fiscal year 2026 budget proposal. The
    Committee notes the U.S. Equal Employment Opportunity
    Commission (EEOC) has the legal responsibility for enforcing
    Federal laws that make it illegal to discriminate against a job
    applicant or an employee because of the person's race, color,
    religion, sex (including pregnancy, childbirth, or related
    conditions), national origin, age (40 or older), disability or
    genetic information. The EEOC investigates and responds to
    instances of potential discrimination related to all types of
    work situations including hiring, firing, promotions,
    harassment, training, wages, and benefits.

                      Office of Labor-Management Standards

                             SALARIES AND EXPENSES

    Appropriation, fiscal year 2025.......................       $48,515,000
    Budget request, fiscal year 2026......................        48,515,000
    Committee Recommendation..............................        48,515,000
        Change from enacted level.........................             - - -
        Change from budget request........................             - - -

        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 2025.......................      $639,359,000
    Budget request, fiscal year 2026......................       582,381,000
    Committee Recommendation..............................       582,381,000
        Change from enacted level.........................       -56,978,000
        Change from budget request........................             - - -

        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:

    ------------------------------------------------------------------------
                       Budget Activity                     FY 2026 Committee
    ------------------------------------------------------------------------
    Safety and Health Standards..........................        $16,000,000
    Federal Enforcement..................................        219,343,000
    Whistleblower Programs...............................         25,000,000
    State Programs.......................................        115,200,000
    Technical Support....................................         23,500,000
    Federal Compliance Assistance........................         78,262,000
    State Consultation Grants............................         60,476,000
    Training Grants......................................              - - -
    Safety and Health Statistics.........................         34,500,000
    Executive Direction and Administration...............         10,100,000
    ------------------------------------------------------------------------

        Non-Mandatory Guidance Concerning Opioid Overdose Reversal
    Medication in the Workplace.--Though drug overdose deaths have
    decreased for the first time in decades, the Committee is still
    extremely concerned about the tens of thousands of deaths that
    still happen annually. These deaths occur everywhere including
    in the workplace, which accounts for nearly 10 percent of all
    occupational injury deaths in 2023. Fortunately, overdose
    reversal medication such as naloxone can assist and treat
    individuals who experience an overdose. The Committee requests
    that within 180 days of passage of this Act, the Occupational
    Safety and Health Administration issue nonmandatory guidance to
    employers on how to acquire and maintain opioid overdose
    reversal medication. The nonmandatory guidance should also
    provide employers with how they can offer voluntary training to
    employees on the usage of such medication. The Committee
    further recommends that this information be made available on
    the Administration's website for all to access.

                     Mine Safety and Health Administration

                             SALARIES AND EXPENSES

    Appropriation, fiscal year 2025.......................      $387,816,000
    Budget request, fiscal year 2026......................       348,207,000
    Committee Recommendation..............................       348,207,000
        Change from enacted level.........................       -39,609,000
        Change from budget request........................             - - -

        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:

    ------------------------------------------------------------------------
                       Budget Activity                     FY 2026 Committee
    ------------------------------------------------------------------------
    Mine Safety and Health Enforcement...................       $252,307,000
    Standards and Regulations Development................          3,700,000
    Assessments..........................................          7,000,000
    Educational Policy and Development...................         25,000,000
    Technical Support....................................         31,200,000
    Program Evaluation and Information Resources.........         15,500,000
    Program Administration...............................         13,500,000
    ------------------------------------------------------------------------

        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.
        Respirable Crystalline Silica.--The Committee shares MSHA's
    commitment to ensure the safety and health of our nation's
    miners. The Committee is aware of concerns regarding the final
    rule, ``Lowering Miners' Exposure to Respirable Crystalline
    Silica and Improving Respiratory Protection,'' published in the
    Federal Register on April 18, 2024. These concerns relate to
    the rule's feasibility, proportionality, and practicality,
    differences between the coal and metal/nonmetal mining sectors,
    and the lack of adequate notice of the inclusion of provisions
    such as an immediate notification requirement. The Committee
    directs MSHA to provide a briefing within 120 days of enactment
    of this Act that includes: an assessment of the technical and
    operational feasibility for operators to achieve compliance
    with the rule's exposure limits and reporting requirements, an
    evaluation of the accuracy of laboratory analyses supporting
    enforcement, and information on how MSHA may apply
    proportionality and flexibility in enforcement actions,
    including consideration of sector-specific and operational
    variability. As part of MSHA's evaluation of this rule and
    respirable crystalline silica protections, the Committee
    encourages MSHA to incorporate feasibility, proportionality,
    and practicality.

                           Bureau of Labor Statistics

                             SALARIES AND EXPENSES

    Appropriation, fiscal year 2025.......................      $703,952,000
    Budget request, fiscal year 2026......................        68,000,000
    Committee Recommendation..............................       713,952,000
        Change from enacted level.........................       +10,000,000
        Change from budget request........................      +645,952,000

        The Bureau of Labor Statistics (BLS) is an independent
    national statistical agency that collects, processes, analyzes,
    and disseminates essential economic data to the Congress,
    Federal agencies, State and local governments, businesses, and
    the public. Its principal surveys include the Consumer Price
    Index and the monthly unemployment series. The Committee
    appreciates the potential value of the Administration's
    proposed consolidation of Federal statistical agencies. While
    the Committee regrets that the pace of the budget cycle
    precludes their consideration by the respective authorizing
    committees of jurisdiction, the Committee looks forward to
    continuing to partner with the Administration to identify
    potential efficiencies in the data collection process while
    preserving the high-quality of BLS's statistical analysis.
        The Committee recommendation includes $645,952,000 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:

    ------------------------------------------------------------------------
                       Budget Activity                     FY 2026 Committee
    ------------------------------------------------------------------------
    Employment and Unemployment Statistics...............       $254,150,000
    Labor Market Information.............................         68,000,000
    Prices and Cost of Living............................        249,436,000
    Compensation and Working Conditions..................         92,354,000
    Productivity and Technology..........................         12,360,000
    Executive Direction and Staff Services...............         37,652,000
    ------------------------------------------------------------------------

        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.
        Different-Cell Imputation.--The Committee recognizes the
    challenges BLS faces in collecting regional inflation data and
    the importance of maintaining high quality reference data. The
    Committee has concerns that methodological variance increase
    uncertainty and has the potential to degrade the public's
    confidence in BLS data.
        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.
        Standard Occupational Classification 29-1051.--The
    Committee is aware that BLS uses a single Standard Occupational
    Classification (SOC) code (29-1051) that reflects a traditional
    definition of pharmacist job functions. However, the single SOC
    does not reflect as many as 46,000 pharmacists working in
    nontraditional roles. The Committee encourages BLS to
    collaborate with HRSA's National Center for Health Workforce
    Analysis, the American Pharmacists Association, and the
    American Association of Colleges of Pharmacy to publicly issue
    a report on the changes necessary for the SOC codes to
    accurately account for the complete pharmacist labor force and
    workforce projections.
        Survey on Employer Provided Training.--The Committee
    directs BLS to include, as part of the fiscal year 2027
    congressional justification, a cost estimate of a survey to
    better understand the incidence and nature of training provided
    to employees by employers.

                     Office of Disability Employment Policy

                             SALARIES AND EXPENSES

    Appropriation, fiscal year 2025.......................       $43,000,000
    Budget request, fiscal year 2026......................        33,810,000
    Committee Recommendation..............................        37,000,000
        Change from enacted level.........................        -6,000,000
        Change from budget request........................        +3,190,000

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

                          Office of Inspector General

                             SALARIES AND EXPENSES

    Appropriation, fiscal year 2025.......................       $97,028,000
    Budget request, fiscal year 2026......................        91,028,000
    Committee Recommendation..............................        99,028,000
        Change from enacted level.........................        +2,000,000
        Change from budget request........................        +8,000,000

        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.

                            Departmental Management

                             SALARIES AND EXPENSES

    Appropriation, fiscal year 2025.......................      $393,197,000
    Budget request, fiscal year 2026......................       300,830,000
    Committee Recommendation..............................       230,620,000
        Change from enacted level.........................      -162,577,000
        Change from budget request........................       -70,210,000

        The Departmental Management appropriation provides funds
    for the staff responsible for Departmental operations,
    management, and policy development.
        The Committee recommendation includes $230,312,000 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:

    ------------------------------------------------------------------------
                       Budget Activity                     FY 2026 Committee
    ------------------------------------------------------------------------
    Program Direction and Support........................        $30,250,000
    Departmental Evaluation..............................          4,281,000
    Legal Services.......................................        119,935,000
    International Labor Affairs..........................              - - -
    Administration and Management........................         28,450,000
    Adjudication.........................................         35,000,000
    Women's Bureau.......................................              - - -
    Civil Rights Activities..............................          6,880,000
    Chief Financial Officer..............................          5,516,000
    ------------------------------------------------------------------------

        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.
        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 encourages the Department to
    develop pilot programs that facilitate education and training
    programs in the field of advanced manufacturing.
        Confidential Threat Briefing.--The Committee directs DOL
    to, within 180 days of the enactment of this Act, brief the
    Committees in a classified setting on the current threat
    landscape as relates to Department personnel covered by section
    113 of this Act.
        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.
        Energy Production and Critical Manufacturing Workforce.--
    The Committee recognizes a need to address workforce shortages
    in energy production and critical manufacturing. To address
    this need, the Committee encourages the Department of Labor to
    conduct a workforce analysis on these industries. The Committee
    recommends the study to include information on growth over the
    last 10 years, existing entry-level occupations, prerequisites
    for occupational entry, salary data, career growth
    opportunities, barriers that prevent individuals from acquiring
    employment in new occupations and career paths in such
    industries, and how digital technology advancements are
    impacting these industries. The Department is encouraged to
    publicly release such analysis within 180 days of the enactment
    of this Act.
        Excess Personal Property.--The Committee directs DOL to
    include in the fiscal year 2027 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, accounting for differences in
    programmatic features such as eligibility of employees, wage
    replacement rate, 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.
        Office of Immigration Policy.--The Committee recognizes
    that employment visas are an important critical tool for
    American employers to have a timely, qualified, and stable
    workforce and commends the establishment of the Office of
    Immigration Policy to carry out the Department's
    responsibilities under the Immigration and Nationality Act,
    including oversight, strategic planning, and management of
    foreign labor certifications--a mandatory piece of the foreign
    labor process. The Committee encourages the Department to
    continue to utilize all statutory and regulatory authorities to
    expeditiously manage and process foreign labor certifications.
        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 United States-
    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 2025.......................       $29,269,000
    Budget request, fiscal year 2026......................         6,889,000
    Committee Recommendation..............................        29,269,000
        Change from enacted level.........................             - - -
        Change from budget request........................       +22,380,000

        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.

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

                              (TRANSFER OF FUNDS)

        Sec. 107. The Committee 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 continues 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.
        Sec. 116. The Committee includes a new provision related to
    Adverse Effect Wage Rate determination.
        Sec. 117. The Committee includes a new provision related to
    H-2A rulemaking.
        Sec. 118. The Committee includes a new prohibition related
    to final rule entitled ``Employee or Independent Contractor
    Classification Under the Fair Labor Standards Act.''
        Sec. 119. The Committee includes a new provision related to
    the Job Corps program.

              TITLE II--DEPARTMENT OF HEALTH AND HUMAN SERVICES

    Appropriation, fiscal year 2025................         $114,965,801,000
    Budget request, fiscal year 2026...............           83,067,660,000
    Committee Recommendation.......................          108,066,863,000
        Change from enacted level..................           -6,898,938,000
        Change from budget request.................          +24,999,203,000

        The Department of Health and Human Services (HHS)
    anticipates exceeding $1.8 trillion in total spending,
    constituting over 6 percent of the United States' gross
    domestic product. Over 90 percent of this expenditure is
    mandatory, with discretionary funding, overseen by the
    Committee on Appropriations, comprising only 9 percent.
        This bill provides just over $108 billion in discretionary
    budget authority for HHS, a reduction of 6 percent over fiscal
    year 2025 enacted level. HHS comprises 54 percent of the total
    302(b) allocation for this subcommittee.
        The Committee supports the efforts of the Secretary of
    Health and Human Services to reform and reorganize the
    Department. The Secretary has made a number of important
    proposals to reorganize the Department to eliminate silos
    within and among subagencies and make the Department more
    efficient and responsive to the needs of the American people.
    The Committee notes that the authorizing committees of
    jurisdiction have not yet had the opportunity to fully consider
    and act on the Department's proposals. Accordingly, the
    Committee's bill and report reflect the current organizational
    structure of the Department. The Committee looks forward to
    working with the authorizing committees of jurisdiction as they
    review the Department's request to reorganize. The Committee
    strongly supports and shares the Secretary's goal to end the
    chronic disease epidemic and Make America Healthy Again.

                  Health Resources and Services Administration

    Appropriation, fiscal year 2025................           $8,286,229,000
    Budget request, fiscal year 2026...............            6,371,802,000
    Committee Recommendation.......................            7,405,460,000
        Change from enacted level..................             -880,769,000
        Change from budget request.................           +1,033,658,000

        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 notes that the Department proposes to
    incorporate HRSA into a new Administration for a Healthy
    America. The Committee looks forward to working with the
    authorizing committees of jurisdiction as they consider the
    Department's proposal.
        The Committee's recommendation for HRSA includes
    $7,133,398,000 in discretionary budget authority and
    $272,062,000 in mandatory funding.

                              PRIMARY HEALTH CARE

    Appropriation, fiscal year 2025.......................    $1,858,772,000
    Budget request, fiscal year 2026......................     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. The Health
    Center Program supports community health centers, health
    centers for the homeless, health centers for residents of
    public housing, and migrant health centers. HRSA reports that
    in 2023, more than 31 million people relied on HRSA-funded
    health centers for care, including 1 in 8 children, more than
    9.7 million rural residents, and over 400,000 veterans.
        Within the amount provided, the Committee includes bill
    language providing up to $120,000,000 for the Federal Tort
    Claims Act program.
        Further, within the total provided for the Health Centers
    program, the Committee provides no less than the following
    amounts:

    ------------------------------------------------------------------------
                       Budget Activity                     FY 2026 Committee
    ------------------------------------------------------------------------
    Addressing Intimate Partner Violence and Project              $2,000,000
     Catalyst............................................
    Alcee L. Hastings Program for Advanced Cancer                 10,000,000
     Screening...........................................
    Early Childhood Development..........................         30,000,000
    Native Hawaiian Health Care..........................         27,000,000
        Papa Ola Lokahi (non-add)........................         10,000,000
    School Based Health Centers..........................         55,000,000
    ------------------------------------------------------------------------

        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 funding 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.
        Autonomous Artificial Intelligence and Diabetic
    Retinopathy.--The Committee encourages HRSA to consider the
    establishment, expansion, or maintenance of efforts at
    Federally Qualified Health Centers (FQHC) to bring specialty
    eyecare services to patients using FDA-cleared autonomous
    artificial intelligence technology that diagnoses diabetic
    retinopathy. HRSA is further encouraged to focus on supporting
    efforts at FQHCs where a majority of patients with diabetes
    face challenges adhering to medical recommendations to receive
    annual comprehensive diabetic eye exams. HRSA is also
    encouraged to evaluate the utilization of FDA-cleared
    autonomous AI within FQHCs and, in consultation with physician
    specialty professional organizations, promote patient and
    provider education on successful patient referral pathways from
    FQHCs to specialty care.
        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 available health center funding.
        Community Health Center Infrastructure.--The Committee
    recognizes that Community Health Centers (CHCs) deliver
    essential care to millions of Americans, regardless of their
    ability to pay. In many rural and socioeconomically
    disadvantaged areas--including colonias along the U.S.-Mexico
    border--CHCs are often the only source of care and serve as a
    vital safety net for families facing persistent poverty and
    limited access to health infrastructure. Despite their vital
    role, many CHCs face serious infrastructure challenges,
    including aging or inadequate facilities that restrict their
    ability to meet growing patient demand or expand services. The
    Committee directs the Secretary of HHS, in coordination with
    the Secretaries of Housing and Urban Development and
    Agriculture, to develop a coordinated strategy to address these
    deficiencies by identifying relevant Federal programs and
    supporting technical assistance for facility improvements. The
    strategy should prioritize CHCs serving rural areas, Tribal
    lands, and border communities such as colonias. The Committee
    further directs HHS to submit a report on this strategy to the
    Committees on Appropriations of the House of Representatives
    and the Senate within 180 days of enactment of this Act.
        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 notes that certain health
    centers throughout the country are ineligible to apply for
    supplemental funding awards because of their status as a FQHC
    Look-Alike (LAL). The Committee requests a briefing from HRSA
    within 180 days of the enactment of this Act on the impact of
    allowing FQHC LALs to apply for supplemental funding
    opportunities under section 330 of the PHS Act and the ways in
    which the FQHC LAL program could be better utilized as a
    pipeline into the section 330 Health Center Program.
        Health Center Collaboration.--The Committee supports health
    centers entering partnerships that close care gaps in medically
    underserved areas. The Committee encourages HRSA to examine how
    to support existing health center partnerships and incentivize
    more collaboration in underserved communities.
        Integration of Behavioral Health Care in Community Health
    Centers.--CHCs play a critical role in providing essential
    health care services to communities across the United States.
    Fewer than nine percent of CHC patients received mental health
    services, and fewer than one percent of CHC patients received
    substance use services in 2023. Both mental health and
    substance use disorder treatment are key drivers of physical
    and behavioral health. Integrating mental health and substance
    use disorder treatment as primary services provided by CHCs is
    an efficient way to meet growing demand for treatment,
    particularly in rural areas. Additionally, integration of these
    services would eliminate cost barriers as CHCs would no longer
    need to submit a formal request to HRSA to add these services.
    The Committee directs HRSA to provide an update to the
    committees of jurisdiction within 180 days of the enactment of
    the Act on efforts and obstacles to including mental health and
    substance use disorder treatment as required primary services
    in CHCs.
        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, no 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).
        Technical Assistance.--The Committee believes funding for
    the training and technical assistance available for health
    centers through national and State cooperative agreements and
    grants is critical to the successful operation and expansion of
    the health centers program. Funds are available within the
    amount provided to enhance technical assistance and training
    activities and further quality improvement initiatives that
    improve health outcomes and continue the development of and
    support for health center-controlled networks so that new and
    existing centers can improve patient access to quality health
    services.
        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 (T1D)
    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. The Committee directs HRSA to provide a report to the
    Committees on Appropriations of the House of Representatives
    and the Senate within one year of the enactment of this Act
    addressing the steps needed to increase screening efforts for
    T1D at health centers and to make such report available on the
    agency's website. The report should assess the feasibility and
    estimated cost of expanding screening efforts among targeted
    populations and include a plan and timeline to implement such
    efforts. When developing the report, HRSA should consult with
    the National Institute of Diabetes and Digestive and Kidney
    Diseases, patient advocacy organizations, and other T1D
    stakeholders.

    Free Clinics Medical Malpractice

        Within the amount provided, the Committee includes bill
    language providing up to $1,000,000 for payment of claims under
    the FTCA to be made available for free clinic health
    professionals as authorized by section 224(o) of the PHS Act.
    This appropriation extends FTCA coverage to medical volunteers
    in free clinics to expand access to healthcare services for
    low-income individuals in medically underserved areas.

                                HEALTH WORKFORCE

    Appropriation, fiscal year 2025.......................    $1,404,376,000
    Budget request, fiscal year 2026......................       394,620,000
    Committee Recommendation..............................     1,366,933,000
        Change from enacted level.........................       -37,443,000
        Change from budget request........................      +972,313,000

        The Bureau of Health Workforce (BHW) strengthens the health
    care workforce by connecting skilled health care providers to
    communities in need through grant, scholarship, and loan
    repayment programs. These programs are designed to help
    underserved communities recruit and retain health care
    providers.
        Community-Based Clinical Rotations for Medical Students.--
    An estimated 80 percent of patient care is now provided in a
    range of community-based settings rather than academic
    hospitals 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. Within the funding provided, the
    Committee encourages HRSA to support opportunities for medical
    schools to partner with FQHCs, Rural Health Clinics, or other
    healthcare facilities located in medically underserved
    communities to increase medical school clinical rotations in
    rural and underserved areas.
        Graduate Education Pipeline in Underserved Areas.--The
    Committee understands the role of programs that assist students
    in enrolling and completing in graduate and professional
    programs that supply health professionals to underserved
    communities. Many Health Professional Shortage Areas (HPSAs)
    and Medically Underserved Areas (MUAs) rely on a stable
    pipeline of health workforce graduates from these institutions.
    The Committee encourages HRSA to assess health workforce
    availability in HPSA and MUA regions. The Committee requests
    that HRSA submit a report within 180 days of enactment of this
    Act identifying strategies to ensure continued access to
    graduate education programs that serve as essential pipelines
    to primary care, behavioral health, dental, and allied health
    professions in shortage areas.
        Health Professions Shortages and Health Workforce
    Enhancement.--The Committee notes the success of online,
    personalized career-training and certification programs to
    address the shortage of registered Medical Assistants and
    related health professionals in communities across the country.
    The Committee encourages HRSA to look to successful programs
    and connect with stakeholders to identify opportunities and
    barriers for collaboration, and to encourage and advance
    similar collaborations in a coordinated fashion moving forward.
        Health Professions Workforce.--The Committee recognizes the
    critical shortages in healthcare professions, particularly
    affecting rural communities. The Committee directs HHS to
    conduct a comprehensive study documenting successful programs
    utilizing skills-based training platforms and public-private
    partnerships that enhance healthcare workforce development
    through online learning platforms. The report should focus on
    professions that are most critical in terms of dealing with
    chronic disease management and high-volume specialty care in
    this environment. Such professions include primary care
    physicians, cardiologists, endocrinologists, orthopedists, and
    behavioral health professionals. Further, such report should
    focus on scalable solutions to balance the high numbers of
    patients with specialized care that are in high demand and
    include recommendations for expanding effective workforce
    development initiatives. The Department shall submit this
    report to the Committees on Appropriations of the House of
    Representatives and the Senate within one year of the enactment
    of this Act.
        Health Workforce Shortages.--The Committee appreciates
    HRSA's efforts to tackle health care workforce shortages across
    the country. The Committee supports the expansion of the
    physician, nursing, and pharmacy workforce to meet the growing
    health needs of the American people. The Committee encourages
    HRSA to consider ways to expand these efforts and requests
    information on the steps the agency is taking to address health
    professions shortages in the fiscal year 2027 congressional
    justification.
        Primary Care Physician Shortages.--The Committee encourages
    HHS to continue its efforts to provide a comprehensive review
    of national trends affecting the recruitment and retention of
    primary care physicians. Such ongoing analysis should evaluate
    the effectiveness of existing Federal policies and programs,
    including loan repayment initiatives, reimbursement models, and
    training programs serving rural and low-income populations.
    Such analysis should also examine geographic and demographic
    factors contributing to physician shortages. The Committee
    requests an update on such efforts in the fiscal year 2027
    congressional justification.

    National Health Service Corps

        The Committee includes $130,000,000, 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) allows States to
    determine how to address healthcare provider shortages.
    However, the Committee is concerned that many States may not be
    focusing on the full range of healthcare providers in shortage,
    including in nursing, pharmacy, dentistry, and behavioral
    healthcare. The Committee requests HRSA include in the fiscal
    year 2027 congressional justification information regarding the
    steps the agency is taking to address health professions
    shortages, including efforts to ensure the SLRP is supporting
    all health care professions in shortage, including in nursing,
    pharmacy, dentistry, and behavioral healthcare. The update
    should include: (1) information, by State, on what professions
    are benefiting from the SLRP and how many individuals in each
    profession have received funding; and (2) how many individuals
    applied, broken down by profession and State. In addition, the
    update should provide information on how HRSA can expand
    efforts to include health professionals who do not typically
    benefit from HRSA workforce programs, such as pharmacists, in
    its educational, training, and loan repayment programs.
        Tribal Set-Aside.--The Committee includes a set-aside of 15
    percent within the total funding 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 $508,304,000 for the health
    professions education and training programs authorized under
    title VII of the PHS Act.

    Centers of Excellence

        The Committee recommends $25,422,000 for the Centers of
    Excellence Program. The Centers of Excellence program provides
    innovative resources and education centers to recruit, train,
    and retain students and faculty at health professions schools.

    Health Careers Opportunity Program

        The Committee recommends $15,000,000 for the Health Careers
    Opportunity Program (HCOP). The purpose of this grant program
    is to assist students from disadvantaged backgrounds to enter
    and successfully complete health profession schools. National
    HCOP Academies prepare students to meet the admissions
    requirements for the next level of their education and receive
    a health professions degree or certificate.

    Faculty Loan Repayment

        The Committee includes $2,310,000 for the Faculty Loan
    Repayment program. 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). The SDS program provides grants
    to health professions and nursing schools to provide
    scholarships to students from disadvantaged backgrounds who
    have financial need.
        Midwifery Training.--Within the total for SDS, the
    Committee includes $5,000,000 to continue grants awarded for
    the purpose of educating midwives to address the national
    shortage of maternity care providers.

    Primary Care Training and Enhancement

        The Committee includes $49,924,000 for Primary Care
    Training and Enhancement programs. These programs support the
    primary care workforce by providing enhanced training for
    future primary care clinicians and faculty and promoting
    primary care practice, particularly in rural and underserved
    areas.
        Community-Based Clinical Rotations for Medical Students.--
    The Committee recognizes that patient care is frequently
    provided in a range of community-based settings and that
    providing outpatient training opportunities in underserved
    areas encourages long-term, sustainable physician practice in
    high-need areas. The Committee encourages HRSA to evaluate and
    facilitate opportunities for medical schools to partner with
    FQHCs, Rural Health Clinics, or other healthcare facilities
    located in medically underserved communities to increase
    medical school clinical rotations in rural and underserved
    areas.

    Oral Health Training

        The Committee includes $43,673,000 for Oral Health
    Training. 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 no less
    than $13,500,000 for general dentistry programs, no less than
    $13,500,000 for pediatric dentistry programs, and no 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.
        The Committee continues to support awards with a preference
    for pediatric dentistry faculty supervising dental students or
    residents and providing clinical services in dental schools,
    hospitals, and community-based affiliated sites.
        State Oral Health Workforce Improvement Grant Program.--The
    Committee commends HRSA for its ongoing efforts to address the
    nation's health workforce. The oral health workforce
    development program offers States the opportunity to address
    their unique workforce and access to care needs.

    Pediatric Specialty Loan Repayment Program

        The Committee includes $10,000,000 for the pediatric
    specialty loan repayment program (PSLRP) authorized by section
    775 of the PHS Act.
        The Committee is concerned that the 2023 and 2024 PSLRP
    application processes did not adequately reflect the way
    pediatric subspecialty care is provided. The Committee is also
    concerned that pediatric medical subspecialists, pediatric
    surgical specialists, and child and adolescent psychiatrists,
    were underrepresented in the initial awards of the program
    despite the intent of the program when it was created. The
    Committee directs 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 actual pediatric specialty practice and reflects the
    regionalization of pediatric specialty care. The Committee also
    directs HRSA to develop award criteria that ensure that more
    applicants with significant medical school debt can benefit
    from the program. The Committee requests an update on these
    efforts in the fiscal year 2027 congressional justification.

    Interdisciplinary Community-Based Linkages

    Area Health Education Centers

        The Committee includes $47,000,000 for the Area Health
    Education Centers program. This program links university health
    science centers with community health service delivery systems
    to provide education and training networks.
        Simulation-Based Clinical Education.--Within the total, the
    Committee provides $3,000,000 for AHEC recipients to continue
    to provide experiential learning opportunities through
    simulation labs designed to educate and train health care
    professionals serving rural, medically underserved communities.
    HRSA shall include as an allowable use the purchase of
    simulation training equipment.

    Geriatrics Programs

        The Committee includes $48,245,000 for the Geriatrics
    Workforce Enhancement Program and the Geriatrics Academic
    Career Awards Program. 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 consolidates activities previously 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. 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 no
    less than the following amounts:

    ------------------------------------------------------------------------
                       Budget Activity                     FY 2026 Committee
    ------------------------------------------------------------------------
    Graduate Psychology Education........................        $25,000,000
    Mental and Substance Use Disorder Workforce Training          34,700,000
     Demonstration.......................................
        Addiction Medicine Fellowship (non-add)..........         25,000,000
    Peer Support Specialists.............................         15,000,000
    ------------------------------------------------------------------------

        Community-Based Settings.--The Committee encourages HRSA to
    work with grantees to use BHWET funds to support individuals
    providing care in community-based settings while completing
    clinical training requirements for licensure. This flexibility
    would allow for improved access to behavioral health services
    in rural and underserved communities across America.
        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 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 FQHCs, to
    support training for medical residents and fellows in
    psychiatry and addiction medicine, as well as 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.

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

        The Committee includes $40,000,000 for this program. 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 the National Center
    for Health Workforce Analysis (NCHWA), consistent with the
    fiscal year 2026 budget request. 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.
        Real-Time Data to Improve U.S. Healthcare Workforce.--The
    Committee encourages HRSA to develop a data dashboard for all
    Graduate Medical Education (GME) training position participants
    that includes real-time information on residency applications,
    interviewee demographics, and residency fulfillment rates.
    NCHWA 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 encourages HRSA to expand these efforts
    to meet locally identified needs by providing support for
    medical residency program feasibility and sustainability
    assessment activities including regional data landscape
    analyses in rural communities to address inequities in location
    and discipline. 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.

    Public Health and Preventive Medicine Training Programs

        The Committee includes $8,000,000 for the Preventive
    Medicine Residency program. This program provides awards for
    residents to obtain enhanced experiential activities with a
    focus on residents having longitudinal clinical rotations in
    FQHCs in rural or medically underserved communities.
        Consistent with the fiscal year 2026 budget request, the
    Committee does not prioritize available funding for the Public
    Health Training Centers program.

    Nursing Workforce Development

        The Committee recommends $258,629,000 for the Nursing
    Workforce Development programs authorized under title VIII of
    the PHS Act.
        Nursing Workforce Center Expansion Program.--The Committee
    supports efforts to provide support within available resources
    to help States establish, expand, or maintain State-based
    centers for nursing. Nursing Workforce Centers are hubs within
    a State that advance nursing education, practice, leadership,
    and workforce development at the State and local levels.
    Currently, there are 39 Nursing Workforce Centers that rely on
    a mix of funding from nurse licensure fees, State governments,
    foundation grants, membership fees, and service fees. Many
    report insufficient funding and lack of technical capabilities
    as major barriers to fully supporting their State's nursing
    workforce needs. Additional resources would help States collect
    localized and granular 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 encourages HRSA to work with Congress and
    stakeholders to examine ways to establish new or enhance
    existing State-based nursing workforce centers to advance
    training.
        Nursing Workforce Development.--The Committee recognizes
    the critical importance of addressing healthcare workforce
    shortages in underserved communities, particularly in States
    that face significant challenges in maternal health outcomes
    and nursing shortages. The Committee encourages HRSA to
    prioritize funding for projects at Historically Black Colleges
    and Universities (HBCU) that establish career pathways from
    entry-level certifications to advanced nursing credentials in
    areas with documented healthcare staffing shortages. The
    Committee further encourages HRSA to prioritize investments in
    healthcare training infrastructure at HBCUs with existing
    clinical programs that can be rapidly scaled to meet critical
    regional nursing shortages.
        Nursing Workforce Shortages.--The Bureau of Labor
    Statistics projects 203,200 openings for nurses in the United
    States 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 expand the number of nursing
    faculty and clinical preceptor sites to educate students at all
    levels.

    Advanced Nursing Education and Nurse Practitioner Optional
            Fellowship Program

        The Committee includes $89,581,000 for the Advanced Nursing
    Education Workforce (ANEW) program and an additional $7,000,000
    for the Nurse Practitioner Optional Fellowship program within
    ANEW. The ANEW 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 (SANE).--The Committee
    continues $15,000,000 for this activity. The Committee
    encourages HRSA 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. The Committee notes that the ANEW program will recompete
    in fiscal year 2027. The Committee requests that HRSA provide
    information in the fiscal year 2027 congressional justification
    on the feasibility of establishing regional SANE training
    programs within the ANEW program that would establish a level
    of excellence in forensic nursing and prepare current and
    future sexual assault nurse examiners/forensic nurse examiners
    to be profession-ready and meet the applicable State
    certification and licensure requirements.
        Nurse Practitioner Optional Fellowship Program.--The
    funding provided for this activity supports grants within the
    Advanced Nursing Education Nurse Practitioner Residency and
    Fellowship Program to establish, expand, or maintain optional
    community-based nurse practitioner fellowship programs with a
    preference for those in FQHCs, for practicing postgraduate
    nurse practitioners in primary care or behavioral health.

    Nurse Education, Practice, Quality, and Retention

        The Committee includes $69,413,000 for the Nurse Education,
    Practice, Quality, and Retention (NEPQR) programs. 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.
        Experiential Learning.--Within the total for NEPQR, the
    Committee continues no less than $10,750,000 for grants to
    enhance nurse education through the expansion of experiential
    learning opportunities. The Committee directs HRSA to ensure
    that these grants include as an allowable use the purchase of
    simulation training equipment.

    Nursing Workforce Diversity

        Consistent with the fiscal year 2026 budget request, the
    Committee does not prioritize available funding for this
    program.

    Nurse Corps Scholarship and Loan Repayment

        The Committee includes $92,635,000 for Nurse Corps,
    consistent with the fiscal year 2026 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

        Consistent with the fiscal year 2026 budget request, the
    Committee does not prioritize available funding for this
    program.

    Children's Hospitals Graduate Medical Education

        The Committee includes $395,000,000 for the Children's
    Hospitals Graduate Medical Education (GME) program. 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. The program trains over
    half of all general pediatrics residents and pediatric
    subspecialty residents and fellows.

    Medical Student Education

        The Committee includes $75,000,000 for the Medical Student
    Education program 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.

    National Practitioner Data Bank

        The Committee includes $33,500,000 for the National
    Practitioner Data Bank (NPDB). As mandated by the Health Care
    Quality Improvement Act (Public Law 99-660), the NPDB is
    financed by the collection of user fees. The NPDB collects
    certain adverse information, medical malpractice payment
    history, and information related to healthcare fraud and abuse.
    The data bank is available to healthcare agencies and
    organizations that make licensing and employment decisions.

                           MATERNAL AND CHILD HEALTH

    Appropriation, fiscal year 2025.......................    $1,170,430,000
    Budget request, fiscal year 2026......................       896,846,000
    Committee Recommendation..............................       985,481,000
        Change from enacted level.........................      -184,949,000
        Change from budget request........................       +88,635,000

        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.

    Maternal and Child Health Services Block Grant

        The Committee recommends $603,584,000 for the maternal and
    child health (MCH) services block grant, consistent with the
    fiscal year 2026 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 2026 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.
        Reducing Maternal Mortality.--The Committee is concerned
    with the persistent rate of maternal mortality in the United
    States. In 2023, the maternal mortality rate was 18.6 deaths
    per 100,000 live births making the U.S. an outlier among
    similarly developed countries. The Committee is encouraged by
    the initial success of the Healthy Start Blood Pressure Cuff
    Kit pilot and recommends an expansion of information provided
    to pregnant women. The Committee recommends HRSA build on the
    Healthy Start Blood Pressure Cuff Kit pilot by administering
    maternity care kits to pregnant women which may include (i) a
    blood pressure cuff; (ii) a factsheet of urgent maternal health
    warning signs, (iii) Maternal Mental Health Hotline (833 TLC
    MAMA) materials; (iv) 988 hotline information; (v) prenatal
    vitamins; (vi) Safe sleep guidance; and (vii) pregnancy-safe
    seatbelt use and car seat safety information. The Committee
    requests an update in the fiscal year 2027 budget justification
    regarding the steps being taken to provide these resources.
        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 during pregnancy 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 affects as many
    as one in twelve pregnancies and can be easily monitored.

    MCH Block Grant--Special Projects of Regional and National
            Significance

        The Committee recommends $163,667,000 for special projects
    of regional and national significance (SPRANS), which fully
    funds the fiscal year 2026 budget request. The Committee
    continues bill language identifying a specific amount for
    SPRANS. Within that amount, the Committee provides no less than
    the following within SPRANS:

    ------------------------------------------------------------------------
                                                                FY 2026
                       Budget Activity                         Committee
    ------------------------------------------------------------------------
    Early Childhood Development Grants...................        $10,250,000
    Epilepsy.............................................          3,642,000
    Fetal Alcohol Syndrome...............................          1,000,000
    Fetal Infant and Child Death Review..................          5,000,000
    Hereditary Hemorrhagic Telangiectasia................          2,000,000
    Infant-Toddler Court Teams...........................         20,000,000
    Minority Serving Institutions........................         10,000,000
    Newborn Essentials Support Toolkits..................          5,000,000
    Oral Health..........................................          5,250,000
    Regional Pediatric Prevention Network................         25,000,000
    Sickle Cell Disease..................................          7,000,000
    State Maternal Health Innovation Grants..............         55,000,000
    ------------------------------------------------------------------------

        Infant Toddler Court Teams.--The Committee includes
    $20,000,000 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.
        Newborn Essentials Support Toolkits.--The Committee
    provides $5,000,000 to continue the work of the Newborn Supply
    Kit program. The Committee directs HRSA to make grants or enter
    into cooperative agreements with eligible entities,
    particularly those that have a multi-state reach, to procure
    supply kits for new mothers and partner with local eligible
    entities to distribute the supply kits. Eligible entities for
    this program shall include hospitals, health centers,
    community-based organizations, or other organizations serving
    mothers and infants. Such supply kits shall be composed of
    essential goods to help mothers recover from childbirth and
    care for newborn infants such as diapers, wipes, blankets,
    infant thermometers, postpartum supplies, breastfeeding
    supplies, information on the Maternal Mental Health Hotline,
    information on the National Breastfeeding Helpline, educational
    material on breastfeeding, information about programs providing
    support to postpartum women and children, evidence-based
    education material on the use of low-dose aspirin (to address
    hypertension, preeclampsia, and preterm birth), and a blood
    pressure monitor. The Committee directs HRSA to ensure, to the
    maximum extent practicable, the geographical diversity of the
    recipients of such kits, emphasizing geographic areas with the
    greatest need, such as maternal care deserts, rural
    communities, and communities with the highest maternal
    mortality rates.
        Oral Health and Primary Care Integration.--Within the total
    provided for oral health within 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 encourages the Chief Dental Officer to continue to
    direct the design, monitoring, oversight, and implementation of
    these projects.
        Regional Pediatric Prevention Network.--The Committee
    includes $25,000,000 for the pediatric prevention network and
    directs HRSA to continue funding the network's current
    structure of two awards consisting of at least five children's
    hospitals (centers) each. Funding shall be equally distributed
    among the ten centers. HRSA is directed to prioritize
    applications from networks with the demonstrated capacity and
    experience to coordinate among the Nation's pediatric hospitals
    and their communities to prepare for and coordinate research-
    informed responses to future pandemics. Such centers shall be
    located in geographically diverse areas of the country to
    ensure a regional approach to the network.

    Sickle Cell Disease Treatment Demonstration Program

        The Committee includes $8,205,000 for this program, which
    is the same as the fiscal year 2026 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. 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 no less than $38,245,000
    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 $20,883,000 for the Heritable
    Disorders program. This program assists States to improve and
    expand their newborn screening programs and to promote parental
    and provider education.
        Duchenne and Becker Muscular Dystrophy.--The Committee is
    aware that the Department is still considering whether to
    recommend Duchenne for inclusion on the Recommended Uniform
    Screening Panel (RUSP) for newborn screening. The Committee
    recognizes the importance of Federal guidance and support in
    State decision making around the detection of chronic illnesses
    at birth. The Committee urges HHS to promptly consider the
    outstanding review of available evidence for Duchenne and
    requests a plan regarding the new process for future
    recommendations for conditions for newborn screening.
        Metachromatic Leukodystrophy.--Metachromatic leukodystrophy
    (MLD) is an ultra-rare, rapidly progressive, irreversible and
    ultimately fatal neurometabolic disease that affects
    approximately one in 100,000 live births. It is caused by an
    error in the gene responsible for encoding the enzyme
    arylsulfatase A (ARSA) leading to neurological damage and
    developmental regression. The Committee notes that a gene
    therapy for early-onset MLD was approved in March 2024,
    offering a potentially curative option for eligible children.
    However, timely diagnosis is critical for treatment to be
    effective. A nomination to add MLD to the RUSP was subsequently
    submitted in June 2024 to the Department. The Committee
    requests an update on the status of the MLD nomination for the
    RUSP in the fiscal year 2027 congressional justification.

    Healthy Start

        The Committee notes that mandatory funding available for
    the Maternal, Infant, and Early Childhood Home Visiting
    (MIECHV) program continues to increase and will exceed
    $600,000,000 in fiscal year 2026. The MIECHV program supports
    pregnant women and parents with young children who live in
    communities that face greater risk and barriers to achieving
    positive maternal and child health outcomes. Therefore,
    consistent with the fiscal year 2026 budget request, the
    Committee does not recommend separate discretionary funding for
    the Healthy Start program.

    Early Hearing Detection and Intervention

        The Committee includes $18,818,000 for the early hearing
    detection and intervention program. 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 $24,334,000 for emergency medical
    services for children. 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 $13,500,000 for the Screening and
    Treatment for Maternal Mental Health and Substance Use
    Disorders (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 the
    MMHSUD program, which was reauthorized in the Consolidated
    Appropriations Act, 2023 (P.L. 117-328).
        According to Maternal Mortality Review Committee data,
    suicide and overdose are the leading causes of maternal
    mortality, accounting for 22 percent of pregnancy-related
    deaths. Maternal mental health (MMH) conditions impact one in
    five pregnant or postpartum women. The MMHSUD program provides
    grants to States to improve access to care and expand the
    workforce by training health care providers to screen, assess,
    and treat MMH conditions and substance use disorders and
    provide specialized psychiatric consultation to providers.
    According to HRSA, almost 50 percent of the providers who used
    the psychiatric consultation line were in a rural or
    underserved area. The program supports women in rural and
    underserved areas who lack access to mental health care,
    especially for the millions of women living in a maternity care
    desert.
        Each MMHSUD program is funded up to $750,000 with 13 States
    currently receiving funding. The additional funding for this
    program will allow for three more programs to receive funding
    to support mothers and babies in their States. The Committee
    encourages HRSA to work to expand grants to Tribes and Tribal
    organizations to address MMH conditions and substance use
    disorders. The Committee requests an update in the fiscal year
    2027 congressional justification on efforts by the agency to
    provide grants for Tribes and Tribal organizations to support
    maternal mental health and substance use disorders in these
    communities.

    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
    2026 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 equal to the fiscal year 2026
    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. This funding
    supports capacity building, technical assistance, and continued
    implementation of the Alliance for Innovation on Maternal
    Health Program's patient safety bundles to all States,
    territories, and Tribal organizations. Patient safety bundles
    are a set of targeted and evidence-informed best practices
    that, when implemented, improve patient outcomes and reduce
    maternal mortality and severe maternal morbidity.

    Maternal Mental Health Hotline

        The Committee includes $8,000,000 for the Maternal Mental
    Health Hotline. The Maternal Mental Health Hotline supports the
    four million women who give birth each year. Maternal mental
    health conditions impact one in five pregnant and postpartum
    women and one in three high-risk populations including service
    members, military spouses, and rural women. The Hotline
    provides 24-hour voice and text support services for pregnant
    and postpartum mothers. Since its launch on Mother's Day in
    2022, the Hotline has served over 64,000 women and families
    across the United States with average response times of less
    than 30 seconds. The most common reasons for calling include
    feeling overwhelmed, depression, and anxiety. The Committee
    directs HRSA to promote public awareness of the Hotline to
    communities at higher risk of developing a maternal mental
    health condition including military members, veterans, military
    spouses, and rural communities. The Committee directs HRSA to
    submit a report to the Committees on Appropriations of the
    House of Representatives and the Senate within 180 days of the
    enactment of this Act detailing actions HRSA has taken to
    increase Hotline awareness.

    Poison Control Centers

        The Committee includes $28,846,000 for Poison Control
    Centers. 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
    2026 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 2025.......................    $2,571,041,000
    Budget request, fiscal year 2026......................     2,497,535,000
    Committee Recommendation..............................     2,045,630,000
        Change from enacted level.........................      -525,411,000
        Change from budget request........................      -451,905,000

        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, including access to HIV-related
    medications.
        Within the total for the Ryan White HIV/AIDS program, the
    Committee provides the following amounts:

    ------------------------------------------------------------------------
                                                                FY 2026
                       Budget Activity                         Committee
    ------------------------------------------------------------------------
    Emergency Assistance.................................       $680,752,000
    Comprehensive Care Programs..........................      1,364,878,000
        AIDS Drug Assistance Program (non-add)...........        900,313,000
    ------------------------------------------------------------------------

        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 new incoming
    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 2027 congressional
    justification on these findings and potential courses of action
    and considerations for a residence-based formula.

                                 HEALTH SYSTEMS

    Appropriation, fiscal year 2025.......................      $122,009,000
    Budget request, fiscal year 2026......................       110,887,000
    Committee Recommendation..............................       122,887,000
        Change from enacted level.........................          +878,000
        Change from budget request........................       +12,000,000

        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 $55,049,000 for the Organ
    Transplantation program, which is a $1,000,000 increase over
    the fiscal year 2024 level.
        Advisory Committee on Organ Transplantation.--As part of
    the effort to modernize the Organ Procurement and
    Transplantation Network (OPTN) and the structures and systems
    that support it, the Committee urges HRSA to appoint members
    to, and reconvene, the Advisory Committee on Organ
    Transplantation (ACOT) so that the agency has important
    external expertise to inform its work. The Committee urges HRSA
    to hold at least one meeting of the ACOT in fiscal year 2026.
        Living Organ Donation Reimbursement Program.--Within the
    funding provided, the Committee includes a $1,000,000 increase
    for the living organ donation reimbursement program. This
    program reduces financial disincentives to living organ
    donation by providing reimbursement to living organ donors 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.
        OPTN Next Generation Technology.--The Committee supports
    HRSA's OPTN Modernization Initiative, with particular interest
    in the efforts to develop and implement a technology solution
    to fully modernize the OPTN so more individuals can be matched
    with life-saving organs. The Committee understands that because
    of outdated technology and a lack of dynamic algorithms, the
    current matching system is inefficient, and therefore critical
    time is lost in the effort to identify and match an available
    organ to the most appropriate candidate, causing some organs to
    go unused. The Committee urges HRSA to prioritize the
    development of a modern, dynamic organ candidate matching
    technology system that better serves donor families and
    recipients, performs efficiently, allows for timely, systematic
    updates in allocation policy, and supports clinical innovation.
        Organ Procurement and Transplantation Network Modernization
    Initiative.--The Committee recognizes the importance of the
    OPTN Modernization Initiative, launched in March 2023, to
    strengthen accountability and the performance of the nation's
    organ transplant system. The Committee is extremely concerned
    by recent reports of cases involving patients with neurological
    signs incompatible with organ donation. Such reports raise
    serious ethical and legal questions. The Committee is
    encouraged by the Secretary's recent announcement that HRSA is
    mandating strict corrective actions for the entities involved.
    The Committee directs HRSA to provide a briefing to the
    Committees on Appropriations of the House of Representatives
    and the Senate within 30 days of enactment of this Act and
    every 90 days thereafter on HRSA's spend plan, progress toward
    its stated objectives, and actions the Department has taken or
    plans to take to improve oversight, protect patient safety,
    increase public and stakeholder trust in the organ allocation
    process, and track and evaluate the effectiveness and impact of
    the modernization initiative.
        Organ Transportation Working Group.--The Committee supports
    the recommendations made by the Federal Aviation
    Administration's (FAA) Organ Transportation Working Group to
    identify best practices for transporting organs in the cabin of
    airplanes. This initiative is critical for patients awaiting
    organ transplants, as transporting organs in the cabin can
    reduce transit time, minimize temperature fluctuations, and
    increase the viability of life-saving organs during critical
    transportation windows. As part of the report, FAA developed 20
    recommendations, including five for HRSA: (1) establish a forum
    for continuous discussion and communications across the
    transplant community and aviation industry stakeholder groups;
    (2) establish standardized data definitions, data types, and
    reporting protocols for data collection in the organ transport
    community; (3) add granularity in data reporting by collecting
    transportation methods and success/failure rates in addition to
    timing in schedule; (4) develop a centralized data management
    system to collect data from OPTN members, couriers, and other
    relevant stakeholders; and (5) share relevant incident reports
    with TSA and airlines. The Committee supports these
    recommendations and directs HRSA to provide an update to the
    Committees on Appropriations of the House of Representatives
    and the Senate within 60 days of enactment of this Act on how
    HRSA will implement these recommendations. In addition, the
    Committee directs HRSA to provide the Committees with an update
    on implementation with 180 days of enactment of this Act and
    post such update on a publicly available website.

    National Cord Blood Inventory

        The Committee includes $19,266,000 for the national cord
    blood inventory (NCBI) program. 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, equal to the fiscal year 2026
    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 and $1,857,000 for payments to Hawaii for treatment of
    Hansen's disease, equal to the fiscal year 2026 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 United States and Puerto Rico; and
    medical care and treatment of persons with Hansen's disease
    throughout the Hawaiian Islands.

                                  RURAL HEALTH

    Appropriation, fiscal year 2025.......................      $364,607,000
    Budget request, fiscal year 2026......................       283,830,000
    Committee Recommendation..............................       515,407,000
        Change from enacted level.........................      +150,800,000
        Change from budget request........................      +231,577,000

        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.
        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 HRSA's efforts to implement
    programs and policies to improve rural health outcomes,
    strengthen care delivery, and address the immediate issues
    facing rural communities.
        Supporting Rural Hospitals Glycemic Management Standards.--
    The Committee recognizes the critical role of advanced
    technology in improving patient safety and health outcomes in
    rural hospitals, particularly for managing diabetes-related
    conditions. To support compliance with the mandatory CMS
    electronic clinical quality measures on hospital harm related
    to hyperglycemia and hypoglycemia, the Committee encourages
    HRSA to allow rural hospitals to utilize existing HRSA grant
    programs for the purchase and implementation of FDA-approved
    insulin management technology. This includes continuous glucose
    monitoring systems, automated insulin delivery systems, and
    associated software solutions designed to prevent adverse
    events related to blood glucose levels. The Committee urges
    HRSA to issue guidance clarifying that these technologies are
    an allowable use of grant funds when consistent with relevant
    statutory authorities, provided they align with program goals
    to improve patient care, enhance safety, and reduce the burden
    on providers.
        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 2027
    congressional justification.

    Rural Health Outreach Programs

        The Committee includes $110,975,000 for rural health
    outreach programs. These programs support projects that
    demonstrate new and innovative modes of outreach in rural
    areas, such as integration and coordination of health services.
        Within the total for Rural Health Outreach Programs, the
    Committee provides no less than the following amounts for
    Regional Grant Programs:

    ------------------------------------------------------------------------
                                                                 FY 2026
                        Budget Activity                        Committee
    ------------------------------------------------------------------------
    Appalachian Region Healthcare Support Program........         $2,500,000
    Delta States.........................................         31,000,000
        Delta States Rural Development Network Grants             12,000,000
         (non-add).......................................
        Delta Region Maternal Care Coordination Program            2,250,000
         (non-add).......................................
        Delta Region Community Health Systems Development         15,000,000
         Program (non-add)...............................
    Rural Northern Border Region Healthcare Support                4,000,000
     Program.............................................
    ------------------------------------------------------------------------

        Delta States.--These programs seek to strengthen healthcare
    delivery in rural areas of the Delta region. The Delta States
    region consists of Alabama, Arkansas, Illinois, Kentucky,
    Louisiana, Mississippi, Missouri, and Tennessee. Within the
    funds provided for Rural Health Outreach Programs, the
    Committee includes an increase of $2,000,000 over the fiscal
    year 2024 enacted level to support the Delta States programs.
    Within the total for the Delta Region Community Health Systems
    Development Program, the Committee includes funding to continue
    the Delta Health Systems Implementation Program.
        Rural Maternity and Obstetrics Management Strategies.--
    Within the funds provided for Rural Health Outreach Programs,
    the Committee includes no less than $14,000,000 for rural
    maternity and obstetrics management strategies (RMOMS). 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 Policy Development

        The Committee includes $14,076,000 for Rural Health Policy
    Development. Funding supports FORHP's activities to analyze,
    advise the Secretary, and provide information to the public
    regarding issues that affect the availability, access to, and
    quality of health care in rural areas.
        Rural Hospital Facilities.--The Committee notes that
    hospital closures present unique challenges for rural
    communities as they seek to repurpose facilities to serve
    community needs. Within the funding provided for Rural Health
    Policy Development, the Committee includes $2,000,000 for FORHP
    to conduct a study and provide a report regarding rural
    hospital facilities that have closed. Such report shall provide
    an overview of the number of rural hospital facilities that
    have closed, a description of the ways in which rural
    communities have repurposed such facilities, an analysis of
    obstacles rural communities have encountered in repurposing
    such facilities, a compilation of best practices for rural
    communities facing a facilities closure, an overview of Federal
    resources available to assist rural communities in successfully
    repurposing such facilities for community needs, and
    recommendations for additional statutory authorities or
    resources that could assist rural communities in repurposing
    rural hospital facilities. The Committee encourages FORHP to
    coordinate with the U.S. Department of Agriculture, which
    administers the Community Facilities Program, the Department of
    Housing and Urban Development, the Department of the Treasury,
    and other relevant Federal agencies in undertaking this study.
    The Committee directs HRSA to provide an interim report to the
    Committees on Appropriations of the House of Representatives
    and the Senate within one year of enactment of this Act and a
    final report within two years of enactment of this Act.
        Rural Health Research Center Program.--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 find solutions to these important issues.
    The Committee provides an increase of $1,000,000 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 Hospital
    Flexibility Grants. 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 $23,442,000 for the Small Rural
    Hospital Improvement Program.

    State Offices of Rural Health

        The Committee includes $13,000,000 for State Offices of
    Rural Health. 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 2026 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 2026 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 2026 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. This program funds physician
    residency training programs that support physician workforce
    expansion in rural areas. The Committee commends FORHP for its
    efforts to improve and expand the physician workforce in rural
    areas by developing new, sustainable rural residency programs
    and supports the continuation and expansion of the program to
    develop new rural residency programs, or Rural Track Programs.

    Financial and Community Sustainability for At Risk Hospitals

        The Committee includes $10,000,000 for this activity. 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 $20,000,000 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.

    Rural Hospital Provider Assistance Program

        The Committee includes $100,000,000 for a Rural Hospital
    Provider Assistance program. The Committee is concerned that
    low reimbursements for low-wage hospitals prevent them from
    paying higher wages, which in turn keeps them at the low end of
    the wage index, resulting in a downward spiral. The Committee
    supports efforts by the Secretary and the CMS Administrator to
    address this issue through the implementation of the Rural
    Health Transformation Program and other regulatory relief. To
    supplement such efforts, the Committee provides new funding for
    HRSA to administer a formula grant program to support hospitals
    at the low end of the wage index serving residents in States
    with the highest poverty rates. By focusing limited resources
    on areas with the greatest demonstrated need, the Committee
    seeks to ensure sustained access to quality health care
    providers for these communities.

                                FAMILY PLANNING

    Appropriation, fiscal year 2025.......................      $286,479,000
    Budget request, fiscal year 2026......................             - - -
    Committee Recommendation..............................             - - -
        Change from enacted level.........................      -286,479,000
        Change from budget request........................             - - -

        Consistent with the fiscal year 2026 budget request, the
    Committee does not recommend funding for the Family Planning
    program. The Family Planning program administers Title X of the
    PHS Act.

