Senate Report 114-274 - DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND RELATED AGENCIES APPROPRIATION BILL, 2017

[Senate Report 114-274]
[From the U.S. Government Publishing Office]

Calendar No. 509
114th Congress } { Report
SENATE
2d Session } { 114-274

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

DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND
RELATED AGENCIES APPROPRIATION BILL, 2017
_______

June 9, 2016.--Ordered to be printed

_______

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

REPORT

[To accompany S. 3040]

The Committee on Appropriations reports the bill (S. 3040)
making appropriations for Departments of Labor, Health and
Human Services, and Education, and related agencies for the
fiscal year ending September 30, 2017, and for other purposes,
reports favorably thereon without amendment and recommends that
the bill do pass.

Amounts to new budget authority

Total of bill as reported to the Senate.................$932,211,568,000
Amount of 2016 appropriations........................... 888,428,751,000
Amount of 2017 budget estimate.......................... 933,107,118,000
Bill as recommended to Senate compared to:
2016 appropriations................................. +43,782,817,000
2017 budget estimate................................ -895,550,000

CONTENTS

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Page

List of Abbreviations............................................ 4
Summary of Budget Estimates and Committee Recommendations........ 8
Overview..................................................... 8
National Institutes of Health................................ 9
Combating Opioid Abuse....................................... 10
Promoting College Affordability and Completion............... 11
Improving Fiscal Accountability.............................. 11
Increasing the Efficiency and Cost Effectiveness of
Government................................................. 12
Guidance Documents........................................... 14
Other Highlights of the Bill................................. 14
Title I: Department of Labor:
Employment and Training Administration....................... 17
Employee Benefits Security Administration.................... 27
Pension Benefit Guaranty Corporation......................... 27
Wage and Hour Division....................................... 28
Office of Labor-Management Standards......................... 29
Office of Federal Contract Compliance Programs............... 29
Office of Workers' Compensation Programs..................... 29
Occupational Safety and Health Administration................ 32
Mine Safety and Health Administration........................ 34
Bureau of Labor Statistics................................... 35
Office of Disability Employment Policy....................... 35
Departmental Management...................................... 36
General Provisions........................................... 39
Title II: Department of Health and Human Services:
Health Resources and Services Administration................. 41
Centers for Disease Control and Prevention................... 59
National Institutes of Health................................ 81
Substance Abuse and Mental Health Services Administration.... 116
Agency for Healthcare Research and Quality................... 124
Centers for Medicare and Medicaid Services................... 126
Administration for Children and Families..................... 135
Administration for Community Living.......................... 144
Office of the Secretary...................................... 151
General Provisions........................................... 163
Title III: Department of Education:
Education for the Disadvantaged.............................. 165
Impact Aid................................................... 168
School Improvement Programs.................................. 169
Indian Education............................................. 173
Innovation and Improvement................................... 174
Safe Schools and Citizenship Education....................... 178
English Language Acquisition................................. 179
Special Education............................................ 180
Rehabilitation Services...................................... 182
Special Institutions for Persons With Disabilities:
American Printing House for the Blind.................... 183
National Technical Institute for the Deaf................ 184
Gallaudet University..................................... 184
Career, Technical, and Adult Education....................... 184
Student Financial Assistance................................. 185
Student Aid Administration................................... 187
Higher Education............................................. 189
Howard University............................................ 194
College Housing and Academic Facilities Loans Program........ 194
Historically Black College and University Capital Financing
Program Account............................................ 194
Institute of Education Sciences.............................. 195
Departmental Management:
Program Administration................................... 197
Office for Civil Rights.................................. 199
Office of the Inspector General.......................... 199
General Provisions........................................... 199
Title IV: Related Agencies:
Committee for Purchase From People Who Are Blind or Severely
Disabled................................................... 201
Corporation for National and Community Service............... 201
Corporation for Public Broadcasting.......................... 204
Federal Mediation and Conciliation Service................... 205
Federal Mine Safety and Health Review Commission............. 205
Institute of Museum and Library Services..................... 206
Medicaid and CHIP Payment and Access Commission.............. 206
Medicare Payment Advisory Commission......................... 207
National Council on Disability............................... 207
National Labor Relations Board............................... 207
National Mediation Board..................................... 208
Occupational Safety and Health Review Commission............. 208
Railroad Retirement Board.................................... 208
Social Security Administration............................... 209
Title V: General Provisions...................................... 215
Compliance With Paragraph 7, Rule XVI of the Standing Rules of
the Sen- ate................................................... 217
Compliance With Paragraph 7(c), Rule XXVI of the Standing Rules
of the Senate.................................................. 217
Compliance With Paragraph 12, Rule XXVI of the Standing Rules of
the Senate..................................................... 218
Budgetary Impact of Bill......................................... 224
Comparative Statement of New Budget Authority.................... 225

LIST OF ABBREVIATIONS

ACA--Patient Protection and Affordable Care Act
ACL--Administration for Community Living
ADAP--AIDS Drug Assistance Program
AHEC--Area Health Education Center
AHRQ--Agency for Healthcare Research and Quality
AP--Advanced Placement
APH--American Printing House for the Blind
ARRA--American Recovery and Reinvestment Act of 2009
ASH--Assistant Secretary for Health
ASPR--Assistant Secretary for Preparedness and Response
BARDA--Biomedical Advanced Research and Development
Authority
BCA--Budget Control Act of 2011
BLS--Bureau of Labor Statistics
CAN--Cures Acceleration Network
CCAMPIS--Child Care Access Means Parents in School
CCDBG--Child Care and Development Block Grant
CDC--Centers for Disease Control and Prevention
CHAFL--College Housing and Academic Facilities Loans
CHC--Community Health Center
CHGME--Children's Hospitals Graduate Medical Education
CJ--Congressional Justification of Estimates for
Appropriations Committees
CMHS--Center for Mental Health Services
CMS--Centers for Medicare and Medicaid Services
CNCS--Corporation for National and Community Service
CPB--Corporation for Public Broadcasting
CSAP--Center for Substance Abuse Prevention
CSAT--Center for Substance Abuse Treatment
CSBG--Community Services Block Grant
CSEOA--Community Service Employment for Older Americans
DOD--Department of Defense
DOE--Department of Energy
DOL--Department of Labor
EBSA--Employee Benefits Security Administration
EEOICPA--Energy Employees Occupational Illness Compensation
Program Act
ERISA--Employee Retirement Income Security Act of 1974
ESEA--Elementary and Secondary Education Act
ETA--Employment and Training Administration
FDA--Food and Drug Administration
FEMA--Federal Emergency Management Agency
FIC--Fogarty International Center
FIE--Fund for the Improvement of Education
FIPSE--Fund for the Improvement of Postsecondary Education
FMCS--Federal Mediation and Coalition Service
FMSHRC--Federal Mine Safety and Health Review Commission
FTE--full-time equivalent
FWS--Federal Work Study
GAANN--Graduate Assistance in Areas of National Need
GAO--Government Accountability Office
GEAR UP--Gaining Early Awareness and Readiness for
Undergraduate Programs
HBCUs--Historically Black Colleges and Universities
HCERA--Health Care and Education Reconciliation Act of 2010
HCFAC--Health Care Fraud and Abuse Control
HEA--Higher Education Act
HELP--Health, Education, Labor, and Pensions
HHS--Health and Human Services
HRSA--Health Resources and Services Administration
IC--Institute and Center
IDeA--Institutional Development Award
IDEA--Individuals with Disabilities Education Act
IES--Institute of Education Sciences
IMLS--Institute of Museum and Library Services
IOM--Institute of Medicine
LEA--local educational agency
LIHEAP--Low Income Home Energy Assistance Program
MACPAC--Medicaid and CHIP Payment and Access Commission
MCH--Maternal and Child Health
MedPAC--Medicare Payment Advisory Commission
MSHA--Mine Safety and Health Administration
NAEP--National Assessment of Educational Progress
NAGB--National Assessment Governing Board
NCATS--National Center for Advancing Transitional Sciences
NCBDDD--National Center on Birth Defects and Developmental
Disabilities
NCES--National Center for Education Statistics
NCHS--National Center for Health Statistics
NCI--National Cancer Institute
NEI--National Eye Institute
NHGRI--National Human Genome Research Institute
NHLBI--National Heart, Lung, and Blood Institute
NIA--National Institute on Aging
NIAAA--National Institute on Alcohol Abuse and Alcoholism
NIAID--National Institute of Allergy and Infectious Disease
NIAMS--National Institute of Arthritis and Musculoskeletal
and Skin Diseases
NIBIB--National Institute of Biomedical Imaging and
Bioengineering
NICHD--Eunice Kennedy Shriver National Institute of Child
Health and Human Development
NIDA--National Institute on Drug Abuse
NIDCD--National Institute on Deafness and Other
Communication Disorders
NIDCR--National Institute of Dental and Craniofacial
Research
NIDDK--National Institute of Diabetes and Digestive and
Kidney Disease
NIDRR--National Institute on Disability and Rehabilitation
Research
NIEHS--National Institute of Environmental Health Sciences
NIGMS--National Institute of General Medical Sciences
NIH--National Institutes of Health
NIMH--National Institute on Mental Health
NIMHD--National Institute on Minority Health and Health
Disparities
NINDS--National Institute of Neurological Disorders and
Stroke
NINR--National Institute of Nursing Research
NLM--National Library of Medicine
NLRB--National Labor Relations Board
NSF--National Science Foundation
NSIP--Nutrition Services Incentives Program
NTID--National Technical Institute for the Deaf
NFP--Not-for-Profit
OAR--Office of AIDS Research
OCR--Office for Civil Rights
ODEP--Office of Disability Employment Policy
OFCCP--Office of Federal Contract Compliance Programs
OIG--Office of the Inspector General
OLMS--Office of Labor-Management Standards
OMB--Office of Management and Budget
OMH--Office of Minority Health
OMHA--Office of Medicare Hearings and Appeals
ONC--Office of the National Coordinator for Health
Information Technology
ORR--Office of Refugee Resettlement
ORWH--Office of Research on Women's Health
OSEP--Office of Special Education Programs
OSHA--Occupational Safety and Health Administration
OWCP--Office of Workers' Compensation Programs
OWH--Office of Women's Health
PAIMI--protection and advocacy for individuals with mental
illness
PATH--Projects for Assistance in Transition From
Homelessness
PBGC--Pension Benefit Guaranty Corporation
PHS--Public Health Service
PPH Fund--Prevention and Public Health Fund
PRNS--Programs of Regional and National Significance
PROMISE--Promoting School Readiness of Minors in SSI
RSA--Rehabilitation Services Administration
SAMHSA--Substance Abuse and Mental Health Services
Administration
SAPT--Substance Abuse Prevention and Treatment
SEA--State educational agency
SEOG--Supplemental Educational Opportunity Grant
SIG--School Improvement Grants
SPRANS--Special Projects of Regional and National
Significance
SSA--Social Security Administration
SSBG--Social Services Block Grant
SSI--Supplemental Security Income
STEM--science, technology, engineering, and mathematics
TB--tuberculosis
TBI--traumatic brain injury
TIF--Teacher Incentive Fund
TIVAS--Title IV Additional Servicers
UAC--unaccompanied alien children
UCEDD--University Center for Excellence in Developmental
Disabilities
UI--unemployment insurance
USAID--U.S. Agency for International Development
VETS--Veterans' Employment and Training Services
VISTA--Volunteers in Service to America
VR--Vocational Rehabilitation
WANTO--Women in Apprenticeship and Non-Traditional
Occupations
WHD--Wage and Hour Division
WIA--Workforce Investment Act
WIF--Workforce Innovation Fund
WISEWOMAN--Well-Integrated Screening and Evaluation for
Women Across the Nation

SUMMARY OF BUDGET ESTIMATES AND COMMITTEE RECOMMENDATIONS

For fiscal year 2017, the Committee recommends total budget
authority of $932,211,568,000 for the Departments of Labor,
Health and Human Services, and Education, and Related Agencies.
This amount includes $161,857,000,000 in current year
discretionary funding subject to discretionary spending caps
and $1,960,000,000 in cap adjustments for healthcare fraud and
abuse control and for program integrity at the Social Security
Administration, in accordance with the allocation for this
bill.
Fiscal year 2016 levels cited in this report reflect the
enacted amounts in Public Law 114-113, the Consolidated
Appropriations Act, 2016, adjusted for comparability.

OVERVIEW

The Labor, Health and Human Services, and Education, and
Related Agencies [Labor-HHS-Education] appropriations bill
constitutes the largest share of non-defense discretionary
spending, 31 percent of the total in fiscal year 2017. Total
spending in this bill subject to discretionary spending caps is
$270,000,000 below the comparable fiscal year 2016 level. This
level has required the Committee to make difficult funding
decisions and consider the appropriate role and jurisdiction of
Federal programs.
The Committee notes that the administration's budget
requests for large programmatic increases, offset by reductions
in core discretionary funding programs, continue to add
financial pressure on existing programs and operations
throughout the bill. This is especially true for the Department
of Health and Human Services, whose budget request shifted
nearly $3,000,000,000 in traditionally discretionary funded
programs out of the annual appropriations process without
knowing whether there is a path forward to fill those holes
with new streams of mandatory funding. Had the Committee
accepted the Department's budget request, it would have
required a $1,000,000,000 cut to the National Institutes of
Health [NIH], $150,000,000 cut to Community Health Centers, and
the elimination of the Children's Hospital Graduate Medical
Education program. Further, the administration requested
increases for critical health activities, historically funded
through discretionary appropriations, such as programs focused
on fighting the growing opioid epidemic, mental health
treatment, and critical medical research programs, such as
advancing precision medicine, on the mandatory side of the
ledger.
The Committee recommendation prioritizes funding for
programs adhering to the spirit and letter of the discretionary
caps agreed to in the Bipartisan Budget Act of 2015. The
priorities and considerations of the Committee in developing
this bill are summarized in the section below:

NATIONAL INSTITUTES OF HEALTH

The Committee recommendation includes $34,084,000,000 for
the NIH, an increase of $2,000,000,000. The Committee strongly
believes that in this difficult budget environment that the
Labor-HHS-Education appropriations bill must continue to
prioritize and recognize the essential role biomedical research
plays in every American's life.
The Committee rejects the administration's budget request
to reduce discretionary funding for medical research at the NIH
by $1,000,000,000. A continued commitment to NIH is essential
to address our Nation's growing health concerns, spur medical
innovation, sustain America's competitiveness, and reduce
healthcare costs. After last year's historic increase of
$2,000,000,000, the largest increase for the NIH in this bill
in over a decade, the administration chose to take a step
backwards by reducing discretionary funding for NIH. Instead of
accepting this misguided budget request, the Committee
increases funding by $2,000,000,000 above fiscal year 2016.
The Committee recommendation allocates funding to areas
holding the most extraordinary promise of scientific
advancement, while allowing NIH to maintain flexibility to
pursue unplanned scientific opportunities and address
unforeseen public health needs. The Committee recommendation is
estimated to support over 11,200 new and competing grants in
fiscal year 2017, an increase of 4.2 percent above fiscal year
2016.
Alzheimer's Disease.--By 2050, the cost to treat and care
for those suffering from Alzheimer's disease is expected to top
$1,100,000,000,000 a year. To put that figure in perspective,
it is twice what the Federal Government currently spends to
defend the Nation. Without a medical breakthrough to prevent,
slow, or stop the disease, Medicare and Medicaid-related costs
could rise nearly five-fold. NIH-funded research offers the
only hope for finding solutions to successfully manage this
disease in the future. Therefore, the Committee recommendation
includes an increase of $400,000,000 for Alzheimer's disease
research, bringing the total available in fiscal year 2017 to
approximately $1,391,000,000, a 40 percent increase above
fiscal year 2016.
Brain Research through Advancing Innovative
Neurotechnologies [BRAIN].--The Committee continues to support
the BRAIN Initiative and provides $250,000,000 in fiscal year
2017. This is an increase of $100,000,000 above fiscal year
2016 and $55,000,000 above the budget request. The BRAIN
Initiative is developing a more complete understanding of brain
function and has the possibility of helping millions of people
who suffer from a wide variety of neurological and psychiatric
disorders such as Parkinson's disease, schizophrenia,
Alzheimer's disease, depression, and traumatic brain injury.
Precision Medicine.--The Committee provides $300,000,000,
an increase of $100,000,000 above fiscal year 2016, for the
Precision Medicine Initiative. Instead of a one-size-fits-all
approach, the Precision Medicine Initiative will allow
physicians to individualize treatment.
Combating Antibiotic Resistant Bacteria [CARB].--Given the
threat posed by the spread of antibiotic resistant bacteria,
the recommendation includes $463,000,000, an increase of
$50,000,000 above fiscal year 2016, for efforts to develop new
antibiotics and rapid diagnostic tests.

COMBATING OPIOID ABUSE

It is estimated that 1.9 million American adults have an
opioid use disorder related to prescription pain relievers, and
586,000 have an opioid use disorder related to heroin.
According to the Centers for Disease Control and Prevention
[CDC], sales from prescription opioids nearly quadrupled
between 1999 and 2014 and there was a corresponding increase in
deaths from prescription opioids, claiming more than 165,000
lives. Even more troubling, prescription opioids can act as a
gateway drug to heroin use, another form of opioids.
Approximately 3 out of 4 new heroin users abused prescription
opioids before switching to heroin. To stop the spread of
further opioid abuse, the bill provides $261,000,000, an
increase of $126,000,000, or 93 percent, above fiscal year
2016, in discretionary funding to fight both prescription
opioid and heroin abuse:
Abuse Prevention.--The Committee provides $98,000,000, a
$28,000,000 increase above the fiscal year 2016 level, or 40
percent, to CDC's Prescription Drug Overdose program to enhance
State-level prevention efforts such as increasing adoption of
safe opioid prescribing guidelines and improving data
collection and collaboration among States.
Drug Treatment, Prevention, and Awareness.--The Committee
provides $60,000,000 to Substance Abuse and Mental Health
Services Administration [SAMHSA] for grants to States to expand
access to drug treatment services for those with a dependence
on prescription opioids or heroin. This level is a $35,000,000,
or 140 percent, increase above fiscal year 2016. Funds will be
targeted to States that have experienced the greatest increase
in treatment admissions for these drugs.
Overdose Reversal.--The Committee includes $26,000,000 to
prevent opioid overdose, a $14,000,000, or 117 percent,
increase above fiscal year 2016. Funds will be used to help
States purchase and train first responders on emergency devices
that rapidly reverse the adverse effects of an opioid overdose
and to increase awareness of the dangers of opioid use to the
public. Of this amount, the Committee provides $8,000,000 to
prevent opioid overdose-related deaths in rural areas.
Americans living in rural communities are especially vulnerable
and more likely to overdose on prescription pain killers than
those in urban areas, according to CDC.
Community Health Centers.--Within the funding provided to
Community Health Centers, $50,000,000 is allocated for services
relating to the treatment and prevention of opioid abuse. This
investment will help health centers hire over 400 new providers
and treat approximately 70,000 new patients nationwide. This is
in addition to the $94,000,000 in funding that HRSA plans to
provide Community Health Centers to improve and expand the
delivery of substance abuse services in health centers for
fiscal year 2017, with a specific focus on treatment of opioid
use disorders in underserved populations.
In total, the Department is expected to spend $356,000,000
in discretionary and mandatory funding for targeted efforts to
combat opioid abuse in fiscal year 2017. In addition, States
have access to the Substance Abuse Prevention and Treatment
Block Grant, funded at $1,858,079,000 in fiscal year 2017.
Finally, the National Institute on Drug Abuse [NIDA] continues
its efforts to understand addiction, fund research on
medications to alleviate pain, support efforts to better
understand the long-term effects of prescription opioid use,
and research alternative ways to treat pain. NIDA receives an
increase of $52,500,000 in this act.

PROMOTING COLLEGE AFFORDABILITY AND COMPLETION

The Committee recommendation restores and modifies a
provision, eliminated in fiscal year 2011, allowing students to
receive Pell grants year-round. This will allow a student who
has exhausted their Pell grant award for the academic year to
receive a Pell grant for an additional term, traditionally the
summer.
Currently, full-time students and some part-time students
exhaust their full Pell grant after two semesters, or the
equivalent. Students who wish to continue coursework for an
additional term during the academic year must use other means
to pay for it, such as student loans, or not take the
additional classes and wait until the beginning of the next
academic year. This expanded eligibility and flexibility in the
Pell grant program will provide an incentive for students to
take classes year-round and stay continuously enrolled, help
them stay on track for graduation, accelerate completion of
their program, enter or re-enter the workforce faster, and
graduate with less student debt. This is expected to provide an
estimated 1 million students an additional Pell grant, on
average, of $1,650 for the 2017-2018 academic year.
In addition, the Committee recommendation is more than
sufficient to support the scheduled increase in the maximum
Pell grant award from $5,815 for the 2016-17 school year to
$5,935 for the 2017-18 school year.

IMPROVING FISCAL ACCOUNTABILITY

The Committee has an obligation to promote fiscal
accountability and the effective use of U.S. taxpayer funds.
The annual appropriations process affords Congress the
opportunity to continuously improve and refine how Government
works. Appropriations bills provide oversight of every
discretionary program, every year, which gives these bills the
unique ability to react to changing needs and unintended
consequences in the intervening years of an authorization bill.
Taxpayer Transparency.--U.S. taxpayers have a right to know
how the Federal Government is spending their hard-earned
taxpayer dollars--especially when that money is being spent on
advertising Federal programs. The Committee recommendation
continues a provision to promote Government transparency and
accountability by requiring Federal agencies funded in this act
to include disclaimers when advertising materials are paid for
with Federal funds. The Committee expects each agency to
include in their fiscal year 2018 CJ information detailing how
much funding was spent on advertising in fiscal year 2017.
Federal Vehicle Fleet Management.--The General Services
Administration [GSA] issues guidance on Federal fleet
management, but the Federal vehicle fleet is decentralized,
with each agency maintaining flexibility to manage vehicle
utilization as appropriate. To provide greater transparency and
accountability of funding for Federal vehicles, the Committee
directs agencies funded in this bill to conduct an annual
review of fleet utilization during the third quarter of each
fiscal year. Agencies are directed to provide their Offices of
Inspectors General [OIGs] with supporting documentation on the
method used for determining optimal fleet inventories and
justification for any deviation from GSA's Federal Property
Management Regulations. OIGs shall be responsible for
conducting annual audits of fleet management practices and
making the subsequent results publicly available.
Public Health Services Act [PHS] Evaluation Transfer.--The
Committee recommendation continues to ensure that in fiscal
year 2017, no funds will leave NIH via the transfer required by
section 241 of the PHS Act.

INCREASING THE EFFICIENCY AND COST EFFECTIVENESS OF GOVERNMENT

The Committee provides funding for a variety of activities
aimed at reducing fraud, waste, and abuse of taxpayer dollars.
These program integrity initiatives have proven to be a wise
Federal investment, resulting in billions of dollars of savings
each year. In addition, the Committee recommendation provides
direction to the Departments on opportunities to take action
where Federal programs are fragmented or duplicative. The bill
advances several initiatives to increase the efficiency and
cost effectiveness of Government, including:
Fighting Healthcare Fraud and Abuse.--The Committee
includes $725,000,000 for the Health Care Fraud and Abuse
Control program at CMS. The Committee notes that the latest
data demonstrates for every $1 spent on fraud and abuse, $2 is
recovered by the U.S. Treasury. By utilizing the cap adjustment
provided in the Budget Control Act, the Committee
recommendation will create over $10,200,000,000 in savings to
the U.S. Treasury over 10 years.
Inspectors General.--The Committee recommendation provides
$672,574,000 for the Inspectors General funded in this act to
conduct additional audits and investigations of possible waste
and fraud in Government programs. The Committee appreciates the
strong working relationships between the Inspectors General and
the agencies they work with under this Committee's
jurisdiction. The Committee reiterates the strong expectation
that Inspectors General have timely and independent access to
all records, reports, audits, reviews, documents, papers,
recommendations, data and data systems, or other materials
related to their responsibilities under this act and under the
Inspector General Act of 1978. Further, the Committee also
expects that all agencies funded by this act treat electronic
data, records, and systems no differently than paper-based
records and files with respect to access by OIGs unless
particular electronic systems are clearly and explicitly
protected from Inspectors General access by statute.
Preventing Improper Social Security Payments.--The
Committee recommendation includes $1,819,000,000, a
$393,000,000 increase, for the Social Security Administration
[SSA] to conduct continuing disability reviews and SSI program
redeterminations of non-medical eligibility and for other
program integrity efforts. Combined, these activities are
estimated to save approximately $10,897,000,000 over 10 years
in taxpayer dollars by reducing waste, fraud, abuse, and
improper payments in the Social Security, Medicare, and
Medicaid programs.
Strengthening Oversight of Social Security Disability
Benefits.--The Committee recommendation includes language
strengthening oversight of Social Security disability programs.
Specifically, the Committee encourages SSA to expedite efforts
to update the medical vocational guidelines used as part of the
initial disability determination process and to clarify how the
medical improvement standard, and exceptions from it, should be
applied during continuing disability reviews, as well as revise
the treating physician rule to reflect changes in healthcare
delivery. The Committee also supports the agency as it
implements recommendations from GAO, as outlined in its annual
duplication report, to reduce overpayments to individuals
receiving concurrent Federal Workers Compensation Act [FECA]
payments.
Taxpayer Accountability.--In recent years, GAO has
published reports that have exposed 200 areas of potential
duplication and overlap. These reports have revealed more than
1,100 potentially duplicative Federal programs that cost
taxpayers billions of dollars every year and have identified
opportunities to achieve greater efficiency and effectiveness
that result in cost savings or enhanced revenue collection.
While GAO has noted that the Nation has achieved significant
savings based on these reports, many more efficiencies may be
realized. The Committee directs each agency funded in this bill
to report to the Committee, within 1 year of enactment of this
act, on all efforts made to address the duplication identified
by the annual GAO reports along with identifying substantive
challenges and legal barriers to implementing GAO's
recommendations, as well as suggested legislative
recommendations that could help the agency to further reduce
duplication. Given the current fiscal environment, it is
imperative for Government agencies to increase efficiencies to
maximize the effectiveness of agency programs.
Unemployment Insurance Trust Fund Integrity.--The Committee
provides $115,000,000 for Reemployment Services and Eligibility
Assessments for fiscal year 2017. Recent data cited by the
administration have shown that this program significantly
reduces the time participating individuals receive unemployment
compensation payments and reduces the total amount of benefits
paid. Claimants are more successful in returning to work sooner
in jobs with higher wages. The data show that $2.60 in savings
is produced for every $1 in cost under this initiative.
Enhanced, in-person assessments also play an impactful role in
protecting the integrity of the Unemployment Insurance Trust
Fund by reducing improper payments made to ineligible
claimants.

GUIDANCE DOCUMENTS

The Committee notes that executive branch agencies may, as
authorized by the Administrative Procedures Act, issue a
variety of types of interpretive guidance documents that are
exempt from the public notice and comment process. However,
some have raised concerns about the use of guidance documents
because while such documents are not legally binding, regulated
entities may interpret them as imposing new legally binding
requirements. Further, the GAO has found that executive branch
agencies could improve procedures for approving, disseminating,
and periodically reviewing guidance documents. For example,
after a sub-agency in the Department of Labor reviewed its
guidance to determine if it was relevant and current, the sub-
agency was able to reduce its guidance by 85 percent.
Consistent with GAO recommendations, the Committee believes
Departments and agencies funded in this act need to make more
progress in adhering to and implementing OMB's 2007 ``Final
Bulletin for Agency Good Guidance Practices,'' which
establishes policies and procedures for the development,
issuance, and use of significant guidance documents by
executive branch departments and agencies.
The Committee recommends that guidance documents include a
statement explaining why the agency believes it is appropriate
to issue guidance about a matter instead of proposing a
regulation and the specific statutory provisions or
regulation(s) the guidance is interpreting. The Committee
further recommends all guidance documents be posted in one
place on its Web site as well as on the relevant sub-agency Web
page. This information should be easily accessible for the
public to comment on guidance. Finally, when appropriate,
guidance should be sent to the Office of Management and Budget
for review if it is significant.

OTHER HIGHLIGHTS OF THE BILL

Access to Mental Health Care.--The Committee continues to
prioritize mental health treatment and services and provides an
increase of $80,000,000 to key mental health activities around
the Nation. The Committee provides an increase of $30,000,000
for the Mental Health Block Grant at SAMHSA as well as
$50,000,000 to expand mental health services in Community
Health Centers.
Apprenticeship Grants.--The Committee recommendation
includes $100,000,000, an increase of $10,000,000, for
innovative, job-driven approaches that result in the expansion
of Registered Apprenticeship programs to train workers with
skills that meet employer and industry workforce needs.
Charter Schools.--The Committee recommendation includes
$343,172,000 for the Charter Schools Program, a $10,000,000
increase, to promote school choice and accountability by
developing and expanding high quality charter schools.
Child Care.--The Committee recommendation includes
$2,786,000,000 for the Child Care and Development Block Grant,
a $25,000,000 increase. This builds on consistent increases in
the program over the last several years to help States
implement important reforms in the recent reauthorization of
the program to strengthen child care health and safety
standards, and improve the overall quality of child care
programs.
Children's Hospitals Graduate Medical Education [CHGME].--
The Committee recommendation includes $300,000,000 for CHGME,
the full authorized level, an increase of $5,000,000 above
fiscal year 2016. This funding supports freestanding children's
teaching hospitals to provide Graduate Medical Education for
physicians.
Community Health Centers [CHC].--The Committee
recommendation includes $1,491,522,000 for CHC's, level with
fiscal year 2016. Combined with mandatory funding provided in
Public Law 114-10, the fiscal year 2017 program level is
$5,091,522,000. The Committee rejects the administration's
proposal to reduce funding by $150,000,000. The Committee's
recommendation is projected to support 27 million patients, an
increase of approximately 4 million since 2014, and continues
quality improvement activities for more than 1,300 health
centers operating over 9,000 primary sites.
Head Start.--The Committee recommendation includes
$9,203,095,000, a $35,000,000 increase for Head Start. This
will help all Head Start programs keep up with costs, recruit
and retain highly qualified staff, maintain enrollment, and
continue to provide high-quality early childhood care and
education for children and families.
International Labor Affairs.--The Committee recommendation
includes $91,125,000, a $5,000,000 increase, to ensure that our
trading partners around the world are respecting workers'
rights. These funds will enable the Bureau of International
Labor Affairs to increase its monitoring of labor provisions in
our trade agreements, support additional grant assistance to
address worker rights issues, and combat exploitative child
labor.
Job Corps.--Maintaining safe and productive learning
environments for the participating youth and staff on the
Nation's Job Corps campuses is a high priority. Recent
increases in incidents of violence and other unsafe behaviors
threaten both the well-being of people that depend on the
program and the effectiveness and viability of the program
itself. The largest discretionary increase in the bill within
the Department of Labor is dedicated to addressing the safety
and welfare of Job Corps students through physical security
enhancements, mental health resources, and other specialized
staffing.
Medicare Appeals Process.--The number of cases appealed to
the Office of Medicare Hearings and Appeals [OMHA] has
increased 1,000 percent over the past 6 years. As of the end of
2015, it takes OMHA nearly 700 days to close out an existing
appeal. The Committee recommendation includes $112,381,000, a
$5,000,000 increase, to OMHA to expand capacity to address the
significant backlog of appeals.
Occupational License Portability.--The Committee enhances
an initiative started in 2016 to reduce barriers created by a
lack of interstate reciprocity for occupational licenses.
Additional funding is provided for consortia of States, with
technical and other types of assistance from the Department of
Labor, to evaluate and pursue cooperative approaches to enhance
reciprocity or portability of occupational licenses across
State lines. Such agreements would significantly ease barriers
to opportunity and reemployment for thousands of Americans,
especially for military spouses, dislocated workers from
various industries, and transitioning servicemembers.
Polio Eradication.--CDC has substantially contributed to
the more than 99 percent decline in global polio cases from
more than 350,000 cases reported in 1988. Currently, polio
remains endemic in three countries, Nigeria, Afghanistan and
Pakistan. The Committee includes $174,000,000, an increase of
$5,000,000, for polio eradication.
Supporting State and Local Flexibility in Elementary and
Secondary Education.--The Committee recommendation supports the
implementation of the Every Student Succeeds Act, the
reauthorization of the Elementary and Secondary Education Act,
that shifts significant responsibility, control, and
accountability for schools back to States and local school
districts. The Committee recommendation includes:
--$15,409,802,000, a $500,000,000 increase for title I grants
to LEAs, including consolidated funding from the School
Improvement Grants program;
--$1,315,603,000, a $10,000,000 increase, for Impact Aid;
--$11,952,848,000, a $40,000,000 increase, for Individuals
with Disabilities Education Act State Grants.
In addition, the Committee recommendation includes
$300,000,000 for a new Student Support and Academic Enrichment
formula block grant program. This represents a $22,239,000
increase over the combined fiscal year 2016 funding level of
the discrete programs consolidated to create this new formula
block grant program.
Telehealth.--The Committee commends the work that is being
done in the area of Telehealth and the impact it is having on
access to care for medically underserved and rural populations.
In addition to a $1,000,000 increase for the Office for the
Advancement of Telehealth [OAT] in fiscal year 2017, the
Committee's recommendation includes several initiatives that
focus on the success of Telehealth networks to increase access,
prevent and treat opioid abuse, and expand continuing education
to medical professionals in medically underserved areas.
Training Assistance to Coal Workers.--The bill continues an
initiative dedicating a portion of the Dislocated Worker
National Reserve to ensure reemployment and training assistance
are provided to workers dislocated from coal mines and closely
related industries. As job losses mount in the coal industry,
it is very important that dislocated workers are able to adapt
existing skills and learn new skills demanded by other growing
industries so they can return to work as soon as possible. The
bill includes $19,000,000 for this initiative.
Veterans Employment and Training Service.--The Committee
recommendation includes $274,541,000, an increase of
$3,431,000. This amount includes a program increase of
$2,391,000 to enhance the Homeless Veteran's Reintegration
Program which provides an array of specialized services to help
homeless veterans, such as job training, social services,
clothing, substance abuse treatment, transportation, and
housing referrals.

TITLE I

DEPARTMENT OF LABOR

Employment and Training Administration

TRAINING AND EMPLOYMENT SERVICES

Appropriations, 2016.................................... $3,335,425,000
Budget estimate, 2017................................... 3,525,460,000
Committee recommendation................................ 3,268,367,000

The Training and Employment Services account provides
funding primarily for activities under the Workforce Innovation
and Opportunity Act [WIOA], and is a decentralized, integrated
system of skill training and related services designed to
enhance the employment and earnings of economically
disadvantaged and dislocated workers. Funds provided for many
training programs for fiscal year 2017 will support the program
from July 1, 2017, through June 30, 2018. A portion of this
account's funding, $1,772,000,000, is available on October 1,
2017, for the 2017 program year.
Any references in this title of the report to the
``Secretary'' or the ``Department'' shall be interpreted to
mean the Secretary of Labor or the Department of Labor,
respectively, unless otherwise noted.
The Committee strongly encourages the Department to
continue to work with other Federal agencies to align and
streamline employment and training services. In cases where
legislation would be required to achieve these goals, the
President's budget request should include recommendations and
specific proposals for consolidation of programs.
The Committee urges the Department to continue and expand
its efforts in preparing workers for in-demand occupations
through a coordinated Federal, State, and local strategy. This
strategy should include close engagement with employers by all
levels of the workforce development system to ensure that
provided training services align with the demands of those who
would hire program participants.
The Committee encourages the Employment and Training
Administration [ETA] to expand its collaborative work with the
Institute of Museum and Library Services to assist in the
implementation of the WIOA to assist States and local boards in
integrating the education, employment, and training services
provided by public libraries into the workforce investment
system. The Committee also encourages ETA to continue to invest
in building and strengthening partnerships between the one-stop
system and public libraries by encouraging applicants for
competitive grant opportunities to collaborate with public
libraries.
Grants to States
The Committee recommends $2,636,000,000 for Training and
Employment Services Grants to States.
Under WIOA, a local board is given up to 100 percent
transfer authority between Adult and Dislocated Worker
activities upon approval of the Governor.
The Committee recommendation is consistent with the WIOA
authorization regarding the amount of WIOA State grant funding
that may be reserved by Governors. Therefore, each Governor of
a State shall reserve not more than 15 percent of the funds
allotted to a State through the WIOA State grant programs for
State-wide workforce investment activities. This increased
flexibility will assist Governors in meeting unexpected needs,
effectively targeting pockets of unemployment in their States
and fulfilling their oversight and technical assistance
responsibilities.
Adult Employment and Training.--For adult employment and
training activities, the Committee recommends $782,000,000.
Formula funding is provided to States and further
distributed to local workforce investment areas through one-
stop centers. The program provides employment and training
services to disadvantaged, low-skilled, unemployed, and
underemployed adults, including veterans.
Funds are made available in this bill for adult employment
and training activities in program year 2017, which occurs from
July 1, 2017, through June 30, 2018. The bill provides that
$70,000,000 is available for obligation on July 1, 2017, and
that $712,000,000 is available on October 1, 2017. Both
categories of funding are available for obligation through June
30, 2018.
Youth Training.--For youth training activities, the
Committee recommends $838,000,000.
The purpose of this program is to provide low-income youth
facing barriers to employment with services that prepare them
to succeed in the knowledge-based economy. The program provides
assistance to youth in achieving academic and employment
success through improved education and skill competencies,
connections to employers, mentoring, training, and supportive
services. The program also supports summer employment directly
linked to academic and occupational learning, incentives for
recognition and achievement, and activities related to
leadership development, citizenship, and community service.
Funds are made available for youth training activities in
program year 2017, which occurs from April 1, 2017, through
June 30, 2018.
Dislocated Worker Assistance.--For dislocated worker
assistance, the Committee recommends $1,016,000,000.
This program is a State-operated effort that provides
training services and support to help permanently separated
workers return to productive unsubsidized employment. In
addition, States must use State-wide reserve funds for rapid
response assistance to help workers affected by mass layoffs
and plant closures. States must also use these funds to carry
out additional State-wide employment and training activities
such as providing technical assistance to certain low-
performing local areas, evaluating State programs, and
assisting with the operation of one-stop delivery systems.
States may also use funds for implementing innovative incumbent
and dislocated worker training programs.
Funds made available in this bill support activities in
program year 2017, which occurs from July 1, 2017, through June
30, 2018. The bill provides that $156,000,000 is available for
obligation on July 1, 2017, and that $860,000,000 is available
on October 1, 2017. Both categories of funding are available
for obligation through June 30, 2018.
Federally Administered Programs
Dislocated Worker Assistance National Reserve.--The
Committee recommends $220,859,000 for the Dislocated Worker
Assistance National Reserve, which is available to the
Secretary for activities such as responding to mass layoffs,
plant and/or military base closings, and natural disasters that
cannot be otherwise anticipated, as well as for technical
assistance, training, and demonstration projects.
Funds made available for the National Reserve in this bill
support activities in program year 2017. The bill provides that
$20,859,000 is available for obligation on July 1, 2017, and
that $200,000,000 is available on October 1, 2017. Both
categories of funding are available for obligation through
September 30, 2018.
The Committee bill continues a $19,000,000 program within
the National Reserve initiated in fiscal year 2016 to focus
dislocated worker training and support for the large numbers of
people losing jobs in the coal mining and closely related
industries. The Department is strongly urged to engage
proactively with Workforce Development Boards and other
appropriate entities at the State and local levels typically
involved in applying for and administering National Dislocated
Worker Grants to ensure that they are aware of the availability
of the targeted funds so they will be sought and utilized
promptly and effectively to assist coal workers in areas
hardest hit by job loss in that industry.
Indian and Native American Programs.--The Committee
recommends $48,500,000 for Indian and Native American Programs.
These programs are designed to improve the academic,
occupational, and literacy skills of Native Americans, Alaskan
Natives, and Native Hawaiians to aid the participants in
securing permanent, unsubsidized employment. Allowable training
services include adult basic education, GED attainment,
literacy training, English language training, as well as the
establishment of linkages with remedial education.
The Committee directs the Department to obligate funding at
the authorized levels for activities pursuant to section 166(k)
of subtitle D of title I of the WIOA.
Migrant and Seasonal Farmworker Programs.--The Committee
recommends $81,896,000 for migrant and seasonal farmworkers
programs, which serve members of economically disadvantaged
families whose principal livelihood is derived from migratory
and other forms of seasonal farm work, fishing, or logging
activities. Enrollees and their families are provided with
employment, training, and related services intended to prepare
them for stable, year-round employment within and outside of
the agriculture industry.
The Committee recommendation provides that $75,885,000 be
used for State service area grants. The Committee
recommendation also includes bill language directing that
$5,517,000 be used for migrant and seasonal farmworker housing
grants, of which not less than 70 percent shall be for
permanent housing. The principal purpose of these funds is to
continue the network of local farmworker housing organizations
working on permanent housing solutions for migrant and seasonal
farmworkers. The Committee recommendation also includes
$494,000 to be used for section 167 training, technical
assistance, and related activities, including funds for migrant
rest center activities.
The Committee is concerned by continued labor shortages in
the agricultural sector. The Committee directs the Department
to ensure that agricultural worker training programs funded
under Section 167 of WIOA prioritize the development of
additional and enhanced skills specifically relevant to
continued agricultural work.
Women in Apprenticeship.--The Committee accepts the
administration's request to eliminate the Women in
Apprenticeship program. The Committee notes that the
recommendation significantly expands funding for the new wide-
scale apprenticeship grant program, which includes an element
designed to support apprenticeship opportunities for women,
minorities, and other under-represented populations more
holistically.
YouthBuild.--The Committee strongly supports the YouthBuild
program and recommends $84,534,000 to support its work to
target at-risk high school dropouts and prepare them with the
skills and knowledge they need to succeed in a knowledge-based
economy. Since becoming a Federal program in 1992, YouthBuild
has helped over 140,000 low-income young people learn valuable,
marketable job skills by combining educational resources, a
supportive environment, and real construction experience with
the successful completion of more than 30,000 units of
affordable housing for low-income communities and over 48
million hours of community service. There are currently over
260 YouthBuild programs across the country.
National Activities
Reintegration of Ex-Offenders.--The Committee recommends
$88,078,000 for the Reintegration of Ex-Offenders program. The
Reintegration of Ex-Offenders program helps prepare and assist
adult ex-offenders return to their communities through pre-
release services, mentoring, and case management. The program
also provides support, opportunities, education, and training
to youth who are involved in court and on probation, in
aftercare, on parole, or who would benefit from alternatives to
incarceration or diversion from formal judicial proceedings.
Programs are carried out directly through State and local
governmental entities and community based organizations, as
well as indirectly through intermediary organizations. States
are encouraged to continue to support reintegration efforts for
ex-offenders with resources available through the comprehensive
workforce development investment system. The Committee directs
the Department to use funding to support efforts in high-crime,
high-poverty areas and, in particular, communities that are
seeking to address relevant impacts and root causes of civil
unrest. The Committee directs the Department to require
grantees to offer training and industry-recognized credentials
that meet the needs of local, high-demand industries and to
establish formal partnerships and job-placement services with
industry employers.
The Committee notes that the Federal YouthBuild program
competed successfully to receive a Reintegration of Ex-
Offenders grant in 2011. According to the grant's final report,
after 3 years of operation involving a total of over 500 young
ex-offenders, the YouthBuild program demonstrated a recidivism
rate of only 1 percent according to Department-established
performance parameters. In fact, the DREAMS YouthBuild program
in Brooklyn, which served over 200 ex-offenders alone, achieved
a zero percent recidivism rate. These results compare very
favorably with the average recidivism rate commonly ranging
from 10 to 15 percent for the Reintegration of Ex-Offenders
program according to the CJ. Success rates were high in part
due to the program's strategy to engage heavily with youth and
their parents pre-release. Due to YouthBuild's exemplary
performance results, an existing national infrastructure
including strong and mature community relationships, leveraged
private support, and its status as a related Federal program,
the Committee encourages ETA to consider establishing an
ongoing, non-competitive, formal partnership between the
Reintegration program and YouthBuild with an appropriate
portion of the Reintegration activity funding. Such a
partnership seems likely to bolster overall program success
rates.
Evaluation.--The bill continues to use a set-aside funding
mechanism to support the evaluation of employment and training
programs. Instead of directly providing funds for evaluation,
the Committee recommendation supports evaluation activities
through a 0.75 percent set-aside on all training and employment
programs, including the WIOA formula programs, Job Corps,
Community Service Employment for Older Americans, the
Employment Service, and others. The set-aside approach ensures
that sufficient funding is available to carry out comprehensive
evaluation and applied research activities.
ETA will continue to conduct evaluation and applied
research activities in consultation with the Department's chief
evaluation officer, who oversees the evaluation program.
Results will inform policy, advance the Department's mission,
and improve its performance-based management initiatives.
Workforce Data Quality Initiative.--The Committee
recommends $6,000,000 for the Workforce Data Quality
Initiative. Funds are used to assist States with incorporating
comprehensive workforce information into longitudinal data
systems being developed in part with the support of funding
provided by the Department of Education. The initiative is also
intended to help improve the quality and accessibility of
performance data being produced by training providers.
Apprenticeship Grants.--The Committee recommendation
includes $100,000,000 to support the ApprenticeshipUSA
Initiative, an increase of $10,000,000 above fiscal year 2016.
This funding will support innovative, job-driven approaches
that expand apprenticeship programs to train workers with the
21st century skills that meet employer and industry workforce
needs. The Committee commends the Department for designing a
national campaign to engage a broad range of stakeholders,
including employers, labor, States, education and workforce
partners, to expand and diversify apprenticeship opportunities
across the country. The Committee directs the Department to use
funding to support economic development strategies that
generate new or leverage existing employer demand for
apprenticeships. The Committee also directs the Department to
build off of the success of the Women Apprentices in Non-
Traditional Occupations program by requiring States and
organizations to engage, recruit, and serve under-represented
populations, with a particular emphasis on increasing the
representation of women in apprenticeship programs.

JOB CORPS

Appropriations, 2016.................................... $1,689,155,000
Budget estimate, 2017................................... 1,754,590,000
Committee recommendation................................ 1,709,955,000

The recommendation for operations of Job Corps centers is
$1,591,625,000, an increase of $9,800,000 above fiscal year
2016. The Committee directs that Job Corps dedicate significant
operations funding in fiscal year 2017 to upgrading safety and
security of Job Corps centers as requested. These investments
will include improved training to detect security risks,
increased security personnel staffing, additional mental health
counseling, integrated behavior management approaches, and
related activities to improve the safety environment at Job
Corps centers. A portion of the increase may be dedicated to
the modernization of curricula, upgrades of equipment to meet
industry standards, and refinement of training to provide
skills and credentials that are in high demand by employers.
The Committee remains deeply concerned about the issue of
student safety on Job Corps campuses across the country as well
as findings by the Department's Office of Inspector General
[OIG] regarding the enforcement of Job Corps' disciplinary
policies, potentially exposing students to unsafe environments.
The Committee recognizes the Department has taken important
steps toward addressing these issues and strongly urges the
Department to take fully corrective actions to ensure the
safety of students and staff.
The Committee recommendation for administrative costs is
$32,330,000.
The Committee also recommends a total of $86,000,000 in
construction, renovation, and acquisition [CRA] funds, an
increase of $11,000,000 above fiscal year 2016. This amount is
available from July 1, 2017, to June 30, 2020. The Department
is directed to utilize not less than $17,000,000 of the CRA
funds to implement urgent targeted security measures at Job
Corps centers, including improved access controls, perimeter
fencing, security cameras, site lighting, and other appropriate
measures. The CRA activity recommendation overall includes
funds for building rehabilitation and replacement, to increase
safety and security, to address conditions that threaten life
or safety, to abate environmentally unsafe conditions, for
engineering and contract support services, for center
telecommunication upgrades, for contingency funds for emergency
repairs, for minor repair and replacement, and for needed major
equipment. The Committee continues bill language allowing the
Secretary to transfer up to 15 percent of CRA funds, if
necessary, to meet the operational needs of Job Corps centers
or to achieve administrative efficiencies. The bill continues
to require the Secretary to notify the House and Senate
Committees on Appropriations at least 15 days in advance of any
transfer. The Committee expects any notification to include a
justification.
The Committee supports the Department's goals to modernize
curricula, upgrade equipment to meet industry standards, and
refine training to provide skills and credentials that are in
high demand by employers. To advance these goals, the Committee
urges Job Corps to require strong, local employer partnerships
and work-based learning opportunities for students as part of
any Job Corps pilot initiative. Additionally, any external
review of the Job Corps program should also include evaluation
of the Job Corps management structure, the procurement process,
and the procedures for determining or changing which academic
and career training programs are offered at Job Corps centers.
In addition, the Committee urges the Department to be
cognizant of the competitiveness of Job Corps teacher and
instructor salaries as well as staff retention and vacancy
rates. Finally, funds should not be used to award a new
contract for operation of a Job Corps center, unless the
Assistant Secretary of ETA ensures that each of the factors
listed in section 147(a)(3) of WIOA are applied to the
procurement process to award a new contract to operate a Job
Corps center as well as to any decision to restrict
competition.
Gulfport Job Corps Center.--The Committee is encouraged by
recent progress made toward the rebuilding of the Gulfport Job
Corps Center. The Committee expects the Department to have
completed the section 106 process, finalized the design of the
new center, and opened a request for contracts as quickly as
possible. The Department should continue to remain committed to
work to ensure that the center is rebuilt and able to return to
serving the number of young people that it once served while,
in the meantime, reserving sufficient funds for the restoration
of the facility consistent with the expectations of the
Committee. Given that Congress provided emergency
appropriations for this purpose shortly after the damage caused
by Hurricane Katrina, the Committee directs the Department to
prioritize the Gulfport Job Corps Center among pending
construction cases in the Construction, Rehabilitation and
Acquisition Account. The Committee requests to be updated on a
regular, continuing basis on the progress of the administrative
steps to complete the design and rehabilitation of this
facility.

COMMUNITY SERVICE EMPLOYMENT FOR OLDER AMERICANS

Appropriations, 2016.................................... $434,371,000
Budget estimate, 2017................................... 434,371,000
Committee recommendation................................ 400,000,000

Community Service Employment for Older Americans [CSEOA]
provides part-time employment in community service activities
for unemployed, low-income persons aged 55 and older. The
Committee recommendation includes $400,000,000 for CSEOA.

FEDERAL UNEMPLOYMENT BENEFITS AND ALLOWANCES

Appropriations, 2016.................................... $861,000,000
Budget estimate, 2017................................... 849,000,000
Committee recommendation................................ 849,000,000

The Committee recommendation includes mandatory funds for
the Federal unemployment benefits and allowances program that
assists trade-impacted workers with benefits and services to
upgrade skills and retrain in new careers. These benefits and
services are designed to help participants find a path back
into middle-class jobs, improve earnings, and increase
credential and education rates. The Committee recommendation
provides for the full operation of the Trade Adjustment Act
program in fiscal year 2017 consistent with current law.

STATE UNEMPLOYMENT INSURANCE AND EMPLOYMENT SERVICE OPERATIONS

Appropriations, 2016.................................... $3,589,878,000
Budget estimate, 2017................................... 3,631,085,000
Committee recommendation................................ 3,535,960,000

The Committee recommendation includes $3,444,394,000
authorized to be drawn from the Employment Security
Administration account of the Unemployment Trust Fund and
$91,566,000 to be provided from the general fund of the
Treasury.
The funds in this account are used to provide
administrative grants and assistance to State agencies that
administer Federal and State unemployment compensation laws and
operate the public employment service.
The Committee recommends a total of $2,712,266,000 for UI
activities. For UI State operations, the Committee recommends
$2,697,019,000. Of these funds, the Committee includes
$115,000,000 to help address and prevent long-term unemployment
and reduce improper payments through the Reemployment Services
and Eligibility Assessments [RESEA] initiative.
The request also proposed $35,000,000 of the total be
provided through a discretionary cap adjustment. The Committee
recommendation does not include funding through the proposed
cap adjustment.
The Administration's request of $50,000,000 to fund State
consortia to modernize their UI tax and benefit systems is also
included in the recommendation. The Committee expects the full
$50,000,000 to be applied to this purpose.
The Committee recommendation includes $6,000,000 for the UI
Integrity Center of Excellence, including $3,000,000 to support
an integrated data hub and data analytics capacity to help
States reduce fraud.
The Committee recommendation provides no funding for an
additional round of State incentive grants related to worker
misclassification.
The Committee recommendation provides for a contingency
reserve amount should the unemployment workload exceed an
average weekly insured claims volume of 2,453,000.
The Committee recommends $15,247,000 for UI national
activities, which will support activities that benefit the
entire Federal-State UI system, including supporting the
continuation of IT upgrades and technical assistance.
For the Employment Service allotments to States, the
Committee recommends $671,413,000. This amount includes
$21,413,000 in general funds together with an authorization to
spend $650,000,000 from the Employment Security Administration
account of the Unemployment Trust Fund.
The Committee also recommends $19,818,000 for Employment
Service national activities. The administration of the work
opportunity tax credit program accounts for $18,485,000 of the
recommended amount; the remainder is for technical assistance
and training to States.
For carrying out the Department's responsibilities related
to foreign labor certification activities, the Committee
recommends $48,028,000. In addition, 5 percent of the revenue
from H-1B fees is available to the Department for costs
associated with processing H-1B alien labor certification
applications.
The Committee is concerned about widespread reports of
lengthy wage determination and application processing delays as
well as allegations of instances of enforcement of regulations
Congress specifically prohibited in the fiscal year 2016
appropriations act. The H-2B program is a critical source of
labor for highly seasonal industries including fishing,
forestry, tourism, hospitality, recreation, and others. The
program ensures a legal labor force to fill temporary jobs when
an insufficient number of American workers are available.
However, some requirements currently imposed by the Department
make the program excessively burdensome and costly on employers
seeking to legally obtain temporary employees which ultimately
jeopardizes jobs for American workers dependent on these
enterprises. General provisions are continued in the bill to
address these concerns; however, persistent delays in
processing applications remain. The delays noted in most of the
guest worker programs have grown so severe that businesses have
to forego part of their work seasons, resulting in missed or
defaulted contracts, preventing growth, and ultimately
jeopardizing the jobs of dependent American workers. The
Committee directs the Department to administer and regulate the
H-2B program in an efficient manner that is consistent with the
law, allowing employers to legally seek temporary workers at
fair and accurate prevailing wages.
The Committee recommendation includes an amendment to a
previously existing general provision to authorize ETA to
utilize up to $20,000,000 of H-1B fee funds to augment staffing
for H-2B and H-2A foreign labor certification processing,
including wage determinations and associated tasks. The
Department is directed to use no less of this authority than is
necessary to eliminate all labor certification backlogs.
In the determination of prevailing wage for the purposes of
the H-2B program, the Secretary shall accept private wage
surveys even in instances where Occupational Employment
Statistics [OES] survey data are available unless the Secretary
determines that the methodology and data in the provided survey
are not statistically supported. The bill continues general
provisions related to enforcement of H-2B regulations.
Additionally, the Committee has been informed of instances
in which certain job duties related to seafood processing have
been categorized by the Department into OES wage rate
categories that may not accurately reflect the work being
performed by workers normally placed in that category. This
type of worker misclassification is believed to have resulted
in inaccurate prevailing wage determinations for many seafood
workers. Therefore, the Committee strongly urges the Department
to establish an OES wage rate category for seafood processing.
For one-stop career centers and labor market information,
the Committee recommends $70,153,000. The Committee includes
$8,500,000 to support the initiative started in fiscal year
2016 to establish occupational licensing grants for State
consortia to identify, explore, and address areas where
licensing requirements create an unnecessary barrier to labor
market entry or labor mobility where interstate portability of
licenses could improve economic opportunity, particularly for
dislocated workers, transitioning servicemembers, veterans, and
military spouses. The Committee also encourages the Department
to urge participating States to consider ways to increase their
recognition of military certifications for equivalent private
sector skills and occupations to further ease the transition of
former servicemembers to comparable civilian jobs. The
Committee requests progress updates as this initiative
proceeds.
These funds also support system capacity building efforts
which allow the American Job Center network to respond to the
needs of the job seekers and businesses in the current economy,
including the Disability Employment Initiative. When reviewing
investment alternatives for the Disability Employment
Initiative in fiscal year 2017, the Committee directs that the
Department strongly consider needs in rural, underserved States
especially in cases where meaningful applicant partnerships
exist with institutions of higher learning and the workforce
investment system.
The recommendation also includes $1,500,000 to conduct a
requested study and to begin to pilot approaches to modernize
and streamline data collection for the O*NET and related tools.
O*NET is a source of labor market information for the workforce
development system.

ADVANCES TO THE UNEMPLOYMENT TRUST FUND AND OTHER FUNDS

The Committee bill continues language providing such sums
as necessary in mandatory funds for this account. The
appropriation is available to provide advances to several
accounts for purposes authorized under various Federal and
State unemployment compensation laws and the Black Lung
Disability Trust Fund, whenever balances in such accounts prove
insufficient.

PROGRAM ADMINISTRATION

Appropriations, 2016.................................... $154,559,000
Budget estimate, 2017................................... 180,826,000
Committee recommendation................................ 160,156,000

The Committee recommendation of $160,156,000 for program
administration includes $110,174,000 in general funds and
$49,982,000 from the Employment Security Administration account
of the Unemployment Trust Fund.
General funds in this account pay for the Federal staff
needed to administer employment and training programs under
WIOA, OAA, the Trade Act of 1974, and the National
Apprenticeship Act. Trust funds provide for the Federal
administration of employment security, training and employment,
and executive direction functions.
Of the funds provided above the fiscal year 2016 level,
$3,200,000 is dedicated toward implementation of the integrated
performance reporting system pursuant to WIOA and the grants
management system, and $2,160,000 is for Office of
Apprenticeship for the administration of the new apprenticeship
grant program.

Employee Benefits Security Administration

SALARIES AND EXPENSES

Appropriations, 2016.................................... $181,000,000
Budget estimate, 2017................................... 205,761,000
Committee recommendation................................ 181,000,000

The Committee recommends $181,000,000 for the Employee
Benefits Security Administration [EBSA]. EBSA is responsible
for the enforcement of title I of ERISA in both civil and
criminal areas and for enforcement of sections 8477 and 8478 of
the Federal Employees' Retirement Security Act of 1986. EBSA
administers an integrated program of regulation, compliance
assistance and education, civil and criminal enforcement, and
research and analysis.
Mental health disorders affected an estimated 43.8 million
Americans last year. The Committee believes that the Mental
Health Parity and Addiction Equity Act of 2008 [MHPAEA] made
significant progress ensuring that individuals in need of
mental health care have access to those services on the same
basis as they would for other medical care. While MHPAEA has
been a strong step towards parity, the Committee believes there
is insufficient guidance on what constitutes parity under the
law. Specific guidance for group health plans and health
insurance issuers as well as for employers and employees
covered by plans governed by the law is particularly needed.
The Committee directs the Secretary to coordinate with the
Secretary of Health and Human Services and prepare annual
reports of parity compliance activities in each State. Reports
shall include inquiries and complaints specific to the MHPAEA,
and a transparent de-identified report of all enforcement
actions. Reports also shall include a compliance guide that
answers questions raised during the previous year and specific
guidelines providing clear interpretations of the law and the
final rule.

Pension Benefit Guaranty Corporation

The Pension Benefit Guaranty Corporation's [PBGC's]
estimated obligations for fiscal year 2017 include single-
employer benefit payments of $7,195,000,000, multi-employer
financial assistance of $315,000,000, and administrative
expenses of $519,506,000. Administrative expenses are comprised
of three activities: pension insurance activities, pension plan
termination expenses, and operational support. These
expenditures are financed by permanent authority. For fiscal
year 2016, the Committee accepted the PBGC's proposal to reform
the previous administrative apportionment classifications from
three budget activities to one budget activity to make
operations more efficient and improve stewardship of resources.
That consolidated approach for the three activities is
continued, but PBGC is directed to continue providing detail
every year on the three activities in its annual congressional
budget justification.
PBGC requested $98,500,000 for costs associated with the
consolidation of three separate headquarters facilities into
one upon the expiration of existing leases. The consolidation
is intended to reduce the leased footprint of the agency,
increase efficiencies associated with consolidated office
space, and reduce overall lease costs. The Committee bill
provides the requested funds, to be available for 5 years and
only available for lease replacement costs. Unused funds for
this purpose will be retained in the revolving fund.
The PBGC is a wholly owned Government corporation
established by ERISA. The law places it within DOL and makes
the Secretary the chair of its board of directors. The
Corporation receives its income primarily from insurance
premiums collected from covered pension plans, assets of
terminated pension plans, collection of employer liabilities
imposed by the act, and investment earnings. The primary
purpose of the PBGC is to guarantee the payment of pension plan
benefits to participants if covered defined benefit plans fail
or go out of existence.
The President's budget proposes and the bill continues
authority for a contingency fund for the PBGC that provides
additional administrative resources when the number of
participants in terminated plans exceeds 100,000. When the
trigger is reached, an additional $9,200,000 becomes available
through September 30, 2018, for every 20,000 additional
participants in terminated plans. The Committee bill also
continues authority allowing the PBGC additional obligation
authority for unforeseen and extraordinary pre-termination
expenses, after approval by OMB and notification of the
Committees on Appropriations of the House of Representatives
and the Senate.

Wage and Hour Division

SALARIES AND EXPENSES

Appropriations, 2016.................................... $227,500,000
Budget estimate, 2017................................... 276,599,000
Committee recommendation................................ 227,500,000

The Committee recommends $227,500,000 for the Wage and Hour
Division [WHD].
WHD is responsible for administering and enforcing laws
that provide minimum standards for wages and working conditions
in the United States. The Fair Labor Standards Act [FLSA],
employment rights under the Family and Medical Leave Act
[FMLA], and the Migrant and Seasonal Agricultural Worker
Protection Act are several of the important laws that WHD is
charged with administering and/or enforcing.

Office of Labor-Management Standards

SALARIES AND EXPENSES

Appropriations, 2016.................................... $40,593,000
Budget estimate, 2017................................... 45,691,000
Committee recommendation................................ 35,529,000

The Committee recommends $35,529,000 for the Office of
Labor-Management Standards [OLMS].
OLMS administers the Labor-Management Reporting and
Disclosure Act of 1959 and related laws. These laws establish
safeguards for union democracy and financial integrity. They
also require public disclosure by unions, union officers,
employers, and others. In addition, the Office administers
employee protections under federally sponsored transportation
programs.

Office of Federal Contract Compliance Programs

SALARIES AND EXPENSES

Appropriations, 2016.................................... $105,476,000
Budget estimate, 2017................................... 114,169,000
Committee recommendation................................ 104,476,000

The Committee recommends $104,476,000 for the Office of
Federal Contract Compliance Programs [OFCCP].
This Office protects workers and potential employees of
Federal contractors from employment discrimination prohibited
under Executive Order 11246, section 503 of the Rehabilitation
Act of 1973, and the Vietnam Era Veterans' Readjustment
Assistance Act of 1974.

Office of Workers' Compensation Programs

SALARIES AND EXPENSES

Appropriations, 2016.................................... $115,501,000
Budget estimate, 2017................................... 126,159,000
Committee recommendation................................ 117,601,000

The Committee recommends $117,601,000 for the Office of
Workers' Compensation [OWCP]. The bill provides authority to
expend $2,177,000 from the special fund established by the
Longshore and Harbor Workers' Compensation Act.
OWCP administers four distinct compensation programs: the
Federal Employees' Compensation Act [FECA], the Longshore and
Harbor Workers' Compensation Act, the Black Lung Benefits
programs, and the Energy Employees Occupational Illness
Compensation Program. In addition, OWCP houses the Division of
Information Technology Management and Services.

SPECIAL BENEFITS

Appropriations, 2016.................................... $210,000,000
Budget estimate, 2017................................... 220,000,000
Committee recommendation................................ 220,000,000

The Committee recommends $220,000,000 for this account.
This mandatory appropriation, which is administered by OWCP,
primarily provides benefits under FECA.
The Committee recommends continuation of appropriations
language to provide authority to require disclosure of Social
Security numbers by individuals filing claims under FECA or the
Longshore and Harbor Workers' Compensation Act and its
extensions.
The Committee continues appropriations language that
provides authority to use FECA funds to reimburse a new
employer for a portion of the salary of a newly reemployed
injured Federal worker. FECA funds will be used to reimburse
new employers during the first 3 years of employment, not to
exceed 75 percent of salary in the worker's first year, and
declining thereafter.
The Committee recommendation continues language that allows
carryover of unobligated balances to be used in the following
year and that provides authority to draw such sums as are
needed after August 15 to pay current beneficiaries. Such funds
are charged to the subsequent year appropriation.
The Committee recommends continuation of appropriations
language to provide authority to deposit into the special
benefits account of the employees' compensation fund those
funds that the Postal Service, the Tennessee Valley Authority,
and other entities are required to pay to cover their fair
share of the costs of administering the claims filed by their
employees under FECA.
Finally, the Committee maintains language consistent with
long-standing interpretations and implementation of this
appropriation stating that, along with the other compensation
statutes already specifically enumerated, the appropriation is
used to pay obligations that arise under the War Hazards
Compensation Act, and the appropriation is deposited in the
Employees' Compensation Fund and assumes its attributes, namely
availability without time limit as provided by 5 U.S.C. section
8147.

SPECIAL BENEFITS FOR DISABLED COAL MINERS

Appropriations, 2016.................................... $69,302,000
Budget estimate, 2017................................... 61,319,000
Committee recommendation................................ 61,319,000

The Committee recommends a mandatory appropriation of
$61,319,000 in fiscal year 2017 for special benefits for
disabled coal miners. This is in addition to the $19,000,000
appropriated last year as an advance for the first quarter of
fiscal year 2017, for a total program level of $80,319,000 in
fiscal year 2017. The decrease in this account below the fiscal
year 2016 level reflects a declining beneficiary population.
These mandatory funds are used to provide monthly benefits
to coal miners disabled by black lung disease and their widows
and certain other dependents, as well as to pay related
administrative costs.
The Committee also recommends an advance appropriation of
$16,000,000 for the first quarter of fiscal year 2018. These
funds will ensure uninterrupted benefit payments to coal
miners, their widows, and dependents.

DIVISION OF ENERGY EMPLOYEES OCCUPATIONAL ILLNESS COMPENSATION

SALARIES AND EXPENSES

Appropriations, 2016.................................... $58,552,000
Budget estimate, 2017................................... 59,846,000
Committee recommendation................................ 59,846,000

The Committee recommends $59,846,000 for the Division of
Energy Employees Occupational Illness Compensation. This is a
mandatory appropriation.
The Division administers EEIOCPA, which provides benefits
to eligible employees and former employees of the Department of
Energy [DOE], its contractors and subcontractors, or to certain
survivors of such individuals. The mission also includes
delivering benefits to certain beneficiaries of the Radiation
Exposure Compensation Act. The Division is part of OWCP.
In fiscal year 2017, the volume of incoming claims under
part B of EEOICPA is estimated at about 5,300 from DOE
employees or survivors, and private companies under contract
with DOE, who suffer from a radiation-related cancer,
beryllium-related disease, or chronic silicosis as a result of
their work in producing or testing nuclear weapons.
Under part E, approximately 4,350 new claims will be
received during fiscal year 2017. Under this authority, the
Department provides benefits to eligible DOE contractor
employees who were found to have work-related occupational
illnesses due to exposure to a toxic substance at a DOE
facility, or to the employees' survivors.

BLACK LUNG DISABILITY TRUST FUND

Appropriations, 2016.................................... $341,467,000
Budget estimate, 2017................................... 371,641,000
Committee recommendation................................ 371,641,000

The Committee bill provides an estimated $371,641,000 as
requested for this mandatory appropriations account. This
estimate is comprised of $69,526,000 for administrative
expenses and an estimated $302,115,000 for benefit payment and
interest costs.
The Committee bill continues to provide indefinite
authority for the Black Lung Disability Trust Fund to provide
for benefit payments. In addition, the bill provides for
transfers from the trust fund for administrative expenses for
the following Department agencies as requested: up to
$38,246,000 for the part C costs of the Division of Coal Mine
Workers' Compensation Programs; up to $30,594,000 for
Departmental Management, Salaries and Expenses; and up to
$330,000 for Departmental Management, Inspector General. The
bill also allows a transfer of up to $356,000 for the
Department of the Treasury.
The Trust Fund pays all black lung compensation/medical and
survivor benefit expenses when no responsible mine operation
can be assigned liability for such benefits or when coal mine
employment ceased prior to 1970, as well as all administrative
costs that are incurred in administering the benefits program
and operating the trust fund.

Occupational Safety and Health Administration

SALARIES AND EXPENSES

Appropriations, 2016.................................... $552,787,000
Budget estimate, 2017................................... 595,023,000
Committee recommendation................................ 552,787,000

The Committee recommends $552,787,000 for the Occupational
Safety and Health Administration [OSHA], which is responsible
for enforcing the Occupational Safety and Health Act of 1970 in
the Nation's workplaces.
The Committee continues bill language to allow OSHA to
retain course tuition and fees for training institute courses
used for occupational safety and health training and education
activities in the private sector. The cap established by the
bill is $499,000, the same as current law.
The bill retains language that continues to exempt farms
employing 10 or fewer people from the provisions of the act
with the exception of those farms having a temporary labor
camp. The bill also retains language exempting small firms in
industry classifications having a lost workday injury rate less
than the national average from general schedule safety
inspections.
The exemption of small farming operations from OSHA
regulation has been in place since 1976. OSHA clarified the
limits of its authority to conduct enforcement on small farms
in July 2014, particularly regarding post-harvest activities of
a farming operation. The continued exemption for small farms
and recognition of limits of the OSHA regulatory authority are
critical for family farms. It is also important the Department
of Agriculture be consulted in any future attempts by OSHA to
redefine or modify any aspect of the small farm exemption.
The Committee recommends $100,850,000 for grants to States
under section 203(g) of the Occupational Safety and Health Act.
These funds primarily are provided to States that have taken
responsibility for administering their own occupational safety
and health programs for the private sector and/or the public
sector. State plans must be at least as effective as the
Federal program and are monitored by OSHA. The Committee bill
continues language that allows OSHA to provide grants of up to
50 percent for the costs of State plans approved by the agency.
The Committee believes that OSHA's worker safety and health
training and education programs are a critical part of a
comprehensive approach to worker protection. Under the program,
grants are made to various types of organizations representing
employers and labor organizations for direct training of
workers on occupational safety and health. The Committee
recommendation includes $10,537,000 for the OSHA Susan Harwood
Training Grant Program and directs OSHA to dedicate no less
than $3,500,000 per year for the purpose of administering the
Voluntary Protection Program [VPP] in its Federal Compliance
Assistance budget. OSHA shall not reduce funding levels or the
number of employees administering the VPP, the Safety and
Health Achievement Recognition Program [SHARP], or Federal
Compliance Assistance, and shall not collect any monies from
participants for the purpose of administering these programs.
The Committee recognizes that fewer injuries mean safer,
more productive workers and lower worker compensation and
healthcare costs. Statistical evidence for VPP success is
impressive. The average VPP worksite has a Days Away Restricted
or Transferred [DART] case rate of 52 percent below the average
for its industry. These sites typically do not start out with
such low rates. Reductions in injuries and illnesses begin when
the site commits to the VPP approach to safety and health
management and the challenging VPP application process.
The Committee repeats and emphasizes the concerns stated in
the joint explanatory statement accompanying the Consolidated
Appropriations Act, 2016 about OSHA's use of guidance documents
to change longstanding OSHA policy. In June and July of 2015,
OSHA issued three guidance documents related to Executive Order
13650, ``Improving Chemical Facility Safety and Security.''
They are Process Safety Management of Highly Hazardous
Chemicals and Covered Concentrations of Listed Appendix A
Chemicals, RAGAGEP in Safety Process Management Enforcement,
and PSM Retail Exemption Interim Enforcement Policy. These
along with other OSHA ``letters of interpretation'' attempt to
change prevailing agency policies without proposing regulatory
changes, which would be governed by the requirements of the
Administrative Procedures Act (5 U.S.C. 551 et. seq.). OSHA has
issued letters of interpretation on substantive policy matters
that leave the agency open to liability that can be avoided by
going through the proper rulemaking process, including notice
and period of public comment. OSHA is expected to implement
agency policy changes through the formal regulatory process.
Therefore, the revised enforcement policy relating to the
exemption of retail facilities from coverage of the Process
Safety Management of Highly Hazardous Chemicals standard (29
CFR 191 0.119(a)(2)(i)) issued by the Occupational Safety and
Health Administration on July 22, 2015, shall not be enforced
nor deemed by the Department of Labor to be in effect until:
the Bureau of the Census establishes a new North American
Industry Classification System code under Sector 44-45 Retail
Trade for Farm Supply Retailers; the Secretary of Labor, acting
through the Assistant Secretary of Labor for Occupational
Safety and Health, has carried out all notice and comment
rulemaking procedures and invited meaningful public
participation in the rulemaking; and the Secretary, acting
through the Assistant Secretary of Labor for Occupational
Safety and Health, arranges for an independent third-party to
conduct a cost-benefit analysis of such proposed rule and the
Secretary includes such analysis in the publication of the
proposed rule.
The Committee understands that, as a result of Executive
Order 13650, Improving Chemical Facility Safety and Security,
OSHA is considering options to ensure the safety of ammonium
nitrate handling and storage. The Committee also understands
that there is no record thus far of an accidental detonation of
ammonium nitrate in a situation where a storage facility has
been compliant with OSHA's existing regulations at 29 CFR
1910.109(i). The existing regulations are based on standards of
the National Fire Protection Association. Before any new
regulations are proposed for the storage of solid ammonium
nitrate, the Secretary shall submit a report to the Committees
on Appropriations of the House Representatives and the Senate;
the Senate Health, Education, Labor and Pensions Committee; and
the House Committee on Education and the Workforce that
identifies any provisions of OSHA's current 29 CFR 1910.109(i)
regulations under consideration for update and that evaluates
the costs and benefits of such changes.
The Committee is concerned about OSHA's implementation of
the Outreach Training Program and its use of Requests for
Proposals [RFPs] to change longstanding OSHA policy. Since
2008, OSHA has implemented and administered online Outreach
Training Program courses via its OSHA Outreach Training
Program--Online Training Guidance document. Instead of
remaining consistent with its own Guidance document, OSHA has
twice used the RFP process unsuccessfully to specifically limit
online distribution of the Outreach Training Program.
Therefore, the Committee urges OSHA to consider recognition of
online training as an equivalent to classroom training with
respect to the Outreach Training Program and improvement of
worker safety and health. Further, OSHA is urged to seek the
meaningful advance participation of policymakers and
stakeholders through public meetings and pre-solicitation
conferences prior to the issuance of any new or amended
training RFP for this program. OSHA is directed to provide
notification to the Committees on Appropriations of the House
of Representatives and the Senate at least 10 days prior to
issuance of any new or amended RFP specific to Outreach
Training Programs.