                    HRSA-WIDE ACTIVITIES AND PROGRAM SUPPORT

    Appropriation, fiscal year 2025.......................      $219,588,000
    Budget request, fiscal year 2026......................        42,050,000
    Committee Recommendation..............................       223,088,000
        Change from enacted level.........................        +3,500,000
        Change from budget request........................      +181,038,000

        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. The fiscal year 2026 budget request amount
    does not include additional program management funding
    requested for the proposed Administration for a Healthy
    America.
        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 was not delegated by
    the previous HRSA Administrator. 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 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.
        Provider Relief Fund and Uninsured Program.--The Committee
    directs HRSA to provide a report to the Committees on
    Appropriations of the House of Representatives and the Senate
    within 180 days of enactment of this Act detailing the total
    amount of funds returned or recovered as a result of fraudulent
    claims or improper payments through this and other HRSA
    pandemic relief accounts and provide the Committees with an
    update on the current status of related program integrity and
    recovery efforts.
        Tribal Engagement.--HRSA's core mission is to improve
    health outcomes and build the health workforce. Historically,
    HRSA has had low participation by Indian Tribes in several core
    program areas, despite the great Tribal need in all of HRSA's
    mission areas. The Committee appreciates HRSA's recent efforts
    to expand Tribal engagement efforts. The Committee directs HRSA
    to provide the Committees on Appropriations of the House of
    Representatives and the Senate 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 within 180 days of enactment of
    this Act. 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 2026 budget request.
    The Committee notes that HHS proposes to transfer the Office of
    Pharmacy Affairs from HRSA to CMS. The Committee looks forward
    to working with the authorizing committees of jurisdiction as
    they consider the Department's proposal.

    Office for the Advancement of Telehealth

        The Committee includes $45,550,000 for the Office for the
    Advancement of Telehealth (OAT). Funds for OAT 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 Accreditation.--The Committee recognizes the
    strong bipartisan support for telehealth and supports efforts
    to ensure telehealth programs are set up for long-term success.
    The Committee supports the Department's efforts to ensure that
    telehealth programs adhere to standards and evidence-based best
    practices. Accreditation processes aim to improve virtual care
    services through the regular review of telehealth programs to
    ensure they have the tools needed to meet and maintain
    established standards. Accreditation provides a recognized
    marker for high quality of care and consistency, which promotes
    and fosters trust and confidence among patients and providers.
    To build on the Department's efforts, the Committee encourages
    HHS and HRSA to utilize telehealth accreditation, where
    appropriate, to ensure high quality and consistent care for
    patients.
        Telehealth Centers of Excellence.--Within the funds
    provided for OAT, the Committee provides no less than
    $8,500,000 for Telehealth Centers of Excellence. 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 Network Grants.--The Telehealth Network Grant
    Program (TNGP) supports the use of telehealth networks to
    improve health care services for medically underserved
    populations in urban, rural, and frontier communities. The
    Committee recognizes the importance of expanding telehealth
    services in rural and underserved communities. To improve
    access to care, the Committee provides an increase of no less
    than $1,000,000 for TNGP within the funding provided for OAT.
    The Committee encourages HRSA to prioritize funding for
    initiatives incorporating AI-driven remote patient monitoring,
    mobile diagnostic units, and telemedicine expansion to address
    critical shortages in primary and specialty care.
        Telehealth Resource Centers.--The Telehealth Resource
    Centers (TRC) program provides expert and customizable
    telehealth technical assistance across the country. The TRCs
    provide training and support, disseminate information and
    research findings, promote effective collaboration, and foster
    the use of telehealth technologies to provide health care
    information and education for providers who serve rural and
    medically underserved areas and populations. The Committee
    recognizes the essential role TRCs play in helping rural and
    other under-resourced communities integrate telehealth into
    care delivery and address persistent challenges related to
    access, reimbursement, and technology adoption. Given the
    exponential growth of telehealth utilization in recent years
    and the increased demand for TRC services, the Committee
    provides an increase of $500,000 for the TRC Program within the
    funding provided for OAT.

                      VACCINE INJURY COMPENSATION PROGRAM

    Appropriation, fiscal year 2025.......................       $15,200,000
    Budget request, fiscal year 2026......................        15,200,000
    Committee Recommendation..............................        15,200,000
        Change from enacted level.........................             - - -
        Change from budget request........................             - - -

        The Vaccine Injury Compensation Program provides
    compensation for individuals with vaccine-associated injuries
    or deaths. The Committee provides $15,200,000 for expenses
    associated with administering the program. The Committee also
    includes $272,062,000 in mandatory funding from the Vaccine
    Injury Compensation Program Trust Fund for claims, the same as
    the fiscal year 2026 budget request.

                   Centers for Disease Control and Prevention

    Appropriation, fiscal year 2025.......................    $9,222,090,000
    Budget request, fiscal year 2026......................     5,475,241,000
    Committee Recommendation..............................     7,480,880,000
        Change from enacted level.........................    -1,741,210,000
        Change from budget request........................    +2,005,639,000

        The Committee recommendation for the Centers for Disease
    Control and Prevention (CDC) program level includes
    $6,027,147,000 in discretionary budget authority, $55,358,000
    in mandatory funds under the terms of the Energy Employees
    Occupational Illness Compensation Program Act, and
    $1,398,375,000 in transfers from the Health Fund (PPHF).

                     IMMUNIZATION AND RESPIRATORY DISEASES

    Appropriation, fiscal year 2025.......................      $919,291,000
    Budget request, fiscal year 2026......................       963,291,000
    Committee Recommendation..............................       931,291,000
        Change from enacted level.........................       +12,000,000
        Change from budget request........................       -32,000,000

        The Committee recommendation includes $231,358,000 in
    discretionary budget authority and $699,933,000 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, conducts surveillance, supports jurisdictions
    in investigating and responding to outbreaks of vaccine-
    preventable diseases, and provides training and quality
    improvement activities to improve healthcare providers' vaccine
    storage, handling, and administration capabilities.
        Within the total for Immunization and Respiratory Diseases,
    the Committee recommends the following amounts:

    ------------------------------------------------------------------------
              Budget Activity            FY 2024 Enacted   FY 2026 Committee
    ------------------------------------------------------------------------
    Immunization and Other Respiratory       $681,933,000       $699,933,000
     Diseases (PPHF)..................
    Influenza Planning and Response...        231,358,000        231,358,000
    ------------------------------------------------------------------------

        Acute Flaccid Myelitis.--The Committee continues to support
    the work of CDC to promote awareness of Acute Flaccid Myelitis
    among front-line clinicians and has integrated this funding
    into the Immunization and Other Respiratory Diseases funding
    line.
        Avian Influenza.--The Committee recognizes the potential
    risk of avian influenza in egg laying hens and cattle migrating
    to humans. The Committee encourages the CDC to collaborate with
    USDA to support outreach and education among at-risk
    agricultural communities through existing funding mechanisms.
        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 (RSV), 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.
        Vaccines for Children.--The Vaccines for Children (VFC)
    Program provides safe, effective, and life-saving immunizations
    for millions of children each year, including the hepatitis B
    immunization and Nirsevimab, a monoclonal antibody that helps
    prevent RSV in infants and young children. The Committee
    continues to support the CDC's administration of the VFC in an
    effort to prevent disease, disability, and death in the U.S.

       VIRAL HEPATITIS, SEXUALLY TRANSMITTED DISEASES, AND TUBERCULOSIS
                                   PREVENTION

    Appropriation, fiscal year 2025.......................    $1,391,056,000
    Budget request, fiscal year 2026......................       520,000,000
    Committee Recommendation..............................       353,000,000
        Change from enacted level.........................    -1,038,056,000
        Change from budget request........................      -167,000,000

        CDC provides national leadership and support for Sexually-
    Transmitted Infections (STI) prevention research and the
    development, implementation, and evaluation of evidence-based
    STI prevention programs serving persons affected by, or at risk
    for, STI infection. Activities include surveillance,
    epidemiologic and laboratory studies, and prevention
    activities.
        Within the total for the National Center for Viral
    Hepatitis, Sexually Transmitted Diseases, and Tuberculosis
    Prevention, the Committee provides the following amounts:

    ------------------------------------------------------------------------
              Budget Activity            FY 2024 Enacted   FY 2026 Committee
    ------------------------------------------------------------------------
    Sexually Transmitted Disease and                - - -       $300,000,000
     Tuberculosis Prevention Block
     Grants...........................
    Domestic HIV/AIDS Prevention and       $1,013,712,000              - - -
     Research.........................
    HIV Prevention by Health                  755,631,000              - - -
     Department.......................
        School Health--HIV BA.........         38,081,000              - - -
    Ending HIV/AIDS Initiative........        220,000,000              - - -
    Viral Hepatitis...................         43,000,000         53,000,000
    Sexually Transmitted Infections...        174,310,000              - - -
    Tuberculosis (TB).................        137,034,000              - - -
    Infectious Diseases and Opioids...         23,000,000              - - -
    ------------------------------------------------------------------------

        The Committee provides $300,000,000 for consolidated
    Sexually Transmitted Disease and Tuberculosis Prevention grants
    to States. This funding will provide flexibility to address
    local needs in addressing State specific challenges by
    consolidating funding for Infectious Disease and Opioids, STIs,
    and TB programs into one newly established grant program. The
    committee recognizes that through the consolidated grant, CDC
    will continue to offer recipients strategic direction,
    technical support, and laboratory and programmatic expertise.
        Viral Hepatitis.--The Committee provides $53,000,000 for
    Viral Hepatitis. This funding 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 2025.......................      $760,272,000
    Budget request, fiscal year 2026......................       870,486,000
    Committee Recommendation..............................       822,372,000
        Change from enacted level.........................       +62,100,000
        Change from budget request........................       -48,114,000

        The Committee recommendation includes $777,372,000 in
    discretionary appropriations and $45,000,000 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:

    ------------------------------------------------------------------------
                                                                FY 2026
              Budget Activity            FY 2024  Enacted      Committee
    ------------------------------------------------------------------------
    Antimicrobial Resistance                 $197,000,000       $197,000,000
     Initiative.......................
    Vector-Borne Diseases.............         63,603,000         65,603,000
    Lyme Disease......................         27,000,000         27,500,000
    Prion Disease.....................          8,000,000          9,000,000
    Emerging Infectious Diseases......        197,997,000        233,997,000
    Mycotic Diseases..................         16,000,000         31,000,000
    Harmful Algal Blooms..............          3,500,000          3,500,000
    Food Safety.......................         72,000,000         72,000,000
    National Healthcare Safety Network         24,000,000         24,000,000
    Travel and Port Health Protection.         53,772,000         63,772,000
    Advanced Molecular Detection......         40,000,000         50,000,000
    Epidemiology and Lab Capacity              40,000,000         45,000,000
     (PPHF)...........................
    ------------------------------------------------------------------------

        Alpha-gal Syndrome.--The Committee appreciates the work of
    the Division of Vector-Borne Diseases to prevent the
    transmission of and promote health provider awareness of Alpha-
    gal Syndrome (AGS). AGS is an emerging tick-borne condition and
    allergy characterized by a potentially life-threatening
    hypersensitivity to galactose-alpha-1,3- galactose (alpha-gal).
    Its prevalence is closely associated with the range of the lone
    star tick. AGS is a growing clinical and public health concern
    for persons in the United States. Exploding lone star tick
    populations may be driving an alarming increase in cases.
    Health care provider knowledge is limited and can lead to
    delayed diagnosis and inappropriate treatment.
        The Committee encourages CDC to accelerate measures to
    improve AGS surveillance, patient care, and public awareness
    with an emphasis on healthcare provider education, in keeping
    with the three public health priorities identified in the CDC
    2023 report. CDC is encouraged to focus on high or growing
    prevalence States. CDC may also benefit from a focused increase
    in its collaboration and partnership with local governments,
    health, education, community, non-profit, and faith-based
    sectors in those same high-incidence communities.
        Antibiotic Resistance Solutions Initiative.--The Committee
    strongly encourages CDC to increase awareness of the elevated
    risk of drug-resistant infections that impact patients,
    especially those with cancer. The Committee urges CDC to
    educate physicians and patients on infection prevention and
    antibiotic stewardship in the cancer patient population.
        Chronic Fatigue Syndrome.--The Committee supports CDC's
    work related to provider education and public awareness for
    postural orthostatic tachycardia syndrome (POTS) and other
    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.
        Emerging Infectious Disease.--Funding for the Emerging
    Infectious Disease program includes funding previously provided
    for parasitic diseases and malaria prevention through the CDC
    Global Health Center but carried out through the National
    Center for Emerging and Zoonotic Infectious Diseases.
        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 including vector-borne and tick-
    related diseases such as alpha-gal, dengue, Lyme, malaria, West
    Nile, and Zika.
        Fungal Infection Disease Surveillance.--The Committee is
    concerned by the spread of deadly fungal infections in the
    United States in recent years and finds that the economic
    burden of fungal infections in the United States is already
    staggering, particularly in western States. The Committee finds
    that a Federal plan with resources to address the threat of
    fungal infections holds the best potential to safeguard the
    health of Americans in the event of a domestic pandemic or in
    foreign theaters of war, and that the Federal government's
    recognition of fungal infections as a microbial threat to human
    health can allow for existing planning mechanisms such as the
    CDC's 2019 AR Threats Report and 2020-2025 PACCARBS National
    Action Plan to better account for steps taken to respond to
    fungal threats in the United States.
        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 develop
    studies to assess the health effects of exposure to cyanotoxins
    in the air and water, including, but not limited to, the Great
    Lakes region. The CDC has a unique role in better understanding
    the intersection of public health and environmental impacts of
    HABs. The Committee encourages the CDC to continue building
    interagency cooperation surrounding HABs, especially the
    Harmful Algal Bloom and Hypoxia Research and Control Act Task
    Force and the Great Lakes Restoration Initiative. The scope of
    future research may expand to include improving laboratory
    methods for identifying and quantifying HAB-related toxins in
    biological specimens, supporting better detection methods to
    identify the origin of dissolved reactive phosphorous in
    upstream river streams and ditches, clinical diagnostic methods
    to identify HAB-related symptoms and illnesses, optimizing
    emergency response capacities, and identifying and addressing
    the impacts of harmful algal toxins on 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 2023, approximately 89,000 cases of the disease were
    reported, compared to estimates showing that more than 476,000
    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 2027 congressional justification on how this
    funding is being utilized.
        National Strategy for Vector-borne Disease.--The Committee
    encourages the CDC to execute the Lyme and tick-borne disease
    portion of the National Strategy for Vector-borne Disease. It
    is also important that the CDC accelerate measures to improve
    Alpha-gal Syndrome surveillance, patient care, and public
    awareness with an emphasis on healthcare provider education, in
    keeping with the three public health priorities identified in
    the 2023 CDC report.
        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 36 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 $9,000,000 for
    surveillance efforts of human prion diseases, including
    Creutzfeldt-Jakob Disease, through the National Prion Disease
    Pathology Surveillance Center and CDC.
        Travel and Port Health Protection.--The Committee provides
    $63,772,000, an increase of $10,000,000, to support the
    Traveler-Based Genomic Surveillance (TGS) program. The
    Committee is aware of the expansion of the TGS program to
    include multiple pathogens of public health interest collected
    through aircraft wastewater, and voluntary nasal swabs from
    travelers arriving at several 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.
        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.
        Tick-Borne Disease Public Information.--The Committee
    directs CDC, within 180 days of enactment of this Act, to
    develop a two-year plan (to include Fiscal Years 2026 and
    Fiscal Year 2027) 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.
        Vector-Borne Diseases.--The Committee recognizes the
    increased threat posed by vector-borne diseases such as Zika,
    West Nile, STARI, Oropouche, alpha-gal syndrome, and dengue and
    provides $65,603,000 to support CDC's ability to assist States
    affected by the increased prevalence in vector-borne diseases.

                CHRONIC DISEASE PREVENTION AND HEALTH PROMOTION

    Appropriation, fiscal year 2025.......................    $1,433,914,000
    Budget request, fiscal year 2026......................        35,000,000
    Committee Recommendation..............................     1,159,953,000
        Change from enacted level.........................      -273,961,000
        Change from budget request........................    +1,124,953,000

        The Committee recommendation includes $742,511,000 in
    discretionary appropriations and $417,442,000 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 2026
              Budget Activity            FY 2024  Enacted      Committee
    ------------------------------------------------------------------------
    Tobacco...........................       $246,500,000              - - -
    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         85,675,000
        Vision and Eye Health.........          6,500,000          4,500,000
        Alzheimer's Disease...........         39,500,000         39,500,000
        Inflammatory Bowel Disease....          2,000,000          3,000,000
        Interstitial Cystitis.........          1,100,000          2,200,000
        Chronic Kidney Disease........          4,500,000          5,500,000
        Chronic Disease Education and           4,500,000         30,975,000
         Awareness....................
    Prevention Research Centers.......         28,961,000              - - -
    Heart Disease and Stroke (PPHF)...        155,105,000        163,130,000
    Diabetes (PPHF)...................        156,129,000        163,130,000
    National Diabetes Prevention               37,300,000         40,300,000
     Program..........................
    Cancer Prevention and Control.....        410,049,000        417,548,000
        Cancer Prevention and Control               - - -        331,366,000
         BA...........................
        Cancer Prevention and Control               - - -         86,182,000
         PPHF.........................
    Oral Health.......................         20,250,000         23,250,000
    Safe Motherhood/Infant Health.....        110,500,000        110,500,000
    Epilepsy..........................         11,500,000         11,500,000
    National Lupus Registry...........         10,000,000         20,000,000
    Community Grants..................         68,950,000         30,000,000
        Racial and Ethnic Approaches           44,950,000              - - -
         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....................
    Healthy Weight Task Force Obesity           5,000,000          5,000,000
     Activities/Early Child Care
     Collaboration (PPHF).............
    ------------------------------------------------------------------------

        Alzheimer's Disease and Related Dementias.--The Committee
    recognizes that conformational disorders, such as Alzheimer's
    disease, Creutzfeldt-Jakob Disease, and prion diseases, may
    share disease characteristics which are overlooked or mistaken
    in diagnosis. The Committee encourages CDC to support broader
    conformational disease prevention and awareness activities with
    Alzheimer's Disease awareness and prevention funding.
        Breast and Cervical Cancer Screening.--The Committee
    provides $240,999,000, an increase of $5,499,000 for this
    program. This includes $154,817,000 in new budget authority and
    $86,182,000 in funding transferred from the PPHF. The Committee
    continues to support provision of critical, lifesaving breast
    and cervical cancer screening and diagnostic services. The
    Committee is aware that there are still substantial barriers to
    screening like geographic isolation, limited health literacy,
    lack of provider recommendation and trust, inconvenient times
    to access services, and physical discomfort. The Committee is
    encouraged by recent progress in screening methods and programs
    that aim to eliminate patient access barriers. The Committee
    encourages CDC to continue efforts to reduce breast and
    cervical cancer and to work to reach women who may have delayed
    screening services.
        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
    screening rates. The use of navigators has proven especially
    successful in reaching women with low rates of screening. The
    Committee further directs CDC publicly release a report on
    these activities within 180 days of the enactment of this Act.
        CAROL Act Activities.--The Committee provides increased
    funding for the CDC Division for Heart Disease and Stroke
    Prevention to support the expansion of the national sudden
    cardiac registry to capture data from all States and to expand
    heart valve disease education awareness as authorized in the
    CAROL Act (P.L. 117-244).
        Cancer Prevention and Control.--The Committee provides
    $417,548,000 for CDC cancer prevention and control activities,
    a $7,499,000 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 2027 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 $5,499,000 for
    Breast and Cervical Cancer programs, $500,000 for Ovarian
    Cancer programs, $500,000 for Johanna's Law programs and
    $1,000,000 for Prostate Cancer programs.
        Cervical Cancer Outreach and Education.--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 NBCCEDP to build on existing programs by
    finding new and innovative outreach and education strategies to
    engage women to increase screening rates. The use of navigators
    has proven especially successful in reaching women with low
    rates of screening. The Committee requests a briefing on these
    activities within 180 days of enactment of this Act.
        Chronic Disease Education and Awareness Program.--The
    Committee is pleased by the continued progress of the Chronic
    Disease Education and Awareness program and notes the success
    and impact of supported projects. The Committee has provided
    $30,975,000 for fiscal year 2026 to support grants for chronic
    diseases, including rare conditions, that lack a specific
    funding line within the CDC's budget. Funding previously
    allocated to excessive alcohol use, arthritis, and the
    Hospitals Promoting Breast Feeding program lines is now
    included in the Chronic Disease Education and Awareness
    program.
        Chronic Mental Health.--An estimated 2,800,000 people in
    the United States are affected by schizophrenia and data show
    approximately 75 percent of patients discontinue treatment
    within the first 18 months. The Committee encourages CDC to
    work with national partners on education, outreach, and public
    awareness activities around schizophrenia.
        Chronic Kidney Disease.--Chronic kidney disease (CKD)
    affects more than 37 million adults in the United States, with
    an additional 80 million Americans at risk of developing CKD
    due to diabetes, cardiovascular disease, or other conditions.
    The vast majority of adults (about 90 percent) are unaware they
    have CKD until there is a need for dialysis or kidney
    transplantation. 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 contributes
    toward better and earlier detection to allow more time for
    interventions targeted to improve outcomes. The Committee
    encourages continued investment to educate the public about
    their risk for CKD, educate clinical professionals, and spur
    innovation by entities serving the CKD 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 and reduce healthcare costs.
        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.
        The Committee recommends that CDC continue 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.
        Diabetes.--The Committee notes that according to the CDC,
    Native Americans and Alaska Native adults are more likely to
    have diabetes than any other racial or ethnic group, with one-
    in-seven Native Americans and Alaska Native adults having
    diabetes. Within the amount provided, the Committee reserves no
    less than 5 percent for Indian Tribes and Tribal Organizations.
        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. Funding previously
    allocated to the Million Hearts Initiative is now consolidated
    with the Heart Disease and Stroke funding line to support core
    programmatic activities.
        High Obesity Rate Counties.--The Committee directs the CDC
    to continue this program at no less than fiscal year 2024
    level. The Committee continues to support land grant
    universities in partnership with their cooperative extensions
    in counties with obesity rates over 40 percent. The Committee
    directs CDC to encourage grantees to 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.
    The Committee further directs that funded projects integrate
    evidence-based policy, systems, and environmental approaches to
    better understand and address the environmental and societal
    implications of obesity. To ensure a more seamless integration
    between grantees and public health partners, the Committee
    directs that preference be given 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 further 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 applauds the
    ongoing work to improve health outcomes for people impacted by
    Crohn's disease and ulcerative colitis, known collectively as
    IBD. The Committee provides $3,000,000, an increase of
    $1,000,000, to support CDC's work to improve the public health
    response to IBD. This includes work to increase awareness of
    IBD, improve understanding of effective treatments, and
    improved early disease diagnosis. The committee directs CDC to
    continue supporting this work.
        Lung Cancer.--The Committee is concerned that only 16
    percent of all those eligible are screened for lung cancer. To
    improve screening rates, the Committee encourages the National
    Comprehensive Cancer Control Program (NCCCP) to work with
    States on targeted, cost-effective strategies that increase
    lung cancer screening rates. Tactics might include improving
    patient and provider education, increasing awareness of the
    screening criteria, and leveraging patient navigators/community
    health workers to reduce barriers to accessing lung cancer
    screening.
        National Lupus Registry.--The Committee continues to
    support the National Lupus Patient Registry and the Developing
    and Disseminating Strategies to Build Sustainable Lupus
    Awareness, Knowledge, Skills, and Partnerships Program to
    educate healthcare providers about the signs and symptoms of
    lupus, to reduce time to diagnosis and ensure referrals to
    appropriate specialty care and self-management tools/services.
    The Committee encourages the CDC to build on this work and
    focus on increasing community-clinical linkages to improve
    chronic care management and patient-centered care programs,
    including through partnerships with national lupus voluntary
    health agencies, to address the needs of people living with
    lupus. 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 $23,250,000, an increase of $3,000,000 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 remains concerned about the
    rise in prostate cancer deaths and supports the CDC's work to
    address this trend by increasing public awareness of prostate
    cancer risks, screening, and treatment in high-risk men. The
    Committee supports the creation of a national education and
    awareness campaign targeting high-risk men and their families.
        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 encourages CDC to use the funding to
    support Perinatal Quality Collaboratives, and other programs
    including the Sudden Unexpected Infant Death and Sudden Death
    in the Young Case Registry. Consistent with the requirements of
    42 U.S.C. 247b-12, the Committee directs CDC to publicly
    release a report regarding current and potential strategies to
    provide support to children and mothers who suffer from rare
    pre-natal or postpartum complications within 180 days of the
    enactment of this Act.
        Triple-Negative Breast Cancers.--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 publicly issue a report
    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.
        U.S. Associated Pacific Islands.--The Committee continues
    to support funding for the prevention and control of chronic
    disease and associated risk factors in the U.S. affiliated
    Pacific Islands, U.S. Virgin Islands, and Puerto Rico.
        Vision and Eye Health.--The Committee provides $4,500,000
    for activities related to vision and eye health including
    glaucoma. The Committee supports national 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 2025.......................      $206,060,000
    Budget request, fiscal year 2026......................       157,810,000
    Committee Recommendation..............................       208,560,000
        Change from enacted level.........................        +2,500,000
        Change from budget request........................       +50,750,000

        The National Center on Birth Defects and Developmental
    Disabilities (NCBDDD) 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 2026
              Budget Activity            FY 2024  Enacted      Committee
    ------------------------------------------------------------------------
    Child Health and Development BA...        $71,300,000        $75,300,000
        Birth Defects.................         19,000,000         34,800,000
        Fetal Death...................            900,000            900,000
        Fetal Alcohol Syndrome........         11,500,000         11,500,000
        Autism........................         28,100,000         28,100,000
    Health and Development with                86,410,000         84,910,000
     Disabilities BA..................
        Special Olympics..............         19,500,000         20,500,000
        Tourette Syndrome.............          2,500,000          2,500,000
        Early Hearing Detection and            10,760,000          6,760,000
         Intervention.................
        Muscular Dystrophy............          8,000,000          8,000,000
        Fragile X.....................          2,000,000          2,000,000
        Spina Bifida..................          7,500,000          8,000,000
        Congenital Heart Defects......          8,250,000          9,250,000
    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............
    ------------------------------------------------------------------------

        Birth Defects and Developmental Disabilities.--Funding
    previously delineated for activities related to Folic Acid,
    Infant Health, and Attention Deficit and Hyperactivity Disorder
    are reflected in the Child Health and Development and Health
    and Development with Disabilities program lines.
        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.-- The majority of blood clots are highly
    preventable, but public awareness remains low. The Committee is
    concerned about the significant economic and health impact of
    blood clots on patients and the health care system,
    particularly for pregnant women, veterans, Black Americans,
    people over 50, cancer patients, and those with co-morbidities.
    The Committee encourages CDC to partner with patient advocacy
    organizations to ensure greater public awareness of blood
    clots. As part of the fiscal year 2027 congressional
    justification, the Committee directs CDC to include a cost
    estimate of a nationwide public awareness campaign to recognize
    the symptoms of blood clots and how to prevent them.
        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 with the goal of
    understanding the public health impact of these conditions. The
    Committee encourages the NCBDDD to support additional
    strategies to promote earlier identification of children with
    FX, such as voluntary newborn screening. The Committee also
    encourages the 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.
        Muscular Dystrophy.--The Committee includes $8,000,000 to
    support Muscular Dystrophy research and monitoring initiatives.
    The Committee encourages CDC to focus on activities that
    leverage existing resources and provide the most benefit to the
    Duchenne community, including active engagement with external
    consortia to help address the array of issues that affect
    adolescents and adults with Duchenne, including bone health,
    adrenal health, cardiac health, pulmonary health, puberty,
    weight management, and fertility. In States where Duchenne
    newborn screening implementation efforts have begun, the CDC is
    encouraged to conduct annual assessment of State implementation
    efforts to include implementation barriers and laboratory
    standards. Further, the Committee considers the incorporation
    of existing data from prior collection efforts into the next
    generation data system to be a priority. The Committee requests
    a briefing within 180 days of the enactment of this Act
    regarding the CDC plan for this legacy data integration.
        Surveillance for Emerging Threats to Mothers and Babies.--
    The Committee includes $23,000,000 to support CDC's
    Surveillance for Emerging Threats to Mothers and Babies. The
    program supports CDC's collaboration with State, Tribal,
    territorial, and local health departments to monitor the impact
    of emerging health threats on pregnant women and their babies
    and inform public health and clinical decision-making to
    improve the health of pregnant women and infants.

                       PUBLIC HEALTH SCIENTIFIC SERVICES

    Appropriation, fiscal year 2025.......................      $754,497,000
    Budget request, fiscal year 2026......................       771,897,000
    Committee Recommendation..............................       789,497,000
        Change from enacted level.........................       +35,000,000
        Change from budget request........................       +17,600,000

        The Committee recommendation includes $604,497,000 in
    discretionary appropriations and $185,000,000 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 2026
              Budget Activity            FY 2024  Enacted      Committee
    ------------------------------------------------------------------------
    Health Statistics.................       $187,397,000       $187,397,000
    Surveillance, Epidemiology, and           298,100,000        319,100,000
     Informatics......................
    Public Health Data Modernization          175,000,000        185,000,000
     Initiative (PPHF)................
    Advancing Laboratory Science......         23,000,000         27,000,000
    Public Health Workforce...........         71,000,000         71,000,000
    ------------------------------------------------------------------------

        Advancing Laboratory Science.--The Committee appreciates
    the work of the Advancing Laboratory Science program to deepen
    organizational ties with commercial laboratories and provides
    an increase of $4,000,000 to support these activities. Such
    collaborations will better position the CDC and the nation to
    respond to future pathogenic threats.
        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, data on health complications experienced by egg
    donors and women undergoing fertility treatment, and the status
    of consumer education materials as they relate to such
    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 180
    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 next YRBSS survey.
        Youth Premium Cigar Usage.--The Committee encourages CDC to
    include one standard question on youth premium cigar usage for
    consideration by State directors in the development of the next
    YRBSS survey.
        Surveillance, Epidemiology, and Informatics.--The
    surveillance, epidemiology, and informatics programs are the
    CDC's critical public health surveillance platforms programs,
    including syndromic data and case reporting at the Federal,
    State, and local level that provide vital information about the
    nation's health. The increase provides continued support of
    broad, State-based surveys used across health conditions and
    risk factors, for both ongoing programs and CDC emergency
    responses. These systems continuously monitor a wide range of
    risk factors, providing health authorities with real-time data
    to identify emerging threats and track trends over time. Early
    detection of these risk factors enables timely interventions,
    which can prevent diseases from spreading or becoming more
    severe. Bolstering CDC's partnerships with State health
    information exchanges will facilitate better use of
    longitudinal health data for essential public and population
    health uses, which benefits all of HHS.
        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
    regarding 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 2025.......................      $242,850,000
    Budget request, fiscal year 2026......................       152,350,000
    Committee Recommendation..............................       232,850,000
        Change from enacted level.........................       -10,000,000
        Change from budget request........................       +80,500,000

        The Committee recommendation includes $181,850,000 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:

    ------------------------------------------------------------------------
              Budget Activity            FY 2024 Enacted   FY 2026 Committee
    ------------------------------------------------------------------------
    Environmental Health Laboratory...        $70,750,000        $70,750,000
        Other Environmental Health             48,500,000         48,500,000
         Laboratory...................
        Newborn Screening Quality              21,000,000         21,000,000
         Assurance Program............
        Newborn Screening/Severe                1,250,000          1,250,000
         Combined Immunodeficiency
         Diseases.....................
    Environmental Health Activities...         48,600,000         38,600,000
        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         17,000,000
    Environmental and Health Outcome           34,000,000         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 recommends a
    funding level of $10,000,000 for the National ALS Registry and
    Biorepository at CDC to maintain the National ALS Registry and
    Biorepository. The Committee encourages CDC to continue its
    investment in research to reduce the incidence of Amyotrophic
    Lateral Sclerosis (ALS) through prevention and risk mitigation
    strategies among civilians, active military personnel and
    veterans in the United States. Additionally, the Committee
    directs the CDC to collaborate with the DOD and Veterans
    Affairs to provide a publicly available report, to include a
    strategy to develop and test risk reduction strategies that
    will lower the incidence of ALS among active-duty personnel and
    veterans, on the incidence and prevalence of ALS among military
    veterans within 270 days of the enactment of this Act.
        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 United States, 2008-2013.'' Specifically, the Committee
    directs CDC to provide a thorough assessment of the following
    key aspects: prevalence, medical costs, absenteeism, and
    mortality.
        Climate and Health.--The Committee provides no funding for
    climate and health related activities.
        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
    2027 congressional justification.
        Polycystic Ovary Syndrome.--The Committee encourages CDC to
    dedicate funding toward establishing standardized reference
    intervals for Polycystic Ovary Syndrome (PCOS) hormone tests in
    women, adolescents, and girls, particularly testosterone,
    antimullerian hormone, and others. This effort aims to enhance
    diagnostic precision, improve the reliability of clinical and
    research data, and support earlier diagnosis and more effective
    management, ultimately driving better health outcomes for those
    affected by PCOS and saving healthcare costs.

                         INJURY PREVENTION AND CONTROL

    Appropriation, fiscal year 2025.......................      $761,379,000
    Budget request, fiscal year 2026......................       550,079,000
    Committee Recommendation..............................       665,329,000
        Change from enacted level.........................       -96,050,000
        Change from budget request........................      +115,250,000

        Within the total, the Committee recommends the following
    amounts:

    ------------------------------------------------------------------------
              Budget Activity            FY 2024 Enacted   FY 2026 Committee
    ------------------------------------------------------------------------
    Domestic Violence and Sexual              $38,200,000        $38,200,000
     Violence Prevention..............
        Child Sexual Abuse Prevention.          3,000,000          3,000,000
    Community and Youth Violence               18,100,000              - - -
     Prevention.......................
    Domestic Violence Community                 7,500,000          7,500,000
     Projects.........................
    Rape Prevention...................         61,750,000         61,750,000
    Suicide Prevention................         30,000,000         30,000,000
    Adverse Childhood Experiences.....          9,000,000          9,000,000
    National Violent Death Reporting           24,500,000              - - -
     System...........................
    Traumatic Brain Injury............          8,250,000          8,250,000
    Elderly Falls.....................          3,050,000          3,050,000
    Drowning..........................          2,000,000          2,000,000
    Injury Prevention Activities......         29,950,000              - - -
    Opioid Overdose Prevention and            505,579,000        505,579,000
     Surveillance.....................
    Injury Control Research Centers...         11,000,000              - - -
    Firearm Injury and Mortality               12,500,000              - - -
     Prevention Research..............
    ------------------------------------------------------------------------

        Cannabinoid Hyperemesis Syndrome in Youth.--The Committee
    is increasingly concerned by the rise in reported cases of
    cannabinoid hyperemesis syndrome (CHS)--a condition associated
    with prolonged, high-potency cannabis use that leads to severe
    nausea and vomiting. With the growth of high-THC vaping
    products and their increasing use among adolescents, the
    Committee believes further study is warranted. The Committee
    directs the Centers for Disease Control and Prevention, in
    coordination with the Substance Abuse and Mental Health
    Services Administration and the National Institute on Drug
    Abuse, to conduct a study on the prevalence of CHS among youth
    and assess any correlations between CHS incidence and youth use
    of THC vaping products. The Committee requests an interim
    report within 180 days of enactment and a final report within
    one year.
        Drowning Prevention.--The Committee includes $2,000,000 to
    prevent fatal drownings. Drowning is the leading cause of death
    among children 1-4 and the second leading cause of
    unintentional death among children 5-14. The funding will allow
    CDC to support proven drowning prevention programs with
    national organizations working with youth at greater risk
    including children who have autism spectrum disorder, to
    support State drowning surveillance efforts, and to begin
    implementation of a national plan on water safety.
        The Committee further encourages the CDC to use drowning
    prevention resources to support the implementation of the
    United States National Water Safety Action Plan (USNWSAP). The
    Committee commends the broad range of stakeholders who
    contributed to the USNWSAP.
        Firearm Research.--The Committee notes the CDC's historic
    avoidance of research into the crimes and fatalities prevented
    through self-defense with a firearm and therefore provides no
    funding for firearm research.
        National Poison Data System.--The committee urges CDC to
    continue to partnership with the National Poison Data System to
    support real-time monitoring of chemical exposures and public
    health hazards.
        Opioid Overdose Prevention Limitation on Administrative
    Expenses.--The Committee supports CDC's activities to promote
    effective strategies to reduce addiction and overdose deaths
    but has concerns that funding for such activities is being
    diverted to support administrative costs. For fiscal year 2026,
    the Committee provides $54,000,000 for salaries and expenses,
    level funding with fiscal year 2024. For the remainder of the
    funds within the account, the Committee directs that no less
    than 85 percent be provided to State, local, and Tribal health
    departments or systems.
        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.
        Suicide.--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. The Committee directs the
    Director to prioritize funding to State public health
    departments to support the Comprehensive Suicide Prevention
    program, and to increase funding to Tribes and territories to
    build capacity and implement strategies to prevent suicide.

             NATIONAL INSTITUTE FOR OCCUPATIONAL SAFETY AND HEALTH

    Appropriation, fiscal year 2025.......................      $362,800,000
    Budget request, fiscal year 2026......................        73,200,000
    Committee Recommendation..............................       312,700,000
        Change from enacted level.........................       -50,100,000
        Change from budget request........................      +239,500,000

        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:

    ------------------------------------------------------------------------
              Budget Activity            FY 2024 Enacted   FY 2026 Committee
    ------------------------------------------------------------------------
    National Occupational Research           $119,500,000       $120,500,000
     Agenda...........................
        Agricultural, Forestry, and            29,000,000         30,000,000
         Fishing (non-add)............
    Education and Research Centers....         32,000,000         34,000,000
    Personal Protective Technology....         23,000,000         23,000,000
    Mining Research...................         66,500,000         70,000,000
    National Mesothelioma Registry and          1,200,000          1,200,000
     Tissue Bank......................
    Firefighter Cancer Registry.......          5,500,000          6,500,000
    Other Occupational Safety and             103,300,000         57,500,000
     Health Research..................
        Total Worker Health...........         11,800,000         11,800,000
    ------------------------------------------------------------------------

        Agricultural, Forestry, and Fishing.--The Committee
    provides $30,000,000 to protect workers in this sector by
    providing leadership in applied research, disease and injury
    surveillance, education, and prevention.
        Chronic Obstructive Pulmonary Disease (COPD).--COPD is a
    highly prevalent chronic disease and is a leading cause of
    death in the U.S. Although combustible tobacco use is the most
    important risk factor in the U.S., there are also other causes
    and about 14 percent is attributable to occupation. The
    Committee notes the opportunity for CDC's implementation of the
    COPD National Action Plan developed by CDC and the NHLBI. The
    Committee encourages CDC, including NCCDPHP and NIOSH to
    support surveillance and awareness activities on COPD through
    existing funding mechanisms.
        Deep Mining.--Within the funding provided for occupational
    mine safety and health, the Committee encourages CDC to partner
    with institutions with the relevant mining expertise to
    establish new safety protocols for deep mining that continue to
    foster U.S. innovation and reduce foreign reliance on critical
    minerals and metals.
        Environmental Exposures and Cancer in First Responders
    including Firefighters.--The Committee is aware that first
    responders have increased rates of cancer diagnoses and death
    relative to the general population they serve. First
    responders, such as firefighters, are exposed to a complex mix
    of known and possible cancer-causing chemicals through
    breathing hazardous substances and absorbing them through their
    skin. Despite an understanding of the risks associated with
    firefighter 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 cause cancer. The Committee
    encourages NIOSH/CDC to establish a Total Worker Health Center
    of Excellence to examine the health and safety of first
    responders, including addressing the cancer disparity among
    those in the fire service to build upon existing scientific
    evidence-based research to further develop new solutions and
    best practices for complex occupational safety and health
    problems such as the toxic exposures and higher cancer
    incidence rates in this population.
        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 $6,500,000 for
    CDC's National Firefighter Registry for Cancer as the registry
    continues to recruit and enroll participants.
        Lung Cancer Screening.--The Committee is concerned that
    only 16 percent of all those eligible are screened for lung
    cancer using low dose chest computed tomography scans. To
    improve screening rates, the Committee encourages the National
    Comprehensive Cancer Control Program (NCCCP) to work with
    States on targeted, cost-effective strategies that increase
    lung cancer screening rates. Tactics might include improving
    patient and provider education, increasing awareness of the
    screening criteria, and leveraging patient navigators/community
    health workers to reduce barriers to accessing lung cancer
    screening. The Committee also encourages NIOSH to support
    efforts to bring lung cancer screening to high-risk workers and
    to explore using low-dose chest computed tomography scans to
    screen for coal workers' pneumoconiosis in its Coal Workers'
    Health Surveillance Program.
        Education and Research Centers.--The Committee includes
    $34,000,000, an increase of $1,000,000, for Education and
    Research Centers (ERCs) in recognition of their important work
    to improve workplace safety and health by translating
    scientific discoveries into practice through effective
    education, training, and outreach. The Committee applauds the
    work of NIOSH to implement innovative approaches, and its
    translational research. The Committee supports the education
    and training of graduate and post-graduate students,
    particularly in Industrial Hygiene, Occupational Health
    Nursing, Occupational Medicine Residency, and Occupational
    Safety. The Committee encourages the CDC to use such funding to
    expand Occupational Medicine Residency programs at new or
    existing ERCs.
        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.
        Respirator Approval.--The Committee supports the work of
    the National Personal Protective Technologies Laboratory's
    Respirator Approval Program (RAP). This continued funding
    better ensures that RAP continues its essential work in
    ensuring that workers in high-risk fields have access to the
    safest, most advanced respiratory protection available.
        Total Worker Health.--The Committee is concerned about the
    negative health impacts faced by large numbers of vehicle
    mechanics and technicians across all mechanical industries. The
    Committee encourages the CDC to analyze the on-the-job health
    impacts of workers in these fields to better understand and
    improve the health and well-being of all mechanics through
    research, workplace studies and interventions. It is essential
    to workers in hazardous fields, including our mechanics, shop
    workers, and our nation's overall health, to create a workplace
    which prioritizes worker's physical and mental health,
    longevity, and safety.
        World Trade Center Health Program.--The Committee remains
    strongly committed to the World Trade Center Health Program
    (WTCHP), which provides critical medical monitoring and
    treatment to responders and survivors of the September 11th
    attacks. The Committee is concerned by recent reports of access
    to care issues affecting both enrollees and network providers,
    particularly in the Nationwide Provider Network (NPN). These
    issues include delays in processing authorizations and
    reimbursements, a lack of transparency in claims resolution,
    and disruptions in continuity of care stemming from
    administrative inefficiencies.
        The Committee is particularly troubled that these
    challenges have resulted in care delays for patients suffering
    from 9/11-related conditions, as well as growing
    dissatisfaction and attrition among providers. These systemic
    barriers undermine the WTCHP's mission and threaten the trust
    built between the program and the 9/11 community. The Committee
    encourages CDC to take steps to resolve these issues which may
    include metrics on provider retention and enrollee complaints;
    an assessment of the NPN contractor's performance and
    accountability measures; and specific actions to improve care
    access and provider support.
        The Committee further encourages CDC to ensure that
    sufficient resources are allocated to administer the WTCHP
    effectively and to evaluate long-term solutions that protect
    patient care continuity.
        World Trade Center Health Program Eligibility.--The
    Committee recognizes that thousands of potentially eligible
    members of the World Trade Center Health Program (WTCHP) reside
    outside the New York metropolitan area. 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 implement a competition to award an additional Clinical
    Center of Excellence outside the New York metropolitan area.

           ENERGY EMPLOYEES OCCUPATIONAL ILLNESS COMPENSATION PROGRAM

    Appropriation, fiscal year 2025.......................       $55,358,000
    Budget request, fiscal year 2026......................        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.
        Dose Reconstruction Program.--Within the funds made
    available by the Energy Employees Occupational Illness
    Compensation Program Act, CDC is encouraged to prioritize
    additional funding to the NIOSH Radiation Dose Reconstruction
    Program for scientific dose reconstruction activities for
    additional health physicists and continue to meet compensation
    timelines and expected applications.

                                 GLOBAL HEALTH

    Appropriation, fiscal year 2025.......................      $692,843,000
    Budget request, fiscal year 2026......................       293,200,000
    Committee Recommendation..............................       473,200,000
        Change from enacted level.........................      -219,643,000
        Change from budget request........................      +180,000,000

        Through its Global Health activities, CDC coordinates,
    cooperates, participates with, and provides consultation to
    other nations, Federal agencies, and international
    organizations to prevent and contain diseases and environmental
    health problems. 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:

    ------------------------------------------------------------------------
              Budget Activity            FY 2024 Enacted   FY 2026 Committee
    ------------------------------------------------------------------------
    Global HIV/AIDS Program...........       $128,921,000              - - -
    Global Tuberculosis...............         11,722,000              - - -
    Polio Eradication.................        180,000,000       $180,000,000
    Folic and other Vaccine                    50,000,000              - - -
     Preventable Diseases.............
    Global Public Health Protection...        293,200,000        293,200,000
    ------------------------------------------------------------------------

        Protecting Life in Global Health Assistance.--The Committee
    remains deeply concerned over the violation of the Helms
    Amendment under the previous Administration. The Helms
    amendment prohibits Federal funds for abortions in foreign aid
    programs. CDC has responsibility for ensuring that implementing
    partners adhere to the terms and conditions of all awards made
    by the agency, including oversight of funding transferred to
    the agency. Within 90 days of the enactment of this Act, the
    CDC is directed to brief the Committee on steps taken since the
    start of fiscal year 2024 to ensure relevant grant management
    officers, grant management specialists, and programmatic staff
    are effective in ensuring adherence to the Helms Amendment.
        Parasitic Diseases and Malaria.--The Committee provides
    funding for parasitic diseases and malaria prevention related
    activities through the Emerging Infectious Diseases program
    line within the CDC Center for Emerging Zoonotic and Infectious
    Diseases.
        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 2025.......................      $938,200,000
    Budget request, fiscal year 2026......................       594,000,000
    Committee Recommendation..............................       913,200,000
        Change from enacted level.........................       -25,000,000
        Change from budget request........................      +319,200,000

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

    ------------------------------------------------------------------------
              Budget Activity            FY 2024 Enacted   FY 2026 Committee
    ------------------------------------------------------------------------
    State and Local Preparedness and         $744,200,000       $744,200,000
     Response Capability..............
        Public Health Emergency               735,000,000        735,000,000
         Preparedness Cooperative
         Agreement....................
        Academic Centers for Public             9,200,000          9,200,000
         Health Preparedness..........
    Ready Response Enterprise Data             55,000,000         30,000,000
     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, technical
    assistance, and resources, including emergency preparedness
    epidemiologist and experts, 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 and the 2024 Smokehouse Creek Fire across the
    Texas Panhandle demonstrates the need to provide rural
    communities support particularly through CDC's assistance
    building public health emergency preparedness plans, supporting
    operational coordination and maintaining and implementing
    response capabilities in real-world events.

                    CDC-WIDE ACTIVITIES AND PROGRAM SUPPORT

    Appropriation, fiscal year 2025.......................      $663,570,000
    Budget request, fiscal year 2026......................       398,570,000
    Committee Recommendation..............................       523,570,000
        Change from enacted level.........................      -140,000,000
        Change from budget request........................      +125,000,000

        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:

    ------------------------------------------------------------------------
              Budget Activity            FY 2024 Enacted   FY 2026 Committee
    ------------------------------------------------------------------------
    Preventive Health and Health             $160,000,000              - - -
     Services Block Grant.............
    Office of the Director............        128,570,000       $128,570,000
        Office of Rural Health (non-            5,000,000          6,000,000
         add).........................
    Infectious Disease Rapid Response          25,000,000         35,000,000
     Reserve Fund.....................
    Public Health Infrastructure and          350,000,000        360,000,000
     Capacity.........................
    ------------------------------------------------------------------------

        Birthing experience and Maternity Care During Public Health
    Emergencies and Natural Disasters.--In the face of public
    health emergencies and natural disasters, pregnant and
    postpartum patients need to take special measures to ensure the
    health and safety of themselves and their children. To ensure
    patients and providers have accurate, evidence-based
    information on maternal and infant health risks during public
    health emergencies and natural disasters, with a particular
    focus on reaching pregnant and postpartum individuals in
    underserved communities, the Committee encourages CDC to
    convene a meeting of Federal; State, local, and/or territorial
    public health officials; Tribal public health officials; and
    public stakeholders representing maternity care providers,
    maternal and infant health focused community based
    organizations, and patient voices to discuss measures to detect
    maternal and infant health need and measures to facilitate
    access and delivery of maternal and infant data during public
    health emergencies and natural disasters.
        CDC Core Capacities.--The Committee has prioritized funding
    for CDC Core Capacities necessary to respond to the threats of
    infectious disease across 15 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; Public Health
    Infrastructure; and Emerging Infectious Diseases. As part of
    the fiscal year 2027 congressional justification, CDC is
    directed to provide a breakout table detailing the funding
    requested for these core capacity program lines.
        CDC Public Health Fellowships.--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 fellowship program, and the placements of CDC fellows
    and their tenure within relevant public health offices.
        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.
        Eating Disorders and Assisted Suicide.--The Committee is
    concerned with the potential practice of referring, counseling,
    prescribing, or administering assisted suicide to individuals
    suffering from chronic mental health conditions, including
    anorexia and other eating disorders. The Committee directs the
    CDC Director to submit a report within 180 days of the
    enactment of this Act to the Committee on instances where
    providers have referred, counseled, prescribed, or administered
    assisted suicide to individuals suffering from chronic mental
    health conditions, including anorexia or other eating
    disorders.
        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.
        Headaches.--The Committee recognizes the significant impact
    of migraine and headache disorders on student health,
    attendance, and academic performance. To address these
    challenges, the Committee encourages the CDC to study migraine
    and other headache disorders within its Healthy Schools Program
    to improve awareness, education, and management of migraine and
    other headache disorders in school settings, specifically to
    include training for school health staff, creation of
    educational materials, and implementation of environmental
    strategies to mitigate headache triggers.
        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.
        Indoor Air Quality.--The Committee encourages CDC to
    conduct a study on how indoor air quality impacts pathogen
    transmission including how increased use of outdoor air
    ventilation, high-efficiency particulate air (HEPA) filtration,
    and germicidal ultraviolet (GUV) light affect such
    transmission.
        Infectious Disease Rapid Response 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.
        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) and ORH's early initiatives. The Committee directs
    the agency to ensure that the established ORH will continue to
    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,
    coordinating 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 $6,000,000 for the continued efforts of this
    office.
        Peripheral Arterial Disease Prevalence.--Between 1995 and
    2020, Peripheral Arterial Disease Prevalence (PAD) prevalence
    in the United States increased from 11,300,000 to 21,000,000.
    Based on the aging population, by 2030 the number of
    individuals with PAD is expected to increase to 23,800,000. The
    Director of CDC is encouraged, in collaboration with HRSA, CMS,
    and leading clinical and patient advocacy organizations, to
    establish a PAD education program.
        Postural Orthostatic Tachycardia Syndrome and
    Dysautonomia.--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.
        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 $5,408,000 to Tribes and Tribal organizations
    through the PHI program in fiscal year 2024, while providing
    $21,750,000 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.
        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.
        Survey and Other Data Products.--The Committee notes the
    proliferation of surveys and other data products related to
    mental health within CDC and across HHS. As part of the Fiscal
    Year 2027 Congressional Justification, the Committee directs
    CDC, in collaboration with SAMHSA, NIH, and HRSA to include a
    summary of all annual, biannual, quadrennial surveys or other
    data products related to mental health.
        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 2025.......................       $40,000,000
    Budget request, fiscal year 2026......................        40,000,000
    Committee Recommendation..............................        40,000,000
        Change from enacted level.........................             - - -
        Change from budget request........................             - - -

        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 2025.......................   $48,301,000,000
    Budget request, fiscal year 2026......................    29,295,186,000
    Committee Recommendation..............................    47,845,000,000
        Change from enacted level.........................      -456,000,000
        Change from budget request........................   +18,549,814,000

        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 National Institutes of
    Health (NIH) program level is $47,845,000,000 including funding
    for the Advanced Research Projects Agency for Health (ARPA-H).
    The Committee provides $46,253,998,000 in discretionary
    appropriations, $1,365,002,000 in PHS Act section 241
    evaluation set-aside transfers, and $226,000,000 as authorized
    in the 21st Century Cures Act (P.L. 114-255).
        The Committee commends the innovative proposal in the
    Administration's fiscal year 2026 budget request to
    comprehensively reorganize the National Institutes of Health.
    The structure of organizations as large, complex, and prominent
    as NIH merit periodic consideration. It is important NIH
    remains responsive to changing science and fosters research
    collaborations across institutes and centers, so that it can
    remain the world pioneer in biomedical research. In the 118th
    Congress, the Committee worked in coordination with the
    Committee on Energy and Commerce of the House of
    Representatives to propose a reorganization of NIH for the 21st
    century. This began a conversation about how to ensure the U.S.
    maintains its innovative edge in basic science and biomedical
    research against global competitors, to drive down duplicative
    administrative costs, and to foster a holistic life stage
    approach to NIH research and eliminate demographic- or disease-
    specific siloes. Ultimately the legislative schedule has not
    permitted such necessary coordination, and the Committee notes
    that any large-scale restructuring proposal remains under the
    jurisdiction of the Committee on Energy and Commerce. The
    Committee recommendation for fiscal year 2026 reflects the NIH
    structure under current law. The Committee looks forward to
    Congress continuing to work with the Administration regarding
    innovative ideas at the National Institutes of Health. The
    Committee includes specific funding allocations for several
    initiatives and activities detailed in the institute- and
    center-specific sections below.

                           NATIONAL CANCER INSTITUTE

    Appropriation, fiscal year 2025.......................    $7,224,159,000
    Budget request, fiscal year 2026......................     4,530,833,000
    Committee Recommendation..............................     7,272,159,000
        Change from enacted level.........................       +48,000,000
        Change from budget request........................    +2,741,326,000

        Mission.--NCI leads, conducts, and supports cancer research
    across the nation to advance scientific knowledge and help all
    people live longer, healthier lives.
        Biliary Tract Cancers (BTC).--The Committee strongly
    encourages NIH to continue to support research to develop novel
    treatment strategies in biliary tract cancers, and for basic
    and translational research as well as clinical trials in liver
    cancers, as both are needed to improve state-of-the-art cancer
    immunotherapy. The Committee strongly supports research on
    novel cancer vaccines and immunotherapies. Targeting recurrent
    cancer neoantigens in BTC with novel cancer treatment vaccine
    in combination with other drugs that work on the human immune
    system could move the treatment paradigm in BTC forward and
    enable combinatorial immunotherapy trials, including adoptive
    cell therapies.
        Breast Cancer Screening Evidence Gaps.--The United States
    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 USPSTF'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 2027 congressional justification.
        Cancer Centers.--The Committee recognizes the role of NIH
    designated cancer centers in supporting high-quality,
    interdisciplinary cancer research with the goal of reducing
    cancer incidence, mortality, and morbidity. This support
    facilitates coordination across a broad spectrum of research--
    from basic laboratory science to clinical investigation and
    population health--by strengthening the organizational capacity
    of cancer centers nationwide. The Committee encourages
    continued support of such efforts.
        Cancer Clinical Trials.--Clinical Cancer trials are pivotal
    to finding new medications and treatment options for patients.
    The Committee is concerned that the lack of genomic variance 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. The Committee provides $3,000,000 for
    the National Cancer Institute for increasing trial participants
    from underrepresented populations.
        Childhood Cancer Data Initiative (CCDI).--The Committee
    includes no less than $55,000,000 for the CCDI, which is a
    $5,000,000 increase from the fiscal year 2024 enacted level.
    Within this total, the Committee continues no less than
    $750,000 for enhancement of the CCDI Molecular Characterization
    Initiative and other efforts as applicable. 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 $35,000,000, which is $5,000,000 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 2027
    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
    DOD, 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 2027 congressional
    justification.
        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, especially 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 unique clinical program across
    institutes that could further validate the clinical utility and
    accessibility of functional precision drug testing approaches,
    to guide therapeutic interventions and accelerate collaboration
    across research and clinical institutions in the nation. The
    Committee requests an update on this topic in the fiscal year
    2027 congressional justification.
        Glioblastoma Therapeutics Network.--The Glioblastoma
    Therapeutics Network is a collaborative initiative between NCI,
    hospitals, and research institutions to evaluate novel
    therapies for glioblastoma. The Committee recognizes its
    contribution as a testing ground for assessing cutting-edge
    treatments and drug combinations in clinical settings, with the
    potential to transform patient outcomes, and encourages
    continued support for such efforts.
        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 continue its coordination with the NIMHD on 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. 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 encourages 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 2027 congressional
    justification, including updates on actions NCI is taking to
    achieve representation of the demographics of the U.S.
    population in clinical trials.
        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 encourages 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.
        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.--The Committee remains concerned that
    prostate cancer, the most diagnosed cancer among American men
    and the second leading cause of cancer-related death, receives
    a disproportionately low share of Federal cancer research
    funding. While prostate cancer accounts for approximately 15
    percent of all new cancer diagnoses and 11 percent of cancer
    deaths among men, it receives only 8 percent of the total
    Federal cancer research investment. The Committee is especially
    concerned about the lack of treatment options for men with
    advanced prostate cancer and the absence of modern diagnostic
    and imaging technologies that are common in other hormone-
    driven cancers with similar burden. To ensure that Federal
    research efforts are aligned and efficient, the Committee
    encourages the NCI to coordinate its research strategy with
    other Federal agencies, including the DOD, and to engage with
    private research foundations and advocacy organizations. The
    Committee urges NCI to prioritize investments in advanced
    diagnostic tools and therapeutic research to improve outcomes
    for men at all stages of prostate cancer.
        Site-Specific Survivorship Issues and Interventions.--The
    Committee commends Office of Cancer Survivorship's (OCS)
    commitment to improve the quality and length of life for
    individuals diagnosed with cancer. The Committee recognizes
    that advances in treatments and care have resulted in long-term
    survivorship for some individuals, and some survivors who
    received multi-modality cancer treatment experience late and
    long-term effects. The Committee encourages OCS to include in
    its research efforts a focus on site-specific, or cancer-
    specific, late and long-term effects, which may yield evidence
    to support improvements in survivorship care. The Committee
    requests an update in the fiscal year 2027 congressional
    justification on such efforts.
        Theranostics.--Theranostics is a nuclear medicine technique
    that combines diagnostic imaging and targeted
    radiopharmaceutical therapies to precisely identify and treat
    diseases like cancer. This technology allows for personalized
    treatment of cancers--such as thyroid cancer, prostate cancer,
    and neuroendocrine tumors--while sparing healthy tissue around
    the tumor. Theranostics shows potential to advance the battle
    against cancer. The Committee encourages NCI to support
    research that utilizes theranostics, where appropriate, to
    provide early, accurate, and effective cancer diagnosis and
    treatment.
        Uterine Leiomyosarcoma Research.--The Committee is aware
    that increased research into uterine leiomyosarcoma, a rare and
    aggressive soft tissue sarcoma with limited treatment options
    and high mortality rates, could lead to improved outcomes for
    patients. The Committee encourages the NIH to prioritize and
    expand research on the biology, early detection, and
    development of novel therapeutic approaches for uterine
    leiomyosarcoma. Such investments could be for basic science,
    translational, or clinical research. The Committee requests
    that NIH include an update in the fiscal year 2027
    congressional justification on such research efforts, including
    any milestones and recommendations for future activities.
        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 encourages 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 2027
    congressional justification.

               NATIONAL HEART, LUNG, AND BLOOD INSTITUTE (NHLBI)

    Appropriation, fiscal year 2025.......................    $3,982,345,000
    Budget request, fiscal year 2026......................             - - -
    Committee Recommendation..............................     3,990,345,000
        Change from enacted level.........................        +8,000,000
        Change from budget request........................    +3,990,345,000

        Mission.--NHLBI provides global leadership for a research,
    training, and education program to promote the prevention and
    treatment of heart, lung, blood and sleep disorders and enhance
    the health of all individuals so that they can live longer and
    more fulfilling lives.
        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 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.
        Duchenne and Becker Muscular Dystrophy.--While there are
    multiple approved therapies to treat Duchenne Muscular
    Dystrophy (DMD), research data does not show that any of these
    important treatments halt or reverse the effects of this
    devastating condition. Recognizing the need for continued
    research, the Committee encourages NIH to ensure that research
    data produced by its grants is shared in a timely and
    transparent manner to accelerate progress. The Committee
    emphasizes the importance of robust data-sharing plans that
    facilitate access to data for sub analyses, enabling
    researchers to maximize insights, identify trends, and advance
    innovation in the field. In addition, the Committee encourages
    NIH to review the structure and processes of the Muscular
    Dystrophy Coordinating Committee to ensure incorporation of
    perspectives of DMD patient and caregiver perspectives, with a
    transparent process and timeline for participation. The
    Committee also encourages NIH to respond to the 2025
    recommendations of the Muscular Dystrophy Coordinating
    Committee and maintain a public record of progress in
    implementation.
        Longitudinal Studies.--The Committee encourages the NIH to
    continue supporting instrumental longitudinal studies that have
    created a tremendous knowledge base and data around human
    health and allowed researchers to understand risk factors for
    diseases such as heart attack and stroke.
        Mitral Valve Prolapse Workshop.--The Committee commends
    NHLBI for convening a 2024 workshop, to review the state of the
    science and identify research needs and opportunities for the
    treatment of individuals with mitral valve prolapse, including
    individuals who are at risk of sudden cardiac arrest or sudden
    cardiac death. The Committee urges NHLBI to continue engaging
    with subject matter experts and stakeholders regarding research
    needs and opportunities related to developing guidelines 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 recognizes NCSDR for facilitating and coordinating
    effective sleep health and sleep disorders research across NIH
    and HHS. The Committee notes that recent scientific progress,
    along with improvements in care and therapy, may not be
    reaching the individuals who could most benefit as time to
    diagnostics for many conditions can take years if not decades.
    The Committee encourages NCSDR to work with stakeholders across
    HHS to better translate research findings, to encourage
    increased awareness of breakthroughs and to further public
    health efforts to link patients to care.
        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 an individual's valves malfunctions,
    and many people in the U.S. can have heart valve defects or
    disease but no symptoms. While the condition remains stable for
    some individuals and does not cause significant or life-
    threatening problems, unfortunately more than 25,000 people die
    each year in the U.S. from this disease, primarily due to
    underdiagnosis and undertreatment. The Committee commends the
    NHLBI for its work in advancing treatments for those with
    valvular heart disease. The Committee 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 life. For these efforts the Committee
    includes $23,000,000, an increase of $3,000,000 from 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 NHLBI 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 OF DENTAL AND CRANIOFACIAL RESEARCH (NIDCR)

    Appropriation, fiscal year 2025.......................      $520,163,000
    Budget request, fiscal year 2026......................             - - -
    Committee Recommendation..............................       525,163,000
        Change from enacted level.........................        +5,000,000
        Change from budget request........................      +525,163,000

        Mission.--The mission of NIDCR is to advance fundamental
    knowledge about dental, oral, and craniofacial health and
    disease and translate these findings into prevention, early
    detection, and treatment strategies that improve overall health
    for all individuals and communities across the lifespan.
        Advancing Head and Neck Cancer Early Detection Research
    (AHEAD).--The Committee commends NIDCR for establishing AHEAD
    to accelerate translational and clinical research on the early
    detection of head and neck cancers (HNC). The initiative aims
    to increase scientific knowledge of the molecular
    characteristics of dysplastic tissue lesions, which are the
    predominant precursor for HNCs. The Committee encourages NIDCR
    to support research to utilize data from The Cancer Genome
    Atlas (TCGA) and other genomic and proteomic projects to help
    match tumor defects with patient clinical outcomes, which could
    lead to tailored biomarker identification for early diagnosis
    and treatments.
        Community Water Fluoridation.--The Committee notes the role
    of community water fluoridation in public health as an
    effective, economical, and evidence-based intervention for the
    prevention of dental caries. The Committee is aware of concerns
    regarding fluoride exposure and its potential impact on human
    neurodevelopment and cognition. The Committee encourages NIDCR
    and other institutes at NIH already conducting research in this
    area such as NIEHS and NICHD, to support additional research to
    investigate any possible links between total fluoride exposure
    from fluoridated water systems and human neurodevelopment,
    cognition, and other health outcomes.
        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 and chronic systemic
    conditions will provide clinical evidence that can be used to
    support coverage of medically necessary dental treatment in
    various benefit programs.

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

    Appropriation, fiscal year 2025.......................    $2,310,721,000
    Budget request, fiscal year 2026......................             - - -
    Committee Recommendation..............................     2,330,721,000
        Change from enacted level.........................       +20,000,000
        Change from budget request........................    +2,330,721,000

        Mission.--The NIDDK mission is to conduct and support
    medical research and research training and disseminate science-
    based information on diabetes and other endocrine and metabolic
    diseases; digestive diseases, nutritional disorders, and
    obesity; and kidney, urologic, and hematologic diseases, to
    improve people's health and quality of life.
        Chronic Kidney Disease.--The Committee notes the
    significant health burden caused by chronic kidney disease
    (CKD) on individuals. According to the CDC, an estimated 35.5
    million people, or more than 1 in 7 U.S. adults, have CKD. The
    Committee is also aware that poor kidney function can also lead
    to other burdensome or debilitating conditions. Therefore, the
    Committee encourages robust support for kidney research at
    NIDDK. The Committee requests an update on such research in the
    fiscal year 2027 congressional justification.
        Diabetes.--The Committee includes an increase of
    $10,000,000 for diabetes research. The Committee urges NIH to
    focus efforts on Type 1 Diabetes.
        Diabetic Eye Disease.--The Committee notes the connection
    between diabetes and eye health. The Committee encourages the
    Institute to engage with relevant ICs and stakeholders to
    identify collaborative opportunities to improve research and
    community-level intervention activities in diabetic eye
    disease.
        Special Diabetes Program.--The Committee notes the role of
    the Special Diabetes Program, which is supported by mandatory
    funding under 42 U.S.C. 254c-2, in advancing research on the
    prevention and cure of Type 1 Diabetes.

        NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKE (NINDS)

    Appropriation, fiscal year 2025.......................    $2,603,925,000
    Budget request, fiscal year 2026......................             - - -
    Committee Recommendation..............................     2,633,925,000
        Change from enacted level.........................       +30,000,000
        Change from budget request........................    +2,633,925,000

        Mission.--The NINDS mission is to seek fundamental
    knowledge about the brain and nervous system and use that
    knowledge to reduce the burden of neurological disease.
        21st Century Cures.--The Committee recommendation includes
    $97,500,000 for the BRAIN Initiative as provided in the Cures
    Act. The Committee notes that fiscal year 2026 is the final
    year for this activity.
        Alzheimer's Disease and Alzheimer's Disease-Related
    Dementias (AD/ADRD).--The Committee includes an increase of
    $15,000,000 above the fiscal year 2024 enacted level for AD/
    ADRD research at NINDS.
        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, rapidly progressing neurological
    disease that is 100 percent fatal, and most people only live
    for two to five years after symptom onset. There are currently
    very limited treatment options that offer only marginal benefit
    to some people. The Committee notes that NIH-funded research
    has facilitated the development of diagnostic and therapeutic
    advances. While there is not yet a cure or treatment that halts
    ALS, there has been significant progress in understanding what
    causes ALS. The Committee urges NINDS to expand its portfolio
    of research into ALS.
        Amyotrophic Lateral Sclerosis Research and Treatments.--The
    Committee recommends increasing funding for extramural research
    and includes an increase of $10,000,000, to reduce the burden
    of ALS on people as quickly as possible. It is crucial for
    people living with ALS and people diagnosed with ALS in the
    future, that NIH increase its ALS research portfolio and grow
    the research workforce. This additional funding should focus
    not only on new drugs for ALS but also on ALS diagnosis
    protocols, enhancing the quality of care, and studying new ALS
    biomarkers.
        Angelman Syndrome.--The Committee understands NINDS may
    convene relevant research leaders, patient organizations, and
    other stakeholders to prepare a roadmap for clinical outcomes
    measures and biomarkers for Angelman syndrome (AS), a rare
    neurogenetic disorder. As part of this, the Committee
    encourages NIH to support funding for clinical outcome measures
    and biomarker development; determine more efficient pathways
    for developing and manufacturing novel gene therapies for
    neurodevelopmental diseases; and inform the next generation of
    clinical studies to pursue based on approved biomarkers. The
    Committee encourages NIH to ensure timely and comprehensive
    data-sharing across investigators and industry. The Committee
    notes the value of incorporating patient perspectives into
    treatments for this devastating disorder, given that without
    treatments, individuals with AS depend on a caregiver to do
    daily activities and navigate their environment.
        Brain Aneurysms.--The Committee remains concerned that an
    estimated 1 out of every 50 individuals in the United States
    has a brain aneurysm, and an estimated 30,000 Americans suffer
    a brain aneurysm rupture each year, often with little or no
    warning. Ruptured brain aneurysms are fatal in about 50 percent
    of cases. Despite the widespread prevalence of this condition
    and the high societal cost it imposes on the United States, the
    Federal Government spends only about $2.94 per year on brain
    aneurysm research for each person afflicted with a brain
    aneurysm. The Committee encourages NINDS to increase its
    support for research focused on prevention and early detection
    of brain aneurysms.
        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 to inspire new treatments, cures, and prevention 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. This initiative promotes
    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.
        Cerebral Palsy.--The Committee encourages NIH to continue
    to prioritize and invest in research on Cerebral Palsy (CP) to
    strengthen and accelerate CP research priorities across the
    lifespan. NIH is encouraged to consider a Cerebral Palsy Notice
    of Special Interest. Progress has been made, but addressing
    remaining gaps can improve outcomes and treatment. 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, and functional outcomes. The
    Committee encourages NIH to support research related to
    lifespan issues to address needs of youth and adults with CP,
    and that could lead to new and improved screening tools,
    treatments, and interventions. NINDS, in coordination with
    other institutes or centers which could include NICHD, is
    encouraged to consider a neuroplasticity workshop and research
    opportunities on the motor and health benefits of physical
    activity for individuals with CP across all Gross Motor
    Functional Classification levels.
        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 the 2024 Update mentioning Creutzfeldt-Jakob Disease (CJD).
    The Committee continues to encourage NIH to recognize prion
    diseases as ADRDs and fund more research for prion diseases,
    like 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.
        Dystonia.--The Committee requests an update in the fiscal
    year 2027 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 collaboration with stakeholders.
        Frontotemporal Dementia Research.--The Committee recognizes
    the critical role NIH funding has in building foundational
    knowledge and tools that can lead to effective treatments for
    frontotemporal dementia (FTD). NIH-funded natural history
    studies, such as the ARTFL LEFFTDS Longitudinal Frontotemporal
    Lobar Degeneration (ALLFTD) Research Study, facilitate
    biomarker discovery and enable the design of clinical trials to
    test innovative treatments. The Committee supports ongoing
    efforts to advance the understanding of FTD and encourages the
    NIH to support research to accelerate the discovery of
    effective treatments for FTD.
        Guillain-Barre Syndrome.--The Committee recognizes the
    effects of Guillain-Barre Syndrome (GBS) and related conditions
    such as Chronic Inflammatory Demyelinating Polyneuropathy
    (CIDP) and Multifocal Motor Neuropathy (MMN). The Committee
    encourages NINDS to continue collaboration with stakeholders on
    reviewing the progress made in GBS, CIDP, and MMN research and
    treatment options, including a state of the science conference.
        Multiple System Atrophy.--The Committee notes the
    connection between Multiple System Atrophy (MSA) and
    Parkinson's Disease and the potential for advancements in
    research that impacts both communities. The Committee notes the
    lack of treatment options and the lengthy time to diagnose MSA
    and encourages NINDS to work with community stakeholders on
    implementation of the National Plan to End Parkinson's Act
    (P.L. 118-66).
        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. Additionally, the Committee
    encourages NIH to support projects studying dementia in
    Parkinson's disease. 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 and other closely associated neurological disorders.
        Pediatric-Onset Epilepsies Network.--The Committee
    encourages NIH to establish a pediatric-onset epilepsies
    network. This network could support continued pediatric-onset
    epilepsies research and help coordinate research of pediatric-
    onset epilepsies across institutions to increase the potential
    for scientific progress in the era of precision medicine. Such
    a network could create a collaborative, multidisciplinary
    research model to enroll patients from many hospitals in the
    same system to enable cooperative research studies, accelerate
    knowledge development about the epilepsies, and rapidly advance
    therapeutic options and their implementation to improve
    treatments and healthcare outcomes.
        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 individuals 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.
        Spinal Muscular Atrophy.--The Committee encourages
    continued NIH research into spinal muscular atrophy (SMA), a
    neuromuscular disease that causes degenerative nerve damage and
    results in severe muscle loss and impaired motor function. The
    Committee is aware that past NINDS research has led to greater
    understanding of the nervous system and contributed toward 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 into the role and function of
    survival motor neuron (SMN) protein, investigation of non-SMN
    pathways and targets capable of modifying disease, and how to
    combine SMN-enhancing and non-SMN approaches for optimal
    therapeutic outcomes.
        Undiagnosed Diseases Network.--The Committee recommendation
    continues to include $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.

         NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES (NIAID)

    Appropriation, fiscal year 2025.......................    $6,562,279,000
    Budget request, fiscal year 2026......................     4,174,965,000
    Committee Recommendation..............................     6,582,279,000
        Change from enacted level.........................       +20,000,000
        Change from budget request........................    +2,407,314,000

        Mission.--The NIAID mission is to conduct and support basic
    and applied research to better understand, treat, and
    ultimately prevent infectious, immunologic, and allergic
    diseases.
        Alpha-gal Syndrome.--The Committee is concerned by the rise
    in incidence of alpha-gal syndrome, an emerging allergic
    condition associated with tick bites that can cause potentially
    life-threatening hypersensitivity to galactose-alpha-1,3-
    galactose. The Committee encourages NIH to increase efforts to
    understand the immunological mechanisms and natural history of
    alpha-gal syndrome, which could lead to new protocols,
    therapies, and tools for managing this condition.
        Antimicrobial Resistance.--The Committee includes
    $570,000,000, an increase of $5,000,000, to support
    antimicrobial resistance research. 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 for Combating
    Antibiotic-Resistant Bacteria. The Committee is aware of the
    challenge that antimicrobial resistance poses to public health,
    with more than 2.8 million antimicrobial-resistant infections
    occurring in the U.S. annually according to the CDC. The
    Committee encourages NIAID's continued basic, translational,
    and clinical research on AMR.
        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
    2020-2025 National Action Plan for Combating Antibiotic-
    Resistant Bacteria, one of the five goals was to Accelerate
    Basic and Applied Research and Development for New Antibiotics,
    Other Therapeutics, and Vaccines 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. The
    Committee recognizes that NIH has supported research to
    understand the mechanisms of AMR spread and to mitigate
    inappropriate usage of antibiotics.
        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 mitigate the risk of future viral outbreaks.
        Bacteriophage Therapy.--The Committee recognizes that
    engineered bacteriophage therapy has emerged as one of the most
    promising technologies for combating the global crisis of
    multi-drug-resistant bacterial infections. The Committee
    further notes that recent advancements in artificial
    intelligence, high-throughput robotic screening, and advanced
    biomanufacturing have enabled bacteriophage therapy to
    selectively eliminate pathogenic bacterial species while
    preserving the body's natural microbiome. The Committee
    encourages NIAID to support research and clinical trials on
    bacteriophage therapy in the United States.
        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 is a
    gluten-free diet; however, recent public and private sector
    research confirms that this is insufficient for many who suffer
    from this disease. The Committee supports focused research
    celiac disease and encourages the newly created NIH Office of
    Autoimmune Disease Research to work with NIAID and other NIH
    Institutes to support new research on celiac disease,
    coordinate existing research, and focus new research efforts on
    causation, diagnosis, management, treatment, and a cure of this
    disease. The Committee requests an update in the fiscal year
    2027 congressional justification on celiac disease research,
    projects, and programs.
        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 United States. The Committee commends the ongoing work of
    NIAID in supporting a total of 27 clinical sites for this
    research, including 14 sites as part of the Consortium of Food
    Allergy Research (CoFAR). The Committee continues to include
    $12,100,000 for CoFAR to maintain its clinical research network
    of centers of excellence in food allergy clinical care and
    expertise in food allergy research.
        Hereditary Angioedema with Normal C1 Inhibitor.--The
    Committee notes that challenges persist in diagnosis,
    treatment, and care for HAE patients with normal C1 inhibitor
    and encourages NIAID to work with other institutes and centers
    and the stakeholder community to advance research in this key
    area.
        Lyme and Other Tick-Borne Diseases.--The Committee includes
    not less than $110,000,000, an increase of $10,000,000 over the
    fiscal year 2024 enacted level, for NIH research into Lyme and
    Other Tick-Borne disease research. 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. Oher
    possible research topics could include Lyme diagnostic and
    therapeutic development, pediatric Lyme disease clinical
    studies, pregnancy with Lyme disease and outcomes in child
    development, neuropsychiatric and mental health effects of Lyme
    disease, clinical studies related to Alpha-gal Syndrome
    treatment and management, and clinical studies for
    immunological symptoms and responses resulting from a tick
    bite. The Committee also is aware of tick-borne infection-
    triggered chronic illnesses such as long COVID, long Lyme,
    Bartonella henselae, West Nile virus, and multiple sclerosis.
    The Committee encourages NIH to periodically review progress on
    activity to address tick-borne infection-triggered chronic
    illnesses and to include a status report in the fiscal year
    2027 congressional justification.
        National Biocontainment Laboratories.--The Committee notes
    the roles of the National Biocontainment Laboratories in
    developing and maintaining research resources, facilities, and
    personnel to meet national biodefense and emerging infectious
    diseases research needs in the event of a deliberate act of
    bioterrorism or naturally occurring public health emergency.
    Research on high consequence zoonotic viruses requires high-
    containment BSL-4 laboratories. Such laboratories enable
    researchers to safely diagnose and investigate these types of
    pathogens, and develop rapid and reliable diagnostics, novel
    antiviral therapeutics, and vaccines. The Committee encourages
    NIH to prioritize: maintaining the research resources for
    biodefense, emerging infectious disease agents, and other
    infectious disease threats to global health; training new
    researchers in biosafety level 4 practices; maintaining a
    workforce skilled in BSL-4 research; and establishing best
    practices for the safe and efficient conduct of research in
    BSL-4 facilities.
        Regional Biocontainment Laboratories.--The Committee notes
    the role that the 12 regional biocontainment laboratories
    (RBLs) have had as part of the nation's biodefense
    infrastructure, helping the U.S. prepare and respond to
    emerging infectious disease agents. The Committee appreciates
    that NIAID competitively awarded UC7 awards and encourages
    continued support of the RBLs. The Committee includes
    $52,000,000 for the 12 RBLs to support core and shared
    resources for BSL-3 containment and related activities within
    the RBL facility in its entirety. No less than $3,000,000 shall
    be provided to each of the 12 RBLs to support training and
    maintaining a capable research workforce with broad, relevant
    biomedical, technological, veterinary, and regulatory
    expertise, supporting operations, facilities, and equipment
    purchase costs, and supporting research utilizing the
    capabilities of the RBLs. The remaining funding shall go to the
    12 RBLs to support: (1) research on biodefense, emerging
    infectious disease agents, and other infectious disease threats
    to global health; (2) training new researchers, including in
    biosafety level 3 practices; (3) maintaining a workforce
    skilled in BSL-3 research; and (4) establishing best practices
    for the safe, effective, and efficient conduct of research in
    BSL-3 facilities. All funding shall be used to support the
    aforementioned activities conducted within the RBL, and should
    not be limited to just the BSL-3 space.
        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 continues to
    include no less than $270,000,000 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 OF GENERAL MEDICAL SCIENCES (NIGMS)

    Appropriation, fiscal year 2025.......................    $3,244,679,000
    Budget request, fiscal year 2026......................     3,677,297,000
    Committee Recommendation..............................     3,265,679,000
        Change from enacted level.........................       +21,000,000
        Change from budget request........................      -411,618,000

        The Committee recommendation includes $1,900,677,000 in
    discretionary appropriations and $1,365,002,000 in PHS Act
    section 241 evaluation set-aside transfers.
        Mission.--NIGMS supports basic research that increases our
    understanding of biological processes and lays the foundation
    for advances in disease diagnosis, treatment, and prevention.
        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 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 the
    number of applicants and success rates per State to ensure NIH
    is supporting capacity building and a robust workforce for the
    future biomedical research enterprise. In addition to the
    portfolio analysis, in the fiscal year 2027 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.
        Bridge Programs.--The Committee strongly supports
    opportunities for students with limited access to STEMM
    (Science, Technology, Engineering, Mathematics, and Medicine)
    education and research. The Committee recognizes the
    effectiveness and importance of the National Institute of
    General Medicine Services bridging programs that support
    historically underserved students and researchers to pursue
    STEMM studies and become the nation's next generation of
    researchers, including programs such as the Bridges to the
    Baccalaureate Research Training Program, Bridges to the
    Doctorate Research Training Program, Postbaccalaureate Research
    Education Program (PREP), Advancing Research Careers (ARC)
    program, and Maximizing Opportunities for Scientific and
    Academic Independent Careers (MOSAIC) program. The Committee is
    concerned that NIH terminated many of these programs in 2025
    and urges NIH to reestablish them. The Committee urges NIH to
    expand the size of existing training programs that bridge
    different educational or career stages and establish these
    programs at institutions that have historically received low
    levels of funding support from NIH, including Minority Serving
    Institutions and institutions that are eligible under the
    Department of Education's Strengthening Institutions Program.
    The Committee urges NIH to set clear mentorship and support
    standards for students participating in these programs. The
    Committee urges NIH to encourage and provide more guidance to
    participating institutions to account for sufficient staff and
    outreach, budget, and other training-related expenses in grant
    applications. Finally, the Committee directs NIH to provide a
    report on these activities within 90 days of enactment.
        Experimental Research.--The Committee recognizes the
    success of the NIGMS Maximizing Investigators' Research Award
    program and encourages the NIH to continue expanding similar
    experimental research opportunities to other institutes.

    Institutional Development Awards

        The Committee provides $455,956,000 for IDeA, which is
    $25,000,000 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. The Committee
    does not support changes to eligibility for the IDeA program to
    any system that would deviate from the original goal of
    supporting more NIH research in States with the lowest levels
    of NIH funding. The Committee urges NIH to take steps to ensure
    robust participation by institutions located throughout a State
    when awarding grants as part of the IDeA program and requests
    an update on this effort in the fiscal year 2027 congressional
    justification.
        Institutional Development Award Networks for Clinical and
    Translational Research (IDeA-CTR).--The Committee notes the
    continued importance of the IDeA-CTR centers to develop
    infrastructure and human resources to more effectively and
    efficiently conduct clinical and translational research and
    acknowledges the potential for further enhancement and progress
    through meaningful collaboration with the CTSA program,
    particularly in rural areas. The Committee encourages NIGMS and
    NCATS to pursue collaborative opportunities between the IDeA-
    CTRs and CTSAs that preserve the autonomy of both programs,
    while removing barriers to allow them to collaborate for rapid
    scientific advancement and improved local care and research.

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

    Appropriation, fiscal year 2025.......................    $1,759,078,000
    Budget request, fiscal year 2026......................             - - -
    Committee Recommendation..............................     1,759,078,000
        Change from enacted level.........................             - - -
        Change from budget request........................    +1,759,078,000

        Mission.--NICHD's mission is to lead research and training
    to understand human development, improve reproductive health,
    enhance the lives of children and adolescents, and optimize
    abilities for all.
        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 continue to expand its current Centers of Excellence with a
    particular emphasis on establishing new ones in regions of
    greatest need.
        Endometriosis.--The Committee encourages NICHD to expand
    basic, clinical, and translational research into the mechanisms
    of endometriosis, including root causes of the disease and new
    treatment methods. The Committee also encourages research in
    additional areas, including: the genetic and immune system
    components of endometriosis, targeted research of endocrine
    disrupting chemicals in endometriosis, the relationship of
    endometriosis and cancer, prenatal, and epigenetic influences
    on the risk for this condition, non-invasive diagnostics of
    endometriosis to reduce delays in diagnosis and improve
    treatment, and growth of endometriosis, and recurrence post-
    surgical procedures.
        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 key topic and urges expanded
    support for research into the cognitive, physical, and mental
    health impacts of young people's use of technologies and the
    long-term developmental effects on children's social,
    communication, and creative skills. The Committee encourages
    NIH to study potential correlations between increased use of
    digital media and technologies on suicidal thoughts and
    ideation among children. NIH is encouraged 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., 11 percent of women of reproductive age have
    difficulty getting pregnant or carrying a pregnancy to term.
    The Committee urges NICHD to continue to research female
    reproductive conditions, specifically adenomyosis, uterine
    fibroids, endometriosis, and polycystic ovary syndrome. This
    research could include diagnostic testing, causes of the
    conditions, and treatment options, especially non-
    pharmacological intervention. The Committee also urges NICHD to
    continue supporting research on male mechanisms of infertility,
    given the gap in knowledge of how to diagnose and treat male
    infertility.
        Learning Disabilities Research Centers and Learning
    Disabilities Innovation Hubs.--The Committee notes the need for
    continued research and improved interventions to address the
    concerning decline in achievement for students with
    disabilities. 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, 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 14 centers across the
    country that conduct clinical studies to improve maternal,
    fetal, and neonatal health that ultimately improves the
    clinical practice of obstetrics. Broadly, 22 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, and one or more of the pelvic organs
    fall downward, protruding from the body. It is common, 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 related to POP 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 also encourages continued support
    of POP research. The Committee requests an update in the fiscal
    year 2027 congressional justification on research to advance
    POP prevention and treatment.
        Polycystic Ovary Syndrome.--The Committee encourages NICHD
    to continue supporting basic, clinical, and translational
    research into the causes and mechanics of polycystic ovary
    syndrome (PCOS). The Committee also encourages NIH to support
    targeted research of endocrine-disrupting chemicals in PCOS;
    the genetic, metabolic, and immune system dysfunction of PCOS;
    the efficacy of various treatments for PCOS; and the incidence
    and impact of PCOS on the development of related comorbidities.
        Population Research.--The Committee has 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 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. 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 course of life. The
    Committee is concerned to learn that NICHD is proposing funding
    reductions to these surveys, which could 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 encouraged to prioritize
    supporting these surveys. The Committee requests an update on
    this topic in the fiscal year 2027 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 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, and to prioritize research applications in
    the following areas: an unmet medical need or gap in treatment,
    and severity and prevalence of a specific disease or condition.
    The Committee requests an update in the fiscal year 2027
    congressional justification on this effort.

                          NATIONAL EYE INSTITUTE (NEI)

    Appropriation, fiscal year 2025.......................      $896,549,000
    Budget request, fiscal year 2026......................             - - -
    Committee Recommendation..............................       896,549,000
        Change from enacted level.........................             - - -
        Change from budget request........................      +896,549,000

        Mission.--The mission of the National Eye Institute is to
    eliminate vision loss and improve quality of life through
    vision research.
        Blepharospasm.--The Committee encourages continued support
    for research into blepharospasm, a form of dystonia, and
    encourages continued collaboration with stakeholders and across
    NIH institutes and centers.
        Retinitis Pigmentosa.--The Committee continues to encourage
    NEI to expand research into Retinitis Pigmentosa and requests
    an update in the fiscal year 2027 congressional justification
    on collaborative efforts among stakeholders and other
    Institutes and Centers on work toward curative treatments and
    therapeutics for retinitis pigmentosa.
        Usher Syndrome.--The Committee strongly encourages NIH to
    enhance and prioritize Usher syndrome research at NEI. Usher
    syndrome is a rare genetic disease that causes deafness and
    blindness, and there is no viable treatment or cure. The
    Committee requests an update in the fiscal year 2027
    congressional justification, and such update should include
    efforts to stimulate the field and to accelerate viable human
    treatment options for those with Usher syndrome.

          NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES (NIEHS)

    Appropriation, fiscal year 2025.......................      $913,979,000
    Budget request, fiscal year 2026......................       594,086,000
    Committee Recommendation..............................       913,979,000
        Change from enacted level.........................             - - -
        Change from budget request........................      +319,893,000

        Mission.--NIEHS's mission is to discover how the
    environment affects people in order to promote healthier lives.
        Microplastics.--The Committee urges NIH to review primary
    chemicals in the life cycle analysis of plastic materials that
    are 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.
        Wildfire Smoke Health Research.--The lack of data about the
    health impacts of wildland fire smoke and wildfire management
    strategies is a 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 types of wildfire and to develop datasets linking
    wildfire smoke to health impacts.

                       NATIONAL INSTITUTE ON AGING (NIA)

    Appropriation, fiscal year 2025.......................    $4,507,623,000
    Budget request, fiscal year 2026......................     2,686,541,000
    Committee Recommendation..............................     4,507,623,000
        Change from enacted level.........................             - - -
        Change from budget request........................    +1,821,082,000

        Mission.--NIA's mission is to understand the nature of
    aging and the aging process, and diseases and conditions
    associated with growing older, to extend the healthy, active
    years of life.
        Alzheimer's Disease and Alzheimer's Disease-Related
    Dementias (AD/ADRD).--The Committee urges continued robust
    funding for AD/ADRD research at the NIA at no less than the
    level provided for fiscal year 2025. The Committee notes that
    Alzheimer's Disease and related dementias pose challenges to
    the nation's health, and AD/ADRD research at NIA is an
    investment in the treatment, prevention, and eventual cure of
    these diseases.
        Basic Biology of Aging.--The healthspan-lifespan gap--the
    average number of years that a person is burdened by disease--
    is growing globally and is wider in the United States than in
    any other country. This impacts the nation's economy, but
    closing this gap remains a challenge, because so much remains
    unknown about how best to target the underlying biology
    responsible for the transition from healthy to unhealthy life.
    The Committee urges the NIA to prioritize funding for the
    Division of Aging Biology and other divisions conducting work
    to explore the precipitating biology of the frailty and loss of
    resilience that defines ill health in people's later years. The
    Committee requests an update on such efforts in the fiscal year
    2027 congressional budget justification.
        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 urges 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, NIA is
    encouraged to increase 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.

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

    Appropriation, fiscal year 2025.......................      $685,465,000
    Budget request, fiscal year 2026......................             - - -
    Committee Recommendation..............................       685,465,000
        Change from enacted level.........................             - - -
        Change from budget request........................      +685,465,000

        Mission.--NIAMS's mission is to support research into the
    causes, treatment, and prevention of arthritis and
    musculoskeletal and skin diseases; the training of basic and
    clinical scientists to carry out this research; and the
    dissemination of information on research progress in these
    diseases.
        Alopecia Areata.--The Committee notes that 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.

       NATIONAL INSTITUTE ON DEAFNESS AND OTHER COMMUNICATION DISORDERS
                                    (NIDCD)

    Appropriation, fiscal year 2025.......................      $534,333,000
    Budget request, fiscal year 2024......................             - - -
    Committee Recommendation..............................       534,333,000
        Change from enacted level.........................             - - -
        Change from budget request........................      +534,333,000

        Mission.--NIDCD conducts and supports biomedical and
    behavioral research and research training in the normal and
    disordered processes of hearing, balance, taste, smell, voice,
    speech, and language. NIDCD also conducts and supports research
    and research training related to disease prevention and health
    promotion; addresses special biomedical and behavioral problems
    associated with people who have communication impairments or
    disorders; and supports efforts to create devices which
    substitute for lost and impaired sensory and communication
    function.
        Spasmodic Dysphonia or Laryngeal Dystonia.--The Committee
    notes the research that NIDCD continues to facilitate regarding
    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 OF NURSING RESEARCH (NINR)

    Appropriation, fiscal year 2025.......................      $197,693,000
    Budget request, fiscal year 2026......................             - - -
    Committee Recommendation..............................       197,693,000
        Change from enacted level.........................             - - -
        Change from budget request........................      +197,693,000

        Mission.--The mission of NINR is to lead nursing research
    to solve pressing health challenges and inform practice and
    policy for health optimization.

           NATIONAL INSTITUTE ON ALCOHOL ABUSE AND ALCOHOLISM (NIAAA)

    Appropriation, fiscal year 2025.......................      $595,318,000
    Budget request, fiscal year 2026......................             - - -
    Committee Recommendation..............................       595,318,000
        Change from enacted level.........................             - - -
        Change from budget request........................      +595,318,000

        Mission.--NIAAA's mission is to generate and disseminate
    fundamental knowledge about the adverse effects of alcohol on
    health and well-being, and apply that knowledge to improve
    diagnosis, prevention, and treatment of alcohol-related
    problems, including alcohol use disorder, across the lifespan.
        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.

                    NATIONAL INSTITUTE ON DRUG ABUSE (NIDA)

    Appropriation, fiscal year 2025.......................    $1,662,695,000
    Budget request, fiscal year 2026......................             - - -
    Committee Recommendation..............................     1,662,695,000
        Change from enacted level.........................             - - -
        Change from budget request........................    +1,662,695,000

        Mission.--NIDA's mission is to advance science on the
    causes and consequences of drug use and addiction and to apply
    that knowledge to improve individual and public health.
        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.
        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 variety, 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 25,000 overdose deaths involved cocaine
    and over 34,000 involved drugs in the category that includes
    methamphetamine in the 12-month period ending in August 2024.
    These elevated levels have 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.
        The Committee also notes that the HEAL Initiative is
    currently supporting basic science and translational studies in
    animal models of opioid addition and how pain mechanisms are
    generated. Continuing these studies will be critical for
    identifying mechanisms and targets for treatment that can be
    translated into clinical studies already occurring in HEAL.
        Opioid Initiative.--The Committee remains concerned about
    the high mortality rate due to the overdose epidemic and
    appreciates the role that research plays in Federal initiatives
    aimed at this crisis. Approximately 220 people die each day in
    the U.S. from drug overdose (more than 149 of them involving
    opioids), making it one of the most common causes of non-
    disease-related deaths for adolescents and young adults. The
    Committee notes the strong concerns related to overdose deaths
    involving synthetic opioids, namely fentanyl. Research is
    needed to find new and better agents to prevent or reverse the
    effects of this class of chemicals and to improve 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 elevated 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 disorder 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 improve 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 abuse prescription opioids, as well as best
    practices for incorporating substance abuse and addiction
    screening and treatment into their clinical practices.
        Raising Awareness and Engaging the Medical Community in
    Drug Abuse and Addiction Prevention and Treatment.--Education
    is a key component of any effort to curb drug use and
    addiction, and it must target all segments 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 abuse screening and treatment into their
    clinical practices.
        Wastewater Drug Testing.--The Committee supports NIDA's
    research of testing wastewater to detect and understand trends
    in drug substances. Wastewater-based drug testing is a
    technique where wastewater samples from the sewer are tested
    for specific targets. It is intended to complement 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 such
    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 certain drugs. The
    Committee encourages NIDA to report data collection and
    analysis of trends and drugs from this research so that the
    field can improve and validate wastewater testing methods and
    enable local governments to target support and reduce overdose
    deaths.

                   NATIONAL INSTITUTE OF MENTAL HEALTH (NIMH)

    Appropriation, fiscal year 2025.......................    $2,187,843,000
    Budget request, fiscal year 2026......................             - - -
    Committee Recommendation..............................     2,187,843,000
        Change from enacted level.........................             - - -
        Change from budget request........................    +2,187,843,000

        Mission.--NIMH's mission is to transform the understanding
    and treatment of mental illnesses through basic and clinical
    research, paving the way for prevention, recovery, and cures.
        21st Century Cures.--The Committee recommendation includes
    $97,500,000 available from the Cures Act for the BRAIN
    Initiative. The Committee notes that fiscal year 2026 is the
    final year of funding under the Cures Act for this activity.
        Autism Spectrum Disorder.--The Committee 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 notes NIH's initiative
    to build a real-world data platform focused on autism. NIH is
    encouraged to ensure any large autism initiatives supplement
    existing funding for autism research. The Committee requests an
    update in the fiscal year 2027 congressional justification on
    the implementation of NIH-related provisions of the Autism
    Collaboration, Accountability, Research, Education, and Support
    Act of 2024 (P.L. 118-80), which include providing an annual
    budget estimate for autism research, ensuring research reflects
    the entire population of individuals with ASD, and establishing
    a process for the public to access information on existing and
    planned autism research activities and provide comments. The
    Committee also encourages the reestablishment of the IACC.
        Mental Health Research.--The Committee supports NIMH's
    high-quality basic research on serious mental illnesses. The
    Committee requests an update in the fiscal year 2027
    congressional justification on the funding allocations at NIMH
    detailing the percentage of funds spent on basic,
    translational, and clinical research.
        Reducing Mental Health Disparities in Youth.--The Committee
    is alarmed by 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. New investments in
    research to guide recovery are key to resolving the rise in
    youth mental health issues.
        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
    these areas, as well as the application of novel measurement
    techniques, statistical analysis, digital initiatives, and
    information systems. The Committee encourages NIMH to promote
    greater collaboration with other institutes and centers with
    expertise in research areas that can contribute to suicide
    prevention, especially NIA, NICHD, NHGRI, NIAAA and NIDA.

                NATIONAL HUMAN GENOME RESEARCH INSTITUTE (NHGRI)

    Appropriation, fiscal year 2025.......................      $663,200,000
    Budget request, fiscal year 2026......................             - - -
    Committee Recommendation..............................       663,200,000
        Change from enacted level.........................             - - -
        Change from budget request........................      +663,200,000

        Mission.--NHGRI's mission is to accelerate scientific and
    medical breakthroughs that improve human health by driving
    cutting-edge research, developing new technologies, and
    studying the impact of genomics on society.
        Pharmacogenomic Research.--NHGRI's pharmacogenomic research
    and programs include working to develop community resources.
    Such efforts support 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 continued
    support for such research.

      NATIONAL INSTITUTE OF BIOMEDICAL IMAGING AND BIOENGINEERING (NIBIB)

    Appropriation, fiscal year 2025.......................      $440,627,000
    Budget request, fiscal year 2026......................             - - -
    Committee Recommendation..............................       440,627,000
        Change from enacted level.........................             - - -
        Change from budget request........................      +440,627,000

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

        NATIONAL CENTER FOR COMPLEMENTARY AND INTEGRATIVE HEALTH (NCCIH)

    Appropriation, fiscal year 2025.......................      $170,384,000
    Budget request, fiscal year 2026......................             - - -
    Committee Recommendation..............................       170,384,000
        Change from enacted level.........................             - - -
        Change from budget request........................      +170,384,000

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

      NATIONAL INSTITUTE ON MINORITY HEALTH AND HEALTH DISPARITIES (NIMHD)

    Appropriation, fiscal year 2025.......................      $534,395,000
    Budget request, fiscal year 2026......................             - - -
    Committee Recommendation..............................       544,395,000
        Change from enacted level.........................       +10,000,000
        Change from budget request........................      +544,395,000

        Mission.--NIMHD's mission is to lead scientific research to
    improve minority health and reduce health disparities.
        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 $14,000,000, which is an increase of $8,000,000 above
    the fiscal year 2024 enacted level, to continue the 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 continue
    support for the current grantees.
        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 $6,000,000, which is an increase of
    $2,000,000 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.
        Research Endowment Program.--The Committee continues to
    include $12,000,000 for the Research Endowment Program. The
    Committee is pleased with NIMHD's reinvigoration of the
    Research Endowment Program and has continued funding for fiscal
    year 2026. The Committee supports efforts to increase funding
    available to existing grantees and continue to expand and
    assist eligible institutions receiving grants through a
    competitive process.
        Research Centers at Minority Institutions (RCMI) Program.--
    The Committee notes that NIMHD's investment in the RCMI program
    provides opportunities for institutions with historical
    missions and precedence of serving minorities and building
    infrastructure to conduct minority health and health
    disparities research. The Committee urges NIMHD to continue
    investing in the RCMI program.

                   JOHN E. FOGARTY INTERNATIONAL CENTER (FIC)

    Appropriation, fiscal year 2025.......................       $95,162,000
    Budget request, fiscal year 2026......................             - - -
    Committee Recommendation..............................        95,162,000
        Change from enacted level.........................             - - -
        Change from budget request........................       +95,162,000

        Mission.--FIC's mission is to support and facilitate global
    health research conducted by U.S. and international
    investigators, building partnerships between health research
    institutions in the U.S. and abroad, and training the next
    generation of scientists to address global health needs.
        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 an update in the fiscal year 2027
    congressional justification on the annual funding level for
    training on obstetric fistula over the preceding five fiscal
    years, including the types of grants supported during this
    period.

                       NATIONAL LIBRARY OF MEDICINE (NLM)

    Appropriation, fiscal year 2025.......................      $497,548,000
    Budget request, fiscal year 2026......................             - - -
    Committee Recommendation..............................       497,548,000
        Change from enacted level.........................             - - -
        Change from budget request........................      +497,548,000

        Mission.--As a leader in computational health and the
    world's largest medical library, NLM collects, organizes,
    preserves, and disseminates data and information important to
    biomedicine and health; serves as a national information
    resource for medical education, research, and health service
    activities; enhances access to biomedical literature through
    electronic services; serves the public by providing electronic
    access to reliable health information for consumers; supports
    and directs the Network of the NLM; provides grants for
    research in biomedical communications, medical library
    development, and training health information specialists;
    conducts and supports research and research training in
    biomedical informatics, computational health, computational
    biology, and data science; supports development, maintenance,
    and dissemination of health data standards that promote
    interoperability among clinical and research information
    systems; and manages and maintains information resources for
    genomics, molecular biology, clinical trials, medical images,
    environmental health, public health, and health services
    research.
        Epitranscriptomics Database Standards.--The Committee is
    aware of interest in establishing clear, consistent standards
    for data and databases for sequencing RNA and its
    modifications, to facilitate data access and sharing. NLM's
    National Center for Biotechnology Information (NCBI)
    collaborates with the scientific community to support
    development of standards for databases and biological
    nomenclature. The Committee encourages the establishment of
    data and database standards for epitranscriptomics, in
    collaboration with the scientific community.

          NATIONAL CENTER FOR ADVANCING TRANSLATIONAL SCIENCES (NCATS)

    Appropriation, fiscal year 2025.......................      $928,323,000
    Budget request, fiscal year 2026......................             - - -
    Committee Recommendation..............................       928,323,000
        Change from enacted level.........................             - - -
        Change from budget request........................      +928,323,000

        Mission.--NCATS was established to transform the
    translational process so that new treatments and cures for
    disease can be delivered to patients faster.
        Clinical and Translational Science Awards (CTSA).--The
    Committee notes the role of the CTSA program in supporting a
    national network of medical institutions to advance the
    translation of research into improved clinical care in
    communities and encourages continued robust support for CTSA
    activities.
        Cures Acceleration Network.--The Committee continues to
    include $75,000,000 for this activity. The Cures Acceleration
    Network is authorized to conduct and support advances in basic
    research, accelerate the development of high need cures, and
    reduce barriers between discoveries in the laboratory and
    clinical trials for new therapies.
        National Clinical Cohort Collaborative.--The Committee
    strongly supports the National Clinical Cohort Collaborative
    (N3C)'s open-science, privacy-preserved data-sharing platform
    to accelerate biomedical research and discovery and includes no
    less than $75,000,000 for the N3C. Supported by the CTSA
    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 complexities of rare
    disease research, to be detailed in a report to the Committee
    within one 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. Such investments have led to investigational new
    drugs and approved therapies. The Committee urges NCATS to
    increase its support for rare disease research.

                             OFFICE OF THE DIRECTOR

    Appropriation, fiscal year 2025.......................    $2,605,514,000
    Budget request, fiscal year 2026......................     1,650,062,000
    Committee Recommendation..............................     2,441,514,000
        Change from enacted level.........................      -164,000,000
        Change from budget request........................      +791,452,000