Mine Safety and Health Administration

SALARIES AND EXPENSES

Appropriations, 2016.................................... $375,887,000
Budget estimate, 2017................................... 397,372,000
Committee recommendation................................ 375,887,000

The Committee recommendation includes $375,887,000 for the
Mine Safety and Health Administration [MSHA].
MSHA enforces the Federal Mine Safety and Health Act by
conducting inspections and special investigations of mine
operations, promulgating mandatory safety and health standards,
cooperating with the States in developing effective State
programs, and improving training in conjunction with States and
the mining industry.
The bill continues language authorizing MSHA to use up to
$2,000,000 for mine rescue and recovery activities. It also
retains the provision allowing the Secretary to use any funds
available to the Department to provide for the costs of mine
rescue and survival operations in the event of a major
disaster. To prepare properly for an actual emergency, the
Committee also directs MSHA to continue to devote sufficient
resources toward a competitive grant activity for effective
emergency response and recovery training in various types of
mine conditions.
The Committee supports MSHA's ongoing work to improve mine
rescue communications capabilities. To prepare properly for an
actual mine rescue emergency, the Committee directs MSHA to
continue to devote sufficient resources towards mine rescue
technology and, to the extent possible, urges MSHA to expedite
progress toward outfitting all five MSHA Mine Rescue teams with
advanced mine rescue technology. The Committee has been
informed that there is a discrepancy among States'
interpretations of whether the purchase of mine rescue
communications equipment is an eligible use of State Assistance
Training funds. The Committee believes that such purchases,
when used in part for training purposes which are the focus of
these funds, are an allowable use and directs MSHA to clarify
this issue for all training grant recipients.
In addition, bill language is included to allow the
National Mine Health and Safety Academy to collect not more
than $750,000 for room, board, tuition, and the sale of
training materials to be available for mine safety and health
education and training activities. Bill language also allows
MSHA to retain up to $2,499,000 from fees collected for the
approval and certification of equipment, materials, and
explosives for use in mines, and to utilize such sums for these
activities.

Bureau of Labor Statistics

SALARIES AND EXPENSES

Appropriations, 2016.................................... $609,000,000
Budget estimate, 2017................................... 640,943,000
Committee recommendation................................ 609,000,000

The Committee recommends $609,000,000 for the Bureau of
Labor Statistics [BLS]. This amount includes $65,000,000 from
the Employment Security Administration account of the
Unemployment Trust Fund and $544,000,000 in Federal funds.
BLS is the principal fact finding agency in the Federal
Government in the broad field of labor economics. The Committee
recognizes that the Nation requires current, accurate, detailed
workforce statistics for Federal and non-Federal data users as
provided by BLS.
The Committee understands that BLS is preparing a report
requested in last year's statement of managers that will
discuss the efforts of BLS to account for and report on all
forms of employment in the current economy. The Committee notes
that the availability of data on trends in employment helps
inform long-term economic policy-making and looks forward to
receiving the report later this year.

Office of Disability Employment Policy

Appropriations, 2016.................................... $38,203,000
Budget estimate, 2017................................... 38,544,000
Committee recommendation................................ 38,203,000

The Committee recommends $38,203,000 for the Office of
Disability Employment Policy to provide leadership, develop
policy and initiatives, and award grants furthering the
objective of eliminating physical and programmatic barriers to
the training and employment of people with disabilities and to
design and implement research and technical assistance grants
and contracts to develop policy that reduces barriers to
competitive, integrated employment for youth and adults with
disabilities.

Departmental Management

SALARIES AND EXPENSES

Appropriations, 2016.................................... $334,373,000
Budget estimate, 2017................................... 387,925,000
Committee recommendation................................ 339,186,000

The Committee recommendation includes $339,186,000 for the
Departmental Management account. Of this amount, $338,878,000
is available from general funds and $308,000 is available by
transfer from the Employment Security account of the
Unemployment Trust Fund. In addition, $30,594,000 is available
by transfer from the Black Lung Disability Trust Fund.
The departmental management appropriation pays the salaries
and related expenses of staff responsible for formulating and
overseeing the implementation of departmental policy and
management activities in support of that goal. In addition,
this appropriation includes a variety of operating programs and
activities that are not involved in departmental management
functions, but for which other appropriations for salaries and
expenses are not suitable.
The administration requested $2,620,000 and 15 full time
equivalent staff to implement Executive Order 13673. This
request is denied by the Committee. The Committee is concerned
that the administration proposes to create additional layers of
bureaucracy to duplicate existing functions of government.
Violations of Federal labor law are a serious matter. Such
violations are already illegal by definition, and enforcement
mechanisms are already in place to adjudicate such cases and to
levy punishment as appropriate, up to and including debarment.
The Committee notes that some have raised concerns about
the Department's use of guidance documents, including Dear
Colleague letters, because such documents are not legally
binding, but regulated entities may interpret them as such.
Accordingly, the Committee recommendation includes new
directives in the overview section of the Committee Report for
each of the Departments and agencies included in this bill
relating to the use of guidance documents.
The Committee recommendation includes $91,125,000 for the
Bureau of International Labor Affairs [ILAB], of which
$61,825,000 is available for obligation through December 31,
2017. ILAB's appropriation is available to help improve working
conditions and labor standards for workers around the world and
carry out ILAB's statutory mandates and international
responsibilities. Funding for international programming to
eliminate the worst forms of child labor should prioritize
comprehensive and sustainable initiatives that address the root
causes of the problem, including lack of education and
vocational training opportunities; household poverty; lack of
data and awareness of the scope and impact of the worst forms
of child labor; gaps in social protection services; and weak
enforcement of labor laws, which increase the vulnerability of
households to the worst forms of child labor.
The Committee recognizes that the exploitation of children
around the world remains a serious problem, including in
settings where children should be safe and protected such as in
homes and schools. Approximately 115 million children are
engaged in hazardous work and 5.5 million children are in
forced labor. The Committee notes ILAB's involvement in the
United States Government Action Plan on Children in Adversity
and requests that the amount of funding by objective for the
Action Plan on Children in Adversity be reported as part of the
fiscal year 2018 CJ.
The Committee expects ILAB to enhance its current effort on
programs to combat exploitative child labor. The Committee also
expects that integrated child labor and worker rights projects
supported by ILAB funds will have a significant and direct
child labor component. The bill requires ILAB to spend not more
than $54,825,000 for programs to combat exploitative child
labor internationally and not less than $7,000,000 to implement
model worker rights programs in countries with which the United
States has trade preference programs or free trade agreements.
The Committee understands ILAB's desire to place labor
attaches in selected U.S. missions abroad and notes that
Honduras has been established as a first priority. The
Committee requests a report, not later than 180 days after
enactment of this act, from the Departments of Labor and State
which describes current labor-related staffing at U.S. missions
overseas and the Departments' coordinated plan for future
staffing and support for effective monitoring and enforcement
of labor provisions related to free trade agreements and trade
preference programs, particularly in priority countries.
The Committee recommendation provides $8,040,000 for
program evaluation and allows these funds to be available for
obligation through September 30, 2018. The Committee bill also
continues the authority of the Secretary to transfer these
funds to any other account in the Department for evaluation
purposes. The Committee bill continues authority to use up to
0.75 percent of certain Department appropriations for
evaluation activities identified by the chief evaluation
officer. The Committee expects to be notified of the planned
uses of funds derived from this authority.
The Committee directs the Chief Evaluation Officer, in
conjunction with the Employee Benefits Security Administration
and other relevant DOL offices, to submit a report to Congress
within 6 months of enactment of this act that explains the
Department's proposal for pilot programs to design, implement,
and evaluate new and existing models and approaches for benefit
portability and the ways in which such approaches would differ
from currently available retirement plans that originate with
employers which can be retained or rolled into other personal
savings options.
The recommendation includes $28,834,000 for the Office of
the Assistant Secretary for Administration and Management. The
increase of $421,000 above fiscal year 2016 is provided to
cover requested inflationary and built-in costs.
The recommendation includes $35,336,000 for the
Adjudication activity, an increase of $3,336,000 above the
fiscal year 2016 level. The Committee directs that the increase
be used to reduce the projected increase in backlogged cases in
the Office of Administrative Law Judges as requested and of
which up to $896,000 may be used for built-in inflationary cost
increases across the agencies within the Adjudication activity.
The Committee recommendation provides $11,536,000 for the
Women's Bureau. The Committee continues bill language allowing
the Bureau to award grants. The requested program increase to
support a Paid Leave Grant Program is not included.

VETERANS EMPLOYMENT AND TRAINING

Appropriations, 2016.................................... $271,110,000
Budget estimate, 2017................................... 285,520,000
Committee recommendation................................ 274,541,000

The Committee recommendation of $274,541,000 for the
Veterans Employment and Training Service [VETS] includes
$40,500,000 in general revenue funding and $234,041,000 to be
expended from the Employment Security Administration account of
the Unemployment Trust Fund.
This account provides resources for VETS to maximize
employment opportunities for veterans and transitioning service
members, including protecting their employment rights. VETS
carries out its mission through a combination of grants to
States, competitive grants, and Federal enforcement and
oversight.
The Committee provides $175,000,000 for the Jobs for
Veterans State Grants [JVSG] program. This funding will enable
Disabled Veterans' Outreach Program specialists and Local
Veterans' Employment Representatives to continue providing
intensive employment services to veterans and eligible spouses;
transitioning service members early in their separation from
military service; wounded warriors recuperating in military
treatment facilities or transition units; and, spouses and
family caregivers to help ensure the family has income to
provide sufficient support. The Committee maintains language
providing authority for JVSG funding to be used for data
systems and contract support to allow for the tracking of
participant and performance information.
The Committee provides $14,600,000 for the Transition
Assistance Program [TAP]. This funding will support over 6,000
employment workshops at military installations and in virtual
classrooms worldwide for exiting service members and spouses.
The Committee recommendation includes $41,027,000 for
Federal administration costs. This funding level will support
oversight and administration of the VETS grant programs, TAP
employment workshops, and compliance and enforcement
activities.
The Committee recommends $40,500,000 for the Homeless
Veterans' Reintegration Program [HVRP], an increase of
$1,891,000, to help homeless veterans attain the skills they
need to gain meaningful employment. This funding will allow DOL
to provide HVRP services to as many as 17,000 homeless veterans
nationwide, including homeless women veterans. The bill allows
Incarcerated Veterans' Transition funds to be awarded through
September 30, 2017, and to serve veterans who have recently
been released from incarceration but are at-risk of
homelessness.
The Committee recommendation includes $3,414,000 for the
National Veterans' Training Institute, which provides training
to Federal staff and veteran service providers.

INFORMATION TECHNOLOGY MODERNIZATION

Appropriations, 2016.................................... $29,778,000
Budget estimate, 2017................................... 63,162,000
Committee recommendation................................ 18,778,000

The Committee recommends $18,778,000 for the IT
Modernization account. Funds available in this account have
been used for two primary activities. The first is departmental
support systems, for which $4,898,000 is provided as requested.
The second activity, IT Infrastructure Modernization, supports
necessary activities associated with the Federal Data Center
Consolidation Initiative.

OFFICE OF THE INSPECTOR GENERAL

Appropriations, 2016.................................... $86,300,000
Budget estimate, 2017................................... 94,541,000
Committee recommendation................................ 87,721,000

The Committee recommends $87,721,000 for the DOL OIG. The
bill includes $82,061,000 in general funds and authority to
transfer $5,660,000 from the Employment Security Administration
account of the Unemployment Trust Fund. In addition, an amount
of $330,000 is available by transfer from the Black Lung
Disability Trust Fund.
Through a comprehensive program of audits, investigations,
inspections, and program evaluations, OIG attempts to reduce
the incidence of fraud, waste, abuse, and mismanagement, and to
promote economy, efficiency, and effectiveness.

General Provisions

Section 101. The bill continues a provision limiting the
use of Job Corps funding for compensation of an individual that
is not a Federal employee at a rate not to exceed Executive
Level II.
Section 102. The bill continues a provision providing for
general transfer authority.
Section 103. The bill continues a provision prohibiting
funding for the procurement of goods and services utilizing
forced or indentured child labor in industries and host
countries already identified by the Department in accordance
with Executive Order 13126.
Section 104. The bill continues a provision requiring that
funds available under section 414(c) of the American
Competitiveness and Workforce Innovation and Opportunity Act
may only be used for competitive grants that train individuals
over the age of 16 who are not enrolled in school, in
occupations and industries for which employers are using H-1B
visas to hire foreign workers. Authority is included to utilize
H-1B fee receipts for the elimination of foreign labor
certification processing backlogs.
Section 105. The bill continues a provision limiting the
use of ETA funds by a recipient or subrecipient for
compensation of an individual at a rate not to exceed Executive
Level II.
Section 106. The bill continues a provision providing the
ETA with authority to transfer funds provided for technical
assistance services to grantees to ``Program Administration''
when it is determined that those services will be more
efficiently performed by Federal employees. The provision does
not apply to section 171 of the WIOA. In addition, authority is
provided for program integrity-related activities as requested
by the administration.
Section 107. The bill continues a provision allowing up to
0.75 percent of discretionary appropriations provided in this
act for all Department agencies to be used by the Office of the
Chief Evaluation Officer for evaluation purposes consistent
with the terms and conditions in this act applicable to such
office.
Section 108. The bill continues a provision regarding the
application of the Fair Labor Standards Act after the
occurrence of a major disaster.
Section 109. The bill continues a provision that provides
flexibility with respect to the crossing of H-2B nonimmigrants.
Section 110. The bill continues a provision related to the
wage methodology under the H-2B program.
Section 111. The bill continues a provision regarding the
three-fourths guarantee and definitions of corresponding
employment and temporary need for purposes of the H-2B program.
Section 112. The bill continues a provision related to
enforcement of H-2B program regulations.

TITLE II

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Any references in this title of the report to the
``Secretary'' or the ``Department'' shall be interpreted to
mean the Secretary of HHS or the Department of HHS,
respectively, unless otherwise noted.

Health Resources and Services Administration

HRSA activities support programs to provide healthcare
services for mothers and infants; the underserved, elderly, and
homeless; rural residents; and disadvantaged minorities. This
agency supports cooperative programs in maternal and child
health, AIDS care, healthcare provider training, and healthcare
delivery systems and facilities.

BUREAU OF PRIMARY HEALTH CARE

Appropriations, 2016.................................... $1,491,522,000
Budget estimate, 2017................................... 1,342,422,000
Committee recommendation................................ 1,491,522,000

The Committee recommendation for the activities of the
Bureau of Primary Health Care is $1,491,522,000.
Community Health Centers
The program level for Community Health Centers is
$5,091,522,000, equal to the amount provided last year.
The Committee provides $1,491,522,000 in this bill, which
is combined with $3,600,000,000 in mandatory funding
appropriated for fiscal year 2017.
Programs supported by this funding include community health
centers, migrant health centers, healthcare for the homeless,
school-based, and public housing health service grants. The
Committee continues to support the ongoing effort to increase
the number of people who have access to medical services at
health centers. Health centers play a vital role in ensuring
access to primary care in underserved areas of the country,
including urban, rural, and frontier areas.
The Committee is supportive of ongoing efforts to expand
the capacity of community health centers to offer a
comprehensive, integrated range of services, through strategic
investment in behavioral health, substance abuse, oral health,
and other services and capacity. The Committee also recognizes
the need for capital resources at community health centers to
meet increased demand and upgrade facilities. The Committee
supports administrative changes to the HRSA Loan Guarantee
Program designed to improve its efficiency and better align the
program with other successful Federal loan guarantees, and to
increase utilization of this tool to leverage outside resources
to meet health centers' capital needs.
The Committee believes that enhanced funding for the
technical assistance and networking functions available for
health centers through national and State cooperative
agreements and grants is critical to the successful operation
and expansion of the Health Centers program. Funds are
available within the amount provided to enhance technical
assistance and training activities, further quality improvement
initiatives, and continue the development of and support for
health center-controlled networks so that new and existing
centers can improve patient access to quality health services.
Of the available funding for fiscal year 2017, bill
language directs that not less than $50,000,000 shall be
awarded for services related to the treatment, prevention, and
awareness of opioid abuse. In addition, not less than
$50,000,000 will be awarded for services related to mental
health.
In addition, within the amount provided, the Committee
provides up to $99,893,000 under the Federal Tort Claims Act
[FTCA], available until expended. These funds are used to pay
judgments and settlements, occasional witness fees and
expenses, and related administrative costs. The Committee
intends FTCA coverage funded through this bill to be inclusive
of all providers, activities, and services included within the
health centers' federally approved scope of project.
Diabetic Retinopathy.--According to the National Eye
Institute, diabetic retinopathy is highly treatable and even
preventable for diabetic patients that receive early
interventions. As one of the major side effects of diabetic
patients, the rates of diabetic retinopathy diagnoses are
increasing at the same rate as the spike in diabetes diagnoses,
an unforeseen issue for urban medical institutions that should
not be neglected. The Committee encourages HRSA to identify
assistance to urban medical institutions that currently serve
underserved populations for diabetic retinopathy.
Native Hawaiian Health Care.--The Committee expects that no
less than $14,400,000 be provided for the Native Hawaiian
Health Care Program.
Perinatal Transmission of Hepatitis B.--The Committee is
pleased that HRSA funded an evaluation of intervention
strategies to eliminate the perinatal transmission of Hepatitis
B. The Committee recognizes that a full evaluation of
intervention strategies will require the training of health
care professionals, followed by service delivery, data
collection, and evaluation. The Committee encourages HRSA to
incorporate these recommended intervention strategies into the
required activities and funding plans for health centers.
Thalassemia.--The Committee supports the important work
HRSA has funded to establish expert recommendations for patient
care in three keys areas in thalassemia treatment and to aid
the development of regional partnership networks related to
thalassemia. The Committee looks forward to this work
continuing and expanding to address more issues related to this
patient population, which deals with a particularly challenging
rare disorder.
Tuberculosis [TB].--The Committee notes that the National
Action Plan for Combating Drug Resistant Tuberculosis
recommends the creation of healthcare liaisons between State
and local health departments and institutions, including health
centers that serve hard-to-reach groups who are at risk for TB.
The Committee looks forward to an update on coordination
between community health centers and State and local TB control
programs to help ensure appropriate identification, treatment,
and prevention of TB among vulnerable populations.
Free Clinics Medical Malpractice Coverage
The Committee provides $1,000,000 for payments of claims
under the FTCA to be made available for free clinic health
professionals as authorized by section 224(o) of the PHS Act.
This appropriation extends FTCA coverage to medical
volunteers in free clinics to expand access to healthcare
services to low-income individuals in medically underserved
areas.

BUREAU OF HEALTH PROFESSIONS

Appropriations, 2016.................................... $836,895,000
Budget estimate, 2017................................... 536,745,000
Committee recommendation................................ 826,806,000

The Committee recommendation for the activities of the
Bureau of Health Professions is $826,806,000.
The Bureau of Health Professions provides policy leadership
and grant support for health professions workforce development.
The mission of the Bureau is to identify shortage areas while
working to make them obsolete. Its programs are intended to
ensure that the Nation has the right clinicians, with the right
skills, working where they are needed.
Health Professions Training.--Given that the Department of
Health and Human Services recently celebrated the 30th year
anniversary of the ``Report of the Secretary's Task Force on
Black and Minority Health,'' commonly called the ``Heckler
Report,'' HRSA is encouraged to work with the Office of
Minority Health and the Office of Women's Health to submit a
follow up report within 1 year after enactment of this act to
the Committees on Appropriations of the House of
Representatives and the Senate to the ``Heckler Report''
concerning advancements and future courses of action. The
report should analyze HRSA's federally funded healthcare
workforce programs, their funding, their impact, and ways to
further increase diversity in the health professions, as well
as increase the number of primary health care professionals.
The Committee recommends that HRSA consider reinstating and
funding the Student/Resident Experiences and Rotations in
Community Health [SEARCH] program which provides opportunities
for health professions students and residents to serve on
multidisciplinary health care teams in underserved communities.
National Health Service Corps
The Committee recommendation does not include discretionary
funding for the National Health Service Corps [Corps], as
proposed by the administration, due to funding constraints, and
because funding was included in Public Law 114-10 for fiscal
year 2017. The Committee strongly supports the Corps' long and
successful record of supporting qualified healthcare providers
that are dedicated to working in underserved areas with limited
access to healthcare.
Nearly 3-in-4 Corps members choose to stay in the area in
which they serve upon completion of their service, and it is
essential to ensure that the Committee is supporting the
creation and development of health care professionals in rural
areas.
The Committee recognizes that the Corps is an essential
tool for recruitment and retention of health professionals at
community health centers, especially given recent expansions of
the program. The Committee encourages HRSA to increase the
proportion of clinicians serving at health centers to improve
alignment between these two programs and to best leverage
investments in Corps health professionals. The Committee
recognizes that the Secretary retains the authority to include
additional disciplines in the Corps. As such, the Committee
urges the Secretary to include pharmacists and pediatric
subspecialists as eligible recipients of scholarships and loan
repayments through the program.
The Committee continues to include section 206 of this act
to modify the rules governing the Corps to allow every Corps
member 60 days to cancel their contract.
Training for Diversity
Centers of Excellence
The Committee recommends $21,711,000 for the Centers of
Excellence [COE] Program.
The Committee recognizes that the COE Program increases the
supply and competencies of underrepresented minorities [URM] in
health professions. Funds support programs of excellence that
enhance the academic performance of URM students, support URM
faculty development, and facilitate research on minority health
issues. Diversity among medical school students is associated
with higher levels of cultural sensitivity of all students and
greater willingness to serve diverse populations. There is
evidence that suggests that minority health professionals are
more likely to serve in areas with high rates of uninsured and
areas of underrepresented racial and ethnic groups.
The Committee commends those institutions with a historic
commitment to educating under-represented minority students in
the health professions. In addition to the ongoing efforts of
COEs, the Committee encourages HRSA to survey current and
former COEs for options on how to better address the low
representation of under-represented minority males in COE's
health professions disciplinary focus areas (medicine,
dentistry, pharmacy, and behavioral health).
Health Careers Opportunity Program
The Committee eliminates the Health Careers Opportunity
Program due to funding constraints. Funding to increase the
diversity of the health professions workforce in this bill is
prioritized by investing in programs that have a more immediate
impact on the production of health professionals by supporting
students who have committed to and are in training as
healthcare professionals.
Faculty Loan Repayment
The Committee provides $1,190,000 for the Faculty Loan
Repayment Program. This amount is the same as the fiscal year
2016 enacted level and the budget request.
Scholarships for Disadvantaged Students
The Committee provides $49,070,000 for Scholarships for
Disadvantaged Students, an increase of $3,100,000 above the
fiscal year 2016 level. The Committee supports diversity among
health professionals. This program provides grants to eligible
health professions and nursing schools to award scholarships to
students from disadvantaged backgrounds who have financial
need.
Increased funding will help to meet the demand for
scholarship support to disadvantaged students who have unmet
financial need in paying for their health professions
education. It is essential that disadvantaged students,
particularly those from rural or underserved health
professional shortage areas, are given the tools to become
effective health care professionals by using their knowledge of
rural healthcare issues and are supported in pursing education
and training.
Primary Care Training and Enhancement
The Committee provides $38,924,000 for Primary Care
Training and Enhancement programs, which support the expansion
of training in internal medicine, family medicine, pediatrics,
and physician assistance. Funds may be used for developing
training programs or providing direct financial assistance to
students and residents. The Committee directs HRSA to
prioritize programs that support underserved communities and
applicants from disadvantaged backgrounds in any new grant
competition in 2017.
Training in Oral Health Care
The Committee provides $35,873,000 for Training in Oral
Health Care programs, which includes not less than $10,000,000
each for general and pediatric dentistry. Funds may be used to
expand training in general dentistry, pediatric dentistry,
public health dentistry, dental hygiene, and other oral health
access programs. Funds may also be used to plan and operate
training programs, as well as to provide financial assistance
to students and residents.
The agency is directed to provide continuation funding for
predoctoral and postdoctoral training grants initially awarded
in fiscal year 2015, and for Section 748 Dental Faculty Loan
Program grants initially awarded in fiscal year 2016.
The Committee understands that since the Chief Dental
Officer [CDO] was created at HRSA, the position has been
downgraded to Senior Dental Advisor. The Committee strongly
encourages HRSA to restore the position of Chief Dental Officer
with executive level authority and resources to oversee and
lead HRSA dental programs and initiatives. The CDO is also
expected to serve as the agency representative on oral health
issues to international, national, State, and/or local
government agencies, universities, and oral health stakeholder
organizations.
The Committee continues long-standing bill language that
prohibits funding for section 340G-1 of the PHS Act.
Interdisciplinary, Community-Based Linkages
Area Health Education Centers
The Committee provides $30,250,000 for Area Health
Education Centers [AHECs], equal to the fiscal year 2016 level.
The program links university health science centers with
community health service delivery systems to provide training
sites for students, faculty, and practitioners. The program
supports three types of projects: core grants to plan and
implement programs; special initiative funding for schools that
have previously received AHEC grants; and model programs to
extend AHEC programs with 50 percent Federal funding. The AHEC
community training model provides a uniquely appropriate
opportunity to bring the training of community health workers
to scale. HRSA is encouraged to provide technical assistance on
and disseminate best practices for training community health
workers to existing AHECs. The Committee is pleased with AHEC's
efforts to improve access to quality healthcare in America's
rural and underserved areas by increasing the number of primary
healthcare professionals who practice in those areas.
Geriatric Programs
The Committee provides $38,737,000 for Geriatric Programs.
The Committee recognizes the importance of geriatric
training programs incorporating culturally sensitive training
programs and encourages HRSA to work to ensure training
programs are collaborative, interdisciplinary, and culturally
competent.
Behavioral Health Workforce Education and Training Program
The Committee provides $50,000,000 for Behavioral Health
Workforce Education and Training Program [BHWET]. The BHWET
Program is focused on developing and expanding the mental
health and substance abuse workforce serving populations across
the lifespan. As requested by the administration, the Committee
transfers the program to HRSA from the Substance Abuse and
Mental Health Services Administration [SAMHSA]. HRSA will
continue to leverage SAMHSA's subject matter expertise in
formatting new investments in fiscal year 2017.
The Committee supports the broadened target populations of
people to be served by the BHWET program. In light of the new
competition that will be held in 2017, the Committee directs
that eligible entities for this program shall include, but is
not limited to, accredited programs that train masters and
clinical doctoral level social workers, psychologists,
counselors, marriage and family therapists, psychiatric mental
health nurse practitioners; psychology interns; and behavioral
health paraprofessionals. The Committee is concerned about the
uneven distribution of funds among specialties resulting from
the initial grant competition in 2014 and therefore directs
HRSA to ensure that funding is distributed proportionately
among the participating health professions and to consider
strategies such as issuing separate funding opportunity
announcements for each participating health profession.
Mental and Behavioral Health Education Training Programs
The Committee provides $9,916,000 for Mental and Behavioral
Health Education Training Programs. The programs provide grants
to higher education institutions and accredited training
programs to recruit and train professionals and faculty in the
fields of social work, psychology, psychiatry, marriage and
family therapy, substance abuse prevention and treatment, and
other areas of mental and behavioral health.
Graduate Psychology Education Program [GPE].--The Committee
recognizes the growing need for highly trained behavioral
health professionals to deliver evidence-based services to
vulnerable populations, including the elderly, returning
military veterans, and those suffering from trauma. The GPE
program is the main Federal initiative dedicated to the
education and training of psychologists. The Committee urges
HRSA to explore evidence-based approaches to leverage workforce
capacity through this program, to invest in geropsychology
training programs, and to help integrate health service
psychology trainees at Federally Qualified Health Centers.
When awarding GPE grants, the Committee directs HRSA to
give priority to Historically Black Colleges and Universities
and other Minority Serving Institutions that propose GPE
projects in underserved and rural areas with significant health
disparities, large minority patient populations, and/or
shortages of behavioral health providers.
Health Professions Workforce Information and Analysis
The Committee provides $4,663,000 for health professions
workforce information and analysis. The program provides for
the collection and analysis of targeted information on the
Nation's healthcare workforce, research on high-priority
workforce questions, the development of analytic and research
infrastructure, and program evaluation and assessment.
Public Health Workforce Development
The Committee provides $17,000,000 for Public Health
Workforce Development. This program line, also called Public
Health and Preventive Medicine, funds programs that are
authorized in titles III and VII of the PHS Act and support
awards to schools of medicine, osteopathic medicine, public
health, and integrative medicine programs.
The Committee recommendation includes funding for Public
Health Training Centers and the Preventative Medicine Residency
with Integrative Health Care program, as requested by the
administration.
Nursing Workforce Development Programs
The Committee provides $229,472,000 for Nursing Workforce
Development programs. The program provides funding to address
all aspects of nursing workforce demand, including education,
practice, recruitment, and retention.
The Committee encourages HRSA to expand the Nurse Corps
Loan Repayment program by naming free and charitable clinics as
accepted sites for nurses to work and take advantage of the
Nurse Corps Loan Repayment program. The Committee supports
efforts to ensure that affordable medication can be obtained by
the neediest patients and urges the inclusion of free and
charitable clinics as designated sites to provide access to
free or low cost prescription drugs.
Children's Hospitals Graduate Medical Education
The Committee provides $300,000,000, an increase of
$5,000,000, for the Children's Hospitals Graduate Medical
Education [CHGME] program. The Committee strongly supports the
CHGME program which provides support for graduate medical
education training programs in both ambulatory and in-patient
settings within freestanding children's teaching hospitals.
CHGME payments are determined by a per-resident formula that
includes an amount for direct training costs added to a payment
for indirect costs. Payments support training of resident
physicians as defined by Medicare in both ambulatory and
inpatient settings.
The Committee recognizes changes made to the program that
have increased the number of children's teaching hospitals
eligible to apply for funding. The Committee notes the
Secretary's use of the authority provided under the current
authorization to make funding available for hospitals
previously ineligible for the program, and urges the Secretary
to continue to make such funding available in future CHGME
application and funding cycles. The Committee encourages HRSA
to continue its work with the Children's Hospitals on the
development and collection of enhanced program performance
measures.
National Practitioner Data Bank
The Committee provides $18,814,000 for the National
Practitioner Data Bank. As mandated by the Health Care Quality
Improvement Act, the National Practitioner Data Bank does not
receive appropriated funds, but instead is financed by the
collection of user fees.
The National Practitioner Data Bank collects certain
adverse information, medical malpractice payment history, and
information related to healthcare fraud and abuse. The data
bank is open to healthcare agencies and organizations that make
licensing and employment decisions.

MATERNAL AND CHILD HEALTH

Appropriations, 2016.................................... $845,117,000
Budget estimate, 2017................................... 845,117,000
Committee recommendation................................ 846,617,000

The Committee recommendation for the Maternal and Child
Health [MCH] Bureau is $846,617,000. The mission of the Bureau
is to improve the physical and mental health, safety, and well-
being of the Nation's women, infants, children, adolescents,
and their families. This population includes fathers and
children with special healthcare needs.
Maternal and Child Health Block Grant
The Committee provides $641,700,000 for the MCH Block
Grant, which provides a flexible source of funding that allows
States to target their most urgent maternal and child health
needs. The program supports a broad range of activities
including: providing prenatal care, well child services, and
immunizations; reducing infant mortality; preventing injury and
violence; expanding access to oral healthcare; addressing
racial and ethnic disparities; and providing comprehensive care
through clinics, home visits, and school-based health programs.
The Committee supports programs that provide early,
continuous, intensive, and comprehensive child development and
family support services using evidence-based home visiting
models with the goal of providing parents with child
development knowledge and parenting support, provide early
detection of developmental delays and health issues, prevent
child abuse and neglect, and increase children's school
readiness.
The Committee encourages HRSA to utilize demonstration
projects to support the implementation of integrating oral
health and primary care practice. The projects should model the
core clinical oral health competencies for non-dental providers
that HRSA published and initially tested in its 2014 report,
``Integration of Oral Health and Primary Care Practice.''
Children's Health and Development.--Evidence shows that
experiences in early childhood have long-term health
consequences over the course of a person's life. These
experiences are critical for a child's educational, social,
physical, and economic well-being. Children living in States
with persistently high child poverty rates experience more
negative health outcomes than their peers elsewhere. Therefore,
the Committee provides an additional $3,500,000 within the
Special Projects of Regional and National Significance program
and directs HRSA to fund a study focused on systemic change
that would positively impact the policy of child-health-related
institutions and systems in States with the highest levels of
childhood poverty. A successful program would consider inter-
and intra-cultural dynamics to yield best practices for areas
across the nation with diverse populations, persistent poverty,
and child health outcomes in need of improvement. The end goal
of the program should be to yield a model for other States to
utilize in improving child health and development outcomes.
Vision Health.--The Committee is concerned that vision
disorders are the leading cause of impaired health in
childhood. One in four school-aged children has a vision
problem significant enough to affect learning. The Committee
recognizes that early detection can help prevent vision loss
and blindness and understands many serious ocular conditions in
children are treatable if diagnosed at an early stage.
Therefore, the Committee commends and supports the work of the
National Center for Children's Vision and Eye Health, which
through partnerships, sound science, and targeted policy
initiatives, advances the development of public health
infrastructure to support a comprehensive, multi-tiered
continuum of vision care for young children.
Sickle Cell Anemia
The Committee provides $4,455,000 for grants and contracts
to help coordinate service delivery for individuals with sickle
cell disease, including genetic counseling and testing;
training of health professionals; and coordination of
education, treatment, and continuity of care programs.
Autism and Other Developmental Disorders
The Committee provides $47,099,000 for the Autism and Other
Developmental Disorders program. The program supports
surveillance, early detection, education, and intervention
activities on autism and other developmental disorders, as
authorized in the Combating Autism Act of 2006.
Leadership Education in Neurodevelopmental and Related
Disabilities [LEND] Programs.--The Committee provides
$28,990,000 for the LEND program to maintain capacity and
expand the number of sites to train professionals to diagnose,
treat, and provide interventions to individuals with autism
spectrum disorder authorized by the Combating Autism Act. This
funding will help these programs initiate or expand their work
in the area of interdisciplinary leadership training to meet
the needs of children with Autism Spectrum Disorders and
related developmental disabilities.
Newborn Screening for Heritable Disorders
The Committee provides $11,883,000 for the Newborn
Heritable Disorders Screening program, as described in section
1109 of the Newborn Screening Saves Lives Act of 2008. This
program provides funding to improve States' ability to provide
newborn and child screening for heritable disorders. Newborn
screening provides early identification and follow-up for
treatment of infants affected by certain genetic, metabolic,
hormonal, and/or functional conditions.
Healthy Start
The Committee provides $103,500,000 for the Healthy Start
infant mortality initiative. The primary purpose of Healthy
Start is to reduce infant mortality and generally improve
maternal and infant health in at-risk communities. Grants are
awarded to State and local health departments and nonprofit
organizations to conduct an infant mortality review, develop a
package of innovative health and social services for pregnant
women and infants, and evaluate these efforts.
Fetal Infant Mortality Review [FIMR].--The FIMR program is
an important component of many Healthy Start and local health
department initiatives that provide evidence-based
interventions crucial to improving infant health in high risk
communities. HRSA is encouraged to continue to support the FIMR
program with Healthy Start funding while educating Healthy
Start Programs on the successes of FIMR.
Universal Newborn Hearing Screening and Early Intervention
The Committee provides $17,818,000 for universal newborn
hearing screening and early intervention activities. This
program awards grants to 53 States and territories that support
Statewide systems of newborn hearing screening, audiologic
diagnostic testing before 3 months of age, and enrollment in
early intervention programs before the age of 6 months.
Emergency Medical Services for Children
The Committee provides $20,162,000 for the Emergency
Medical Services for Children program which focuses on
improving the pediatric components of the emergency medical
services system and improving the quality of care provided to
children in the pre-hospital setting. Funding is available to
every State emergency medical services office to improve the
quality of emergency care for children and to pay for research
and dissemination of best practices.

HIV/AIDS BUREAU

Appropriations, 2016.................................... $2,322,781,000
Budget estimate, 2017................................... 2,331,781,000
Committee recommendation................................ 2,293,781,000

The Committee recommendation includes $2,293,781,000 for
the HIV/AIDS Bureau.
The mission of the Bureau is to address the unmet care and
treatment needs of persons living with HIV/AIDS. The Bureau
administers the Ryan White Care Act, which provides a wide
range of community-based services, including primary and home
healthcare, case management, substance abuse treatment, mental
health, and nutritional services.
Emergency Assistance
The Committee provides $655,876,000 for emergency
assistance grants to eligible metropolitan areas
disproportionately affected by the HIV/AIDS epidemic.
Grants are provided to metropolitan areas meeting certain
criteria. Two-thirds of the funds are awarded by formula, and
the remainder is awarded through supplemental competitive
grants.
Comprehensive Care Programs
The Committee provides $1,315,005,000 for HIV healthcare
and support services.
Funds are awarded to States to support HIV service delivery
consortia, the provision of home- and community-based care
services for individuals with HIV disease, continuation of
health insurance coverage for low-income persons with HIV
disease, and support for State AIDS drug assistance programs
[ADAP].
The Committee provides $900,313,000 for AIDS medications in
ADAP.
Early Intervention Services
The Committee provides $201,079,000 for early intervention
grants. These funds are awarded competitively to primary
healthcare providers to enhance healthcare services available
to people at risk of HIV and AIDS. Funds are used for
comprehensive primary care, including counseling, testing,
diagnostic, and therapeutic services.
Children, Youth, Women, and Families
The Committee provides $75,088,000 for grants for
coordinated services to women, infants, children, and youth.
The President's request did not include funding for this
program. The Committee once again rejects the President's
proposal to consolidate this program with the Early
Intervention Services program.
Funds are awarded to a variety of providers, including
community health centers, comprehensive hemophilia centers,
county and municipal health departments, and other nonprofit
community-based programs that provide comprehensive primary
healthcare services to populations with or at risk for HIV.
AIDS Dental Services
The Committee provides $13,122,000 for the AIDS Dental
Services program. This program provides grants to dental
schools, dental hygiene schools, and postdoctoral dental
education programs to assist with the cost of providing
unreimbursed oral healthcare to patients with HIV.
The Ryan White Part F program provides for the Dental
Reimbursement Program [DRP] which covers the unreimbursed costs
of providing dental care to persons living with HIV/AIDS.
Programs qualifying for reimbursement are dental schools,
hospitals with postdoctoral dental education programs, and
colleges with dental hygiene programs.
AIDS Education and Training Centers
The Committee provides $33,611,000 for AIDS Education and
Training Centers [AETCs]. AETCs train healthcare practitioners,
faculty, and students who care for AIDS patients outside of the
traditional health professions education venues and support
curriculum development on the diagnosis and treatment of HIV
infection for health professions schools and training
organizations.
Special Projects of National Significance
Due to budget constraints, the Committee does not include
funding for Special Projects of National Significance. However,
the Committee continues to preserve the core HIV/AIDS Bureau
programs that provide treatment, care, and direct services to
patients.

HEALTH CARE SYSTEMS

Appropriations, 2016.................................... $103,193,000
Budget estimate, 2017................................... 110,193,000
Committee recommendation................................ 103,193,000

The Committee recommendation for the Health Care Systems
Bureau is $103,193,000.
The Health Care Systems Bureau protects the public health
and improves the health of individuals through efforts to
support and enhance the systems by which healthcare is
delivered in America.
Organ Donation and Transplantation
The Committee provides $23,549,000 for organ donation and
transplantation activities.
Funds support a scientific registry of organ transplant
recipients and the National Organ Procurement and
Transplantation Network to match donors and potential
recipients of organs. A portion of the appropriated funds may
be used to educate the public and health professionals about
organ donations and transplants and to support clearinghouse
and technical assistance functions.
National Cord Blood Inventory
The Committee provides $11,266,000 for the National Cord
Blood Inventory. The purpose of this program is to provide
funds to cord blood banks to build an inventory of the highest
quality cord blood units for transplantation.
C.W. Bill Young Cell Transplantation Program
The Committee provides $22,109,000 for the C.W. Bill Young
Cell Transplantation Program.
The Committee continues to support cell transplantation
through the use of cord blood, bone marrow, peripheral blood
stem cells, and other sources of stem cells that may be
available in the future. The Committee appreciates HRSA's
efforts to increase the diversity of the registry and the
program's research efforts to improve the availability,
efficiency, safety, and cost of transplants and the
effectiveness of program operations.
Office of Pharmacy Affairs
The Committee provides $10,238,000 for the Office of
Pharmacy Affairs [OPA]. OPA administers the 340B drug pricing
program, which requires drug manufacturers to provide discounts
or rebates to a set of programs and hospitals that serve a
disproportionate share of low-income patients.
The Committee includes a statutory provision to allow a
nominal cost recovery fee to fund the program integrity
provisions recommended by the inspector general. The fee will
be set at 0.1 percent for covered entities and is expected to
generate $9,000,000 in fiscal year 2018. The Committee expects
HRSA to report the estimated and actual amounts generated by
the fee in HRSA's annual CJ.
The 340B statute requires HRSA to make 340B ceiling prices
available to covered entities through a secure Web site. The
Committee urges OPA to complete the development of a
transparent system to verify the accuracy of the 340B discount
or ceiling prices.
The Committee recognizes that OPA recently published the
first, comprehensive program guidance. The Committee urges OPA
to consider carefully the comments received from all
stakeholders.
Poison Control Centers
The Committee provides $18,846,000 for poison control
activities. The Poison Control Centers program currently
supports a mix of grantees. Most serve States; a few serve
multi-State regions; and, in a handful of cases, more than one
grantee serves a single State.
The Committee recognizes the critical role of Poison
Control Centers and the value of its highly effective public-
private/local-State-Federal partnership in helping the country
address the opioid epidemic, as well as contributing
significantly to Congressional goals of achieving the most
efficient delivery of healthcare services to all citizens.
The Committee commends HRSA for successfully recognizing
the first accreditation of a Poison Control Center through an
approved State accrediting body in 2015. This accreditation,
executed pursuant to the Poison Center Network Act,
demonstrates the viability of the State-based accrediting
process and makes clear that this designation confers the full
approval of HRSA on centers successfully utilizing this
pathway. The Committee urges HRSA to offer assistance to any
Poison Control Center seeking State-based accreditation and to
approve those deemed to meet standards sufficient to protect
public safety.
National Hansen's Disease Program
The Committee includes $15,206,000 for the National
Hansen's Disease program. The program consists of inpatient,
outpatient, long-term care as well as training and research in
Baton Rouge, Louisiana; a residential facility at Carville,
Louisiana; and 11 outpatient clinic sites in the continental
United States and Puerto Rico.
National Hansen's Disease Program Buildings and Facilities
The Committee provides $122,000 for the repair and
maintenance of buildings at the Gillis W. Long Hansen's Disease
Center.
Payment to Hawaii for Hansen's Disease Treatment
The Committee provides $1,857,000 to Hawaii for Hansen's
Disease treatment. Payments are made to the State of Hawaii for
the medical care and treatment of persons with Hansen's disease
in hospital and clinic facilities at Kalaupapa, Molokai, and
Honolulu. Expenses above the level of appropriated funds are
borne by the State of Hawaii.

RURAL HEALTH

Appropriations, 2016.................................... $149,571,000
Budget estimate, 2017................................... 144,162,000
Committee recommendation................................ 152,571,000

The Committee recommendation for Rural Health programs is
$152,571,000, an increase of $3,000,000 above the fiscal year
2016 level.
The Office of Rural Health Policy [ORHP] administers HHS
rural health programs, coordinates activities related to rural
healthcare within HHS, and analyzes the possible effects of
policy on the more than 42 million residents of rural
communities. ORHP advises the Secretary on the effects of
Medicare and Medicaid on rural citizens' access to care, the
viability of rural hospitals, and the availability of
physicians and other health professionals.
Reliable Energy Supply for Rural Health Facilities.--The
Committee recognizes that rural health facilities, including
dialysis centers, are often dependent on inconsistent energy
supply that can be interrupted for days or weeks following
severe weather events. The lack of consistent power may require
that patients travel long distances, often in less than safe
conditions, for simple, life-saving procedures. This problem
can be solved with alternative power generation capacity
located at health facilities. The Committee encourages HRSA to
design a competitive grant program that would support energy
reliability and power generation capacity for qualified health
and dialysis facilities located outside Metropolitan
Statistical Areas or in a Rural Urban Commuting Areas.
Rural Health Outreach
The Committee provides $65,500,000 for the Rural Health
Outreach program, $2,000,000 above the fiscal year 2016 level.
This program supports projects that demonstrate new and
innovative modes of outreach in rural areas, such as
integration and coordination of health services. The Committee
recommendation provides not more than $12,514,000 for Outreach
Service Grants; not more than $19,412,000 for Rural Network
Development Grants; not less than $12,000,000 for Delta States
Network Grant Program; not more than $2,400,000 for Network
Planning Grants; and not less than $4,148,000 for Small
Healthcare Provider Quality Improvement Grants.
Delta States Rural Development Network Grant Program.--The
Committee encourages HRSA to consult with the Delta Regional
Authority [DRA] on the awarding and administration of grants
under the Delta States Network Grant Program in fiscal year
2017. Further, the Committee encourages HRSA to solicit input
from DRA on the implementation, administration, and monitoring
of Delta States Network Grant Program in fiscal year 2017. The
Committee encourages HRSA to align its awards as closely as
possible with the DRA's strategic plan and with DRA economic
and community development plans. In addition, of the funds
provided, the Committee provides $2,000,000 to support HRSA's
collaboration with the DRA to develop a pilot program to help
underserved rural communities identify and better address their
health care needs and to help small rural hospitals improve
their financial and operational performance. Finally, the
Committee encourages HRSA to participate and collaborate on
DRA's next health strategic plan for the Delta Region. The
Committee believes that the information the DRA collects in the
development of that plan will be of substantial value to HRSA,
and encourages HRSA to provide support to DRA for the provision
of that information.
Rural Health Research
The Committee provides $9,351,000 for the Rural Health
Research program. Funds are used for rural health research
centers, the National Advisory Committee on Rural Health, and a
reference and information service. Supported activities focus
on improving the delivery of health services to rural
communities and populations.
Rural Hospital Flexibility Grants
The Committee provides $41,609,000 for Rural Hospital
Flexibility grants and the Small Hospital Improvement Program.
Under these grant programs, HRSA works with States to provide
support and technical assistance to critical access hospitals
to focus on quality and performance improvement and to
integrate emergency medical services. The Committee
recommendation continues to reject the administration's
proposal to eliminate the Small Hospital Improvement Program.
The Committee recognizes the continuing need to provide
support for hospitals located in rural and underserved
communities. The Rural Hospital Flexibility Grant Program has
improved access for the millions of Americans who reside
outside of a reasonable scope of a critical access hospital.
State Offices of Rural Health
The Committee provides $9,511,000 for State Offices of
Rural Health. These offices help States strengthen rural
healthcare delivery systems by enabling them to coordinate care
and improve support and outreach in rural areas.
Black Lung Clinics
The Committee provides $6,766,000 for the Black Lung
Clinics program. This program funds clinics that treat
respiratory and pulmonary diseases of active and retired coal
miners, steel mill workers, agricultural workers, and others
with occupationally related respiratory and pulmonary
impairments. These clinics reduce the incidence of high-cost
inpatient treatment for these conditions.
The Committee is deeply concerned about changes HRSA has
made to the Black Lung Clinic Grants Program in fiscal year
2014, including the adoption of a three-tiered funding system
and an overall per-applicant cap. These changes to the program
have unnecessarily increased the administrative burden on
applicants and may result in reductions in funding for States
and communities most in-need of the essential health care
services provided by this program. The fiscal year 2014 policy
violates HRSA regulations which require the Secretary to give
preference to State agencies, account for the number of miners
to be served and their needs, and evaluate the quality and
breadth of services to be provided by a prospective grantee.
The Secretary is directed to evaluate funding levels for
applicants based on the needs of the populations those
applicants will serve and the ability of those applicants to
provide health care services to miners with respiratory
illnesses, with preference given to State agency applications
over other applicants in that State, without regard to the
funding tiers and overall per-applicant funding cap established
by the Secretary in fiscal year 2014.
Radiation and Exposure Screening and Education Program
The Committee provides $1,834,000 for activities authorized
by the Radiation Exposure Compensation Act. This program
provides grants for the education, prevention, and early
detection of radiogenic cancers and diseases resulting from
exposure to uranium during mining and milling at nuclear test
sites.
Telehealth
The Committee provides $18,000,000, an increase of
$1,000,000 above the fiscal year 2016 level, for the Office for
the Advancement of Telehealth [OAT], which promotes the
effective use of technologies to improve access to health
services for people who are isolated from healthcare and to
provide distance education for health professionals.
The Committee strongly supports OAT and their mission to
expand high quality medical care to rural communities that do
not have adequate access to medical providers including many
medical specialties.
Extension for Community Health Outcomes [ECHO].--Project
ECHO is an innovative continuing medical education model that
uses interactive videoconferencing to link specialist teams
with primary care providers in rural and underserved areas. The
Committee is encouraged by early implementations of the ECHO
model in rural communities and requests a report from the
Government Accountability Office regarding opportunities for
increased adoption of such models, efficiencies, and potential
cost savings, as well as ways to improve health care through
such models, and field recommendations to advance the use of
such models.
Telehealth Center of Excellence.--The Committee recognizes
the growing importance of telehealth in delivering high-quality
healthcare to medically underserved communities in both rural
and urban areas. The Federal Government's need for telehealth
research and cross-agency coordination has grown as more
Federal agencies, including HHS, USDA, DOD, VA, and FCC, have
developed telehealth programs. Therefore, the Committee directs
HRSA to develop a plan to create a telehealth center of
excellence [COE] to test the efficacy of telehealth services in
both urban and rural geographic locations. The COE would
operate varied sites of service, including patients' homes;
examine the benefits to student health of school-based
telehealth; establish standards and best practices for various
telehealth modes of delivery, including real-time audio-visual,
audio-only, store-and-forward, and remote patient monitoring;
pilot new health care delivery models as they emerge; test
innovative payment models to examine potential cost savings to
Federal health care spending from telehealth; facilitate inter-
agency coordination on telehealth issues; and perform any other
telehealth-related research that is needed. To lead this COE,
HHS should consider a public academic medical center with
demonstrated success, a high volume of annual telehealth
visits, and established programs that provide telehealth
services in medically underserved areas with high chronic
disease prevalence and high poverty rates. The selected site
should also have established a reimbursement structure that
allows telehealth services to be financially self-sustaining.
The Committee requests a written report outlining HRSA's plans
for a telehealth COE within 120 days of enactment of this act.
Telehealth for the Prevention of Opioid Abuse.--The
Committee encourages the Office of Rural Health Policy to
explore how telehealth networks can improve access to,
coordination of, and quality of prevention and treatment of the
opioid epidemic, especially in rural areas. Increased use of
telehealth networks will help ensure those struggling with a
substance use disorder have access to the care they need,
provide continuing education to rural clinicians and emergency
medical providers on emerging treatment options, and will help
patients who are prescribed opioids for pain management use
them effectively and appropriately.
Telehealth Resource Centers Grant Program.--The Committee
recognizes the vital role of existing Telehealth Resource
Centers across the United States to provide support to
healthcare organizations, providers, and networks. In addition,
these current centers are an important part of the telehealth
infrastructure; helping to improve access to healthcare and
ultimately improve outcomes for underserved populations. The
Committee recommends that part of OAT funding should be used to
support increased outreach to providers and communities
regarding the benefits of telehealth and the availability of
technical assistance to support its further adoption. The
Committee supports continued funding of the current 12 regional
centers and two National centers in fiscal year 2017.
Rural Opioid Overdose Reversal Program
The Committee does not provide funding for this program
under HRSA, but has provided funds to combat the opioid
epidemic in rural communities through the Centers for Substance
Abuse within SAMHSA.

FAMILY PLANNING

Appropriations, 2016.................................... $286,479,000
Budget estimate, 2017................................... 300,000,000
Committee recommendation................................ 286,479,000

The Committee provides $286,479,000 for the title X Family
Planning program. This program supports preventive and primary
healthcare services at clinics nationwide.

PROGRAM MANAGEMENT

Appropriations, 2016.................................... $154,000,000
Budget estimate, 2017................................... 157,061,000
Committee recommendation................................ 154,000,000

The Committee provides $154,000,000 for program management
activities.
The Committee does not include bill language requested by
the administration to provide additional transfer authority to
the Administrator beyond that which is already provided to the
Secretary.

VACCINE INJURY COMPENSATION PROGRAM TRUST FUND

Appropriations, 2016.................................... $244,500,000
Budget estimate, 2017................................... 249,200,000
Committee recommendation................................ 247,500,000

The Committee provides that $247,500,000 be released from
the Vaccine Injury Compensation Trust Fund in fiscal year 2017.
Of that amount, $7,500,000 is for administrative costs.
The National Vaccine Injury Compensation program provides
compensation for individuals with vaccine-associated injuries
or deaths. Funds are awarded to reimburse medical expenses,
lost earnings, pain and suffering, legal expenses, and death
benefits. The Vaccine Injury Compensation Trust Fund is funded
by excise taxes on certain childhood vaccines.

Centers for Disease Control and Prevention

The Committee recommendation provides a program level of
$7,115,106,000 in this bill for the Centers for Disease Control
and Prevention [CDC], which includes $55,358,000 in mandatory
funds under the terms of the Energy Employees Occupational
Illness Compensation Program Act [EEOICPA], $891,300,000 in
transfers from the Prevention and Public Health [PPH] Fund, and
$15,000,000 in Public Health and Social Services Emergency Fund
[PHSSEF] unobligated balances from pandemic influenza
supplemental appropriations.
The activities of CDC focus on several major priorities:
providing core public health functions; responding to urgent
health threats; monitoring the Nation's health using sound
scientific methods; assuring the Nation's preparedness for
emerging infectious diseases and potential pandemics; and
providing leadership in the implementation of nationwide
prevention strategies that are conducive to improving and
maintaining health.

IMMUNIZATION AND RESPIRATORY DISEASES

Appropriations, 2016.................................... $798,405,000
Budget estimate, 2017................................... 748,066,000
Committee recommendation................................ 798,405,000

The Committee recommendation for the activities of the
National Center for Immunization and Respiratory Diseases is
$798,405,000, which includes $324,350,000 in transfers from the
PPH Fund and $15,000,000 in transfers from PHSSEF unobligated
balances.
The mission of the National Center for Immunization and
Respiratory Diseases is the prevention of disease, disability,
and death through immunization and by control of respiratory
and related diseases.
The Committee recommendation includes funding for the
following activities in the following amounts:

Cost Estimates.--The Committee is pleased with CDC's report
on estimated funding needs of the Section 317 Immunization
Program and requests that the report be updated and submitted
not later than February 1, 2017, to reflect fiscal year 2018
cost estimates. The updated report should also include an
estimate of optimum State and local operations funding, as well
as a discussion of the evolving role of the 317 program as
expanded coverage for vaccination becomes available from
private and public sources over the next several years.
Influenza.--The Committee provides the same level of budget
authority as in fiscal year 2016 and directs the Department to
use $15,000,000 in pandemic influenza supplemental balances to
support CDC's global influenza activity. The Committee expects
in the future that CDC and the Department will clearly identify
in budget documents when and how supplemental appropriations
are used. In particular, the Committee expects to be notified
if any additional balances are used by CDC in fiscal year 2017.
Immunizations.--The Committee rejects the reduction to the
Section 317 Immunization Program proposed by the Administration
and provides funding at last year's level to enhance core
activities including the infrastructure for the Vaccines for
Children program. The Committee believes a strong public health
immunization infrastructure is critical for ensuring high
vaccination coverage levels, preventing vaccine-preventable
diseases, and responding to outbreaks. During the 2015 measles
outbreak, funds from this program supported State and local
health departments in rapid response, public health
communication, data gathering, and diagnostics.

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

Appropriations, 2016.................................... $1,122,278,000
Budget estimate, 2017................................... 1,127,278,000
Committee recommendation................................ 1,112,278,000

The Committee recommendation for the activities of the
National Center for HIV, Viral Hepatitis, Sexually Transmitted
Diseases [STDs], and TB Prevention is $1,112,278,000.
The Center administers CDC's activities on HIV/AIDS, viral
hepatitis, STDs, and TB, with the exception of the Global AIDS
program, which is housed in the Center on Global Health.
The Committee recommends funding for the following
activities in the following amounts:

Hepatitis B.--The Committee is concerned that even with a
Hepatitis B vaccine that is 95 percent effective, CDC estimates
that there are up to 2 million Americans infected with
Hepatitis B, with over 19,500 new infections occurring each
year and more than 10 deaths each day as a direct result of
Hepatitis B. The Committee encourages CDC to prioritize the
acceleration of Hepatitis B interventions within its Viral
Hepatitis program.
HIV Screening.--The Committee continues to support CDC
grant programs that work to reduce the rate of undiagnosed
persons among those infected with HIV, increase linkage to
care, and increase viral suppression. The Committee
acknowledges geographic disparities in rates of undiagnosed
persons among those infected, viral suppression, and death
rates based on the findings in the 2015 CDC HIV State
Prevention Progress Report. The Committee requests that CDC
partner closely with States to improve diagnosis rates among
the undiagnosed and improve viral suppression rates, focusing
specifically on States with the lowest scores on these outcome
measures and with States who need to improve collection of
complete laboratory data to measure viral suppression.
Tuberculosis [TB].--The Committee applauds CDC for its
leadership role in the President's National Action Plan for
Combating Multi Drug Resistant TB. The Committee encourages the
Director to prioritize implementation of the action plan,
including the plan's objective to explore the development of a
national stockpile of TB drugs and diagnostics and ensure that
State and local TB control programs have adequate resources to
pursue the plan's goals.
Viral Hepatitis Prevention Coordinators.--The Committee
recognizes the importance of the Viral Hepatitis Prevention
Coordinator [VHPC] program as the only source of Federal
expertise on hepatitis prevention for States. The Committee
encourages the Division of Viral Hepatitis to expand efforts
within current resources in jurisdictions not currently funded,
including U.S. territories, to build the Federal response for
all impacted areas by providing technical assistance to VHPCs
for the provision of core prevention services such as
screening, testing, linking to care, education, and
surveillance.
Viral Hepatitis Screening.--The Committee continues to
support hepatitis screening activities and encourages CDC to
prioritize screening programs in medically underserved and
minority communities. Point-of-care testing allows for
utilization of effective and innovative screening technology in
a variety of health care settings.

EMERGING AND ZOONOTIC INFECTIOUS DISEASES

Appropriations, 2016.................................... $579,885,000
Budget estimate, 2017................................... 629,485,000
Committee recommendation................................ 578,885,000

The Committee recommendation for the activities of the
National Center for Emerging and Zoonotic Diseases is
$578,885,000, which includes $52,000,000 in transfers from PPH
Fund.
The National Center for Emerging and Zoonotic Infectious
Diseases aims to detect, prevent, and control infectious
diseases from spreading, whether they are naturally occurring,
unintentional, or the result of terrorism.
The Committee recommendation includes funding for the
following activities in the following amounts:

Antibiotic Stewardship.--The Committee commends CDC on its
efforts to improve antibiotic use, specifically its work to
align the complementary work of antibiotic stewardship and
early sepsis recognition. The Committee directs CDC to continue
this dual approach for improving antibiotic use.
Combating Antibiotic Resistant Bacteria [CARB].--The
Committee continues to support the CARB initiative and provides
$163,000,000 for this effort. The Committee recognizes the
importance of addressing antibiotic-resistant bacteria through
a ``One Health'' approach, simultaneously combating antibiotic
resistance in human, animal, and environmental settings. The
Committee directs CDC to competitively award research
activities that address aspects of antibiotic resistance
related to ``One Health'' among entities, including public
academic medical centers, veterinary schools with agricultural
extension services, and State public health departments whose
proposals are in line with CDC's strategy for addressing
antibiotic resistant bacteria. CDC shall provide an updated
spend plan to the Committee within 30 days after enactment of
this act and include an update on these efforts in the fiscal
year 2018 CJ.
The Committee encourages CDC to develop a national capacity
to identify and catalog microbial genome sequences, paying
attention to antibiotic-resistant microbes. The CDC should
continue to pursue research opportunities in the area of
antimicrobial stewardship in diverse healthcare settings and
encourage regional collaborations to study the most effective
strategies to improve antibiotic prescribing and stewardship.
Emerging and Zoonotic Infections Diseases.--The Committee
encourages CDC to continue improving a comprehensive outbreak
response, including leveraging existing Federal and State
investments to work with research universities with expertise
in disease detection, surveillance, containment, and early
vaccine development response capabilities.
National Healthcare Safety Network.--The Committee notes
that each year, hospital acquired catheter associated urinary
tract infections [CAUTIs] results in the death of 15,000
patients. The Committee urges the CDC to examine existing
evidence regarding the use of stents to address CAUTIs and
issue appropriate communications to hospitals, including an
update to its 2009 guidelines to prevent CAUTIs if necessary.
The Committee also notes that treatment gaps in healthcare
associated infections persist across non-hospital health care
settings. The Committee recognizes that the National Healthcare
Safety Network started collecting data from ambulatory surgical
centers and encourages CDC to continue to expand its data
collection efforts to additional providers in non-hospital
settings.
Prion Diseases.--The Committee commends the work of the
National Prion Disease Pathology Surveillance Center and
supports its work developing better diagnostic tools. Prion
diseases are a group of fatal neurodegenerative disorders
causing dementia. Creutzfeldt-Jakob disease is one of the more
devastating types of prion disease that can be transmitted from
disease carriers by tissue transplants or from ingesting beef
contaminated with Bovine Spongiform Encephalopathy, more
commonly known as ``mad cow'' disease. The Center monitors all
human and animal prion diseases, identifies the origin, and
together with CDC develops more efficient diagnostic methods to
prevent spreading into the human population.
Responding to Emerging Threats.--The Epidemiology and
Laboratory Capacity for Infectious Diseases Program [ELC]
strengthens the epidemiologic and laboratory capacity in 50
States, six local health departments, and eight territories.
This funding provides critical support to epidemiologists and
laboratory scientists who are instrumental in discovering and
responding to various food and vector-borne outbreaks. The
Committee provides funding for ELC grants to sustain core
surveillance capacity and ensure that State and local
epidemiologists are equipped to respond rapidly to emerging
threats including antimicrobial resistant superbugs and the
Zika virus.
Sepsis.--The Committee is pleased that the CDC addressed
sepsis as a priority within the CARB initiative in its fiscal
year 2017 CJ. The Committee supports the CDC's goals to scale
up the evaluation of sepsis surveillance to help track national
sepsis rates, assess the impact of prevention and treatment
initiatives, and enable comparisons between health care
facilities to identify problem areas. The Committee requests a
breakdown of funding used for sepsis awareness, prevention, and
treatment across CDC programs in the fiscal year 2018 CJ.
Vector Borne Diseases.--The Committee notes the importance
of the Epidemiology and Lab Capacity program to help protect
the nation from Zika, West Nile, Lyme disease, and other
bacterial and viral diseases caused by mosquitos, ticks, and
other arthropods. CDC is encouraged to allocate the maximum
amount possible to support evidence-based efforts at the
Federal, State, and local public health agencies and labs for
arbovirus control, testing, and reporting. In particular, the
Committee encourages CDC to focus research on tick borne
illnesses, including Lyme disease and Rocky Mountain Spotted
Fever, which have increased significantly in the past decade.

CHRONIC DISEASE PREVENTION AND HEALTH PROMOTION

Appropriations, 2016.................................... $1,177,096,000
Budget estimate, 2017................................... 1,117,145,000
Committee recommendation................................ 1,064,646,000

The Committee recommendation for the activities of the
National Center for Chronic Disease Prevention and Health
Promotion is $1,064,646,000, which includes $337,950,000 in
transfers from the PPH Fund.
The mission of the National Center for Chronic Disease
Prevention is to provide national leadership in promoting
health and well-being through prevention and control of chronic
diseases. Nearly one-half of all American adults have at least
one chronic illness; such diseases account for nearly 70
percent of all U.S. deaths and three-quarters of all healthcare
costs in the United States.
Within the total provided for the National Center for
Chronic Disease Prevention and Health Promotion, the following
amounts are available for the following categories of funding:

[In thousands of dollars]
----------------------------------------------------------------------------------------------------------------
Fiscal year 2016 Fiscal year 2017 Committee
Budget activity appropriation request recommendation
----------------------------------------------------------------------------------------------------------------
Tobacco................................................... 210,000 210,000 210,000
Nutrition, Physical Activity and Obesity.................. 49,920 49,920 49,920
High Obesity Rate Counties (non-add).................. 10,000 10,000 10,000
School Health............................................. 15,400 15,400 15,400
Health Promotion.......................................... 14,025 14,025 14,025
Community Health Promotion............................ ................ ................ ................
Glaucoma.............................................. 3,300 3,300 3,300
Visual Screening Education............................ 525 525 525
Alzheimer's Disease................................... 3,500 3,500 3,500
Inflammatory Bowel Disease............................ 750 750 750
Interstitial Cystitis................................. 850 850 850
Excessive Alcohol Use................................. 3,000 3,000 3,000
Chronic Kidney Disease................................ 2,100 2,100 2,100
Prevention Research Centers............................... 25,461 25,461 25,461
Heart Disease and Stroke.................................. 160,037 160,037 130,037
Diabetes.................................................. 170,129 170,129 140,129
National Diabetes Prevention Program...................... 20,000 20,000 20,000
Cancer Prevention and Control............................. 356,174 302,173 356,174
Breast and Cervical Cancer............................ 210,000 169,204 210,000
WISEWOMAN (non-add)............................... 21,120 21,120 21,120
Breast Cancer Awareness for Young Women............... 4,960 4,960 4,960
Cancer Registries..................................... 49,440 49,440 49,440
Colorectal Cancer..................................... 43,294 39,515 43,294
Comprehensive Cancer.................................. 19,675 19,675 19,675
Johanna's Law......................................... 5,500 5,500 5,500
Ovarian Cancer........................................ 7,500 7,500 7,500
Prostate Cancer....................................... 13,205 ................ 13,205
Skin Cancer........................................... 2,125 2,125 2,125
Cancer Survivorship Resource Center................... 475 475 475
Other................................................. ................ 3,779 ................
Oral Health............................................... 18,000 18,000 16,000
Safe Motherhood/Infant Health............................. 46,000 46,000 46,000
Arthritis................................................. 11,000 11,000 11,000
Epilepsy.................................................. 8,000 8,000 8,500
National Lupus Registry................................... 6,000 6,000 6,000
Racial and Ethnic Approach to Community Health............ 50,950 30,000 ................
Partnerships to Improve Community Health.................. ................ ................ ................
Million Hearts............................................ 4,000 4,000 4,000
Workplace Wellness........................................ ................ ................ ................
National Early Child Care Collaboratives.................. 4,000 4,000 4,000
Hospitals Promoting Breastfeeding......................... 8,000 8,000 8,000
Good Health and Wellness in Indian Country................ ................ 15,000 ................
----------------------------------------------------------------------------------------------------------------

Alzheimer's and Healthy Aging.--The Committee commends the
Healthy Brain Initiative for its leadership in bringing
attention to the public health crisis of Alzheimer's disease.
The Committee encourages CDC to continue implementing the
action steps listed in the updated Road Map, including working
towards a consensus on the mortality burden of the disease.
Asthma.--The Committee applauds CDC's 618
Initiative and its recognition that asthma is one of the most
common and costly health conditions in the United States.
Twenty-four million Americans have asthma, including 6.3
million children. The annual direct healthcare costs and lost
productivity attributed to asthma total $56,000,000,000. The
Committee understands that better coordination of public health
and health systems interventions are necessary to reduce the
disease burden of asthma, and encourages increased
collaboration with payers.
Atopic Dermatitis [AD].--The Committee understands that AD
is the most severe and long-lasting form of eczema impacting as
many as one out of every four children and 7-8 million adults
in the United States. The Committee recognizes that AD is a
potentially debilitating condition which can severely
compromise a person's quality of life, and yet, there is a lack
of understanding into what causes AD and how it can be managed,
treated, and, ultimately, prevented. The Committee recognizes
that there are continued gaps in data on eczema and atopic
dermatitis in adults, particularly regarding prevalence rates
and linkages between comorbidities including asthma and food
allergies. The Committee encourages the Center on Chronic
Disease Prevention and Health Promotion to collaborate with the
National Center for Health Statistics to identify survey
instruments that could be used to obtain better data and begin
to fill these gaps.
Breast and Cervical Cancer Early Detection Program.--The
Committee again rejects the administration's proposed funding
reduction to the Breast and Cervical Cancer early detection
program and provides funding at the fiscal year 2016 level. The
Committee notes that, in 2017, roughly 2.6 million women aged
40-64 will remain uninsured and eligible for breast cancer
screening services under this program. Similarly, 5.7 million
women aged 21-64 will remain uninsured in 2017 and eligible for
cervical cancer screening through the Breast and Cervical
Cancer Early Detection Program. This program remains critical
for women across the country and has shown strong success in
specifically providing low-income, uninsured, and underinsured
women with the lifesaving preventive services they need.
Cancer Screening in Minority Populations.--The Committee
remains concerned about the disparity in cancer screening and
treatment in minority and medically underserved populations.
CDC is encouraged to employ novel partnerships with both cancer
providers and community leaders in community-based outreach
efforts, such as those in faith-based organizations, clinics,
and recreational centers, designed to improve early detection
and prevention in regions of the country that have high numbers
of economically disadvantaged minorities.
Cancer Survivor Resource Center.--Recognizing there are
more than 14,500,000 cancer survivors in the United States, the
Committee encourages the CDC to invest in evidence-based
physical activity and wellness programs for cancer survivors.
Evidence-based physical activity programs have been shown to
improve survivors' overall quality of life, increase
cardiovascular endurance, decrease cancer-related fatigue, and
help them meet or exceed recommended amounts of physical
activity.
Children in Adversity.--The Committee recognizes that CDC
is a key implementing partner of the United States Government
Action Plan on Children in Adversity's three principle
objectives. The Committee fully supports the use of funds
provided to the CDC through this act for activities that the
agency has identified as being necessary to link representative
data to effective, sustainable, and scalable action, and thus
ensure that: (1) the percentage of children achieving age-
appropriate growth and developmental milestones are increased;
(2) the percentage of children living outside of family care is
reduced; and (3) the percentage of children experiencing
violence, exploitation, abuse, and neglect is reduced. The
Committee directs the CDC to collaborate with USAID, PEPFAR,
and the Department of Labor to ensure monitoring and evaluation
is aligned for all of the Action Plan's objectives. The
Committee asks that the annual Public Law 109-95 report to
Congress display the amount of funding by objective to the
Action Plan on Children in Adversity.
Chronic Fatigue Syndrome.--The Committee applauds the CDC's
efforts to collaborate with disease experts in its multi-site
study. The Committee is pleased that the National Academy of
Medicine [NAM] has clarified the disease definition and that
the NAM and the CFS Advisory Committee have made
recommendations to educate the medical community. The Committee
encourages CDC to leverage those recommendations to provide new
clinical guidelines and to execute a broad-based medical
education campaign. To address the critical lack of access to
clinical care, the Committee encourages CDC to work with the
NIH and other agencies within the Department to find creative
ways to support a clinical care component to regional Centers
of Excellence.
Chronic Pain.--The Committee commends CDC for including
chronic pain in the Healthy People 2020 initiative. The
Committee encourages CDC to analyze data collected from the
chronic pain questions included in the 2016 National Health
Interview Survey, make this information available to the
public, and expand the topic area on chronic pain in the
Healthy People 2030 initiative. The Committee further
encourages the CDC to address the public health epidemic of
chronic pain by making information and current statistics on
chronic pain publicly available through the CDC Vital Signs
reports.
Colorectal Cancer.--The Committee rejects the
administration's proposed funding reduction to this program and
emphasizes the importance of continuing to provide screenings
for low-income, uninsured, and underinsured adults who may not
have benefited from the ACA.
Community Grants.--The Committee eliminated the
Partnerships to Improve Community Health [PICH] in the fiscal
year 2016 agreement. To lessen the disruption during PICH close
out, last year the agreement directed CDC to shift fiscal year
2016 continuation costs to two chronic disease budget lines,
$30,000,000 to Heart Disease and Stroke and $30,000,000 to
Diabetes. In fiscal year 2017, PICH close out will be
completed. Therefore, the Committee has removed funds from
these two chronic disease budget lines and directs that no
funds shall be used for continuing PICH activities. Within 120
days of enactment of this act, the Division of Community Health
shall provide a report to the Committee on evaluation plans for
PICH following the final year of funding in fiscal year 2016.
Community Prevention.--The Committee requests that, within
120 days of enactment of this act, CDC shall provide the
Committee any evaluation data or analysis related to previous
investments in community prevention and health promotion,
including Communities Putting Prevention to Work and the
Community Transformation Grant programs. This report shall
summarize previous funding histories, list projects and
activities funded, and provide specific evidence-based data on
how these projects advanced public health.
Diabetes Prevention Program.--The Committee recommendation
includes $20,000,000, the same as fiscal year 2016, for the
Diabetes Prevention Program. This program promoting lifestyle
interventions has proven to reduce the risk of developing
diabetes by 58 percent in individuals at high risk.
Division of Diabetes Translation [DDT].--The Committee
recognizes the work of CDC's DDT to address the diabetes
epidemic and encourages CDC to continue to ensure that the
prevention needs of those Americans with, and at risk for,
diabetes and prediabetes are met. The Committee believes these
activities must include clear outcomes and ensure transparency
and accountability that demonstrate how funding was used to
support diabetes prevention and specifically how diabetes
funding reached State and local communities. Additionally, the
Committee encourages CDC to support the translation of research
into better prevention and care, as well as the National
Diabetes Education Program, the expansion of diabetes
surveillance, and other DDT activities.
Early Child Care Collaboratives.--The Committee recognizes
that the early care and education setting is an important one
for promoting healthy habits in young children. The Committee
provides $4,000,000 to the National Early Child Care
Collaboratives to enable training of early care and education
providers in implementation of healthy eating and physical
activity best practices, including strategies for engaging
families. Funds will also support technical assistance for
integration of healthy eating and physical activity best
practices into existing State and local professional
development systems Early Care and Education settings and
health initiatives.
Electronic Cigarettes.--The Committee notes a rise in usage
of electronic cigarettes, or e-cigarettes, by U.S. middle and
high school students. The Committee is aware of an ongoing NAM
study on the health effects from e-cigarettes and
recommendations for future federally funded research. The
Committee looks forward to the results and recommendations from
the study.
Epilepsy in Rural Areas.--Over 2,000,000 individuals in the
United States have epilepsy and, while new cases are most
common among young children, the onset of epilepsy can occur at
any age. The Committee has included an increase of $500,000
from last year's level for CDC to expand telehealth and
educational training programs for rural and underserved areas
that reach school nurses, child care personnel, first
responders, and care providers for seniors, to recognize and
respond appropriately to seizures caused by epilepsy or result
from trauma and other acute chronic illness. Given the link
between epilepsy and Tuberous Sclerosis Complex, the Committee
also supports efforts to increase awareness of Tuberous
Sclerosis Complex clinical trials and effective therapeutics,
and encourages the CDC to update the study of all-cause
mortality of persons diagnosed with TSC.
Heart Disease and Stroke Prevention.--The Committee
supports the Division for Heart Disease and Stroke Prevention's
efforts against cardiovascular disease and supports the Paul
Coverdell National Acute Stroke Registry and the projects
within State and Local Public Health Actions to Prevent
Obesity, Diabetes, and Heart Disease, and Stroke.
Heart Valve Disease.--The Committee understands that heart
valve disease can be debilitating and if not treated properly
can result in heart failure, sudden cardiac arrest, and death.
The Committee encourages CDC to include information on valve
disease on its Web site and to help bring public awareness to
this disease. The Committee encourages CDC to engage with
patient and research organizations to explore collaborative
ways to integrate information about the warning signs,
symptoms, and risk factors of valve disease into CDC's existing
programs.
High Obesity Rate Counties.--The Committee remains
concerned about the growing body of evidence suggesting that
obesity is one of the most significant challenges facing the
public health system. If this epidemic continues unabated,
obesity and the many complications it causes will increase the
disease burden among Americans, particularly youth. The
Committee continues to include $10,000,000 to support the rural
extension and outreach services grants for rural counties with
an obesity prevalence of over 40 percent. The Committee expects
CDC to work with State and local public health departments to
support measurable outcomes through evidenced-based obesity
research, intervention, and prevention programs. Grants should
combine basic, clinical, and population research to better
understand and treat the metabolic, medical, surgical,
environmental, and societal implications of obesity in
cooperation with partners that have existing outreach capacity
to develop and implement educational and intervention programs.
CDC should focus its efforts in areas of the country with the
highest burden of obesity and with the comorbidities of
hypertension, cardiac disease, and diabetes from county level
data in the Behavioral Risk Factor Surveillance System. The
Committee encourages CDC to only support activities that are
supported by scientific evidence.
Inflammatory Bowel Disease [IBD].--The Committee commends
CDC for exploring the burden of IBD and communicating these
results to the public. Little is known about the impact of IBD
on minority and underserved populations, and the Committee
encourages CDC to complement its existing epidemiological study
with a focus on these populations.
Interstitial Cystitis [IC].--The Committee recommendation
for interstitial cystitis activities provides support for the
ongoing epidemiology study, as well as education, outreach, and
public awareness activities.
Johanna's Law.--The Committee is pleased by the agency's
recent launch of ``Know: BRCA'' to help increase the public's
awareness of hereditary breast and ovarian cancers and improve
understanding the individual risk of having a BRCA mutation.
The Committee urges CDC to take steps to integrate components
of the ``Inside Knowledge campaign'' and ``Know: BRCA'' to the
extent possible, to ensure coordination of public health
messages related to ovarian cancer, leveraging of resources,
and maximizing economies of scale.
Lupus Registry.--The Committee continues to support
research efforts under the National Lupus Patient Registry
program, but acknowledges that challenges still remain. Burden
of illness studies are needed to better understand and evaluate
issues such as the disease impact on quality of life,
productivity, frequency of clinical events, natural history,
and the direct and indirect costs associated with lupus. The
Committee encourages CDC to support the lupus cohort and burden
of illness studies.
Marfan Syndrome.--The Committee remains concerned that
structural cardiovascular disorders, such as Marfan syndrome,
continue to claim the lives of high school athletes across the
country who received a sports physical prior to competition.
CDC is encouraged to work with patient and professional
stakeholders to develop minimum screening guidelines that
ensure all young athletes are appropriately screened for
potentially life-threatening structural cardiovascular
disorders.
Million Hearts.--The Committee supports the Million Hearts
program, a public-private initiative setting goals for our
Nation in preventing heart attacks and strokes. These funds
support enhanced ways to implement the ABCS: aspirin when
appropriate, blood pressure control, cholesterol management,
and smoking cessation, as well as activities to increase the
use of cardiac rehabilitation, as appropriate.
Mississippi Delta Health Collaborative [MDHC].--The
Committee commends CDC's efforts supporting the Mississippi
Delta Health Collaborative in implementing a successful,
evidenced-based strategy to reduce the burden of heart disease
and stroke. These advancements were made possible with chronic
disease prevention interventions through partnerships at the
local level, and team-based approaches designed to link
communities with clinical care, such as education and
counseling, medication therapy management, comprehensive
medication management, and utilizing health information
technology to change health outcomes. Taking these lessons
learned, the Committee wants to build upon the investments and
see whether this success can be replicated in other high-risk
and underserved areas in the future. Therefore, the Committee
encourages CDC, working with the Collaborative and relevant
stakeholders, to reach populations at high risk in the Delta
with effective interventions while maintaining the current
strategy. CDC shall consider using lifestyle change
intervention models like the Diabetes Prevention Program;
utilizing local pharmacy schools with existing community-based
research programs that could focus on screenings, medication
reviews, medication therapy management, comprehensive
medication management, and disseminating prevention strategies;
and working with communities to establish health networks to
better coordinate and manage community based health
initiatives. To reach the target population, the Committee
encourages CDC to take advantage of rapidly evolving healthcare
technology by leveraging the resources of States with
recognized leadership in areas of electronic medical records,
telehealth, and innovative delivery of education tools. CDC
shall provide an update on these activities in the fiscal year
2018 CJ.
Ovarian Cancer.--The Committee commends the CDC for its
work to evaluate existing risk assessment tools, which can be
used to help identify patients with a genetic predisposition to
ovarian and other cancers, and identify which of these existing
tools are valid, reliable, and the most user-friendly for
providers and patients. The Committee requests that the CDC
present the findings of this review and provide recommendations
with respect to how CDC can support the deployment of the tools
found to have the greatest value and utility in the fiscal year
2018 CJ.
Pulmonary Hypertension [PH].--The Committee understands
that PH causes heart failure and death. CDC is encouraged to
support education, outreach, and awareness activates that
promote early and accurate diagnosis of PH.
Racial and Ethnic Approach to Community Health [REACH].--
The Committee eliminates the REACH program due to funding
constraints. Funding continues to be provided to other programs
that conduct outreach to reduce ethnic disparities in health
status.
Safe Motherhood Initiative.--Preterm birth affects more
than 500,000 babies each year in the United States and is the
leading cause of neonatal mortality. The Committee commends CDC
for funding State-based Perinatal Collaboratives that focus on
improving birth outcomes using known preventative strategies
such as reducing early elective deliveries.
Sleep Surveillance.--The Committee is pleased by CDC's work
on a national public health awareness campaign for sleep. The
Committee urges CDC to ensure that funding for surveillance
activities on sleep disorders and sleep health is maintained in
addition to these awareness efforts.
WISEWOMAN.--The Committee lauds the WISEWOMAN program that
helps uninsured and under-insured low-income women ages 40 to
64 decrease, prevent, or control heart disease and stroke by
providing preventive health services, referrals to local health
care providers, lifestyle programs and health counseling
services tailored to identified risk factors to promote
lasting, healthy behavior change. From 2008 through 2014,
WISEWOMAN served more than 165,000 women and over 90 percent
had at least one heart disease and stroke risk factor. More
than 118,000 evidenced-based behavior change services were
provided to help reduce heart disease and stroke.