        Mission.--The OD is responsible for the research, mission,
    policies, and administration of the agency. The OD leads and
    supports NIH-wide initiatives in partnership with NIH
    Institutes and Centers and their constituents. OD guides the
    development and management of intramural and extramural
    research and research training policy, the review of program
    quality and effectiveness, the coordination of selected NIH-
    wide program activities, and the administration of centralized
    support activities essential to the operations of NIH.
        The items below include issues and programs specific to the
    Office of the Director as well as those that involve multiple
    institutes and centers.
        ACT for Amyotrophic Lateral Sclerosis Expanded Access.--In
    addition to encouraging more research broadly for Amyotrophic
    Lateral Sclerosis (ALS), the Committee includes $80,000,000,
    which is a $5,000,000 increase above 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 Committee 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, wound healing, and autoimmune
    and immune-mediated disease. The Committee encourages the
    development and launch of a coordinated program to support
    research, development, and manufacturing of somatic (adult)
    gene and cell-based therapies for patients with serious and
    life-threatening conditions. Such efforts could support large-
    scale, randomized, placebo-controlled clinical trials exploring
    the use of somatic gene and cell-based therapies for serious
    and life-threatening conditions; support for characterization,
    optimization, and scaling of manufacturing of 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
    incorporate the knowledge of experts with experience in
    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 recommendation includes
    $31,000,000 available in the Cures Act for the All of Us
    Research program. The Committee supports 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. The Committee notes that this
    initiative supports large-scale genome sequencing, innovations
    in health data science, and the development of a next-
    generation biomedical workforce. The Committee notes that
    fiscal year 2026 is the final year of funding under the Cures
    Act for this activity. As NIH evaluates plans for the
    activities currently supported by this program, the Committee
    encourages the agency to consider the merits of integrating
    such activities into an existing institute or center such as
    NCATS or NHGRI.
        Alternatives to Animal Testing.--The Committee commends NIH
    for launching an initiative to expand human-based research
    technologies--such as tissue chips and computational models--
    and reduce the use of traditional animal models. Within this
    effort, a new Office of Research Innovation, Validation, and
    Application will coordinate agency-wide development and
    expansion of non-animal approaches in NIH's research. The
    Committee also notes that NIH announced in July 2025 that it
    will no longer issue Notices of Funding Opportunities that rely
    solely on animal models. Additionally, the Committee supports
    the Complement Animal Research In Experimentation (Complement-
    ARIE) Program, intended to spur the development,
    standardization, validation, and use of new approach
    methodologies (NAMs) intended to more accurately model human
    biology. The Committee encourages NIH, in new announcements and
    other indications of funding opportunities, to continue
    consideration of NAMs as the preferred option for areas of
    preclinical research when it is not appropriate to use human
    participants. The Committee encourages implementation of non-
    animal methods based on human biology in developing and
    evaluating potential treatments for rare diseases, where
    scientifically justifiable non-animal models exist to mimic
    human disease.
        Additionally, to encourage investigators to consider the
    use of NAMs and promote the competitive evaluation of
    applications that use NAMs, the Committee encourages NIH to
    include grant proposal reviewers with expertise in NAMs and
    provide reviewers with access to appropriate resources as
    relates to evaluating applications that may include NAMs, such
    as a reference librarian with expertise in evaluating the
    adequacy of the search methods used by the applicant for non-
    animal methods. The Committee requests an update in the fiscal
    year 2027 congressional justification on the feasibility of
    such actions and progress made on implementation.
        Artificial Intelligence Innovation.--The Committee notes
    the Bipartisan Artificial Intelligence Task Force's efforts to
    issue a December 2024 report that outlines principles,
    recommendations, and proposals for ensuring U.S. leadership in
    responsible artificial intelligence (AI) innovation. The report
    highlighted past and future benefits of AI, machine learning,
    and informatics in basic biomedical research, including at NIH.
    It underscored the role of basic scientific research in
    contributing scientific data that AI can leverage to find new
    discoveries.
        Bayh-Dole.--The Committee notes that the prior
    Administration proposed a ``Draft Interagency Guidance
    Framework for Considering the Exercise of March-in Rights,''
    (Framework) which reviewed factors, including price, that a
    Federal agency could 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 NIH, such an approach could adversely impact
    America's global leadership in pharmaceutical innovation. It
    could lead to negative effects on current and future scientific
    advancements in promising new therapies under development to
    treat cancer, immune disorders, and other chronic conditions,
    and could threaten the United States' global leadership in
    pharmaceuticals. The Committee notes that since the inception
    of the Bayh-Dole Act more than 40 years ago, the U.S. has never
    exercised its march-in rights authority. U.S. investment and
    technology communities, universities, and research institutions
    have been empowered 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.
        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 using this technology. Findings
    from the ongoing NCI-supported research will inform progress in
    this promising field. The Committee urges NIH to continue to
    provide robust funding for research that moves the field
    forward for mRNA vaccines in cancer, collaborating closely with
    interested parties. Areas of particular opportunity include
    enhancing immune recognition of solid tumors, overcoming
    suppression in the tumor microenvironment, and personalization
    of mRNA vaccines. 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 infections. The Committee urges NIH to continue to
    prioritize research on PANS/PANDAS and related to autoimmune
    encephalitic conditions and requests an update on such research
    in the fiscal year 2027 congressional justification.
        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 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 2027
    congressional justification.
        Diet and Chronic Disease Research.--The Committee commends
    the NIH for convening a workshop in August 2024 that explored
    the role food and diet have in developing mucosal immunity for
    conditions such as Crohn's disease, ulcerative colitis, and
    other digestive and auto-immune or immune-mediated diseases.
    The Committee is aware of the increasing interest in research
    focused on preventing such conditions, especially through
    targeted research on environmental and dietary factors that may
    trigger these conditions, particularly during the pre-clinical
    windows. The Committee encourages NIH to build upon these
    activities across NIH. Additionally, the Committee encourages
    NIH efforts to address gaps in knowledge about the role diet
    and environmental factors may have in development of IBD and
    other digestive and auto-immune or immune-mediated diseases.
    Such efforts could include collaborations between NIEHS or
    other institutes and the Office of Nutrition Research, as well
    as the incorporation of immune-mediated digestive diseases and
    nutrition into existing programs which could include the
    Environmental Influences on Child Health Outcomes program.
        Disease Prevalence and Population Health.--The Committee
    urges the NIH to prioritize improving population health in its
    work and is encouraged by the budget request indicating NIH
    shares this view. As the U.S. and global leader in biomedical
    research, NIH research has led to scientific and medical
    breakthroughs that have enhanced and saved countless lives.
    Progress has been made in many areas, yet the Committee remains
    concerned about prevalent diseases including chronic conditions
    ranging from heart disease and stroke to cancer, diabetes, and
    AD/ADRD. Such prevalent diseases are among the leading causes
    of death and bring high costs to individuals, the health care
    system, and the economy. Maximizing research investments to
    address prevalent diseases can have a tremendous positive
    impact on population health outcomes, as discoveries lead to
    new strategies for prevention, as well as treatments,
    therapies, and cures. The Committee also believes that NIH is
    uniquely positioned to conduct and support fundamental
    scientific and biomedical research, and the Committee urges NIH
    to prioritize such core research.
        Dog and Cat Research.--Congress has previously expressed
    concern about the use of dogs and cats in biomedical research,
    particularly in research classified in pain category D or E as
    defined by the USDA. The Committee remains concerned about this
    issue. The Committee is encouraged by NIH's commitment to
    prioritize human-focused research and expand the use of non-
    animal approaches, while reducing the use of animals. Similar
    efforts are being implemented by the Department of Veterans
    Affairs. The Committee directs NIH to submit a report to the
    Committee within 180 days of enactment of this Act that
    includes an update on efforts to reduce and replace the use of
    dogs and cats in NIH-funded intramural or extramural research
    classified in pain category D or E, as part of NIH efforts to
    advance human-focused research and reduce the use of animals,
    including objective performance metrics to assess progress. The
    contents of the final report shall be made publicly available
    on the agency's website.
        Duchenne and Becker Muscular Dystrophy.--There are multiple
    therapies approved to treat Duchenne, but research data does
    not show that these key treatments halt or reverse this
    devastating condition, so more research investment is
    warranted. The Committee encourages NIH to ensure that research
    data produced by its grants is shared in a timely and
    transparent way to accelerate progress. The Committee
    emphasizes the importance of robust data-sharing plans that
    facilitate access to data for sub analyses, enabling
    researchers to maximize insights, identify trends, and advance
    innovation in the field. The Committee encourages a review of
    the structure and processes of the Muscular Dystrophy
    Coordinating Committee, to incorporate Duchenne muscular
    dystrophy patient and caregiver perspectives with a transparent
    process and timeline for participation. The Committee urges NIH
    to respond to the 2025 recommendations of the Muscular
    Dystrophy Coordinating Committee and maintain a public record
    of progress in implementation.
        Early-Career Scientists.--The Committee highlights the
    important role of NIH fellows and other early-career
    scientists. The Committee encourages NIH to continue support
    for research fellows and other early-career scientists, which
    will encourage talented students to pursue a scientific career
    path, strengthen the research workforce, and ultimately
    contribute to the nation's place as the global leader in
    scientific innovation.
        Facilities and Administrative Costs.--The Committee is
    aware of the longstanding cost-sharing model for facilities and
    administrative (F&A) costs, or indirect costs, between the
    Federal government and research institutions, and that this
    cost-sharing has an important role in supporting NIH-funded
    research. The Committee is aware of concerns about high
    negotiated F&A rates and that if such rates were lower, Federal
    funding could support more biomedical research. The Committee
    is also aware of interests in making the current model more
    transparent and efficient, and better tailoring costs to
    different types of research, among other possible changes.
    Additionally, the Committee understands that research
    institutions' effective--or actual--reimbursement rates may be
    quite lower than their negotiated rates. Three researchers
    analyzed this difference for about 350 research institutions
    that account for roughly 90 percent of NIH's extramural
    funding, in ``Indirect Cost Recovery in U.S. Innovation Policy:
    History, Evidence, and Avenues for Reform,'' a National Bureau
    of Economic Research working paper issued in March 2025. They
    found that most institutions' negotiated rates were between 50
    and 70 percent, averaging 58 percent, while their effective
    rates tended to be between 25 and 45 percent and averaged 42
    percent. They found that while negotiated rates have increased
    during the past several decades, effective rates have remained
    relatively constant. The Committee recognizes recent efforts by
    interested stakeholders to develop recommendations for a new
    F&A model and notes that such efforts are a valuable
    contribution to the dialogue about the future of F&A rates.
        Firearm Injury and Mortality Prevention Research.--The
    Committee does not include funding for this activity.
        Focused Ultrasound.--The Committee understands focused
    ultrasound is a noninvasive, non-pharmacological, safe, and
    cost-effective alternative or complement to conventional
    surgery, radiation therapy, or drug-based treatments. It is a
    promising intervention for patients suffering from serious
    conditions like Parkinson's disease, essential tremor, and
    prostate cancer, as well as for conditions and diseases
    affecting women such as breast cancer, gynecological cancers,
    uterine fibroids, and endometriosis, and it is being explored
    for many other indications. The Committee encourages NIH to
    continue engaging with the focused ultrasound stakeholder
    community, explore existing focused ultrasound research groups,
    and ensure coordinated cross-NIH research. The Committee
    directs NIH to provide an update in the fiscal year 2027
    congressional justification, including an NIH-wide overview of
    grants awarded to support focused ultrasound research and
    research opportunities for advancing increased focused
    ultrasound research across the institutes and centers. The
    Committee also encourages the development and implementation of
    effective approaches to integrate patient perspectives into
    research, which could include the establishment of a Focused
    Ultrasound Patient Engagement Advisory Board.
        Food as Medicine.--The Committee understands the potential
    for food as medicine interventions such as medically tailored
    meals, medically tailored groceries, and produce prescriptions,
    to improve health outcomes and treat diet-related chronic
    diseases. The Committee encourages NIH to provide an update in
    the fiscal year 2027 congressional justification on its food as
    medicine research, including consideration of Food as Medicine
    Centers of Excellence and collaborations with the scientific
    community.
        Forced Swim/Tail Suspension Tests.--The Committee commends
    NIH's efforts to decrease the use of animal models in research
    but remains concerned about the use of certain neurobehavioral
    approaches, such as the forced swim and tail suspension test,
    which are known to have poor predictive value for understanding
    human mental illness, such as depression, or developing
    effective therapeutics. The Committee is aware that other
    countries have limited the use of the forced swim test due to
    scientific and animal welfare concerns. The Committee
    appreciates that NIH has provided guidance to potential
    research applicants considering the use of animal
    neurobehavioral approaches in basic and pre-clinical research
    relevant to mental illnesses. In such guidance, NIH explains
    NIMH's priorities when determining funding priorities include
    the ability of the proposed model to answer the project's
    research question. The guidance also recommends using animal
    models for addressing neurobiological questions versus models
    of specific mental illnesses and strongly discourages proposals
    from describing animal behaviors in terms of human emotions.
    The Committee urges NIH to limit any funding for grants
    involving the forced swim test or tail suspension test. The
    Committee strongly encourages NIH to continue to increase
    support for human-specific mental health and behavioral health
    research, including imaging, epidemiological, clinical,
    computational, and cell-derived approaches, which can provide
    more translational insights into the underlying neurobiology of
    human mental illness.
        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 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.
        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 2025
    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 predict drug
    options. The benefits of this technology include the ability to
    stretch clinical trial resources efficiently to address patient
    needs. The Committee acknowledges that if properly implemented
    during the drug development process, this technology could
    increase 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 directs NIH to provide an update in the fiscal year
    2027 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 $110,000,000, a $20,000,000 increase
    above the level provided in fiscal year 2025, within OD for the
    INvestigation of Co-occurring conditions across the Lifespan to
    Understand Down syndrome (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. The Committee urges
    NIH to streamline, coordinate, and synergize research for
    IACCIs across the NIH institutes, centers, and offices, to
    reduce duplication, inefficiency, and redundancies.
        Menopause Research.--The Committee is aware of the research
    gaps related to basic research into and knowledge and
    understanding of menopause and perimenopause and treatments.
    Addressing this gap could improve health outcomes and the
    quality of life for the nation's middle aged and older women.
    The Committee encourages NIH to research more into the
    different stages of menopause, including research related to
    symptoms and treatments for menopause at its different stages.
    As part of the fiscal year 2027 congressional justification,
    the Committee requests an update on recent NIH research into
    menopause and its treatments.
        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 encourages NIH to
    review primary chemicals in the life cycle analysis of plastic
    materials and 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.
        Morgan Island.--The Committee is concerned about the Morgan
    Island rhesus macaque breeding colony supported by NIAID and
    available for other institutes and centers to use for research
    purposes. The Committee understands that the more than 3,000
    NIAID-owned rhesus monkeys currently held there are considered
    an invasive species that may pose health and environmental
    risks. The Committee is aware other Federal agencies such as
    the FDA and Department of Veterans Affairs are implementing
    initiatives to reduce animal testing and research in animals,
    respectively, and in the case of the FDA to advance new
    alternative methods (NAMs), too. The Committee commends NIH's
    recently announced efforts to advance human-focused research,
    such as NAMs, and reduce the use of animals. Such efforts will
    encourage research investigators to consider and use the models
    that best translate research findings to human health and
    disease. The Committee urges NIH to assess whether there
    remains a scientific need to continue breeding primates on
    Morgan Island. Such assessment should be included in the fiscal
    year congressional justification.
        Mucopolysaccharidoses and Mucolipidosis.--The Committee
    recognizes the severity of Mucopolysaccharidoses and
    Mucolipidosis (MPS/ML) diseases and the need for additional
    research 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 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, as well as
    research into preventing the next pandemic, including studies
    that utilize non-human primates.
        Nutrition Research.--The Committee acknowledges NIH's past
    investments in nutrition research, including through various
    institutes and centers, the Office of Nutrition Research, and
    initiatives such as the Nutrition for Precision Health powered
    by the All of Us Research program. The Committee also notes the
    recently announced NIH-FDA initiative, the Nutrition Regulatory
    Science Program. This effort seeks to advance nutrition
    research to inform policy decisions and improve health
    outcomes, by exploring research topics such as the relationship
    between ultra-processed foods and health, maternal and infant
    dietary exposures and health outcomes over the lifespan, and
    others. The Committee notes with concern the limited research
    into rates of chronic disease among the population and the role
    of nutrition in preventing and addressing chronic disease. To
    support increased NIH investment in nutrition and its relation
    to human health and disease, the Committee directs an increase
    of $10,000,000 for nutrition research, out of funding available
    under the Office of the Director.
        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. The Committee recognizes that women's health includes
    conditions and diseases that disproportionately or differently
    affect women and that sex differences are at the cellular
    level. Despite prior investments and progress made, gaps remain
    in research, scientific understanding, and medical care due to
    factors such as a lack of consistent sex-based data,
    coordination across disciplines, and representative
    participation in clinical trials. The Committee notes that
    opportunities to enhance NIH efforts focused on the health of
    women across the lifespan could address these gaps and urges
    NIH to prioritize research that addresses the most pressing
    research gaps. The Committee supports expanded, integrated NIH-
    wide investment in women's health research focused on
    accelerating innovative biomedical discoveries and solutions
    and requests an update in the fiscal year 2027 congressional
    justification on such research.
        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 past 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 2027 congressional justifications
    information on the representation of COMs in NIH applications
    and awards. Additionally, the Committee encourages engagement
    by the NIH with osteopathic education leaders.
        Pediatric Lyme Disease.--As part of the fiscal year 2027
    congressional justification, the Committee requests an update
    on the agency's plans to advance research on pediatric Lyme
    disease. The Committee encourages NIH, including NIAID, NINDS
    and NIMH, to increase study of neurologic symptoms of Lyme
    disease, including in children, and to investigate novel
    treatments of neurologic symptoms.
        Pediatric Researchers.--The Committee urges NIH to maintain
    a robust pediatric research portfolio spanning basic,
    translational, and clinical research, to support early career
    researchers focused on pediatrics, to ensure pediatric
    components are included within larger NIH research priorities,
    structures or processes influence the number of investigator-
    initiated pediatric research projects, pediatric research
    priorities are established, and pediatric research activity is
    coordinated across NIH.
        Peripheral Neuropathy.--Peripheral neuropathy is a
    debilitating condition that affects 30 million Americans, often
    causing considerable pain, mobility issues, and other forms of
    disability. The Committee encourages NIH institutes researching
    peripheral neuropathy to coordinate efforts related to the
    diagnosis and treatment of various types of peripheral
    neuropathy. There are several known causes of this condition,
    including Type 2 diabetes and chemotherapy. The Committee
    encourages NIH to consider the merits of a Peripheral
    Neuropathy Center of Excellence program, as part of NIH's
    overall efforts to expand research into the multiple causes and
    manifestations of this condition.
        Physician Scientist Workforce.--The Committee encourages
    NIH to continue supporting efforts to increase the number of
    physician-scientists who pursue biomedical research
    opportunities. Such efforts could include supporting research-
    oriented career development grants with mentorship activities
    and postdoctoral trainees, empowering researchers to
    independently pursue new fields of research, and building on
    the findings of its June 2014 Physician-Scientist Workforce
    Working Group Report.
        Polycystic Ovary Syndrome.--The Committee commends OD for
    incorporating Polycystic Ovary Syndrome (PCOS) into Research,
    Condition, and Disease Categories (RCDC) reporting. Despite
    progress, the Committee notes the profound impact that PCOS has
    on 10 percent of women and its annual economic burden of over
    $15,000,000,000 in the U.S., compared to $10,000,000 in
    research projects supported in 2023, per the RCDC. PCOS has a
    large health and economic burden, given its metabolic,
    cardiovascular, reproductive, maternal health, and mental
    health manifestations and the lack of FDA approved treatments
    specifically for it. The Committee urges increased NIH support
    for PCOS research, including the metabolic, cardiovascular,
    psychosocial, maternal fetal, oncologic, pediatric,
    dermatologic, neurologic, and reproductive aspects of PCOS. The
    Committee encourages the NIH to invest in fundamental
    laboratory science, patient-oriented research, clinical trials,
    and longitudinal studies on the cardiometabolic features and
    endocrinopathy of PCOS throughout the lifespan. Areas of
    interest include closing knowledge gaps, researching novel
    diagnostics and treatments, 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 treatment priorities.
        Replication Experiments and Fraud Detection.--The Committee
    is concerned that many biomedical research studies have turned
    out to be irreproducible or even outright fraudulent. The
    recent Reproducibility Project in Cancer Biology showed that
    cancer biology studies in top journals often failed to be
    replicable (with replication effects that were 85 percent
    smaller than the original study), and a prominent line of
    Alzheimer's studies was found in recent years to be based on an
    allegedly fraudulent study funded by NIH in the early 2000s.
    Additionally, the Committee commends the NIH for setting
    reproducibility and rigor among its key priorities, as outlined
    in the budget request, for enabling the agency to advance
    science in pursue of improving health for Americans, as well as
    to restore public trust and confidence in the agency's research
    findings. Given the importance of both reproducibility in the
    scientific enterprise and the detection of fraud, the Committee
    provides $100,000,000 to establish a program out of the Common
    Fund in the Office of the Director to fund replication
    experiments on significant lines of research, as well as
    attempts to proactively look for signs of academic fraud. The
    Committee directs NIH to brief the Committee within 180 days of
    enactment of this Act on the establishment, staffing, and plans
    for this effort in fiscal years 2026 and 2027.
        Reporting on Monetary Donations.--The Committee is
    concerned by findings in the HHS OIG report, ``Most
    Institutions That Received NIH Funding Did Not Fully Understand
    When They Must Report Monetary Donations,'' published in March
    2025. NIH-funded institutions must report all ``other support''
    that their NIH-funded investigators receive related to their
    research, including resources from foreign and domestic
    entities, such as financial support, high-value materials, and
    in-kind contributions such as laboratory space or employees.
    Before making awards, NIH uses this to determine if the other
    support and an NIH award would result in a scientific,
    budgetary, or commitment overlap. NIH disburses more than 80
    percent of its approximately $48 billion budget to
    universities, medical schools, and other research institutions.
    It is therefore concerning that only one in five institutions
    that responded to OIG's survey could accurately identify
    instances in which they must report monetary donations to NIH.
    One quarter of the institutions did not correctly identify any
    of the instances that require monetary reporting. Insufficient
    reporting by institutions undermines NIH's oversight of awards,
    and it increases the risk that taxpayer dollars are spent on
    duplicative support to researchers. The Committee requests an
    update in the fiscal year 2027 congressional justification on
    NIH's efforts to implement the OIG's recommendation that NIH
    provide clarity to institutions on their monetary reporting
    requirements.
        Sjogren's Disease.--Recognizing that research into
    Sjogren's disease can lead to improved care for those living
    with this disease, the Committee requests an update in the
    fiscal year 2027 congressional justification on NIH research
    and other activities related to the diagnosis and treatment of
    Sjogren's disease.
        Somatic Mosaicism Across Human Tissues Program.--The
    Somatic Mosaicism across Human Tissues program, supported by
    the Common Fund, aims to discover somatic mutations in the
    tissues of 150 otherwise healthy, but deceased individuals, to
    identify fundamental mutational mechanisms that may give rise
    to common human diseases. The Committee encourages continued
    support of such efforts, including planned efforts to generate
    somatic variant catalogs, develop of tools and methods, and
    create an integrative data workbench.
        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,
    and to support research related to the treatment and management
    of spina bifida and associated conditions, such as
    hydrocephalus, wounds and related amputations, and sudden death
    in the adult spina bifida population. The Committee requests an
    update in the fiscal year 2027 congressional justification on
    research findings on spina bifida and related issues. The
    Committee supports NICHD's research to understand early human
    development, set the foundation for a healthy pregnancy, and
    promote lifelong wellness of women and children with spina
    bifida. NIH is encouraged to support research to identify time
    sensitive periods to optimize health interventions,
    therapeutics, and devices to improve health during transition
    from adolescence to adulthood.
        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.

                            BUILDINGS AND FACILITIES

    Appropriation, fiscal year 2025.......................      $350,000,000
    Budget request, fiscal year 2026......................       210,000,000
    Committee Recommendation..............................       352,000,000
        Change from enacted level.........................        +2,000,000
        Change from budget request........................      +142,000,000

        Mission.--This account provides for the design,
    construction, improvement, major repair, and demolition of
    clinical, laboratory, and office buildings and supporting
    facilities essential to the mission of the NIH. The funds in
    this appropriation support the buildings on the main NIH campus
    in Bethesda, Maryland; the Animal Center in Poolesville,
    Maryland; the National Institute of Environmental Health
    Sciences facility in Research Triangle Park, North Carolina;
    the National Institute of Allergy and Infectious Diseases in
    Hamilton, Montana; and other smaller facilities throughout the
    U.S.
        The Committee understands that safe, reliable, and up-to-
    date facilities are integral for supporting NIH research now
    and in the future. The Committee is aware that according to the
    fiscal year 2027 congressional justification, the agency's
    maintenance and repairs backlog across its campuses exceeded
    $4.1 billion as of the end of fiscal year 2024. The Committee
    appreciates the Building and Facilities program's commitment to
    its Repairs and Improvements program, as such investments in
    existing facilities are intended to enhance facility
    performance and reduce building emergencies which can be costly
    and disruptive to research.

                             NIH INNOVATION ACCOUNT

    Appropriation, fiscal year 2025.......................      $127,000,000
    Budget request, fiscal year 2026......................       226,000,000
    Committee Recommendation..............................       226,000,000
        Change from enacted level.........................       +99,000,000
        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; $31,000,000 for the
    All of Us precision medicine initiative within the Office of
    the Director and $195,000,000 for the BRAIN initiative split
    equally between NIMH and NINDS. The Committee notes that fiscal
    year 2026 is the final year of funding from the Cures Act for
    these activities.

             ADVANCED RESEARCH PROJECTS AGENCY FOR HEALTH (ARPA-H)

    Appropriation, fiscal year 2025.......................    $1,500,000,000
    Budget request, fiscal year 2026......................       945,000,000
    Committee Recommendation..............................       945,000,000
        Change from enacted level.........................      -555,000,000
        Change from budget request........................             - - -

        Mission.--The Advanced Research Projects Agency for Health
    fosters the development of novel, breakthrough, and broadly
    applicable capabilities and technologies to accelerate
    transformative innovation in biomedical science and medicine in
    a manner that cannot be readily accomplished through
    traditional Federal biomedical research and development
    programs or commercial activity.
        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 wide-ranging network of experts to advance innovation
    and commercialization of medical technologies. Additionally,
    the Committee notes the role of funding sprints to rapidly
    accelerate innovation in targeted priority areas, by delivering
    specialized entrepreneurial assistance, commercialization and
    market readiness programming, and other targeted services as
    innovators seek to translate critical transformative biomedical
    and health breakthroughs.
        Fall Prevention Research.--Falls are the top cause of
    injury and injury-related death among adults 65 and older. The
    Committee encourages ARPA-H to support research on fall risk
    factors and interventions to reduce falls among older adults.
        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.
        Mental Health Research.--The Committee encourages ARPA-H to
    support mental health research, including on the diagnosis and
    treatment of severe mental illness to address widespread
    behavioral health issues. The committee also encourages
    research on developing treatments and cures for dementia, given
    the prevalence and impact of this disease on society and the
    potential for such an investment to spur industry developments
    and new academic partnerships.
        Nanovaccine Research.--The Committee recognizes the
    importance of investing 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 encourages ARPA-H to
    support funding for academic researchers working on
    nanovaccines.
        Respiratory Health.--The Building Resilient Environments
    for Air and Total Health (BREATHE) program seeks to
    revolutionize the early detection, treatment, and long-term
    management of respiratory conditions, including asthma, COPD,
    pulmonary fibrosis, and other lung diseases. The Committee
    recognizes that current diagnostics and therapies for many
    respiratory illnesses remain inadequate, and that improved
    interventions could improve patient outcomes and reduce health
    care system costs. The Committee encourages ARPA-H to include
    populations living in communities with poor air quality as part
    of efforts to continue this program.

           SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION

    Insert 133AAppropriation, fiscal year 2025............    $7,374,306,000
    Budget request, fiscal year 2026......................     5,693,278,000
    Committee Recommendation..............................     7,075,855,000
        Change from enacted level.........................      -298,451,000
        Change from budget request........................    +1,382,577,000

        The Committee recommendation for the SAMHSA program level
    includes $6,932,188,000 in discretionary budget authority,
    $131,667,000 in PHS Evaluation Tap Funding, and $12,000,000 in
    transfers from the PPHF.
        SAMHSA is the agency within HHS that leads public health
    efforts to reduce the impact of substance abuse and mental
    illness in the United States. The Committee notes that CDC's
    provisional data on national drug overdose fatalities revealed
    a promising 26.9 percent decrease in 2024, reaching the lowest
    level since 2019. While drug overdose fatalities remain
    exceptionally high, the Committee commends this progress and
    recognizes SAMHSA's efforts in reducing drug overdose
    fatalities in the United States.
        The Committee further notes that the Department proposes to
    incorporate SAMHSA into a new Administration for a Healthy
    America. The Committee looks forward to working with the
    authorizing committees of jurisdiction as they consider this
    proposal.
        The Committee continues to include bill language that
    exempts the MHBG and the SUPTRS Block Grant as a source of
    funding 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 remains
    concerned about the high rates of mental health challenges and
    suicidal ideation among adolescent females. Recent studies find
    that adolescent females are highly susceptible to negative
    health outcomes associated with extended social media use,
    including higher rates of psychological distress, body image
    issues, and eating disorders. The Committee directs the
    Secretary, 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 Addiction.--The Committee notes that problem
    gambling costs the United States millions each year. This
    behavioral disorder often leads to poor financial, emotional,
    social, occupational, and physical health outcomes. Therefore,
    the Committee directs SAMHSA to include in its fiscal year 2027
    congressional justification information on how the agency is
    supporting prevention and treatment efforts for individuals
    struggling with gambling addiction.
        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, United States Code,''
    which is the drug and alcohol testing program for operators of
    commercial motor vehicles. While more than seven 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, synthetic
    opioids, and polysubstance abuse--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
    2027 congressional justification.
        Harm Reduction.--The Committee commends the Trump
    Administration's efforts to prioritize prevention, treatment,
    and long-term 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 use of illicit
    controlled substances.
        Homelessness.--The Committee directs HHS to include in the
    fiscal year 2027 congressional justification information on how
    the Department currently prioritizes substance use and mental
    health programs for populations at high risk of becoming
    homeless, evaluates the effectiveness of current policies, and
    considers new policies that could lead to improved outcomes.
    The Committee also directs HHS to prioritize programs that
    require proper treatment, robust accountability, and pathways
    to self-sufficiency.
        Right to Bear Arms.--The Committee recognizes that firearm
    ownership is a constitutionally guaranteed right recognized by
    the United States 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 Opioid Technical Assistance Regional Centers.--The
    Committee directs SAMHSA to maintain funding for the 10
    cooperative agreements under the Rural Opioid Technical
    Assistance Regional Centers program at not less than the fiscal
    year 2024 level without consolidation of the program. The
    Committee further directs SAMHSA to provide a briefing on this
    topic within 90 days of enactment of this Act.
        Substance Abuse Treatment.--The Committee recognizes the
    potential benefits of Glucagon-like peptide-1 (GLP-1)
    medications in treating and reducing alcohol and substance
    abuse disorders and encourages SAMHSA to take steps to support
    the use of GLP-1s to target such disorders.
        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 2025.......................    $2,808,546,000
    Budget request, fiscal year 2026......................     1,463,331,000
    Committee Recommendation..............................     2,700,560,000
        Change from enacted level.........................      -107,986,000
        Change from budget request........................    +1,237,229,000

    988 Suicide & Crisis Lifeline

        The Committee provides $519,618,000 for the 988 Suicide &
    Crisis Lifeline, which is the same as the fiscal year 2025
    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.
        Campus Awareness Activities.--The Committee encourages HHS,
    in coordination with the Department of Education and relevant
    State and local stakeholders, to increase awareness of the 988
    Lifeline among college students, including the publication of
    988 on newly-printed standard issue student identification
    cards.
        Program Integrity.--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
    continue to 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 facilitates seamless coordination with local
    crisis and emergency response teams, accommodates a connection
    to follow-up and community resources, incorporates robust
    cybersecurity standards, 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, strengthening 988
    cybersecurity infrastructure, and responding to feedback from
    States and other 988 program partners.
        Public Awareness and Education Activities.--The Committee
    remains concerned that suicide is a leading cause of death in
    the United States, with particular concern regarding the
    suicide rates among youth, adolescents, young adults, veterans,
    and rural and underserved communities. The Committee notes that
    despite studies repeatedly demonstrating that crisis
    intervention services such as 988 are effective in reducing
    suicidal ideation and providing support to individuals in
    crisis, public awareness of the 988 Lifeline remains below 50
    percent. Therefore, the Committee directs SAMHSA to prioritize
    funding for 988 public awareness and education activities
    targeted toward all high-risk populations. The Committee
    requests that SAMHSA include an update in the fiscal year 2027
    congressional justification on the agency's progress in
    addressing disparities in public awareness and utilization of
    the 988 Lifeline, including the allocation of funds for
    carrying out public awareness and education activities.
        Tribal Capacity Building.--Tribal Nations continue to face
    unique challenges with fully adopting 988 services, including
    access to technology and crisis support services,
    intergovernmental coordination, and culturally responsive
    mental health services. Therefore, the Committee requests a
    briefing within 90 days of enactment of this Act on SAMHSA's
    988 crisis capacity activities as they relate to Tribal
    communities funded under the Bipartisan Safer Communities Act
    (P.L. 117-159).

    Assisted Outpatient Treatment for Individuals With Serious Mental
            Illness

        The Committee provides $26,420,000 for Assisted Outpatient
    Treatment for Individuals with Serious Mental Illness (AOT),
    which is a $5,000,000 increase above the fiscal year 2025
    enacted program level, to deliver outpatient treatment under a
    civil court order to adults with a serious mental illness who
    meet State civil commitment AOT criteria, such as prior history
    of non-adherence to treatment, repeated hospitalizations, or
    arrest. The Committee notes that AOT may reduce psychiatric
    hospitalizations, emergency department visits, and
    incarceration rates while improving health outcomes and
    treatment satisfaction and adherence. The Committee encourages
    HHS to continue supporting the implementation and evaluation of
    new AOT programs, including the continued support for the
    technical assistance center. The Committee notes ongoing
    assessment challenges of existing AOT programs and urges the
    Department to identify program metrics that can be reliably
    reported by grantees for the purpose of assessing the grant
    program's effectiveness. The Department should also continue to
    work with grantees to ensure that their programs are consistent
    with the goals of the AOT program and focused on serving
    participants who would not otherwise agree to participate in
    treatment voluntarily.

    Certified Community Behavioral Health Clinics

        The Committee provides $385,000,000 for the CCBHC program,
    which is the same as the fiscal year 2025 enacted program
    level. CCBHCs are designed to ensure access to coordinated,
    comprehensive behavioral health care by providing services for
    mental health and substance use disorders to all who request
    them, regardless of age or ability to pay. CCBHCs provide
    access to crises services around the clock, support outpatient
    mental health and substance use treatment, and provide
    community-based mental health care for veterans.
        Technical Assistance and Screening for Physical Health
    Conditions.--The Committee recognizes that individuals living
    with serious mental illnesses and substance use disorders face
    higher risks for developing chronic physical conditions
    commonly associated with long-term use of certain mental health
    medications, including diabetes, cardiovascular disease, and
    medication-induced movement disorders. The Committee encourages
    SAMHSA to expand technical assistance to improve integrated
    care through the CCBHC State Technical Assistance Center and
    the CCBHC Expansion Grantee National Training and Technical
    Assistance Center. This technical assistance and training would
    enhance routine screening, prevention, and early intervention
    for physical health conditions commonly associated with long-
    term use of antipsychotic medications, particularly among high-
    risk populations. The Committee further encourages SAMHSA to
    coordinate with HRSA to facilitate dissemination of technical
    information on screening at-risk patients in integrated care
    models to Federally Qualified Health Centers and Rural Health
    Clinics.

    Children's Mental Health Services

        The Committee provides $132,000,000 for Children's Mental
    Health Services, which is a $2,000,000 increase above the
    fiscal year 2025 enacted program level, to fund grants and
    technical assistance for community-based services for children
    and adolescents with serious emotional, behavioral, and/or
    other mental health disorders. Grants assist States, local
    jurisdictions, and Tribes in developing integrated systems of
    community care. The Committee directs SAMHSA to continue
    supporting grant funding and the technical assistance center,
    including increasing mental health services and supports for
    children and youth.

    Mental Health Services Block Grant

        The Committee provides $1,017,571,000 for the MHBG, which
    is $10,000,000 above the fiscal year 2025 enacted program
    level. Of the funds provided, $21,039,000 shall be derived from
    evaluation set-aside funds available under section 241 of the
    PHS Act. 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 among at-risk youth and young adults, and the 5
    percent set-aside for crisis-based services. The Committee
    notes that, consistent with State plans, communities may choose
    to direct additional funding to crisis stabilization programs.
        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.

    National Child Traumatic Stress Initiative

        The Committee provides $100,887,000 for the National Child
    Traumatic Stress Initiative (NCTSI), which is a $2,000,000
    increase above the fiscal year 2025 enacted program level, to
    increase access to effective trauma and grief focused treatment
    and services systems for children, adolescents, and their
    families, who experience traumatic events. The Committee
    recognizes NCTSI's network for building, evaluating,
    disseminating, and delivering evidence-based services and best
    practices to prevent and mitigate the impact of exposure to
    trauma among children and families. The Committee encourages
    SAMHSA to continue awarding new Category I, II, and III grants
    to meet core mission activities of NCTSI, support collaboration
    among grantees, and expand the capacity of current National
    Child Traumatic Stress Network grantees for activities related
    to child trauma.

    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 2025 enacted program level, 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.

    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 (PAIMI),
    which is the same as the fiscal year 2025 enacted program
    level, 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. The Committee notes that Federal funding continues to
    supplement non-Federal funds available to States for PAIMI
    activities.
        Within the total provided for Mental Health Programs of
    Regional and National Significance, the Committee includes the
    following amounts:

    ------------------------------------------------------------------------
                                                                FY 2026
              Budget Activity            FY 2025  Enacted      Committee
    ------------------------------------------------------------------------
    Capacity:
        Seclusion and Restraint.......         $1,147,000         $1,147,000
        Project AWARE.................        140,001,000        126,551,000
            Tribal Set-Aside..........              - - -         12,655,000
        Mental Health Awareness                27,963,000              - - -
         Training.....................
        Healthy Transitions...........         28,451,000         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              - - -
         Grants.......................
        Project LAUNCH................         23,605,000              - - -
        Mental Health System                    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         30,200,000
         Prevention...................
            Zero Suicide..............         22,800,000         23,800,000
            American Indian and Alaska          3,400,000          4,400,000
             Native Set-Aside.........
        Garrett Lee Smith-Youth
         Suicide Prevention
            State Grants..............         43,806,000         46,806,000
            Campus Grants.............          8,488,000         12,488,000
        American Indian and Alaska              3,931,000          4,931,000
         Native Suicide Prevention....
        Tribal Behavioral Health               22,750,000         30,000,000
         Grants.......................
        Homeless Prevention Programs..         33,696,000              - - -
        Minority AIDS.................          9,224,000              - - -
        Criminal and Juvenile Justice          11,269,000              - - -
         Programs.....................
        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              - - -
        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 2025 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 $126,551,000 for
    Project AWARE (Advancing Wellness and Resiliency in Education)
    State and Tribal grants, which is a $13,450,000 decrease below
    the fiscal year 2025 enacted program level and a $6,050,000
    increase above the President's Budget, to implement mental
    health related promotion, awareness, prevention, intervention,
    and resilience activities to ensure that school-aged youth have
    access and are connected to trauma-informed and developmentally
    appropriate behavioral health services. The Committee notes
    that program funding is intended to supplement State and local
    investments in school mental health services.
        Tribal Set-Aside.--Of the funds made available for Project
    AWARE, the Committee directs that no less than 10 percent 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 SAMHSA prioritizes services and programing for
    individuals with severe mental illness.
        Healthy Transitions.--The Committee provides $28,451,000
    for the Healthy Transitions program, which is the same as the
    fiscal year 2025 enacted program level, to expand access to
    services and supports for transition-aged youth and young
    adults with serious mental illness.
        Infant and Early Childhood Mental Health.--The Committee
    provides $15,000,000 for the Infant and Early Childhood Mental
    Health program, which is the same as the fiscal year 2025
    enacted program level, to support human service agencies and
    nonprofit organizations that provide age-appropriate mental
    health promotion and early intervention or treatment for
    children 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 for the Children and Family program, which is a
    $1,000,000 increase above the fiscal year 2025 enacted program
    level, to provide grants to Tribes and Tribal organizations 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
    no funding for the Consumer and Family Network program in
    accordance with the President's Budget. The Committee
    prioritizes treatment, prevention, and support services for
    individuals with serious mental illness and does not provide
    funding for broad advocacy activities that may promote bias
    views on mental health treatment.
        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 no funding for the Mental Health System Transformation
    program in accordance with the President's Budget. The
    Committee notes that the Transforming Lives through Supported
    Employment Program (SEP) is also funded through the Practice
    Improvement and Training programs.
        Primary and Behavioral Health Care Integration.--The
    Committee provides $55,877,000 for the Primary and Behavioral
    Health Care Integration program, which is the same as the
    fiscal year 2025 enacted program level, 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 $30,200,000 for the implementation of the National
    Strategy for Suicide Prevention, which is a $2,000,000 increase
    above the fiscal year 2025 enacted program level.
        Within the amount provided, the Committee includes
    $23,800,000 for the Zero Suicide program, which is an increase
    of $1,000,000 above the fiscal year 2025 enacted program level.
    Zero Suicide grants support suicide prevention efforts in
    health systems, including screening adults for suicide risks,
    providing referral services, implementing evidence-based
    practices to provide services to high-risk adults, and raising
    awareness of such risks.
        Within the amount provided, $4,400,000 is included for Zero
    Suicide grants to American Indian and Alaska Native health
    systems, which is an increase of $1,000,000 above the fiscal
    year 2025 enacted program level.
        Garrett Lee Smith Youth Suicide Prevention.--The Committee
    provides $59,294,000 for GLS Youth Suicide Prevention grant
    programs, which is a $7,000,000 increase above the fiscal year
    2025 enacted program level.
        Within the amount provided, the Committee includes
    $46,806,000 for grants to States and Tribes to support
    development and implementation efforts of youth suicide
    prevention activities and services, which is a $3,000,000
    increase above the fiscal year 2025 enacted program level. Of
    the funds provided, $12,000,000 shall be transferred from the
    PPHF.
        Within the amount provided, $12,488,000 is included for
    grants to institutions of higher education to support students
    with mental health or substance use disorders, which is an
    increase of $4,000,000 above the fiscal year 2025 enacted
    program level.
        Garrett Lee Smith Peer Support Activities.--The Committee
    recognizes that delayed mental health treatment can lead to
    higher acuity, health care costs, and suicide rates. Campus
    programs that provide peer training on early intervention and
    education on primary prevention have shown promise in improving
    treatment-seeking behaviors and mental health referrals among
    students. Therefore, the Committee encourages SAMHSA to
    prioritize funding for grantees that support on-campus student
    groups with peer-to-peer crisis intervention training and
    primary prevention education for mental health. The Committee
    requests that SAMHSA include an update in the fiscal year 2027
    congressional justification on the agency's efforts to improve
    peer support activities as part of the grants to institutions
    of higher education program.
        American Indian/Alaska Native Suicide Prevention
    Initiative.--The Committee provides $4,931,000 for the Tribal
    Training and Technical Assistance Center, which is a $1,000,000
    increase above the fiscal year 2025 enacted program level, 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 abuse, and reduce substance misuse among AI/AN
    communities.
        Tribal Behavioral Grants.--The Committee provides
    $30,000,000, which is a $7,250,000 increase above the fiscal
    year 2025 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 Programs, noting
    that these programs are duplicative of the Projects for
    Assistance in Transition from Homelessness program and other
    Federal housing assistance programs administered by the
    Department of Housing and Urban Development.
        Criminal and Juvenile Justice Activities.--The Committee
    provides no funding for Criminal and Juvenile Justice
    Activities in accordance with the President's Budget. The
    Committee notes that the Office of Juvenile Justice and
    Delinquency Prevention under the Department of Justice provides
    funding to States and Tribes for the purpose of improving the
    juvenile justice system, including support for mental health
    and substance abuse treatment.
        Assertive Community Treatment for Individuals with Serious
    Mental Illness.--The Committee provides $9,000,000 for
    Assertive Community Treatment programs, which is the same as
    the fiscal year 2025 enacted program level, to support 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, which is the same as the fiscal year
    2025 enacted program level.

    Science and Service:

        Garrett Lee Smith Suicide Prevention Resource Center.--The
    Committee provides $11,000,000 for the GLS Suicide Prevention
    Resource Center, which is the same as the fiscal year 2025
    enacted program level, to build national capacity for
    preventing suicide by providing technical assistance, training,
    and resources to assist States, Tribes, private organizations,
    and SAMHSA grantees to develop suicide prevention strategies.
    The Committee encourages SAMHSA to continue expanding training
    opportunities and public-private collaboration on youth suicide
    prevention and early intervention strategies.
        Practice Improvement and Training.--The Committee provides
    $7,828,000, which is the same as the fiscal year 2025 enacted
    program level, to support the dissemination of key information,
    such as evidence-based mental health practices, 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 2025 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 2025 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 520K of the PHS
    Act 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 2025 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 2025 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 screening and treatment of eating disorders. The
    Committee encourages SAMHSA to conduct a public service
    announcement with the purpose of raising awareness about
    identifying, preventing, and treating eating disorders.

                           SUBSTANCE ABUSE TREATMENT

    Appropriation, fiscal year 2025.......................    $4,159,298,000
    Budget request, fiscal year 2026......................        19,770,000
    Committee Recommendation..............................     4,008,963,000
        Change from enacted level.........................      -150,335,000
        Change from budget request........................    +3,989,193,000

    State Opioid Response Grants

        The Committee includes $1,575,000,000 for State Opioid
    Response (SOR) grants, which is the same as the fiscal year
    2025 enacted program level. The Committee supports efforts from
    SAMHSA through SOR grants to expand access to substance use
    disorder 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 not less than 5 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.
        Data Collection and Sharing Information.--The Committee
    recognizes the importance of data collection and reporting
    information to help inform grant recipients and subrecipients
    of effective Opioid Response interventions and to inform
    congressionally mandated reporting of the Opioid Response
    program. As noted in a December 2024 Government Accountability
    Office report (GAO-25-106944), grant recipients have used
    Federal funds to support a variety of prevention, treatment,
    and recovery services. However, opportunities exist to improve
    data sharing and transparency, particularly about subrecipients
    of Opioid Response funding. Therefore, the Committee directs
    SAMHSA to finalize implementation of subrecipient data
    collection and reporting requirements for grant recipients as
    authorized under 42 U.S.C. Sec. 290ee-3a(c) and (f). The
    Committee further directs SAMHSA to publicly report aggregated,
    de-identified grantee data or other information about the use
    of Opioid Response funding for purposes of advancing best
    practices among grant recipients. The Committee requests SAMHSA
    brief the congressional committees of jurisdiction on its
    implementation plans no later than 90 days after the enactment
    of this Act.
        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.

    Substance Use Prevention, Treatment, and Recovery Services Block Grant

        The Committee includes $2,013,079,000 for the SUPTRS Block
    Grant, which is a $5,000,000 increase above the fiscal year
    2025 enacted program level. Of the funds provided, $79,200,000
    shall be derived from evaluation set-aside funds available
    under section 241 of the PHS Act. 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.
        Opioid Use Disorder in Rural Communities.--The Committee is
    aware that the opioid use disorder crisis continues to pose
    unique challenges for rural America, including 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.
        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 by emphasizing that opioid
    detoxification should be followed by proper treatment and long-
    term recovery services. The Committee encourages SAMHSA to
    continue these programs in all settings where detoxification is
    offered, including opioid treatment programs, rehabilitation
    centers, and criminal justice settings.
        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.
        Preventing Prescription Drug and Opioid Overdoses.-- The
    Committee notes strong concerns about the high number of
    unintentional overdose deaths attributable to prescription,
    nonprescription, and illicit 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.
        Within the total provided for Programs of Regional and
    National Significance, the Committee recommends the following
    amounts:

    ------------------------------------------------------------------------
                                                  FY 2025         FY 2026
                 Budget Activity                  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-General.     122,416,000     131,416,000
            Medication-Assisted Treatment        111,000,000     120,000,000
             for Prescription Drug and
             Opioid Addiction...............
                Tribal Set-Aside............      14,500,000      20,000,000
        Grants to Prevent Prescription Drug       16,000,000      16,000,000
         Opioid Overdose....................
        First Responder Training............      57,000,000      58,000,000
            Rural Emergency Medical Services      32,000,000      33,000,000
             Training Grants (non-add)......
        Pregnant and Postpartum Women.......      38,931,000      38,931,000
        Recovery Community Services Program.       4,434,000       4,434,000
        Children and Families...............      30,197,000      30,197,000
        Treatment Systems for the Homeless..      37,144,000           - - -
        Minority AIDS.......................      66,881,000           - - -
        Criminal Justice Activities.........      94,000,000      75,000,000
            Drug Courts.....................      74,000,000      75,000,000
        Improving Access to Overdose               1,500,000       1,500,000
         Treatment..........................
        Building Communities of Recovery....      17,000,000       8,500,000
        Peer Support Technical Assistance          2,000,000           - - -
         Center.............................
        Comprehensive Opioid Recovery              6,000,000       8,000,000
         Centers............................
        Emergency Department Alternatives to       8,000,000       8,000,000
         Opioids............................
        Treatment, Recovery, and Workforce        12,000,000      12,000,000
         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 2025 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 in accordance
    with the President's Budget.
        Targeted Capacity Expansion.--The Committee provides
    $131,416,000 for the Targeted Capacity Expansion program
    including the Medication-Assisted Treatment for Prescription
    Drug and Opioid Addition program (MAT-PDOA), which is a
    $9,000,000 increase above the fiscal year 2025 enacted program
    level. These programs support State and local governments,
    Tribes, nonprofit organizations, and health care facilities to
    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 2025 enacted 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.
        The Committee notes that while fatal opioid overdose rates
    among young Americans have decreased, the issue remains a
    serious public health threat. Studies show that access to
    opioid overdose reversal agents such as naloxone reduce
    overdose deaths, therefore, the Committee encourages SAMHSA to
    provide schools access to and administration training for
    naloxone and other effective drug reversal agents.
        First Responder Training.--The Committee provides
    $58,000,000 for First Responder Training program. This amount
    includes $33,000,000 for Rural Emergency Medical Services
    Training Grants, which is a $1,000,000 increase above the
    fiscal year 2025 enacted program level, 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 2025 enacted 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 2025 enacted
    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 2025 enacted
    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 $75,000,000 for
    SAMSHA's Drug Court initiative, which is a $1,000,000 increase
    above the fiscal year 2025 enacted program level. 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 2025
    enacted 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
    $8,500,000 for the Building Communities of Recovery program,
    which is a $8,500,000 decrease below the fiscal year 2025
    enacted program level and $8,500,000 above the President's
    Budget. This program enables the development, expansion, and
    enhancement of recovery community organizations.
        Peer Support Technical Assistance Center.--The Committee
    provides no funding for the Peer Support Technical Assistance
    Center in accordance with the President's Budget.
        Comprehensive Opioid Recovery Centers.--The Committee
    provides $8,000,000 for Comprehensive Opioid Recovery Centers,
    which is a $2,000,000 increase above the fiscal year 2025
    enacted program level. This program provides grants to entities
    that operate comprehensive treatment and recovery centers for
    individuals with opioid use disorder.
        Emergency Department Alternatives to Opioids.--The
    Committee provides $8,000,000 for the Emergency Department
    Alternatives to Opioids program, which is the same as the
    fiscal year 2025 enacted program level. 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 for the Treatment, Recovery, Workforce
    Support program, which is the same as the fiscal year 2025
    enacted program level. This program supports individuals in
    substance use disorder treatment and recovery to live
    independently and participate in the workforce.
        Youth Prevention and Recovery Initiative.--The Committee
    provides $2,000,000 for the Youth Prevention and Recovery
    Initiative, which is the same as the fiscal year 2025 enacted
    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 including
    those with co-occurring mental illnesses.

    Science and Services:

        Minority Fellowship Program.--The Committee provides
    $7,136,000, which is the same as the fiscal year 2025 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 2025.......................      $236,879,000
    Budget request, fiscal year 2026......................        18,704,000
    Committee Recommendation..............................       205,009,000
        Change from enacted level.........................       -31,870,000
        Change from budget request........................      +186,305,000

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

    ------------------------------------------------------------------------
              Budget Activity            FY 2025 Enacted   FY 2026 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         14,500,000
         Underage Drinking............
            National Adult-Oriented             2,500,000          2,500,000
             Media Public Service
             Campaign.................
            Community Based Coalition          11,000,000         12,000,000
             Enhancement Grants.......
            Interagency Coordinating            1,000,000              - - -
             Committee to Prevent
             Underage Drinking........
        Tribal Behavioral Health               23,665,000         30,000,000
         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:

        Drug Free Communities.--The Committee notes that the
    Department proposes to transfer the Drug-Free Communities (DFC)
    from the Office of National Drug Control Policy (ONDCP) to the
    Administration for a Healthy America. DFC supports community-
    based coalitions that engage multiple sectors of the community
    to prevent youth substance use. The Committee looks forward to
    working with the authorizing committees of jurisdiction as they
    consider this proposal.
        Strategic Prevention Framework.--The Committee provides
    $140,484,000 for the Strategic Prevention Framework (SPF),
    which is a $5,000,000 increase above the fiscal year 2025
    enacted program level. SPF provides grants to States, Tribes,
    and local governmental organizations to prevent substance
    abuse. The Committee provides no funding for SPF Rx in
    recognition of the continually evolving nature of substance
    addiction and abuse. 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 abuse, 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 for Federal Drug-Free Workplace Programs (DFWP),
    which is the same as the fiscal year 2025 enacted program
    level. 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 $14,500,000 for the Sober Truth on
    Preventing Underage Drinking (STOP) Act, which is the same as
    the fiscal year 2025 enacted program level. 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 and provides grants to prevent and reduce
    alcohol use among youth under the age of 21. This program has
    also historically funded the Interagency Coordinating Committee
    on the Prevention of Underage Drinking (ICCPUD).
        The Committee is concerned that under the Biden
    Administration, funding for ICCPUD was diverted for purposes
    unrelated to preventing underage drinking. The Committee notes
    concern that ICCPUD carried out research on adult alcohol
    consumption and used those findings as input for the 2025
    Dietary Guidelines for Americans. Furthermore, this research is
    duplicative as the Committee had previously allocated
    $1,300,000 under section 772 of the Consolidated Appropriations
    Act, 2023, for an independent study on alcohol consumption
    practices for the purposes of informing the Dietary Guidelines.
    These actions raise serious concerns about ICCPUD's ability to
    function within its scope and authority, maintain transparency
    with Congress, and prevent duplicative efforts. Therefore, the
    Committee provides no funding for the Interagency Coordinating
    Committee on the Prevention of Underage Drinking.
        Tribal Behavioral Grants.--The Committee provides
    $30,000,000, which is $6,335,000 increase above the fiscal year
    2025 enacted program level, to address the high incidence of
    substance abuse and suicide among the AI/AN population. Despite
    the recent national decline in drug overdose deaths, Tribal
    communities continue to experience disproportionately higher
    rates of illicit drug use, opioid misuse, misuse of
    prescription drugs, and fatal and non-fatal drug overdoses. The
    AI/AN population is also at higher risk of dying by suicide
    compared to the general U.S. population.
        Fentanyl and Prescription Drug Misuse Prevention.--The
    Committee supports efforts to better educate the public and
    increase awareness about the potential lethality of fentanyl
    and polysubstance and other prescription drug misuses.

    Science and Service:

        Center for the Application of Prevention Technologies.--The
    Committee provides $9,493,000 for the Center for the
    Application of Prevention Technologies, which is the same as
    the fiscal year 2025 enacted program level, 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 recognizes the Center for Substance Abuse
    Prevention and the Prevention Technology Transfer Centers for
    their work in implementing the Prevention Fellowship Program.
    This program supports early career prevention fellows in
    gaining 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 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 authorized for such grants.
        Science and Service Activities.--The Committee provides
    $4,072,000, which is the same as the fiscal year 2025 enacted
    program level, to support the adoption and use of effective
    substance use disorder prevention strategies across the
    continuum of care, with a special focus on health systems. The
    program also supports the Tribal Training and Technical
    Assistance Center, which provides specialized training and
    assistance to improve Tribal behavioral health outcomes.
        Minority Fellowship Program.--The Committee provides
    $1,321,000, which is the same as the fiscal year 2025 enacted
    program level, to provide stipends to increase the number of
    addiction 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 2025.......................      $169,583,000
    Budget request, fiscal year 2026......................        65,823,000
    Committee Recommendation..............................       161,323,000
        Change from enacted level.........................        -8,260,000
        Change from budget request........................       +95,500,000

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

    ------------------------------------------------------------------------
              Budget Activity            FY 2025 Enacted   FY 2026 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
    Public Awareness and Support......         13,260,000          5,000,000
    Performance and Quality                    10,200,000         10,200,000
     Information Systems..............
    Drug Abuse Warning Network........         10,000,000         10,000,000
    Behavioral Health Workforce.......          1,000,000          1,000,000
        PHS Evaluation Funds..........          1,000,000          1,000,000
    ------------------------------------------------------------------------

        National Online Treatment Services Locator.--The Committee
    recognizes the importance of individuals and families having
    access to timely, accurate, and complete information on
    substance use and mental health treatment services. The
    Committee is concerned that SAMHSA's national treatment
    locator, FindTreatment.gov, contains inaccurate information
    that may be hindering access to care. As noted in a March 2025
    HHS Office of the Inspector General report (A-09-23-01003), an
    estimated 14,283 of 22,106 facilities found on this platform
    contained inaccurately reported information such as contact and
    services information. Therefore, the Committee directs SAMHSA
    to brief the congressional committees of jurisdiction--no later
    than 90 days after the day of the enactment of this Act--on the
    actions the agency, in coordination with its contractor, have
    taken to meet OIG's recommendations, including additional steps
    taken to improve the accuracy of the online treatment services
    locator.

                   Agency for Healthcare Research and Quality

                        HEALTHCARE RESEARCH AND QUALITY

    Appropriation, fiscal year 2025.......................      $369,000,000
    Budget request, fiscal year 2026......................             - - -
    Committee Recommendation..............................             - - -
        Change from enacted level.........................      -369,000,000
        Change from budget request........................             - - -

        The Committee provides no funding for 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, the Substance Abuse and Mental Health Services
    Administration, and the Office of the Assistant Secretary for
    Health.

                    Centers For Medicare & Medicaid Services

                         GRANTS TO STATES FOR MEDICAID

    Appropriation, fiscal year 2025................         $383,609,399,000
    Budget request, fiscal year 2026...............          508,148,791,000
    Committee Recommendation.......................          508,148,791,000
        Change from enacted level..................         +124,539,392,000
        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 $261,063,820,000, which was
    provided as advance funding for the first quarter of fiscal
    year 2026. In addition, the Committee recommends an advance
    appropriation of $316,514,725,000 for program costs in the
    first quarter of fiscal year 2027, to remain available until
    expended.
        The Committee continues bill language providing indefinite
    budget authority for unanticipated costs in fiscal year 2026.
    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 2025................         $521,757,000,000
    Budget request, fiscal year 2026...............          593,817,000,000
    Committee Recommendation.......................          593,817,000,000
        Change from enacted level..................          +72,060,000,000
        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 resources for the Medicare
    Part D drug benefit program if the annual appropriation is
    insufficient.

                               PROGRAM MANAGEMENT

    Appropriation, fiscal year 2025................           $3,669,744,000
    Budget request, fiscal year 2026...............            3,464,391,000
    Committee Recommendation.......................            3,474,391,000
        Change from enacted level..................             -195,353,000
        Change from budget request.................              +10,000,000

        The Committee notes that the Department proposes to
    administer the Office of Pharmacy Affairs within CMS rather
    than HRSA. The Committee looks forward to working with the
    authorizing committees of jurisdiction as they consider the
    Department's proposal.