NATIONAL CENTER ON BIRTH DEFECTS, DEVELOPMENTAL DISABILITIES,
DISABILITY AND HEALTH

Appropriations, 2016.................................... $135,610,000
Budget estimate, 2017................................... 135,610,000
Committee recommendation................................ 137,560,000

The Committee recommendation for the activities of the
National Center on Birth Defects and Developmental Disabilities
[NCBDDD] is $137,560,000.
This Center improves the health of children and adults by
preventing birth defects, developmental disabilities, and
complications of heredity blood disorders and by promoting
optimal child development and health and wellness among
children and adults living with disabilities.
Within the total provided, the following amounts are
provided for the following categories of funding:

Cerebral Palsy.--The Committee encourages CDC to build on
established surveillance and research methods to support
research infrastructure focused on Cerebral Palsy across
various geographic U.S. regions.
Congenital Heart Disease [CHD].--CHD is the number one
cause of birth defects in the United States and a leading cause
of birth defect-related infant mortality. The Committee notes
that children and adults with CHD require ongoing, specialized
cardiac care, and there remain gaps in the epidemiological data
as children and adolescents transition to adult care. The
Committee commends the National Center for Birth Defects and
Developmental Disabilities for its leadership in addressing CHD
and adult CHD surveillance efforts, including on the estimated
number of individuals in the United States living with CHD,
epidemiology of CHD across the lifespan, age-specific
prevalence, and factors associated with those patients who may
have dropped out of appropriate specialty care.
Fetal Alcohol Spectrum Disorders [FASD].--The Committee
encourages the CDC to collaborate with State substance abuse
agencies to establish a State-Federal partnership on FASD
issues. This collaboration would involve dissemination of FASD
best practices, providing technical assistance, and creating
State-to-State sharing opportunities.
Fragile X and Associated Disorders.--The Committee commends
CDC's efforts to identify and define the population impacted by
FX and FXD with the goal of understanding the public health
impact of these conditions. The Committee acknowledges
significant progress made by the NCBDDD Fragile X Clinical and
Research Consortium in growing its FORWARD Database and its
Patient Registry. The CDC is encouraged to continue this
effort. The Committee also supports the public-private
partnership which resulted in the ``Future of Fragile X:
Setting the Public Health Research Agenda'' meeting in 2014 and
the resulting Funding Opportunity Announcement which seeks to
use longitudinal data to characterize the natural history of
Fragile X to improve services and outcomes. The Committee
encourages the NCBDDD to continue data driven public health
research to reduce the public health burden of both FX and
autism.
Health and Development for Those With Disabilities.--The
Committee supports the work of the National Center on Health,
Physical Activity and Disability [NCHPAD] and its goal of
promoting better health for adults and children with
disabilities. By mobilizing national networks to provide
technical assistance, provide community leaders and community
organizations with health promotion training, and by
disseminating effective strategies and tools for disability
service providers, NCHPAD plays an important role in
encouraging a healthier lifestyle for Americans with
disabilities.
Hemophilia.--The Committee has included sufficient funding
to maintain the Center's hemophilia programs, which provide
critical information to better understand risk factors for
complications and identify high-risk populations for prevention
measures. The Committee recognizes the importance of CDC's
research on inhibitors and the recommendation that people with
hemophilia be tested for inhibitors at least annually. The
Committee encourages CDC, working with stakeholders and the
network of hemophilia treatment centers, to implement inhibitor
testing across the United States and support further research
to better understand inhibitors and how they can be prevented.
Improving the Health of People With Intellectual
Disabilities.--People with disabilities have a high risk of
poor health outcomes such as obesity, hypertension, and mood
disorders such as depression. Therefore, the Committee includes
$6,700,000 for the Healthy Athletes program.
Muscular Dystrophy Surveillance.--The Committee is aware of
the CDC's established surveillance efforts through the Muscular
Dystrophy Surveillance, Tracking, and Research Network [MD
STARnet] and supports the development of a plan to enhance the
quality and quantity of the data being collected through MD
STARnet. Additionally, the Committee is interested in the
agency's plans to disseminate and implement the updated care
standards, including for adults with Duchenne and for other
forms of muscular dystrophy, and requests a report on this
activity 180 days after the enactment of this act. The
Committee also supports CDC's engagement of multiple Divisions
and Centers in the development of a Duchenne newborn screening
program.
Spina Bifida.--While spina bifida and related neural tube
defects are highly preventable through education and adequate
daily folic acid consumption, it is the most common permanently
disabling birth defect in the United States. The Committee
supports the continuation of the Spina Bifida Clinical Care
Monitoring and Tracking program and commends the National Spina
Bifida Program in serving as a model for programs assisting
other individuals living with similar complex conditions. The
Committee encourages CDC to continue the dissemination of
information to clinicians, parents, and families living with
spina bifida.
Thalassemia.--The Committee commends CDC's thalassemia
program and encourages CDC to coordinate the efforts of the
treatment centers and the nonprofit patient advocacy community
to enhance public and provider awareness about thalassemia
prevention and treatment.
Tuberous Sclerosis Complex [TSC].--The Committee encourages
CDC to take into consideration all the major manifestations of
TSC in its surveillance network.

PUBLIC HEALTH SCIENTIFIC SERVICES

Appropriations, 2016.................................... $491,597,000
Budget estimate, 2017................................... 500,631,000
Committee recommendation................................ 485,000,000

The Committee recommendation for Public Health Scientific
Services is $485,000,000.
This funding supports the work of all of the CDC Centers by
compiling statistical information to inform public health
policy. In particular, these activities assure the accuracy and
reliability of laboratory tests; apply digital information
technology to help detect and manage diseases, injuries, and
syndromes; and develop and inform the public health community
on sound public health surveillance, laboratory protocols, and
epidemiological practices.
The Committee recommendation includes funding for the
following activities in the following amounts:

Alzheimer's Disease and Dementia.--The Committee is aware
of recent peer-reviewed studies suggesting that more than
500,000 U.S. deaths each year are attributable to Alzheimer's
disease and dementia, far in excess of the deaths reported by
the Center each year. Such statistics would elevate Alzheimer's
disease from the sixth leading cause of death to the third
leading cause of death. The Committee directs the CDC to make
recommendations on ways to ensure the accuracy and completeness
of measurements of the Alzheimer's disease and dementia death
rate and to develop a consensus on the mortality burden of the
disease.
Community Preventive Services Task Force.--The Committee
notes that the Task Force recommendations provide information
about evidence-based options that decision makers and
stakeholders can consider when determining what best meets the
specific needs, preferences, available resources, and
constraints of their jurisdictions and constituents. These
recommendations and the reviews of the evidence on which they
are based are compiled in the Guide to Community Preventive
Services. The Committee recognizes CDC's continuing efforts to
support the Task Force and to conduct dissemination activities
that provide information to help communities make informed
decisions.
Modernizing Vital Statistics Collection.--While most States
now or will soon have operational electronic birth and death
registration systems, many do not have the resources to
maximize electronic death reporting or to modernize their
systems to keep pace with new technology. The Committee
encourages CDC to support States in upgrading antiquated
systems and improving the quality and accuracy of vital
statistics reporting.

ENVIRONMENTAL HEALTH

Appropriations, 2016.................................... $182,303,000
Budget estimate, 2017................................... 182,303,000
Committee recommendation................................ 182,303,000

The Committee recommendation for the National Center for
Environmental Health is $182,303,000. The Committee
recommendation includes $17,000,000 in transfers from the PPH
Fund.
The National Center for Environmental Health addresses
emerging pathogens and environmental toxins that pose
significant challenges to public health. The Center conducts
surveillance and data collection to determine which substances
in the environment are found in people and to what degree. The
Center also determines whether and at what level of exposure
these substances are harmful to humans.
The Committee recommendation includes funding for the
following activities:

Amyotrophic Lateral Sclerosis [ALS] Registry.--The
Committee commends CDC and the Agency for Toxic Substances and
Disease Registry [ATSDR] for its continued efforts to maintain
and strengthen the National ALS Registry and to ensure that the
registry supports and advances research into the causes and
treatment of ALS and the care of ALS patients. The Committee
encourages ATSDR to identify and support additional ways the
registry can advance ALS treatment development including as a
tool to identify cohorts for research studies; assess benefit-
risk and patient preferences; assist in conducting natural
history studies; collect patient and caregiver reported
outcomes and post-marketing data; and identify geographic
locations for trial sites based on proximity of larger patient
populations that meet enrollment criteria. The Committee also
encourages ATSDR to continue to consult with ALS organizations,
patients, researchers, the pharmaceutical industry and Federal
agencies, including NIH, VA, and the FDA, to coordinate efforts
and ensure the registry continues to be a resource for
stakeholders.
Environmental Health Activities.--The Committee is aware
that local health departments are involved in a wide array of
environmental health activities including groundwater
protection, protection of the food supply, pollution
prevention, and hazardous waste disposal. CDC is urged to
ensure that funds are available to State and local health
departments in communities to address local level threats.
Healthy Housing.--The Committee recognizes the important
role that healthy housing can play in reducing the risk of
numerous conditions, including asthma and lead poisoning. CDC
is encouraged to continue to support healthy housing
activities.
Lead Poisoning.--The Committee notes that the National
Advisory Committee on Childhood Lead Poisoning Prevention was
disbanded in 2013. The lead poisoning crisis in Flint,
Michigan, demonstrates that this committee is greatly needed by
providing a forum for convening lead poisoning experts and
providing these experts with an official conduit for
recommendations to CDC to address emerging lead poisoning
problems quickly. CDC is encouraged to re-establish this
Committee. CDC is also encouraged to prioritize the geocoding
and mapping of lead poisoning surveillance data, which is
inexpensive and makes the data much more accessible to local
jurisdictions and agencies serving lead-poisoned children.

INJURY PREVENTION AND CONTROL

Appropriations, 2016.................................... $236,059,000
Budget estimate, 2017................................... 268,629,000
Committee recommendation................................ 264,059,000

The Committee recommendation for the National Center for
Injury Prevention and Control is $264,059,000.
CDC is the lead Federal agency for injury prevention and
control. Programs are designed to prevent premature death and
disability and reduce human suffering and medical costs caused
by fires and burns, poisoning, drowning, violence, and traffic
accidents. The national injury control program at CDC
encompasses non-occupational injury and applied research in
acute care and rehabilitation of the injured.
The Committee recommendation includes funding for the
following activities:

Children's Exposure to Violence.--The Committee believes
that understanding children's exposure to violence and its
potential impacts on a child's health and well-being is of
critical importance. The Committee encourages CDC to continue
its collaboration with the Office of Juvenile Justice and
Delinquency Prevention at the Department of Justice on the
National Survey of Children's Exposure to Violence.
Combating Opioid Abuse.--The Committee includes
$98,000,000, an increase of $28,000,000 above fiscal year 2016,
for the Prescription Drug Overdose [PDO] Prevention for States
program. CDC shall use this increase, which is $18,000,000
above the administration's request, to expand its competitive
cooperative agreement program that funds States with the
greatest burden of opioid overdoses and readiness to implement
prevention activities and improve interventions that monitor
prescribing and dispensing practices, inform clinical practice,
and protect high risk patients. The Committee notes the strong
connection between abuse of prescription opioids and use of
other types of opioids like heroin. Activities targeting one
area will have a significant impact on the other. Therefore,
funding will support activities such as implementing guidelines
to improve prescribing behaviors and collecting real-time and
more accurate data for heroin-related opioid deaths. The
Committee urges CDC to require applicants applying for the PDO
Prevention for States Program to collaborate with the State
substance abuse agency or those agencies managing the State's
PDMP to ensure linkages to clinically appropriate substance use
disorder services.
Concussion Surveillance.--The 2013 NAS study ``Sports-
Related Concussions in Youth: Improving the Science, Changing
the Culture'' recommended that CDC establish and oversee a
national surveillance system to accurately determine the
incidence of sports-related concussions, including youth ages 5
to 21. The Committee is aware of the promising progress CDC has
made in creating a comprehensive survey instrument which the
agency will be piloting in the coming months to prepare for a
national survey in the future. The Committee supports CDC's
work in this area and urges the agency to increase its efforts.
Opioid Prescribing Guidelines.--The Committee applauds
CDC's Guidelines for Prescribing Opioids for Chronic Pain and
directs the agency to translate the guidelines into succinct,
usable formats and toolkits accessible to providers across the
country. CDC is also directed to broadly disseminate the
guidelines and toolkits to promote use among as many providers
as possible. The Committee expects CDC to offer technical
assistance to States and expand training modules available for
continuing medical education credit and maintenance of
certification to spur uptake of guidelines by professional
societies and health systems. CDC is urged to coordinate with
the Office of the National Coordinator for Health Information
Technology to develop and disseminate clinical decision support
tools derived from the opioid prescribing guidelines. CDC is
also urged to work with the VA and the DOD on implementing
these guidelines to ensure consistent, high-quality care
standards across the Federal Government.

OCCUPATIONAL SAFETY AND HEALTH

Appropriations, 2016.................................... $339,121,000
Budget estimate, 2017................................... 285,621,000
Committee recommendation................................ 334,121,000

The Committee recommendation for National Institute for
Occupational Safety and Health [NIOSH] programs is
$334,121,000.
NIOSH is the only Federal agency responsible for conducting
research and making recommendations for the prevention of work-
related illness and injury. The NIOSH mission is implemented by
conducting basic and applied scientific research and
translating the knowledge gained into products and services
that impact workers in settings from corporate offices to
construction sites to coal mines.
Total Worker Health.--The Committee commends CDC's Total
Worker Health Program, which aims to promote and protect the
health and productivity of the American workforce through
research and dissemination of innovative and cost-effective
tools and interventions for American businesses. The Committee
commends CDC's work in this area and encourages CDC to continue
dissemination of these tools.
The Committee recommendation includes funding for the
following activities at the following amounts:

ENERGY EMPLOYEES OCCUPATIONAL INJURY COMPENSATION ACT

Appropriations, 2016.................................... $55,358,000
Budget estimate, 2017................................... 55,358,000
Committee recommendation................................ 55,358,000

The Committee recommendation for the Energy Employees
Occupational Illness Compensation Program Act [EEOICPA] is
$55,358,000. This mandatory funding supports NIOSH scientists
who reconstruct radiation dose levels to inform compensation
decisions.

GLOBAL HEALTH

Appropriations, 2016.................................... $427,121,000
Budget estimate, 2017................................... 442,121,000
Committee recommendation................................ 432,121,000

The Committee recommends $432,121,000 for global health-
related activities at CDC.
The Center for Global Health leads international programs
and coordinates CDC's global efforts with the goal of promoting
health and preventing disease in the United States and abroad.
The Center has a particular focus on ensuring rapid detection
and response to emerging health threats.
The Committee recommendation includes funding for the
following activities in the following amounts:

Antimicrobial Resistance [AMR].--As a result of the
increased global availability and over-prescription of
antimicrobial medicines to humans and animals, a number of
disease-causing microbes have developed resistance to drugs
previously used to treat them. Yet U.S. efforts to combat AMR
may be insufficient, since most resistance emerges in other
regions of the world where antimicrobial use in people and food
animals is rampant and poorly regulated. The Committee urges
CDC to consider partnering with a coalition of hospitals, State
public health departments, global health non-governmental
organizations, and biotech companies, among others, with the
goal of linking global patterns of emerging resistance to their
impact in U.S. hospitals and clinical settings. Such a
coalition would attempt to identify the most important factors
that contribute to the emergence and the spread of AMR
infections worldwide, and how they are spread to the United
States.
Malaria and Parasitic Diseases.--The Committee recognizes
the important role the Center for Global Health plays in the
fight against malaria and parasitic diseases. CDC's crucial
monitoring and surveillance of transmission, evaluation of
interventions for effectiveness and impact, and testing of
tools in a real world setting are critical to understanding how
to scale up global health programs and ensure that our global
health investments are smarter, better, and not wasteful. The
Committee therefore encourages CDC to continue to research,
monitor, and evaluate efforts for malaria and parasitic disease
in collaboration with other divisions and agencies.
Polio.--CDC is the lead U.S. agency in the global effort to
eradicate polio and currently works with various organizations
by providing expertise in training, vaccines, epidemiology,
laboratory capacity, and surveillance. Currently, polio is
endemic in only three countries, Nigeria, Afghanistan, and
Pakistan. However, Nigeria has not reported a case since August
of 2014 and will be declared polio free if no cases are
reported by August of 2017. The Committee commends these
efforts and includes a $5,000,000 increase above the fiscal
year 2016 level to help eradicate this disease.
Tropical Disease.--The Committee recognizes the critical
role the Center and its Vector Borne Disease program play in
ongoing efforts to prepare for and fight tropical diseases
emerging on U.S. soil, such as Dengue, Chikungunya and now
Zika. The groundwork laid in the Center's efforts on Dengue and
Chikungunya will be critical for fighting Zika. The Committee
recognizes that without a robust Vector Borne Disease program,
the United States will be ill equipped to monitor and prepare
for Zika and new vector-borne infectious disease threats.

PUBLIC HEALTH PREPAREDNESS AND RESPONSE

Appropriations, 2016.................................... $1,405,000,000
Budget estimate, 2017................................... 1,402,166,000
Committee recommendation................................ 1,396,800,000

The Committee recommendation for the Office of Public
Health Preparedness and Response [PHPR] is $1,396,800,000.
The mission of PHPR is to build and strengthen national
preparedness for public health emergencies including natural,
biological, chemical, radiological, and nuclear incidents. PHPR
administers national response programs and assets, as well as
grants to States and localities to enhance preparedness efforts
across the country.
The Committee recommendation includes funding for the
following activities in the following amounts:

Emergency Preparedness.--The Committee continues to request
detailed information on how State Public Health Emergency
Preparedness [PHEP] funding is distributed at the local level
by States. CDC is encouraged to provide in the fiscal year 2018
CJ an update on how much of the Federal PHEP funding is being
allocated to local health departments and what basis or formula
each State is using to make such allocations.
State and Local Preparedness and Response.--The Committee
eliminates the Academic Centers for Public Health Preparedness
as requested by the administration. CDC will continue to
support research and training through its Office of Public
Health Preparedness and Response.
Strategic National Stockpile [SNS].--The Committee
encourages CDC to evaluate the latest approved advances in
influenza prevention and antiviral treatment for inclusion in
the SNS in preparation for pandemic influenza. Moreover, CDC
should consider a comprehensive approach to preparedness
through vaccines, diagnostics, and antiviral therapeutics.
U.S. Public Health Capacity and Needs.--The Committee
directs GAO to issue a report within 180 days of the enactment
of this act that reviews the U.S. public health system's
current capacity to respond to infectious disease outbreaks,
including Federal emergency response. The GAO report shall
identify response best practices based on a review of the
responses to recent major global infectious disease outbreaks,
and provide recommendations about how to ensure that every
State public health department has the capacity to provide for
a minimum necessary level of public health services. During the
course of their review and preparation of recommendations, GAO
shall review the 2012 Institute of Medicine report entitled
``For the Public's Health: Investing in a Healthier Future.''

CDC-WIDE ACTIVITIES

Appropriations, 2016.................................... $283,570,000
Budget estimate, 2017................................... 144,791,000
Committee recommendation................................ 273,570,000

The Committee provides $113,570,000 for public health
leadership and support activities at CDC.
CDC is encouraged to work with the Department to use the
Nonrecurring Expenses Fund for capital projects and National
Repair and Improvement activities at CDC.
The recommendation includes $160,000,000 in transfers from
the PPH Fund.
The Committee recommendation includes funding for the
following activities in the following amounts:

Preventative Health and Health Services Block Grant.--The
Committee continues to reject the administration's proposal to
eliminate this program and provides $160,000,000, the same
level as in fiscal year 2016. These grants are crucial for
States because they provide enough flexibility necessary to
resolve any emerging health issues at the local level while
tailoring those activities to best address the diverse,
complex, and constantly changing local community.
Underground Mine Safety.--The Committee appreciates the
requested timeline submitted by CDC and continues to support a
replacement facility for the Lake Lynn Experimental Mine and
Laboratory. The Committee directs CDC to utilize prior-year
funding for the planning and design, land acquisition,
construction, and equipping of the replacement facility. No
later than 180 days after enactment, the CDC shall submit a
detailed update of its activities to date to replace the Lake
Lynn facility and accompanying plan to complete the timely
acquisition of a replacement facility to the Committees on
Appropriations of the House of Representatives and the Senate.
The Committee does not include bill language requested by
the administration to provide additional transfer authority to
the Director beyond that which is already provided to the
Secretary.

National Institutes of Health

The National Institutes of Health [NIH] is the global
leader in medical research. The Committee provides
$34,084,000,000 for NIH activities within the jurisdiction of
this bill, an increase of $2,000,000,000, or 6.3 percent, above
fiscal year 2016. This includes $857,000,000 in transfers
available under section 241 of the PHS Act. The Committee
continues a reform to section 241 allocations such that no NIH
funding will be removed from NIH under this authority. This
reform ensures that section 241 transfers are a benefit to NIH
rather than a liability. In addition, it improves the
transparency of NIH's budget, so that the enacted total is
truly the amount the Committee expects to be used for
biomedical research.
The Committee recommendation provides $300,000,000 in
fiscal year 2017 from the Department's Nonrecurring Expenses
Fund [NEF]. Bill language is included to repurpose this portion
of the NEF, created in fiscal year 2008, for biomedical
research activities at the NIH.
The Committee continues its commitment to funding research
on Alzheimer's disease and increases funding by $400,000,000 to
a total of approximately $1,391,000,000 in fiscal year 2017;
increases funding for the Precision Medicine Initiative by
$100,000,000; increases funding for antibiotic resistance
research by $50,000,000; and increases funding for the BRAIN
Initiative by $100,000,000. In addition, funding is provided to
ensure that every Institute and Center receives an increase
above fiscal year 2016 to continue investments in innovative
research that will advance the fundamental knowledge and speed
the development of new therapies, diagnostics, and preventive
measures to improve the health of all Americans. Revolutionary
discoveries often come from unexpected, untargeted research.
The Committee continues to support these basic advances as well
as the clinical and translational research that moves basic
discoveries from ``bench-to-bedside.''

NATIONAL CANCER INSTITUTE

Appropriations, 2016.................................... $5,213,509,000
Budget estimate, 2017................................... 5,097,287,000
Committee recommendation................................ 5,429,769,000

The Committee recommendation includes $5,429,769,000 for
the National Cancer Institute [NCI]. Of this amount,
$50,000,000 is available for repairs and improvements to the
NCI facility in Frederick, Maryland.
Biospecimen Resource Locator.--The Committee appreciates
that the NCI has developed and supports the Specimen Resource
Locator, a searchable database of biospecimen collections. The
Committee also appreciates that pediatric cancer biospecimen
resources are included within the Specimen Resource Locator,
and requests an update from NCI on pediatric cancer biospecimen
collections in the fiscal year 2018 CJ.
Breast Cancer.--Recent advances in breast cancer screening
include the introduction of digital mammography [DM] and
magnetic resonance imaging [MRI] for women at high risk for
breast cancer. A new technology available for breast cancer
screening, tomosynthesis [TM], is FDA-approved and being
adopted as the ``standard of care'' in some markets. Limited
trial results to date show a strong reduction in false
positives and a trend toward more cancers diagnosed with TM
than with DM. The Committee recommends NCI continue its vital
research to help provide breast cancer patients and their
physicians with a clear, informed picture of the role of breast
cancer imaging. The Committee encourages NCI to conduct a 5-
year, large cohort study exploring the validity and merits of
TM and how it compares to other forms of imaging.
Cancer Kinome and Ovarian Cancer.--The Committee is aware
that research into the role of kinases-enzymes in the human
genome that regulate an immense variety of cellular function-
holds the promise to drive the development of new treatments
and cures for a variety of cancers, including ovarian cancer.
NCI is encouraged to support research in this area.
Cancer and Mitochondria.--The Committee commends NCI for
its work in establishing a Mitochondrial Model Organisms and
Cellular Systems Working Group and for its work to identify
needs, barriers, and opportunities pertaining to mitochondrial
biology relevant to addressing mechanistic questions in cancer.
The Committee encourages NCI to continue to support research
studies that examine the mechanisms by which cancer cells
utilize oxidative stress in stromal cells to fuel their growth.
Colorectal Cancer and Inflammatory Bowel Diseases.--The
Committee recognizes that left untreated, inflammatory bowel
diseases can advance to colorectal cancer. The Committee
encourages additional research on the developmental pathway of
colorectal cancer among patients with IBD.
Deadliest Cancers.--While overall cancer incidence and
death rates are declining, the Committee is concerned that
there are a group of cancers, defined in statute as
recalcitrant cancers, whose 5-year survival rates remains below
50 percent. The Committee applauds the NCI for launching its
Molecular Analysis for Therapy Choice [MATCH] study, a
potentially ground-breaking trial that analyzes patients'
tumors to determine whether they contain genetic abnormalities
for which a targeted drug exists and assigns treatment based on
the abnormality. The Committee was pleased to learn that a goal
of MATCH is to ensure patients with rare cancers represent at
least 25 percent of the enrollees in the trial. Given the
growing toll recalcitrant cancers take on society, and the
enormous potential MATCH offers for our Nation's deadliest
cancers, the Committee strongly urges NCI to continue to
prioritize rare cancers within the MATCH trial.
Cancer and Hereditary Hemorrhagic Telangiectasia [HHT].--
HHT is a genetic disorder of the blood vessels, and one
variation of the disorder, HHT1, is characterized by deficiency
in endoglin, an angiogenic protein. Recent research has
indicated improved survival outcomes for cancer patients who
also have HHT1. The Committee encourages NCI to support
research investigating whether reduced systemic endoglin
levels, expected in patients diagnosed with HHT1, impacts
clinical outcomes for cancer. The Committee requests an update
in the fiscal year 2018 CJ on the status of research related to
this topic.
Early Detection.--The Committee is pleased to support the
NCI's goal of increasing early detection research. Early
detection is an important means to saving lives and reducing
the need for systemic treatments which have long-term side
effects for many patients.
Immunotherapy.--Recent NCI research demonstrates that new
cancer immunotherapy approaches that specifically attack tumor
cells with characteristics unique to a certain cancer could be
effective against a wide range of cancers. The Committee
encourages NCI to further explore new interventions, such as
immunotherapy, as a promising new treatment strategy for
children with cancer.
Liver Cancer.--The Committee notes that the number of liver
cancer cases has more than tripled since 1980 and the death
rate for this cancer has continued to increase. The Committee
continues to be concerned with the increasing incidence of
liver cancer and its low 5-year survival rate. Therefore, the
Committee encourages NCI to continue to support liver cancer
research across its portfolio, including research focused on
the development of biomarkers to serve as early detection
markers of cancer to offer the prospect of improved outcomes.
Melanoma.--Melanoma is the most responsive tumor type to
the new generation of immune therapies. As many phase 3 trials-
the essential platform to provide high quality annotated
biospecimens for biomarker discovery-are launched under the
aegis of the NCI, and industry has specimens that have not been
fully analyzed, the Committee urges a coordinated effort to
analyze biospecimens across NCI and industry trials and
treatment type with the most advanced technologies. The current
Exceptional Responders Initiative has been focused primarily on
chemotherapy which has been proven to be ineffective in
improving outcomes for the majority of patients with melanoma.
This initiative could be extended to exceptional responders to
targeted therapies and/or immunotherapies. The Committee
continues to encourage efforts to use advances in genomic,
proteomic, and digital imaging technologies for early
detection, research to understand genetic changes that occur in
melanogenesis and mechanisms that underlie clinical dormancy to
provide effective means of preventing recurrence. The Committee
requests an update on these requests in the fiscal year 2018
CJ.
Metastatic Brain Tumor Research.--The incidence of
metastatic brain tumors has been increasing, largely due to the
fact that more Americans are surviving and living longer after
treatment for other cancer diagnoses. While the increased
incidence is a significant cause of concern, brain metastases
are often treatable if diagnosed in a timely manner. The
Committee encourages NCI to continue to involve stakeholders in
the brain tumor community in its research efforts to develop
strategies that improve our understanding of the molecular
basis for cancer metastasis to the brain, detection through
enhanced imaging, early intervention, and treatment.
Military Hospitals and Cancer Centers Collaboration.--The
Committee is aware that formal alliances between American
military hospitals and NCI-designated cancer centers would
provide an ideal context to facilitate research on the causes,
prevention, and treatment of cancer in military personnel and
their families. The Committee encourages NCI to explore
opportunities for collaborative clinical research efforts
between American military hospitals and NCI-designated cancer
centers. The Committee urges NCI to focus on populations with
significant health disparities, including multiethnic
populations.
Ovarian Cancer.--The Committee notes that despite
scientific advancements, ovarian cancer remains the fifth most
prevalent disease for women with 5-year survival rates still
below 50 percent. The Committee encourages NCI to continue to
support clinical trials with emerging genomics-driven
immunotherapies applied to human ovarian cancer, with
particular emphasis on treatments that target the molecular
characteristics of each tumor. The Committee requests an update
in the fiscal year 2018 CJ.
Pancreatic Cancer.--The Scientific Framework for Pancreatic
Ductal Adenocarcinoma [PDAC] made four important
recommendations for expanding pancreatic cancer research:
understanding the biological relationship between PDAC and
diabetes mellitus; evaluating longitudinal screening protocols
for biomarkers for early detection of PDAC and its precursors;
studying new therapeutic strategies in immunotherapy; and
developing new treatment approaches that interfere with RAS
oncogene-dependent signaling pathways. The Committee looks
forward to receiving the fiscal year 2018 CJ to learn how the
specific recommendations included in the report are being
implemented.
Pediatric Cancer.--The Committee remains concerned that
pediatric cancers remain the leading cause of death by disease
past infancy among children in the United States, and that the
majority of childhood cancer survivors suffer from late effects
of cancer treatment. The Committee strongly encourages NCI to
bolster pediatric cancer research and clinical trials. The
Committee urges NCI to continue key investments in pediatric
oncology research, including clinical studies for children with
brain tumors, development of the novel pediatric MATCH study,
and the important pediatric preclinical testing program
evaluating new agents for treating pediatric malignancies.
Further, the NCI Director is urged to conduct research related
to the needs, outcomes, health disparities, and barriers of
pediatric cancer survivors, with an emphasis on minority or
other medically underserved populations. The Committee requests
an update 90 days after enactment of this act on specific
pediatric cancer initiatives as well as how general cancer
research will benefit pediatric cancer activities. In addition,
the Committee expects a further update to be included in the
fiscal year 2018 CJ on how the NCI is focusing on the unique
needs of children.
Precision Medicine.--The Committee continues to strongly
support NCI's PMI, and provides $70,000,000 to continue its
efforts to develop effective patient-specific treatments that
target the disease's genetic and molecular abnormalities. NCI
has made significant progress in changing the way we understand
cancer, advances that have and are producing massive amounts of
new data. To make the fullest use of all of this information,
NCI has committed resources to launch the Genomic Data Commons
to stimulate sharing of information among researchers, and is
evaluating the expansion of existing databases and other
approaches to data sharing with the NCI cloud pilots. NCI and
the broader research community recognize that the need for data
integration and manipulation to make full use of these massive
cancer datasets not only entails investment in open data
hosting, but requires significant investments in scalable,
interactive data management that combines imaging, clinical,
and molecular datasets. It also requires further data standards
development to enable discovery, increase accessibility,
improve interoperability, and promote data reuse and
reproducibility, as well as resolve uncertainty in technical
variation that can arise from different approaches in sample
storage, acquiring biomaterial, and choices in computational
pipelines. It is hoped that open sharing on this scale,
accessible for research, clinical decision making, and drug
development, will accelerate understanding--and more effective
treatments--for many cancers. The Committee directs NCI to
provide a plan, developed in collaboration with its external
partners, to the Committee 6 months after enactment of this act
outlining its efforts to address these questions to effectively
build a cancer genomics data ecosystem that enables and
promotes data sharing, including schedule and cost estimates.
Finally, the Committee notes the importance of NCI clinical
trials in the area of immuno-oncology. The Committee encourages
NCI to engage leaders in this emerging field to utilize the
network of existing comprehensive cancer centers and the
National Clinical Trials Network to aggressively develop new
therapies through clinical trials using engineered T-cells,
coordinated research strategies, and training initiatives for
broad application. Of particular interest is the use of
precision medicine to develop therapies for late stage and
other cancers where conventional treatments have proved largely
ineffective.
Prostate Cancer.--The Committee is aware of NCI's ongoing
investment in prostate cancer research, and encourages further
efforts into treatments for men with advanced disease as well
as diagnostic and imaging methodologies common in other
hormone-driven cancers with similar disease burden. The
Committee encourages NCI to coordinate its response to these
needs with other Federal agencies, and collaborators as
appropriate, including the Department of Defense, as well as
private research foundations and advocacy groups.
Psycho-Social Distress Complications.--According to the
Institute of Medicine, nearly 50 percent of all cancer patients
experience distress. Further, studies suggest that distress in
cancer patients leads to higher healthcare costs, less
compliance with treatment pathways, and poorer health outcomes.
While significant advancements have been made in biomedical
treatments in cancer care, the Committee is concerned that the
unaddressed psycho-social needs of patients are adversely
impacting the effectiveness and cost of care, as well as the
individuals' overall well-being. The Committee encourages NCI
to implement distress screenings in the NIH Clinical Center and
in NCI-funded clinical trials as appropriate.
Radiation Oncology.--It is increasingly evident that
combination therapy-involving radiation therapy, surgery,
chemotherapy, immunotherapy and/or precision therapy-provides
the best treatment options for many cancer patients. The
Committee applauds the recent funding announcement for
Cooperative Agreements to Develop Targeted Agents for Use with
Systemic Agents Plus Radiotherapy and supports the NCI's
prioritization of breaking down the existing silos, fostering a
collaboration of the best scientists in far-reaching fields.
Sleep Health and Cancer.--The Committee understands the
complex intersection between sleep health and cancer
development, cancer progression, and remission. The Committee
encourages NCI to explore the role of sleep in cancer
development and progression.

NATIONAL HEART, LUNG, AND BLOOD INSTITUTE

Appropriations, 2016.................................... $3,115,538,000
Budget estimate, 2017................................... 3,069,901,000
Committee recommendation................................ 3,242,685,000

The Committee recommendation includes $3,242,685,000 for
the National Heart, Lung, and Blood Institute [NHLBI].
Asthma.--The Committee applauds NHLBI for its efforts to
develop better treatments to manage severe asthma as part of
the Precision Medicine Initiative, and urges the NHLBI to
expand these efforts.
Cardiovascular Disease [CVD].--The Committee is aware that
for certain disease areas, like CVD, rural States and their
respective patient populations have disproportionately high
incidence. In the case of cardiovascular disease, high rates of
obesity, diabetes, and smoking among rural populations create
much higher risks for acute cardiovascular disease. While the
NHLBI has the primary lead for research in CVD, other
Institutes that include emphasis on children or bioengineering
have important secondary roles in helping to generate positive
research outcomes to combat this disease area. For this reason,
the Committee urges the NIH to consider convening a cross
disciplinary, multi-Institute effort to identify ways to
include rural populations in research and to work with
institutions located in heavily rural States.
Chronic Obstructive Pulmonary Disease [COPD].--The
Committee notes NHLBI's collaboration with the CDC in the
development of a COPD action plan and is pleased with the
stakeholder town hall meeting held recently on the NIH campus
to advance its completion. The Committee expects CDC and NIH to
work together to complete the action plan on a timely basis and
report bi-annually on the implementation of the plan's
recommendations. Further, the Committee remains aware and
concerned that Alpha 1 Antitrypsin Deficiency [Alpha 1] is a
major genetic risk factor for developing COPD. The Committee,
therefore, encourages NHLBI to continue to advance Alpha 1
research as part of the overall plan.
Congenital Heart Disease [CHD].--The Committee commends the
NHLBI for its continued work to better understand causation and
appropriate treatment needs for those with the most life
threatening congenital heart defects through its biomedical
research program 'Bench to Bassinet' and the critical multi-
centered infrastructure of the Pediatric Heart Network. The
Committee urges NHLBI to continue its work with other Federal
agencies and professional and patient organizations to expand
collaborative research initiatives and other related activities
targeted toward prevention and treatment of the diverse
lifelong needs of children and adults living with CHD.
Cystic Fibrosis [CF].--The Committee encourages advancement
of cell-based tools to advance new therapies to patients based
on an individual's specific CF-causing mutation. These tools
may be used to develop new personalized approaches to CF
therapeutics, including new means to identify and characterize
the efficacy of multidrug therapies that address the mutant
CFTR protein, which is the underlying cause of CF in the
majority of those with the disease. In particular, the
Committee supports research into nonsense mutations for CF,
which truncate the creation of CFTR protein in about 10 percent
of the CF population and contribute to thousands of other
genetic diseases. In addition, the Committee urges further
research into live cell imaging modalities that are able to
characterize mucus and monitor mucociliary clearance, the
defense mechanisms at the heart of CF, and many other
respiratory diseases. The Committee encourages funding for new
technologies aimed at the genetic repair of cystic fibrosis.
This includes technologies for gene editing, lung stem cell
biology and nucleic acid delivery. Such technologies are
critical for developing therapies to reach all CF patients,
especially those with mutations that are not amenable to
protein manipulation with CFTR modulating therapies.
Fibrotic Diseases.--The Committee encourages NIH to
continue to vigorously support research into fibrotic diseases
affecting different organs, including the lung, liver, kidney,
heart, and skin, and to ensure enhanced coordination between
its Institutes as they conduct necessary, expanded single organ
or cross-organ fibrotic disease research to save lives and
reduce healthcare expenses in future budget years. Furthermore,
the Committee encourages NIH to explore the creation of a
trans-NIH fibrotic disease working group, which would bring
together key stakeholders at the NIH and elsewhere, to evaluate
current research efforts and develop strategic paths forward to
maximize efforts in fibrotic disease research. The Committee
also directs NIH to include an update in its fiscal year 2018
CJ on its work relating to idiopathic pulmonary fibrosis
following the November 2012 NHLBI workshop, ``Strategic
Planning for Idiopathic Pulmonary Fibrosis.''
Heart Disease.--The Committee is aware of the enormous and
growing burden heart disease inflicts on our Nation's
population and economy, particularly as the population ages,
and strongly encourages NIH to increase its heart research
investment commensurate with the impact on public health and
scientific opportunities. The Committee looks forward to
receiving details on the Institute's strategic vision for heart
research.
Hemophilia.--The Committee encourages NHLBI to include rare
diseases such as hemophilia in its work through the Precision
Medicine Initiative. For patients with hemophilia, there is
wide variation in disease severity and therapeutic outcomes not
readily explained by the disease-causing gene mutations.
Genome-wide studies would yield new insights into the
pathogenesis of hemophilia and patient responses to therapies,
benefiting patients with bleeding disorders and broader patient
communities.
Lung Disease.--The Committee applauds NHLBI's efforts on
primary lung disease prevention, from prenatal lung development
through the aging process. The Committee requests that NHLBI
report on its efforts to prevent lung disease, which is now the
third leading cause of death in the United States, in the
fiscal year 2018 CJ.
Lymphangioleiomyomatosis [LAM].--The Committee remains very
interested in efforts to find a cure for LAM, a progressive and
often fatal lung disease in women. The Committee supports both
intramural and extramural means of expanding research on LAM
and urges NHLBI to use all available mechanisms as appropriate
to stimulate a broad range of clinical and basic research. The
Committee commends NIH for supporting multi-center LAM trials
and encourages additional support of such trials.
Pulmonary Hypertension [PH].--The Committee applauds NHLBI
for leading research efforts that have helped prolong life for
individuals affected by PH. NHLBI is encouraged to further
study the underlying mechanisms of PH, particularly idiopathic
pulmonary arterial hypertension, so that additional gains can
be made that benefit patient health and wellness.
Sickle Cell Disease [SCD].--The Committee encourages NHLBI
to devote more research to the study of SCD. Academic medical
centers located in States with significant populations of
sickle cell patients have made progress in treating the disease
through NIH-sponsored clinical trials and through blood and
marrow transplantation, which is currently the only therapy
that can cure the disease. However, more focused research is
needed to augment the limited treatment options available. The
Committee notes recent advances in treatment of SCD and urges
the Institute to support clinical trials for prenatal and
postnatal treatment of SCD, which includes multiple promising
approaches to eradicate the disease, save lives, and reduce
dramatically the substantial health care costs associated with
SCD for children and adults.
Sleep Phenotypes.--The health consequences of sleep
disorders such as obstructive sleep apnea and insomnia include
increased risk of hypertension, cardiovascular disease and
obesity. The Committee is encouraged by NHLBI's efforts to
improve our understanding of sleep disorders and urges NHLBI to
partner with other NIH Institutes to continue advancing
research for sleep phenotypes and biomarkers that further
explore health disparities and the intersection between chronic
diseases and sleep.
Thoracic Aortic Disease.--The Committee is concerned by
sudden, preventable death caused by thoracic aortic aneurysm
and dissection attributed to structural cardiovascular
disorders, such as Marfan syndrome, and encourages NHLBI to
further study the mechanisms of disease and opportunities to
improve patient health.

NATIONAL INSTITUTE OF DENTAL AND CRANIOFACIAL RESEARCH

Appropriations, 2016.................................... $413,396,000
Budget estimate, 2017................................... 404,560,000
Committee recommendation................................ 430,544,000

The Committee recommendation includes $430,544,000 for the
National Institute of Dental and Craniofacial Research [NIDCR].
Dental Materials.--Biomaterials is an important section of
biomedical research for practicing dentists. The Committee
urges NIDCR to continue to invest in the development and
innovation of dental materials.
Overlapping Pain Conditions.--The Committee commends the
NIDCR for its ongoing support for the Orofacial Pain
Prospective Evaluation and Risk Assessment program, which is
yielding valuable information on many physiological aspects of
temporomandibular disorders and overlapping pain conditions.
The Committee encourages continued research on overlapping pain
conditions and increased collaboration across NIH Institutes on
epidemiological, basic, clinical and translational research
related to pain conditions.

NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASES

Appropriations, 2016.................................... $1,816,310,000
Budget estimate, 2017................................... 1,786,086,000
Committee recommendation................................ 1,891,652,000

The Committee recommendation includes $1,891,652,000 for
the National Institute of Diabetes and Digestive and Kidney
Diseases [NIDDK].
Asian Americans and Diabetes.--The Committee supports
targeted research to examine the physiological differences
between Asian Americans and other populations affected by
diabetes with the goal of establishing appropriate indices for
risk and disease detection, including a specific Body Mass
Index cut point to identify Asian Americans with, or at risk
for, future diabetes.
Autism.--The Committee urges NIDDK to study the
relationship between GI diseases and Autism Spectrum Disorders.
Biomarkers.--The Committee encourages NIDDK to accelerate
the discovery and validation of biomarkers to aid in designing
and conducting clinical trials to prevent, treat, and cure type
1 diabetes. The Committee also encourages NIDDK to work with
NIAID to develop biomarkers specifically related to immune
interventions for multiple autoimmune diseases, including type
1 diabetes.
Celiac Disease and Type 1 Diabetes.--The Committee is
encouraged by the TEDDY study which has led to discoveries in
the risk for pediatric celiac disease and the development of
type 1 diabetes. The Committee urges the Institute to explore
the intersection of type 1 diabetes with celiac disease
prevention.
Diabetes.--The Committee recognizes the important work of
NIDDK, the lead Federal agency conducting research to find a
cure for diabetes and improve diabetes care. The Committee
recognizes the success of NIDDK-supported research in the
development of essential tools to manage diabetes, including
insulin pumps and blood glucose monitors, ongoing development
of artificial pancreas technologies, and new and better
medications to treat diabetes. The Committee urges NIDDK to
commit resources commensurate with the severity and escalating
costs of the epidemic to further diabetes research that will
build upon these past successes, improve prevention and
treatment, and bring the Nation closer to a cure.
Gestational Diabetes.--The Committee recognizes the
importance of research funded by the NIDDK related to
gestational diabetes, a disease affecting up to 9.2 percent of
all pregnant women. Given that both women with gestational
diabetes and their babies face long-term health consequences as
a result of the disease, such as increased risk of developing
type 2 diabetes, the Committee urges NIDDK to explore
additional opportunities for research on gestational diabetes.
Inflammatory Bowel Disease Genetics Consortium.--The
Committee is pleased by NIDDK's work on the Inflammatory Bowel
Disease Genetics Consortium and supports this ongoing
initiative. The Committee also urges NIDDK to expand its
portfolio on pediatric IBD research through existing and new
initiatives.
Interstitial Cystitis.--The Committee is pleased that the
Multidisciplinary Approach to the Study of Chronic Pelvic Pain
Research Network is leading to novel and multidisciplinary
efforts to study interstitial cystitis and has the potential to
have a particularly positive impact on women's health.
Irritable Bowel Syndrome [IBS].--The Committee is
encouraged by the work of NIDDK to explore symptoms of IBS
among various patient populations and urges NIDDK to further
explore the etiology of IBS and the efficacy of treatments for
IBS symptoms.
Liver Disease.--The Committee continues to be concerned by
the morbidity and mortality of Hepatitis C-related liver
disease and the development of cirrhosis, liver failure, and
liver cancer in chronically infected persons with viral
hepatitis. The Committee urges NIDDK to enhance multi-Institute
collaborations on liver research to understand these diseases.
The Committee encourages NIDDK and NIAID to collaborate
research efforts in this area.
Medical Foods.--The Committee is encouraged by the opening
of a new Office of Nutrition Research. The Committee requests
the Office develop research initiatives that explore the impact
of medical foods on nutrition and digestive disease management.
Pancreatitis and Pancreatic Cancer.--The Committee is
encouraged by NIDDK's consortium for the Study of Chronic
Pancreatitis Diabetes and Pancreatic Cancer in collaboration
with NCI. The Committee urges additional efforts to utilize the
diverse data of patients within the consortium in precision
medicine to inform targeted treatment and prevention.
Pediatric Kidney Disease.--The Committee is encouraged by
NIDDK's plans to conduct pilot studies of candidate therapies
for Pediatric Chronic Kidney Disease. These studies will
further optimize study designs for larger trials of new
pediatric chronic kidney disease treatments. Further, the
Committee continues to support NIDDK efforts to work
collaboratively with other NIH Institutes, including the NICHD
and NHLBI, to encourage multi-disciplinary research for
children and young adults with kidney disease. Such
collaborative efforts will aid in identifying childhood
antecedents of chronic kidney disease, including modifiable
risk factors that could be critical to developing interventions
for pediatric kidney disease.
Psychosocial Issues and Chronic Disease Management.--People
with chronic diseases have an elevated risk of psychosocial
issues such as depression, anxiety, and eating disorders. These
issues correlate with an increase in negative outcomes for
disease management. The Committee urges NIDDK to devote
resources toward investigating the psychosocial burdens related
to chronic diseases, particularly as it relates to type 1
diabetes, and identify steps that can be taken to help improve
disease management.

NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKE

Appropriations, 2016.................................... $1,695,180,000
Budget estimate, 2017................................... 1,659,416,000
Committee recommendation................................ 1,803,306,000

The Committee recommendation includes $1,803,306,000 for
the National Institute of Neurological Disorders and Stroke
[NINDS].
Amyotrophic Lateral Sclerosis [ALS].--The Committee
strongly supports NIH's research in ALS and encourages NIH to
continue to support promising ALS research related to IPS
cells, whole genome sequencing, biomarkers, precision medicine,
natural history studies, and translational research that could
help identify new treatments for the disease. NIH is encouraged
to partner with ALS organizations and other Federal agencies
and programs, including the ALS Research Program at DOD, the
VA, and the National ALS Registry at CDC/ATSDR. The Committee
further encourages NIH to work with FDA, industry, and other
stakeholders to identify opportunities to inform and advance
the development of treatments for ALS, particularly how the NIH
can support Phase II and Phase III clinical trials in ALS.
Cerebral Cavernous Angioma.--The Committee urges HHS
agencies [NIH, FDA, and CDC] to work together with the research
and advocacy community to increase the efficiency and
effectiveness of the research and clinical drug trials effort.
Cerebral Palsy [CP].--Over 800,000 Americans are impacted
by CP and currently there are no identified best practices at
diagnosis or through the lifespan, organized standards of care,
CP Registry, or proven therapy protocols. The Committee
commends NINDS for working with scientists and stakeholders to
develop a 5-year, research-focused strategic plan for CP
prevention, treatment, and cure through the lifespan. The
Committee urges NINDS, working with other relevant NIH ICs, to
strengthen research efforts in support of the strategic plan to
advance basic and translational research for CP, as well as
clinical efforts to improve outcomes of diverse impairments and
health issues on functioning, participation and well-being
across the lifespan.
Duchenne Muscular Dystrophy.--The Committee recommends
NINDS consider strategies that could lead to the development of
combinatorial therapies for Duchenne Muscular Dystrophy. The
Committee supports facilitating clinical trial readiness and
establishing research infrastructure needed to conduct high-
quality, efficient trials in Duchenne alongside efforts to
improve performance of clinical trial endpoints and develop and
validate biomarkers of the disease. The Committee also
recognizes that there have been significant scientific advances
in exon skipping technology since the 2010 NIH/FDA meeting and
urges the NIH, in coordination with the FDA and other agencies,
to conduct a Duchenne follow-on meeting to examine the current
state of the science of exon skipping and targeted
therapeutics.
Lyme Disease.--With over 300,000 individuals suffering from
Lyme disease, especially in rural States across the United
States, an improved understanding of the disease is essential
to the health and wellbeing of Americans. In patients who
suffer from long-term complications associated with Lyme
disease, clear treatment pathways are often missed as a result
of inaccurate and incomplete testing. The Committee urges the
NINDS, in coordination with CDC, to study the long-term effects
of Lyme disease. Specifically, the Committee urges NINDS to
evaluate the effectiveness of laboratory tests associated with
the detection of Borrellia burgdori to diagnose the disease
early, which can improve the effectiveness of treatment.
Parkinson's Disease.--The Committee commends NINDS for
taking critical steps in identifying priority research
recommendations to advance research on Parkinson's disease,
which impacts between 500,000 and 1,500,000 Americans and is
the second most prevalent neurodegenerative disease in the
United States. The 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. The
Committee also encourages NINDS to submit an update of its
progress on implementing these recommendations in the fiscal
year 2018 CJ.
Peripheral Neuropathies.--The Committee notes the lack of
ongoing research into Guillain-Barre syndrome, chronic
inflammatory demyelinating polyneuropathy, and related
conditions, and encourages NINDS to work with stakeholders to
identify research needs and develop strategies for supporting
critical projects.
Stroke.--The Committee recognizes the immense burden stroke
places on our Nation's population and economy, and strongly
support NINDS increase its stroke research efforts. NINDS is
also encouraged to continue to implement top priorities
identified in the 2012 planning initiative for stroke
prevention, treatment, and recovery research, particularly
augmentation of the Stroke Clinical Trials Network, including
early stroke recovery.

NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES

Appropriations, 2016.................................... $4,715,697,000
Budget estimate, 2017................................... 4,700,548,000
Committee recommendation................................ 4,961,305,000

The Committee recommendation includes $4,961,305,000 for
the National Institute of Allergy and Infectious Diseases
[NIAID].
Autoimmune Neuropathies.--The Committee encourages NIAID to
work with NINDS and other ICs to support efforts to gauge the
state-of-the-science of autoimmune neuropathies research into
conditions like Guillain-Barre syndrome and chronic
inflammatory demyelinating polyneuropathy, and to establish a
cross-cutting research plan for this portfolio.
Combating Antibiotic Resistant Bacteria [CARB].--With the
identification of the first case of CRE in the United States
last month, the Committee remains deeply concerned by the
threat posed by the rise of antibiotic resistant bacteria. The
Committee continues to strongly support NIAID's work related to
CARB and includes approximately $463,000,000, an increase of
$50,000,000, for NIAID to expand efforts to develop new
antibiotics and rapid diagnostic tests, and build a national
genome sequence database on all reported resistant human
infections. Critical to the success of these efforts is
developing a comprehensive understanding of the biological
mechanisms that cause or contribute to antibiotic resistance,
both in terms of resistance due to human activity or by
inherent natural processes. This fundamental knowledge will
enhance efforts to responsibly steward existing antibiotics,
develop new antibiotics, and repurpose current antibiotics in
new ways or combinations. The Committee encourages NIH and FDA
to convene industry and other stakeholders to develop
strategies to augment and enhance the infrastructure supporting
clinical trials of new antibiotics. The Committee also
encourages NIH to continue and expand its collaboration with
USDA and CDC to develop a research strategy to promote a
fundamental understanding of antibiotic resistance and
improving the responsible use of antibiotics in agriculture.
The Committee requests an update on these activities in the
fiscal year 2018 CJ.
Healthcare-Associated Infections [HAIs].--HAIs are
estimated to occur in 5 percent of all hospitalizations in the
United States, resulting in more than 1,700,000 illnesses and
99,000 deaths annually. While HHS has been leading efforts to
develop and encourage hospitals to implement improved infection
control strategies, potential solutions are complicated by the
difficulty of removing dangerous pathogens, including
multidrug-resistant organisms, from the clinical environment by
disinfection protocols alone. The Committee has been encouraged
by the progress made in reducing central line-associated
bloodstream infections and methicillin-resistant Staphylococcus
aureus bacteremia, but there has been little or no improvement
since 2009 in, for example, the rates of catheter-associated
urinary tract infections and colon surgery surgical site
infections [SSI]. Clearly, more action is needed at every level
of health care to eliminate infections that commonly threaten
hospital patients. As efforts to develop a systems approach to
decontamination increase, one of most promising areas of
research is related to technologies that can provide surfaces
with self-disinfection capability. Advancements in this area
could be greatly beneficial to health outcomes, reduce
healthcare expenses, and improve patient life-quality. The
Committee encourages NIAID to support efforts to accelerate the
development of self-disinfecting medical devices, disinfecting
strategies to alleviate SSIs, as well as materials engineering
approaches to minimize or prevent the transmission of pathogens
from surfaces within clinical care environments.
Hepatitis B.--The Committee is aware that it is now
possible to study the entire Hepatitis B virus life cycle, and,
therefore, a research program to identify life cycle
vulnerabilities. The Committee encourages NIAID to collaborate
with NIDDK to advance innovative research to discover and
develop new therapies and treatments to interrupt the life
cycle of the Hepatitis B virus to eliminate the infection and
to help cure this deadly disease.
Hereditary Angioedema [HAE].--The Committee applauds NIAID
for co-hosting the Expanding Boundaries of our HAE Knowledge
Conference and supports its focus on continuing HAE research
activities moving forward.
HIV/AIDS.--The Committee appreciates that NIAID has made
reducing the incidence of HIV/AIDS, including the development
of safe and effective vaccines, a high priority. The Committee
is aware of several promising HIV vaccine candidates, including
candidates that use novel immunogens and vaccine platforms,
such as cytomegalovirus [CMV]. The Committee supports NIAID
efforts to advance such innovative and promising vaccine
candidates into early clinical testing.
Tuberculosis [TB].--The Committee encourages NIAID to
continue prioritizing and implementing the National Action Plan
for Combating Multi-drug Resistant Tuberculosis, including
addressing the Plan's objectives, and coordinating with other
TB research agency partners including USAID and CDC.

NATIONAL INSTITUTE OF GENERAL MEDICAL SCIENCES

Appropriations, 2016.................................... $2,512,437,000
Budget estimate, 2017................................... 2,434,144,000
Committee recommendation................................ 2,633,755,000

The Committee recommendation includes $2,633,755,000 for
the National Institute of General Medical Sciences [NIGMS],
which includes $857,000,000 in transfers available under
section 241 of the PHS Act.
Institutional Development Award [IDeA].--The Committee
provides $333,361,000 for the IDeA program, an increase of
$13,277,000. The IDeA program continues to support high-quality
research throughout the country and enhances the
competitiveness of investigators at institutions located in
States in which the aggregate success rate for NIH grants has
been historically low. Discoveries and medical breakthroughs
can come from anywhere, and the Committee continues to strongly
support the IDeA program, particularly its focus on serving
rural and medically underserved communities in IDeA States. In
particular, the Committee is concerned that many institutions
eligible for funding under the National Science Foundation's
Experimental Program to Stimulate Competitive Research [EPSCoR]
are ineligible to participate in the IDeA program. The
Committee directs NIGMS to report to the Committee no later
than 120 days after enactment of this act with updated IDeA
eligibility criteria that would incorporate EPSCoR States into
the IDeA program.
Science Education Partnership Awards [SEPA].--SEPA fosters
important connections between biomedical researchers and K-12
teachers and their students. These connections establish an
education pipeline to careers in biomedical sciences, which is
one of the most important areas of workforce development for
the U.S. economy. Therefore, NIH is directed to continue
funding the SEPA program at no less than $17,100,000, the
fiscal year 2016 level. Further, because of the central role
NIGMS plays in managing programs that support the development
of the biomedical research workforce, the Committee transfers
the SEPA program from OD to NIGMS.
Small Business Research Funding.--The Committee supports
the initiative to direct small business research funding to
IDeA States to foster the development of products to advance
public health. The Committee asks NIGMS to consider allocating
funding for one shared innovation incubator in each of the four
IDeA regions that would be competitively bid among IDeA States
and would serve IDeA States. NIH shall not use funding from its
IDeA allocation for these grants.

EUNICE KENNEDY SHRIVER NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN
DEVELOPMENT

Appropriations, 2016.................................... $1,338,348,000
Budget estimate, 2017................................... 1,316,607,000
Committee recommendation................................ 1,395,811,000

The Committee recommendation includes $1,395,811,000 for
the Eunice Kennedy Shriver National Institute of Child Health
and Human Development [NICHD].
Demographic Research.--The NICHD Population Dynamics Branch
fosters scientific understanding of changes in human health and
development at the population level by supporting research and
research training in demography--the scientific study of human
populations--and reproductive health. The Committee urges NICHD
to sustain this research by making a strong investment in its
Population Dynamics Centers Research Infrastructure Program.
Further, the Committee supports NICHD's efforts to make wise
investments in large-scale longitudinal scientific surveys and
prioritize data sharing as a condition of award. Making these
survey data widely available efficiently promotes and supports
broad-based scientific research activities on health and
development.
Fragile X.--The Committee commends NICHD for leading the
effort to map the molecular, physiological, biological, and
genetic connections between fragile X [FX], and the fragile X
protein, and autism spectrum disorder. The fragile X gene and
its protein continue to present important insight into
discovering the root cause of autism and disease modifying
treatments for FX and autism. The Committee urges the NICHD to
explore ways to utilize funding for FX and autism in tandem to
accelerate the pace of research toward identification of the
commonality between the two conditions and the development of
disease modifying treatments that will reduce health burdens.
Intellectual and Developmental Disabilities Research
Centers [IDDRC].--The Committee recognizes the outstanding
contributions of the IDDRCs toward understanding why child
development goes awry, discovering ways to prevent
developmental disabilities, and discovering treatments and
interventions to improve the lives of people with developmental
disabilities and their families. The Committee urges NICHD to
continue to support the IDDRCs to conduct basic and
translational research to develop effective prevention,
treatment, and intervention strategies for children and adults
with developmental disabilities.
Preterm Birth.--The Committee applauds NICHD's work with
leading global health organizations to develop a research
agenda aimed at reducing preterm birth. Public and privately
funded research that, taken together, spans the range of
discovery, development, and delivery science is needed to
identify the causes of premature birth. The Committee urges
NICHD to enhance investments in biomedical and clinical
research related to the prevention of preterm birth and the
care and treatment of preterm infants.

NATIONAL EYE INSTITUTE

Appropriations, 2016.................................... $707,998,000
Budget estimate, 2017................................... 687,249,000
Committee recommendation................................ 740,826,000

The Committee recommendation includes $740,826,000 for the
National Eye Institute [NEI].
Age-Related Macular Degeneration [AMD].--The Committee
recognizes NEI's leadership in identifying more than 500 genes
associated with both common and rare eye diseases. NEI's
International AMD Genomics Consortium has now discovered a
total of 52 genetic variants that are associated with AMD,
located among 34 regions of the human genome called loci, 16 of
which had not been previously associated with AMD. With past
NEI-funded research solidifying a link between AMD and genes
encoding the complement system, a set of proteins that plays a
central part in immune responses and inflammation, the
Committee anticipates additional findings from initial research
that suggest that a class of medications used to treat HIV,
called nucleoside reverse transcriptase inhibitors [NRTIs],
shows promise to treat AMD, and may be repurposed to treat
other inflammatory disorders.
Audacious Goals Initiative [AG].--The Committee commends
NEI's leadership through its Audacious Goals Initiative, which
aims to restore vision within the next decade through
regeneration of the retina by replacing cells that have been
damaged by disease and injury and restoring their visual
connections to the brain. The Committee is pleased that NEI has
awarded the first set of grants associated with novel imaging
technologies to help clinicians observe the function of
individual neurons in human patients and follow them over time
as they test new therapies, and will proceed with a second
round of awards associated with identifying new factors that
control regeneration and comparing the regenerative process
among model organisms, rodents, and non-human primates.
Cataract.--The Committee recognizes that clouding of the
eye's lens in cataracts is the leading cause of blindness
worldwide. It commends recent NEI-funded research that reported
on the use of the fiber optic-based dynamic light scattering
technology, developed by NASA, to estimate the level of the
structural protein alpha-crystalline in the lens every 6 months
in patients at risk for cataracts over the course of 3 years.
This effort confirmed the correlation of the loss of protein
with the rate of nuclear cataract progression, enabling
clinicians to determine cataract progression and a potential
time to intervene to prevent their formation. The Committee is
also pleased that a recent NEI study has identified molecules
that restore transparency to the lens in animal models, which
could lead to therapies being delivered by eye drops, thereby
eliminating surgery.
Diabetic Retinopathy Clinical Research Network.--The
Committee commends NEI for the collaborative efforts of the
Diabetic Retinopathy Clinical Research Network. The Committee
acknowledges the importance of clinical trial networks and
hopes the NEI will maintain the Diabetic Retinopathy Clinical
Research Network's commitment to facilitating clinical research
on diabetic retinopathy. The Committee strongly encourages the
NEI to build on the success of the Diabetic Retinopathy
Clinical Research Network to expand and extend the scope of the
network to include other retinal diseases.
Glaucoma.--The Committee recognizes the identification of
three new genes by the NEI Glaucoma Human Genetics
Collaboration Heritable Overall Operational Database Consortium
that are strongly associated with primary open-angle glaucoma,
the most common form of the disease. The finding that variants
of these genes may alter the protection of the optic nerve from
degeneration due to oxidative stress increases the total number
of genes associated with primary open angle glaucoma to 15,
demonstrating that the underlying mechanisms of the disease may
involve the interaction of many genes with environmental
influences.
Usher Syndrome.--The Committee continues to urge the
prioritization of Usher syndrome research at NEI. The Committee
requests an update on NEI and NIDCD basic, clinical, and
translational research that will lead to additional treatment
options and improved patient outcomes for individuals with
Usher syndrome. The update should include a description of the
criteria used by NIH to evaluate grant submissions to ensure
the prioritization of those that accelerate human treatment
options that would benefit individuals with Usher syndrome.

NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES

Appropriations, 2016.................................... $693,533,000
Budget estimate, 2017................................... 681,613,000
Committee recommendation................................ 722,301,000

The Committee recommendation includes $722,301,000 for the
National Institute of Environmental Health Sciences [NIEHS].
Autism.--The Committee urges the NIEHS, as the lead agency
on environmental health research and a member agency of the
Interagency Autism Coordinating Committee [IACC], to ask the
IACC to consider research on environmental factors related to
autism, including onset patterns, in the upcoming revision to
the IACC Strategic Plan for Autism Research. In addition, as
the lead NIH Institute on Autism Spectrum Disorders research,
the Committee suggests that NIMH work in coordination with
NIEHS to assure that research on environmental factors
continues to be supported.
Healthy Housing.--The Committee encourages NIEHS to further
study the impact healthy housing has on reducing environmental
exposures that lead to health risks such as asthma and lead
poisoning.

NATIONAL INSTITUTE ON AGING

Appropriations, 2016.................................... $1,598,246,000
Budget estimate, 2017................................... 1,265,133,000
Committee recommendation................................ 2,067,138,000

The Committee recommendation includes $2,067,138,000 for
the National Institute on Aging [NIA].
Alzheimer's Disease.--The bill includes approximately
$1,391,000,000, an increase of $400,000,000 above fiscal year
2016, for high-quality research on Alzheimer's disease, subject
to the scientific opportunity presented in the peer review
process. NIA is encouraged to continue addressing the research
goals set forth in the National Plan to Address Alzheimer's
Disease, as well as the recommendations from the Alzheimer's
disease Research Summit in 2015. Further, the Committee
recognizes the importance of well-characterized, longitudinal,
population-based cohort studies in providing new insights into
risk factors related to dementia, with special focus on
minority populations where disease burden is greatest. As the
participants in these studies have aged, much has been learned
about cognitive decline and the role of mid-life risk factors,
but key challenges remain, particularly in the identification
of biomarkers and in understanding the role of environmental
versus genetic factors. The Committee directs NIH to support
research involving the subsequent generations of such cohorts,
as studying the adult children of these extensively
characterized cohort members may provide new insights into risk
identification and accelerated prevention efforts. In
particular, NIA is encouraged to fund a pilot program to test
community-based clinical trials for the prevention of cognitive
decline. Such a longitudinal study should include an ethnically
representative sample, incorporate genomic and environmental
Alzheimer's disease risk factors and monitor cognitive and
motor function, disability, and morbidity over time. The
Committee notes that poor sleep health and sleep disorders
progress diseases that impair cognitive functioning, such as
Alzheimer's disease. The Committee encourages support for
research that explores the linkages between sleep cycle,
cardiovascular system, and Alzheimer's disease, in an effort to
inform prevention. Priority consideration should be given to
applicants with a NIA designated Alzheimer's Disease Center,
Alzheimer's Disease Accelerating Medicines Partnership award,
and at least one Patient-Centered Outcomes Research Institute
grant. Finally, the Committee is particularly interested in
NIH's plans to place additional emphasis on high-risk, high-
reward projects using a DARPA-like approach to goal-oriented
and milestone-driven research. The Committee believes such an
approach can be particularly valuable in addressing major
scientific gaps and encourages NIH to establish clear
priorities, including Alzheimer's disease and dementia and
other high-cost diseases of aging, particularly given our
national goal of preventing and effectively treating
Alzheimer's disease by 2025.
Demographic Research.--The Committee is greatly concerned
by the health and financial threats that dementia-related
disorders, including Alzheimer's disease, pose as the U.S.
population ages. NIA is urged to respond by investing in the
full spectrum of scientific research, including population
research, to address the complex nature of dementia-related
disorders and its devastating effects on patients, families,
and caregivers. This effort should include sustained investment
in large-scale longitudinal studies, such as the Health and
Retirement Study. The Committee encourages NIA to support
research and data collection on the causes of widening
disparities in health and longevity at older ages, and the role
of social factors, such as education and income, in the health
and well-being of older people.

NATIONAL INSTITUTE OF ARTHRITIS AND MUSCULOSKELETAL AND SKIN DISEASES

Appropriations, 2016.................................... $541,662,000
Budget estimate, 2017................................... 532,753,000
Committee recommendation................................ 564,131,000

The Committee recommendation includes $564,131,000 for the
National Institute of Arthritis and Musculoskeletal and Skin
Diseases [NIAMS].
Arthritis Disparities.--Research from CDC notes that
minority groups, including African American and Latino/Hispanic
populations, experience higher rates of arthritis-attributable
activity and work limitations than other populations. The
Committee encourages NIAMS to support research to understand
these disparities, in collaboration with NIMHD.
Epidermolysis Bullosa [EB].--The Committee recognizes the
promising scientific gains made in pursuit of treatments for EB
and supports the private partners working to advance research
towards practical EB treatments. Further research in this area
holds great promise for both EB and for other skin and
connective-tissue disorders treatments. The Committee
encourages the NIH to continue to support meritorious research
and collaboration activities related to EB.

NATIONAL INSTITUTE ON DEAFNESS AND OTHER COMMUNICATION DISORDERS

Appropriations, 2016.................................... $422,936,000
Budget estimate, 2017................................... 416,146,000
Committee recommendation................................ 441,778,000

The Committee recommendation includes $441,778,000 for the
National Institute on Deafness and Other Communication
Disorders [NIDCD].
Otolaryngology.--The Committee is concerned that research
in the study of human temporal bone tissues may be jeopardized
by the loss of technical and pathological expertise in this
field. Active temporal bone laboratories are largely
responsible for the pathologic characterizations of many of the
diseases that are treated on a frequent basis, including
otosclerosis, Meniere's disease and chronic otitis media.
However, there are other disorders for which the pathology has
not been well characterized and the need remains for the active
participation of multiple laboratories to develop new
techniques to allow for molecular investigations that have not
been possible in the past. The Committee urges NIDCD to work
with the otolaryngology community to facilitate new and
innovative therapies that examine the pathology of the ear and
to ensure that hypothesis driven research is retained in
pathology centers.
Usher Syndrome.--The Committee continues to encourage the
NIDCD to prioritize Usher syndrome research. The Committee
requests an update on NEI and NIDCD basic, clinical, and
translational research that will lead to additional treatment
options and improved patient outcomes for individuals with
Usher syndrome. The update should include a description of the
criteria used by NIH to evaluate grant submissions to ensure
that prioritization of those that accelerate human treatment
options that would benefit individuals with Usher syndrome.

NATIONAL INSTITUTE OF NURSING RESEARCH

Appropriations, 2016.................................... $145,912,000
Budget estimate, 2017................................... 143,942,000
Committee recommendation................................ 151,965,000

The Committee recommendation includes $151,965,000 for the
National Institute of Nursing Research [NINR].
Nursing Research.--The Committee supports NINR's Strategic
Plan, Bringing Science to Life, as well as its efforts to
bolster the new NIH-Wide Strategic Plan. The Committee applauds
NINR's aim to enhance health promotion and disease prevention.
The Committee supports NINR's commitment to improving quality-
of-life by managing symptoms of acute and chronic illness;
improving palliative and end-of-life care; enhancing innovation
in science and practice; and developing the next generation of
nurse scientists. The Committee remains particularly interested
in NINR's efforts to invest in young nurse scientists who will
produce the evidence to improve quality of care nationally and
globally.

NATIONAL INSTITUTE ON ALCOHOL ABUSE AND ALCOHOLISM

Appropriations, 2016.................................... $467,445,000
Budget estimate, 2017................................... 459,578,000
Committee recommendation................................ 488,782,000

The Committee recommendation includes $488,782,000 for the
National Institute on Alcohol Abuse and Alcoholism [NIAAA].
Genomic Research and Alcohol Dependence.--The Committee
remains concerned about the negative impact of alcohol abuse
both to individuals struggling with alcoholism and to the
budgets of Federal health programs. Research has implicated
several gene variants that confer risk for Alcohol Use Disorder
[AUD] and posttraumatic stress, suggesting that there may be
shared genetic vulnerabilities for these disorders. The
Committee encourages the NIAAA to capitalize on advances in
genetic tools and available datasets to gain additional insight
into the genetics of co-occurring AUD and posttraumatic stress
to inform prevention and treatment for affected individuals.
NIAAA shall provide a report to the Committee within 180 days
after enactment of this act that provides a detailed plan on
how to move large-scale genetic screening initiatives forward
to focus on high-risk populations, including those who exhibit
alcohol dependency after suffering from post-traumatic stress.

NATIONAL INSTITUTE ON DRUG ABUSE

Appropriations, 2016.................................... $1,050,550,000
Budget estimate, 2017................................... 1,020,459,000
Committee recommendation................................ 1,103,032,000

The Committee recommendation includes $1,103,032,000 for
the National Institute on Drug Abuse [NIDA].
Adolescent Brain Development.--The Committee recognizes and
supports the Adolescent Brain and Cognitive Development [ABCD]
Study, which will continue to study the dramatic brain
development that takes place during adolescence and how the
various experiences children are exposed to during this time
interact with each other and a child's brain development. As
the largest longitudinal brain-imaging study of youth, the ABCD
study will follow approximately 10,000 U.S. children from ages
9-10 into early adulthood, and will yield critical insights
into the foundational aspects of adolescence that shape life
trajectories. The Committee requests an update on the ABCD
study in the fiscal year 2018 CJ.
Drug Treatment in Justice System Settings.--The Committee
understands that providing evidence-based treatment for
substance use disorders offers a strong alternative for
interrupting the drug use/criminal justice cycle for offenders
with drug problems. NIDA's Juvenile Justice Translational
Research on Interventions for Adolescents in the Legal System
[JJ-TRIALS] program identifies and tests strategies for
improving the delivery of evidence-based substance abuse and
HIV prevention and treatment services for justice-involved
youth. The JJ-TRIALS initiative will provide insight into the
process by which juvenile justice and other service settings
can successfully adopt and adapt existing evidence-based
programs and strategies to improve treatment for at-risk youth.
The Committee requests an update on the JJ-TRIALS in the fiscal
year 2018 CJ.
Expansion of Research on Opioid Alternatives.--The
Committee remains concerned about the growing epidemic of
opioid overdoses. The widespread availability of opioid
painkillers has contributed to the millions of Americans who
suffer from addiction disorders. Although NIDA has studied the
effectiveness and risks associated with long-term opioid use
for chronic pain, little research has been done to investigate
new and alternative treatment options for treating pain, both
acute and chronic. The Committee strongly encourages NIDA to
expand scientific activities related to research on medications
used to treat and reduce chronic pain. In doing this, NIDA
should coordinate with CDC, HHS, VA, FDA, DOD, DEA, industry,
experts in the field of pain research and addiction, and the
medical research community at large, to identify gaps in
scientific research related to opioid abuse and addiction, and
the treatment of acute and chronic pain. In addition, NIDA
should continue to sponsor research to better understand the
effects of long-term prescription opioid use, especially as it
relates to the prevention and treatment of opioid abuse and
addiction.
Medications Development.--The Committee recognizes that new
technologies are required for the development of next-
generation pharmaceuticals. The Committee is encouraged by
NIDA's current approaches to develop viable immunotherapeutic
or biologic methods for treating addiction. The goal of this
research is the development of safe and effective vaccines or
antibodies that target specific addictive drugs. The Committee
is encouraged by this approach; if successful, immunotherapies,
alone or in combination with other medications, behavioral
treatments, or enzymatic approaches, stand to revolutionize how
we treat, and ultimately prevent addiction.
Opioid Misuse and Addiction.--The Committee appreciates the
important role that research plays in the various Federal
initiatives aimed at addressing the opioid crisis. The
Committee urges NIDA to continue to fund research on
medications to alleviate pain, including the development of
those with reduced abuse liability, and continue to work with
industry to fund innovative research into such medications. The
Committee requests an update in the fiscal year 2018 CJ on
these initiatives.
Raising Awareness of Drug Abuse and Addiction Prevention
and Treatment.--Education is a critical component of any effort
to curb drug use and addiction, and it must target every
segment of society, including healthcare providers, patients,
and families. Through its NIDAMeD initiative, NIDA is advancing
addiction awareness, prevention, and treatment in primary care
practices through seven Centers of Excellence for Physician
Information. Intended to serve as national models, these
centers target physicians-in-training, including medical
students and resident physicians in primary care specialties.
NIDA also developed, in partnership with the Office of National
Drug Control Policy, two online continuing medical education
courses on safe prescribing for pain and managing patients who
abuse prescription opioids. The Committee is pleased with
NIDAMed, and urges NIDA to continue its focus on activities to
provide physicians and other medical professionals with the
tools and skills needed to incorporate drug abuse screening and
treatment into their clinical practices.

NATIONAL INSTITUTE OF MENTAL HEALTH

Appropriations, 2016.................................... $1,518,673,000
Budget estimate, 2017................................... 1,459,700,000
Committee recommendation................................ 1,619,537,000

The Committee recommendation includes $1,619,537,000 for
the National Institute of Mental Health [NIMH].
Autism.--As the lead agency on Autism Spectrum Disorders
policy, the Committee urges the NIMH to include research on
environmental factors related to autism, especially regressive
autism, in the upcoming revision to the Strategic Plan for
Autism Research.

NATIONAL HUMAN GENOME RESEARCH INSTITUTE

Appropriations, 2016.................................... $513,227,000
Budget estimate, 2017................................... 509,762,000
Committee recommendation................................ 534,516,000

The Committee recommendation includes $534,516,000 for the
National Human Genome Research Institute [NHGRI].

NATIONAL INSTITUTE OF BIOMEDICAL IMAGING AND BIOENGINEERING

Appropriations, 2016.................................... $343,506,000
Budget estimate, 2017................................... 334,025,000
Committee recommendation................................ 361,062,000

The Committee recommendation includes $361,062,000 for the
National Institute of Biomedical Imaging and Bioengineering
[NIBIB].
Healthcare-Associated Infections [HAIs].--HAIs are
estimated to occur in 5 percent of all hospitalizations in the
United States, resulting in more than 1.7 million illnesses and
99,000 deaths annually. While HHS has been leading efforts to
develop and encourage hospitals to implement improved infection
control strategies, potential solutions are complicated by the
difficulty of removing dangerous pathogens, including
multidrug-resistant organisms, from the clinical environment by
disinfection protocols alone. The Committee has been encouraged
by the progress made in reducing central line-associated
bloodstream infections and methicillin-resistant Staphylococcus
aureus bacteremia, but there has been little or no improvement
since 2009 in, for example, the rates of catheter-associated
urinary tract infections and colon surgery surgical site
infections [SSI]. Clearly, more action is needed at every level
of health care to eliminate infections that commonly threaten
hospital patients. As efforts to develop a systems approach to
decontamination increase, one of most promising areas of
research is related to technologies that can provide surfaces
with self-disinfection capability. Advancements in this area
could be greatly beneficial to health outcomes, reduce
healthcare expenses, and improve patient life-quality. The
Committee encourages NIBIB to support efforts to accelerate the
development of self-disinfecting medical devices, disinfecting
strategies to alleviate SSIs, as well as materials engineering
approaches to minimize or prevent the transmission of pathogens
from surfaces within clinical care environments.

NATIONAL CENTER FOR COMPLEMENTARY AND INTEGRATIVE HEALTH

Appropriations, 2016.................................... $129,941,000
Budget estimate, 2017................................... 126,673,000
Committee recommendation................................ 136,195,000

The Committee recommendation includes $136,195,000 for the
National Center for Complementary and Integrative Health
[NCCIH].
Pain Management.--The Committee is encouraged by the
ongoing collaboration between NCCIH, VA, DOD, and other NIH
Institutes to develop and test efficacious non-pharmacological
approaches to pain management and comorbidities-including
opioid misuse, abuse, and disorder-in military personnel,
veterans, and their families. As opioid prescribing rates have
increased at the VA in recent years, and opioid abuse has risen
among young veterans, the Committee believes it is critical to
support research on non-pharmacological treatments to ensure
the best quality of care for our Nation's veterans and
servicemembers, and urges the NIH, VA, and DOD to continue this
vital research.

NATIONAL INSTITUTE ON MINORITY HEALTH AND HEALTH DISPARITIES

Appropriations, 2016.................................... $280,680,000
Budget estimate, 2017................................... 279,680,000
Committee recommendation................................ 292,323,000

The Committee recommendation includes $292,323,000 for the
National Institute on Minority Health and Health Disparities
[NIMHD].
Cohort Studies.--The Committee is aware of novel efforts
underway to recruit individuals from racially and ethnically
diverse backgrounds for participation in the PMI Cohort
Program. Information from the cohort will be a broad, powerful
resource for researchers working on a variety of important
health questions. The Committee applauds NIH's efforts to
partner with HRSA to begin partnerships with several Federally
Qualified Health Centers to develop, pilot, and refine
approaches for bringing underserved individuals, families, and
communities into the PMI Cohort Program. The Committee believes
that the NIMHD can and should help support these efforts to
ensure participation of racially and ethnically diverse
individuals.
Research Centers in Minority Institutions.--The Committee
continues to recognize the critical role played by minority-
serving institutions in addressing minority health and health
disparities, while also providing training for a diverse health
workforce. In particular, the RCMI program fosters the
development of new generations of minority scientists for the
Nation and provides support for crucial gaps in the biomedical
workforce pipeline, with each $1 invested being leveraged to
generate an additional $5 to $6 in competitive research
funding. The RCMI program has the capability to promote
solutions to the significant gap in R01 grant funding among
black and other minority researchers when compared to non-
minority researchers. The Committee remains concerned NIMHD may
be considering changing RCMI's configuration and funding
structure without adequate congressional or stakeholder input.
Therefore, the Committee directs NIH to maintain the existing
vital infrastructure support provided through the RCMI program
and make available not less than last year's level for the RCMI
program. Further, NIMHD is directed to provide an update to the
Committee no later than 90 days after enactment of this act on
any proposed changes to the program and prior to any changes
being implemented.

JOHN E. FOGARTY INTERNATIONAL CENTER FOR ADVANCED STUDY IN THE HEALTH
SCIENCES

Appropriations, 2016.................................... $70,117,000
Budget estimate, 2017................................... 69,175,000
Committee recommendation................................ 73,026,000

The Committee recommendation includes $73,026,000 for the
Fogarty International Center [FIC].
Global Health Research.--Recent disease outbreaks such as
Ebola and the flu have shown the importance of the Center's
essential role in global infectious disease health research
training and health system strengthening. These efforts help
developing countries to eventually advance their own research
and health solutions and tools. FIC also has developed
partnerships in countries to fight malaria, neglected tropical
diseases, and other infectious diseases that disproportionately
impact the global poor. The Committee urges FIC to continue
this important work of building relationships with scientists
abroad to foster a stronger and more effective science
workforce and health capacity on the ground, and improving the
image of the United States through health diplomacy in their
countries.

NATIONAL LIBRARY OF MEDICINE

Appropriations, 2016.................................... $395,684,000
Budget estimate, 2017................................... 395,110,000
Committee recommendation................................ 412,097,000

The Committee recommends $412,097,000 for the National
Library of Medicine [NLM]. Of the funds provided, $4,000,000 is
for the improvement of information systems, to remain available
until September 30, 2018.

NATIONAL CENTER FOR ADVANCING TRANSLATIONAL SCIENCES

Appropriations, 2016.................................... $685,417,000
Budget estimate, 2017................................... 660,131,000
Committee recommendation................................ 713,849,000

The Committee recommendation includes $713,849,000 for the
National Center for Advancing Translational Sciences [NCATS].
The Committee includes bill language allowing up to $25,835,000
of this amount, the same as the budget request and fiscal year
2016, to be used for the Cures Acceleration Network [CAN].
Clinical and Translational Science Awards [CTSA] Program.--
The Committee includes $520,740,000, an increase of
$20,740,000, for the CTSA Program. The Committee applauds the
success of the CTSA Program and recognizes recent NCATS efforts
to update the program following the recommendations of the
Institute of Medicine. NCATS is encouraged to further integrate
the CTSA Program into the full spectrum of medical research
activities at NIH, including collaboration with other ICs, and
greater support for the CTSA hubs and network.

OFFICE OF THE DIRECTOR

Appropriations, 2016.................................... $1,558,600,000
Budget estimate, 2017................................... 1,432,859,000
Committee recommendation................................ 1,731,152,000

The Committee recommendation includes $1,731,152,000 for
the Office of the Director [OD]. Within this total,
$790,542,000 is provided for the Common Fund, which includes
$230,000,000 for the Precision Medicine Initiative, an increase
of $100,000,000 above fiscal year 2016.
Academic Research Enhancement Award [AREA] Program.--The
Committee believes that biomedical discoveries can occur
anywhere, and continues to support programs that foster
biomedical research and opportunities for students at
institutions who may not receive significant NIH funding. In
particular, the Committee continues its long-standing support
of the IDeA program. However, the Committee notes that many
institutions that may benefit from the IDeA program are
ineligible because they reside in States that are EPSCoR
States, but not IDeA States. The Committee encourages NIH to
enhance support for the AREA program by holding regional
workshops to provide guidance on writing and submitting R15/
AREA applications and on developing institutional capacities
for undergraduate research. Further, NIH is urged to develop
ways to improve ties between institutions that receive
significant NIH funding and AREA-eligible institutions.
Amyloidosis.--The Committee recommends that NIH continue
its research efforts into amyloidosis, a group of rare diseases
characterized by abnormally folded protein deposits in tissues.
Amyloidosis is often fatal and there is no known cure. Current
methods of treatment are risky and unsuitable for many
patients. The Committee requests NIH to update the Committee on
the steps taken to increase the understanding of the causes of
amyloidosis and the efforts to improve the diagnosis and
treatment of this devastating group of diseases.
Angiogenesis.--The Committee commends the NIH for posting
the Trans-NIH Angiogenesis Workshop findings. The Committee
urges NIH to address the needs outlined in the comments
including, the establishment of cross-disciplinary
collaborations across therapeutic fields by NCI, NHLBI, NIDDK,
NEI and other institutes, and the creation of a trans-NIH
Program Project Grant. The Committee further encourages NIH to
examine angiogenesis modifying interventions across populations
using data to identify differences in response and benefit
across age, gender, ethnicity/race/ancestral categories,
socioeconomic strata, chronic disease States, and genetic
background. Specifically, NIH is encouraged to study:
angiogenesis and metabolism; biomarkers that reflect normal and
abnormal angiogenesis; epigenetic changes of angiogenesis
induced by natural stimuli such as diet, physical activity, and
lifestyle, as well as medications; the effect of angiogenesis
regulation on health and disease outcomes; the functional
connections between angiogenesis and other health defense
systems in the body (inflammation, regeneration, anti-aging,
and immunity).
Big Data Infrastructure Plan.--Biomedical research has
become increasingly reliant on growing amounts of digital data,
a development with tremendous--and potentially disruptive--
promise if this data can be used effectively by the research
community to enable major scientific breakthroughs. Figuring
out how to make this possible is one of the biggest issues
facing NIH as it pursues ambitious initiatives related to
cancer, the human brain, Alzheimer's disease, and other
challenges. In 2012, NIH began an extramural program to provide
a framework of pilot programs, centers of excellence, and grant
opportunities to advance thinking in how to organize, share,
and use big data. The Committee believes that NIH now needs to
build on this progress by developing a strategic plan to
realize the full potential of these efforts for NIH's
Institutes and Centers. The Committee directs NIH to provide
such a plan to the Committee within 1 year of enactment of this
act. This plan should describe how NIH intends to make big data
sustainable, interoperable, accessible and usable, and include
a roadmap to achieve these objectives. The plan should be
developed with the input of external partners and stakeholders,
and include milestones and estimates of the resources that will
be necessary to achieve its goals.
Brain Health.--The Committee supports brain health
research, education, and care that can be advanced through
collaborative and interdisciplinary efforts that seek to study
issues of cognition across the age spectrum with a goal to
improve overall community health. The Director is strongly
encouraged to recognize brain health as a top research priority
with a special emphasis for initiatives that cross the age
continuum and include autism, PTSD/TBI, and Alzheimer's
Disease.
Brain Research through Application of Innovative Neuro-
technologies [BRAIN] Initiative.--The Committee continues to
strongly support the BRAIN initiative. The bill provides
$250,000,000, an increase of $100,000,000 above fiscal year
2016, to expand the initiative consistent with the BRAIN 2025
report issued in 2014. The Committee is encouraged by the rapid
progress the initiative has made in dramatically changing the
ways we gather data about the brain, generating advances in
tools for measuring brain structure and activity that have the
potential to produce massive amounts of new data. To prepare
for the management of all this information, BRAIN has dedicated
some of its existing budget to stimulate the development of
centers for data warehousing, analysis and visualization for
each of its defined research areas. However, the Committee
believes the need for data integration and manipulation that
would make full use of these large cross-disciplinary datasets
not only entails a large investment in open data hosting, but
also requires significant investments in interactive data
management that combines neurophysiological, imaging, clinical,
and molecular datasets in both human and model organisms. The
Committee encourages NIH to work with its Federal, academic and
private partners, as well as leaders in the technology sector,
to jointly develop integrated, user friendly, scalable data
analysis hubs for BRAIN data as well as methods for tool
dissemination. The goal of such an effort would be a network
that has at its core an interconnected open platform of
imaging, neurophysiological, behavioral, clinical, and
molecular data along with the metadata essential for its
interpretation. This collaborative effort would guide
development and sharing of best practices in data acquisition,
analysis, and choices in computational pipelines. Open sharing
on this scale would enable data analysis and visualization
across institutional boundaries to accelerate understanding of
brain function and dysfunction. The Committee directs NIH to
provide a plan, developed in collaboration with its partners,
to the Committee 6 months after enactment of this act to create
such a network, including schedule and cost estimates.
Building Infrastructure Leading to Diversity [BUILD].--The
Committee supports the NIH Director's efforts to reverse the
trend of underrepresentation of researchers from ethnically
diverse backgrounds and continues to be pleased with the
commitment to increase the number of minority investigators.
The Committee encourages NIH to ensure that graduate
institutions with a historic mission of educating minorities in
the health professions and biomedical sciences can participate
in the program.
Burden of Disease.-- The Committee expects NIH to consider
the burden of a disease when setting priorities and developing
strategic plans across its Institutes and Centers. Diseases
such as Alzheimer's, diabetes, heart disease, and cancer affect
a large portion of the population, especially the aging
population. The impact of these diseases on patients and their
families are substantial and costly. Targeting biomedical
research funding toward these diseases is an important strategy
to finding better treatments and cures. Further, the Committee
commends the NIH on the inclusion of burden of disease as part
of its NIH-Wide Strategic Plan for Fiscal Years 2016-2020. The
Plan calls for the relative burdens of individual diseases and
medical disorders to be regarded as crucial considerations in
balancing the priorities of the Federal research portfolio. The
Committee supports a focus on conditions in need of further
funding such as chronic pain, including migraine and other
treatment alternatives for chronic pain.
Chimpanzees.--The Committee supports NIH in its decision to
make chimpanzees eligible for retirement from NIH-supported
biomedical research and reaffirm its commitment to the care of
the federally owned and supported chimpanzee population.
Consistent with that policy, the Committee directs NIH to
report its estimated timeline for moving chimpanzees to
accredited sanctuaries within 30 days after enactment of this
act. In addition, the Committee recognizes the need to provide
greater financial support for the lifelong care of federally
owned and supported chimpanzees, including sanctuary facility
capital and care costs.
Chronic Fatigue Syndrome [CFS].--The Committee is pleased
to see the 2015 reports from the Institute of Medicine and the
NIH's Pathways to Prevention Workshop, along with the recent
advances in science and renewed interests of researchers,
relating to CFS. The Committee urges the NIH to collaborate
with disease researchers, clinicians, patients, and their
advocates to address the historical lack of research and to
capitalize on these opportunities to make progress on this
poorly understood disease. Specifically, the Committee
encourages NIH to use funding to jumpstart the field through a
set of intramural and extramural investments that could include
Funding Opportunity Announcements for biomarkers and treatment
trials; other investigator-initiated studies, including for
early-stage research; and support for research to develop
consensus on a case definition and research standards.
Chronic Overlapping Pain Conditions.--The Committee notes
the strong scientific evidence substantiating common disease
mechanisms underlying Chronic Overlapping Pain Conditions.
However, evidence needed to inform practice guidelines is
insufficient, sometimes resulting in the misdiagnosis and
ineffective and harmful treatment of patients with these
disorders. A coordinated effort on chronic overlapping pain
conditions is urgently needed to maximize the Federal research
investment and inform clinical practice. Research
recommendations from the 2012 NIH Workshop on Chronic
Overlapping Pain Conditions and September 2014 scientific
meeting, co-sponsored by various NIH ICs and the TMJ
Association, should continue to guide the relevant ICs in
advancing research that spans the basic, translational and
clinical research continuum to advance scientific understanding
of chronic overlapping pain conditions, as well as the
development and discovery of safe and effective treatments.
Chronic Pain Research.--The 2011 Institute of Medicine
report, ``Relieving Pain in America,'' revealed the devastating
public health crisis of chronic pain, demonstrating that 4-in-
10 American adults report chronic pain at a cost of
$1,600,000,000 per day. The Committee strongly urges NIH to
intensify and expand its basic, translational, and clinical
research effort on chronic pain to elucidate underlying
mechanisms of disease, as well as to discover and develop safe,
effective, non-habit forming drug and non-drug therapies. The
Committee encourages the Director to include chronic pain in
ongoing NIH initiatives that have potential for yielding
significant advancements in this area, such as the Precision
Medicine Initiative, the NIH Common Fund, Advanced Medicines
Partnership, BRAIN Initiative, and public-private partnerships
within NCATS.
Clinical Center Reorganization.--The Committee notes NIH's
recently announced plans to restructure its Clinical Center
[CC] to ensure patient safety and care are always its foremost
priorities. The restructuring follows the advice of a blue
ribbon panel tasked with assessing the CC and NIH intramural
clinical research following a highly critical FDA inspection of
the CC Pharmacy in May 2015. The Committee commends NIH for its
efforts to look beyond the serious problems in the Pharmacy to
assess other aspects of its operations. It is understandable
that the decentralized nature of NIH would lead to fragmented
accountability and governance at the CC, and the decision to
adopt a centralized management structure modeled on the best
practices in the Nation's top hospitals makes sense. The
Committee directs NIH to continue to provide timely updates as
these efforts move forward, including providing an update in
the fiscal year 2018 CJ, including the status of recruitment of
the CC's new management team, the activities of the Hospital
Board and Office of Research Support and Compliance, and
adoption of other industry best practices by the CC.
Duchenne Muscular Dystrophy.--The Committee is aware of the
updated MD Action Plan released in the winter of 2015, and
supports the Plan's recommendation to expand Duchenne research
into bone health, endocrine functioning, and cardio-pulmonary
functioning. Further, the Committee is encouraged that NIH
support for earlier stage research in Duchenne muscular
dystrophy has successfully resulted in a substantial pipeline
of new potential therapeutics. To provide a smooth transition
for these projects into clinical development and to increase
the potential for success, the Committee urges NIH to increase
support for late stage preclinical and early stage clinical
projects; and to consider partnering with outside entities,
including patient organizations and industry, to facilitate
research focused on the rapid identification and qualification
of new biomarkers for Duchenne.
Environmental Influences on Child Health Outcomes Program/
National Children's Study Alternative [ECHO].--The Committee
continues its support of the ECHO program and the goal to
understand the effects of environmental exposures on child
health and development. Sufficient funding, level with fiscal
year 2016, is provided to the OD to continue this program. In
particular, the Committee notes its support for the IDeA States
Pediatric Clinical Trials Network in ECHO which will leverage
the infrastructure at existing IDeA State centers by embedding
clinical trials experts at IDeA State locations. This structure
will facilitate their partnership with other academic
institutions and help address access gaps for rural and
medically underserved children.
Fragile X [FX].--The Committee commends NIH for the NICHD-
led effort that resulted in significant progress in mapping the
molecular, physiological, biological, and genetic connections
among FX, the FX protein, and autism spectrum disorder.
Increased focus on basic science is needed to identify
additional targetable mechanisms of the disease. The Committee
urges the Director to support expanded natural history studies
to supplement the CDC's efforts, and to focus on validating
outcome measures and identifying biomarkers. Given the
inextricable connection between the FX protein and autism, the
Committee urges the Director and IC Directors with Fragile X
and autism portfolios to explore ways to create greater
efficiency and synergy among these two research tracks to
accelerate translational research toward a better understanding
of both conditions and to shorten the time to bring effective
treatments to market. Finally, the Committee commends the NIH
for its previous work to create and update the Research Plan on
Fragile X Syndrome and Associated Disorders and urges the NICHD
to reconvene this group before the end of fiscal year 2017 to
discuss updates to the research plan.
Gabriella Miller Kids First Research Act.--The Committee
provides the full budget request of $12,600,000. The Committee
requests that NIH provide information on how it has disbursed
the fiscal year 2016 funding for the Gabriella Miller Kids
First Research Act, including any personnel that are
responsible for overseeing the allocation of designated
research dollars, the criteria that NIH employed to ensure
awards will advance the objectives of the act, and a
description of the research projects that were funded at the
end of fiscal year 2016. This report should also describe the
criteria and process for grant awards the NIH intends to use
for fiscal year 2017 and subsequent years of funding under the
act.
Government-Wide Collaborations.--NIH, VA, and DOD
collaborate frequently and successfully on various research
activities. The Committee looks forward to the report in the
fiscal year 2018 CJ focusing on the cooperative and strategic
approach the agencies take in areas of biomedical research that
overlap to maximize the potential of the research.
Gut Microbiome.--The Committee commends the Office of the
Director for its work to partner with NIDDK on the Human
Microbiome project, which has led to valuable scientific
discoveries in therapeutic and genetic research on inflammatory
bowel diseases. The Committee urges expanded research on
predictors and modifiable factors that can improve early
interventions and treatments, particularly among pediatric and
young adult populations.
Hereditary Hemorrhagic Telangiectasia [HHT].--The Committee
supports the formation of an HHT coordinating committee of
multiple ICs, including NINDS, NHLBI, NICHD, NHGRI, NIDDK,
NIBIB, and NCATS. The Committee urges the coordinating
committee to initiate a workshop to explore collaborative
research opportunities into the diagnosis and treatment of HHT,
including efforts to foster translational research in the
development of new therapeutics for vascular anomalies, the
identification of potential targets for interrupting pathways
to prevent HHT progression, and new imaging methods to enable
more precise detection of vascular malformations. The Committee
requests an update in the fiscal year 2018 CJ on the status of
research related to this topic.
Human Trisome.--The Committee looks forward to the results
of NIH's feasibility report on a multi-year study to examine
the molecular, cellular, and physiological mechanisms that
predestine individuals born with a third copy of human
chromosome 21 to either live with--or be protected from--a
range of diseases that cause nearly 60 percent of U.S. deaths.
The Committee encourages NIH to focus on whether aspects of the
project, from accrual of children and adults with T21, to
analysis of biological samples at the genetic, epigenetic,
biochemical, and cellular levels, to advanced bioinformatics
analysis of large genomics datasets, fit within the priorities
set in the NIH research plan published in 2014.
Imaging.--The Committee notes that imaging research occurs
in multiple ICs throughout the NIH and is an integral component
of the BRAIN Initiative. The Committee requests NIH provide an
overview of imaging research throughout all NIH activities,
including collaborations with other HHS and non-HHS agencies.
The Committee requests this information be included in the
fiscal year 2018 CJ.
Inclusion of Children.--The Committee appreciates the
commitment made by the NIH in its fiscal year 2017 budget
request to pursue plans to collect age-related inclusion
information for research studies to support enhanced analyses
and reporting on inclusion by age. Reporting study
participation by age will assist the Committee, researchers,
and other stakeholders in understanding whether children as a
whole, or particular pediatric subpopulations, are
underrepresented in federally funded biomedical research. The
Committee believes that the implementation challenges cited by
the NIH, including determining the appropriate format for
collecting age-related data and establishing meaningful age-
based categories, are addressable with appropriate expertise
and stakeholder input. The Committee directs the NIH to develop
a detailed plan to collect data and report publicly on the
actual numbers of children and age distribution that are
enrolled in its clinical studies.
Infrastructure.--The Committee understands that Federal
agencies such as NIH need to maintain and upgrade parts of
their physical infrastructure every year. The NIH facilities
budget has been relatively flat since 2009. Over time, only the
most essential maintenance and repairs for health and safety
have been addressed, leaving an increasing backlog of projects
requiring attention. To ensure the Committee is informed of
NIH's critical facility needs and inform future infrastructure
budgets, the Committee has included up to $1,000,000 for NIH to
enter into a contract with the National Research Council,
Division of Engineering and Physical Sciences, to prepare a
report that assesses the capital needs of NIH's main campus.
The report should identify facilities in greatest need of
repair, describe the work needed to bring them up to current
standards, and include cost estimates for each project. The
Committee directs NIH to provide the report with its
recommendations to the House and Senate Committees on
Appropriations no later than 1 year from the date of the
contract agreement on the statement of work between NIH and the
National Research Council.
Interagency Pain Research.--The Committee encourages the
Director to intensify and coordinate fundamental,
translational, and clinical research with respect to the
understanding of pain, the discovery and development of
therapies for chronic pain, and the development of alternatives
to opioids for effective pain treatments. In doing so, the
Committee urges the NIH to consider recommendations made by the
Federal Pain Research Strategy, an ongoing effort coordinated
by the Interagency Pain Research Coordinating Committee and the
NIHDemographic.
Lymphatic Research and Lymphatic Disease.--The Committee
commends the trans-NIH Coordinating Committee for Lymphatic
Research, which sponsored a historic Lymphatic Symposium in
2015. The Committee supports building on this momentum by
growing the cadre of lymphatic researchers through the
establishment of extramural interdisciplinary research training
programs relevant to the lymphatic system in health and disease
and by incorporating greater reviewer expertise in lymphatic
biology/disease in the pertinent standing study sections within
the Center for Scientific Review. This research will be
instrumental in understanding the pivotal role of the lymphatic
system in the pathogenesis and/or treatment of cancer
metastasis, AIDS, auto-immune diseases, obesity, cardiovascular
disease, and organ transplantation as well as those affected by
lymphatic conditions after cancer or those with congenital
conditions.
Mitochondrial Disease Research.--The Committee appreciates
the NIH's support of the trans-NIH Mitochondrial Disorders
Working Group, the North American Mitochondrial Disease
Consortium, the Mitochondrial Disease Sequence Data Resource
Consortium, and its support for investigator initiated
intramural and extramural studies. The Committee looks forward
to the pending publication of a report in follow up to the
December 2014 workshop on Nutritional Interventions in Primary
Mitochondrial Disease that will identify a research agenda for
evidence-based nutritional interventions for mitochondrial
disorders. With the growing recognition mitochondrial disease
provides a window into understanding and treating many
conditions that afflict large segments of the population, the
Committee strongly encourages the Director to urge an
aggressive research effort around primary mitochondrial disease
as well as mitochondrial function and dysfunction.
National Pediatric Research Network [NPRN].--The Committee
is aware that the National Pediatric Research Network
authorizes an innovative model to accelerate research through
infrastructure consortia across the Nation's pediatric research
institutions. The Committee has provided sufficient funding to
explore how to carry out provisions of the act, as feasible,
and requests that NIH update the Committee on how it is
implementing the goals of the act within 60 days of enactment
of this act.
Natural Products Collections.--The Committee continues to
urge NIH to increase access to comprehensive and professionally
organized natural products libraries.
Neurofibromatosis [NF].--The Committee supports NIH's
commitment to NF research and treatment at multiple ICs,
including NCI, NINDS, NIDCD, NHLBI, NICHD, NIMH, NCATS, and
NEI. The Committee encourages NCI to continue to support its NF
research portfolio in fundamental basic science, translational
research and clinical trials focused on NF. The Committee also
encourages the NCI to support NF preclinical mouse models and
associated tumor sequencing efforts. Because NF causes brain
and nerve tumors and is associated with cognitive and
behavioral problems, the Committee urges NINDS to continue to
support fundamental basic science research on NF relevant to
nerve damage and repair. Based on emerging findings from
numerous researchers worldwide demonstrating that children with
NF are at significant risk for autism, learning disabilities,
motor delays, and attention deficits, the Committee encourages
NINDS, NIMH and NICHD to continue to support laboratory-based
and clinical investigations in these areas. Since NF2 accounts
for approximately 5 percent of genetic forms of deafness, the
Committee encourages NIDCD to continue its investment in NF2
basic and clinical research. NF1 can cause vision loss due to
optic gliomas; the Committee encourages NEI to continue its
investment in NF1 basic and clinical research.
Neurogenic Bladder and Kidney Disease.--The Committee
encourages NIH to study the causes and care of the neurogenic
bladder and kidney disease to improve the quality of life of
children and adults with Spina Bifida; to support research to
address issues related to the treatment and management of Spina
Bifida and associated secondary conditions, such as
hydrocephalus; and to support research to understand the myriad
co-morbid conditions experienced by individuals with Spina
Bifida, including those associated with both paralysis and
developmental delay.
Nonrecurring Expenses Fund [NEF].--Created in fiscal year
2008, the NEF permits HHS to transfer unobligated balances of
expired discretionary funds into the NEF account for capital
acquisitions. For fiscal year 2017, the Committee transfers
$300,000,000 from the NEF to OD for carrying out activities
associated with biomedical research. The OD shall provide
actual expenditures based on activity in the fiscal year 2018
CJ.
Phelan-McDermid Syndrome.--Phelan-McDermid Syndrome is a
genetic disorder caused by a partial deletion of chromosome 22
and a loss of the SHANK3 gene. The Committee encourages NIH to
continue its multi-Institute approach to research into the
Syndrome and related ``shankopathies.'' Some topics of
interest, if feasible, include the correlation of the syndrome
with mental health disorders, including autism, schizophrenia,
catatonia, and bipolar disorder; the study of SHANK3 as a
target for better understanding risk factors for mental health
problems that occur in adolescence; phenotype studies of the
syndrome as a model for studying prodromes as indicators of
later manifestations in disorders; and gastro-intestinal
complications associated with Phelan-McDermid Syndrome and
related disorders. The Committee requests an update in the
fiscal year 2018 CJ on the status of research related to this
topic.
Physician-Scientist Workforce.--The Committee is concerned
about the impact of the decrease in the number of physician-
scientists who can accelerate the translation of science to the
treatment of widespread chronic, and currently incurable
diseases such as diabetes and other diseases. The Committee
applauds NIH for the actions it has already taken to address
barriers that are preventing physician-scientists from entering
the biomedical research workforce and looks forward to
continuing progress on this front. The Committee expects a
report in the fiscal year 2018 CJ on the specific steps NIH has
taken and their effect, as well as the path forward to
implement the recommendations of the Physician-Scientist
Workforce Working Group.
Precision Medicine Initiative [PMI].--The Committee
recommendation continues its strong support for PMI by
providing $230,000,000 to develop a national research cohort of
1 million or more U.S. volunteers. This level of funding is
$100,000,000 above fiscal year 2016, and is in addition to
$70,000,000 included in the bill for NCI-led PMI for oncology.
The Committee is aware that the Advisory Committee to the
Director in its final report supported the inclusion of
children in the PMI Cohort Program and recommended that NIH
consider how to best incorporate necessary safeguards to ensure
appropriate enrollment, retention and protections for children.
Since much of adult health is rooted in the earliest years,
there is great value to including children in the PMI-Cohort
Program. The Committee encourages NIH to ensure that through
the process of awarding funds for the PMI-Cohort Program, that
pediatric populations are appropriately included in the study.
The Committee also encourages NIH to use in vitro clinical
trials and broader phenotypic data analysis to test how a
particular cancer or other disease conditions may react to a
specific therapy or combination of therapies. Finally, the
Committee directs NIH to provide a report within 6 months of
enactment of this act assessing PMI plans to safeguard
participants' personal data.
Research Facilities.--Much of the Nation's biomedical
research infrastructure, including laboratories and research
facilities at academic institutions and nonprofit research
organizations, is outdated or insufficient. For taxpayers to
receive full value from their considerable investments in
biomedical research, scientists must have access to appropriate
research facilities. Therefore, $25,000,000 is provided for
grants or contracts to public, nonprofit, and not-for-profit
entities to expand, remodel, renovate, or alter existing
research facilities or construct new research facilities as
authorized under 42 U.S.C. section 283k. The Committee urges
NIH to consider recommendations made by the NIH Working Group
on Construction of Research Facilities, including making awards
that are large enough to underwrite the cost of a significant
portion of newly constructed or renovated facilities.
Severe Acute Shock and Multi-Organ Failure.--There are an
estimated 1,300,000 cases in the United States each year of
severe, acute shock, which can trigger multi-organ failure,
often resulting in death. Despite the number of Americans
affected by this condition and the lack of a proven treatment
for shock, the Committee notes that there is no dedicated
Federal research focused on addressing these challenges. The
Committee encourages NIH to support research to develop
treatments for severe, acute shock, including septic shock,
cardiogenic shock, hypovolemic shock, and hemorrhagic shock.
Temporomandibular Disorders [TMD].--The Committee
understands that NIH-funded research has demonstrated that TMD
is primarily a multisystem disorder with overlapping co-morbid
conditions influenced by multiple biological and environmental
factors rather than solely an orofacial pain condition.
However, diagnosis and care of patients have not changed to
reflect this major paradigm shift. Therefore, the Committee
strongly supports research to examine the safety and efficacy
of current clinical treatments of TMD, the burden and costs
associated with TMD, and the development of future scientific
and clinical, professional and policy directions for TMD.
Further, the Committee encourages NIH ICs with pertinent
expertise on the temporomandibular joint to collaborate and
implement the recommendations from the Temporomandibular Joint
in Health and Disease Round Table held in 2013. Research to
develop safe and effective techniques for joint repair and
regeneration is essential. An analysis of problems associated
with current joint replacements should provide guidance in
these efforts.
Transfer Authority.--The Committee does not include bill
language requested by the administration to provide additional
transfer authority to the Director beyond that which is already
provided to the Secretary.
Translational Science and Clinical Trials.--The Committee
commends NIH's continued focus on clinical and translational
science, but is concerned with the need to expand this work to
geographic regions with the highest burdens of chronic disease,
limited access to health care providers, and minority
populations. By providing support for the necessary
infrastructure for translational science across the spectrum
from drug and natural product discovery to clinical trial
implementation to community and population health, citizens
with significant needs in these underserved regions will
benefit. Therefore, NIH is directed to support efforts to build
and sustain integrated clinical and translational science
infrastructure to optimize the movement of drug and natural
product discoveries across the translational spectrum in States
where funding has not previously been provided, but where there
is significant disease burden.
Tuberous Sclerosis Complex [TSC].--The Committee is
encouraged by progress on updating NIH's 2003 TSC Research
Plan, including a March 2015 workshop sponsored by NINDS and
the Tuberous Sclerosis Alliance that assessed progress and
prioritized new opportunities for research in TSC. Building on
this progress, the Committee encourages the Director to
coordinate the participation of multiple ICs on a research
strategy aimed at addressing the numerous medical and
neuropsychological burdens associated with TSC while
deciphering the biology underlying phenotypic heterogeneity.
Manifestations of TSC are highly variable among affected
individuals, and TSC can be a model condition for developing
precision medicine approaches to treat each individual's
symptoms to maximize the benefit-risk ratio. NIH should
encourage research opportunities in the five key areas
prioritized by workshop participants: understanding phenotypic
heterogeneity in TSC, gaining a deeper knowledge of TSC
signaling pathways and the cellular consequences of TSC
deficiency, improving TSC disease models, developing clinical
biomarkers for TSC, and facilitating therapeutics and clinical
trials research.

BUILDINGS AND FACILITIES

Appropriations, 2016.................................... $128,863,000
Budget estimate, 2017................................... 128,863,000
Committee recommendation................................ 128,863,000

The Committee recommendation includes $128,863,000 for NIH
buildings and facilities. This funding will remain available
for obligation for 5 years. The Committee does not include the
request by the administration to make funding available until
expended.

Substance Abuse and Mental Health Services Administration

The Committee recommends $3,738,077,000 for the Substance
Abuse and Mental Health Services Administration [SAMHSA]. The
recommendation includes $134,667,000 in transfers available
under section 241 of the PHS Act and $12,000,000 in transfers
from the PPH Fund.
SAMHSA is responsible for supporting mental health programs
and alcohol and other drug abuse prevention and treatment
services throughout the country, primarily through categorical
grants and block grants to States.
The Committee recommendation continues bill language that
instructs the Administrator of SAMHSA and the Secretary to
exempt the Mental Health Block Grant [MHBG] and the Substance
Abuse Prevention and Treatment [SAPT] Block Grant from being
used as a source for the PHS evaluation set-aside in fiscal
year 2017.

MENTAL HEALTH

Appropriations, 2016.................................... $1,166,987,000
Budget estimate, 2017................................... 1,158,766,000
Committee recommendation................................ 1,170,037,000

The Committee recommends $1,170,037,000 for mental health
services. The recommendation includes $21,039,000 in transfers
available under section 241 of the PHS Act and $12,000,000 in
transfers from the PPH Fund. Included in the recommendation is
funding for programs of regional and national significance
[PRNS], the MHBG, children's mental health services, Projects
for Assistance in Transition from Homelessness [PATH], and
Protection and Advocacy for Individuals with Mental Illness
[PAIMI].
Programs of Regional and National Significance
The Committee recommends $387,659,000 for PRNS within the
Center for Mental Health Services [CMHS]. The Committee
recommendation includes $12,000,000 in transfers to PRNS from
the PPH Fund. These programs address priority mental health
needs by developing and applying evidence-based practices,
offering training and technical assistance, providing targeted
capacity expansion grants, and changing the delivery system
through family, client-oriented, and consumer-run activities.
Within the total provided for PRNS, the Committee
recommendation includes funding for the following activities:

SCIENCE AND SERVICE:
GLS--Suicide Prevention Resource Center............... 5,988 5,988 5,988
Practice Improvement and Training..................... 7,828 7,828 7,828
Primary and Behavioral Health Care Integration TA..... 1,991 1,991 1,991
Consumer & Consumer Support TA Centers................ 1,918 1,918 1,918
Minority Fellowship Program........................... 8,059 8,059 8,059
Disaster Response..................................... 1,953 1,953 1,953
Homelessness.......................................... 2,296 2,296 2,296
HIV/AIDS Education.................................... 771 771 771
----------------------------------------------------------------------------------------------------------------

Primary and Behavioral Healthcare Integration.--The
Committee directs SAMHSA to require grantees of the Primary and
Behavioral Health Care Integration program to include in their
biannual National Outcome Measures report a summary of the
policies that serve as barriers to the provision of integrated
care and the specific steps the grantee has taken or will take
to address such barriers.
Project Aware.--The Committee strongly supports Project
AWARE which increases awareness of mental health issues and
connects young people that have behavioral health issues and
their families with needed services. The Committee
recommendation reflects the administration's proposal to
reallocate funding from Youth Violence Prevention to Project
AWARE. This shift will allow SAMHSA to avoid program
duplication. The increase provided will support a new cohort of
Project AWARE State Education Agency awards. Of the amount
provided for Project AWARE, the Committee directs SAMHSA to use
$10,000,000 for discretionary grants to support efforts in
high-crime, high-poverty areas and, in particular, communities
that are seeking to address relevant impacts and root causes of
civil unrest. These grants should maintain the same focus as
fiscal year 2016 grants and continue to be coordinated with the
Department of Education grants. The Committee requests a report
on progress of fiscal year 2016 grantees 180 days after the
enactment of this act.
Project Linking Actions for Unmet Needs in Children's
Health [LAUNCH].--The Committee continues to support Project
LAUNCH activities which promote the wellness of young children
from birth to age 8 by addressing the physical, social, and
emotional, cognitive, and behavioral aspects of their
development. The Committee provides continuation funding for
all existing grant activities.
Community Mental Health Services Block Grant
The Committee recommends $562,571,000 for the MHBG. The
recommendation includes $21,039,000 in transfers available
under section 241 of the PHS Act.
The MHBG distributes funds to 59 eligible States and
territories through a formula based on specified economic and
demographic factors. Grant applications must include an annual
plan for providing comprehensive community mental health
services to adults with a serious mental illness and children
with a serious emotional disturbance.
The Committee recommendation continues bill language
requiring that at least 10 percent of the funds for the MHBG
program be set-aside for evidence-based programs that address
the needs of individuals with early serious mental illness,
including psychotic disorders. The Committee commends SAMHSA
for its collaboration with NIMH on the implementation of this
set-aside. The Committee notes that it usually takes 17 years
to translate research findings into practice and hopes that
this joint effort between NIMH and SAMHSA may be a model for
how to reduce this timeframe. The Committee directs SAMHSA to
continue its collaboration with NIMH to ensure that funds from
this set-aside are only used for programs showing strong
evidence of effectiveness and that target the first episode of
psychosis. SAMHSA shall not expand the use of the set-aside to
programs outside of the first episode psychosis. The Committee
directs SAMHSA to include in the fiscal year 2018 CJ a detailed
table showing at a minimum each State's allotment, name of the
program being implemented, and a short description of the
program.
Children's Mental Health Services
The Committee recommends $119,026,000 for the Children's
Mental Health Services program. This program provides grants
and technical assistance to support comprehensive, community-
based systems of care for children and adolescents with serious
emotional, behavioral, or mental disorders. Grantees must
provide matching funds and services must be coordinated with
the educational, juvenile justice, child welfare, and primary
healthcare systems. The Committee has not included bill
language requested by the administration to set aside up to 10
percent of these funds to carry out early interventions for
young people at high risk of developing psychosis. While the
Committee applauds SAMHSA's focus on this population, it
believes further evidence of effectiveness is needed before
these interventions are widely adopted.
Projects for Assistance in Transition From Homelessness
The Committee recommends $64,635,000 for PATH, which
addresses the needs of individuals with serious mental illness
who are experiencing homelessness or are at risk of
homelessness. Funds are used to provide an array of services,
such as screening and diagnostic services, emergency
assistance, case management, and referrals to the most
appropriate housing environment.
Protection and Advocacy for Individuals With Mental Illness
The Committee recommends $36,146,000 for PAIMI. This
program helps ensure that the rights of mentally ill
individuals are protected while they are patients in all public
and private facilities or while they are living in the
community, including in their own homes. Funds are allocated to
States according to a formula based on population and relative
per capita incomes.

SUBSTANCE ABUSE TREATMENT

Appropriations, 2016.................................... $2,195,424,000
Budget estimate, 2017................................... 2,186,348,000
Committee recommendation................................ 2,194,563,000

The Committee recommends $2,194,563,000 for substance abuse
treatment programs, including PRNS and the substance abuse
prevention and treatment block grant to the States. The
recommendation includes $81,200,000 in transfers available
under section 241 of the PHS Act.
Programs of Regional and National Significance
The Committee recommends $336,484,000 for PRNS within the
Center for Substance Abuse Treatment [CSAT]. The recommendation
includes $2,000,000 in transfers available under section 241 of
the PHS Act.
PRNS include activities to increase capacity by
implementing service improvements using proven evidence-based
approaches as well as science-to-services activities that
promote the identification of practices thought to have
potential for broad service improvement.
Within the total provided for PRNS, the Committee
recommendation includes funding for the following activities:

SCIENCE AND SERVICE:
Addiction Technology Transfer Centers................. 9,046 8,081 9,046
Minority Fellowship Program........................... 3,539 3,539 3,539
Special Initiatives/Outreach.......................... ................ ................ ................
----------------------------------------------------------------------------------------------------------------

Addiction Technology Transfer Centers [ATTCs].--The
Committee again rejects the administration's proposal to reduce
funding for the ATTCs and instead provides the same funding
level as fiscal year 2016. The Committee directs SAMHSA to
ensure that ATTCs maintain a primary focus on addiction
treatment and recovery services.
Combating Opioid Abuse.--Of the amount provided for
Targeted Capacity Expansion, the Committee includes $60,000,000
for discretionary grants to States for the purpose of expanding
treatment services to those with heroin or opioid dependence.
The Committee directs CSAT to ensure that these grants include
as an allowable use the support of medication assisted
treatment and other clinically appropriate services. These
grants should target States with the highest age adjusted rates
of admissions and that have demonstrated a dramatic age
adjusted increase in admissions for the treatment of opioid use
disorders.
Complex Trauma.--Child traumatic stress occurs when
children and adolescents are exposed to traumatic events or
situations that overwhelm their ability to cope and affects
tens of thousands of children each year. The Committee supports
SAMHSA's current efforts in this area and encourages SAMHSA to
explore opportunities to address the causes of complex trauma
throughout the lifespan.
Drug Courts.--SAMHSA is directed to ensure that all Drug
Treatment Court funding is allocated to serve people diagnosed
with a substance use disorder as their primary condition.
SAMHSA is further directed to ensure that all drug treatment
court grant recipients work directly with the corresponding
State substance abuse agency in the planning, implementation,
and evaluation of the grant. SAMHSA should expand training and
technical assistance to drug treatment court grant recipients
to ensure evidence-based practices are fully implemented.
Medication-Assisted Therapy.--The Committee encourages
SAMHSA to finalize regulations on prescribing buprenorphine to
treat opioid dependence while supporting strategies to
eliminate diversion as expeditiously as possible.
Opioids State Targeted Response/State Targeted Response
Cooperative Agreements.--The Committee recognizes the valuable
work conducted by Sheriff's Departments across the country that
have undertaken a collective effort to enhance the continuum of
care for incarcerated individuals with substance use disorders.
These efforts by Sheriff's Departments that have jail-operation
powers and corrections duties serve as a critical component as
it relates to a variety of treatment and recovery support
services. As SAMHSA works to allocate resources for States
grappling with the opioid crisis, the Committee encourages
SAMHSA to consider these efforts for the Opioids State Targeted
Response grants.
Oral Fluid Guidelines.--The Committee is pleased with
SAMHSA's recommendation of oral fluid as an alternative
specimen for drug testing and commends SAMSHA for the progress
made on issuing oral fluid guidelines for the Federal Workplace
Drug Testing Programs. The Committee urges SAMSHA to publish
the guidelines expeditiously and to implement the guidelines in
partnership with stakeholders and other agencies.
Pregnant and Postpartum Women [PPW].--The Committee
recommendation provides the same level of funding for the PPW
program, which supports comprehensive, family-based residential
substance use disorder services for pregnant and parenting
women, their minor children, and other family members. The
Committee has not included language requested by the
administration to support non-residential family-based services
through innovation grants. The Committee notes that this issue
is addressed in reauthorization legislation that is pending in
both the House of Representatives and Senate.
Screening, Brief Intervention, and Referral to Treatment
[SBIRT].--The Committee is pleased that SAMHSA recently
included language in the SBIRT Request for Proposal to allow
grantees to focus 20 percent of the funding on individuals
between the ages of 12 and 18 who are seeking medical services.
This will expand opportunities for health care and youth
service practitioners to engage young people in preventative
conversations about substance use, as well as identify and
address risky use before it progresses to addiction. The
Committee expects SAMHSA to continue to encourage applicants to
take advantage of this allowable use of funds for 12- to 18-
year-olds.
Viral Hepatitis Screening.--The Committee applauds SAMHSA
for encouraging grantees to screen for viral hepatitis,
including the use of innovative strategies like rapid testing
and urges SAMHSA to continue these efforts. The Committee notes
the disproportionate impact of viral hepatitis among minority
populations and the co-infection rate among individuals with
HIV/AIDS. The Committee urges SAMHSA to work with minority AIDS
grantees to incorporate hepatitis screening into programmatic
activities.
Substance Abuse Prevention and Treatment Block Grant
The Committee recommends $1,858,079,000 for the Substance
Abuse Prevention and Treatment Block Grant [SAPT] block grant.
The recommendation includes $79,200,000 in transfers available
under section 241 of the PHS Act. The block grant provides
funds to States to support alcohol and drug abuse prevention,
treatment, and rehabilitation services. Funds are allocated to
States according to a formula.

SUBSTANCE ABUSE PREVENTION

Appropriations, 2016.................................... $211,219,000
Budget estimate, 2017................................... 211,148,000
Committee recommendation................................ 225,219,000

The Committee recommends $225,219,000 for the Center for
Substance Abuse Prevention [CSAP], the sole Federal
organization with responsibility for improving accessibility
and quality of substance abuse prevention services.
The Committee notes that youth drug use continues to be a
major issue and that perceptions of harm are significantly
waning. Therefore, the Committee directs that all of the money
appropriated explicitly for Substance Abuse Prevention purposes
both in CSAP's PRNS lines as well as the funding from the 20
percent prevention set-aside in the SAPT Block Grant be used
only for bona fide substance abuse prevention activities and
not for any other purpose.
Programs of Regional and National Significance
The Committee provides $225,219,000 for PRNS within CSAP.
Through these programs, CSAP supports: development of new
practice knowledge on substance abuse prevention;
identification of proven effective models; dissemination of
science-based intervention information; State and community
capacity building for implementation of proven, effective
substance abuse prevention programs; and programs addressing
new needs in the prevention system.
Within the total provided for PRNS, the Committee
recommendation includes funding for the following activities:

SCIENCE AND SERVICE:
Fetal Alcohol Spectrum Disorder....................... ................ ................ ................
Center for the Application of Prevention Technologies. 7,493 7,493 7,493
Science and Service Program Coordination.............. 4,072 4,072 4,072
Minority Fellowship Program........................... 71 71 71
----------------------------------------------------------------------------------------------------------------

Combating Opioid Abuse.--The Committee provides $26,000,000
for grants to prevent opioid overdose related deaths. Part of
the initiative to Combat Opioid Abuse, this program will help
States equip and train first responders and other community
partners with the use of devices that rapidly reverse the
effects of opioids. Of this amount, the Committee provides
$8,000,000 to prevent opioid overdose-related deaths in rural
areas. People in rural communities are especially vulnerable
and more likely to overdose on prescription pain killers than
people in urban areas, according to the CDC. The Committee
encourages SAMHSA to work with HRSA in the administration of
these resources to rural areas. The Committee directs SAMHSA to
ensure applicants outline how proposed activities in the grant
would work with treatment and recovery communities in addition
to first responders. Furthermore, the Committee provides
$10,000,000 for the Strategic Prevention Framework Rx program
to increase awareness of opioid abuse and misuse in
communities.
Strategic Prevention Framework State Incentive Grant and
Partnerships for Success.--The Committee intends that these two
programs continue to focus exclusively on: addressing State-
and community-level indicators of alcohol, tobacco, and drug
use; targeting and implementing appropriate universal
prevention strategies; building infrastructure and capacity;
and preventing substance use and abuse.
STOP Act.--The Committee directs that all funds
appropriated for STOP Act community-based coalition enhancement
grants shall be used for making grants to eligible communities
and not for any other purposes or activities.

HEALTH SURVEILLANCE AND PROGRAM SUPPORT

Appropriations, 2016.................................... $156,306,000
Budget estimate, 2017................................... 173,886,000
Committee recommendation................................ 148,258,000

The Committee recommends $148,258,000 for Health
Surveillance and Program Support activities. The recommendation
includes $32,428,000 in transfers available under section 241
of the PHS Act.
This activity supports Federal staff and the administrative
functions of the agency. It also provides funding to SAMHSA's
surveillance and data collection activities, including national
surveys such as the National Survey on Drug Use and Health.
Within the total provided for Health Surveillance and
Program Support, the Committee recommendation includes funding
for the following activities:

Behavioral Health Workforce Education and Training.--The
Committee transfers this program to HRSA as requested by the
administration.
Minority Fellowship Program.--The Committee maintains the
separate accounts for the Minority Fellowship Programs at the
Center for Mental Health Services, Center for Substance Abuse
Prevention, and the Center for Substance Abuse Treatment like
in previous fiscal years and does not consolidate them as
proposed by SAMHSA. Therefore, funding for these programs is
reflected in the tables for each of the centers.
The Committee does not include bill language requested by
the administration that would provide additional transfer
authority to the Administrator beyond that which is already
provided to the Secretary.

Agency for Healthcare Research and Quality

Appropriations, 2016.................................... $334,000,000
Budget estimate, 2017................................... 363,698,000
Committee recommendation................................ 324,000,000

The Committee provides $324,000,000 for the Agency for
Healthcare Research and Quality [AHRQ]. AHRQ was established in
1990 to enhance the quality, appropriateness, and effectiveness
of health services, as well as access to such services. AHRQ
conducts, supports, and disseminates scientific and policy-
relevant research on topics such as promoting high-quality
care, eliminating healthcare disparities, using information
technology, and evaluating the effectiveness of clinical
services.

HEALTH COSTS, QUALITY, AND OUTCOMES

The Committee provides $184,279,000 for research on health
costs, quality, and outcomes [HCQO]. The HCQO research activity
is focused upon improving clinical practice, improving the
healthcare system's capacity to deliver quality care, and
tracking progress toward health goals through monitoring and
evaluation.
Within the total provided for HCQO, the Committee
recommendation includes funding for the following activities:

Antimicrobial Stewardship.--The Committee supports AHRQ's
efforts to develop, improve, and disseminate antimicrobial
stewardship interventions to combat the ongoing and serious
threat of antimicrobial resistance. AHRQ is directed to work
closely with CDC, NIH, and other Federal agencies to coordinate
efforts to improve the use of antibiotics in humans across
hospital and community settings.
Consumer Assessment of Healthcare Providers and Systems
[CAHPS].--The Committee notes that CAHPS surveys are important
tools for patients to make more informed decisions about their
medical care and for providers and insurers to inform quality
improvement initiatives and incentives. Patient experience data
in maternity care is currently not regularly and systematically
collected. Therefore, the Committee urges AHRQ to expand its
current set of surveys and develop a CAHPS survey for maternity
care.
Effective Healthcare Program.--The Committee is aware of
AHRQ's interest in expanding the areas of focus for the Horizon
Scanning System. The Committee believes it is equally important
for AHRQ to improve the utility of the system by streamlining
the processes by which it collects information and improving
the manner and timeliness that this information is made
available to the public. Therefore, the Committee requests a
report from AHRQ within 90 days of enactment regarding how it
can better accomplish these objectives.
Health IT Safety.--The Committee recommendation includes
$16,500,000 for AHRQ's work on safe health IT practices
specifically related to the design, implementation, usability,
and safe use of health IT systems. The Committee believes this
investment will generate new evidence regarding safe health IT
practices that will ultimately be used by ONC, FDA, CMS, and
others to inform policy interventions.
Healthcare-Associated Infections.--Within the Patient
Safety portfolio, the Committee provides $37,253,000, the same
level as in fiscal year 2016, for healthcare-associated
infection activities. Within this funding level, the Committee
includes $10,000,000 for activities as part of the CARB
initiative. These funds will support the development and
expansion of antibiotic stewardship programs specifically
focused on ambulatory and long-term care settings. In addition,
the Committee directs AHRQ to collaborate with NIH, BARDA, CDC,
FDA, VA, DOD, and USDA to leverage existing resources to
increase capacities for research aimed at developing
therapeutic treatments, reducing antibiotic use and resistance
in animals and humans, and implementing effective infection
control policies.
Healthcare Delivery Systems.--Within the Patient Safety
portfolio, the Committee includes $10,000,000 for Healthcare
Delivery Systems grants, or ``patient safety learning labs.''
The purpose of these grants is to test new ways of addressing
entrenched patient safety issues by using a systems engineering
approach.
U.S. Preventative Task Force [USPSTF].--The Committee
strongly urges the Secretary to ensure greater transparency and
inclusion of appropriate physician experts in the development
of USPSTF recommendations. The Committee is concerned about the
lack of communication with relevant stakeholders and
inconsistency with recommendations by other Federal agencies or
organizations. Therefore, the Committee emphasizes the need for
the USPSTF to conduct outreach to relevant stakeholders,
including provider groups, practicing specialists that treat
the specific disease or condition under review, and relevant
patient and disease advocacy organization before voting on a
draft recommendation statement. To promote greater
transparency, the Committee urges that any final recommendation
statement include a description of comments received on the
draft recommendation statement and relevant recommendations of
other Federal agencies and organizations.

MEDICAL EXPENDITURES PANEL SURVEYS

The Committee provides $68,877,000 for Medical Expenditure
Panel Surveys [MEPS], which collect detailed information
annually from households, healthcare providers, and employers
regarding how Americans use and pay for healthcare. The data
from MEPS are used to develop estimates of healthcare
utilization, expenditures, sources of payment, and the degree
of health insurance coverage of the U.S. population.

PROGRAM SUPPORT

The Committee recommends $70,844,000 for program support.
This activity funds the overall management of AHRQ, including
salaries, benefits, and overhead costs such as rent.

Centers for Medicare And Medicaid Services

GRANTS TO STATES FOR MEDICAID

Appropriations, 2016

$243,545,410,000

Budget estimate, 2017

262,003,967,000
Committee recommendation
262,003,967,000

The Committee recommends $262,003,967,000 in mandatory
funding for Grants to States for Medicaid.
The fiscal year 2017 recommendation excludes
$115,582,502,000 in fiscal year 2016 advance appropriations for
fiscal year 2017. As requested by the administration,
$125,219,452,000 is provided for the first quarter of fiscal
year 2018.
The Medicaid program provides medical care for eligible
low-income individuals and families. It is administered by each
of the 50 States, the District of Columbia, Puerto Rico, and
the territories. Federal funds for medical assistance are made
available to the States according to a formula that determines
the appropriate Federal matching rate for State program costs.
This matching rate is based on the State's average per capita
income relative to the national average and cannot be less than
50 percent.

PAYMENTS TO HEALTHCARE TRUST FUNDS

Appropriations, 2016

$283,171,800,000

Budget estimate, 2017

299,187,700,000
Committee recommendation
299,187,700,000

The Committee recommends $299,187,700,000 in mandatory
funding for payments to healthcare trust funds.
This entitlement account includes the general fund subsidy
to the Federal Supplementary Medical Insurance Trust Fund for
Medicare Part B benefits and for Medicare Part D drug benefits
and administration, plus other reimbursements to the Federal
Hospital Insurance Trust Fund for Part A benefits and related
administrative costs that have not been financed by payroll
taxes or premium contributions.
The Committee provides $214,944,000,000 for the Federal
payment to the Supplementary Medical Insurance Trust Fund. This
payment provides matching funds for premiums paid by Medicare
Part B enrollees.
The Committee further provides $82,512,000,000 for the
general fund share of benefits paid under Public Law 108-173,
the Medicare Prescription Drug, Improvement and Modernization
Act of 2003. As in previous years, the Committee includes bill
language requested by the administration providing indefinite
authority for paying the general revenue portion of the Part B
premium match and provides resources for the Part D drug
benefit program in the event that the annual appropriation is
insufficient.
The Committee recommendation also includes $405,000,000 to
be transferred to the Supplementary Insurance Trust Fund as the
general fund share of Part D administrative expenses. The
Committee recommendation includes $299,000,000 in
reimbursements to the Health Care Fraud and Abuse Control
[HCFAC] fund, which reflects the portion of the HCFAC spending
to be reimbursed by the General Fund.