    Program Operations

        The Committee includes $2,302,942,000 for Program
    Operations. 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.
        Advancing Non-Opioid Alternatives for Chronic Pain.--The
    Committee recognizes the impact of chronic pain on millions of
    Americans and is concerned that, despite advances in expanding
    access to non-opioid alternatives for acute pain, barriers
    remain for chronic pain that limit beneficiaries' treatment
    options. The Committee requests an update no later than 180
    days after enactment of this Act on the availability of non-
    opioid treatment options to manage chronic pain conditions and
    encourages CMS to work with Congress and relevant stakeholders
    to identify coverage and payment incentives to improve access
    to non-opioid alternatives for chronic pain.
        Area Wage Index.--The Committee notes the significant
    disparities in Medicare reimbursement created by the current
    wage index system. These disparities create financial and
    operational disadvantages between hospitals, endangering
    critical access to care for communities served by the lowest
    paid providers, which are often rural and underserved areas.
    The Committee strongly urges the establishment of 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, Energy and Commerce, and Ways and Means of
    the House of Representatives and the Committee on
    Appropriations of the Senate 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 data and data updates used to generate prior
    authorization decisions drawn from AI applications, the
    accountability measures ensuring quality of care, and privacy
    safeguards in place.
        Behavioral and Mental Health Guidance for Home and
    Community-Based Behavior Health Services.--The Committee
    requests that CMS issue a guide similar to the guide CMS issued
    on school-based behavioral health services titled, ``Delivering
    Service in School-Based Settings'', outlining how States can
    implement intensive home and community-based behavioral health
    services to address the growing behavioral and mental health
    crisis. The Committee encourages CMS to include in such
    guidance information regarding potential billing codes that
    States can use to cover intensive home and community-based
    behavioral health services.
        Calibrating the Risk Adjustment Model on MA Encounter.--The
    Committee recognizes that a Medicare Advantage (MA) risk
    adjustment model calibrated using fee-for-service claims data
    does not account for coding patterns between volume-based and
    value-based care differences. The Committee understands that MA
    encounter data is available to CMS and more thoroughly
    documents consumer diagnoses, treatments, and services, and the
    use of encounter data to calibrate risk adjustment models will
    lead to improved payment accuracy and deter aggressive coding
    practices. The Committee encourages CMS to incorporate
    encounter data where possible in calibrating MA risk adjustment
    models.
        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 pass-through 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.
        Certificate of Need Requirements.--The Committee notes that
    certificate of need (CON) laws vary widely across State
    jurisdictions. Such laws require healthcare providers to obtain
    authorization from State authorities to construct or expand
    health care facilities or offer health care services. The
    Committee directs GAO to examine, to the extent data are
    available and reliable, how selected State CON laws may affect
    Federal healthcare spending. The Committee requests that GAO
    provide a preliminary briefing to the Committees on
    Appropriations of the House of Representatives and the Senate
    no later than 12 months following the enactment of this Act
    with a report to follow.
        Chronic Kidney Disease Guidelines (CKD) and Early Screening
    for CKD.--The Committee is committed to ensuring that patients
    with 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 savings to the Federal government.
    Therefore, the Committee encourages CMS to work to ensure the
    Medicare benefit guidelines reflect the most recent clinical
    CKD guidelines and to increase access to early screening
    utilizing both estimated glomerular filtration rate (eGFR) and
    urine Albumin-to-Creatinine Ratio (uACR) testing, diagnosis,
    and treatment for high-risk populations for CKD.
        Chronic Obstructive Pulmonary Disease (COPD).--COPD has a
    significant impact on the U.S. health care system as the fourth
    most common reason for death and disability and the third
    leading cause of hospital readmissions. The Committee
    encourages CMS to increase awareness of best clinical practices
    for COPD management, identify gaps in current Medicare quality
    measure sets where more targeted measurement of the effective
    COPD management is needed, and consider developing service
    delivery models that increase access to high-quality COPD care.
        Clarifying Organ Recovery Reimbursement.--The Committee
    notes that Organ Procurement Organization (OPO) Recovery
    Centers can increase the number of organs available for
    transplantation and ICU bed capacity for living patients. The
    Committee is concerned that the current reimbursement guidance
    disincentives effective and efficient organ recovery.
    Therefore, the Committee encourages CMS to consider updating
    Medicare provider guidance to expand safe procurement of organs
    including through other available measures such as deceased
    donor organs sent to other Certified Transplant Centers (CTCs),
    organs sent to OPOs, organs recovered from CTC patients
    transferred to OPOs, and kidneys sent to U.S. military renal
    transplant centers (MRTCs).
        Coding Intensity Adjustments.--The Committee is aware that
    Medicare Advantage (MA) payments are risk-adjusted to provide
    sufficient resources to deliver comprehensive care for
    individuals with complex health needs, but appropriate use of
    diagnosis coding can vary. The Committee understands CMS
    applies a statutory coding intensity adjustment equally to all
    MA health plans regardless of any existing variance in coding
    intensity. The Committee encourages CMS to evaluate existing
    incentives for coding intensity and make recommendations to
    Congress for revisions to coding intensity adjustments that
    will result in more effective care management.
        Cognitive Screening and Diagnostic Tools.--The Committee
    notes the importance of early cognitive screening as a critical
    step in diagnosing a patient with Alzheimer's disease (AD),
    which is the most common cause of dementia, and recognizes the
    limited uptake among Medicare beneficiaries during the Medicare
    annual wellness visit (AWV). Additionally, the Committee notes
    new AD blood-based biomarker tests are entering the field that
    could make future diagnosis less invasive, less costly, and
    more accessible to patients, but may not have clear coverage
    pathways under Medicare. The Committee encourages CMS to
    explore coverage policies that would improve access to
    cognitive screening tools and AD blood-based biomarker tests
    under Medicare.
        Colorectal Cancer Screenings.--The Committee recognizes the
    importance of ensuring access to medically necessary colorectal
    cancer screenings. The Committee is concerned that barriers
    including utilizing up-to-date clinical standards and ensuring
    adequate access to wraparound services remain. The Committee
    encourages CMS to review such barriers to support updated
    clinical evidence for colorectal cancer screenings and related
    services.
        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.
        Critical Access Hospital Designations.--The Committee is
    aware that CMS periodically conducts reviews of Critical Access
    Hospital (CAH) designations across the country. The Committee
    is concerned that CMS is revoking CAH status from longstanding
    CAHs without accounting for issues related to access to care.
    This issue is particularly acute for rural communities with
    hospitals that have retained and relied on a CAH designation
    for decades, have been recertified multiple times, and have
    nevertheless lost their CAH designation even though no new
    primary or secondary roads or hospitals have been constructed
    in the vicinity of the hospital. The Committee strongly urges
    CMS to review such circumstances in which CAHs have reasonably
    relied on their CAH designation for decades, work with hospital
    officials and local stakeholders to restore CAH designations
    where appropriate, and work with Congress on any further
    reforms that may be needed to assist facilities in such
    circumstances. The Committee requests an update on these
    efforts in the fiscal year 2027 congressional justification.
        Digital Services Modernization.--The Committee supports the
    efforts by CMS to modernize and expand both internal and
    public-facing digital services, consistent with the 21st
    Century Integrated Digital Experience Act (P.L. 115-336). The
    Committee recognizes that digitizing paper-based processes can
    reduce administrative burden, enhance accuracy and speed of
    benefits delivery, and improve overall efficiency. The
    Committee encourages CMS to prioritize such efforts to
    streamline provider enrollment, beneficiary services, and
    program integrity functions, including the prevention of fraud,
    waste, and abuse.
        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 promote efficiency, improve patient outcomes, and ensure
    patient safety.
        Ensuring Access to 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 years
    old. 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.
        Flint Water Crisis.--The Committee recognizes the long-
    lasting impacts of the Flint water crisis on the health and
    well-being of affected residents. The Committee is aware that
    settlement payments to impacted residents are forthcoming and
    is concerned that CMS may assert liens or other penalties
    against these payments. In order to ensure these resources are
    delivered to those harmed by the Flint water crisis, the
    Committee encourages CMS to avoid any actions that would unduly
    reduce or delay the settlement funds due to Flint residents.
        Guam Memorial Hospital TEFRA Rate Adjustment Study.--The
    Committee notes that Medicare payments for the Guam Memorial
    Hospital (GMH) are calculated using out-of-date payment data
    and formulas under the Tax Equity and Fiscal Responsibility Act
    of 1982 (TEFRA). The Committee urges CMS to deliver a report to
    Congress on the feasibility of updating payment rates to GMH
    pursuant to TEFRA.
        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 VA system versus coverage
    provided under Medicare. The information gaps may have resulted
    in some veterans receiving late-enrollment penalties under the
    Medicare program. 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.
        Long-Term Care Facility Metrics.--The Committee is
    concerned the long-stay antipsychotic medication quality
    measure from the Skilled Nursing Facility (SNF) Five-Star
    Quality Rating System fails to distinguish between appropriate
    and inappropriate use of these medications, as determined by
    the HHS Office of the Inspector General. As such, the Committee
    encourages CMS to develop an alternative long-term care
    facility metric regarding the use of antipsychotic medication
    for conditions associated with neurodegenerative diseases.
        Maintaining Access to Essential Medical Devices.--The
    Committee recognizes that CMS has authority to make payment
    adjustments under the inpatient prospective payment system
    (IPPS) and the hospital outpatient prospective payment system
    (OPPS) to support higher-quality domestically sourced medical
    products. The Committee encourages CMS to consider building on
    existing payment adjustments under IPPS and OPPS to promote
    access to domestically made medical devices and essential
    medical supplies, such as needles, syringes, and blood
    collection products.
        Maternal Healthcare in Rural Hospitals.--The Committee
    recognizes the importance of rural hospitals in providing
    maternal health care services, educating patients, and ensuring
    post-partum safety. The Committee is concerned that
    insufficient reimbursement and payments, increasing costs of
    operation, and narrowing profit margins threaten the viability
    of hospitals in rural areas. The Committee is aware that
    Medicaid payment rates are often insufficient for 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 directs CMS to submit a report to the
    Committees on Appropriations and Energy and Commerce of the
    House of Representatives and the Committee on Appropriations of
    the Senate within 180 days of the 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 how
    payment rates impact care options, including how the rates may
    impact the utilization of new treatment pathways and devices
    for birthing complications.
        Medicare ``e-Prescribing'' Template.--The Committee is
    aware that CMS developed a set of clinical data elements in
    2018 to identify the data necessary to support medical
    necessity of supplemental oxygen claims and allow for
    electronic prescribing of supplemental oxygen. However, CMS has
    not yet approved contractors to use this electronic template to
    establish medical necessity and support all audit documentation
    requirements. The Committee requests that CMS provide an update
    on such efforts in its fiscal year 2027 congressional
    justification.
        Medicare Prescription Repayment Program.--The Committee
    directs CMS to provide a quarterly report to Congress and post
    on a publicly available website with (1) the number of
    beneficiaries who have opted into the Medicare Prescription
    Payment Plan, including trends and demographic breakdowns, to
    ensure transparency and inform potential improvements to the
    program; (2) the total number of beneficiaries categorized as
    ``likely to benefit'' by the Part D plan sponsor; (3)
    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 (4)
    information on additional outreach efforts that CMS is
    conducting with stakeholders, including provider associations
    and societies, patient and consumer advocacy groups, and
    pharmacy benefit managers. The Committee also encourages CMS to
    assess and identify barriers to participation and make targeted
    investments in outreach, education, and enrollment facilitation
    efforts to increase beneficiary uptake. The Committee
    acknowledges concerns raised by pharmacy groups regarding
    point-of-sale enrollment but emphasizes the need for a
    streamlined and accessible enrollment process for
    beneficiaries. As such, the Committee urges CMS to explore
    mechanisms to facilitate point-of-sale enrollment, ensuring
    that beneficiaries can easily access the program at the time of
    filling their prescriptions in person or online.
        Money Follows the Person Demonstration Grant.--The
    Committee notes that it is not the intent of 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 (911 calls; ER visits) for
    MFP participants.
        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. The
    Committee requests CMS provide a report to the Committees on
    Appropriations of the House of Representatives and the Senate,
    no later than 180 days after enactment of this Act, that
    delineates specific proposals to ensure access to care for an
    obesity diagnosis and addresses steps CMS can take to include
    anti-obesity medications under Medicare Part D. The report
    should include an analysis on the ways CMS can integrate anti-
    obesity medications to treat obesity as part of a comprehensive
    response, which Medicare policies could be improved to reduce
    obesity and its comorbidities for those that need clinical
    intervention, and how those CMS policies will be updated.
        One Big Beautiful Bill Act (OBBBA) Implementation.--Within
    90 days of enactment of this Act, the Committee directs CMS to
    provide a report to the Committees on Appropriations of the
    House of Representatives and the Senate detailing the
    obligation and expenditure of funds appropriated by the OBBBA
    for the Rural Health Transformation Program (RHTP). The
    Committee directs CMS to include in such report: (1) aggregate
    commitments, obligations, and outlays for the RHTP, (2)
    commitments, obligations and outlays for each State based on
    the equal allotments provided for each State under the OBBBA,
    and (3) commitments, obligations and outlays for each State
    based on amounts determined by the Administrator under the
    OBBBA. The Committee further directs CMS to provide thereafter
    a biannual update on such report to the Committees.
        Organ Procurement Organization (OPO) Performance.--The
    Committee recognizes that in recent years, CMS has taken steps
    to increase oversight of OPOs, including by establishing new
    methods to evaluate performance and issuing rules to decertify
    OPOs falling below the median performance on certain metrics.
    The Committee remains extremely concerned by the findings of a
    recent investigation by HRSA that revealed practices by a major
    OPO that compromised patient safety. CMS has a considerable
    responsibility for ensuring that OPOs operate in a safe, fair,
    and efficient manner that is transparent, accountable, and
    effective. Patients are also at risk if OPOs are unable to
    operate due to stringent or unworkable requirements from CMS.
    As CMS continues to work with OPOs to ensure that the organ
    donation system promotes patient safety and operates
    effectively, the Committee encourages the agency to prioritize
    outreach and education to stakeholders; alleviate disruption;
    ensure that OPOs can effectively expand into new service areas,
    when necessary; and issue clarifying guidance. The Committee
    urges CMS to continue to promote accountability, identify
    vulnerabilities, and issue strict corrective actions as needed
    to ensure that any donation processes do not continue if
    patient safety concerns arise.
        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 (MPFS) are inflated and
    exceed what is statutorily required. The Committee is concerned
    that CMS overestimates utilization 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, 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 to which
    CMS 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. The
    Committee directs GAO to provide a briefing on this study to
    the Committees on Appropriations, Energy and Commerce, and Ways
    and Means of the House of Representatives, and the Committee on
    Appropriations of the Senate, within 120 days of enactment of
    this Act with a report to follow.
        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 the scalable involvement of
    pharmacists. The Committee encourages CMS to create a mechanism
    to provide greater visibility into the quality and outcomes of
    the Medicare services currently provided by pharmacists.
        Program of All-Inclusive Care for the Elderly (PACE).--The
    Committee acknowledges the important role the Program of All-
    Inclusive Care (PACE) has had in keeping its medically complex
    population living at home safely. Given the increasing demand
    for home and community-based services by older adults and those
    living with disabilities, the Committee encourages the
    Secretary to move forward expeditiously on PACE-specific model
    tests. Examining methods of increasing access and affordability
    for this comprehensive, coordinated, integrated, and fully
    risk-bearing model of care will allow more Medicare
    beneficiaries, Medicaid beneficiaries, and dually eligible
    individuals to age in place cost effectively and with better
    health outcomes.
        Protecting Essential Medicines.--The Committee recognizes
    the critical importance of maintaining domestic manufacturing
    capacity for essential medications. The Committee is concerned
    that the statutory design of the Manufacturer Discount Program
    (MDP) intended for brand products inadvertently includes
    products that were approved under a New Drug Application (NDA)
    rather than a generic Abbreviated New Drug Application (ANDA)
    due solely to unique FDA regulatory circumstances. The
    Committee requests the Department provide an update in the
    fiscal year 2027 congressional justification specifying the
    current impact on patients, steps that can be taken by CMS and
    Congress to address this issue, and efforts to support domestic
    manufacturers producing essential medicines.
        Protecting Medicare Beneficiary Access to Therapy.--The
    Committee is concerned with the HHS OIG's findings that
    Medicare Part D payors have denied or delayed timely Medicare
    beneficiary access to medically necessary medication through
    excessive use of utilization management, and the negative
    implications for beneficiaries with the implementation of Part
    D benefit redesign. The Committee acknowledges the growing
    concerns by patients regarding the consequences of Part D
    redesign for Medicare beneficiaries and the timely opportunity
    for the agency to improve transparency around the use of
    utilization in response to these concerns. The Committee
    requests an update in the fiscal year 2027 congressional
    justification on the new actions the agency is taking to
    protect Medicare beneficiaries by enhancing its oversight of
    and transparency related to the use of utilization management
    by Part D plans to ensure no adverse impacts to beneficiary
    access to therapies.
        Provider Education for Opioid Alternatives.--The Committee
    recognizes the importance of the Non-Opioid Addiction in the
    Nation (NOPAIN) Act, which went into effect in January 2025,
    and seeks to increase access to non-opioid pain management. The
    Committee directs CMS, in coordination with CDC, to furnish
    educational materials and training for providers at outpatient
    surgical settings in both hospital outpatient department and
    ambulatory surgery centers on the usage, benefits, and options
    for non-opioid pain management. The Committee directs CMS and
    CDC to report on the status of these plans and activities
    within 180 days of enactment of this Act.
        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 support efforts by CMS to
    work closely with all affected stakeholders to develop reforms
    that support patient's access to high quality, innovative care.
        Recognition of Licensed Naturopathic Physicians.--The
    Committee requests a report within three years of enactment of
    this Act regarding the number of naturopathic physicians
    enrolled in Medicaid, including an analysis of the impact of
    covering naturopathic physicians as Medicaid providers.
        Reducing False-Positive Sepsis Blood Cultures.--The
    Committee is aware that false-positive results may occur with
    blood culture tests used to diagnose blood stream infections,
    like sepsis. These false-positive test results can lead to
    morbidity and mortality among misdiagnosed patients, spending
    on unnecessary treatment, and the overuse of antibiotics. The
    Committee encourages CMS to adopt a blood culture contamination
    rate measure to better address and account for factors that
    lead to false-positive test results.
        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 would support efforts to
    identify alternative data sources.
        Review of Medicare Coverage Criteria for Insulin Pumps.--
    Insulin pumps are critical for people with diabetes to manage
    their condition and it is important for CMS to ensure Medicare
    coverage policies are consistent with current clinical
    standards of care. The Committee encourages CMS to review its
    coverage policies to ensure that requirements, including those
    relating to the measurement of C-peptide levels or an antibody
    test, are consistent with clinical standards of care and report
    to the Committees on Appropriations of the House of
    Representatives and the Senate within 180 days of enactment of
    this Act regarding the ability of Medicare beneficiaries to
    receive covered insulin pumps.
        Robotic Stereotactic Radiosurgery.--The Committee
    recognizes how robotic stereotactic radiosurgery (SRS) and
    robotic stereotactic body radiation therapy (SBRT) are
    treatment options for many types of cancer in both the hospital
    and freestanding center setting. The Committee encourages CMS
    to review current billing arrangements to ensure access to
    robotic SRS and robotic SBRT, including maintaining existing
    applicable G-codes.
        Rural Health Transformation Program.--The Committee notes
    that the Rural Health Transformation Program, established by
    the One Big Beautiful Bill Act (OBBBA), provides
    $50,000,000,000 over the next five fiscal years to improve
    access to hospitals and health care providers for rural
    residents of each State. Fifty percent of such funding shall be
    allotted in amounts to be determined by the Administrator
    taking into consideration various enumerated factors, including
    such factors that the Administrator determines appropriate. In
    making such determinations, the Committee urges the
    Administrator to take into consideration the financial
    stability of hospitals that are adversely impacted by the
    significant disparities in Medicare reimbursement created by
    the current wage index system, hospitals located on Indian
    Reservations that are not currently eligible for a Critical
    Access Hospital designation, and hospitals in States that had
    not fully implemented a Medicaid managed care program prior to
    passage of the OBBBA.
        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 United States. Given the promise of
    HPV self-sampling, the Committee urges CMS to expedite review.
        Stark Law Compliance.--The Committee encourages CMS 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) where appropriate in related
    guidance, rulemaking, and enforcement action. 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 will continue to go
    unaddressed, increasing costs to patients and the health care
    system.
        Strengthening Medicare Advantage Networks for Cancer
    Patients.--The Committee acknowledges the remarkable advances
    in more effective treatments and cures for patients affected by
    cancer, a disease which afflicts more than 2 million Americans
    each year. Approximately 60 percent of cancer patients are aged
    65 or older and rely on the Medicare program as their primary
    source of health care coverage. The Committee notes that many
    Medicare Advantage (MA) networks do not include federally
    recognized National Cancer Institute (NCI)-designated
    comprehensive cancer centers (CCC), which are scientific
    leaders meeting rigorous standards for their transdisciplinary
    research across cancer prevention, management, and treatment.
    These specialized cancer centers translate research into
    advanced clinical care that has been proven to deliver the
    highest survival rates for cancer patients.Effective treatment
    relies on the accuracy of initial diagnosis, timeliness of
    intervention, therapy selection, collaboration among multiple
    experts, and access to appropriate clinical trials or novel
    therapies. The Committee requests information in the fiscal
    year 2027 congressional justification on beneficiary access to
    NCICCCs in Medicare Advantage plans and in Medicare Parts A and
    B.
        Whole Child Health.--The Committee commends CMS for
    establishing the Integrated Care for Kids Model and for CMS'
    support of State flexibility to improve the quality of care for
    children covered by Medicaid. The Committee encourages CMS to
    design a next generation whole child health demonstration
    program. The model would address the root causes of poor
    physical and mental health in children served by Medicaid and
    CHIP and would promote financially sustainable pediatric
    payment and delivery models that support disease prevention and
    improve health. Such models would focus on proven local
    strategies to improve pediatric health in a variety of
    settings, such as primary care and schools, including in rural
    areas. The Committee requests an update from CMS within 120
    days of enactment of this Act on efforts to design a whole
    child health demonstration program, including cost estimates
    for implementation.

    State Survey and Certification

        The Committee provides $407,334,000 for State Survey and
    Certification activities. 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 $744,061,000 for Federal
    Administration activities related to the Medicare and Medicaid
    programs. 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 CARE FRAUD AND ABUSE CONTROL ACCOUNT

    Appropriation, fiscal year 2025.......................      $941,000,000
    Budget request, fiscal year 2026......................       941,000,000
    Committee Recommendation..............................       941,000,000
        Change from enacted level.........................             - - -
        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 in budget
    adjustment funding.
        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 2025.......................    $3,924,000,000
    Budget request, fiscal year 2026......................     4,147,000,000
    Committee Recommendation..............................     4,147,000,000
        Change from enacted level.........................      +223,000,000
        Change from budget request........................             - - -

        The Committee also provides $1,800,000,000 in advance
    funding, as requested, for the first quarter of fiscal year
    2027 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 2025.......................    $4,025,000,000
    Budget request, fiscal year 2026......................             - - -
    Committee Recommendation..............................     4,035,000,000
        Change from enacted level.........................       +10,000,000
        Change from budget request........................    +4,035,000,000

        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 recognizes the positive impact LIHEAP has
    on low-income families and encourages HHS to maintain this
    program for eligible recipients.
        LIHEAP Workforce.--The Committee encourages ACF to address
    any vacancies that may affect program operations or its ability
    to fulfill its statutory responsibility to provide home heating
    and cooling assistance to low-income households Nationwide.

                         REFUGEE AND ENTRANT ASSISTANCE

    Appropriation, fiscal year 2025.......................    $6,327,214,000
    Budget request, fiscal year 2026......................     4,292,755,000
    Committee Recommendation..............................     4,292,755,000
        Change from enacted level.........................    -2,034,459,000
        Change from budget request........................             - - -

        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:

    ------------------------------------------------------------------------
              Budget Activity            FY 2025 Enacted   FY 2026 Committee
    ------------------------------------------------------------------------
    Transitional and Medical Services.       $564,000,000              - - -
    Refugee Support Services..........        307,201,000              - - -
    Victims of Trafficking............         30,755,000        $30,755,000
    Unaccompanied Alien Children......      5,406,258,000      4,243,000,000
    Survivors of Torture..............         19,000,000         19,000,000
    ------------------------------------------------------------------------

        The Committee provides no funding for the Transitional and
    Medical Services program (TAMS) and the Refugee Support
    Services (RSS) programs. Under the previous administration,
    TAMS and RSS incentivized unchecked migration through cash
    handouts, medical assistance, and public welfare services. The
    Committee recognizes the Trump Administration's efforts to curb
    refugee border encounters and referrals by the Department of
    Homeland Security (DHS) to ORR. The Committee encourages HHS to
    continue processing credible refugee referrals made by the
    Department of State and DHS through existing refugee assistance
    programs.

    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 United States.
        Within the $30,755,000 provided for Victims of Trafficking
    program, the Committee includes not less than $5,000,000 for
    the National Human Trafficking Hotline (Hotline), which is the
    same as the fiscal year 2025 enacted program level.
        Education and Awareness in Health Care.--The Committee
    recognizes that victims of trafficking often utilize the health
    care system and medical professionals are in a unique position
    to identify and respond to signs of abuse. The Committee
    encourages ACF to continue funding the SOAR to Health and
    Wellness Training Program (SOAR Program) to train health care
    professionals to understand the risk factors of trafficking, to
    recognize indicators of trafficking, to screen patients and
    identify potential victims, and to work with relevant
    stakeholders to deliver trauma-informed and person-centered
    care. The Committee further encourages the agency to evaluate
    the effectiveness of the SOAR Program, specifically its impacts
    on identifying and reporting suspected trafficking cases in
    health care settings. The evaluation should also include a
    cost-benefit analysis of Federal spending on the SOAR Program.
    The Committee requests ACF include an update in its fiscal year
    2027 congressional justification detailing the findings of this
    evaluation.
        Hotline Mandatory Reporting.--The Committee is alarmed by
    recent reports that the current Hotline grantee is no longer
    sharing trafficking tips from concerned third parties and
    distressed family members with law enforcement. The Committee
    recognizes the Department's commitment to the goals and
    operations of the Hotline, including the referral of actionable
    tips to law enforcement. As outlined in the fiscal year 2025
    Hotline Notice of Funding, an objective of the Hotline is to
    notify law enforcement and child welfare agencies of potential
    cases of human trafficking, as well as instances when a
    trafficking victim is in imminent danger, and to document
    emerging or common trafficking schemes to assist in the
    detection and investigation of trafficking cases. However, the
    Committee is concerned that the grantee's current policies may
    be undermining the safety of trafficking victims. Therefore,
    the Committee directs HHS to ensure the Hotline is compliant
    with all Federal, State, and local laws, regulations, or
    policies, that require mandatory reporting to law enforcement
    for investigations into possible human trafficking. The
    Committee further directs the Department to conduct robust
    oversight of the Hotline to ensure accurate and timely
    reporting of trafficking tips to law enforcement. The Committee
    requests HHS include an update in its fiscal year 2027
    congressional justification detailing the Hotline's compliance
    with respect to these reporting requirements.
        Public Awareness Campaign.--The Committee notes that HHS
    currently coordinates with DHS on various national trafficking
    prevention awareness activities, including the HHS Look Beneath
    the Surface Campaign and the DHS Blue Campaign. Each campaign
    is designed to educate and partner with the public, law
    enforcement, grantees, and key industry stakeholders to
    recognize the indicators of human trafficking, and how to
    appropriately respond to possible cases. The Committee
    encourages HHS, in coordination with DHS, to continue improving
    the public health response to human trafficking, including
    providing the necessary support services for survivors and
    families, partnering with schools and community-based agencies
    to raise awareness, and identifying and mitigating risk factors
    for trafficking.
        Youth Prevention Education and Awareness.--The Committee
    recognizes the important role of educators in preventing human
    trafficking and providing a safe and supportive school
    environment for survivors. The Committee strongly encourages
    ACF to continue funding the Human Trafficking Youth Prevention
    Education (HTYPE) Demonstration Grant Program. HTYPE provides
    funds to local educational agencies for the purpose of
    partnering with law enforcement and non-governmental
    organizations to develop and implement human trafficking
    prevention education and training opportunities for students,
    caregivers, teachers, and other school personnel. The Committee
    notes the program's success in helping participants identify,
    respond to, and support potential victims of trafficking. The
    Committee urges ACF to expand education and training
    opportunities to school nurses and other school-based health
    care providers.

    Unaccompanied Alien Children

        The UAC program supports the care and placement of
    unaccompanied children under the age of 18 apprehended by DHS.
    These unaccompanied minors are at risk for human trafficking
    and child exploitation. Costs to serve this population have
    soared in recent years, leading to unsustainable growth and the
    risk of increased illicit activities. The safety and well-being
    of vulnerable children was jeopardized when ORR reduced its
    vetting requirements for sponsors and adult members living in a
    sponsor's household. Thousands of children were released to
    improperly vetted sponsors and placed at increased risk of
    trafficking, forced labor, and other forms of exploitation. In
    2025, the Trump Administration prioritized child safety by
    strengthening ORR's vetting process for UAC households,
    including enhancements to its mandated background checks, DNA
    testing, and home study requirements. ORR also implemented
    other UAC policies such as requiring proof of income for all
    sponsors and denying the release of children when a sponsor
    provides false information or refuses biometric screening. The
    Committee notes that the Trump Administration's immigration
    enforcement measures have reduced the number of UAC border
    encounters and UAC-associated costs. Therefore, the Committee
    proposes reduced funding consistent with the historical needs
    of the account.
        Care and Placement 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 2021-2025 and shall
    make such a report available on its website.
        Case Management.--The Committee directs the Department, in
    coordination with DHS, to continue its implementation of a new
    case management system that can be integrated with the Unified
    Immigration Portal (UIP) for improved UAC placement and release
    decisions. The UIP helps with real-time data collection and
    tracking of UACs at the time of apprehension and through the
    referral, placement, and repatriation process.
        Facility Occupancy Rates.--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.
        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.
        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. The Committee notes ORR's recent updates to the
    UAC Policy Guide Section 2.4.2 Home Study Requirement,
    including mandating a home study in cases where a potential
    sponsor claims a biological relationship with the child but
    refuses to conduct a DNA test or when a potential sponsor is
    unrelated to a child. The updated policy also requires a home
    study for cases where a potential sponsor is unable to provide
    the required documentation. The Committee encourages ORR to
    continue prioritizing the safety and security of UACs by
    providing a home study when necessary.
        Interagency Information Sharing.--The Committee directs the
    Department and DHS to finalize an interagency information
    sharing agreement to address long-standing information sharing
    gaps identified in a February 2020 GAO report (GAO-20-245). The
    Committee requests the Department and DHS brief the
    congressional committees of jurisdiction on the implementation
    of a final interagency agreement on information sharing for
    UACs within 180 days of enactment of this Act.
        Know Your Rights Presentations.--The Committee encourages
    the Department to continue providing Know Your Rights
    presentations for UACs in custody, consistent with the William
    Wilberforce Trafficking Victims Protection Reauthorization Act
    of 2008 (P.L. 110-457). The Committee further encourages HHS to
    continue providing information on resources to prevent child
    labor exploitation as part of ORR's notice of rights.
        Notification of Fatalities in ORR Care.--The Committee
    directs ORR to continue to report the death of any UAC in its
    custody within 24 hours, including relevant details regarding
    the circumstances of the fatality.
        ORR Employee Vetting.--The Committee encourages ORR to
    continue working with influx care facilities (ICFs) and
    emergency intake sites (EISs) to conduct all required
    background checks for employees, volunteers, and contractors
    who may have contact with children in ORR care. The Committee
    further encourages ORR to maintain and enforce monitoring
    requirements for ICFs and EISs, including reviewing compliance
    with all background check requirements and conducting quarterly
    on-site monitoring visits.
        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.
        Spend Plan.--The Committee continues to direct the
    Secretary to submit a comprehensive spend plan to the Committee
    every 90 days.

    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 2025.......................      $417,515,000
    Budget request, fiscal year 2026......................       482,515,000
    Committee Recommendation..............................       482,515,000
        Change from enacted level.........................       +65,000,000
        Change from budget request........................             - - -

        The Committee provides $420,000,000 in mandatory funds and
    $62,515,000 in discretionary funds for the Promoting Safe and
    Stable Families program. This program enables each State to
    operate a coordinated program of family preservation services,
    community-based family support services, time-limited
    reunification services, and adoption promotion and support
    services.
        Within the discretionary total, the Committee provides
    $2,750,000 for the Family First Clearinghouse and related
    research and evaluation.

       PAYMENTS TO STATES FOR THE CHILD CARE AND DEVELOPMENT BLOCK GRANT

    Appropriation, fiscal year 2025.......................    $8,746,387,000
    Budget request, fiscal year 2026......................     8,746,387,000
    Committee Recommendation..............................     8,746,387,000
        Change from enacted level.........................             - - -
        Change from budget request........................             - - -

        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 to not less than 6 percent.
        Food Preparation Impacts.--The Committee notes that States
    may assess whether regulations could result in limitations on
    the preparation of fresh fruits and vegetables in child care
    facilities.

                          SOCIAL SERVICES BLOCK GRANT

    Appropriation, fiscal year 2025.......................    $1,700,000,000
    Budget request, fiscal year 2026......................     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 Center services and programs at school and community-
    based Family Resource Centers to strengthen families through a
    localized, family-centered approach. The Committee encourages
    HHS to evaluate how States are utilizing Federal funds to
    support FRC activities and to measure the outcomes of such
    investments.

                    CHILDREN AND FAMILIES SERVICES PROGRAMS

    Appropriation, fiscal year 2025.......................   $14,789,089,000
    Budget request, fiscal year 2026......................    13,657,693,000
    Committee Recommendation..............................    14,480,087,000
        Change from enacted level.........................      -309,002,000
        Change from budget request........................      +822,394,000

        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:

    ------------------------------------------------------------------------
              Budget Activity            FY 2025 Enacted   FY 2026 Committee
    ------------------------------------------------------------------------
    Programs for Children, Youth, and
     Families:
        Head Start....................    $12,271,820,000    $12,271,820,000
        Preschool Development Grants..        315,000,000              - - -
        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         36,000,000
         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         53,000,000
        Adoption and Legal                     75,000,000         75,000,000
         Guardianship Incentive
         Payments.....................
        Social Services Research and           35,012,000         30,010,000
         Demonstration................
        Native American Programs......         60,500,000         65,500,000
        Community Services Block Grant
         Act Programs:
            Community Services Block          770,000,000        775,000,000
             Grant....................
            Community Economic                 22,383,000         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        240,000,000
         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 (EHS) programs fund
    competitive grants to promote school readiness of children
    under 5 from low-income families through preschool services.
        Early Head Start.--The Committee directs HHS to maintain
    the EHS allocation of funds to at least the current proportion
    of funding within the overall Head Start appropriations to
    ensure that eligible pregnant women, infants and toddlers, and
    families continue to benefit from EHS high-quality,
    comprehensive services. The Committee directs HHS to prioritize
    maintenance of current slots and then expand slots where
    possible, including through Head Start to Early Head Start
    (ES2EHS) slot conversion. Finally, the Committee continues to
    direct HHS to include in future congressional justifications
    the actual and estimated number of slots in each of Head Start,
    EHS, EHS Child Care Partnerships, and slots converted from
    ES2EHS.
        Head Start Facilities.--The Committee recognizes that
    repair, renovation, rebuilding, and replacement of Head Start
    and EHS facilities is necessary to provide a safe, high-
    quality, and developmentally appropriate environment for
    children and families. The Committee notes that the last
    comprehensive Head Start facilities report was conducted in
    fiscal year 2015 and the last American Indian and Alaska Native
    (AI/AN) Head Start facilities report was produced in 2020. The
    Committee believes that updated assessments are necessary to
    understand the current infrastructure needs. Therefore, the
    Committee directs ACF to produce and make public on its website
    new facilities reports on the Head Start and AI/AN Head Start
    programs. The Committee further directs the agency to include
    an analysis of the various funding mechanisms available within
    ACF that grantees can use for construction, renovation, or
    other capital improvement activities. The Committee encourages
    ACF to ensure all grantees are aware of any funding
    opportunities for facility improvements. Additionally, the
    Committee urges the agency to provide the necessary technical
    assistance to grantees for the purpose of navigating and
    completing the application process.
        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 a $4,000,000 increase above the fiscal year 2025 enacted
    program level.

    Preschool Development Grants

        The Committee does not provide funding for the Preschool
    Development Grants (PDG) program. The Committee prioritizes
    funding for early learning and care programs through Head
    Start, EHS, the Child Care and Development Block Grant (CCDBG)
    and TANF.

    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. The Committee encourages the agency to continue
    the Runaway and Homeless Youth Prevention Demonstration
    Program, which has awarded funding to community-based
    organizations focused on prevention services for youth at risk
    of homelessness.

    Child Abuse Prevention 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 2025 enacted program 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.

    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, which is the same as
    the fiscal year 2025 enacted program 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 and
    section 429B of the Social Security Act (42 U.S.C. 628d) 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, which is the same as the fiscal year
    2025 enacted program 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. The Committee encourages
    the Department to provide grantees with resources that focus on
    understanding the sensitivities regarding adoption in the
    health care industry and the best practices for interacting
    with prospective birth mothers and adoptive families, including
    the use of non-directive education for expectant parents
    considering adoption, parenting, and kinship care. Eligible
    grantees should not provide or refer for abortion.
        Family First Prevention Services Clearinghouse.--The
    Committee continues to direct not less than $2,000,000, which
    is the same as the fiscal year 2025 enacted program 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 for
    the National Adoption Competency Mental Health Training
    Initiative, which is the same as the fiscal year 2025 enacted
    program level.
        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. Therefore, 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 Social Services Research and Demonstration funds
    research, evaluation, and demonstration efforts that focus on
    preventing and reducing dependency on government programs and
    improving the administration and effectiveness of services for
    children and families.
        Diaper Distribution Demonstration and Research Pilot.--
    Within the total, the Committee continues to provide
    $20,000,000, which is the same as the fiscal year 2025 enacted
    program level, for the Diaper Distribution Demonstration and
    Research Pilot (DDRP). The pilot helps address diaper needs and
    supports economic mobility for low-income families. The
    Committee encourages ACF to continue funding grants and to
    support program evaluation activities, including the release of
    the final DDRP evaluation report.
        Affordable Housing and Supportive Services Demonstration.--
    Within the total, the Committee continues to provide
    $2,500,000, which is the same as the fiscal year 2025 enacted
    program level, for grants to Community Action Agencies and
    Tribes that own affordable housing for the purpose of
    connecting residents to support services that improve housing
    stability, economic mobility, and well-being.

    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

        The Community Services Block Grant is a program that
    provides formula grants to States, territories, and Tribes to
    alleviate the causes and conditions of poverty in communities.
        Community Economic Development.--Community Economic
    Development is a competitive grant program, which funds
    Community Development Corporations seeking to address the
    economic needs of low-income individuals and families through
    the creation of sustainable business development and employment
    opportunities.
        Rural Community Facilities.--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 aid 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.

    National Domestic Violence Hotline

        The National Domestic Violence Hotline provides free and
    confidential 24-hour, toll-free telephone, chat and text
    services immediately connecting callers to local service
    providers. The Committee encourages ACF to continue building
    the Hotline's capacity and to support investments in technology
    infrastructure and staffing to ensure a timely response to
    requests for help.
        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 FVPSA program provides funding to support the
    prevention of incidents of family violence, domestic violence,
    and dating violence, and provide immediate shelter and
    supportive services for adult and youth victims. The Committee
    recognizes that all forms of domestic violence is strongly
    associated with poor mental health outcomes and substance
    abuse. Therefore, the Committee encourages ACF to fund domestic
    violence prevention programs that support individuals with co-
    occurring health conditions linked to domestic violence while
    ensuring families remain together through recovery and the best
    interests of children exposed to violence in the home are
    prioritized.
        Within the total, the Committee provides $12,000,000, which
    is an increase of $5,000,000 from the fiscal year 2025 enacted
    program level, for supporting Native American Tribes and Tribal
    organizations to fund immediate shelter and supportive services
    for survivors of domestic violence and their dependents.
        Within the total, the Committee provides $2,000,000 for the
    Native Hawaiian Resource Center on Domestic Violence program,
    which is the same as the fiscal year 2025 enacted program
    level, to continue providing technical assistance, services and
    supports for Native Hawaiian adults, children, and youth
    experiencing domestic violence.
        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 Pilot Projects.--
    The Committee recognizes the Department's commitment to
    personal responsibility, self-sufficiency, strong families, and
    State-led innovation in its redesigned TANF pilot program.
    These projects are authorized under section 302 of the Fiscal
    Responsibility Act (P.L. 118-5) and aim to build evidence to
    evaluate if existing accountability mechanisms help improve
    employment outcomes and reduce government dependency. The
    Committee directs HHS to provide notice to the committees of
    jurisdiction of the States selected to participate in the TANF
    pilot projects at least seven days prior to public release.

                    PAYMENTS FOR FOSTER CARE AND PERMANENCY

    Appropriation, fiscal year 2025.......................    $6,768,000,000
    Budget request, fiscal year 2026......................     6,843,000,000
    Committee Recommendation..............................     6,843,000,000
        Change from enacted level.........................       +75,000,000
        Change from budget request........................             - - -

        The Committee also provides an advance appropriation of
    $3,800,000,000 for the first quarter of fiscal year 2027 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
    2027 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 $5,517,000,000 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 $4,397,000,000 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 $386,000,000 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 2025.......................    $2,518,744,000
    Budget request, fiscal year 2026......................     2,443,100,000
    Committee Recommendation..............................     2,508,132,000
        Change from enacted level.........................       -10,642,000
        Change from budget request........................       +65,032,000

        Created in 2012, 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 notes that the Department proposes to
    integrate ACL functions into the Administration for Children
    and Families. The Committee looks forward to working with the
    authorizing committees of jurisdiction as they consider this
    proposal.
        The Committee continues to fund the Senior Medicare Patrol
    Program through the Health Care Fraud and Abuse Control Account
    under CMS.

    Home and Community Based Supportive Services

        The Committee provides $414,000,000 for Home and Community-
    Based Supportive Services, which is a $4,000,000 increase above
    the fiscal year 2025 enacted program 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 the same as fiscal year 2025 enacted program
    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 $26,885,000 for activities to
    protect vulnerable older Americans, which is a $227,000
    increase above the fiscal year 2025 enacted program 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 $207,000,000 for the National
    Caregiver Support program, which is the same as the fiscal year
    2025 enacted program 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 $14,000,000 for the Native American
    Caregivers Support program, which is a $2,000,000 increase
    above the fiscal year 2025 enacted program 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 $1,058,684,000 for senior
    nutrition programs. This is the same overall funding level as
    the fiscal year 2025 enacted program level. Funding for this
    population is also available from the Department of
    Agriculture. Within the overall amount, the Committee includes
    $565,342,000 for Congregate Meals, $381,342,000 for Home
    Delivered Meals, and $112,000,000 for the Nutrition Services
    Incentives program. 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.
        Greatest Need Eligibility Assessment.--The Committee notes
    that under section 305(a)(2)(E) of the OAA (P.L. 89-73), States
    are required to provide assurance that preference will be given
    to providing OAA services, including senior nutrition services,
    to older adults with greatest social and economic need. In its
    2019 OAA annual report to Congress, ACL noted ``. . . a third
    of all (OAA) services were delivered to older adults with the
    greatest social need and greatest economic need.'' The
    Committee believes that senior nutrition services should fully
    benefit older adults with the greatest economic and social
    need. Therefore, the Committee directs ACL to produce and make
    public on its website an updated OAA annual report that
    includes information and an analysis of the methodology used by
    States to determine the proportion of OAA participants that
    meet the definition of greatest economic and social need, and
    policies and procedures, including outreach efforts, that
    States are implementing to improve the proportion of seniors
    served with actual greatest need.

    Grants for Native Americans

        The Committee provides $40,264,000 for Native American
    Nutrition and Supportive Services, which is a $2,000,000
    increase above the fiscal year 2025 enacted program 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 $30,461,000 for Aging Network
    Support Activities, which is the same as the fiscal year 2025
    enacted program level. This program supports activities that
    expand public understanding of aging and the aging process.
        The Committee does not provide funding for the Direct Care
    Workforce Demonstration and the Older Adult Equity
    Collaborative.
        Care Corps.--Within the total amount, the Committee
    continues to provide $5,500,000 for the Care Corps volunteer
    program to support non-medical services for seniors,
    individuals with disabilities and family caregivers. These
    include respite care, transportation, meal preparation, minor
    home cleaning and modifications, education, caring calls/
    visits, and training.
        Holocaust Survivor Assistance Program.--Within the total
    amount, the Committee continues to provide $8,500,000 for the
    Holocaust Survivor Assistance program. This program provides
    supportive services for aging Holocaust survivors living in the
    U.S. The Committee recognizes the program's success in serving
    nearly 44,000 Holocaust survivors, more than 8,000 older adults
    with a history of trauma, and over 7,000 family caregivers.
        Interagency Coordinating Committee on Healthy Aging and
    Age-Friendly Communities.--The Committee continues to provide
    $1,000,000 for the coordination of healthy aging programs
    across HHS, the Department of Housing and Urban Development,
    the Department of Transportation, and other related agencies,
    with a focus on falls prevention programs and safe living
    environments for seniors.
        Older Americans Act Funding Study.--The Committee
    recognizes that due to progress in the treatment of HIV, the
    majority of Americans living with this chronic disease will
    soon be eligible for Social Security and Medicare. Older adults
    living with HIV face unique challenges and barriers to
    accessing services, particularly in smaller cities and rural
    areas where availability of health care services is limited.
    Therefore, the Committee encourages that the Administration on
    Aging study how to better target Older Americans Act funding to
    older adults living with HIV.
        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. The center researches best practices in the
    field of falls prevention, it awards competitive grants to
    Aging Network entities to implement best practices and
    evaluates new and ongoing falls prevention programs.

    Alzheimer's Disease Program

        The Committee provides $31,500,000 for the Alzheimer's
    disease program, which is the same as the fiscal year 2025
    enacted program 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. Of the funds provided, $14,700,000 shall be
    transferred from the PPHF.
        Within this amount, the Committee provides no less than
    $3,000,000 for the National Alzheimer's Call Center.

    Lifespan Respite Care

        The Committee provides $10,000,000 for Respite Care, which
    is the same as the fiscal year 2025 enacted program 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 from the PPHF for the
    Chronic Disease Self-Management program, which is the same as
    the fiscal year 2025 enacted program 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 the same as the fiscal year 2025 enacted
    program level. Falls prevention competitive grants and
    cooperative agreements support the promotion and dissemination
    of prevention tools delivered in community settings. Of the
    funds provided, $5,000,000 shall be transferred from the PPHF.

    Elder Rights Support Activities

        The Committee provides $34,005,000 for Elder Rights Support
    Activities, which is a $131,000 increase above the fiscal year
    2025 enacted program 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 the same as the fiscal year
    2025 enacted program 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 the same as the fiscal
    year 2025 enacted program 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 the same as fiscal year 2025 enacted
    program 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 the same as the fiscal year 2025
    enacted program 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 $13,118,000 for the Traumatic Brain
    Injury program, which is the same as the fiscal year 2025
    enacted program level. 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 the same as the fiscal
    year 2025 enacted level. This program provides formula grants
    to States and territories to support State Councils, which work
    to develop, improve, and expand the system of services and
    supports for people with intellectual and 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 the same as the
    fiscal year 2025 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
    further encourages the Department to prohibit an eligible
    protection and advocacy system to use funds under this heading
    to institute class action litigation against an intermediate
    care facility in good standing with licensure requirements.
        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 the same as the
    fiscal year 2025 enacted program 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 the
    same as the fiscal year 2025 enacted program 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 the same
    as the fiscal year 2025 enacted program 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 the same as the fiscal year 2025
    enacted program 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 $100,000,000 for the National
    Institute on Disability, Independent Living, and Rehabilitation
    Research (NIDILRR), which is a $19,000,000 decrease below the
    fiscal year 2025 enacted program level. NIDILRR funds research
    and development of new innovative technological devices,
    prototypes, measurement tools, and interventions to help people
    with disabilities live more independently.
        The Committee continues to support the Traumatic Brain
    Injury Model Systems National Data and Statistical Center at no
    less than the fiscal year 2025 enacted program level.

    Assistive Technology

        The Committee provides $40,000,000 for Assistive Technology
    (AT), which is the same as the fiscal year 2025 enacted program
    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.
        Veteran Mobility Pilot Program.--The Committee encourages
    the Department to establish a Veteran Mobility Pilot Program
    with the goal of identifying, procuring, distributing, and
    evaluating enhanced mobility devices for use in VA nursing
    homes and State veterans' homes. The pilot would prioritize
    assistive technology that improve rehabilitation outcomes,
    reduce fall risk, and restore mobility for veterans living with
    age-related or service-connected mobility challenges.

    Program Administration

        The Committee provides $48,063,000 for Program
    Administration, which is the same as the fiscal year 2025
    enacted program level. This funding supports Federal
    administrative costs associated with administering ACL's
    programs.

             Administration for Strategic Preparedness and Response

    Appropriation, fiscal year 2025.......................    $3,634,606,000
    Budget request, fiscal year 2026......................     2,825,880,000
    Committee Recommendation..............................     3,509,606,000
        Change from enacted level.........................      -125,000,000
        Change from budget request........................      +683,726,000

        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.
        The Committee first funded ASPR as an operating division as
    part of the Fiscal Year 2024 budget cycle. The Committee
    included BARDA, Project BioShield, the associated Special
    Reserve Fund, and the SNS within a single Treasury account to
    better ensure the seamless transition of MCMs from development
    to production and procurement to ensure the strongest possible
    response partner from natural and man-made threats. The
    Committee encourages HHS to recognize the significance of
    ASPR's work combating chemical, biological, radiological and
    nuclear (CBRN) threats as well as assistance in all efforts for
    preparedness to face these threats. In their work, the
    Committee recognizes the importance of maintaining the
    Strategic National Stockpile, the Center for the Biomedical
    Advanced Research and Development Authority, Project BioShield
    and the Special Reserve Fund under ASPR's independent operating
    body.
        ASPR is uniquely positioned to support continued investment
    and support for biomanufacturing and the onshoring of the
    Medical Countermeasure supply chain essential to ensure the
    health and security of the American public. To that end, the
    Committee includes a series of provisions designed to support
    the domestic manufacturing of active pharmaceutical
    ingredients, antibiotics, diagnostics, essential medicines,
    medical devices, personal protective equipment and other
    pharmaceutical products critical to maintaining our MCM
    capacity. The Committee includes a new provision prohibiting
    ASPR, and the SNS in particular, from purchasing MCMs or other
    goods and services, from China or China-owned companies unless
    such services are otherwise not available.
        Continued Support for Onshoring.--The Committee remains
    concerned that the United States is dependent on foreign
    sources for critical raw materials and manufacturing of
    essential antivirals for infectious diseases. 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 MCMs and ancillary products.
        Therefore, the Committee encourages ASPR to prioritize
    funding for companies that are investing in domestic
    manufacturing, especially for products that are currently
    dependent on China for sourcing of raw materials. Additionally,
    the Committee directs the ASPR to provide a briefing, within
    180 days of the enactment of this Act, on the progress of
    onshoring investments to establish a resilient domestic supply
    chain for antivirals.
        Diagnostics Manufacturing.--Diagnostics are critical for
    the prevention, protection and surveillance of known and
    unknown CBRN threat. The ability to rapidly develop and access
    diagnostics is essential to ensure U.S. readiness and biohazard
    preparedness. The Committee has previously encouraged ASPR to
    promote policies for flexible contracting options between HHS
    and diagnostic companies, which would provide incentives to
    keep US manufacturing companies with warm production lines. The
    Committee is aware that companies that HHS invested in during
    COVID have closed or drastically reduced their domestic
    footprint. Therefore, the Committee encourages ASPR to continue
    to support the diagnostic domestic manufacturing
    infrastructure.
        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.
        Domestic Manufacturing of Medical Countermeasures.--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.
        Domestic Medicine & Active Pharmaceutical Ingredient
    Manufacturing.--The Committee is concerned with the national
    security risk of our reliance on foreign-based sources of
    active pharmaceutical ingredients (APIs), their key starting
    materials, and off-shore drug production. The Committee
    recognizes the importance of domestic drug manufacturing and
    onshore production of medicine to support increased U.S.-based
    manufacturing capabilities. The Committee acknowledges the
    impact of weather events on U.S.-based manufacturing
    capabilities, and encourages intentional efforts to vary
    manufacturing locations for active pharmaceutical ingredients
    including their chemical precursors. The successful work of
    BARDA in addressing public health vulnerabilities and securing
    a national stockpile of drugs has unique potential to consider
    program expansion to include at-risk drug ingredients. The
    Committee encourages ASPR to engage in public-private
    partnerships for U.S.-based advanced manufacturing for active
    pharmaceutical ingredients including their chemical precursors
    for the SNS. The Committee directs ASPR to provide a briefing,
    to include the authorizing Committees, within 180 days of the
    enactment of this Act detailing their efforts to promote
    domestic drug and active pharmaceutical ingredient
    manufacturing.
        Development of Treatments for Nasal and Sinus Infections.--
    The Committee supports the development of MCMs related to the
    treatment of nasal and sinus infections that carry a material
    threat determination from the PHEMCE.
        Interagency Alignment of Biomedical Countermeasures
    Research and Development.--The Committee has prioritized
    investments in research and development of biodefense MCMs 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 MCM requirements,
    priorities, and projects across these agencies. To improve
    alignment and efficiency of research and development
    activities, the Committee encourages 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 further
    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 2027 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 the development of MCMs for combatting emerging
    pathogens.
        Medical Countermeasures Preparedness Review.--The most
    recent Medical Countermeasures Preparedness Review, submitted
    to Congress as part of the required annual threat-based review
    of the SNS, found the Department has not met medical
    countermeasure stockpiling requirements for numerous public
    health threats. Furthermore, the review demonstrated how the
    SNS often relies on decades-old products to fulfill other
    stockpiling requirements. The SNS is a key pillar in the
    nation's broader strategy to protect the American people. Gaps
    in the stockpile's preparedness against these threats
    jeopardizes national security. The Committee requests a
    classified briefing within 180 days from ASPR regarding the
    CBRN threat landscape and actions taken by the agency to
    rectify stockpile shortfalls identified by the Medical
    Countermeasures Preparedness Review.
        Multiyear Budget.--The Committee notes that 42 U.S.C.
    300hh-10 requires annual updates to the PHEMCE multiyear
    budget. The Committee continues to direct ASPR to notify the
    Committee and the Energy and Commerce 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 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. The Committee requests a briefing within 180 days of
    enactment on efforts to engage and include industry partners in
    the MCM development efforts and supporting activities.
        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. Consistent 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.

                     RESEARCH, DEVELOPMENT, AND PROCUREMENT

    Appropriation, fiscal year 2025.......................    $3,135,000,000
    Budget request, fiscal year 2026......................     2,437,402,000
    Committee Recommendation..............................     3,265,000,000
        Change from enacted level.........................      +130,000,000
        Change from budget request........................      +827,598,000

    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 2025 enacted level. 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
    reemerging infectious diseases.
        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.
        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. The Committee requests a
    report within the 180 days of the date of enactment of this Act
    on actions taken.
        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.
        Biodosimetry.--The Committee continues to support ASPR's
    research and investment in biodosimetry technologies to improve
    the nation's preparedness for a large-scale radiological or
    nuclear incident.
        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
    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.
        Diagnostic Rapid Response Initiative.--The Committee is
    aware that biological threats remain a persistent and evolving
    danger, requiring robust and proactive preparedness measures.
    The committee is encouraged by HHS and BARDA's leadership in
    developing the Diagnostic Rapid Response Initiative (DxR2).
    Continued investment in DxR2 has the potential to enhance our
    national ability to rapidly respond to biothreat incidents.
    BARDA is encouraged to maintain this important program as a
    priority within the PHEMCE portfolio.
        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 BARDA's engagement in public-private
    partnerships to support advanced research and development of
    innovative platform technologies and medical countermeasure
    programs focused on vaccines, therapeutics, and other MCMs 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.
        Multidrug Resistance.--The Committee recognizes the urgent
    global health threat posed by multidrug resistant organisms and
    the need for innovative, engineering-based solutions that can
    be deployed across diverse clinical settings. The Committee is
    aware of the early development of novel anti-microbial drug
    resistance platforms and supports their ongoing research. The
    Committee continues to support the development of platforms
    designed for broad application, from hospitals to community
    medical offices, and encourages ASPR to support research and
    development activities that make use of existing safety and
    effectiveness data from a reference listed drug, as well as
    innovative approaches to new classes of antimicrobial
    technologies.
        Pathogen Reduction Technologies.--The Committee encourages
    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.
        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 recognizes that next-generation
    cryo-preserved platelet products, currently in clinical trials,
    align with BARDA's strategic objectives for blood products. 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 (PCI) 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 PCI.

    Project BioShield

        The Committee provides $850,000,000 for Project BioShield,
    which is $25,000,000 above the fiscal year 2025 enacted level.
    These funds support the acquisition of promising MCMs 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
    2025 enacted level.
        Antimicrobial Resistance.--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 MCMs
    appropriate to respond to the continued evolution of
    antimicrobial resistant organisms.
        Guidance to State and Local Jurisdictions.--The Committee
    recognizes that SNS focuses on chemical, biological,
    radiological, and nuclear threats, and therefore the Committee
    supports the efforts of State and local jurisdictions to secure
    additional 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 SNS.
    The Committee encourages 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.
        Made in America Strategic National Stockpile.--The
    Committee is concerned about the nation's limited
    infrastructure to produce essential products such as MCMs and
    personal protective equipment (PPE). 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 directs the ASPR to
    develop a long-term sustainable procurement plan that gives
    preference to and results in purchases directly from domestic
    manufacturers to the maximum extent practicable.
        Nuclear Threat Preparedness.--The Committee notes with
    concern that the SNS faces potential shortfalls regarding the
    stockpiling of MCMs necessary in the event of a nuclear event
    to counter the potential release of radioactive iodine. The
    Committee encourages ASPR to prioritize investments in the MCMs
    necessary for such a response and directs the agency to provide
    a briefing on measures taken to prepare for a nuclear threat
    within 180 days of the enactment of this Act.
        Persistent Procurement Challenges.--The Committee is
    concerned about the SNS'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 CBRN countermeasures that lack a traditional marketplace.
    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.
        Poxvirus Countermeasures.--The Committee notes that
    Administration decisions, including the decision to ship
    vaccine oversees, has depleted MCMs 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
    MCMs 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.
        Reusable Respirators.--The Committee recognizes the
    potential of reusable respirators to provide strategic long-
    term value to the SNS due to their longer operational lifetime
    and extended shelf life when compared with disposable masks.
    The Committee encourages the SNS to consider reusable
    respirators when planning personal protective equipment (PPE)
    investments. The Committee continues to support warm-base surge
    production capacity contracts with domestic PPE suppliers,
    including reusable respirators. ASPR is encouraged to maintain
    domestic manufacturing surge capabilities that can rapidly ramp
    up large-scale PPE production in response to CBRN threats or
    other public health crises that pose a significant national
    security risk. ASPR is directed to provide a report, no later
    than 180 days after enactment of this act, on specific steps it
    has taken to support up warm-basing capabilities to include PPE
    investments and an analysis of future products considered a
    priority for future years.
        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 the initial FDA
    expiration date and the number of these aged products in the
    SLEP program.

    Pandemic Influenza Preparedness

        The Committee includes $315,000,000, 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 2025.......................      $499,606,000
    Budget request, fiscal year 2026......................       388,478,000
    Committee Recommendation..............................       244,606,000
        Change from enacted level.........................      -255,000,000
        Change from budget request........................      -143,872,000

    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.
        Health Preparedness and Response Center of Excellence.--The
    Committee encourages ASPR to consider the establishment of a
    Center of Excellence for Health Preparedness and Response in
    alignment with the agency's mission. ASPR leads the nation's
    medical and public health preparedness, response, and recovery
    efforts for disasters and public health emergencies,
    continuously scanning the horizon to anticipate both natural
    and man-made threats. Such a center may serve as a national
    resource to support ASPR's mission by leading a national
    network providing technical support and advanced training and
    education, research, and implementation actions for a resilient
    national system for biothreat response.
        Rural Medical Autonomy and Assessing the Use of Unmanned
    Aircraft Systems in Disaster Response.-- The Committee is aware
    of the challenges facing emergency medical response to natural
    or man-made disasters in rural areas. Resources are often
    limited and remote, leading to delays in treatment that result
    in poor outcomes. The role of autonomous systems can be
    invaluable, quickly providing life-saving tools across a range
    of medical applications such as drone delivery of critical
    medical supplies and drugs, as well as autonomous air and
    ground systems that evaluate safety in a chem-bio, electrical
    hazard or fire environment. Autonomous systems can be paired
    with telemedicine capabilities to deliver real-time
    connectivity between emergency responders and Level 1 trauma
    centers and other emergency medicine professionals. Within 180
    days of the enactment of this Act, ASPR is directed to publicly
    release a report assessing the potential effectiveness of
    unmanned aircraft systems for medical emergency response in
    rural areas.
        Remote Hospital Emergency Preparedness Activities.--The
    Committee encourages ASPR to support contingency planning and
    emergency preparedness training for the Guam Memorial Hospital
    Authority (GMHA), the only public hospital serving the
    territory. Given its remote location and strategic importance,
    GMHA requires enhanced capabilities to maintain operations
    during natural disasters and other emergencies. ASPR is further
    encouraged to facilitate opportunities for GMHA to participate
    in relevant Federal training programs and exercises, and to
    consider GMHA's unique needs when designing or allocating
    resources for emergency preparedness initiatives.