PROGRAM MANAGEMENT

Appropriations, 2016.................................... $3,669,744,000
Budget estimate, 2017................................... 4,109,549,000
Committee recommendation................................ 3,669,744,000

The Committee recommends $3,669,744,000 for CMS program
management, which includes funding for research, program
operations, survey and certification programs, and Federal
administration.
Research, Demonstrations and Evaluations.--The Committee
recommends $20,054,000 for research, demonstrations, and
evaluation activities.
Program Operations
The Committee recommends $2,519,823,000 for the Program
Operations account, which covers a broad range of activities
including claims processing and program safeguard activities
performed by Medicare contractors. These contractors also
provide information, guidance, and technical support to both
providers and beneficiaries.
ACA Notifications.--The Committee continues bill language
requiring the administration to provide detailed enrollment
figures to the Committees on Appropriations of the House of
Representatives and the Senate not less than two full business
days before any public release of the information.
Access to Mental Health Care.--The Committee continues to
prioritize mental health treatment and services and provides an
increase within the bill for these programs. The Committee
provides an increase of $30,000,000 for the Mental Health Block
Grant at SAMHSA as well as $50,000,000 to expand mental health
services in Community Health Centers around the Nation. While
these programs remain fundamental components of the mental and
behavioral health system, the Committee notes that without
access to these services, many Americans suffering from mental
or behavioral health issues will continue to go untreated. The
Committee strongly urges CMS to pursue initiatives that expand
access to quality care and increase parity for mental health
services.
Adult Immunization Quality Measures.--The Committee is
aware that CMS is working to close gaps in quality measures to
improve care delivery and patient outcomes, including reducing
racial and ethnic health disparities. Adult immunization
quality measures are one area where more work is needed as
noted in the August 2014, the National Quality Forum [NQF]
report entitled ``Priority Setting for Healthcare Performance
Measurement: Addressing Performance Measure Gaps for Adult
Immunization''. The Committee recommends CMS partner with the
Core Measures Collaborative and NQF's Measure Application
Partnership to address the current gaps in adult immunization
measures and ensure the reflect current best practices. The
Committee requests a report from CMS no later than 18 months
following enactment on the steps the agency has taken to expand
and improve quality measures applicable to adult immunization
under Medicare and Medicaid, including an action plan to
disseminate measures to enable widespread adoption.
Air Ambulance Services and Payment Structures.--The
Committee directs the GAO to submit a report to the Committees
on Appropriations of the House of Representatives and the
Senate no later than 12 months after the enactment of this act
on air ambulance services and payment structures. The report
should include analysis of the following costs: maintenance of
aircrafts; medical supplies; fuel; employee expenses; recurring
training relating to aviation, maintenance, communication, and
clinical; rent and utilities; communications; travel; hull and
aviation liability insurance, life insurance, and professional
malpractice insurance; marketing; supplies; overhead support;
aircraft ownership expenses; safety enhancement capital costs;
and safety enhancement recurring costs, as well as the amounts
charged to individuals who utilize these services. The report
should reflect regional, State, demographic, and urban/rural/
super rural differences; coverage maps for rotor and fixed
winged services; number of providers vs. number of transports
over the last decade broken out by year and by region; health
plans accepted, including Medicare, Medicaid, and stand-alone
air medical transport insurance, and type and amount of
coverage; number of air ambulance providers that accept
Medicare reimbursement, number of carriers that in network
agreements with health insurance providers, and out of network
carriers; whether health insurance, including Medicare and
Medicaid, reimbursements cover costs and which air ambulance
providers balance bill those receiving services; differences in
rates, costs, and frequency for transports from accident sites
in comparison to rates, costs, and frequency for facility-to-
facility transports; differences in emergency rates, costs, and
frequency in comparison to non-emergency, or chartered, rates,
costs, and frequency; evaluate costs/reimbursement rates
relative to quality of aircraft and services provided; and
startup costs and fixed and variable costs. Finally, the report
should also include analysis of the disproportionate share of
super-rural air ambulance utilization as a ratio of all super-
rural ambulance usage in comparison to rural air ambulance
utilization as a ratio of all rural ambulance usage, including
the factors leading to an increased super-rural proportion of
use of air ambulance services and whether the increased use is
justified.
Ambulance Moratorium.--The Committee supports CMS' efforts
to extend home health and ambulance moratoriums to curb and
prevent waste, fraud, and abuse. The Committee encourages CMS
to continue to ensure patients have appropriate access to care
while weighing additional extensions.
American Board of Interventional Pain Physicians [ABIPP].--
The ABIPP has extensive training requirements and a
credentialing process that requires primary board certification
from the American Board of Medical Specialties [ABMS]. The
Committee encourages CMS to consider ABIPP specialty
certification as equivalent to certifications recognized by
ABMS, including, but not limited to accreditation, licensing,
participation in Managed Care Organizations and Accountable
Care Organizations and privileges to practice interventional
pain management.
Appropriate Use Criteria [AUC] for Certain Imaging
Services.-- In section 218(b) of Public Law 113-93, Congress
instructed CMS to promote the use of AUC for certain imaging
services in the Medicare program. This language was intended to
support the study and adoption of clinical decision support
systems, which can be integrated into electronic health
records. In seeking to implement section 218(b), the Committee
encourages CMS to focus on consultation with clinical
guidelines when ordering advanced imaging tests before
instituting prior authorization. The Committee encourages CMS
to continue to support the use of AUC by closing knowledge gaps
with health care professionals on how to apply AUC when
choosing an imaging text.
Assistive Technology Act Programs Reutilization Program.--
The Committee is encouraged that several State Medicaid
Programs have developed assistive technology and durable
medical equipment reuse programs. These programs retrieve and
refurbish devices that were purchased with Medicaid funds, but
are no longer being used by Medicaid recipients or other
sources. Refurbished equipment may be reassigned to Medicaid
members as a priority or to other eligible individuals who are
disabled or elderly. CMS should encourage State Medicaid
programs to partner with State Assistive Technology Act
Programs to develop and implement reutilization programs with a
goal of containing Medicaid costs.
Cancer Screening Technologies.--The Committee believes it
is critical for Medicare beneficiaries to have access to high-
quality preventive services, including innovative cancer
screening tests. To help maintain robust access to quality
preventive cancer care, the Committee requests that CMS, when
considering Medicare quality measurements, work with
stakeholders, as appropriate, to ensure that cancer screening
technologies are reviewed in a timely manner.
Caregiver Counseling and Supportive Services.--The
Committee is aware of a body of evidence that suggests defined
counseling and supportive services delivered to family (non-
paid) caregivers of Medicare beneficiaries with Alzheimer's
disease and dementia can substantially delay beneficiary
placement in an institutional care setting and reduce Federal
expenditures associated with such care. The Committee is
concerned about the current and anticipated Medicare and
Medicaid costs associated with Alzheimer's disease and
recommends that CMS, in consultation with ACL, consider a pilot
or demonstration program to evaluate the impact of such
evidence-based Alzheimer's caregiver support models could have
on the Medicare and Medicaid programs.
Complex Rehabilitation Technology.--The Committee
encourages CMS to ensure that individuals with severe
disabilities, including those with cerebral palsy, muscular
dystrophy, multiple sclerosis, and spinal cord injuries, who
are entitled to Medicare benefits have adequate information on
how to access complex rehabilitation technology that
appropriately addresses their unique needs.
Critical Access Hospitals [CAH].--The Committee is
disappointed that the administration continues to propose
eliminating CAH status from facilities located less than 10
miles from another hospital and reducing the reimbursement rate
from 101 percent to 100 percent of reasonable cost. A recent
Health Affairs study reviewed the impact of similar minimum
distance requirements and found that currently 37.6 percent of
CAHs had a negative operating margin, and if such a distance
requirement went into effect, it would rise to 75.6 percent. If
a CAH lost its designation, it would be forced under the
applicable prospective payment systems which are designed for
larger facilities, not small, low volume rural hospitals. The
results of the study underscore the importance of factoring
clinical expertise, physician distribution, availability of
telehealth, sufficient volume to maintain key services, and the
needs of underserved populations. Coupled with over regulation,
decreased reimbursements, and workforce shortages, CAHs would
be forced to close without their designation, causing patients
to travel farther, forego preventative care, and ultimately
cost more in CMS healthcare expenditures.
CT Colongraphy.--Due to the proven life and cost-savings of
preventative screening for colorectal cancer, the Committee
encourages CMS to consider covering CT Colonography as a
Medicare-covered colorectal cancer screening test under section
1861(pp)(1) of the Social Security Act.
Diabetes Technologies.--Diabetes technologies known as
continuous glucose monitors [CGM] have been shown in clinical
trials to improve health care outcomes of people with type 1
diabetes and reduce the risk of low blood sugar emergencies
which can lead to hospitalizations. These technologies are
recommended by national diabetes guidelines and covered by 95
percent of private health plans. Medicare, however, does not
cover CGM technologies, leaving seniors vulnerable. The
Committee encourages Medicare to modernize its policies to
cover CGM technologies to ensure access for those with type 1
diabetes or those entering Medicare who have benefitted from
the technology under their prior health plan.
Electrodiagnostic Tests.--The Committee requests an update
from CMS submitted to the Committees on Appropriations of the
House of Representatives and the Senate on the three
recommendations proposed by the 2014 OIG Report: ``Questionable
Billing for Medicare Electrodiagnostic Tests''.
Evaluation and Management Research.--The Committee
recognizes that both traditional and innovative payment models
rely on traditional fee-for-service as a foundation for
physician payment. The existing outpatient evaluation and
management service codes do not adequately capture the range of
outpatient evaluation and management work performed by
cognitive physicians. The Committee encourages CMS to
commission the research necessary to understand, on the basis
of newly collected data, what occurs during and following an
outpatient evaluation and management service. Once complete,
CMS should use these findings to develop new outpatient service
codes and the associated documentation requirements. This
research model can then be used to revise the other evaluation
and management code families. The Committee expects a report
submitted to the Committees on Appropriations of the House of
Representatives and the Senate on the status of this research
in the fiscal year 2018 CJ.
Graduate Medical Education [GME].--Communities throughout
the country, particularly those in rural areas, struggle with
physician shortages, particularly with access to primary care
and mental health care. GME serves as the final step in a
physician's training, and Medicare provides the majority of
public financing for GME. The Committee is concerned that
current public financing for GME does not adequately address
the needs of all communities or the changing demands of the
health care system. The Committee directs CMS to submit a
report to Congress, no later than 180 days after the enactment
of this act, on what steps can be taken under current law to
address physician shortages.
Health Insurance Exchange Transparency.--The Committee
continues bill language that requires CMS to provide cost
information for the following categories: Federal Payroll and
Other Administrative Costs; Exchange related Information
Technology [IT]; Non-IT Program Costs, including Health Plan
Benefit and Rate Review, Exchange Oversight, Payment and
Financial Management, Eligibility and Enrollment; Consumer
Information and Outreach, including the Call Center, Navigator
Grants and Consumer Education and Outreach; Exchange Quality
Review; Small Business Health Options Program [SHOP] and
Employer Activities; and Other Exchange Activities. Cost
Information should be provided for each fiscal year since the
enactment of the Patient Protection and Affordable Care Act
(Public Law 111-148). CMS is also required to include the
estimated costs for fiscal year 2018.
Home Dialysis.--The Committee encourages CMS to review,
streamline, and update the Medicare Administrative Contractor
waiver requirements to incorporate a fair and transparent
process to granting waivers for use of remote monitoring and
management technologies. The Committee requests a report on the
status of the review and update process within 180 days of the
enactment of this act.
Intrathecal Pain Pumps.--The Committee is concerned that
recent changes to Medicare billing practice may restrict
patient access to intrathecal pain pumps as an option for pain
management in States where the boards of pharmacy prohibit sale
of compounded solutions from a pharmacist to a physician.
Therefore, the Committee directs the Secretary, in consultation
with relevant stakeholders, to conduct a study of the effect of
this billing practice change on patient access in these States.
The Secretary shall submit the report within 6 months after
enactment of this act to the Committees on Appropriations of
the House of Representatives and the Senate with
recommendations rectifying any identified limits to patient
access to intrathecal pain pump medication.
Medicare Advantage.-- The Committee is concerned that the
formula to determine Medicare Advantage reimbursement rates is
calculated based on the per capita cost of coverage to
beneficiaries enrolled in Medicare Part A and/or Part B.
However, where there is high enrollment in Medicare Advantage,
a relatively large proportion of Medicare beneficiaries without
Part B coverage, and relatively lower fee-for-service costs,
Medicare Advantage reimbursement rates may be better based on
the per capita cost of coverage to beneficiaries enrolled in
both Medicare Parts A and B. The Committee encourages CMS to
consider more accurate adjustments for fiscal year 2018.
Out of Network Emergency Care.--The Committee believes that
beneficiary protections are important to reduce the financial
exposure of patients who receive emergency care outside of
their insurance network. The Committee is concerned that the
Center for Consumer Information and Insurance Oversight [CCIIO]
has not provided sufficient clarity on how to determine the
``Usual, Customary & Reasonable'' [UCR] amount and encourages
that CCIIO publish clarifying guidance.
Part D Billing of Vaccines.--The Committee is aware that
Medicare Part B covers vaccines for several serious vaccine-
preventable diseases, including influenza, pneumonia, and
Hepatitis B for at-risk patients. However, a growing number of
other vaccines are only covered under Medicare's pharmacy
benefit, which can be challenging and burdensome for Part B
providers to bill. This can impede beneficiary access to the
full complement of vaccines recommended by the Advisory
Committee on Immunization Practices. The Committee encourages
CMS to prioritize the establishment and deployment of a Web-
based system to facilitate access to information regarding Part
D coverage criteria for vaccines and streamline billing for
Part D vaccines. Such a system should reduce administrative
burdens by enabling physicians to search plan coverage and
allow electronic submission claims for vaccines and vaccine
administration directly to Part D plans. The Committee requests
a report within 1 year of enactment submitted to the Committee
detailing implementation, including health care professional
education efforts among health care professionals and
utilization rates of recommended Part D vaccines among Medicare
beneficiaries.
Pre-Dispute Arbitration SNF.--The Committee is aware that
CMS has proposed regulations that would restrict or prohibit
pre-dispute arbitration agreements in skilled nursing
facilities. The Committee urges CMS to more thoroughly study
the impact of restricting pre-dispute arbitration agreements
before taking further action.
Prosthetic Coverage.--The Committee recognizes that
Medicare payments for all prosthetics, and especially the newer
advanced technologies, have declined over each of the years
2010-2014. The Committee encourages CMS to consult broadly with
clinicians, patient groups, and the prosthetics field regarding
revisions to the draft Local Coverage Determination, prior to
publishing an updated draft policy for public comment.
Recovery Audit Contractors [RAC].--The Committee directs
the Medicare appeals intra-agency working group to provide
quarterly updates to the Committees on Appropriations of the
House of Representatives and the Senate reflecting the total
number of appeals filed, appeals pending, and appeals disposed
of for all four levels of the appeals process. The quarterly
updates should include a breakout of RAC and non-RAC claims, an
update on RAC contracting and how new RAC requirements have
affected the rate of appeals.
Relative Values Under the Medicare Physician Fee
Schedule.--The Committee encourages the Secretary to increase
the representation of actively practicing board certified
primary care physicians on any advisory board, working group,
task force or panel that is charged with formulating
recommendations to any annual updates involving physician work
standards.
Risk Corridor Program.--The agreement continues bill
language to prevent the CMS Program Management appropriation
account from being used to support risk corridor payments. The
agreement directs CMS to provide a report starting with plan
year 2014 and continuing through the duration of the program to
the Committees on Appropriations of the House of
Representatives and the Senate detailing the receipts and
transfer of payments for the Risk Corridor Program.
Robotic Stereotactic Radiosurgery.--The Committee was
encouraged by CMS' decision to reverse the National Correct
Coding Initiative [NCCI] procedure edit regarding the provision
of robotic radiosurgery. With this decision, CMS recognizes the
safety and value of dosimetry calculations in radiation
oncology. However, the Committee remains concerned that the
cuts to robotic stereotactic radiosurgery threatens its
viability in both the hospital and freestanding center setting.
The Committee encourages CMS not to make further changes to
these services in the freestanding center as CMS complies with
Public Law 114-115.
Rural Health.--While nearly a quarter of the U.S.
population lives in rural areas, access to CAHs continues to be
a challenge for many residents as these hospitals face
significant financial challenges. The majority of rural
residents are older, poorer, and less likely to have employer
sponsored health plans. As a result, if a rural hospital
closes, many patients end up driving long distances to see a
doctor, forgo seeking medical care, or even worse, wait until
it is too late to seek proper medical attention. These patients
spend more money out of pocket to travel and miss out on
routine preventative care which will end up increasing
healthcare costs in the long run. The Committee continues to
direct CMS to work with HRSA's Office of Rural Health and
provide an update in the fiscal year 2018 CJ on actions taken
to alleviate the disproportionate impact of regulations,
reimbursement cuts, and workforce issues on rural hospitals.
Smart Medicare Card.--The Committee encourages CMS to
continue to explore smart card technology for Medicare
beneficiaries and providers to increase quality of care, reduce
identity theft, and increase the accuracy of Medicare billing.
Third Party Premium Assistance.--The Committee remains
concerned that CMS guidance on qualified health plan third
party payment remains unclear and is being interpreted as
prohibiting premium assistance by nonprofit organizations. CMS
is encouraged to continue to clarify language and consider
outlining specific instances when third-party payment premium
assistance should be accepted.
Use of Opioid Drugs to Manage Chronic Pain.--The Committee
understands that opioid pain medications are used and are often
essential in the appropriate management of acute and chronic
pain. Given the national problem of misuse and abuse of
prescription opioid pain medications, the Committee encourages
CMS to increase awareness of alternative pain management
strategies to opioids to reduce opioid monotherapy in
appropriate cases.
Use of Social Security Numbers on Medicare Beneficiaries'
Cards.--Under Public Law 114-10, Congress prohibits the use of
Social Security numbers on Medicare beneficiary cards. The
Committee urges CMS to work expeditiously to remove Social
Security numbers from Medicare cards as directed in Public Law
114-10. The Committee directs CMS to provide an update on the
progress of this initiative in their fiscal year 2018 CJ.
Vial Size.--Within 90 days of enactment of this act, CMS
shall enter into an agreement with the Health and Medicine
Division of the National Academies of Sciences, Engineering,
and Medicine [the Academies] to conduct a study on the Federal
healthcare costs, safety, and quality concerns associated with
discarded drugs that results from weight-based dosing of
medicines contained in single-dose vials. As part of this
study, the Academies should assess factors such as patient
safety; storage/shipping issues; FDA guidance; CDC guidelines
to biopharmaceutical manufacturers; and the Federal cost of
discarded drugs. Stakeholders, including CMS, FDA, CDC, DOD,
IHS, VA, specialty physicians [including rural practitioners],
specialty clinics [including rural clinics], patient groups,
biopharmaceutical manufacturers, health insurance companies,
and healthcare distributors/wholesalers shall be consulted. The
Committee directs this report, which shall include
recommendations to Congress, to be submitted to the Committees
on Appropriations of the House of Representatives and the
Senate no later than 12 months after the contract date.
State Survey and Certification
The Committee recommends $397,334,000 for State Survey and
Certification activities, which ensure that institutions and
agencies providing care to Medicare and Medicaid beneficiaries
meet Federal health, safety, and program standards. On-site
surveys are conducted by State survey agencies, with a pool of
Federal surveyors performing random monitoring surveys.
The Committee continues to support CMS collecting and
analyzing the findings from this surveillance tool to inform
the agency's education and surveillance efforts moving forward.
Federal Administration
The Committee recommends $732,533,000 for Federal
Administration, which funds the majority of CMS' staff and
operating expenses for routine activities such as planning,
implementing, evaluating, and ensuring accountability in the
programs administered by CMS.

HEALTH CARE FRAUD AND ABUSE CONTROL

Appropriations, 2016.................................... $681,000,000
Budget estimate, 2017................................... 725,000,000
Committee recommendation................................ 725,000,000

The Committee recommends $725,000,000, to be transferred
from the Medicare trust funds, for Health Care Fraud and Abuse
Control [HCFAC] activities. The latest data demonstrate for
every $1.00 spent on fraud and abuse, $2 is recovered by the
Treasury. By utilizing the cap adjustment provided in the
Budget Control Act, the Committee recommendation will create
over $10,200,000,000 in savings to the U.S. Treasury over 10
years.
The Committee recommendation includes a base amount of
$311,000,000 and an additional $414,000,000 through a budget
cap adjustment authorized by section 251(b) of the Balanced
Budget and Emergency Deficit Control Act of 1985.
Senior Medicare Patrol Program.--The bill includes language
to fully fund the Senior Medicare Patrol Program administered
through the Administration for Community Living from the level
provided in this account.

Administration for Children and Families

PAYMENTS TO STATES FOR CHILD SUPPORT ENFORCEMENT AND FAMILY SUPPORT
PROGRAMS

Appropriations, 2016.................................... $2,944,906,000
Budget estimate, 2017................................... 3,010,631,000
Committee recommendation................................ 3,010,631,000

The Committee recommendation includes $3,010,631,000 in
fiscal year 2017 mandatory funds for Child Support Enforcement
and Family Support programs. In addition, the Committee
recommends $1,400,000,000 in advance funding for the first
quarter of fiscal year 2018.
These funds support States' efforts to promote the self-
sufficiency and economic security of low-income families,
including administrative expenses matching funds and incentive
payments to States for child support enforcement; grants to
States to help establish and administer access and visitation
programs between noncustodial parents and their children;
payments to territories for benefits to certain aged, blind, or
disabled individuals; and temporary benefits for certain
repatriated citizens.

LOW INCOME HOME ENERGY ASSISTANCE PROGRAM

Appropriations, 2016.................................... $3,390,304,000
Budget estimate, 2017................................... 3,000,304,000
Committee recommendation................................ 3,390,304,000

The Committee recommendation includes $3,390,304,000 for
LIHEAP, which provides home heating and cooling assistance to
low-income households, generally in the form of payments to
energy vendors on behalf of the recipient. Within the total,
the Committee recommendation includes up to $2,988,000 for
program integrity and oversight efforts.

REFUGEE AND ENTRANT ASSISTANCE

Appropriations, 2016.................................... $1,674,691,000
Budget estimate, 2017................................... 2,249,860,000
Committee recommendation................................ 1,674,691,000

The Committee recommends $1,674,691,000 for Refugee and
Entrant Assistance programs. These programs provide a variety
of benefits and services to refugees, asylees, Cuban and
Haitian entrants, immigrants arriving on Special Immigrant
Visas, trafficking victims, and torture victims (collectively
referred to below as ``refugees''). These programs also provide
temporary care and services for unaccompanied children
apprehended by the Department of Homeland Security or other law
enforcement agencies, who have no lawful immigration status in
the United States until they can be placed with a parent,
guardian, or other sponsor while awaiting adjudication of their
immigration status.
Transitional and Medical Services
The Committee recommendation includes $490,000,000 for
Transitional and Medical Services [TAMS]. This program provides
grants to States and nonprofit organizations to provide up to 8
months of cash and medical assistance to arriving refugees, as
well as foster care services to unaccompanied minors.
The Committee notes that there is considerable uncertainty
in the estimates of costs for this program, which depend
heavily on the number of refugees admitted and entering the
United States, as well as estimates of financial, medical, and
foster care costs of arriving refugees. In addition, there are
significant prior-year unobligated balances available within
ORR that may be used for the TAMS program. Congress has
provided extended availability for funds appropriated in this
account specifically to account for uncertainties in this
program. The Committee will consider future funding needs as
more data becomes available.
Victims of Trafficking
The Committee recommendation includes $18,755,000 for
Victims of Trafficking programs. These programs support a
national network of organizations that provide a variety of
services--including case management, counseling, benefit
coordination, and housing assistance--for victims of commercial
sex and forced labor trafficking.
Within the total, the Committee recommendation includes
$13,000,000 for services for foreign national victims, and
$5,755,000 to improve services available for U.S. citizens and
legal permanent residents, the same as the fiscal year 2016
funding levels. The Committee recommendation also includes
continued funding for a national human trafficking resource
center, and includes bill language clarifying that funds can
continue to be used for these activities.
Social Services
The Committee recommendation includes $155,000,000 for
Social Services programs for refugees. These funds include both
formula and discretionary grants to States and nonprofit
organizations to provide a variety of employment and support
services to recently arrived refugees.
Preferred Communities.--The Committee is encouraged that
ORR integrates long-term intensive case management services for
vulnerable refugee populations and secondary migrants through
the Preferred Communities Program. Extended case management
services help to ensure refugees achieve self-sufficiency and
integrate into their new communities.
Preventive Health
The Committee recommendation includes $4,600,000 for
Preventive Health services for refugees. This program funds
competitive grants to States to provide newly arrived refugees
health orientation and education services, referrals for
medical and mental health services, and access to ongoing
healthcare.
Targeted Assistance
The Committee recommendation includes $47,601,000 for the
Targeted Assistance program. This program provides additional
funds to States and counties with the greatest number of
refugee arrivals and high concentrations of refugees facing
difficulties achieving self-sufficiency.
Unaccompanied Children
The Committee recommendation includes $948,000,000 for the
Unaccompanied Children [UC] program. The UC program provides
temporary shelter and basic services to children who have no
lawful immigration status in the United States and who have
been apprehended in the United States by the Department of
Homeland Security or other law enforcement agencies without a
parent or guardian. HHS takes custody of the children until
they can be placed with a parent or guardian living in the
United States pending resolution of their immigration status,
or until their immigration status otherwise changes.
Similar to the TAMS program, there is considerable
uncertainty in the estimates of costs for this program, which
depend heavily on the number of unaccompanied children coming
to the United States and referred to HHS. There are also
significant prior-year unobligated balances available for use
under this program that may be used in fiscal year 2016 and
2017. The amount of unobligated balances available in fiscal
year 2017, which will directly impact the amount of new budget
authority needed for fiscal year 2017, will depend on costs in
fiscal year 2016, for which there is also considerable
uncertainty. The Committee will consider future funding needs
for this program as more data becomes available.
The Committee notes that HHS is responsible for providing
post-release services, including home visits, for certain
children it places with a sponsor pending adjudication of their
immigration status. The Committee strongly encourages HHS to
continue efforts to improve its process for providing post-
release services to ensure that children are placed in safe,
appropriate environments.
Victims of Torture
The Committee recommendation includes $10,735,000 for the
Victims of Torture program. This program provides treatment,
social, and legal services to victims of torture and training
to healthcare providers on treating the physical and
psychological effects of torture.

PAYMENTS TO STATES FOR THE CHILD CARE AND DEVELOPMENT BLOCK GRANT

Appropriations, 2016.................................... $2,761,000,000
Budget estimate, 2017................................... 2,961,672,000
Committee recommendation................................ 2,786,000,000

The Committee recommends $2,786,000,000 for the Child Care
and Development Block Grant [CCDBG], a formula grant to States
that provides financial assistance to families to help pay for
child care, and otherwise improve the quality of child care
programs.
The CCBDG Act of 2014 included a new set-aside requiring
States to reserve a specified percentage of funding for
improving the quality of infant and toddler child care. This
replaces a similar set-aside previously included in
appropriations language. Accordingly, the Committee
recommendation removes the set-aside previously included in
appropriations language.

SOCIAL SERVICES BLOCK GRANT

Appropriations, 2016.................................... $1,700,000,000
Budget estimate, 2017................................... 1,700,000,000
Committee recommendation................................ 1,700,000,000

The Committee recommends $1,700,000,000 in mandatory funds
for the SSBG, a flexible source of funding that allows States
to provide a diverse array of services to low-income children
and families, the disabled, and the elderly.

CHILDREN AND FAMILIES SERVICES PROGRAMS

Appropriations, 2016.................................... $11,234,268,000
Budget estimate, 2017................................... 11,725,057,000
Committee recommendation................................ 11,214,935,000

The Committee recommends $11,214,935,000 for Children and
Family Services programs. These funds support a variety of
programs for children, youth, and families; Native Americans;
victims of child abuse, neglect, and domestic violence; and
other vulnerable populations.
The Committee directs the Department, in conjunction with
the Department of Education, to conduct the review of all
federally funded early childhood education programs required by
section 9213 of the Every Student Succeeds Act, to develop a
plan for the elimination of overlapping programs, determine if
activities conducted by States using grant funds from Race to
the Top and Preschool Development Grants have led to a better
utilization of resources, and make recommendations to Congress
for streamlining all such programs.
Head Start
The Committee recommendation includes $9,203,095,000 for
Head Start. Head Start provides grants directly to local
organizations to provide comprehensive early childhood
education services to children and their families, from before
birth to age 5.
The Committee recommendation includes a $35,000,000
increase to support increases for all current Head Start
programs which will help programs keep up with costs, recruit
and support highly qualified staff, maintain enrollment levels,
and continue to provide high-quality, comprehensive services
for children and families.
Within the total for Head Start, in addition to funds
otherwise available for Early Head Start, the Committee
recommendation includes $635,000,000, the same as the fiscal
year 2016 level, to support the continuation of Early Head
Start Expansion and Child Care Partnerships grants. The
Committee continues to direct HHS to give equal priority to
grantees providing more traditional Early Head Start services
and those forming child care partnerships. The Committee
continues to support this partnership model but such
partnerships will not be viable in every community and in many
places it may be more appropriate to simply provide traditional
Early Head Start services.
Within the total for Head Start, the Committee
recommendation also includes up to $25,000,000, the same as the
comparable fiscal year 2016 level and the budget request, for
transition-related costs associated with the Head Start
Designation Renewal System [DRS]. HHS is in the process of
evaluating the DRS, including its validity, its sensitivity in
differentiating lower performing programs from higher
performing programs, and its role in improving the quality of
Head Start programs. The Committee looks forward to the results
of this evaluation. In addition, the Committee encourages HHS
to continue to consider the unique challenges faced by Head
Start grantees in remote and frontier areas when reviewing such
grantees' compliance with health and dental screening
requirements as part of the DRS.
The Committee continues to support efforts to expand the
duration of Head Start services. Research increasingly
indicates that expanding the duration of services, including
lengthening the school day and school year, is critical to
increasing and sustaining the benefits of early childhood
programs. However, the Committee directs HHS to ensure that as
part of the effort to expand the duration of services, grantees
continue to have flexibility to meet the needs of their local
community, and to fund other quality improvement activities
that may be necessary to improve the quality of programs prior
to expanding the duration of services.
Preschool Development Grants
The Committee recommendation includes $250,000,000 for
Preschool Development Grants. The Every Student Succeeds Act
moves this program from the Department of Education to HHS, and
the Committee recommendation is consistent with that move.
Funding for Preschool Development Grants in fiscal year 2016 is
shown in HHS for comparability.
The Preschool Development Grants program provides
competitive grants to States to develop or expand preschool
programs for 4-year olds from low- and moderate-income
families. This fiscal year 2017 funding will support the
continuation costs for the fourth and final year of existing
State grants.
Consolidated Runaway and Homeless Youth Program
The Committee recommendation includes $101,980,000 for the
Consolidated Runaway and Homeless Youth program. This program
supports the Basic Centers program, which provides temporary
shelter, counseling, and after-care services to runaway and
homeless youth under age 18 and their families; the
Transitional Living Program, which provides longer-term shelter
and services for older youth; and a national toll-free runaway
and homeless youth crisis hotline.
Education and Prevention Grants To Reduce Sexual Abuse of Runaway Youth
The Committee recommendation includes $17,141,000 for
Education and Prevention Grants to Reduce Sexual Abuse of
Runaway and Homeless Youth. This program provides competitive
grants for street-based outreach and education services for
runaway and homeless youth who are subjected to, or are at risk
of being subjected to, sexual abuse or exploitation.
Child Abuse Prevention and Treatment State Grants
The Committee recommendation includes $25,310,000 for the
Child Abuse Prevention and Treatment State Grant program. This
program provides formula grants to States to improve their
child protective service systems.
Child Abuse Discretionary Activities
The Committee recommendation includes $33,000,000 for Child
Abuse Discretionary Activities. This program supports
discretionary grants for research, demonstration, and technical
assistance to increase the knowledge base of evidence-based
practices and to disseminate information to State and local
child welfare programs.
Community-Based Child Abuse Prevention
The Committee recommendation includes $39,764,000 for the
Community-Based Child Abuse Prevention program. This program
provides formula grants to States that then disburse funds to
local, community-based organizations to improve local child
abuse prevention and treatment efforts, including providing
direct services and improving the coordination between State
and community-based organizations.
Child Welfare Services
The Committee recommendation includes $268,735,000 for
Child Welfare Services. This formula grant program helps State
and tribal public welfare agencies improve their child welfare
services with the goal of keeping families together. These
funds help States and tribes provide a continuum of services
that prevent child neglect, abuse or exploitation; allow
children to remain with their families, when appropriate;
promote the safety and permanence of children in foster care
and adoptive families; and provide training and professional
development to the child welfare workforce.
Child Welfare Research, Training, and Demonstration
The Committee recommendation includes $17,984,000 for child
welfare research, training, and demonstration projects. This
program provides grants to public and nonprofit organizations
for demonstration projects that encourage experimental and
promising types of child welfare services, as well as projects
that improve education and training programs for child welfare
service providers.
National Survey of Child and Adolescent Well-Being.--The
Committee recommendation includes funding within this program
for HHS to continue the National Survey of Child and Adolescent
Well-Being. This survey provides critical, nationally
representative, longitudinal data on children who have been
involved in State child protective services programs. This
helps examine the current characteristics and needs of children
and families involved with child protective services, and
evaluate the impact of interventions to improve child and
family well-being.
Adoption Opportunities
The Committee recommends $39,100,000 for the Adoption
Opportunities program. This program funds discretionary grants
to help facilitate the elimination of barriers to adoption and
provide technical assistance to help States increase the number
of children adopted, particularly children with special needs.
The Committee encourages ACF to fund activities to improve
hospital-based adoption support services for pregnant and
expectant mothers, including training for hospital staff and
doctors. Such activities would help ensure that mothers who
wish to make an adoption have access to trained staff and
comprehensive supports throughout the adoption process.
Adoption Incentives
The Committee recommends $37,943,000 for the Adoption
Incentives program. This program provides formula-based
incentive payments to States to encourage them to increase the
number of adoptions of children from the foster care system,
with an emphasis on children who are the hardest to place.
Social Services and Income Maintenance Research
The Committee recommends $6,512,000 for Social Services and
Income Maintenance Research. These funds support research and
evaluation of cost-effective programs that increase the
stability and economic independence of families and contribute
to the healthy development of children and youth.
Native American Programs
The Committee recommends $50,000,000 for Native American
programs. These funds support a variety of programs to promote
self-sufficiency and cultural preservation activities among
Native American, Native Hawaiian, Alaska Native, and Pacific
Islander organizations and communities.
Within the total, the Committee recommendation includes
$12,000,000 for Native American language preservation
activities, including no less than $4,000,000 for Native
American language nests and survival schools, as authorized by
sections 803C(b)(7)(A)-(B) of the Native American Programs Act.
The Committee directs HHS to give priority to programs with the
most rigorous immersion programs.
Community Services Block Grant
The Committee recommendation includes $715,000,000 for the
Community Services Block Grant [CSBG]. The CSBG is a formula
grant to States and Indian tribes to provide a wide range of
services to alleviate causes of poverty in communities and to
assist low-income individuals in becoming self-sufficient.
States are required to pass on at least 90 percent of these
funds to local community-based organizations, the vast majority
of which are community action agencies.
Community Economic Development
The Committee recommendation does not include funding for
the Community Economic Development [CED] program, as proposed
by the administration. The President's budget proposed
eliminating this program because it is similar or duplicative
of programs administered by other agencies, including the
Department of Treasury.
Rural Community Facilities
The Committee recommendation does not include funding for
the Rural Community Facilities program, as proposed by the
administration. The President's budget proposed eliminating
this program because it is similar or duplicative of programs
administered by other agencies, including the Department of
Agriculture and Environmental Protection Agency.
Assets for Independence
The Committee recommendation does not include funding for
the Assets for Independence program. This program was created
in 1998 as a demonstration program to test the impact of
individual development accounts on a range of outcomes for low-
income individuals and families.
National Domestic Violence Hotline
The Committee recommendation includes $8,250,000 for the
National Domestic Violence Hotline. This national, toll-free
hotline provides critical emergency assistance and information
to victims of domestic violence 24 hours a day.
Family Violence Prevention and Services
The Committee recommendation includes $151,000,000 for
Family Violence Prevention and Services programs. These funds
support programs to prevent family violence and provide
immediate shelter and related assistance for victims of
domestic violence and their dependents.
Chafee Education and Training Vouchers
The Committee recommendation includes $43,257,000 for the
Chafee Education and Training Voucher program. This program
supports vouchers to foster care youth to help pay for expenses
related to postsecondary education and vocational training.
Disaster Human Services Case Management
The Committee recommends $1,864,000 for Disaster Human
Services Case Management. This program assists States in
establishing the capacity to provide case management services
in a timely manner in the event of a disaster. It ensures that
States are able to meet social service needs during disasters
by helping disaster victims prepare recovery plans, referring
them to service providers and FEMA contacts to identify needed
assistance, and providing ongoing support and monitoring
through the recovery process.
Program Administration
The Committee recommendation includes $205,000,000 for the
Federal costs of administering ACF programs.

CHILDREN'S RESEARCH AND TECHNICAL ASSISTANCE

Appropriations, 2016....................................................
Budget estimate, 2017................................... $10,000,000
Committee recommendation................................................

The Committee recommendation does not include new
discretionary funding for Children's Research and Technical
Assistance. This program receives dedicated mandatory funding
to carry out authorized activities.

PROMOTING SAFE AND STABLE FAMILIES

Appropriations, 2016.................................... $404,765,000
Budget estimate, 2017................................... 424,765,000
Committee recommendation................................ 384,765,000

The Committee recommends $384,765,000 for the Promoting
Safe and Stable Families program. The Committee recommendation
includes $325,000,000 in mandatory funds authorized by the
Social Security Act and $59,765,000 in discretionary
appropriations.
This program supports activities that can prevent the
emergence of family crises that might require the temporary or
permanent removal of a child from his or her home. Grants allow
States to operate coordinated programs of family preservation
services, time-limited family reunification services,
community-based family support services, and adoption promotion
and support services.
The Committee notes that the authorization for Promoting
Safe and Stable Families expiries in fiscal year 2016.
Mandatory funding for certain activities within this account
are not assumed to continue in the CBO baseline. Accordingly,
the Committee recommendation does not include funding for those
activities.

PAYMENTS FOR FOSTER CARE AND PERMANENCY

Appropriations, 2016.................................... $5,298,000,000
Budget estimate, 2017................................... 5,764,000,000
Committee recommendation................................ 5,764,000,000

The Committee recommends $5,764,000,000 in mandatory funds
for Payments for Foster Care and Permanency. In addition, the
Committee recommends $2,500,000,000 in advance mandatory
funding for the first quarter of fiscal year 2018. These funds
support programs that assist States with the costs of
maintaining eligible children in foster care, prepare children
for living on their own, assist relatives with legal
guardianship of eligible children, and find and support
adoptive homes for children with special needs.
The Committee notes that older youth in the foster care
system or aging out of the foster care system have extremely
high rates of homelessness. There are many steps that State and
local child welfare agencies can take to help prevent
homelessness for these youth, and to help prevent child abuse
and neglect, including extending foster care payments for youth
up to age 21 and better coordinating with programs supported by
the Department of Housing and Urban Development, the Department
of Labor, and the Department of Education. The Committee
strongly encourages HHS to provide States and localities with
guidance and examples of best practices for using extended
foster care payments to help maintain housing stability. The
Committee further encourages HHS to develop, in coordination
with the U.S. Interagency Council on Homelessness,
comprehensive guidance on transition planning for youth exiting
the foster care system including lessons from the Youth At Risk
of Homelessness Planning Grants; best practices regarding
seeking legal permanency and permanent connections to caring
adults for youth nearing the end of eligibility for foster
care; example transition plans; and guidance about the Federal
funding sources available to assist with the transition process
for youth exiting foster care including housing and supportive
services such as tenancy supports, basic living skills
development, behavioral health, and connections to education
and employment. The Committee directs HHS to report to the
House and Senate Committees on Appropriations within 120 days
of enactment of this act on the actions it has taken, as well
as future actions it will undertake, to implement these
directives.
Ensuring Timely Mental Health Screenings and Assessments
for Children in Foster Care.--The Committee strongly encourages
HHS to provide guidance to States to improve mental health
screenings and services for children in foster care.
Specifically, the Committee strongly encourages HHS to require,
as part of the State plan required under section 422 of the
Social Security Act, that a child receives an initial health
screening within 30 days of entry into foster care and, if an
initial mental health issue is identified, the child receives a
comprehensive assessment in mental health within 60 days.

Administration for Community Living

AGING AND DISABILITY SERVICES PROGRAMS

Appropriations, 2016.................................... $1,992,550,000
Budget estimate, 2017................................... 2,020,994,000
Committee recommendation................................ 1,935,435,000

The Committee recommends an appropriation of $1,935,435,000
for the Administration for Community Living [ACL]. The
Committee recommendation also includes $27,700,000 to be
transferred to ACL from the PPH Fund.
ACL was created with the goal of increasing access to
community support for older Americans and people with
disabilities. It is charged with administering programs
authorized under the Older Americans Act [OAA] and the
Developmental Disabilities Act, as well as promoting community
living policies throughout the Federal Government for older
Americans and people with disabilities.
The Committee understands that ACL has proposed to expand
the administrative capacity of the formula grant programs by
transferring up to 2 percent from the State grants to support
new staff. The Committee recognizes that this additional
capacity may enhance program oversight and performance.
However, the Committee is concerned about the disproportionate
impact the transfer may have on grantees in the smaller formula
programs, particularly those authorized under the Development
Disabilities Assistance and Bill of Rights Act. The Committee
urges ACL to more thoughtfully examine the impact of the
proposed transfer on the smaller programs before taking further
action.
Home- and Community-Based Supportive Services
The Committee recommends an appropriation of $347,724,000
for the Home- and Community-Based Supportive Services program.
This program provides formula grants to States and territories
to fund a wide range of social services that enable seniors to
remain independent and in their homes for as long as possible.
State agencies on aging award funds to designated area agencies
on aging that, in turn, make awards to local service providers.
This activity supports services such as transportation, adult
day care, physical fitness programs, and in-home assistance
such as personal care and homemaker assistance. The Committee
directs ACL to work with States to prioritize innovative
service models, like naturally occurring retirement communities
[NORCs], which help older Americans remain independent as they
age. The Committee notes that NORCs, and similar settings, are
a more cost-effective alternative to long-term care that
enables older Americans to be more engaged in their communities
while living at home.
Preventive Health Services
The Committee recommends $19,848,000 for Preventive Health
Services. This program funds activities such as medication
management and enhanced fitness and wellness programs. These
programs help seniors stay healthy and avoid chronic disease,
thus reducing the need for costly medical interventions. The
Committee maintains bill language that requires States to use
these funds to support evidence-based models that enhance the
wellness of seniors.
Protection of Vulnerable Older Americans
The Committee recommends $20,658,000 for grants to States
for the Long-term Care Ombudsman program and the Prevention of
Elder Abuse program. Both programs provide formula grants to
States to prevent the abuse, neglect, and exploitation of older
individuals. The ombudsman program focuses on the needs of
residents of nursing homes and other long-term care facilities,
while the elder abuse prevention program targets the elderly
community at large.
National Family Caregiver Support Program
The Committee recommends $150,586,000 for the National
Family Caregiver Support program. Funds appropriated for this
activity establish a multifaceted support system in each State
for family caregivers, allowing them to care for their loved
ones at home for as long as possible. States may use funding to
provide information to caregivers about available services,
assistance to caregivers in gaining access to services,
caregiver counseling and training, respite care to enable
caregivers to be temporarily relieved from their caregiving
responsibilities, and limited supplemental services that fill
remaining service gaps.
Native American Caregiver Support Program
The Committee recommendation includes $7,531,000 to carry
out the Native American Caregiver Support program. This program
provides grants to tribes for the support of American Indian,
Alaskan Native, and Native Hawaiian families caring for older
relatives with chronic illness or disability, as well as for
grandparents caring for grandchildren.
Congregate and Home-Delivered Nutrition Services
The Committee recommends an appropriation of $448,342,000
for congregate nutrition services and $226,342,000 for home-
delivered meals. These programs address the nutritional needs
of older individuals, thus helping them to stay healthy and
reduce their risk of disability. Funded projects must make
home-delivered and congregate meals available at least once a
day, 5 days a week, and each meal must meet a minimum of one-
third of daily dietary requirements. While States receive
separate allotments of funds for congregate meals, home-
delivered meals, and supportive services, they have flexibility
to transfer funds between these programs.
Nutrition Services Incentives Program.--The Committee
recommendation includes $160,069,000 for the Nutrition Services
Incentives Program [NSIP]. NSIP augments funding for congregate
and home-delivered meals provided to older adults. States and
tribes may choose to receive all or part of their funding in
the form of commodities from the USDA.
Aging Grants to Indian Tribes and Native Hawaiian Organizations
The Committee recommends $26,158,000 for grants to Native
Americans. This program provides grants to eligible tribal
organizations for the delivery of nutrition and supportive
services to Native Americans.
Aging Network Support Activities
The Committee recommends $9,961,000 for Aging Network
Support activities. These funds support activities that expand
public understanding of aging and the aging process, apply
social research and analysis to improve access to and delivery
of services for older individuals, test innovative ideas and
programs, and provide technical assistance to agencies that
administer programs authorized by the OAA.
Within funding for the Aging Network Support Activities,
the Committee supports the continuation of the National
Alzheimer's Call Center, which is available in all States, 24-
hours a day, 7 days a week, year-round, to provide expert
advice, crisis counseling, care consultation and information
referral services in at least 140 languages, for persons with
Alzheimer's disease, their family members and informal
caregivers.
The Committee also includes $2,500,000 to help provide
supportive services for aging Holocaust survivors in the United
States.
Alzheimer's Disease Demonstration Grants to States
The Committee recommendation includes $4,800,000 for
Alzheimer's Disease Demonstration Grants to States. This
program funds competitive grants to States to test and
implement new models of care for individuals with Alzheimer's
disease.
Alzheimer's Disease Initiative
The Committee recommends $14,700,000 in mandatory funding
be transferred from the PPH Fund to ACL for the Alzheimer's
Disease Initiative. Of the total, $10,500,000 is provided to
expand the availability of home- and community-based dementia
services and supports. The remaining $4,200,000 is provided for
a public awareness outreach campaign regarding Alzheimer's
disease.
Lifespan Respite Care
The Committee recommends $3,360,000 for the Lifespan
Respite Care program. The Lifespan Respite Care program
provides grants to States to expand respite care services to
family caregivers, improve the local coordination of respite
care resources, and improve access to and quality of respite
care services, thereby reducing family caregiver strain.
Chronic Disease Self-Management Program
The Committee recommends $8,000,000 be transferred from the
PPH Fund to ACL for the Chronic Disease Self-Management Program
[CDSMP]. This program assists those with chronic disease manage
their conditions and improve their health status. Topics
covered by the program include nutrition; appropriate use of
medications; fitness; and effective communications with
healthcare providers. CDSMP has been shown through multiple
studies to result in significant and measurable improvements in
health and quality of life, as well as reductions in
hospitalizations and emergency room visits.
Elder Falls Prevention
The Committee recommends that $5,000,000 be transferred
from the PPH Fund for Elder Falls Prevention activities at ACL.
Preventing falls will help seniors stay independent and in
their homes and avoid costly hospitalizations and hip
fractures, which frequently lead to nursing home placement. The
Committee intends that these funds should be used in
coordination with CDC for public education about the risk of
these falls, as well as implementation and dissemination of
community-based strategies that have been proven to reduce the
incidence of falls among seniors.
Elder Rights Support Activities
The Committee recommends $13,874,000, an increase of
$2,000,000 above fiscal year 2016, for Elder Rights Support
activities, including $10,000,000 for the Elder Justice
Initiative. These activities support programs that provide
information, training, and technical assistance to legal and
aging services organizations in order to prevent and detect
elder abuse and neglect.
Elder Justice Initiative.--The Committee is aware of the
work being carried out by the Elder Justice Coordinating
Council [EJCC], where the Department is a permanent member, and
remains supportive of efforts to help protect older adults from
all forms of abuse, including through increasing public
awareness to occurrences of elder abuse and the dissemination
of information about how members of the public may obtain
services. Through the work of the EJCC, the Committee
encourages the Department of Justice to work with the Secretary
of the HHS, and other relevant agencies, to develop a national
elder justice awareness campaign.
Aging and Disability Resource Centers
The Committee recommendation includes $6,119,000 for Aging
and Disability Resource Centers [ADRCs]. These centers provide
information, one-on-one counseling, and access for individuals
to learn about their long-term services and support options
with the goal of allowing seniors and individuals with
disabilities to maintain their independence. The Committee
urges ACL to improve coordination among ADRCs, area agencies on
aging, and centers for independent living to ensure that there
is ``no wrong door'' to access services.
State Health Insurance Assistance Program
Due to budget constraints, the Committee recommendation
does not include funding for the State Health Insurance
Assistance Program. The Committee expects ACL, in coordination
with CMS and States, to continue to provide accurate and
understandable health insurance information to Medicare
beneficiaries and their families through existing HHS programs
that support these activities.
Paralysis Resource Center
The Committee recommendation includes $7,700,000 for the
Paralysis Resource Center, which provides comprehensive
information and referral services to people living with
paralysis and their families. These resources and services
focus on the promotion of independence and quality of life for
the over 6,000,000 Americans living with paralysis.
Limb Loss
The Committee provides $2,810,000 for the Limb Loss
program, which supports programs and activities to improve the
health of people with limb loss and promote their well-being,
quality of life, prevent disease, and provide support to their
families and caregivers.
Traumatic Brain Injury
The Committee provides $9,321,000 for the Traumatic Brain
Injury program. The program supports implementation and
planning grants to States for coordination and improvement of
services to individuals and families with traumatic brain
injuries. Such services can include: pre-hospital care,
emergency department care, hospital care, rehabilitation,
transitional services, education, employment, long-term
support, and protection and advocacy services.
The Committee includes not less than the fiscal year 2016
funding level for protection and advocacy services, as
authorized under section 1305 of Public Law 106-310.
Developmental Disabilities State Councils
The Committee recommendation includes $73,000,000 for State
councils on developmental disabilities. These councils work to
develop, improve, and expand the system of services and
supports for people with developmental disabilities at the
State and local level. Councils engage in activities such as
training, educating the public, building capacity, and
advocating for change in State policies with the goal of
furthering the inclusion and integration of individuals with
developmental disabilities in all aspects of community life.
Developmental Disabilities Protection and Advocacy
The Committee recommendation includes $38,734,000 for
protection and advocacy programs for people with developmental
disabilities. This formula grant program provides funds to
States to establish and maintain protection and advocacy
systems that protect the legal and human rights of persons with
developmental disabilities who are receiving treatment,
services, or rehabilitation.
Voting Access for Individuals With Disabilities
The Committee recommendation includes $4,963,000 to improve
voting access for individuals with disabilities. This program
provides grants to protection and advocacy organizations to
ensure that individuals with disabilities have the opportunity
to participate in every step of the electoral process,
including registering to vote, accessing polling places, and
casting a vote.
Developmental Disabilities Projects of National Significance
The Committee recommendation includes $10,000,000 for
projects of national significance to assist persons with
developmental disabilities. This program funds grants and
contracts that develop new technologies and demonstrate
innovative methods to support the independence, productivity,
and integration into the community of persons with
developmental disabilities.
Technical Assistance.--The Committee provides $575,000 for
technical assistance and training for the State Councils on
Developmental Disabilities.
Transportation.--The Committee includes $1,000,000 to fund
transportation assistance activities for older adults and
persons with disabilities. These activities should focus on the
most cost-effective and sustainable strategies that can be
replicated to other communities. The Committee is pleased with
the Inclusive Community Transportation program's efforts to
integrate rural transit systems for individuals with
disabilities and older adults to access health care services,
paratransit, multiple transportation providers, and other
critical community based supports. These small community
demonstration grants should be designed to include the
perspectives of individuals with disabilities and older adults
in the transportation system and service design.
University Centers for Excellence in Developmental Disabilities
The Committee recommendation includes $38,619,000 for the
University Centers for Excellence in Developmental Disabilities
[UCEDDs], a network of 67 centers that are interdisciplinary
education, research and public service units of a university
system or public or nonprofit entities associated with
universities. The funding will keep the national network of
Centers strong and able to assist States to initiate
collaborative research, education, training, and service
efforts that help States to implement ESSA and WIOA, thereby
ensuring that youth with disabilities successfully complete
elementary school and transition from school to postsecondary
education and/or integrated employment. The funding will also
allow the Centers to continue to respond to emerging and
emergent national issues such as assisting in ongoing
developmental monitoring, especially for children exposed to
lead and other environmental teratogens, and for infants
exposed to the Zika virus with its resulting complications.
Independent Living
The Committee recommendation includes $101,183,000 for the
Independent Living Program. This program helps ensure that
individuals with disabilities can live a productive and
independent life in society. Funding supports States sustain,
improve, and expand independent living services and establish
and support a network of centers for independent living.
National Institute on Disability, Independent Living, and
Rehabilitation Research
The Committee recommendation includes $103,970,000 for the
National Institute on Disability, Independent Living, and
Rehabilitation Research [NIDILRR]. The NIDILRR supports
research and activities that help to maximize the full
potential of individuals with disabilities in employment,
independent living, and social activities.
The Committee recognizes that there is a significant
opportunity over the next decade for the Department to
simultaneously lower healthcare costs and improve quality of
life for the older adult and disabled population by embracing
the rapidly growing shift to technology solutions for daily
living. These solutions are poised to extend the ability to
live independently into advanced age, and ``age in place'',
helping to bridge the ``care gap'' so that older and disabled
adults might avoid nursing homes and other institutionalized
care as long as possible, while also remaining connected to
their families and communities.
The Committee encourages the NIDILRR to continue to support
research and activities that help older or disabled adults,
including those in rural and tribal communities, to increase,
maintain, or improve their functional capabilities. To that
end, the Committee supports increased investment in university
research to harness technological advances that improve health,
maximize community engagement, encourage productivity, and
preserve independence among older individuals and their
families. Special emphasis should be given to research projects
that seek to develop technologies that allow for independent
living, seek to address aging and disabled populations, and
target rural, frontier, and tribal communities as they stand to
benefit the most from home and community-delivered technologies
that reduce isolation, increase safety and well-being, prevent
falls and related injuries, and maximize mobility.
Assistive Technology
The Committee recommendation includes $32,000,000 for
Assistive Technology [AT]. AT provides States with funding to
support individuals with disabilities of all ages to obtain
devices and services that will increase, maintain, or improve
their functional capabilities.
The Committee also includes report language directing CMS
to work with ACL to encourage Assistive Technology
Reutilization programs at the State level.
Program Administration
The Committee recommends $40,063,000 for program
administration at ACL. These funds support salaries and related
expenses for program management and oversight activities.
Muscular Dystrophy.--The Committee is aware that the ACL is
included in the Muscular Dystrophy Coordinating Committee under
the Muscular Dystrophy CARE Act Amendments enacted in September
2014. The Committee supports programs and initiatives focused
on the transitions of persons with Duchenne into adulthood. The
Committee requests a report within 180 days of enactment of
this act on the administration's plans to conduct comprehensive
studies focused on demonstrating the cost-effectiveness of
independent living programs and supports for persons living
with various forms of muscular dystrophy.

Office of the Secretary

GENERAL DEPARTMENTAL MANAGEMENT

Appropriations, 2016.................................... $520,837,000
Budget estimate, 2017................................... 544,890,000
Committee recommendation................................ 509,747,000

The Committee recommends $509,747,000 for General
Departmental Management [GDM]. The recommendation includes
$64,828,000 in transfers available under section 241 of the PHS
Act.
This appropriation supports activities that are associated
with the Secretary's role as policy officer and general manager
of the Department. It supports health activities performed by
the Office of the Assistant Secretary for Health [ASH],
including the Office of the Surgeon General. GDM funds also
support the Department's centralized services carried out by
several Office of the Secretary staff divisions, including
personnel management, administrative and management services,
information resources management, intergovernmental relations,
legal services, planning and evaluation, finance and
accounting, and external affairs.
Alzheimer's Education Campaign.--Although many medical
organizations recommend early documented diagnosis and prompt
treatment of Alzheimer's to assure safety and provide timely
advice to patients and their families, several studies have
concluded that many physicians lack sufficient training and
experience in assessing and treating Alzheimer's disease. The
Committee directs the Secretary to plan and implement a
comprehensive outreach and education campaign directed at
physicians, practitioners, patients, and caregivers with a goal
of increasing information going to patients who are members of
racial and ethnic minority groups. The campaign shall include
dissemination of the following information: (1) Early detection
and diagnosis of Alzheimer's confers many benefits; (2) What
the criteria and guidelines are for diagnosis of Alzheimer's
disease; (3) Comprehensive care planning improves the quality
of long term Alzheimer's outcomes and may slow or prevent
cognitive impairment, improve management of accompanying
chronic conditions, increase access to medical and non-medical
treatment, provide access to support services, allow time for
financial planning and building a care team, and increase
treatment options such as enrollment in clinical trials; and
(4) Any other information the Secretary determines appropriate.
The information from the comprehensive Alzheimer's
education initiative shall be posted on the Web sites of
relevant Federal agencies, including OWH, OMH, and the Office
of Rural Health Policy, and shared with providers and advocacy
organizations. The campaign shall not specify, or be designed
as a tool to limit the health care providers available to
patients. In developing the information to be disseminated, the
Secretary shall consult with appropriate medical societies and
patient advocate organizations for Alzheimer's disease, and
with patient advocate organizations representing racial and
ethnic minority groups with a special emphasis on African
American and Hispanic populations.
The Committee directs the Secretary to submit to the
Committees on Appropriations of the House of Representatives
and Senate, the Committee on Finance of the Senate, and the
Committee on Ways and Means and the Committee on Energy and
Commerce of the House of Representatives an annual report
describing the activities carried out under this section during
the preceding fiscal year, and an evaluation of the extent to
which such activities have been effective in improving the
health and well-being of racial and ethnic minority groups.
Antibiotic Resistance.--The Committee supports the CARB
initiative that strengthens efforts to prevent, detect, and
control illness and deaths related to infections caused by
antibiotic resistant bacteria. The Committee directs the
Department to continue to work with DOD, USDA, VA, and FDA to
broaden and expand efforts to track and store both antibiotic
resistant bacteria genes and the mobile genetic elements from
antibiotic resistant bacteria along with metadata. The
Committee also recognizes the importance of basic and applied
research toward the development of new vaccines as a way to
prevent future antibiotic resistance through infection
prevention and control. The Committee urges the Secretary to
prioritize this research as part of its strategy to combat
antibiotic resistance. The Committee also urges the Secretary
to consider the use of existing vaccines in antibiotic
stewardship efforts to help mitigate new resistance
development. The Department shall include in the fiscal year
2018 CJ a detailed update on the progress being made to
implement the CARB national strategy.
Antimicrobial Usage, Risks, and Prevention.--The Committee
is deeply concerned about the continued misuse of dangerous
chemicals and unapproved animal drugs in aquaculture production
in developing countries. Findings highlighted in a November 30,
2008, report by the Food and Drug Administration [FDA] cited
clear scientific evidence that the application of certain
compounds during the various stages of production may result in
carcinogenic, mutagenic and other negative effects to human
health. The Secretary, in coordination with FDA, CDC, and other
relevant Federal agencies, is directed to submit to the
Committees on Appropriations within 180 days after enactment of
this act a report on the current risks of unapproved substances
used in foreign imported aquaculture and an updated assessment
of the human health impacts associated with these risks.
Breast Cancer Patient Education Campaign.--The Committee
continues to prioritize education and awareness related to
breast cancer and appreciates that this remains a priority for
the Secretary. The Committee encourages the Secretary to
continue updating outreach materials designed to inform breast
cancer patients anticipating surgery about the availability and
coverage of breast reconstruction, prostheses, and other
options, with a focus on informing patients who are members of
racial and ethnic minority groups.
Chronic Pain.--The Committee remains concerned about the
public health epidemic of chronic pain. The Committee is
pleased with the Department's release of the National Pain
Strategy and encourages the Secretary to begin implementation
efforts across all relevant HHS agencies and in coordination
with the DOD and VA.
Dietary Guidelines.--The Committee encourages HHS to work
with related agencies to ensure that Dietary Guidelines are
consistent with Federal nutrition policy, education, outreach,
and food assistance programs. The Department should include an
update on these efforts in its fiscal year 2018 CJ.
E-Health and Telemedicine.--The Committee encourages the
Secretary to convene a national working group on e-health and
telemedicine to communicate, coordinate, and collaborate on e-
health needs, standards, Federal goals, and Federal efforts.
Such a working group would reduce duplication and e-health
incompatibility, as well as improve health quality,
effectiveness, and outcomes.
Federal Anaphylaxis Policy.--The Committee recognizes that
immediate access to epinephrine is the primary and most
effective treatment for anaphylaxis. It is also critically
important that epinephrine be readily available wherever
allergic triggers for anaphylaxis are present. Access to
epinephrine auto-injectors within the first 5 minutes of an
anaphylactic event can be life-saving. The Committee encourages
Federal Occupational Health to engage with patient groups,
healthcare professionals and manufacturers to develop
recommendations for a program to address treatment for
anaphylaxis in Federal buildings, parks, and other federally
controlled facilities.
Geroscience.--The Committee commends NIA's leadership of
the Trans-NIH Geroscience Interest Group, which promotes
coordinated discussion and action on NIH-funded geroscience
research to reduce the burden of age-related diseases. The
Committee remains concerned over the rates of chronic disease
in the older adult population and recognizes that accelerated
breakthroughs from geroscience research into the biological
basis of aging is essential to targeting changes that take
place as a result of aging. The Committee urges the Secretary
to consider establishing an Interagency Geroscience Research
Coordination Committee [IGRCC] comprised of representatives
from the NIA, NIAMS, the NCI, the NEI, NHLBI, NINDS, NIGMS,
NHGRI, CDC, FDA, DOD, VA, and EPA. The goal of the IGRCC would
be to identify and direct grants for new geroscience research.
Global Health Research Strategy.--The Committee requests an
update on how CDC, FDA, BARDA, and NIH--including NCATS--
jointly coordinate global health research activities with
specific measurable metrics used to track progress toward
agreed upon health goals.
Guidance Documents.--The Committee notes that some have
raised concerns about the Department's use of guidance
documents, including Dear Colleague letters, because such
documents are not legally binding, but regulated entities may
interpret them as such. Accordingly, the Committee
recommendation includes new directives in the overview section
of the Committee report for each of the Departments and
agencies included in this bill relating to the use of guidance
documents.
High-Containment Transport.--The need to transport patients
quickly, safely, and without transmitting highly infectious
diseases was an identified need during the 2014 Ebola outbreak.
The Committee requests a report within 180 days after enactment
of this act on how the Department is preparing for other events
that may require the transport of highly contagious patients.
Nonrecurring Expenses Fund [NEF].--The Department is
directed to include in its fiscal year 2018 CJ the amount of
expired unobligated balances available for transfer to the NEF
and the amount of any such balances transferred to the NEF.
This should include actual or estimated amounts for the prior,
current, and future budget years. The description should
include specific projects, costs, project total cost, and years
expected to complete as well as the specific projects supported
in the current year.
Open Access to Federal Research.--The Committee has
received reports by the Office of Science and Technology
Policy's [OSTP] on the progress of all Federal agencies in
developing and implementing policies to increase public access
to Federally funded scientific research. The Committee is
pleased by the progress, but previously instructed OSTP to have
plans approved from all relevant Departments' and Agencies'
plans in this act's jurisdiction approved by the end of
calendar year 2014 with implementation occurring by January 1,
2016. Agencies funded in this act are instructed to continue
providing quarterly reports to the Committees on Appropriations
of the House of Representatives and Senate to keep Congress
apprised of the remaining progress needed to make federally
funded research accessible to the public as expeditiously as
possible.
Opioid Use and Abuse.--The Committee notes that opiate use
and addiction continue to pose epidemic-sized challenges in the
United States. To increase access to life-saving anti-addiction
medication, the Secretary is urged to consider whether naloxone
should cease to be a prescription-only drug and be more readily
available as a behind-the-counter drug. The Committee also
urges the Secretary to convene or coordinate an interagency
working group to encourage States and local governments to
increase opportunities for disposal of opiates and to reduce
opportunities for abuse, such as by establishing opioid
dispensing limits at hospital emergency departments and other
locations. The Secretary should take all appropriate action to
increase access to treatment of opioid use disorders, including
medication-assisted treatment.
Prenatal Opioid Use Disorders and Neonatal Abstinence
Syndrome.--The Committee is aware that the Protecting Our
Infants Act of 2015 requires the Secretary to conduct a review
of the Department's planning and coordination activities
related to prenatal opioid use disorders and neonatal
abstinence syndrome, as well as address gaps in research and
treatment. The act also requires the Secretary to develop
recommendations for preventing and treating prenatal opioid use
disorders and neonatal abstinence syndrome. The Committee urges
the Secretary to ensure that the report and recommendations
required by the act are submitted within the timeframe required
by the act.
Pulmonary Hypertension [PH].--The Committee is concerned
that most PH patients are not diagnosed for many years until
the condition has reached a catastrophic stage, which leads to
significant disability, greatly increased mortality, and the
need for costly and dramatic medical interventions, such as
heart-lung transplantation. Given the availability of effective
therapies for early-stage PH, the Department is encouraged to
work across agencies and with the patient and professional
community to prepare recommendations to improve early diagnosis
and treatment of PH.
Seafood Sustainability.--The Committee prohibits the
Department from using or recommending third party,
nongovernmental certification for seafood sustainability.
Tuberculosis [TB].--The Committee notes the release of the
President's National Action Plan for Combating Multi Drug
Resistant TB in December 2016. The Committee urges the
Secretary to prioritize implementation of the plan in
coordination with the Federal TB Task Force, CDC, and NIH.
United States/Mexico Border.--The Committee notes that in
2015, almost 181,000,000 people crossed this border, often to
work or visit family, and were infected with, or were exposed
to, serious infectious diseases. The Committee urges the
Department to continue its efforts to conduct border infectious
disease surveillance in order to identify and implement needed
prevention and treatment. Such activity could focus on priority
surveillance, epidemiology and preparedness activities along
the borders in order to be able to respond to potential
outbreaks and epidemics, including those caused by potential
bioterrorism agents.
Teen Pregnancy Prevention
The Committee recommendation includes $107,800,000 for the
Teen Pregnancy Prevention [TPP] program. This program supports
competitive grants to public and private entities to replicate
evidence-based teen pregnancy prevention approaches.
The Committee notes that the eligibility criteria for the
most recent 5-year grant cycle for the TPP program was changed
significantly from the previous grant cycle. To reflect a shift
toward a collective impact strategy, prospective grantees were
required to meet a minimum threshold of 700 youth to be served
across three implementation sites. As a result, some
communities, particularly those in rural areas, were excluded
from consideration due to their smaller youth population and
lack of implementation sites. These communities, with a single
or very few youth-serving agencies, have limited ability to
form the kind of community collaboration required by the Office
of Adolescent Health. The Committee requests that HHS submit a
report to the Committees on Appropriations of the House of
Representatives and Senate on the differences between
communities funded during the first grant cycle of the TPP
program compared to the second, with a focus on the type of
grantee location (urban, rural, or suburban), population size,
and capacity to form a collective impact strategy.
Office of Minority Health
The Committee recommends $50,000,000 for the Office of
Minority Health [OMH]. This Office focuses on strategies
designed to decrease health disparities and to improve the
health status of racial and ethnic minority populations in the
United States. OMH establishes goals and coordinates all
departmental activity related to improving health outcomes for
disadvantaged and minority individuals.
HIV Community-Based Testing Programs.--The Committee
recognizes that several community-based programs have
encouraged individuals at risk for HIV/AIDS to utilize FDA-
approved home-based HIV testing technology to monitor their HIV
status. The Committee urges the OMH to consider pilot or
demonstration program within existing resources to gauge the
effectiveness of this approach.
HIV/AIDS and Hepatitis C.--The Committee continues to be
concerned about the HIV/AIDS epidemic in the African American
community, and is aware of the concurrent high rates of co-
infection with Hepatitis C as outlined by the HHS 2015 Forum on
Hepatitis C in African American Communities. The Committee
urges OMH to work aggressively to address opportunities to
reduce the burden of HIV/AIDS and Hepatitis C by exploring
partnerships for screening and implementing community
engagement programs.
Lupus Initiative.--The Committee continues to support the
OMH National Health Education Lupus Program and its efforts to
develop a clinical trial education and implementation plan for
lupus. The action plan will focus on developing public-private
and community partnerships, evaluating current minority
clinical trial education and participation programs, and
developing a research plan for creating new clinical trial
education models in lupus. This will inform the development of
the broader actionable lupus clinical trial education plan.
Sexual Risk Avoidance
The Committee recommends $15,000,000 for sexual risk
avoidance education. This is a competitive grant program that
funds evidenced based abstinence models for adolescents.
Funding for competitive grants for sexual risk avoidance
shall use medically accurate information referenced to peer-
reviewed publications by educational, scientific, governmental,
or health organizations; implement an evidence-based approach;
and teach the benefits associated with self-regulation, success
sequencing for poverty prevention, healthy relationships, goal
setting, and resisting sexual coercion, dating violence, and
other youth risk behaviors.
Office of the Surgeon General
The Committee understands that the Surgeon General has
announced and is in the process of creating a Report on
Substance Use, Addiction, and Health. Given the current
national opioid epidemic, the Committee looks forward to the
report focusing on opioid research and providing
recommendations for future direction on best practices to
address opioid abuse.
The Committee urges the Surgeon General to develop a report
on improving the health of America's children. Too many
children still live in poverty, affecting their ability to be
healthy, to succeed in school, and to raise healthy families
themselves. A report by the Surgeon General on improving the
health of children could increase awareness and generate
additional effort on ameliorating this problem.
Office of Women's Health
The Committee recommends $29,000,000 for the Office of
Women's Health [OWH]. This office develops, stimulates, and
coordinates women's health research, healthcare services, and
public and healthcare professional education across the
Department. It advances important crosscutting initiatives and
develops public-private partnerships, providing leadership and
policy direction to address the disparities in women's health.
The Committee recommendation includes $3,100,000 to combat
violence against women through the State partnership
initiative. This program provides funding to State-level public
and private health programs to partner with domestic and sexual
violence organizations to improve healthcare providers' ability
to help victims of violence and improve prevention programs.

OFFICE OF MEDICARE HEARINGS AND APPEALS

Appropriations, 2016.................................... $107,381,000
Budget estimate, 2017................................... 120,000,000
Committee recommendation................................ 112,381,000

The Committee provides $112,381,000 for the Office of
Medicare Hearings and Appeals [OMHA]. This Office is
responsible for hearing Medicare appeals at the Administrative
Law Judge [ALJ] level, which is the third level of Medicare
claims appeals. OMHA ensures that Medicare beneficiaries who
are dissatisfied with the initial decisions about their
benefits or eligibility can appeal and exercise their right to
a hearing in front of an ALJ.
Appeals Backlog.--The Committee continues to be concerned
over the substantial backlog in the number of cases pending
before ALJs at OMHA. In fiscal year 2016, the Committee
provided an increase of $20,000,000 over fiscal year 2015 level
and provides $5,000,000 in additional funding in fiscal year
2017. The Committee directs OMHA to use the additional funds
provided to address the current backlog and requests a spend
plan within 30 days after enactment of this act. This spend
plan should include an estimate of total appeals that will be
processed in fiscal years 2016-2018 with the resources
available. This estimate should include the effect of
administrative actions taken to reduce the backlog.

OFFICE OF THE NATIONAL COORDINATOR FOR HEALTH INFORMATION TECHNOLOGY

Appropriations, 2016.................................... $60,367,000
Budget estimate, 2017................................... 82,000,000
Committee recommendation................................ 60,367,000

The Committee makes available $60,367,000 to the Office of
the National Coordinator for Health Information Technology
[ONC]. The Committee provides funding for ONC entirely through
budget authority. ONC is responsible for promoting the use of
electronic health records in clinical practice, coordinating
Federal health information systems, and collaborating with the
private sector to develop standards for a nationwide
interoperable health information technology infrastructure.
Electronic Health Records.--The Committee believes HHS'
work to encourage the adoption of electronic health records has
provided important new opportunities to improve the quality,
safety, and cost-effectiveness of health care. The Secretary is
directed to further this work by studying approaches to improve
person-centered healthcare through patient access to health
information. That work should examine accurate and timely
record matching so that all EHR systems are collecting the
information necessary for a fully interoperable system that
protects patients from identity mismatch errors, but also
considers patient privacy and security.
Immunization Information Systems [IIS].--The threat of
disease outbreaks and the ongoing work to target outreach to
under immunized communities underscores the importance of
maintaining robust immunization information systems [IIS]. The
Committee is aware of the Immunization Registry Data Exchange
and the Consumer Access Immunization Registry pilot projects
exploring ways to improve the efficiency and effectiveness of
IIS. The Committee encourages ONC to continue these pilots and
requests a report to the Committee from ONC no later than 180
days after enactment of this act with findings, results, and
recommendations from the pilot studies. The Committee
encourages ONC to partner with CDC and other relevant HHS
partners to leverage knowledge and enhance education and
information sharing opportunities between registry system
administrators and related State and local personnel.

OFFICE OF INSPECTOR GENERAL

Appropriations, 2016.................................... $75,000,000
Budget estimate, 2017................................... 85,000,000
Committee recommendation................................ 75,000,000

The Committee recommends $75,000,000 for the HHS Office of
Inspector General [OIG]. In addition to discretionary funds
provided in this act, the Health Insurance Portability and
Accountability Act of 1996 provides a permanent appropriation
of $334,097,000 for OIG.
OIG conducts audits, investigations, and evaluations of the
programs administered by the Department's operating and staff
divisions, including the recipients of the Department's grant
and contract funds. In doing so, OIG addresses issues of waste,
fraud, and abuse and makes recommendations to improve the
efficiency and effectiveness of the Department's programs and
operations.

OFFICE FOR CIVIL RIGHTS

Appropriations, 2016.................................... $38,798,000
Budget estimate, 2017................................... 42,705,000
Committee recommendation................................ 38,798,000

The Committee recommends $38,798,000 for the Office for
Civil Rights [OCR], which is responsible for enforcing civil
rights-related statutes in healthcare and human services
programs. To enforce these statutes, OCR investigates
complaints of discrimination, conducts program reviews to
correct discriminatory practices, and implements programs to
generate voluntary compliance among providers and constituency
groups of health and human services.
Pending Complaints.--OCR is tasked with ensuring that
individuals are not subject to unlawful discrimination in
healthcare programs. Yet, for nearly 3 years, since September
2014, three Weldon Amendment cases have been filed with OCR
without resolution. Therefore, the Committee directs OCR to
properly investigate the pending cases and urges OCR to resolve
the pending cases expeditiously.

RETIREMENT PAY AND MEDICAL BENEFITS FOR COMMISSIONED OFFICERS

Appropriations, 2016.................................... $586,188,000
Budget estimate, 2017................................... 630,408,000
Committee recommendation................................ 630,408,000

The Committee provides an estimated $630,408,000 in
mandatory funds for Retirement Pay and Medical Benefits for
Commissioned Officers of the U.S. Public Health Service. This
account provides for retirement payments to PHS officers who
are retired due to age, disability, or length of service;
payments to survivors of deceased officers; and medical care to
Active Duty and retired officers, as well as their dependents.

PUBLIC HEALTH AND SOCIAL SERVICES EMERGENCY FUND

Appropriations, 2016.................................... $1,532,958,000
Budget estimate, 2017................................... 1,431,117,000
Committee recommendation................................ 1,532,958,000

The Committee recommends $1,532,958,000 for the Public
Health and Social Services Emergency Fund, which includes
$15,000,000 in transfers from PHSSEF unobligated funds. This
appropriation supports the activities of the Assistant
Secretary for Preparedness and Response [ASPR] and other
components within the Office of the Secretary to prepare for
the health consequences of bioterrorism and other public health
emergencies, including pandemic influenza. It also provides
funding for the Department's cybersecurity efforts.
The Committee does not include bill language requested by
the administration that would provide additional transfer
authority beyond that which is already provided to the
Secretary.
Office of the Assistant Secretary for Preparedness and Response
The Committee recommendation includes $1,396,628,000 for
activities administered by ASPR. This Office was created by the
Pandemic and All-Hazards Preparedness Act [PAHPA] to lead the
Department's activities regarding preventing, preparing for,
and responding to public health emergencies, including
disasters and acts of terrorism.
National Disaster Medical System.--The Committee continues
bill language providing coverage under the Federal Employees
Compensation Act for National Disaster Medical System
intermittent employees who are activated for training or
deployment.
Trauma Service Availability and Systems Development.--The
Committee continues to support efforts to improve trauma center
sustainability and service availability in rural, exurban,
suburban, and urban locations. The Committee encourages ASPR to
develop a proposal for how trauma center improvements could be
made in these areas to address problems with trauma care
resiliency and reach to unserved populations. In doing so, ASPR
should incorporate its analysis of the ability of existing
trauma care infrastructure to respond to mass casualty events
in a variety of geographic locations previously requested by
the Committee.
Hospital Preparedness Program
The Committee's recommendation includes $254,555,000 for
the Hospital Preparedness Program [HPP]. This program provides
grants to States to build healthcare coalitions that enhance
regional and local hospital preparedness and improve overall
surge capacity in public health emergencies. The Committee
recognizes the importance of this program in helping
communities respond to tragic events and believes this funding
should be carefully coordinated within communities to continue
to provide our Nation's hospitals and emergency responders the
necessary tools to respond quickly and collaboratively to these
and other public health emergencies that are inevitable in our
Nation's communities.
Bioweapon Response Assessment.--The Blue Ribbon Study Panel
on Biodefense, published in October 2015, noted that ``certain
requirements associated with highly infectious diseases and low
frequency biological events fit well within hospital disaster
preparedness frameworks designed to address earthquakes,
hurricanes, and other disasters, but other requirements do
not.'' The Committee believes that understanding the unique
requirements necessary to respond to a biological attack will
help improve our preparedness. For this reason, within 120 days
of enactment, the Committee requests that the ASPR submit an
assessment to the Committees on Appropriations of the House of
Representatives and Senate of the unique response requirements
for biological weapons attacks, including attacks that may
result in mass fatalities. The assessment should also note the
role of other Federal agencies in the response.
Rural Areas.--The Committee encourages ASPR to ensure that
hospital systems in remote and rural areas are benefiting from
this program and are prepared in cases of emergencies,
epidemics, or natural disasters.
Biomedical Advanced Research and Development Authority [BARDA]
The Committee recommendation includes $511,700,000 for
advanced research and development.
The Committee commends BARDA for supporting advanced
development efforts of industry to develop vaccines,
diagnostics, drugs, and therapeutics to minimize serious
threats of infectious disease and urges BARDA to continue to
invest in the development of countermeasures for infectious
diseases through the CARB initiative and the Emerging
Infectious Disease program.
Blood Platelet.--The Committee is aware of BARDA's
investigation into blood platelet-derived medical counter-
measures as a hemostatic agent, and urges BARDA to expand its
research to address the opportunities that cell stabilization
of blood platelets provides, including radiation exposure
remediation, acute burn healing, drug delivery, hemorrhagic
fevers, and diagnostic imaging.
Equine Hyperimmune Globulin.--Antibody preparations,
produced from horse serum or plasma, have been used over the
past century for the treatment of humans suffering from a
variety of infectious diseases, intoxications, or
envenomations. However, adverse reactions limited its use to
the most life threatening of situations. The Committee is aware
of recent improvements in processing techniques that reduce
risks by as many as two orders of magnitude. The Committee
encourages BARDA to explore the viability of developing medical
countermeasures using equine hyperimmune globulin.
Project BioShield Special Reserve Fund
The Committee recommendation includes $510,000,000 for the
Project BioShield Special Reserve Fund. The Committee is
committed to ensuring the Nation is adequately prepared against
chemical, biological, radiological, and nuclear attacks. The
Committee recognizes a public-private partnership to develop
medical countermeasures [MCMs] is required to successfully
prepare and defend the Nation against these threats. Where
there is little or no commercial market, the Committee supports
the goal of Government financing providing a market guarantee
Other Activities
The Committee recommendation includes the following amounts
for the following activities within ASPR:
--Operations.--$30,938,000;
--Preparedness and Emergency Operations.--$24,654,000;
--National Disaster Medical System.--$49,904,000; and
--Policy and Planning.--$14,877,000.
Office of the Assistant Secretary for Administration
The Committee recommends $50,860,000 for information
technology cybersecurity in the Office of the Assistant
Secretary for Administration. These funds provide for
continuous monitoring and security incident response
coordination for the Department's computer systems and
networks.
Office of the Assistant Secretary for Health/Medical Reserve Corps
The Committee recommendation includes $6,000,000 for the
Medical Reserve Corps program in ASH. This program is a
national network of local volunteers who work to strengthen the
public health infrastructure and preparedness capabilities of
their communities.
Office of the Secretary
The Committee recommendation includes $79,470,000 for
activities within the Office of the Secretary.
Pandemic Influenza Preparedness
The Committee recommendation includes $72,000,000 for
Pandemic Influenza Preparedness. Of the total, $17,000,000 is
provided in annual funding, $40,000,000 in no-year funding, and
$15,000,000 in transfers from PHSSEF unobligated balances.
Emergency Supplemental Pandemic Influenza Balances.--The
Committee requests a detailed summary from ASPR in its fiscal
year 2018 CJ about the level of unspent pandemic influenza
supplemental balances. This summary should include an analysis
of how funds have been spent over the previous 3 fiscal years
and how any remaining funds will be allocated.
Office of Security and Strategic Information
The Committee includes $7,470,000 for the Office of
Security and Strategic Information to maintain the security of
the Department's personnel, systems, and critical
infrastructure.

PREVENTION AND PUBLIC HEALTH FUND

In fiscal year 2017, the level transferred from the fund
after accounting for sequestration is $931,000,000. The
Committee includes bill language in section 221 of this act
that requires that funds be transferred within 45 days of
enactment of this act to the following accounts, for the
following activities, and in the following amounts:

[Dollars in thousands]
----------------------------------------------------------------------------------------------------------------
Committee
Agency Account Program recommendation
----------------------------------------------------------------------------------------------------------------
ACL.................................... Aging and Disability Alzheimer's Disease 14,700
Services Programs. Prevention Education and
Outreach.
ACL.................................... Aging and Disability Chronic Disease Self 8,000
Services Programs. Management.
ACL.................................... Aging and Disability Falls Prevention......... 5,000
Services Programs.
CDC.................................... Immunization and Section 317 Immunization 324,350
Respiratory Diseases. Grants.
CDC.................................... Emerging and Zoonotic Epidemiology and 40,000
Infectious Diseases. Laboratory Capacity
Grants.
CDC.................................... Emerging and Zoonotic Healthcare Associated 12,000
Infectious Diseases. Infections.
CDC.................................... Chronic Disease Prevention Office of Smoking and 175,950
and Health Promotion. Health (Tobacco
Prevention/Media & Quit
Lines).
CDC.................................... Chronic Disease Prevention Breast Feeding Grants 8,000
and Health Promotion. (Hospitals Promoting
Breastfeeding).
CDC.................................... Chronic Disease Prevention Million Hearts Program... 4,000
and Health Promotion.
CDC.................................... Chronic Disease Prevention Heart Disease & Stroke 73,000
and Health Promotion. Prevention Program.
CDC.................................... Chronic Disease Prevention Diabetes................. 73,000
and Health Promotion.
CDC.................................... Chronic Disease Prevention Early Care Collaboratives 4,000
and Health Promotion.
CDC.................................... Environmental Health...... Lead Poisoning Prevention 17,000
CDC.................................... CDC-Wide Activities....... Preventive Health and 160,000
Health Services Block
Grants.
SAMHSA................................. Mental Health............. Suicide Prevention 12,000
(Garrett Lee Smith).
----------------------------------------------------------------------------------------------------------------

General Provisions

Section 201. The bill continues a provision placing a
$50,000 ceiling on official representation expenses.
Section 202. The bill continues a provision limiting the
use of certain grant funds to pay individuals more than an
annual rate of Executive Level II.
Section 203. The bill continues a provision restricting the
Secretary's use of taps for program evaluation activities
unless a report is submitted to the Appropriations Committees
of the House of Representatives and the Senate on the proposed
use of funds.
Section 204. The bill continues a provision authorizing the
transfer of up to 2.6 percent of PHS Act funds for evaluation
activities.
Section 205. The bill continues a provision restricting
transfers of appropriated funds and requires a 15-day
notification to the Committees on Appropriations of the House
of Representatives and the Senate Appropriations Committees.
Section 206. The bill continues a general provision
allowing National Health Service Corps contracts to be canceled
up to 60 days after award.
Section 207. The bill continues a provision regarding
requirements for family planning applicants.
Section 208. The bill continues language which states that
no provider services under title X of the PHS Act may be exempt
from State laws regarding child abuse.
Section 209. The bill continues language which restricts
the use of funds to carry out the Medicare Advantage Program if
the Secretary denies participation to an otherwise eligible
entity.
Section 210. The bill continues a provision prohibiting the
use of funds for lobbying activities related to gun control.
Section 211. The bill continues a provision that limits the
assignment of certain public health personnel.
Section 212. The bill continues a provision which
facilitates the expenditure of funds for international health
activities.
Section 213. The bill continues a provision permitting the
transfer of up to 3 percent of AIDS funds among ICs by the
Director of NIH and the Director of the Office of AIDS Research
at NIH.
Section 214. The bill continues language which requires
that the use of AIDS research funds be determined jointly by
the Director of NIH and the Director of the Office of AIDS
Research and that those funds be allocated directly to the
Office of AIDS Research for distribution to the ICs consistent
with the AIDS research plan.
Section 215. The bill continues a provision authorizing the
Director of NIH to enter into certain transactions to carry out
research in support of the NIH Common Fund.
Section 216. The bill continues a provision permitting NIH
to use up to $45,000,000 per project for improvements and
repairs of facilities.
Section 217. The bill continues a provision that transfers
funds from NIH to HRSA and AHRQ, to be used for National
Research Service Awards.
Section 218. The bill continues a provision related to
third party payments to NIH.
Section 219. The bill continues a provision that provides
BARDA with authority to enter into a multiyear contract for up
to 10 years and to repurpose unused termination costs to pay
contract invoices.
Section 220. The bill continues a provision requiring a
publicly available Web site that details expenditures from the
PPH Fund.
Section 221. The bill continues a provision transferring
mandatory funds from section 4002 of the Patient Protection and
Affordable Care Act to accounts within the Department for
activities outlined under the heading ``Prevention and Public
Health Fund'' in this report.
Section 222. The bill continues a provision requiring CJs
to include certain FTE information with respect to ACA.
Section 223. The bill continues a provision related to ACA
exchange funding transparency.
Section 224. The bill continues a provision related to
notifications for ACA enrollment and Community Health Centers
awards.
Section 225. The bill continues a provision prohibiting
funds for the Risk Corridor program.
Section 226. The bill continues a provision for Medicare
and Medicaid expenses.
Section 227. The bill restates a requirement for HHS to
conduct an analysis of the ACA's impact on eligibility for
certain discretionary programs.
Section 228. The bill continues a provision related to
breast cancer screening recommendations.
Section 229. The bill includes new language on care
management for Alzheimer's disease.
Section 230. The bill includes new language on medical
marijuana.

TITLE III

DEPARTMENT OF EDUCATION

Education for the Disadvantaged

Appropriations, 2016.................................... $16,043,790,000
Budget estimate, 2017................................... 16,043,790,000
Committee recommendation................................ 16,093,790,000

The Committee recommends an appropriation of
$16,093,790,000 for education for the disadvantaged.
The programs in the Education for the Disadvantaged account
provide a foundation of support to help ensure that all
children receive a high-quality education. Funds appropriated
in this account primarily support activities in the 2017-2018
school year.
Grants to Local Educational Agencies
Title I grants to local educational agencies [LEAs] provide
supplemental education funding, especially in high-poverty
areas, for local programs that provide extra academic support
to help raise the achievement of eligible students or, in the
case of schoolwide programs, help all students in high-poverty
schools meet challenging State academic standards. Title I
grants are distributed through four formulas: basic,
concentration, targeted, and education finance incentive grant.
The Committee recommends $15,409,802,000 for the title I
grants to LEAs program. Of the funds available for title I
grants to LEAs, up to $3,984,000 shall be available on October
1, 2016 for transfer to the Census Bureau for poverty updates;
$4,564,641,000 will become available on July 1, 2017; and
$10,841,177,000 will become available on October 1, 2017. The
funds that become available on July 1, 2017, and October 1,
2017, will remain available for obligation through September
30, 2018.
Consistent with the Every Student Succeeds Act [ESSA], the
reauthorization of the Elementary and Secondary Education Act
[ESEA], the Committee recommendation consolidates funding for
the School Improvement Grants [SIG] program into title I grants
to LEAs. In eliminating SIG, ESSA increases the amount States
must reserve from their title I allocation for schools
identified for improvement, from 4 percent under the previous
authorization to 7 percent (or, if higher, the amount States
reserved in fiscal year 2016 plus their fiscal year 2016 SIG
allocation).
ESSA shifts significant responsibility, authority, and
accountability for schools, including school improvement
efforts, back to States and LEAs. The Committee recommendation
includes a total increase of $500,000,000 for title I grants to
LEAs, including the consolidation of SIG, building on the
$500,000,000 increase provided in fiscal year 2016, to help
States implement ESSA. Combined, the Committee recommendation
is $397,484,000 more than the authorized level, which will
provide sufficient funding through authorized set-asides to
help States implement comprehensive and targeted support and
improvement efforts for schools identified for improvement,
while also protecting funding for LEAs, and allowing for
significantly more funding for LEAs than envisioned in
reauthorization. The Committee recommendation does not include
appropriations language requested by the administration
increasing the amount set-aside for comprehensive support and
improvement activities or targeted support and improvement
activities.
Report on Community Eligibility Program.--The Committee
requests the Department, in collaboration with the Department
of Agriculture, submit a report to the Committee as well as the
Education and the Workforce Committee of the House of
Representatives, and the Health, Education, Labor and Pensions
Committee of the Senate, within 180 days that describes the
impact of the Community Eligibility Program on accountability
provisions of the ESEA, including how it impacts school
rankings under 1113(a)(3), and how disadvantaged students are
incorporated into State accountability systems under sections
1111(c) and (d) and how their performance is reported under
subsection (h).
Parent and Family Engagement.--The Committee notes that
ESSA includes several provisions promoting parent and family
engagement in schools and their children's education, including
requiring LEAs to reserve at least 1 percent of title I funds
for such activities. The Committee strongly supports these
activities, and the use of funds for these purposes.
Report on Improving Conditions for Student Learning.--The
Committee believes that improving conditions for student
learning is vital for student success and notes that ESSA
requires States to submit plans to the Secretary that describe
how SEAs will support LEAs in improving conditions for student
learning, including through reducing the use of aversive
behavioral interventions that compromise student health and
safety, such as seclusion and restraint. The Committee requests
that the Secretary prepare a report on State-identified efforts
to reduce such interventions and other completed and planned
activities of the Department on this issue.
School Improvement Grants
The Committee recommendation does not include funding for
the SIG program. Consistent with ESSA, the Committee
recommendation eliminates this program and consolidates the
funding into title I grants to LEAs.
Comprehensive Literacy State Development Grants
The Committee recommendation includes $190,000,000 for the
Comprehensive Literacy State Development Grants program. This
program, formerly the Striving Readers Comprehensive Literacy
program, was newly authorized in ESSA and provides competitive
grants to State educational agencies [SEAs] that then subgrant
at least 95 percent of such funds to eligible entities to
support efforts to improve literacy instruction in high-need
schools and early education programs in a State for each of
several age bands ranging from birth through 12th grade.
The Committee notes that under the new authorization of
this program, home-based early childhood literacy programs are
identified as eligible entities. The Committee encourages the
Department to provide clear guidance that States may subgrant
funds to such programs.
Innovative Approaches to Literacy
The Committee recommendation includes $27,000,000 for the
Innovative Approaches to Literacy program. This program was
funded under the authority in the Fund for the Improvement of
Education [FIE] in fiscal year 2016, but was separately
authorized in ESSA.
The Innovative Approaches to Literacy program provides
competitive grants to national not-for-profit organizations and
school libraries for providing books and childhood literacy
activities to children and families living in high-need
communities.
The Committee continues to direct the Department to reserve
no less than 50 percent of funds under this program for grants
to develop and enhance effective school library programs, which
may include providing professional development to school
librarians, books, and up-to-date materials to high-need
schools. School library programs increase access to a wide
range of print and electronic resources, and provide learning
opportunities for all students, particularly those who are less
likely to have access to such materials at home. In addition,
the Committee directs the Department to ensure that grants are
distributed among eligible entities that will serve
geographically diverse areas, including rural areas.
Migrant Education Program
The Committee recommends $374,751,000 for the title I
Migrant Education program.
This funding supports grants to SEAs for programs to meet
the special educational needs of the children of migratory
agricultural workers or migratory fishworkers. Funding also
supports activities to improve interstate and intrastate
coordination of migrant education programs, as well as identify
and improve services to the migrant student population.
Neglected and Delinquent
The Committee recommends $47,614,000 for the title I
Neglected and Delinquent program.
This program provides financial assistance to SEAs for
education services to neglected and delinquent children and
youth in State-run institutions and for juveniles in adult
correctional institutions. States are authorized to set aside
at least 15 percent, but not more than 30 percent, of their
Neglected and Delinquent funds to help students in State-
operated institutions make the transition into locally operated
programs and to support the successful reentry of youth
offenders who are age 20 or younger and have received a
secondary school diploma or its recognized equivalent.
Special Programs for Migrant Students
The Committee recommends $44,623,000 for Special Programs
for Migrant Students, which consist of HEP and CAMP.
HEP projects are 5-year grants to institutions of higher
education and other nonprofit organizations to recruit migrant
students ages 16 and older and provide the academic and support
services needed to help them obtain a high school equivalency
certificate and subsequently gain employment, attain admission
to a postsecondary institution or a job training program, or
join the military.
CAMP projects are 5-year grants to institutions of higher
education and nonprofit organizations to provide tutoring,
counseling, and financial assistance to migrant students during
their first year of postsecondary education.

Impact Aid

Appropriations, 2016.................................... $1,305,603,000
Budget estimate, 2017................................... 1,305,603,000
Committee recommendation................................ 1,315,603,000

The Committee recommends $1,315,603,000 for the Impact Aid
program.
Impact Aid provides financial assistance to school
districts affected by the presence of Federal activities and
federally owned land. These school districts face unique
challenges because they must educate children living on
federally owned land, such as military bases, while federally
owned property is also exempt from local taxes, a primary
source of revenue for local school districts.
The Committee bill retains language that provides for
continued eligibility for students affected by the deployment
or death of their military parent, as long as these children
still attend schools in the same school district.
Basic Support Payments.--The Committee recommends
$1,176,233,000 for the Basic Support Payments program. Under
this statutory formula, payments are made on behalf of all
categories of federally connected children, with a priority
placed on making payments first to heavily impacted school
districts and providing any remaining funds for regular basic
support payments.
The Committee is concerned that the Department is not
notifying school districts in a timely advanced manner of
changes in their Impact Aid eligibility status. Hold harmless
provisions in ESEA and timely enactment of appropriations bills
would provide school districts with adequate time to adjust to
significant changes in funding. The Committee directs the
Department to enhance its communication with school districts
about significant payment decreases likely in the coming school
year, particularly those that are likely to enter hold harmless
provisions for a given school year.
Payments for Children With Disabilities.--The Committee
bill includes $48,316,000 for Payments for Children With
Disabilities. Under this program, additional payments are made
for certain federally connected children eligible for services
under IDEA.
Facilities Maintenance.--The Committee recommends
$4,835,000 for Facilities Maintenance. This activity provides
funding for emergency repairs and comprehensive capital
improvements to certain school facilities owned by the
Department and used by LEAs to serve federally connected
military dependent students. Funds appropriated for this
purpose are available until expended.
Construction.--The Committee recommends $17,406,000 for
eligible LEAs for emergency repairs and modernization of school
facilities.
The Committee recommendation includes bill language
allowing these funds to be awarded entirely on a competitive
basis and be available for obligation through September 30,
2018, as requested by the administration.
Payments for Federal Property.--The Committee recommends
$68,813,000 for Payments for Federal Property. These payments
compensate LEAs specifically for revenue lost due to the
removal of Federal property from local tax rolls, regardless of
whether any federally connected children attend schools in the
district. The budget request proposed eliminating this program.
The Committee recommendation again rejects this elimination and
continues to note that this funding represents a key component
of fulfilling the Federal Government's commitment to school
districts impacted by the presence of federally owned land.

School Improvement Programs

Appropriations, 2016.................................... $4,433,629,000
Budget estimate, 2017................................... 4,558,409,000
Committee recommendation................................ 4,177,239,000

The Committee recommendation includes $4,177,239,000 for
the School Improvement Programs account.
Supporting Effective Instruction State Grants
The Committee recommends $2,055,830,000 for Supporting
Effective Instruction State Grants. The fiscal year 2016
appropriation for this program included $93,993,000 in funding
set-aside for the Supporting Effective Educator Development
[SEED] program. ESSA reauthorized SEED as a stand-alone program
and the Committee's fiscal year 2017 recommendation for SEED is
included in the Innovation and Improvement account.
The appropriation for this program primarily supports
activities associated with the 2017-2018 academic year. Of the
funds provided, $374,389,000 will become available on July 1,
2017, and $1,681,441,000 will become available on October 1,
2017. These funds will remain available for obligation through
September 30, 2018.
States and LEAs may use funds for a range of activities
related to the certification, recruitment, professional
development, and support of teachers and administrators.
Activities may include reforming teacher certification and
licensure requirements, addressing alternative routes to State
certification of teachers, recruiting teachers and principals,
and implementing teacher mentoring systems, teacher testing,
merit pay, and merit-based performance systems. These funds may
also be used by districts to hire teachers to reduce class
sizes.
ESSA includes new provisions to promote the use of title I
and title II funds to support principals and school leaders,
including an optional 3 percent set-aside of title II-A funds
for such activities. Many States already use these funds to
support principals and school leaders but all States would
benefit from clear guidance and examples of how States and LEAs
could best use these funds to support effective strategies in
this area. Therefore, the Committee strongly encourages the
Department to issue guidance on the importance of strong school
leadership, and how States can use existing resources to
support principals and school leadership, including examples of
best practices.
Mathematics and Science Partnerships
The Committee recommendation does not include funding for
Mathematics and Science Partnerships. ESSA eliminated this
program and consolidated the funding into a new Student Support
and Academic Enrichment Grants program. The Committee
recommendation is consistent with this consolidation.
Supplemental Education Grants
The Committee recommendation includes $16,699,000 for
supplemental education grants to the Republic of Marshall
Islands [RMI] and the Federated States of Micronesia [FSM].
This grant program was authorized by the Compact of Free
Association Amendments Act of 2003. These funds will be
transferred from the Department to the Secretary of the
Interior for grants to these entities. The Committee bill
includes language requested in the budget that allows the
Secretary of Education to reserve 5 percent of these funds to
provide FSM and RMI with technical assistance.
21st Century Community Learning Centers
The Committee recommends an appropriation of $1,050,000,000
for the 21st Century Community Learning Centers [21st CCLC]
program.
Funds are allocated to States by formula, which in turn,
award at least 95 percent of their allocations to LEAs,
community-based organizations, and other public and private
entities. Grantees use these resources to establish or expand
community learning centers that provide activities offering
significant extended learning opportunities, such as before-
and after-school programs, recreational activities, drug and
violence prevention, and family literacy programs for students
and related services to their families. Centers must target
their services to students who attend schools that are eligible
to operate a schoolwide program under title I of the ESEA or
serve high percentages of students from low-income families.
The Committee notes that ESSA reduced the authorized
funding level of the 21st CCLC program below the previously
authorized level and below the fiscal year 2015 appropriated
level, the last enacted appropriation prior to passage of ESSA.
Accordingly, the Committee recommends a reduced funding level
for this program.
State Assessments Grants
The Committee recommends $378,000,000 for the State
Assessments Grants program.
This program provides formula grants to States for
developing and implementing standards and assessments required
by the ESEA and helping States and LEAs carry out audits of
their assessment systems to eliminate low-quality or
duplicative assessments. It also provides competitive grants to
States, including consortia of States, to improve the quality,
validity, and reliability of academic assessments.
Reducing Duplicative and Redundant Assessments.--The
Committee strongly supports the steps that Congress took last
year in ESSA to help address the issue of over testing in
schools. The Committee appreciates the Department's guidance
issued earlier this year that identifies Federal funding
available to help States and LEAs address the issue this school
year. The Committee requests that the Department report to
Congress, no later than 90 days after the enactment of this
act, on the concrete steps it has already taken and plans to
take during this year to help States and LEAs reduce the number
of duplicative and redundant assessments and the amount of
classroom time spent on unnecessary test preparation, rather
than teaching and learning.
Education for Homeless Children and Youth
For carrying out education activities authorized by title
VII, subtitle B of the McKinney-Vento Homeless Assistance Act,
the Committee recommends $77,000,000.
This program provides assistance to each State to support
an office of the coordinator of education for homeless children
and youth, to develop and implement State plans for educating
homeless children, and to make subgrants to LEAs to support the
education of those children. Grants are made to States based on
the total that each State receives in title I grants to LEAs.
Under the McKinney-Vento Homeless Children and Youth
Program, SEAs must ensure that homeless children and youth have
equal access to the same free public education, including a
public preschool education, as is provided to other children
and youth.
Training and Advisory Services
For Training and Advisory Services authorized by title IV
of the Civil Rights Act, the Committee recommends $6,575,000.
The funds provided will support awards to operate regional
equity assistance centers [EACs]. Each EAC provides services to
school districts upon request. Activities include disseminating
information on successful practices and legal requirements
related to nondiscrimination on the basis of race, color, sex,
or national origin in education programs.
Native Hawaiian Education
The Committee recommendation includes $33,397,000 for
Native Hawaiian Education.
The Committee bill continues a provision that allows
funding provided by this program to be used for construction.
Alaska Native Education
The Committee recommends $32,453,000 for the Alaska Native
Education.
These funds address the severe educational handicaps of
Alaska Native schoolchildren. Funds are used for the
development of supplemental educational programs to benefit
Alaska Natives. The Committee bill continues language that
allows funding provided by this program to be used for
construction. The Committee bill also includes language
overriding the authorizing statute's requirement to make
noncompetitive awards to certain organizations.
The Committee directs the Department to ensure that Alaska
Native tribes, Alaska Native regional nonprofits, and Alaska
Native corporations have the maximum opportunity to
successfully compete for grants under this program by providing
these entities multiple opportunities for technical assistance
in developing successful applications for these funds, both in
Alaska and via various forms of telecommunications, and to make
every effort to ensure that Alaska Natives and Alaskans
represent a significant proportion of peer reviewers for grant
applications submitted in fiscal year 2017.
Rural Education
The Committee recommends $175,840,000 for rural education
programs.
The Committee expects that rural education funding will be
equally divided between the Small, Rural School Achievement
Program, which provides funds to LEAs that serve a small number
of students, and the Rural and Low-Income School Program, which
provides funds to LEAs that serve concentrations of poor
students, regardless of the number of students served.
Comprehensive Centers
The Committee recommends $51,445,000 for the Comprehensive
Centers program.
These funds provide support to a network of comprehensive
centers that are operated by research organizations, agencies,
institutions of higher education, or partnerships thereof, and
provide training and technical assistance on various issues to
States, LEAs, and schools as identified through needs
assessments undertaken in each region. The system currently
includes 15 regional centers, which are charged with providing
intensive technical assistance to SEAs to increase their
capacity to assist LEAs and schools with meeting the goals of
the ESEA, and 7 content centers, which are organized by topic
area.
In fiscal year 2017, the Department is scheduled to hold a
competition to fund a new cohort of comprehensive centers. With
the passage of ESSA, this new cohort of comprehensive centers
will reflect changing priorities and the expanded role and
responsibilities of States under reauthorization. The Committee
directs the Department to brief the Committee within 30 days of
enactment on how they plan to ensure this new cohort of
comprehensive centers will provide a well-coordinated,
accessible, and robust technical assistance system for SEAs.
In selecting priorities for a new cohort of comprehensive
centers, the Committee directs the Department to recognize the
unique challenges affecting rural schools, and strongly
encourages the Department to establish at least one university-
led center in a State with a significant percentage of students
in rural schools. Such a center could focus on rural education
and provide assistance to rural districts, including those that
serve high poverty and minority students.
The Committee recommendation includes continued support for
a comprehensive center, first funded in fiscal year 2016 and as
authorized in ESSA, on students at risk of not attaining full
literacy skills due to a disability, including dyslexia, or
developmental delay.
Student Support and Academic Enrichment Grants
The Committee recommendation includes $300,000,000 for
Student Support and Academic Enrichment Grants. This new
program provides formula grants to States, which then sub-grant
to LEAs, to help support activities to provide students with a
well-rounded education, ensure safe and supportive learning
environments, and use technology to improve instruction. This
program was created by consolidating funding for several
previously individually authorized programs. The combined
fiscal year 2016 funding level of the programs eliminated and
consolidated into this new formula block grant was
$277,761,000. The Committee recommendation represents a
$22,239,000 increase above the fiscal year 2016 level.
The Committee notes that funds available under this program
may be used for local activities that may include programs that
build skills in STEM, including computer science, and that
foster innovation in learning by supporting nontraditional STEM
education teaching methods. The Committee believes that such
activities, including robotics competitions through
partnerships with local schools and nonprofit organizations,
will help further engage and inspire students to pursue further
study or careers in STEM.
In conducting a needs assessment pursuant to section
4106(d) of the ESEA, the Committee encourages States to work
with LEAs in identifying already available and appropriate
local data and metrics, which may include incidence and
prevalence of the issues and behaviors that are appropriate to
be addressed by the program, such as drug use and bullying.

Indian Education

Appropriations, 2016.................................... $143,939,000
Budget estimate, 2017................................... 174,939,000
Committee recommendation................................ 143,939,000

The Committee recommends $143,939,000 for Indian education
programs.
Grants to Local Educational Agencies
For grants to LEAs, the Committee recommends $100,381,000.
These funds provide financial support to elementary and
secondary school programs that serve Indian students, including
preschool children. Funds are awarded on a formula basis to
LEAs, schools supported and operated by the Department of the
Interior/Bureau of Indian Education, and in some cases directly
to Indian tribes.
Special Programs for Indian Children
The Committee recommends $37,993,000 for special programs
for Indian children.
Funds are used for demonstration grants to improve Indian
student achievement from early childhood education through
college preparation programs, and for professional development
grants for training Indians who are preparing to begin careers
in teaching and school administration.
National Activities
The Committee recommends $5,565,000 for national
activities.
Funds are used to expand efforts to improve research,
evaluation, and data collection on the status and effectiveness
of Indian education programs, and to continue grants to tribal
educational departments for education administration and
planning.
The Committee notes that there are significant cognitive,
psychological, and academic benefits that result from Native
American language immersion programs. Schools where the
indigenous language is the primary language of instruction have
a strong, positive effect on the educational and social
outcomes of American Indian, Alaska Native, and Native Hawaiian
students compared to schools where Native students are taught
in English. In addition, language education programs are
essential for tribal self-determination. The Committee supports
the dedication of resources for language maintenance and
preservation activities. The Committee intends that funds
available for carrying out section 6133 of the ESEA be
allocated to all types of eligible entities in a way that
supports the most extensive possible distribution across
geography and language diversity and support both existing and
new Native language immersion programs and schools. Further,
the Committee directs the Department to give the same
consideration to applicants that propose to provide partial
immersion schools and programs as to full immersion, as the
local tribes, schools, and other applicants know best what type
of program will most effectively assist their youth to succeed.

Innovation and Improvement

Appropriations, 2016.................................... $894,226,000
Budget estimate, 2017................................... 1,411,556,000
Committee recommendation................................ 942,743,000

The Committee recommends $942,743,000 for programs within
the Innovation and Improvement account.
Education Innovation and Research
The Committee recommendation includes $120,000,000 for the
Education Innovation and Research [EIR] program. This program,
newly authorized in ESSA, supports the creation, development,
implementation, replication, and scaling up of evidence-based,
field-initiated innovations designed to improve student
achievement and attainment for high-need students. EIR
incorporates a tiered evidence framework that provides early-
phase, mid-phase, and expansion and replication grants. This
supports interventions throughout the pipeline, from smaller
grants for early stage projects that are willing to undergo
rigorous evaluation to test their efficacy to larger grants to
scale-up proven-effective interventions that have demonstrated
significant impacts through multiple rigorous evaluations.
The Committee recommendation does not include funding or
bill language requested by the administration for a new
Advanced Research Projects Agency--Education program.
School Leader Recruitment and Support
The Committee recommendation includes $16,368,000 for the
School Leader Recruitment and Support program, which funds
activities to improve the recruitment, placement, support, and
retention of effective principals and other school leaders in
high-need schools.
Charter School Program
The Committee recommends $343,172,000 for the Charter
School Program. This program supports the start-up,
replication, and expansion of high-quality charter schools.
Within the total, the Committee recommendation includes
$204,000,000 for grants to State entities to support high-
quality charter schools, including for grants directly to
charter school developers in a State if no State entity
receives a grant; $100,000,000 for grants to charter management
organizations for the replication and expansion of high-quality
charter schools; $26,000,000 for facilities financing
assistance, of which not less than $16,000,000 shall be for the
per-pupil facilities aid program; and not less than $11,000,000
for national activities to provide technical assistance,
disseminate best practices, and evaluate the impact of the
charter school program.
Magnet Schools Assistance
The Committee recommends $96,647,000 for the Magnet Schools
Assistance program.
This program supports grants to LEAs to establish and
operate magnet schools that are part of a court-ordered or
federally approved voluntary desegregation plan. Magnet schools
are designed to attract substantial numbers of students from
different social, economic, ethnic, and racial backgrounds.
Grantees may use funds for planning and promotional materials;
salaries of instructional staff; transportation, as long as
such expenses are sustainable beyond the grant period and not a
significant portion of the grant; and the purchase of
technology, educational materials, and equipment.
Fund for the Improvement of Education
The Committee recommendation does not include funding for
FIE, which was eliminated in ESSA. For comparability, funding
for programs funded under FIE in fiscal year 2016 that were
separately authorized in ESSA are shown as separate programs in
both fiscal year 2016 and fiscal year 2017.
Arts in Education
The Committee recommendation includes $27,000,000 for the
Arts in Education program. The funding is used for competitive
awards for national nonprofit organizations engaged in arts
education, professional development activities, and model arts
education programs. Funds also are used for evaluation and
dissemination activities.
Javits Gifted and Talented Students
The Committee recommendation includes $12,000,000 for the
Javits Gifted and Talented Students Education program. Funds
are used for awards to State and local educational agencies,
institutions of higher education, and other public and private
agencies for research, demonstration, and technical assistance
activities designed to enhance the capability of elementary and
secondary schools to meet the special educational needs of
gifted and talented students, including those from
disadvantaged and underrepresented populations.
American History and Civics Academies
The Committee recommendation includes $1,815,000 for
American History and Civics Academies. Presidential Academies
for the Teaching of American History and Civics offer
residential workshops to elementary and secondary school
teachers to strengthen their knowledge through instruction and
interaction with primary scholars and accomplished teachers in
these fields. The Congressional Academies for Students of
American History and Civics provide similar workshops to
students to enrich their understanding of American history and
civics.
Teacher and School Leader Incentive Grants
The Committee recommendation includes $213,000,000 for
Teacher and School Leader Incentive Grants.
This program, newly authorized in ESSA and the successor to
the Teacher Incentive Fund, provides competitive grants to
eligible entities to develop, implement, improve, or expand
human capital management systems or performance-based
compensation systems in schools. Funds can be used for a wide-
range of activities, including developing or improving
evaluation and support systems that are based in part on
student achievement; providing principals with necessary tools
to make school-level decisions; implementing a differentiated
salary structure based on a variety of factors; improving the
recruitment and retaining of effective teachers, principals,
and other school leaders; and instituting career advancement
opportunities that reward effective teachers, principals and
other school leaders.
Ready-To-Learn Television
The Committee recommendation includes $25,741,000 for the
Ready-to-Learn Television program.
This program is designed to facilitate student academic
achievement by leveraging the power and reach of public
television to develop and distribute educational video
programming for preschool and elementary school children and
their parents.
Advanced Placement
The Committee recommendation does not include funding for
Advanced Placement [AP] programs. ESSA eliminated the AP
program and consolidated the funding into a new Student Support
and Academic Enrichment Grants program. The Committee
recommendation is consistent with this consolidation.
Supporting Effective Educator Development
The Committee recommendation includes $87,000,000 for the
Supporting Effective Educator Development [SEED] program. SEED
provides competitive grants to improve teacher and principal
effectiveness by supporting pathways that help teachers,
principals, or other school leaders with non-traditional
preparation and certification obtain employment in underserved
LEAs; providing evidence-based professional development; and
making services and learning opportunities freely available to
LEAs.
This program was formerly funded as a set-aside of the
title II Teacher Quality State Grants program. ESSA authorized
SEED as a separate program and the Committee recommendation is
consistent with that authorization.
The Committee notes that funding provided in fiscal year
2016 for this program, as a set-aside of the former title II
Teacher Quality State Grants program, and funding provided in
this bill for a separately authorized SEED program is all
available through September 30, 2017. The Committee directs the
Department to manage these appropriations efficiently, in a
manner that is beneficial to all potential grantees and
simplifies administration of the program. Further, the
Committee directs the Department to ensure a smooth transition
in program costs from fiscal year 2017 through fiscal year
2018.
Within the total for SEED, the Committee includes funding
for a competitive award to establish a consortium of
university-led centers operating in multiple States, to improve
academic preparation and college readiness, including the
college-and-career pipeline, of rural youth. Such a consortium
would increase access to workshops and partnerships for new and
experienced educators, and should support teachers in all grade
levels and across disciplines, kindergarten through university,
as well as students, families, and community members, in high-
need rural areas. University-led centers would be able to focus
on the specific needs of local rural communities, schools,
teachers, and students in their State. Specific activities
could include professional development and on-site programming
for teachers and school administrators throughout the year,
youth writing and literacy programs, and community-based
workshops.
STEM Master Teacher Corps
The Committee recommendation does not include funding for
the STEM Master Teacher Corps program, a new program authorized
in ESSA.
Stronger Together
The Committee recommendation does not include funding for
Stronger Together, a new, unauthorized program.
Next Generation High Schools
The Committee recommendation does not include funding for
Next Generation High Schools, a new, unauthorized program.
Computer Science for All Development Grants
The Committee recommendation does not include funding for
Computer Science for All Development Grants, a new,
unauthorized program. However, the Committee notes the Student
Support and Academic Enrichment Grants program authorizes a
range of activities to support well-rounded educational
opportunities including computer science.
Teach to Lead
The Committee recommendation does not include funding for
Teach to Lead, a new, unauthorized program.

Safe Schools and Citizenship Education

Appropriations, 2016.................................... $254,815,000
Budget estimate, 2017................................... 228,000,000
Committee recommendation................................ 143,254,000

The Committee recommends a total of $143,254,000 for
activities to promote safe schools, healthy students, and
citizenship education.
Promise Neighborhoods
The Committee recommendation includes $73,254,000 for the
Promise Neighborhoods program. This program awards competitive
grants to not-for-profit, community-based organizations for the
development of comprehensive neighborhood programs designed to
combat the effects of poverty and improve educational and life
outcomes for children and youth, from birth through college.
Each Promise Neighborhood grantee serves a high-poverty urban
neighborhood or rural community.
The Committee strongly believes that Promise Neighborhoods
grantees may need more than 5 years to implement the
transformational reforms and demonstrate the results in
underserved communities envisioned by this program. ESSA, which
authorizes Promise Neighborhoods as a stand-alone program,
allows the Department to extend Promise Neighborhoods grants
for a period of up to 2 years. This bill extends that authority
to grants made under the previous authorization of the program.
The Committee directs the Department to use that authority to
extend funding for current high-quality Promise Neighborhoods
programs operating in underserved areas that have demonstrated
promising results through their initial implementation grant
and propose to continue pursuing ambitious goals through
continued innovative activities during such extension of their
award. Further, the Committee directs the Department to ensure
that in any new grant competition, the Department gives equal
weight to new and current programs, including grantees
proposing to continue programs operating in a particular
neighborhood or community, provided they can demonstrate
successful outcomes and justify the need for continued funding.
School Safety National Activities
The Committee recommendation includes $70,000,000 for the
national activities portion of the Safe and Drug-Free Schools
and Communities program, including up to $5,000,000 for Project
SERV. This funding will help schools address the consequences
of their students witnessing or beingthe victim of violence and
other root causes of unhealthy school climates. The Committee
recommendation includes sufficient funding for Project SERV to
help restore a stable and safe learning environment for
schools, students and educators who have experienced violent or
traumatic situations, including through the provision of
extended services grants.
The Committee recommendation includes $5,000,000 to
continue an initiative started in fiscal year 2016 to improve
school-based services for children in communities that have
experienced significant episodes of civil unrest. This funding
supports the establishment of school-based programs in such
communities to address, including through counseling services,
the comprehensive educational, behavioral, and mental health
needs of youth who have experienced significant trauma related
to recent events in their communities. This program is
administered in coordination with SAMHSA.
Elementary and Secondary School Counseling
The Committee recommendation does not include funding for
the Elementary and Secondary School Counseling program. ESSA
eliminated this program and consolidated the funding into a new
Student Support and Academic Enrichment Grants program. The
Committee recommendation is consistent with this consolidation.
Carol M. White Physical Education for Progress Program
The Committee recommendation does not include funding for
the physical education program. ESSA eliminated this program
and consolidated the funding into a new Student Support and
Academic Enrichment Grants program. The Committee
recommendation is consistent with this consolidation.
Full Service Community Schools
The Committee recommendation does not include funding for
Full Service Community Schools. This program provides grants to
LEAs, in partnership with community-based organizations,
nonprofits, and other organizations, to provide comprehensive
academic, social, and health services for students, student's
families, and community members that will result in improved
education outcomes for children.

English Language Acquisition

Appropriations, 2016.................................... $737,400,000
Budget estimate, 2017................................... 800,400,000
Committee recommendation................................ 737,400,000

The Committee recommends an appropriation of $737,400,000
for the English Language Acquisition program.
The Department makes formula grants to States based on each
State's share of the Nation's limited-English-proficient and
recent immigrant student population. The program is designed to
increase the capacity of States and school districts to address
the needs of these students. The authorizing statute requires
that 6.5 percent of the appropriation be used to support
national activities, which include professional development
activities designed to increase the number of highly qualified
teachers serving limited-English-proficient students; a
National Clearinghouse for English Language Acquisition and
Language Instructional Programs. National activities funds
shall be available for 2 years.

Special Education

Appropriations, 2016.................................... $12,976,858,000
Budget estimate, 2017................................... 13,066,858,000
Committee recommendation................................ 13,019,358,000

The Committee recommends an appropriation of
$13,019,358,000 for special education programs.
Grants to States
The Committee recommendation includes $11,952,848,000 for
IDEA Part B Grants to States. This program provides formula
grants to assist States, outlying areas, and other entities in
meeting the costs of providing special education and related
services for children with disabilities. States pass along most
of these funds to LEAs, but may reserve some for program
monitoring, enforcement, technical assistance, and other
activities.
The appropriation for this program primarily supports
activities associated with the 2017-2018 academic year. Of the
funds available for this program, $2,669,465,000 will become
available on July 1, 2017, and $9,283,383,000 will become
available on October 1, 2017. These funds will remain available
for obligation through September 30, 2018.
The Committee recommendation includes bill language
continuing several provisions relating to MOE requirements, as
requested by the administration.
Preschool Grants
The Committee recommends $368,238,000 for Preschool Grants.
This program provides formula grants to States to assist them
in making available special education and related services for
children with disabilities aged 3 through 5. States distribute
the bulk of the funds to LEAs. States must serve all eligible
children with disabilities aged 3 through 5 and have an
approved application under the IDEA.
Grants for Infants and Families
The Committee recommends $458,556,000 for the Grants for
Infants and Families program under part C of the IDEA. Part C
of the IDEA authorizes formula grants to States, outlying
areas, and other entities to implement State-wide systems for
providing early intervention services to all children with
disabilities, ages 2 and younger, and their families. The IDEA
also gives States the option of extending eligibility for part
C services to children 3 and older if they were previously
served under part C and will continue to be served until
entrance to kindergarten.
State Personnel Development
The Committee recommends $41,630,000 for the State
Personnel Development program. Ninety percent of funds must be
used for professional development activities. The program
supports grants to SEAs to help them reform and improve their
personnel preparation and professional development related to
early intervention, educational, and transition services that
improve outcomes for students with disabilities. The bill
includes language proposed in the budget request that allows
funds under the program to be used for program evaluation.
Technical Assistance and Dissemination
The Committee recommends $56,928,000 for Technical
Assistance and Dissemination. This program supports awards for
technical assistance, model demonstration projects, the
dissemination of useful information, and other activities.
Funding supports activities that are designed to improve the
services provided under the IDEA.
Within the total, the Committee recommendation includes
$12,583,000, an increase of $2,500,000 above the fiscal year
2016 funding level and the budget request, to support
activities authorized by the Special Olympics Sport and
Empowerment Act, including Project UNIFY. This funding supports
efforts to expand Special Olympics programs and the design and
implementation of Special Olympics education programs that can
be integrated into classroom instruction and are consistent
with academic content standards.
Personnel Preparation
The Committee recommends $83,700,000 for the Personnel
Preparation program.
Funds support competitive awards to help address State-
identified needs for personnel who are qualified to work with
children with disabilities, including special education
teachers and related services personnel. The program is
required to fund several other broad areas, including training
leadership personnel and personnel who work with children with
low-incidence disabilities, and providing enhanced support for
beginning special educators.
Parent Information Centers
The Committee recommends $27,411,000 for Parent Information
Centers.
This program makes awards to parent organizations to
support parent training and information centers, including
community parent resource centers. These centers provide
training and information to meet the needs of parents of
children with disabilities living in the areas served by the
centers, particularly underserved parents, and parents of
children who may be inappropriately identified.
Technology and Media Services
The Committee recommends $30,047,000 for Technology and
Media Services. This program makes competitive awards to
support the development, demonstration, and use of technology
and educational media activities of value to children with
disabilities.
The Committee recognizes the ongoing progress made with the
tools and services provided under the Educational Technology,
Media and Materials program that have allowed more than 380,000
students with disabilities free access to more than 325,000
books in digitally accessible formats. The Committee strongly
encourages continued effort to expand this program's reach to
K-12 students in underserved areas.

Rehabilitation Services

Appropriations, 2016.................................... $3,529,605,000
Budget estimate, 2017................................... 3,541,389,000
Committee recommendation................................ 3,536,389,000

Vocational Rehabilitation State Grants
The Committee recommends $3,398,554,000 in mandatory
funding for Vocational Rehabilitation [VR] State Grants.
State Grants assist States in providing a range of services
to help persons with physical and mental disabilities prepare
for and engage in meaningful employment.
The Rehabilitation Act requires that not less than 1
percent and not more than 1.5 percent of the appropriation for
VR State Grants be set aside for Grants for American Indians.
The Committee recommendation continues bill language
allowing the Department to use unobligated VR State grant funds
that remain available subsequent to the reallottment process,
to be used for innovative activities to improve outcomes for
individuals with disabilities, including for the PROMISE
initiative.
Client Assistance State Grants
The Committee recommends $13,000,000 in discretionary funds
for Client Assistance State Grants.
This program funds State formula grants to help VR clients
or client applicants understand the benefits available to them.
States must operate client assistance programs to receive VR
State Grant funds.
Training
The Committee recommends $30,188,000 for training
rehabilitation personnel. This program supports grants to
provide training to new VR staff, or upgrade the qualifications
of existing staff.
Demonstration and Training Programs
The Committee recommendation includes $5,796,000 for
demonstration and training programs. These programs support
activities designed to increase employment opportunities for
individuals with disabilities by expanding and improving the
availability and provision of rehabilitation and other
services.
Protection and Advocacy of Individual Rights
The Committee recommends $17,650,000 for the Protection and
Advocacy of Individual Rights program.
This program provides grants to agencies to protect and
advocate for the legal and human rights of persons with
disabilities who are ineligible for the protection and advocacy
services available through the Developmental Disabilities
Assistance and Bill of Rights Act or the Protection and
Advocacy for Individuals with Mental Illness Act.
Supported Employment State Grants
The Committee recommendation includes $27,548,000 for the
Supported Employment State Grants Program. This program
supports collaborative programs between States and appropriate
public and private nonprofit organizations to provide supported
employment services for individuals with the most significant
disabilities.
Independent Living Services for Older Individuals Who Are Blind
The Committee recommends $33,317,000 for Independent Living
State Grants.
This program supports assistance to individuals over age 55
to help them adjust to their blindness and continue to live
independently, including daily living skills training,
counseling, community integration information and referral, the
provision of low-vision and communication devices, and low-
vision screening.
Helen Keller National Center
The Committee recommends $10,336,000 for the Helen Keller
National Center for Deaf-Blind Youth and Adults.
The Helen Keller National Center consists of a national
headquarters in Sands Point, New York, with a residential
training and rehabilitation facility where deaf-blind persons
receive intensive specialized services; a network of 10
regional field offices that provide referral and counseling
assistance to deaf-blind persons; and an affiliate network of
agencies.

Special Institutions for Persons With Disabilities

AMERICAN PRINTING HOUSE FOR THE BLIND

Appropriations, 2016.................................... $25,431,000
Budget estimate, 2017................................... 25,431,000
Committee recommendation................................ 25,431,000

The Committee recommends $25,431,000 to help support APH.
APH provides educational materials to students who are
legally blind and enrolled in programs below the college level.
The Federal subsidy provides approximately 65 percent of APH's
total sales income. Materials are distributed free of charge to
schools and States through per capita allotments based on the
total number of students who are blind. Materials provided
include textbooks and other educational aids in Braille, large
type, recorded form, and computer applications. Appropriated
funds may be used for staff salaries and expenses, as well as
equipment purchases and other acquisitions consistent with the
purpose of the Act to Promote the Education of the Blind.
The Committee commends APH for the significant progress
being made through the Resources with Enhanced Accessibility
for Learning [REAL] Plan toward developing new technologies to
translate educational materials for delivery to students who
are blind and visually impaired. These technological advances
will provide educational materials to students more quickly
than ever before, enhancing opportunities for academic
achievement. The Committee continues to support implementation
of the REAL plan, and includes no less than $475,000 for such
activities, the same as the fiscal year 2016 level.

NATIONAL TECHNICAL INSTITUTE FOR THE DEAF

Appropriations, 2016.................................... $70,016,000
Budget estimate, 2017................................... 70,016,000
Committee recommendation................................ 70,016,000

The Committee recommends $70,016,000 for the National
Technical Institute for the Deaf [NTID].
NTID, located on the campus of the Rochester Institute of
Technology in Rochester, New York, was created by Congress in
1965 to provide a residential facility for postsecondary
technical training and education for persons who are deaf. NTID
also provides support services for students who are deaf,
trains professionals in the field of deafness, and conducts
applied research.
The Committee recommendation includes $2,000,000 in
continued funding to support NTIDs operational costs and to
continue support for at least one regional partnership via a
subcontract with an external organization consistent with its
mission and strategic plan. These partnerships enable NTID to
expand the geographic reach of services and activities
supported by the college for individuals who are deaf and hard
of hearing. The partnership activities include a focus on:
promoting training and postsecondary participation in STEM
fields; working with NTID faculty to develop postsecondary
preparation for students; providing professional development
for teachers and developing partnerships with business and
industry to promote employment opportunities for individuals
who are deaf and hard of hearing.

GALLAUDET UNIVERSITY

Appropriations, 2016.................................... $121,275,000
Budget estimate, 2017................................... 121,275,000
Committee recommendation................................ 121,275,000

The Committee recommends $121,275,000 for Gallaudet
University.
Gallaudet University is a private, not-for-profit
institution offering undergraduate and continuing education
programs for students who are deaf, as well as graduate
programs in fields related to deafness for students who are
hearing and deaf. The university conducts basic and applied
research related to hearing impairments and provides public
service programs for the deaf community.
This funding also supports the Model Secondary School for
the Deaf, which serves as a laboratory for educational
experimentation and development; disseminates curricula,
materials, and models of instruction for students who are deaf;
and prepares adolescents who are deaf for postsecondary
academic or vocational education or the workplace. The
university's Kendall Demonstration Elementary School develops
and provides instruction for children from infancy through age
15.

Career, Technical, and Adult Education

Appropriations, 2016.................................... $1,720,686,000
Budget estimate, 2017................................... 1,808,686,000
Committee recommendation................................ 1,720,686,000
Career and Technical Education
The Committee recommends $1,125,019,000 for the Career and
Technical Education [CTE] account.
State Grants.--The Committee recommends $1,117,598,000 for
CTE State grants. The budget request included an increase of
$75,000,000 for this program for a new American Technical
Training Fund, a new competitive grant program as part of a
larger reauthorization proposal for the Carl D Perkins Career
and Technical Education Act. The Committee recommendation does
not include funding for this activity.
Funds provided under the State grant program assist States,
localities, and outlying areas to expand and improve their CTE
program and help ensure equal access to CTE for populations
with special needs. Persons assisted range from secondary
students in prevocational courses through adults who need
retraining to adapt to changing technological and labor market
conditions. Funds are distributed according to a formula based
on State population and State per capita income.
Under the Indian and Hawaiian Natives programs, competitive
grants are awarded to federally recognized Indian tribes or
tribal organizations and to organizations primarily serving and
representing Hawaiian Natives for services that are additional
to what these groups receive under other provisions of the
Perkins Act.
Of the funds available for this program, $326,598,000 will
become available July 1, 2017, and $791,000,000 will become
available on October 1, 2017. These funds will remain available
for obligation until September 30, 2018.
National Programs.--The Committee recommends $7,421,000 to
support research, development, demonstration, dissemination,
evaluation, and assessment of activities aimed at improving the
quality and effectiveness of CTE.
Adult Education
The Committee recommends $595,667,000 for Adult Education
programs.
Adult Education State Grants.--The Committee recommendation
includes $581,955,000 for Adult Education State Grants, which
provides grants to States for programs that assist adults in
becoming literate and in obtaining the skills necessary for
employment and self-sufficiency.
National Leadership Activities.--The Committee recommends
$13,712,000 for adult education national leadership activities.

Student Financial Assistance

Appropriations, 2016.................................... $24,198,210,000
Budget estimate, 2017................................... 24,198,210,000
Committee recommendation................................ 24,198,210,000

The Committee recommends an appropriation of
$24,198,210,000 for programs under the Student Financial
Assistance account.
Federal Pell Grant Program
The Committee recommends $22,475,352,000 in discretionary
funding for the Pell grant program. Pell grants provide need-
based financial assistance that helps undergraduate students
and their families defray a portion of the costs of
postsecondary education. Awards are determined according to a
statutory need-analysis formula that takes into account a
student's family income and assets, household size, and the
number of family members, excluding parents, attending
postsecondary institutions.
The Committee recommended funding level is more than
sufficient to support an increase in the maximum Pell grant
award, from $5,815 for the 2016-17 school year to an estimated
$5,935 for the 2017-18 school year.
Over the last several years, the Labor-HHS-Education bill
has appropriated significantly more discretionary funding than
has been needed to fully fund the Pell grant program. That was
in anticipation of future increased costs in the program, which
have not materialized. Instead, projected costs have
significantly, and consistently, decreased year-after-year
relative to prior estimates. This has resulted in significant
current and projected unobligated balances that are expected to
persist through fiscal year 2024. CBO's estimate of the fiscal
year 2015 Omnibus projected unobligated Pell ``surplus''
funding would be exhausted in fiscal year 2016, and there would
be a $206,000,000 shortfall in funding. In the most recent
estimate, with no increase in funding or legislative changes to
the program in the meantime, CBO now estimates, instead of a
shortfall in funding, there will be surplus funding of
$7,754,000,000 in fiscal year 2016, that will grow to over
$9,000,000,000 by fiscal year 2018, and will not be fully
exhausted until fiscal year 2025.
Given the significant unobligated balances in the program,
the projected balances going forward, and the significant
improvement in the overall discretionary funding outlook for
the program, the Committee recommendation restores and modifies
a provision previously implemented from the Higher Education
Opportunity Act of 2008 allowing students to receive Pell
grants year-round. This provision will allow a student who has
exhausted their Pell grant award for the academic year, and
wishes to enroll in additional coursework, to receive a Pell
grant for an additional payment period during the academic
year, traditionally the summer term. The total Pell grant a
student may receive during an academic year, who is receiving
an additional Pell grant under this provision, is capped at 150
percent of the maximum Pell grant award. Currently, full-time
students and some part-time students exhaust their Pell grant
award after two semesters or the equivalent. This expanded
eligibility and flexibility for the Pell grant program will
provide an incentive for students to take classes year-round
and stay continuously enrolled. This will help students stay on
track for graduation or accelerate completion of their program.
This provision is expected to provide an estimated 1 million
students an average additional Pell grant of $1,650 for the
2017-2018 award year.
The Committee intends the expanded eligibility to be
implemented in such a way to maximize flexibility for
institutions of higher education and avoid unnecessary
administrative burdens associated with the previous
implementation of year-round Pell grants, while still ensuring
the best interests of students. The Committee believes that
this can be facilitated by issuing guidance on this expanded
authority not later than 90 days after enactment of this act.
The Committee strongly encourages the Department to implement
this provision as soon as possible. The Committee also expects
the Department to provide reliable data on the implementation
of this provision.
Finally, given the significant decrease in estimated costs
compared to estimates used in formulating prior year
appropriations, the Committee recommendation includes a one-
time rescission of $1,200,000,000 from unobligated prior-year
discretionary balances appropriated in the Labor-HHS-Education
bill. Based on CBO estimates, after restoring year-round Pell
and assuming level funding going forward, the discretionary
costs of the Pell grant program are estimated to be fully
funded through fiscal year 2021. This one-time rescission
prevents cuts to other programs in this bill serving students,
children, families, and workers this coming fiscal year, while
allowing for targeted increases and investments in other
critical programs.
Federal Supplemental Educational Opportunity Grant Program
The Committee recommends $733,130,000 for the Supplemental
Educational Opportunity Grant [SEOG] program.
The SEOG program provides funds to approximately 3,700
postsecondary institutions for need-based grants to more than
1.5 million undergraduate students. Institutions must
contribute at least 25 percent toward SEOG awards. Students
qualify for grants of up to $4,000 by demonstrating financial
need. Priority is given to Pell grant recipients with
exceptional need.
Federal Work-Study Program
The Committee bill provides $989,728,000 for the Federal
Work-Study [FWS] program.
This program provides grants to approximately 3,300
institutions and helps nearly 700,000 undergraduate, graduate,
and professional students meet the costs of postsecondary
education through part-time employment. Institutions must
provide at least 25 percent of student earnings.
Within the total for FWS, the Committee recommendation
includes $8,390,000 for the Work Colleges program authorized
under section 448 of the HEA.

Student Aid Administration

Appropriations, 2016.................................... $1,551,854,000
Budget estimate, 2017................................... 1,631,990,000
Committee recommendation................................ 1,546,854,000

The Committee recommends $1,546,854,000 for the Student Aid
Administration account. These funds are available until
September 30, 2018, and support the Department's student aid
management expenses.
The Committee recommendation includes $691,643,000 for
administrative costs and $855,211,000 for loan servicing
activities.
The Committee directs the Department to continue to provide
quarterly reports detailing its obligation plan by quarter for
student aid administrative activities broken out by servicer
and activity. Further, any reallocation of funds between
administrative costs and servicing activities within this
account should be treated as a reprogramming of funds, and the
Committee should be notified in advance of any such changes.
Student Loan Servicing.--The Committee has serious concerns
about the Department's management of the student loan servicing
system, including how it has adhered to congressional
directives, intent, and notice requirements in this area. The
Department is currently in the process of re-competing
contracts that will significantly change the current student
loan servicing system. The Committee supports the Department's
efforts to improve the student loan servicing process by moving
to a more simple, consistent, and unified experience for all
student borrowers and to take steps that will reduce student
delinquencies and defaults. However, the Committee is concerned
that other changes the Department is proposing in the current
solicitation could ultimately jeopardize the quality of service
to student borrowers. The Committee directs the Department to
ensure that the new student loan servicing contract includes
the participation of multiple student loan servicers, each
responsible for all aspects of servicing loans, which would
allow the Department to allocate loans to different servicers
based on performance. The Committee strongly believes this will
promote competition and increase incentives for such entities
to provide high-quality service to student borrowers. The
Department should brief the Committee on Appropriations of the
House of Representatives and the Senate, the Senate Committee
on Health, Education, Labor, and Pensions, and the House
Committee on Education and the Workforce no less than 15 days
prior to releasing a final request for proposals for a new
student loan servicing contract.
Until a new student loan servicing contract is implemented,
the Committee directs the Department to continue to allocate
new student loan accounts to servicers based on performance
compared against all servicers, utilizing common metrics
established by the Department. The Committee appreciates recent
efforts to work with servicers to develop these common metrics.
However, the Committee remains concerned about the quality of
servicing being provided to borrowers and servicers' compliance
with the law, and expects the Department to adhere to
congressional directive to produce a common policies and
procedures manual that applies to all Direct Loan servicers and
provides voluntary best practices intended to improve the
consistency of servicing for student loan borrowers. Finally,
the Committee directs the Department, no later than March 1,
2017, to allow Federal student loan borrowers who are
consolidating their student loans to select from any of the
existing student loan servicers to service their new
consolidated student loans. Furthermore, borrowers who are
consolidating their loans should have ready access to the
aforementioned common performance metrics to help guide their
decision for which servicer to select. Allowing the student
borrower to select from any of the servicers will allow the
borrower to remain with their existing servicer if they wish
to, limit unnecessary disruption for borrowers, and provide
another incentive for servicers to provide high-quality
services to student borrowers.
Federal Student Aid Enforcement Office.--The Committee
notes that in fiscal year 2016 the Department established an
independent enforcement office within the Office of Federal
Student Aid. However, budget justification materials provide
little information about the specific focus of the unit, how it
will operate and be managed, and how its work will relate to
and be coordinated with other work being done in FSA, elsewhere
in the Department, and other enforcement agencies. The
Committee appreciates the need to ensure students are protected
and that there is proper oversight of the significant taxpayer
investment in Federal student aid. However, the Committee
directs the Secretary to ensure that the work of this unit is
transparent, and not duplicative of other work being done at
the Department. The Committee directs the Department to brief
the Committees on Appropriations of the House of
Representatives and the Senate, the Senate Health, Education,
Labor, and Pensions Committee, and House Education and
Workforce Committee within 30 days of enactment on the current
and planned actions of this new office. Further, the Secretary
shall ensure that the Chief Operating Officers reports on the
operations of the enforcement unit as part of the required
reports under section 141 of the HEA, including how information
is shared internally within FSA and between relevant agencies.
Interagency Task Force on For Profit Colleges.--The
Committee is concerned about the lack of available public
information on a task force the Department of Education
established on for-profit colleges and universities, including
the frequency of meetings, contact information, and topics of
discussion and the focus on one particular sector of higher
education. The Committee directs the Department to brief the
Committees on Appropriations of the House of Representatives
and the Senate, the Senate Health, Education, Labor, and
Pensions Committee, and House Education and Workforce Committee
within 30 days of enactment on the current and planned actions
of the taskforce, and how it works with and shares information
with other Federal and State agencies.
National Student Loan Data System.-- The Committee
encourages the Department to determine the steps necessary to
expand the National Student Loan Data System, develop a new
system or adopt or improve upon an existing system to ensure
that borrowers have access to all of their student loan
information, both Federal and private, in one central online
location.

Higher Education

Appropriations, 2016.................................... $1,982,185,000
Budget estimate, 2017................................... 2,189,200,000
Committee recommendation................................ 1,986,792,000

The Committee recommends an appropriation of $1,986,792,000
for higher education programs.
Aid for Institutional Development
The Committee recommends $579,514,000 in discretionary
funding for Aid for Institutional Development. These totals do
not include separately authorized and appropriated mandatory
funding.
Strengthening Institutions.--The Committee bill recommends
$86,534,000 to provide competitive, 1-year planning and 5-year
development grants for institutions with a significant
percentage of financially needy students and low educational
and general expenditures per student in comparison with similar
institutions. Applicants may use these funds to develop
faculty, strengthen academic programs, improve institutional
management, and expand student services.
Hispanic-Serving Institutions [HSIs].--The Committee
recommends $107,795,000 for competitive grants to institutions
at which Hispanic students make up at least 25 percent of
enrollment. Funds may be used for acquisition, rental, or lease
of scientific or laboratory equipment; renovation of
instructional facilities; development of faculty; support for
academic programs; institutional management; and purchase of
educational materials.
Promoting Postbaccalaureate Opportunities for Hispanic
Americans.--The Committee recommends $9,671,000 for
competitive, 5-year grants to HSIs to help Hispanic Americans
gain entry into and succeed in graduate study. Institutions may
use funding to support low-income students through outreach
programs; academic support services; mentoring and financial
assistance; acquisition, rental, or lease of scientific or
laboratory equipment; construction and other facilities
improvements; and purchase of educational materials.
Strengthening Historically Black Colleges and
Universities.--The Committee recommends $244,694,000 for the
Strengthening HBCUs program. The program makes formula grants
to HBCUs that may be used to purchase equipment; construct and
renovate facilities; develop faculty; support academic
programs; strengthen institutional management; enhance
fundraising activities; provide tutoring and counseling
services to students; and conduct outreach to elementary and
secondary school students.
Strengthening Historically Black Graduate Institutions
[HBGIs].--The Committee recommends $63,281,000 for the
Strengthening HBGIs program. This program provides 5-year
grants to provide scholarships for low-income students and
academic and counseling services to improve student success.
Funds may also be used for construction, maintenance, and
renovation activities; the purchase or lease of scientific and
laboratory equipment; and the establishment of an endowment.
Strengthening Predominately Black Institutions [PBIs].--The
Committee recommends $9,942,000 for the Strengthening PBIs
program. This program provides 5-year grants to PBIs to plan
and implement programs to enhance the institutions' capacity to
serve more low- and middle-income Black American students.
Strengthening Asian American and Native American Pacific
Islander-Serving Institutions [AANAPISIs].--The Committee
recommends $3,348,000 for competitive grants to AANAPISIs that
have an enrollment of undergraduate students that is at least
10 percent Asian American or Native American Pacific Islander
students. Grants may be used to improve their capacity to serve
Asian American and Native American Pacific Islander students
and low-income individuals.
Strengthening Alaska Native and Native Hawaiian-Serving
Institutions [ANNHs].--The Committee recommends $13,802,000 for
the Strengthening ANNHs program.
The purpose of this program is to improve and expand the
capacity of institutions serving Alaska Native and Native
Hawaiian students and low-income individuals. Funds may be used
to plan, develop, and implement activities that encourage
faculty and curriculum development; improve administrative
management; renovate educational facilities; enhance student
services; purchase library and other educational materials;
and, provide education or counseling services designed to
improve the financial and economic literacy of students or
their families.
Strengthening Native American-Serving Non-Tribal
Institutions.--The Committee recommends $3,348,000 for this
program, which serves institutions that enroll at least 10
percent Native American students and at least 50 percent low-
income students. This program helps institutions plan, develop,
and implement activities that encourage faculty and curriculum
development; improve administrative management; renovate
educational facilities; enhance student services; and purchase
library and other educational materials.
Strengthening Tribally Controlled Colleges and
Universities.--The Committee recommends $27,599,000 for this
program. Tribal colleges and universities rely on a portion of
the funds provided to address developmental needs, including
faculty development, curriculum, and student services.
Strengthening Masters Degree Programs at Historically Black
Colleges and Universities.--The Committee recommends $9,500,000
for this program, authorized by section 723 of the HEA. This
program provides grants to specified colleges and universities
making a substantial contribution to graduate education
opportunities at the masters level in mathematics, engineering,
the physical or natural sciences, computer science, information
technology, nursing, allied health, or other scientific
disciplines.
International Education and Foreign Language Studies
The bill includes a total of $67,271,000 for International
Education and Foreign Language Studies programs.
Funds are used to increase the number of experts in foreign
languages and area or international studies to meet national
security needs through visits and study in foreign countries.
Domestic Programs.--The Committee recommends $65,103,000
for domestic program activities related to international
education and foreign language studies under title VI of the
HEA. Funds are used to support centers, programs, and
fellowships. The Committee urges the Secretary to preserve the
program's longstanding focus on activities and institutions
that address the Nation's need for a strong training and
research capacity in foreign languages and international
studies, including increasing the pool of international experts
in areas that are essential to national security and economic
competitiveness.
Overseas Programs.--The Committee recommends $2,168,000 for
overseas programs authorized under the Mutual Educational and
Cultural Exchange Act of 1961, popularly known as the
Fulbright-Hays Act. Funding is provided for group, faculty, or
doctoral dissertation research abroad as well as special
bilateral projects. Grants focus on training American
instructors and students to improve foreign language and area
studies education in the United States.
Fund for the Improvement of Postsecondary Education
The Committee recommendation does not include funding for
the Fund for the Improvement of Postsecondary Education.
Model Comprehensive Transition and Postsecondary Programs for Students
With Intellectual Disabilities
The Committee recommendation includes $11,800,000 for
competitive grants to postsecondary institutions to support
model programs that help students with intellectual
disabilities transition to and complete college, as authorized
by section 767 of the HEA. Funds may be used for student
support services; academic enrichment, socialization, or
independent living; integrated work experiences; and
partnerships with LEAs to support students with intellectual
disabilities participating in the model program who are still
eligible for special education and related services under the
IDEA.
Minority Science and Engineering Improvement
The Committee recommends $9,648,000 for the Minority
Science and Engineering Improvement program. Funds are used to
provide discretionary grants to institutions with minority
enrollments greater than 50 percent to purchase equipment,
develop curricula, and support advanced faculty training.
Grants are intended to improve science and engineering
education programs and increase the number of minority students
in the fields of science, mathematics, and engineering.
Tribally Controlled Postsecondary Career and Technical Institutions
The Committee recommends $8,286,000 for tribally controlled
postsecondary vocational institutions. This program provides
grants for the operation and improvement of tribally controlled
postsecondary vocational institutions to ensure continued and
expanding opportunities for Indian students.
Federal TRIO Programs
The Committee recommends $900,000,000 for Federal TRIO
programs, which provide a variety of services to improve
postsecondary education opportunities for low-income
individuals and first-generation college students.
Upward Bound offers disadvantaged high school students
academic services to develop the skills and motivation needed
to pursue and complete a postsecondary education; Student
Support Services provides developmental instruction,
counseling, summer programs, and grant aid to disadvantaged
college students to help them complete their postsecondary
education; Talent Search identifies and counsels individuals
between ages 11 and 27 regarding opportunities for completing
high school and enrolling in postsecondary education;
Educational Opportunity Centers provide information and
counseling on available financial and academic assistance to
low-income adults who are first-generation college students;
and the Ronald E. McNair Postbaccalaureate Achievement Program
supports research internships, seminars, tutoring, and other
activities to encourage disadvantaged college students to
enroll in doctoral programs.
The Committee recommendation does not include funding for a
new demonstration program proposed by the administration. The
Committee also directs the Department, when additional funding
is provided to non-competing programs based on increased
appropriations, to provide the maximum amount of flexibility to
such programs in how to best allocate those additional
resources under existing authorities. Finally, the Committee
directs the Department to ensure that fiscal year 2017 grant
competitions are announced and awarded in a timely manner, to
allow grantees sufficient lead-time prior to the beginning of
their program-year.
Gaining Early Awareness and Readiness for Undergraduate Programs
The Committee recommends $322,754,000 for GEAR UP, which
provides grants to States and partnerships of colleges, middle
and high schools, and community organizations to assist cohorts
or students in middle and high schools serving a high
percentage of low-income students. Services provided help
students prepare for and pursue a postsecondary education.
The Committee continues bill language allowing the
Department to set aside up to 1.5 percent of the total provided
for evaluation purposes.
Graduate Assistance in Areas of National Need and Javits Fellowships
The Committee recommends $29,293,000 to support the
Graduate Assistance in Areas of National Need [GAANN] program.
GAANN supports fellowships through 3-year competitive
grants to graduate academic departments and programs in
scientific and technical fields and other areas of national
need as determined by the Secretary. Fellowship recipients must
have excellent academic records and high financial need and
must be pursuing doctoral degrees or the highest graduate
degrees in their academic field. Each fellowship consists of a
student stipend to cover living costs and an institutional
payment to cover each fellow's tuition and other expenses.
Institutions of higher education must match 25 percent of the
grant amount.
Teacher Quality Partnership Program
The Committee recommends $43,092,000 for the Teacher
Quality Partnership [TQP] program. The budget request
consolidates activities supported by this program into a
proposed new Teacher and Principals Pathways program. The TQP
program helps improve the quality of teachers working in high-
need schools and early childhood education programs by creating
model teacher preparation and residency programs.
Within the TQP program, the Committee encourages the
Department to consider funding for programs, including those
operating in HBCUs, focused on increasing the number of high-
quality teachers from diverse and underrepresented backgrounds.
The Committee further directs the Department to ensure that
grants are distributed among eligible entities that will serve
geographically diverse areas, including rural areas.
Child Care Access Means Parents in Schools
The Committee recommendation includes $15,134,000 for the
Child Care Access Means Parents in Schools program. This
program provides competitive grants to institutions of higher
education to establish or support campus-based child care
programs, to help support needs and participation of low-income
parents in post-secondary education.
Teacher and Principal Pathways
The Committee recommendation does not include funding
Teacher and Principal Pathways, a new, unauthorized program.

Howard University

Appropriations, 2016.................................... $221,821,000
Budget estimate, 2017................................... 221,821,000
Committee recommendation................................ 221,821,000

The Committee recommends an appropriation of $221,821,000
for Howard University. Located in the District of Columbia,
Howard offers undergraduate, graduate, and professional degrees
through 12 schools and colleges. The university also
administers the Howard University Hospital. Federal funds from
this account support approximately 38 percent of the
university's operating costs. The Committee recommends, within
the funds provided, not less than $3,405,000 for the endowment
program.
Howard University Hospital.--Within the funds provided, the
Committee recommends $27,325,000 for Howard University
Hospital. The hospital provides inpatient and outpatient care,
as well as training in the health professions. It also serves
as a major acute and ambulatory care center for the District of
Columbia and functions as a major teaching facility attached to
the university. The Federal appropriation provides partial
funding for the hospital's operations.

College Housing and Academic Facilities Loans Program

Appropriations, 2016.................................... $435,000
Budget estimate, 2017................................... 457,000
Committee recommendation................................ 435,000

Federal Administration.--The Committee bill includes
$435,000 for Federal administration of the CHAFL, College
Housing Loans, and Higher Education Facilities Loans programs.
Prior to fiscal year 1994, these programs provided financing
for the construction, reconstruction, and renovation of
housing, academic, and other educational facilities. While no
new loans have been awarded since fiscal year 1993, costs for
administering the outstanding loans will continue through 2030.
These funds will be used to reimburse the Department for
administrative expenses incurred in managing the existing loan
portfolio.

Historically Black College and University Capital Financing Program
Account

Appropriations, 2016.................................... $20,484,000
Budget estimate, 2017................................... 20,499,000
Committee recommendation................................ 20,484,000

The Committee recommends $20,484,000 for the HBCU Capital
Financing Program.
The Committee recommendation includes $20,150,000 to pay
the loan subsidy costs in guaranteed loan authority under this
program. This amount will support an estimated $282,212,855 in
new loan volume in fiscal year 2017. The remaining $334,000
will be used for administrative expenses.
The HBCU Capital Financing Program makes capital available
to HBCUs for construction, renovation, and repair of academic
facilities by providing a Federal guarantee for private sector
construction bonds. Construction loans will be made from the
proceeds of the sale of the bonds.

Institute of Education Sciences

Appropriations, 2016.................................... $618,015,000
Budget estimate, 2017................................... 693,818,000
Committee recommendation................................ 612,525,000

The Committee recommends $612,525,000 for the Institute of
Education Sciences [IES]. This account supports education
research, development, dissemination, and evaluation; data
collection and analysis activities; and the assessment of
student progress.
Under the Education Sciences Reform Act of 2002, Congress
established IES to provide objective and valid research-driven
knowledge that was free of political influence or bias so as to
better inform effective education practices at the State and
local levels. The act required IES, in carrying out its
mission, ``to compile statistics, develop products, and conduct
research, evaluations, and wide dissemination activities in
areas of demonstrated national need and ensure that such
activities conform to high standards of quality, integrity, and
accuracy and are objective, secular, neutral, and
nonideological and are free of partisan political influence.''
The Committee directs the Director to submit an operating
plan within 90 days of enactment of this act to the Committees
on Appropriations of the House of Representatives and the
Senate detailing how IES plans to allocate funding available to
the Institute for research, evaluation, and other activities
authorized under law.
The Committee is aware of serious concerns about the
privacy of student data, particularly personally identifiable
information [PII]. The Committee directs the Department to
ensure that its employees, contractors, and grantees, including
States that receive funds from Statewide Longitudinal Data
System grants, adhere to the strictest and highest standards
for protecting PII. The Committee further directs the
Department to report to the Committee, as well as to the Senate
Health, Education, Labor, and Pensions Committee and the House
Education and the Workforce Committee, no later than one year
from the date of enactment of this act, on the actions it has
taken to comply with this directive.