    National Disaster Medical System

        The Committee provides $78,904,000 for the National
    Disaster Medical System (NDMS). NDMS deploys trained medical,
    mortuary, victim identification and veterinarian teams to
    communities impacted by public health and medical emergencies
    due to natural and man-made 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 $65,055,000 for the Hospital
    Preparedness Program which supports a tiered system of care
    prepared to respond to a special pathogen event. HPP supports a
    variety of programs to strengthen the preparedness and response
    of the health care sector. Due to funding constraints, the
    Committee eliminates funding for formula grants while
    continuing to fund the National Special Pathogen System and the
    Regional Emerging Special Pathogen Treatment Centers.
        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.
        Portable Bio-Containment Units (PBCUs).--The Committee
    supports ASPR's recent investment in Portable Bio-Containment
    Units (PBCUs). The Committee recognizes the potential value of
    such units for the repatriation and domestic transfer of
    American's afflicted with high-consequence infectious diseases
    to facilities able to safely meet patient needs. The Committee
    directs ASPR to include an estimate of the funding needed to
    maintain the two existing PBCUs as well as the estimated
    procurement costs of two additional PBCUs in the fiscal year
    2027 congressional justification.

    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 2027 congressional justification the
    Committee requests an update on the investments this funding
    has produced since the program's inception.

    Industrial Base Management and Supply Chain

        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.
        Improved Access to Intravenous Saline.--The Committee
    recognizes the potential for natural disasters and other supply
    chain disruptions to adversely affect the ability of hospitals
    and other medical providers to access saline solutions. The
    Committee directs ASPR, within 180 days of the enactment of
    this Act, to evaluate and publicly release a supply chain
    analysis of intravenous saline solution to include potential
    measures to remediate potential disruptions to one or more
    suppliers of such products.
        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.

                            Office of the Secretary

                     GENERAL DEPARTMENTAL MANAGEMENT (GDM)

    Appropriation, fiscal year 2025.......................      $710,955,000
    Budget request, fiscal year 2026......................       405,696,000
    Committee Recommendation..............................       607,189,000
        Change from enacted level.........................      -103,766,000
        Change from budget request........................      +201,493,000

        Of the funds provided, $58,028,000 shall be derived from
    evaluation set-aside funds available under section 241 of the
    PHS Act.
        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 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.
        The Committee notes that HHS proposes to transfer various
    functions within the Office of the Secretary. The Committee
    looks forward to working with the authorizing committees of
    jurisdiction as they consider the Department's proposal.
        Within the total provided for GDM, the Committee provides
    no less than the following amounts:

    ------------------------------------------------------------------------
                       Budget Activity                     FY 2026 Committee
    ------------------------------------------------------------------------
    Children's Interagency Coordinating Council..........         $3,000,000
    Embryo Adoption Awareness Campaign...................          2,000,000
    Interagency Coordinating Committee on the Promotion            2,000,000
     of Optimal Birth Outcomes...........................
    KidneyX..............................................          5,000,000
    LymeX................................................          5,000,000
    Make America Healthy Again...........................        100,000,000
    ------------------------------------------------------------------------

        Adoption Opportunities.--The Committee recognizes that much
    has changed in adoption practices in the nearly two decades
    since HHS conducted its seminal National Survey of Adoptive
    Parents. The Committee is interested in obtaining additional
    information from the Assistant Secretary for Planning and
    Evaluation on the feasibility and projected cost to conduct a
    large, nationally representative survey and report of findings
    on adoptive families across adoption types and to include a
    secondary sample focused on adopted children with special
    healthcare needs. Such a survey and report should be modeled
    after the prior HHS National Survey of Adoptive Parents and the
    National Council for Adoption's ``Profiles in Adoption''
    surveys. The Committee requests HHS provide a feasibility
    assessment and cost estimate in its fiscal year 2027
    congressional justification.
        Automated Referral for Organ Donations.--Automated
    electronic deceased organ donor referrals are used by hospitals
    to refer patients who may become deceased organ donors.
    Widespread use of automated electronic deceased organ donor
    referral could increase patient safety and reduce the number of
    Americans waiting for a lifesaving organ transplant. The
    Committee directs ASPE to submit a report to the Committees on
    Appropriations of the House of Representatives and the Senate,
    and post such report on a publicly available website, within
    one year of the enactment of this Act, that shall: (1) identify
    savings in time, variation in timeliness to determine
    eligibility for organ donation, as well as potential
    improvement over human interaction for the identification of
    potential organ donors, if any, attained through the use of
    electronic referrals; (2) identify benefits, if any, in
    identifying potential organ donors through the use of
    electronic medical records and standardized clinical criteria;
    (3) review the impact of such electronic automated referrals,
    without the need for manual reporting, on donation volumes; (4)
    assess published peer-reviewed clinical literature on such
    electronic automated referrals; (5) review best practices for
    using such electronic automated referrals; (6) review
    information technology practices to ensure the secure
    transmission of information for purposes of such referrals; (7)
    develop recommendations related to the use of such electronic
    automated referrals; and (8) identify what actions would be
    needed to establish the use of such electronic automated
    referrals nationwide.
        Bill Wide Requirements.--The Committee notes the inclusion
    of a bill wide requirements section of this report. This
    section contains requirements that apply to all agencies funded
    by this Act.
        Brain Aneurysms.--The Committee recognizes that although
    one 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 continues to
    support efforts by HHS 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 to develop and implement a strategy for disseminating
    information about such best practices in consultation with
    appropriate stakeholders.
        Cancer Mobile Screening.--The Committee recognizes that
    early detection of cancer significantly reduces mortality rates
    and improves treatment outcomes, particularly for lung cancer.
    Mobile screening units are a proven method of expanding access
    to preventive care and addressing healthcare disparities in
    rural and socioeconomically disadvantaged communities. The
    Committee supports efforts by HHS to incorporate mobile cancer
    screening into its health program portfolio where appropriate,
    including within its rural health programs. The Committee
    requests an update on implementation efforts and outcomes as
    part of the fiscal year 2027 congressional justification.
        Centrally Managed Projects (formerly Joint Funding
    Arrangements).--The Committee directs the agency to include all
    amounts assessed from any operating or staffing division and
    the methodology used to determine such amounts for each project
    funded.
        Certificate of Need Requirements.--The Committee notes that
    ``certificate of need'' (CON) laws vary widely across State
    jurisdictions. Such laws require healthcare providers to obtain
    authorization from State authorities to construct or expand
    health care facilities or offer health care services. The
    Committee directs GAO to examine, to the extent that data are
    available and reliable, how selected State CON laws may affect
    Federal healthcare spending. The Committee directs GAO to
    provide a preliminary briefing to the Committees on
    Appropriations of the House of Representatives and the Senate
    within 12 months of the enactment of this Act with a report to
    follow.
        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.
        Child-Placing Agency Liability Insurance.--The Committee
    directs the Assistant Secretary for Planning and Evaluation to
    conduct a review and provide a report on the availability and
    affordability of professional liability insurance for child-
    placing agencies, including private agencies that provide
    foster care services, adoption from foster care services,
    private domestic adoption services, and intercountry adoption
    services. Such report shall include a review and analysis of
    trends in costs for child-placing agencies to obtain adequate
    insurance coverage. The report shall include recommended
    policies or other actions to address limitations, barriers, or
    shortage of access and affordability of professional liability
    insurance. The Committee requests such report include policy
    proposals that can be made at the Federal level as well as
    policy solutions that can be implemented by States. The
    Committee requests the report within one year of enactment of
    this Act and directs HHS to make such report available on the
    Department's website.
        Children's Interagency Coordinating Council.--The Committee
    continues to include $3,000,000 for the Children's Interagency
    Coordinating Council.
        Congressional Justifications.--The Committee directs HHS
    and each subagency thereof to include citations to the relevant
    authorizing legislation and authorization level for each
    program, project, or activity for which funding is requested in
    the fiscal year 2027 congressional justification.
        Cybersecurity Threats in Grantmaking.--The Committee
    supports efforts by the Department to adopt 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. The Committee urges HHS 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
    supports efforts by HHS to take 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 Prices and Pharmacy Access.--The Committee recognizes
    the critical role community pharmacies play in providing life-
    saving prescription drugs and medications to our rural
    communities and seniors. The Committee appreciates the
    Secretary of HHS's cooperation with the Federal Trade
    Commission and Department of Justice to investigate the
    activity of pharmacy benefit managers and the impact on drug
    prices and pharmacy access.
        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 Committees on
    Appropriations of the House of Representatives and the Senate,
    and to post such report on a publicly available website, within
    18 months of 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 an 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 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.
        Global Health Research.--The Committee requests an update
    in the fiscal year 2027 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.
        Graduate Psychiatry Education.--The Committee supports
    efforts to expand Graduate Medical Education (GME) programs in
    underserved areas and recognizes the critical role that public
    universities and teaching hospitals play in meeting the
    healthcare needs of rural communities, veterans, and other
    high-need populations. Within the various GME programs
    supported by HHS, the Committee encourages the Department to
    expand opportunities for applications for residency positions
    from academic institutions that demonstrate established and
    sustained partnerships with community-based providers,
    including Rural Health Centers, Community Health Centers,
    Veterans clinics, VA hospitals, Women and Children's units, and
    other community-based outpatient clinics.
        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 one in
    14 hospital deaths. Regular oral care during inpatient stays
    may 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 on 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.
        Ileostomy Supplies.--The Committee encourages ASPE to
    complete a report on ileostomy supplies, focusing on ostomy
    bags and adherent tools, to better understand rates of
    infection and ease of use, especially for senior patients. The
    Committee further encourages ASPE to suggest ways to improve
    the ease of use for ileostomy supplies, including possible new
    materials for ostomy bags, and ways to reshore manufacturing of
    these supplies.
        Lyme and Other Tick-Borne Diseases Network.--The Committee
    encourages the Office of the Secretary and the Director of 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.
        LymeX.--The Committee includes $5,000,000 to continue the
    LymeX Innovation Accelerator to advance public-private
    partnerships and innovation in Lyme disease prevention
    diagnosis.
        Make America Healthy Again Initiative.--The Committee
    includes $100,000,000 for the Secretary's Make America Healthy
    Again (MAHA) initiative. This funding will allow the Secretary
    to invest in prevention innovation programs for rural
    communities as proposed in the fiscal year 2026 budget request.
    Within the funding provided for this suite of innovation
    programs, the Committee includes a 10 percent set-aside for
    Tribes, Tribal organizations, urban Indian health
    organizations, and health service providers to Tribes serving
    rural communities. This funding is also available for the
    Secretary to invest in telehealth resources for chronic care
    and nutrition services, as proposed in the fiscal year 2026
    budget request. Within such funding, the Committee encourages
    the Secretary to support opportunities for advancing
    telemedicine tools and remote monitoring technologies at
    universities. This research should support studies on the
    efficacy of virtual care for managing chronic illnesses,
    development of AI-assisted telehealth platforms, and training
    programs for healthcare providers on integrating remote
    solutions into standard practice.
        Maternal Healthcare in Rural Hospitals.--The Committee
    recognizes the importance of rural hospitals in providing
    maternal health care, educating patients, and ensuring maternal
    safety. The continued closure of rural labor and delivery units
    creates significant downstream economic burdens. When these
    services close, costs shift to emergency transportation with
    high costs per case for maternal emergency transfers, higher-
    acuity care at distant facilities with an estimated 30 to 45
    percent cost increase per delivery, and increased complications
    from delayed care.
        Measurements and Definitions for Loneliness and Social
    Isolation.--The Committee recognizes the concerning trend of
    individuals who are experiencing loneliness and social
    isolation. The Committee notes that a 2024 Harvard University
    study found that nearly one in four Americans between the age
    ranges of 18-29 and 30-44, respectively, reported as
    experiencing loneliness consistently. Therefore, the Committee
    encourages the Secretary, in coordination with other relevant
    Federal departments and agencies, to establish a national
    working group to find consensus on definitions and measurements
    for purposes of cohesive public and private research into these
    matters.
        Mental and Behavioral Health Surveys and Other Data
    Products.--The Committee notes the proliferation of surveys and
    other data products related to mental health and behavioral
    health within CDC and across HHS. As part of the fiscal year
    2027 congressional justification, the Committee directs HHS to
    include a summary of all annual, biannual, and quadrennial
    surveys or other data products related to mental and behavioral
    health, including how these data are being used to inform
    policies across the Department.
        Mobile Stroke Unit Reimbursement.--The Committee directs
    GAO to undertake a study to review and analyze data and
    information, as available and reliable, on the public health
    benefits of mobile stroke units, how the Medicare program
    reimburses their services, and the financial barriers they face
    that threaten their operations and prevent their expansion. The
    Committee directs GAO to provide a preliminary briefing to the
    Committees on Appropriations of the House of Representatives
    and the Senate within 12 months of the enactment of this Act
    with a report to follow.
        Mobile Stroke Units.--The Committee recognizes that stroke
    is a leading cause of death and long-term disability in the
    United States, and that rapid intervention is critical to
    improving outcomes and reducing long-term health care costs.
    Mobile stroke units, which provide on-site imaging, diagnosis,
    and treatment, have been shown to significantly reduce the time
    to treatment and improve recovery prospects. The Committee
    encourages the Secretary to evaluate the feasibility of
    supporting the deployment and integration of mobile stroke
    units through existing Departmental grant programs and to
    identify strategies for broader implementation across the
    country. The Committee requests an update on such efforts in
    the fiscal year 2027 congressional justification.
        Mycotic Disease Surveillance.--The Committee is concerned
    by the spread of deadly fungal infections in the United States
    in recent years and the associated economic burden of fungal
    infections, particularly in western States. A Federal plan with
    resources to address the threat of fungal infections holds the
    potential to safeguard the health of Americans in the event of
    a domestic pandemic or in foreign theaters of war. The Federal
    government's recognition of fungal infections as a microbial
    threat to human health can allow for existing planning
    frameworks, mechanisms, and tools such as the U.S. National
    Action Plan for Combating Antibiotic-Resistance Bacteria, the
    Presidential Advisory Council on Combating Antibiotic-Resistant
    Bacteria, and CDC reports on priority antimicrobial resistance
    threats to better account for steps taken to respond to fungal
    threats in the United States. Therefore, the Committee
    encourages HHS to include fungal diseases under its priorities
    for Federal funding sources and authorities intended to address
    the public health threats caused by infectious diseases and
    antimicrobial resistance. In so doing, the Department should
    prioritize: National action plans or programs that seek to
    increase disease surveillance and foster interagency
    collaborations to combat fungal diseases, antimicrobial
    stewardship that includes both antibiotics and antifungals, and
    patient education and awareness activities; Biothreat readiness
    or activities that deliver expedited and actionable results at
    the point-of-care, provide potential to reduce unnecessary
    hospitalizations or escalations of care, or aid the
    government's ability to halt the spread of deadly fungal
    infections nationally using a One Health approach; and Medical
    products, such as diagnostics, drugs, and vaccines that work
    against a priority fungal pathogen with particular attention
    paid to products that are novel and create new classes of
    products capable of spurring future product types.
        National Action Plan on Medical Foods.--The Committee notes
    the potential to improve patient care and lower healthcare
    costs, particularly for individuals with chronic and costly
    illness, through reinvigorated efforts to develop and provide
    proper access to medical foods. The Committee encourages the
    Secretary to convene a meeting with patient, professional, and
    industry stakeholders and coordinate follow-up activities to
    develop a national action plan on medical foods to help
    increase access to medical foods and medical nutrition. The
    Committee requests an update on these efforts in the fiscal
    year 2027 budget justification.
        Neurodegenerative Diseases Diagnostics.--The Committee
    supports the Department's 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 stage, the
    Committee encourages HHS to work with stakeholders to research,
    develop, and improve access to novel diagnostic testing for
    neurodegenerative diseases.
        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 the current fiscal year; and any
    expected future obligations. For any project ongoing for more
    than three 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.
        Orthopedics.--The Committee encourages ASPE to complete a
    report on orthopedic foot care supplies, such as shoes and shoe
    inserts, including a focus on diabetics and their unique needs
    such as diabetic shoes. The Committee further encourages ASPE
    to suggest ways to reshore manufacturing of orthopedic foot
    care supplies.
        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 five years in excess of
    $25,000,000, the report shall include a narrative describing
    the status of the project.
        Packaging and Transport of Life-Saving Medical Products.--
    The Committee recognizes the critical importance of American-
    made cold ship containers and protective packaging in
    maintaining domestic supply chains of life-saving medical
    products and supporting multiple missions central to HHS. Cold
    ship containers are vital to maintaining the temperature
    integrity of vaccines, as well as insulin, biologics, and
    specialty drugs, requiring strict temperature controls from
    manufacturing to administration sites. Similarly, protective
    packaging is essential to the secure delivery of sensitive and
    costly medical equipment including diagnostic and imaging
    devices, laboratory and testing equipment, and electronic
    health monitoring devices used in hospitals, community health
    clinics, and other medical settings. The Committee urges HHS to
    prioritize public health and safety in any review of materials
    used to package, ship, and distribute temperature-sensitive
    pharmaceuticals and medical equipment and devices used in a
    health care setting.
        PHS Act Evaluation Funding.--The Committee recommendation
    includes amounts made available under section 241 of the PHS
    Act, as specified in the bill language. The Committee continues
    to assume an assessment of 2.5 percent. The Committee's
    assumptions include the exclusion of certain program management
    and related administrative costs and non-PHS Act authorized
    programs for which funding is provided in the bill. In
    addition, the bill continues to exclude biodefense programs
    consistent with prior years.
        Additionally, as part of the President's Budget Request,
    HHS is directed to provide the Committee, in electronic format,
    tables providing PHS evaluation funding exclusions,
    assessments, and uses for the budget request year. Such tables
    shall also include a column for the most recently executed full
    fiscal year and most recently enacted appropriation. HHS is
    also directed to provide the Committees an updated version of
    this table on a quarterly basis.
        Postmenopausal Osteoporosis.--Postmenopausal Osteoporosis
    (PMO) is responsible for nearly 2,000,000 fractures every year
    in the United States in women aged 65 and older and only one in
    six women receive osteoporosis treatment in the months
    following an osteoporotic fracture. Two out of three women with
    PMO at high risk for fracture will break a bone in their
    lifetime. Despite the U.S. Preventive Services Task Force
    (USPSTF) recommending the use of bone measurement testing to
    screen both women age 65 and older for osteoporosis and
    postmenopausal women younger than 65 who are at increased risk
    of osteoporosis, nationwide screening of this high-risk
    population is lacking. The Committee directs the Secretary to
    provide a report to the Committees on Appropriations of the
    House of Representatives and the Senate no later than one year
    after the enactment of this Act on the gap in post fracture
    care for PMO and recommendations on how to improve care. The
    report shall include information on the prevalence of bone
    measurement testing nationwide and how geography may impact
    access; whether the primary care workforce is implementing the
    USPSTF's recommendations and any barriers to implementation;
    and whether implementing new or updated CMS reimbursement
    policies would positively impact PMO care.
        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 and provide a related report. Such a report should
    include a review and analysis of challenges to 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 encourages ASPE to make such report
    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.
        Protection of Innocent Life.--The Department of Health and
    Human Services must prohibit any governmental discrimination
    against any providers of health services on the basis that they
    are not involved in abortion.
        Psychiatric Hospitals.--The Trump Administration's
    Executive Order 14321 on Ending Crime and Disorder on America's
    Streets seeks to refocus Federal programs that have veered too
    far in supporting vagrancy and drug use; these programs need to
    refocus and adopt policies to help those who suffer from
    serious mental illness. In order to support meaningful efforts
    to address the needs of this population, the Committee
    encourages efforts to expand access to psychiatric care. HHS
    may consider establishing a working group to examine the
    effectiveness of psychiatric hospitals, and other means of
    supporting hospitals through funding mechanisms to assist in
    caring for this population.
        Public-Private Partnerships to Address Hygiene Poverty.--
    The Committee supports nonprofit partnerships that ensure
    access to hygiene products. Public-private partnerships that
    provide access to basic hygiene products like soap, toothpaste,
    and menstrual hygiene promote public health and human dignity
    for many low-to-middle-income families. The Committee
    encourages HHS to work with local and nonprofit organizations
    to foster initiatives that close the needs gap and enhance
    access to hygiene products in underserved areas.
        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
    encourages enhanced coordination and collaboration across the
    Federal government and encourages the Secretary to develop a
    framework for an Interagency Coordinating Committee (ICC) for
    Rare Diseases. The ICC should focus on optimizing rare disease
    activities across the Federal government and produce an annual
    report assessing all Federal agency activities concerning rare
    diseases, including but not limited to 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 ICC
    members.
        Restorative Reproductive Medicine General Education.--
    Restorative reproductive medicine (RRM) seeks to identify and
    correct underlying causes and factors contributing to
    infertility and reproductive dysfunction. RRM does not employ
    methods that are inherently suppressive, circumventive, or
    destructive and respects the integrity of the human person. The
    Committee encourages HHS to explore opportunities to integrate
    RRM into already existing and new Federal health programs. The
    Committee further encourages OWH to develop and include RRM in
    departmental programs.
        Rural Hospital Closures and Financial Stability.--The
    Committee is concerned about the ongoing crisis of rural
    hospital closures, which jeopardize health care access in
    medically underserved regions. Rural communities often face
    compounding challenges, including older and sicker populations
    and a higher reliance on public insurance or uncompensated
    care. While the Committee supports continued investments in key
    rural hospital designations--such as Critical Access Hospitals,
    Rural Emergency Hospitals, and Medicare-Dependent Hospitals--
    the Committee encourages HHS to evaluate and address the needs
    of rural hospitals that do not fall within these existing
    categories but still face persistent operational and financial
    challenges.
        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 to 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.
    Within 90 days of enactment of this Act, the Committee directs
    the Office of the Secretary 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.
        School Safety Grant Application Feedback Requisite.--The
    Committee acknowledges the challenges that urban and rural
    school districts encounter when applying for Federal funding
    for school safety-related grants. The Committee recommends that
    the Department of Education, Department of Homeland Security,
    Department of Justice, and the Department of Health and Human
    Services provide applicants with a detailed explanation of any
    grant denials and explicit feedback on grant applications
    within 30 days of the announcement of awardees. By implementing
    a standardized feedback system through existing grant portals,
    Federal agencies can assist districts in developing stronger
    applications, resulting in more effective school safety
    programs and improved outcomes for students overall.
        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 four largest block
    grants administered by HHS within 90 days of enactment of this
    Act.
        Sleep and Circadian Disorders.--The Committee notes the
    lack of dedicated sleep health and sleep disorders activities
    across HHS despite the number of Americans affected, the
    economic cost and burden of illness, and the connection between
    sleep and serious chronic diseases, including obesity and heart
    disease. The Committee encourages HHS to establish a
    coordinating effort to promote sleep health and provider
    education and awareness of sleep disorders.
        Study on Models to Strengthen Supply Chain Resiliency.--The
    Committee notes that stable and efficient pharmaceutical supply
    chains are important strategic objectives for our nation. A key
    finding from the 2019 Drug Shortages: Root Causes and Potential
    Solutions Report was that the market does not recognize and
    reward manufacturers for ``mature quality systems'' that focus
    on continuous improvement and early detection of supply chain
    issues. The Committee also appreciates that the 2019 Report
    underscored the unique supply chain challenges for sterile
    injectable generic drugs which play a critical role in patient
    care across provider settings. The Committee recognizes that
    despite the ongoing efforts to strengthen our nation's
    medicines supply chain, drug shortages continue to threaten the
    ability to provide American patients with the care they need
    and more needs to be done to prevent and mitigate drug
    shortages for our nation's patients. The Committee requests the
    Department issue a supply chain resiliency report that assesses
    and makes recommendations regarding potential market-based
    solutions, such as ways to use available metrics and criteria
    to evaluate the resilience and reliability of manufacturers to
    incentivize changes in purchasing practices, that would provide
    value to patients and our nation's health care providers by
    enhancing supply chain predictability and reliability in the
    marketplace for commonly used sterile injectable generic drugs.
        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 report should 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.
        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
    continues to direct the Department to prioritize actions that
    will improve the safety of the biologic supply chain from
    mycobacterium tuberculosis, particularly reducing the risk of
    exposure for immunocompromised Americans.
        Veterinary Medicine.--According to the Bureau of Labor and
    Statistics, at the national level the employment of
    veterinarians is projected to grow 19 percent from 2021 to
    2031, much faster than the average for all occupations. Not
    surprisingly, the U.S. agriculture industry faces a serious
    challenge due to the current and projected shortage of
    veterinarians. According to the USDA, 500 counties in 46 States
    reported a critical shortage of veterinarians in 2022. A high
    demand exists in rural farming communities where there is an
    acute shortage of large animal veterinarians. The development
    of a large animal ambulatory rotation would train veterinary
    students to address this critical shortage in rural communities
    and have a positive economic impact on these communities.

    Minority HIV/AIDS Fund

        The Committee includes $20,000,000 for the Secretary's
    Minority HIV/AIDS Fund (MHAF).
        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 reserves no less than $6,000,000 as a Tribal set-
    aside within the MHAF.

    Office of the Assistant Secretary for Health

        Abortion Hotline.--The Committee includes a provision
    prohibiting funds for an abortion hotline.
        Food is Medicine.--The United States continues to face a
    nutrition-related health crisis with rapid increases in the
    incidence and prevalence of diet-related chronic conditions and
    diseases and the negative impacts of these illnesses, including
    poor health outcomes, increased risk of comorbid conditions
    (e.g., cancer), premature deaths, and rapidly increasing health
    care costs. The Committee continues to support the Food is
    Medicine program focused on using healthy, nutritious, and
    affordable foods to prevent, treat, and manage chronic health
    conditions. The Committee continues to urge the Department to
    include in its annual reports details on how community
    pharmacies may be able to play a critical role in the Food is
    Medicine model, specifically how they can help improve
    nutrition-related outcomes. These reports should also be posted
    on a publicly available website.
        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 Tick-Borne Diseases (TBD) portfolio to other Institutes and
    Centers in addition to NIAID. Due to 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. Due to the severe
    impacts of TBD on children, the National Institute of Child
    Health and Human Development (NICHD) may also greatly enhance
    NIH accomplishments in developing tools to manage pediatric
    cases of TBD. The Committee strongly encourages the Secretary
    to establish within OASH a Tick-Borne disease 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 should 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 the OASH TBD
    Coordinating Office to establish a program for temporary
    agency/stakeholder panels or commissions to address a need or
    gap related to TBD goals and objectives in an HHS agency or
    across agencies. Such panels should consist of a range of
    stakeholders, similar to the TBD Working Group (TBDWG), except
    on a smaller scale, to operate for a short period of time 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 VBD Centers of Excellence,
    industry, and State and local governments. The Committee
    commends OASH and CDC for building upon the six years of
    dedication of numerous TBDWG participants. Although the TBDWG
    is now sunset, the Committee sincerely thanks its participants
    and other stakeholders, including patients, patient advocates,
    researchers, clinicians, and Federal staff, who made sacrifices
    from their professional and personal lives in the hope of
    helping patients and their care providers.
        Obesity.--The Committee notes that the CDC formally
    recognizes obesity as a disease and recommends that it should
    be treated with evidence-based therapies. Intensive behavioral
    therapy, improved diet and nutrition, and medication, in
    addition to surgical procedures, can lead to weight loss and
    have the potential to improve health outcomes for those with
    obesity-related health conditions including diabetes, coronary
    heart disease, and hypertension. The Committee encourages HHS
    to take a comprehensive approach to preventing and treating
    obesity as a chronic disease and to find ways to improve access
    to treatment options. The Committee also encourages HHS to
    continue to collaborate with other Federal agencies that are
    already treating obesity as a chronic disease as it considers
    best practices to improve care for people with obesity.
        Reproductive Rights.--No funds are provided for
    www.reproductiverights.gov or any similar website.

    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 $45,000,000 for the Office of
    Minority Health (OMH), which is equal to the fiscal year 2026
    budget request.
        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 United States.
    OMH develops and implements new policies; partners with States,
    Tribes, and communities through cooperative agreements;
    supports research, demonstration, and evaluation projects; and
    disseminates information.
        Within the total provided for OMH, the Committee provides
    no less than the following amounts:

    ------------------------------------------------------------------------
                                                                FY 2026
                       Budget Activity                         Committee
    ------------------------------------------------------------------------
    Center for Indigenous Innovation and Health..........         $6,000,000
    Improving Maternal Health Outcomes...................          7,000,000
    National Lupus Training, Outreach, and Clinical Trial          3,000,000
     Education...........................................
    Promoting Language Access Services...................          4,000,000
    ------------------------------------------------------------------------

        Center for Indigenous Innovation and Health.--The Committee
    continues to recognize the importance of advancing Indigenous
    solutions to achieve health excellence. The Committee includes
    $6,000,000 to support the work of the Center for Indigenous
    Innovation and Health. The Committee supports HHS in its
    partnerships with universities with a focus on Indigenous
    health research and policy among Native Americans and Alaska
    Natives, as well as universities with a focus on Indigenous
    health policy and innovation among Native Hawaiians/Pacific
    Islanders.
        National Lupus Training, Outreach, and Clinical Trial
    Education.--The Committee continues to support the National
    Lupus Outreach and Clinical Trial Education Program and the
    goal of increasing participation in lupus clinical trials and
    ensuring that trials are representative of the lupus
    population. There are approximately 140 lupus clinical trials
    underway in the United States and important progress has been
    made in raising trial awareness. However, challenges remain in
    identifying people with lupus from representative populations
    who meet trial enrollment criteria, yet who may not be aware of
    trial opportunities. Moreover, research continues to show that
    patients who may be eligible for trials do not learn about
    those opportunities from their physicians. Therefore, the
    Committee encourages OMH to support efforts such as patient
    registries, peer-to-peer education and training programs, and
    provider outreach that will enable the community to more
    effectively raise awareness of trial opportunities among
    representative populations who are eligible to participate.
        Promoting Language Access Services.--The Committee supports
    the Department's efforts to improve external communications to
    reach limited English proficient (LEP) communities. The
    Committee encourages the Department to review communication
    practices and create uniform applications across all HHS
    agencies to strengthen communication practices to include
    digital, television, and radio advertising when working with
    LEP communities.

    Office on Women's Health

        The Committee includes $30,000,000 for the Office on
    Women's Health (OWH), which is equal to the fiscal year 2026
    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, 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
    no less than the following amounts:

    ------------------------------------------------------------------------
                                                                FY 2026
                       Budget Activity                         Committee
    ------------------------------------------------------------------------
    Combatting Violence Against Women....................        $10,100,000
    Eating Disorders Research............................          1,000,000
    Pregnant and Lactating Women's Advisory Committee....            200,000
    Stillbirth Working Group.............................          2,000,000
    ------------------------------------------------------------------------

        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 among 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
    among women and girls.
        Increasing Diagnosis of Migraine Disease in Women.--The
    Committee is aware of the substantial burden of migraine
    disease on women's health given that migraine doubles the risk
    of pre-eclampsia, confers a higher risk for cardiovascular
    disease than either hypertension or hyperlipidemia, and is
    closely co-morbid with chronic diseases such as anxiety and
    depression. The Committee is concerned that migraine disease
    affects nearly 40 million Americans and women are three times
    more likely to experience migraine, leading to a significant
    need for improved screening and diagnosis to prevent painful
    and chronic disease progression. The Committee recognizes the
    gaps that exist for migraine diagnosis in existing screening
    and prevention guidelines for women and urges the inclusion of
    migraine screening in the annual women's wellness visit in the
    Medicare program.
        Pregnant and Lactating Women's 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 2027 congressional justification on progress and
    Federal activities undertaken to implement the PRGLAC
    recommendations and suggestions for further implementation of
    PRGLAC recommendations.
        Stillbirth Working Group.--The Committee includes funding
    for the Secretary to prioritize implementation of the
    Stillbirth Working Group's recommendations across the
    Department and to 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). The Committee directs
    the Secretary to continue to prioritize the Department-wide
    implementation of the Stillbirth Working Group's
    recommendations and engage in efforts to promote evidence-based
    stillbirth awareness and prevention activities. The Committee
    further directs the Department to prioritize (1) improved data
    collection and surveillance systems including the modernization
    of fetal death reporting and interstate data harmonization, (2)
    identification of evidence-based risk reduction strategies,
    especially in disproportionately affected populations, and (3)
    initiatives to support maternal mental health and bereavement
    care. The Committee directs the Department to provide a report
    to the Committees on Appropriations of the House of
    Representatives and the Senate on the progress made toward
    these directives and the implementation of the Working Group's
    recommendations and to make such report available on the
    agency's website within 180 days of enactment of this Act.

    Office of the Assistant Secretary for Administration

    Cybersecurity

        The Committee provides $100,000,000 for information
    technology cybersecurity to strengthen the Department's
    cybersecurity posture.
        In addition, the Committee permits the transfer of
    $30,000,000 from the Nonrecurring Expenses Fund.

    Office of National Security

        The Committee provides $8,983,000, the same as the fiscal
    year 2026 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 for the Office of Global
    Affairs to coordinate HHS policy to strengthen U.S. health
    security.
        U.S.-Mexico Border Health Commission (USMBHC).--The
    Committee remains concerned about the risks posed to border
    communities from infectious disease outbreaks, given the
    region's unique cross-border mobility and economic
    interdependence. The Committee directs USMBHC, in coordination
    with relevant agencies and local health agencies, to submit a
    report to the Committee within 180 days of the date of
    enactment of this Act outlining a comprehensive plan to enhance
    preparedness and response to infectious diseases along the
    U.S.-Mexico border. The plan should include: (a) an assessment
    of the capacity of the United States-Mexico Border Area to
    strengthen its response to infectious diseases, including
    strategies for improving testing, contact tracing, and other
    infection prevention and control measures; (b) an analysis of
    how the economic conditions in the United States-Mexico Border
    Area are impacted by such diseases and how the effects can be
    mitigated through coordinated public health and economic
    interventions; and (c) recommendations to improve the sharing
    of relevant health data, including testing and positivity
    rates, between health agencies operating within the United
    States-Mexico Border Area to enhance binational coordination
    and situational awareness. The Committee encourages the USMBHC
    to engage stakeholders across all levels of government,
    academia, and the nonprofit sector in the development of this
    plan and to ensure that the unique needs of border communities
    are reflected in national infectious disease preparedness
    efforts.

                         MEDICARE HEARINGS AND APPEALS

    Appropriation, fiscal year 2025.......................      $196,000,000
    Budget request, fiscal year 2026......................       180,000,000
    Committee Recommendation..............................       180,000,000
        Change from enacted level.........................       -16,000,000
        Change from budget request........................             - - -

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

      OFFICE OF THE NATIONAL COORDINATOR FOR HEALTH INFORMATION TECHNOLOGY

    Appropriation, fiscal year 2025.......................       $69,238,000
    Budget request, fiscal year 2026......................             - - -
    Committee Recommendation..............................        59,238,000
        Change from enacted level.........................       -10,000,000
        Change from budget request........................       +59,238,000

        The Office of the National Coordinator for Health
    Information Technology is the principal Federal entity charged
    with coordinating efforts to implement and use health
    information technology and exchange electronic health
    information. The fiscal year 2026 budget request amount does
    not include funding requested for the proposed Office of the
    Chief Technology Officer.
        Information Blocking.--Given the significant penalties for
    information blocking and the complexity of the rules for
    regulated entities, the Committee encourages ASTP to provide
    stakeholders with clear, practical guidance regarding
    ``reasonable and necessary activities'' which are not
    information blocking as required by the 21st Century Cures Act
    (P.L. 114-255). ASTP should focus any such guidance on
    developing best practices for information sharing, which is its
    mandate from Congress.
        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
    no 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 such
    standards.

                            OFFICE FOR CIVIL RIGHTS

    Appropriation, fiscal year 2025.......................       $39,798,000
    Budget request, fiscal year 2026......................        39,798,000
    Committee Recommendation..............................        39,798,000
        Change from enacted level.........................             - - -
        Change from budget request........................             - - -

        The Office for Civil Rights (OCR) is responsible for
    enforcing civil rights statutes that prohibit discrimination in
    health and human services programs. OCR implements the civil
    rights laws through a compliance program designed to generate
    voluntary compliance among all HHS recipients.
        Patient Health Information Regulation.--The Committee
    recognizes that OCR has been working on matters pertaining to
    regulatory barriers that impede the delivery of coordinated,
    value-based care. The Notice of Proposed Rulemaking (NPRM)
    published on January 21, 2021 (HHS-OCR-0945-AA00) was intended
    to modify existing patient privacy regulations to support
    coordinated care, case management, and value-based care while
    protecting the privacy and security of electronic protected
    health information (ePHI). However, the Committee is concerned
    that this draft NPRM could have unintended consequences, such
    as granting unprecedented access to valuable health information
    by commercial entities as well as eroding patient privacy
    protections through disclosure of more information than
    necessary to third-party interests, most of whom operate
    outside the bounds of HIPAA. The Committee is also concerned
    that the NPRM, as drafted, could shift the growing economic
    burden of fulfilling requests for ePHI securely and lawfully
    from commercial requestors to the healthcare system. Therefore,
    the Committee urges the Secretary to withdraw and rescind the
    proposed ``HIPAA Privacy Rule: Changes to Support the Use of
    Telecommunications Relay Services and Improve Information
    Sharing for Uniformed Services Personnel.''
        Report on Antisemitism in Health Care.--In accordance with
    the Civil Rights Act of 1964 and the Affordable Care Act (ACA),
    OCR investigates discrimination in institutions that receive
    Federal funding, including antisemitism and other forms of
    discrimination within healthcare settings based on (i) national
    origin, including shared ancestry and other ethnic
    characteristics, or (ii) citizenship or residency in a country
    with a dominant religion or distinct religious identity,
    impacting discrete communities such as Jews, Hindus, Sikhs, and
    Muslims. For instance, in 2025, OCR investigated reviews of
    four medical schools for alleged antisemitic incidents during
    their 2024 commencement addresses. Despite ongoing efforts,
    there remains a significant gap in the comprehensive tracking
    of antisemitism and other forms of discrimination in healthcare
    settings. This lack of data makes it difficult to fully
    understand the extent of the problem and develop targeted,
    effective interventions. The Committee directs OCR to use all
    available resources to collect and analyze data related to
    antisemitism and other civil rights violations in the
    healthcare and medical education sectors. The Committee further
    directs HHS to submit a report to the Committees on
    Appropriations of the House of Representatives and the Senate
    within 180 days of enactment of this Act summarizing and
    detailing, without personally identifying information, all
    pending and resolved civil rights complaints within the
    healthcare and medical education sectors over the past two
    years. This report should be disaggregated by type of
    discrimination where appropriate, including those involving
    antisemitic conduct, and must include the total number of
    complaints received, the number of investigations initiated and
    substantiated, and the outcomes of those investigations--
    specifically indicating whether a violation was found and what
    corrective actions, if any, were taken.

                          OFFICE OF INSPECTOR GENERAL

    Appropriation, fiscal year 2025.......................       $87,000,000
    Budget request, fiscal year 2026......................        87,000,000
    Committee Recommendation..............................        87,000,000
        Change from enacted level.........................             - - -
        Change from budget request........................             - - -

        The Committee recommends $87,00,000 for the Office of
    Inspector General, which is equal to the fiscal year 2026
    budget request.
        In addition, within the Health Care Fraud and Abuse Control
    program discretionary appropriations for fiscal year 2026, the
    Committee provides the OIG with $108,735,000, which is the same
    as the fiscal year 2026 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.
        The Committee commends the OIG and its Federal and State
    law enforcement partners for the recently-announced 2025
    National Health Care Fraud Takedown, which resulted in criminal
    charges against 324 defendants, with intended losses exceeding
    $14.6 billion. This amount doubled the previous record of $6
    billion for such a Takedown. The Committee encourages OIG and
    its law enforcement partners to disseminate best practices and
    lessons learned from this action to prevent similar incidents
    of fraud within Federal health care programs.

         RETIREMENT PAY AND MEDICAL BENEFITS FOR COMMISSIONED OFFICERS

    Appropriation, fiscal year 2025.......................      $894,795,000
    Budget request, fiscal year 2026......................       947,182,000
    Committee Recommendation..............................       947,182,000
        Change from enacted level.........................       +52,387,000
        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 modifies a provision to prohibit
    the Secretary from using evaluation set-aside funds in this or
    any other Act 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 2027 budget request.
        Sec. 220. The Committee modifies a provision for a report
    on CMS's Health Insurance Exchange activities in the fiscal
    year 2027 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 2026, the level appropriated for the fund is
    $1,438,075,000 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 2025 Enacted   FY 2026 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........................................  Breast and Cervical Cancer...              - - -         86,182,000
    CDC........................................  Diabetes.....................         66,412,000        163,130,000
    CDC........................................  Epidemiology and Laboratory           40,000,000         45,000,000
                                                  Capacity Grants.
    CDC........................................  Heart Disease and Stroke              29,255,000        163,130,000
                                                  Prevention Program.
    CDC........................................  Immunization Grants..........        681,933,000        699,933,000
    CDC........................................  Lead Poisoning Prevention....         51,000,000         51,000,000
    CDC........................................  Public Health Data                         - - -        185,000,000
                                                  Modernization.
    CDC........................................  Early Care Collaboratives....          5,000,000          5,000,000
    SAMHSA.....................................  Garrett Lee Smith--Youth              12,000,000         12,000,000
                                                  Suicide Prevention.
    ----------------------------------------------------------------------------------------------------------------

        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 allowing HHS
    to cover travel expenses when necessary for employees to obtain
    medical care when they are assigned to duty in a location with
    a public health emergency.
        Sec. 228. The Committee continues a provision related to
    donations for unaccompanied alien children.
        Sec. 229. 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. 230. The Committee continues a provision related to
    Members of Congress and oversight of facilities responsible for
    the care of unaccompanied alien children.
        Sec. 231. 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. 232. The Committee continues a provision related to
    primary and secondary school costs for eligible dependents of
    personnel stationed in a U.S. territory.
        Sec. 233. The Committee includes a new provision modifying
    the Community Services Block Grant Act.

                                  (RESCISSION)

        Sec. 234. The Committee modifies a provision related to
    unobligated balances in the Nonrecurring Expenses Fund.
        Sec. 235. The Committee includes a new provision related to
    facilities and administration costs.
        Sec. 236. The Committee includes a new provision related to
    fetal tissue.
        Sec. 237. The Committee includes a new provision related to
    physician training for abortions.
        Sec. 238. The Committee includes a new provision
    restricting funding to certain health care entities.
        Sec. 239. The Committee includes a new provision related to
    providing information on abortion.
        Sec. 240. The Committee includes a new provision related to
    referral for abortions.
        Sec. 241. The Committee includes a new provision related to
    executive orders addressing reproductive services.
        Sec. 242. The Committee includes a new provision regarding
    a CMS rule related to vaccination requirements.
        Sec. 243. 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. 244. The Committee includes a new provision limiting
    funding for certain elective services.
        Sec. 245. The Committee includes a new provision related to
    rulemaking for section 1557 of the Affordable Care Act.
        Sec. 246. The Committee includes a new provision related to
    placement under Titles IV-E and IV-B of the Social Security
    Act.
        Sec. 247. The Committee includes a new provision related to
    the unaccompanied alien children foundational rule.
        Sec. 248. The Committee includes a new provision related to
    placement of unaccompanied alien children.
        Sec. 249. The Committee includes a new provision related to
    nursing home staffing standards.
        Sec. 250. The Committee includes a new provision related to
    a final rule for short term, limited duration health plans.
        Sec. 251. The Committee includes a new provision related to
    a public health emergency and a citizen's Second Amendment
    rights.
        Sec. 252. The Committee includes a new provision related to
    civil actions for certain designated violations of law.
        Sec. 253. The Committee includes a new provision related to
    a final rule for the Child Care and Development Fund.
        Sec. 254. The Committee includes a new provision related to
    placements of unaccompanied alien children.
        Sec. 255. The Committee includes a new provision related to
    research on firearm-related restrictions or policies.
        Sec. 256. The Committee includes a new provision related to
    restrictions on animal research.
        Sec. 257. The Committee includes a new provision related to
    a prior authorization pilot program.
        Sec. 258. The Committee includes a new provision related to
    continuing medical education grant programs.

                       TITLE III--DEPARTMENT OF EDUCATION

    Appropriation, fiscal year 2025.....................     $78,736,810,000
    Budget request, fiscal year 2026....................      66,702,839,000
    Committee Recommendation............................      66,681,178,000
        Change from enacted level.......................     -12,055,632,000
        Change from budget request......................         -21,661,000

        The U.S. Department of Education's discretionary spending
    encompasses the budget allocated to various education programs,
    determined through annual appropriations.
        The Committee commends the Department for its forward-
    thinking budget proposals aimed at ensuring better educational
    outcomes for students, from K-12 education through education
    and training opportunities beyond high school. In particular,
    the Committee commends the renewed focus on literacy, which is
    crucial for students' later academic success and a necessary
    skill in life. Similarly, the Committee commends the budget's
    consideration of ideas to create efficiencies in Federal
    programs and empower States. The Committee also commends the
    Department for prioritizing the return to repayment for the
    country's 43 million borrowers with Federally held student
    loans, including by providing a clear message to borrowers,
    providing resources to assist borrowers in becoming current on
    payments, and safeguarding taxpayer dollars.
        This bill provides $66.7 billion in discretionary budget
    authority for the Department of Education, a reduction of 15
    percent over fiscal year 2025 enacted level. The Department of
    Education comprises 33 percent of the total 302(b) allocation
    for this subcommittee.

                  Office of Elementary and Secondary Education

                        EDUCATION FOR THE DISADVANTAGED

    Appropriation, fiscal year 2025.....................      $19,107,790,00
    Budget request, fiscal year 2026....................      18,406,802,000
    Committee Recommendation............................      13,912,224,000
        Change from enacted level.......................      -5,195,566,000
        Change from budget request......................      -4,494,578,000

        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, $3,780,313,000 is
    appropriated for fiscal year 2026 for obligation on or after
    July 1, 2026, and $10,841,177,000 is appropriated for fiscal
    year 2027 for obligation on or after October 1, 2026.

    Grants to Local Educational Agencies

        For fiscal year 2026, 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 2025 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 continue
    to remain below pre-pandemic levels.
        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.
    Moreover, public school enrollment continues on its downward
    trend since the pandemic.

    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 2025 enacted level. Of
    this amount, $763,776,000 is available for fiscal year 2027.
        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 2026 budget request and fiscal year 2025 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 2026 budget request and the
    fiscal year 2025 enacted level for Title I Targeted Grants.
    Within this amount, $4,357,550,000 is available for fiscal year
    2027.
        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 2026 budget request and the
    fiscal year 2025 enacted level for Title I Education Finance
    Incentive Grants. Within this amount, $4,357,550,000 is
    available for fiscal year 2027.
        These funds 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 students.

    Innovative Approaches to Literacy

        The Committee provides $30,000,000 for the Innovative
    Approaches to Literacy program, which is $30,000,000 above the
    fiscal year 2026 budget request and the same as the fiscal year
    2025 enacted level. This program provides competitive grants to
    support school libraries.

    Comprehensive Literacy Development Grants

        The Committee provides $194,000,000 for the Innovative
    Approaches to Literacy program, which is $194,000,000 above the
    fiscal year 2026 budget request and the same as the fiscal year
    2025 enacted level. This program supports competitive grants to
    States to subgrant to school districts and/or early education
    programs to improve literacy instruction for disadvantaged
    students.

    State Agency Programs: Migrant

        The Committee does not provide funding for the State Agency
    Program for Migrant Education, which is the same as the fiscal
    year 2026 budget request and $375,626,000 below the fiscal year
    2025 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.
        The Committee has chosen to prioritize funding for local
    school districts to improve student outcomes in the core
    curriculum of writing, reading comprehension, and math.

    State Agency Programs: Neglected and Delinquent/High Risk Youth

        The Committee does not provide funding for the State Agency
    Program for Neglected and Delinquent Children, which is the
    same as the fiscal year 2026 budget request and $49,239,000
    below the fiscal year 2025 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 are provided for projects
    that support the successful reentry of youth from the criminal
    justice system into postsecondary and vocational programs.
        The Committee has chosen to prioritize funding for local
    school districts to improve student outcomes in the core
    curriculum of writing, reading comprehension, and math.

    Special Programs for Migrant Students

        The Committee does not provide funding for the Special
    Programs for Migrant Students, which is the same as the fiscal
    year 2026 budget request and $52,123,000 below the fiscal year
    2025 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.
        The Committee has chosen to prioritize funding for local
    school districts to improve student outcomes in the core
    curriculum of writing, reading comprehension, and math.

                                   IMPACT AID

    Appropriation, fiscal year 2025.......................    $1,625,151,000
    Budget request, fiscal year 2026......................     1,625,151,000
    Committee Recommendation..............................     1,630,151,000
        Change from enacted level.........................        +5,000,000
        Change from budget request........................        +5,000,000

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

    Basic Support Payments

        The Committee provides $1,477,000,000 for Basic Support
    Payments to LEAs, which is an increase of $3,000,000 from the
    fiscal year 2026 budget request and the fiscal year 2025
    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 2027 congressional justification, the Committee
    requests data and analysis on special education needs at Impact
    Aid schools. This includes comparison data on the percentage of
    students at Impact Aid schools who receive special education
    services versus the percent of such students at non-Impact Aid
    schools.

    Payments for Children with Disabilities

        The Committee provides $49,316,000 for Payments for
    Children with Disabilities, which is an increase of $1,000,000
    from the fiscal year 2026 budget request and the fiscal year
    2025 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 2026 budget
    request and the fiscal year 2025 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 2026 budget
    request and the fiscal year 2025 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 $80,000,000 for payments for Federal
    property, which is the same as the fiscal year 2026 budget
    request and the fiscal year 2025 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 2025.....................      $5,776,178,000
    Budget request, fiscal year 2026....................       2,000,000,000
    Committee Recommendation............................       4,840,964,000
        Change from enacted level.......................        -935,214,000
        Change from budget request......................      +2,840,964,000

        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 2026 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 urges the Department to
    publish a report on the agency's website on the specific uses
    of these funds.

    State Assessments

        The Committee does not provide funding for this program.
    The Committee believes that other sources of educational
    funding can 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 $129,000,000
    above the fiscal year 2026 budget request and the same as the
    fiscal year 2025 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 training and ideologies on public school teachers and
    other officials by training them 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 the Nita M. Lowey
    21st Century Community Learning Centers program, which is
    $1,329,673,000 below the fiscal year 2026 budget request and
    the same as the fiscal year 2025 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.
        The Committee is aware of the unique barriers students with
    disabilities face in accessing after-school programs, which
    include identifying an appropriate program and experiencing
    higher-than-average costs. These barriers prevent students from
    experiencing the many benefits of afterschool programs, such as
    improved academic performance, social competence, and improved
    motor skills. The Committee encourages the Department of
    Education to prioritize funds awarded under the Nita M. Lowey
    21st Century Community Learning Centers program to applicants
    that increase accessibility to high-quality and inclusive
    after-school programs for students with disabilities.
        The Committee notes there are reports of some States adding
    unnecessary barriers to applying and accessing funds through
    this program. The Committee encourages the Department to
    provide guidance to States to ensure their competitive grant
    and reporting process is streamlined, adheres to congressional
    intent, is void of additional regulations, and does not
    disadvantage rural schools. States should encourage partnership
    with non-profit organizations. The Department is directed to
    report to the Committee within 180 days of enactment of this
    Act on its progress and findings and any additional measures
    taken to address the program's overall standards. Such report
    shall be made available on the agency's website.

    Student Support and Academic Enrichment Grants

        The Committee provides $1,385,000,000 for Student Support
    and Academic Enrichment State Grants, which is an increase of
    $5,000,000 from the fiscal year 2026 budget request and the
    fiscal year 2025 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.

    Rural Education

        The Committee provides $225,000,000 for Rural Education
    programs, which is an increase of $5,000,000 from the fiscal
    year 2026 budget request and the fiscal year 2025 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 $45,897,000 more than the
    fiscal year 2026 budget request and the same as the fiscal year
    2025 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 $44,953,000 more than the fiscal
    year 2026 budget request and the same as the fiscal year 2025
    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 2025.......................      $457,000,000
    Budget request, fiscal year 2026......................             - - -
    Committee Recommendation..............................       190,000,000
        Change from enacted level.........................      -267,000,000
        Change from budget request........................      +190,000,000

        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, which is the same as the fiscal year 2026
    budget request and $91,000,000 below the fiscal year 2025
    enacted level.
        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 $190,000,000 for the School Safety
    National Activities program, which is $190,000,000 below the
    fiscal year 2026 budget request and $26,000,000 below the
    fiscal year 2025 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 2025 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.
        The Committee 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, including LEAs in rural and geographically
    underserved areas. 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 courses that focus on
    maintaining a safe K-12 school environment. These types of
    specialized training 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
    Committee 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 by
    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 $20,000,000
    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 Committee at least seven
    days before any notice of funding opportunity is published or
    any grantees for a new competition are announced.
        School Safety Grant Application Feedback.--The Committee
    acknowledges the challenges that urban and rural school
    districts encounter when applying for federal funding for
    school safety-related grants. The Committee encourages the
    Department to provide applicants with a detailed explanation of
    any grant denials and explicit feedback on grant applications
    within 30 days of the announcement of awardees.
        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 Safety and 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 does not provide funding for Full-Service
    Community Schools program, which is the same as the fiscal year
    2026 budget request and a decrease of $150,000,000 from the
    fiscal year 2025 enacted level. This program makes competitive
    grants to support comprehensive school-based services for
    students, families, and communities, such as mental health and
    nutrition services.
        The Committee believes the core role of the Department
    should be to support local school districts in educating
    children in areas such as reading, writing, and math. Some of
    the services provided by community schools are duplicative of
    other free and subsidized government programs that serve the
    same population.

                                Indian Education

    Appropriation, fiscal year 2025.......................      $194,746,000
    Budget request, fiscal year 2026......................       194,746,000
    Committee Recommendation..............................       199,746,000
        Change from enacted level.........................        +5,000,000
        Change from budget request........................        +5,000,000

        This account supports programs authorized by part A of
    title VI of the ESEA.
        The Office of Elementary and Secondary Education has
    recognized that the Federal government has a unique political
    and legal relationship with Federally recognized Indian Tribes
    and has committed to continuing to deliver on all statutory
    grant programs that support American Indian, Alaska Native, and
    Native Hawaiian students. Over 90 percent of AI/AN students
    attend public schools, and the dedicated funds to serve this
    population are an essential part of meeting our Federal trust
    and treaty obligations to Tribal nations.

    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 2026
    budget request and the fiscal year 2025 enacted level. This
    program provides 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 2026
    budget request and the fiscal year 2025 enacted level. These
    programs make competitive grants to improve the quality of
    education for American Indian students.

    National Activities

        The Committee provides $17,365,000 for National Activities,
    which is an increase of $5,000,000 from the fiscal year 2026
    budget request and the fiscal year 2025 enacted level.
        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.
        Native American Language Programs.--Within the amount for
    national activities, the Committee includes not less than
    $5,000,000 for language immersion programs 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.
        Native American Language Resource Centers.--Within the
    amount for national activities, the Committee provides no less
    than $3,500,000 to support American Indian, Alaska Native, and
    Native Hawaiian language activities for the Native American
    Language Resource Center program established in the explanatory
    statement accompanying the Department of Education
    Appropriations Act, 2022.
        State-Tribal Education Partnerships.--Within the amount for
    national activities, the Committee provides no less than
    $4,000,000 to State-Tribal Education Partnerships. This program
    is designed to improve educational opportunities and
    achievement for Indian students. The program focuses on
    promoting Tribal self-determination in education, improving
    academic outcomes, and fostering collaboration between Tribal,
    State, and local educational agencies.