RESEARCH, DEVELOPMENT, AND DISSEMINATION

The Committee recommends $190,000,000 for education
research, development, and national dissemination activities.
Funds are available for obligation for 2 fiscal years. These
funds support activities that are aimed at expanding
fundamental knowledge of education and promoting the use of
research and development findings in the design of efforts to
improve education.
The Committee recognizes the importance of research in
guiding the implementation of evidence-based practices
throughout our education system. The Committee is particularly
interested in research that addresses the specific needs of
diverse rural schools. The Committee directs the Department to
brief the Committees on Appropriations of the Senate and House
of Representatives within 120 days of enactment on how IES is
contributing to research in this area.

STATISTICS

The Committee recommends $112,000,000 for data gathering
and statistical analysis activities at the National Center for
Education Statistics [NCES].
NCES collects, analyzes, and reports statistics on
education in the United States. Activities are carried out
directly and through grants and contracts. The Center collects
data on educational institutions at all levels, longitudinal
data on student progress, and data relevant to public policy.
NCES also provides technical assistance to SEAs, LEAs, and
postsecondary institutions.

REGIONAL EDUCATIONAL LABORATORIES

The Committee recommends $54,423,000 to continue support
for the Regional Educational Laboratories program. Funds
available in this bill will continue to support a network of 10
laboratories. The laboratories are responsible for promoting
the use and development of knowledge and evidence in broad-
based systemic strategies to increase student learning and
further school improvement efforts. The Committee appreciates
the efforts of IES to strengthen the connections between
practitioners and the research community, so that federally
supported research is timely, relevant, and responsive to the
needs of the field.

RESEARCH AND INNOVATION IN SPECIAL EDUCATION

The Committee recommends $54,000,000 for research and
innovation in special education conducted by the National
Center for Special Education Research.
The Center addresses gaps in scientific knowledge to
improve special education and early intervention services and
outcomes for infants, toddlers, and children with disabilities.
Funds provided to the Center are available for obligation for 2
fiscal years.

SPECIAL EDUCATION STUDIES AND EVALUATIONS

The Committee recommends $10,818,000 for special education
studies and evaluations.
This program supports competitive grants, contracts, and
cooperative agreements to assess the implementation of IDEA.
Funds are also used to evaluate the effectiveness of State and
local efforts to deliver special education services and early
intervention programs. Funds are available for obligation for 2
fiscal years.

STATEWIDE DATA SYSTEMS

The Committee recommendation includes $34,539,000 for the
Statewide Data Systems program.
This program supports competitive grants to SEAs to enable
such agencies to design, develop, and implement Statewide,
longitudinal data systems to manage, analyze, disaggregate, and
use individual data for students of all ages. Early childhood,
postsecondary, and workforce information systems may be linked
to such systems or developed with program funds. The Committee
believes the Department should continue its efforts to ensure
every State has the base support necessary to develop effective
systems. Funds are available for obligation for 2 fiscal years.

ASSESSMENT

The Committee recommends $156,745,000 to provide support
for the National Assessment of Educational Progress [NAEP], a
congressionally mandated assessment created to measure and
report the educational achievement of American students in a
range of subjects and analyze trends over time.
Within the funds appropriated, the Committee recommends
$7,745,000 for the National Assessment Governing Board [NAGB],
which is responsible for formulating policy for NAEP.
The Committee is pleased that the NAGB reinstated
assessments for 8th and 12th grade students in United States
History, Civics, and Geography. Previous assessments conducted
by NAGB indicate that fewer than one in four 4th, 8th, and 12th
grade students at all grade levels are proficient in United
States History. The Committee directs the NAGB to continue
administering the assessments in these three areas at least
every four years, in accordance with the current NAEP schedule.
According to this schedule, the next administration will be in
2018.

Departmental Management

PROGRAM ADMINISTRATION

Appropriations, 2016.................................... $432,000,000
Budget estimate, 2017................................... 474,827,000
Committee recommendation................................ 432,000,000

The Committee recommends $432,000,000 for program
administration.
Funds support personnel compensation and benefits, travel,
rent, communications, utilities, printing, equipment and
supplies, automated data processing, and other services
required to award, administer, and monitor Federal education
programs. Support for program evaluation and studies and
advisory councils is also provided under this account.
The Committee notes that some have raised concerns about
the Department's use of guidance documents, including Dear
Colleague letters, because such documents are not legally
binding, but regulated entities may interpret them as such.
Accordingly, the Committee recommendation includes new
directives in the overview section of the Committee Report for
each of the Departments and agencies included in this bill
relating to the use of guidance documents.
The Committee urges the Secretary to provide clear and
coordinated technical assistance and guidance for ESEA student
data collection and reporting early in fiscal year 2017, to
help States and LEAs prepare for the 2017-18 school year, the
first full year of implementation of the recent reauthorization
of ESEA. This could include highlighting existing best
practices in the field, convening working groups, hosting
webinars, and other methods that will best support effective
and efficient data collection and reporting.
Competitive Grant Priorities for Rural Areas.--The
Committee urges the Department to continue efforts to ensure
that competitive grants are reaching rural areas and States so
that support and solutions developed with Federal funding are
relevant to and available in such areas.
Open Textbooks.--The Committee directs the Department to
provide a report to the Committee no later than 180 days after
enactment of this act on steps it has taken or plans to take to
help achieve the highest level of savings possible for students
through the sustainable, expanded use of open textbooks at
institutions of higher education and production of the highest
quality open textbooks.
Performance Partnerships.--Performance Partnerships allow
States and localities to demonstrate better ways of improving
outcomes for disconnected youth (low-income people, ages 14-24,
who are homeless, in foster care, involved in the justice
system, or are not working or enrolled in an educational
institution) by giving them additional flexibility in using
discretionary funds across multiple Federal programs. States
and localities that elect to participate in these pilots will
commit to achieving significant improvements in educational,
employment and other key outcomes in exchange for this new
flexibility. This eases the strain on communities trying to
meet the needs of disconnected youth, while advancing the goals
of individual Federal programs. In making awards under this
program the administration shall continue to give priority to
those communities that have experienced civil unrest. Such
events in communities across the Nation have illustrated, in
part, the important need to improve opportunities and services
for disconnected populations, and Performance Partnerships
focused in these communities will allow localities to pilot
better ways of improving outcomes. The Committee also notes
that thus far a number of factors have led to a more modest
start to utilizing flexibility available to pilot sites. The
Committee urges the administration to enhance its efforts
working with existing and new sites on the full range of
flexibility that could be employed to improve outcomes for
youth served through pilot sites. Further, the Committee bill
also includes language extending the flexibility for current
and future pilot sites by up to an additional 5 years in
recognition of the challenges associated with implementing
sustainable, positive change in systems serving this
population. Finally, the Committee directs the administration
to continue to provide annual reports providing the following
information: detailed summary of all involved pilot programs,
overview of how pilots were selected, summary of findings from
the various pilots, and recommendations for Congress on how to
apply any best practices learned more broadly.
Pooled Evaluation Authority.--The Committee requests that
the Department provide a report to the Committees on
Appropriations on the planned use of pooled evaluation funds
under section 8601 of the ESEA, consistent with the required
plan under such section, not later than 15 days prior to any
transfer of funds.

OFFICE FOR CIVIL RIGHTS

Appropriations, 2016.................................... $107,000,000
Budget estimate, 2017................................... 137,708,000
Committee recommendation................................ 110,000,000

The Committee recommends $110,000,000 for the Office of
Civil Rights [OCR].
OCR is responsible for the enforcement of laws that
prohibit discrimination on the basis of race, color, national
origin, sex, disability, and age in all programs and
institutions that receive financial assistance from the
Department. To carry out this responsibility, OCR investigates
and resolves discrimination complaints, monitors desegregation
and equal educational opportunity plans, reviews possible
discriminatory practices by recipients of Federal education
funds, and provides technical assistance to recipients of funds
to help them meet these civil rights requirements.

OFFICE OF INSPECTOR GENERAL

Appropriations, 2016.................................... $59,256,000
Budget estimate, 2017................................... 61,941,000
Committee recommendation................................ 59,256,000

The Committee recommends $59,256,000 for OIG.
OIG has the authority to investigate all departmental
programs and administrative activities, including those under
contract or grant, to prevent and detect fraud and abuse, and
to ensure the quality and integrity of those programs. The
Office investigates alleged misuse of Federal funds and
conducts audits to determine compliance with laws and
regulations, efficiency of operations, and effectiveness in
achieving program goals.

General Provisions

Section 301. The bill continues a provision prohibiting the
use of funds for the transportation of students or teachers in
order to overcome racial imbalance.
Section 302. The bill continues a provision prohibiting the
involuntary transportation of students other than to the school
nearest to the student's home.
Section 303. The bill continues a provision prohibiting the
use of funds to prevent the implementation of programs of
voluntary prayer and meditation in public schools.
Section 304. The bill continues a provision giving the
Secretary authority to transfer up to 1 percent of any
discretionary funds between appropriations.
Section 305. The bill continues a provision that allows the
Republic of Palau to receive certain Federal funds.
Section 306. The bill includes a new provision making
evaluation funds pooled under section 8601 of the ESEA
available for obligation from July 1, 2017 through September
30, 2018.
Section 307. The bill continues a general provision
allowing certain institutions to continue to use endowment
income for student scholarships.
Section 308. The bill continues a provision extending
authorization of the National Advisory Committee on
Institutional Quality and Integrity.
Section 309. The bill continues a provision extending
authority to provide account maintenance fees to guarantee
agencies.
Section 310. The bill includes a new general provision
expanding eligibility and flexibility in the Pell grant program
relating to year-round Pell grants.
Section 311. The bill includes a new general provision
rescinding discretionary unobligated balances from the Pell
grant program.

TITLE IV

RELATED AGENCIES

Committee for Purchase From People Who Are Blind or Severely Disabled

SALARIES AND EXPENSES

Appropriations, 2016.................................... $6,191,000
Budget estimate, 2017................................... 10,612,000
Committee recommendation................................ 8,000,000

The Committee recommends $8,000,000 for the Committee for
Purchase from People Who Are Blind or Severely Disabled, of
which no less than $1,000,000 shall be made available for the
Office of Inspector General.
The AbilityOne program provides more than 46,000 blind or
severely disabled Americans with employment opportunities each
year. The primary purpose of this program is to increase the
employment opportunities for people who are blind or have other
severe disabilities and, whenever possible, to prepare them to
engage in competitive employment. Encompassing approximately
$3,000,000,000 in contracts, it is the Federal Government's
largest employment program for the severely disabled. The
Committee is encouraged by the steps the Commission has taken
to implement the recommendations outlined in the May 2013 GAO
report addressing the concerns regarding the oversight of the
Central Nonprofit Agencies, the independent contracted
organizations which administer the program. The Committee
directs the Commission to provide an update on these efforts to
the Committees on Appropriations of the House of
Representatives and the Senate within 120 days of enactment of
this act.

Corporation for National and Community Service

The Corporation for National and Community Service [CNCS],
a corporation owned by the Federal Government, was established
to enhance opportunities for national and community service.
CNCS administers programs authorized under the Domestic
Volunteer Service Act, the National and Community Service Trust
Act, and the SERVE America Act. Grants are awarded to States,
public and private nonprofit organizations, and other entities
to create service opportunities for students, out-of-school
youth, adults, and seniors.
The Committee recommendation for CNCS provides a total
program level of $1,030,358,000.

OPERATING EXPENSES

Appropriations, 2016.................................... $787,929,000
Budget estimate, 2017................................... 794,608,000
Committee recommendation................................ 736,529,000

The Committee recommends $736,529,000 for the operating
expenses of CNCS.
Volunteers in Service to America [VISTA]
The Committee recommends $92,364,000 for VISTA. This
program provides capacity building for small, community-based
organizations with a mission of combating poverty. VISTA
members raise resources, recruit and organize volunteers, and
establish and expand programs in housing, employment, health,
and economic development activities.
National Senior Volunteer Corps
The Committee recommends $202,117,000 for the National
Senior Volunteer Corps programs, a collection of programs that
connect Americans older than the age of 55 with opportunities
to contribute their job skills and expertise to community
projects and organizations. These programs include the Retired
Senior Volunteer Program [RSVP], the Foster Grandparent
Program, and the Senior Companion Program.
AmeriCorps State and National Grants
The Committee recommends $386,010,000 for AmeriCorps State
and National Grants, which provide funds to local and national
organizations and agencies to address community needs in
education, public safety, health, and the environment. Each of
these organizations and agencies, in turn, uses its AmeriCorps
funding to recruit, place, and supervise AmeriCorps members.
AmeriCorps members receive a modest living allowance and other
benefits proportional to their level of time commitment.
The fiscal year 2016 appropriations act modified a bill
language provision to allow CNCS to use an authorized set-aside
to reserve up to 2.5 percent of program funds for evaluation,
training, and technical assistance. This provision had
previously been overridden by appropriations language. The
Committee directs CNCS to use this authority to provide no less
than $7,500,000 for training and technical assistance
activities for State commissions, to expand the capacity of
current and potential AmeriCorps programs, particularly in
underserved areas.
The Committee continues to strongly encourage CNCS to
provide AmeriCorps grants to organizations to support
activities in communities that have experienced civil unrest.
AmeriCorps programs are uniquely situated to respond to such
sudden crises that have impacted communities across the country
but also the challenges underlying them. The Committee strongly
supports activities focused in this area.
The Committee notes that over the last several years CNCS
has begun limiting operating funds for professional corps
programs. The Committee is concerned that significantly
limiting these resources may have an impact on professional
corps programs being able to provide high-quality services,
particularly those operating in underserved communities without
ready access to other funding sources. The Committee directs
CNCS to issue clear, extensive guidance as part of their fiscal
year 2017 request for proposals for AmeriCorps grants outlining
specifically how grantees can demonstrate and justify the need
for operating funds as part of their professional corps grant.
Further, the Committee directs CNCS to provide potential
grantees flexibility in justifying this need to ensure these
programs are able to provide high-quality services in all
communities, regardless of the availability of other funding
sources. Finally, the Committee directs CNCS to provide a
report to the Committees on Appropriations on how they have
awarded operating funds as part of professional corps grants
from fiscal year 2010 through fiscal year 2016, including a
breakdown of operating funds provided by programs operating in
different geographic areas.
The Committee has serious concerns about CNCS management
and oversight of its AmeriCorps programs, including grantee
compliance with Federal laws and CNCS regulations. The
Committee directs CNCS to submit a report to the Committee on
what specific steps it has taken, and plans to take, to improve
oversight of AmeriCorps programs, and to ensure compliance with
Federal laws and regulations.
The Committee encourages CNCS to work with State service
commissions, current grantees engaged in service-learning
activities, and other relevant stakeholders, to create a plan
to support activities and programs previously sustained by
Learn and Serve America.
National Civilian Community Corps [NCCC]
The Committee recommendation includes $30,000,000 for NCCC,
a full-time, team-based residential program for men and women
ages 18 to 24. Members are assigned to one of five campuses for
a 10-month service commitment.
Innovation, Demonstration, and Assistance Activities
The Committee recommendation includes $5,000,000 for
innovation, demonstration, and assistance activities.
Social Innovation Fund [SIF].--The Committee recommendation
does not include funding for SIF and instead focuses resources
on the core national and community service activities at CNCS.
Volunteer Generation Fund.--Within the total, the Committee
recommendation includes $3,800,000 for the Volunteer Generation
Fund authorized under section 198P of the SERVE America Act,
the same as the comparable fiscal year 2016 funding level.
Evaluation
The Committee recommendation includes $4,000,000 for CNCS
evaluation activities.
State Commission Grants
The Committee recommendation includes $17,038,000 for State
Commission Grants.
The Committee strongly encourages CNCS to improve
coordination with State commissions as part of CNCS' grant
making process, including in announcing the availability and
awarding of funds under AmeriCorps. State Commissions are a
vital local resource and primary point of entry for national
and community service at the local level. Improving
coordination between CNCS and local State commissions would
improve the administration of service programs at the local
level and promote innovation by supporting the organizations
that know their communities best.

PAYMENT TO THE NATIONAL SERVICE TRUST

Appropriations, 2016.................................... $220,000,000
Budget estimate, 2017................................... 206,842,000
Committee recommendation................................ 206,842,000

The Committee recommends an appropriation of $206,842,000
for making payments to the National Service Trust, as requested
by the administration.
The National Service Trust makes payments of Segal
education awards, pays interest that accrues on qualified
student loans for AmeriCorps participants during terms of
service in approved national service positions, and makes other
payments entitled to members who serve in the programs of CNCS.

SALARIES AND EXPENSES

Appropriations, 2016.................................... $81,737,000
Budget estimate, 2017................................... 89,330,000
Committee recommendation................................ 81,737,000

The Committee recommends an appropriation of $81,737,000
for CNCS salaries and expenses. The salaries and expenses
appropriation provides funds for staff salaries, benefits,
travel, training, rent, equipment, and other operating expenses
necessary for management of CNCS programs and activities.

OFFICE OF INSPECTOR GENERAL

Appropriations, 2016.................................... $5,250,000
Budget estimate, 2017................................... 6,100,000
Committee recommendation................................ 5,250,000

The Committee recommends an appropriation of $5,250,000 for
the CNCS OIG. The OIG's goals are to increase organizational
efficiency and effectiveness within the Corporation and to
prevent fraud, waste, and abuse.

ADMINISTRATIVE PROVISIONS

The Committee retains language from the fiscal year 2016
appropriations act concerning five administrative provisions:
requiring the Corporation to make any significant changes to
program requirements or policy through rule making (section
401); stipulating minimum share requirements (section 402);
requiring that donations supplement and not supplant operations
(section 403); aligning requirements regarding the use of
Education Awards at GI bill-eligible institutions (section
404); and allowing the required background check of certain
applicants to be processed by States under terms of the
National Child Protection Act (section 405).

Corporation for Public Broadcasting

Appropriations, 2018.................................... $445,000,000
Budget estimate, 2019................................... 445,000,000
Committee recommendation, 2019.......................... 445,000,000

The Committee recommends $445,000,000 for the Corporation
for Public Broadcasting [CPB] as an advance appropriation for
fiscal year 2019.
The majority of these funds go directly to local public
television and radio stations to support their programming. CPB
funds also support the creation of content for radio,
television, and other platforms; system support activities that
benefit the entire public broadcasting community; and CPB's
administrative costs.
The Committee recommendation includes the additional
$50,000,000 in fiscal year 2017 requested for the replacement
of the public broadcasting interconnection system. Technology
and distribution systems have greatly evolved since Congress
established the practice of funding the public television and
radio interconnection systems. The Committee is aware that
improved technology may enable the public television and radio
stations to share certain elements of the planned
interconnection system, leading to greater efficiencies.

Federal Mediation and Conciliation Service

SALARIES AND EXPENSES

Appropriations, 2016.................................... $48,748,000
Budget estimate, 2017................................... 50,738,000
Committee recommendation................................ 48,638,000

The Committee recommends $48,638,000 for the Federal
Mediation and Conciliation Service [FMCS]. FMCS provides
mediation, conciliation, and arbitration services to labor and
management organizations to prevent and minimize work stoppages
and promote stable labor-management relationships. FMCS is also
authorized to provide dispute resolution consultation and
training to all Federal agencies.
Within the total, FMCS may utilize up to $2,500,000 for
labor-management partnership grants. These grants support
innovative approaches to collaborative labor-management
relationships to resolve potential problems, explore ways to
improve productivity, and avert serious work stoppages.

Federal Mine Safety and Health Review Commission

SALARIES AND EXPENSES

Appropriations, 2016.................................... $17,085,000
Budget estimate, 2017................................... 17,184,000
Committee recommendation................................ 17,184,000

The Committee recommends $17,184,000 for the Federal Mine
Safety and Health Review Commission [FMSHRC], which provides
administrative trial and appellate review of legal disputes
under the Federal Mine Safety and Health Act of 1977. Most
cases involve civil penalties proposed by MSHA. FMSHRC's
administrative law judges [ALJs] decide cases at the trial
level and the five-member Commission provides review of the
ALJ's decisions. In allocating resources and staff, the
Committee directs the Commission to make reducing the excessive
time substantive cases on appeal are awaiting a decision a top
priority.

Institute of Museum and Library Services

OFFICE OF MUSEUM AND LIBRARIES: GRANTS AND ADMINISTRATION

Appropriations, 2016.................................... $230,000,000
Budget estimate, 2017................................... 230,000,000
Committee recommendation................................ 231,000,000

The Committee recommends $231,000,000 for the Institute of
Museum and Library Services [IMLS]. This agency supports
programs for museums and libraries that encourage innovation,
provide lifelong learning opportunities, promote cultural and
civic engagement, and improve access to a variety of services
and information.
Within the total for IMLS, the Committee recommendation
includes the amounts below:

Museum Services Act:
Museums for America................................... 21,149 20,200 20,392
Native American/Hawaiian Museum Services.............. 972 924 924
National Leadership: Museums.......................... 7,741 9,120 9,120
-----------------------------------------------------
Subtotal, MSA....................................... 29,862 30,244 30,436

African American History and Culture Act.................. 1,481 1,407 1,481
Administration............................................ 1,713 1,920 1,713
Research, Analysis and Data Collection.................... 14,000 14,000 14,000
-----------------------------------------------------
IMLS Total.......................................... 230,000 230,000 231,000
----------------------------------------------------------------------------------------------------------------

Medicaid and CHIP Payment and Access Commission

SALARIES AND EXPENSES

Appropriations, 2016.................................... $7,765,000
Budget estimate, 2017................................... 8,700,000
Committee recommendation................................ 7,765,000

The Committee recommends $7,765,000 for the Medicaid and
CHIP Payment and Access Commission [MACPAC]. This commission
was established in the Children's Health Insurance Program
Reauthorization Act of 2009 and is tasked with reviewing State
and Federal Medicaid and Children's Health Insurance Program
access and payment policies and making recommendations to
Congress, the Secretary of HHS, and the States on a wide range
of issues affecting those programs. The Committee
recommendation will allow MACPAC to continue to carry out these
activities.

Medicare Payment Advisory Commission

SALARIES AND EXPENSES

Appropriations, 2016.................................... $11,925,000
Budget estimate, 2017................................... 12,234,000
Committee recommendation................................ 11,925,000

The Committee recommends $11,925,000 for the Medicare
Payment Advisory Commission [MedPAC], which provides
independent policy and technical advice on issues affecting the
Medicare program.

National Council on Disability

SALARIES AND EXPENSES

Appropriations, 2016.................................... $3,250,000
Budget estimate, 2017................................... 3,468,000
Committee recommendation................................ 3,439,000

The Committee recommends $3,439,000 for the National
Council on Disability [NCD]. NCD is mandated to make
recommendations to the President, Congress, the Rehabilitation
Services Administration, and the National Institute on
Disability and Rehabilitation Research on issues of concern to
individuals with disabilities. The Council gathers information
on the implementation, effectiveness, and impact of the
Americans with Disabilities Act and examines emerging policy
issues as they affect persons with disabilities and their
ability to enter or re-enter the Nation's workforce and to live
independently.

National Labor Relations Board

SALARIES AND EXPENSES

Appropriations, 2016.................................... $274,224,000
Budget estimate, 2017................................... 274,695,000
Committee recommendation................................ 274,224,000

The Committee recommends $274,224,000 for the National
Labor Relations Board [NLRB or ``the Board''], which
administers and enforces the National Labor Relations Act and
protects employee and employer rights provided under that act.
The Committee is aware of concerns expressed by some
employers that employee professional development and mobility
may be hindered by having collective bargaining units that are
limited to distinct departments within a workplace. The
Committee requests the NLRB to report back to the Committee
regarding these concerns, and any suggestions to ensure that
cross-training and career advancement may continue between
employees in departments who are represented by a union, and
employees in departments who are not represented by a union.
In the fiscal year 2016 report, the Committee noted that
the Board had submitted a diminished, superficial CJ for its
appropriations request. In previous years, the NLRB
justification had provided far more complete information about
workload, performance, administrative plans and priorities, and
other supporting detail relevant to its annual budget
requirements. The Committee requires more substantial
information about the agencies' activities and needs to
appropriate resources among many competing priorities.
Unfortunately, the Board ignored the Committee's direction and
again submitted an incomplete CJ with little justification. The
Board is once again directed to provide justification for its
fiscal year 2018 request, including at least as much detail as
it has traditionally provided prior to fiscal year 2016.

ADMINISTRATIVE PROVISIONS

The Committee maintains language from the fiscal year 2016
appropriations act restricting the use of electronic voting
(section 406).

National Mediation Board

SALARIES AND EXPENSES

Appropriations, 2016.................................... $13,230,000
Budget estimate, 2017................................... 13,300,000
Committee recommendation................................ 14,000,000

The Committee recommends $14,000,000 for the National
Mediation Board [NMB], which mediates labor-management
relations in the railroad and airline industries under the
Railway Labor Act. The NMB mediates collective bargaining
disputes, conducts elections to determine the choice of
employee bargaining representatives, and administers
arbitration of employee grievances.
The bill provides an additional $700,000 above the
administration's request for NMB and directs the additional
funds to be used for arbitrator salaries and expenses. The
Committee is concerned about the length of time it takes the
NMB to resolve arbitration cases, and the impact that the delay
has on the individuals served by the NMB. The Committee directs
the NMB to provide detailed information as to how these funds
are used and their impact on the backlog in the fiscal year
2018 CJ.

Occupational Safety and Health Review Commission

SALARIES AND EXPENSES

Appropriations, 2016.................................... $12,639,000
Budget estimate, 2017................................... 13,411,000
Committee recommendation................................ 13,411,000

The Committee recommends $13,411,000 for the Occupational
Safety and Health Review Commission [OSHRC]. OSHRC serves as a
court to resolve disputes between OSHA and employers charged
with violations of health and safety standards enforced by
OSHA.

Railroad Retirement Board

The Railroad Retirement Board [RRB] administers the
retirement/survivor and unemployment/sickness insurance benefit
programs for railroad workers and their families under the
Railroad Retirement Act and Railroad Unemployment Insurance
Act.

DUAL BENEFITS PAYMENTS ACCOUNT

Appropriations, 2016.................................... $29,000,000
Budget estimate, 2017................................... 25,000,000
Committee recommendation................................ 25,000,000

The Committee recommends $25,000,000 for the Dual Benefits
Payments Account. This amount includes an estimated $2,000,000
derived from income taxes on vested dual benefits. This
appropriation provides for vested dual benefit payments to
beneficiaries covered under both the railroad retirement and
Social Security systems.

FEDERAL PAYMENTS TO THE RAILROAD RETIREMENT ACCOUNTS

Appropriations, 2016.................................... $150,000
Budget estimate, 2017................................... 150,000
Committee recommendation................................ 150,000

The Committee recommends $150,000 for Federal Payments to
the Railroad Retirement Account. These funds reimburse the
railroad retirement trust funds for interest earned on non-
negotiated checks.

LIMITATION ON ADMINISTRATION

Appropriations, 2016.................................... $111,225,000
Budget estimate, 2017................................... 122,499,000
Committee recommendation................................ 113,500,000

The Committee recommends $113,500,000 for RRB's costs
associated with the administration of railroad retirement/
survivor and unemployment/sickness benefit programs. This
account limits the amount of funds in the railroad retirement
and railroad unemployment insurance trust funds that may be
used by the Board for administrative expenses.
The Committee maintains bill language giving RRB the
authority to hire new attorneys in the excepted service.

LIMITATION ON THE OFFICE OF THE INSPECTOR GENERAL

Appropriations, 2016.................................... $8,437,000
Budget estimate, 2017................................... 10,499,000
Committee recommendation................................ 10,000,000

The Committee recommends $10,000,000 for the RRB OIG. This
Office conducts audits and investigations to protect the
integrity of the RRB trust funds and provides comprehensive
oversight of all RRB operations and programs.

Social Security Administration

PAYMENTS TO SOCIAL SECURITY TRUST FUNDS

Appropriations, 2016.................................... $11,400,000
Budget estimate, 2017................................... 11,400,000
Committee recommendation................................ 11,400,000

The Committee recommends $11,400,000 in mandatory funds for
payments to Social Security trust funds. This account
reimburses the Old Age and Survivors Insurance [OASI] and
Disability Insurance [DI] trust funds for special payments to
certain uninsured persons, costs incurred administering pension
reform activities, and the value of the interest for benefit
checks issued but not negotiated. This appropriation restores
the trust funds to the same financial position they would have
been in had they not borne these costs and they were properly
charged to general revenues.

SUPPLEMENTAL SECURITY INCOME PROGRAM

Appropriations, 2016.................................... $46,305,733,000
Budget estimate, 2017................................... 43,824,868,000
Committee recommendation................................ 43,618,163,000

The Committee recommends $43,618,163,000 in fiscal year
2017 mandatory funds for the SSI program. This is in addition
to the $14,500,000,000 provided in the fiscal year 2016
appropriations act for the first quarter of fiscal year 2017.
In addition, the Committee recommends $15,000,000,000 in
advance funding for the first quarter of fiscal year 2018. The
SSI program guarantees a minimum level of income to individuals
who are disabled, blind, or older than age 65, and meet certain
income and resource limitations.
Federal Benefit Payments
The Committee recommendation includes a fiscal year 2017
program level of $52,941,736,000 for Federal benefit payments.
This will support an average monthly benefit of approximately
$561 for 8,200,000 recipients.
Beneficiary Services
The Committee recommendation includes $89,000,000 in new
mandatory budget authority for beneficiary services.
These funds reimburse vocational rehabilitation [VR]
agencies for successfully rehabilitating disabled SSI
recipients by helping them achieve and sustain productive,
self-supporting work activity. Funds also support the Ticket to
Work program that provides SSI recipients with a ticket to
offer employment networks [ENs], including VR agencies, in
exchange for employment and support services. Instead of
reimbursing ENs for specific services, the Ticket to Work
program pays ENs based on recipients achieving certain
milestones and outcomes.
Research and Demonstration
The Committee recommendation includes $58,000,000 in
mandatory funds for research and demonstration projects
conducted under sections 1110, 1115, and 1144 of the Social
Security Act. These funds support a variety of research and
demonstration projects designed to improve the disability
process, promote self-sufficiency and assist individuals in
returning to work, encourage savings and retirement planning
through financial literacy, and generally provide analytical
and data resources for use in preparing and reviewing policy
proposals.
The Committee commends the SSA for developing a pilot to
test innovative and evidence-based approaches to improving
outcomes for individuals with disabilities who are eligible for
Social Security disability benefits as well as youth through
the multi-agency PROMISE initiative. The Committee strongly
encourages SSA to consider what is being learned from the
PROMISE evaluation in order to undertake further demonstration
project work for young adults with disabilities who are
eligible for SSI. In developing this initiative, the Committee
directs the SSA to work in close consultation with the
Departments of Labor, Education and Health and Human Services,
and nationwide disability and peer advocacy organizations. The
Committee also directs the SSA to submit a report to the House
and Senate Appropriations Committees no later than 180 days
after the enactment of this act regarding the agency's progress
in developing this proposal.
Administrative Expenses
The Committee recommendation includes $5,029,427,000 for
SSI program administrative expenses. This appropriation funds
the SSI program's share of administrative expenses incurred
through the Limitation on Administrative Expenses [LAE]
account.

LIMITATION ON ADMINISTRATIVE EXPENSES

Appropriations, 2016.................................... $12,161,945,000
Budget estimate, 2017................................... 13,064,000,000
Committee recommendation................................ 12,481,945,000

The Committee recommends $12,481,945,000 for SSA's LAE
account. This account provides resources for SSA to administer
the OASI, DI, and SSI programs, and to support CMS in
administering the Medicare program. The LAE account is funded
by the Social Security and Medicare trust funds for their share
of administrative expenses, the general fund for the SSI
program's share of administrative expenses, and applicable user
fees. These funds support core administrative activities
including processing retirement and disability claims,
conducting hearings to review disability determination appeals,
issuing Social Security numbers and cards, processing
individuals' annual earnings information, and ensuring the
integrity of Social Security programs through continuing
disability reviews [CDR] and SSI redeterminations of non-
medical eligibility.
The Committee recommendation includes $1,819,000,000 for
program integrity activities, including CDRs and SSI
redeterminations of non-medical eligibility. This includes
$273,000,000 in base funding and $1,546,000,000 in cap
adjustment funding allowed under the Budget Control Act [BCA].
The Committee recommendation is a $393,000,000 increase over
the fiscal year 2016 funding level, as specified in the BCA.
Combined, these activities are estimated to save approximately
$10,897,000,000 for the Social Security, Medicare, and Medicaid
programs by preventing waste, fraud, abuse, and improper
payments.
The Committee bill adopts language included in the
President's budget allowing these funds to be used for a
broader range of program integrity activities identified in the
BCA. The bill also removes bill language allowing SSA to use
additional non-cap adjustment program integrity funding for the
full costs of CDRs and redeterminations given SSA's budgeting
of the full cost for such activities without this additional
authority.
The Committee is supportive of efforts to reduce improper
payments and improve program integrity in the SSA's disability
and Supplemental Security Income benefits programs. As part of
the Bipartisan Budget Act of 2015, Congress empowered SSA to
enter into an information exchange with a payroll data provider
to prevent improper payments of such benefits. These programs
have proven to be beneficial in reducing improper payments for
other Federal and State benefits programs, and the Committee
urges SSA to prioritize the utilization of these opportunities.
Within the funds provided to SSA for continuing disability
reviews under titles II and XVI of the Social Security Act and
conducting redeterminations of eligibility, the Committee
encourages SSA to utilize all of the tools available to it from
commercial and non-commercial entities that collect and
maintain data regarding employment and wages, to ensure that
disability and SSI benefits are properly paid and to reduce
fraud and abuse. The Committee requests an update in the fiscal
year 2018 CJ on the progress that SSA has made in utilizing
additional tools to identify improper payments, as well as
progress it has made in those efforts.
Disability Hearing Pilot Program Expansion.--The Committee
supports SSA's efforts to reduce the backlog of disability
claims hearings. Given the successful implementation of the
Disability Hearing Pilot Program in Region 1, the Committee
encourages SSA to implement the changes on a nationwide level.
The changes should include providing advance notice of a
hearing date, and requiring claimants to inform SSA or submit
written evidence within a certain period in advance of the
hearing, subject to the good cause exception. Furthermore, as
recommended in the pilot, SSA should consider removing ``new
and material evidence'' as a basis for reopening any decision
made at the hearing of Appeals Council levels for benefits
based on disability. The Committee requests a report on plans
for implementation no later than 60 days after the enactment of
this act.
Duplication.--As part of its annual duplication report GAO
identified areas within the SSA where there are opportunities
to improve efficiency and effectiveness and reduce costs. GAO
report 15-531 recommends that the SSA evaluate the costs and
benefits of alternatives for reducing the potential
overpayments to individuals receiving concurrent Federal
Employees' Compensation Act payments to determine how best to
strengthen internal controls. The Committee is encouraged by
the Administration's willingness to implement these
recommendations, and requests a report on the progress of the
implementation in the fiscal year 2018 CJ.
Medical Vocational Guidelines.--The Committee is dedicated
to ensuring that the disabled have access to needed benefits,
and strongly encourages SSA to work with us to achieve that
goal. The Committee continues to be concerned that SSA uses
outdated rules to determine whether or not a claimant meets
SSA's definition of disability. The Committee is encouraged by
SSA's indication that they are beginning the regulatory
process, having already received input from the National
Disability Forum, the National Institute of Medicine, as well
as various aging and employment experts. These initial steps
are well received by the Committee as we continue to work with
the Administration to modernize the outdated vocational
guidelines into a structure that reflects the 21st century
labor market. As this is the first significant overhaul of the
grid in nearly 40 years, the Committee requests SSA to submit,
no later than 60 days after the enactment of this act, a report
on its ongoing efforts to update the grid. In addition, the
report shall include a study assessing the feasibility of
maintaining a continuous update of the medical vocational
guidelines every 10 years.
Muscular Dystrophy.--The Committee is aware that the Social
Security Administration is included in the Muscular Dystrophy
Coordinating Committee under the Muscular Dystrophy CARE Act
Amendments enacted in September 2014. The Committee expects the
agency to make data available on the rate at which persons with
Duchenne and Becker Muscular Dystrophy utilize SSA programs,
particularly those focused on promoting employment and
community independence such as the Ticket to Work Program.
Prioritizing Continuing Disability Reviews To Maximize Cost
Savings.--While the Committee commends SSA on its continued
Program Integrity efforts towards becoming current with regards
to the Continuing Disability Review [CDR] backlog, a recent GAO
report found that SSA's CDR prioritization models fail to
maximize potential cost savings to the trust funds and the
Treasury. Within 1 year, and every 3 years thereafter, the
Committee directs SSA to review and update the models for
prioritization of CDRs with the primary intent of efficiently
and effectively maximizing lifetime cost savings to the Federal
Government, both for the DI trust fund and Treasury. A
detailed, cost-based explanation for the model's prioritization
of different CDR types and justification for any updates made
should be included in the annual CDR Report to Congress.
Reducing the Hearing Backlog.--The Committee is aware of
the discord between SSA and the ALJ community regarding the
implementation of part of SSA's Compassionate and Responsive
Service [CARES] plan to reduce the significant hearing backlog
at the agency. Specifically, there is concern regarding the
Administration's hiring of Administrative Appeals Judges for
non-disability and remanded cases. The Committee recognizes the
need for further discussion regarding this matter and
encourages SSA to engage with the ALJ community and appropriate
stakeholders to find innovative solutions to address hearing
wait times, keeping in mind the goal of reducing the backlog to
serve the over 1.1 million individuals and their families
awaiting a hearing decision.
Social Security Advisory Board.--The Committee
recommendation includes not less than $2,300,000 for the Social
Security Advisory Board. This board advises the Commissioner of
Social Security and makes recommendations to Congress and the
President on policies relating to the OASI, DI, and SSI
programs.
The Medical Improvement Standard.--The Committee commends
SSA for its work to improve program integrity. However, the
Committee is concerned, per previous GAO testimony and report
findings from the SSA Office of the Inspector General, that
confusion still exists about the Medical Improvement Standard
(MIRS) and its exceptions. The Committee directs SSA to submit
a report no later than 60 days after the enactment of this act
on its progress in educating Disability Determinations Services
in the proper application of the MIRS and its exceptions.
The Treating Physician Rule.--The Committee expects that in
resolving claims for disability insurance, SSA's consideration
of medical evidence should reflect the degree of relevance and
familiarity each medical source has with the effect of an
individual's medically determinable impairment(s) on his or her
ability to perform Substantial Gainful Activity [SGA]. Since
the Treating Physician rule was first published in the Federal
Register in 1991, healthcare delivery in the United States has
changed significantly and the Treating Physician rule no longer
reflects the present reality of the medical personnel with
greatest knowledge of an individual's physical and/or mental
condition. The Committee encourages SSA to consider revising
the controlling weight doctrine in the Treating Physician rule
and revising its Acceptable Medical Sources to reflect the new
degree of familiarity with their patients, and rigorous
training of, nurse practitioners, physician assistants,
licensed clinical social workers, audiologists, and speech and
language pathologists for the particular impairments that they
are well-equipped to treat.
User Fees.--Within the total for LAE, the Committee
recommendation includes up to $124,000,000 for administrative
activities funded from user fees. This includes $123,000,000 in
fees collected from States that request SSA to administer State
SSI supplementary payments and up to $1,000,000 from fees
collected from non-attorney claimant representatives.
Vocational Experts [VE].--The Committee notes that the
SSA's OIG has recommended that SSA periodically determine
whether VE fees are appropriate to obtain the required level of
VE service. The Committee understands that SSA plans to conduct
such a review, including benchmark studies of VE fees paid in
the national economy and those paid by other governmental and
non-governmental organizations, during SSA's acquisition
planning process for the contracts to be awarded in fiscal year
2018. The Committee looks forward to an update in the fiscal
year 2018 CJ regarding these studies.
Work Incentives Planning and Assistance [WIPA] and
Protection and Advocacy for Beneficiaries of Social Security
[PABSS].--The Committee recommendation includes $23,000,000 for
WIPA and $7,000,000 for PABSS, the same as the comparable
fiscal year 2016 levels, respectively. These programs provide
valuable services to help Social Security disability
beneficiaries return to work.

OFFICE OF INSPECTOR GENERAL

Appropriations, 2016.................................... $105,500,000
Budget estimate, 2017................................... 112,000,000
Committee recommendation................................ 105,500,000

The Committee recommends $105,500,000 for SSA's OIG. This
includes $75,713,000 funded from the OASI and DI trust funds
for those programs' share of OIG's expenses and $29,787,000
funded from general revenues for the SSI program's share of
expenses.

TITLE V

GENERAL PROVISIONS

Section 501. The bill continues a provision authorizing
transfers of unexpended balances.
Section 502. The bill continues a provision limiting
funding to 1-year availability unless otherwise specified.
Section 503. The bill continues a provision limiting
lobbying and related activities.
Section 504. The bill continues a provision limiting
official representation expenses.
Section 505. The bill continues a provision clarifying
Federal funding as a component of State and local grant funds.
Sections 506 and 507. The bill continues provisions
limiting the use of funds for abortion.
Section 508. The bill continues a provision restricting
human embryo research.
Section 509. The bill continues a provision limiting the
use of funds for promotion of legalization of controlled
substances.
Section 510. The bill continues a provision prohibiting the
use of funds to promulgate regulations regarding the individual
health identifier.
Section 511. The bill continues a provision limiting the
use of funds to enter into or review contracts with entities
subject to the requirement in section 4212(d) of title 38,
United States Code, if the report required by that section has
not been submitted.
Section 512. The bill continues a provision prohibiting the
transfer of funds made available in this act to any department,
agency, or instrumentality of the U.S. Government, except as
otherwise provided by this or any other act.
Section 513. The bill continues a provision prohibiting
Federal funding in this act for libraries unless they are in
compliance with the Children's Internet Protection Act.
Section 514. The bill continues a provision maintaining a
procedure for reprogramming of funds.
Section 515. The bill continues a provision prohibiting
candidates for scientific advisory committees from having to
disclose their political activities.
Section 516. The bill continues a provision requiring each
department and related agency to submit an operating plan.
Section 517. The bill continues a provision requiring the
Secretaries of Labor, Health and Human Services, and Education
to submit a report on the number and amounts of contracts,
grants, and cooperative agreements awarded by the Departments
on a noncompetitive basis.
Section 518. The bill continues a provision prohibiting SSA
from processing earnings for work performed under a fraudulent
social security number if based on a conviction for a violation
under section 208(a)(6) or (7) of the Social Security Act.
Section 519. The bill continues a provision prohibiting SSA
from establishing a totalization agreement with Mexico.
Section 520. The bill continues a provision regarding
funding for programs that carry out distribution of sterile
needles or syringes.
Section 521. The bill continues a provision requiring
computer networks to block pornography.
Section 522. The bill continues a provision prohibiting
funding from going to the Association of Community
Organizations for Reform Now [ACORN], or any of its affiliates,
subsidiaries, allied organizations, or successors.
Section 523. The bill continues a provision related to
reporting requirements for conference spending.
Section 524. The bill continues a provision related to
advertisement costs.
Section 525. The bill continues a modified provision on
Performance Partnerships.
Section 526. The bill continues a provision regarding
reporting status of balances of appropriations.
Section 527. The bill includes a new provision
reauthorizing the Special Olympics Sport and Empowerment Act of
2004.
Section 528. The bill continues a provision rescinding
funds from the Independent Payment Advisory Board.
Section 529. The bill modifies a provision rescinding funds
from the Children's Health Insurance Program child enrollment
contingency fund.
Section 530. The bill modifies a provision rescinding funds
from the Children's Health Insurance Program regarding State
allotments.
Section 531. The bill includes a new provision rescinding
funds from the Children's Health Insurance Program Performance
Bonus Fund.
Section 532. The bill includes a new provision regarding
the use of funds in this act for background checks of school
personnel.

COMPLIANCE WITH PARAGRAPH 7, RULE XVI, OF THE STANDING RULES OF THE
SENATE

Paragraph 7 of rule XVI requires that Committee reports on
general appropriations bills identify each Committee amendment
to the House bill ``which proposes an item of appropriation
which is not made to carry out the provisions of an existing
law, a treaty stipulation, or an act or resolution previously
passed by the Senate during that session.''
The Committee is filing an original bill, which is not
covered under this rule, but reports this information in the
spirit of full disclosure.
The Committee recommends funding for the following programs
and activities which currently lack authorization: Institute of
Education Sciences; parts C and D of the Individuals with
Disabilities Education Act; Special Olympics Sport and
Empowerment Act of 2004; Nurse Education Loan Repayment;
Education and Training Related to Geriatrics; Mental and
Behavioral Health Training; Children's Hospital Graduate
Medical Education; Title XVII of the PHS Act; Ryan White CARE
Act; Universal Newborn Hearing Screening; Organ
Transplantation; Family Planning; Rural Health programs;
Traumatic Brain Injury programs; Combating Autism Act; Public
Health Improvement Act; Healthy Start; Telehealth; Health
Professions Education Partnership Act; Children's Health Act;
Women's Health Research and Prevention Amendments of 1998;
Birth Defects Prevention, Preventive Health Amendments of 1993;
Substance Abuse and Mental Health Services programs; Low Income
Home Energy Assistance Program; Refugee and Entrant Assistance
programs (except for Victims of Trafficking); Head Start;
Runaway and Homeless Youth programs; Adoption Incentives;
Developmental Disabilities programs; Voting Access for
Individuals with Disabilities; Native American Programs;
Community Services Block Grant Act programs; National
Institutes of Health; Assets for Independence; Alzheimer's
Disease Demonstration Grants; Office of Disease Prevention and
Health Promotion; YouthBuild Transfer Act; Assistive Technology
Act; Carl D. Perkins Career and Technical Education Improvement
Act; Corporation for Public Broadcasting; National Council on
Disability; Older Americans Act; Second Chance Act; Work
Incentive Planning and Assistance; and Protection and Advocacy
for Beneficiaries of Social Security.

COMPLIANCE WITH PARAGRAPH 7(c), RULE XXVI OF THE STANDING RULES OF THE
SENATE

Pursuant to paragraph 7(c) of rule XXVI, on June 9, 2016,
the Committee ordered favorably reported an original bill (S.
3040) making appropriations for the Departments of Labor,
Health and Human Services, and Education, and related agencies
for the fiscal year ending September 30, 2017, and for other
purposes, provided, that the bill be subject to amendment and
that the bill be consistent with its budget allocation, and
provided that the Chairman of the Committee or his designee be
authorized to offer the substance of the original bill as a
Committee amendment in the nature of a substitute to the House
companion measure, by a recorded vote of 29-1, a quorum being
present. The vote was as follows:
Yeas Nays
Chairman Cochran Mr. Lankford
Mr. McConnell
Mr. Shelby
Mr. Alexander
Ms. Collins
Ms. Murkowski
Mr. Graham
Mr. Kirk
Mr. Blunt
Mr. Moran
Mr. Hoeven
Mr. Boozman
Mrs. Capito
Mr. Cassidy
Ms. Mikulski
Mr. Leahy
Mrs. Murray
Mrs. Feinstein
Mr. Durbin
Mr. Reed
Mr. Tester
Mr. Udall
Mrs. Shaheen
Mr. Merkley
Mr. Coons
Mr. Schatz
Ms. Baldwin
Mr. Murphy

COMPLIANCE WITH PARAGRAPH 12, RULE XXVI OF THE STANDING RULES OF THE
SENATE

Paragraph 12 of rule XXVI requires that Committee reports
on a bill or a joint resolution repealing or amending any
statute include ``(a) the text of the statute or part thereof
which is proposed to be repealed; and (b) a comparative print
of that part of the bill or joint resolution making the
amendment and of the statute or part thereof proposed to be
amended, showing by stricken through type and italics, parallel
columns, or other appropriate typographical devices the
omissions and insertions which would be made by the bill or
joint resolution if enacted in the form recommended by the
committee.''
In compliance with this rule, changes in existing law
proposed to be made by the bill are shown as follows: existing
law to be omitted is enclosed in black brackets; new matter is
printed in italic; and existing law in which no change is
proposed is shown in roman.

TITLE 20--EDUCATION

CHAPTER 28--HIGHER EDUCATION RESOURCES AND STUDENT ASSISTANCE

SUBCHAPTER I--GENERAL PROVISIONS

Part B--Additional General Provisions

Sec. 1011c. National Advisory Committee on Institutional Quality and
Integrity

(a) Establishment

* * * * * * *

(f) Termination

The Committee shall terminate on September 30, [2016] 2017.

* * * * * * *

SUBCHAPTER IV--STUDENT ASSISTANCE

Part A--Grants to Students in Attendance at Institutions of Higher
Education

SUBPART 1--FEDERAL PELL GRANTS

Sec. 1070a. Federal Pell Grants: amount and determinations;
applications

(a) Program authority and method of distribution

* * * * * * *

(b) Purpose and amount of grants

(1) * * *

(7) Additional funds.--

(A) In general.--* * *

(i) * * *

* * * * * * *

(vi) to carry out this section--

(I) * * *

* * * * * * *

(VII) [$1,574,000,000]
$1,320,000,000 for fiscal year 2017;

* * * * * * *

(XI) $1,145,000,000 for fiscal year
2021 and each succeeding fiscal year.

(8)(A) Effective in the 2017-2018 award year and
thereafter, the Secretary shall award an eligible student not
more than one and one-half Federal Pell Grants during a single
award year to permit such student to work toward completion of
an eligible program if, during that single award year, the
student--

(i) has received a Federal Pell Grant for an award
year and is enrolled in an eligible program for one or
more additional payment periods during the same award
year that are not otherwise fully covered by the
student's Federal Pell Grant; and

(ii) is enrolled on at least a half-time basis
while receiving any funds under this section.

(B) In the case of a student receiving more than one
Federal Pell Grant in a single award year under subparagraph
(A), the total amount of Federal Pell Grants awarded to such
student for the award year may exceed the maximum basic grant
level specified in the appropriate appropriations Act for such
award year.

(C) Any period of study covered by a Federal Pell Grant
awarded under subparagraph (A) shall be included in determining
a student's duration limit under subsection (c)(5).

(D) In any case where an eligible student is receiving a
Federal Pell Grant for a payment period that spans two award
years, the Secretary shall allow the eligible institution in
which the student is enrolled to determine the award year to
which the additional period shall be assigned, as it determines
is most beneficial to students.

* * * * * * *

Part C--William D. Ford Federal Direct Loan Program

Sec. 1087h. Funds for administrative expenses

(a) Program authority and method of distribution

(1) Mandatory funds for fiscal year 2006

* * * * * * *

(4)Continuing mandatory funds for account maintenance fees

For each of the fiscal years 2007 through [2016] 2017,
there shall be available to the Secretary, from funds not
otherwise appropriated, funds to be obligated for account
maintenance fees payable to guaranty agencies under part B and
calculated in accordance with subsection (b).
------

TITLE 42--THE PUBLIC HEALTH AND WELFARE

Chapter 7--Social Security

SUBCHAPTER XVIII--HEALTH INSURANCE FOR AGED AND DISABLED

Part B--Supplementary Medical Insurance Benefits for Aged and Disabled

Sec. 1395w-4. Payment for physicians' services

(a) Payment based on fee schedule

* * * * * * *

(b) Establishment of fee schedules

(1) In general

* * * * * * *

(11) Special rule for certain radiation therapy services

The code definitions, the work relative value units under
subsection (c)(2)(C)(i), and the direct inputs for the practice
expense relative value units under subsection (c)(2)(C)(ii) for
radiation treatment delivery and related imaging services
(identified in 2016 by HCPCS G-codes G6001 through G6015) for
the fee schedule established under this subsection for services
furnished in 2017 and 2018 shall be the same as such
definitions, units, and inputs for such services for the fee
schedule established for services furnished in 2016.

(12) Encouraging care management for individuals with
alzheimer's disease or related dementias.--

(A) In general.--In order to care for individuals
with Alzheimer's disease or related dementias the
Secretary shall, subject to subparagraphs (B) and (C),
make payment (as the Secretary determines to be
appropriate) under this section for a care planning
session furnished on or after January 1, 2018, by a
physician (as defined in section 1861(r)(1)), physician
assistant or nurse practitioner (as defined in section
1861(aa)(5)(A)), clinical nurse specialist (as defined
in section 1861(aa)(5)(B)), or other practitioners
deemed appropriate by the Secretary.

(B) Policies relating to payment.--In carrying out
this paragraph, the Secretary shall--

(i) make payment to only one applicable
provider for a care planning session furnished
to a beneficiary diagnosed with Alzheimer's or
related dementia;

(ii) not make payment under subparagraph
(A) if such payment would be duplicative of
payment that is otherwise made under this
title; and

(iii) not require that an annual wellness
visit (as defined in section 1861(hhh)) or an
initial preventive physical examination (as
defined in section 1861(ww)) be furnished as a
condition of payment for such care planning
session.

(i) An explanation of Alzheimer's disease
or related dementias, as well as the expected
progression of the disease and related
dementias as appropriate.

(ii) Creation of a patient-centered
comprehensive care plan, as determined
appropriate by the Secretary.

(iii) Information regarding treatment
options.

(iv) A discussion of resources and services
available in the individual's community that
may reduce the individual's health risks and
promote self-management of Alzheimer's disease
or related dementias.

(v) Other information, as determined
appropriate by the Secretary.

(D) Stakeholder input.--The Secretary shall seek
input from physicians, practitioners, and other
stakeholders regarding the structure of care planning
sessions provided under this paragraph.
------

TITLE 48--TERRITORIES AND INSULAR POSSESSIONS

Chapter 18--Micronesia, Marshall Islands, and Palau

SUBCHAPTER I--MICRONESIA AND MARSHALL ISLANDS

Part B--Approval and Implementation of Compacts, As Amended

Sec. 1921d. Supplemental provisions

(a) Domestic program requirements

* * * * * * *

(f) Continuing programs and laws

(1) Federated States of Micronesia and Republic of the
Marshall Islands

* * * * * * *

(A) Emergency and disaster assistance

* * * * * * *

(B) Treatment of additional programs

(i) Consultation

* * * * * * *

(ix) Applicability

The government, institutions, and people of
Palau shall remain eligible for appropriations
and to receive grants under the provisions of
law specified in clauses (ii) and (iii) until
the end of fiscal year [2016] 2017, to the
extent the government, institutions, and people
of Palau were so eligible under such provisions
in fiscal year 2003.
------

SPECIAL OLYMPICS SPORT AND EMPOWERMENT ACT OF 2004, PUBLIC LAW 108-406

SEC. 5. AUTHORIZATION OF APPROPRIATIONS.

There are authorized to be appropriated--

(1) for grants, contracts, or cooperative
agreements under section 3(a), [$5,500,000 for fiscal
year 2005, and such sums as may be necessary for each
of the 4 succeeding fiscal years;] such sums as may be
necessary for fiscal year 2017 and each of the 4
succeeding fiscal years;

(2) for grants, contracts, or cooperative
agreements under section 3(b), [$3,500,000 for fiscal
year 2005, and such sums as may be necessary for each
of the 4 succeeding fiscal years; and] such sums as may
be necessary for fiscal year 2017 and each of the 4
succeeding fiscal years; and

(3) for grants, contracts, or cooperative
agreements under section 3(c), [$6,000,000 for each of
fiscal years 2005 through 2009.] such sums as may be
necessary for fiscal year 2017 and each of the 4
succeeding fiscal years.
------

CONSOLIDATED APPROPRIATIONS ACT, 2014,
PUBLIC LAW 113-76

DIVISION H--DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND
EDUCATION, AND RELATED AGENCIES APPROPRIATIONS ACT, 2014

TITLE V

GENERAL PROVISIONS

Sec. 526. (a) Definitions.--* * *

* * * * * * *

(b) Use of Discretionary Funds in [Fiscal Year 2014] Fiscal
Year 2017.--* * *

* * * * * * *

(1) is entered into between--

* * * * * * *

(2) specifies, at a minimum, the following
information:

(A) the length of the Agreement (which
shall not extend beyond [September 30, 2018]
September 30, 2021);

* * * * * * *

(e) Transfer Authority.--For the purpose of carrying out
the Pilot in accordance with the Performance Partnership
Agreement, and subject to the written approval of the Director
of the Office of Management and Budget, the head of each
participating Federal agency may transfer Federal discretionary
funds that are being used in the Pilot to an account of the
lead Federal administering agency that includes Federal
discretionary funds that are being used in the Pilot. Subject
to the waiver authority under subsection (f), such transferred
funds shall remain available for the same purposes for which
such funds were originally appropriated: Provided, That such
transferred funds shall remain available for obligation by the
Federal Government until the expiration of the period of
availability for those Federal discretionary funds (which are
being used in the Pilot) that have the longest period of
availability, except that any such transferred funds shall not
remain available beyond [September 30, 2018] September 30,
2021.

BUDGETARY IMPACT OF BILL

PREPARED IN CONSULTATION WITH THE CONGRESSIONAL BUDGET OFFICE PURSUANT TO SEC. 308(A), PUBLIC LAW 93-344, AS
AMENDED
[In millions of dollars]
----------------------------------------------------------------------------------------------------------------
Budget authority Outlays
---------------------------------------------------
Committee Amount in Committee Amount in
allocation bill allocation bill
----------------------------------------------------------------------------------------------------------------
Comparison of amounts in the bill with the subcommittee
allocation for 2017: Subcommittee on Labor, HHS, Education,
and Related Agencies:
Mandatory............................................... 775,898 775,898 775,274 \1\775,274
Discretionary........................................... 161,857 163,817 168,923 \1\170,554
Security............................................ ........... ........... NA NA
Nonsecurity......................................... 161,857 163,817 NA NA
Projections of outlays associated with the recommendation:
2017.................................................... ........... ........... ........... \2\846,261
2018.................................................... ........... ........... ........... 74,484
2019.................................................... ........... ........... ........... 21,263
2020.................................................... ........... ........... ........... 3,575
2021 and future years................................... ........... ........... ........... 3,260
Financial assistance to State and local governments for NA 422,105 NA \2\423,379
2017.......................................................

----------------------------------------------------------------------------------------------------------------
\1\Includes outlays from prior-year budget authority.
\2\Excludes outlays from prior-year budget authority.

NA: Not applicable.

NOTE.--Consistent with the funding recommended in the bill for continuing disability reviews and
redeterminations and for healthcare fraud and abuse control and in accordance with subparagraphs (B) and (C)
of section 251(b)(2) of the BBEDCA of 1985, the Committee anticipates that the Budget Committee will provide a
revised 302(a) allocation for the Committee on Appropriations reflecting an upward adjustment of
$1,960,000,000 in budget authority plus associated outlays.

COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 2016 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL FOR FISCAL
YEAR 2017
[In thousands of dollars]
--------------------------------------------------------------------------------------------------------------------------------------------------------
Senate Committee recommendation
compared with (+ or -)
Item 2016 Budget estimate Committee -----------------------------------
appropriation recommendation 2016
appropriation Budget estimate
--------------------------------------------------------------------------------------------------------------------------------------------------------
TITLE I--DEPARTMENT OF LABOR

EMPLOYMENT AND TRAINING ADMINISTRATION

Training and Employment Services

Grants to States:
Adult Training, current year.............................. 103,556 130,376 70,000 -33,556 -60,376
Advance from prior year............................... (712,000) (712,000) (712,000) ................ ................
Fiscal year 2018...................................... 712,000 712,000 712,000 ................ ................
-----------------------------------------------------------------------------------------
Subtotal............................................ 815,556 842,376 782,000 -33,556 -60,376

Youth Training............................................ 873,416 902,139 838,000 -35,416 -64,139
Dislocated Worker Assistance, current year................ 160,860 243,346 156,000 -4,860 -87,346
Advance from prior year............................... (860,000) (860,000) (860,000) ................ ................
Fiscal year 2018...................................... 860,000 860,000 860,000 ................ ................
-----------------------------------------------------------------------------------------
Subtotal............................................ 1,020,860 1,103,346 1,016,000 -4,860 -87,346
-----------------------------------------------------------------------------------------
Subtotal, Grants to States.......................... 2,709,832 2,847,861 2,636,000 -73,832 -211,861

Current Year...................................... (1,137,832) (1,275,861) (1,064,000) (-73,832) (-211,861)
Fiscal year 2018.................................. (1,572,000) (1,572,000) (1,572,000) ................ ................

National Programs:
Dislocated Worker Assistance National Reserve:
Current year.......................................... 20,859 30,859 20,859 ................ -10,000
Advance from prior year............................... (200,000) (200,000) (200,000) ................ ................
Fiscal year 2018...................................... 200,000 200,000 200,000 ................ ................
-----------------------------------------------------------------------------------------
Subtotal............................................ 220,859 230,859 220,859 ................ -10,000
-----------------------------------------------------------------------------------------
Subtotal, Dislocated Worker Assistance.............. 1,241,719 1,334,205 1,236,859 -4,860 -97,346

Native American Programs.................................. 50,000 52,000 48,500 -1,500 -3,500
Migrant and Seasonal Farmworker programs.................. 81,896 81,896 81,896 ................ ................
Women in Apprenticeship................................... 994 ................ ................ -994 ................
YouthBuild activities..................................... 84,534 84,534 84,534 ................ ................
Technical assistance...................................... 3,232 3,232 2,500 -732 -732
Reintegration of Ex-Offenders............................. 88,078 95,078 88,078 ................ -7,000
Workforce Data Quality Initiative......................... 6,000 40,000 6,000 ................ -34,000
Apprenticeship programs................................... 90,000 90,000 100,000 +10,000 +10,000
-----------------------------------------------------------------------------------------
Total, National Programs................................ 625,593 677,599 632,367 +6,774 -45,232
Current Year........................................ (425,593) (477,599) (432,367) (+6,774) (-45,232)
Fiscal year 2018.................................... (200,000) (200,000) (200,000) ................ ................
-----------------------------------------------------------------------------------------
Total, Training and Employment Services [TES]........... 3,335,425 3,525,460 3,268,367 -67,058 -257,093
Current Year........................................ (1,563,425) (1,753,460) (1,496,367) (-67,058) (-257,093)
Fiscal year 2018.................................... (1,772,000) (1,772,000) (1,772,000) ................ ................

Job Corps

Operations.................................................... 1,581,825 1,608,535 1,591,625 +9,800 -16,910
Construction, Rehabilitation and Acquisition.................. 75,000 105,000 86,000 +11,000 -19,000
Administration................................................ 32,330 41,055 32,330 ................ -8,725
-----------------------------------------------------------------------------------------
Total, Job Corps........................................ 1,689,155 1,754,590 1,709,955 +20,800 -44,635
Current Year........................................ (1,689,155) (1,754,590) (1,709,955) (+20,800) (-44,635)

Community Service Employment For Older Americans.............. 434,371 434,371 400,000 -34,371 -34,371
Federal Unemployment Benefits and Allowances (indefinite)..... 861,000 849,000 849,000 -12,000 ................

State Unemployment Insurance and Employment Service Operations

Unemployment Compensation [UI]:
State Operations.......................................... 2,745,550 2,777,919 2,697,019 -48,531 -80,900
National Activities....................................... 14,547 15,247 15,247 +700 ................
-----------------------------------------------------------------------------------------
Subtotal, Unemployment Compensation..................... 2,760,097 2,793,166 2,712,266 -47,831 -80,900

Employment Service [ES]:
Allotments to States:
Federal Funds......................................... 21,413 21,413 21,413 ................ ................
Trust Funds........................................... 658,587 658,587 650,000 -8,587 -8,587
-----------------------------------------------------------------------------------------
Subtotal, Trust Funds............................... 658,587 658,587 650,000 -8,587 -8,587
-----------------------------------------------------------------------------------------
Subtotal, Allotments to States...................... 680,000 680,000 671,413 -8,587 -8,587

ES National Activities.................................... 19,818 19,818 19,818 ................ ................
-----------------------------------------------------------------------------------------
Subtotal, Employment Service............................ 699,818 699,818 691,231 -8,587 -8,587
Federal Funds....................................... (21,413) (21,413) (21,413) ................ ................
Trust Funds......................................... (678,405) (678,405) (669,818) (-8,587) (-8,587)

Foreign Labor Certification:
Federal Administration.................................... 48,028 48,666 48,028 ................ -638
Grants to States.......................................... 14,282 14,282 14,282 ................ ................
-----------------------------------------------------------------------------------------
Subtotal, Foreign Labor Certification................... 62,310 62,948 62,310 ................ -638

One-Stop Career Centers/Labor Market Information.............. 67,653 75,153 70,153 +2,500 -5,000
-----------------------------------------------------------------------------------------
Total, State UI and ES.................................. 3,589,878 3,631,085 3,535,960 -53,918 -95,125
Federal Funds....................................... (89,066) (96,566) (91,566) (+2,500) (-5,000)
Trust Funds......................................... (3,500,812) (3,534,519) (3,444,394) (-56,418) (-90,125)

State Paid Leave Fund......................................... ................ ................ ................ ................ ................

Program Administration

Training and Employment....................................... 60,074 76,331 63,274 +3,200 -13,057
Trust Funds............................................... 8,639 10,615 8,639 ................ -1,976
Employment Security........................................... 3,469 3,640 3,469 ................ -171
Trust Funds............................................... 39,264 39,821 39,264 ................ -557
Apprenticeship Services....................................... 34,000 40,089 36,160 +2,160 -3,929
Executive Direction........................................... 7,034 8,251 7,271 +237 -980
Trust Funds............................................... 2,079 2,079 2,079 ................ ................
-----------------------------------------------------------------------------------------
Total, Program Administration........................... 154,559 180,826 160,156 +5,597 -20,670
Federal Funds....................................... (104,577) (128,311) (110,174) (+5,597) (-18,137)
Trust Funds......................................... (49,982) (52,515) (49,982) ................ (-2,533)
=========================================================================================
Total, Employment and Training Administration........... 10,064,388 10,375,332 9,923,438 -140,950 -451,894
Federal Funds....................................... 6,513,594 6,788,298 6,429,062 -84,532 -359,236
Current Year.................................... (4,741,594) (5,016,298) (4,657,062) (-84,532) (-359,236)
Fiscal year 2018................................ (1,772,000) (1,772,000) (1,772,000) ................ ................
Trust Funds......................................... 3,550,794 3,587,034 3,494,376 -56,418 -92,658

EMPLOYEE BENEFITS SECURITY ADMINISTRATION [EBSA]

Salaries and Expenses

Enforcement and Participant Assistance........................ 147,400 ................ 147,400 ................ +147,400
Policy and Compliance Assistance.............................. 26,901 ................ 26,901 ................ +26,901
Executive Leadership, Program Oversight and Administration.... 6,699 ................ 6,699 ................ +6,699
Employee benefits security programs........................... ................ 205,761 ................ ................ -205,761
-----------------------------------------------------------------------------------------
Total, EBSA............................................. 181,000 205,761 181,000 ................ -24,761

PENSION BENEFIT GUARANTY CORPORATION (PBGC)

Pension Benefit Guaranty Corporation Fund

Consolidated Administrative budget............................ (431,799) (421,006) (421,006) (-10,793) ................
Operational Support........................................... ................ ................ ................ ................ ................
Headquarters space costs...................................... ................ (98,500) (98,500) (+98,500) ................
WAGE AND HOUR DIVISION, Salaries and Expenses................. 227,500 276,599 227,500 ................ -49,099
OFFICE OF LABOR-MANAGEMENT STANDARDS, Salaries and Expenses... 40,593 45,691 35,529 -5,064 -10,162
OFFICE OF FEDERAL CONTRACT COMPLIANCE PROGRAMS, Salaries and 105,476 114,169 104,476 -1,000 -9,693
Expenses.....................................................

OFFICE OF WORKERS' COMPENSATION PROGRAMS

Salaries and Expenses......................................... 113,324 123,982 115,424 +2,100 -8,558
Trust Funds............................................... 2,177 2,177 2,177 ................ ................
-----------------------------------------------------------------------------------------
Total, Salaries and Expenses............................ 115,501 126,159 117,601 +2,100 -8,558
Federal Funds....................................... (113,324) (123,982) (115,424) (+2,100) (-8,558)
Trust Funds......................................... (2,177) (2,177) (2,177) ................ ................

Special Benefits

Federal Employees' Compensation Benefits...................... 207,000 217,000 217,000 +10,000 ................
Longshore and Harbor Workers' Benefits........................ 3,000 3,000 3,000 ................ ................
-----------------------------------------------------------------------------------------
Total, Special Benefits................................. 210,000 220,000 220,000 +10,000 ................

Special Benefits for Disabled Coal Miners

Benefit Payments.............................................. 85,000 75,000 75,000 -10,000 ................
Administration................................................ 5,302 5,319 5,319 +17 ................
-----------------------------------------------------------------------------------------
Subtotal, Fiscal year 2017 program level................ 90,302 80,319 80,319 -9,983 ................

Less funds advanced in prior year..................... -21,000 -19,000 -19,000 +2,000 ................
-----------------------------------------------------------------------------------------
Total, Current Year................................. 69,302 61,319 61,319 -7,983 ................

New advances, 1st quarter, fiscal year 2018......... 19,000 16,000 16,000 -3,000 ................
-----------------------------------------------------------------------------------------
Total, Special Benefits for Disabled Coal Miners........ 88,302 77,319 77,319 -10,983 ................

Energy Employees Occupational Illness Compensation Fund

Administrative Expenses....................................... 58,552 59,846 59,846 +1,294 ................

Black Lung Disability Trust Fund

Benefit Payments and Interest on Advances..................... 275,261 302,115 302,115 +26,854 ................
Workers' Compensation Programs, Salaries and Expenses......... 35,244 38,246 38,246 +3,002 ................
Departmental Management, Salaries and Expenses................ 30,279 30,594 30,594 +315 ................
Departmental Management, Inspector General.................... 327 330 330 +3 ................
-----------------------------------------------------------------------------------------
Subtotal, Black Lung Disability......................... 341,111 371,285 371,285 +30,174 ................

Treasury Department Administrative Costs...................... 356 356 356 ................ ................
-----------------------------------------------------------------------------------------
Total, Black Lung Disability Trust Fund................. 341,467 371,641 371,641 +30,174 ................
=========================================================================================
Total, Workers' Compensation Programs................... 813,822 854,965 846,407 +32,585 -8,558
Federal Funds....................................... 811,645 852,788 844,230 +32,585 -8,558
Current year.................................... (792,645) (836,788) (828,230) (+35,585) (-8,558)
Fiscal year 2018................................ (19,000) (16,000) (16,000) (-3,000) ................
Trust Funds......................................... 2,177 2,177 2,177 ................ ................

OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION [OSHA]

Salaries and Expenses

Safety and Health Standards................................... 20,000 23,173 18,000 -2,000 -5,173
Federal Enforcement........................................... 208,000 225,972 208,000 ................ -17,972
Whistleblower enforcement..................................... 17,500 21,604 17,500 ................ -4,104
State Programs................................................ 100,850 104,337 100,850 ................ -3,487
Technical Support............................................. 24,469 25,403 24,469 ................ -934
Compliance Assistance:
Federal Assistance........................................ 68,433 72,784 70,981 +2,548 -1,803
State Consultation Grants................................. 57,775 59,775 59,500 +1,725 -275
Training Grants........................................... 10,537 10,537 10,537 ................ ................
-----------------------------------------------------------------------------------------
Subtotal, Compliance Assistance......................... 136,745 143,096 141,018 +4,273 -2,078

Safety and Health Statistics.................................. 34,250 40,095 32,900 -1,350 -7,195
Executive Direction and Administration........................ 10,973 11,343 10,050 -923 -1,293
=========================================================================================
Total, OSHA............................................. 552,787 595,023 552,787 ................ -42,236

MINE SAFETY AND HEALTH ADMINISTRATION

Salaries and Expenses

Coal Enforcement.............................................. 167,859 171,768 162,071 -5,788 -9,697
Metal/Non-Metal Enforcement................................... 91,697 97,563 94,500 +2,803 -3,063
Standards Development......................................... 5,416 6,197 4,500 -916 -1,697
Assessments................................................... 6,976 8,277 6,627 -349 -1,650
Educational Policy and Development............................ 36,320 40,419 39,320 +3,000 -1,099
Technical Support............................................. 33,791 35,041 35,041 +1,250 ................
Program Evaluation and Information Resources [PEIR]........... 17,990 21,815 17,990 ................ -3,825
Program Administration........................................ 15,838 16,292 15,838 ................ -454
=========================================================================================
Total, Mine Safety and Health Administration............ 375,887 397,372 375,887 ................ -21,485
=========================================================================================
Total, Worker Protection Agencies....................... 1,598,744 1,760,774 1,594,780 -3,964 -165,994
Federal Funds....................................... (1,596,567) (1,758,597) (1,592,603) (-3,964) (-165,994)
Trust Funds......................................... (2,177) (2,177) (2,177) ................ ................

BUREAU OF LABOR STATISTICS

Salaries and Expenses

Employment and Unemployment Statistics........................ 208,000 219,258 208,000 ................ -11,258
Labor Market Information...................................... 65,000 67,016 65,000 ................ -2,016
Prices and Cost of Living..................................... 207,000 219,672 207,000 ................ -12,672
Compensation and Working Conditions........................... 83,500 87,517 83,500 ................ -4,017
Productivity and Technology................................... 10,500 10,993 10,500 ................ -493
Executive Direction and Staff Services........................ 35,000 36,487 35,000 ................ -1,487
=========================================================================================
Total, Bureau of Labor Statistics....................... 609,000 640,943 609,000 ................ -31,943
Federal Funds....................................... 544,000 573,927 544,000 ................ -29,927
Trust Funds......................................... 65,000 67,016 65,000 ................ -2,016

OFFICE OF DISABILITY EMPLOYMENT POLICY

Salaries and Expenses......................................... 38,203 38,544 38,203 ................ -341

DEPARTMENTAL MANAGEMENT

Salaries and Expenses

Executive Direction........................................... 31,010 37,406 30,250 -760 -7,156
Departmental Program Evaluation............................... 8,040 9,500 8,040 ................ -1,460
Legal Services................................................ 125,000 140,374 121,745 -3,255 -18,629
Trust Funds............................................... 308 310 308 ................ -2
International Labor Affairs................................... 86,125 101,230 91,125 +5,000 -10,105
Administration and Management................................. 28,413 36,604 28,834 +421 -7,770
Adjudication.................................................. 32,000 36,325 35,336 +3,336 -989
Women's Bureau................................................ 11,536 12,902 11,536 ................ -1,366
Civil Rights Activities....................................... 6,880 8,041 6,880 ................ -1,161
Chief Financial Officer....................................... 5,061 5,233 5,132 +71 -101
=========================================================================================
Total, Departmental Management.......................... 334,373 387,925 339,186 +4,813 -48,739
Federal Funds....................................... (334,065) (387,615) (338,878) (+4,813) (-48,737)
Trust Funds......................................... (308) (310) (308) ................ (-2)

Veterans Employment and Training

State Administration, Grants.................................. 175,000 175,000 175,000 ................ ................
Transition Assistance Program................................. 14,100 14,600 14,600 +500 ................
Federal Administration........................................ 40,487 42,506 41,027 +540 -1,479
National Veterans' Employment and Training Services Institute. 3,414 3,414 3,414 ................ ................
Homeless Veterans Program..................................... 38,109 50,000 40,500 +2,391 -9,500
-----------------------------------------------------------------------------------------
Total, Veterans Employment and Training................. 271,110 285,520 274,541 +3,431 -10,979
Federal Funds....................................... 38,109 50,000 40,500 +2,391 -9,500
Trust Funds......................................... 233,001 235,520 234,041 +1,040 -1,479

IT Modernization

Departmental support systems.................................. 4,898 4,898 4,898 ................ ................
Infrastructure technology modernization....................... 24,880 58,264 13,880 -11,000 -44,384
-----------------------------------------------------------------------------------------
Total, IT Modernization................................. 29,778 63,162 18,778 -11,000 -44,384

Office of Inspector General

Program Activities............................................ 80,640 88,881 82,061 +1,421 -6,820
Trust Funds............................................... 5,660 5,660 5,660 ................ ................
-----------------------------------------------------------------------------------------
Total, Office of Inspector General...................... 86,300 94,541 87,721 +1,421 -6,820
=========================================================================================
Total, Departmental Management.......................... 721,561 831,148 720,226 -1,335 -110,922
Federal Funds....................................... 482,592 589,658 480,217 -2,375 -109,441
Current Year.................................... (482,592) (589,658) (480,217) (-2,375) (-109,441)
Trust Funds......................................... 238,969 241,490 240,009 +1,040 -1,481
=========================================================================================
Total, Workforce Investment Act Programs................ 5,023,586 5,280,050 4,978,322 -45,264 -301,728
Current Year........................................ (3,251,586) (3,508,050) (3,206,322) (-45,264) (-301,728)
Fiscal year 2018.................................... (1,772,000) (1,772,000) (1,772,000) ................ ................
=========================================================================================
Total, Title I, Department of Labor..................... 13,730,217 14,375,547 13,614,453 -115,764 -761,094
Federal Funds....................................... 9,873,277 10,477,830 9,812,891 -60,386 -664,939
Current Year.................................... (8,082,277) (8,689,830) (8,024,891) (-57,386) (-664,939)
Fiscal year 2018................................ (1,791,000) (1,788,000) (1,788,000) (-3,000) ................
Trust Funds......................................... 3,856,940 3,897,717 3,801,562 -55,378 -96,155

TITLE II--DEPARTMENT OF HEALTH AND HUMAN SERVICES

HEALTH RESOURCES AND SERVICES ADMINISTRATION [HRSA]

Primary Health Care

Community Health Centers...................................... 1,491,422 1,341,422 1,490,522 -900 +149,100
Free Clinics Medical Malpractice.............................. 100 1,000 1,000 +900 ................
-----------------------------------------------------------------------------------------
Total, Primary Health Care.............................. 1,491,522 1,342,422 1,491,522 ................ +149,100

Health Workforce

National Health Service Corps................................. ................ 20,000 ................ ................ -20,000

Training for Diversity:
Centers of Excellence..................................... 21,711 21,711 21,711 ................ ................
Health Careers Opportunity Program........................ 14,189 14,189 ................ -14,189 -14,189
Faculty Loan Repayment.................................... 1,190 1,190 1,190 ................ ................
Scholarships for Disadvantaged Students................... 45,970 49,070 49,070 +3,100 ................
-----------------------------------------------------------------------------------------
Total, Training for Diversity........................... 83,060 86,160 71,971 -11,089 -14,189

Training in Primary Care Medicine............................. 38,924 38,924 38,924 ................ ................
Oral Health Training.......................................... 35,873 35,873 35,873 ................ ................
Interdisciplinary Community-Based Linkages:
Area Health Education Centers............................. 30,250 ................ 30,250 ................ +30,250
Geriatric Programs........................................ 38,737 38,737 38,737 ................ ................
Behavioral Health Workforce Education and Training............ 50,000 56,000 50,000 ................ -6,000
Mental and Behavorial Health.............................. 9,916 9,916 9,916 ................ ................
-----------------------------------------------------------------------------------------
Total, Interdisciplinary Community Linkages............. 128,903 104,653 128,903 ................ +24,250

Workforce Information and Analysis............................ 4,663 4,663 4,663 ................ ................
Public Health and Preventive Medicine programs................ 21,000 17,000 17,000 -4,000 ................

Nursing Programs:
Advanced Education Nursing................................ 64,581 64,581 64,581 ................ ................
Nurse Education, Practice, and Retention.................. 39,913 39,913 39,913 ................ ................
Nursing Workforce Diversity............................... 15,343 15,343 15,343 ................ ................
Loan Repayment and Scholarship Program.................... 83,135 83,135 83,135 ................ ................
Nursing Faculty Loan Program.............................. 26,500 26,500 26,500 ................ ................
-----------------------------------------------------------------------------------------
Total, Nursing programs................................. 229,472 229,472 229,472 ................ ................

Children's Hospitals Graduate Medical Education............... 295,000 ................ 300,000 +5,000 +300,000
National Practitioner Data Bank............................... 18,814 21,037 18,814 ................ -2,223
User Fees................................................. -18,814 -21,037 -18,814 ................ +2,223
-----------------------------------------------------------------------------------------
Total, Health Workforce................................. 836,895 536,745 826,806 -10,089 +290,061

Maternal and Child Health

Maternal and Child Health Block Grant......................... 638,200 638,200 641,700 +3,500 +3,500
Sickle Cell Anemia Demonstration Program...................... 4,455 4,455 4,455 ................ ................
Autism and Other Developmental Disorders...................... 47,099 47,099 47,099 ................ ................
Heritable Disorders........................................... 13,883 13,883 11,883 -2,000 -2,000
Healthy Start................................................. 103,500 103,500 103,500 ................ ................
Universal Newborn Hearing Screening........................... 17,818 17,818 17,818 ................ ................
Emergency Medical Services for Children....................... 20,162 20,162 20,162 ................ ................
-----------------------------------------------------------------------------------------
Total, Maternal and Child Health........................ 845,117 845,117 846,617 +1,500 +1,500

Ryan White HIV/AIDS Program

Emergency Assistance.......................................... 655,876 655,876 655,876 ................ ................
Comprehensive Care Programs................................... 1,315,005 1,315,005 1,315,005 ................ ................
AIDS Drug Assistance Program [ADAP] (NA).................. (900,313) (900,313) (900,313) ................ ................
Early Intervention Program.................................... 205,079 280,167 201,079 -4,000 -79,088
Children, Youth, Women, and Families.......................... 75,088 ................ 75,088 ................ +75,088
AIDS Dental Services.......................................... 13,122 13,122 13,122 ................ ................
Education and Training Centers................................ 33,611 33,611 33,611 ................ ................
Special Projects of National Significance..................... 25,000 ................ ................ -25,000 ................
-----------------------------------------------------------------------------------------
Total, Ryan White HIV/AIDS program...................... 2,322,781 2,297,781 2,293,781 -29,000 -4,000
(Evaluation Tap Funding).............................. ................ (34,000) ................ ................ (-34,000)

Health Care Systems

Organ Transplantation......................................... 23,549 23,549 23,549 ................ ................
National Cord Blood Inventory................................. 11,266 11,266 11,266 ................ ................
CW Bill Young Cell Transplantation program.................... 22,109 22,109 22,109 ................ ................
340B Drug Pricing program/Office of Pharmacy Affairs.......... 10,238 26,238 19,238 +9,000 -7,000
User Fees................................................. ................ -9,000 -9,000 -9,000 ................
Poison Control................................................ 18,846 18,846 18,846 ................ ................
National Hansen's Disease Program............................. 15,206 15,206 15,206 ................ ................
Hansen's Disease Program Buildings and Facilities............. 122 122 122 ................ ................
Payment to Hawaii, Treatment of Hansen's...................... 1,857 1,857 1,857 ................ ................
-----------------------------------------------------------------------------------------
Total, Health Care Systems.............................. 103,193 110,193 103,193 ................ -7,000

Rural Health

Rural Outreach Grants......................................... 63,500 63,500 65,500 +2,000 +2,000
Rural Health Research/Policy Development...................... 9,351 9,351 9,351 ................ ................
Rural Hospital Flexibility Grants............................. 41,609 26,200 41,609 ................ +15,409
State Offices of Rural Health................................. 9,511 9,511 9,511 ................ ................
Black Lung Clinics............................................ 6,766 6,766 6,766 ................ ................
Radiation Exposure Screening and Education Program............ 1,834 1,834 1,834 ................ ................
Telehealth.................................................... 17,000 17,000 18,000 +1,000 +1,000
Rural Opioid Overdose Reversal grant program.................. ................ 10,000 ................ ................ -10,000
-----------------------------------------------------------------------------------------
Total, Rural Health..................................... 149,571 144,162 152,571 +3,000 +8,409

Family Planning............................................... 286,479 300,000 286,479 ................ -13,521
Program Management............................................ 154,000 157,061 154,000 ................ -3,061

Vaccine Injury Compensation Program Trust Fund

Post-fiscal year 1988 Claims.................................. 237,000 240,000 240,000 +3,000 ................
HRSA Administration........................................... 7,500 9,200 7,500 ................ -1,700
-----------------------------------------------------------------------------------------
Total, Vaccine Injury Compensation Trust Fund........... 244,500 249,200 247,500 +3,000 -1,700
=========================================================================================
Total, Health Resources and Services Administration..... 6,434,058 5,982,681 6,402,469 -31,589 +419,788

CENTERS FOR DISEASE CONTROL AND PREVENTION

Immunization and Respiratory Diseases......................... 459,055 411,716 459,055 ................ +47,339
Pandemic Flu balances (Public Law 111-32)................. (15,000) ................ (15,000) ................ (+15,000)
Prevention and Public Health Fund\1\...................... (324,350) (336,350) (324,350) ................ (-12,000)
-----------------------------------------------------------------------------------------
Subtotal................................................ (798,405) (748,066) (798,405) ................ (+50,339)

HIV/AIDS, Viral Hepatitis, Sexually Transmitted Diseases, and 1,122,278 1,127,278 1,112,278 -10,000 -15,000
Tuberculosis Prevention......................................
Emerging and Zoonotic Infectious Diseases..................... 527,885 577,485 526,885 -1,000 -50,600
Prevention and Public Health Fund\1\...................... (52,000) (52,000) (52,000) ................ ................
-----------------------------------------------------------------------------------------
Subtotal................................................ 579,885 629,485 578,885 -1,000 -50,600

Chronic Disease Prevention and Health Promotion............... 838,146 679,745 726,696 -111,450 +46,951
Prevention and Public Health Fund\1\...................... (338,950) (437,400) (337,950) (-1,000) (-99,450)
-----------------------------------------------------------------------------------------
Subtotal................................................ 1,177,096 1,117,145 1,064,646 -112,450 -52,499

Birth Defects, Developmental Disabilities, Disabilities and 135,610 67,644 137,560 +1,950 +69,916
Health.......................................................
Prevention and Public Health Fund\1\...................... ................ (67,966) ................ ................ (-67,966)
-----------------------------------------------------------------------------------------
Subtotal................................................ 135,610 135,610 137,560 +1,950 +1,950

Public Health Scientific Services............................. 491,597 464,355 485,000 -6,597 +20,645
Prevention and Public Health Fund\1\...................... ................ (36,276) ................ ................ (-36,276)
-----------------------------------------------------------------------------------------
Subtotal................................................ (491,597) (500,631) (485,000) (-6,597) (-15,631)

Environmental Health.......................................... 165,303 167,825 165,303 ................ -2,522
Prevention and Public Health Fund\1\...................... (17,000) (14,478) (17,000) ................ (+2,522)
-----------------------------------------------------------------------------------------
Subtotal................................................ 182,303 182,303 182,303 ................ ................

Injury Prevention and Control................................. 236,059 268,629 264,059 +28,000 -4,570
National Institute for Occupational Safety and Health......... 339,121 213,621 334,121 -5,000 +120,500
Evaluation Tap Funding.................................... ................ (72,000) ................ ................ (-72,000)
-----------------------------------------------------------------------------------------
Subtotal................................................ (339,121) (285,621) (334,121) (-5,000) (+48,500)

Energy Employees Occupational Illness Compensation Program.... 55,358 55,358 55,358 ................ ................
Global Health................................................. 427,121 442,121 432,121 +5,000 -10,000
-----------------------------------------------------------------------------------------
Subtotal................................................ (427,121) (442,121) (432,121) (+5,000) (-10,000)

Public Health Preparedness and Response....................... 1,405,000 1,402,166 1,396,800 -8,200 -5,366
Buildings and Facilities...................................... 10,000 31,221 ................ -10,000 -31,221

CDC-Wide Activities and Program Support

Prevention and Public Health Fund\1\.......................... (160,000) ................ (160,000) ................ (+160,000)
Office of the Director........................................ 113,570 113,570 113,570 ................ ................
-----------------------------------------------------------------------------------------
Subtotal, CDC-Wide Activities........................... (273,570) (113,570) (273,570) ................ (+160,000)
=========================================================================================
Total, Centers for Disease Control...................... 6,326,103 6,022,734 6,208,806 -117,297 +186,072
Pandemic Flu balances (Public Law 111-32)............... (15,000) ................ (15,000) ................ (+15,000)
Prevention and Public Health Fund\1\.................... (892,300) (944,470) (891,300) (-1,000) (-53,170)
Total, Centers for Disease Control Program Level........ (7,233,403) (7,039,204) (7,115,106) (-118,297) (+75,902)

NATIONAL INSTITUTES OF HEALTH

National Cancer Institute..................................... 5,213,509 5,097,287 5,429,769 +216,260 +332,482
National Heart, Lung, and Blood Institute..................... 3,113,533 3,069,901 3,242,685 +129,152 +172,784
National Institute of Dental and Craniofacial Research........ 413,396 404,560 430,544 +17,148 +25,984
National Institute of Diabetes and Digestive and Kidney 1,816,310 1,786,086 1,891,652 +75,342 +105,566
Diseases [NIDDK].............................................
Juvenile Diabetes (mandatory)............................. (150,000) (150,000) (150,000) ................ ................
-----------------------------------------------------------------------------------------
Subtotal, NIDDK program level........................... 1,966,310 1,936,086 2,041,652 +75,342 +105,566

National Institute of Neurological Disorders and Stroke....... 1,695,180 1,659,416 1,803,306 +108,126 +143,890
National Institute of Allergy and Infectious Diseases......... 4,715,697 4,700,548 4,961,305 +245,608 +260,757
National Institute of General Medical Sciences................ 1,732,437 1,586,655 1,776,755 +44,318 +190,100
Evaluation Tap Funding.................................... (780,000) (847,489) (857,000) (+77,000) (+9,511)
-----------------------------------------------------------------------------------------
Subtotal, NGMS program level............................ 2,512,437 2,434,144 2,633,755 +121,318 +199,611

Eunice Kennedy Shriver National Institute of Child Health and 1,338,348 1,316,607 1,395,811 +57,463 +79,204
Human Development............................................
National Eye Institute........................................ 707,998 687,249 740,826 +32,828 +53,577
National Institute of Environmental Health Sciences........... 693,533 681,613 722,301 +28,768 +40,688
National Institute on Aging................................... 1,598,246 1,265,133 2,067,138 +468,892 +802,005
National Institute of Arthritis and Musculoskeletal and Skin 541,662 532,753 564,131 +22,469 +31,378
Diseases.....................................................
National Institute on Deafness and Other Communication 422,936 416,146 441,778 +18,842 +25,632
Disorders....................................................
National Institute of Nursing Research........................ 145,912 143,942 151,965 +6,053 +8,023
National Institute on Alcohol Abuse and Alcoholism............ 467,445 459,578 488,782 +21,337 +29,204
National Institute on Drug Abuse.............................. 1,050,550 1,020,459 1,103,032 +52,482 +82,573
National Institute of Mental Health........................... 1,518,673 1,459,700 1,619,537 +100,864 +159,837
National Human Genome Research Institute...................... 513,227 509,762 534,516 +21,289 +24,754
National Institute of Biomedical Imaging and Bioengineering... 343,506 334,025 361,062 +17,556 +27,037
National Center for Complementary and Integrative Health...... 129,941 126,673 136,195 +6,254 +9,522
National Institute on Minority Health and Health Disparities.. 280,680 279,680 292,323 +11,643 +12,643
John E. Fogarty International Center.......................... 70,117 69,175 73,026 +2,909 +3,851
National Library of Medicine [NLM]............................ 395,684 395,110 412,097 +16,413 +16,987
National Center for Advancing Translational Sciences.......... 685,417 660,131 713,849 +28,432 +53,718
Office of the Director........................................ 1,571,200 1,445,459 1,443,752 -127,448 -1,707
Common Fund (non-add)..................................... (675,639) (565,639) (790,542) (+114,903) (+224,903)
Gabriella Miller Kids First Research Act (Common Fund) (12,600) (12,600) (12,600) ................ ................
(non-add)................................................
Transfers from Non-Recurring Expense Fund (non-add)....... ................ ................ (300,000) (+300,000) (+300,000)
-----------------------------------------------------------------------------------------
Subtotal................................................ 1,571,200 1,445,459 1,743,752 +172,552 +298,293

Buildings and Facilities...................................... 128,863 128,863 128,863 ................ ................
NIH undistributed............................................. ................ ................ ................ ................ ................
=========================================================================================
Total, National Institutes of Health [NIH].............. 31,304,000 30,236,511 32,927,000 +1,623,000 +2,690,489
(Evaluation Tap Funding).............................. (780,000) (847,489) (857,000) (+77,000) (+9,511)
(Transfers from Non-Recurring Expense Fund)........... ................ ................ (300,000) (+300,000) (+300,000)
Total, NIH Program Level................................ (32,084,000) (31,084,000) (34,084,000) (+2,000,000) (+3,000,000)

SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION
[SAMHSA]

Mental Health

Programs of Regional and National Significance................ 402,609 386,388 375,659 -26,950 -10,729
Evaluation Tap Funding.................................... ................ (10,000) ................ ................ (-10,000)
Prevention and Public Health Fund\1\...................... (12,000) (10,000) (12,000) ................ (+2,000)
-----------------------------------------------------------------------------------------
Subtotal................................................ 414,609 406,388 387,659 -26,950 -18,729

Mental Health block grant..................................... 511,532 511,532 541,532 +30,000 +30,000
Evaluation Tap Funding.................................... (21,039) (21,039) (21,039) ................ ................
-----------------------------------------------------------------------------------------
Subtotal................................................ (532,571) (532,571) (562,571) (+30,000) (+30,000)

Children's Mental Health...................................... 119,026 119,026 119,026 ................ ................
Grants to States for the Homeless (PATH)...................... 64,635 64,635 64,635 ................ ................
Protection and Advocacy....................................... 36,146 36,146 36,146 ................ ................
-----------------------------------------------------------------------------------------
Subtotal, Mental Health................................. 1,133,948 1,117,727 1,136,998 +3,050 +19,271
(Evaluation Tap Funding).............................. (21,039) (31,039) (21,039) ................ (-10,000)
-----------------------------------------------------------------------------------------
Subtotal, Mental Health program level............... (1,166,987) (1,158,766) (1,170,037) (+3,050) (+11,271)

Substance Abuse Treatment

Programs of Regional and National Significance................ 335,345 298,269 334,484 -861 +36,215
Evaluation Tap Funding.................................... (2,000) (30,000) (2,000) ................ (-28,000)
-----------------------------------------------------------------------------------------
Subtotal................................................ (337,345) (328,269) (336,484) (-861) (+8,215)

Substance Abuse block grant................................... 1,778,879 1,778,879 1,778,879 ................ ................
Evaluation Tap Funding.................................... (79,200) (79,200) (79,200) ................ ................
-----------------------------------------------------------------------------------------
Subtotal, block grant................................... (1,858,079) (1,858,079) (1,858,079) ................ ................
-----------------------------------------------------------------------------------------
Subtotal, Substance Abuse Treatment..................... 2,114,224 2,077,148 2,113,363 -861 +36,215
(Evaluation Tap Funding).............................. (81,200) (109,200) (81,200) ................ (-28,000)
Subtotal, Program level................................. (2,195,424) (2,186,348) (2,194,563) (-861) (+8,215)

Substance Abuse Prevention

Programs of Regional and National Significance................ 211,219 194,680 225,219 +14,000 +30,539
Evaluation Tap Funding.................................... ................ (16,468) ................ ................ (-16,468)
-----------------------------------------------------------------------------------------
Subtotal................................................ 211,219 194,680 225,219 +14,000 +30,539

Health Surveillance and Program Support....................... 124,878 99,228 115,830 -9,048 +16,602
Evaluation Tap Funding (NA)............................... (31,428) (56,828) (32,428) (+1,000) (-24,400)
Prevention and Public Health Fund\1\...................... ................ (17,830) ................ ................ (-17,830)
-----------------------------------------------------------------------------------------
Subtotal................................................ 156,306 173,886 148,258 -8,048 -25,628
=========================================================================================
Total, SAMHSA........................................... 3,584,269 3,488,783 3,591,410 +7,141 +102,627
(Evaluation Tap Funding).............................. (133,667) (213,535) (134,667) (+1,000) (-78,868)
(Prevention and Public Health Fund)\1\................ (12,000) (27,830) (12,000) ................ (-15,830)
Total, SAMHSA Program Level......................... (3,729,936) (3,730,148) (3,738,077) (+8,141) (+7,929)

AGENCY FOR HEALTHCARE RESEARCH AND QUALITY [AHRQ]

Healthcare Research and Quality

Research on Health Costs, Quality, and Outcomes:
Federal Funds............................................. 196,800 140,519 184,279 -12,521 +43,760
Evaluation Tap funding................................ ................ (83,458) ................ ................ (-83,458)
Patient-Centered Outcomes Research transfer........... ................ ................ ................ ................ ................
-----------------------------------------------------------------------------------------
Subtotal, Health Costs, Quality, and Outcomes....... (196,800) (223,977) (184,279) (-12,521) (-39,698)
(Evaluation Tap Funding)............................ ................ (83,458) ................ ................ (-83,458)

Medical Expenditures Panel Surveys:
Federal Funds............................................. 66,000 68,877 68,877 +2,877 ................
Program Support:
Federal Funds............................................. 71,200 70,844 70,844 -356 ................
-----------------------------------------------------------------------------------------
Total, AHRQ Program Level............................... (334,000) (363,698) (324,000) (-10,000) (-39,698)
Federal funds....................................... (334,000) (280,240) (324,000) (-10,000) (+43,760)
(Evaluation Tap Funding)............................ ................ (83,458) ................ ................ (-83,458)
=========================================================================================
Total, Public Health Service [PHS] appropriation........ 47,982,430 46,010,949 49,453,685 +1,471,255 +3,442,736
(Evaluation Tap Funding).............................. ................ ................ ................ ................ ................
Total, Public Health Service Program Level.............. (49,815,397) (48,233,731) (51,363,652) (+1,548,255) (+3,129,921)

CENTERS FOR MEDICARE AND MEDICAID SERVICES

Grants to States for Medicaid

Medicaid Current Law Benefits................................. 334,936,328 354,223,901 354,223,901 +19,287,573 ................
State and Local Administration................................ 17,771,915 18,975,984 18,975,984 +1,204,069 ................
Vaccines for Children......................................... 4,109,307 4,386,584 4,386,584 +277,277 ................
-----------------------------------------------------------------------------------------
Subtotal, Medicaid Program Level........................ 356,817,550 377,586,469 377,586,469 +20,768,919 ................
Less funds advanced in prior year................... -113,272,140 -115,582,502 -115,582,502 -2,310,362 ................
-----------------------------------------------------------------------------------------
Total, Grants to States for Medicaid.................... 243,545,410 262,003,967 262,003,967 +18,458,557 ................

New advance, 1st quarter, fiscal year 2018........ 115,582,502 125,219,452 125,219,452 +9,636,950 ................
Payments to Health Care Trust Funds

Supplemental Medical Insurance................................ 198,530,000 214,944,000 214,944,000 +16,414,000 ................
Federal Uninsured Payment..................................... 158,000 147,000 147,000 -11,000 ................
Program Management............................................ 1,044,000 877,500 877,500 -166,500 ................
General Revenue for Part D Benefit............................ 82,453,000 82,512,000 82,512,000 +59,000 ................
General Revenue for Part D Administration..................... 691,000 405,000 405,000 -286,000 ................
HCFAC Reimbursement........................................... 291,000 299,000 299,000 +8,000 ................
State Low-Income Determination for Part D..................... 4,800 3,200 3,200 -1,600 ................
-----------------------------------------------------------------------------------------
Total, Payments to Trust Funds, Program Level........... 283,171,800 299,187,700 299,187,700 +16,015,900 ................

Program Management

Research, Demonstration, Evaluation........................... 20,054 ................ 20,054 ................ +20,054
Program Operations............................................ 2,519,823 2,936,499 2,519,823 ................ -416,676
State Survey and Certification................................ 397,334 437,200 397,334 ................ -39,866
Federal Administration........................................ 732,533 735,850 732,533 ................ -3,317
-----------------------------------------------------------------------------------------
Total, Program management............................... 3,669,744 4,109,549 3,669,744 ................ -439,805

Health Care Fraud and Abuse Control Account

Centers for Medicare and Medicaid Services.................... 486,120 486,936 486,935 +815 -1
HHS Office of Inspector General............................... 67,200 121,824 79,355 +12,155 -42,469
Medicaid/CHIP................................................. 67,200 ................ 79,355 +12,155 +79,355
Department of Justice......................................... 60,480 116,240 79,355 +18,875 -36,885
-----------------------------------------------------------------------------------------
Total, Health Care Fraud and Abuse Control.............. 681,000 725,000 725,000 +44,000 ................
=========================================================================================
Total, Centers for Medicare and Medicaid Services....... 646,650,456 691,245,668 690,805,863 +44,155,407 -439,805
Federal funds....................................... 642,299,712 686,411,119 686,411,119 +44,111,407 ................
Current year.................................... (526,717,210) (561,191,667) (561,191,667) (+34,474,457) ................
New advance, fiscal year 2018................... (115,582,502) (125,219,452) (125,219,452) (+9,636,950) ................
Trust Funds......................................... 4,350,744 4,834,549 4,394,744 +44,000 -439,805

ADMINISTRATION FOR CHILDREN AND FAMILIES [ACF]

Payments to States for Child Support Enforcement and Family
Support Programs

Payments to Territories....................................... 33,000 33,000 33,000 ................ ................
Repatriation.................................................. 1,000 1,000 1,000 ................ ................
-----------------------------------------------------------------------------------------
Subtotal................................................ 34,000 34,000 34,000 ................ ................

Child Support Enforcement:
State and Local Administration............................ 3,541,359 3,680,840 3,680,840 +139,481 ................
Federal Incentive Payments................................ 519,547 585,791 585,791 +66,244 ................
Access and Visitation..................................... 10,000 10,000 10,000 ................ ................
-----------------------------------------------------------------------------------------
Subtotal, Child Support Enforcement..................... 4,070,906 4,276,631 4,276,631 +205,725 ................
-----------------------------------------------------------------------------------------
Total, Family Support Payments Program Level............ 4,104,906 4,310,631 4,310,631 +205,725 ................
Less funds advanced in previous years............... -1,160,000 -1,300,000 -1,300,000 -140,000 ................
-----------------------------------------------------------------------------------------
Total, Family Support Payments, current year............ 2,944,906 3,010,631 3,010,631 +65,725 ................
New advance, 1st quarter, fiscal year 2018........ 1,300,000 1,400,000 1,400,000 +100,000 ................

Low Income Home Energy Assistance [LIHEAP]

Formula Grants................................................ 3,390,304 3,000,304 3,390,304 ................ +390,000
Utility Innovation Fund....................................... ................ ................ ................ ................ ................
-----------------------------------------------------------------------------------------
Total, LIHEAP, Program Level............................ 3,390,304 3,000,304 3,390,304 ................ +390,000

Refugee and Entrant Assistance

Transitional and Medical Services............................. 490,000 581,357 490,000 ................ -91,357
Victims of Trafficking........................................ 18,755 22,000 18,755 ................ -3,245
Social Services............................................... 155,000 176,927 155,000 ................ -21,927
Preventive Health............................................. 4,600 4,600 4,600 ................ ................
Targeted Assistance........................................... 47,601 55,601 47,601 ................ -8,000
Unaccompanied Minors.......................................... 948,000 1,226,000 948,000 ................ -278,000
Unaccompanied Minors Contingency Fund......................... ................ 95,000 ................ ................ -95,000
CBO adjustment............................................ ................ 65,000 ................ ................ -65,000
-----------------------------------------------------------------------------------------
Subtotal................................................ ................ 160,000 ................ ................ -160,000

Victims of Torture............................................ 10,735 23,375 10,735 ................ -12,640
-----------------------------------------------------------------------------------------
Total, Refugee and Entrant Assistance................... 1,674,691 2,249,860 1,674,691 ................ -575,169

Payments to States for the Child Care and Development Block 2,761,000 2,961,672 2,786,000 +25,000 -175,672
Grant........................................................
Social Services Block Grant (Title XX)........................ 1,700,000 1,681,500 1,700,000 ................ +18,500
Social Services Block Grant Research/Evaluation............... ................ 18,500 ................ ................ -18,500
-----------------------------------------------------------------------------------------
Total, Social Services Block Grant...................... 1,700,000 1,700,000 1,700,000 ................ ................

Children and Families Services Programs

Programs for Children, Youth and Families:
Head Start, current funded................................ 9,168,095 9,601,724 9,203,095 +35,000 -398,629
Preschool Development Grants\3\........................... 250,000 350,000 250,000 ................ -100,000
Consolidated Runaway, Homeless Youth Program.............. 101,980 108,330 101,980 ................ -6,350
Prevention Grants to Reduce Abuse of Runaway Youth........ 17,141 17,491 17,141 ................ -350
Child Abuse State Grants.................................. 25,310 25,310 25,310 ................ ................
Child Abuse Discretionary Activities...................... 33,000 43,744 33,000 ................ -10,744
Community Based Child Abuse Prevention.................... 39,764 39,764 39,764 ................ ................
Child Welfare Services.................................... 268,735 268,735 268,735 ................ ................
Child Welfare Training, Research, or Demonstration 17,984 21,984 17,984 ................ -4,000
projects.................................................
Adoption Opportunities.................................... 39,100 39,100 39,100 ................ ................
Adoption Incentive........................................ 37,943 37,943 37,943 ................ ................
Social Services and Income Maintenance Research............... 6,512 10,762 6,512 ................ -4,250
Native American Programs...................................... 50,000 53,100 50,000 ................ -3,100

Community Services:
Community Services Block Grant Act programs:
Grants to States for Community Services............... 715,000 674,000 715,000 ................ +41,000
Economic Development.................................. 29,883 ................ ................ -29,883 ................
Rural Community Facilities............................ 6,500 ................ ................ -6,500 ................
-----------------------------------------------------------------------------------------
Subtotal............................................ 751,383 674,000 715,000 -36,383 +41,000

Individual Development Account Initiative............. 18,950 18,950 ................ -18,950 -18,950
-----------------------------------------------------------------------------------------
Subtotal, Community Services........................ 770,333 692,950 715,000 -55,333 +22,050

Domestic Violence Hotline..................................... 8,250 12,300 8,250 ................ -4,050
Family Violence/Battered Women's Shelters..................... 150,000 151,000 151,000 +1,000 ................
Chafee Education and Training Vouchers........................ 43,257 43,257 43,257 ................ ................
Faith-Based Center............................................ ................ ................ ................ ................ ................
Disaster Human Services Case Management....................... 1,864 1,864 1,864 ................ ................
Program Direction............................................. 205,000 205,699 205,000 ................ -699
-----------------------------------------------------------------------------------------
Total, Children and Families Services Programs.......... 11,234,268 11,725,057 11,214,935 -19,333 -510,122

Children's Research and Technical Assistance

Systems Innovation Center and other expenses.................. ................ 10,000 ................ ................ -10,000
(By transfer)............................................. ................ (15,000) ................ ................ (-15,000)
-----------------------------------------------------------------------------------------
Total, Children's research and technical assistance..... ................ 25,000 ................ ................ -25,000

Promoting Safe and Stable Families............................ 345,000 345,000 325,000 -20,000 -20,000
Discretionary Funds....................................... 59,765 79,765 59,765 ................ -20,000
-----------------------------------------------------------------------------------------
Total, Promoting Safe and Stable Families............... 404,765 424,765 384,765 -20,000 -40,000

Payments for Foster Care and Permanency

Foster Care................................................... 4,772,100 4,992,000 4,992,000 +219,900 ................
Adoption Assistance........................................... 2,562,900 2,780,000 2,780,000 +217,100 ................
Guardianship.................................................. 123,000 152,000 152,000 +29,000 ................
Independent Living............................................ 140,000 140,000 140,000 ................ ................
-----------------------------------------------------------------------------------------
Total, Payments to States............................... 7,598,000 8,064,000 8,064,000 +466,000 ................
Less Advances from Prior Year......................... -2,300,000 -2,300,000 -2,300,000 ................ ................
-----------------------------------------------------------------------------------------
Total, payments, current year....................... 5,298,000 5,764,000 5,764,000 +466,000 ................
New Advance, 1st quarter, fiscal year 2018........ 2,300,000 2,500,000 2,500,000 +200,000 ................
=========================================================================================
Total, ACF.............................................. 33,007,934 34,746,289 33,825,326 +817,392 -920,963

Current year........................................ (29,407,934) (30,846,289) (29,925,326) (+517,392) (-920,963)
Fiscal year 2018.................................... (3,600,000) (3,900,000) (3,900,000) (+300,000) ................
Total, ACF Program Level................................ 33,007,934 34,761,289 33,825,326 +817,392 -935,963

ADMINISTRATION FOR COMMUNITY LIVING

Aging and Disability Services Programs

Grants to States:
Home and Community-based Supportive Services.............. 347,724 357,724 347,724 ................ -10,000
Preventive Health......................................... 19,848 19,848 19,848 ................ ................
Protection of Vulnerable Older Americans-Title VII........ 20,658 20,658 20,658 ................ ................
-----------------------------------------------------------------------------------------
Subtotal................................................ 388,230 398,230 388,230 ................ -10,000

Family Caregivers......................................... 150,586 150,586 150,586 ................ ................
Native American Caregivers Support........................ 7,531 7,531 7,531 ................ ................
-----------------------------------------------------------------------------------------
Subtotal, Caregivers.................................... 158,117 158,117 158,117 ................ ................

Nutrition:
Congregate Meals...................................... 448,342 454,091 448,342 ................ -5,749
Home Delivered Meals.................................. 226,342 234,397 226,342 ................ -8,055
Nutrition Services Incentive Program.................. 160,069 160,069 160,069 ................ ................
Nutrition Initiative.................................. ................ ................ ................ ................ ................
-----------------------------------------------------------------------------------------
Subtotal............................................ 834,753 848,557 834,753 ................ -13,804
-----------------------------------------------------------------------------------------
Subtotal, Grants to States.............................. 1,381,100 1,404,904 1,381,100 ................ -23,804

Grants for Native Americans................................... 31,158 31,158 26,158 -5,000 -5,000
Aging Network Support Activities.............................. 9,961 9,961 9,961 ................ ................
Alzheimer's Disease Demonstrations............................ 4,800 4,800 4,800 ................ ................
Prevention and Public Health Fund\1\...................... (14,700) (14,700) (14,700) ................ ................
Lifespan Respite Care......................................... 3,360 5,000 3,360 ................ -1,640
Chronic Disease Self-Management Program....................... ................ ................ ................ ................ ................
Prevention and Public Health Fund\1\...................... (8,000) (8,000) (8,000) ................ ................
Elder Falls Prevention........................................ ................ ................ ................ ................ ................
Prevention and Public Health Fund\1\...................... (5,000) (5,000) (5,000) ................ ................
Senior Medicare Patrol Program................................ ................ ................ ................ ................ ................
Elder Rights Support Activities............................... 11,874 13,874 13,874 +2,000 ................
Aging and Disability Resources................................ 6,119 8,119 6,119 ................ -2,000
State Health Insurance Program................................ 52,115 52,115 ................ -52,115 -52,115
National Clearinghouse for Long-Term Care Information......... ................ ................ ................ ................ ................
Paralysis Resource Center..................................... 7,700 7,700 7,700 ................ ................
Limb loss..................................................... 2,810 2,810 2,810 ................ ................
Traumatic Brain Injury........................................ 9,321 9,321 9,321 ................ ................
Developmental Disabilities Programs:
State Councils............................................ 73,000 73,000 73,000 ................ ................
Protection and Advocacy................................... 38,734 38,734 38,734 ................ ................
Voting Access for Individuals with Disabilities........... 4,963 4,963 4,963 ................ ................
Developmental Disabilities Projects of National 10,000 10,000 10,000 ................ ................
Significance.............................................
University Centers for Excellence in Developmental 38,619 38,619 38,619 ................ ................
Disabilities.............................................
-----------------------------------------------------------------------------------------
Subtotal, Developmental Disabilities Programs........... 165,316 165,316 165,316 ................ ................

Workforce Innovation and Opportunity Act Independent Living... 101,183 101,183 101,183 ................ ................
National Institute on Disability, Independent Living, and 103,970 103,970 103,970 ................ ................
Rehabilitation Research..................................
Assistive Technology...................................... 34,000 32,000 32,000 -2,000 ................
-----------------------------------------------------------------------------------------
Subtotal, Workforce Innovation and Opportunity Act...... 239,153 237,153 237,153 -2,000 ................

Program Administration........................................ 40,063 41,063 40,063 ................ -1,000
=========================================================================================
Total, Administration for Community Living [ACL]........ 1,964,850 1,993,294 1,907,735 -57,115 -85,559
Federal funds....................................... 1,912,735 1,941,179 1,907,735 -5,000 -33,444
Trust Funds......................................... (52,115) (52,115) ................ (-52,115) (-52,115)
(Prevention and Public Health Fund)\1\.................. (27,700) (27,700) (27,700) ................ ................
Total, ACL program level............................ 1,992,550 2,020,994 1,935,435 -57,115 -85,559

OFFICE OF THE SECRETARY

General Departmental Management

General Departmental Management, Federal Funds................ 200,000 214,610 199,620 -380 -14,990
Teen Pregnancy Prevention Community Grants................ 101,000 104,790 101,000 ................ -3,790
Evaluation Tap Funding.................................... (6,800) (6,800) (6,800) ................ ................
-----------------------------------------------------------------------------------------
Subtotal, Grants........................................ (107,800) (111,590) (107,800) ................ (-3,790)

Faith-Based Center............................................ 1,299 1,382 1,299 ................ -83
Sexual Risk Avoidance......................................... 10,000 ................ 15,000 +5,000 +15,000
Minority Health............................................... 56,670 56,670 50,000 -6,670 -6,670
Office of Women's Health...................................... 32,140 32,140 29,000 -3,140 -3,140
Minority HIV/AIDS prevention and treatment.................... 53,900 53,900 48,000 -5,900 -5,900
Embryo Adoption Awareness Campaign............................ 1,000 ................ 1,000 ................ +1,000
Planning and Evaluation, Evaluation Tap Funding............... (58,028) (59,278) (58,028) ................ (-1,250)
-----------------------------------------------------------------------------------------
Subtotal, General Departmental Management............... 456,009 463,492 444,919 -11,090 -18,573

DATA Act activities........................................... ................ 10,320 ................ ................ -10,320
HHS Digital Service Team...................................... ................ 5,000 ................ ................ -5,000
-----------------------------------------------------------------------------------------
Total, General Departmental Management.................. 456,009 478,812 444,919 -11,090 -33,893
Federal Funds....................................... (456,009) (478,812) (444,919) (-11,090) (-33,893)
(Evaluation Tap Funding)............................ (64,828) (66,078) (64,828) ................ (-1,250)
Total, General Departmental Management Program.......... 520,837 544,890 509,747 -11,090 -35,143

Office of Medicare Hearings and Appeals....................... 107,381 120,000 112,381 +5,000 -7,619
Office of the National Coordinator for Health Information 60,367 ................ 60,367 ................ +60,367
Technology...................................................
Evaluation Tap Funding.................................... ................ (82,000) ................ ................ (-82,000)
-----------------------------------------------------------------------------------------
Total, Program Level.................................... (60,367) (82,000) (60,367) ................ (-21,633)

Office of Inspector General

Inspector General Federal Funds............................... 75,000 85,000 75,000 ................ -10,000
HCFAC funding (NA)........................................ (333,893) ................ (334,097) (+204) (+334,097)
-----------------------------------------------------------------------------------------
Total, Inspector General Program Level.................. (408,893) (85,000) (409,097) (+204) (+324,097)

Office for Civil Rights

Federal Funds................................................. 38,798 42,705 38,798 ................ -3,907

Retirement Pay and Medical Benefits for Commissioned Officers

Retirement Payments........................................... 441,977 457,459 457,459 +15,482 ................
Survivors Benefits............................................ 28,603 31,559 31,559 +2,956 ................
Dependents' Medical Care...................................... 115,608 141,390 141,390 +25,782 ................
-----------------------------------------------------------------------------------------
Total,Medical Benefits for Commissioned Officers........ 586,188 630,408 630,408 +44,220 ................
=========================================================================================
Public Health and Social Services Emergency Fund [PHSSEF]

Assistant Secretary for Preparedness and Response

Operations.................................................... 30,938 30,938 30,938 ................ ................
Preparedness and Emergency Operations......................... 24,654 24,654 24,654 ................ ................
National Disaster Medical System.............................. 49,904 55,054 49,904 ................ -5,150
Hospital Preparedness Cooperative Agreement Grants:
Formula Grants............................................ 254,555 254,555 254,555 ................ ................
Biomedical Advanced Research and Development Authority [BARDA] 511,700 511,700 511,700 ................ ................
Policy and Planning........................................... 14,877 14,877 14,877 ................ ................
Project BioShield............................................. 510,000 350,000 510,000 ................ +160,000
-----------------------------------------------------------------------------------------
Subtotal, Preparedness and Response..................... 1,396,628 1,241,778 1,396,628 ................ +154,850

Assistant Secretary for Administration

Assistant Secretary for Administration, Cybersecurity......... 50,860 50,860 50,860 ................ ................
Office of Security and Strategic Information.................. 7,470 7,470 7,470 ................ ................

Public Health and Science

Medical Reserve Corps......................................... 6,000 6,000 6,000 ................ ................
Pandemic Influenza Preparedness............................... 72,000 125,009 57,000 -15,000 -68,009
Pandemic Flu balances (Public Law 111-32)..................... ................ ................ (15,000) (+15,000) (+15,000)
-----------------------------------------------------------------------------------------
Subtotal, Non-pandemic flu/BioShield/Parklawn/Other 950,958 956,108 950,958 ................ -5,150
construction...........................................
=========================================================================================
Total, PHSSEF........................................... 1,532,958 1,431,117 1,517,958 -15,000 +86,841
Total, PHSSEF, program level............................ 1,532,958 1,431,117 1,532,958 ................ +101,841
=========================================================================================
Total, Office of the Secretary.......................... 2,856,701 2,788,042 2,879,831 +23,130 +91,789
Federal Funds....................................... 2,749,320 2,668,042 2,767,450 +18,130 +99,408
Trust Funds......................................... 107,381 120,000 112,381 +5,000 -7,619
(Evaluation Tap Funding)............................ (64,828) (148,078) (64,828) ................ (-83,250)
-----------------------------------------------------------------------------------------
Total, Office of the Secretary Program Level............ 2,921,529 2,936,120 2,959,659 +38,130 +23,539
=========================================================================================
Total, Title II, Health and Human Services.............. 732,462,371 776,784,242 778,872,440 +46,410,069 +2,088,198
Federal Funds....................................... 727,944,631 771,768,378 774,357,815 +46,413,184 +2,589,437
Current year.................................... (608,762,129) (642,648,926) (645,238,363) (+36,476,234) (+2,589,437)
Fiscal year 2018................................ (119,182,502) (129,119,452) (129,119,452) (+9,936,950) ................
Trust Funds......................................... 4,517,740 5,015,864 4,514,625 -3,115 -501,239
Pandemic Flu balances (Public Law 111-32)........... (15,000) ................ (30,000) (+15,000) (+30,000)
Total, Prevention and Public Health Fund\1\............. (932,000) (1,000,000) (931,000) (-1,000) (-69,000)

TITLE III--DEPARTMENT OF EDUCATION

EDUCATION FOR THE DISADVANTAGED

Grants to Local Educational Agencies [LEAs] Basic Grants:
Advance from prior year................................... (2,890,776) (2,390,776) (2,390,776) (-500,000) ................
Forward funded............................................ 4,064,641 4,513,625 4,564,641 +500,000 +51,016
Current funded............................................ 3,984 5,000 3,984 ................ -1,016
-----------------------------------------------------------------------------------------
Subtotal, Basic grants current year approp.............. 4,068,625 4,518,625 4,568,625 +500,000 +50,000
Subtotal, Basic grants total funds available............ (6,959,401) (6,909,401) (6,959,401) ................ (+50,000)

Basic Grants fiscal year 2018 Advance..................... 2,390,776 1,940,776 1,890,776 -500,000 -50,000
-----------------------------------------------------------------------------------------
Subtotal, Basic grants, program level................... 6,459,401 6,459,401 6,459,401 ................ ................

Concentration Grants:
Advance from prior year............................... (1,362,301) (1,362,301) (1,362,301) ................ ................
Fiscal year 2018 Advance.............................. 1,362,301 1,362,301 1,362,301 ................ ................
-----------------------------------------------------------------------------------------
Subtotal............................................ 1,362,301 1,362,301 1,362,301 ................ ................

Targeted Grants:
Advance from prior year............................... (3,294,050) (3,544,050) (3,544,050) (+250,000) ................
Fiscal year 2018 Advance.............................. 3,544,050 3,769,050 3,794,050 +250,000 +25,000
-----------------------------------------------------------------------------------------
Subtotal............................................ 3,544,050 3,769,050 3,794,050 +250,000 +25,000

Education Finance Incentive Grants:
Advance from prior year............................... (3,294,050) (3,544,050) (3,544,050) (+250,000) ................
Fiscal year 2018 Advance.............................. 3,544,050 3,769,050 3,794,050 +250,000 +25,000
-----------------------------------------------------------------------------------------
Subtotal............................................ 3,544,050 3,769,050 3,794,050 +250,000 +25,000
=========================================================================================
Subtotal, Grants to LEAs, program level................. 14,909,802 15,359,802 15,409,802 +500,000 +50,000

School Improvement Grants..................................... 450,000 ................ ................ -450,000 ................
Innovative Approaches to Literacy............................. 27,000 27,000 27,000 ................ ................
Comprehensive literacy development grants (formerly Striving 190,000 190,000 190,000 ................ ................
Readers).....................................................
State Agency Programs:
Migrant................................................... 374,751 374,751 374,751 ................ ................
Neglected and Delinquent/High Risk Youth.................. 47,614 47,614 47,614 ................ ................
-----------------------------------------------------------------------------------------
Subtotal, State Agency programs......................... 422,365 422,365 422,365 ................ ................

Migrant Education:
High School Equivalency Program........................... 44,623 44,623 44,623 ................ ................
=========================================================================================
Total, Education for the disadvantaged.................. 16,043,790 16,043,790 16,093,790 +50,000 +50,000
Current Year........................................ (5,202,613) (5,202,613) (5,252,613) (+50,000) (+50,000)
Fiscal year 2018.................................... (10,841,177) (10,841,177) (10,841,177) ................ ................
Subtotal, Forward Funded................................ (5,127,006) (5,125,990) (5,177,006) (+50,000) (+51,016)

IMPACT AID

Basic Support Payments........................................ 1,168,233 1,168,233 1,176,233 +8,000 +8,000
Payments for Children with Disabilities....................... 48,316 48,316 48,316 ................ ................
Facilities Maintenance (Sec. 8008)............................ 4,835 71,648 4,835 ................ -66,813
Construction (Sec. 8007)...................................... 17,406 17,406 17,406 ................ ................
Payments for Federal Property (Sec. 8002)..................... 66,813 ................ 68,813 +2,000 +68,813
=========================================================================================
Total, Impact aid....................................... 1,305,603 1,305,603 1,315,603 +10,000 +10,000

SCHOOL IMPROVEMENT PROGRAMS

State Grants for Supporting Effective Instruction............. 668,389 568,559 374,389 -294,000 -194,170
Advance from prior year................................... (1,681,441) (1,681,441) (1,681,441) ................ ................
Fiscal year 2018.......................................... 1,681,441 1,681,441 1,681,441 ................ ................
-----------------------------------------------------------------------------------------
Subtotal, State Grants for Improving Teacher Quality, 2,349,830 2,250,000 2,055,830 -294,000 -194,170
program level..........................................

Mathematics and Science Partnerships.......................... 152,717 ................ ................ -152,717 ................
Supplemental Education Grants................................. 16,699 16,699 16,699 ................ ................
21st Century Community Learning Centers....................... 1,166,673 1,000,000 1,050,000 -116,673 +50,000
State Assessments/Enhanced Assessment Instruments............. 378,000 403,000 378,000 ................ -25,000
Education for Homeless Children and Youth..................... 70,000 85,000 77,000 +7,000 -8,000
Training and Advisory Services (Civil Rights)................. 6,575 6,575 6,575 ................ ................
Education for Native Hawaiians................................ 33,397 33,397 33,397 ................ ................
Alaska Native Education Equity................................ 32,453 32,453 32,453 ................ ................
Rural Education............................................... 175,840 175,840 175,840 ................ ................
Comprehensive Centers......................................... 51,445 55,445 51,445 ................ -4,000
Student Support and Academic Enrichment grants................ ................ 500,000 300,000 +300,000 -200,000
=========================================================================================
Total, School Improvement Programs...................... 4,433,629 4,558,409 4,177,239 -256,390 -381,170
Current Year........................................ (2,752,188) (2,876,968) (2,495,798) (-256,390) (-381,170)
Fiscal year 2018.................................... (1,681,441) (1,681,441) (1,681,441) ................ ................
Subtotal, Forward Funded................................ (2,611,619) (2,232,399) (2,055,229) (-556,390) (-177,170)

INDIAN EDUCATION

Grants to Local Educational Agencies.......................... 100,381 100,381 100,381 ................ ................

Federal Programs:
Special Programs for Indian Children...................... 37,993 67,993 37,993 ................ -30,000
National Activities....................................... 5,565 6,565 5,565 ................ -1,000
-----------------------------------------------------------------------------------------
Subtotal, Federal Programs.............................. 43,558 74,558 43,558 ................ -31,000
=========================================================================================
Total, Indian Education................................. 143,939 174,939 143,939 ................ -31,000

INNOVATION AND IMPROVEMENT

Education Innovation and Research............................. 120,000 180,000 120,000 ................ -60,000
STEM Master Teacher Corps..................................... ................ 10,000 ................ ................ -10,000
American History and Civics Academies......................... 1,815 1,815 1,815 ................ ................
School Leader Recruitment and Support......................... 16,368 30,000 16,368 ................ -13,632
Charter Schools Grants........................................ 333,172 350,000 343,172 +10,000 -6,828
Magnet Schools Assistance..................................... 96,647 115,000 96,647 ................ -18,353
Fund for the Improvement of Education [FIE]................... 3,000 ................ ................ -3,000 ................
Teacher and School Leader Incentive Grants.................... 230,000 250,000 213,000 -17,000 -37,000
Ready-to-Learn television..................................... 25,741 25,741 25,741 ................ ................
Advanced Placement............................................ 28,483 ................ ................ -28,483 ................
Supporting Effective Educator Development [SEED].............. ................ 100,000 87,000 +87,000 -13,000
Art in Education.............................................. 27,000 27,000 27,000 ................ ................
Javits Giffted and Talented Students.......................... 12,000 12,000 12,000 ................ ................
Teach to Lead (proposed legislation).......................... ................ 10,000 ................ ................ -10,000
Stronger Together (proposed legislation)...................... ................ 120,000 ................ ................ -120,000
Next Generation High Schools (proposed legislation)........... ................ 80,000 ................ ................ -80,000
Computer Science for All Development Grants (proposed ................ 100,000 ................ ................ -100,000
legislation).................................................
=========================================================================================
Total, Innovation and Improvement....................... 894,226 1,411,556 942,743 +48,517 -468,813
Current Year........................................ (894,226) (1,411,556) (942,743) (+48,517) (-468,813)

SAFE SCHOOLS AND CITIZENSHIP EDUCATION

Promise Neighborhoods......................................... 73,254 128,000 73,254 ................ -54,746
School Safety National Activities............................. 75,000 90,000 70,000 -5,000 -20,000
Elementary and Secondary School Counseling.................... 49,561 ................ ................ -49,561 ................
Carol M. White Physical Education Program..................... 47,000 ................ ................ -47,000 ................
Full-Service Community Schools................................ 10,000 10,000 ................ -10,000 -10,000
=========================================================================================
Total, Safe Schools and Citizenship Education........... 254,815 228,000 143,254 -111,561 -84,746

ENGLISH LANGUAGE ACQUISITION

Current funded................................................ 47,931 52,026 47,931 ................ -4,095
Forward funded................................................ 689,469 748,374 689,469 ................ -58,905
=========================================================================================
Total, English Language Acquisition..................... 737,400 800,400 737,400 ................ -63,000

SPECIAL EDUCATION

State Grants:
Grants to States Part B current year...................... 2,629,465 2,629,465 2,669,465 +40,000 +40,000
Part B advance from prior year........................ (9,283,383) (9,283,383) (9,283,383) ................ ................
Grants to States Part B (fiscal year 2018)................ 9,283,383 9,283,383 9,283,383 ................ ................
-----------------------------------------------------------------------------------------
Subtotal, program level................................. 11,912,848 11,912,848 11,952,848 +40,000 +40,000

Preschool Grants.......................................... 368,238 403,238 368,238 ................ -35,000
Grants for Infants and Families........................... 458,556 503,556 458,556 ................ -45,000
-----------------------------------------------------------------------------------------
Subtotal, program level................................. 12,739,642 12,819,642 12,779,642 +40,000 -40,000

IDEA National Activities (current funded):
State Personnel Development............................... 41,630 41,630 41,630 ................ ................
Technical Assistance and Dissemination (including Special 54,428 64,428 56,928 +2,500 -7,500
Olympics Education)......................................
Personnel Preparation..................................... 83,700 83,700 83,700 ................ ................
Parent Information Centers................................ 27,411 27,411 27,411 ................ ................
Technology and Media Services............................. 30,047 30,047 30,047 ................ ................
-----------------------------------------------------------------------------------------
Subtotal, IDEA special programs......................... 237,216 247,216 239,716 +2,500 -7,500
=========================================================================================
Total, Special education................................ 12,976,858 13,066,858 13,019,358 +42,500 -47,500
Current Year........................................ (3,693,475) (3,783,475) (3,735,975) (+42,500) (-47,500)
Fiscal year 2018.................................... (9,283,383) (9,283,383) (9,283,383) ................ ................
Subtotal, Forward Funded................................ (3,456,259) (3,536,259) (3,496,259) (+40,000) (-40,000)

REHABILITATION SERVICES AND DISABILITY RESEARCH

Vocational Rehabilitation State Grants........................ 3,391,770 3,398,554 3,398,554 +6,784 ................
Client Assistance State grants................................ 13,000 13,000 13,000 ................ ................
Training...................................................... 30,188 30,188 30,188 ................ ................
Demonstration and Training programs........................... 5,796 5,796 5,796 ................ ................
Protection and Advocacy of Individual Rights [PAIR]........... 17,650 17,650 17,650 ................ ................
Supported Employment State grants............................. 27,548 30,548 27,548 ................ -3,000
Independent Living:
Services for Older Blind Individuals...................... 33,317 35,317 33,317 ................ -2,000
-----------------------------------------------------------------------------------------
Subtotal................................................ 33,317 35,317 33,317 ................ -2,000

Helen Keller National Center for Deaf/Blind Youth and Adults.. 10,336 10,336 10,336 ................ ................
Assistive Technology.......................................... ................ ................ ................ ................ ................
=========================================================================================
Total, Rehabilitation services.......................... 3,529,605 3,541,389 3,536,389 +6,784 -5,000

SPECIAL INSTITUTIONS FOR PERSONS WITH DISABILITIES

American Printing House for the Blind......................... 25,431 25,431 25,431 ................ ................
National Technical Institute for the Deaf [NTID]:
Operations................................................ 70,016 70,016 70,016 ................ ................
Gallaudet University:
Operations................................................ 121,275 121,275 121,275 ................ ................
-----------------------------------------------------------------------------------------
Total, Gallaudet University............................. 121,275 121,275 121,275 ................ ................
=========================================================================================
Total, Special Institutions for Persons with 216,722 216,722 216,722 ................ ................
Disabilities...........................................

CAREER, TECHNICAL, AND ADULT EDUCATION

Career Education:
Basic State Grants/Secondary & Technical Education State 326,598 401,598 326,598 ................ -75,000
Grants, current funded...................................
Advance from prior year............................... (791,000) (791,000) (791,000) ................ ................
Fiscal year 2018...................................... 791,000 791,000 791,000 ................ ................
-----------------------------------------------------------------------------------------
Subtotal, Basic State Grants, program level......... 1,117,598 1,192,598 1,117,598 ................ -75,000

National Programs......................................... 7,421 9,421 7,421 ................ -2,000
-----------------------------------------------------------------------------------------
Subtotal, Career Education.............................. 1,125,019 1,202,019 1,125,019 ................ -77,000

Adult Education:
State Grants/Adult Basic and Literacy Education:
State Grants, current funded.......................... 581,955 581,955 581,955 ................ ................
National Leadership Activities................................ 13,712 24,712 13,712 ................ -11,000
-----------------------------------------------------------------------------------------
Subtotal, Adult education............................... 595,667 606,667 595,667 ................ -11,000
=========================================================================================
Total, Career, Technical, and Adult Education........... 1,720,686 1,808,686 1,720,686 ................ -88,000
Current Year........................................ (929,686) (1,017,686) (929,686) ................ (-88,000)
Fiscal year 2018.................................... (791,000) (791,000) (791,000) ................ ................
Subtotal, Forward Funded................................ (929,686) (1,017,686) (929,686) ................ (-88,000)

STUDENT FINANCIAL ASSISTANCE

Pell Grants--maximum grant (NA)............................... (4,860) (4,860) (4,860) ................ ................
Pell Grants................................................... 22,475,352 22,475,352 22,475,352 ................ ................
Federal Supplemental Educational Opportunity Grants........... 733,130 733,130 733,130 ................ ................
Federal Work Study............................................ 989,728 989,728 989,728 ................ ................
=========================================================================================
Total, Student Financial Assistance [SFA]............... 24,198,210 24,198,210 24,198,210 ................ ................

STUDENT AID ADMINISTRATION

Salaries and Expenses......................................... 696,643 732,352 691,643 -5,000 -40,709
Servicing Activities.......................................... 855,211 899,638 855,211 ................ -44,427
=========================================================================================
Total, Student Aid Administration....................... 1,551,854 1,631,990 1,546,854 -5,000 -85,136

HIGHER EDUCATION

Aid for Institutional Development:
Strengthening Institutions................................ 86,534 86,534 86,534 ................ ................
Hispanic Serving Institutions............................. 107,795 107,795 107,795 ................ ................
Promoting Post-Baccalaureate Opportunities for Hispanic 9,671 9,671 9,671 ................ ................
Americans................................................
Strengthening Historically Black Colleges [HBCUs]......... 244,694 244,694 244,694 ................ ................
Strengthening Historically Black Graduate Institutions.... 63,281 63,281 63,281 ................ ................
Strengthening Predominantly Black Institutions............ 9,942 9,942 9,942 ................ ................
Asian American Pacific Islander........................... 3,348 3,348 3,348 ................ ................
Strengthening Alaska Native and Native Hawaiian-Serving 13,802 13,802 13,802 ................ ................
Institutions.............................................
Strengthening Native American-Serving Nontribal 3,348 3,348 3,348 ................ ................
Institutions.............................................
Strengthening Tribal Colleges............................. 27,599 27,599 27,599 ................ ................
Strengthening HBCU Masters programs....................... ................ ................ 9,500 +9,500 +9,500
-----------------------------------------------------------------------------------------
Subtotal, Aid for Institutional development............. 570,014 570,014 579,514 +9,500 +9,500

International Education and Foreign Language:
Domestic Programs......................................... 65,103 65,103 65,103 ................ ................
Overseas Programs......................................... 7,061 2,168 2,168 -4,893 ................
-----------------------------------------------------------------------------------------
Subtotal, International Education & Foreign Lang........ 72,164 67,271 67,271 -4,893 ................

Fund for the Improvement of Postsec. Ed. [FIPSE]-First in the ................ 100,000 ................ ................ -100,000
World........................................................
Postsecondary Program for Students with Intellectual 11,800 11,800 11,800 ................ ................
Disabilities.................................................
Minority Science and Engineering Improvement.................. 9,648 9,648 9,648 ................ ................
Tribally Controlled Postsec Voc/Tech Institutions............. 8,286 8,286 8,286 ................ ................
Federal TRIO Programs......................................... 900,000 900,000 900,000 ................ ................
GEAR UP....................................................... 322,754 322,754 322,754 ................ ................
Graduate Assistance in Areas of National Need................. 29,293 29,293 29,293 ................ ................
Teacher Quality Partnerships.................................. 43,092 ................ 43,092 ................ +43,092
Child Care Access Means Parents in School..................... 15,134 15,134 15,134 ................ ................
HCBU and Minority-Serving Institutions Innovation for ................ 30,000 ................ ................ -30,000
Completion Fund (proposed legislation).......................
Teacher and Principal Pathways (proposed legislation)......... ................ 125,000 ................ ................ -125,000
=========================================================================================
Total, Higher Education................................. 1,982,185 2,189,200 1,986,792 +4,607 -202,408

HOWARD UNIVERSITY

Academic Program.............................................. 191,091 191,091 191,091 ................ ................
Endowment Program............................................. 3,405 3,405 3,405 ................ ................
Howard University Hospital.................................... 27,325 27,325 27,325 ................ ................
=========================================================================================
Total, Howard University................................ 221,821 221,821 221,821 ................ ................

COLLEGE HOUSING AND ACADEMIC FACILITIES LOANS PROGRAM......... 435 457 435 ................ -22

HISTORICALLY BLACK COLLEGE AND UNIVERSITY [HBCU]

CAPITAL FINANCING PROGRAM ACCOUNT

HBCU Federal Administration................................... 334 349 334 ................ -15
HBCU Loan Subsidies........................................... 20,150 20,150 20,150 ................ ................
=========================================================================================
Total, HBCU Capital Financing Program................... 20,484 20,499 20,484 ................ -15

INSTITUTE OF EDUCATION SCIENCES [IES]

Research, Development and Dissemination....................... 195,000 209,273 190,000 -5,000 -19,273
Statistics.................................................... 112,000 125,360 112,000 ................ -13,360
Regional Educational Laboratories............................. 54,423 54,423 54,423 ................ ................
Research in Special Education................................. 54,000 54,000 54,000 ................ ................
Special Education Studies and Evaluations..................... 10,818 13,000 10,818 ................ -2,182
Statewide Data Systems........................................ 34,539 81,017 34,539 ................ -46,478
Assessment:
National Assessment....................................... 149,000 149,000 149,000 ................ ................
National Assessment Governing Board....................... 8,235 7,745 7,745 -490 ................
-----------------------------------------------------------------------------------------
Subtotal, Assessment.................................... 157,235 156,745 156,745 -490 ................
=========================================================================================
Total, IES.............................................. 618,015 693,818 612,525 -5,490 -81,293

DEPARTMENTAL MANAGEMENT

Program Administration:
Salaries and Expenses..................................... 431,000 450,342 431,000 ................ -19,342
Building Modernization.................................... 1,000 24,485 1,000 ................ -23,485
-----------------------------------------------------------------------------------------
Total, Program administration........................... 432,000 474,827 432,000 ................ -42,827

Office for Civil Rights....................................... 107,000 137,708 110,000 +3,000 -27,708
Office of Inspector General................................... 59,256 61,941 59,256 ................ -2,685
=========================================================================================
Total, Departmental management.......................... 598,256 674,476 601,256 +3,000 -73,220
=========================================================================================
Total, Title III, Department of Education............... 71,448,533 72,786,823 71,235,500 -213,033 -1,551,323
Current Year........................................ (48,851,532) (50,189,822) (48,638,499) (-213,033) (-1,551,323)
Fiscal year 2018.................................... (22,597,001) (22,597,001) (22,597,001) ................ ................

TITLE IV--RELATED AGENCIES

COMMITTEE FOR PURCHASE FROM PEOPLE WHO ARE BLIND OR SEVERELY 6,191 10,612 8,000 +1,809 -2,612
DISABLED.....................................................

CORPORATION FOR NATIONAL AND COMMUNITY SERVICE

Operating Expenses

Domestic Volunteer Service Programs:
Volunteers in Service to America [VISTA].................. 92,364 95,880 92,364 ................ -3,516
National Senior Volunteer Corps:
Foster Grandparents Program........................... 107,702 107,702 107,702 ................ ................
Senior Companion Program.............................. 45,512 45,512 45,512 ................ ................
Retired Senior Volunteer Program...................... 48,903 48,903 48,903 ................ ................
-----------------------------------------------------------------------------------------
Subtotal, Senior Volunteers......................... 202,117 202,117 202,117 ................ ................
-----------------------------------------------------------------------------------------
Subtotal, Domestic Volunteer Service.................... 294,481 297,997 294,481 ................ -3,516

National and Community Service Programs:
AmeriCorps State and National Grants...................... 386,010 386,010 386,010 ................ ................
Innovation, Assistance, and Other Activities.............. 57,400 57,601 5,000 -52,400 -52,601
Evaluation................................................ 4,000 6,000 4,000 ................ -2,000
National Civilian Community Corps [NCCC].................. 30,000 30,000 30,000 ................ ................
State Commission Support Grants........................... 16,038 17,000 17,038 +1,000 +38
-----------------------------------------------------------------------------------------
Subtotal, National and Community Service................ 493,448 496,611 442,048 -51,400 -54,563
-----------------------------------------------------------------------------------------
Total, Operating expenses............................... 787,929 794,608 736,529 -51,400 -58,079

National Service Trust........................................ 220,000 206,842 206,842 -13,158 ................
Salaries and Expenses......................................... 81,737 89,330 81,737 ................ -7,593
Office of Inspector General................................... 5,250 6,100 5,250 ................ -850
=========================================================================================
Total, Corp. for National and Community Service......... 1,094,916 1,096,880 1,030,358 -64,558 -66,522

CORPORATION FOR PUBLIC BROADCASTING:
Fiscal year 2019 (current) with fiscal year 2017 445,000 445,000 445,000 ................ ................
comparable...............................................
Fiscal year 2018 advance with fiscal year 2016 comparable (445,000) (445,000) (445,000) ................ ................
(NA).....................................................
Fiscal year 2017 advance with fiscal year 2015 comparable (445,000) (445,000) (445,000) ................ ................
(NA).....................................................
Public television interconnection system (current)........ 40,000 50,000 50,000 +10,000 ................
FEDERAL MEDIATION AND CONCILIATION SERVICE.................... 48,748 50,738 48,638 -110 -2,100
FEDERAL MINE SAFETY AND HEALTH REVIEW COMMISSION.............. 17,085 17,184 17,184 +99 ................
INSTITUTE OF MUSEUM AND LIBRARY SERVICES...................... 230,000 230,000 231,000 +1,000 +1,000
MEDICAID AND CHIP PAYMENT AND ACCESS COMMISSION............... 7,765 8,700 7,765 ................ -935
MEDICARE PAYMENT ADVISORY COMMISSION.......................... 11,925 12,234 11,925 ................ -309
NATIONAL COUNCIL ON DISABILITY................................ 3,250 3,468 3,439 +189 -29
NATIONAL LABOR RELATIONS BOARD................................ 274,224 274,695 274,224 ................ -471
NATIONAL MEDIATION BOARD...................................... 13,230 13,300 14,000 +770 +700
OCCUPATIONAL SAFETY AND HEALTH REVIEW COMMISSION.............. 12,639 13,411 13,411 +772 ................

RAILROAD RETIREMENT BOARD

Dual Benefits Payments Account................................ 29,000 25,000 25,000 -4,000 ................
Less Income Tax Receipts on Dual Benefits..................... -2,000 -2,000 -2,000 ................ ................
-----------------------------------------------------------------------------------------
Subtotal, Dual Benefits................................. 27,000 23,000 23,000 -4,000 ................

Federal Payments to the Railroad Retirement Accounts.......... 150 150 150 ................ ................
Limitation on Administration.................................. 111,225 122,499 113,500 +2,275 -8,999
Limitation on the Office of Inspector General................. 8,437 10,499 10,000 +1,563 -499

SOCIAL SECURITY ADMINISTRATION

Payments to Social Security Trust Funds....................... 11,400 11,400 11,400 ................ ................

Supplemental Security Income Program

Federal Benefit Payments...................................... 60,686,000 52,941,736 52,941,736 -7,744,264 ................
Beneficiary Services.......................................... 70,000 89,000 89,000 +19,000 ................
Research and Demonstration.................................... 101,000 58,000 58,000 -43,000 ................
Afghanistan Special Immigrant Visa............................ ................ 2,000 ................ ................ -2,000
Administration................................................ 4,648,733 5,234,132 5,029,427 +380,694 -204,705
-----------------------------------------------------------------------------------------
Subtotal, SSI program level............................. 65,505,733 58,324,868 58,118,163 -7,387,570 -206,705

Less funds advanced in prior year................... -19,200,000 -14,500,000 -14,500,000 +4,700,000 ................
-----------------------------------------------------------------------------------------
Subtotal, regular SSI current year...................... 46,305,733 43,824,868 43,618,163 -2,687,570 -206,705
New advance, 1st quarter, fiscal year 2018.......... 14,500,000 15,000,000 15,000,000 +500,000 ................
-----------------------------------------------------------------------------------------
Total, SSI program...................................... 60,805,733 58,824,868 58,618,163 -2,187,570 -206,705

Limitation on Administrative Expenses

OASI/DI Trust Funds........................................... 5,100,054 5,702,038 5,145,407 +45,353 -556,631
HI/SMI Trust Funds............................................ 1,777,800 2,001,330 1,684,753 -93,047 -316,577
Social Security Advisory Board................................ 2,300 2,500 2,300 ................ -200
SSI........................................................... 3,718,791 3,415,132 3,706,485 -12,306 +291,353
-----------------------------------------------------------------------------------------
Subtotal, regular LAE................................... 10,598,945 11,121,000 10,538,945 -60,000 -582,055

User Fees:
SSI User Fee activities................................... 136,000 126,000 126,000 -10,000 ................
CBO adjustment........................................ ................ -3,000 -3,000 -3,000 ................
SSPA User Fee Activities.................................. 1,000 1,000 1,000 ................ ................
-----------------------------------------------------------------------------------------
Subtotal, User fees..................................... 137,000 124,000 124,000 -13,000 ................
-----------------------------------------------------------------------------------------
Subtotal, Limitation on administrative expenses......... 10,735,945 11,245,000 10,662,945 -73,000 -582,055

Program Integrity:
OASDI Trust Funds......................................... 496,058 1,819,000 496,058 ................ -1,322,942
SSI....................................................... 929,942 ................ 1,322,942 +393,000 +1,322,942
-----------------------------------------------------------------------------------------
Subtotal, Program integrity funding..................... 1,426,000 1,819,000 1,819,000 +393,000 ................
=========================================================================================
Total, Limitation on Administrative Expenses............ 12,161,945 13,064,000 12,481,945 +320,000 -582,055

Office of Inspector General

Federal Funds................................................. 29,787 31,000 29,787 ................ -1,213
Trust Funds................................................... 75,713 81,000 75,713 ................ -5,287
-----------------------------------------------------------------------------------------
Total, Office of Inspector General...................... 105,500 112,000 105,500 ................ -6,500

Adjustment: Trust fund transfers from general revenues........ -4,648,733 -5,234,132 -5,029,427 -380,694 +204,705
=========================================================================================
Total, Social Security Administration................... 68,435,845 66,778,136 66,187,581 -2,248,264 -590,555
Federal funds....................................... 60,983,920 58,991,268 58,783,350 -2,200,570 -207,918
Current year.................................... (46,483,920) (43,991,268) (43,783,350) (-2,700,570) (-207,918)
New advances, 1st quarter, fiscal year 2018..... (14,500,000) (15,000,000) (15,000,000) (+500,000) ................
Trust funds......................................... 7,451,925 7,786,868 7,404,231 -47,694 -382,637
=========================================================================================
Total, Title IV, Related Agencies....................... 70,787,630 69,160,506 68,489,175 -2,298,455 -671,331
Federal Funds....................................... 63,204,118 61,228,406 60,949,519 -2,254,599 -278,887
Current Year.................................... (48,259,118) (45,783,406) (45,504,519) (-2,754,599) (-278,887)
Current Year (emergency)........................ ................ ................ ................ ................ ................
Fiscal year 2018 Advance........................ (14,500,000) (15,000,000) (15,000,000) (+500,000) ................
Fiscal year 2018 Advance........................ (445,000) (445,000) (445,000) ................ ................
Trust Funds......................................... 7,583,512 7,932,100 7,539,656 -43,856 -392,444
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Grand Total, current year......................... 888,428,751 933,107,118 932,211,568 +43,782,817 -895,550
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\1\Section 4002 of Public Law 111-148.
\2\Fiscal year 2016 funds of $50 million provided under Substance Abuse and Mental Health Services Administration. Fiscal year 2017 funds proposed under
Health Resources and Services Administration.

[all]