                           INNOVATION AND IMPROVEMENT

    Appropriation, fiscal year 2025.......................    $1,115,000,000
    Budget request, fiscal year 2026......................       500,000,000
    Committee Recommendation..............................       891,000,000
        Change from enacted level.........................      -224,000,000
        Change from budget request........................      +391,000,000

        This appropriation account includes programs authorized
    under portions of Titles II and IV of the ESEA.
        Civics Knowledge.--The Committee is aware of interests in
    increasing Americans' knowledge of foundational civics matters
    including the structure of the U.S. government and
    constitutional ideas. The 2022 NAEP Civics Assessment found
    that average civics scores in eighth grade remained below the
    proficient level, and they had decreased by two points since
    2018. Moreover, the scores had not changed significantly since
    the assessment began in 1998. The Committee highlights the
    Department's announcement of a grant program for IHEs and
    organizations, to support seminars that examine integral
    elements of the American constitutional government and American
    history as well as commemorate the 250th anniversary of the
    nation's founding. Further, the Committee encourages efforts by
    IHEs to strengthen civics knowledge and understanding.

    American History and Civics Academies

        The Committee provides $3,000,000 for this program, which
    is the same as the fiscal year 2025 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 provides $20,000,000 for this program, which
    is the same as the fiscal year 2025 enacted level.
        National Activities grants promote evidence-based
    instructional methods and professional development programs in
    American history, civics and government, and geography,
    particularly those methods and programs that benefit students
    from low-income backgrounds and underserved students. Grant
    projects may include civic engagement activities and
    educational programs on the history and principles of the
    Constitution and Bill of Rights. The Department makes
    competitive grants to institutions of higher education and
    other nonprofit or for-profit organizations with demonstrated
    expertise.

    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 research
    demonstrating that these grants have improved teacher quality
    or student achievement.

    Charter Schools Grants

        The Committee provides $500,000,000 for Charter School
    Program (CSP) Grants, which is the same as the fiscal year 2026
    budget request and an increase of $60,000,000 from the fiscal
    year 2025 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.
        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 $139,000,000 above the fiscal year 2026 budget request and
    the same as the fiscal year 2025 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 does not provide funding for these
    competitive grants, which is the same as the fiscal year 2026
    budget request and $31,000,000 below the fiscal year 2025
    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. The Committee has chosen to prioritize funding for
    local school districts to improve student outcomes in the core
    curriculum of writing, reading comprehension, and math.

    Arts in Education

        The Committee does not provide funding for these
    competitive grants, which is the same as the fiscal year 2026
    budget request and $36,500,000 below the fiscal year 2025
    enacted level. 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, which is the same as the fiscal year 2026
    budget request and $16,500,000 below the fiscal year 2025
    enacted level. The Committee is concerned that the Department's
    prior 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, which is the same as the fiscal year 2026
    budget request and $20,000,000 below the fiscal year 2025
    enacted level. 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.

    Education Innovation and Research

        The Committee provides $229,000,000 for the Education
    Innovation and Research (EIR) program, which is $229,000,000
    above the fiscal year 2026 budget request and $30,000,000 below
    the fiscal year 2025 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 $90,000,000 for STEM
    education, including computer science.
        Technology Access and Engagement.--The Committee recognizes
    that STEM workforce shortages in emerging sectors are
    increasing at an alarming rate and that K-12 schools can be a
    critical pipeline in recruiting younger people into key
    industry sectors. The Committee also recognizes that providing
    learning experiences to students that incorporate innovative
    technologies, such as mobile education technology labs and
    industry-aligned curriculum and experiences, improves STEM
    learning outcomes and equips students with vital skills for
    high demand STEM fields. The Committee encourages the
    Department to facilitate technology-focused experiences that
    strengthen STEM education and employment opportunities for
    students living in underserved or economically disadvantaged
    areas.
        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 2025.......................      $890,000,000
    Budget request, fiscal year 2026......................             - - -
    Committee Recommendation..............................             - - -
        Change from enacted level.........................      -890,000,000
        Change from budget request........................             - - -

        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 2025.......................   $15,467,264,000
    Budget request, fiscal year 2026......................    15,467,264,000
    Committee Recommendation..............................    15,493,264,000
        Change from enacted level.........................       +26,000,000
        Change from budget request........................       +26,000,000

        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 $14,233,704,000 for Part B Grants to
    States, which is $657,560,000 below the fiscal year 2026 budget
    request and an increase of $20,000,000 from the fiscal year
    2025 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. To be eligible for funds, States must
    make free appropriate public education available to all
    children with disabilities.
        The Committee recognizes the central importance of the
    Individuals with Disabilities Education Act programs for the
    well-being of American schools and youth. This program supports
    the most vulnerable students, families, teachers, and schools.
    The Committee continues to fund this critical program to ensure
    necessary opportunities and support for students.

    Preschool Grants

        The Committee provides $420,000,000 for Preschool Grants,
    which is $420,000,000 above the fiscal year 2026 budget request
    and the same as the fiscal year 2025 enacted level.
        These funds provide additional assistance to States to help
    them make free, appropriate public education available to
    children with disabilities aged 3 through 5.

    Grants for Infants and Toddlers with Disabilities (Part C)

        The Committee provides $540,000,000 for Grants for Infants
    and Toddlers with Disabilities, which is the same as the fiscal
    year 2026 budget request and the fiscal year 2025 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 $258,560,000 for IDEA National
    Activities, which is $258,560,000 more than the fiscal year
    2026 budget request and $1,000,000 above the fiscal year 2025
    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
    $38,630,000 above the fiscal year 2026 budget request and the
    same as the fiscal year 2025 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 $39,345,000 above the fiscal year 2026
    budget request and the same as the fiscal year 2025 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 $115,000,000 above the
    fiscal year 2026 budget request and the same as the fiscal year
    2025 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
    $33,152,000 above the fiscal year 2026 budget request and the
    same as the fiscal year 2025 enacted level. This program makes
    awards for 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 recommends $32,433,000, which is an increase of
    $1,000,000 over the fiscal year 2026 budget request and the
    fiscal year 2025 enacted level, for the Educational Technology,
    Media and Materials program. This program makes competitive
    awards to support the development, demonstration, and use of
    technology and educational media activities of value to
    children with disabilities. The Committee recognizes the
    ongoing progress made with the tools and services provided
    under the Educational Technology, Media and Materials program
    that have allowed more than 1.1 million students with
    disabilities free access to more than 1.36 million books in
    digitally accessible formats while creating systemic change in
    the publishing industry by equipping publishers with tools and
    processes to make their product ``Born Accessible,'' ensuring
    all students, with and without disabilities, can use the same
    educational materials.
        The Committee recognizes that to meet the educational needs
    of more students with print disabilities, new investments are
    required to develop technology and expand capacity so that the
    growing diversity of educational materials, such as teacher
    curated educational materials not included in standard
    textbooks, are also available to eligible students in a timely
    manner. Additionally, the Committee recognizes the benefit of
    making more accessible educational materials available to pre-K
    and post-secondary students in addition to the K-12 student
    population, which requires additional resources and greater
    capacity to process and convert a larger volume of educational
    materials into accessible formats. The Committee continues
    funding for the Educational Technology, Media and Materials
    program to support the efforts required to make a broader range
    of educational materials available to students and to meet the
    needs of all eligible students, including pre-K and
    postsecondary students.

    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 2026 budget request and fiscal year 2025 enacted
    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 2025.......................    $4,533,156,000
    Budget request, fiscal year 2026......................     4,556,413,000
    Committee Recommendation..............................     4,648,295,000
        Change from enacted level.........................      +115,139,000
        Change from budget request........................       +91,882,000

        The programs in this account are authorized by the
    Rehabilitation Act of 1973 and the Helen Keller National Center
    Act.
        With the funding provided to Rehabilitation Services, the
    Committee urges the Department to update applicable data,
    guidance, and policies to be consistent with 41 U.S.C. 8501-
    8506; the Rehabilitation Act of 1973, P.L. 93-112; and the
    Workforce Innovation and Opportunity Act, Pub. L. 113-78, to
    ensure employment through a nonprofit organization
    participating in the AbilityOne program is a positive
    employment outcome for those who are blind and or disabled.

    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 encourages 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 2027
    congressional justification, the Committee requests an update
    on such efforts from fiscal year 2025 and planned efforts in
    fiscal years 2026 and 2027.

    Client Assistance State Grants

        The Committee provides $13,000,000 for Client Assistance
    State Grants, which is $13,000,000 above the fiscal year 2026
    budget request and the same as the fiscal year 2025 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 $29,388,000 above the fiscal year 2026 budget
    request and the same as the fiscal year 2025 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 $5,796,000 above the fiscal year
    2026 budget request and the same as the fiscal year 2025
    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 $20,150,000 above the
    fiscal year 2026 budget request and the same as the fiscal year
    2025 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 $22,548,000 above the fiscal year 2026
    budget request and the same as the fiscal year 2025 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 $33,317,000 above the fiscal year
    2026 budget request and the same as the fiscal year 2025
    enacted level.
        Funds are distributed to States according to a formula
    based on the population of individuals who are 55 or older and
    provide support for services to persons 55 years old or over
    whose severe visual impairment makes gainful employment
    extremely difficult to obtain, but for whom independent living
    goals are feasible.

    Helen Keller National Center

        The Committee provides $20,000,000 for the Helen Keller
    National Center for DeafBlind Youth and Adults, which is
    $1,000,000 above the fiscal year 2026 budget request and the
    fiscal year 2025 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.
        The Committee recognizes the need to ensure delivery of
    high-quality special education and related services to children
    and youth who are blind or visually impaired, deaf, hard of
    hearing, deaf disabled, or deafblind through specialized
    instructional services and methodologies designed to meet their
    unique language and learning needs. The Committee also
    recognizes the need to support the development of personnel
    serving children and youth who are blind or visually impaired,
    deaf, hard of hearing, deaf disabled, or deafblind. The
    Committee includes an increase of $1,000,000 for grants to
    provide support to eligible deafblind schools, or other
    applicable entities, to expand the capacity to work with
    medically complex students.

               SPECIAL INSTITUTIONS FOR PERSONS WITH DISABILITIES

    Appropriation, fiscal year 2025.......................      $303,292,000
    Budget request, fiscal year 2026......................       303,292,000
    Committee Recommendation..............................       307,292,000
        Change from enacted level.........................        +4,000,000
        Change from budget request........................        +4,000,000

                     AMERICAN PRINTING HOUSE FOR THE BLIND

    Appropriation, fiscal year 2025.......................       $43,431,000
    Budget request, fiscal year 2026......................        43,431,000
    Committee Recommendation..............................        44,431,000
        Change from enacted level.........................        +1,000,000
        Change from budget request........................        +1,000,000

        This funding supports the production of educational
    materials for legally blind persons enrolled in pre-college
    programs. The American Printing House for the Blind (APH),
    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 APH 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 for continued support
    and development of assistive technology products and
    educational materials for students who are blind or visually
    impaired.
        Center for Assistive Technology Training.--Within the
    amounts provided for APH, the Committee includes up to
    $6,000,000, which is the same as the fiscal year 2025 enacted
    level, for the Center for Assistive Technology Training,
    including regional partnerships to provide instruction and
    technical assistance throughout the United States. The
    Committee believes training on a national level is essential to
    ensure teachers and families have the resources necessary to
    fully utilize APH products and technologies.
        Monarch.--Within amounts provided for APH, the Committee
    includes up to $6,000,000, which is an increase of $1,000,000
    from the fiscal year 2025 enacted level, to support production
    and distribution of an innovative braille and tactile display
    product developed by APH and its partners.

                NATIONAL TECHNICAL INSTITUTE FOR THE DEAF (NTID)

    Appropriation, fiscal year 2025.......................       $92,500,000
    Budget request, fiscal year 2026......................        92,500,000
    Committee Recommendation..............................        94,500,000
        Change from enacted level.........................        +2,000,000
        Change from budget request........................        +2,000,000

        Congress established the National Technical Institute for
    the Deaf (Institute) in 1965 to provide a residential facility
    for postsecondary technical training and education for deaf
    persons with the purpose of promoting the employment of these
    individuals. The Institute also conducts applied research and
    provides training related to various aspects of deafness. The
    Secretary of Education administers these activities through a
    contract with the Rochester Institute of Technology in
    Rochester, New York.
        Regional STEM Center.--The Committee includes up to
    $9,500,000, which is equal to the fiscal year 2025 enacted
    level, to continue NTID's current Regional STEM Center
    partnership. The STEM Center program expands NTID's
    geographical reach and improves access to postsecondary STEM
    education and employment for students who are deaf or hard of
    hearing in underserved areas. This has included professional
    development for teachers, developing relationships with
    business and industry to promote employment opportunities, and
    preparing students to be successful in STEM fields.

                              GALLAUDET UNIVERSITY

    Appropriation, fiscal year 2025.......................      $167,361,000
    Budget request, fiscal year 2026......................       167,361,000
    Committee Recommendation..............................       168,361,000
        Change from enacted level.........................        +1,000,000
        Change from budget request........................        +1,000,000

        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 (ELAP).--The Committee
    includes $8,500,000, which is equal to the fiscal year 2025
    enacted level, to continue the national expansion of ELAP
    through the Gallaudet University regional centers, of which the
    current partner is a regional center. ELAP supports early
    language acquisition for children from birth through age three
    who are deaf or hard of hearing. This program also supports
    activities to improve early language acquisition training for
    early educators, caretakers, and other professionals and allows
    Gallaudet to expand and build on its current research in this
    area, and test and evaluate interventions in diverse geographic
    areas.

                Office of Career, Technical, and Adult Education

                     CAREER, TECHNICAL, AND ADULT EDUCATION

    Appropriation, fiscal year 2025.......................    $2,181,436,000
    Budget request, fiscal year 2026......................     1,450,000,000
    Committee Recommendation..............................     1,475,000,000
        Change from enacted level.........................      -706,436,000
        Change from budget request........................       +25,000,000

        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.
        The Committee supports skilled workforce education in
    schools and recognizes what it brings to America's skilled
    professions through educating a new generation of pride,
    progress, and professionals.
        The Committee notes Congress' intent for Perkins funding to
    provide career and technical education for the ``middle
    grades,'' which may include 5th and 6th graders in some States.
    Where applicable, the Committee supports efforts to limit
    barriers of Federal support not reaching all eligible
    populations.
        Dual Enrollment.--The Committee urges the Department to
    recommend pathways to expand dual enrollment for technical
    work, such as welding and shop class, and encourages the
    Department to offer additional technical assistance to schools
    to support this use.

    Career and Technical Education: State Grants

        The Committee provides $1,464,848,000 for Career and
    Technical Education (CTE) State Grants, which is an increase of
    $25,000,000 from the fiscal year 2026 budget request and the
    fiscal year 2025 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.

    Career and Technical Education: National Programs

        The Committee provides $10,152,000 for National Programs,
    which is the same as the fiscal year 2026 budget request and a
    decrease of $2,269,000 from the fiscal year 2025 enacted level.
    This program supports the conduct and dissemination of research
    in career and technical education.

    Adult Education State Grants

        The Committee does not provide funding for Adult Basic and
    Literacy Education State Grants, which is the same as the
    fiscal year 2026 budget request and $715,455,000 below the
    fiscal year 2025 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.
        Due to funding constraints, the Committee has focused
    limited resources on programs working directly with local
    school districts.

    Adult Education National Leadership Activities

        The Committee does not provide funding for National
    Leadership Activities, which is the same as the fiscal year
    2026 budget request and $13,712,000 below the fiscal year 2025
    enacted level. This program supports applied research,
    development, dissemination, evaluation, and program improvement
    efforts to strengthen the quality of adult education services.
        Due to funding constraints, the Committee has focused
    limited resources on programs working directly with local
    school districts.

                       Office of Postsecondary Education

                                HIGHER EDUCATION

    Appropriation, fiscal year 2025.......................    $3,080,952,000
    Budget request, fiscal year 2026......................       949,671,000
    Committee Recommendation..............................     2,714,241,000
        Change from enacted level.........................      -366,711,000
        Change from budget request........................    +1,764,570,000

    Aid for Institutional Development

    Strengthening Institutions

        The Strengthening Institutions program under Part A of
    title III of the HEA 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 $107,070,000 for the Strengthening
    Institutions program, which is $5,000,000 below the fiscal year
    2024 enacted level.

    Developing Hispanic-Serving Institutions

        The Committee provides $228,890,000 for the Developing
    Hispanic-Serving Institutions (HSI) program, which is the same
    as the fiscal year 2025 enacted level.
        The Developing HSIs program provides operating subsidies to
    schools that serve at least 25 percent Hispanic students. Funds
    may be used for faculty and academic program development,
    management, joint use of libraries and laboratories,
    acquisition of equipment, and student services.
        Hispanic-Serving Institutions Support.--The Committee
    requests an update in the fiscal year 2027 congressional
    justification on the Department's activities and efforts
    related to supporting HSIs.
        New Hispanic-Serving Institutions.--The Committee
    encourages the Department to provide technical assistance to
    newly designated HSIs on 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 2025 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.
        Hispanic-Serving Institutions Funding.--The Committee
    directs that no funds provided in this Act may be used to
    freeze, delay, or cancel funding for Hispanic-Serving
    Institutions. The Committee further expects the Department to
    distribute funds in a timely manner to ensure continuity of
    support for HSIs.

    Strengthening Historically Black Colleges and Universities

        The Committee provides $406,966,000 for Strengthening
    Historically Black Colleges and Universities (HBCUs), which is
    $6,000,000 more than the fiscal year 2025 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 seeks to support educational opportunities
    for students at these schools. The Committee is aware that many
    students choose to pursue their academic and career goals by
    enrolling in programs offered by two-year HBUCs. These students
    may attain an associate's degree or other certification and
    enter the workforce directly or choose to transfer to complete
    a bachelor's degree at a four-year IHE. The Committee
    recognizes the important role of two-year HBCUs, given that
    community colleges can provide students with opportunities to
    more quickly and affordably obtain the learning and skills
    required for their chosen field. The Committee continues
    language providing supplemental awards to junior or community
    colleges that are eligible under the Historically Black
    Colleges and Universities program.
        Reducing Recidivism.--The Committee supports the
    Department's coordination and collaboration with Historically
    Black Colleges and Universities to provide educational programs
    for individuals engaged with the criminal justice system, to
    assist them in obtaining skills that will help them
    successfully transition back into their communities.

    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 2025 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 2025 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 2025
    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 2025 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 $12,462,000 for the Native American
    Serving Non-Tribal Institutions program, which is the
    $1,000,000 more than the fiscal year 2025 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 $56,807,000 for the Strengthening
    Tribally Controlled Colleges and Universities (TCCUs) program,
    which is $5,000,000 more than the fiscal year 2025 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
    2025 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 does not include funding for the Domestic
    Programs of the International Education and Foreign Languages
    Studies program. The Committee prioritizes limited resources
    for other programs providing financial aid to students and aid
    to institutions and supports efforts by States, localities, and
    institutions of higher education to conduct the activities
    supported by the Domestic Programs according to their policy
    priorities.

    Overseas Programs

        The Committee does not include funding for the Overseas
    Programs. The Committee prioritizes limited resources for other
    programs providing financial aid to students and aid to
    institutions and supports efforts by States, localities, and
    institutions of higher education to conduct the activities
    supported by the Overseas Programs according to their policy
    priorities.

    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 2025 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 2025 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 2025
    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 the Federal TRIO
    programs, which is the same as the fiscal year 2025 enacted
    level. TRIO provides a variety of outreach and support services
    to encourage low-income, first-generation college students and
    individuals with disabilities to enter and complete college.
    Discretionary grants of up to four or five years are awarded
    competitively to IHEs and other nonprofit organizations. At
    least two thirds of the eligible participants in TRIO must be
    low-income, first-generation college students.
        The Department is directed to allocate funding for each of
    the individual TRIO programs at no less than the following
    levels: Talent Search $190,182,000; Upward Bound $380,830,000;
    Veterans Upward Bound $22,253,000; Upward Bound Math-Science
    $79,614,000; EOCs $59,450,000; Student Support Services
    $380,816,000; Ronald E. McNair Postbaccalaureate Achievement
    Program $61,357,000; and TRIO Training Grants $4,150,000.
        The Department is also directed to ensure that the notices
    inviting applications for new awards for the Talent Search and
    Educational Opportunity Centers grant competitions are
    published no later than December 1, 2025. The Department is
    further directed to take steps necessary to issue grant award
    notifications for all TRIO programs (both new and non-competing
    continuation award notices) no later than June 30, 2026.

    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 the same as the fiscal year 2025 enacted level. GEAR UP
    provides grants to States and partnerships of low-income middle
    and high schools, IHEs, and community organizations to target
    entire grades of students and give them the skills,
    encouragement, and scholarships to pursue successfully
    postsecondary education.
        The Committee continues bill language allowing the
    Department to maintain the GEAR UP evaluation set-aside at 1.5
    percent to work with the GEAR UP community and grantees to
    standardize data collection, including through the use of
    third-party data systems. 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).
        Gaining Early Awareness and Readiness for Undergraduate
    Programs (GEAR UP) Funding.--The Committee directs that no
    funds provided in this Act may be used to freeze, delay, or
    cancel funding for GEAR UP. The Committee further expects the
    Department to distribute funds without interruption to ensure
    the program continues to expand educational opportunity for
    lowincome students.

    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 recommendation prioritizes other programs
    providing support to students and recognizes that institutions
    of higher education or non-Federal sources of postsecondary
    funding are alternative sources of support for 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 2023 was 56 percent, down from 63
    percent in 2021. Additionally, the program's cost per PhDs and
    for students who pass preliminary exams exceeded the target of
    $68,0000 in both 2023 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 are most able to be
    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 programs such
    as Head Start and the Child Care and Development Block Grant,
    which provide early learning and care programs for low-income
    families and for which the Committee has included funding.

    Fund for the Improvement of Postsecondary Education

        The Committee recommendation includes $47,500,000 for the
    Fund for the Improvement of Postsecondary Education.

    ------------------------------------------------------------------------
                       Budget Activity                     FY 2026 Committee
    ------------------------------------------------------------------------
     Increasing Hispanic PhDs Pilot......................         $2,500,000
    Rural Postsecondary and Economic Development Grant            45,000,000
     Program.............................................
    ------------------------------------------------------------------------

        Increasing Hispanic-Serving Institutions PhDs Pilot.--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 Ph.D. attainment. Grant priority
    will go to institutions with 25 percent or higher Pell
    enrollment. Funding should be used to develop and test new
    models of cross-institutional partnerships that facilitate the
    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.
        Rural Postsecondary and Economic Development Grants.--The
    Committee provides $45,000,000, the same as 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
    significantly less likely than their peers in other areas to
    pursue 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 prior 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 more
    flexibility, longer application timelines, and targeted
    technical assistance for RPED grants and other funding
    opportunities.

    Augustus F. Hawkins Centers of Excellence

        The Committee continues $15,000,000 for the Hawkins Centers
    of Excellence program. The Hawkins program is intended to
    support teacher education programs at Minority Serving
    Institutions, Historically Black Colleges or Universities,
    Historically Black Graduate Institutions, Hispanic-Serving
    Institutions, Tribally Controlled Colleges, Alaska Native-
    Serving Institutions, Native Hawaiian-Serving Institutions,
    Predominantly Black Institutions, Asian American and Native
    American Pacific Islander-Serving Institutions, and Native
    American-Serving Nontribal Institutions. The program provides
    competitive grants for up to five years for IHEs to improve or
    expand their teacher education programs through the
    establishment of centers of excellence.

                               HOWARD UNIVERSITY

    Appropriation, fiscal year 2025.......................      $304,018,000
    Budget request, fiscal year 2026......................       240,018,000
    Committee Recommendation..............................       240,018,000
        Change from enacted level.........................       -64,000,000
        Change from budget request........................             - - -

        The Committee provides $240,018,000 for Howard University,
    which is $64,000,000 less than the fiscal year 2025 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 2025 enacted level.
        Howard University Hospital.--Within the funds provided for
    Howard University, the Committee recommends $13,325,000 for the
    Howard University Hospital for ongoing hospital operations,
    which is the same as the budget request. The Committee does not
    provide additional funding for construction for the new Howard
    University Hospital, following appropriations in fiscal years
    2021 through 2025 that completed the University's request for
    funding to support construction of the new hospital.

             COLLEGE HOUSING AND ACADEMIC FACILITIES LOANS PROGRAM

    Appropriation, fiscal year 2025.......................          $298,000
    Budget request, fiscal year 2026......................           298,000
    Committee Recommendation..............................           298,000
        Change from enacted level.........................             - - -
        Change from budget request........................             - - -

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

      HISTORICALLY BLACK COLLEGE AND UNIVERSITY CAPITAL FINANCING PROGRAM
                                    ACCOUNT

    Appropriation, fiscal year 2025.......................       $20,678,000
    Budget request, fiscal year 2026......................        20,678,000
    Committee Recommendation..............................        20,678,000
        Change from enacted level.........................             - - -
        Change from budget request........................             - - -

        The Committee provides $20,678,000 for the HBCU Capital
    Financing program, which is the same as the fiscal year 2025
    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 administrative expenses to
    carry out the program and $20,150,000 for loan subsidy costs,
    which will support an estimated $500,000,000 in new loan volume
    in fiscal year 2026.

                      Office of Federal Student Aid (FSA)

        90/10 Rule.--The 90/10 rule under the HEA requires
    proprietary IHEs to derive at least 10 percent of their tuition
    and fee revenue from non-Title IV sources. Under the prior
    Administration, the Department issued a rule in October 2022 to
    include other Federal education assistance funds from other
    Federal agencies, not just Title IV funds, as required by P.L.
    117-2, as well as other changes. The rule was effective July 1,
    2023, for institutional fiscal years that begin on or after
    January 1, 2023, requiring some institutions to comply as of
    January 1, 2023. The Committee is aware that commenters
    questioned this timing for compliance and sought clarification
    on what statutory authority the Department used as a basis for
    that determination. The Committee also notes strong concerns
    that the preamble to the rule purported to interpret the rule
    to penalize institutions for utilizing distance learning. The
    Committee understands that the Department issued an
    interpretive rule, ``Classification of Revenue Under Title
    IV,'' published in the Federal Register on July 7, 2025,
    stating that this preamble language is non-binding, because the
    Department did not incorporate it through changes to the
    regulatory text. The interpretive rule further rescinded that
    non-binding language in the preamble and made clear that the
    Department believes ineligible distance education program
    revenue may be included in the 90/10 revenue calculation.
    Additionally, the Committee encourages efforts by the
    Department to provide clear communication and information on
    this rule, given its complexities and significant impact on
    students and proprietary institutions.
        Consolidation Loans.--The Committee is concerned that under
    the previous Administration, the Department of Education did
    not have adequate processes and safeguards in place to ensure
    it upholds the statutory and regulatory requirements regarding
    the consolidation of Federal Family Education Loan (FFEL)
    Consolidation Loans into the Direct Loan program under the HEA,
    and that any incorrect consolidation can adversely impact those
    involved including students and student loan organizations. The
    HEA permits borrowers who consolidated their loans into a
    single Consolidation Loan to receive a subsequent consolidation
    loan only under specified circumstances. The Department is
    directed to provide an update in the fiscal year 2027
    congressional justification on the processes and safeguards in
    place to ensure that FFEL Consolidation Loans are consolidated
    into the Direct Loan program for a legally permitted purpose.
        Federal Financial Aid Fraud.--The Committee is aware of
    concerns about fraud in Federal financial aid. The Department
    and institutions of higher education have roles related to
    flagging potentially fraudulent financial aid applicants and
    verifying applicant information, and the Department of
    Education's Office of Inspector General investigates reports of
    waste, fraud, and abuse. Any fraudulent activity misuses
    taxpayer dollars and is unfair to law-abiding individuals and
    institutions of higher education. In December 2024, the
    Department of Education Office of Inspector General reported
    that over fiscal year 2019 through 2024 it closed 128
    investigations stemming from institutional fraud, the use of
    falsified data for ineligible students, identity theft, and
    discharge or repayment fraud. It noted that fraud rings
    accounted for a substantial share of these identify theft and
    ineligible student cases. OIG reported ways FSA could
    strengthen its risk-based verification procedures, monitoring,
    and other internal controls to mitigate fraud. Given the
    substantial amount of financial aid the Department oversees--
    $120.8 billion in grants, loans, and work-study funding
    disbursed in fiscal year 2024 alone, according to Federal
    Student Aid's annual report--the Committee commends the
    Department for its renewed focus on stewarding taxpayer dollars
    in Federal financial aid. In June 2025, the Department
    announced it will implement new efforts to combat identify
    theft and fraud in Federal student aid programs in fall 2025,
    as well as require certain verification changes in the near-
    term. The Committee requests an update in the fiscal year 2027
    congressional budget justification on efforts the Department
    has made, including in coordination with IHEs, to mitigate
    Federal financial aid fraud.
        Public Service Loan Forgiveness.--The Committee appreciates
    existing Federal Student Aid reporting on the Public Service
    Loan Forgiveness (PSLF) program portfolio, applications, and
    processed discharges but remains interested in the fiscal and
    distributional impact associated with the program. 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 120 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,
    which shall include to the extent possible: 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 under the prior Administration, the Department of
    Education 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). This was consistent with the prior Administration's
    disastrous rollout of the 2024-25 FAFSA, which caused delays
    and confusion among students and their families and
    institutions of higher education. Such information is necessary
    for GAO to complete its work. Recognizing that the Department
    is now under new leadership, the Committee urges FSA to comply
    with ongoing and future GAO information requests related to the
    two FAFSA reviews, in keeping with GAO's statutory authority to
    access agency records under 31 U.S.C. Sec. 716(a). The
    Committee encourages GAO to provide the Committee periodic
    updates on the Department's responsiveness to GAO's information
    requests on the two FAFSA reviews. The Committee requests the
    Department include in the fiscal year 2027 congressional
    justification the status of any outstanding recommendation, not
    fully implemented, from any prior GAO publication.

                          STUDENT FINANCIAL ASSISTANCE

    Appropriation, fiscal year 2025.......................   $24,615,352,000
    Budget request, fiscal year 2026......................    22,725,352,000
    Committee Recommendation..............................    23,254,221,000
        Change from enacted level.........................    -1,361,131,000
        Change from budget request........................      +528,869,000

    Pell Grants

        The Committee provides $22,475,352,000 in discretionary
    funding for the Pell Grant program, which is the same as the
    fiscal year 2025 enacted level. These funds will support Pell
    Grants to students for the 2026-2027 award year.
        The Committee recommendation includes $6,335 for the
    discretionary portion of the maximum Pell grant award, the same
    as the fiscal year 2025 enacted level. Combined with mandatory
    funding under current law, this would continue to support a
    total maximum award of $7,395 for the 2026-2027 award year.
        Pell Grants are the foundation of Federal postsecondary
    student aid programs, increasing access to educational and
    economic opportunities for lower-income students by providing
    need-based financial assistance. Grants are determined
    according to a statutory formula, which considers income,
    assets, household size, cost of attendance, and full-time or
    part-time enrollment status, among other factors.
        Second Chance Pell.--The Committee understands that the
    FAFSA Simplification Act authorized Federal Pell Grants for
    students who are incarcerated and enrolled in a prison
    education programs (PEPs), which are offered by eligible IHEs.
    The Committee recognizes the value in evaluating outcomes of
    such students enrolled in PEPs. The Committee strongly
    encourages the Department, in coordination with IHEs offering
    PEPs and/or IHEs that participated in the PEP experimental
    site, to evaluate the outcomes of such programs on incarcerated
    students' enrollment, retention, completion, earnings, and
    similar outcomes metrics, and to make such an evaluation
    publicly available on the Department's website.

    Federal Supplemental Educational Opportunity Grants

        The Federal Supplemental Educational Opportunity Grant
    (FSEOG) 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 does not provide funding for
    FSEOG. Given limited Federal resources, the Committee
    prioritizes funding for other assistance to students, primarily
    through the Pell Grant program which is the foundation of
    Federal student aid and goes directly to students. The
    Committee is aware of concerns that the program's statutory
    formula allocates funding in part based on an institution's
    historical participation in the program and therefore may not
    optimize the delivery of grant aid to institutions with the
    greatest shares of students with financial need.

    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 $778,869,000 for this
    program, which is $451,131,000 below the fiscal year 2025
    enacted level.
        The Committee encourages the Department to continue support
    in fiscal year 2026 for the Work Colleges program authorized
    under section 448 of the HEA at $11,053,000, the same rate
    provided in fiscal year 2024.
        Marine Environment Opportunities.--The Committee is aware
    that FWS jobs are intended to complement or reinforce the
    student's educational program or vocational goals as much as
    possible, and that a broad range of jobs can be eligible under
    the FWS program. FWS community service jobs opportunities, for
    example, may include programs focused on animal habitats and
    marine environments, including but not limited to the
    rehabilitation and the improvement of wildlife habitats, fish
    culture, and other fishery assistance. The Committee encourages
    such opportunities related to marine science and conservation,
    consistent with the FWS program requirements, and notes the
    benefits for participants in providing valuable experience in a
    students' chosen field, especially to the extent there are
    projected increases in workforce demands in such field.

                           STUDENT AID ADMINISTRATION

    Appropriation, fiscal year 2025.......................    $2,058,943,000
    Budget request, fiscal year 2026......................     2,058,943,000
    Committee Recommendation..............................     2,058,943,000
        Change from enacted level.........................             - - -
        Change from budget request........................             - - -

        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
    $1,058,943,000 for salaries and expenses, which is the same as
    the fiscal year 2024 enacted level.

    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.
        Borrower Repayment Information.--In monthly briefings to
    the Committees and to the Committees on Education and Workforce
    of the House of Representatives and on Health, Education,
    Labor, and Pensions of the Senate on student aid administrative
    activities during fiscal year 2026, the Committee requests the
    Department include information related to borrower status,
    including on the number of borrowers for whom processing of
    income-driven repayment (IDR) applications is paused, updates
    on borrower progress related to IDR repayment requirements, and
    communications to borrowers regarding such repayment progress.
        Free Application for Federal Student Aid (FAFSA).--The
    Committee is encouraged by the Department's efforts to minimize
    disruptions and ensure proper performance of the 2025-2026
    FAFSA process. This progress is welcome after the highly
    problematic rollout of the 2024-2025 FAFSA under the prior
    Administration, during which financial aid applicants and IHEs
    experienced numerous delays and technical problems. The
    Committee appreciates the Department's regular communication
    with the Committee on administration of the current FAFSA cycle
    and looks forward to continued updates, including preparations
    for the upcoming 2026-2027 FAFSA.
        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 516 of this Act.
        Return to Repayment.--The Committee commends the Department
    for a strong commitment to returning borrowers to repayment.
    This is a welcome departure from the irresponsible policies and
    unnecessarily tumultuous return to repayment under the prior
    Administration. The Committee is aware that many borrowers are
    making payments for the first time in several years. In April
    2025, the Department stated that out of about 43 million
    borrowers, only 38 percent were in repayment and current on
    their loans. More than 5 million were in default, having not
    made a payment in more than 360 days. Another 4 million were in
    late-stage delinquency of nonpayment for 91 to 180 days. The
    Department projected that potentially 10 million borrowers
    could be in default within a few months, which would amount to
    about 1 in four borrowers in the portfolio being in default.
    The new Administration is charged with fixing the problems left
    by the prior Administration, and the Committee is encouraged by
    the Department's efforts to responsibly steward the student
    loan program. The Committee underscores the Department's
    efforts to provide clear communication to borrowers, including
    assisting them in how to become current on their loans and
    avoid default. As the Department undertakes this important work
    the Committee directs the Department to continue providing
    monthly briefings to the Committees on Appropriations,
    Education and Workforce, and Health, Education, Labor, and
    Pensions on progress related to Federal student loan servicing
    and repayment. The Committee also encourages the Department to
    provide periodic updates to the Committee regarding the
    performance of the Unified Servicing and Data Solution (USDS).
        Spend Plans.--The Committee directs the Department to
    provide a detailed spend plan of the planned uses of funds in
    this account for fiscal year 2026, within 45 days of enactment
    of this Act, and to provide quarterly updates on this plan no
    later than 10 days prior to the start of such quarter. This
    shall include 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 2026.
    The Department is encouraged to provide a comparison to the
    prior fiscal year in such spend plan, as well as include a
    description of planned activities and any notable comparisons
    to the prior fiscal year. Such spend plans should include
    details of major activities, including the Unified Servicing
    and Data Solution and initiatives related to the implementation
    of recent legislation, as applicable.

                        Institute Of Education Sciences

                        INSTITUTE OF EDUCATION SCIENCES

    Appropriation, fiscal year 2025.......................      $793,106,000
    Budget request, fiscal year 2026......................       261,300,000
    Committee Recommendation..............................       740,373,000
        Change from enacted level.........................       -52,733,000
        Change from budget request........................      +479,073,000

        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 $245,000,000 above the
    fiscal year 2026 budget request and the same as the fiscal year
    2025 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.
        Innovative Learning Model Development Program.--To ensure
    students maximize their potential and meet the needs of the
    21st century economy, a portion of these funds should be
    directed to support a new funding opportunity to develop
    innovative learning models that improve student outcomes.
    Innovative learning models are bundles of integrated tools,
    resources, systems, and teaching practices that enable schools
    to provide their students with individualized learning
    experiences through different learning modalities. The Director
    shall make awards for both early-phase and mid-phase
    development, implementation, feasibility testing, and rigorous
    evaluation of an innovative learning model. Eligible entities
    for the award include innovative learning model providers that
    partner with schools and school communities to support the
    implementation of such models, while sharing accountability for
    student outcomes. The Committees direct IES to provide a
    briefing on plans for making new awards not less than two weeks
    before the publication of a funding opportunity notice. In
    addition, the IES shall provide a briefing and notice of awards
    to the Committees at least seven days before grantees are
    announced.
        National Center for Special Education Research.--The
    Committee supports the National Center for Special Education
    Research, which provides high quality and rigorous research on
    special education and related services on the full range of
    issues facing children with disabilities, parents of children
    with disabilities, and school personnel. Research findings help
    inform interventions, teaching strategies, and other critical
    factors in educating children with disabilities.

    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 2026 budget request and the
    fiscal year 2025 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 2027 congressional justification.
        Legacy Status.--The Committee notes interest in promoting
    merit in college admissions. The Committee further notes the
    lack of data available regarding legacy status--the
    relationship to institution alumni--and first-time, first-year,
    degree-seeking admissions decisions. Starting with the 2022-
    2023 Integrated Postsecondary Education Data System (IPEDS)
    admission surveys, NCES began to ask if IHEs consider legacy
    status. The Committee encourages NCES to consider collecting
    data on applications, admission, and enrollments by applicants
    with legacy status at institutions eligible to participate in
    Title IV programs under the HEA and those IHEs that also
    provide legacy preferences according to their IPEDS response.
        School Cellphone Bans.--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 same as the fiscal year 2025 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.
        National Center for Special Education Research.--The
    Committee supports the National Center for Special Education
    Research, which provides high quality and rigorous research on
    special education and related services on the full range of
    issues facing children with disabilities, parents of children
    with disabilities, and school personnel. Research findings help
    inform interventions, teaching strategies, and other critical
    factors in educating children with disabilities.

    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
    2025 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 $28,500,000 below the fiscal year 2026 budget request and
    the same as the fiscal year 2025 enacted level. These
    competitive grants are awarded to States to design and maintain
    longitudinal data systems.
        Strengthening Data Privacy.--The Committee directs the
    Secretary, in conjunction with the Secretary of Labor, to
    provide guidance and technical assistance on integrated data
    systems and student and worker privacy. This guidance should
    build on and expand the guidance issued by the Privacy
    Technical Assistance Center in January 2017 (PTAC-IB-4).

    Assessment

        The Committee provides $193,300,000 for Assessment, which
    is $55,970,000 above the fiscal year 2026 budget request and
    the same as the fiscal year 2025 enacted level. This amount
    includes $8,300,000 for the National Assessment Governing Board
    (NAGB), which is $870,000 above the fiscal year 2026 budget
    request and the same as the fiscal year 2025 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 $73,500,000 above the fiscal year 2026
    budget request and the same as the fiscal year 2025 enacted
    level.
        Operating Plan.--The agreement directs the Director to
    submit an operating plan within 90 days of enactment of this
    Act to the Committees detailing how IES plans to allocate
    funding available to the Institute for research, evaluation,
    statistics, administration, and other activities.

                            DEPARTMENTAL MANAGEMENT

    Appropriation, fiscal year 2025.......................      $627,407,000
    Budget request, fiscal year 2026......................       447,007,000
    Committee Recommendation..............................       447,007,000
        Change from enacted level.........................      -180,400,000
        Change from budget request........................             - - -

                             PROGRAM ADMINISTRATION

    Appropriation, fiscal year 2025.......................      $419,907,000
    Budget request, fiscal year 2026......................       293,007,000
    Committee Recommendation..............................       293,007,000
        Change from enacted level.........................      -126,900,000
        Change from budget request........................             - - -

        The Committee recommends $293,007,000 for Program
    Administration, which is $126,900,000 less than the fiscal year
    2025 enacted level. 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.
        Comprehensive Literacy Programs.--The Committee supports
    efforts to equip educators with comprehensive literacy
    resources in a 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.
        Course Materials.--The Committee recognizes there are
    different models through which students obtain course
    materials. The Committee is aware of concerns regarding
    proposed restrictions related to the use of certain models
    known as tuition- and fee-based course materials fees and
    access programs. The Committee supports the Department in not
    restricting the use of such models as a condition of receiving
    a Federal grant.
        Cost Savings of Inclusive Access Programs Study.--The
    Committee is aware of concerns regarding previously proposed
    changes to the Cash Management regulations related to Books and
    Supplies for Title IV funds, including concerns about
    unintentional price increases and limits on 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.
        Healthcare Workforce Education.--The U.S. healthcare
    workforce faces challenges including primary care shortages,
    high levels of burnout and mental health issues, declining job
    and career satisfaction, and a workforce that is aging along
    with the general population. The U.S. Bureau of Labor
    Statistics projects 193,100 openings for nurses in the U.S.
    each year through 2032. These openings are due to increased
    demand associated with the aging population and a decrease in
    supply due, as well as educational enrollment not keeping pace
    with the demand for healthcare workers. Accrediting agencies
    play an important role in ensuring a basic level of quality
    education for these and other healthcare workers. The Committee
    is aware of concerns related to the supply of healthcare
    workers and encourages efforts to address existing barriers to
    ensure such supply can meet demands.
        Military Student Identifier.--The Committee recognizes the
    unique challenges faced by children of members of the National
    Guard and Reserve who are not currently identified under the
    Military Student Identifier (MSI) established in the Every
    Student Succeeds Act. The Committee encourages the Department
    of Education to explore options for expanding the MSI to
    include all military-connected students, including those whose
    parents serve in the Reserve Components but are not on full-
    time active duty. The Committee further urges the Department to
    provide guidance to States and local educational agencies on
    how to support these students through targeted programs, data
    collection, and educator training, to ensure equitable
    recognition and support for all military-connected children.
        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.
        Paperwork Reduction.--The Committee appreciates efforts, as
    appropriate, by the Department to streamline the paperwork
    burden associated with administering grants to school
    districts.
        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 is aware that under
    the prior Administration, there were engagements where the
    Department of Education delayed in providing GAO with timely
    and complete information in response to GAO requests. Such
    actions diminished transparency and accountability. The public
    rightly expects both. The Committee notes the opportunity for
    the Department under the new Administration to provide timely
    and complete information to GAO on its engagements within
    timeframes as GAO may specify and urges it to do so. The
    Committee notes GAO may choose to develop timeliness criteria
    to measure the Department's responsiveness to GAO requests for
    information, and in such case, GAO should consult with the
    Department, as GAO determines appropriate, in developing such
    criteria. Congressional oversight often relies on GAO
    activities, and the development of such criteria will assist
    GAO in the timely completion of work.
        Science of Reading.--The Committee commends the success
    science of reading curriculum has had on literacy scores in
    States such as Louisiana, California, and Mississippi. The
    Committee encourages the Department of Education to develop a
    report on State implementation of science of reading
    curriculum, including the use of grants, roadblocks to State
    implementation, and best practices for science of reading
    curriculum.
        Teacher Resources.--The Committee is concerned about the
    decreasing number of candidates entering the teaching
    profession, which has a direct impact on classroom performance
    by students at every grade level. The Committee supports
    efforts by the Department to foster new approaches to human
    capital management systems and performance-based compensation
    systems through the development and implementation of strategic
    school staffing models that include new educator roles, team-
    based models, distributed expertise, and opportunities for
    teacher leadership.
        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. Section 117 of the HEA
    requires institutions of higher education receiving Federal
    funding to disclose foreign-sourced gifts and contracts if the
    value is $250,000 or more, and they must disclose ownership or
    control by a foreign source. The Committee notes the White
    House executive order issued on April 23, 2025, ``Transparency
    Regarding Foreign Influence at American Universities,'' to
    enhance reporting transparency under section 117, and the
    Department's announcement that it is transferring enforcement
    of these issues from the Office of Federal Student Aid back to
    the Office of General Counsel. Given the missed opportunity for
    strong oversight under the prior Administration, the Committee
    is encouraged by the Department's renewed focus in this area
    and requests a briefing within 90 days of enactment of this Act
    on the Department's enforcement efforts related to section 117.
        Additionally, as part of the Department's efforts to ensure
    robust enforcement, the Committee encourages the Department to
    consider the merits of utilizing a secure, data-driven
    technology platform that could strengthen the Department's
    ability to monitor and analyze section 117 compliance, provide
    greater transparency to Congress and the public, and ultimately
    improve the Department's ability to fulfill its obligations
    under section 117.
        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.

                            OFFICE FOR CIVIL RIGHTS

    Appropriation, fiscal year 2025.......................      $140,000,000
    Budget request, fiscal year 2026......................        91,000,000
    Committee Recommendation..............................        91,000,000
        Change from enacted level.........................       -49,000,000
        Change from budget request........................             - - -

        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 campuses and to complete pending investigations of
    complaints relating to antisemitism under Title VI of the Civil
    Rights Act of 1964.
        Antisemitism Investigations.--The Committee remains
    concerned by instances of antisemitism on campuses and commends
    the new Administration for taking steps to address this
    increase. Following the explosion of antisemitism at IHEs
    across the U.S. after the terrorist attack on Israel and the
    subsequent failure of some IHEs to address antisemitic conduct
    on campus, it was unclear what actions OCR took under the prior
    Administration to respond to submitted complaints. The
    Committee requests an update in the fiscal year 2027
    congressional justification on such efforts, including the
    processing of shared ancestry investigations, responses to
    complaints, investigation completions, and related activities
    to address antisemitism.

                          OFFICE OF INSPECTOR GENERAL

    Appropriation, fiscal year 2025.......................       $67,500,000
    Budget request, fiscal year 2026......................        63,000,000
    Committee Recommendation..............................        63,000,000
        Change from enacted level.........................        -4,500,000
        Change from budget request........................             - - -

        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, 2026 through September 30, 2027.
        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 modifies a provision regarding
    centralized support costs for the Institute of Education
    Sciences.

                  (INCLUDING RESCISSION AND TRANSFER OF FUNDS)

        Sec. 310. The Committee includes a new provision rescinding
    amounts from the Nonrecurring Expenses Fund and transferring
    funds to Student Aid Administration.
        Sec. 311. The Committee includes a new provision regarding
    participation in athletic programs.
        Sec. 312. The Committee includes a new provision
    prohibiting certain rules regarding Title IX of the Education
    Amendments of 1972.
        Sec. 313. The Committee includes a new provision regarding
    protection for religious student groups at institutions of
    higher education.
        Sec. 314. 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.
        Sec. 315. The Committee includes a new provision
    redesignating Workforce Pell Grants as ``Trump Grants.''
        Sec. 316. The Committee includes a new provision related to
    local education agencies.

                           TITLE IV--RELATED AGENCIES

    Appropriation, fiscal year 2025.......................   $16,918,955,000
    Budget request, fiscal year 2026......................    14,840,697,000
    Committee Recommendation..............................    16,280,246,000
        Change from enacted level.........................      -638,709,000
        Change from budget request........................    +1,439,549,000

        This bill provides just over $16 billion in discretionary
    budget authority for the title IV Related Agencies, a reduction
    of 4 percent over fiscal year 2025 enacted level. The agencies
    within title IV comprise 8 percent of the total 302(b)
    allocation for this subcommittee.

                              America First Corps

    Appropriation, fiscal year 2025.......................    $1,027,806,000
    Budget request, fiscal year 2026......................       -92,319,000
    Committee Recommendation..............................       642,947,000
        Change from enacted level.........................      -384,859,000
        Change from budget request........................      +735,266,000

        The Committee renames the Corporation for National and
    Community Service, operating under the name of AmeriCorps, as
    the America First Corps (AFC) to more clearly reflect the
    agency's core mission of funding organizations that place
    Americans at the center of service initiatives. The new name
    emphasizes resilience, civic responsibility, and a renewal of
    national pride through community-based service. The Committee
    recognizes the potential of improving recruitment, enhancing
    visibility, and increasing program participation through the
    program's alignment with America First principles.

                               OPERATING EXPENSES

    Appropriation, fiscal year 2025.......................      $975,525,000
    Budget request, fiscal year 2026......................        32,430,000
    Committee Recommendation..............................       524,725,000
        Change from enacted level.........................      -450,800,000
        Change from budget request........................      +492,295,000

        The Committee notes that ongoing audit findings confirm AFC
    has not fully resolved long-standing issues or conducted proper
    oversight of its grant programs.
        Within the total for AFC, the Committee provides the
    following amounts:

    ------------------------------------------------------------------------
                                                                FY 2026
              Budget Activity            FY 2025  Enacted      Committee
    ------------------------------------------------------------------------
    Operating Expenses
        Volunteers in Service to             $103,285,000        $51,643,000
         America......................
        National Senior Volunteer             236,917,000        146,012,000
         Corps........................
            Foster Grandparents               125,363,000         62,682,000
             Program..................
            Senior Companion Program..         56,449,000         28,225,000
            Retired Senior Volunteer           55,105,000         55,105,000
             Program..................
        State and National Grants.....        557,094,000        278,547,000
        Innovation, Assistance, and            14,706,000         14,706,000
         Other Activities.............
        Research and Evaluation.......          6,250,000          3,125,000
        National Civilian Community            37,735,000         20,923,000
         Corps........................
        State Service Commission               19,538,000          9,769,000
         Grants.......................
    ------------------------------------------------------------------------

        Data Collection.--The Committee directs AFC 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.

    National Senior Volunteer Corps

        The Retired Senior Volunteer Program (RSVP) provides grants
    to organizations that engage Americans aged 55 years and older
    in volunteer service. RSVP volunteers participate in community
    service activities that put Americans First including serving
    veterans and military families, supporting workforce
    development and training in job readiness skills, assisting in
    disaster preparedness and mitigation efforts, and mentoring and
    tutoring opportunities.

    Innovation, Assistance, and Other Activities

        The Committee provides $14,706,000 for innovation,
    assistance and other activities, which is the same as the
    fiscal year 2025 enacted program level. These activities help
    increase recruitment and retention of volunteers and promote
    national service and civic participation.
        Volunteer Generation Fund.--Within the total, the Committee
    provides $8,558,000 for the Volunteer Generation Fund as
    authorized under section 198P of the SERVE America Act (P.L.
    111-13). This program supports community-based organizations to
    improve volunteer capacity.
        National Days of Service.--Within the total, the Committee
    provides $6,148,000 for National Days of Service including 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 AFC to prioritize
    making grants, entering into cooperative agreements, or
    providing other forms of support to 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 2025.......................      $180,000,000
    Budget request, fiscal year 2026......................             - - -
    Committee Recommendation..............................        40,000,000
        Change from enacted level.........................      -140,000,000
        Change from budget request........................       +40,000,000

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

                             SALARIES AND EXPENSES

    Appropriation, fiscal year 2025.......................       $99,686,000
    Budget request, fiscal year 2026......................        69,627,000
    Committee Recommendation..............................        69,627,000
        Change from enacted level.........................       -30,059,000
        Change from budget request........................             - - -

                          OFFICE OF INSPECTOR GENERAL

    Appropriation, fiscal year 2025.......................        $7,595,000
    Budget request, fiscal year 2026......................         5,624,000
    Committee Recommendation..............................         8,595,000
        Change from enacted level.........................        +1,000,000
        Change from budget request........................        +2,971,000

        The OIG provides oversight of AFC programs, operations, and
    grantees with the goal of preventing and detecting fraud,
    waste, and abuse. The Committee notes the OIG identified
    approximately $10,290,000 in wasteful spending during fiscal
    year 2024 due to improper recordkeeping, insufficient
    documentation, inadequate subgrantee monitoring, and
    noncompliance with Federal requirements.
        The Committee directs the OIG to continue focusing on its
    top three priority areas for AFC, including: (1) improving
    agency compliance with applicable laws and regulations; (2)
    ensuring robust financial reporting processes and internal
    controls; and (3) strengthening the grant processes to ensure
    grantees are prioritizing Americans seeking volunteer
    opportunities.

                           ADMINISTRATIVE PROVISIONS

        Sec. 401. The Committee continues a provision requiring the
    agency to make any significant changes to program requirements,
    service delivery 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.
        Sec. 408. The Committee adds a provision renaming the
    agency as the America First Corps.

     Committee For Purchase From People Who are Blind or Severely Disabled

                             SALARIES AND EXPENSES

    Appropriation, fiscal year 2025.......................       $13,124,000
    Budget request, fiscal year 2026......................        13,124,000
    Committee Recommendation..............................        13,124,000
        Change from enacted level.........................             - - -
        Change from budget request........................             - - -

        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.
    These organizations are dedicated to training and employing
    individuals with disabilities.
        Employment Outcomes.--The Committee notes the seven percent
    increase in private sector AbiltyOne jobs in the last year,
    including the delivery of mission critical Made in America
    products and services for our armed forces. The Committee
    encourages continued growth in the number and quality of
    employment opportunities that the program makes possible for
    more than 39,000 Americans, including approximately 2,500
    Veterans, who are blind or have significant disabilities.
        OIG.--The Committee provides not less than $3,150,000 for
    the Office of Inspector General, the same as the fiscal year
    2025 enacted level.

                      Corporation for Public Broadcasting

    Appropriation, fiscal year 2025.......................      $595,000,000
    Budget request, fiscal year 2026......................        30,000,000
    Committee Recommendation..............................             - - -
        Change from enacted level (for FY 2026)...........      -595,000,000
        Change from budget request........................       -30,000,000

        The Committee provides no funding for the Corporation for
    Public Broadcasting, including both National Public Radio (NPR)
    and the Public Broadcasting System. Under CPB leadership
    appointed by the Biden Administration, the CPB failed to abide
    by the statutory requirement that the CPB adhere to principals
    of political impartiality (47 U.S.C. 396(f)(3)) resulting in
    taxpayer funding being used to subsidize politicized messaging
    in promotion of Democrat candidates and policy priorities.

                   Federal Mediation and Conciliation Service

                             SALARIES AND EXPENSES

    Appropriation, fiscal year 2025.......................       $53,705,000
    Budget request, fiscal year 2026......................         7,400,000
    Committee Recommendation..............................         7,400,000
        Change from enacted level.........................       -46,305,000
        Change from budget request........................             - - -

        The Federal Mediation and Conciliation Service provides
    mediation and conflict resolution services to industry,
    government agencies, and communities.
        The Committee provides $7,400,000 for expenses necessary
    for carrying out the closure of the agency, including the
    discharge of financial obligations, proper disposal of
    government assets, and the protection of government information
    and records.

                Federal Mine Safety and Health Review Commission

                             SALARIES AND EXPENSES

    Appropriation, fiscal year 2025.......................       $18,012,000
    Budget request, fiscal year 2026......................        16,890,000
    Committee Recommendation..............................        16,890,000
        Change from enacted level.........................        -1,122,000
        Change from budget request........................             - - -

        The FMSHRC 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 2025.......................      $294,800,000
    Budget request, fiscal year 2026......................         6,000,000
    Committee Recommendation..............................       291,800,000
        Change from enacted level.........................        -3,000,000
        Change from budget request........................      +285,800,000

        Within the total for IMLS, the Committee provides the
    following amounts:

    ------------------------------------------------------------------------
              Budget Activity            FY 2025 Enacted   FY 2026 Committee
    ------------------------------------------------------------------------
    Library Services Technology Act:
        Grants to States..............       $180,000,000       $180,400,000
        Native American Library                 5,763,000          5,763,000
         Services.....................
        National Leadership: Libraries         15,287,000         15,287,000
        Laura Bush 21st Century                10,000,000         10,000,000
         Librarian....................
    Museum Services Act:
        Museums for America...........         30,330,000         28,730,000
        Native American/Hawaiian                3,772,000          3,772,000
         Museum Service...............
        National Leadership: Museums..          9,348,000          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          5,500,000
         Collection...................
    Program Administration............         22,650,000         21,000,000
    ------------------------------------------------------------------------

        America250.--The Committee recognizes IMLS's commitment to
    the 250th Anniversary of the United States in coordination with
    the U.S. Semiquincentennial Commission and the White House Task
    Force on Celebrating America's 250th Birthday. 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 2025.......................        $9,405,000
    Budget request, fiscal year 2026......................        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 Congress
    on issues affecting Medicaid and CHIP. MACPAC conducts policy
    and data analysis on Medicaid and CHIP to support policymakers
    and promote 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
    Committee encourages MACPAC to include with their policy
    recommendations additional specific recommended policy changes
    to the programs that can result in savings designed to help
    improve access to care for beneficiaries and offset proposed
    increases in spending. Additionally, the Committee encourages
    MACPAC to provide more detailed cost estimates and actuarial
    analyses for costs that would be incurred by the Federal
    government and the States to better understand the implications
    of the Commission's recommendations.

                      Medicare Payment Advisory Commission

                             SALARIES AND EXPENSES

    Appropriation, fiscal year 2025.......................       $13,824,000
    Budget request, fiscal year 2026......................        14,673,000
    Committee Recommendation..............................        14,673,000
        Change from enacted level.........................          +849,000
        Change from budget request........................             - - -

        The Medicare Payment Advisory Commission (MedPAC) is an
    independent agency tasked with advising 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 responsible for providing analysis on access
    to care, quality of care, and other issues affecting Medicare.

                         National Council on Disability

                             SALARIES AND EXPENSES

    Appropriation, fiscal year 2025.......................        $3,850,000
    Budget request, fiscal year 2026......................         3,850,000
    Committee Recommendation..............................         3,850,000
        Change from enacted level.........................             - - -
        Change from budget request........................              - --

        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 2025.......................      $299,224,000
    Budget request, fiscal year 2026......................       285,224,000
    Committee Recommendation..............................       200,000,000
        Change from enacted level.........................       -99,224,000
        Change from budget request........................       -85,224,000

        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.

                           ADMINISTRATIVE PROVISIONS

        Sec. 409. The Committee continues language restricting the
    use of electronic voting.

                            National Mediation Board

                             SALARIES AND EXPENSES

    Appropriation, fiscal year 2025.......................       $15,113,000
    Budget request, fiscal year 2026......................        14,300,000
    Committee Recommendation..............................        14,300,000
        Change from enacted level.........................          -813,000
        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 2025.......................       $15,449,000
    Budget request, fiscal year 2026......................        14,214,000
    Committee Recommendation..............................        14,214,000
        Change from enacted level.........................        -1,235,000
        Change from budget request........................             - - -

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

                           Railroad Retirement Board

                         DUAL BENEFITS PAYMENTS ACCOUNT

    Appropriation, fiscal year 2025.......................        $7,000,000
    Budget request, fiscal year 2026......................         5,000,000
    Committee Recommendation..............................         5,000,000
        Change from enacted level.........................        -2,000,000
        Change from budget request........................             - - -

        This appropriation is authorized by the Railroad Retirement
    Act of 1974 to fund vested dual benefits received by railroad
    retirees who, under prior law, would have become covered by
    both the railroad retirement system and the Social Security
    system because railroad retirement was not fully coordinated
    with Social Security from 1937 to 1974.
        The Committee 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 2025.......................          $150,000
    Budget request, fiscal year 2026......................           150,000
    Committee Recommendation..............................           150,000
        Change from enacted level.........................             - - -
        Change from budget request........................             - - -

                          LIMITATION ON ADMINISTRATION

    Appropriation, fiscal year 2025.......................      $126,000,000
    Budget request, fiscal year 2026......................       126,000,000
    Committee Recommendation..............................       126,000,000
        Change from enacted level.........................             - - -
        Change from budget request........................             - - -

                 LIMITATION ON THE OFFICE OF INSPECTOR GENERAL

    Appropriation, fiscal year 2025.......................       $14,000,000
    Budget request, fiscal year 2026......................        14,000,000
    Committee Recommendation..............................        14,000,000
        Change from enacted level.........................             - - -
        Change from budget request........................             - - -

                         Social Security Administration

        In fiscal year 2026, the Social Security Administration
    (SSA) anticipates exceeding $1.72 trillion in total spending on
    social security retirement, disability insurance, and
    supplemental security income (SSI) payments. SSA's total
    outlays have grown 194 percent since 2006 as mandatory
    entitlement programs continue to grow. 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 23 percent cut to their
    benefits. By comparison, SSA's discretionary budget request for
    fiscal year 2026, which funds the agency's administrative
    expenses, totals $14.8 billion, an increase of 62 percent since
    2006. The escalating pace of mandatory entitlement-driven
    spending remains the primary cost driver within SSA.

                    PAYMENTS TO SOCIAL SECURITY TRUST FUNDS

    Appropriation, fiscal year 2025.......................       $15,000,000
    Budget request, fiscal year 2026......................        15,000,000
    Committee Recommendation..............................        15,000,000
        Change from enacted level.........................             - - -
        Change from budget request........................             - - -

        The Committee provides this mandatory funding to reimburse
    the Old Age and Survivors Insurance (OASI) and Disability
    Insurance (DI) trust funds for non-trust fund activities. This
    appropriation restores the trust funds to the same financial
    position they would have been in had they not borne these
    costs.

                      SUPPLEMENTAL SECURITY INCOME PROGRAM

    Appropriation, fiscal year 2025.......................   $46,252,042,000
    Budget request, fiscal year 2026......................    49,447,966,000
    Committee Recommendation..............................    49,447,966,000
        Change from enacted level.........................    +3,195,924,000
        Change from budget request........................             - - -

        The Committee provides $49,447,966,000 in fiscal year 2026
    mandatory funds for the SSI program. This is in addition to the
    $22,100,000,000 provided in the fiscal year 2025 appropriations
    act for the first quarter of fiscal year 2026. In addition, the
    Committee provides $23,500,000,000 in advance funding for the
    first quarter of fiscal year 2027, as requested.

    Federal Benefit Payments

        The Committee provides a fiscal year 2026 program level of
    $66,762,000,000 for Federal benefit payments.

    Beneficiary Services

        The Committee provides $75,000,000 in new mandatory budget
    authority for beneficiary services. These funds reimburse
    vocational rehabilitation (VR) agencies for successfully
    rehabilitating disabled SSI recipients by helping them achieve
    and sustain productive, self-supporting work activity. Funds
    also support the Ticket to Work program that provides SSI
    recipients with a ticket to offer employment networks (ENs),
    including VR agencies, in exchange for employment and support
    services. The Ticket to Work program pays ENs based on
    recipients achieving certain milestones and outcomes.

    Research and Demonstration

        Sections 1110, 1115, and 1144 of the Social Security Act
    provide authority to the Social Security Administration to
    conduct research and demonstration projects related to SSA's
    programs. Within the appropriation for Supplemental Security
    Income, the Committee provides $91,000,000 in mandatory funds
    for research and demonstration activities, as requested. These
    funds support a variety of research and demonstration projects
    designed to improve the disability process, promote self-
    sufficiency and assist individuals in returning to work,
    encourage savings and retirement planning through financial
    literacy, and generally provide analytical and data resources
    for use in preparing and reviewing policy proposals.

    Administration

        Within the appropriation for SSI, the Committee provides
    $4,619,966,000 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 2025.......................   $14,297,978,000
    Budget request, fiscal year 2026......................    14,791,978,000
    Committee Recommendation..............................    14,791,978,000
        Change from enacted level.........................      +494,000,000
        Change from budget request........................             - - -

        The Limitation on Administrative Expenses (LAE) account
    funds the administrative and operational costs for
    administering the OASI, DI, and SSI programs, and associated
    costs to support CMS in administering the Medicare program. The
    LAE account is funded by the Social Security and Medicare trust
    funds for their share of administrative expenses, the general
    fund for the SSI program's share of administrative expenses,
    and applicable user fees. These funds support core
    administrative activities including processing retirement and
    disability claims, conducting hearings to review disability
    determination appeals, issuing Social Security numbers and
    cards, processing individuals' annual earnings information, and
    ensuring the integrity of Social Security programs through
    continuing disability reviews (CDR) and SSI redeterminations of
    non-medical eligibility.
        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.
        Hiring and Retention.--The Committee continues to direct
    SSA to provide a quarterly staffing report to the Committee
    detailing full-time permanent staff and new hires by component
    and retention rates of new hires by component.
        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 such timeline, and the costs
    associated with the project.
        Payment Integrity.--The Committee understands the
    importance of maintaining accurate records and delivering
    timely and reliable benefits to those who qualify. The
    Committee directs SSA to submit a report to the Committees on
    Appropriations of the House of Representatives and the Senate
    within 180 days of the enactment of this Act detailing the
    steps the agency is taking to improve the timeliness and
    efficiency of its error correction processes. The report should
    include any ongoing or planned improvements to internal review
    systems, how the agency informs the applicant of an error,
    staffing and training initiatives, and what improvements the
    agency has taken to avoid prolonged delays resulting from such
    errors.
        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 2027 congressional justification include a historical
    table of costs and fiscal year 2027 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.
        Social Security Administration Technology Development.--The
    Committee urges SSA to consider the delays faced by individuals
    who apply for Social Security Disability Insurance (SSDI) and
    are waiting for their initial determination. The Committee
    urges SSA to explore and expand process changes that lead to
    faster determinations for applicants. The Committee also urges
    SSA to allocate adequate resources to the development of new
    technology that will relieve burdens on disability adjudicators
    and other personnel who play a role in preparing, evaluating,
    or finalizing initial determinations for SSDI applications. The
    Committee directs SSA to provide an update in the fiscal year
    2027 congressional justification detailing specific procedures,
    staffing strategies, technology investments, and planned
    process improvements to reduce the backlog of disability
    claims.
        Social Security Program Integrity.--The Committee supports
    continued efforts to strengthen SSA's program integrity efforts
    in the SSDI and SSI benefit programs. Section 824 of the
    Bipartisan Budget Act of 2015 authorized SSA to enter into an
    information exchange with payroll data providers. There has
    been considerable success in reducing improper payments and
    leveraging technology to assist with beneficiary reporting
    requirements for other Federal and State benefit programs, and
    the Committee urges SSA to prioritize opportunities to do so
    for the SSDI and SSI benefit programs. Within the funds
    provided to SSA for enhancing beneficiary service delivery, the
    Committee urges SSA to use all the available tools provided by
    commercial entities that collect and maintain data regarding
    employment and wages to ensure that SSDI and SSI benefits are
    properly paid and to strengthen program integrity. In addition,
    the Committee encourages SSA to proceed expeditiously to
    implement system requirements and integrate the program for all
    beneficiaries throughout the agency. Further, the Committee
    requests SSA provide an update in its fiscal year 2027
    congressional justification regarding the status and progress
    of the payroll information exchange.
        Work Incentives Planning and Assistance (WIPA) and
    Protection and Advocacy for Beneficiaries of Social Security
    (PABSS).--The recommendation includes $23,000,000 for WIPA and
    $10,000,000 for PABSS. These programs provide services to help
    Social Security disability beneficiaries return to work.

    Continuing Disability Reviews, Redeterminations, and Program
            Integrity Activities

        As requested in the fiscal year 2026 budget request, the
    Committee provides $2,397,000,000 for program integrity
    activities, an increase of $494,000,000 over the fiscal year
    2025 enacted level. This includes $273,000,000 in base funding
    and $2,124,000,000 in budget adjustment funding.
        The bill also includes language transferring up to
    $24,600,000 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 2025
    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 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.
        Sec. 410. The Committee includes a new provision related to
    phone services and field offices.

                        OFFICE OF THE INSPECTOR GENERAL

    Appropriation, fiscal year 2025.......................      $114,665,000
    Budget request, fiscal year 2026......................       114,665,000
    Committee Recommendation..............................       114,665,000
        Change from enacted level.........................             - - -
        Change from budget request........................             - - -

        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.
        Social Security Administration Office of Investigations.--
    The Committee supports SSA's anti-fraud operations that ensure
    only individuals who qualify for Social Security benefits
    receive them. The Committee encourages SSA to support
    appropriate staffing levels of OIG special agents and to
    encourage strong partnerships with SSA field offices, State
    Disability Determination Services offices, State and local law
    enforcement, and others as appropriate in order to improve
    investigations and prosecutions of fraudulent claims.

                          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.

                                  (RESCISSION)

        Sec. 528. The Committee modifies a provision to permanently
    rescind funds from the Child Enrollment Contingency Fund.

                                  (RESCISSION)

        Sec. 529. The Committee includes a new provision rescinding
    unobligated balances from the American Rescue Plan Act.
        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
    antisemitism.
        Sec. 537. The Committee includes a new provision related to
    gain of function research in certain countries.
        Sec. 538. The Committee includes a new provision related to
    COVID mask and vaccine mandates.
        Sec. 539. The Committee includes a new provision related to
    certain actions with specific entities or subsidiaries.
        Sec. 540. The Committee includes a new provision related to
    the provision related to partnerships with entities operated or
    controlled by the Chinese Communist Party or the Government of
    the People's Republic of China.
        Sec. 541. The Committee includes a new provision related to
    entities in which the People's Republic of China has any
    ownership stake.

                           SPENDING REDUCTION ACCOUNT

        Sec. 542. 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:

                                 Minority Views

        Pursuant to the provisions of clause 3(a)(1) of House Rule
    XIII and sec. 6(i) of the Committee Rules, the dissenting views
    of the minority party of the House of Representatives, are
    printed below:
        This bill is a continuation of the Republican Party's
    multi-year effort to dismantle the nation's health care and
    public education systems. It would cut funding for health care,
    education, and labor programs by $24 billion--more than 10
    percent below the 2025 level.
        This bill would hurt the middle class, the working class,
    and the vulnerable across every single one of our congressional
    districts.
        Americans are struggling with rising costs of everyday
    necessities. They are living paycheck to paycheck. But the
    President, and House Republicans, are not laser-focused on the
    cost-of-living crisis. They are making it worse.
        In their first six months in office, Republicans passed a
    budget bill to cut nearly a trillion dollars from Medicaid and
    the Affordable Care Act, which will take away health care
    coverage from more than 15 million people. Their budget bill
    also slashed nutrition benefits for poor families, which will
    lead to an additional 1 million kids going hungry. And the
    Republican bill will trigger a cut of more than $500 billion to
    Medicare over the next 10 years, harming America's seniors.
        All to pass trillions of dollars in tax cuts for big
    corporations and billionaires--adding $4 trillion to the
    national debt over the next 10 years.
        At the same time, President and House Republicans are
    marching toward their goal of shutting down the Department of
    Education and turning public education into a for-profit
    enterprise.
        In March, President Trump signed an executive order seeking
    to eliminate the Department of Education. Elon Musk and DOGE
    fired or pushed out half of the Department of Education's
    workforce. And OMB Director Russ Vought illegally froze
    billions of dollars in funding for education programs.
        And now, Republicans are eviscerating our public health
    system and promoting Secretary Robert F. Kennedy Jr.'s anti-
    vaccine ideology.
        Secretary Kennedy has no scientific or medical expertise.
    He pushes deadly conspiracies and spreads lies about vaccines.
    He has surrounded himself with political appointees, or
    inserted appointees at the Centers for Disease Control and
    Prevention (CDC), who have no expertise on vaccines or
    immunization.
        In June, Secretary Kennedy fired all 17 independent
    scientific advisers on the Advisory Committee on Immunization
    Policy (ACIP) and replaced them with anti-vaccine acolytes. He
    hired an unqualified and discredited vaccine skeptic as a top
    adviser on vaccine policy.
        In August, President Trump fired the CDC Director, Dr.
    Susan Monarez, at Secretary Kennedy's request because the CDC
    Director refused to rubber-stamp Secretary Kennedy's anti-
    vaccine agenda that would hurt millions of our children. Dr.
    Monarez insisted that CDC's vaccine recommendations be based on
    credible data--not ideology or preordained outcomes. For
    standing on scientific principle, Dr. Monarez was fired.
        ACIP's next meeting is scheduled for September 18th and
    19th. They are going to consider recommendations for an array
    of vaccines, including Hepatitis B, Covid, RSV, chickenpox, and
    the combination vaccine for measles, mumps, and rubella. I have
    serious concerns that a number of these recommendations are in
    grave danger.
        The ACIP meeting must be postponed. All original ACIP
    members must be reinstated and Secretary Kennedy's unqualified
    appointees must be removed.
        And now, the Republican majority has introduced a fiscal
    year 2026 appropriations bill that continues the Republican
    assault on education, health care, and workers.
        The bill decimates support for public schools, students,
    and K-12 school teachers, and it abandons college students.
        The bill cuts the Department of Education by $12 billion,
    or 15 percent, including a $4.7 billion cut to Title I Grants
    to Local Educational Agencies which will take at least 72,000
    teachers out of low-income classrooms.
        The bill eliminates $2.2 billion for Supporting Effective
    Instruction State grants, which provide professional
    development opportunities for teachers and educators;
    eliminates $890 million for English language acquisition, which
    helps more than five million English learners nationwide; and
    eliminates $729 million for Adult Education grants, which help
    more than one million adults with basic education services.
        The bill slashes $1.4 billion for need-based financial aid
    for students who need assistance to finance their post-
    secondary education--including a cut of $451 million to Federal
    Work Study, affecting 220,000 students, and elimination of $910
    million for Supplemental Educational Opportunity Grants, which
    provide financial assistance for more than 1.6 million low-
    income students.
        Moreover, the bill eviscerates job training programs by
    more than 50 percent, including the elimination of funding for
    WIOA Adult Job Training, WIOA Youth Job Training, and the Job
    Corps program, destroying job training and career development
    opportunities for more than 300,000 adults and more than
    150,000 young adults.
        And, once again, the majority's bill would harm women's
    health, children's health, and public health, surrendering the
    safety and wellbeing of the American people to multiple health
    crises.
        The bill completely eliminates funding for HIV/AIDS
    prevention at CDC, a cut of more than $1 billion, and cuts HIV/
    AIDS treatment under the Ryan White program by more than $500
    million.
        The bill would eliminate 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. And it
    would eliminate funding for the Teen Pregnancy Prevention
    Program.
        In addition, the bill eliminates funding for CDC's tobacco
    prevention programs, as well as firearm injury and mortality
    prevention research.
        The bill cuts funding for research at the National
    Institutes of Health by nearly $500 million. This comes as OMB
    Director Russell Vought has cancelled billions of dollars in
    previously-awarded research grants, throwing away potential
    discoveries of life-saving cures or treatments.
        And in keeping with the majority's other partisan bills,
    this bill includes the usual poison pill riders, including
    multiple provisions that target abortion rights and
    reproductive health care services. Policy riders in the bill
    create an open season for discrimination against LGBTQI+
    individuals, and they prohibit policies and programs intended
    to promote diversity in the federal government.
        Similar to previous years, 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 proposed
    amendments to restore funding for Title I Grants to Local
    Educational Agencies, Preschool Development Grants, Promise
    Neighborhoods, Full Service Community Schools, English Language
    Acquisition, Federal Work Study, and Supplemental Educational
    Opportunity Grants, but each of the amendments were rejected by
    the Republican majority.
        House Democrats proposed amendments to restore funding for
    HIV/AIDS prevention and treatment, community health centers,
    nursing workforce development, tobacco prevention, firearm
    injury and mortality prevention research, substance use
    prevention and treatment, criminal and juvenile justice
    programs, and senior nutrition, but each of the amendments were
    rejected by the Republican majority.
        House Democrats proposed amendments to restore funding for
    WIOA Adult and Youth Job Training, Job Corps, the Bureau of
    International Labor Affairs (ILAB), the Women's Bureau, and the
    Federal Mediation and Conciliation Service, but each of the
    amendments were rejected by the Republican majority.
        House Democrats proposed amendments to restore funding for
    the Corporation for Public Broadcasting, but it was rejected by
    the Republican majority.
        In addition, House Democrats proposed an amendment to
    prohibit CDC from removing vaccines from the Child and
    Adolescent Immunization Schedule, as well as an amendment to
    prohibit CDC from making any changes that would reduce no-cost
    coverage of vaccines by federal or private health insurance
    plans, but both amendments were rejected by the Republican
    majority.
        Finally, House Democrats proposed amendments to strike
    harmful policy riders that do not belong in the Labor-HHS-
    Education appropriations bill, including the Hyde and Weldon
    amendments, the prohibition on funding for Planned Parenthood
    clinics, and multiple poison pill riders that target abortion
    rights and reproductive health care services, but each of the
    amendments were rejected by the Republican majority.

    Impoundment

        This bill has been considered during a time of remarkable
    upheaval for the Committee. Since taking office in January 2025
    the executive branch has been engaged in a rampant, unlawful,
    and unconstitutional disregard for spending laws. In
    particular, the Office of Management and Budget has been at the
    center of a government-wide effort to thwart the intent of this
    Committee's laws in its actions, while also unlawfully refusing
    to publish the agency's legally-binding budget decisions (known
    as apportionments) in contravention of an unambiguous and
    constitutionally sound assertion of the Congress's authority to
    impose transparency requirements upon the executive branch.
        The current executive branch has contended--at times--an
    inherent Presidential power to impound. However, while this
    bill was approved over the objection of all Democrats on the
    Committee, the debate and proceedings made unmistakably clear,
    just as former Chief Justice of the Supreme Court of the United
    States William Rehnquist concluded (at the time an Assistant
    Attorney General with the Department of Justice Office):

              ``With respect to the suggestion that the President
            has a constitutional power to decline to spend
            appropriated funds, we must conclude that existence of
            such a broad power is supported by neither reason nor
            precedent.''

        The current Administration's unfounded views of their
    purported authorities peaked one week before this bill was
    considered when the President transmitted a second special
    message of proposed rescission under the Impoundment control
    Act of 1974 to the Congress. The Office of Management and
    Budget followed that message--sent 34 days before the end of
    the fiscal year--by issuing an apportionment to freeze all of
    the funding proposed for rescission and has publicly stated
    that it intends to keep those funds frozen through their
    expiration, describing their request to Congress as a ``pocket
    rescission.'' This action is unlawful, and the Government
    Accountability Office's 2018 legal opinion remains the correct
    view on the matter:

              ``We conclude that the [Impoundment Control Act of
            1974] ICA does not permit the impoundment of funds
            through their date of expiration. The plain language of
            the ICA permits only the temporary withholding of
            budget authority and provides that unless Congress
            rescinds the amounts at issue, they must be made
            available for obligation. Amounts proposed for
            rescission must be made available for prudent
            obligation before the amounts expire, even where the
            45-day period provided in the ICA approaches or spans
            the date on which funds would expire.''
        GAO B-33030, December 10, 2018

        The laws considered and enacted by this Committee reflect
    the legally binding expression of Congress's constitutional
    power of the purse, effectuated through the conditions and
    permissions the Committee places on spending authority through
    the Congress's Article I powers. Just as the Committee chooses
    to allow or restrict the purpose for any funds in the bill, so
    too does the Committee decide the amount for which an activity
    shall be funded. When the Committee allows the flexibility of
    merely mandating a ceiling (or upper limit) or a floor (lowest
    required level) for an activity, it does so in contrast to
    every other instance where it has included a specific amount,
    which unless otherwise stated is Congress's clear intent to be
    both a floor and a ceiling.
        These perspectives are both uncontroversial and
    longstanding principles on which all of the Committee's work
    rests.

    Conclusion

        Instead of addressing the cost-of-living crisis, this bill
    continues the Republican Party's multi-year effort to dismantle
    the nation's health care and public education systems--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.
        Despite my opposition to the current bill, I look forward
    to working with Chairman Cole and Chairman Aderholt through
    this year's appropriations process to produce a responsible
    bill that both parties can support.

                                                       Rosa L. DeLauro.
                              Full Committee Votes

        Pursuant to the provisions of clause 3(b) of rule XIII of
    the House of Representatives, the results of each roll call
    vote on an amendment or on the motion to report, together with
    the names of those voting for and those against, are printed
    below:

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

                   Comparative Statement of Budget Authority

        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.
        Funding amounts displayed under the FY 2025 Estimate column
    reflect FY 2025 Operating Plans and other available
    information. Some funding amounts displayed under the FY 2026
    Request column are displayed in accordance with the programs
    and accounts under current law and may not be directly
    comparable to the display in the FY 2026 budget request
    submitted by the Office and Management and Budget.

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

        BUDGETARY IMPACT OF THE DEPARTMENTS OF LABOR, HEALTH AND HUMAN
      SERVICES, AND EDUCATION, AND RELATED AGENCIES APPROPRIATIONS BILL,
      2026, PREPARED IN CONSULTATION WITH THE CONGRESSIONAL BUDGET OFFICE
       PURSUANT TO SECTION 308(A) OF THE CONGRESSIONAL BUDGET ACT OF 1974

                            [IN MILLIONS OF DOLLARS]

                       COMPARISON WITH BUDGET RESOLUTION

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

                                                [In millions of dollars]
    ----------------------------------------------------------------------------------------------------------------
                                                             302(b) Allocation                   This Bill
                                                     ---------------------------------------------------------------
                                                          Budget                          Budget
                                                         Authority        Outlays        Authority        Outlays
    ----------------------------------------------------------------------------------------------------------------
    Comparison of amounts in the bill with Committee
     allocations to its subcommittees: Subcommittee
     on Labor, Health and Human Services, and
     Education, and Related Agencies:
        Discretionary...............................        $187,245  ..............        $187,245     \1\$233,405
        Mandatory...................................  ..............  ..............       1,362,476    \1\1,353,213
    ----------------------------------------------------------------------------------------------------------------
    \1\Includes outlays from prior-year budget authority.

                          FIVE-YEAR OUTLAY PROJECTIONS

        Pursuant to clause 3(c)(2) of rule XIII and section
    308(a)(1)(A) 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:
        2026.............................................      \1\$1,416,168
        2027.............................................            103,940
        2028.............................................             24,844
        2029.............................................              5,830
        2030 and future years............................              1,209
    ------------------------------------------------------------------------
    \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)(A) 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            $582,734        \1\$732,016
     local governments for 2026.......
    ------------------------------------------------------------------------
    \1\ Excludes outlays from prior-year budget authority.

             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 Law 111-139, or a program
    related to a program identified in the most recent Catalog of
    Federal Domestic Assistance.

                               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, 2024:
        The Subcommittee on Labor, Health and Human Services,
    Education, and Related Agencies held a hearing on February 12,
    2025, entitled ``Career Ready Students: Innovations from
    Community Colleges and the Private Sector.'' The Subcommittee
    received testimony from:
              Preston Cooper, Senior Fellow, American Enterprise
            Institute,
              Dr. Vicki Karolewics, President, Wallace State
            Community College,
              Dennis Parker, Consultant for Regional Talent
            Development, Toyota Motor North America, and
              Dr. Mary Alice McCarthy, Senior Director, Center on
            Education & Labor, New America.
        The Subcommittee on Labor, Health and Human Services,
    Education, and Related Agencies held a hearing on February 26,
    2025, entitled ``Federal Investments in Elementary Education.''
    The Subcommittee received testimony from:
              Virginia Gentles, Director, Defense of Freedom
            Institute for Policy Studies,
              Dr. Lindsey Burke, Director of Education Policy, The
            Heritage Foundation,
              Robert Kim, Executive Director, Education Law Center,
            and
              Ms. Starlee Coleman, President and CEO, National
            Alliance for Public Charter Schools.
        The Subcommittee on Labor, Health and Human Services, and
    Education, and Related Agencies held a hearing on March 5,
    2025, entitled ``Member Day.'' The Subcommittee received
    testimony from:
              The Honorable Glenn Thompson, and
              The Honorable Seth Magaziner.
        The Subcommittee on Labor, Health and Human Services, and
    Education, and Related Agencies held a hearing on April 9,
    2025, entitled ``Public Witness Day.'' The Subcommittee
    received testimony from:
              Jessica Pescatore, Clinical Director Alabama Poison
            Information Center, America's Poison Centers,
              Jennifer Carroll, Assistant Director, Community
            Action Partnership of North Alabama,
              Michelle Sie Whitten, Executive Director, The Global
            Down Syndrome Foundation,
              Christopher French, Co-Chair and Senior Vice
            President, Alliance for BioSecurity,
              Christopher M. Kramer, President, American College of
            Cardiology,
              Rey Saldana, President and CEO, Communities in
            Schools,
              Theresa Sokol, Louisiana State Epidemiologist, Board
            Member, Council of State and Territorial
            Epidemiologists,
              Sara Schapiro, Executive Director, Alliance for
            Learning Innovation,
              Dr. Scott Harris, State Health Officer of the Alabama
            Department of Health, President, Association of State
            and Territorial Health Officials,
              Dr. Colleen Kelley, Chair, HIV Medicine Association.
        The Subcommittee on Labor, Health and Human Services, and
    Education, and Related Agencies held a budget hearing on May
    14, 2025, entitled ``Fiscal Year 2026 Request for the
    Department of Health and Human Services.'' The Subcommittee
    received testimony from:
              The Honorable Robert F. Kennedy Jr., 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 May
    21, 2025, entitled ``Fiscal Year 2026 Request for the United
    States Department of Labor.'' The Subcommittee received
    testimony from:
              The Honorable Lori Chavez-DeRemer, Secretary,
            Department of Labor.
        The Subcommittee on Labor, Health and Human Services, and
    Education, and Related Agencies held a budget hearing on May
    21, 2025, entitled ``Fiscal Year 2026 Request for the United
    States Department of Education.'' The Subcommittee received
    testimony from:
              The Honorable Linda McMahon, Secretary, Department of
            Education.

              Compliance With Rule XIII, Cl. 3(d) (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):

              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

                              (Public Law 62-141)

                    AN ACT To create a Department of Labor.

               *       *       *       *       *       *       *
      Sec. 11. That this Act (except for section 12) shall take
    effect March fourth, nineteen hundred and thirteen, and all
    Acts or parts of Acts inconsistent with this Act are hereby
    repealed.

    SEC. 12. SECURITY DETAIL.

      (a) In General.--The Secretary of Labor is authorized to
    employ law enforcement officers or special agents to provide--
              (1) protection for the Secretary and Deputy Secretary
            during the performance of official duties by each such
            officer and during any activity that is preliminary or
            postliminary to the performance of official duties by
            each such officer;
              (2) protection, incidental to the protection provided
            pursuant to paragraph (1), to an individual
            accompanying each such officer who is participating in
            an activity or event relating to the official duties of
            each such officer when there is an articulable threat
            to such individual;
              (3) continuous protection to the Secretary and Deputy
            Secretary (including during periods not described in
            paragraph (1)) if there is an articulable threat of
            physical harm, in accordance with guidelines
            established by the Secretary; and
              (4) protection of another senior officer (including a
            person nominated to be the Secretary during the
            pendency of such nomination) if there is an articulable
            threat of physical harm, in accordance with guidelines
            established by the Secretary.
      (b) Authorities of the Protective Operation.--
              (1) In general.--The Secretary may authorize officers
            or special agents employed pursuant to subsection (a)--
                      (A) to carry firearms;
                      (B) to conduct criminal investigations into
                    potential threats to the security of persons
                    protected under this section;
                      (C) to make arrests without a warrant for any
                    offense against the United States committed in
                    the presence of such officer or special agent;
                      (D) to perform protective intelligence work,
                    including identifying and mitigating potential
                    threats and conducting advance work to review
                    security matters relating to sites and events;
                    and
                      (E) coordinate with local law enforcement
                    agencies.
              (2) Guidelines.--The authority provided by this
            section shall be exercised in accordance with any--
                      (A) guidelines issued by the Attorney
                    General; and
                      (B) such additional guidelines as may be
                    issued by the Secretary.
      (c) Exception.--The authorities granted under this section
    may be exercised notwithstanding section 1343(b)(1) of Title
    31.
                                  ----------

                       COMMUNITY SERVICES BLOCK GRANT ACT

              Subtitle B--Community Services Block Grant Program

               *       *       *       *       *       *       *

    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.

               *       *       *       *       *       *       *

                                  ----------

                           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 division D of the
                    Further Consolidated Appropriations Act, 2024
                    (or any subsequent substantially similar
                    provision); or
                      (B) any funding condition imposed by the
                    Federal Government pursuant to such section
                    507(d) (or such substantially similar
                    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).

               *       *       *       *       *       *       *

                   TITLE VII--HEALTH PROFESSIONS EDUCATION

               *       *       *       *       *       *       *

              PART D--INTERDISCIPLINARY, COMMUNITY-BASED LINKAGES

               *       *       *       *       *       *       *

    SEC. 752. CONTINUING EDUCATIONAL SUPPORT FOR HEALTH PROFESSIONALS
                SERVING IN RURAL AND UNDERSERVED COMMUNITIES.

      (a) In General.--The Secretary, as appropriate, shall make
    grants to, and enter into contracts with, eligible entities to
    support access to accredited continuing medical education for
    primary care physicians and health care providers at community
    health centers or rural health clinics to improve and increase
    access to care for patients in rural and medically underserved
    areas. Such grants or contracts may be used to improve health
    care, increase retention, increase representation of minority
    health care providers, enhance the practice environment,
    increase primary care physician and health care provider
    knowledge, and provide information dissemination and
    educational support to reduce professional isolation through
    the timely dissemination of research findings using relevant
    resources.
      (b) Eligible Entities.--For purposes of this section, the
    term ``eligible entity'' means an entity described in section
    799(b), such as a community health center or rural health
    clinic.
      (c) Application.--An eligible entity desiring to receive an
    award under this section shall submit to the Secretary an
    application at such time, in such manner, and containing such
    information as the Secretary may require.
      (d) Use of Funds.--
              (1) In general.--An eligible entity shall use amounts
            awarded under a grant or contract under this section to
            provide innovative supportive activities to enhance
            education for primary care physicians and health care
            providers described in subsection (a) through distance
            learning, continuing educational activities,
            collaborative conferences, and electronic and
            telelearning activities, with priority for primary care
            providers who are seeking additional education in
            specialty fields such as infectious disease,
            endocrinology, pediatrics, mental health and substance
            use disorders, pain management, geriatrics, and other
            areas, as appropriate, in order to--
                      (A) improve retention of primary care
                    physicians and health care providers and
                    increase access to specialty health care
                    services for patients; and
                      (B) support access to the integration of
                    specialty care through existing service
                    delivery locations and care across settings.
              (2) Clarification.--Entities may use amounts awarded
            under a grant or contract under this section for
            continuing educational activities that include a
            clinical training component, including in-person
            patient care, in the respective community health center
            or rural health clinic, with the primary care physician
            or health care provider at such site and the clinical
            specialist from whom such additional training is being
            provided.
      (e) Administrative Expenses.--An entity that revives a grant
    or contract under this section shall use not more than 5
    percent of the amounts received under the grant or contract
    under this section for administrative expenses.
      (f) Non-duplication of Effort.--The Secretary shall ensure
    that activities under this section do not unnecessarily
    duplicate efforts of other programs overseen by the Health
    Resources and Services Administration, including activities
    described in section 330N.
      (g) Authorization.--There is authorized to be appropriated to
    carry out this section $5,000,000 for each of [fiscal years
    2023 through 2025] fiscal years 2026 through 2028.

               *       *       *       *       *       *       *

                   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 a number of 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 ``State Unemployment Insurance
    and Employment Service Operations'' providing funds to States
    to improve operations and modernize State Unemployment
    Insurance systems.
        Language is included under ``State Unemployment Insurance
    and Employment Service Operations'' providing authority for
    States to use funds to assist other States to carry out
    authorized activities in cases of a major disaster declared by
    the President under the Robert T. Stafford Disaster Relief and
    Emergency Assistance Act.
        Language is included under ``State Unemployment Insurance
    and Employment Service Operations'' providing that the
    Department of Labor may make payments on behalf of States for
    the use of the National Directory of New Hires.
        Language is included under ``State Unemployment Insurance
    and Employment Service Operations'' providing that the
    Department of Labor may make payments from funds appropriated
    for States' grants on behalf of States to the entity operating
    the State Information Data Exchange System.
        Language is included under ``State Unemployment Insurance
    and Employment Service Operations'' providing that
    appropriations for establishing a national one-stop career
    system may be obligated in contracts, grants or agreements with
    States or non-State entities.
        Language is included under ``State Unemployment Insurance
    and Employment Service Operations'' providing that 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 Gold Star Spouses.
        Language is included under ``Veterans' Employment and
    Training'' providing that the Department may award grants under
    section 2023 of Title 38, United States Code.
        Language is included under ``Veterans' Employment and
    Training'' providing that services may be provided to certain
    homeless or recently incarcerated veterans under section 2021,
    2021A, and 2023 of Title 38, United States Code.
        Language is included under ``Veterans' Employment and
    Training'' providing that the fees assessed pursuant to the
    HIRE Vets Medallion Award Fund shall be available to the
    Secretary for expenses of the HIRE Vets Medallion Award Program
    and that the start date prescribed in the Act shall not apply.
        Language is included under ``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 reemployed, 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 of funds transferred from entities under 5 U.S.C. 8147(c),
    specified amounts may be used by the Department of Labor for
    maintenance and data and communications systems, workload
    processing, roll disability management and medical review, and
    program integrity with remaining amounts paid into the
    Treasury.
        Language is included under ``Special Benefits'' providing
    that the Secretary may prescribe regulations requiring
    identification for the filing of benefit claims.
        Language is included under ``Administrative Expenses,
    Energy Employees Occupational Illness Compensation Fund''
    providing that the Secretary may prescribe regulations for
    requiring identification for the filing of benefit claims.
        Language is included under ``Occupational Safety and Health
    Administration'' providing that up to a certain amount of fees
    collected from the training institute may be retained and used
    for related training and education.
        Language is included under ``Occupational Safety and Health
    Administration'' providing that fees collected from Nationally
    Recognized Testing Laboratories may be used to administer
    laboratory recognition programs that ensure safety of equipment
    used in the workplace.
        Language is included under ``Mine Safety and Health
    Administration'' providing that a specific amount may be
    collected by the National Mine Health and Safety Academy and
    made available for mine safety and health education and
    training.
        Language is included under ``Mine Safety and Health
    Administration'' providing that a specific amount may be
    collected from the approval and certification of equipment and
    materials and made available for other such activities.
        Language is included under ``Mine Safety and Health
    Administration'' providing that the Department of Labor may
    accept lands, buildings, equipment, and other contributions
    from public and private sources for cooperative projects.
        Language is included under ``Mine Safety and Health
    Administration'' providing that the Department of Labor may
    promote health and safety education and training through
    cooperative agreements with States, industry, and safety
    associations.
        Language is included under ``Mine Safety and Health
    Administration'' providing that the Department of Labor may
    recognize the Joseph A. Holmes Safety Association as the
    principal safety association and may provide funds or personnel
    as officers in local chapters or the national organization.
        Language is included under ``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'' 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.

               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'' providing that fees
    collected for the disclosure of information under the
    information reporting requirement program authorized by section
    1921 of the Social Security Act shall be sufficient to recover
    the full costs of the operation program and shall remain
    available until expended to carry out that Act.
        Language is included under ``Health Resources and Services
    Administration--Health Workforce'' allowing funds for the Nurse
    Corps and National Health Service Corps Scholarship and Loan
    programs to be used to make prior year adjustments.
        Language is included under ``Health Resources and Services
    Administration--Health Workforce'' providing funding under the
    National Health Service Corps Loan Repayment Program for
    substance use disorder counselors and placement in Indian
    Health Service facilities.
        Language is included under ``Health Resources and Services
    Administration--Health Workforce'' to provide funds for the
    purpose of establishing or expanding optional community-based
    nurse practitioner fellowship programs.
        Language is included under ``Health Resources and Services
    Administration--Health Workforce'' to provide funds for grants
    to public institutions of higher education meeting certain
    requirements for graduate education for physicians.
        Language is included under ``Health Resources and Services
    Administration--Rural Health'' to provide funding for State
    Offices of Rural Health notwithstanding section 338J(k), which
    terminates the program after an aggregate funding amount.
        Language is included under ``Centers for Disease Control
    and Prevention--CDC-Wide'' related to the implementation of the
    Epidemiology-Laboratory Capacity Grant program.
        Language is included under ``Centers for Disease Control
    and Prevention--Buildings and Facilities'' providing the use of
    funds to support acquisition, renovation, or replacement, of
    the National Institute Occupational Safety and Health's
    underground and surface coal mining research capacity.
        Language is included under ``Substance Use And Mental
    Health Services Administration--Mental Health'' related to data
    infrastructure development.
        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 ``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--Payments to States for the Child Care and
    Development Block Grant'' to make amounts available for Federal
    administrative expenses.
        Language is included under ``Administration for Children
    and Families--Children and Families Services Programs'' 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 Children
    and Families--Children and Families Services Programs'' related
    to the allocation of funding in the Family Violence Prevention
    and Services Act.
        Language is included under ``Administration for Community
    Living'' to allow funding provided for adult protective
    services grants under section 2042 of title XX of the Social
    Security Act to be set-aside for Tribes and Tribal
    organizations.
        Language is included limiting the amount of appropriations
    available for the Public Health Service Act Evaluation transfer
    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 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 limiting the circumstances when the
    Secretary may accept donations related to the care of
    unaccompanied alien children.
        Language is included related to allowed uses of funds in
    the Community Services Block Grant program.
        Language is included prohibiting funding from being made
    available to Planned Parenthood Federation of America or its
    affiliates.
        Language is included prohibiting funding from being made
    available for drugs or surgery that alter bodily sex traits as
    interventions for gender dysphoria.
        Language is included allowing for civil actions for certain
    violations.

                       TITLE III--DEPARTMENT OF EDUCATION

        Language is included under ``Impact Aid'' allowing
    continued eligibility for students affected by the deployment
    or death of their military parent so long as the children
    attend school in the same local education agency they attended
    prior to the parent's death or deployment.
        Language is included under ``School Improvement Programs''
    related to the funding limitation for administrative purposes.
        Language is included under ``School Improvement Programs''
    related to the funding limitation for administrative purposes.
        Language is included under ``Innovation and Improvement''
    related to the provision of awards under the Charter School
    Program.
        Language is included under ``Innovation and Improvement''
    related to the provision of awards under the Per-Pupil
    Facilities Aid Program.
        Language is included under ``Innovation and Improvement''
    related to the period of availability of funding awarded under
    such section.
        Language is included under ``Special Education'' regarding
    the factors to be considered by the Secretary when making
    formula awards to States.
        Language is included under ``Special Education'' outlining
    procedures for reducing a State 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'' 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'' to promote
    continuity of services for eligible infants and their families.
        Language is included under ``Rehabilitation Services''
    expanding State allowed uses of funding for funding received
    under the Rehabilitation Act.
        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 United States
    national security and who plan to apply their language skills
    and knowledge of these countries in the fields of government,
    the professions, or international development.
        Language is included under ``Higher Education'' 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
    the provision of awards to institutions of higher education to
    assist the institutions in providing campus-based child care
    services.
        Language is included under ``Higher Education'' allowing
    activities authorized under sections 317(c)(2)(B),
    319(c)(2)(B), and 320(c)(2)(B) of the Higher Education Act to
    include construction and maintenance in classrooms, libraries,
    laboratories, and other instructional facilities.
        Language is included under ``General Provisions'' allowing
    certain institutions to continue to use endowment income for
    student scholarships.
        Language is included under ``General Provisions'' regarding
    the National Advisory Committee on Institutional Quality and
    Integrity.
        Language is included under ``General Provisions'' regarding
    account maintenance fees.

                           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'' related to the provision of awards.
        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'' related to the grantee minimum share
    requirement.
        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 education awards.
        Language is included under ``National Labor Relations
    Board'' related to electronic voting.
        Language is included under ``Railroad Retirement Board--
    Limitation on Administration'' related to the hiring of
    attorneys.

                          TITLE V--GENERAL PROVISIONS

        Language is included related to the use of funds
    transferred pursuant to Section 4002 of Public Law 111-148.
        Language is included related to public posting requirements
    for programs, projects, or activities funded with Federal
    funds.
        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 related to sincerely held religious
    beliefs and moral convictions.
                      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..............  FY 2020...........  $899,987,000......  $854,649,000......  $885,649,000
        Dislocated Worker Employment  FY 2020...........  1,436,137,000.....  1,052,053,000.....  1,095,553,000
         and Training Activities.
        Native Americans............  FY 2020...........  54,137,000........  55,000,000........  65,000,000
        YouthBuild..................  FY 2020...........  91,087,000........  94,534,000........  105,000,000
        Job Corps...................  FY 2020...........  1,983,236,000.....  1,743,655,000.....  880,078,000
        One-Stop Career Centers/      FY 2020...........  70,667,000........  62,653,000........  52,893,000
         Labor Market Information.
    DEPARTMENT OF HEALTH AND HUMAN
     SERVICES HRSA
        School-Based Health Centers.  FY 2013...........  50,000,000........  47,450,000........  55,000,000
        Nurse Practitioner Optional   N/A...............  N/A...............  N/A...............  7,000,000
         Fellowship Program.
        Medical Student Education...  N/A...............  N/A...............  N/A...............  75,000,000
        Early Hearing Detection and   FY 2022...........  19,522,758........  17,818,000........  18,818,000
         Intervention.
        Heritable Disorders.........  FY 2019...........  19,900,000........  18,883,000........  20,883,000
        Pediatric Mental Health       FY 2022...........  9,000,000.........  10,000,000........  13,000,000
         Access.
        Screening and Treatment for   FY 2022...........  5,000,000.........  5,000,000.........  13,500,000
         Maternal Depression.
        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
        Organ Transplantation.......  FY 1993...........  Such Sums.........  2,767,000.........  54,049,000
        Rural Hospital Flexibility    FY 2012...........  Such Sums.........  41,040,000........  74,277,000
         Grants.
        State Offices of Rural        FY 2002...........  Such Sums.........  4,000,000.........  12,500,000
         Health.
    CDC
        Sexually Transmitted          FY 1998...........  Such Sums.........  112,117,000.......  30,000,000
         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
        Injury Prevention and         FY 2005...........  Such Sums.........  138,237,000.......  665,329,000
         Control.
        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.......  208,560,000
         Disability, Disability and
         Health.
        Breast and Cervical Cancer..  FY 2012...........  275,000,000.......  204,779,000.......  206,380,000
        Public Health Workforce.....  FY 2013...........  39,500,000........  64,000,000........  71,000,000
        National Diabetes Prevention  FY 2014...........  Such Sums.........  10,000,000........  40,300,000
         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.......  699,993,000
        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........  16,205,000
         with regard to Prostate
         Cancer.
        Combating Antimicrobial       FY 2006...........  Such Sums.........  17,443,000........  197,000,000
         Resistance.
        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....  47,845,000,000
         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.....  4,035,000,000
         Assistance Program.
        Child Care and Development    FY 2020...........  2,748,591,018.....  5,826,000,000.....  8,746,387,000
         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.......  793,000,000
         Grant.
        Economic Development........  FY 2003...........  Such Sums.........  27,082,000........  22,383,000
        Rural Community Development.  FY 2003...........  Such Sums.........  7,203,000.........  13,000,000
        Head Start..................  FY 2012...........  Such Sums.........  7,968,544,000.....  12,271,820,000
        Runaway and Homeless Youth    FY 2013...........  Such Sums.........  107,852,000.......  125,283,000
         Programs.
        CAPTA programs..............  FY 2015...........  Such Sums.........  143,981,000.......  105,091,000
        Family Violence Programs....  FY 2015...........  178,500,000.......  139,500,000.......  240,000,000
        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.
        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........  30,755,000
         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.......  190,369,000
        Voting Access for People      FY 2005...........  17,410,000........  13,879,000........  10,000,000
         with Disabilities.
        Traumatic Brain Injury......  FY 2019...........  8,600,000.........  11,321,000........  13,118,000
        Paralysis Resource Center...  FY 2011...........  25,000,000........  6,352,000.........  10,700,000
        Limb Loss...................  N/A...............  N/A...............  N/A...............  4,200,000
        Independent Living and the    FY 2020...........  214,135,000.......  228,153,000.......  268,183,000
         National Institute on
         Disability, Independent
         Living and Rehabilitation
         Research.
    ASPR
        BARDA.......................  FY 2024...........  611,700,000.......  1,015,000.........  1,100,000,000
        Strategic National Stockpile  FY 2024...........  610,000,000.......  980,000,000.......  1,000,000,000
        Pandemic Influenza..........  FY 2024...........  250,000,000.......  315,000,000.......  315,000,000
        National Disaster Medical     FY 2024...........  57,404,000........  78,904,000........  78,904,000
         System.
        Hospital Preparedness         FY 2024...........  385,000,000.......  305,055,000.......  65,055,000
         Program.
        Medical Reserve Corps.......  FY 2024...........  11,200,000........  6,240,000.........  6,240,000
    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.......  27,000,000........  30,000,000
         Literacy.
        Comprehensive Literacy        FY 2020...........  (include in         192,000,000.......  194,000,000
         Development.                                      program above).
        Impact Aid..................  FY 2020...........  1,388,603,000.....  1,486,112,000.....  1,628,151,000
        Supporting Effective          FY 2020...........  2,295,830,000.....  2,131,830,000.....  1,681,441,000
         Instruction State Grants.
        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...........  85,000,000........  101,500,000.......  129,000,000
         Children and Youth.
        Education for Native          FY 2020...........  32,397,000........  36,897,000........  45,897,000
         Hawaiians.
        Alaska Native Education.....  FY 2020...........  31,453,000........  35,953,000........  44,953,000
        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.....  1,385,000,000
         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.........  17,365,000
         Activities.
        Education Innovation and      FY 2020...........  90,611,000........  190,000,000.......  229,000,000
         Research.
        American History and Civics.  FY 2020...........  19,567,000........  4,815,000.........  23,000,000
        Charter Schools Grants......  FY 2020...........  300,000,000.......  440,000,000.......  500,000,000
        Magnet Schools..............  FY 2020...........  108,530,000.......  107,000,000.......  139,000,000
        School Safety National        FY 2020...........  5,000,000.........  105,000,000.......  190,000,000
         Activities.
        Vocational Rehabilitation     FY 2021...........  3,675,021,000.....  3,675,021,000.....  4,504,096,000
         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........  20,150,000
         Individual Rights.
        Helen Keller National Center  FY 2004...........  Such Sums.........  8,666,000.........  20,000,000
         for Deaf-Blind Youths and
         Adults.
        National Technical Institute  FY 2015...........  Such Sums.........  67,016,000........  94,500,000
         for the Deaf.
        Gallaudet University........  FY 2015...........  Such Sums.........  120,275,000.......  168,361,000
        Aid for Institutional         FY 2015...........  Such Sums.........  429,762,000.......  1,031,618,000
         Development.
        Aid for Hispanic-Serving      FY 2015...........  Such Sums.........  109,223,000.......  228,890,000
         Institutions.
        Federal TRIO Programs.......  FY 2015...........  Such Sums.........  839,752,000.......  1,195,000,000
        IDEA National Activities....  FY 2010...........  Such Sums.........  260,203,000.......  258,560,000
        IDEA Grants for Infants and   FY 2010...........  Such Sums.........  439,427,000.......  540,000,000
         Families.
    RELATED AGENCIES
        Corporation for National and  FY 2014...........  Such Sums.........  1,049,954,000.....  183,466,000
         Community Service.
    ----------------------------------------------------------------------------------------------------------------

                               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

                                   JOB CORPS

        Language is included under ``Job Corps'' allowing the
    transfer of funds from the construction, rehabilitation, and
    acquisition account to the operations account.

         STATE UNEMPLOYMENT INSURANCE AND EMPLOYMENT SERVICE OPERATIONS

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

                       VETERANS' EMPLOYMENT AND TRAINING

        Language is included under ``Veterans' Employment and
    Training'' which provides for the reallocation of funds within
    ``Veterans' Employment and Training'' accounts.

                                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 Works Compensation Programs,'' ``Departmental Management,''
    and ``Inspector General'' salaries and expenses accounts and to
    the ``Department of the Treasury, Miscellaneous Expenses''
    account.

                            DEPARTMENTAL MANAGEMENT

        Language is included under ``Departmental Management''
    which provides for the transfer of funds for program evaluation
    to any appropriate account within the Department.

                     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,'' ``Job Corps,'' ``Community Service
    Employment for Older Americans,'' 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,'' funds made available for the ``Bureau of
    International Labor Affairs'' and ``Women's Bureau'' within the
    ``Departmental Management, Salaries, and Expenses'' account 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, CDC Wide Activities and Program Support'' for
    funds to be transferred to and merged with the Infectious
    Diseases Rapid Response Reserve Fund.
        Language is included under ``Centers for Disease Control
    and Prevention, Buildings and Facilitates'' 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
    and research facility.

                         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 Canters to support activities authorized
    in the 21st Century Cures Act (PL 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 three 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'' and the ``National Institutes of Health'' to the
    ``Health Resources and Services Administration.''
        A general provision is included to direct the transfer of
    the ``Prevention and Publish 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 Institute of Health.''
        A general provision is included allowing the transfer of
    funds from the ``Federal Hospital Insurance Trust Fund'' and
    the ``Federal Supplementary Medical Insurance Trust Fund'' to
    the ``Centers for Medicare & Medicaid Services--Program
    Management'' account for purposes of program management related
    to the Medicare program.
        A general provision is included allowing the transfer of
    funds from the ``Non-recurring Expenses Fund'' to ``General
    Departmental Management'' for cybersecurity and allowing for
    the transfer of funds into the ``Nonrecurring Expenses Fund.''

                       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
    $13,000,000 of funding made available for ``Institute of
    Education Sciences'' to be available for the Secretary of
    Education to provide support services to the Institute of
    Education Sciences.
        A general provision is included that allows the transfer of
    funds from the ``Department of Education Nonrecurring Expenses
    Fund'' to Student Aid Administration for purposes of
    information technology and allowing for the transfer of funds
    into the ``Nonrecurring Expenses Fund.''

                           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 $24,600,000
    to the ``Social Security Administration, Office of Inspector
    General,'' for the costs of jointly operated-co-operative
    disability investigation units.
        Language is included under ``Office of the Inspector
    General'' allowing the transfer of funds from the ``Federal
    Old-Age and Survivors Insurance Trust Fund'' and the ``Federal
    Disability Trust Fund'' for carrying out provisions of the
    Inspector General Act of 1978 as well as allowing the transfer
    of funds from ``Social Security Administration--Limitation on
    Administrative Expenses'' to ``Social Security Administration--
    Office of the Inspector General.''

                     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 OF FUNDS

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

    ------------------------------------------------------------------------
                      Program or Activity                        Amount
    ------------------------------------------------------------------------
    Department of Labor
        Employment and Training Administration Adult            $712,000,000
         Training FY 2025 Advance.........................
    Department of Health and Human Services
        Nonrecurring Expenses Fund (sec. 234).............     1,613,000,000
    Department of Education
        Education for the Disadvantaged FY 2025 Advance...       938,266,000
        School Improvement Programs Supporting Effective       1,681,441,000
         Instruction State Grants FY 2025 Advance.........
        Nonrecurring Expenses Fund (sec. 310).............       197,000,000
    Title V--General Provisions
        Child Enrollment Contingency Fund (sec. 528)......    12,835,000,000
        American Rescue Plan Act (sec. 529)...............       183,000,000
    ------------------------------------------------------------------------

       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.

                                      [all]